CAMLAW: Complementary and Alternative Medicine Law Blog

CAM for functional bowel disorders, HIV, and stress management; herbal medicine on "Lost"

Physicians should discuss CAM use and effectiveness with their patients and refer patients if appropriate, concludes one recent study.

CAM is being used for functional bowel disorders and HIV:

Functional Bowel Disorders (FBD) are chronic disorders that are difficult to treat and manage. Many patients and doctors are dissatisfied with the level of improvement in symptoms that can be achieved with standard medical care which may lead them to seek alternatives for care.

There are currently no data on the types of Complementary and Alternative Medicine (CAM) used for FBDs other than Irritable Bowel Syndrome (IBS), or on the economic costs of CAM treatments. The aim of this study is to determine prevalence, types and costs of CAM in IBS, functional diarrhea, functional constipation, and functional abdominal pain.

Methods: 1012 Patients with FBD were recruited through a health care maintenance organization and followed for 6 months.

Questionnaires were used to ascertain: Utilization and expenditures on CAM, symptom severity (IBS-SS), quality of life (IBS-QoL), psychological distress (BSI) and perceived treatment effectiveness. Costs for conventional medical care were extracted from administrative claims.

Results: CAM was used by 35% of patients, at a median yearly cost of $200.

The most common CAM types were ginger, massage therapy and yoga. CAM use was associated with female gender, higher education, and anxiety.

Satisfaction with physician care and perceived effectiveness of prescription mediation were not associated with CAM use. Physician referral to a CAM provider was uncommon but the majority of patients receiving this recommendation followed their physician's advice.

Conclusions: CAM is used by one-third of FBG patients.

CAM use does not seem to be driven by dissatisfaction with conventional care. Physicians should discuss CAM use and effectiveness with their patients and refer patients if appropriate.

Author: Miranda AL van Tilburg, Olafur S Palsson, Rona L Levy, Andrew D Feld, Marsha Turner, Douglas A Drossman and William E Whitehead
Credits/Source: BMC Complementary and Alternative Medicine 2008, 8:46

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Traditional medicine use has been reported is common among individuals with moderate and advanced HIV disease. The aim of this cross-sectional study was to assess the use of Traditional Complementary and Alternative Medicine (TCAM) for HIV patients prior to initiating antiretroviral therapy in three public hospitals in KwaZulu-Natal, South Africa.

Methods: Using systematic sampling, 618 HIV-positive patients were selected from outpatient departments from three hospitals and interviewed with a questionnaire.

Results: TCAM was commonly used for HIV in the past six months by study participants (317, 51.3%) and herbal therapies alone (183, 29.6%).

The use of micronutrients (42.9%) was excluded from TCAM since mostly vitamins were provided by the health facility. Herbal therapies were the most expensive, costing on average 128 Rand (US$16) per patient per month.

Most participants (90%) indicated that their health care provider was not aware that they were taking herbal therapies for HIV (90%). Herbal therapies were mainly used for pain relief (87.1%) and spiritual practices or prayer for stress relief (77.6%).

Multivariate logistic regression with use of herbs for HIV as the dependent variable identified being on a disability grant and fewer clinic visits to be associated with use of herbs, and TCAM use for HIV identified being on a disability grant, number of HIV symptoms and family members not contributing to main source of household income to be associated with TCAM use.

Conclusion: Traditional herbal therapies and TCAM are commonly used by HIV treatment naive outpatients of public health facilities in South Africa. Health care providers should routinely screen patients on TCAM use when initiating ART and also during follow-up and monitoring keeping in mind that these patients may not fully disclose other therapies.

Author: Karl Peltzer, Natalie Friend-Dupreez, Shandir Ramlagan and Henry Fomundam
Credits/Source: BMC Public Health 2008, 8:255

The Wellness Blog in Meditation and Spirituality: Complementary Medicine for Health, discusses CAM therapies for stress management:

Conventional, complementary and alternative medicine: Their relevance for health promotion

Conventional, Western, allopathic medicine has, in modern times, often been the only system of medicine "taken seriously." In order to help people to attain the highest possible level of health, the World Health Organization is now viewing non-allopathic therapies, which assist in helping to maintain health, as important potential contributions to health. Traditional medicines can be used as means of promoting health in healthy and sick people, and are generally divided into those that are considered alternative, i.e., those used instead of conventional, allopathic medicine, and those that are considered complementary, i.e. those used alongside conventional allopathic medicine, such as the touch therapies including, reflexology, aromatherapy and massage, and the so called mind body therapies that help people to change their thought processes and thus their behavior, such as relaxation, meditation and autogenic training. There is some overlap in these definitions, as some traditional medicines are in fact systems of medicine, such as acupuncture, which can be used along side allopathic medicine. Integrative medicine is a term coined by Weil to describe a synergistic combination of complementary and conventional therapies (Kuhn, 1999).

Kuhn (1999) describes how the National Institute of Health has defined seven areas relating to the practice of traditional medicine:

Herbal medicine, derived from culturally diverse traditional practices

Diet, nutrition and lifestyle changes, focusing on health maintenance and illness prevention

Mind/body or behavioral interventions fostering internal homeostasis and self-efficacy

Alternative systems of medical practice, again derived from culturally diverse traditional practices

Manual healing methods: For example the touch therapies, osteopathy and physical therapy

Bioelectromagnetics focusing on how people interact with electromagnetic fields

Pharmacological and biologic treatments not yet accepted by mainstream medicine
Endacott (1996) lists a wide range of therapies shown to be useful in the management of stress. He states that while alternative medicine was mainly used as separate from orthodox medicine, complementary therapies, first used in 1976 in the UK, is holism in practice, allowing health care professionals to seek to complement the needs of the patient. The "placebo effect" contributes to the healing process, as it is essential that the person utilizing a given complementary therapy believe in its efficacy. The main benefit for public health is that people know that they must play a role in their own health care. All complementary therapies offer the participant support during the therapy and may facilitate the participant to review his or her present lifestyle and relationship with the environment (Endacott, 1996). It is well-documented that the experience of hospitalization for severe illness, especially that involving the experience of pain, may remove sense of control and mastery from even the most confident and independent person.

Complementary therapies, as well as providing a means to maintain health and well-being for the healthy individual, may also help to restore sense of self-efficacy for the person who has experienced serious loss of health, by providing an environment of empathy, encouragement and support for the participant, thereby facilitating restoration of sense of control and confidence.

And in Season 1 of "Lost," one of the passengers is an expert in using plants for herbal medicine.

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Anesthesiology Physicians - July 27, 2008 8:23 AM
[...] making appropriate recommendations, are also protected under State law, when acting appropriately.Furthermore, physicians are also protected Federally by Conant v McCaffrey (Federal District Court) and Conant v Walters (Federal [...]
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