Complementary

1
Complementary Alternative Medicine (CAM) for
Librarians - Facts, Sources, Issues

• Diane Helmer
• Dean Giustini
• March 26th, 2003
• LIBR538F - Health Sciences Librarianship

2
CAM - Terms Types

• Terms used
  alternative, ayurvedic, Chinese, complementary,
  homeopathic, holistic, integrative, native,
  natural, naturopathic, unconventional
• Others?

• Five Domains
• Alternative
• Mind-Body
• Pharmacologic and Biologic Treatments
• Herbal Medicine
• Diet and Nutrition
• Manipulative/Manual Healing Methods
• Energy therapies NCCAM site

3
CAM Trends - US Canada

• Statistics
• 60 million CAM users in US Canada
• 50 of Canadians consume natural products
• 22.7 billion dollars in provider fees
• (55 paid completely by patients)
• 4 billion dollars in products
• 629 million visits to CAM providers is - greater
  than visits to physicians!

4
CAM - important to patients?

• CAM often used to supplement care
• Women tend to be greater users baby boomers -
  incomes gt 60,000 per yr
• Patients with chronic or life-threatening
  illnesses (HIV, cancer, DM, arthritis, MS)
• 75 of users of CAM therapies dont tell their
  physicians
• Canadas Standing Committee on Health, 1998

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Focus - CAM therapies

• Why do patients seek CAM therapies?
• Patient is an active participant in care
• Supports improved QoL and well-being
• May validate subjective experiences of chronic or
  mind-body conditions
• Patients are treated as individuals
• Aims for the root of a problem rather than
  treating symptoms
• Practitioner patient relationships

6
A current definition

• CAM is a broad domain of healing and resources
  that encompasses all health systems and
  practices, their theories and beliefs other
  than those intrinsic to the dominant political
  health care systems in place in a society or
  culture
• NIH Panel on Definition and Description, 2001

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But is it scientific?

• I am confident that complementary and
  alternative medicine is destined to drag
  conventional medicine - kicking and screaming -
  into a renaissance - a radical restructuring and
  transformation that will render it more powerful
  and effective in the long run
• Dr. R Ballentyne. Radical healing and the rebirth
  of science. 2001

8
Challenges in CAM

• Evidence base is weak - but improving
• Lack of suitable definitions
• Prescribed drugs vs. herbal remedies
• Canada, unlike US, does not have CAM org
• Regulation is weak - quackery still a problem
• Placebo? Lack of quality control
• Efficacy and safety
• Advertising vs. information sources

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Drugs vs. CAM regulation
Drugs

• Health Canada USFDA - regulatory/ legislative
  bodies
• Drug safety effectiveness known prior to
  marketing
• Side effects reported patents secured
• Prescription or over-the-counter (OTC) drugs

CAM Products

• Health Canada - Natural Health Products
  Directorate
• controlled trials/studies currently underway to
  assess efficacy or effectiveness

10
Newer Legislation. United States - Dietary
Supplement Ed Act 1994 Canada - Food and
Drugs Act - 1997

• Office of Dietary Supplements (ODS) within
  National Institutes of Health
• In 1997, ODS did 40 million in research
• Natural Health Products Directorate (Health
  Canada)
• focussed on products but not much more
• regulations to be published in Spring 2003
  (Canada Gazette Part II)
• CAM research is definitely growing
• IBIDS - ODS Database searches free

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Humour

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DSHEA CAM Definition vs. Canadian definition

• Product other than tobacco intended to
  supplement diet that contains one of the
  following dietary ingredients a vitamin,
  mineral, an herb or other botanical, an amino
  acid, a dietary substance for use by man to
  supplement the diet by increasing the total daily
  intake, or a concentrate, metabolite,
  constituent, extract, or combinations of these
  ingredients (DSHEA website)
• Currently, there is no definition for natural
  health products in the Food and Drugs Act.
  Historically, they have been referred to as
  complementary medicines and traditional
  remedies.The scope of products that were
  considered in the Standing Committee's report
  included traditional herbal medicines,
  traditional Chinese, Ayurvedic (East Indian) and
  Native North American medicine homeopathic
  preparations and vitamin and mineral
  supplements. - Health Canada

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Dietary Supplements

• Adverse reports
• CAM journal literature
• FDA website (ADEs)

• NCCAM - NIH funded studies
• More in traditional journals
• German E commission monographs
• Other objective sources

St. Johns Wort
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Herbals - Safety Information

• Adverse Reports vital
• Herbals are popular
• Ephedra - adverse reactions
• Chomper - abnormal heart rate
• Sleeping Buddha estazolam
• Herbal Fen-Phen ephedra plus St. Johns Wort
  (Hypericum perforatum)
• Pennyroyal oil Comfrey - liver toxic
• Plantin may contain digitalis

15
CAM Info vs. Advertising

• Difficult to distinguish
• Media - Lay press / Health magazines
• Weight lifting / Body building mags
• Retail stores that sell the products
• Web - dot.com sites, quackwatch
• Beware of misleading claims testimonials

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Herbal Products - Canada

• Natural Health Products Directorate
• Keep up with and monitor therapeutic names and
  products newest regulations
• Buyer / librarians beware
• Why? Same herb may have several names/ derived
  from different plant species
• Manufacturers add names for single ingredient and
  combination products

17
CAM Information Resources

• Drug sources
• CAM Subject guide
• Review of Natural Products
• New PDR for Herbal products
• German E Commission monographs
• CAM websites free databases

• CAM on PubMed
• AMED (allied and alternative medicine)
• HOM-Inform
• CINAHL, EMBASE, AGRICOLA
• Cochrane Library
• IBIDS Database
• Grey literature

18
CAM Issues for HSL Librarians

• Patients and consumers want the information
• Health professionals can be skeptical of CAM
• The evaluation of CAM information may be
  problematic for librarians
• Librarians can facilitate integration of CAM
• Hard to find what is in CAM products
• Limited safety and adverse reaction information
  available to librarians

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A few common HerbalsHypericum perforatum

• St. Johns Wort
• Depression
• MAOI
• Re-uptake inhibitor
• Better than placebo

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Very popular herbals

• Echinacea
• Gingko biloba- Memory, cerebral blood flow
• Saw palmetto - prostate
• PC-Spes (a commercial product with 8 herbs) -
  prostate cancer

• Chamomile- relaxant and anti-anxiety
• Valerian- anti-anxiety and sleep aid
• Hawthorn- heart and circulatory ailments
• Senna - constipation

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Range of 12 Arthritis herbals

• Feverfew
• Chamomile
• Devils Claw
• Aspen, Ash, and Willow Bark
• Bromelain
• Myrosin

• Topical menthol, camphor, capsicum
• Glucosamine
• Chondroitin
• Rhus toxicodendrom
• RH3 (procaine)
• Myristan

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Feverfew - typical herbal

• Fever, headache, and arthritis
• Inhibits synthesis of prostaglandins, Serotonin
  Antagonist
• Did not work for RA, Prevents headaches, causes
  HA when discontinue it

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Other popular CAM therapies

• Acupuncture
• Biofeedback
• Exercise
• Hypno/hydrotherapies
• Massage Therapy
• Manipulation or energy (ie. Reiki)
• Prayer/spiritual pursuits..??? Others

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CAM summary

• CAM is a wide range of therapies in five domains
• Herbal/drug reactions a big problem
• Evidence based practice - safety first, then
  efficacy, then integration
• Buyer beware - caveat lector
• Finding reliable information for patients and
  health professionals

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Summary - Librarians

• CAM is a big consumer health issue
• Read, learn issues, trends
• Monitor research and media reports
• Tzu Chi Library is closing
• Librarians can assist clinical care on both sides
  of issues
• Keep up to evidence-based CAM!