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

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

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

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

4. 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

5. 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

6. 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

7. 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)

8. 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

9. 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

10. 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

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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

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

21. 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

22. Evaluating Web Sites • Accuracy • Authority • Bias • Currency • Coverage

23. 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

24. 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

25. 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

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