National Center For Complementary And Alternative Medicine Research Articles

Is evidence‐based complementary and alternative medicine a contradiction in terms? –‘No’

Is evidence‐based complementary and alternative medicine a contradiction in terms? –‘No’

An independent review of studies of ‘energy medicine’ funded by the US National Center for Complementary and Alternative Medicine

AbstractThe US National Center for Complementary and Alternative Medicine (NCCAM) has frequently been criticised for funding research that is less than rigorous. Our aim was to review NCCAM‐funded clinical trials of ‘energy medicine’. We searched MEDLINE to locate all NCCAM‐funded studies of energy medicine. Data were extracted by two independent reviewers according to predefined criteria. Five RCTs were identified. Those with a low risk of bias showed no effect beyond placebo. Testing implausible treatments in clinical trials is wasteful and perhaps even detrimental.

Safe Needling Depth of Acupuncture Points

The objective of this review is to investigate the existing scientific information on the safe needling depth of acupuncture points. The PubMed, EMBASE, Cochrane, AMED (Allied and Complementary Medicine), NCCAM (The National Center for Complementary and Alternative Medicine), and CNKI (China National Knowledge Infrastructure) databases were searched to identify relevant monographs from 1991 to 2009. Additional articles were also identified from the reference list of identified articles. Chinese journals that we thought might be relevant to our study were hand searched. Thirty-three (33) studies were recruited into the review. Each research study was analyzed for study design, investigated acupuncture points, definition of safe depth, measuring methods, subject number, and for discussion of de qi. Factors that would affect the measured depth such as gender, age, body sizes, right or left side of limb, if using Ton Shen Cun for comparison, and needling angles were also reviewed. Needling depth of each point was revealed as well. There is great inconsistency in terms of safe needling depths measured from different subject groups and measuring methods. There is suitable justification for a well-designed clinical trial to investigate the real needling depth for each acupuncture points to avoid adverse effects or complications.

An independent review of NCCAM-funded studies of chiropractic

To promote an independent and critical evaluation of 11 randomised clinical trials (RCTs) of chiropractic funded by the National Centre for Complementary and Alternative Medicine (NCCAM). Electronic searches were conducted to identify all relevant RCTs. Key data were extracted and the risk of bias of each study was determined. Ten RCTs were included, mostly related to chiropractic spinal manipulation for musculoskeletal problems. Their quality was frequently questionable. Several RCTs failed to report adverse effects and the majority was not described in sufficient detail to allow replication. The criticism repeatedly aimed at NCCAM seems justified, as far as their RCTs of chiropractic is concerned. It seems questionable whether such research is worthwhile.

Cochrane CAM Reviews Commentary: Is There More to Quality Than the Research Method Itself?

The Cochrane Complementary Medicine Field is the group within the Cochrane Collaboration focused on facilitating the conduct of Cochrane systematic reviews of CAM therapies. The CAM Field represents an international collaborative effort among researchers, clinicians, consumers, and CAM practitioners from nearly every continent. The Field's central office is located at the Center for Integrative Medicine, University of Maryland School of Medicine, 520 W. Lombard St., Baltimore, MD 21201. For more information, contact Eric Manheimer at: emanheimer@compmed.umm.edu. The Complementary Medicine Field is supported by Grant R24 AT001293 from the National Center for Complementary and Alternative Medicine (NCCAM). The contents of this article are solely the responsibility of the author and do not necessarily represent the official views of the NCCAM, or the National Institutes of Health.

A GLANCE AT THE MOVE FROM COMPLEMENTARY ALTERNATIVE MEDICINE (CAM) TO INTEGRATIVE MEDICINE IN THE UNITED KINGDOM (UK), UNITED STATES (US), AND WORLD HEALTH ORGANIZATION (WHO)’S HEALTH CARE SYSTEMS

Today's medical world has gained a growing appeal towards CAM/TM which can be seen in the strategies of US in the form of establishing National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) and White House Commission on Complementary and Alternative Medicine Policy (WHCCAMP) at the White House, the annual increase of integration of CAM classical education in UK’s colleges and medical schools beside conventional medicine and strategies of WHO about the CAM. In this article we take a glance at some of the main strategies and programs of UK, US and WHO in the field of CAM/TM as examples of advanced modern medical system and their trend towards CAM/TM. 1-Increase of CAM/TM education integration in the medical education systems up to 60% (UK). 2-Emphasis of need to evaluate widely used CAM treatments for safety, efficacy and effectiveness by the use of modern experiments and clinical trials and presentation of credible data to curious public (NIH). 3-The need to train, encourage, and support of skilled investigators in both CAM and conventional medical academic communities and facilitating research, training, education and communication for interdisciplinary integration thus moving from CAM towards integrating medicine (WHO). With respect to the trend seen in medically advance countries, and considering that TIM is one of the oldest and richest branches of CAM/TM, in order to avoid falling behind the frontiers of today’s medicine which is now incorporating CAM/TM into its infrastructure, we propose that the IR of Iran must institute research, education, and therapy of TIM into the IRI health care delivery system.

Applying Principles from Complex Systems to Studying the Efficacy of CAM Therapies

In October 2007, a National Center for Complementary and Alternative Medicine (NCCAM)-sponsored workshop, entitled "Applying Principles from Complex Systems to Studying the Efficacy of CAM Therapies," was held at Georgetown University in Washington, DC. Over a 2-day period, the workshop engaged a small group of experts from the fields of complementary and alternative medicine (CAM) research and complexity science to discuss and examine ways in which complexity science can be applied to CAM research. After didactic presentations and small-group discussions, a number of salient themes and ideas emerged. This paper article describes the workshop program and summarizes these emergent ideas, which are divided into five broad categories: (1) introduction to complexity; (2) challenges to CAM research; (3) applications of complexity science to CAM; (4) CAM as a model of complexity applied to medicine; and (5) future directions. This discusses possible benefits and challenges associated with applying complexity science to CAM research. By providing an introductory framework for this collaboration and exchange, it is hoped that this article may stimulate further inquiry into this largely unexplored area of research.

Biofield therapies and psychoneuroimmunology

In this issue of Brain, Behavior, and Immunity, Lutgendorf et al. (this issue) report on a prospective randomized clinical trial that examined the effects of a biofield therapy (versus relaxation therapy or standard care) on natural killer cell cytotoxicity (NKCC), depression and quality of life in cervical cancer patients receiving chemoradiation. Biofield therapy? This type of Complementary and Alternative Medicine (CAM) therapy includes practices such as Healing Touch, Therapeutic Touch, Qi gong, and Reiki. The National Institutes of Health (NIH) National Center for Complementary and Alternative Medicine (NCCAM) describes biofield therapies as ‘‘intended to affect energy fields that purportedly surround and penetrate the human body” (NCCAM Publication No. D347). Biofield therapies seek to work with the human body’s putative vital energy field, which has been described across cultures as chi, qi, ki, and prana, such that changes in the field interact with and lead to changes in physiology as well as mood. This theory has its roots in traditional medical practices such as Ayurveda and Chinese Medicine. Among all of the CAM modalities, biofield practices are without doubt the most controversial. They do not fit conceptually with the traditional allopathic medical understanding of the human body or with broader Western scientific concepts of physiological and biochemical systems, although there are increasing efforts to understand and describe such interfaces (e.g., Brown, 2009; Tafur et al., 2010). The use of biofield therapies, particularly in cancer patients, has increased significantly in recent years and hence presents a need for more rigorous evaluation of their potential effectiveness. Lutgendorf et al.’s study is noteworthy for several reasons. First, the design represents how biofield practices are generally used as complementary therapies in cancer (i.e., patients use these approaches in conjunction with, as opposed to as an alternative to, standard treatment). The findings suggest the need to further investigate these and other complementary strategies as part of an Integrative Medicine model. Integrative Medicine refers to the integration of conventional, allopathic medicine with complementary medicine modalities that have demonstrated strong scientific evidence of safety and effectiveness. Integrative Medicine is a more

Ethics for the Pediatrician: The Ethics of Complementary and Alternative Medicine

1. Brenda J. Mears, MD* 1. *Department of Pediatrics, University of Texas at Southwestern Medical School, Dallas, Tex. Complementary and alternative medicine (CAM) is being used by a significant segment of society. To aid families who are using or considering CAM, pediatricians need to educate themselves about the available modalities and make this information available to these families. (1)(2) The 2007 National Health Interview Survey from the Centers for Disease Control and Prevention's National Center for Health Statistics estimated that 38.2% of adults and 11.8% of children had used some type of CAM in the preceding 12 months. (3) The rates may range as high as 70% in some groups. (4) In one survey, 87% of pediatricians had been asked by patients or parents about CAM, although as many as 66% may not tell their physicians when they do use CAM. (4)(5) Some of the cost of this care may be covered by insurance or government programs, but much is paid directly by families. The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health defines CAM as “a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine.” Everything from whole medical systems such as homeopathy or naturopathy; mind-body medicine such as meditation, prayer, yoga, biofeedback, hypnosis, guided imagery, and art or music therapy; biologically based practices such as herbs, vitamins, and nutritional therapy; manipulative and body-based practices such as chiropractic or massage; and energy medicine such as biofield and bioelectromagnetic therapies has been considered CAM by some people. (6) When families use alternative medicine, these therapies are used instead of conventional medicine. Complementary medicine uses these therapies as …

Commentary on the Cochrane Review of Acupuncture for Peripheral Joint Osteoarthritis

The Cochrane Complementary Medicine Field is the group within the Cochrane Collaboration focused on facilitating the conduct of Cochrane systematic reviews of CAM therapies. The CAM Field represents an international collaborative effort among researchers, clinicians, consumers, and CAM practitioners from nearly every continent. The Field's central office is located at the Center for Integrative Medicine, University of Maryland School of Medicine, 2200 Kernan Drive, Kernan Hospital Mansion, Baltimore, MD 21207-6697. For more information, contact Eric Manheimer at emanheimer@compmed.umm.edu. The Complementary Medicine Field is supported by grant R24 AT001293 from the National Center for Complementary and Alternative Medicine (NCCAM). The contents of this article are solely the responsibility of the author and do not necessarily represent the official views of the NCCAM or the National Institutes of Health.

More About the Evidence in Evidence-Based Integrative Medicine Programs

To the Editor: In their article “An evaluation of the evidence in ‘evidence-based’ integrative medicine programs,” Marcus and McCullough1 refer to a 1999–2003 program in support of curriculum development on complementary and alternative medicine (CAM) sponsored by the National Center for Complementary and Alternative Medicine (NCCAM) at the NIH. Their statement that “the premise of the NCCAM program was that there was strong evidence supporting the efficacy of some complementary and alternative therapies” is incorrect (italics added). In fact, the original solicitation2 made no reference to the efficacy of CAM therapies. The program was undertaken to address concerns that physicians and other health care practitioners had relatively little reliable training or information about CAM therapies, even though approximately 40% of adult patients were employing these practices. The premise of the program was that the education and training of conventional practitioners about the state of the evidence regarding CAM would help ensure better communication with, advice for, and care of, their patients. Josephine Briggs, MD Director, National Center for Complementary and Alternative Medicine, National Institutes of Health, Bethesda, Maryland. Jack Killen, MD Deputy director, National Center for Complementary and Alternative Medicine, National Institutes of Health, Bethesda, Maryland; [email protected].

Changing Definitions of Meditation-Is there a Physiological Corollary? : Skin temperature changes of a mental silence orientated form of meditation compared to rest

Objectives) Until very recently, the U.S. National Center for Complementary and Alternative Medicine (NCCAM) defined meditation as "a conscious mental process that induces a set of integrated physiological changes termed the relaxation response". Recently the NCCAM appears to have reviewed its understanding of meditation, by including a new central feature: "In meditation, a person learns to focus his attention and suspend the stream of thoughts that normally occupy the mind", indicating a shift from a physiological ("relaxation-response") to an experiential (suspension of thinking activity) definition, more in line with traditional eastern understandings. We explore the physiological implications of this paradigmatic shift. (Design) A controlled, observational study.of acute physiological changes. N=26. Participants were asked to either meditate or rest for 10 minutes. (Settings/Location) A temperature controlled room at Swinburne University's Psychophysiology Laboratory, Melbourne. (Subjects) 16 meditators proficient at a mental silence orientated form of meditation (Sahaja yoga, SYM) and 10 non-meditators with an interest in meditation. (Interventions) A mental silence orientated form of meditation (Sahaja yoga, SYM) was compared to rest. (Outcome Measures) Palmar skin temperature and heart rate. (Results) Throughout the meditation period mean ST of the SYM group decreased while that of the Rest group increased. After ten minutes of meditation, 13 of the 16 meditators manifested a reduction in ST compared to baseline whereas 7 of the 10 participants in the control group manifested an increase compared to baseline. Chi-Square tests showed that the difference between the two groups was significant (p=.003). Heart rate changes however did not differ between the two groups. (Conclusions) The study suggests that the experience of mental silence and rest are not psychophysiologically identical despite the fact that they are overtly similar. Implications of this, and need for further evaluation, are discussed.

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.

Effect of Acupuncture on Induction of Labor

The objective of this study is to review the existing scientific evidence on the potential role of acupuncture on induction of labor during pregnancy. The Medline, EMBASE, Cochrane Central Register of Controlled Trials, AMED (Allied and Complementary Medicine), and NCCAM (The National Center for Complementary and Alternative Medicine) databases were searched to identify relevant monographs from 1970 to 2008. These criteria included all available human acupuncture studies on pregnant women carrying a viable fetus due for third trimester induction of labor. These criteria included studies not meeting the inclusion criteria, in languages other than English, or animal studies. Ten (10) studies on labor induction were identified. The duration of labor as a result of acupuncture treatment ranged from 10 hours 20 minutes to 29.1 hours. All of the studies demonstrated labor induction by acupuncture treatment. However, because two randomized controlled trials reported that there was no statistically significant effect of acupuncture, these results are more suggestive than definitive. Furthermore, although the relationship between cervical ripening and interleukin-8 (IL-8), prostaglandin F(2alpha) (PGF(2alpha)), and beta-endorphin is well documented in the literature, there is no evidence to suggest that acupuncture alters these mediators. Serum levels of IL8, beta-endorphin, and PGF(2alpha) were not found to be significantly influenced by acupuncture. Although the definitive role of acupuncture in inducing labor is still yet to be established, the existing studies suggest that acupuncture may be beneficial in labor induction. Further randomized clinical trials are needed to investigate this further.

Editorial: The need for complementary and alternative medicine familiarisation in undergraduate nurse education

Editorial: The need for complementary and alternative medicine familiarisation in undergraduate nurse education

Witchcraft and Reiki: Voodoo Economics and Voodoo Healing

Witchcraft and Reiki: Voodoo Economics and Voodoo Healing

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.

Current alternative and complementary therapies used in menopause

Objective. To determine the efficacy and safety of common complementary and alternative medicine (CAM) therapies used to relieve the menopausal symptoms.Design. Comprehensive literature search was conducted through the databases Medline, EMBASE, Cochrane, AMED (Allied and Complementary Medicine), NCCAM (The National Centre for Complementary and Alternative Medicine) to identify relevant monographs in English language.Results. Studies have shown that some therapies such as clonidine, selective serotonin receptor inhibitors (SSRIs) and gabapentin are effective in decreasing the degree and frequency of somatic symptoms in menopause, while phytooestrogens and black cohosh have shown mixed results. Use of Ginseng, evening primrose, Dong Quai or vitamin E appears not to be efficacious for the relieving hot flushes. Other effects of these therapies including possible improvements in mood are yet to be substantiated.Inclusion criteria. All available human complementary medicine studies on menopausal women with regard to the relief of menopausal symptoms.Exclusion criteria. Studies not meeting the inclusion criteria, published in languages other than English or animal studies.Conclusion. There is a general lacking of longer-term follow-up beyond the trial lengths of 6–12 weeks in the use of CAM, although women may be taking these medications for many years. Well-designed, randomised control trials are needed to elucidate the true effect of these therapies above the placebo effect.

Integrity of Active Components of Botanical Products Used in Complementary and Alternative Medicine

TotheEditors:TheEditorialbyDrChan, whichaccompanied the randomized trial of use of Hypericum perforatum (St John’s wort)forattention-deficit/hyperactivitydisorderinchildrenand adolescentsbyDrWeberandcolleagues, summarizedtheneed for rigorous researchoncomplementaryandalternativemedicine(CAM)interventions. Itprovidedinsights intosomeof the challenges in performing high-quality CAM research. An additional challenge in studies of herbal remedies, which was well documented in the study by Weber et al but not emphasized in the Editorial, is the importance of the integrity and stability of biologically active components of herbal products. The study by Weber et al documented only at the end of the trial the oxidative degradation of the investigational product over time, such that the dose delivered during some portion of the study was less than half of the target dose. The article also acknowledged the challenge, encountered in studies of many herbal remedies, of identifying the optimal components for standardizing the preparation. Such issues raise concern about the generalizability of the results. The National Institutes of Health (NIH) National Center for Complementary and Alternative Medicine (NCCAM) has established a policy regarding biologically active agents used in all studies that it funds. Although the study by Weber et al preceded the establishment of this policy, its results highlight the need for investigators to document product stability over the course of the study. The center now requires that detailed information regarding the composition and integrity of botanical products, as well as plans to assess stability, be provided for evaluation and approval by a group of independent technical experts prior to funding. The NIH Office of Dietary Supplements (ODS) endorses this approach to the characterization and integrity of products used in research. The ODS has developed its own program to enhance the availability of tools such as methods and reference materials to support this work.

Commentary on the Cochrane Review of Chinese Herbal Medicine for Dysmenorrhea

The Cochrane Complementary Medicine Field is the group within the Cochrane Collaboration focused on facilitating the conduct of Cochrane systematic reviews of CAM therapies. The CAM Field represents an international collaborative effort among researchers, clinicians, consumers, and CAM practitioners from nearly every continent. The Field's central office is located at the Center for Integrative Medicine, University of Maryland School of Medicine, 2200 Kernan Drive, Kernan Hospital Mansion, Baltimore, MD 21207-6697. For more information, contact Eric Manheimer at emanheimer@compmed.umm.edu. The Complementary Medicine Field is supported by grant R24 AT001293 from the National Center for Complementary and Alternative Medicine (NCCAM). The contents of this article are solely the responsibility of the author and do not necessarily represent the official views of the NCCAM or the National Institutes of Health.