The Evidence Is In – Complimentary and Alternative Medicine
What is
In her course description she included these facts. “In 1997, the total visits to Complementary
and Alternative Medicine (CAM) providers (629M) exceeded total visits to all
primary care physicians (386M). Total out of pocket expenditures for
Her course content is posted at http://nnlm.gov/mcr/consumer_health/cam/. Many
links to reputable evidence based resources can be found through out the link
indicated above. We worked through the
following agenda. In the half-day course
we were able to briefly cover each topic.
What is complementary
and alternative medicine?
Complementary and alternative medicine, as defined
by NCCAM (National Center for complementary and Alternative Medicine), http://nccam.nci.nih.gov/is a group of diverse
medical and health care systems, practices, and products that are not presently
considered to be part of conventional medicine. While some scientific evidence exists
regarding some
Are complementary
medicine and alternative medicine different?
Again, NACAM presents the following distinctions.
·
Complementary
medicine is used together with
conventional medicine. An example of a complementary therapy is using aromatherapy to help lessen a patient's discomfort
following surgery.
·
Alternative
medicine is used in place of
conventional medicine. An example of an alternative therapy is using a special diet
to treat cancer instead of undergoing surgery, radiation, or chemotherapy that
has been recommended by a conventional doctor.
Interesting Facts in the
History of Alternative Medicine
·
Study from 1900 to present: shows
·
Leading physician in the 18th century,
Benjamin Rush, believed that blood
letting and purging were examples of scientific medicine. Alternative medicine usage was high during
this period.
·
In ancient
·
Many prescription drugs are “anti” they
stop things from happening: Anticonvulsants Antidepressants,
Antihistamines. Alternative medicine
seeks to be more pro active or positive.
·
Claims against chiropractors, massage
therapists, and acupuncturists occur less frequently then claims against medical doctors.
NCCAM: Categorization of Therapies
The
MD Anderson Cancer Center gives
a thorough review of these therapies
1. Alternative Medical Systems:
Examples
·
Western: homeopathic
medicine and naturopathic
medicine.
·
Non-western: Chinese medicine
and Ayurveda.
·
Some techniques that were considered
·
Other mind-body techniques are still
considered CAM, including meditation, prayer,
mental healing, and therapies that use creative outlets such as art, music, or dance
3. Biologically Based Therapies...
Use substances found in
nature, such as herbs, foods, and vitamins.
Some examples include dietary supplements, herbal products, and the
scientifically unproven therapies (for example, using shark cartilage to treat
cancer).
4. Manipulative and Body-Based Methods...
Are based on
manipulation and/or movement of one or more parts of the body. Some examples
include chiropractic
or osteopathic
manipulation, and massage.
5. Energy Therapies:
·
Biofield therapies - Examples include qi gong, Reiki, and Therapeutic Touch. Bioenergetics
·
Bioelectromagnetic-based therapies -
electromagnetic fields, such as pulsed fields, magnetic
fields, or alternating current or direct current fields.
Review of Evidence
Many therapies introduced before the 1960’s do not
meet the criteria of evidenced based medicine (EBM) -- Most CAM therapies were
introduced way before 1960
EBM – well designed randomized controlled clinical
trials. Since the 1960’s all drugs approved by the FDA have met this standard.
Warfarin, aspirin and heparin were introduced
before the randomized clinical trial. Warfarin is still not evidenced based - but
remains a conventional therapy for heart disease.
If introduced in mainstream western society,
though not evidenced based, the treatment is more likely to be accepted.
Western medicine must sort through therapies to
find which should undergo RCT. If it passes criteria it should be integrated
into the physicians treatment possibilities.
Selected Consensus
Reports, Clinical Trials and Reviews Suggesting that
David Eisenberg, Harvard Medical School, addresses
these issues in an article linked here.
Links to a series of abstracts on these topics is listed here. Full text is available in some cases.
|
|
|
Selected Clinical Trials Suggesting That CAM
Therapies May Lack Efficacy
Acupuncture
for Peripheral Neuropathy
Chiropractic
for Infantile Colic
Chiropractic
vs. Physical Therapy vs. Education for Low Back Pain
Group
Psychosocial Support for Metastatic Breast Cancer
Hair
Analysis of Trace Minerals
Hydroxycitric Acid for Obesity
Selected Articles
Describing Significant Drug-Herb Interactions and/or Toxicity
Case
Studies Involving the Most Commonly Used Medicinal Plants
Adverse
Reactions Between St. John's wort and Prescription Drugs
Open-label
Study Showing St. John's wort Decreases Indinavir Concentrations
Association
of a Chinese Herb (Aristolochia fangchi) with Renal Failure and Urothelial
Carcinoma
Letter
to Lancet Editor regarding St. John's Wort Induced Heart Transplant Rejections
Summary
of Ephedra's toxicity and Herbal
medicines and perioperative care
Complementary and Alternative Medical Databases
Free
AGRICOLA - A bibliographic
database of citations to the agricultural literature created by the U.S.
National Agricultural Library and its cooperators.
The Combined Health Information
Database (CHID) -
CHID lists a wealth of health promotion and education materials and program
descriptions that are not indexed elsewhere. CHID is updated four times a year.
January, April, July, and October.
Database of Abstracts of Reviews of
Effectiveness (DARE)The
The Center for Reviews and Dissemination was established in January 1994 to provide
the National Health Service with important information on the effectiveness of
treatments and the delivery and organization of health care.
Patient Information for Natural Therapies (The German, Patienteninformation
fur Naturheilkunde) A searchable database, much of it in English, providing
information on holistic medicine and a network linking research institutions
and organizations worldwide. There are over 5,000 bibliographic entries and
1,000 addresses.
ClinicalTrials.gov A database of ongoing and closed clinical
trials developed and maintained by the U.S. National Institutes of Health
Cochrane Library
Abstracts of Systematic Reviews A
searchable database of the most up to date Cochrane Systematic Reviews.
Includes reviews of
Cochrane Consumer Network
The Collaboration is an international non-profit organization that aims to help
people make informed decisions about health care, by reviewing and promoting
the best available evidence on the effects of interventions and treatments.
HerbMed A
searchable database which provides hyper linked access to the scientific data
underlying the use of herbs for health. It is an evidence-based information
resource for professionals, researchers, and general public.
HOM-INFORM
The British Homeopathic Library indexes homeopathic literature in this free
database. A database of literature references to homeopathy, with key terms and
some abstracts. (Search on Clinical Trials)
The
International Bibliographic Information on Dietary Supplements (IBIDS)
A database of published, international, scientific
literature on dietary supplements, including vitamins, minerals, and
botanicals.
MEDLINEplus is the National Library of Medicine's web site for consumer health information in English and Spanish. Content is provided for health topics, interactive health tutorials, drug information, current health news, dictionaries, directories, organizations, libraries, and databases.
Native
American Ethnobotany -
A database of plants used as drugs, food, fibers, dyes by native American
people
Natural Pharmacist
contains detailed information on more than 200 herbs and supplements, more than
100 different conditions and the conventional and natural treatments used to
treat them, plus drug-herb and drug-supplement interactions for more than 75
drug categories
The
University of Hawaii has a version you can access.
Poisonous Plant Database
is a set of working files of scientific information about the animal and human
toxicology of vascular plants of the world. The initial files were created in
1994, and are updated periodically.
Fee-Based
We have the following databases available through
subscription.
Alt HealthWatch A
full text database of journal articles from 140 periodicals, 24
peer-reviewed publications included: EBSCO.
Health
Source: Consumer Edition provides full text articles, pamphlets,
and book chapters on nutrition, exercise, medical self-care, drugs, alcohol,
and more. Information provided in this consumer health database should not be
viewed as a means of self-diagnosis or a substitute for professional medical
advice.
·
Clinical
Reference Systems provides over 7,000 reports, in every-day
language, describing symptoms, treatments, risks, and after-effects of a vast
array of medical topics and conditions. Spanish records have been added. It is
part of Health Source: Consumer Edition.
Others databases are available, as well. Consult http://nnlm.gov/mcr/consumer_health/cam/database.php
for a list of these.
Virtually everyone in
the
Spending in Alternative Medicine - Out of pocket expenditures
doubled from
1990 – 1997 -- $14b to $28b
Herbal medicine out of pocket payments $5.1b in
1997 with 12.1% of the adult
1999 - U.S. Pharmaceutical industry launches
herbal products line -- $10b industry, 25% growth per year
The presenter reminds us the course was in no way a compilation of all of the complementary and alternative medicine resources that are available. Instead, it is an attempt to provide a look at evidence based and peer reviewed alternative medicine resources.
I, immediately, utilized this newly-found
knowledge to update our Complementary and Alternative CAM resources on our
redesigned web site http://www.methodistcollege.edu/library/chsinternetresrcs/alternmedicine.htm.
Stephanie’s list is included, as a gateway, for
it’s comprehensive coverage of this important topic.
comments and questions?
contact Angela Arner, Coordinator
Consumer Health Library Services,
John Moritz Library
354-4611 or aarner@methodistcollege.edu
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