Medicina Tradicional Chinesa - Desconfie das pesquisas

[krebz 3757]

Estou postando isso na parte de suplementação pois me parece mais suplementos do que realmente remédios < aos mods que queiram mover o topico, fiquem a vontade >

 

Não vou contar a historinha desde quando a medicina tradicional chinesa começo e blablabla, mas vamos tentar discutir o que é comprovado e o que não é de forma geral.

 

Tem gente que vem com aqueles papos mole de que "os antigos povos chineses, cheio de conhecimentos e experiencias...utilizavam e utilizam até hoje centenas de substancias da medicina tradicional china." ----> Isso não é evidencia de nada, se fosse também vamos voltar considerar astrologia como sendo certeira pois "utilizada por antigos povos, cheio de conhecimentos e experiencias...".

 

Um negocio que eu notei a tempos atrás quando entrava no pubmed e procurava alguma substancia (bastante utilizada na china) é que:

 

• As pesquisas que foram feitas por chineses quase sempre mostram que a substancia funciona (se não melhor do que medicamentos ocidentais).

  • Um exemplo recente sobre pesquisa da medicina tradicional sendo melhor que a do ocidente "porém..." no final:

    https://www.ncbi.nlm.nih.gov/pubmed/28922926
    https://www.ncbi.nlm.nih.gov/pubmed/28901172
    https://www.ncbi.nlm.nih.gov/pubmed/28335756
    https://www.hindawi.com/journals/ecam/2017/8242136/
    https://www.ncbi.nlm.nih.gov/pubmed/25335274
    https://www.ncbi.nlm.nih.gov/pubmed/23259285
    Basicamente é sempre a mesma coisa "A medicina/tratamento tradicional chines X é melhor para tratar Y, porém os estudos são fracos"

• Por outro lado, cada vez há mais reviews, feitos pelos próprios chineses, apontando que muitos estudos chineses sobre medicina tradicional está no mínimo mal feito, se não totalmente errado.

 

Começando com um levantamento antigo, mas alarmante:

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DATA SYNTHESIS:

In the study of acupuncture trials, 252 of 1085 abstracts met the inclusion criteria. Research conducted in certain countries was uniformly favorable to acupuncture; all trials originating in China, Japan, Hong Kong, and Taiwan were positive, as were 10 out of 11 of those published in Russia/USSR. In studies that examined interventions other than acupuncture, 405 of 1100 abstracts met the inclusion criteria. Of trials published in England, 75% gave the test treatment as superior to control. The results for China, Japan, Russia/USSR, and Taiwan were 99%, 89%, 97%, and 95%, respectively. No trial published in China or Russia/USSR found a test treatment to be ineffective.

CONCLUSIONS:

Some countries publish unusually high proportions of positive results. Publication bias is a possible explanation. Researchers undertaking systematic reviews should consider carefully how to manage data from these countries.

https://www.ncbi.nlm.nih.gov/pubmed/9551280

 

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[Methodological quality evaluation of randomized controlled trials for traditional Chinesemedicines for treatment of sub-health].

[Article in Chinese]

Zhao J^1,2, Liao X³, Zhao H¹, Li ZG⁴, Wang NY⁵, Wang LM².

Author information

 

Abstract

To evaluate the methodological quality of the randomized controlled trials(RCTs) for traditional Chinese medicines for treatment of sub-health, in order to provide a scientific basis for the improvement of clinical trials and systematic review. Such databases as CNKI, CBM, VIP, Wanfang, EMbase, Medline, Clinical Trials, Web of Science and Cochrane Library were searched for RCTS for traditional Chinese medicines for treatment of sub-health between the time of establishment and February 29, 2016. Cochrane Handbook 5.1 was used to screen literatures and extract data, and CONSORT statement and CONSORT for traditional Chinese medicine statement were adopted as the basis for quality evaluation. Among the 72 RCTs included in this study, 67 (93.05%) trials described the inter-group baseline data comparability, 39(54.17%) trials described the unified diagnostic criteria, 28(38.89%) trials described the unified standards of efficacy, 4 (5.55%) trials mentioned the multi-center study, 19(26.38%) trials disclosed the random distribution method, 6(8.33%) trials used the random distribution concealment, 15(20.83%) trials adopted the method of blindness, 3(4.17%) study reported the sample size estimation in details, 5 (6.94%) trials showed a sample size of more than two hundred, 19(26.38%) trials reported the number of withdrawal, defluxion cases and those lost to follow-up, but only 2 trials adopted the ITT analysis,10(13.89%) trials reported the follow-up results, none of the trial reported the test registration and the test protocol, 48(66.7%) trials reported all of the indicators of expected outcomes, 26(36.11%) trials reported the adverse reactions and adverse events, and 4(5.56%) trials reported patient compliance. The overall quality of these randomized controlled trials for traditionalChinese medicines for treatment of sub-health is low, with methodological defects in different degrees. Therefore, it is still necessary to emphasize the correct application of principles such as blindness, randomization and control in RCTs, while requiring reporting in accordance with international standards.

https://www.ncbi.nlm.nih.gov/pubmed/28929694

 

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Quality assessment of reporting of randomization, allocation concealment, and blinding in traditional Chinese medicine RCTs: a review of 3159 RCTs identified from 260 systematic reviews.

He J¹, Du L, Liu G, Fu J, He X, Yu J, Shang L.

Author information

 

Abstract

BACKGROUND:

Randomized controlled trials (RCTs) which are of poor quality tend to exaggerate the effect estimate and lead to wrong or misleading conclusions. The aim of this study is to assess the quality of randomization methods, allocation concealment and blinding within traditional Chinese medicine (TCM) RCTs, discuss issues identified for current TCM RCTs, and provide suggestions for quality improvement.

METHODS:

We searched Chinese Biomedical Database (CBM, 1978 to July 31, 2009) and the Cochrane Library (Issue 2, 2009) to collect TCM systematic reviews and meta-analyses according to inclusion/exclusion criteria, from which RCTs could be identified. The quality assessment involved whether the randomization methods, allocation concealment and blinding were adequate or not based the study reported. Stratified analyses were conducted of different types of diseases published in different journals (both Chinese and foreign) using different interventions. SPSS 15.0 software was used for statistic analyses.

RESULTS:

A total of 3159 RCTs were included, of which 2580 were published in Chinese journals and 579 in foreign journals. There were 381 (12%) RCTs which used adequate randomization methods; 207 (7%) RCTs which used adequate allocation concealment and 601 (19%) which used adequate blinding; there were 130 (4%) RCTs which both used adequate randomization methods and allocation concealment; and there were only 100 (3%) RCTs which used adequate randomization methods, allocation concealment, as well as blinding. In the RCTs published in foreign journals, the adequate randomization methods, allocation concealment and blinding accounted for a relatively large proportion (25%, 26%, and 60%, respectively) and increased with years, while in the RCTs published in Chinese journals, only the adequate randomization methods improved over time. The quality of non-drug intervention (chiefly acupuncture) RCTs was higher than that of drug intervention RCTs. In drug intervention, the quality of listed drugs is higher than the others. The quality of all included RCTs of all types of diseases was generally poor and no studies that were large in size and of high quality were found.

CONCLUSION:

The quality of the current TCM RCTs as judged by their publications is generally poor, especially those published in Chinesejournals. In future, researchers of TCM RCTs should attach more importance to experimental design and methodological quality, receive relevant training, and improve reporting quality using the Consolidated Standards of Reporting Trials (CONSORT) statement, so as to improve the quality of TCM clinical research and ensure truth and reliability of conclusions.

https://www.ncbi.nlm.nih.gov/pubmed/21569452

 

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Complement Ther Med. 2015 Apr;23(2):283-97. doi: 10.1016/j.ctim.2015.01.014. Epub 2015 Feb 13.

Oral Chinese herbal medicine for kidney nourishment in Alzheimer's disease: a systematic reviewof the effect on MMSE index measures and safety.

Zeng LF¹, Wang NS², Wang Q³, Zou YP⁴, Liang ZH⁵, Kong LS⁴, Wu HT⁴, Liao NY⁴, Liang XW⁴, Mo YS⁴.

Author information

 

Abstract

OBJECTIVE:

To evaluate the effectiveness and safety of the Chinese herbal medicine for kidney nourishment (CHMK) assessed with the Mini-Mental Status Examination (MMSE) index objective outcome measures in individuals with Alzheimer's disease.

METHODS:

Searches were conducted in 7 medical databases from their inceptions until July 19, 2014 for randomized controlled trials (RCTs) that compared the oral administration of CHMK plus conventional pharmacotherapy with the same conventional pharmacotherapy alone with MMSE index measures as outcomes. Relevant resources were also manually retrieved. Two reviewers screened the citations of the reports, assessed the risk of bias and extracted data independently. Data analysis was carried out with Cochrane Collaboration's RevMan5.2.6 software and evidence quality grading evaluation of the systematic review was conducted with Grades of Recommendations Assessment Development and Evaluation (GRADE) profiler software.

RESULTS:

A total of 20 studies involving 1682 participants were included in the meta-analysis. There were 15 trials that compared CHMK with conventional pharmacotherapy and 5 trials that compared CHMK plus conventional pharmacotherapy with conventional pharmacotherapy alone. The main meta-analysis results showed relative benefits in effective rates in five studies (odds ratio [OR] 2.74, 95% confidence interval [CI] 1.55-4.85) and cure rate/clinical-control rates in five studies (OR 1.91, 95% CI 1.27-2.88) in favor of the CHMK plus conventional pharmacotherapy group. As for CHMK compared with conventional pharmacotherapy, no significant differences were noted in the effective rate (OR 1.09, 95% CI 0.82-1.46; cure rate (OR 1.06, 95% CI 0.81-1.38) and detailed sub-group of MMSE scores from the onset time to 4 weeks (weighted mean difference [WMD] 0.31, 95% confidence interval [CI] -0.81 to 1.42, 8 weeks WMD 1.12, 95% CI -0.54 to 2.78, 12 weeks (WMD 0.43, 95% CI -1.62 to 2.48, or 24 weeks WMD 1.92, 95% CI -1.60 to 5.44) follow-up and the overall effect (WMD 0.79, 95% CI -0.11 to 1.69). Moreover, weaknesses in methodological quality were identified in most studies according to Cochrane Risk of Bias tool assessment, while the quality level of GRADE classification indicated "very low". The incidence of adverse events with CHMK (0.87%) was lower than in the conventional pharmacotherapy group (4.08%), which revealed use of CHMK was relatively safer than conventional pharmacotherapy alone.

CONCLUSION:

The effectiveness and safety of oral administration of CHMK cannot be currently determined because of publication bias and the low quality level of the included trials. Further studies on a larger scale and with more rigorous designs are required to define the role of CHMK in the treatment of AD.

https://www.ncbi.nlm.nih.gov/pubmed/25847567

 

Positive Results in Randomized Controlled Trials on Acupuncture Published in Chinese Journals: A Systematic Literature Review

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Results: A total of 840 RCTs with 71,871 participants were identified, including 727 RCTs comparing acupuncture with conventional treatment, 51 RCTs with no treatment, and 62 RCTs with sham-acupuncture. Among them, 838 trials (99.8%) reported positive results from primary outcomes, while only two trials (0.2%) reported negative results, comparing acupuncture with conventional treatment and sham-acupuncture respectively. Among the 726 RCTs comparing acupuncture with conventional treatment, 641 trials (88.3%) favored acupuncture groups; While 85 trials (11.7%) showed no significant difference between acupuncture and conventional treatment groups, the authors concluded positive results based on the findings. For methodological quality, the percentages of reporting ‘random number generation’, ‘concealment of the allocation sequence’, ‘blinding’, ‘information on withdraws or lost of follow-up’, and ‘Sample Size Calculation’ among the 840 RCTs were 43.7%, 5.9%, 4.9%, 9.9%, and 1.7% respectively. In addition, 99.8% of trials reported names of points used, 74.5% of trials reported manipulation methods to gain response sought such as de qi, and 18.2% of trials reported syndrome differentiation.

 

Conclusion: Publication bias might be major issue in RCTs on acupuncture published in Chinese journals reported, which is related to high risk of bias. We suggest that all trials should be prospectively registered in international trial registry in future.

http://online.liebertpub.com/doi/pdfplus/10.1089/acm.2014.5346.abstract

 

 

E algumas noticias sobre estes casos:

 

Chinese Clinical Trials Data 80 Percent Fabricated: Government

http://www.rfa.org/english/news/china/clinical-fakes-09272016141438.html

Basicamente 80% dos dados clínicos chineses (sobre medicina tradicional) é fabricada pelo governo

 

Why China’s traditional medicine boom is dangerous

https://www.economist.com/news/china/21727945-unproven-remedies-promoted-state-why-chinas-traditional-medicine-boom-dangerous

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America’s National Institutes of Health looked at 70 systematic reviews of TCM treatments. In 41 of them, the trials were too small or badly designed to be of use. In 29, the studies showed possible benefits but problems with sample sizes and other flaws meant the results were inconclusive. Shu-chuen Li of Newcastle University in Australia found that only a quarter of the studies he looked at showed some benefits, but most of these were marginal.

 

Resumindo:

No meio de tanta substancia em potencial da medicina tradicional podendo ser investigada, testada e (com esperança) mostrando algum resultado interessante, temos centenas de pesquisa sendo "produzidas" concluindo de antemão que elas "são melhores que ocidentais" apenas deixar o governo chines e o mercado da medicina tradicional feliz.

 

Tomara que essa moda não chegue logo no brasil, apesar de que aos poucos vemos cada vez mais "remédios naturais milagrosos" por aqui....

 

PS: Não vou chegar no assunto moxabustão ser uma bosta(1,2,3,4,5,6,7,8,9) e outras bobagens da medicina tradicional.

Editado Fevereiro 12, 2019 às 18:55 por krebz

[OliJunior 255]

Muito bom. Vi também um estudo chinês sobre a turmalina negra em piscicultura. E parece coisa mágica segundo eles. Acelera crescimento, inibe algas, melhora qualidade da água e várias outras "miraculosidades". O engraçado é que ninguém conseguiu recriar esses mesmos resultados além deles.

[Lucas, o Schrödinger 12260]

Curti o tópico. Eu tenho um pé atrás com essas coisas mais exotéricas... 

 

@krebz, como o tópico é antigo, viu mais algo sobre isso? Fiquei curioso especialmente sobre acupuntura. Até onde sei é bem aceita pela medicina ocidental.

[krebz 3757]

Acupuntura não funciona melhor que placebo, tanto faz aonde coloca a agulha ou se ao menos coloca ela no corpo.

https://sciencebasedmedicine.org/acupuncture-doesnt-work/

 

e um review de meta-analise...chinesa...que conseguiu passar em um dos jornais sem nocao em 2018

https://sciencebasedmedicine.org/plos-one-peer-review-and-a-crappy-acupuncture-study/

 

E é com esse tipo de material e um monte de gente que “testou e funciona” que os profissionais continuam indicando, plano de saude cobrindo, etc

 

entre outros casos https://sciencebasedmedicine.org/tag/acupuncture/

 

[leo_jitsu 7]

Depois de olhar sua pesquisa, realmente é de desconfiar...tava olhando uma substância que aparentemente tem algum efeito sobre o câncer, me deparei com essa...https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4220249/ mas como são todos chineses vai saber a veracidade? 

Editado Abril 29, 2019 às 03:18 por leo_jitsu

[krebz 3757]

16 horas atrás, leo_jitsu disse:

Depois de olhar sua pesquisa, realmente é de desconfiar...tava olhando uma substância que aparentemente tem algum efeito sobre o câncer, me deparei com essa...https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4220249/ mas como são todos chineses vai saber a veracidade? 

é complicado mesmo.

Ainda mais dificil tendo uma perspectiva mais de fora da area estudada, o máximo que daria para alguem não da area perceber é se tem alguns furos de metodologia utilizada: https://www.sciencedirect.com/science/article/pii/S188319581000112X

 

mas ao menos não aparenta estar vendendo milagres como algumas pesquisas. Foram até que bem sinceros na parte de:

 

"However, clinical evidence is very limited as far as we know. TPL has been approved for Phase I clinical trials for the treatment of prostate cancer, but the anti-tumor effect and mechanism of TPL need to be further elucidated."

 

PS:

Eu já tenho muitas ressalvas com pesquisas indianas depois que vi que eles tem partes do governo dedidadas a medicina tradicional deles, mas até muitos cientistas indianos ao menos estão cientes desse problema

https://pdfs.semanticscholar.org/9286/060eff5ebe9c42082268625bc594a9d1f654.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4230501/