1. Will duct tape cure my warts? Examining Complementary and Alternative Medicine Karen Vargas Consumer Health Outreach Coordinator National Network of Libraries of Medicine South Central Region

2. Agenda Introducing CAM Evaluating Web Sites Recommended Websites Reviewing the Evidence

3. How do you get rid of a wart? raw meat banana peel potato witch hazel duct tape silk thread alfalfa pills apple cider toothpaste castor oil quarters dandelion juice cigarette ashes garlic pills cabbage orange peel nail polish iodine aloe c e

4. 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

5. 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

6. CAM becomes “legit” 1995 – NIH Office of Dietary Supplements – 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

7. CAM becomes “legit” 1998 – National Center for Complementary & Alternative Medicine (NCCAM) established http://nccam.nih.gov/ 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/ http://www.cancer.gov/cam/ 2001 – CAM on PubMed (NCCAM and NLM) 2009 - $296 million in NIH CAM research

8. Impact of CAM CDC Report (2007) – 38% of adults used some form of CAM – Children whose parent used CAM were 2x as likely to have used CAM – CAM use more prevalent for: women, adults aged 30-69, higher levels of education, adults who were not poor, adults living in the West, and former smokers Full report: http://nccam.nih.gov/news/camstats/ http://nccam.nih.gov/news/camstats/

9. Diseases and Conditions

10. Top CAM Therapies

11. Top 10 Supplements

12. 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 Medicine

13. 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 Medicine

14. 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 Medicine

15. Biologically Based - Supplements What is a supplement? Regulated by FDA http://www.fda.govhttp://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 http://www.cfsan.fda.gov/~dms/ds-warn.html

16. Energy Medicine Veritable - energy that can be measured – Includes sound, visible light, magnetism Putative – energy that has yet to be measured – human beings are infused with a subtle form of energy – Includes qi (ki in Japanese); doshas; prana, homeopathic resonance National Center of Complementary and Alternative Medicine

17. Energy Medicine - Acupuncture Few complications Scientific evidence? – post chemotherapy management of nausea – pain relief NIH Consensus Statement (1997) – http://consensus.nih.gov/1997/1997Acupuncture1 07html.htm http://consensus.nih.gov/1997/1997Acupuncture1 07html.htm

18. 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, rolfing, Alexander technique, Feldenkrais method *National Center of Complementary and Alternative Medicine

19. 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 Medicine

20. Other CAM Therapies Aromatherapy Colonic Irrigation Therapeutic Touch EDTA Chelation Cupping Primordial Sound Meditation

21. Avoiding Bad Science The “One Product Does It All” claim http://www.emuoilcanada.com/ Personal Testimonials http://www.getslimslippers.com/ http://www.getslimslippers.com/ Quick Fixes/Cures http://www.improveyourhealthonline.com/ The “No Risk Money Back Guarantee” http://www.naturalhpvcure.com/ http://www.naturalhpvcure.com/ The “Natural” claim http://www.amtrueman.com/products.html

22. Evaluating Web Sites Accuracy Authority Bias Currency Coverage

23. Evaluation Exercises

24. Recommended Websites About Herbs, Botanicals & Other Products

25. 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 http://clinicaltrials.gov

26. Clinical Trials and CAM Drug companies vs. supplement companies Customization of treatment in CAM CAM does not necessarily want to be studied CAM has only recently become “legit” in the scientific community

27. Money to fund CAM NCCAM: $121.7 million (2009) OCCAM: $121.9 million (2009) – Total all NIH: $296 million What about funding for pharmaceuticals? – $65.2 billion on R&D (2008) by drug companies – $114.4 billion on R&D (2008) by NIH (this includes NCCAM and OCCAM)

28. The other side Some say CAM research should not be funded – http://www.nccamwatch.org/ (Stephen Barrett) http://www.nccamwatch.org/ Or some CAM research should not be funded – http://tinyurl.com/46ayhjj http://tinyurl.com/46ayhjj

29. Reviewing the Evidence Evidence Based Medicine: “What evidence do we have to justify the treatment…” National Center for Complementary and Alternative Medicine (NCCAM) CAM on PubMed http://pubmed.govhttp://pubmed.gov

30. CAM on PubMed Exercises

31. Questions? Karen Vargas karen.vargas@exch.library.tmc.edu National Network of Libraries of Medicine South Central Region 800-338-7657