Will Duct Tape Cure My Warts? Exploring Complementary and Alternative Medicine (CAM)

1. Will Duct Tape Cure My Warts?Exploring Complementary and Alternative Medicine (CAM) Gail Kouame Consumer Health Coordinator National Network of Libraries of Medicine Pacific Northwest Region

2. Introductions Gail Kouame Consumer Health Coordinator NN/LM, PNR University of Washington Serve 5 states: Alaska, Idaho, Montana, Oregon, and Washington

3. Introductions Services/Resources We Provide: Promote NLM resources Provide training – like today! Provide training materials you can use Fund health information projects Promotional materials Consult on proposed outreach efforts

4. Introductions Who we serve: Health Professionals Medical Libraries – hospital and other Public Libraries Academic Libraries Community-Based Organizations Faith-Based Organizations You! Emphasis on underserved, underrepresented groups

5. Introductions • Tell us about you! • Your name • Where you work, study, or volunteer • Ever used a CAM treatment? (if comfortable) • Why you’re interested in this topic

6. Agenda • Definitions • History, Impact and Development • Usage and Therapies • Evaluating Web Sites • Avoiding Bad Science • Recommended Websites • Reviewing the Evidence

7. What We Won’t Do • Cover the complete picture of CAM – Too broad! • Misrepresent CAM therapies • Suggest or recommend any one form of CAM over another

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

9. Defining CAM – what it isn’t • Conventional • Allopathic • Western • All are words for systems in which symptoms are treated or controlled (palliated) • Traditional • Affiliated more with native and indigenous populations, and may also be under the umbrella of CAM

10. Defining CAM • Complementary and Alternative Medicine (CAM) • Complementary: together with • Use of medical aromatics may help alleviate pain after surgery

11. Defining CAM • Alternative: in place of • Using garlic to lower blood pressure • Integrative: combine • Using CAM and conventional treatment to manage HIV CD4 cell count

12. Defining CAM • Definition by the World Health Association (WHO): Traditional, Complementary and Alternative Medicine (TCAM)

13. CAM in the spotlight • 1990 • Wilk et al vs. American Medical Association • 1991 • $2 million in funding to establish NIH Office of Alternative Medicine • 1994 • Dietary Supplement Health and Education Act

14. CAM in the spotlight • 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

15. CAM in the spotlight • 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)

16. CAM in the limelight March 2000: • White House Commission on Complementary and Alternative Medicine Policy • Consortium of Academic Health Centers for Integrative medicine http://www.ahc.umn.edu/cahcim/members/home.html www.camlawblog.com www.Naturalhealers.com

17. Impact of CAM • CDC Report (2002/2007) • 38.3% of adults used some form of CAM • 12% of children 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

18. Who Uses CAM? • Overall, CAM use is greater by: • Women than men • People with higher education levels and higher income • People who have been hospitalized in the past year • Former smokers, as compared to current smokers or those who never smoked • National Center for Complementary and Alternative Medicine

19. Who Uses CAM? • In 2007, data show 1 in 9 children (age 17 and under) used some form of CAM therapy in last 12 months • In 2007, Race and Ethnic breakdown shows 50.3% American Indian and Alaska Native, 43.1% White, 39.9% Asian, 25.5% Black and 23.7% Hispanic • National Center for Complementary and Alternative Medicine

20. Diseases and Conditions in 2007 • Back pain* or problem • Neck pain • Joint pain • Arthritis • Anxiety/depression* • Cholesterol • Head or Chest Cold* • Other MSK* • Headaches/Migraines • Among Children*: ADHD and insomnia *Barnes PM,et al. Complementary and alternative medicine use among adults: United States 2002; CDC *Barnes PM,et al. Complementary and alternative medicine use among adults and children: United States 2007; CDC

21. Top 5 CAM Therapies in 2007 • Natural products, dietary supplements • Deep breathing exercises • Meditation • Chiropractic Manipulation • Yoga • Increase in acupuncture, massage therapy and Naturopathic Medicine • Among Children: Homeopathic Treatment, Traditional Healers, Progressive relaxation and Diet-Based Therapies *Barnes PM,et al. Complementary and alternative medicine use among adults: United States 2002; CDC *Barnes PM,et al. Complementary and alternative medicine use among adults and children: United States 2007; CDC

22. Top 10 Supplements in 2007 • 6. Combinations herb and pills • 7. Ginkgo Biloba • 8. Chondroitin • 9. Garlic Supplements • 10.Co-enzyme Q10 • Fish oil • Glucosamine • Echinacea • Flaxseed oil pills • Ginseng *Barnes PM,et al. Complementary and alternative medicine use among adults: United States 2002; CDC *Barnes PM,et al. Complementary and alternative medicine use among adults and children: United States 2007; CDC

23. 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

24. Whole Medical Systems • Complete systems of theory and practice that evolved independently • Traditional systems of medicine practiced by individual cultures throughout the world • Includes traditional Chinese medicine, Ayurvedic medicine, Homeopathy, Naturopathy National Center of Complementary and Alternative Therapy

25. Biologically Based Practices • Botanicals • Animal-derived extracts • Vitamins • Minerals • Fatty acids • Amino acids • Proteins • Whole diets • Functional foods • Dietary supplements are a subset of biologically based practices National Center of Complementary and Alternative Therapy

26. 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

27. Energy Medicine • Veritable - energy that can bemeasured • 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

28. 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

29. Manipulative and Body-Based • Structures and systems of the body, including: • bones and joints • soft tissues • circulatory and lymphatic systems • Includes: • chiropractic manipulation • massage therapy • Reflexology • Rolfing • Alexander technique • Feldenkrais method National Center of Complementary and Alternative Therapy

30. 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 *National Center of Complementary and Alternative Therapy

31. Other CAM Modalities • Aromatherapy (Medical Aromatics) • Colonic Irrigation • Therapeutic Touch (Reiki) • EDTA Chelation • Cupping (Licensed acupuncturist) • Primordial Sound Meditation

32. Break!

33. CAM – Where’s the Good Stuff?

34. Finding the Good Stuff: - Evaluating Web Sites • Use these suggested criteria: • Accuracy • Authority • Bias • Currency • Coverage

35. 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.naturalhpvcure.com/ • The “Natural” claim • http://www.amtrueman.com/products.html

36. Good Starting Places • MedlinePlus.gov • NLM’s consumer health portal site • NCCAM - http://nccam.nih.gov/ • National Center for Complementary and Alternative Medicine at NIH • Alternative Medicine Foundation • http://www.amfoundation.org/index.htm

37. Reviewing the Evidence • Evidence Based Medicine: “What evidence do we have to justify the treatment…” • National Center for Complementary and Alternative Medicine (NCCAM) • http://nccam.nih.gov/ • CAM on PubMed • Pubmed.gov • http://nccam.nih.gov/camonpubmed/

38. Examining the Research • Observational Studies • Clinical Trials/Studies • controlled • blind/double-blind • randomized • ClinicalTrials.gov • Government and private clinical studies involving humans • http://clinicaltrials.gov

39. Anatomy of a Medical Research Article Most are research articles are structured similarly Abstract – summary of the article Methods – the heart of the matter Results – crunching the numbers Conclusion/Recommendations – the wrap-up Let’s go deeper…

40. Abstract What are the objectives in performing the research study to begin with? What are the research questions being asked? Who’s paying for the research? Might there be a bias from the get-go?

41. Methods How was the study designed? What type of study was performed Top three are: randomized clinical trials, longitudinal or cohort studies, and case control studies – all have comparison to a control group How was the study population sampled?

42. Results Three key concerns Is it real or did it happen by chance? Statistical significance – look for the “p-value” – it should be less than .05 Is it big enough to be important? Relative risk vs. absolute risk

43. Results Three key concerns 3.Does is apply to me? Is it relevant? Is the study generalizable? If the subjects were male college students, will it apply to middle-aged women? If animal study – wait and see!

44. Conclusion Do you agree with the conclusions the authors make? Does the study have bearings on your own circumstances? When in doubt, consult a health professional!

45. Health Literacy and CAM • All this boils down to health literacy: • The degree to which individuals have the capacity to: • Obtain • Process • Understand • basic health information and services needed to make appropriate health decisions. • Healthy People 2010

46. 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.

47. Clinical Trials and CAM • Why are there so few CAM clinical trials? • 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

48. Exercises

49. Thank You! National Network of Libraries of Medicine Pacific Northwest Region 800-338-7657 Gail Kouame gmarie@u.washington.edu 206-221-3449