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					Will duct tape cure my warts?
 Examining Complementary
     and Alternative Medicine

                                Karen Vargas
        Consumer Health Outreach Coordinator

      National Network of Libraries of Medicine
                         South Central Region
• Introducing CAM

• Evaluating Web Sites

• Recommended Websites

• Reviewing the Evidence
      garlic pills                   cabbage
                     alfalfa pills
     castor oil                           e
iodine                     banana peel
   How do you get rid of a wart?
       potato silk thread
                            nail polish
 duct tape
                raw meat witch hazel
dandelion juice
                 cigarette ashes aloe
  apple cider
 c         orange peel       quarters
What is CAM?
• Complementary and Alternative Medicine

• Complementary: together with
   – aromatherapy to help with pain after surgery

• Alternative: in place of
   – using garlic to lower blood pressure
CAM becomes “legit”
• 1990
  – Wilk et al v. AMA

• 1991
  – $2 million in funding to establish NIH Office of
    Alternative Medicine

• 1994
  – Dietary Supplement Health and Education Act
CAM becomes “legit”
• 1995
  – NIH Office of Dietary Supplements
  – FDA declassifies Acupuncture
    needles as experimental product

• 1996
  – NIH Consensus Conference on Acupuncture

• 1997
  – First large trial of CAM therapy, St. John’s Wort
    for depression
CAM becomes “legit”
• 1998
  – National Center for Complementary &
    Alternative Medicine (NCCAM) established
  – First full scale article in JAMA on herbal medicine
  – Office of Cancer Complementary and Alternative
    Medicine (OCCAM) established

• 2001
  – CAM on PubMed (NCCAM and NLM)

• 2009 - $296 million in NIH CAM research
Impact of CAM
• CDC Report (2007)
  – 38% of adults used some form of CAM
  – Children whose parent used CAM were 2x as likely
    to have used CAM
  – CAM use more prevalent for: women, adults aged
    30-69, higher levels of education, adults who were
    not poor, adults living in the West, and former

• Full report:
Diseases and Conditions
Top CAM Therapies
Top 10 Supplements
           Categorization of Therapies
•    Whole Medical Systems
•    Biologically Based Practices
•    Energy Medicine
•    Manipulative and Body-Based Practices
•    Mind-Body Medicine

National Center of Complementary and Alternative Medicine
           Whole Medical Systems
• Complete systems of theory and practice
  that evolved independently
• Traditional systems of medicine that are
  practiced by individual cultures throughout
  the world
      – Includes traditional Chinese
        medicine, Ayurvedic medicine,
        homeopathy, naturopathy

National Center of Complementary and Alternative Medicine
           Biologically Based Practices
• Includes: botanicals, animal-derived extracts,
  vitamins, minerals, fatty acids, amino acids,
  proteins, whole diets, and functional foods
      – Dietary supplements are a subset
        of biologically based practices

National Center of Complementary and Alternative Medicine
Biologically Based - Supplements
• What is a supplement?

• Regulated by FDA
  – no requirements for FDA testing
  – manufacturers responsible for ensuring
    product safety
  – label requirements

• Safety alerts:
Energy Medicine
• Veritable - energy that can be
      – Includes sound, visible light, magnetism

• Putative – energy that has yet to be
      – human beings are infused with a subtle form of
      – Includes qi (ki in Japanese); doshas; prana,
        homeopathic resonance
National Center of Complementary and Alternative Medicine
Energy Medicine - Acupuncture
• Few complications
• Scientific evidence?
  – post chemotherapy management of nausea
  – pain relief
• NIH Consensus Statement (1997)
            Manipulative and Body-Based
• Structures and systems of the body,
  including the bones and joints, the soft
  tissues, and the circulatory and lymphatic
      – Includes chiropractic manipulation,
        massage therapy, reflexology,
        rolfing, Alexander technique,
        Feldenkrais method

*National Center of Complementary and Alternative Medicine
Mind-Body Medicine
• Interactions among the brain,
  mind, body, and behavior

• The ways in which emotional, mental, social,
  spiritual, and behavioral factors can directly
  affect health
      – Includes relaxation, hypnosis, visual imagery,
        meditation, yoga, biofeedback, tai chi, group
        support, and spirituality
*National Center of Complementary and Alternative Medicine
Other CAM Therapies
•   Aromatherapy
•   Colonic Irrigation
•   Therapeutic Touch
•   EDTA Chelation
•   Cupping
•   Primordial Sound Meditation
Avoiding Bad Science
• The “One Product Does It All” claim
• Personal Testimonials
• Quick Fixes/Cures
• The “No Risk Money Back Guarantee”
• The “Natural” claim
Evaluating Web Sites

 • Accuracy
 • Authority
 • Bias
 • Currency
 • Coverage
Evaluation Exercises
Recommended Websites

           About Herbs, Botanicals &
           Other Products
Examining the Research
• Observational Studies
• Clinical Trials/Studies
  – controlled
  – blind/double-blind
  – randomized

  – Government and private clinical studies
    involving humans
Clinical Trials and CAM

• Drug companies vs. supplement companies
• Customization of treatment in CAM
• CAM does not necessarily want to be
• CAM has only recently become “legit” in the
 scientific community
Money to fund CAM
• NCCAM: $121.7 million (2009)
• OCCAM: $121.9 million (2009)
  – Total all NIH: $296 million

• What about funding for pharmaceuticals?
  – $65.2 billion on R&D (2008) by drug companies
  – $114.4 billion on R&D (2008) by NIH (this
    includes NCCAM and OCCAM)
The other side
• Some say CAM research should not be
  – (Stephen Barrett)

• Or some CAM research should not be funded
Reviewing the Evidence
• Evidence Based Medicine: “What evidence
  do we have to justify the treatment…”
• National Center for Complementary and
  Alternative Medicine (NCCAM)
• CAM on PubMed
CAM on PubMed Exercises

             Karen Vargas

National Network of Libraries of Medicine
          South Central Region