Complementary and alternative medicine and the NIH

Managing dermatology patients who prefer "all natural" treatments

Dermatology patients are expressing a growing interest in complementary and alternative medicine (CAM) and natural treatment options for management of dermatologic conditions. Counseling on the optimal integration of CAM with conventional therapeutic approaches can be daunting for practitioners who do not feel well-versed in these modalities. A productive conversation between the clinician and patient seeking natural treatments should address the appropriate role and scope of CAM in a therapeutic plan, which is best suited for use as maintenance therapy or to augment traditional pharmaceutical or procedural interventions. Understanding the patient's goals, discussing evidence-based conventional and complementary treatment options, and employing shared decision making can enhance the clinical encounter and strengthen the physician-patient relationship.

Prolonged endoplasmic reticulum stress induces apoptotic cell death in an experimental model of chronic cyclosporine nephropathy

BACKGROUND/AIMS

Apoptosis contributes to cyclosporine (CsA)-induced renal cell death. This study tested the effects of CsA-induced endoplasmic reticulum (ER) stress on apoptotic cell death in an experimental model of chronic CsA nephropathy.

METHODS

CsA (15 mg/kg per day) was given to rats for 7 or 28 days. The ER stress response was evaluated with BiP expression, and the proapoptotic response was assessed with CHOP and caspase 12 expression. ER structure was evaluated by transmission electron microscopy, and apoptotic cell death was detected with TUNEL staining.

RESULTS

Short-term treatment of CsA for 7 days activated both the ER stress response (induction of BiP mRNA and protein) and the proapoptotic response (upregulation of caspase 12 and CHOP mRNAs and proteins). However, long-term treatment with CsA for 28 days decreased BiP and further increased CHOP. The imbalance between the two responses coincided with the timing of the appearance of apoptotic cell death and the disruption of the ER structure.

CONCLUSION

Prolonged CsA-induced ER stress causes apoptotic cell death by depleting molecular chaperones and activating the proapoptotic pathway.

Complementary therapy for psoriasis

The authors provide some specifications regarding the correct terminology to be applied in the field of complementary medicine, and review and comment on several complementary treatments for psoriasis. Putative psychotherapeutic equivalents are kept distinct from treatments based on the surreptitious administration of physical or pharmacologic agents. Limits on the application of psychotherapeutic techniques are discussed. Risks inherent to complementary treatments (psychological derangements, moral subjugation, physical damage, economic exploitation) are underscored. The authors plead for the application of adequate scientific criticism in complementary medicine, but warn that any approach to the practice of medicine which is not disinterested and patient oriented--as the academic one should be--will be inappropriate, misleading, or even immoral. In the authors' opinion, this could also apply to the evidence-based medicine movement (often perceived as the archenemy of alternative medicine), should this movement be influenced by economical, political, or other nonmedical factors.

Alternative therapy in pruritus

Because of its multitude of origins, the symptom complex of pruritus has a plethora of purported remedies and few therapeutic indications. Very few topical and systemic FDA approved medications have the indication of pruritus. Specific therapy still awaits a better definition of the exact physiologic events in chronic pruritus. Hence most medications actually focus on the central nervous system--the peripheral receptors--and the lack of specific physiologic targets has inhibited pharmacologic development. The resulting gap has opened the door to a variety of alternative therapies.