CAMLAW: Complementary and Alternative Medicine Law Blog

Table salt good or bad and other complementary medicine news

Whether CAM will enter the health care reform debate more prominently remains to be seen; meanwhile NaCl is not the same as sodium.

Here are this week's health trends:

Reflexology's effectiveness is question in this study by Ernst:

After the methodological quality of the trials was assessed by two independent reviewers, all but 18 randomised controlled trials were excluded from the review.

Of these 18 remaining studies, 12 failed to show convincingly that reflexology is an effective treatment, five suggested positive effects and the direction of one result was unclear.

"The methodological quality was often poor, and sample sizes were generally low," Dr Ernst said.

"Most higher-quality trials did not generate positive findings."

Dr Ernst warned patients against using reflexology as a diagnostic tool.

"Most proponents of reflexology would argue that this method is free of risks," he said.

"However, if used as a diagnostic tool, it will generate false-positive and false-negative diagnoses. Moreover, if employed as an alternative therapy to treat serious conditions, reflexology can be life-threatening."

The Medical Journal of Australia is a publication of the Australian Medical Association.

The Jakarta Post reports legal issues surrounding Indonesian herbal supplements:

Jamu (herbal medicine) has long been part of Indonesian healing methods and it becomes an alternative when health care fees and prices of modern medicine continue rising. Unfortunately some producers, at domestic and international levels, take advantage of these conditions by mixing certain chemicals to their products which are hazardous to public health.

Therefore the idea to introduce ASEAN standards for traditional medicine was welcome by the industry, even though some concerns have emerged.

"We are most concerned with the Good Manufacturing Practice *GMP* standard because we all know jamu producers in Indonesia are mostly small and medium enterprises that produce jamu traditionally," Abdul Ghani, deputy head of the Jamu Industry Association (GP Jamu) said Friday.

He said among the 1,166 GP Jamu members, around 90 percent were small-and middle-scale enterprises, therefore if the GMP was enforced, the traditional jamu makers would find it hard to keep up with other countries, because this could be quite difficult.

"It requires the producers to fulfil certain levels *of standards* on pollution, pesticides and other detailed technical requirements. Therefore if the requirements are implemented I'm afraid it will force around 50 percent of the jamu producers to close down," said the man who has participated in these discussions in the last five years.

He expected the government could fight for a partial derogation from these standards so they would not have to be implemented by the whole industry straight from the start.

"It is all right for the big producers because I'm sure they all can catch up with the new standards. Therefore I suggest the requirements to be compulsory for the export oriented producers only," he said.

In the meantime, he added, the big producers also had responsibility to help the small and medium producers to improve the quality of their products.

Ruslan Aspan, deputy for the traditional medicine, cosmetic and complementary products' monitoring division at the Food and Drug Monitoring Agency (BPOM) said they were still discussing many technical requirements and thought they would not reach agreement anytime soon even though ASEAN countries had set a deadline for a deal by 2011.

***

"So far we have given them training to improve product quality by using good traditional medicine production methods," he said.

According to data from the World Health Organization in 2001, some 40 percent of 220 million Indonesian people use traditional medicine, 70 percent of whom are in rural areas.

Indonesian herbal markets are also quite promising with annual sales totalling between US$144 million and $189 million in 2000-2002.

Tennessee debates whether to include complementary care in health care reform:

reported by The Tennessean newspaper.

The article profiles Dr. Cathy Stallworth, who refers her patients to complementary practitioners: "When patients come to see [the doctor] with back pain, they're as likely to get enrolled in a therapeutic yoga class, receive hypnosis or be sent for acupuncture as they are to be prescribed drugs."

Also covered in the article is the ongoing debate on health-care reform and complementary medicine.

Chelation therapy is profiled in an article on heart disease and complementary, alternative and integrative medicine. Chelation therapy raises legal issues including standard of care for physicians and the question of medical board discipline for using therapies outside those conventionally used to treat heart problems.

"This study is by far the largest clinical trial of chelation therapy," said Dr. Gervasio Lamas, chief of the Columbia University Division of Cardiology at Mount Sinai Medical Center in Miami Beach, and the study leader. "We expect we will be able to settle the controversy over chelation therapy in the next several years."

Kohlmeier isn't waiting for the results. The Noblesville grandfather of two believes that chelation, along with other therapies that Guyer prescribes, have helped him maintain optimal health for the past decade.

While he also has made changes in his diet, his endurance has improved and he feels more energetic.

"I'm 58 now, and I feel much healthier today than when I was 48," he said. "As long as I can afford this, I'm going to continue it. The whole idea is to keep me being as healthy as I can as long as I can."

The American Heart Association estimates a single chelation treatment costs $50 to $100. Some patients receive as many as 30 treatments a month.

Chelation therapy entails introducing the drug ethylene diamine tetra-acetic acid, or EDTA, into the bloodstream, where it binds with heavy metals. The EDTA and metals are then excreted from the body through sweat and urine.

An article for pharmacists advises about dietary supplements and herb-drug interactions:

Herbal supplements are among the most commonly used complementary and alternative medical therapies. The quarterly journal of the American Botanical Council, HerbalGram, reported that 2008 sales of herbal supplements in the United States reached $4.8 billion. About $289 million of these sales occurred at mainstream outlets such as food, drug, and mass outlets (excluding Wal-Mart), according to Information Resources Inc. (IRI). This was an increase of more than 7 percent from 2007.

Why the sudden increase after several years of declining sales? Some believe the economic downturn has caused patients to forgo expensive prescriptions in place of less-expensive herbal alternatives. The increase in use may also be connected to the growing number of consumers who view herbal supplements as all-natural and safe to ingest. Yet other reasons for increased use may include the accessibility of herbal supplements and consumer dissatisfaction with prescription medications.

Consumers are using herbs for a number of reasons. They want to lower cholesterol, shorten the duration of colds, improve memory or energy levels, reduce pain, lose weight, and protect vision. A Nielsen survey reported by Functional Ingredients magazine showed that 55 percent of North Americans take supplements proactively to boost their immune systems.


Self-Rx, Tx with herbals is common

Do herbal supplements work? Many shoppers believe that they do and are already taking them. This is illustrated by a 2008 Nielsen Global Online Survey that found that more than half of all U.S. consumers use supplements. Three quarters of those consumers say that they use supplements every day.


Top-selling herbal supplements

Many consumers self-diagnose their conditions and self-prescribe herbal medications on the basis of marketing claims, advice from friends, books, blog posts, and other Internet sources. In fact, the Pew Research Center recently reported that the number of adults who turn to the Internet for health information has nearly doubled in the past two years, from 31 percent to 60 percent. These are typically nonclinical sources, and for patients who follow what they read or hear without talking to a medical practitioner, the consequences could be devastating.

Herb-drug interactions

The overall public perception is that because herbs are natural, they must be safe. In fact, a 2002 National Health Interview survey showed that half of the adults questioned did not disclose their herb use to conventional medical professionals, such as physicians, nurses or pharmacists. Not only do individuals who use herbal remedies risk therapeutic failure, they also risk dangerous side effects from unforseen drug-herb or herb-herb interactions.

The reality is that more than 17,000 supplement-related health problems were handled by U.S. poison control centers in 2007. Unfortunately, many pharmacists neglect to ask what kinds of supplements patients are taking when they fill or refill a prescription. As reported by the open-access journal BMC Complementary and Alternative Medicine, a U.S. national survey found that only 7 percent of pharmacists agreed that they add herbs to their patients' profiles.

Pharmacists can help clients avoid interactions

BMC Complementary and Alternative Medicine also reported that approximately half the adults polled in one U.S. study preferred to purchase alternative healthcare products from a pharmacy. It also reported that 37 percent of respondents agreed that pharmacist advice about alternative therapies such as herbal supplements is important. Clearly, pharmacists are in the right position to help patients make good choices.

An Australian university profiles a naturopath turned researcher:

A journey that started with a bad back and the threat of a major operation is about to culminate in a study tour to a leading American medical facility for a researcher at The University of Queensland.

Research scholar Jon Wardle has received a UQ Trans-Pacific Fellowship worth almost $10,000 to meet experts in the field of complementary medicine at the University of Washington.

Mr Wardle will talk to his Seattle counterparts about the role of complementary medicine in rural general practice during a 10-week stint in the US early next year.

"It is a very exciting opportunity," Mr Wardle said.

"The North-West Pacific region is the complementary medicine research capital of the USA. The amount I can learn there is amazing."

Mr Wardle said he became interested in complementary medicine when he hurt his back while working as a nursing student and assistant nurse at the age of 21.

Instead of going for an operation to have a rod inserted in his back, he decided to try acupuncture and naturopathy.

"I was on pain killers and could not get out of bed some days. I was freaking out about having a rod in my back," he said.

"I was quite young and it was a scary proposition. I went looking for other options."

When the pain disappeared and Mr Wardle recovered using the complementary medicine therapies, he decided to become a naturopath.

Since then, he has completed a Master of Public Health at UQ and become a director of NORPHCAM, a collaborative network established to encourage international public health and health services research focusing on complementary and alternative medicine.

Mr Wardle said one in six Australian people used complementary medicine as their first option for treating illness or injuries, making it important to have plenty of research in the field.

Other fellowship recipients are Dr Simon Corrie, Dr Darby Kozak, Dr Christine Neville, Professor Peter Gray, Lahn Straney, Dr Christian Hamilton-Craig, Muharrem Akcan, Timothy Green and Bethany van Hameren.

Sodium is apparently different than sodium chloride, and table salt may not be what you think:

Sodium chloride will raise your blood pressure if you're salt-sensitive and also have inherited your family's gene variation for hypertension. But it's the chloride in sodium as well as the chloride in calcium chloride (put into some canned vegetables to preserve color) that significantly raises your blood pressure.

Is it chloride in calcium and chloride in sodium rather than sodium by itself that aggravates hypertension? On the other hand, magnesium chloride often is given to people to lower they blood pressure.

At the Solay Wellness Inc. site and at Natural News.com, you'll see an article published Dec 14, 2005 titled, "Blaming dietary sodium for high blood pressure is too simplistic; the real problem may be mineral deficiencies."

The problem to be solved may be about imbalance in minerals: how too little or too much of magnesium, calcium, and potassium (out of balance) play a role in your hypertension. Can ionic multiple minerals that might be more absorbable actually help if your body isn't absorbing minerals from other sources?

Another problem is genetic essential hypetension possibly caused by a common gene variation that affects the way your kidneys get rid of salt. And those with kidney disease or malfunctioning kidney conditions may be worsened by taking magnesium.

So always ask your doctor whether your kidneys are healthy enough for magnesium coming from various foods or supplements. It's important to know how your body processes magnesium, sodium, and calcium.

A variation in genes working together may be why some people respond to salt with hypertension and others are salt-resistant. See the book titled, Healing with Vitamins: Straight from Nature, Backed by Science--The Best Nutrients to Slow, Stop, and Reverse Disease (Rodale Health Books) by Editors of Rodale Health Books (Paperback - Mar 17, 2009)

Research on how sodium alone, as in baking soda (bicarbonate of soda) affects hypertension are ongoing. Baking soda contains sodium but not chloride. It's known that calcium chloride put into food cans to preserve color significantly raises the blood pressure in some people that are sensitive to calcium chloride. And sodium chloride also raises the blood pressure of salt-sensitive people.

The best way to handle the issue is to find out which mineral raises your blood pressure. In the meantime, balance is important, the balance of potassium along with magnesium and calcium. On one hand people can't live without salt, but salt is found in many foods such as celery, carrots, and animal protein.

Scientists are researching how potassium lowers blood pressure by relaxing small vessels and helping to remove excess water and sodium. But too much potassium can kill you.

Magnesium is very important. Find out whether you're deficient in magnesium. See the research site of the Nutritional Magnesium Association. You also need multiple minerals in balance in a form you can absorb such as ionic minerals. Check out the Eidon ionic liquid multiple minerals site.

If the potassium is unbalanced with other minerals it can raise blood pressure. A number of studies have found that limiting sodium alone doesn't lower blood pressure in many people unless potassium intake is upped simultaneously. But some people using the potassium chloride in salt substitute find their blood pressure rising after they stopped eating salted foods. What's happening?

There are a lot of issues involved. For example, your individual blood pressure problem could be associated with a high level of rennin.

It's an enzyme released by the kidneys that eventually leads to the formation of angiotensin and the release of aldosterone. These compounds cause the blood vessels to constrict and the blood pressure to increase. If you cut out salt completely, your blood pressure could rise significantly from the imbalance of too much potassium.

See The Encyclopedia of Nutritional Supplements. It lists foods by their sodium:potassium ratio. Also see Debra's Natural Gourmet site. Be careful if you're sensitive to the potassium chloride in salt substitutes.

A teaspoon generally provides 1200-1300 mg, potassium. If your kidneys or heart can't handle that much potassium chloride, your blood pressure could skyrocket, especially if you're not eating salt and other minerals in a balanced state. That's why it's important to be tested anytime you are taking something like potassium, magnesium, sodium or any supplements. You need tests of what minerals actually are being absorbed in your cells.

What's happening inside your body? In which minerals are you deficient? What are your cells actually absorbing? Is your doctor ordering the correct test of what minerals are being absorbed by your cells and not just what's in your blood serum?

Or if you have "elevated intracellular sodium or decreased intracellular potassium levels," maybe you'd respond better to magnesium supplementation.

Only you and your doctor can find out by testing or giving you a four-week trial of a mineral such as magnesium to see how your body is reacting to that basic mineral. The goal is to see what could be out of balance or deficient in some areas.

Your doctor may want to put you on a month-long trial of taking magnesium. No one wants to be low on magnesium if and when that person ends up in the emergency room.

If you don't like the way conventional medicine is handling your nutrition questions, talk to a reputable medical doctor who also has training in naturopathy, complementary medicine, preventive medicine, integrative medicine, or alternative medicine and nutrition...and who knows what tests to give.

Is there competition between what big business gains by selling more drugs versus various natural solutions? And do these solutions appear in a variety of natural health-oriented books? Such solutions include "eating four stalks of celery to lower essential hypertension (for one week on and three weeks off)." I also see studies on drinking beet juice or using slow breathing machines.

In the meantime, I am now reading the label printed on a container of a particular antioxidant supplement that has a little baking soda added to its capsules. I see the following statement: "Research suggests that sodium may impact blood pressure in some individuals only when it is consumed as sodium chloride (NaCl) table salt and not in other forms."

This means maybe your next topic to research is whether sodium alone, such as found in baking soda has a different effect on your hypertension than table salt, including sea salt and mineral salt, which is sodium chloride. Could that be why magnesium is added to restaurant salt shakers in parts of Finland?

I'd like to read those studies online about sodium alone affecting the hypertensive person differently than sodium chloride. And I'd also like to know how much sodium (as in baking soda) is okay to use to make a dozen muffins rise without making one's pressure rise as well.

Spokane Acupunture advertises its offerings:

Acupuncture is one of the oldest ways of healing on earth. It is derived from traditional Chinese medicine, and its goal is to repair and preserve health by stimulating certain points on the human body. The Spokane Acupuncture practitioners include the traditions from China, Japan, Korea, and other countries where acupuncture is considered a part of complementary and alternative medicine.

But What Is Spokane Acupuncture and is it right for me?

The word "acupuncture" means to prick with a needle. It is a technique of inserting and manipulating fine threadlike needles into certain points on the anatomy to relieve pain for a healing objective. As stated by the traditional Chinese medical principle, acupuncture points are located on meridians which are pathways in the body where vital energy and your chi is believed to flow. There is no known reason or foundation for the specific points or meridians. It is believed that acupuncture maintains the balance of your body, your yin and yang. They use it because sickness is thought to be an imbalance of yin and yang which can block you chi along the pathways.

Can Spokane Acupuncture Really Keep You Healthy?

It has been in active scientific research since the late 20th century, but it is still controversial between Western medical researchers and clinicians. Because spokane acupuncture is invasive it is hard to create studies that have correct controls. Some studies show that as a treatment it can be described through the placebo effect meaning, its all psychological and it only works because you believe it works. Other studies propose that Spokane acupuncture can be effective in treatment of specific conditions. They have looked into:

Whether it works for specific health conditions, similar to chronic back pain, headache, and osteoarthritis of the knee
How it might work, such as what happens in the brain during treatment
Ways to better recognize and understand the possible neurological properties or meridians and chi points
Methods and tools for improving the quality of the research.

There is a universal agreement with the health organizations the acupuncture is safe when administered by a well-trained professional using sterile needles, but further research is needed.

So finally, acupuncture could work for your health if you psychologically believe that Spokane Acupuncture will work, or you could just try spokane acupuncture for fun, but in the end the best way to stay heathy is the stay in shape and eat right.

Dr. Oz gets a new show:

Dr. Mehmet Oz--world-renowned heart surgeon, Oprah darling and host of the upcoming Dr. Oz Show--recently sat down with Diane Sawyer on Good Morning America and talked about complementary medicine.

I think we're beginning to globalize medicine now," said Dr. Oz. "You have to take Eastern approaches and bring them to the West and share West with the East."

Dr. Oz demonstrates this philosophy by taking Diane Sawyer into a hospital room where he leads a group of patients in song. Dr. Oz explains that singing actually promotes deep breathing and healing. While he and his colleagues used to spend hours asking patients to breathe deeply, they found that singing with them accomplished this goal more quickly and enjoyably.

Dr. Oz proclaims, "energy medicine is at the forefront of healing."

And he takes this statement seriously. For example, all patients recovering from heart surgery at Dr. Oz's own New York Presbyterian Hospital Columbia Medical Center are offered massage therapy and cranial touch therapy.

Back in the studio with Diane Sawyer, Dr. Oz discusses using lavender as a form of aromatherapy to help with insomnia. He suggests rubbing a small amount of the oil on your skin and breathing in the aroma. The smell triggers a relaxed state and can help with sleep. He also recommends meditation for depression and hypertension, explaining that meditation trains the brain to relax and shift perspective.

No doubt complementary medicine will be a focus on the Dr. Oz Show, premiering September 14th.

Michael H. Cohen is a California, New York, Massachusetts, and Washington, D.C. lawyer and providing business legal advice to entrepreneurs, and health care law advice to businesses and clinicians in the wellness industry. He represents individual entrepreneurs whose businesses are taking off vertically. He also advises medical spas and integrative medicine clinics, physicians, chiropractors, naturopathic physicians, massage therapists, energy healers, nutritionists and herbalists and others, as well as companies with new technologies including quantum, resonance, and other bio-energy devices. He is also known as a spiritual lawyer, because of his interest in numerous alternative medicine modalities, and in advising entrepreneurs and businesses with legal advice that is grounded yet intuitive. Read the Entrepreneur's Legal Toolkit for legal issues affecting small, medium, and emerging businesses. Michael also sponsors Being Central, a Portal for Potential. To speak with a lawyer about health care law issues pertaining to complementary and alternative medicine, or to consult a business lawyer about legal issues for entrepreneurs and new enterprises that are organizing or seeking investors, contact the Law Offices of Michael H. Cohen today.

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