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Tesio L, Scarano S, Caronni A. Physical and Rehabilitation Medicine: say relational or functional, not holistic. Eur J Phys Rehabil Med 2024; 60:182-189. [PMID: 38483334 DOI: 10.23736/s1973-9087.24.08309-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Modern medicine tends to privilege disciplines promising "objective" laws governing body parts (from molecules to organs). Studies on a person's illness and disability are (apparently) confined to "subjectivity." The Specialty of Physical and Rehabilitation Medicine is often regarded as a humanitarian approach, belonging at best to the family of "soft," "qualitative," or "quasi-experimental" sciences. This specialty often claims specificity by labelling itself as "functional" and "holistic." However, it is shown here that the former term is acceptable, yet redundant, and the second misleading. When human behaviors and perceptions are at stake, "function" indicates a person's relationship with the outer world (already tackled by the definitional term "physical" from the Greek "physis"). The word "holistic" emphasizes mind-body unity and person-environment interdependence but, in current usage, overshadows the complementary need for an analytic, experimental approach to any function. Medicine aims at fighting disease and disability in single persons. This endeavor requires knowing body parts and mechanisms and understanding how interventions on "parts" affect the "whole." This understanding rests on the experimental method. For instance, returning to a given societal role (participation) may require restoration of walking (activity), which may require reinforcement of weakened muscular groups (impairment). Working only on holistic bio-psycho-social "wholes" may miss the therapeutic mission of medicine.
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Affiliation(s)
- Luigi Tesio
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Stefano Scarano
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy -
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Antonio Caronni
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Tesio L, Buzzoni M. The illness-disease dichotomy and the biological-clinical splitting of medicine. MEDICAL HUMANITIES 2021; 47:507-512. [PMID: 32994200 PMCID: PMC8639948 DOI: 10.1136/medhum-2020-011873] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/22/2020] [Indexed: 05/04/2023]
Abstract
In a recent paper, Sharpe and Greco (2019) argue that some clinical conditions, such as chronic fatigue syndrome (sometimes called myalgic encephalomyelitis), should be treated by altering the patient's experience and response to symptoms without necessarily searching for an underlying cause. As a result, we should allow for the existence of 'illnesses without (underlying) diseases'. Wilshire and Ward (2019) reply that this possibility requires unwarranted causal assumptions about the psychosocial origins of conditions not predicted by a disease model. In so doing, it is argued that Sharpe and Greco introduce epistemological and methodological problems with serious medical consequences, for example, patients feel guilt for seeking treatment for illnesses that only exist 'all in the mind', and medical researchers are discouraged from looking for more effective treatments of such conditions. We propose a view that integrates the insights of both papers. We abandon both the strict distinction between disease and illness and the naïve unidirectional account of causality that accompanies it. This, we claim, is a step towards overcoming the current harmful tendencies to conceptually separate (1) Symptom management and disease-modifying treatments. (2) Rehabilitative-palliative care and 'causal' curing. (3) Most importantly, biomedicine and clinical medicine, where the latter is currently at risk of losing its status as scientific.
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Affiliation(s)
- Luigi Tesio
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
- Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, Milano, Italy
| | - Marco Buzzoni
- Dipartimento di Studi Umanistici, Università degli Studi di Macerata, Macerata, Italy
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The Challenges of Ethical Review in Clinical Research of Traditional Chinese Medicine. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:6754985. [PMID: 34804184 PMCID: PMC8604572 DOI: 10.1155/2021/6754985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/27/2021] [Indexed: 11/18/2022]
Abstract
The ethical review of TCM (traditional Chinese medicine) clinical research in China is highly consistent with that of Western medicine, but it lacks the characteristics and culture of TCM. Compared with modern medicine, TCM has its own characteristics, such as the theory of Yin-Yang and the five elements, the treatment of syndrome differentiation, and the compatibility of prescriptions. These characteristics determine the ethical particularity of TCM clinical research. This article discusses the challenges in the ethical review of TCM clinical research, such as scientific design, efficacy evaluation, risk assessment, informed consent, and placebo use. We propose opportunities and difficulties in the ethical review of TCM clinical research and provide some relevant suggestions.
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He H, Li H, Zeng X, Zhao H, Zhang Y. Development and validation of a patient-reported outcome measure for patients with chronic respiratory failure: The CRF-PROM scale. Health Expect 2021; 24:1842-1858. [PMID: 34337839 PMCID: PMC8483203 DOI: 10.1111/hex.13324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/05/2021] [Accepted: 07/18/2021] [Indexed: 12/01/2022] Open
Abstract
Background Various health‐related quality‐of‐life (HRQOL) tools are used to evaluate patients with chronic respiratory failure (CRF), but there is a relative lack of tools available for the evaluation of social support and treatment in these patients. The present study focused on the development of a systematic patient‐reported outcome measure (PROM) tool for use in patients with CRF. Methods The CRF‐PROM scale conceptual framework and item bank were generated after reviewing the corresponding literature and HRQOL scales, interviewing CRF patients and focus groups. After creation of the initial scale, the items in the scale were selected through two item selection theories, and the final scale was created. The reliability, validity and feasibility of the final scale were assessed. Results The CRF‐PROM scale includes four domains (i.e., physiological domain, psychological domain, social domain and therapeutic domain) and 10 dimensions. After the item selection process, the final scale included 50 items. Cronbach's α coefficients, which were all above 0.7, indicated the reliability of the scale. The results of structural validity met the relevant standards of confirmatory factor analysis. The response rates of the preinvestigation and the formal investigation were 93.3% and 97.6%, respectively. Conclusions The CRF‐PROM scale developed in the present study is effective and reliable. It could be used widely in the posthospital management of patients, in CRF studies and in clinical trials of new medical products and interventions. Patient or Public Contribution Participants from eight different hospitals and communities participated in the development or validation phase of the CRF‐PROM scale.
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Affiliation(s)
- Hangzhi He
- Department of Health Statistics, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Hao Li
- Department of Health Statistics, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Xianhua Zeng
- Department of Health Statistics, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Hui Zhao
- Respiratory Medicine, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Yanbo Zhang
- Department of Health Statistics, Shanxi Medical University, Taiyuan, Shanxi Province, China
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Arnica montana and Bellis perennis for seroma reduction following mastectomy and immediate breast reconstruction: randomized, double-blind, placebo- controlled trial. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-019-01618-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Ijaz N, Rioux J, Elder C, Weeks J. Whole Systems Research Methods in Health Care: A Scoping Review. J Altern Complement Med 2019; 25:S21-S51. [PMID: 30870019 PMCID: PMC6447996 DOI: 10.1089/acm.2018.0499] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objectives: This scoping review evaluates two decades of methodological advances made by “whole systems research” (WSR) pioneers in the fields of traditional, complementary, and integrative medicine (TCIM). Rooted in critiques of the classical randomized controlled trial (RCT)'s suitability for evaluating holistic, complex TCIM interventions, WSR centralizes the principle of “model validity,” representing a “fit” between research design and therapeutic paradigm. Design: In consultation with field experts, 41 clinical research exemplars were selected for review from across 13 TCIM disciplines, with the aim of mapping the range and methodological characteristics of WSR studies. Using an analytic charting approach, these studies' primary and secondary features are characterized with reference to three focal areas: research method, intervention design, and outcome assessment. Results: The reviewed WSR exemplars investigate a wide range of multimodal and multicomponent TCIM interventions, typified by wellness-geared, multitarget, and multimorbid therapeutic aims. Most studies include a behavioral focus, at times in multidisciplinary or team-based contexts. Treatments are variously individualized, often with reference to “dual” (biomedical and paradigm-specific) diagnoses. Prospective and retrospective study designs substantially reflect established biomedical research methods. Pragmatic, randomized, open label comparative effectiveness designs with “usual care” comparators are most widely used, at times with factorial treatment arms. Only two studies adopt a double-blind, placebo-controlled RCT format. Some cohort-based controlled trials engage nonrandomized allocation strategies (e.g., matched controls, preference-based assignment, and minimization); other key designs include single-cohort pre–post studies, modified n-of-1 series, case series, case report, and ethnography. Mixed methods designs (i.e., qualitative research and economic evaluations) are evident in about one-third of exemplars. Primary and secondary outcomes are predominantly assessed, at multiple intervals, through patient-reported measures for symptom severity, quality of life/wellness, and/or treatment satisfaction; some studies concurrently evaluate objective outcomes. Conclusions: Aligned with trends emphasizing “fit-for-purpose” research designs to study the “real-world” effectiveness of complex, personalized clinical interventions, WSR has emerged as a maturing scholarly discipline. The field is distinguished by its patient-centered salutogenic focus and engagement with nonbiomedical diagnostic and treatment frameworks. The rigorous pursuit of model validity may be further advanced by emphasizing complex analytic models, paradigm-specific outcome assessment, inter-rater reliability, and ethnographically informed designs. Policy makers and funders seeking to support best practices in TCIM research may refer to this review as a key resource.
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Affiliation(s)
- Nadine Ijaz
- 1 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | | | - Charles Elder
- 3 Kaiser Permanente Center for Health Research, Portland, OR
| | - John Weeks
- 4 johnweeks-integrator.com, Editor-in-Chief, JACM, Seattle, WA
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Tesio L. 6.3B Scientific background of physical and rehabilitation medicine: Specificity of a clinical science. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2019. [DOI: 10.4103/jisprm.jisprm_27_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Acupuncture on the Stress-Related Drug Relapse to Seeking. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:5367864. [PMID: 30416533 PMCID: PMC6207895 DOI: 10.1155/2018/5367864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 01/30/2018] [Accepted: 07/19/2018] [Indexed: 11/23/2022]
Abstract
Drug addiction is a chronic relapsing disease, which causes serious social and economic problems. The most important trial for the successful treatment of drug addiction is to prevent the high rate of relapse to drug-seeking behaviors. Opponent process as a motivational theory with excessive drug seeking in the negative reinforcement of drug dependence reflects both loss of brain reward system and recruitment of brain stress system. The negative emotional state produced by brain stress system during drug withdrawal might contribute to the intense drug craving and drive drug-seeking behaviors via negative reinforcement mechanisms. Decrease in dopamine neurotransmission in the nucleus accumbens and recruitment of corticotropin-releasing factor in the extended amygdala are hypothesized to be implicated in mediating this motivated behavior. Also, a brain stress response system is hypothesized to increase drug craving and contribute to relapse to drug-seeking behavior during the preoccupation and anticipation stage of dependence caused by the exposure to stress characterized as the nonspecific responses to any demands on the body. Acupuncture has proven to be effective for reducing drug addiction and stress-related psychiatric disorders, such as anxiety and depression. Furthermore, acupuncture has been shown to correct reversible brain malfunctions by regulating drug addiction and stress-related neurotransmitters. Accordingly, it seems reasonable to propose that acupuncture attenuates relapse to drug-seeking behavior through inhibition of stress response. In this review, a brief description of stress in relapse to drug-seeking behavior and the effects of acupuncture were presented.
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Evaluating integrative medicine acute stroke inpatient care in South Korea. Health Policy 2018; 122:373-379. [DOI: 10.1016/j.healthpol.2018.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/29/2017] [Accepted: 02/10/2018] [Indexed: 11/22/2022]
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Fischer HF, Junne F, Witt C, von Ammon K, Cardini F, Fønnebø V, Johannessen H, Lewith G, Uehleke B, Weidenhammer W, Brinkhaus B. Key issues in clinical and epidemiological research in complementary and alternative medicine--a systematic literature review. ACTA ACUST UNITED AC 2014; 19 Suppl 2:51-60. [PMID: 23883945 DOI: 10.1159/000343126] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In the last 2 decades there has been a large increase in publications on complementary and alternative medicine (CAM). However, CAM research methodology was heterogeneous and often of low quality. The aim of this systematic review was to investigate scientific publications with regards to general issues, concepts and strategies. We also looked at research priorities and methods employed to evaluate the clinical and epidemiological research of CAM in the past to identify the basis for consensus-based research strategies. METHODS We performed a systematic literature search for papers published between 1990 and 2010 in 7 electronic databases (Medline, Web of Science, PsychArticles, PsycInfo, CINAHL, EMBASE and Cochrane Library) on December 16 and 17, 2010. In addition, experts were asked to nominate relevant papers. Inclusion criteria were publications dealing with research methodology, priorities or complexities in the scientific evaluation of CAM. All references were assessed in a multistage process to identify relevant papers. RESULTS From the 3,279 references derived from the search and 98 references contributed by CAM experts, 170 papers fulfilled the criteria and were included in the analysis. The following key issues were identified: difficulties in past CAM research (e.g., randomisation, blinding), utility of quantitative and qualitative research methods in CAM, priority setting in CAM research and specific issues regarding various CAM modalities. CONCLUSIONS Most authors vote for the use of commonly accepted research methods to evaluate CAM. There was broad consensus that a mixed methods approach is the most suitable for gathering conclusive knowledge about CAM.
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Affiliation(s)
- H Felix Fischer
- Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin, Germany.
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Herman PM, Dodds SE, Logue MD, Abraham I, Rehfeld RA, Grizzle AJ, Urbine TF, Horwitz R, Crocker RL, Maizes VH. IMPACT--Integrative Medicine PrimAry Care Trial: protocol for a comparative effectiveness study of the clinical and cost outcomes of an integrative primary care clinic model. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 14:132. [PMID: 24708726 PMCID: PMC3984431 DOI: 10.1186/1472-6882-14-132] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 03/31/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Integrative medicine (IM) is a patient-centered, healing-oriented clinical paradigm that explicitly includes all appropriate therapeutic approaches whether they originate in conventional or complementary medicine (CM). While there is some evidence for the clinical and cost-effectiveness of IM practice models, the existing evidence base for IM depends largely on studies of individual CM therapies. This may in part be due to the methodological challenges inherent in evaluating a complex intervention (i.e., many interacting components applied flexibly and with tailoring) such as IM. METHODS/DESIGN This study will use a combination of observational quantitative and qualitative methods to rigorously measure the health and healthcare utilization outcomes of the University of Arizona Integrative Health Center (UAIHC), an IM adult primary care clinic in Phoenix, Arizona. There are four groups of study participants. The primary group consists of clinic patients for whom clinical and cost outcomes will be tracked indicating the impact of the UAIHC clinic (n = 500). In addition to comparing outcomes pre/post clinic enrollment, where possible, these outcomes will be compared to those of two matched control groups, and for some self-report measures, to regional and national data. The second and third study groups consist of clinic patients (n = 180) and clinic personnel (n = 15-20) from whom fidelity data (i.e., data indicating the extent to which the IM practice model was implemented as planned) will be collected. These data will be analyzed to determine the exact nature of the intervention as implemented and to provide covariates to the outcomes analyses as the clinic evolves. The fourth group is made up of patients (n = 8) whose path through the clinic will be studied in detail using qualitative (periodic semi-structured interviews) methods. These data will be used to develop hypotheses regarding how the clinic works. DISCUSSION The US health care system needs new models of care that are more patient-centered and empower patients to make positive lifestyle changes. These models have the potential to reduce the burden of chronic disease, lower the cost of healthcare, and offer a sustainable financial paradigm for our nation. This protocol has been designed to test whether the UAIHC can achieve this potential. TRIAL REGISTRATION Clinical Trials.gov NCT01785485.
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Affiliation(s)
| | - Sally E Dodds
- Arizona Center for Integrative Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Melanie D Logue
- University of Arizona College of Nursing, Tucson, AZ, USA
- Center for Health Outcomes & PharmacoEconomic Research (HOPE), University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Ivo Abraham
- Center for Health Outcomes & PharmacoEconomic Research (HOPE), University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Rick A Rehfeld
- Center for Health Outcomes & PharmacoEconomic Research (HOPE), University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Amy J Grizzle
- Center for Health Outcomes & PharmacoEconomic Research (HOPE), University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Terry F Urbine
- Center for Health Outcomes & PharmacoEconomic Research (HOPE), University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Randy Horwitz
- Arizona Center for Integrative Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Robert L Crocker
- Arizona Center for Integrative Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Victoria H Maizes
- Arizona Center for Integrative Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
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Jiang L, Liu B, Xie Q, Yang S, He L, Zhang R, Yan S, Zhou X, Liu J. Investigation into the influence of physician for treatment based on syndrome differentiation. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2013; 2013:587234. [PMID: 24288563 PMCID: PMC3830859 DOI: 10.1155/2013/587234] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 08/02/2013] [Accepted: 08/14/2013] [Indexed: 01/22/2023]
Abstract
Background. The characteristics of treatment based on syndrome differentiation (TBSD) cause great challenges to evaluate the effectiveness of the clinical methods. Objectives. This paper aims to evaluate the influence of physician to personalized medicine in the process of TBSD. Methods. We performed a randomized, triple-blind trial involving patients of primary insomnia treated by 3 physicians individually and independently. The patients (n = 30) were randomly assigned to receive treatments by the 3 physicians for every visit. However, they always received the treatment, respectively, prescribed by the physician at the first visit. The primary outcome was evaluated, respectively, by the Pittsburgh Sleep Quality Index (PSQI) and the TCM symptoms measuring scale. The clinical practices of the physicians were recorded at every visit including diagnostic information, syndrome differentiation, treating principles, and prescriptions. Results. All patients in the 3 groups (30 patients) showed significant improvements (>66%) according to the PSQI and TCM symptoms measuring scale. Conclusion. The results indicate that although with comparable effectiveness, there exist significant differences in syndrome differentiation, the treating principles, and the prescriptions of the approaches used by the 3 physicians. This means that the physician should be considered as an important factor for individualized medicine and the related TCM clinical research.
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Affiliation(s)
- Lijie Jiang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, No. 16 NanXiaoJie, DongZhiMenNei, Dong Cheng District, Beijing 100700, China
| | - Baoyan Liu
- China Academy of Chinese Medical Sciences, No. 16 NanXiaoJie, DongZhiMenNei, Dong Cheng District, Beijing 100700, China
| | - Qi Xie
- China Academy of Chinese Medical Sciences, No. 16 NanXiaoJie, DongZhiMenNei, Dong Cheng District, Beijing 100700, China
| | - Shuhong Yang
- Community Health Management Center of Dong Cheng District, No. 2 He Ping Li Dong Jie & Jiao Lin Jia Dao Jia, Dong Cheng District, Beijing 100013, China
| | - Liyun He
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, No. 16 NanXiaoJie, DongZhiMenNei, Dong Cheng District, Beijing 100700, China
| | - Runshun Zhang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5 BeiXianGe, GuangAnMenNei, XiCheng District, Beijing 100053, China
| | - Shiyan Yan
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, No. 16 NanXiaoJie, DongZhiMenNei, Dong Cheng District, Beijing 100700, China
| | - Xuezhong Zhou
- School of Computer and Information Technology, Beijing Jiaotong University, No. 3 Shangyuancun, HaiDian District, Beijing 100044, China
| | - Jia Liu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, No. 16 NanXiaoJie, DongZhiMenNei, Dong Cheng District, Beijing 100700, China
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Ferraresi M, Clari R, Moro I, Banino E, Boero E, Crosio A, Dayne R, Rosset L, Scarpa A, Serra E, Surace A, Testore A, Colombi N, Piccoli BG. Reiki and related therapies in the dialysis ward: an evidence-based and ethical discussion to debate if these complementary and alternative medicines are welcomed or banned. BMC Nephrol 2013; 14:129. [PMID: 23799960 PMCID: PMC3694469 DOI: 10.1186/1471-2369-14-129] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 06/03/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Complementary and Alternative Medicines (CAMs) are increasingly practiced in the general population; it is estimated that over 30% of patients with chronic diseases use CAMs on a regular basis. CAMs are also used in hospital settings, suggesting a growing interest in individualized therapies. One potential field of interest is pain, frequently reported by dialysis patients, and seldom sufficiently relieved by mainstream therapies. Gentle-touch therapies and Reiki (an energy based touch therapy) are widely used in the western population as pain relievers.By integrating evidence based approaches and providing ethical discussion, this debate discusses the pros and cons of CAMs in the dialysis ward, and whether such approaches should be welcomed or banned. DISCUSSION In spite of the wide use of CAMs in the general population, few studies deal with the pros and cons of an integration of mainstream medicine and CAMs in dialysis patients; one paper only regarded the use of Reiki and related practices. Widening the search to chronic pain, Reiki and related practices, 419 articles were found on Medline and 6 were selected (1 Cochrane review and 5 RCTs updating the Cochrane review). According to the EBM approach, Reiki allows a statistically significant but very low-grade pain reduction without specific side effects. Gentle-touch therapy and Reiki are thus good examples of approaches in which controversial efficacy has to be balanced against no known side effect, frequent free availability (volunteer non-profit associations) and easy integration with any other pharmacological or non pharmacological therapy. While a classical evidence-based approach, showing low-grade efficacy, is likely to lead to a negative attitude towards the use of Reiki in the dialysis ward, the ethical discussion, analyzing beneficium (efficacy) together with non maleficium (side effects), justice (cost, availability and integration with mainstream therapies) and autonomy (patients' choice) is likely to lead to a permissive-positive attitude. SUMMARY This paper debates the current evidence on Reiki and related techniques as pain-relievers in an ethical framework, and suggests that physicians may wish to consider efficacy but also side effects, contextualization (availability and costs) and patient's requests, according also to the suggestions of the Society for Integrative Oncology (tolerate, control efficacy and side effects).
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Affiliation(s)
- Martina Ferraresi
- SS Nephrology ASOU, san Luigi (regione Gonzole 10), Orbassano 10043, Torino, Italy.
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Patterson SM, Graf HM. Integrating Complementary and Alternative Medicine into the Health Education Curriculum. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/10556699.2000.10603442] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Sheila M. Patterson
- a Health and Interim associate Provost , West Chester University , 3 Philips Memorial Building, West Chester , PA , 19383 , USA
| | - Helen M. Graf
- b Department of Health & Kinesiology , Georgia Southern University , P.O. Box 8076, Statesboro , GA , 30460 , USA
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Jonas WB, Eisenberg D, Hufford D, Crawford C. The evolution of complementary and alternative medicine (CAM) in the USA over the last 20 years. ACTA ACUST UNITED AC 2013; 20:65-72. [PMID: 23727764 DOI: 10.1159/000348284] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Medical practices that reside outside the mainstream medical structures have existed for centuries, often waxing and waning in prominence and use for various reasons. Recently, there has been a resurgence in interest and use of such practices in the USA generally referred to under the label of 'complementary and alternative medicine' (CAM). In this article we summarize some of the highlight events that punctuated this resurgence over the last 20 years. As in the past, social forces affecting these trends circulate around power, resources, and scope of practice. However, a prominent feature of this dynamic is a discussion about the role of science and 'evidence-based medicine' in addressing pluralistic healthcare-related practices. In the early years of this period, attempts to formulate the place of CAM practices as they relate to epistemology, nonconventional assumptions about health and healing, and the complexity of understanding 'whole systems' were discussed and often examined. Less attention is being paid to those core assumptions in more recent times. The focus now seems to be on how CAM practices can be judiciously and effectively 'integrated' into mainstream medicine. Examples of how this dynamic is evolving are described.
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Wong W, Lam CLK, Fong DYT. Treatment effectiveness of two Chinese herbal medicine formulae in upper respiratory tract infections--a randomized double-blind placebo-controlled trial. Fam Pract 2012; 29:643-52. [PMID: 22490614 DOI: 10.1093/fampra/cms027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM AND OBJECTIVES To study the effect of two Chinese herbal medicines (CHMs) formulae in treating acute upper respiratory tract infections (URTIs), diagnosed by Traditional Chinese medicine (TCM), compared to placebo. DESIGN Two randomized, double-blind placebo-controlled trials nested in a study of 327 patients who were diagnosed with URTIs in Hong Kong. Subjects were classified into one of two TCM syndrome groups by a Chinese medicine practitioner and randomized to receive the corresponding CHM formulae or placebo up to maximum of 10 days. The proportions of patients who had resolution of illness on Days 4 and 7 were the primary outcomes. The duration of symptom resolution, health-related quality of life scores measured by the SF-36 and ChQOL, and adverse effects were secondary outcomes. RESULTS There was no statistically significant difference between the treatment and placebo in resolution rates at Day 4 or 7. The mean time of resolution of symptoms was Day 10, for either wind-cold or wind-heat syndrome. Both patients in treatment and placebo had significantly improved in health-related quality of life with time, but patients in wind-cold group had significantly more improvement in the SF-36 general health score (P = 0.01) than placebo. CONCLUSIONS Two CHM formulae commonly used for URTIs were not found to be more effective than placebo in either cure or reduction of symptoms of URTIs. However, Jing Fan Bai Du san might be able to improve general health more than placebo for patients with wind-cold syndrome. Both formulae were not associated with any more side effects.
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Affiliation(s)
- Wendy Wong
- Department of Family Medicine and Primary Care, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
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Ali A, Kahn J, Rosenberger L, Perlman AI. Development of a manualized protocol of massage therapy for clinical trials in osteoarthritis. Trials 2012; 13:185. [PMID: 23035641 PMCID: PMC3519579 DOI: 10.1186/1745-6215-13-185] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 09/27/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical trial design of manual therapies may be especially challenging as techniques are often individualized and practitioner-dependent. This paper describes our methods in creating a standardized Swedish massage protocol tailored to subjects with osteoarthritis of the knee while respectful of the individualized nature of massage therapy, as well as implementation of this protocol in two randomized clinical trials. METHODS The manualization process involved a collaborative process between methodologic and clinical experts, with the explicit goals of creating a reproducible semi-structured protocol for massage therapy, while allowing some latitude for therapists' clinical judgment and maintaining consistency with a prior pilot study. RESULTS The manualized protocol addressed identical specified body regions with distinct 30- and 60-min protocols, using standard Swedish strokes. Each protocol specifies the time allocated to each body region. The manualized 30- and 60-min protocols were implemented in a dual-site 24-week randomized dose-finding trial in patients with osteoarthritis of the knee, and is currently being implemented in a three-site 52-week efficacy trial of manualized Swedish massage therapy. In the dose-finding study, therapists adhered to the protocols and significant treatment effects were demonstrated. CONCLUSIONS The massage protocol was manualized, using standard techniques, and made flexible for individual practitioner and subject needs. The protocol has been applied in two randomized clinical trials. This manualized Swedish massage protocol has real-world utility and can be readily utilized both in the research and clinical settings. TRIAL REGISTRATION Clinicaltrials.gov NCT00970008 (18 August 2009).
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Affiliation(s)
- Ather Ali
- Department of Pediatrics, Yale University School of Medicine, 2 Church Street South, New Haven, CT 06519, USA.
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Jazieh AR, Al Sudairy R, Abulkhair O, Alaskar A, Al Safi F, Sheblaq N, Young S, Issa M, Tamim H. Use of complementary and alternative medicine by patients with cancer in Saudi Arabia. J Altern Complement Med 2012; 18:1045-9. [PMID: 22906212 DOI: 10.1089/acm.2011.0266] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of complementary and alternative medicine (CAM) is common among patients with cancer. However, the issue is not well-studied among the Saudi patient population. Our study aimed at determining the patterns of CAM use among patients with cancer in Saudi Arabia. METHODS A cross-sectional study using interview-administered questionnaire was conducted in patients with cancer in the Oncology Department of King Abdulaziz Medical City for National Guards, Riyadh, Kingdom of Saudi Arabia. Patients were asked about CAM use including dietary supplement (DS) and non-DS remedies. Univariate and multivariate analyses were conducted to identify predicting factors for CAM use. RESULTS A total of 453 adult patients were enrolled in the study, with a median age of 53.5 years (14.7-94.6), and the ratio of females to males was 271/182 (59.8%/40.2%). Of those, 410 patients (90.5%) used some type of CAM remedy. Non-DS remedies were used by 399 patients (88%) and were mainly of a religious nature including reciting the Quran (74.8%), prayer (16%), supplication (13%), and others (3.7%). However, 386 patients (85.2%) used DS including: Zamzam water (59.8%), honey (54.3%), black seed (35.1%), water with the Quran recited over it (29.8%), and other remedies. The majority of patients (90%) used CAM as a cancer treatment and the rest used it for various reasons, such as symptom control or supportive treatment. Only 18% of the patients discussed CAM use with their physicians, compared to 68% discussing it with religious clergypeople (Sheikhs).The univariate analysis revealed that only female gender is a predictor of CAM use, which remained significant in a multivariate analysis, in addition to current employment. CONCLUSIONS The use of complementary therapies among Saudi patients with cancer is highly prevalent, with a predominance of interventions of religious background, indicating the strong influence of religion on peoples' lives, especially when people are faced with life-threatening illnesses.
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Affiliation(s)
- Abdul Rahman Jazieh
- King Saud bin Abdulaziz University for Health Sciences, and King Abdullah International Medical Research Center, National Guard Health Affairs Riyadh, Kingdom of Saudi Arabia.
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Walach H. CAMbrella--complementary medicine research in Europe. FORSCHENDE KOMPLEMENTARMEDIZIN (2006) 2012; 19 Suppl 2:1-2. [PMID: 23883937 DOI: 10.1159/000345309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Adams SK, Koinis-Mitchell D. Perspectives on complementary and alternative therapies in asthma. Expert Rev Clin Immunol 2010; 4:703-11. [PMID: 20477120 DOI: 10.1586/1744666x.4.6.703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Asthma is a chronic disease that affects millions of individuals living in the USA. Proper asthma management is essential for controlling asthma symptoms and exacerbations. In recent years, however, there has been increased recognition of individuals using complementary and alternative medicine (CAM) to treat asthma. This article reviews the status of the current literature on various cultural factors that influence CAM use. In addition, current research of two widely used forms of CAM, herbal remedies and relaxation techniques, is presented. Future directions and recommendations to increase the methodological rigor of CAM research are discussed, particularly as they pertain to herbal remedies and relaxation strategies. The importance of well-designed research studies, including observational studies and randomized controlled trials, is highlighted.
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Affiliation(s)
- Sue K Adams
- University of Rhode Island, Department of Human Development and Family Studies, 2 Lower College Road, Transition Center 210, Kingston, RI 02881, USA.
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Mao J, Hou Y, Shang H, Wang H, Wang X, Zhao Y, Niu T, Cui J, Li G, Lin Q, Shi L, Jia X, Fan R, Wang B, Wang H, Ruan J. Study on the evaluation of the clinical effects of traditional chinese medicine in heart failure by complex intervention: protocol of SECETCM-HF. Trials 2009; 10:122. [PMID: 20030859 PMCID: PMC2809053 DOI: 10.1186/1745-6215-10-122] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 12/24/2009] [Indexed: 12/01/2022] Open
Abstract
Background Experts in Traditional Chinese Medicine (TCM) have studied the TCM subject of the pathogenesis of heart failure (HF) for several decades. As a result, the general idea is ben deficiency and biao excess. However, the clinical evaluation system which combined the TCM and western medicine in HF has not been developed yet. The objective is to establish the evaluation index system for the integration of TCM and western medicine. The evaluation indexes which include TCM items will specify the research design and methods. Methods Nine medical centers in different cities in China will participate in the trial. A population of 340 patients with HF will be enrolled through a central randomized system for different test groups. Group A will be treated with only western medicine, while group B with western and Chinese medicine together. The study will last for 12 months from the date of enrollment. The cardiovascular death will be the primary outcome. Discussion By putting the protocol into practice, the clinical effects of TCM for HF will be identified scientifically, objectively as well as rationally. The proper index system which built in the study will be helpful for the clinical effect expression of HF by integrated medicine in future. Trial Registration ChiCTR-TRC-00000059
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Affiliation(s)
- Jingyuan Mao
- Cardiovascular Department of The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, 314 Anshan Western Road, Nankai District, Tianjin, China.
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Eton DT, Koffler K, Cella D, Eisenstein A, Astin JA, Pelletier KR, Riley D. Developing a self-report outcome measure for complementary and alternative medicine. Explore (NY) 2009; 1:177-85. [PMID: 16781527 DOI: 10.1016/j.explore.2005.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our objective was to develop a pilot measure of subjective outcomes of complementary and alternative medicine (CAM). Current options for assessing subjective outcomes in CAM are either too burdensome or fail to represent diverse outcomes. A single measure specifying common, patient-reported outcomes of CAM would be of value. DESIGN We conducted a three-phase instrument development study. In phase I, 30 CAM-receiving patients and 12 CAM practitioners completed a battery of standardized measures. Participants identified those standardized items relevant to CAM outcome and suggested additional outcome issues. In phase II, 20 CAM-receiving patients completed a Q-sort to determine which items from phase I were most relevant to CAM outcome. In phase III, five experts reviewed the items from phase II for content validity. SETTING An integrative medicine clinic at a private, Midwest US hospital. PARTICIPANTS CAM patients, practitioners, and researchers and an outcomes measurement specialist. RESULTS In phase I, 30 standardized items were judged relevant to CAM outcome, and 8 additional items were suggested. In phase II, 29 of the 38 phase I items were deemed at least "moderately relevant" to CAM outcome. In phase III, experts added 15 items, dropped 9 items, and altered 3 items. The 35 resulting items were classified into content domains, forming a testable, pilot version of the instrument.
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Affiliation(s)
- David T Eton
- Evanston Northwestern Healthcare, Evanston, IL, USA.
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Komesaroff PA, Black CVS, Cable V, Sudhir K. Effects of wild yam extract on menopausal symptoms, lipids and sex hormones in healthy menopausal women. Climacteric 2009. [DOI: 10.1080/cmt.4.2.144.150] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Levin J. Scientists and healers: toward collaborative research partnerships. Explore (NY) 2008; 4:302-10. [PMID: 18775400 DOI: 10.1016/j.explore.2008.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Indexed: 10/21/2022]
Abstract
In recent years we have witnessed growing interest in the study of healers and healing. Yet because of barriers segregating the professional worlds of scientists and healers, research on this topic has not met its potential. Even the most sympathetic of scientific investigators have failed to treat healers as full research partners, neglecting to take seriously healers' informed perspectives in formulating study questions and in making key decisions regarding assessment and outcomes. Likewise, some of the most gifted healers exhibit antipathy toward scientific research that is uninformed and works at cross purposes with efforts to validate the efficacy of healing and to integrate its practice into conventional medical settings. For this situation to improve, scientists and healers must recognize that each party has critical gaps in knowledge and skills that the other party possesses. Only through true collaborative partnerships can the potential benefits of research on healing be realized.
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Affiliation(s)
- Jeff Levin
- Duke University Medical Center, Durham, NC, USA
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25
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Levin J, Mead L. Bioenergy healing: a theoretical model and case series. Explore (NY) 2008; 4:201-9. [PMID: 18466852 DOI: 10.1016/j.explore.2008.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Jeff Levin
- Duke University Medical Center, Durham, NC, USA
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Liang FR, Tang Y. [Acupuncture in treatment of cerebrosis: advances in clinical research over 20 years]. ZHONG XI YI JIE HE XUE BAO = JOURNAL OF CHINESE INTEGRATIVE MEDICINE 2008; 6:561-564. [PMID: 18559230 DOI: 10.3736/jcim20080603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Over the past twenty years, with the development of brain science, many acupuncture clinical researchers have used multidisciplinary methods and techniques to perform acupuncture clinical research on cerebrosis. Up to now, many achievements have been obtained such as expanding studied disease entities, standardizing methods, identifying objects, and developing more and more treatment methods and in-depth mechanism research.
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Affiliation(s)
- Fan-rong Liang
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province 610075, China.
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Pilot validation of a self-report outcome measure of complementary and alternative medicine. Explore (NY) 2008; 3:592-9. [PMID: 18005911 DOI: 10.1016/j.explore.2007.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2007] [Indexed: 11/22/2022]
Abstract
BACKGROUND We previously developed a multidomain, self-report outcome measure relevant to a wide range of complementary and alternative medical (CAM) therapies. We report the results of a pilot study to validate the measure. METHODS Fifty-two patients (60% female, mean age, 53 years) seeking services from CAM providers completed a battery of measures prior to a scheduled visit. The battery included the Positive and Negative Affect Schedule, items from the Brief Pain and Fatigue Inventories, ratings of global quality of life (QOL) and change in physical health, and our pilot measure consisting of six hypothesized subscales (pain, fatigue, physical/functional ability, personal control, existential issues, and general QOL). Internal reliability, item convergence and discrimination, construct, and concurrent validity were assessed. RESULTS Pilot measure domains appeared to be internally reliable with five of six alpha coefficients exceeding 0.70. Multitrait scaling analyses demonstrated that most items converged on the domains that they were hypothesized to represent, although item discrimination was demonstrated for the pain domain only. Correlations with standardized assessments of pain, fatigue, and global QOL showed evidence of construct validity. All domain scores differentiated patients classified high versus low in global QOL (P < .01) and four (pain, fatigue, physical/functional ability, and general QOL) differentiated patients who perceived recent changes in their physical health (improvement vs decline; P < .05). CONCLUSION These results provide preliminary psychometric data for a pilot measure of CAM outcomes, though further testing is warranted.
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Khalsa PS, Pearson NJ. Financial Support for Research Training and Career Development in Complementary and Alternative Medicine from the National Institutes of Health. J Manipulative Physiol Ther 2007; 30:483-90. [PMID: 17870416 DOI: 10.1016/j.jmpt.2007.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Revised: 05/03/2007] [Indexed: 11/16/2022]
Abstract
Research careers are a relatively new reality for complementary and alternative medicine (CAM) practitioners (eg, chiropractors, naturopaths, doctors of oriental medicine, etc). Before the establishment in 1998 of the National Center for Complementary and Alternative Medicine (NCCAM) as part of the National Institutes of Health (NIH), there were few funding resources available for those interested in a CAM research career and fewer still feasible paths. Now, however, NCCAM provides a broad array of research training and career development awards for those seeking a long-term career in CAM research. These awards include predoctoral and postdoctoral fellowships, individual career development awards, and institutional training awards. The goal of this article is to provide information about current research training funding opportunities from NCCAM and NIH as a whole that are available to CAM practitioners in the context of the historical challenges of transitioning from a clinical career in CAM practice to a CAM research career.
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Coulter ID. Evidence Based Complementary and Alternative Medicine: Promises and Problems. Complement Med Res 2007; 14:102-8. [PMID: 17464161 DOI: 10.1159/000101054] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The present paper examines the experience of establishing a center for evidence-based complementary and alternative medicine (EBCAM) practice. It examines both the difficulties and the challenges of doing research to establish EBCAM. The paper also examines the political context of the demand for evidence- based practice (EBP) for CAM. IMPLEMENTATION A center for EBCAM was funded for 3 years within the Southern California Evidence-Based Practice Center by the National Center for CAM and administered by the Agency for Health Research Quality. This experience provides the basis for this paper. RESULTS While the experience of creating an EBM Center for CAM has shown that much work can be accomplished by applying standard methods of EBP medicine, it also highlights the weaknesses of such an agenda. Many standard research methods are simply not applicable to CAM, and even where they are, effectiveness is a much more important means of assessing CAM than simply efficacy. Researchers however, must be conscious of the political motivations behind much of the demand for EBCAM. Where such demands are coming from allopathic medicine, they clearly form a continuing part of medical opposition to CAM and may be intended to perpetuate the dominance of the biomedical paradigm in healthcare. The challenge for CAM is to recognize the limitations of EBP but not to throw the 'baby out with the bathwater'. There is much in EBP that clearly should be emulated by the CAM community but only where it is appropriate.
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Affiliation(s)
- Ian D Coulter
- Samueli Institute, UCLA School of Dentistry, RAND, Santa Monica, Southern California University of Health Sciences, Corona del Mar, CA 92625, USA.
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Haas M, Bronfort G, Evans RL. Chiropractic Clinical Research: Progress and Recommendations. J Manipulative Physiol Ther 2006; 29:695-706. [PMID: 17142164 DOI: 10.1016/j.jmpt.2006.09.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Revised: 04/27/2006] [Accepted: 04/30/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this white paper is to help inform the chiropractic clinical research agenda with a focus on the United States. METHODS AND DISCUSSION The recommendations and action items from 2 previous articles published in 1997 are discussed within the context of 3 broad topics: research culture, research infrastructure, and clinical research studies. Progress made toward the action items in these areas is summarized. A summary of findings is presented of the most influential clinical research studies during the past decade performed by or with major contributions by chiropractic investigators. In light of the current evidence and previous recommendations, new clinical research recommendations are proposed. CONCLUSIONS Based on the assessment of the scientific literature and research currently underway, it is evident that members of the chiropractic research community have made important progress in becoming active players in the clinical research arena. During the past decade, the work of chiropractic researchers has contributed substantially to the amount and quality of the evidence for or against spinal manipulation in the management of low back pain, neck pain, headache, and other conditions.
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Affiliation(s)
- Mitchell Haas
- Center for Outcomes Studies, Western States Chiropractic College, Portland, Oregon, USA
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Shea JL. Applying Evidence-Based Medicine to Traditional Chinese Medicine: Debate and Strategy. J Altern Complement Med 2006; 12:255-63. [PMID: 16646724 DOI: 10.1089/acm.2006.12.255] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Drawing on recent paper published literature in both English and Chinese, this explores reactions to the evaluation of Chinese medicine using randomized controlled trials (RCTs) and the standards of evidence-based medicine (EBM). The literature review revealed a few sources which contend that Chinese medicine should not be evaluated on the basis of RCTs, but a far greater number which advocate for applying RCT and EBM standards to Chinese medicine. This paper describes the position of the detractors and points out ways in which their arguments contain oversimplified representations of Chinese medicine, biomedicine, EBM, and RCTs. In describing the position of the proponents, the analysis outlines some of the numerous innovative techniques they are developing for dealing with issues of control and standardization in efficacy research. Overall, the analysis indicates that important refinements are being generated in Chinese medicine research and clinical trial design in response to the challenges posed by the forced encounter of these two paradigms.
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Affiliation(s)
- Jeanne L Shea
- Department of Anthropology, University of Vermont, Burlington, VT 05405, USA.
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Herman PM, Craig BM, Caspi O. Is complementary and alternative medicine (CAM) cost-effective? A systematic review. Altern Ther Health Med 2005; 5:11. [PMID: 15932647 PMCID: PMC1182346 DOI: 10.1186/1472-6882-5-11] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2004] [Accepted: 06/02/2005] [Indexed: 11/10/2022]
Abstract
BACKGROUND Out-of-pocket expenditures of over 34 billion dollars per year in the US are an apparent testament to a widely held belief that complementary and alternative medicine (CAM) therapies have benefits that outweigh their costs. However, regardless of public opinion, there is often little more than anecdotal evidence on the health and economic implications of CAM therapies. The objectives of this study are to present an overview of economic evaluation and to expand upon a previous review to examine the current scope and quality of CAM economic evaluations. METHODS The data sources used were Medline, AMED, Alt-HealthWatch, and the Complementary and Alternative Medicine Citation Index; January 1999 to October 2004. Papers that reported original data on specific CAM therapies from any form of standard economic analysis were included. Full economic evaluations were subjected to two types of quality review. The first was a 35-item checklist for reporting quality, and the second was a set of four criteria for study quality (randomization, prospective collection of economic data, comparison to usual care, and no blinding). RESULTS A total of 56 economic evaluations (39 full evaluations) of CAM were found covering a range of therapies applied to a variety of conditions. The reporting quality of the full evaluations was poor for certain items, but was comparable to the quality found by systematic reviews of economic evaluations in conventional medicine. Regarding study quality, 14 (36%) studies were found to meet all four criteria. These exemplary studies indicate CAM therapies that may be considered cost-effective compared to usual care for various conditions: acupuncture for migraine, manual therapy for neck pain, spa therapy for Parkinson's, self-administered stress management for cancer patients undergoing chemotherapy, pre- and post-operative oral nutritional supplementation for lower gastrointestinal tract surgery, biofeedback for patients with "functional" disorders (eg, irritable bowel syndrome), and guided imagery, relaxation therapy, and potassium-rich diet for cardiac patients. CONCLUSION Whereas the number and quality of economic evaluations of CAM have increased in recent years and more CAM therapies have been shown to be of good value, the majority of CAM therapies still remain to be evaluated.
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Affiliation(s)
- Patricia M Herman
- Program in Integrative Medicine, University of Arizona, Tucson, Arizona, USA
| | - Benjamin M Craig
- Department of Pharmacy, University of Arizona, Tucson, Arizona, USA
| | - Opher Caspi
- Recanati Center for Internal Medicine and Research, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
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Vuksan V, Sievenpiper JL. Herbal remedies in the management of diabetes: lessons learned from the study of ginseng. Nutr Metab Cardiovasc Dis 2005; 15:149-160. [PMID: 15955462 DOI: 10.1016/j.numecd.2005.05.001] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2005] [Revised: 04/27/2005] [Accepted: 05/05/2005] [Indexed: 11/16/2022]
Abstract
The only example of an approved antidiabetic drug that was developed from a herbal source with a long history of use for diabetes is the biguanide Metformin from French lilac (Galega officinalis). Clinical data are beginning to emerge that support antidiabetic indications for several other herbs. This viewpoint discusses the state of the evidence for their clinical antidiabetic efficacy. One of the most studied herbs, ginseng (Panax spp.), is used as a model to illustrate the challenges associated with achieving reproducible clinical efficacy. It is concluded that the best evidence for clinical efficacy in diabetes remains for ginseng. But overall insufficient evidence exists to claim a diabetes indication for herbs. The experience with ginseng suggests that although reproducible efficacy may be achieved using an acute postprandial clinical screening model to select an efficacious ginseng batch, dose, and time of administration, there is a need to develop a basis for standardization that ties the composition of herbs to efficacy. In absence of such standardization, the use of herbs in diabetes must be approached cautiously.
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Affiliation(s)
- Vladimir Vuksan
- Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada.
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Wei HF, Zheng PY, Ji G. General methods for clinical effect assessment of traditional Chinese medicine. ACTA ACUST UNITED AC 2005; 3:184-90. [PMID: 15885163 DOI: 10.3736/jcim20050305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Along with the changes of disease spectrum, medical models and health concept, people pay more and more attention to the diagnostic and therapeutic approaches of traditional Chinese medicine (TCM). With the effect assessment being changed from disease-based model to patient-based model, how to scientifically and objectively explain the validity of TCM has become the premise for further development of TCM and dissemination of it throughout the world. In this article, the authors analyzed the status quo and problems of the effect assessment of TCM, and proposed some general methods for clinical effect assessment of TCM, including formulating criteria for syndrome differentiation under the guidance of TCM theories, paying attention to quality of life, proper selection of indexes for outcome assessment, application of modern clinical study methods, such as the methods of evidence-based medicine and clinical epidemiology, designing randomized controlled trials, multi-subject co-operation, strict supervision of the quality of researches, and establishment of organizations for professional training.
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Affiliation(s)
- Hua-Feng Wei
- Center of Clinical Effect Assessment, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
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Les enfants et les produits de santé naturels: Ce que le clinicien devrait savoir. Paediatr Child Health 2005. [DOI: 10.1093/pch/10.4.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Vohra S, Clifford T. Children and natural health products: What a clinician should know. Paediatr Child Health 2005; 10:227-32. [PMID: 19668621 PMCID: PMC2722533 DOI: 10.1093/pch/10.4.227] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Levin J, Steele L. The transcendent experience: Conceptual, theoretical, and epidemiologic perspectives. Explore (NY) 2005; 1:89-101. [PMID: 16781509 DOI: 10.1016/j.explore.2004.12.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This paper provides a conceptual, theoretical, and empirical overview of the concept of the transcendent experience. The principal goal is to formalize a scientific field around the study of dimensions, determinants, and health outcomes of transcendence. This is accomplished through posing several fundamental questions and then answering them as concisely as possible in light of current theory and existing empirical research. These include the following: "What is the transcendent experience?" "Can the transcendent experience be studied?" "What do we (and don't we) know about the transcendent experience?" "How is the transcendent experience triggered?" "How is the transcendent experience sustained?" "Are there physiological models of the transcendent experience?" "Are there health effects of the transcendent experience?" and, "How should we study the health effects of the transcendent experience?" Finally, an agenda is proposed for research on the role of the transcendent experience in health, emphasizing development of an epidemiology of the transcendent experience.
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Aickin M. Participant-centered analysis in complementary and alternative medicine comparative trials. J Altern Complement Med 2004; 9:949-57. [PMID: 14736365 DOI: 10.1089/107555303771952280] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Participant-centered analysis involves applying the customary methods of statistical decision making at the level of the individual research participant. Consequently, each individual is declared a responder who benefited, a nonresponder, or possibly a responder who was harmed, using intensively collected data that were specific to that individual. There are several implications of the participant-centered approach. More data actually relevant to the important outcome need to be collected on individuals. The study results can be summarized in a simple table of responders/nonresponders by treatment group, and probabilities of true response can be estimated. The actual nature of the data collected and the statistical models used to analyze them drop into the background. Finally, production of individual-level decisions permits standard statistical approaches to be applied to the issue of which modality should be recommended for which person, instead of focusing on average effects and which modality should be recommended for everyone.
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Affiliation(s)
- Mikel Aickin
- Center for Health Research, Kaiser Permanente Northwest Region, 3800 N. Interstate Avenue, Portland, OR 97227-1098, USA.
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Bell IR, Koithan M, Gorman MM, Baldwin CM. Homeopathic practitioner views of changes in patients undergoing constitutional treatment for chronic disease. J Altern Complement Med 2003; 9:39-50. [PMID: 12676034 DOI: 10.1089/107555303321222937] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES To identify areas that classical homeopathic practitioners would want to see evaluated in a patient self-report questionnaire sensitive to change during constitutional treatment. DESIGN Open-ended, written practitioner questionnaire, analyzed using inductive content analysis. SETTINGS/LOCATION Two classical homeopathic meetings held in the western United States. SUBJECTS Homeopathic practitioners attending the above professional meetings and volunteering to complete the questionnaire in response to announcements prior to sessions. DATA COLLECTION METHODS Practitioners completed a demographic questionnaire and answered an open-ended question inquiring for changes about which to ask people undergoing classical homeopathic constitutional treatment. RESULTS The categories that the 38 homeopaths identified included changes in: (1) emotions; (2) mentation; (3) specific physical functioning; (4) general physical changes; (5) perception of self; (6) relationships; (7) spirituality; (8) lifestyle; (9) energy; (10) dream content and tone; (11) well-being; (12) perceptions by others; (13) life relationships; (14) a sense of freedom or feeling less "stuck"; (15) sleep; (16) coping; (17) ability to adapt; (18) creativity; and (19) recall of past experiences. Sixteen percent (16%) of participants added more in-depth description of the nature of changes across categories (i.e., a rhythmical process of innovation and flux). CONCLUSIONS The findings are consistent with the systemic orientation of classical homeopathic philosophy to evaluate and treat the patient as a whole. Taken together, the results support the need for development of new, multidimensional outcome measures for clinical research in homeopathy beyond the disease-specific and health-related quality-of-life scales available from conventional medical research.
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Affiliation(s)
- Iris R Bell
- Program in Integrative Medicine, University of Arizona, Tucson, AZ 85724-5153, USA.
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Oberbaum M, Vithoulkas G, Van Haselen R. Clinical trials of classical homeopathy: reflections on appropriate research designs. J Altern Complement Med 2003; 9:105-11. [PMID: 12676039 DOI: 10.1089/107555303321222982] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The growing popularity of complementary medicine has been accompanied by a call for controlled clinical studies to examine the efficacy and validity of its various methods. The difficulties encountered in applying the evaluation methods of conventional medicine to complementary medicine are the result of the different paradigms underlying these two methods of medicine, and the differences in the healing process. This paper attempts to bridge the gap between these two approaches and to suggest a possibility to use conventional research methodology in clinical studies of classical homeopathy. Two methods are described. One is the randomization into a placebo or a treatment group after an individual remedy is chosen for each patient. This method requires an experienced homeopath and is reproducible only by the same homeopath in the same population. On the other hand, the expected success rate will be high. Another method is prescribing and treating according to so-called keynotes, a set of symptoms known to respond to a particular remedy that must be present in a patient in order to elicit a reaction from the remedy. This method is more suitable to a conventional design of a clinical study and is reproducible by anyone. Yet the expected success rate is much lower. Some general design issues that may have a particular impact on clinical trials of classical homeopathy are discussed, including the need for sufficiently powered trials to detect relatively small effects, strategies to deal with patient preference and embracing the use of "active-control" pragmatic trial designs.
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Affiliation(s)
- Menachem Oberbaum
- Institute of Research on Complementary Medicine and The Center of Integrated Complementary Medicine, Shaare Zedek Medical Center, Jerusalem, Israel.
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Sievenpiper JL, Arnason JT, Leiter LA, Vuksan V. Variable effects of American ginseng: a batch of American ginseng (Panax quinquefolius L.) with a depressed ginsenoside profile does not affect postprandial glycemia. Eur J Clin Nutr 2003; 57:243-8. [PMID: 12571655 DOI: 10.1038/sj.ejcn.1601550] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND We have repeatedly reported that American ginseng (AG) with a specific ginsenoside profile significantly decreases postprandial glycemia. Whether this effect is reproducible using AG with a different profile is unknown. We therefore investigated the effect of a different batch of AG on glycemia following a 75 g oral glucose tolerance test (OGTT). METHODS Using a randomized, single blind design, 12 normal subjects (six males and six females, aged 31+/-3 y, body mass index (BMI) 28+/-2 kg/m(2)) received 6 g AG or placebo 40 min before a 75 g OGTT. The protocol followed the guidelines for the OGTT, with venous blood samples drawn at -40, 0, 15, 30, 45, 60, 90 and 120 min. Ginsenosides in the AG were assessed by established methods for HPLC-UV. RESULTS Repeated measures analysis of variance demonstrated that there was no significant effect of the AG on incremental plasma glucose (PG) or insulin (PI) or their areas under the curve Indices of insulin sensitivity (insulin sensitivity index (ISI)) and release (deltaPI(30-0)/deltaPG(30-0)) calculated from the OGTT were also unaffected. The AG contained 1.66% total ginsenosides, 0.90% (20S)-protopanaxadiol (PPD) ginsenosides, and 0.75% (20S)-protopanaxatriol (PPT) ginsenosides, with the following key ratios: PPD:PPT of 1.2, Rb(1):Rg(1) of 8.1, and Rb(2):Rc of 0.18. CONCLUSIONS The present batch of AG was unable to reproduce the postprandial hypoglycemic effects we observed previously. Possible explanations for this discrepancy include marked decrements in total ginsenosides and the key ratios PPD:PPT, Rb(1):Rg(1), and Rb(2):Rc. These data suggest that the ginsenoside profile of AG might play a role in its hypoglycemic effects. The involvement of other components cannot, however, be precluded.
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Affiliation(s)
- J L Sievenpiper
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Tamayo C, Boon H, Ghishan F, Trinh K. Research Methodology Evaluating Complementary and Alternative Therapies. ACTA ACUST UNITED AC 2002. [DOI: 10.1177/009286150203600308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Richardson MA, Straus SE. Complementary and alternative medicine: opportunities and challenges for cancer management and research. Semin Oncol 2002; 29:531-45. [PMID: 12516036 DOI: 10.1053/sonc.2002.50002] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Given the widespread use of diverse complementary and alternative medicine (CAM) approaches by cancer patients, research to establish their safety and efficacy is critical as is improved patient-physician communication about their possible risks and benefits. The mission of the National Center for Complementary and Alternative Medicine (NCCAM) is to support exacting research and disseminate clear and compelling information on CAM. Although many of the challenges facing such research are not unique to CAM, these approaches do present unique challenges, but the opportunities are many for prevention, palliation, and even treatment. Using the current research portfolio of NCCAM to illustrate how the field may mature, this report summarizes the challenges facing CAM investigators, the most fruitful areas for exploration, and existing information resources.
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Affiliation(s)
- Mary Ann Richardson
- National Center for Complementary and Alternative Medicine, National Institutes of Health, 6707 Democracy Boulevard, Suite 106, Bethesda, MD 20892-5475, USA
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Veltri RW, Marks LS, Miller MC, Bales WD, Fan J, Macairan ML, Epstein JI, Partin AW. Saw palmetto alters nuclear measurements reflecting DNA content in men with symptomatic BPH: evidence for a possible molecular mechanism. Urology 2002; 60:617-22. [PMID: 12385921 DOI: 10.1016/s0090-4295(02)01838-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine the nuclear chromatin characteristics of epithelial cells, looking for an SPHB-mediated effect on nuclear DNA structure and organization. Saw palmetto herbal blend (SPHB) causes contraction of prostate epithelial cells and suppression of tissue dihydrotestosterone levels in men with symptomatic benign prostatic hyperplasia, but a fundamental mechanism remains unknown. METHODS A 6-month randomized trial, comparing prostatic tissue of men treated with SPHB (n = 20) or placebo (n = 20), was performed. At baseline, the two groups were similar in age (65 versus 64 years), symptoms (International Prostate Symptom Score 18 versus 17), uroflow (maximal urinary flow rate 10 versus 11 mL/s), prostate volume (59 versus 58 cm(3)), prostate-specific antigen (4.2 versus 2.7 ng/mL), and percentage of epithelium (17% versus 16%). Prostatic tissue was obtained by sextant biopsy before and after treatment. Five-micron sections were Feulgen stained and quantitatively analyzed using the AutoCyte QUIC-DNA imaging system. Images were captured from 200 randomly selected epithelial cell nuclei, and 60 nuclear morphometric descriptors (NMDs) (eg, size, shape, DNA content, and textural features) were determined for each nucleus. Logistic regression analysis was used to assess the differences in the variances of the NMDs between the treated and untreated prostate epithelial cells. RESULTS At baseline, the SPHB and placebo groups had similar NMD values. After 6 months of placebo, no significant change from baseline was found in the NMDs. However, after 6 months of SPHB, 25 of the 60 NMDs were significantly different compared with baseline, and a multivariate model for predicting treatment effect using 4 of the 25 was created (P <0.001). The multivariate model had an area under the receiver operating characteristic curve of 94% and an accuracy of 85%. CONCLUSIONS Six months of SPHB treatment appears to alter the DNA chromatin structure and organization in prostate epithelial cells. Thus, a possible molecular basis for tissue changes and therapeutic effect of the compound is suggested.
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Affiliation(s)
- Robert W Veltri
- Department of Urology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Schnyer RN, Allen JJB. Bridging the gap in complementary and alternative medicine research: manualization as a means of promoting standardization and flexibility of treatment in clinical trials of acupuncture. J Altern Complement Med 2002; 8:623-34. [PMID: 12470444 DOI: 10.1089/107555302320825147] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION An important methodological challenge encountered in acupuncture clinical research involves the design of treatment protocols that help ensure standardization and replicability while allowing for the necessary flexibility to tailor treatments to each individual. Manualization of protocols used in clinical trials of acupuncture and other traditionally-based complementary and alternative medicine (CAM) systems facilitates the systematic delivery of replicable and standardized, yet individually-tailored treatments. OBJECTIVES To facilitate high-quality CAM acupuncture research by outlining a method for the systematic design and implementation of protocols used in CAM clinical trials based on the concept of treatment manualization. METHODS A series of treatment manuals was developed to systematically articulate the Chinese medical theoretical and clinical framework for a given Western-defined illness, to increase the quality and consistency of treatment, and to standardize the technical aspects of the protocol. In all, three manuals were developed for National Institutes of Health (NIH)-funded clinical trials of acupuncture for depression, spasticity in cerebral palsy, and repetitive stress injury. In Part I, the rationale underlying these manuals and the challenges encountered in creating them are discussed, and qualitative assessments of their utility are provided. In Part II, a methodology to develop treatment manuals for use in clinical trials is detailed, and examples are given. CONCLUSIONS A treatment manual provides a precise way to train and supervise practitioners, enable evaluation of conformity and competence, facilitate the training process, and increase the ability to identify the active therapeutic ingredients in clinical trials of acupuncture.
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Affiliation(s)
- Rosa N Schnyer
- Department of Psychology, University of Arizona, Tucson, AZ, USA.
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Siganga WW, Dastani HB. An Overview of Four Nonpharmacologic Complementary and Alternative Medicine Modalities. J Pharm Technol 2002. [DOI: 10.1177/875512250201800401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To provide an overview of 4 nonmedical complementary and alternative medicine (CAM) modalities with an emphasis on 1 mind-body approach (yoga), 2 alternative systems (acupuncture, tai chi), and 1 energy therapy (therapeutic touch). Support in the scientific literature for the usefulness of each technique is presented. Data Sources Primary articles on alternative medicine were obtained by performing a MEDLINE search. An online book search was conducted on the Ohio Library and Information Network, a consortium of 79 Ohio colleges, universities, and community colleges and the State Library of Ohio. Data Synthesis All 4 CAM modalities had a scientific basis and were supported in the literature. Main drawbacks to many scientific studies were in methodologic flaws such as small sample sizes, variable interventions, and the absence of controls. Many researchers are beginning to include evidence-based and scientific techniques in their studies that more closely meet established scientific standards. This will lead to more robust, valid, reliable, and uniform methodologic approaches. Discussion Many patients use both CAM and mainstream therapies for their medical conditions. As the quality of scientific studies improves, pharmacists can gain confidence in using the results to provide pharmaceutical care to such patients. It is the pharmacists' responsibility to educate themselves about CAM therapies. Conclusions Embracing a holistic approach to care may enable pharmacists to optimize the pharmaceutical care they provide to all their patients.
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Verhoef MJ, Casebeer AL, Hilsden RJ. Assessing efficacy of complementary medicine: adding qualitative research methods to the "Gold Standard". J Altern Complement Med 2002; 8:275-81. [PMID: 12165185 DOI: 10.1089/10755530260127961] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Randomized controlled trials (RCTs) have an important place in the assessment of the efficacy of complementary and alternative medicine (CAM). However, they address only one, limited, question, namely whether an intervention has-statistically-an effect. They do not address why the intervention works, how participants are experiencing the intervention, and/or how they give meaning to these experiences. Therefore, we argue that the addition of qualitative research methods to RCTs can greatly enhance understanding of CAM interventions. Qualitative research can assist in understanding the meaning of an intervention to patients as well as patients' beliefs about the treatment and expectations of the outcome. Qualitative research also assists in understanding the impact of the context and the process of the intervention. Finally, qualitative research is helpful in developing appropriate outcome measures for CAM interventions. Greater understanding of CAM interventions has the potential to improve health care delivery.
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Affiliation(s)
- Marja J Verhoef
- Department of Community Health Sciences, University of Calgary, Alberta, Canada.
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Bell IR, Baldwin CM, Schwartz GE, Davidson JRT. Homeopathic constitutional type questionnaire correlates of conventional psychological and physical health scales: individual difference characteristics of young adults. HOMEOPATHY 2002; 91:63-74. [PMID: 12371459 DOI: 10.1054/homp.2002.0003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study examined associations between scores for 19 different remedies on the constitutional type questionnaire (CTQ) and scores on standardized psychological and medical trait and state scales from health psychology research. Subjects were 104 young adult American college students (mean age 20 years; 67% female). Scales included the chemical intolerance index (CII) for environmental sensitivity, the NEO personality inventory, Marlowe-Crowne social desirability (MCSD) Scale for defensiveness, Harvard parental caring scale (HPCS) for perceived mother and father traits, Profile of Mood State (POMS) scale, Pennebaker symptom checklist (PSC), and a 3-item global health rating scale. The majority of CTQ constitutional type scores correlated significantly with greater NEO neuroticism, lower MCSD defensiveness, and greater psychological distress on the POMS subscales. NEO Extraversion and Openness subscales correlated with specific CTQ scores in directions consistent with clinical remedy pictures. CTQ Carcinosin differed from other remedies, showing no significant correlations with other scales. As hypothesized (a) persons high on CTQ scores for Carcinosin and low in parental caring (HPCS) had the highest symptom score; (b) those high on CTQ scores for Sulphur and low on HPCS had the poorest global health ratings; (c) individuals high on four different CTQ type scores (Carcinosin, Lachesis, Nux vomica, Sulphur) and high on environmental sensitivity (CII) exhibited the highest symptom scores. Taken together, the data offer additional validation of the CTQ and provide a foundation for studying interactions of constitutional type with both psychosocial and physicochemical environmental factors in homeopathic provers and patients.
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Affiliation(s)
- Iris R Bell
- Program in Integrative Medicine, The University of Arizona Health Sciences Center, Tucson 85719, USA.
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Tonelli MR, Callahan TC. Why alternative medicine cannot be evidence-based. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2001; 76:1213-1220. [PMID: 11739043 DOI: 10.1097/00001888-200112000-00011] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The concept of evidence-based medicine (EBM) has been widely adopted by orthodox Western medicine. Proponents of EBM have argued that complementary and alternative medicine (CAM) modalities ought to be subjected to rigorous, controlled clinical trials in order to assess their efficacy. However, this does not represent a scientific necessity, but rather is a philosophical demand: promoters of EBM seek to establish their particular epistemology as the primary arbiter of all medical knowledge. This claim is problematic. The methods for obtaining knowledge in a healing art must be coherent with that art's underlying understanding and theory of illness. Thus, the method of EBM and the knowledge gained from population-based studies may not be the best way to assess certain CAM practices, which view illness and healing within the context of a particular individual only. In addition, many alternative approaches center on the notion of non-measurable but perceptible aspects of illness and health (e.g., Qi) that preclude study within the current framework of controlled clinical trials. Still, the methods of developing knowledge within CAM currently have limitations and are subject to bias and varied interpretation. CAM must develop and defend a rational and coherent method for assessing causality and efficacy, though not necessarily one based on the results of controlled clinical trials. Orthodox medicine should consider abandoning demands that CAM become evidence-based, at least as "evidence" is currently narrowly defined, but insist instead upon a more complete and coherent description and defense of the alternative epistemic methods and tools of these disciplines.
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Affiliation(s)
- M R Tonelli
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
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