Kare about Health

On Monday, November 2, 2009 the Arizona Daily Star published an article, “Alternative-healing instruction in medical schools is questioned.” Right up front before the article, the following was seen: EDITOR’S NOTE: Ten years and $2.5 billion in research have found no cures from alternative medicine. Yet these mostly unproven treatments are now mainstream and used by more than a third of all Americans. This is one part of an occasional Associated Press series on their use and potential risks.

I was perplexed to say the least, since I have done medical writing and have been involved with some alternative therapy research that was shown to be highly effective.

Then, the next day an article “More insurers are covering alternative healing, at a cost,” with the same editor’s note staring you in the face before you read the article.

I am currently with no institutional backing to be able to do thorough research into recent clinical trials, but I was able to spend a few hours and find many clinical research journal articles that showed alternative therapies to be statistically significantly effective over either controls or conventional therapy. What bothers me is the technicality in that editor’s note about finding “cures.” That editor’s note has been worded to be manipulative through sensationalism. It shows obvious bias (which is why it is an editor’s note, I suppose) and is expressing that bias before the reader even gets a chance to read the article. You will not find a lot of “cures” in conventional medicine clinical trials either! Taking Lipitor for high cholesterol does not “cure” high cholesterol. Taking blood pressure meds does not “cure” hypertension.

So what predicts who will use alternative therapy? NCCAM (National Center for Complementary and Alternative Medicine – see below) found that predictors were: more education, poorer health, holistic orientation to health, had a transformational experience that changed their worldview, or classification in a cultural group identifiable by their commitment to environmentalism, feminisim, and interest in spirituality and personal growth psychology. Hmmm… now that’s a mouthful! A person is also more likely to seek alternative therapies for back problems, chronic pain and urinary tract problems. Interesting.

The bottom line is consumers are demanding alternatives to conventional medicine. In their annual survey, the NCCAM found that a full 38% of American adults used some form of alternative medicine in 2007. And it seems to be growing. Is is possible that we are not getting satisfactory results from conventional therapies and are searching for answers?

Alternative therapies like acupuncture are being used more and more.

Ten years ago the National Center for Complementary and Alternative Medicine (NCCAM) was established. The National Center for Complementary and Alternative Medicine’s mission is to explore complementary and alternative medical practices in the context of rigorous science, train CAM researchers, and disseminate authoritative information to the public and professionals. It is housed by the National Institutes of Health (NIH)—The Nation’s Medical Research Agency—which includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical, and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases.

It made merging alternative and mainstream medicine “a central and overarching goal” and gave $22.5 million to 12 medical schools, two nursing schools and the American Medical Student Association to develop curriculum plans.

“Consumers are demanding it,” and more research is needed to see what works, said Mary Jo Kreitzer, who directs the Minnesota school’s alternative-medicine curriculum. “Ultimately, we need to align policy” so that insurers pay for these therapies, she said.

“Complementary and alternative medicine (CAM), more recently known as integrative health or integrative medicine, is a diverse field comprising numerous treatments and practitioners of various levels of training. This review defines several of the main CAM modalities and reviews some of the research relevant to their clinical application. The goal is to provide healthcare providers with a basic understanding of CAM to start the incorporation of proven treatments into their clinical practice as well as guide them to working with CAM providers; ultimately, such knowledge is a fundamental part of a collaborative approach to optimal patient health and wellness.”

How anyone can say that medical doctors and nurses should not be made aware of CAM, is ludicrous. The last I read, knowledge is defined as acquaintance with facts, truths, or principles, as from study or investigation; the body of truths or facts accumulated in the course of time.  The number of visits per year of Americans to practitioners of CAM has risen to over 600 million in 2007. That exceeds the total visits to all US primary care physicians!  I sure want my doctor to know what other options are out there for me when he or she is unable to help me. Or just to know what other therapies may actually be better for my particular ailment.

Basically, there is no “alternative medicine.” There is scientifically proven, evidence-based medicine and there is unproven medicine for which scientific evidence may be lacking. Whether a therapeutic practice is traditional or unconventional is irrelevant (except for cultural interest). There are vast differences in skills, knowledge and capabilities of both “Western” practitioners and “alternative” practitioners. Bottom line is that we need to focus on the fundamental issues here — namely the patient and the target disease or condition — and what is the best way to restore health. Let’s not forget preventative medicine, which is a much larger component to health care than conventional medicine allows. CAM seems to address prevention on a much larger scale if practiced appropriately.

Please do not shout out that there have been no “cures” found even after 10 years and billions of dollars spent. Find the facts and present them scientifically. Let us make up our own minds as to whether we deem them worth trying or not. And please don’t limit the education of our doctors and nurses who are struggling within this health care “system” we are currently dealing with as much as we are.

Dear Editor,

Here are just a few studies I found in a quick search of the literature. They are all well-designed studies appearing in peer-reviewed journals. Some show statistically significant effectiveness, some do not. This is the kind of solid research that is needed to differentiate between what is evidence-based good medicine and what is not. The evidence is mounting.

1. Meta-analysis: acupuncture for low back pain.  Ann Intern Med. 2005 Apr 19;142(8):651-63.

The 33 randomized, controlled trials that met inclusion criteria were subgrouped according to acute or chronic pain, style of acupuncture, and type of control group used. CONCLUSIONS: Acupuncture effectively relieves chronic low back pain. No evidence suggests that acupuncture is more effective than other active therapies.

2. A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Chronic Low Back Pain. Archives of Internal Medicine. 2009;169[9]:858–866.

People suffering from chronic low back pain who received acupuncture or simulated acupuncture treatments fared better than those receiving only conventional care according to a recent study published in the Archives of Internal Medicine. The study highlights central questions about the mechanisms of benefit seen in acupuncture studies.

3. Meta-analysis on acupuncture for treatment of depression in patients of poststroke

CONCLUSION: The therapeutic effect of acupuncture for treatment of the depression in patients of poststroke is superior to other common medicine with safety, but it still needs more large sample RCTs to verify.

4. Acupuncture provides pain relief and improves function for people with osteoarthritis of the knee and serves as an effective complement to standard care. This landmark study was funded by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), both components of the National Institutes of Health. The findings of the study—the longest and largest randomized, controlled phase III clinical trial of acupuncture ever conducted—were published in the December 21, 2004, issue of the Annals of Internal Medicine.

5. NCCAM-funded researchers recently analyzed the use of prescription drugs and dietary supplements in a sample of 3,070 people aged 75 and older. Nearly 75 percent of the GEM study participants took at least one prescription drug and one dietary supplement. Approximately 33 percent used three or more prescription drugs and three or more supplements. Furthermore, 10 percent of the participants combined five or more prescription drugs with five or more dietary supplements. If this is happening, isnt it better for our doctors to know what the ramifications are?

The dietary supplement Ginkgo biloba was found to be ineffective in reducing the development of dementia and Alzheimer’s disease in older people, according to a study published in the Journal of the American Medical Association

Also, the use of St. John’s Wort for depression was not found to be any more effective than placebo.

But the use of Red Yeast Rice was found to be effective for lowering bad cholesterol (LDLs) in the blood compared to a placebo.

Studies have been completed, but no results posted yet from NCCAM, for the use of laser light therapy for various disorders. Light energy therapies have been in practice for decades and much research has been published especially in the last 10 years or so. I look forward to the NCCAM’s clinical trial results so that this important adjunct therapy may become more recognized.

For additional information, call NCCAM’s Clearinghouse toll free at 1-888-644-6226, or visit the NCCAM Web site at nccam.nih.gov. NCCAM 1999–2009: Celebrating 10 years of rigorous research.