Complementary And Alternative Medicine Products Research Articles

Medical pluralism in action? A case study of community pharmacies in Johannesburg, South Africa.

The main aim of this study was to examine whether, and to what extent, community pharmacies have become sites for the practice of complementary and alternative medicine (CAM) as an example of "medical pluralism." Qualitative as well as quantitative methods such as a telephone survey of all pharmacies in Johannesburg, observations, and in-depth interviews with pharmacists and CAM healers were used. The evidence presented in this paper, although based on a study of community pharmacies in Johannesburg only, can be interpreted as an indication of a general trend in urban areas in South Africa, that of involvement with CAM in the form of dispensing and sales of CAM products, provision of advice, and, in a few cases, employment of CAM practitioners to consult on their premises. Thus the two systems of CAM and allopathic medicine are being practiced within the same premises. However, the manner in which they operate, as portrayed in this study, is that of two separate systems existing in relative harmony side-by-side. Because of the constraints of the study, it is difficult to ascertain to what extent this is a first step toward the development of a more meaningful integration between the systems. It is much easier to demonstrate that this growth is driven by the pharmacists' response to the growing demand from the public and their readiness to seize the opportunity to expand their responsibilities and increase their profits. This is supported by the willingness of CAM healers to participate in the endeavor.

An assessment of the utilization of complementary and alternative medication in women with gynecologic or breast malignancies.

To describe and assess the current utilization of complementary and alternative medicines (CAMs) in women with a diagnosis of either gynecologic or breast cancer and evaluate their reasons for use. This study included 250 female patients from the Multidisciplinary Breast Center and 250 patients from the Gynecologic Oncology Center of The University of Texas M.D. Anderson Cancer Center (Houston, TX). Patients were selected by having an odd-numbered medical record number, and they were contacted before their clinic visit. The goals of the study were explained, and verbal consent was obtained. Patients who agreed to participate were asked to bring a written list and the medication bottles of all over-the-counter prescriptions and CAMs with them to clinic. In clinic, the investigator obtained a written informed consent and administered the survey. All patients and surveys were assessable. The most frequently used herbal products and megavitamins/minerals were identified from the patient medication histories. Overall, we found the proportion of patients using CAM to be 48% (95% CI, 44% to 53%; 241 of 500 patients). CAM use was related to patients' educational status: 62% had postgraduate degrees, 50% had college degrees, 56% had some college, and 33% had a high school education or less. Also, among patients using CAMs, only 53.5% had spoken to a healthcare provider regarding CAM therapy. The use of CAM is common among women with cancer. Studies need to be conducted to establish if there are any potential drug interactions and/or therapeutic benefit of CAM products. Moreover, there is a need to educate patients and healthcare providers on appropriate and safe use of CAM products.

Drug Discovery, CAM and Natural Products.

This editorial is related to two papers in volume 1 issue 2 of eCAM and to others concerned with molecules derived from terrestrial and marine species (1‐15). These papers focus on natural products, especially those derived from the sea. Therefore, it is appropriate to apply the contributions of these papers, since they can offer a different perspective. It is, indeed, a matter of great coincidence that these papers are being published at a time when eCAM is making extensive efforts to highlight this subject, which occupies an important place in biomedicine and has enormous potential. This situation in which the focus, at least of publications, is on animal products, is in marked contrast to that of botanicals and herbals—qua plant-derived molecules, the available literature on which may be considered immense and sometimes focused in highly specialized journals. A recent issue of Science offers a veritable cornucopia of evidence concerned with new drugs, and it begins with an editorial entitled ‘Drug Discovery’ by Donald Kennedy Editor-in-Chief (16). This is followed by an introduction titled ‘Rethinking Drug Discovery (17) and a news essay, ‘Surviving the Blockbuster Syndrome; Orphan Drugs of the Future’ (18). Five reviews and viewpoints examine various aspects of molecular biology, organic chemistry and drug delivery systems (19‐23). If one explores the enormous wealth in this issue of Science in science’s next wave (www.nextwave.org), at least five presentations offer enormous potential for application (Bioprospecting beginning with ‘The Sweet Side of Venom and Practicing’ (24‐28). This sojourn into the world of drug discovery is, in my opinion, an area pertinent to complementary and alternative medicine (CAM). It is not remote but is closely related, relevant and highly visible, not to mention that it has rapidly increasing potential for wider distribution and understanding. This appears almost inevitable with the practice of western medicine shifting somewhat or, at least, bridging the divide between western and eastern medicine through the intervention of CAM. After all, many of these claims of healing have deep and everlasting recorded roots in the ancient world, most notably throughout Asia. The challenge will be to subject certain claims to the rigors of science and demand that conclusions be evidence-based (12). Otherwise, CAM will be unable to withstand the criticism of biologists and, sometimes, that of educated and skeptical public.

Consuming health: The market for complementary and alternative medicine

A brief account of the collapse of PAN pharmaceuticals is used to identify the major interest groups in the market for complementary and alternative medicine (CAM) products - individual consumers, CAM businesses, insurance companies, doctors, and governments. These interest groups are then described. It is argued that CAM use is primarily driven by individual consumers, but the final form of the market is produced by the intersection of interest group pressures. Finally, it is suggested there may be two consumer markets for CAM products: one oriented towards symptom relief and one towards health maintenance. Therapists are foremost in symptom relief and CAM medicaments foremost in health maintenance.

Survey of the use of complementary and alternative medicine among Korean diabetes mellitus patients.

This study was designed to measure the prevalence of complementary and alternative medicine (CAM) use among Korean diabetes mellitus (DM) patients. A 23-question survey on DM was used and included questions on demographic information (7), clinical information (7) and the utilisation of CAM (9). Of 223 respondents, 145 (65%) had taken CAM products, while 78 (35%) had not. At the suggestion of family members and relatives, 43.5% of the respondents started taking CAM products. A total of 57.9% of the users felt that it was effective, 30.3% considered that it regulated the blood glucose level and 27.6% felt it was effective in achieving psychological relaxation. Of 93 CAM materials used by respondents, 63.7% were various types of plants, 21.6% were animal material and 14.7% were a mixture of both. The majority of DM patients (81.2%) were trying a new type of CAM, and one third of all patients were trying to start using a new type of CAM after consulting with their physicians. Doctors should recognise that complementary medicines are widely used by diabetic patients and should appreciate that these medicines can cause adverse effects. Doctors should therefore be prepared to question patients to determine what non-conventional medicines they are using.

Perceptions and attitudes of clinical oncologists on complementary and alternative medicine: a nationwide survey in Japan.

The prevalence of complementary and alternative medicine (CAM) is increasing worldwide because of the growing public interest in natural or holistic therapies and because of the flow of information through the Internet. However, there is a lack of communication between cancer patients and their physicians on topics relating to CAM. The authors performed a cross-sectional survey to evaluate the perceptions and attitudes of Japanese clinical oncologists toward cancer CAM. The CAM questionnaires were sent to 2118 clinical oncologists. The questionnaires gathered data on background (age, gender, years in practice, specialty, and knowledge of cancer CAM), perception (effectiveness/ineffectiveness, scientific evidence, and drug interactions), and attitude (experience with and response to CAM users). Questions about oncologists' perceptions and attitudes to CAM were limited to herbs and other natural products that were sold over the counter. One hundred sixty-six questionnaires were returned as undeliverable. Of the remaining questionnaires, 751 were returned (a response rate of 39%). Two-thirds of the responders were surgical oncologists and most of the remaining responders were medical oncologists. The majority of oncologists (82%) believed that CAM products were ineffective against cancer. The main reason for this belief was a lack of reliable information (as cited by 85% of oncologists). Only 13% of oncologists had experienced CAM-associated disease improvement in their cancer patients. Of all the oncologists, 84% considered the possibility of drug interactions between anticancer drugs and CAM products. The majority of oncologists (80%) replied that they could neither promote the use of CAM products nor recommend quitting the products, when they were asked about the use of CAM products by cancer patients. Negative perceptions of CAM products persist among clinical oncologists. A lack of proven effectiveness of CAM products and concerns about drug interactions with anticancer treatment suggest a need for both accurate information on CAM products and clinical trials.

Supporting Herbal Resource Needs for Health Plan Members

We describe a health plan-based herbal resource program designed within the framework of a systems approach to population health improvement. The setting is a not-for-profit, consumer-governed health plan in the Midwestern US. Telephone-based, centralized services facilitate a process of access, communication, documentation and intervention in the area of complementary and alternative medicine (CAM) use. A herbal-trained resource pharmacist is employed to provide evidence-based information on CAM products, when available, to patients and healthcare providers, educate patients who have chosen to self-medicate with CAM products for chronic conditions, and assist patients in the selection of quality CAM products prescribed by a physician. Three case studies are presented as examples of how the program is accessed, the intervention is tailored to individual needs, communication is established, documentation is organized and support is facilitated.

National policy on CAM: the White House Commission Report.

In March 2000, President William Clinton signed Executive Order 13,147, establishing the White House Commission on Complementary and Alternative Medicine, to develop public policy proposals geared toward maximizing “the benefits to Americans of complementary and alternative medicine.” Disconcertingly, the Commission's charge presumed the safety and efficacy of complementary and alternative medicine (CAM). In so doing, it placed the proverbial cart before the horse by setting the Commission on a mission to “address education and training of health care practitioners in CAM; [coordinate] research to increase knowledge about CAM products; [provide] reliable and useful information on CAM to health care professions, and [provide] guidance on the appropriate access to and delivery of CAM.”The Commission's final report (“Commission Report”), issued in March 2002, similarly skirts the fundamental question of whether evidence exists that CAM interventions are safe or offer sufficient benefit to justify their proliferation.

Complementary/alternative medicine in chronic illness as informed self-care decision making

The reasons that persons with chronic illness explore complementary and alternative medicine (CAM) have not been well understood. Using data from a study of self-care decision making in chronic illness, we conducted a qualitative secondary analysis to interpret the rationale underlying decisions to experiment with and use various CAM practices and products. The findings confirm that CAM use can be understood as a critical component of self-care management in general, and not as a rejection of conventional medicine or an unrealistic search for cure. In contrast, it represents personal responsibility for health, reframing the measures by which therapeutics are evaluated, and adopting a pragmatic approach to living as well as possible in the context of a chronic condition.

New opportunities and proven approaches in complementary and alternative medicine research at the National Institutes of Health.

This presentation describes some of the issues that arise when applying the clinical-trial approach of conventional medicine to complementary and alternative medicine (CAM) modalities. Conventional medicine has been making the evolution to using an evidence base and to making recommendations only when the evidence is strong. The National Center for Complementary Medicine (NCCAM), one of twenty-five Institutes or Centers of the National Institutes of Health (NIH), is working to hold CAM to the same high standards, not by rejecting previous CAM research, but by building on that strong evidence base of what works and what is safe. The process for conventional drug and device development follows an orderly process of preclinical studies (usually on animals), phase I, phase II, and phase III studies (with the large human clinical trial phase taking place in phase III). Today, the randomized controlled trial is recognized as providing the highest level of scientific evidence. This conventional medicine approach to development is now being used to develop complementary and alternative therapies. For instance, the discovery and development of Taxol (Bristol-Meyers Squibb, New York, NY), an extract from the bark of the Pacific yew tree that is now a widely used chemotherapeutic agent, followed the conventional pathway to approval and marketing. But for most CAM products, the pathway is not so straightforward. Most CAM therapies are traditional therapies or new products that are already available to the public. Most of what is known about these therapies is of an anecdotal nature. There has been little isolation of the active principals from the crude product and there has usually been no preclinical testing. This presentation details various approaches and programs that address how to plan and conduct a rigorous clinical trial of a CAM product. And, while it takes a good deal of persistence and a strong focus on what are the critical principals in a trial, I conclude that it is possible to apply randomized controlled trials to most of the CAM modalities.

Use of complementary and alternative medicine remedies in Sweden. A population-based longitudinal study within the northern Sweden MONICA Project. Multinational Monitoring of Trends and Determinants of Cardiovascular Disease.

Previous studies have shown a high prevalence of users of complementary and alternative medicine (CAM) remedies in Anglo-Saxon countries. We have explored the use of CAM remedies in Sweden, its distribution in different population groups and time trends during the years 1990-99. Within the framework of the population-based northern Sweden Multinational Monitoring of Trends and Determinants of Cardiovascular Disease (MONICA) Project, randomly selected 25-74-year-old participants in risk factor surveys performed in 1990, 1994 and 1999 responded to questions about their use of CAM remedies. The participation rate was 72%. Amongst 5794 respondents in the 1999 survey, 30.5% reported that they had taken a CAM product (vitamins, minerals or biological CAM remedy) in the preceding 2 weeks. Vitamins/minerals only had been taken by 11.7% and other CAM remedies (dominated by fish oil, ginseng and Q10) with or without vitamins/minerals by 18.8%. Use of CAM remedies was more frequent in women than in men and more frequent in people with high than with low level of education. The prevalence was unrelated to a history of severe cardiovascular disease or diabetes but significantly more common in subjects with poor self-perceived health, particularly so in women. During 1990-99, the use of CAM remedies increased, more in women than in men. The prevalence of CAM remedy use (other than vitamins and minerals) is high in Sweden. It has been increasing during the 1990s. Its use is particularly common in women, well-educated people and in those with poor self-perceived health.

The White House Commission on Complementary and Alternative Medicine Policy: meeting on the Access to, and Delivery of, Complementary and Alternative Medicine Services.

109 The second full meeting on Access and Delivery of Complementary and Alternative Medicine (CAM) Services took place in Washington, D.C., on Monday and Tuesday, December 4th and 5th, 2000. The White House Commission was established by President Clinton in March 2000 to develop a set of legislative and administrative policy recommendations to maximize the benefits of CAM practices and products for the general public. The Commission has a charge to submit a report to the new President and Congress by March 2002. Information about the Commission, the now nineteen commissioners, and the future schedule of full meetings and Town Hall meetings can be found on the Commission’s Web site at: http://www.whccamp.hhs.gov/ A final appointment, bringing the number of commissioners to twenty, will shortly be announced and posted on the Web site. All meetings are open to members of the public. There cannot be many Capitol Hill meetings that start with a period of meditation. The basic structure of the room and the proceedings followed the usual committee format but, at the meeting I attended, there was no sense of constrained formality. Jim Gordon, M.D., is a sensitive and empathic chair who initiated the meditation. Steven Groft, Pharm.D., the Executive Director, was the first acting director of the Office of Alternative Medicine at the National Institutes of Health (NIH). He and his team knowledgeably, yet unobtrusively, ensure a smooth, focused operation. The commissioners are warm, caring, and dedicated. During the 2 days, expert witnesses were called to make written and verbal presentations. In an open session, preregistered members of the public had an opportunity to comment. Some familiar wrangles and longstanding tensions were aired at this gathering but the mood was positive. Gone were the acrimonious exchanges of the early years of the NIH Office of Alternative Medicine. There was a new feeling of tolerance, compassion, and good humor rather than a jaded sense of “here we go again.” Therapists frequently feel squeezed out of the process of integration. Those who spoke at this meeting argued persuasively that the art of, for example, an acupuncturist is a result of long, high-level training and cannot be learned or understood in a few weeks by a physician. Many expressed the view that the M.D.s are dominating the movement to integrate. On the other hand, some physicians were sensitive to the CAM practitioners views and eager to work with the therapists on an assumption of parity. It was clear from the commissioners’ reactions that they do not believe that “one size fits all” and that there is need and room in the future for a pragmatic mix of therapist-led integrative centers employing some conventional physicians, to physician-led centers with referrals to practitioners. There was strong recognition from testimo-

Complementary and Alternative Medicine in Cardiovascular Care

Complementary and alternative medicine (CAM) refers to a broad set of health care practices that are not part of a country’s own tradition and are not integrated into the dominant health care system. Herbal remedies, dietary supplements, acupuncture, homeopathy, ayurveda, unani, traditional Chinese medicine, prayer, yoga and meditation are the common examples. CAM therapies often represent an enormous area of unregulated and widely practised therapeutics with an inadequate scientific literature. However, there is emerging evidence that some of the CAM therapies are effective in certain clinical conditions. Presently, throughout the world, there is rampant growth of CAM industries, and increasing number of reputed pharmaceutical companies are producing herbals and dietary supplements. Herbal products used for cardiovascular purposes include garlic, hawthorn, ginkgo, horse chestnut and arjun. These substances are often popularly believed to be ‘natural’, hence safe. But adverse reactions including deaths have been reported with some of the CAM products. There is also growing concern for significant drug interaction among commonly used herbals, dietary supplements and cardiovascular drugs. At present, CAM therapies may best be regarded as an adjunct to standard medical care. More scientific research and strict regulation by standard national and international authorities are needed to ensure their efficacy and safety in cardiovascular care. Key words: Complementary and alternative medicine, Herbals, Cardiovascular care. DOI: http://dx.doi.org/10.3329/cardio.v1i1.8211 Cardiovasc. j. 2008; 1(1) : 84-96