Complementary therapy and genital warts
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《性传输感染》
1 St Mary’s Hospital, London W2 1NY, UK
2 Imperial College London, UK
3 Hull York Medical School, UK
4 Imperial College London, UK
Keywords: complementary therapy; genital warts
Complementary therapy (CT) is now the second biggest growth industry in Europe (after IT). Up to 20% of the UK population visit a complementary therapist each year and as much as ￡5 billion is spent annually on such therapies.1 In the United States this figure is $30 billion. The National Institutes of Health in the United States are keen to fund good scientific studies showing efficacy of CT, in order to "disseminate authoritative information to the public and professionals".2 Objective data gathering is all the more important as a large majority of physicians view CT very negatively.3
Five years ago we were approached by a group of Reiki therapists to undertake a study showing the efficacy of Reiki healing on STIs. Reiki healing (RH) is a hands-on healing method that may be undertaken as distance healing.4 There is a precedent for CT therapies being used in the form of yoga for patients with infection—in particular a well designed randomised trial showing efficacy in tuberculosis.5 In view of this we undertook a study of the effect of RH at a distance on genital warts. The study had local ethics committee approval.
Patients with anogenital warts who were awaiting surgical treatment initially had their wart size and number assessed by a nurse using standard techniques.6 Waiting time from this point to surgical removal of the warts averaged 6 weeks (plus or minus 1 week). Another nurse, who was blind to the initial wart visualisation, photographed the back of patient’s head and then allocated each patient to a treatment (RH) or no treatment group according to a random code .Twelve Reiki healers were then each sent the photographs and undertook RH on them at a distance on a daily basis for about 10 minutes. Thus, half the patients received RH and the other half did not. Just before surgical removal of the warts the size and number of the warts was again assessed by the original nurse.
Considering a difference between a 35% reduction in wart volume for the Reiki treated group and a 10% reduction for the placebo (90% power 0.05) it was considered that 130 patients would be needed (65 in each arm); in fact, only 27 patients were enrolled into the study. Ten were lost to follow up .Of the 17 who completed the study nine received RH and eight did not. Two patients who received RH and one who did not totally cleared their warts. Seven who received RH and two who did not had an increase in wart mass/number. No patient who received RH and five who did not showed some degree of decrease in wart mass/number. These rates of regression are similar to those described in the placebo arms of recent double blind trials.7,8
Although this is a small study, we believe it was well designed but we failed to enrol large enough numbers. We also think it failed to show any efficacy for RH. Undertaking well designed trials of CT in the STI arena is important—not least because a majority of patients attending STI clinics may already be using them, and open discussion about them can help patients to make informed decisions as well as avoid drug interactions.9
In terms of common skin warts, efficacy of Reiki healing has not been shown to be effective.10
References
What Medicine. CAM on the up as more people look for an alternative (www.whatmedicine.co.uk/articlesCompMed.htm).
Anonymous. About the National Center for Complementary and Alternative Medicine. (/nccam.nih.gov/aboutnccam/index.htm).
Risberg T, Kolsta A, Bremmes Y, Knowledge of and attitudes toward complementary and alternative therapies; a national multicentre study of oncology professionals in Norway, et al. Eur J Cancer 2004;40:529–35.
Mansour AA, Beuche M, Laing G, et al. A study to test the effectiveness of placebo Reiki standardised procedures developed for a planned Reiki efficacy study. J Altern Complement Med 1999;5:153–64.
Visweswaraiah NK, Telles S. Randomised trial of yoga as a complementary therapy for pulmonary tuberculosis. Respirology 2004;9:96–101.
Lacey CJN, Goodall R, Tennvall GT, et al. Randomised controlled trial and economic evaluation of podophyllotoxin solution, podophyllotoxin cream, and podophyllin in the treatment of genital warts. Sex Transm Infect 2003;79:270–5.
Tyring S, Edwards L, Cherry K, et al. Safety and efficacy of 0.5% podofilox gel in the treatment of anogenital warts. Arch Dermatol 1998;134:33–8.
Edwards L, Ferenczy A, Eron L, et al. Self-administered topical 5% imiquimod cream for external anogenital warts. Arch Dermatol 1998;134:25–30.
Trutnovsky G, Law C, Simpson JM, et al. Use of complementary therapies in a sexual health clinic setting. Int J STD AIDS 2001;12:307–9.
Harkness EF, Abbot NC, Ernst E. A randomised trial of distant healing for skin warts. Am J Med 2000;108:507–8.(D Goldmeier, P Madden, C )
2 Imperial College London, UK
3 Hull York Medical School, UK
4 Imperial College London, UK
Keywords: complementary therapy; genital warts
Complementary therapy (CT) is now the second biggest growth industry in Europe (after IT). Up to 20% of the UK population visit a complementary therapist each year and as much as ￡5 billion is spent annually on such therapies.1 In the United States this figure is $30 billion. The National Institutes of Health in the United States are keen to fund good scientific studies showing efficacy of CT, in order to "disseminate authoritative information to the public and professionals".2 Objective data gathering is all the more important as a large majority of physicians view CT very negatively.3
Five years ago we were approached by a group of Reiki therapists to undertake a study showing the efficacy of Reiki healing on STIs. Reiki healing (RH) is a hands-on healing method that may be undertaken as distance healing.4 There is a precedent for CT therapies being used in the form of yoga for patients with infection—in particular a well designed randomised trial showing efficacy in tuberculosis.5 In view of this we undertook a study of the effect of RH at a distance on genital warts. The study had local ethics committee approval.
Patients with anogenital warts who were awaiting surgical treatment initially had their wart size and number assessed by a nurse using standard techniques.6 Waiting time from this point to surgical removal of the warts averaged 6 weeks (plus or minus 1 week). Another nurse, who was blind to the initial wart visualisation, photographed the back of patient’s head and then allocated each patient to a treatment (RH) or no treatment group according to a random code .Twelve Reiki healers were then each sent the photographs and undertook RH on them at a distance on a daily basis for about 10 minutes. Thus, half the patients received RH and the other half did not. Just before surgical removal of the warts the size and number of the warts was again assessed by the original nurse.
Considering a difference between a 35% reduction in wart volume for the Reiki treated group and a 10% reduction for the placebo (90% power 0.05) it was considered that 130 patients would be needed (65 in each arm); in fact, only 27 patients were enrolled into the study. Ten were lost to follow up .Of the 17 who completed the study nine received RH and eight did not. Two patients who received RH and one who did not totally cleared their warts. Seven who received RH and two who did not had an increase in wart mass/number. No patient who received RH and five who did not showed some degree of decrease in wart mass/number. These rates of regression are similar to those described in the placebo arms of recent double blind trials.7,8
Although this is a small study, we believe it was well designed but we failed to enrol large enough numbers. We also think it failed to show any efficacy for RH. Undertaking well designed trials of CT in the STI arena is important—not least because a majority of patients attending STI clinics may already be using them, and open discussion about them can help patients to make informed decisions as well as avoid drug interactions.9
In terms of common skin warts, efficacy of Reiki healing has not been shown to be effective.10
References
What Medicine. CAM on the up as more people look for an alternative (www.whatmedicine.co.uk/articlesCompMed.htm).
Anonymous. About the National Center for Complementary and Alternative Medicine. (/nccam.nih.gov/aboutnccam/index.htm).
Risberg T, Kolsta A, Bremmes Y, Knowledge of and attitudes toward complementary and alternative therapies; a national multicentre study of oncology professionals in Norway, et al. Eur J Cancer 2004;40:529–35.
Mansour AA, Beuche M, Laing G, et al. A study to test the effectiveness of placebo Reiki standardised procedures developed for a planned Reiki efficacy study. J Altern Complement Med 1999;5:153–64.
Visweswaraiah NK, Telles S. Randomised trial of yoga as a complementary therapy for pulmonary tuberculosis. Respirology 2004;9:96–101.
Lacey CJN, Goodall R, Tennvall GT, et al. Randomised controlled trial and economic evaluation of podophyllotoxin solution, podophyllotoxin cream, and podophyllin in the treatment of genital warts. Sex Transm Infect 2003;79:270–5.
Tyring S, Edwards L, Cherry K, et al. Safety and efficacy of 0.5% podofilox gel in the treatment of anogenital warts. Arch Dermatol 1998;134:33–8.
Edwards L, Ferenczy A, Eron L, et al. Self-administered topical 5% imiquimod cream for external anogenital warts. Arch Dermatol 1998;134:25–30.
Trutnovsky G, Law C, Simpson JM, et al. Use of complementary therapies in a sexual health clinic setting. Int J STD AIDS 2001;12:307–9.
Harkness EF, Abbot NC, Ernst E. A randomised trial of distant healing for skin warts. Am J Med 2000;108:507–8.(D Goldmeier, P Madden, C )