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Will duct tape cure my warts? Examining Complementary and Alternative Medicine: 

Will duct tape cure my warts? Examining Complementary and Alternative Medicine National Network of Libraries of Medicine South Central Region

Agenda: 

Agenda Definitions History and Impact Usage and Therapies Evaluating Web Sites Avoiding Bad Science Recommended Websites Reviewing the Evidence

How do you get rid of a wart?: 

How do you get rid of a wart? raw meat banana peel potato witch hazel duct tape silk thread alfalfa pills apple cider toothpaste castor oil quarters windex dandelion juice cigarette ashes garlic pills cabbage orange peel nail polish iodine aloe c e

What is CAM?: 

What is CAM? Complementary and Alternative Medicine Complementary: together with aromatherapy to help with pain after surgery Alternative: in place of using garlic to lower blood pressure

CAM becomes “legit”: 

CAM becomes “legit” 1990 Wilk et al v. AMA 1991 $2 million in funding to establish NIH Office of Alternative Medicine 1994 Dietary Supplement Health and Education Act

CAM becomes “legit”: 

CAM becomes “legit” 1995 NIH Office of Dietary Supplements http://ods.od.nih.gov/ FDA declassifies Acupuncture needles as experimental product 1996 NIH Consensus Conference on Acupuncture 1997 First large trial of CAM therapy, St. John’s Wort for depression

CAM becomes “legit”: 

CAM becomes “legit” 1998 National Center for Complementary & Alternative Medicine (NCCAM) established http://nccam.nih.gov/ First full scale article in JAMA on herbal medicine Office of Cancer Complementary and Alternative Medicine (OCCAM) established http://www.cancer.gov/cam/ 2001 CAM on PubMed (NCCAM and NLM)

Impact of CAM: 

Impact of CAM CDC Report (2004) 36% of adults used some form of CAM 55% CAM + conventional treatments 26% used CAM because a medical professional suggested it $36-47 billion on CAM therapies in 1997 $5 billion on herbal remedies JAMA (1998) 12.1% of population use herbal medicine

Diseases and Conditions*: 

Diseases and Conditions* Back pain or problem Head or chest cold Neck pain or problem Joint pain or stiffness Anxiety/depression Arthritis, gout, lupus or fibromyalgia Stomach or intestinal illness Severe headache or migraine *Barnes PM,et al. Complementary and alternative medicine use among adults: United States 2002; CDC

Top 5 CAM Therapies*: 

Top 5 CAM Therapies* Natural products, dietary supplements Deep breathing exercises Meditation Chiropractic Yoga *Barnes PM,et al. Complementary and alternative medicine use among adults: United States 2002; CDC

Top 10 Supplements*: 

Top 10 Supplements* Echinacea Ginseng Ginkgo biloba Garlic Glucosamine St. John’s Wort Peppermint Fish oil/Omega 3 Ginger Soy *Barnes PM,et al. Complementary and alternative medicine use among adults: United States 2002; CDC

Categorization of Therapies* : 

Categorization of Therapies* Whole Medical Systems Biologically Based Practices Energy Medicine Manipulative and Body-Based Practices Mind-Body Medicine *National Center of Complementary and Alternative Therapy

Whole Medical Systems: 

Whole Medical Systems Complete systems of theory and practice that evolved independently Traditional systems of medicine that are practiced by individual cultures throughout the world Includes traditional Chinese medicine, Ayurvedic medicine, homeopathy, naturopathy *National Center of Complementary and Alternative Therapy

Biologically Based Practices: 

Biologically Based Practices Includes: botanicals, animal-derived extracts, vitamins, minerals, fatty acids, amino acids, proteins, whole diets, and functional foods Dietary supplements are a subset of biologically based practices *National Center of Complementary and Alternative Therapy

Biologically Based - Supplements: 

Biologically Based - Supplements What is a supplement? Regulated by FDA http://www.fda.gov no requirements for FDA testing manufacturers responsible for ensuring product safety label requirements safety alerts: http://www.cfsan.fda.gov/~dms/ds-warn.html

Energy Medicine: 

Energy Medicine Veritable - energy that can be measured Includes sound, visible light, magnetism Putative – energy that has yet to be measured human beings are infused with a subtle form of energy Includes qi (ki in Japanese); doshas; prana, homeopathic resonance *National Center of Complementary and Alternative Therapy

Energy Medicine - Acupuncture: 

Energy Medicine - Acupuncture Few complications Scientific evidence? post chemotherapy management of nausea pain relief NIH Consensus Statement (1997) http://consensus.nih.gov/1997/1997Acupuncture107html.htm

Manipulative and Body-Based: 

Manipulative and Body-Based Structures and systems of the body, including the bones and joints, the soft tissues, and the circulatory and lymphatic systems Includes chiropractic manipulation, massage therapy, reflexology, rolfing, Alexander technique, Feldenkrais method *National Center of Complementary and Alternative Therapy

Mind-Body Medicine: 

Mind-Body Medicine Interactions among the brain, mind, body, and behavior The ways in which emotional, mental, social, spiritual, and behavioral factors can directly affect health Includes relaxation, hypnosis, visual imagery, meditation, yoga, biofeedback, tai chi, group support, and spirituality *National Center of Complementary and Alternative Therapy

Other CAM Therapies: 

Other CAM Therapies Aromatherapy Colonic Irrigation Therapeutic Touch EDTA Chelation Cupping Primordial Sound Meditation

Avoiding Bad Science: 

Avoiding Bad Science The “One Product Does It All” claim http://www.emuoilcanada.com/ Personal Testimonials http://www.getslimslippers.com/ Quick Fixes/Cures http://www.cure-your-asthma.com The “No Risk Money Back Guarantee” http://www.bodycatalyst.com/colon_cleanse.html The “Natural” claim http://www.amtrueman.com/products.html

Evaluating Web Sites: 

Evaluating Web Sites Accuracy Authority Bias Currency Coverage

Examining the Research : 

Examining the Research Observational Studies Clinical Trials/Studies controlled blind/double-blind randomized ClinicalTrials.gov Gov’t and private clinical studies involving humans http://clinicaltrials.gov

Clinical Trials and CAM : 

Clinical Trials and CAM Why are there so few CAM clinical trials? Drug companies have to do studies to go on the market—supplement companies do not, so clinical trials sponsored by supplement companies are rare Alternative treatments are often customized for a specific person. Clinical trials try to prove something works for most people. Belief systems of some CAM practitioners do not agree with the idea of Western studies, so they do not participate CAM has only recently become “legit” in the scientific community

Reviewing the Evidence : 

Reviewing the Evidence Evidence Based Medicine: “What evidence do we have to justify the treatment…” National Center for Complementary and Alternative Medicine (NCCAM) CAM on PubMed

Slide26: 

Thank You! National Network of Libraries of Medicine South Central Region 800-338-7657