Complementary And Alternative Medicine Products Research Articles

The Role of Rigorous Scientific Evaluation in the Use and Practice of Complementary and Alternative Medicine

Complementary and alternative medicine (CAM) is the set of health care systems, products, and practices not considered part of conventional medicine. The increase in CAM use among the general public in recent decades led Congress to establish the Office of Alternative Medicine under the National Institutes of Health in 1992. In 1998, the Office of Alternative Medicine became the National Center for Complementary and Alternative Medicine (NCCAM), an independent institute that aims to use rigorous scientific research to evaluate CAM practices and products. Several policy changes are necessary to ensure that the results of NCCAM-funded research are used to provide the best possible health care to patients and to facilitate the integration of safe and efficacious CAM therapies into conventional medicine. First, NCCAM must commit to fund only studies that use rigorous methodology. Second, to ensure the purity and consistency of dietary supplements, a federal law should be passed to establish a new regulatory framework for dietary supplements. Finally, the results of NCCAM-funded clinical trials should be used to modify conventional and CAM practices. Treatments that are unsafe and inefficacious should be abandoned, and those that are both safe and efficacious should become standards-of-care for conventional medicine; the use of therapies that are either safe or efficacious but not both should be based on the risk/benefit ratios of the therapies. Rigorous scientific research must be used to evaluate the safety and efficacy of CAM therapies to ensure that patients receive care with the most favorable risk/benefit ratio.

Complementary and Alternative Medications Consumed by Renal Patients in Southern Germany

Complementary and alternative medicine (CAM) is frequently used in the general population, yet scant data are available regarding the prevalence of these medications in patients with end-stage renal disease (ESRD). To survey patients with ESRD regarding their use of CAM and health foods. Consecutive patients treated with dialysis or renal transplantation for ESRD were approached by nephrologists of 5 renal centers to report their usage of and knowledge on CAM and health foods by answering a questionnaire. Of 180 approached patients, 164 returned completed questionnaires for analysis. Fifty-seven percent of dialysis patients and 49% of transplant patients reported to be regular CAM-consumers. CAM consumption was positively associated with female sex and negatively with diabetes as comorbidity. Forty-one different CAM products had been named, with mineral supplements and vitamins ranking first. Besides CAM, many renal patients had regularly consumed herbal teas and citrus-juices (50% and 35%, respectively). Close to 40% of the documented CAM/health food consumptions have potential risks for patients because of constituents that either accumulate in renal failure or interact with pharmaceutical medication. However, only about 50% of dialysis patients, but 73% of transplant patients used to inform their physicians about CAM consumption (P = .005). Awareness about interaction risks linked to CAM was especially low in dialysis patients when compared to transplant patients (39% versus 78%, P < .0001) and increased when physicians had routinely questioned patients about their CAM consumption. Currently, however, patients reported that only a minority of physicians had taken an active interest into consumption of these substances. Consumption of CAM and health food is common among renal patients. Physicians are currently not adequately informed about CAM consumption by their patients. Because many products are at risk to either accumulate or cause interactions with medication, physicians should take an active role to inform themselves.

Bibliographical investigation of complementary alternative medicines for osteoarthritis and rheumatoid arthritis

A variety of complementary and alternative medicine (CAM) treatments are provided to the elderly. We investigated the efficacy and safety of CAM substances that are available to patients with osteoarthritis (OA) and rheumatoid arthritis (RA), both in Japan and overseas. Information on CAM products was collected from the World Wide Web, using the keywords "arthritis" and "supplement" in five languages (Japanese, English, French, Italian and German) using a popular search engine for each of the languages. References to published work on the products were researched using PubMed with the keywords of "arthritis", "anti-inflammatory" and "analgesics". Such published work was classified according to the evidence levels established by the Cochrane Library. Two-hundred and sixty CAM products for OA or RA were available in Japan, of which 41 CAM products had been tested in randomized controlled trials (RCT); there was no scientific evidence for the remaining 219 CAM products. Most of the previous RCT suggested that CAM was effective in OA or RA. Herein, we confirmed the significant OA relieving effects of chondroitin sulfate through a meta-analysis. Effectiveness was assessed using subjective scores, not disease-specific immunological or serological markers for assessment. Toxicological investigations had only been performed for a few CAM products. Some CAM products that are effective against RA may be used together with biological therapy. However, some of the CAM products available in Japan should be tested using objective markers. Some CAM products for OA could be used for the relief of pain.

Comparative analysis of complementary and alternative medicine (CAM) use in the US cancer and noncancer populations

Significance/background Complementary and alternative medicine (CAM) therapies are often used with conventional medical treatments; hence healthcare providers need to understand factors influencing use and implications for patient care. Since estimates of use by cancer survivors vary widely (7–64%), population-level studies are needed to compare usage patterns. Purpose This study compares prevalence and patterns of CAM use in the US cancer population and the noncancer population. Factors that predict use of CAM providers, practices and products in relationship to symptom experience and purpose of use were identified. Methods A secondary analysis of the 2002 National Health Interview Survey data using STATA 9.2 software for population estimation was conducted. CAM use by cancer survivors ( N =2262; estimated cancer population=14.3 million) and individuals without cancer ( N =28,734; estimated population=191.5 million) was compared. Responses to 22 CAM use items in the NHIS Alternative Health Supplement were analyzed. Predisposing (gender, age, race, education, marital status), enabling (income, health insurance, provider-contact), and need factors (symptoms, co-morbidity, health status) in the CAM Healthcare Model were analyzed for ability to predict CAM use from a health service utilization perspective. Data analysis Binary and Multinomial Logistic Regression, the primary statistical models employed in the analysis, focused on between-subject differences in CAM use. A stepwise procedure was followed and potential predictor variables were excluded from the model if their p -value exceeded 0.10. Findings and implications Cancer and noncancer populations differ in their CAM use patterns, with cancer survivors more likely to use CAM. Predisposing, enabling and need factors were strong predictors of CAM use in both populations. Use was more prevalent among female, middle-aged, white, and well-educated people; women were specifically more likely to use CAM practices than men. A curvilinear relationship of use with age was noted suggesting a possible cohort effect. Higher income, private insurance, contact with conventional providers, pain and co-morbidity were strong predictors of CAM use. More than 39% of all cancer survivors used CAM, highlighting the need for oncology nurses and healthcare providers to assess use by their patients. Data will be compared with the soon to be released 2007 NHIS data set to determine trend patterns in CAM use over time.

Self-Reported Use Of Traditional, Complementary And Over-The-Counter Medicines By Hiv-Infected Patients On Antiretroviral Therapy In Pretoria, South Africa

Current management of HIV involves the use of conventional prescription medicines, called 'antiretroviral drugs' (ARV), over-the-counter (OTC), complementary and alternative medicines (CAM), as well as African traditional medicine (ATM). The aim of this study was to determine the prevalence of use of traditional, complementary and over-the-counter medicines. A cross-sectional survey of HIV-infected patients who started ART between July 2004 and August 2005 at Dr George Mukhari Hospital (Pretoria), who consented to be interviewed, was conducted. Using a pre-tested structured questionnaire, data were collected by two trained interviewers on sociodemographic characteristics, and on non-prescribed medicines used of three sources: African traditional medicine (ATM), complementary and alternative medicine (CAM), and over-the-counter (OTC) medicines. The 180 patients who consented to be interviewed had a mean age of 36.7 (+/-8.1) years old; 68.8% were female, 86.7% unemployed, 73.9% with high school level of education, 77.8% single. Some 8.9% of respondents used at least one non-prescribed medicine. In descending order, 4.4% of respondents used ATM, 3.3% CAM, and 1.7% OTC medicines. The ATM products used included unspecified traditional mixtures, and those made of the African potato (Hypoxis hemerocallidea), and coconut (Cocos nucifera); OTC products used were paracetamol and sennosides (Senokot) tablets as well as a soap containing triclosan 1.5%; CAM products used were "sex booster" capsules of unknown composition, mercury-containing soaps (Mekako), and the Zion Church of Christ special tea, a mixture of Rooibos tea (Aspalathus linearis) plus sunflower oil (Helianthus annuus) and prayed for. In conclusion, only 8.9% of HIV-infected patients on ART in this study used a limited range of over-the-counter products as well as those from traditional, complementary and alternative medicine practices.

How Should Oncologists Face Complementary and Alternative Medicine?

There are many inconsistent usages of complementary and alternative medicine (CAM) in modern medicine. Once a kind of CAM is evaluated on the basis of scientific method and is revealed to have the substantial effects and acceptable downsides against some malignancies, it would be integrated into standard oncology care as major or supportive medicine. CAM is outside the evidence-based medicine. In other words, modern medical practitioners named the experiencebased or traditional medicine that has not been assessed scientifically yet as CAM, as a tentative and generic term. Humankind have profited greatly from the development of medicine. However, this benefit is mainly limited to those living in the developed countries, and traditional medicine is still a mainstream in many other countries. Many people throughout Africa, Asia and Latin America use traditional medicine to meet their primary health-care needs. It is easily accessible and affordable for them. Traditional medicine is also often part of a wider belief system and is considered integral to everyday life and well-being. In Western countries, CAM is increasingly being used in parallel to allopathic medicine, particularly for treating and managing chronic disease. Concerns about the adverse drug effects, a desire for more personalized health care, and greater public access to health information fuel the increasing use of CAM in many developed countries. Recent surveys demonstrate that .50% of US cancer patients use CAM therapies at some point after their diagnosis. Despite extensive use, there is a paucity of data available to indicate whether these therapies are efficacious and safe. An enormous amount of unreliable information on cancer CAM is released into the Internet and other media sources. CAM products (herbs and other natural products, such as shark cartilage, mushrooms etc.) in cancer medicine are widely available in Japan and the Western countries (1). Internet and its marketing have accelerated it. The providers emphasize their effects on boosting the immune system based on the pre-clinical experimental findings and advertise using anecdotal reports of users. No reliable and well-designed clinical trials in cancer patients have been performed with this kind of products. Nonetheless, many cancer patients use such products hoping for tumor growth suppression and cure rather than complementary effects. These natural products are generally expensive. It is often the case that the cancer patients and their relatives are at a loss about how to deal with such information and have a difficult time choosing what kind of CAM they should adopt. Oncologist cannot advice them appropriately due to the lack of evidence and even information. A great need for public and professional education regarding this subject is evident. Munshi et al. (2) have reviewed the prominent modalities in CAM for cancer treatment in this issue of JJCO. They see CAM in oncology practice as a complicated issue like a Pandora box in a medical labyrinth. Many oncologists can share this thought. They tried to search evidence on CAM in the literatures and could not find many well-designed trials. A few kinds of CAMs (yoga, acupuncture, some herbal medicine, homeopathy etc.) have been studied in clinical trials. However, the evidence from randomized controlled trials is fragmentary and inconclusive. Therefore, many kinds of CAMs could not be evaluated properly for both efficacy and safety. Many previous reports on CAM indicate that more reliable evidence-based information on CAM is needed for better patient–physician communication (3). The lack of useful information on CAM makes oncologists tend to neglect CAM and avoid communication with patients on its usage. To resolve this problem, a study team consisted of oncologists, pharmacists, psychologists, nurses and CAM providers was organized by the research grant from the Ministry of Health, Labor and Welfare. They are now aggressively educating cancer patients on CAM and evaluating natural products used for cancer treatment in the prospective comparative studies. Another remaining issue is the high prevalence of the concurrent use of anticancer drugs and CAM. Our present knowledge of interactions is incomplete, and further study is urgently needed.

Comparative Analysis of CAM Use in the U.S. Cancer and Noncancer Populations

Background: Complementary and alternative medicine (CAM) therapies are often used with conventional medical treatments, hence it is important for healthcare providers to understand factors influencing use and implications for patient care. Method: This study compared patterns and predictors of use of CAM providers, practices, and products among the U.S. cancer and noncancer population. Predisposing, enabling, and need factors in the CAM Healthcare Model were examined for ability to predict CAM use from a health service utilization perspective. A secondary analysis of the 2002 National Health Interview Survey was conducted for population estimation using STATA 9.2 software. The analysis compared CAM use by cancer survivors (N=2,262; estimated cancer population=14.3 million) and individuals without cancer (N=28,734; estimated population=191.5 million). Multinomial Logistic Regression identified between-subject differences and allowed for population comparison. Results: Data suggest that cancer survivors and noncancer populations differ in their CAM use patterns, with cancer survivors more likely to use CAM. Conclusion: While these patterns may have begun during the initial period of cancer diagnosis and treatment, they continue among long-term survivors. Predisposing, enabling, and need factors were strong predictors of CAM use in both populations.

Potential Interactions Between Complementary/Alternative Products and Conventional Medicines in a Medicare Population

Despite the high prevalence of complementary and alternative medicine (CAM) product use among the elderly, little is known about the extent of concurrent CAM-conventional medicine use and the potential for adverse reactions. To determine the prevalence of CAM product use concurrent with conventional medications, prescription and nonprescription, in a Medicare population and assess the risk for adverse interactions. Retrospective analysis was performed on Cardiovascular Health Study interview data from 1994, 1995, 1997, and 1999. The prevalence of concurrent combinations of CAM products and conventional drugs was tabulated. The adverse interaction risks were categorized as unknown, theoretical, and significant. Of 5052 participants, the median age was 75, 60.2% were female, 16.6% were African American, and 83.4% were white. The percent using CAM products during the 4 time periods was 6.3%, 6.7%, 12.8%, and 15.1%. The percent using both CAM products and conventional drugs was 6.0%, 6.2%, 11.7%, and 14.4%. Of these, 294 (5.8%) individuals took combinations considered to have a significant risk for an adverse interaction. Combinations with risk were observed on 393 separate interviews. Most (379) involved a risk of bleeding due to use of ginkgo, garlic, or ginseng together with aspirin, warfarin, ticlopidine, or pentoxifylline. An additional 786 observations of combinations were considered to have some, albeit theoretical or uncertain, risk for an adverse interaction. Concurrent use of CAM products and conventional medicines in a Medicare population was found to be common. Research to define the risks of combining ginkgo and garlic supplements with aspirin should be of high priority.

Use of complementary and alternative medicine by rheumatoid arthritis patients in Korea

This study measured the prevalence of use of complementary and alternative medicine (CAM) in Korean patients with rheumatoid arthritis (RA). A trained nurse conducted 20-min questionnaire-based interviews at the hospitals when each patient visited as an outpatient. The questionnaire included questions on demographic information, clinical information, and the use of CAM. Of the 153 respondents, 125 (82%) had used CAM; 37% of those who used CAM had started taking CAM products following suggestions from family members and other relatives. In users of CAM, 35% considered that it improved the symptoms of RA, and 14% felt it was effective in achieving psychological relaxation. We categorized treatment into six CAM categories used by the respondents: 84.0% of patients used traditional Oriental medical treatments, 70.4% used plant- and animal-derived over-the-counter health care products, and 13.6% used manual therapies. Most RA patients (64%) would like to try a new type of CAM. About half of the respondents (48%) expected to receive information about CAM from their general practitioner even if most (72%) did not discuss their use of CAM with their doctor. Most of the RA patients in this study used CAM, and half reported beneficial effects. Despite the presence of adverse side effects, patients tended to use CAM without discussing it with their main physicians, suggesting that physicians should be actively involved in the prescription and use of CAM.

Women's health during mid-life survey

To survey the extent of complementary and alternative medicine (CAM) use among women for the alleviation of menopausal symptoms. A total of 1,296 eligible women aged 45 to 65 years were recruited from three Sydney menopause clinics, general practice clinics, and government agencies between July 2003 and July 2004. Volunteers were invited to complete a 19-item questionnaire covering basic demographics, general health status, use of CAM therapies and products, use of pharmaceuticals, and sources of CAM advice. Of respondents, 53.8% had visited a CAM practitioner and/or used a CAM product during the past year, with 34% using a product only and 5% consulting a practitioner only. The most commonly visited practitioners were naturopaths (7.2%) and acupuncturists (4.8%), whereas the most popular products were soy (25.4%) and evening primrose oil (18.4%). Massage, chiropractic, and nutrition were rated the most effective therapies, and phytoestrogen tablets, evening primrose oil, and black cohosh were deemed the most effective products. Of the 59.9% of respondents currently using prescription or over-the-counter pharmaceuticals, 62.5% reported using CAM products during the past 12 months. Of CAM users 71% had informed their doctor about CAM use, whereas 26.4% of respondents reported their doctor had inquired about CAM use. CAM use by women to alleviate menopausal symptoms is common, with several therapies perceived to be effective. Although a significant proportion of women may use CAM in conjunction with pharmaceuticals, relevant communication between medical practitioners and patients remains inadequate and may expose the patient to potential drug-herb interactions.

Patterns of Using Complementary and Alternative Medicine by Stroke Patients at Two University Hospitals in Korea

This study measured the prevalence of complementary and alternative medicine (CAM) use among Korean stroke patients. Questionnaire-based 20-min interviews were conducted at the hospitals by a trained nurse after an outpatient visit. It included questions on demographic information, clinical information and the utilization of CAM. Of 304 stroke-patient respondents, 164 (54%) had used CAM, of which 66% had started taking CAM products following suggestions from family members and other relatives. Of the 57% of users who felt that CAM was effective, 84% considered that it improved the symptoms of stroke and 16% felt it was effective in achieving psychological relaxation. Of the eight CAM categories used by respondents, 92% used traditional Oriental medical treatments, 36% used plant- and animal-derived over-the-counter health care products, 24% used minerals and vitamins, and 11% used manual therapies. The majority of stroke patients (68%) were trying a new type of CAM, and half of the respondents (45%) relied on the knowledge of their general practitioner about CAMs when deciding whether to use them. Most of the stroke patients in this study used CAM, and a half of them reported beneficial effects. Despite the presence of adverse side effects, they tended to be used without discussion with chief physicians, and hence physicians should be actively involved in the usage of CAM.

Using the Behavioral Model for Complementary and Alternative Medicine: The CAM Healthcare Model

Complementary and alternative medicine (CAM) therapies, products and practices are increasingly being used across the United States and worldwide by individuals who are healthy, as well as by those who are ill (Barnes, Powell-Griner, McFann &amp; Nahin et al., 2004; Burstein, Gelber, Guadagnoli, &amp; Weeks, 1999; Eisenberg, et al., 1998; Ernst &amp; Cassileth, 1998; Kessler, et al., 2001; Richardson &amp; Straus, 2002). This trend, which is anticipated to continue, reflects changing health care behavior. Individuals, who are experiencing illness, use CAM for treatment, management of illness related symptoms and to enhance quality of life. Those who are well also use CAM to promote health, and prevent disease. This increasing prevalence of CAM has created a need to identify patterns and predictors of use among the diverse populations of users. Concurrently, this trend evokes questions about the effect of CAM on the utilization of conventional health services and providers, health outcomes and quality of life. This paper presents an emerging conceptual framework, referred to as the CAM Healthcare Model. This model aims to identify factors associated with the use of CAM providers, therapies, products and practices within a health services framework, thereby providing a guide for CAM research and practice. The CAM Healthcare Model is a modification of Andersen's Behavioral Model for Health Service Use, a framework that has guided research on conventional health services for more than three decades (Andersen, 1969, 1995). The CAM Healthcare Model identifies factors influencing the use of CAM health services and resources that are provider-directed, and CAM use as a self-directed health care activity and/or practice. The authors propose that CAM use, with or without a provider, has the potential to affect utilization of conventional health services as it offers more choices to healthcare consumers. These choices ultimately affect healthcare outcomes, research, health service delivery and policy, hence the importance of this work Understanding the trends and implications of CAM use further emphasizes the need for a model to study CAM within a health service/resource context.

Hypersensitivity Reactions to Complementary and Alternative Medicine Products

Complementary and alternative medicine (CAM) is becoming increasingly popular, and is often used for treating hypersensitivity diseases. Virtually all alternative remedies can cause hypersensitivity reactions, but the most frequently involved ones are tea tree oil, members of the Compositae family, propolis, oils used in aromatherapy, substances responsible for photosensitization, and metal-containing compounds. The main target organ is skin, with manifestations ranging from contact dermatitis (the most common) to urticaria-angioedema, maculopapular eruptions, photosensitivity reactions, and the Stevens-Johnson syndrome. Other types of reactions are possible, including respiratory and anaphylactic ones. Different pathogenic mechanisms have been suggested for CAM product reactions, including immunologic ones. Basophils and mast cells participate in IgE-mediated reactions through the release of mediators like histamine and tryptase, whereas a T-cell-mediated pathogenic mechanism is involved in most delayed reactions, particularly contact dermatitis and maculopapular eruptions. Skin tests and serum specific IgE assays are carried out to diagnose immediate hypersensitivity reactions, while patch tests and lymphocyte transformation tests are usually performed to evaluate delayed hypersensitivity reactions. Thus clinicians should know about the potential of CAM products for causing adverse reactions. Our study is aimed at highlighting the risk of hypersensitive reactions to CAM remedies on the basis of the numerous cases reported in the literature. Because little is known about adverse reactions to CAM products, further systematic studies and an appropriate regulation by heath authorities are necessary.

Complementary and Alternative Medicine: A Rising Healthcare Issue

More than half of all Canadians use some form of complementary and alternative medicine (CAM) every year. The way CAM is being used, the magnitude of its use and the lack of clarity on standards of evidence make CAM a rising healthcare issue. A recent research priority-setting exercise by the Canadian Interdisciplinary Network for CAM Research (IN-CAM) identified three research priority areas: (1) healthcare delivery and policy research, including (a) exploring if and how CAM should be regulated, (b) defining what constitutes acceptable evidence of safety and efficacy, (c) investigating the organization and delivery of integrative healthcare; (2) methodological research, including exploring how best to assess whole systems of care and how to choose patient-, practitioner- and policy-relevant outcome measures; and (3) knowledge transfer, including formal education strategies, the provision of information and dialogue with those who use information in decision-making. The high use of CAM products and therapies leads to many questions from patients, practitioners and policy makers. The research agenda presented here provides a guide to begin programs of research that will answer these questions.

Attitudes of Australian Pharmacists Toward Complementary and Alternative Medicines

The increase in the use of complementary and alternative medicine (CAM) by the general public has led to increasing interest in how health professionals view these therapies. To determine the knowledge and attitudes of pharmacists toward CAM. An anonymous, self-administered questionnaire was designed and mailed to 1500 randomly selected pharmacists in New South Wales, Australia. Four hundred eighty-four responses were received, with 77% of respondents indicating that they had personally used CAM and 60% correctly identifying that CAM was comprised of more than just botanicals and nutritional agents. The most commonly used CAMs were herbal and vitamin supplements (74%), which was significantly above use of the next most frequent CAM, massage therapy (6%). Most pharmacists (71%) reported offering CAM products for sale; however, 27% of these practices did not have access to CAM information for pharmacy staff or patients. Pharmacists generally viewed CAM positively and believed that they enhanced the customers' image of pharmacy (57%), increased customer numbers (87%), and could increase annual sales (72%). Ninety-one percent of respondents believed that it is necessary for pharmacists to have knowledge of both CAM and conventional medicine to be able to inform patients about their treatment options. Books and journal articles were their primary information sources, with the main reasons for recommending CAM evidence of efficacy and to maintain general health. CAM use is prevalent among Australian pharmacists. While pharmacists are aware of their role as educators about both CAM and conventional medicines, there is a need for greater access to CAM resources and education on these therapies.

Development of a complementary and alternative medicine (CAM) pharmacy and therapeutics (P&T) subcommittee and CAM guide for providers.

The objective was 2-fold: (1) to evaluate the feasibility and value of developing a Pharmacy and Therapeutics (P&T) subcommittee aimed at scientifically evaluating complementary and alternative medicine (CAM) products for an integrated managed care organization (IMCO) and (2) to assess provider acceptance and usefulness of a CAM guide. Three factors drove the decision to form a CAM P&T subcommittee to evaluate current commonly used CAM products: (1) physicians, pharmacists, and dieticians expressed a desire for an easy-to-use, scientifically based mechanism for evaluating the ever-increasing number of CAM products; (2) Intermountain Health Care Health Plans (Health Plans), the insurance division of this IMCO, offers access to certain CAM products to its members at a discounted price in an effort to remain competitive with other IMCOs; and (3) this IMCO owns and operates more than a dozen community pharmacies that sell CAM products. Some IMCO clinicians believed an efficacy and safety review of the products offered through the organization was warranted. Subcommittee members included clinical pharmacists (IMCO and university), pharmacy directors, a community pharmacist, practicing physicians (from the drug P&T committee), a medical director, dieticians and nutritionists, and a representative from the Health Plans sales department. The primary outcome was the development of a CAM guide listing recommendations for use of CAM products. Outcome measures included survey results (survey sent with guide to physicians and (pharmacists) regarding acceptance and usefulness of the guide. The CAM P&T subcommittee met monthly to evaluate current commonly used CAM products. A CAM guide was developed in paperback and electronic versions. The electronic version was downloadable to handheld devices. Thousands of CAM guides were disseminated to IMCO-employed physicians, network pharmacies, dieticians, and nutritionists affiliated with this managed care organization. A survey that accompanied distribution of the first CAM guide in 2003 showed that 89% of physicians and pharmacists felt that the guide would be somewhat or very helpful as a counseling aide; the remainder was unsure. A second CAM guide was disseminated one year later, in 2004. The accompanying survey showed that 78% of physicians and 97% of pharmacists felt that the guide would be somewhat or very helpful as a counseling aide; 7% of physicians and 3% of pharmacists felt the guide would be unhelpful. A CAM guide developed through the work of a subcommittee of the P&T committee of this IMCO appears to be widely accepted by pharmacists and physicians. A CAM guide should be easy to use and available online with the ability to download to a handheld device.

Characteristics of Pediatric and Adolescent Patients Attending a Naturopathic College Clinic in Canada

The use of complementary and alternative medicine (CAM) has grown substantially in North America and has drawn the attention of conventional-medicine practitioners. Conventional-medicine practitioners have expressed concern about the potential for unregulated CAM therapies to cause harm, the sometimes-uncertain cost-benefit ratios associated with these therapies, and the possibility that some CAM providers might advise against established conventional therapies, such as vaccination. These concerns are heightened with respect to the pediatric use of CAM products. To address this issue, we conducted a systematic audit of pediatric and adolescent case files at a large, college-based, Canadian naturopathic teaching clinic. We specifically sought to describe the demographic characteristics, reasons for presentation, use of CAM products, and vaccinations status of children presenting for naturopathic assessment. We also determined factors associated with the use of CAM products and vaccination status. We identified all charts for children (<18 years of age) who presented to the Robert Schad Naturopathic Clinic, the teaching clinic of the Canadian College of Naturopathic Medicine, between February 1 and May 31, 2002. Data were abstracted directly from the standardized patient intake forms and from clinical notes recorded during the patient's initial visit to the clinic. The following data were obtained: age, gender, chief presenting complaints reported by parents, CAM product use at presentation, vaccination status, and reactions to vaccination. We conducted logistic regression analyses to identify factors associated with both CAM product use and vaccination status. A total of 482 charts were identified. The mean age of patients was 6.5 years (95% confidence interval [CI]: 1.6-11.4 years). The ratio of female subjects to male subjects was 1.09:1 (248:227). The most common reasons for presentation were skin disorders (23%), gastrointestinal complaints (17%), and psychiatric/behavioral disorders (15%). Thirty-five percent of children were using CAM products at presentation (21.2% when both vitamins and minerals were excluded). Vitamins were the most commonly used products (34.6%), followed by herbal remedies (14.9%), oil blends/fats (7.2%), minerals (5.6%), probiotics (4.5%), and homeopathic remedies (3.7%). Of charts with vaccination information, 8.9% indicated that children had not been vaccinated; possible vaccine-associated adverse events were reported for 27% of those who had been vaccinated. Partial or unvaccinated status was associated with younger age, attending the Canadian College of Naturopathic Medicine for advice regarding vaccination, and greater use of CAM products. CAM product use was associated with unvaccinated or partially vaccinated status (odds ratio [OR]: 2.86; 95% CI: 1.46-5.63), presenting with poor energy or fatigue (OR: 3.36; 95% CI: 1.00-11.26), or presenting with throat or sinus infections (OR: 4.06; 95% CI: 1.23-13.04). Children present for naturopathic assessment for diverse reasons, are high-level consumers of CAM products, and have lower rates of vaccination than population averages. The conventional-medicine community should work with naturopaths to address public health concerns in this population.

Nationwide Survey on Complementary and Alternative Medicine in Cancer Patients in Japan

To determine the prevalence of use of complementary and alternative medicine (CAM) by patients with cancer in Japan, and to compare the characteristics of CAM users and CAM nonusers. A questionnaire on cancer CAM and the Hospital Anxiety and Depression Scale were delivered to 6,607 patients who were treated in 16 cancer centers and 40 palliative care units. There were 3,461 available replies for a response rate of 52.4%. The prevalence of CAM use was 44.6% (1,382 of 3,100) in cancer patients and 25.5% (92 of 361) in noncancer patients with benign tumors. Multiple logistic regression analysis determined that history of chemotherapy, institute (palliative care units), higher education, an altered outlook on life after cancer diagnosis, primary cancer site, and younger age were strongly associated with CAM use in cancer patients. Most of the CAM users with cancer (96.2%) used products such as mushrooms, herbs, and shark cartilage. The motivation for most CAM use was recommendation from family members or friends (77.7%) rather than personal choice (23.3%). Positive effects were experienced by 24.3% of CAM users with cancer, although all of them received conventional cancer therapy concurrently. Adverse reactions were reported by 5.3% of cancer patients. CAM products were used without sufficient information by 57.3% of users with cancer and without a consultation with a doctor by 60.7% of users. This survey revealed a high prevalence of CAM use among cancer patients, without sufficient information or consultation with their physicians. Oncologists should not ignore the CAM products used by their patients because of a lack of proven efficacy and safety.

Developing a National Vision for Complementary and Alternative Medicine in Undergraduate Medical Education: Report on an Invitational Workshop

The increasing use of Complementary and Alternative Medicine (CAM) among Canadians has led to exploring the potential role of CAM in undergraduate medical education (UME). As part of a multi-phased project to begin developing CAM curriculum for UME, representatives of 14 Canadian medical schools attended a two day workshop in September 2003 in Saskatoon, SK. Workshop outcomes included developing (1) a rationale for CAM in UME, (2) draft student learning objectives, (3) a list of potential CAM curriculum topics, and (4) a list of factors affecting curriculum implementation. Much of the discussions centred on what Canada’s future physicians need to know about CAM. Broad curricular categories included (1) general CAM topics (e.g., definitions, utilization, reasons for use, evidence, implications for practice, bridging paradigms), and (2) specific CAM products and practices. The top rated practice areas for physicians to know about were Natural Health Products, Traditional Chinese Medicine, chiropractic, naturopathy and homeopathy. Participants identified that for each of these practices/products a descriptive overview, information about evidence, safety and regulation, and clinical implications needs to be discussed. Using the workshop recommendations as a foundation, the CAM in UME project team continues to develop a national, consensus-based CAM curriculum for Canadian medical schools.

Complementary and alternative medicine use by patients visiting a free health clinic: A single-site, pilot study

Background: The rate of use of complementary and alternative medicine (CAM) has been documented to fluctuate widely, can greatly impact medical outcomes, and can influence patients' adherence to conventional medicines. Health care providers should assess the prevalence of CAM use (primarily herbal medicine) in individual settings to most accurately provide appropriate patient care. Objectives: The aim of this study was to determine the following: (1) differences in demographic characteristics between users and nonusers of CAM; (2) which CAM patients are using; (3) patients' sources of information concerning CAM; and (4) whether patients recall being asked about CAM use by their health care providers. Methods: In this single-center, pilot study, a self-administered survey concerning CAM use was made available to persons seeking care at an inner-city free health clinic (Kansas City Free Health Clinic, Kansas City, Missouri). Completed surveys were scanned into a database, and descriptive analyses were performed. Results: Three hundred eleven patients completed ≥1 question on the survey. Of those who reported race (n = 278), 168 (60.4%) were Caucasian/white, 73 (26.3%) were African American/black, and 24 (8.6%) were Hispanic/Latino. Of those who reported educational level (n = 287), 101 (35.2%) had some high school or were high school graduates or had a general equivalency development diploma, 102 (35.5%) had completed some college or vocational training, and 84 (29.3%) had completed college. Of those who reported personal annual income (n = 191), 107 (56.0%) reported up to US $15,000, and 54 (28.3%) reported >$15,000 to $30,000. A high rate of CAM use (past or present) was found among survey respondents (116/285 [40.7%]). No correlation was found between CAM use and any of the demographic characteristics studied. Of 98 patients reporting whether their CAM use was past or current, 64 (65.3%) were using CAM at the time of the survey. Friends and physicians were reported to be most supportive of CAM use (21/41 [51.2%] and 33/86 [38.4%] patients, respectively). The most common CAM products reported as being currently used were garlic and chamomile (both, 5 patients [7.1%]), and echinacea and ginseng (both, 3 patients [4.7%]). Conclusion: This survey of patients using an inner-city free health clinic showed a high rate of CAM use, which could significantly impact patient outcomes.