DDW 5/9/2011 session related to Complimentary and Alternative Tx(CAM)

Hi,
The following was an oral session that I heard in the “Epidemiology and cost of CAM in managing liver disease”” presented by Dr. Doris B. Strader , Professor at University of Vermont.
It may be of interest to those who like to know more about CAM.
The added explanations by me are in ( ) and not from the lecture.

All in the beginning were the use of herbals to treat diseases including liver disease thousands years ago and the practice was passed along generations to generations thru apprenticeship.
Within the last couple hundreds years,research were tried to identified the active ingredients in the herbals in order to be used for the conventional western style medical practice .
(that is using organic pharmacological approach and synthesis method to produce the active ingredient and make it into medicine; the advantage are the proof of the effectiveness and side effect of the actual ingredient,the purity of the drug ,better quality control and mass production;and this is the basis and approach for FDA approval and manufacture of current medicines. The advance from crude botanic herbal to current pharmacy practice is only about 200 years old.)
It is important to understand the definition of the components in CAM first:
Complimentary medicine=Use separated from and in ADDITION to the conventional treatment.currently,there were few scientific method to reproduce
the responses patient claims that it works.
Alternative medicine or tx= Use separated from and IN PLACE of the conventional treatment.currently,there are randomized studies to support
some alternative treatment did work.(ie. yoga ,prayer support and massage and more).
(see CAM on this web sites under alternative Tx discussion )

In 1990, the number of practitioners in alternative medicine was roughly equal to the number of conventional medical physicians.In 1997,however the alternative practitioners is 30% more than the physicians in numbers.

Study around 1990s indicated 40% of the U.S, population had used some form of alternative treatment from the previous year.In 1997 study ,the US spent 12.2 billions on alternative medicines;5 billions in herbals alone compared to the 33 billions spent on CAM;compare to other countries,450million pounds were spent in England and 3 billions were for Australia.

A study done by Duke University on 2010 with 150 patients indicated that
80% of the them had used alternative tx between November 2007-August,2008.
30% of the users are black;56% of them used dietary vitamin supplements;
25% of them using herbals medicine(predominantly with milk thistle);
65% using prayer as alternative treatment.
college student,income>50,000,alcoholic & hepatitis patients use alternative Tx

Another study was done in 2010 (213 patient) indicated
68% agreed of the Statement “using CAM alone will improve my own well-being)
90% will agree to that statement only if use CAM in combination with current traditional treatment.
50% of non-CAM user were uncertain about the statement.
50% of CAM user disagreed on the statement”the CAM treatment is ineffective.”
65% o of CAM user disagreed and 20% of them were strongly disagreed about the statement” that CAM should only be used when conventional treatments are failed.”

A 2010 study with liver clinic patients indicated
67% are using CAM in addition to the conventional medical care; 33% are women and patients with sport injury.
72%user never thought about the adverse effects of CAM vs conventional tx.
43% CAM user were suggested by CAM providers.
40% of CAM users were recommended by their friends to use CAM.

Another 2010 study with 1000 patients in 3 US counties ;
27% use dietary supplements and herbals;again, higher education and income,hepatitis and alcohol patients use complimentary medicines more often.

Another study with 1145 patients being interviewed for use of HERBAL products; 56% said they had never used them before;
23% did use some forms of alternative medicines prior to the study.
The finding: there were no improvement on liver enzymes in using herbal products,(a slight increase on ALT,decrease on ALK and WBC.); But patients indicated improvements on fatigue,joint and muscle pain,anorexia,nausea and vomiting and overall better quality of life.

It is difficult to perform comparative studies on the cost and effectiveness on CAM.due to the fact that
1.most of the cost are paid by the patients out of their own pockets .
2. the 3rd parties like insurance co. at this point seldom approve payments for CAM.
3.The large number of UNPROVEN alternative medicine practitioners also presented a negative effect on CAM.and
4. patients use CAM seldom ask for the proof of effectiveness of the treatment as long as they believe it works.

Since 1. the world population is becoming older and that will increase the need the use of CAM to treat their chronic diseases and symptoms as they get older.
2. the patients now are demanding the insurance co. to paid for CAM benefits more and more .
3. The need to prove cost vs. benefit and risk is obvious and in doing so may decrease the mystique of CAM and increase the proven effectiveness of it.
Thus there are incentives to use scientific method to analysis the cost and the effectiveness of CAM is of great importance. ( I skip the discussion of all the methods, as patient at this point,I do not think it is necessary for me to know the details).

Currently NIH in US provides about 2 billions dollars in 6000 research projects related to dietary supplements and herbals.
USDA also provides 47 millions for study about herbs, vitamins ,minerals antioxidants and the like.

Complimentary medicine treatment,as up to now, did not shown any proven benefits of being effective therefore it may increase the cost of medicare in the future; on the other hand
Alternative medicine and treatment,it may be cost effective if it is not interfere with the conventional medical treatment.
(This is the current medical professional view of the difference between complimentary and alternative medicine in CAM)
I hope the above info from the session helps us more in understanding the current view of CAM and its future .
God bless.