Homoeopathy is a controversial form of medicine that is governed by the premise that highly diluted substances that can a defined set of symptoms in a healthy person can cure a similar set of symptoms in a non-healthy person. The use of highly diluted homoeopathic substances that may no longer be expected to contain any trace of the original substance is contrary to accepted pharmacological theory. In addition to serial dilution, homoeopathic “potentisation” of substances also includes violent agitation of the substance at each dilution step, a process known as “succussion”. The role of this process is not understood. The fact that the mechanism of action of homoeopathic substances is unknown adds to the controversial nature of this therapy.A review of the literature demonstrated that a more rigorous approach to the research of homoeopathy was needed in order to investigate whether homoeopathy could be investigated within a scientifically appropriate context. It was initially proposed that, through the successful replication of an existing trial, a series of clinical trials based on this replication could be conducted to test fundamental questions of homoeopathy. For pragmatic reasons, this initial approach was abandoned. A novel protocol that was subsequently designed to scientifically evaluate the effects of homoeopathy, in particular, the homoeopathic treatment of osteoarthritis of the knee and hip, was subsequently developed.A description of homoeopathy, its development, its placement within the scientific paradigm and its role in the treatment of various clinical conditions is reviewed in Chapter 1. From this literature review, hypotheses were generated to test the effect of the homoeopathic treatment of osteoarthritis. Chapter 2 describes the selection process and proposed replication of a prior clinical trial with a successful outcome upon which to base a further series of clinical trials to test fundamental questions in homoeopathy. The selected study was a randomised, double-blind clinical trial designed to compare the effects of a complex homoeopathic preparation with the effects of paracetamol in the treatment of osteoarthritic knee pain. The study was prematurely terminated when another study presented evidence that the analgesic effect of paracetamol was no better than placebo. The uncertainty that paracetamol was no better than placebo raised doubts as to the validity of any outcome had the trial proceeded. The proposal to develop a series of clinical trials replicating the protocol of this study was postponed as a consequence.Chapter 3 describes the subsequent formation of a ‘think tank’ consisting of epidemiologists, biostatisticians, clinical researchers in complementary medicine and homoeopaths and the subsequent development of a rigorous research protocol for the investigation of homoeopathy within the scientific paradigm. This homoeopathic research model and is described in detail.Chapter 4 describes a randomised, double-blind, placebo-controlled trial with five arms designed to evaluate both the research model and the homoeopathic treatment of osteoarthritis of the hip and knee.Chapter 5 details the results of this clinical trial. No significant difference was demonstrated between individualised homoeopathic treatment, generic complex homoeopathic treatments or placebo. Furthermore, no positive effect on treatments was demonstrated by the inclusion of a full homoeopathic consultation.Chapter 6 provides a discussion of the clinical trial. Possible reasons for the discrepancy between the hypothesised outcomes and the results of the clinical trial are explored and directions for future research are suggested.

Chapter 1 will cover who is uploading the videos and how individuals navigate from professional to amateur videos and visa versa. The discussion will be in context of YouTube as a public sharing space that can contain personal information. A central advantage of YouTube as a space for health information is health communication. Chapter 2 will focus on social networking and the comments section, where patients voluntarily share their voice in an online medical community.

Scientific research is just beginning to empirically prove what people who practice somatic disciplines have known for years. In this thesis, I theorize that it is possible to combine yoga and somatics with modern research into the mind and body in a manner that could facilitate healing in a holistic, beneficial manner. There is an indisputable relationship between a person's overall physical and mental health. The practice of yoga strives to facilitate both physical and mental health, in addition to inner peace and well-being. By identifying similarities between the teachings of yoga and modern kinesthetic research, it is possible to gain a better understanding of why and how yoga makes practitioners feel better.

The use of Complementary and Alternative Medicine (CAM) is now widespread and endeavours are increasingly being made to incorporate CAM into conventional healthcare and move towards Integrative Medicine (IM). To date research has primarily focused on the prevalence of use, and safety and efficacy of CAM; less is known about patients' experiences of and reasons for using specific therapies. While therapeutically diverse, it has been suggested that many CAM modalities share mutually referential ideologies and that people who use them may be motivated to do so by specific health beliefs. This study focuses on traditional acupuncture in a New Zealand context and investigates users' experiences and perceptions of the therapy, and discusses how personal health beliefs influence usage. A systematic review of relevant international qualitative research informed the main study, which was carried out using an interpretive phenomenological methodology (Heidegger's approach). Data was gathered from interviews with 12 participants who had recently received treatment from traditionally trained (non-biomedical) acupuncturists. Thematic analysis suggested that acupuncture was often sought for health conditions (typically of a chronic and benign nature) that are difficult to treat conventionally. Whereas initial access was primarily motivated by ineffective biomedical treatment, personal health beliefs-particularly subscription to holistic and vitalistic ideologies-often inspired more extensive and ongoing use. The therapeutic encounter was interpreted to contain many elements-other than needling-integral to treatment. Outcomes were perceived to be wide ranging, personal and necessarily subjective, and included the relief of symptoms, increased well-being, and changes to understandings and health behaviours. It is concluded that the attraction of acupuncture for patients and many of its perceived benefits lie in therapeutic components that are ultimately embedded in Chinese medicine (holistic) theories of health. A more pluralistic schema for assessing evidence may be necessary to acknowledge treatment outcomes that are meaningful to patients, and to accommodate the divergent ontologies and practice models of acupuncture, other CAMs and biomedicine. Increased interdisciplinary cooperation and communication is suggested as a means to improve patient safety and satisfaction and as a scenario for moving forward with IM.

A number of Oriental and European herbal remedies have been historically attributed with cognition enhancing properties. They also exhibit physiological effects that may be commensurate with the enhancement of cognitive performance. This thesis examined the cognitive and mood effects of acute administration of Gingko biloba, Panax ginseng, a combination of ginkgo/ginseng, S. lavandulaefolia (Sage) and Melissa officinalis (Lemon balm) to healthy volunteers, in a series of double-blind, placebo-controlled, balanced cross-over, multiple-dose, multiple time-point experiments. In the case of each herbal remedy, treatment related changes in cognitive performance were quantified with computerised assessment tools (the CDR battery and serial subtraction tasks), and mood was assessed with Bond-Lader visual analogue scales. Relevant in vitro properties of both sage and lemon balm were also assessed. In separate studies electroencephalograph (EEG) recordings following both Ginkgo biloba and Panax ginseng, and blood glucose levels obtained following the latter of these, were also analysed. The results show that all of the herbal remedies under investigation are capable of modulating cognitive performance, mood, and, where they have been assessed, physiological parameters. The most striking results include: improved speed of attentional tasks following ginkgo; improved serial subtraction performance following both ginkgo and the ginkgo/ginseng combination; consistently improved secondary memory performance following ginseng and the ginkgo/ginseng combination, but with decrements in the speed of performing attentional tasks for the less optimum doses of each; modulation of EEG recordings following both ginkgo and ginseng; improved memory performance and mood following sage; and decrements on timed memory tasks for lemon balm, but with differential modulation of mood and improved accuracy of memory task performance depending on the dose and cholinergic properties of the specific treatment. The majority of these studies represent either the first studies to investigate cognitive modulation in humans, or alternatively the first studies to investigate the cognitive effects of single doses in humans, of each of the treatments under investigation.

Current research suggests resveratrol, a phytoalexin found predominately in grapes, may function as a chemopreventive and/or chemotherapeutic agent for various cancers, including colorectal cancer. However, the underlying mechanism(s) involved in these activities remain elusive. Thus, the objective of the studies discussed here sought to investigate the effect of resveratrol treatment on gene modulation in human colorectal cancer cells in order to identify and characterize novel molecular targets that contribute to the observed anticancer activities of resveratrol. Here, we identify activating transcription factor 3 (ATF3) and early growth response-1 (Egr-1) as novel targets of resveratrol and provide data to elucidate the mechanism(s) of regulation and how each target contributes to the anticancer effect of resveratrol in colorectal cancer cells. We demonstrate the involvement of resveratrol in ATF3 transcriptional regulation, which is facilitated by Egr-1 and Krüppel-like factor 4 interactions, and show that ATF3 contributes, at least partially, to resveratrol-induced apoptosis (Chapter 3). Moreover, we suggest that increased Egr-1 transcriptional activity by resveratrol requires posttranslational acetylation of Egr-1 in a SIRT1-independent manner. This acetylation by resveratrol may contribute to Egr-1-mediated expression of the pro-apoptotic protein nonsteroidal anti-inflammatory drug (NSAID)-activated gene-1 (NAG-1) induced by the phytoalexin (Chapter 4). Taken together, the work presented here provide (1) novel mechanisms by which resveratrol induces ATF3 and Egr-1 expression and (2) represent additional explanations for the anti-tumorigenic/anti-carcinogenic effects of resveratrol in human colorectal cancer cells.

Homoeopathy is a controversial form of medicine that is governed by the premise that highly diluted substances that can a defined set of symptoms in a healthy person can cure a similar set of symptoms in a non-healthy person. The use of highly diluted homoeopathic substances that may no longer be expected to contain any trace of the original substance is contrary to accepted pharmacological theory. In addition to serial dilution, homoeopathic “potentisation” of substances also includes violent agitation of the substance at each dilution step, a process known as “succussion”. The role of this process is not understood. The fact that the mechanism of action of homoeopathic substances is unknown adds to the controversial nature of this therapy.A review of the literature demonstrated that a more rigorous approach to the research of homoeopathy was needed in order to investigate whether homoeopathy could be investigated within a scientifically appropriate context. It was initially proposed that, through the successful replication of an existing trial, a series of clinical trials based on this replication could be conducted to test fundamental questions of homoeopathy. For pragmatic reasons, this initial approach was abandoned. A novel protocol that was subsequently designed to scientifically evaluate the effects of homoeopathy, in particular, the homoeopathic treatment of osteoarthritis of the knee and hip, was subsequently developed.A description of homoeopathy, its development, its placement within the scientific paradigm and its role in the treatment of various clinical conditions is reviewed in Chapter 1. From this literature review, hypotheses were generated to test the effect of the homoeopathic treatment of osteoarthritis. Chapter 2 describes the selection process and proposed replication of a prior clinical trial with a successful outcome upon which to base a further series of clinical trials to test fundamental questions in homoeopathy. The selected study was a randomised, double-blind clinical trial designed to compare the effects of a complex homoeopathic preparation with the effects of paracetamol in the treatment of osteoarthritic knee pain. The study was prematurely terminated when another study presented evidence that the analgesic effect of paracetamol was no better than placebo. The uncertainty that paracetamol was no better than placebo raised doubts as to the validity of any outcome had the trial proceeded. The proposal to develop a series of clinical trials replicating the protocol of this study was postponed as a consequence.Chapter 3 describes the subsequent formation of a ‘think tank’ consisting of epidemiologists, biostatisticians, clinical researchers in complementary medicine and homoeopaths and the subsequent development of a rigorous research protocol for the investigation of homoeopathy within the scientific paradigm. This homoeopathic research model and is described in detail.Chapter 4 describes a randomised, double-blind, placebo-controlled trial with five arms designed to evaluate both the research model and the homoeopathic treatment of osteoarthritis of the hip and knee.Chapter 5 details the results of this clinical trial. No significant difference was demonstrated between individualised homoeopathic treatment, generic complex homoeopathic treatments or placebo. Furthermore, no positive effect on treatments was demonstrated by the inclusion of a full homoeopathic consultation.Chapter 6 provides a discussion of the clinical trial. Possible reasons for the discrepancy between the hypothesised outcomes and the results of the clinical trial are explored and directions for future research are suggested.

Homoeopathy is a controversial form of medicine that is governed by the premise that highly diluted substances that can a defined set of symptoms in a healthy person can cure a similar set of symptoms in a non-healthy person. The use of highly diluted homoeopathic substances that may no longer be expected to contain any trace of the original substance is contrary to accepted pharmacological theory. In addition to serial dilution, homoeopathic “potentisation” of substances also includes violent agitation of the substance at each dilution step, a process known as “succussion”. The role of this process is not understood. The fact that the mechanism of action of homoeopathic substances is unknown adds to the controversial nature of this therapy.A review of the literature demonstrated that a more rigorous approach to the research of homoeopathy was needed in order to investigate whether homoeopathy could be investigated within a scientifically appropriate context. It was initially proposed that, through the successful replication of an existing trial, a series of clinical trials based on this replication could be conducted to test fundamental questions of homoeopathy. For pragmatic reasons, this initial approach was abandoned. A novel protocol that was subsequently designed to scientifically evaluate the effects of homoeopathy, in particular, the homoeopathic treatment of osteoarthritis of the knee and hip, was subsequently developed.A description of homoeopathy, its development, its placement within the scientific paradigm and its role in the treatment of various clinical conditions is reviewed in Chapter 1. From this literature review, hypotheses were generated to test the effect of the homoeopathic treatment of osteoarthritis. Chapter 2 describes the selection process and proposed replication of a prior clinical trial with a successful outcome upon which to base a further series of clinical trials to test fundamental questions in homoeopathy. The selected study was a randomised, double-blind clinical trial designed to compare the effects of a complex homoeopathic preparation with the effects of paracetamol in the treatment of osteoarthritic knee pain. The study was prematurely terminated when another study presented evidence that the analgesic effect of paracetamol was no better than placebo. The uncertainty that paracetamol was no better than placebo raised doubts as to the validity of any outcome had the trial proceeded. The proposal to develop a series of clinical trials replicating the protocol of this study was postponed as a consequence.Chapter 3 describes the subsequent formation of a ‘think tank’ consisting of epidemiologists, biostatisticians, clinical researchers in complementary medicine and homoeopaths and the subsequent development of a rigorous research protocol for the investigation of homoeopathy within the scientific paradigm. This homoeopathic research model and is described in detail.Chapter 4 describes a randomised, double-blind, placebo-controlled trial with five arms designed to evaluate both the research model and the homoeopathic treatment of osteoarthritis of the hip and knee.Chapter 5 details the results of this clinical trial. No significant difference was demonstrated between individualised homoeopathic treatment, generic complex homoeopathic treatments or placebo. Furthermore, no positive effect on treatments was demonstrated by the inclusion of a full homoeopathic consultation.Chapter 6 provides a discussion of the clinical trial. Possible reasons for the discrepancy between the hypothesised outcomes and the results of the clinical trial are explored and directions for future research are suggested.

Regulation of integrative and complementary medicine Student: Eva Škulková Tutor: PharmDr. Jitka Pokladníková, Ph.D. Dept. of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, the Czech Republic Background: The prevalence of complementary and alternative medicine (CAM) is high 76% and it is rising. In the Czech Republic, there are no legislation or general standards that would ensure uniform requirements for providing CAM. At present, there is a lack of comprehensive understanding of how CAM methods are provided. Aim: To determine the level of regulation of the most commonly used CAM methods in the Czech Republic. Methods: The level of regulation has been evaluated according to regulatory criteria based on requirements for healthcare professionals. The list of the researched methods is based on foreign studies and at the same time specific CAM methods for the Czech Republic were added. Specific methods were selected by the expert group. The data was obtained by searching the Internet using The Google. The obtained data was processed in MS Excel using descriptive statistics. Results: Altogether, 98 CAM methods were searched. Of these, 28 methods were excluded from the evaluation, 70 methods were evaluated according to the criteria, and 2 methods were double...

Cultural factors affecting the development of an evidence-based information service in a third sector provider of complementary cancer care Matthew Breckons Introduction Many people with cancer access complementary and alternative medicine (CAM) and a need for high quality information was emphasised in reports by the House of Lords and the National Institute for Health and Clinical Excellence. Organisational culture, incorporating people’s underlying assumptions, values and actions, has been highlighted as an important factor when attempting to introduce evidence-based practices. Opinion is divided over the relevance of evidence to CAM practice, although the influence that this has on the cultural context of a CAM organisation is not understood. Aims To identify cultural factors affecting the introduction of an evidence-based information service in a third-sector CAM organisation and, in light of factors identified, to suggest feasible innovations to achieve a more evidenced-based approach. Methods Access to the charity was gained through a Knowledge Transfer Partnership. Soft Systems Methodology, a form of action research, was used to carry out four ‘learning cycles’ in which data was collected and fed back to staff at the organisation to prompt discussion on what could be improved. Learning cycles focused on improving the quality of web-based and printed information and gaining an understanding of how the information service could be improved from staff and service-user perspectives. Results Results suggested that a lack of time and emphasis on marketing values led to difficulties feeding back results and making changes that were perceived to reduce demand for the charity’s services. A lack of management support and a reluctance to implement rules made introducing any form of information policy problematic. Additionally, structural factors such as a large team of part-time staff and a lack of financial resources led to communication difficulties as well as limiting the opportunity for staff development. Conclusions This is the first study to document systematic attempts to make evidence-based changes in a third sector CAM organisation. As such, this study has generated results demonstrating how cultural and structural constraints in this type of organisation may influence attempts to make evidence-based changes. Introduction of an initiative such as the Information Accreditation Scheme (IAS) may provide benefits to an organisation of this type by guiding the development of information production systems at the same time as raising the profile of the organisation. The findings of this study strongly suggest that, despite demands from policy makers for the provision of evidence-based CAM information, there may be systematic difficulties experienced by organisations responsible for the production of this information. Further research is needed to understand how producers of CAM information can be supported in providing high quality, evidence-based materials.