Medical Decision Making in Integrative Medicine: Safety, Efficacy, and Patient Preference

A Case Study of the Neti Pot's Rise, Americanization, and Rupture as Integrative Medicine in U.S. Media Discourse

In a period of only one decade in the United States, the neti pot shifted from obscure Ayurvedic health device to mainstream complementary and integrative medicine (CIM), touted by celebrities and sold widely in drug stores. We examine the neti pot as a case study for understanding how a foreign health practice became mainstreamed, and what that process reveals about more general discourses of health in the United States. Using discourse analysis of U.S. popular press and new media news (1999-2012) about the neti pot, we trace the development of discourses from neti's first introduction in mainstream news, through the hype following Dr. Oz's presentation on Oprah, to 2011 when two adults tragically died after using Naegleria fowleri amoeba-infested tap water in their neti pots. Neti pot discourses are an important site for communicative analysis because of the pot's complexity as an intercultural artifact: Neti pots and their use are enfolded into the biomedical practice of nasal irrigation and simultaneously Orientalized as exotic/magical and suspect/dangerous. This dual positioning as normal and exotic creates inequitable access for using the neti pot as a resource for increasing cultural health capital (CHC). This article contributes to work that critically theorizes the transnationalism of CIM, as the neti pot became successfully Americanized. These results have implications for understanding global health practices' incorporation or co-optation in new contexts, and the important role that popularly mediated health communication can play in framing what health care products and practices mean for consumers.

Testing of a Statewide Initiative to Enhance Depression Care in Older Home Care Patients

Late-life depression is becoming increasingly prevalent among older adults in the United States and is predictive of a wide range of negative health-related outcomes. Fourteen home care agencies participated in a quasi-experimental, pre-test, post-test design of a depression screening training program nested within a two-cycle, phased introduction of the intervention. The primary aim of this study was to evaluate the effects of the program at three levels of outcomes: the trainers, the trainees, and the agencies. There was a significant increase in the knowledge and self-efficacy of the trainers and trainees and a trend toward decreased hospitalization.

Exploration of Why Alaskans Use Complementary Medicine: A Focus Group Study

PURPOSE

To explore why Alaskans choose to pursue complementary medicine as a health care option.

DESIGN

Qualitative descriptive.

METHOD

A purposive convenient recruitment methodology was used to recruit project participants. Focus groups were conducted to collect the research data.

FINDINGS

Five themes were identified that highlighted why participants use complementary medicine: dissatisfaction, effective, holistic, relationship focused, and a personal journey.

Shared decision making in complementary and alternative medicine therapies

OBJECTIVE

This paper provides a structured approach for pediatricians responding to requests from patients and their families about the complementary medicine treatment options.

METHODS

Using a case-based narrative review approach, the authors outline practical strategies for addressing conflict, uncertainty, and challenges in explaining alternative health paradigms in routine pediatric care. Reflections are drawn from the clinical experience of the authors, the literature, and recent high-profile cases in the United States.

RESULTS

The discussion of common case-based scenarios illustrates a general guide for approaching conversations about complementary medicine in the care of the pediatric patient that is responsive to evidence and informed by patient and family values.

CONCLUSIONS

The principles of shared decision making can guide constructive conversations in this area in an effort to facilitate improved satisfaction for patient, family, and provider.

PRACTICE IMPLICATIONS

Discussions of complementary and alternative medicine in pediatrics pose a specific challenge with regard to patient and/or family preferences and the duty of the provider to advocate for the safety of the child. The proposed structured approach is useful in navigating these important conversations.

Conventional medical attitudes to using a traditional medicine vodou-based model of pain management: survey of French dentists and the proposal of a pain model to facilitate integration

OBJECTIVES

The purposes of this study were to develop a pain management model using traditional medicine (TM) vodou healing methods; to survey a sample of French dentists to rate components of conventional and proposed TM vodou-based pain management model; and to assess the possibility of conventional, allopathic providers to integrate TM or complementary and alternative medicine concepts.

METHODS

From a set of 30 fact sheets collected from TM African healers (vodou healers), main clinical concepts and terminology were extracted. Twenty vodou-based pain management concepts were collected from an interview with a TM vodou practitioner. From this information, a 7-step vodou-based pain management model was created. A sample of 40 French dentists from Nantes, France, whose practices focused on the clinical treatment of dental pain, was surveyed to assess the importance of both TM (vodou) and conventional biomedical components.

RESULTS

Seventy percent of the dentists sampled rated the rational components of the TM model as "very important" or "important" for pain treatment, whereas 2 other traditional concepts were considered to be "supernatural" or beyond understanding.

CONCLUSION

This study showed that traditional healers used conventional concepts and conventional practitioners could use traditional concepts. This suggests that conventional allopathic medical providers have the capacity to integrate biomedical concepts and other therapeutic and explanatory models. This information may be helpful to understand and improve risk management by anticipating and preventing potential reasons for failure in TM integration strategies and to enhance communication between patients, healers, and physicians to optimize TM or complementary and alternative medicine integration.

Geographic variations in availability and use of chiropractic under medicare

OBJECTIVE

The purpose of this study was to measure geographic variations in the availability and use of chiropractic under Medicare.

METHODS

A cross-sectional design was used to analyze a large nationally representative sample of Medicare data. Data from a 20% representative sample of all paid Medicare Part B fee-for-service claims for 2007 were merged with files containing beneficiary and provider data. The sample was restricted to adults aged 65 to 99 years. Measures of chiropractic availability and use were described and selectively mapped by state. Geographic variations were quantified. Spearman test was used to evaluate for correlation between chiropractic availability and use.

RESULTS

The average number of doctors of chiropractic (DC) by state was 1135; average DC per 1000 beneficiaries was 2.5 (SD, 1.1). The average number of chiropractic users by state was 34,502 (SD, 30,844); average chiropractic users per 1000 beneficiaries was 76 (SD, 41). Chiropractic availability by state varied 6-fold, and chiropractic use varied nearly 30-fold. Availability was strongly correlated with use (Spearman ρ, 0.86; P < .001). Expenditures per DC were highest in the upper Midwest and lowest in the far West; expenditures per user were highest in New England and New York, and lowest in the West.

CONCLUSION

Chiropractic availability and use by older adults under Medicare predominated in rural states in the North Central United States. Expenditures were higher in the East and Midwest and lower in the far West. Chiropractic availability and use by state were highly correlated. Future analyses should use small-area analysis and statistical modeling to identify factors predictive of chiropractic use.

Spinal manipulation for headaches: will better quality trials do the trick?

Treatment for cervicogenic headache (CGH) can be challenging and is not always effective. Many patients turn to manipulative therapies, but what is the evidence this form of treatment works? Posadzki and Ernst performed a systematic review of trials of spinal manipulation for the treatment of CGH, which is published in this issue of Headache. The studies they located did not use clear or standard definitions for CGH or the manipulative interventions. The authors conclude that the evidence for spinal manipulative therapies for CGH is weak and more research is needed. This is particularly important because of rare but serious risks associated with this treatment option.