The Richard and Hinda Rosenthal Lectures -- 2001 Exploring Complementary and Alternative Medicine (2003) / Chapter Skim
Currently Skimming:
Complementary and Integrative Medical Therapies Current Status and Future Trends
Complementary and Integrative Medical Therapies Current Status and Future Trends
Pages 1-24
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therapies may be defined as interventions neither taught widely in medical schools nor generally available in hospitals (3~. Ernst et al.
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intended to supplement the diet that bear or contain one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, soft gel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet. The DSHEA legislation stipulates that botanicals and other dietary supplements are not "drugs" and, as such, are not held to the same regulatory requirements as drugs (i.e., prerequisite evidence of both safety and efficacy)
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· Current use of CAM services is likely to under-represent utilization patterns if insurance coverage for CAM therapies increases in the future. · Despite the dramatic increases in the use and expenditures associated with CAM services, the extent to which patients disclose their use of CAM therapies to their physicians remains low.
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This trend suggests a continuing demand for CAM therapies that will offset health care delivery for the foreseeable future." A recent publication by Eisenberg et al. examined perceptions about CAM therapies relative to conventional therapies among adults who used both.
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Examples include surveys involving CAM therapy use among individuals with: cancer (26-35~; rheumatologic disorders (36-38~; self-reported disability (39~; HIV (40~; inflammatory bowel disease (41~; and rhinosinusitis (42~; as well as surgical patients (43~; and patients in an emergency department (44~. National surveys performed outside the United States suggest that CAM is popular throughout the industrialized world (45~.
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(54~. In light of these findings, the authors conclude that there is broad public support to increase governmental regulation to ensure that advertising claims about health benefits of dietary supplements are true.
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Drug Store News, May 2000 German Commission E, 1998
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questions "whether a true integration of conventional and unconventional therapies is even possible" and addresses educational options in this regard (57~. In recent years, the NIH NCCAM has awarded multiple educational training grants to a growing number of medical schools, universities, and CAM educational institutions.
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Increasingly, however, the peer-reviewed medical literature has included consensus conferences, randomized controlled trials, systematic reviews, and meta-analyses involving CAM therapies. Noteworthy examples of recently published original trials and reviews include: Selected Consensus Reports, Clinical Trials, and Reviews Suggesting That CAM Therapies May Be Effective and/or Warrant Further Clinical Investigation 1)
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Selected Clinical Trials Suggesting That CAM Therapies May Lack Efficacy 1) Acupuncture for Peripheral Neuropathy (93)
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. Ernst has documented the relative absence of cost-effectiveness research involving CAM Integrative Medicine interventions (118~.
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Their findings, published in JAMA included the observation that claims against licensed CAM practitioners occurred less frequently and typically involved injury that was less severe than claims against physicians during the same period. This article also described specific situations in which referral by a medical doctor to a licensed CAM practitioner will or will not likely be construed as negligent.
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The Annals of Internal Medicine special series on CAM has scheduled the publication of individual papers on CAM-related malpractice, credentialing and ethics in the spring of 2002. In addition, the Federation of State Medical Boards is scheduled to vote on model guidelines for the use of CAM therapies in medical practice later this year (2002~.
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insurance coverage for alternative therapies increases in the future (19~. Trends involving insurance coverage for CAM therapies have recently been reviewed by Pelletier et al.
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fiscal constraints and the absence of a financially sustainable model; 4) ignorance about CAM therapies on the part of referring physicians; 5)
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· Models that include access for CAM services for those with less expendable income and/or lack of medical insurance. · Medical-legal guidelines for conventional and CAM practitioners, institutions and third party payers so as to minimize liability exposure.
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be required to address quality assurance issues regarding dietary supplements? How can the issue of intellectual property (i.e., patents)
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The persuasive appeal of alternative medicine. Ann Intern Med.
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Use of alternative therapies among breast cancer outpatients compared with the general population. Altern Ther Health Med.
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Americans' views on the use and regulation of dietary supplements. Arch Intern Med.
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Guo A, Ngu M Treatment of irritable bowel syndrome with Chinese herbal medicine: A randomized controlled trial [In Process Citation]
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Acupuncture for recurrent headaches: A systematic review of randomized controlled trials. Cephalalgia.
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Randomised controlled trial of infantile colic treated with chiropractic spinal manipulation. Arch Dis Child.
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Advising patients who seek alternative medical therapies. Ann Intern Med.
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