Intersting article on Alternative medicine

[Guest guest]

(Most studies by establishment organizations about alternative medicine are

designed to fail. Frank)

 

 

Here is a synopsis of lecture to digestive diseases specialists by

Chief of gastroenterology at the UCLA:

http://www.diagnosishealth.com/complementary_and_alternative_medicine.

htm

 

Complementary and Alternative Medicine

 

(CAM)

Synopsis of the lecture by Ronald L. Koratz - Chief, Division of

Gastroenterology at UCLA, at the annual PG course of American

Gastroenterological Association, May, 2003.

Dr. Koratz started by reminded the audience that he does not practice nor

advocate use of these therapies, but was merely reviewing the literature as an

objective observer because he had been asked to. He focussed on the following

issues:

Definition: Those treatments and health care practices not taught widely in

Medical Schools, not generally used in hospitals and not usually reimbursed by

medical insurance companies.

 

Socioeconomic impact: One third of the public uses complementary and alternative

medicines (CAM). The number of visits to CAM practitioners is comparable to the

traditional practitioners. CAM accounts for about $15 billion in health care

costs. Patients pay this almost entirely out of pocket with respect to CAM since

most insurance companies do not cover them.

 

Criticism of CAM data: While there are numerous studies, they suffer from type I

and II errors, as well significant dropouts. Many of the studies are not

blinded.

 

 

 

EXAMPLES OF THERAPIES

 

Ginger root: Three randomized control trials have been done in pregnant women

for treatment of nausea and vomiting. Ginger was effective in all the studies.

 

Two studies have been done for treatment of peri-operative nausea and

one of them was positive. As such, the jury is out on the issue.

 

Peppermint oil: It has been studied in non-ulcer dyspepsia and irritable bowel

syndrome in several studies and its " use appears to be beneficial " .

 

Chinese herbs: These have been examined in patients with non-ulcer dyspepsia

(Drs. Cash & Schoenfeld, in DYSPEPSIA, 2000) and irritable bowel syndrome

(Journal of American Medical Association 1998 )and have been found affective in

randomized controlled trials.

 

Herbs in viral hepatitis: Herbs including Milk Thistle have been studied with

one review article and 16 randomized control trials, whereas other herbs have

been studies in 3 reviews and 22 randomized controlled trials. The benefit has

been " limited " . Quality of the trials was low.

 

A shot at critics of CAM: Dr. Koratz showed a humorous slide that stated, " When

a physician puts a needle into the back, we call it lumbar puncture. When a non-

physician puts a needle into the back we call it acupuncture. "

 

Acupuncture: Based on two systematic reviews of literature (NHS Center for

Reviews and Dissemination. Acupuncture 2001; Alberta Heritage Foundation for

Medical Research 2002), it can be stated that acupuncture is effective in

nausea, vomiting, as well as, post-operative dental care. It has not been

affective in substance abuse, obesity, tinnitus, chronic musculoskeletal pain,

and asthma.

 

Homeopathy: This system of medicine defies logic since the medicine administered

is so dilute, it hardly has any active drug in it. It is based on the principle,

" If some is good, less is better " . Dr. Linde et al (Lancet 1997) did a

meta-analysis of 89 randomized controlled trials covering 9,283 patients. The

conclusions were startling. The odds ratio in favor of homeopathy treatment was

2.54, and the authors stated that the affect of homeopathy cannot be attributed

solely to placebo effect.

 

Similarly, Dr. Cucherat, et al, (European Journal of Clinical Pharmacology 2000)

looked at 16 randomized controlled trials of over 5,000 patients. They concluded

that there is evidence that homeopathy is more affective than placebo.

 

Distant or spiritual healing: Dr. Astin, et al. (Annals of Internal Medicine

2000) studied distant or spiritual healing, by systemic review of 23 randomized

controlled trials of over 2,700 patients. The authors concluded that there was

some type of benefit and it merited further study.

 

Remote Intercessory prayer in ill health has been studied (Dr. Roberts, et al,

Cochran Reviews 2000). While several studies showed benefit, the authors

concluded that dropouts created problems with data combination but results are

" interesting enough " to justify further study of prayer. Similarly, Dr.

Leibovici, (British Medical Journal 2001) did a retrospective randomized

controlled trial of patients with septicemia. Patients were divided into 2

groups, one group received prayers (4-10 years after the fact). Although the

mortality was similar, the length of stay in the hospital and duration of fever

was shorter in the group that received prayers.

 

Quality of CAM versus traditional medicine studies: The criticism of many CAM

trials has been that their quality is poor. A systemic review of 250 randomized

controlled trials of complementary and alternative medicine was performed for

elements of quality and the mean score was 44.7 out of 100. Dr. Bloom et al (Int

Journal Tech Assess Health Care 2000) compared it to the quality of randomized

controlled trials in mainstream or traditional medicine. Surprisingly, the score

was 44.7 versus 45 out of a total of 100. They concluded that while they were

more randomized controls in traditional medicine, their quality was no better

either.

 

Example (cited by Dr. Koratz) : Angioplasty is a common intervention used by

Cardiologists. Angioplasty has been shown to be equal to medical therapy and

there is no difference in mortality or rate of infarction, but then why are we

doing angioplasty?

 

Conclusion: A challenge to the thought process is, that we should not be

dogmatic and maintain intellectual consistency. Acceptance of traditional

medicine is okay and but physicians must be equally accepting and/or cynical of

CAM.

 

Regarding physicians in mainstream medicine he asserted that that " ..much of

what they do in their own traditional practices also has no evidence of efficacy

but is employed because dogmatic authorities say it should be done " …. " ..one

should be equally skeptical about what other colleagues in traditional medicine

tout and practice "