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Complementary & Alternative Medicine (CAM)
Boon or bogus?
Allopathic Medicine, despite its undeniable benefits, has its limits. There are a whole host of diseases and disorders for which it can offer no cure or respite. Patients are unable to accept this situation and, frequently, look for remedies in other systems of Medicine, collectively labeled as Complementary and Alternative Medicine (CAM). Those seeking solutions in CAM will have to contend with a profusion of choices; the range on offer appears chaotic. There is no single point from which directions can be obtained. In an era where scientific validation is the unnegotiable bar for usage in clinical practice - evidence based Medicine as it is referred to - the vast majority of CAM treatments on offer are unproven. What is more, side effects and harm are poorly documented. Many, if not most, practitioners have not gone through a formal process of training and certification. Large numbers are nothing more than quacks. The patient who seeks remedies in CAM has to sail carefully through essentially uncharted seas.

29 November 2008

Politically correct definition

"Complementary and Alternative Medicine (CAM) is a broad domain of resources that encompasses health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the dominant health system of a particular society or culture in a given historical period. ... Boundaries within CAM and between the CAM domain and the domain of the dominant system are not always sharp or fixed." (The Institute of Medicine, 2005) "There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. ... What most sets alternative medicine apart, in our view, is that it has not been scientifically tested and its advocates largely deny the need for such testing." Angell M, Kassirer JP. N. Engl. J. Med., 1998. 339 (12): 83941.

CAM - a plethora of choices

To make sense of the many therapies available, it might help to look at them in the broad categories that the National Institutes of Health uses for classification. Healing systems: complete sets of theories and practices, not just a single practice or remedy, that center on a philosophy. Examples of complementary and alternative medicine healing systems include: * Ayurveda * Homeopathy * Naturopathy * Ancient medicines: Chinese, Asian, Pacific Islander, American Indian and Tibetan practices. Mind-body connections: techniques that strengthen the communication between mind and body. Examples include: * Meditation * Yoga * Biofeedback * Prayer * Hypnosis * Relaxation and art therapies, such as poetry, music and dance. Dietary supplements and herbal remedies: treatments that use ingredients found in nature. Examples include ginseng, ginkgo and echinacea, selenium, and glucosamine sulfate. Herbs and supplements can be taken as teas, oils, syrups, powders, tablets or capsules. Manipulation and touch: use of human touch to move or manipulate a specific part of your body. They include: * Chiropractic and spinal manipulation * Massage * Other types of manipulation and touch therapies, such as osteopathy, craniosacral therapy and acupressure. Energy therapies: those that believe an invisible energy force flows through your body, and when this energy flow is blocked or unbalanced illness ocurs. Unblocking or re-balancing the energy force is the goal of these therapies. Proponents of acupuncture, for instance, say that the insertion of needles into points along energy pathways (meridians) in the body restores natural energy. Energy therapies include: * Acupuncture * Therapeutic touch * Reiki * Magnet therapy * Polarity therapy * Light therapy.

"But, it works" Scams and health fraud The placebo effect No consensus

Making a choice of CAM to use for a specific condition is not an easy task. For any given condition, there are dozens of options.

Much more at:

Dr Arjun Rajagopalan

29 November 2008

Complementary and alternate explanations

"Did you hear how ..."
It is hard to counter a person who affirms that they have been witness to the efficacy of CAM, either personally or in someone closely known. We are so conditioned by the adage that seeing is believing that we refuse to concede that anecdotal reports are not scientific evidence. There are several explanations for these episodes. months, but it was only when she started on homeopathy that she got better". The fact that the poor infantry slaved away for six months is forgotten in the glamour of magic. Original diagnosis may be wrong: Bandolier has highlighted the difficulty of diagnosis. If the diagnosis is wrong, then miraculous cures are less miraculous. Mood improvement or cure?: Alternative healers often have much more time to spend with their patient than a harassed GP loaded down with kilograms of guidelines and tight prescribing budgets. Is it any wonder that alternative healers can make patients feel better? That mood change is sometimes seen as the cure. Psychological investment in alternatives - self-fulfilling prophesies: Alternative healing can be as simple as some herbal remedy bought from a shop. Sometimes it can involve huge amounts of time, massive involvement of the family, and an intense psychological investment in believing that something (anything) will work. It is not surprising, then, that many people find some redeeming value in the treatment. (From Bandolier http://www.jr2.ox.ac.uk/bandolier/band71/b71-2.html)

Many diseases are self-limiting: The old saying is that a cold will go away in a week or in seven days if you treat it. Determining whether an intervention has made a difference is therefore difficult. Unless rigorous study methods are applied, an apparent benefit cannot be ascribed to the intervention or the natural course of the disease. Many diseases are cyclical: Allergies, multiple sclerosis, arthritis and gastrointestinal problems like irritable bowel syndrome all have their ups and downs. Sufferers may seek therapy on a down, so that when an up comes that has to be due to the therapy, doesn't it. Again, only rigorous study design combats this. Placebo effect: Both the above contribute to what is called a placebo effect. It can be seen as the natural course of things. For instance, some people need no pain relief after surgery, making a pre-emptive intervention which claims to reduce pain after surgery a sure win. There will always be some people publicly to declaim its value. Natural "placebo" rates depend on what the problem is and what the benefit is. There will always be some people who benefit without an intervention. Bets are "hedged": "My auntie was under the doctor for six

... when it comes to human motivation I am working blind. I can only guess why most people seem to prefer the unproven to the proven, the anecdotal to the rigorously demonstrated, and the so-called natural to the scientific.
John Diamond, Snake Oil and other Preoccupations

Navigating the minefield of the internet

Faced with the profusion of choices and the lack of a single, reliable point of entry to CAM, patients most often turn to the internet to find answers. Their searches will throw up an even larger range of possibilities, mostly quackery and some outright frauds. Opportunists abound on the internet and often target people who are overweight or who have medical conditions for which there is no cure: multiple sclerosis, diabetes, Alzheimer's disease, cancer, HIV/AIDS and arthritis. Remember: if it sounds too good to be true, it probably is. The following warning signs could tip you off to scams and fraudulent sites: Red flag words: Words such as "satisfaction guaranteed," "miracle cure" or "new discovery." Pseudomedical jargon: Terms such as "purify," "detoxify" and "energize" may sound impressive but are generally used to cover up a lack of scientific proof. Cure-alls: Claims that the product can treat a wide range of symptoms, or cure or prevent a number of diseases. No single product can do all this. Anecdotal evidence: Testimonials are no substitute for solid scientific documentation. False accusations: The purveyor of the product accuses the government or a medical profession of suppressing important information about their product's benefits.
Source: MayoClinic.com http://www.mayoclinic.com/health/altern ative-medicine/SA00078

The placebo effect

Placebos - "sugar pills" - can provide relief from symptoms of illness more often than can be explained on the basis of chance or random occurrence. Good science, therefore, demands that trials of drug effectiveness have to be pitched against a placebo and shown to be significantly more effective. Placebo-controlled trials are the cornerstone of drug research. Research with tools to image the brain as it is working (dynamic imaging) strengthens the connection between the placebo effect and the anticipation of reward. In simple words, external motives will enhance the benefit of placebos. It is intriguing to note that the strength of the placebo response depended on the intensity with which the person believed that he or she would benefit. The "nocebo" - placebo's dark twin Expecting to feel ill can bring illness on in some instances, particularly when stress is involved - the "nocebo effect". In one 1960s test, when hospital patients were given sugar water and told it would make them vomit, 80% of them did. If you are inclined toward health anxiety, reading up on your malady or medication on the Internet can fuel your fears.

Dr Arjun Rajagopalan