Alternative Medical Therapies Research Articles

Complementary, Holistic, and Integrative Medicine: Headaches

1. Kathi J. Kemper, MD, MPH* 2. Cora Collette Breuner, MD, MPH† 1. *Caryl J. Guth Chair for Holistic & Integrative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC. 2. †Associate Professor, Pediatrics, University of Washington, Seattle, Wash. ### Case 1 Daria is a 15-year-old girl who has a 2-year history of migraine headaches. Her headaches occur on most days, particularly if she has had insufficient sleep, excessive stress, or exposure to tobacco smoke. She has been evaluated by a neurologist, dentist, and ophthalmologist. All of her physical examinations, computed tomography scan of the head, magnetic resonance imagining, and blood tests have yielded normal results. She has tried multiple medications, including acetaminophen, ibuprofen (which she tries to limit to once or twice weekly), triptans, imipramine, propranolol, and a short course of prednisone. She missed 20 days of school in the past 3 months, and her parents are in the midst of a separation (her father moved about 10 months ago). Her mother has read about natural remedies, including feverfew, riboflavin, and magnesium, and wants to know if they might help. ### Case 2 Simon is an 8-year-old boy who, according to his mother, “has had headaches as long as I can remember.” As a toddler, he had cyclic vomiting. His evaluation by a pediatric gastroenterologist yielded normal results. In kindergarten, he began having headaches with vomiting, which were severe enough to necessitate a visit to the school nurse weekly. Before some of his headaches, he sees wavy, curling lines with flashing lights. Acetaminophen and ibuprofen have not been helpful. A neurologist has recommended prophylactic propranolol. His mother, who also suffers from recurrent headaches, asks about nonpharmaceutical therapies, including massage and acupuncture. Complementary and alternative medical (CAM) therapies are used commonly to prevent and treat headaches. Children and adolescents often have headaches; among …

Complementary and Alternative Medicine in Alopecia Areata

Alopecia areata is an unpredictable hair-loss condition. As there is no cure for alopecia areata and no effective conventional therapy, a substantial number of alopecia areata patients resort to complementary and alternative medical remedies and therapies (CAM). This review on the application of CAM in alopecia areata addresses two pertinent aspects. First, it provides a current overview of the published medical literature on CAM used in alopecia areata, and alopecia areata-related studies. Second, it presents a thorough assessment of the considerations and limitations of the use of CAM for the treatment of alopecia areata. A systematic MEDLINE search yielded 13 studies of the clinical use of CAM in the management of alopecia areata, all belonging to one of the five main categories of CAM. Methodological quality was analyzed using objective assessment scores (Wilson and Lawrence scores). Unfortunately, no study was of sufficient internal validity to provide robust evidence of the benefit of CAM. This might be attributable to several specific disease characteristics of alopecia areata, which require an especially solid trial design to properly assess the therapeutic effects of CAM. The review concludes with some recommendations for improving the quality of trials incorporating CAM in the treatment of alopecia areata.

Childrenʼs experiences of their postoperative pain management: a qualitative systematic review

Childrenʼs experiences of their postoperative pain management: a qualitative systematic review

Aroma Therapy in Anti-Aging Medicine

Medical aromatherapy aimed at enhancing the prevention and symptomatic treatment of disease is widely used in nursing and the nursing field. It is important that the specific fragrance and its application are selected only after the absorption and mechanism of action of its essential oil are understood. Because it acts on the hippocampus and autonomic nervous system, fragrance stimulation has been considered a complementary and alternative medical therapy for dementia, sleeplessness and sleep disturbance, all of which are related to aging. The in vivo role of free radicals in the development of various diseases has recently been identified. A recent study reported that fragrance use enhanced the elimination of free radicals, and wide application of this modality in complementary and alternative medicine is expected.

Probiotics marketed to patients with Crohnʼs Disease lack supporting data

It has been reported n up to 70% of patients with inflammatory bowel disease (IBD) use alternative medical therapies. Probiotics are among these therapies and are easily available on the Internet. Probiotics have been reported to be effective as adjunctive therapy for maintaining remission in ulcerative colitis and preventing pouchitis. However, the role of probiotics in Crohn's disease remains unclear. Despite the lack of data supporting their use, probiotics are marketed to Crohn's patients. This study evaluated the therapeutic claims and microbial composition of probiotics marketed to patients with Crohns' disease. Using the online search engine Google, “Crohn's AND probiotic” was searched using Boolean logic. Data was retrieved from 07/22/09-07/24/09. The first 100 websites were categorized as commercial, academic, informational or as blogs. Commercial websites were defined as those marketing or selling a product. Academic websites were those containing scholarly journal articles or textbooks. Informational websites were defined as sites containing information regarding Crohn's disease and probiotics, but did not market or sell products. A blog was defined as a personal chronological log. For each commercial website, the products' microbial composition, therapeutic claims and cost were obtained. In the first 100 websites, there were 9 commercial, 32 academic, 36 informational websites and 22 blogs. 1 website was not operational. In the 9 commercial websites, 20 different products were marketed. These 20 products contained varying combinations of 25 microbes. 11 (55%) products claimed to be curative for Crohn's disease and 9 (45%) were marketed as adjunctive therapy. The therapeutic claims included, 3 (15%) products providing testimonials and 12 (60%) claiming efficacy through “laboratory evaluation” and/or “proven clinical effectiveness”. 6 products (30%) provided no information about microbial composition, laboratory evaluation, testimonials or clinical trials. The link for 1 (5%) product was not operational. 4 of the 20 products did not contain any microbes shown to be beneficial in IBD. 14 products contained at least one microbe that had been studied in IBD, with 13 of the products also containing microbes that have not been studied. 1 product did not specify individual microbes, noting that it contained “six complementary beneficial bacteria”. 1 product's website was not operational and the microbial composition and cost could not be obtained. The cost of the marketed products ranged from $167.40 to $1908 annually. The chronic and relapsing nature of Crohn's disease contributes to the use of probiotics. While future studies may support probiotics as adjunctive therapy in Crohn's disease, there are presently few studies that have shown therapeutic efficacy. Internet searches seeking probiotic information can lead to sites selling products. This study revealed that probiotics marketed on the Internet frequently make statements that are not supported by clinical data, often claiming to be curative. Most marketed products are not limited to the microbes that have been studied. Crohn's patients can be misled into believing that marketed probiotics have clear treatment benefit. Physicians must recognize potential misinformation, remain informed about probiotics and educate patients about all therapies used in inflammatory bowel disease.

Educational initiatives in integrative medicine: The imperative for change

As the public's use of complementary and alternative medical (CAM) therapies has increased, and as research into the safety and efficacy of these modalities has intensified, medical schools are faced with the challenge of determining how best to integrate this information into the curriculum. Over the past decade, there has been increased interest and activity at many medical schools to incorporate complementary, alternative and integrative medicine (CAM) into the 4-year-undergraduate medical curriculum, as well as to graduate medical education programs. Beginning in 2000, the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health in the US funded 15 institutions for multi-year grants (R25 awards) to foster these types of educational initiatives. The efforts of this group have been documented in a series of articles published in Academic Medicine and other key journals. Another important development has been the formation in 2002 of the Consortium of Academic Health Centers for Integrative Medicine , a group of now 43 medical schools in North America dedicated to helping transform healthcare through rigorous scientific studies, new models of clinical care, and innovative educational programs that integrate biomedicine with the rich diversity of various therapeutic systems and modalities. The Consortium published a suggested list of core competencies in integrative medicine that all graduates of medical school should possess ( Acad. Med. 79:521–531, 2004 ), and also compiled a series of modules for teaching elements of Integrative Medicine. In Canada, efforts are underway, through the CAM in UME (Undergraduate Medical Education) Project, to broaden the awareness of CAM practices, products and perspectives in an evidence-based manner across the various curricula. In this plenary presentation, Dr. Haramati will outline the imperative for moving medical education in this direction. A variety of approaches will be highlighted in which material from the thematic thread of Complementary and Integrative Medicine , that is the blending of conventional and non-conventional therapies, can be used to advance both scientific curricular objectives and also to help students attain proficiency in competencies related to professionalism, such as self-awareness, self-care and personal growth.

Vertigo—The practitioner's view

Dizziness and vertigo (International Classification of Disease-R42) are listed under the top 10 symptoms in an outpatient setting seeking advice by a primary care physician. The lifetime prevalence of dizziness/vertigo is reported to be up to 30% with a female preponderance. The incidence of dizziness and vertigo increases with age. Common findings of comorbidities like hypertension, lipid disorders and others pointing to arteriosclerosis in the elderly are associated with dizziness symptoms; however, a causal relationship is not uniformly given. Therefore the role of concomitant disease for dizziness in the elderly is still under discussion. Epidemiological studies from specialised vertigo referral centers usually report specific diagnosis of vestibular vertigo. Their figures might well be different from an outpatient population. In line with these two reports (Neuhauser et al., 2005; Kruschinski et al., 2008) from different working groups investigating dizziness/vertigo in an outpatient population, we have come to the conclusion that 80% of all dizziness/vertigo (R42) cases present with unspecific symptoms. The symptoms might be feeling unsteady, a tendency to fall or feeling of staggering. To date, little data are available on how to proceed further with this large group of patients presenting with unspecific vertigo symptoms. Undoubtedly referral to a specialist is mandatory if warning symptoms like additional neurologic findings or the new onset of symptoms suggest emergency cases. However, in most elderly patients the symptoms prevail for a longer time and daily activities might be restricted because of that. Given the multifactorial origin in most of the cases (visual, vestibular and somatosensoric disturbances) the dizziness with unspecific symptoms is a therapeutic challenge not well included in treatment guidelines. Treatment strategies to date reach from ignorance from the physicians’ side over physiotherapeutic measures to complementary alternative medical approaches or drug-based therapies derived from experience with vestibular symptoms. However, as most drugs prescribed for vestibular symptoms will have anticholinergic side effects, current guidelines do not recommend this group of antivertiginosa in the dizzy patient. Therefore there is still the quest for a safe, effective therapy. A complementary alternative medical approach might be an option in this unsolved problem for the practitioner.

Are Positive Alternative Medical Therapy Trials Credible?

Forty-five complementary and alternative medicine (CAM) efficacy randomized controlled trials (RCTs) from high-impact medical journals (NEJM, JAMA, Annals of Internal Medicine, and Archives of Internal Medicine) were reviewed based on their meeting three validity criteria (the existence of a placebo control, moderate attrition rates, and 50 or more participants per group). Of the 26 efficacy trials meeting all three criteria, only 2 (7.7%) were judged to be positive (i.e., the alternative therapy was significantly superior to its placebo control), while over half (55.5%) of the 19 trials that failed to meet one or more of these criteria reported positive results (p < .001). Of the two positive high-validity trials, one was funded and authored by the herbal company marketing the product tested and one used a placebo-control group of questionable credibility. This analysis is consistent with the hypothesis that CAM therapies are no more effective than placebos when adequate experimental control is present.

An Unusual Complication: Prolonged Myopathy Due to an Alternative Medical Therapy with Heat and Massage

A 66-year-old male presented with swelling of the neck and arms, which was limiting his daily activities. Serum muscle enzymes were increased. A detailed history revealed that the patient received 10 cycles of infrared heat and massage therapy approximately 1 month before his first visit to the outpatient clinic. The swelling of the extremities began on day 11 of therapy, and the pain became unbearable. He was followed up with analgesics. There was a significant decrease in the muscle enzymes and a subjective improvement of 60-70% one month after discharge. Alternative therapies may have serious complications, and patients usually do not report them unless asked specifically.

Complementary and alternative medical therapies used by children with cancer treated at an Italian pediatric oncology unit

Research has identified a growing use of complementary and alternative medicines (CAM) in the pediatric oncology setting and health care professionals should consider how they might interact with and/or be used in lieu of conventional treatment. The present study was designed to establish the prevalence of CAM usage at an Italian pediatric oncology department, and the reasons why patients used these unconventional therapies. This was an observational study involving parents whose children were treated for tumors at the pediatric oncology unit of the Istituto Nazionale Tumori in Milano. Data were collected on their sociodemographic variables and their use of CAM by means of a self-administered questionnaire. We distributed 145 questionnaires and 97 of them (67%) were returned. Judging from this survey, 12.4% of the children used at least one type of CAM and homoeopathy was the most often used. Benefits were reported by 83% of parents. The most common reasons for using CAM were to reduce the side-effects of conventional therapies. The oncologists taking care of the patients were notified of the child's use of CAM in only one case. CAM were used not as a substitute but in addition to conventional treatments. In almost all cases, oncologists were not informed that a child was using CAM, posing a risk of any interaction with pharmacological treatments being inadequately understood.

The inflammatory reflex and the role of complementary and alternative medical therapies.

The body's first defense against invading pathogens or tissue injury is the innate immune system. Since excessive immune responses can be damaging, anti-inflammatory mechanisms function to control the pro-inflammatory response and prevent injury. The cholinergic anti-inflammatory pathway is a neural mechanism that suppresses the innate inflammatory response. Knowledge concerning innervation of the immune system offers a unique opportunity to explore previously unrecognized techniques to treat disease. It also enables consideration of the neurological basis of complementary and alternative medical therapies, such as meditation and acupuncture. This evolving area of research has implications for the pathogenesis of chronic inflammatory conditions including inflammatory bowel disease, rheumatoid arthritis, type 2 diabetes, and other conditions of excessive cytokine release.

보완대체의학의 윤리적 성찰*

The increasing use of complementary and alternative medical (CAM) therapies by patients, health care providers, and medical institutions has made it imperative that physicians consider their ethical obligations when recommending, tolerating, or proscribing these therapies. When CAM and conventional medical therapies intersect, there is the potential for serious physician–patient conflicts as well as harm to patients. Some CAM therapies in and of themselves can be hazardous, but harm can also occur indirectly when patients choose less effective CAM treatments instead of conventional methods that have demonstrated efficacy. Physician–patient conflicts arising from issues related to CAM therapies are common, but the physician-patient relationship is more likely to remain intact if physicians are willing to engage creatively with patients when problems seem unsolvable. Even in the absence of scientific evidence for CAM therapies, providers can formulate a plan that is clinically sound, ethically appropriate, and targeted to the unique circumstances of individual patients. Physicians are encouraged to remain engaged in problem-solving with their patients and to attempt to clarify the patient’s core values and beliefs when counseling about CAM therapies. The commitment to joint problem-solving over time, which is a central obligation of the physician–patient relationship, becomes even more important when considering the use of CAM therapies. A long-standing, carefully nurtured partnership between a physician and a patient that has grown over time may be strained or completely destroyed if common ground in such situations cannot be found. The way forward for physicians involves not only preventing negligence and fraud, but also facilitating therapeutic exchanges between various healthcare providers and their patients. The use of case-based reasoning in questions of CAM therapy allows a fuller appreciation of the way in which circumstances play an intrinsic role in moral judgments. This paper presents two prototypical cases that illustrate the challenges already discussed as well as other ethical challenges that will arise as CAM therapies gain popularity in Korea.

A portable virtual reality system as an alternative medical treatment to reduce pain-related anxiety in ambulatory surgical operations: a randomized controlled study

Event Abstract Back to Event A portable virtual reality system as an alternative medical treatment to reduce pain-related anxiety in ambulatory surgical operations: a randomized controlled study Alessandra Gorini1, 2*, G. Riva2, 3, D. Mosso4, E. Pineda5, N. L. Ruíz4, A. Almazán4, M. Ramíez4, J L. Morales4 and J. L. Mosso4, 5 1 Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Italy 2 Maastricht University, Research Institute Brain and Behavior, Netherlands 3 Psychology Department, Catholic University of Milan, Italy 4 Panamericana University, Mexico 5 Regional Hospital No. 25 of the IMSS, Mexico Pain-related anxiety is a common problem for patients who undergo surgical operations. Since drug treatments alone have frequently proved to be inadequate to reduce stress and anxiety in surgical contexts, there is an increasing interest in non invasive complementary and alternative medical therapies (CAM) that reduce pain and tension during pre and post operative phases. Virtual reality can be considered an innovative form of CAM therapy having gained recognition as a means of attenuating pain during medical procedures. The aim of this study is to test the efficacy of a small, portable and immersive virtual reality system to reduce anxiety in a sample of patients who underwent ambulatory surgical operations. Forty-seven patients were randomly divided in three groups: the virtual reality group (VR); the Music group (MU); and the control group (CTR). Psychological and physiological measures were recorded immediately before, after 45 minutes, and after 90 minutes of operation. The results demonstrated that virtual reality is faster than music alone in reducing the patients’ perceived anxiety, suggesting that a very portable and inexpensive virtual reality system can be safe and effective in ameliorating anxiety experienced in ambulatory surgical contexts. Conference: Annual CyberTherapy and CyberPsychology 2009 conference, Villa Caramora, Italy, 21 Jun - 23 Jun, 2009. Presentation Type: Oral Presentation Topic: Oral Presentations Citation: Gorini A, Riva G, Mosso D, Pineda E, Ruíz NL, Almazán A, Ramíez M, Morales JL and Mosso JL (2009). A portable virtual reality system as an alternative medical treatment to reduce pain-related anxiety in ambulatory surgical operations: a randomized controlled study. Front. Neuroeng. Conference Abstract: Annual CyberTherapy and CyberPsychology 2009 conference. doi: 10.3389/conf.neuro.14.2009.06.038 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 19 Mar 2009; Published Online: 19 Mar 2009. * Correspondence: Alessandra Gorini, Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy, alessandra.gorini@unimi.it Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Alessandra Gorini G. Riva D. Mosso E. Pineda N. L Ruíz A. Almazán M. Ramíez J L Morales J. L Mosso Google Alessandra Gorini G. Riva D. Mosso E. Pineda N. L Ruíz A. Almazán M. Ramíez J L Morales J. L Mosso Google Scholar Alessandra Gorini G. Riva D. Mosso E. Pineda N. L Ruíz A. Almazán M. Ramíez J L Morales J. L Mosso PubMed Alessandra Gorini G. Riva D. Mosso E. Pineda N. L Ruíz A. Almazán M. Ramíez J L Morales J. L Mosso Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Effectiveness of the Homeopathic Preparation Neurexan®Compared with that of Commonly used Valerian-Based Preparations for the Treatment of Nervousness/Restlessness – an Observational Study

Mild anxieties, nervousness, and restlessness are common in the general population and are commonly treated by complementary and alternative medical (CAM) therapies. A prospective, nonrandomized, noninterventional, observational study, using conventional or CAM practices, was conducted in 49 German practices. Each practice could include up to 15 subjects treated with either the homeopathic preparation Neurexan® or with combination formulations based on valerian extracts. There was no placebo group. Choice and doses of study therapies were at the respective physician's discretion. The planned treatment duration was 2 weeks. A total of 826 subjects were included in the study and 777 (553 Neurexan and 224 valerian) subjects were available for the final examination. Subjects receiving Neurexan tended to weigh less, to have fewer concomitant illnesses and slightly milder severity of nervousness/restlessness, and were likelier to be female than the subjects receiving valerian therapies. The summary score for nervousness/restlessness was reduced from 19.0 ± 6.1 at baseline to 7.4 ± 6.8 at the end of the observation period in the Neurexan group, a reduction of 11.5 ± 7.3 score units. In the valerian group, the summary score was reduced from 21.4 ± 6.0 to 12.6 ± 7.3, a reduction of 9.0 ± 6.6 score units. The changes from baseline and the differences between the groups were statistically significant. Similar significant differences in effects were seen on the subscores and on the subjects' assessments of effectiveness. Both study therapies were well tolerated. Neurexan appears to be an effective and well-tolerated alternative to valerian-based combination therapies for the treatment of nervousness/restlessness in subjects favorable towards a CAM-based therapy.

Herbal Medications and their Anaesthetic Implications

Products made from plants that are used to maintain or improve health have a long history of use and claimed health benefits. Most patients fail to report their usage during history taking. However, many herbal supplements have potent pharmacologic activity by themselves and, along with various additives incorporated in various preparations can contribute to adverse effects and drug interactions. The use of herbal supplements by patients in the perioperative period is common and consistent with the substantial increase in the use of alternative medical therapies. We reviewed the literature to examine the constituents, safety, pharmacokinetics, and pharmacodynamics of those herbal supplements that are commonly used. Different supplements possess antiplatelet activity, adversely interact with other drugs, have gastrointestinal manifestations, produce organ toxicities, and produce additive effects when used with sedatives. With the increasing use of herbal supplements by patients, there is now a definite need to screen patients preoperatively for use of these supplements to prevent potential adverse events that may arise from herbal medications taken alone or combined with conventional therapies during the perioperative period. The American Society of Anesthesiologists (ASA) suggests that all herbal medications should be discontinued 2 to 3 weeks before an elective surgical procedure.

Herbal medicine in acute care medicine: past, present, and future?

Throughout medical history, clinicians have used herbal medications for a variety of ailments. Nowadays, complementary and alternative medicine (CAM) based on herbal preparations is commonly used across the world and not uncommonly encountered even in the emergency department (ED) setting. Indeed, the use of CAM has become such a common practice that a survey in the United States revealed that 42% of the adult population consulted regularly alternative medical practitioners and spent more than US $27 billion per year on alternative medical therapies [1]. An exponential rise in the use of CAM, especially the use of herbal remedies, has been seen in Western countries over the past 10 years. Indeed, many patients presenting to the ED are routinely taking herbal components before their visit [2]. What is evenmore interesting is that in many instances, either the patient or a family member requests that these herbal preparations are continued during their hospital stay [3]. An interesting point, not familiar to many acute care practitioners, deals with the regulations of these herbal preparations. For example, in the United States, herbal medications are not subject to the Food and Drug Administration regulations. In 1994, the United States congress approved the Dietary Supplement Health and Education Act, defining a dietary supplement as a product containing any of the following: vitamin, mineral, amino acid, herb, or other botanical concentrate [4]. Based on this Act, herbal products

Herbal remedy clinical trials in the media: a comparison with the coverage of conventional pharmaceuticals

BackgroundThis study systematically compares newspaper coverage of clinical trials for herbal remedies, a popular type of complementary and alternative medicine, with clinical trials for pharmaceuticals using a comparative content analysis. This is a timely inquiry given the recognized importance of the popular press as a source of health information, the complex and significant role of complementary and alternative medicine in individual health-care decisions, and the trend toward evidence-based research for some complementary and alternative medical therapies. We searched PubMed for clinical trials, Lexis/Nexis for newspaper articles in the UK, US, Australia/New Zealand, and Factiva for Canadian newspaper articles from 1995 to 2005. We used a coding frame to analyze and compare 48 pharmaceutical and 57 herbal remedy clinical trials as well as 201 pharmaceutical and 352 herbal remedy newspaper articles.ResultsHerbal remedy clinical trials had similar Jadad scores to pharmaceutical trials but were significantly smaller and of shorter duration. The trials were mostly studies from Western countries and published in high-ranking journals. The majority of pharmaceutical (64%) and herbal remedy (53%) clinical trials had private sector funding involvement. A minority declared further author conflicts of interest. Newspaper coverage of herbal remedy clinical trials was more negative than for pharmaceutical trials; a result only partly explained by the greater proportion of herbal remedy clinical trials reporting negative results (P = 0.0201; χ2 = 7.8129; degrees of freedom = 2). Errors of omission were common in newspaper coverage, with little reporting of dose, sample size, location, and duration of the trial, methods, trial funding, and conflicts of interest. There was an under-reporting of risks, especially for herbal remedies.ConclusionOur finding of negative coverage of herbal remedy trials is contrary to the positive trends in most published research based primarily on anecdotal accounts. Our results highlight how media coverage is not providing the public with the information necessary to make informed decisions about medical treatments. Most concerning is the lack of disclosure of trial funding and conflicts of interest that could influence the outcome or reporting of trial results. This lack of reporting may impact the medical research community, which has the most to lose by way of public trust and respect.

PALLIATIVE CARE OF ADVANCE LUNG CANCER

PURPOSE: Care of advance lung cancer remains a clinical challenge. Most patients treated with high dose opiods for pain control, have adverse effect on their underlying COPD causing increasing dyspnea, fatigue and mental confusion. Alternative adjunctive medical therapy with better symptom control serves an important role in the palliative care of patients with advance end stage lung cancer.

Assessing the Economic Attractiveness of Coronary Artery Revascularization in Chronic Kidney Disease Patients

Chronic kidney disease (CKD) is associated with increased morbidity and mortality in coronary artery disease (CAD) patients. We compared the economic attractiveness of CAD revascularization procedures in patients with and without CKD. Our population included 6218 patients with significant CAD undergoing cardiac catheterization at Duke University between 1996 and 2001, with follow-up through 2002. We investigated the influence of CKD (creatinine clearance < 60 mL/min) upon 3-year survival and medical costs in our CAD population. Coronary artery bypass graft (CABG) surgery was an economically attractive alternative vs. percutaneous coronary intervention (PCI) or medical therapy for all patients with left main disease, three-vessel CAD patients without CKD, and two-vessel CAD patients with CKD. Medical therapy was an economically attractive strategy vs. CABG surgery or PCI for three-vessel CAD patients with CKD, two-vessel CAD patients without CKD, and all single-vessel CAD patients.

Asthma: A Review of Complementary and Alternative Therapies

1. Cecilia Bukutu, PhD* 2. Christopher Le* 3. Sunita Vohra, MD, FRCPC, MSc* 1. *Complementary and Alternative Research and Education (CARE) Program, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada. On behalf of the American Academy of Pediatrics Section on Complementary and Integrative Medicine Although effective medications for managing asthma exist within conventional Western medicine (eg, inhaled corticosteroids and bronchodilators), some parents turn to complementary and alternative medical (CAM) therapies to treat their children's asthma. (1) Some reasons cited for using CAM therapies include concern about the long-term effects of steroid use; frustration that asthma does not resolve with conventional therapies; dissatisfaction with physician-patient interactions; belief that CAM is natural and, therefore, safe; and desire to have autonomy in making health choices. (1)(2) This review of published scientific literature assesses the efficacy and safety of some common CAM therapies in preventing and treating pediatric asthma. Natural health products (NHPs), including vitamins, minerals, herbal remedies, and other dietary supplements such as fish oil and probiotics, are used widely to prevent and treat asthma. (3) Like conventional therapies, NHPs used to treat asthma can be categorized as having anti-inflammatory, bronchodilator, and other effects. Few of these NHPs have been evaluated in pediatric trials. ### Vitamin C Vitamin C is an important antioxidant found in abundance in the extracellular fluid lining of the lung. Low intake of vitamin C is associated with pulmonary dysfunction. (4) Several observational studies in children have reported a beneficial relationship between a high fruit intake and improved lung function. (5)(6) However, a 2004 Cochrane systematic review of eight randomized, controlled trials (RCTs) concluded that evidence was insufficient to recommend a specific role for vitamin C in treating asthma. (4) Of the eight included studies, three small studies (fewer than 41 participants each) concluded that vitamin C supplementation was beneficial; five studies, including the largest trial (n=210), showed little or no beneficial effect. Larger, long-term RCTs are needed to clarify the possible role of vitamin C in the treatment of asthma. Most researchers have used daily doses of 500 to 1,000 mg. …