Health: Alternative Medicine
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.
National Center for Complementary and Alternative Medicine at the National Institutes of Health
Tuesday, June 29, 2004; 2:00 p.m ET
More Americans are willing to experiment with alternative medicine, supplements and therapies -- anything from taking echinacea for colds to relieving back pain with yoga exercises -- without waiting for scientific proof of their efficacy. According to the Nutritional Business Journal, supplement sales and payments to alternative health care providers in 2002 generated $49.6 billion.
Some researchers say it is time for science to catch up with this hefty market, especially since not all treatments can be presumed to be harmless.
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D., of the National Center for Complementary and Alternative Medicine at the National Institutes of Health (NCCAM) will be online Tuesday, June 29 at 2 p.m. ET, to answer questions about the latest reasearch on alternative medicine.
Submit your questions and comments before or during today's discussion.
Straus is the director of NCCAM and Nahin is the senior adviser for Scientific Coordination and Outreach at NCCAM.
Editor's Note: washingtonpost.com moderators retain editorial control
over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: We are pleased to join you today to answer questions about the science of complementary and alternative medicine (CAM). We have been invited by the Washington Post to participate in this chat to coincide with the publication of today's special "Health" medicine on CAM.
_______________________
Scottsdale, Ariz.:
Could you SPECIFICALLY list the 5 most important
scientific results or findings from the research funded by
NCCAM since its inception? J. Holliday
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: Variations in the quality and content of dietary supplements: Our research has shown that these are more variable than consumers might have expected.
Some herbs interact powerfully with prescription drugs and can interfere with their actions.
Helped clarify the mechanism of acupuncture using state of the art brain imaging technology.
St. John's wort is not as effective as people initially thought for the treatment of major depression.
In collaboration with the Centers for teh Disease Control and Prevention, we completed the most detailed analysis of the CAM practices used by Americans--who uses it, what they use, and why they use it.
_______________________
Des Moines, Iowa:
What type of science is necessary to show that a dietary supplement is efficacious? How do marketers obtain such science? Thank you.
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: The very same kinds of science that are needed to prove that drugs are safe and effective. It involved a detailed analysis of the material itself, studies of its actions on the body, and rigorous large studies in patients (randomized double-blind clinical trials). Re the second Q: Because there is no requirement for these products to have been proven safe and effective before they are sold, there has been little incentive, tehre has vbeen littel incentive for manufacturerse to study the products. This is an important place that the NCCAM can take a leadership role. The results of our studies are published in peer reviewed journals.
_______________________
Falls Church, Va.:
What are the risks of acupuncture? I am considering it for a skin condition that seems autoimmune in nature. Western medicine has no answers for me.
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: The main risk is using acupuncture in lieu of a conventional treatment that is known to be effective. Then there are the now minor risks of acupuncture itself - pain, local bleeding, and infection if unclean needles are used.
_______________________
Falls Church, Va.:
I just wanted to point out that yoga can also be very helpful for people who suffer from nerve tension or damage. Two years ago I began to suffer extreme pain in my right wrist, arm, back, and even neck from damage to my ulnar nerve (a condition similar to carpal tunnel, but in a different nerve--in my case, the mouse was to blame). I was sent to physical therapy, and began taking hatha yoga classes at the same time. Some of the positions in the yoga class were very similar to what I was doing in physical therapy, and now yoga helps me manage the pain and relieve the tension that creeps into my back and neck.
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: In anecdotal evidence, many people report that a modality such as yoga has been helpful to them. But to provide definitive proof, you have to test these modalities in rigorous clinical trials.
_______________________
Pittsburgh, Pa.:
If I am correct, I believe there is a study ongoing which is studying the effect of herbal medications on the treatment of menopausal symptoms. Any preliminary findings?
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: There are actually a number of studies looking at herbs such as black cohosh, red clover, and soy products for the management of menopausal symptoms. Thus far, the studies have been too small to permit any conclusive results, but given the recent evidence that conventional hormones may have long-term risks for menopausal women, we are taking seriously the need to study these alternative approaches--not only to determine whether they work, but whether they are safe.
_______________________
Reston, Va.:
What do you think about Omega 3 fatty acids? Do they help relieve depression? Are there any risks? Are they safe to take during pregnancy?
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: Studies of Omega 3 fatty acids for depression are ongoing, so we don't know yet whether they're helpful. In the interim, it's important to be sure that one is in the hands of a mental health professional to make sure that one's diagnsosi and management choices, including Omega 3 fatty acids, are wise. As to safety in pregnancy, there are no reasons we know of to think that they're unsafe.
_______________________
Washington, DC:
Are there any promising alternative therapies that have proved effective for treating HIV/AIDS or reducing the symptoms of this disease?
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: There are as yet no compelling data that alternative treatments are useful for HIV/AIDS but there are ways to make patients' quality of life better--to relieve pain, to sustain appetite, for mood, for wasting, sleep disorders, etc.
_______________________
Boston, Mass.:
There seems to be a tremendous intelligence gap between the marketing materials of dietary supplements and the average physician's ability to recommend good quality products. Not even the best commercial databases available on the topic provide help in selecting one product over another. Does NCCAM have any advice on how to change this state of affairs? Or is our only hope to wait until Canada publishes its approved products and only recommend those?
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: THe public is truly in a quandary here. We have neither the strong evidence that herbal products are safe and effective nor the legal requirements that what's on the label is in the bottle. We ourselves survey the scientific literature for the latest research findings and rely often on laboratory tests to prove that the supplements we're studying are what they purport to be. We have information on dietary supplements on our Web site, http://nccam.nih.gov.
_______________________
Oslo, Norway:
When many eastern medical systems are based on a holistic view of the human body - whether it be through Chakras or Meridians - why does the western medical system have such trouble accepting acupuncture & Herbs, Tai-Chi, Chi-Gong, Yoga etc. as a valid alternative healing system.
Especially when these treatment methods show time and time again to heal people whom the western system has given up on.
Thank you for taking the time.
Rasmus
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: In fact, Western medicine is increasingly accepting CAM practices as the evidence shows that they are safe and effective. Acupuncture, for example, is practiced widely for pain relief. European countries are even more accepting, with wide use of herbs and homeopathy.
_______________________
Boston, Mass.:
I have read some reports of the survey that you published along with the CDC. I am interested in self-care remedies that are used by ethnic minorities in the U.S., and the way in which they decide "what works?" Is NCCAM considering any research specifically on ethnomedical practices?
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: RN: Many of the interventions that are considered CAM in the U.S. originate from couitries where they are considered primary care. When people emigrate to the U.S., they may bring these practices and therapies with them. NCCAM is currently testing many forms of herbal medicine from Asia, Africa, South America, and other regions. In addition, many established ethnic communities in the U.S. have developed their own folk medicines and remedies and our studies encompass many of these.
_______________________
Washington, DC:
One of the obvious problems to me, as one of the folks involved in the CAM grad program at Georgetown, is that the public has very little access to quality controlled information regarding CAM modalities. Is NCCAM doing much in the area of public education?
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: Absolutely. One example is what we're doing right now online. Other things we do are providing extensive resources on our Web site; we have a toll-free number for information (go to nccam.nih.gov); town meetings around the United States; lectures for the public at NIH; fact sheets written in plain language for the public; and of course the scientists who are leading the over 800 projects we have funded to date are our emissaries in their own communities.
_______________________
Fairfax, Va.:
Dear Drs. Straus and Nahin,
First of all, thank you for making yourselves available
online. I have worked with a doctor of homeopathy for a
number of years after conventional antibiotic treatment
failed to bring long-term improvement to my recurrent
bronchial infections. I find homeopathy to be gentle and
effective -- it not only cleared up my initial problem, but I
am now free of springtime allergies. Does your research
regarding homeopathy support my anecdotal experience?
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: No. But that does not mean that your experience is not correct or valid. It is just that recent large studies have not found homeopathic products to be effective for the management of allergies.
_______________________
Atlanta, Ga.:
Are there any non-pharmaceutical ways to treat clinical depression that are supported by scientific research?
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: Proven psychotherapy techniques aside, there are only small studies suggesting that herbal medicines, mind-body practices, or other dietary supplements are effective for depression. We strongly advise people who feel they're depressed to consult a trained mental health professional.
_______________________
San Antonio, Tex.:
Constipation is a very common malady with many over the counter medications available for temporary relief. However, chronic use of laxative for obvious reasons is not recommended. In addition to the usual recommendations of fruit, fiber, water and bowel regimen what herbal/alternative recommendations can you make? Is the daily chronic use of Senekot S safe for a young person (this is not an illness restricted to the elderly).
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: SES: The medicinal ingredient in Senekot is a plant product used for thousands of years. It is effective for mild episodic constipation and safe over the short term. Chronic constipation warrants evaluation by a GI specialist and prolonged use of any laxative can have problems.
_______________________
Arlington, Va.:
Has NCCAM done any research on alternative methods for controlling high blood pressure and cholesterol?
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: RN: NCCAM funded a clinical trial testing the use of acupuncture to reduce blood pressure. The results from this study were negative. As to cholesterol, garlic products are commonly used. The literature suggests that garlic has only a small effect in lowering choleslterol. However, none of these studies provided the definitive answer.
_______________________
Annandale, Va.:
Chiropractic care is one of the few "alternative" treatments that has a great deal of science demonstrating its efficacy for musculoskeletal conditions. Do you feel it is entering the mainstream of health care?
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: CHreiropractic is a licensed specialty in every state and DC. Chiropractic care is now provided as part of the health coverage for the military, their dependents, and veterans. Many insurers provide partial coverage for chiropractic services.
_______________________
Vienna, Va.:
Do herbal remedies and acupuncture work on bacterial infections? I have H. Pylori and three treatments of antibiotics have not worked. Now I go to a Korean acupuncturist/herbal doctor whom I trust and I know that he gets tested twice a year and is certified. The tea that he gives me has helped a lot with the bloating and gas pains but I'm not sure if it will kill the bacteria. I'm pretty wary of taking another dose of antibiotics and I'm sensitive to the side effects.
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: There is no scientific evidence that herbal remedies or acupuncture work on H pylori infection.
_______________________
Baltimore, Md.:
I have a very mild case of foot drop due to a herniated disk. I was recommended surgery, but I have very little pain, and the foot drop is the only real problem to speak of. Have you run across any alternative treatments that are meant to improve nerve conduction rather than to treat pain? Any thoughts would be appreciated.
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: THere are many CAM approaches to managing pain, but no modality has been shown to restore impaired nerve function.
_______________________
Virginia:
How did NCCAM come about from NIH. You have a lot of cases and studies where treatments and illnesses are unknown or difficult to diagnose. Have there been any cases or cures from alternative care through NCAAM? Can you give us some examples? Also what are the alternative medicines or treatments that you support?
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: NCCAM is one of the 27 institutes that comprise the NIH. It was created in 1999 at the request of the U.S. Congress to study the safety and effectiveness of CAM used by the U.S. public, to train CAM scientists, and to provide public information as we are doing today. It is not NCCAM's mission to endorse any individual CAM approach. Our job is to provide the public and practitioners with the information on which to make their own best decisions.
_______________________
Mission, Kan.:
Hello Gentleman,
My 83 old active father has a very high triglycerides level, over 600. He has to take 1 half cap. 10mg of lipitor and 1 baby aspirin per day. The Dr.wants him to go on higher dose of the Lipitor. He is open to herbs and supplements. Can he take cod liver oil instead of or along with the meds. If yes how much cod liver oil can he take? Also what about flaxseed oil and garlic? He has had no health problems.
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: Generally speaking, cod liver oil and flaxseed oil will not interfere with cholesterol-lowering drugs, but they are not nearly as effective as the conventional drugs in lowering cholesterol levels.
_______________________
Durham, Conn.:
Good afternoon
Are there any studies that show effective non-surgical treatment for an ovarian cyst, e.g. acupuncture, Chinese herbs or any other alternative therapies? Thank you very much
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: We are not aware of any, sorry.
_______________________
Boston, Mass.:
As important as it is for our scientific community to establish the efficacy, safety, and mechanism of CAM therapies that are widely used by US adults, we need to know more about costs and also cost-effectiveness of these therapies. Do you intend to incorporate any questions on cost into subsequent Alternative Health Supplements? Are there ongoing NIH-supported studies that focus on cost-effectiveness of CAM therapies?
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: Yes. Besides studying the safety and effectiveness of CAM therapies, we have studies in place that are assessing the cost effectiveness of acupuncture for degenerative arthritis and EDTA chelation therapy for cardiovascular disease, among others.
_______________________
Silver Spring, Md.:
Do you feel that as more patients use alternative methods that doctors need to know more about providing treatment that would go along with or not have adverse effects by the combination of conventional and alternative treatments.
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: Absolutely. Both patients and their physicians need to have the information on which to make good decisions. It's important that they communicate about the pros and cons of using various CAM therapies. To help in this dialogue, we have funded educational grants to 15 medical, nursing, pharmacy, and allied health professions schools to help their students understand the nature and claims of CAM. We regularly lecture at annual meetings of professional associations. NCCAM and the National LIbrary of Medicine provide free access to a vast repository of CAM research literature through CAM on PubMed, accessible through the NCCAM homepage (nccam.nih.gov).
_______________________
Arlington, Va.:
Hello,
What do you know about treating herpes with Chinese herbs and acupuncture? Thanks for your time.
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: SES: My own research has involved treatments for herpes for the past 25 years. While some herbal products do block the growth of herpesviruses in laboratory settings, they and acupuncture have not shown meaningful benefits in clinical studies.
_______________________
Stanford, Calif.:
I work in pediatric rheumatology. We consistently get visited by parents that have a child with either rheumatoid arthritis or lupus that will not follow our prescription of usually steroids plus methotrexate or steroids and cytoxan. It is very frustrating to see these children in pain and to know that their parents will not listen to our prescription. What kinds of alternative therapies have been empirically proven that I can suggest to these parents? I would like to see if there is an alternative medicine that we can combine with the treatment of methotrexate or steroids so that we can lower the doses of both of these toxic agents for our children. Is NCCAM interested in funding clinical research in this area?
Lastly, dance and music are two behaviors universally found in different healing contexts around the world. Considering the universality of dance and music in healing rituals around the world, I believe that the evolution of these behaviors is not a coincidence and that there is likely some biological evolutionary strategic reason for their popularity throughout the world. Is NCCAM interested in funding research into the basic physiological mechanisms and responses involved in the behaviors of dance and music?
Thank you very much for your time.
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: Q 1. Chronic medications needed fo r the management of rheumatological conditions in children are indded a challenge. Acupuncture may provide some pain relief. There are preliminary studies suggesting that certain herbal products such as Thunder God Vine benefit adults with RA. We in NCCAM would be interested in receiving applications to perform well-designed laboratory or clinical studies of such approaches.
Q2. We do receive and consider funding applications to study dance and music therapies.
_______________________
San Rafael, Calif.:
Is there any move afoot to get Congress and the FDA to support CAM projects?
In other words, by and large, going through the FDA approval process is so expensive only those with huge budgets and the resources to invest years of time can realistically think about seeking approval. Yet there are many excellent new approaches begin offered by small companies that cannot afford to seek medical approval for their products and therapies.
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: The U.S. Congress has proven to be very committed to supporting studies of CAM approaches. Among the funds allocated by Congress to the NIH this year, about $300 million dollars will be invested in CAM studies. The FDA does not generally support research studies. Its primary mission is to review study data to determine whether therapies are safe and effective. Most CAM approaches are not subject to FDA oversight. The FDA is not charged to decide whether such therapies are acupuncture, chiropractic, and mind-body technqiues are effective.
_______________________
Virginia:
What alternative methods gets insured and how does one go about getting treatment at NCCAM?
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: Only some CAM therapies are covered by insurers. Insurers typically make their decisions based on the evidence of safety and benefit, the cost of providing the CAM service relative to conventional treatment, and client preferences. Currently, chiropractic and acupuncture are partially covered by many insurers. As to treatment, NCCAM lists all its current clinical studies at www.clinicaltrials.gov and our Web site. However, these treatments are only available as part of these studies, for people who qualify for the studies. Routine care is not provided.
_______________________
Maryland:
What alternative treatments and medicines do you recommend over others?
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: We do not make recommendations per se. We present the scientific evidence on safety and effectiveness (e.g., in our fact sheets) and allow people to make their own decisions. THe evidence for a few dietary supplements such as glucosamine for arthritis, or acupuncture for pain, is relatively stronger than for many other CAM approaches.
_______________________
Stephen E. Straus, M.D. and Richard L. Nahin, Ph.D.: Thank you for submitting excellent questions. For more information on CAM and NCCAM, see our Web site at http://www.nccam.nih.gov or call our information clearinghouse toll free at 1-888-644-6226.
Stephen E. Straus, M.D.
Richard L. Nahin, Ph.D., M.P.H.
_______________________
| 
