Complementary and Alternative Medicine CAM for Librarians

					Complementary & Alternative Medicine (CAM) for Librarians

Dean Giustini & Greg Rowell LIBR538f - Health sciences librarianship March 8th, 2005

Range of terms in CAM
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Terms used: alternative medicine, ayurvedic, Chinese medicine, complementary medicine, homeopathic, holistic, integrative, native, natural, naturopathic medicine, unconventional medicine

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Can you think of others?
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Allied health or CAM?
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Some allied health therapies are considered by the medical establishment as alternative. These include:
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Music therapy* Art therapy Drama therapy Relaxation therapy
Richardson A, Giustini D. The information needs of clinical music therapists: challenges of assessment in clinical setting. JCHLA/JABSC. 2004; 25(4): 107-110.

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B.C. CAM information
British Columbia Naturopathic Association http://www.bcna.ca/index-new.htm

Boucher Institute Of Naturopathic Medicine http://www.binm.org
BC Government – Naturopathy Regulations
http://www.healthplanning.gov.bc.ca/leg/notice/naturopathy.html

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Five domains of CAM *
1) 2) 3)

Alternative medical systems Mind-body Pharmacologic and biologic Rx
• Herbal supplements, special diets, nutrition

4) 5)

Manual healing-manipulative methods Energy field therapies
*National Center for Complementary and Alternative Medicine. Expanding horizons of healthcare. Five- year strategic plan 2001-2005. Available from: http://nccam.nih.gov/strategic/
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Definition:
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“CAM is a broad domain of healing and resources encompassing all health systems and practices, theories and beliefs … other than those intrinsic to the dominant political health systems in place in society …”
Adopted by the Cochrane Collaboration. Achilles, R. 2000 Defining

complementary & alternative health care , Health Canada.

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CAM trends - Canada
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Fastest growing trend in health care
6 million+ CAM users in Canada $1.8 billion paid out for CAM providers 55% paid outside of insurance plans
4 billion dollars spent on products  40 million visits to CAM providers annually  Greater than visits to physicians! …………..!
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Who seeks CAM ?
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Women use CAM more than men Baby boomers with incomes of $60K+ per yr Highly-educated - major predictor of CAM use Patients with chronic problems or illness seek CAM (ie. anxiety, back pain, HIV, cancer, arthritis, MS) Problem:
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75% of users of CAM therapies don’t tell their physicians
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Canada’s Standing Committee on Health, 1998

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Why patients/consumers seek CAM?
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Good practitioner-patient relations Patients say they feel understood by CAM doctors Validated as individuals CAM aims to get to the root of a problem, not only treat symptoms Improves quality of life & well-being generally CAM can validate a patient’s subjective experience of chronic or mind-body illnesses

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Challenges for librarians
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Credible sources “Evidence base” is weak; some RCTs Is placebo the reason why CAM works? CAM regulation is weak; patients don’t tell doctors Lack of quality control with CAM Prescribed drugs interact with herbal remedies Problem with ads that look like information sources Fitness magazines & websites - dot.com Quackwatch – website devoted to uncovering scams Librarians must be aware of misleading claims & testimonials

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Regulation – Canada & US
• Health Canada - Natural Health Products Directorate
• Regulations published in 2003; with Food & Drug Act • To ensure safe, effective, high quality product approval • Six year transition to Drug Information Numbers (DINs)

• Food and Drug Adminstration (FDA) – United States
• Monitors safety of food & drugs, including CAM products • FDA established Office of Dietary Supplements in 1994 • Research is conducted at the NIH:
• U.S. Center for Complementary & Alternative Medicine

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Information Resources
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CAM subject guide CAM subset search - PubMed CINAHL, EMBASE, AGRICOLA Cochrane Library IBIDS Database Grey literature

Specialized CAM resources abound!
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Issues for librarians
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Health professionals can be skeptical of CAM patients sense that skepticism Evaluation of information is a challenge • Poor bibliographic control; fragmentation of information Librarians can facilitate integration of CAM Variability of CAM products Limited safety and adverse reaction information How will we teach consumers about fraudulent claims or exploitative information

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Summary
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CAM is a wide range of therapies in five domains Herbal/drug reactions big problem Evidence based practice CAM on the rise • Librarians can take lead here • Emphasize safety to patients & consumers • Help them to evaluate info/ health fraud Emphasize buyer beware - reader beware

Librarians can help patients & physicians find the best, most reliable evidence-based CAM information
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