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 • Terms used: alternative medicine, ayurvedic, Chinese medicine, complementary medicine, homeopathic, holistic, integrative, native, natural, naturopathic medicine, unconventional medicine • Can you think of others? 2 Allied health or CAM? • Some allied health therapies are considered by the medical establishment as alternative. These include: – – – – 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. 3 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 4 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/ 5 Definition: • “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. 6 CAM trends - Canada • • • • 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! …………..!  7 Who seeks CAM ?      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:  75% of users of CAM therapies don’t tell their physicians  Canada’s Standing Committee on Health, 1998 8 Why patients/consumers seek CAM? • • • • • • 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 9 Challenges for librarians • • • • • • • • • 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 • 10 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 11 Information Resources        CAM subject guide CAM subset search - PubMed CINAHL, EMBASE, AGRICOLA Cochrane Library IBIDS Database Grey literature Specialized CAM resources abound! 12 Issues for librarians • • • • • • 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 13 Summary • • • • 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 14 •