Effectiveness and non-effectiveness of CAM use in children and adolescents: let's take a look beyond prevalence rates.

Abstract

Dear Sir, We read with interest the systematic review on prevalence rates and predictors of complementary and alternative medicine (CAM) use among children and adolescents by Italia and colleagues [2]. They demonstrated that prevalence rates for overall CAM use ranged from 10.9 to 87.6 % for lifetime use and from 8 to 48.5 % for current use. The respective percentages for homeopathy—which were highest in Germany, UK, and Canada—vary from 0.8 to 39 % (lifetime) and from 1 to 14.3 % (current). Herbal drug use (again highest in Germany as well as Turkey and Brazil) was reported for 0.8–85.5 % (lifetime) and 2.2–8.9 % (current) of the children and adolescents. Furthermore, higher parental income and education and older children were uniform predictors of overall CAM use. These results are in line with our experiences regarding the use of CAM in children and adolescents with different underlying diseases in Germany [1, 3]. Undoubtedly, these data are of great importance for the treating physician given the possibility of intrinsic potential side effects and unwanted interactions of CAM therapies/medications with “conventional” drugs [1, 3]. Given the ongoing controversy surrounding the use, and more importantly the (non-) effectiveness of CAM, we would like to add some further information on this important issue. In a recently published systematic analysis, we analyzed all Cochrane reviews published between 1995 and 2012 in pediatrics that assessed the efficacy and clinical implications and limitations of CAM use in children [4]. Main outcome variables of our study were percentage of reviews that concluded that a certain intervention provides a benefit, percentage of reviews that concluded that a certain intervention should not be performed, and percentage of studies that concluded that the current level of evidence is inconclusive. A total of 135 reviews were included in our study, most from the UK (29/ 135), Australia (24/135), and China (24/135). Only 5/135 (3.7 %) reviews gave a recommendation in favor of a certain intervention; 26/135 (19.4 %) issued a conditional positive recommendation, and 9/135 (6.6 %) reviews concluded that certain interventions should not be performed. Ninety-five reviews (70.3 %) were inconclusive. The proportion of inconclusive reviews increased from the first to the second interval, and then remained roughly on the same high level during the third time interval (1995–2000, 15/27 [55.6 %]; 2001–2006, 33/44 [75 %]; and 2007–2012, 47/64 [73.4 %]). The three most common criticisms of the quality of the studies included were the following: more research needed (82/135), low methodological quality (57/135), and small number of study participants (48/135). Given the disproportionate number of inconclusive reviews in the field of CAM use in pediatrics, also when compared to other subspecialties in pediatrics [5], there is an ongoing need for high-quality research to assess the potential role and limitations of CAM in children. Unless the study of CAM is performed to the same science-based standards as conventional therapies, CAM therapies risk being perpetually marginalized by mainstream medicine. Moreover, our data may help physicians, pharmacists, and other health care workers when discussing different aspects of CAM in an open manner with children, adolescents, and their parents, thus being able to provide them with information regarding the (non-) Communicated by Peter de Winter