Objective : To evaluate and compare the use of complementary and alternative medicine (CAM) by patients seen in five specialty areas of a tertiary-care centre. Subjects and Methods : A total of 1514 patients presenting for consultation to five different specialty areas (general internal medicine, oncology, preoperative evaluation clinic, physical medicine and rehabilitation, and a spine centre) between September and December 2002 were invited to participate in a survey regarding their CAM use. The instrument used was an 85-question survey addressing different CAM domains. Results : The overall response rate was 99.5%. CAM was used by 76% of patients (80% of women, 72% of men). The ten most frequently used types were vitamin E, exercise for a specific medical problem, vitamin C, chiropractic methods, spiritual healing (prayers), green tea, massage therapy, glucosamine, vitamin B complex and chondroitin. The number of types used differed among the specialty areas surveyed and was highest for patients seen in physical medicine and rehabilitation and in the spine centre and lowest for patients seen in oncology (p = 0.002). Conclusions : CAM use was common in patients seen at a tertiary-care centre. The types used varied among the specialty areas surveyed. Physicians should be familiar with CAM use in their patients and advise them regarding its risks and benefits.
As the use of complementary and alternative medicine (CAM) therapies increases, the integration of these therapies requires collaboration with conventional medicine and healthcare disciplines. The purpose of this article was to characterise the profile of patients seeking CAM therapies at the University of Colorado Hospital’s outpatient Center for Integrative Medicine.
Ginseng (Panax ginseng C.A. Meyer, ginseng) has been the most precious and renowned tonic drug in traditional Chinese medicine. Although the original discovery of its therapeutic efficacy has been lost in antiquity, believers in ginseng as a panacea have sought, cultivated, preserved and extracted its essences for the treatment of a wide range of ailments. Many patients have used aqueous and alcoholic extracts of ginseng during convalescence, particularly where previous health problem(s) resulted in some degree of debilitation, and a corresponding deficit in mental, physical or other functional capacities. An impressive body of information has been accumulated and scientific research has documented and reviewed the useful effects of P. ginseng C.A. Meyer. The high variability in composition of the marketed products clearly affects the results of clinical studies. The availability of the standardised ginseng extract G115® has made it possible to generate reproducible results in animal studies and human clinical research.
Healthcare is changing as evidence-based medicine (EBM) is incorporated into education and practice. This article considers the hierarchy of evidence, the validation of evidence for decision making and the extent to which this includes aspects of cultural and social constructs of health. We review the influence and the methodology of EBM as it is applied to complementary and alternative medicine (CAM), and suggest that there is an uneasy relationship as the two approaches to health have divergent understandings of health and evidence. There are fundamental philosophical and epistemological differences between orthodox and complementary medicine and we suggest that EBM is limited in how it can be applied to CAM. We question how the two approaches to healthcare can work together to create optimal outcomes in practice.
Basic research has identified some nutrients as agents that inhibit mutagenesis and hyperproliferation, as well as some that induce apoptosis or differentiation, which are critical characteristics for chemoprevention regardless of the nutrient’s specific molecular targets. Some of the most promising nutrients identified as chemopreventive agents in prostate cancer are green tea polyphenols. The components of green tea are epigallocatechin-3-gallate [(−)-EGCG], epigallocatechin [(−)-EGC], epicatechin-3-gallate [(−)-ECG], epicatechin [(−)-EC] and their epimers (−)-GCG, (−)-CG, (−)-GC and (−)-C. Of these components, (−)-EGCG has been the most extensively investigated because of its relative abundance and strong cancer-preventive properties. Recently, several epidemiological, animal and laboratory studies have demonstrated the cancer-preventive properties of green tea polyphenols, specifically in prostate cancer. This article reviews the evidence to date in the role of green tea polyphenols in prostate cancer, and the future directions of this field of research.
A systematic literature review was conducted to investigate the effects of Ginkgo biloba preparations on blood coagulation parameters. Systematic literature searches were carried out using MEDLINE (via PubMed), EMBASE, AMED, CINAHL®, the Cochrane Library and PsycINFO to identify randomised, double-blind, clinical trials of G. biloba mono-preparations assessing at least one blood coagulation parameter as either a primary or a supplementary outcome measure. Five manufacturers of G. biloba preprations were asked to contribute any unpublished material. Data were validated and extracted independently by two reviewers according to pre-specified criteria.
The problem of herb-drug interactions is being increasingly recognised. However, except for hypericum ( Hypericum perforatum L.; St John’s wort), data on drug interactions with other herbs are still inconclusive, although research has started to fill in the gaps, and knowledge is being gained about this important safety issue. This review summarises clinical data on interactions between drugs and herbal medicines, which were compiled using the following databases: MEDLINE via PubMed, Web of Science® (from their inception until March 2005) and the Cochrane Library (until 2005, issue 1). Clinical data on herb-drug interactions, observed in case reports, case series or clinical trials, were included. Results are described for the following herbs: Devil’s claw ( Harpagophytum procumbens D.C.), echinacea, evening primrose ( Oenothera biennis L.), garlic ( Allium sativum L.), ginkgo ( Ginkgo biloba L.), goldenseal ( Hydrastis canadensis L.), hawthorn, kava ( Piper methysticum Forst.), milk thistle ( Silybum marianum [L.] Gaertn.), peppermint, saw palmetto ( Serenoa repens [Bartel] Small) and valerian. Information on herb-drug interactions is discussed through use of in vivo and experimental data, and conclusions are drawn when possible.
This study evaluated the potential for transdermal absorption of castor oil, a treatment modality recommended by Edgar Cayce and used as an alternative medical treatment. Specific epoxydicarboxylic acids are known to be excreted via the urine when castor oil is administered orally.
The opinions of healthcare providers play a crucial role in the debate around integrating complementary and alternative medicine (CAM) into the current healthcare system. The aim of this study is to explore the issue of CAM integration from the provider viewpoint by determining (a) what working relationship CAM practitioners and general practitioners (GPs) prefer or find acceptable, (b) whether there is agreement in the responses of CAM practitioners and GPs and (c) whether expressed opinions differ by CAM modalities.
Extract of the aerial part of Asclepias curassavica L. (Asclepiadaceae family) was screened for both in vitro and in vivo antioxidant activity.
Myocardial infarction (MI) and strokes are leading causes of death in the US. Surgical and medical treatments can be helpful, but carry risks of morbidity and mortality.
Frequently, dietary supplements, vitamins and nutraceuticals are studied and recommended as sole sources of therapy, based upon their individual activities. Scientifically, studies of multiple agents, especially in humans, are infrequent because of the difficulty in asserting mechanisms of action. However, foods are complex mixtures of water- and fat-soluble antioxidants, providing key functions in health promotion and interacting to maintain antioxidant homeostasis. In prevention and treatment of disease mixtures, two or more dietary supplements should be more effective than each individual one. Therefore, we evaluated the published literature and some initial research suggesting that Pycnogenol® and coenzyme Q 10 , water- and lipid-soluble antioxidants respectively, may have synergies to promote heart health.
As specialists who care for families and communities, family physicians have a responsibility to respond to evolving views of healthcare among their patients. Americans are using complementary and alternative medicine (CAM) with increasing frequency and family physicians are well suited to becoming the guides for ensuring the safe and effective integration of conventional and complementary approaches to healthcare.
The best medical practice involves the integration of the therapies taken from the full range of available healthcare options, applied after considering the circumstances of each individual patient. This requires a knowledge of both conventional and non-conventional therapies along with a consideration of the personal preferences of both the practitioner and the patient in the context of informed consent, the strength of the available scientific evidence, the range of possible alternatives, the associated costs and risks versus the potential benefits of treatment, as well as the availability, accessibility and immediacy of treatment.
The use of mindfulness-based stress reduction (MBSR) programmes has become increasingly common in many healthcare settings over the last decade. However, the use and indications for MBSR in an oncology setting has not been well explicated. This paper provides an overview of the psychosocial challenges of cancer diagnosis, treatment and recovery, followed by a description of how MBSR programmes have and may be used with cancer populations, using our programme in Calgary, Canada, as an exemplar.
This commentary provides listings of two main types of botanical medicine information resource: databases and monograph series. The problematic and over-used term ‘database’ is explained and a distinction drawn between herbal monographs that are essentially collections of pre-linked and interpreted text in the form of flat files (pages in electronic format) and scientific botanical medicine and natural product databases that are dynamically created and updated using multiple fields of primary data. Each type of resource has advantages and disadvantages depending on the purpose and needs of the user.
With the increasing use of complementary and alternative medicine (CAM) in the US, academic medical centres need to provide evidence-based CAM information and services. To develop a CAM programme involving practice, education and research at our tertiary-care academic medical centre, we initiated a four-pronged approach: (i) creation of an interdisciplinary CAM interest group, (ii) a survey of CAM use among 1514 patients seen at our institution, (iii) a survey of knowledge and attitudes toward CAM among 660 physicians in our institution’s Department of Internal Medicine and (iv) a pilot study of CAM consultations provided at no cost to 102 patients. Bringing together individuals from multiple disciplines across our institution resulted in numerous alliances and collaborations. We documented that many of our internists thought that addressing CAM therapies would improve patient satisfaction and that our patients used CAM therapies and found CAM consultations helpful. Our present programme is devoted to practice (a CAM consultation service has been implemented), education (medical school lectures and a postgraduate-level curriculum in CAM medicine have been developed) and research (there are several ongoing clinical trials).
Patients’ use of herbal and other dietary supplements and poor reporting of this to medical practitioners is widely documented in the literature. Many herbal supplements have potent pharmacological activity that can lead to potential adverse effects and drug interactions. The perioperative setting is a critical point in patient care for preventing these potential complications. A literature review was conducted regarding commonly used herbal and natural supplements and their potential for adverse effects in the surgical setting. Several herbal supplements or botanicals used by patients may, because of their chemical structure and pharmacokinetics, have adverse effects if used during the perioperative period. With the increasing use of herbal supplements by patients, it is critical for healthcare workers to screen patients pre-surgically for use of herbal and other natural supplements and to be knowledgeable about their potential adverse effects.
