|
Evaluation
Criteria for Complementary and Alternative Medicine (CAM) Practices
There are many medical treatment decisions to make within the conventional
medicine framework for medicine. In addition, today many people
consider complementing their conventional therapies with treatments
once considered outside of that framework. Possible reasons for
this include a greater need:
-
to feel that all
possible approaches have been tried
-
to gain personal
control
-
to take some responsibility
for some of their healing
-
to minimize side
effects of conventional therapies
-
to promote a sense
of well-being
-
to improve the odds
for total cure
It is critical to thoroughly research and objectively evaluate any
CAM therapy under consideration for use. Of course, some of the
treatments like the more invasive practice of dietary supplementation
pose greater health threat and require more investigation than therapies
such as psychological support. As Michael Lerner outlines in Choices
in Healing, when evaluating a particular CAM therapy, one must weigh
all potential risks and benefits of the therapy according to:
-
the specifics of
the disease
-
one's life situation
and personal values
-
the time frame involved,
and
-
available research
findings, which are usually incomplete and more suggestive than
definitive.
In addition, several important questions, again from Lerner's book,
need to be honestly answered:
-
Can
you assess whether the therapy is probably harmless, possibly
dangerous or plausibly helpful in some significant way?
-
Does the therapy
operate according to known or plausible principles?
-
Is there any significant
scientific literature that supports the use if this therapy?
CAM therapies are often described as either open therapies or closed
therapies.An open therapy is one in which all of the information
regarding the treatment is publicly available and easy to research.
Spiritual, physiological, most nutritional and physical therapies
are typical examples of open therapies.
A closed therapy is one where the practitioner, knowingly or unknowingly,
keeps critical information secret. This is most often seen with
pharmacological therapies. This should cause one to question the
motive of the practitioner but unfortunately the air of mystic is
attractive to people and often these therapies are quite popular
despite the fact that little public information is available.
Once a treatment is selected for possible trial, another very important
set of questions recommended by the Canadian Cancer Society needs
to be addressed.
-
Is treatment safe?
As with any invasive therapy, side effects should be anticipated.
What information is available on side effects and the effect
the CAM treatment has on existing health problems? If any substance
is going to be ingested, have any adverse nutrient/drug or drug/drug
interactions been identified? And finally, what scientific literature
is available to ensure safety? The need for good systematic
research can not be mentioned enough. Most of the medications
consumed have been thoroughly tested and manufacturing practices
regulated by the FDA. This is not always the case with CAM treatments.
-
Is the treatment
effective? Efficacy is usually measured by the treatment's ability
to improve health and well being. Some of the more objective
endpoints one can use to evaluate efficacy include survival,
reduced pain/discomfort, reduced tumor size, improved appetite/weight
gain, and a number of other already identified quality of life
measures.
-
Do possible treatment
benefits outweigh possible treatment harm? One must carefully
and objectively evaluate the possible benefits and harm done
by a particular treatment. This is most easily done after researching
an open-type therapy. Fear of the recommended conventional treatment
and personal prejudice should not cloud judgment.
In summary, considerable time and energy should be dedicated
to investigation before starting a CAM treatment in order to
maximize the possible benefit and avoid possible harm. Communication
with the treating conventional medicine practitioner is of the
utmost importance as well. Many practitioners are at least vaguely
aware of most of the popular CAM treatments and can be invaluable
resources and sounding boards.
Why Choose CAM?
Introduction
and Background
Goals
Disclaimer
Introduction
The terms "alternative"
or "complementary" or "integrative" medicine are most often
used to describe non-traditional forms of health care. Generally,
those who use the term "alternative," view these therapies
as outside the mainstream of traditional Western medicine.
Those who utilize the term "complementary" often believe that
these therapies may be helpful as an adjunct to mainstream
medicine; those who use the term "integrative" tend to value
the therapies as nearly equal to mainstream therapies. For
the purposes of a health sciences university, the terms "complementary
medicine" or "integrative medicine" may seem to be the two
best choices, but there is little doubt that the term alternative
is widespread in its use and that, in fact, a sizeable portion
of the public seeks alternatives to traditional medical care.
It is noteworthy that the Federal Government has changed the
name "Center for Alternative Medicine" to "The National Center
for Complementary and Alternative Medicine." The term "medicine"
is broad in its concept and is not, as such, restricted to
the practice of physicians. In this broad sense of the term,
certain components of health care that may not easily fall
under a narrow interpretation of medicine, for example the
role that faith may have in health preservation or healing,
would fit appropriately under the terms "complementary or
alternative medicine" (CAM).
The National Center
for Complementary and Alternative Medicine has provided an
extensive classification of what it considers complementary
or alternative medicine. The list follows (1):
- Alternative Medical Systems "Complete systems of theory
and practice that have evolved independent of and often
prior to the conventional biomedical approach." (1) Traditional
oriental medicine, acupuncture, Ayurveda, homeopathy, naturopathy.
- Mind-Body Interventions "Techniques designed to facilitate
the mind's capacity to affect bodily function and symptoms"
(1) Meditation, hypnosis, dance, music and art therapy,
prayer and mental healing.
- Biological Based Therapies "Natural and biologically-based
practices, interventions, and products."(1) Herbal therapies,
specialized diet therapies, orthomolecular nutrition and
individual biological therapies.
- Manipulative and Body-Based Methods "Methods that are
based on manipulation and/or movement of the body"(1). Massage,
chiropracty.
- Energy Therapies "Energy fields originating within the
body (biofields) or those from other sources (electromagnetic
fields)"(1). Biofield therapies, Bioelectromagnetic-based
therapies.
This classification
and listing of therapies is neither complete nor authoritative.
There is little doubt
that the American public self-treats itself with a variety
of substances, including herbal and food derivatives, either
to ward off disease or to complement traditional health care
modalities. Several recent studies have shown the extent to
which these CAM practices are used.
-
In a 1998 survey
of over 1000 Americans, 40% reported using some form of
alternative medicine.
-
A national study
on use of complementary and alternative medicine by the
elderly revealed 30% had used some form of CAM in the
past year.
-
In 1997, $21.2
billion was spent on alternative medicine services in
the U.S.; an estimated $5.1 billion was expended on herbal
medicine.
-
Similar spendings
have been reported for 1999.
-
Of concern is that
approximately 15 million adults have reported taking biological
therapies concurrently with medications.
-
A1999 New Jersey
Eagleton poll revealed 36% of respondents in NJ had used
at least one form of CAM within the year and less than
30% sought a physician's advice regarding the therapy.
-
This increasing
bent to seek alternatives to traditional care is clearly
acknowledged by the United States Congress in its establishment
of the National Center for Complementary and Alternative
Medicine, within the National Institutes of Health. Senator
Tom Harkin (D-IA) notes: "An important component of a
healthy life is access to viable medical alternatives."
He also points out that "positive research studies have
not always overcome the objections of traditional medical
practitioners" albeit there are "many currently accepted
conventional treatments" which were originally branded
as quackery by the medical establishment.
-
Increasingly, medical
schools are also seeking ways in which to expose their
students to the growing reality of alternative or complementary
medicine. In fact, 64% of respondent medical schools (N=75)
indicated that either elective or required courses in
alternative or complimentary medicine were offered in
their institutions.
- The issue of alternative or complementary medicine or
health care is not restricted to medical schools alone.
In July 1998, Clement Bezold, Ph.D., President of the Institute
for Alternative Futures, wrote to deans of allied health
schools with copies of the report, "The Future of Complementary
and Alternative Approaches (CAAs) in US Health Care" released
by the Institute. Bezold notes that the notion of alternative
or complementary care is not foreign at all to at least
some components of the allied health workforce. Nor is the
practice of alternative or complementary therapies out of
the purview of many practicing health professionals who
recognize that treating the whole person may well indeed
be more than a value-added component of traditional health
care. Indeed, the role of patients' perceptions of their
own health status and of what they consider effective therapies
is a key ingredient of whole health care. There is an increasingly
rich body of literature concerning the benefits of such
mind-body therapies such as meditation and yoga as well
as acupuncture for the treatment of select pain syndromes.
Return
to Top
Background
The University of Medicine
and Dentistry of New Jersey (UMDNJ) is a multi campus health
sciences university dedicated to being the best in education,
research, community service, and patient care service. The
strong emergence of CAM use and the study of same has created
both a challenge and an opportunity for UMDNJ. Indeed, there
is empirical evidence that faculties of the Newark campus
schools utilize some form or other of herbal medicine either
for themselves or for their patients and/or incorporate their
practices into their teaching programs. In a 1998 survey of
UMDNJ faculty in Newark personal and professional use of herbal
medicine (6), almost one third (29.6%) responded that they
used herbal medicines. The most commonly used herbs among
the faculty were garlic (47%), chamomile (41%), echinacea
(38%); ginger (28%) and ginseng (26%). Faculty self-use of
herbal therapies has had a strong impact on faculty practices.
Those who use herbals (54.8%) are more likely to recommend
herbal medicines to patients than those faculty who do not
use herbals (45.2%). Users of herbal medicine were also significantly
more likely to teach about herbal medicine as well. Faculty
in each of the Newark schools, the schools of dentistry, health
related professions, medicine and nursing all reported teaching
about herbal medicine. There are some inherent challenges
in this rising phenomenon for UMDNJ. First, our students must
be made aware of the array of CAM practices currently being
utilized by the public. As part of this knowledge base, they
must learn or relearn the importance of compassionate care,
which includes the cultural and religious customs and beliefs
of their prospective patients. The University serves the public
and should be a source of sound advice and information concerning
various CAM techniques or practices, whether through the media,
a Website or a hot-line information center. There is a well
defined need for empirical research, including outcomes research
on the applications / practices of complementary or alternative
medicine. There is a considerable amount of interest at UMDNJ
in this subject since every school of the University has some
faculty with a keen interest in complementary medicine. Students
are increasingly interested in didactic and clinical experiences
in CAM. It is important, however, to garner the collective
wisdom of individuals engaged in the study of this phenomenon
and to bring their talents to bear on a shared vision of how
UMDNJ should proceed, what role the university should take
in disseminating information concerning CAM and what types
of research protocols best meet the rubric of rigor and integrity.
Since 1998, the UMDNJ
Taskforce on Alternative/Complementary Medicine more than
doubled its membership. In July 1999 all taskforce members
became members of the new Center . The Institute for Complementary
and Alternative Medicine (ICAM), formerly the Center for the
Study of Alternative and Complementary Medicine (CSACM), includes
faculty and staff from throughout the University. Goals for
the UMDNJ - ICAM are listed below. As we prepare our students
for the 21st century health care workforce, we must develop
strong research protocols and teaching programs concerning
complementary and alternative medicine. Considering the rapidity
with which CAM therapies has grown in this country, UMDNJ
must be viewed as a viable and reliable source of information
on the risks and benefits of alternative medicine and be willing
to recognize that some of these alternatives will, in fact,
replace current therapies and become "mainstream" themselves.
References
-
http://nccam.nih.gov/nccam/fcp/classify/
National Center for Complementary and Alternative
Medicine, National Institutes of Health, December 1999,
revised December 2000.
-
Astin, JA. Why
patients use alternative Medicine, Journal of the American
Medical Association, 279:1548-1553, 1998.
-
Eisenberg, M. et
al. Unconventional medicine in the U.S., New England Journal
of Medicine, 328:246-252, 1998.
-
Harkin, T. Forward
to The Future of Complementary and Alternative Approaches
[CAAs] in US Health Care, Institute for Alternative Futures,
NCMIC Insurance Company, 1998.
-
Wetzel, M. et al.
Courses involving complementary and alternative medicine
in US medical schools, Journal of the American Medical
Association, V. 280, No. 9, September 2, 1998.
- Dougherty, K. Thesis for the Master of Science in Clinical
Nutrition: Personal Beliefs and Practices and Professional
Practices Regarding Herbal Medicine of Full-Time UMDNJ Faculty
in Newark, December 1998.
Return
to Top
Goals
-
To serve as a resource
to the UMDNJ faculties and students for: grants and contracts
information on various alternative/complementary therapies
or interventions, educational information for curricular
changes or reform, and clinical practice.
-
To serve as an
educational resource to the University's consumer community
regarding complementary, integrative and alternative medicine
practices.
-
To identify research
studies or practices within UMDNJ so as to serve in a
coordinating role among the faculties of the various schools
who may share common interests.
-
To generate grant
or contractual funding to support research in complementary,
alternative or integrative medicine.
-
To partner with
industry, federal, state and local agencies in the study
of complementary and alternative medicine.
Disclaimer
If you have questions or comments regarding this site or the
information within, please send your comments via
e-mail .
The information in this site is not intended to be used
to diagnose or treat. Speak with your health care provider
before using herbs or supplements. Additionally, the Institute
for Complementary and Alternative Medicine is not responsible
for the content of suggested links you may access from this
site.
|
References
-
Lerner, M. Choices
in Healing: integrating the best of conventional and complementary
approaches to cancer. Cambridge, MA, London, England. MIT Press.1994.
-
Website: Canadian
Cancer Society.
|
