Herbal medicine for diabetes, new CAM survey

A new survey of alternative therapies reveals extensive use; herbal medicine is promoted for sugar control; a skeptic knocks CAM.

An Ayurvedic herb for diabetes:

Known as Gurmar and Merasingi, gymnema sylvestre is a member of the milkweed family. It is a woody plant that grows in the tropical regions of central and south India. The leaves are used as an herbal extract to slow the absorption of glucose.

Gurmar means sugar destroyer.

It is considered an ayurvedic medicine. Ayurvedic is the ancient Hindu art of medicine and of prolonging life....

The National Center for Complementary and Alternative Medicine (NCCAM), a division of the National Institute of Health is a U.S. government agency whose mission is to "explore complementary and alternative healing practices in the context of rigorous science, train complementary and alternative medicine researchers and disseminate authoritative information to the public and professionals."

NCCAM lists safety considerations when choosing herbal supplements. These include discussing supplements with your health provider as they interact and act just like drugs. Additionally NCCAM states:

"In the United States, herbal and other dietary supplements are regulated by the U.S. Food and Drug Administration (FDA) as foods. This means that they do not have to meet the same standards as drugs and over-the-counter medications for proof of safety, effectiveness, and what the FDA calls Good Manufacturing Practices."

A new CAM survey has emerged:

As more consumers become aware of medical alternatives to health and healing, physicians and other health professionals face the challenge of deciding what procedures, modalities, and therapies might be incorporated into their practice or recommended for patients to consider through alternative health practitioners. According to a recent survey by Jackson & Coker, a significant number of healthcare providers are using some form of complementary and alternative medicine (CAM) to enhance their own health and well-being, or they have introduced certain facets of alternative medicine into their patient care.

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"Our concern in commissioning this survey was to assess the extent to which health professionals are drawn to non-conventional forms of medical treatment, either for themselves or their patients," mentions Sandra Garrett, president of Jackson & Coker. "As Eastern and Western medical approaches become more blended in the healthcare field, important decisions must be made as to what treatments are acceptable according to customary medical standards of care and also covered by medical insurers."

The survey, entitled "Healthcare Providers' Use of Complementary and Alternative Medicine," was sent during June to thousands of physicians and other health professionals throughout the United States, with nearly 300 individuals responding.

The vast majority of participants (76%) held a Doctor of Medicine (MD) degree, versus a Doctor of Osteopathic Medicine degree (DO). Sixty percent were males. The largest age category was 50-59 (33%). Forty-five percent of respondents have been practicing medicine from 15-40 years.

The health practitioners surveyed learned about complementary and alternative medicine through various means: formal medical training (13%), seminars on holistic medicine (21%), and self-teaching or interaction with colleagues (25%). The types of alternative modalities, therapies, and treatments with which health providers were most familiar included: herbal medicine, massage therapy and reflexology, yoga and meditation, chiropractic treatment, biofeedback, and acupuncture. Other approaches with which they were less familiar included: hypnotherapy, aromatherapy, Tai Chi, and Ayurvetic medicine. The last two are common to Eastern medical practice.

The survey queried respondents as to what heath measures they personally hope to achieve in using some form of CAM. The results were as follows:

Stress relief 19.0%
Improve general health 15.6%
Pain management 13.3%
Improve mental alertness 11.4%
Weight reduction / control 9.3%
Reduce hypertension 8.2%
Overcome insomnia 7.8%
Lower cholesterol 5.9%
Control diabetes 3.5%.

A key survey question asked, "To what extent do you use CAM approaches in your own medical practice?" The responses were as follows; 4% frequently, 44% occasionally, and 22% not at all.

Thirty percent of respondents indicated their intent to incorporate more CAM procedures into their medical practice, whereas 28% felt they might be included to do that and 31% replied 'probably not."

The reasons prompting healthcare providers to consider adopting more CAM procedures or techniques included their personal belief in CAM, growing patient requests, additional sources of revenue, and more favorable view by insurers.

On the matter of insurance reimbursement, a slight number (2%) had experienced significant problems with medical insurers in the past, 11% had encountered some difficulties, and 26% had experienced major problems in dealing with insurers.

The survey pointed out, interestingly, that only a small number of doctors (15%) believe that as complementary and alternative medicine becomes more acceptable within the healthcare field, more insurers will provide approved reimbursement. Sixty-two percent felt it was either "not too likely" or "probably unlikely" that insurance coverage will substantially increase in the foreseeable future.

Another key question was asked: "From your perspective, do physicians tend to draw a line between CAM procedures that are acceptable versus non-acceptable to Western-trained clinicians?" A few of their comments are noteworthy:

* "I draw the line on anything that isn't proven scientifically. Unacceptable are those treatments that only target the practice's bottom line."
* "Yes, only those that have stood up to the test of controlled studies are accepted."
* "No. It seems to me to be driven almost entirely by personal preferences / exposure."
* "Doctors are not properly trained in the use of alternative medicine and therefore are very reluctant to use them in their practice."
* "I believe that most physicians are fixed in their mind set about 'scientific medicine' and 'alternative medicine," and it is difficult to change their mind set."
* "Probably not. From my experience, physicians who discount CAM tend to lump all CAM modalities together regardless of their actual credibility (or lack thereof) and toss out proven methods such as acupuncture regardless of the results."

The survey commentary concluded with an interview by a board certified Internal Medicine doctor who incorporates certain aspects of complementary medicine into her medical practice.

Dr. Frenesa Hall, Founder and Chief Medical Officer of Mobile-Medicine.net, sees a trend in more healthcare providers being receptive to integrating certain CAM therapies into their patient care. Her remarks: "I see trends in this regard due to more publicity and public demand. Another reason is being able to incorporate and add cash (unrelated to insurance) revenue into the practice. Also, patients actually get better" when they are offered alternative options to improve their health.

About Jackson & Coker

With three decades of experience, Jackson & Coker is a prominent physician-staffing firm headquartered in Alpharetta, Georgia. The company places physicians in over 40 medical specialties and advanced practitioners (chiefly CRNA's) in temporary (locum tenens) and permanent placement opportunities.

Jackson & Coker is a member of a "family of companies" known as Jackson Healthcare that provides information technology and human resources solutions to hospitals and healthcare organizations across the nation. For more information on Jackson & Coker, visit the company's website a JacksonCoker.com.

Two authors comment on CAM and evidence-based medicine:

Evidence-based practice (EBP) has become an important competency in many allied and complementary and alternative medicine (CAM) health care practitioners' professional standards of proficiency.

Methods: To compliment an EBP course for allied health care professionals and CAM practitioners, we undertook a questionnaire survey to assess learning needs.

We developed a questionnaire to measure allied health care professionals and CAM practitioners' basic knowledge, skills and beliefs concerning the main principles of EBP. The questionnaires were administered to all attendees of one-day EBP workshops.

Results: During 2004-5 we surveyed 193 allied health care professionals and CAM practitioners who attended one-day EBP courses prior to commencement of teaching. Of the respondents 121 (62.7%) were allied health care professionals and 65 (33.7%) practitioners stated that they work in the CAM field Our survey found that the majority of the respondents had not previously attended a literature appraisal skills workshop (87.3%) or received formal training in research methods (69.9%), epidemiology (91.2%) or statistics (80.8%).

Furthermore, 67.1% of practitioners specified that they felt that they had not had adequate training in EBM and they identified that they needed more training and education in the principles of EBM (86.7%). Differences in knowledge and beliefs concerning EBP amongst allied and CAM practitioners were found and length of time since qualification was also found to be an important factor in practitioner's beliefs.

More CAM practitioners compared to allied health professionals accessed educational literature via the Internet (95.3% v 68.1%, p=0.008). Whilst, practitioners with more than 11 years experience felt that original research papers were far more confusing (p=0.02) than their less experienced colleagues.

Conclusions: The results demonstrate that practitioner's learning needs do vary according to the type of profession, time since graduation and prior research experience.

Our survey findings are exploratory and will benefit from further replication, however, we do believe that they warrant consideration by allied health care and CAM tutors and trainers when planning EBP teaching curricula as it is important to tailor teaching to meet the needs of specific subgroups of trainees to ensure that specific learning needs are met.

Author: Julie Hadley, Ismail Hassan and Khalid S Khan
Credits/Source: BMC Complementary and Alternative Medicine 2008, 8:45

Here's yet another anti-CAM missive with advice on how to spot a quack:

As well as listing the usual contradictory ragbag of therapies familiar from the windows of the high-street altmed clinic - homeopathy, acupuncture, aromatherapy, Ayurvedic medicine and the like - it is peppered with the universal language of what Americans call "Woo": wellbeing, harmony, bioenergy and, most revealingly, "quantum". There's the long list of ailments he claimed to be able to treat, everything from diabetes to sports injuries and asthma. There are the pendants that supposedly protect the wearer from negative energies and, disturbingly, phallic objects apparently employed to both diagnose and cure.

Actually, it's not all bad -- there is actually some usually corrective language in here:

For a start, quacks often use language that is abstract and subjective but is ultimately meaningless. Words such as "quantum" sound impressive to those of us with only a weak grasp of theoretical physics, but are in fact nothing but pseudo-scientific window dressing designed to lure a gullible public. Their therapies are frequently based on "ancient wisdom" and their methods never change, regardless of any new evidence about their efficacy (or the lack of it).

Impressive sounding buzzwords -- watch out. I'm reminded of the first international congress on alternative medicine, as it was styled, sponsored in Washington, D.C. by Mary Ann Liebert. Just outside the glass window of a long walkway was a lovely pond, and inside, quacking away ... a family of ducks. I just had to laugh at the universe's sense of humor.

Quacks are flattering and will appeal to your vanity. They tell you that you are unique and extraordinary and not like other people. On the rare occasions that they find nothing wrong they say you need maintenance treatment "in order to keep your energies in balance". One chiropractic guru, when asked what to say to the patient who asks how long they should have treatment, said the pat answer should be "only as long as you want to stay healthy".

Anyway, the hostile articles go on with quack this and quack that. Quack, quack, quack. Can anyone truly take offense? After a while it's just plain humorous, if one adopts a 'sticks-and-stones' philosophy. The war of epithets does not really solve anything or create sound public policy, but it does reveal some deeply held feelings and digging in to one position or another. Fortunately, regulation aims to help mediate the balance.

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