Finding Quality Online Information about

Complementary and Alternative Medicine (CAM)

National Network of Libraries of Medicine

New England Region

The headlines….

With the constant flux of new information on CAM…

1) How can we find information that is evidence based?

2) What are the top consumer health and clinical resources to find quality information about CAM?

3) How can we help our patrons evaluate CAM information?

Agenda

• Definitions

• History and Impact

• Usage and Therapies

• Evaluating Web Sites

• Avoiding Bad Science

• Recommended Websites

• Reviewing the Evidence

How do you get rid of a wart?

raw meat

banana peel

potato

witch hazelduct tape silk thread

alfalfa pills

apple cider

toothpaste

castor oil

quarters

windex

dandelion juice cigarette ashes

garlic pills cabbage

orange peel

nail polish

iodine

aloe

c

e

What is CAM?

• Complementary and Alternative Medicine

• Complementary: together with – aromatherapy to help with pain after surgery

• Alternative: in place of– using garlic to lower blood pressure

CAM becomes “legit”

• 1990– Wilk et al v. AMA

• 1991 – $2 million in funding to establish NIH Office of

Alternative Medicine

• 1994 – Dietary Supplement Health and Education Act

CAM becomes “legit”

• 1995– NIH Office of Dietary Supplements

http://ods.od.nih.gov/– FDA declassifies Acupuncture needles as

experimental product

• 1996– NIH Consensus Conference on Acupuncture

• 1997– First large trial of CAM therapy, St. John’s

Wort for depression

CAM becomes “legit”• 1998

– National Center for Complementary & Alternative Medicine (NCCAM) established http://nccam.nih.gov/

– First full scale article in JAMA on herbal medicine

– Office of Cancer Complementary and Alternative Medicine (OCCAM) established http://www.cancer.gov/cam/

• 2001– CAM on PubMed (NCCAM and NLM)

Impact of CAM

• CDC Report (2004)– 36% of adults used some form of CAM – 55% CAM + conventional treatments– 26% used CAM because a medical

professional suggested it– $36-47 billion on CAM therapies in 1997– $5 billion on herbal remedies

• JAMA (1998)– 12.1% of population use herbal medicine

Impact of CAM

According to the National Health Statistics Report of the CDC, in 2007:

• 4 out of 10 adults used a CAM therapy in the last 12 months

• 1 out of 9 children used CAM therapies in the last 12 months

• Between 2002 and 2007 increased use was seen among adults for acupuncture, deep breathing, massage therapy, meditation, naturopathy, and yoga

Diseases and Conditions 2002

1. Back pain or problem2. Head or chest cold3. Neck pain or problem4. Joint pain or stiffness5. Anxiety/depression6. Arthritis, gout, lupus or fibromyalgia7. Stomach or intestinal illness8. Severe headache or migraine

*Barnes PM,et al. Complementary and alternative medicine use among adults: United States 2002; CDC

Diseases and Condition 2007

1. Back pain

2. Neck pain

3. Joint pain or stiffness

4. Arthritis

5. Other, specify

6. Anxiety

7. Cholesterol

8. Head or Chest Cold

Top 5 CAM Therapies 2002

1. Natural products, dietary supplements

2. Deep breathing exercises

3. Meditation

4. Chiropractic

5. Yoga

*Barnes PM,et al. Complementary and alternative medicine use among adults: United States 2002; CDC

Top 5 CAM Therapies 2007:Same as 2002

Top 10 Supplements 2002

1. Echinacea

2. Ginseng

3. Ginkgo biloba

4. Garlic

5. Glucosamine

6. St. John’s Wort

7. Peppermint

8. Fish oil/Omega 3

9. Ginger

10.Soy

*Barnes PM,et al. Complementary and alternative medicine use among adults: United States 2002; CDC

Top supplement for 2007?

Top 10 Supplements 2007

1. Fish Oil or Omega 3 or DHA

2. Glucosamine

3. Echinacea

4. Flaxseed oil or pills

5. Ginseng

6. Combination herb pill

7. Ginkgo biloba

8. Chondrotin

9. Garlic Supplements

10.Coenzyme Q-10

Categorization of Therapies*

• Whole Medical Systems

• Biologically Based Practices

• Energy Medicine

• Manipulative and Body-Based Practices

• Mind-Body Medicine

*National Center of Complementary and Alternative Therapy

Whole Medical Systems

• Complete systems of theory and practice that evolved independently

• Traditional systems of medicine that are practiced by individual cultures throughout the world – Includes traditional Chinese

medicine, Ayurvedic medicine, homeopathy, naturopathy

*National Center of Complementary and Alternative Therapy

Biologically Based Practices

• Includes: botanicals, animal-derived extracts, vitamins, minerals, fatty acids, amino acids, proteins, whole diets, and functional foods– Dietary supplements are a subset

of biologically based practices

*National Center of Complementary and Alternative Therapy

Biologically Based - Supplements

• What is a supplement?

• Regulated by FDA http://www.fda.gov– no requirements for FDA testing– manufacturers responsible for ensuring

product safety– label requirements– safety alerts:

http://www.cfsan.fda.gov/~dms/ds-warn.html

Energy Medicine

• Biofield therapies: qi gong, Reiki, Therapeutic touch, Bioenergetics

• Bioelectricmagnetic based therapies:Electromagnetic fields, magnetic fields

*National Center of Complementary and Alternative Therapy

Manipulative and Body-Based

Structures and systems of the body,

including the bones and joints, the soft

tissues, and the circulatory and lymphatic

systems. Includes: chiropractic manipulation massage therapy reflexology Alexander technique Feldenkrais method

*National Center of Complementary and Alternative Therapy

Mind-Body Medicine

• Interactions among the brain, mind, body, and behavior• The ways in which emotional, mental, social, spiritual, and

behavioral factors can directly affect health. Includes:– relaxation – hypnosis – visual imagery – meditation– yoga – biofeedback – tai chi – group support and – spirituality

*National Center of Complementary and Alternative Therapy

Other CAM Therapies

• Aromatherapy

• Colonic Irrigation

• Therapeutic Touch

• EDTA Chelation

• Cupping

• Primordial Sound Meditation

Avoiding Bad Science

• The “One Product Does It All” claimhttp://www.emuoilcanada.com/

• Personal Testimonials http://www.getslimslippers.com/

• Quick Fixes/Cureshttp://www.cure-your-asthma.com

• The “No Risk Money Back Guarantee” http://www.naturalhpvcure.com/

• The “Natural” claim http://www.amtrueman.com/products.html

Evaluating Web Sites

• Accuracy

• Authority

• Bias

• Currency

• Coverage

• User Friendliness

Examining the Research

• Observational Studies• Clinical Trials/Studies

– controlled– blind/double-blind– randomized

• ClinicalTrials.gov– Government and private clinical studies

involving humans– http://clinicaltrials.gov

Clinical Trials and CAM

• Why are there so few CAM clinical trials?– Drug companies have to do studies to go on the

market—supplement companies do not, so clinical trials sponsored by supplement companies are rare

– Alternative treatments are often customized for a specific person. Clinical trials try to prove something works for most people.

– Belief systems of some CAM practitioners do not agree with the idea of Western studies, so they do not participate

– CAM has only recently become “legit” in the scientific community

National Center for Complementary and Alternative Medicine (NCCAM)

http://nccam.nih.gov

MedlinePlus.gov

http://www.mskcc.org/mskcc/html/11570.cfm

http://nccam.nih.gov/research/camonpubmed/

http://dietarysupplements.nlm.nih.gov

http://www.cancer.gov/CAM/

http://www.noah-health.org/en/alternative/index.html

http://amfoundation.org

Questions???

Take home points

• Learn more about commonly used CAM to help you better serve your library users

• Familiarize yourself with quality online resources for CAM

• Be a “selective searcher”…evaluate online CAM information carefully

Thank You!

Michelle EberleConsumer Health Information Coordinator

michelle.eberle@umassmed.edu

National Network of Libraries of Medicine

New England Region

800-338-7657