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Will Duct Tape Cure My Warts? Exploring Complementary and Alternative Medicine (CAM). Gail Kouame Consumer Health Coordinator National Network of Libraries of Medicine Pacific Northwest Region. Introductions. Gail Kouame Consumer Health Coordinator NN/LM, PNR University of Washington

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Will duct tape cure my warts exploring complementary and alternative medicine cam l.jpg

Will Duct Tape Cure My Warts?Exploring Complementary and Alternative Medicine (CAM)

Gail Kouame

Consumer Health Coordinator

National Network of Libraries of Medicine

Pacific Northwest Region


Introductions l.jpg

Introductions

Gail Kouame

Consumer Health Coordinator

NN/LM, PNR

University of Washington

Serve 5 states:

Alaska, Idaho, Montana, Oregon, and Washington


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Introductions

Services/Resources We Provide:

Promote NLM resources

Provide training – like today!

Provide training materials you can use

Fund health information projects

Promotional materials

Consult on proposed outreach efforts


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Introductions

Who we serve:

Health Professionals

Medical Libraries – hospital and other

Public Libraries

Academic Libraries

Community-Based Organizations

Faith-Based Organizations

You!

Emphasis on underserved, underrepresented groups


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Introductions

  • Tell us about you!

    • Your name

    • Where you work, study, or volunteer

    • Ever used a CAM treatment? (if comfortable)

    • Why you’re interested in this topic


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Agenda

  • Definitions

  • History, Impact and Development

  • Usage and Therapies

  • Evaluating Web Sites

  • Avoiding Bad Science

  • Recommended Websites

  • Reviewing the Evidence


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What We Won’t Do

  • Cover the complete picture of CAM – Too broad!

  • Misrepresent CAM therapies

  • Suggest or recommend any one form of CAM over another


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garlic pills

How do you get rid of a wart?

cabbage

alfalfa pills

castor oil

banana peel

toothpaste

Liquid nitrogen

iodine

potato

windex

nail polish

raw meat

silk thread

duct tape

witch hazel

aloe

dandelion juice

cigarette ashes

apple cider

quarters

orange peel


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Defining CAM – what it isn’t

  • Conventional

  • Allopathic

  • Western

    • All are words for systems in which symptoms are treated or controlled (palliated)

  • Traditional

    • Affiliated more with native and indigenous populations, and may also be under the umbrella of CAM


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Defining CAM

  • Complementary and Alternative Medicine (CAM)

  • Complementary: together with

    • Use of medical aromatics may help alleviate pain after surgery


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Defining CAM

  • Alternative: in place of

    • Using garlic to lower blood pressure

  • Integrative: combine

    • Using CAM and conventional treatment to manage HIV CD4 cell count


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Defining CAM

  • Definition by the World Health Association (WHO):

    Traditional, Complementary and Alternative Medicine (TCAM)


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CAM in the spotlight

  • 1990

    • Wilk et al vs. American Medical Association

  • 1991

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

  • 1994

    • Dietary Supplement Health and Education Act


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CAM in the spotlight

  • 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


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CAM in the spotlight

  • 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)


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CAM in the limelight

March 2000:

  • White House Commission on Complementary and Alternative Medicine Policy

  • Consortium of Academic Health Centers for Integrative medicine

    http://www.ahc.umn.edu/cahcim/members/home.html

    www.camlawblog.com

    www.Naturalhealers.com


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Impact of CAM

  • CDC Report (2002/2007)

    • 38.3% of adults used some form of CAM

    • 12% of children 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


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Who Uses CAM?

  • Overall, CAM use is greater by:

    • Women than men

    • People with higher education levels and higher income

    • People who have been hospitalized in the past year

    • Former smokers, as compared to current smokers or those who never smoked

    • National Center for Complementary and Alternative Medicine


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Who Uses CAM?

  • In 2007, data show 1 in 9 children (age 17 and under) used some form of CAM therapy in last 12 months

  • In 2007, Race and Ethnic breakdown shows 50.3% American Indian and Alaska Native, 43.1% White, 39.9% Asian, 25.5% Black and 23.7% Hispanic

  • National Center for Complementary and Alternative Medicine


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Diseases and Conditions in 2007

  • Back pain* or problem

  • Neck pain

  • Joint pain

  • Arthritis

  • Anxiety/depression*

  • Cholesterol

  • Head or Chest Cold*

  • Other MSK*

  • Headaches/Migraines

  • Among Children*: ADHD and insomnia

*Barnes PM,et al. Complementary and alternative medicine use among adults: United States 2002; CDC

*Barnes PM,et al. Complementary and alternative medicine use among adults and children: United States 2007; CDC


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Top 5 CAM Therapies in 2007

  • Natural products, dietary supplements

  • Deep breathing exercises

  • Meditation

  • Chiropractic Manipulation

  • Yoga

  • Increase in acupuncture, massage therapy and Naturopathic Medicine

  • Among Children: Homeopathic Treatment, Traditional Healers, Progressive relaxation and Diet-Based Therapies

*Barnes PM,et al. Complementary and alternative medicine use among adults: United States 2002; CDC

*Barnes PM,et al. Complementary and alternative medicine use among adults and children: United States 2007; CDC


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Top 10 Supplements in 2007

  • 6. Combinations herb and pills

  • 7. Ginkgo Biloba

  • 8. Chondroitin

  • 9. Garlic Supplements

  • 10.Co-enzyme Q10

  • Fish oil

  • Glucosamine

  • Echinacea

  • Flaxseed oil pills

  • Ginseng

*Barnes PM,et al. Complementary and alternative medicine use among adults: United States 2002; CDC

*Barnes PM,et al. Complementary and alternative medicine use among adults and children: United States 2007; CDC


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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


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Whole Medical Systems

  • Complete systems of theory and practice that evolved independently

  • Traditional systems of medicine practiced by individual cultures throughout the world

    • Includes traditional Chinese medicine, Ayurvedic medicine, Homeopathy, Naturopathy

National Center of Complementary and Alternative Therapy


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Biologically Based Practices

  • Botanicals

  • Animal-derived extracts

  • Vitamins

  • Minerals

  • Fatty acids

  • Amino acids

  • Proteins

  • Whole diets

  • Functional foods

  • Dietary supplements are a subset of biologically based practices

National Center of Complementary and Alternative Therapy


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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


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Energy Medicine

  • Veritable - energy that can bemeasured

    • Includes sound, visible light, magnetism

  • Putative – energy that has yet to be measured

    • human beings are infused with a subtle form of energy

    • Includes qi (ki in Japanese); doshas; prana, homeopathic resonance

National Center of Complementary and Alternative Therapy


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Energy Medicine - Acupuncture

  • Few complications

  • Scientific evidence?

    • post chemotherapy management of nausea

    • pain relief

  • NIH Consensus Statement (1997)

    • http://consensus.nih.gov/1997/1997Acupuncture107html.htm


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Manipulative and Body-Based

  • Structures and systems of the body, including:

    • bones and joints

    • soft tissues

    • circulatory and lymphatic systems

  • Includes:

    • chiropractic manipulation

    • massage therapy

    • Reflexology

    • Rolfing

    • Alexander technique

    • Feldenkrais method

National Center of Complementary and Alternative Therapy


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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

*National Center of Complementary and Alternative Therapy


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Other CAM Modalities

  • Aromatherapy (Medical Aromatics)

  • Colonic Irrigation

  • Therapeutic Touch (Reiki)

  • EDTA Chelation

  • Cupping (Licensed acupuncturist)

  • Primordial Sound Meditation




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Finding the Good Stuff: - Evaluating Web Sites

  • Use these suggested criteria:

    • Accuracy

    • Authority

    • Bias

    • Currency

    • Coverage


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Avoiding Bad Science

  • The “One Product Does It All” claim

  • http://www.emuoilcanada.com/

    • Personal Testimonials http://www.getslimslippers.com/

    • Quick Fixes/Cures

  • http://www.cure-your-asthma.com

    • The “No Risk Money Back Guarantee”

      • http://www.naturalhpvcure.com/

    • The “Natural” claim

  • http://www.amtrueman.com/products.html


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    Good Starting Places

    • MedlinePlus.gov

      • NLM’s consumer health portal site

      • NCCAM - http://nccam.nih.gov/

        • National Center for Complementary and Alternative Medicine at NIH

      • Alternative Medicine Foundation

        • http://www.amfoundation.org/index.htm


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    Reviewing the Evidence

    • Evidence Based Medicine: “What evidence do we have to justify the treatment…”

    • National Center for Complementary and Alternative Medicine (NCCAM)

      • http://nccam.nih.gov/

    • CAM on PubMed

      • Pubmed.gov

      • http://nccam.nih.gov/camonpubmed/


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    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


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    Anatomy of a Medical Research Article

    Most are research articles are structured similarly

    Abstract – summary of the article

    Methods – the heart of the matter

    Results – crunching the numbers

    Conclusion/Recommendations – the wrap-up

    Let’s go deeper…


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    Abstract

    What are the objectives in performing the research study to begin with?

    What are the research questions being asked?

    Who’s paying for the research? Might there be a bias from the get-go?


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    Methods

    How was the study designed?

    What type of study was performed

    Top three are: randomized clinical trials, longitudinal or cohort studies, and case control studies – all have comparison to a control group

    How was the study population sampled?


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    Results

    Three key concerns

    Is it real or did it happen by chance?

    Statistical significance – look for the “p-value” – it should be less than .05

    Is it big enough to be important?

    Relative risk vs. absolute risk


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    Results

    Three key concerns

    3.Does is apply to me? Is it relevant?

    Is the study generalizable?

    If the subjects were male college students, will it apply to middle-aged women?

    If animal study – wait and see!


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    Conclusion

    Do you agree with the conclusions the authors make?

    Does the study have bearings on your own circumstances?

    When in doubt, consult a health professional!


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    Health Literacy and CAM

    • All this boils down to health literacy:

  • The degree to which individuals have the capacity to:

    • Obtain

    • Process

    • Understand

  • basic health information and services needed to make appropriate health decisions.

  • Healthy People 2010


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    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.


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    Clinical Trials and CAM

    • Why are there so few CAM clinical trials?

      • 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



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    Thank You!

    National Network of Libraries of Medicine

    Pacific Northwest Region

    800-338-7657

    Gail Kouame

    [email protected]

    206-221-3449


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