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Transcript of Finding Quality Online Information about Complementary and Alternative Medicine (CAM) National...
Finding Quality Online Information about
Complementary and Alternative Medicine (CAM)
National Network of Libraries of Medicine
New England Region
The headlines….
With the constant flux of new information on CAM…
1) How can we find information that is evidence based?
2) What are the top consumer health and clinical resources to find quality information about CAM?
3) How can we help our patrons evaluate CAM information?
Agenda
• Definitions
• History and Impact
• Usage and Therapies
• Evaluating Web Sites
• Avoiding Bad Science
• Recommended Websites
• Reviewing the Evidence
How do you get rid of a wart?
raw meat
banana peel
potato
witch hazelduct tape silk thread
alfalfa pills
apple cider
toothpaste
castor oil
quarters
windex
dandelion juice cigarette ashes
garlic pills cabbage
orange peel
nail polish
iodine
aloe
c
e
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
http://ods.od.nih.gov/– 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 http://nccam.nih.gov/
– First full scale article in JAMA on herbal medicine
– Office of Cancer Complementary and Alternative Medicine (OCCAM) established http://www.cancer.gov/cam/
• 2001– CAM on PubMed (NCCAM and NLM)
Impact of CAM
• CDC Report (2004)– 36% of adults used some form of CAM – 55% CAM + conventional treatments– 26% used CAM because a medical
professional suggested it– $36-47 billion on CAM therapies in 1997– $5 billion on herbal remedies
• JAMA (1998)– 12.1% of population use herbal medicine
Impact of CAM
According to the National Health Statistics Report of the CDC, in 2007:
• 4 out of 10 adults used a CAM therapy in the last 12 months
• 1 out of 9 children used CAM therapies in the last 12 months
• Between 2002 and 2007 increased use was seen among adults for acupuncture, deep breathing, massage therapy, meditation, naturopathy, and yoga
Diseases and Conditions 2002
1. Back pain or problem2. Head or chest cold3. Neck pain or problem4. Joint pain or stiffness5. Anxiety/depression6. Arthritis, gout, lupus or fibromyalgia7. Stomach or intestinal illness8. Severe headache or migraine
*Barnes PM,et al. Complementary and alternative medicine use among adults: United States 2002; CDC
Diseases and Condition 2007
1. Back pain
2. Neck pain
3. Joint pain or stiffness
4. Arthritis
5. Other, specify
6. Anxiety
7. Cholesterol
8. Head or Chest Cold
Top 5 CAM Therapies 2002
1. Natural products, dietary supplements
2. Deep breathing exercises
3. Meditation
4. Chiropractic
5. Yoga
*Barnes PM,et al. Complementary and alternative medicine use among adults: United States 2002; CDC
Top 5 CAM Therapies 2007:Same as 2002
Top 10 Supplements 2002
1. Echinacea
2. Ginseng
3. Ginkgo biloba
4. Garlic
5. Glucosamine
6. St. John’s Wort
7. Peppermint
8. Fish oil/Omega 3
9. Ginger
10.Soy
*Barnes PM,et al. Complementary and alternative medicine use among adults: United States 2002; CDC
Top supplement for 2007?
Top 10 Supplements 2007
1. Fish Oil or Omega 3 or DHA
2. Glucosamine
3. Echinacea
4. Flaxseed oil or pills
5. Ginseng
6. Combination herb pill
7. Ginkgo biloba
8. Chondrotin
9. Garlic Supplements
10.Coenzyme Q-10
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 Therapy
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 Therapy
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 Therapy
Biologically Based - Supplements
• What is a supplement?
• Regulated by FDA http://www.fda.gov– no requirements for FDA testing– manufacturers responsible for ensuring
product safety– label requirements– safety alerts:
http://www.cfsan.fda.gov/~dms/ds-warn.html
Energy Medicine
• Biofield therapies: qi gong, Reiki, Therapeutic touch, Bioenergetics
• Bioelectricmagnetic based therapies:Electromagnetic fields, magnetic fields
*National Center of Complementary and Alternative Therapy
Manipulative and Body-Based
Structures and systems of the body,
including the bones and joints, the soft
tissues, and the circulatory and lymphatic
systems. Includes: chiropractic manipulation massage therapy reflexology Alexander technique Feldenkrais method
*National Center of Complementary and Alternative Therapy
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 Therapy
Other CAM Therapies
• Aromatherapy
• Colonic Irrigation
• Therapeutic Touch
• EDTA Chelation
• Cupping
• Primordial Sound Meditation
Avoiding Bad Science
• The “One Product Does It All” claimhttp://www.emuoilcanada.com/
• Personal Testimonials http://www.getslimslippers.com/
• Quick Fixes/Cureshttp://www.cure-your-asthma.com
• The “No Risk Money Back Guarantee” http://www.naturalhpvcure.com/
• The “Natural” claim http://www.amtrueman.com/products.html
Evaluating Web Sites
• Accuracy
• Authority
• Bias
• Currency
• Coverage
• User Friendliness
Examining the Research
• Observational Studies• Clinical Trials/Studies
– controlled– blind/double-blind– randomized
• ClinicalTrials.gov– Government and private clinical studies
involving humans– http://clinicaltrials.gov
Clinical Trials and CAM
• Why are there so few CAM clinical trials?– Drug companies have to do studies to go on the
market—supplement companies do not, so clinical trials sponsored by supplement companies are rare
– Alternative treatments are often customized for a specific person. Clinical trials try to prove something works for most people.
– Belief systems of some CAM practitioners do not agree with the idea of Western studies, so they do not participate
– CAM has only recently become “legit” in the scientific community
National Center for Complementary and Alternative Medicine (NCCAM)
http://nccam.nih.gov
MedlinePlus.gov
http://www.mskcc.org/mskcc/html/11570.cfm
http://nccam.nih.gov/research/camonpubmed/
http://dietarysupplements.nlm.nih.gov
http://www.cancer.gov/CAM/
http://www.noah-health.org/en/alternative/index.html
http://amfoundation.org
Questions???
Take home points
• Learn more about commonly used CAM to help you better serve your library users
• Familiarize yourself with quality online resources for CAM
• Be a “selective searcher”…evaluate online CAM information carefully
Thank You!
Michelle EberleConsumer Health Information Coordinator
National Network of Libraries of Medicine
New England Region
800-338-7657