The National Cancer Institute's perspective and agenda for promoting awareness and research on alternative therapies for cancer

The widespread use of a variety of nutritional, psychologic, and natural medical approaches, collectively termed complementary and alternative medicine (CAM), has been well documented. Recent surveys demonstrate that between 9% and 91% of U.S. patients with cancer use CAM therapies at some time after their diagnosis. However, there is a paucity of data available to indicate whether these CAM practices are efficacious and safe. Despite, or possibly because of, this controversy there has been considerable growth of interest in CAM by the American public. This interest has also resulted in a growth of research resources. Concurrently there has been an expansion of interest in the conventional medical establishment manifested by the creation of Departments of CAM or Integrative Medicine in respected conventional medical institutions, privately funded research centers and the National Institutes of Health (NIH) Office of Alternative Medicine (OAM)/National Center for Complementary and Alternative Medicine (NCCAM). Communication between conventional and unconventional practitioners is beginning. These changes are leading to a conversion of the dialogue about CAM from a focus on "quackery" to an exploration of the potential for novel therapeutics and the beginnings of focused, rigorous research. The National Cancer Institute is establishing programs to increase the amount and quality of CAM cancer research, support the production of high-quality CAM cancer information, and facilitate the dialogue between CAM practitioners and cancer researchers.     

NCCAM support for the Cochrane Collaboration CAM Field

Americans use CAM therapies now more than ever before, yet there is a shortage of accessible high-quality evidence from clinical trials to show which CAM therapies work best and for which conditions. The need for such evidence is great, not only among people with serious, chronic health conditions, but also among healthcare providers, who often require clinical trial evidence before recommending a medical treatment. For the last few years, the University of Maryland Center for Integrative Medicine has been working steadily to meet this need for information by identifying published clinical trials of alternative therapies, summarizing these into rigorous scientific reviews, and disseminating these reviews to the general public and to healthcare providers. In May 2003, the Center was awarded a large 4-year research grant from the National Institutes of Health's National Center for Complementary and Alternative Medicine (NCCAM) to support and extend this important work.     

Financial support for research training and career development in complementary and alternative medicine from the National Institutes of Health

Research careers are a relatively new reality for complementary and alternative medicine (CAM) practitioners (eg, chiropractors, naturopaths, doctors of oriental medicine, etc). Before the establishment in 1998 of the National Center for Complementary and Alternative Medicine (NCCAM) as part of the National Institutes of Health (NIH), there were few funding resources available for those interested in a CAM research career and fewer still feasible paths. Now, however, NCCAM provides a broad array of research training and career development awards for those seeking a long-term career in CAM research. These awards include predoctoral and postdoctoral fellowships, individual career development awards, and institutional training awards. The goal of this article is to provide information about current research training funding opportunities from NCCAM and NIH as a whole that are available to CAM practitioners in the context of the historical challenges of transitioning from a clinical career in CAM practice to a CAM research career.     

New opportunities and proven approaches in complementary and alternative medicine research at the National Institutes of Health

This presentation describes some of the issues that arise when applying the clinical-trial approach of conventional medicine to complementary and alternative medicine (CAM) modalities. Conventional medicine has been making the evolution to using an evidence base and to making recommendations only when the evidence is strong. The National Center for Complementary Medicine (NCCAM), one of twenty-five Institutes or Centers of the National Institutes of Health (NIH), is working to hold CAM to the same high standards, not by rejecting previous CAM research, but by building on that strong evidence base of what works and what is safe. The process for conventional drug and device development follows an orderly process of preclinical studies (usually on animals), phase I, phase II, and phase III studies (with the large human clinical trial phase taking place in phase III). Today, the randomized controlled trial is recognized as providing the highest level of scientific evidence. This conventional medicine approach to development is now being used to develop complementary and alternative therapies. For instance, the discovery and development of Taxol (Bristol-Meyers Squibb, New York, NY), an extract from the bark of the Pacific yew tree that is now a widely used chemotherapeutic agent, followed the conventional pathway to approval and marketing. But for most CAM products, the pathway is not so straightforward. Most CAM therapies are traditional therapies or new products that are already available to the public. Most of what is known about these therapies is of an anecdotal nature. There has been little isolation of the active principals from the crude product and there has usually been no preclinical testing. This presentation details various approaches and programs that address how to plan and conduct a rigorous clinical trial of a CAM product. And, while it takes a good deal of persistence and a strong focus on what are the critical principals in a trial, I conclude that it is possible to apply randomized controlled trials to most of the CAM modalities.     

The spectrum of therapeutic influences and integrative health care: classifying health care practices by mode of therapeutic action

The growing popularity of complementary and alternative medicine (CAM) and integrative medicine (IM) highlight the need for a clinically relevant system for classifying health care practices. All systems, modalities, and techniques of health care (conventional, complementary, alternative, and traditional) can be organized in categories of "primary mode of therapeutic action." This results in six categories: biochemical; biomechanical; mind-body; energy; psychological (symbolic); and nonlocal. In each category, there are subdivisions. Organizing health care by primary mode of therapeutic action has numerous benefits: (1) conventional and CAM practitioners, and the public, can readily see some of the general similarities and differences among practices; (2) health care educators gain a common foundation and shared language for explaining CAM and IM; (3) professionals and the public, wishing to combine dissimilar practices, gain a common framework for evaluating the meaning of integration; and (4) the crossover problem can be understood as a natural occurrence in health care, not a confusing intellectual dilemma. The National Center for Complementary and Alternative Medicine (NCCAM) system of categories for CAM is briefly critiqued.     

Views regarding use of complementary therapies for acute respiratory infections: Systematic review of qualitative studies

BackgroundUnnecessary antibiotic prescribing and use are most common for uncomplicated acute respiratory infections (ARIs). Some Complementary and Alternative Medicine (CAM) treatments have evidence of effectiveness for symptom relief and could be used instead of antibiotics.AimTo understand views of the general public and health professionals regarding use of CAM for uncomplicated ARIs.Design and SettingSystematic review and thematic synthesis of qualitative studies.MethodWe systematically searched MEDLINE, EMBASE, AMED, COREHOM, CINAHL, Dissertation and theses global and Web of Science Core Collection. We included studies which reported qualitative data on the use of CAM for uncomplicated ARIs where participants were either patients or parents of patients, health professionals or the general public. Analysis followed thematic synthesis.ResultsTwenty-two studies were included from four high-income and ten low-and-middle income countries; almost all focussed on non-White populations. Nineteen concerned parents’ treatment of ARIs in their children. In all settings, treatment decisions were influenced by beliefs about the illness (cause, severity), beliefs about treatments (efficacy, safety), availability of treatments and of trustworthy advice. Participants mostly thought CAM is an acceptable option for treatment of mild ARIs but felt that they need trustworthy advice on which treatments to use and when.ConclusionTreatment decisions depend on beliefs about the illness and treatments, availability of treatments and advice. CAM treatments appear to be acceptable to people from many different settings as a possible alternative to antibiotics for mild ARIs. There is a need for reliable, evidence-based advice on which treatments to use.     

The use of complementary and alternative therapies

The National Center for Complementary and Alternative Medicine (NCCAM) was created by Congress in 1998 as part of the National Institutes of Health. As interest in alternative and complementary therapies among healthcare providers and consumers has increased in recent years, the NCCAM has provided research funding to determine the efficacy of various types of unconventional treatments. The Center also provides research training and acts as a clearing-house for information dissemination to practitioners and the general public. Inclusion and exclusion criteria for alternative and complementary medicine as defined by the NCCAM are provided. Interest in these non-traditional treatments will likely continue to increase over the next few years. The NCCAM is playing a vital role as it provides avenues to determine how these therapies can lead to enhanced quality of life for individuals as we enter the new millennium.     

Complementary care: Alternatives for the neonatal intensive care unit

This report presents a variety of complementary and alternative medicine (CAM) modalities that may expand the conceptual framework and the evolution of the field of neonatology. This brief overview provides evidence-based support of CAM therapies and suggests areas for future expansions. The National Center of Complementary Medicine (NCCAM) categories of lifestyle and biomechanical therapies guide the discussion. The catalyst for exploring complementary care is a desire to identify and expand the nuturants newborns require, such as intense care. The fundamental philosophy of intense care emphasizes the infant and family and inspires a fresher, clearer vision of relationships. Knowing that infants are amazingly responsive organisms, health care providers are faced with the realization that the environment must be thoughtfully designed. The holistic medical movement has increasingly challenged the health care profession to broaden the definitions of care and maximize the awareness of the mother-infant bond and parent competency. Copyright © 2001 by W.B. Saunders Company     

Questions and answers about using magnets to treat pain

The National Center for Complementary and Alternative Medicine of the National Institutes of Health has published a detailed set of questions and answers about using magnets to treat pain. This resource cites the relevant scientific literature and addresses the following questions. What are magnets? Is the use of magnets considered conventional medicine or complementary and alternative medicine? What is the history of the discovery and use of magnets to treat pain? How common is the use of magnets to treat pain? What are some examples of theories and beliefs about magnets and pain? How are static magnets used in attempts to treat pain? How are electromagnets used in attempts to treat pain? What is known from the scientific evidence about the effectiveness of magnets in treating pain? Are there scientific controversies associated with using magnets for pain? Have any side effects or complications occurred from using magnets for pain? What should consumers know if they are considering using magnets to treat pain? Is the National Center for Complementary and Alternative Medicine (NCCAM) funding research on magnets for pain and other diseases and conditions? The report also includes definitions and three appendices that address the following issues: Research on Theories and Beliefs On How Magnets Might Relieve Pain, General and Systematic Reviews on CAM Magnetic Therapy for Pain Published From August 1999 to August 2003, and Reports on Randomized Clinical Trials of Magnetic Therapy for Pain from January 1997 to March 2004.     

Public demand and the integration of complementary and alternative medicine in the US health care system

Public use of complementary and alternative medicine (CAM) grew 25% between 1990 and 1997 and had a number of implications for chiropractic and the US health care system. Recent surveys describe the issues surrounding definitions of CAM; patterns of CAM use and its costs; attitudes of the public, health care providers and business entities; increasing scientific research; and changes in the health care system. Almost one third (192 million) of the 629 million visits to CAM providers in 1997 were to chiropractors. The new US National Center for Complementary and Alternative Medicine have funded chiropractic and other CAM research as a regular part of its scientific portfolio. Health maintenance organizations and other health care business entities have created new markets for CAM services, including chiropractic. profession, chiropractic appears to be positioned somewhere between mainstream practice and CAM, with conflicting opinions held by the public, the health care industry, and chiropractors themselves. The benefits and risks of chiropractic being identified with the CAM movement must be weighed carefully.     

Complementary and alternative medicine (CAM) and supportive care in cancer: a synopsis of research perspectives and contributions by an interdisciplinary team

Goals of work The purpose of this short review is to provide a commonly accepted definition of complementary and alternative medicine (CAM), to illustrate the widespread use of CAM by people affected by cancer around the world, and to highlight the research contributions of the Cancer Complementary and Alternative Medicine (CCAM) research team and its colleagues. Methods Based on research conducted by CCAM and several European colleagues, a collection of articles was compiled, reviewed, and edited. Main results CAM modalities play a role in supportive care and cancer. Because of the high CAM utilization, it is critical to help cancer patients make safe, informed, evidence-based decisions for their care. In addition, advances in research methodology, outcomes, and measurement in CAM studies are suggested to better account for individual and collective experiences. Conclusion This special issue provides clinicians with a summary of information about CAM and perspectives for better responding to cancer patient’s needs.     

Complementary and alternative medicine use and disclosure amongst Australian radiotherapy patients

Purpose

Information on complementary and alternative medicine (CAM) use in Australian radiotherapy patients is sparse. This study investigated the type and prevalence of CAM amongst an Australian regional radiotherapy patient cohort and the disclosure of information to the consultant radiation oncologist.

Methods

A single hardcopy questionnaire survey was provided to patients regarding the use of CAM and discussion with the treating medical practitioner. The National Centre for Complementary and Alternative Medicine (NCCAM) classification was used to group responses. The study was open for a period of 4 months, and all patients on treatment during this period were approached.

Results

A total of 170 questionnaires were distributed to eligible patients, and 152 patients returned a completed questionnaire (89.4 % response rate). Sixty-nine of the 152 patients (45.4 %) reported active CAM use. Of the 69 patients who used CAM, mind–body medicine (n?=?54, 78.3 %) and biological-based therapies (n?=?54, 78.3 %) were the commonest NCCAM group, whilst manipulative/body-based therapies (n?=?44, 63.8 %), whole medical systems (n?=?7, 10.1 %) and energy therapies (n?=?5, 7.2 %) were the least common. The most common therapies were vitamins and mineral supplementation (n?=?33, 47.8 %) and massage therapy (n?=?18, 26.1 %). Of note, only 29 participants stated that they had discussed CAM therapies with their radiation oncologist.

Conclusions

CAM use was prevalent amongst cancer patients undergoing radiotherapy, but frequently not discussed with the treating radiation oncologist. Considering the high prevalence of CAM, further resources could be justifiably directed at providing this service for cancer patients to foster a more holistic approach to their care.     

Conceptualization and analysis of mechanistic studies

Much recent attention has been given to the priority for doing "mechanistic studies" of complementary and alternative medicine (CAM) modalities. A preference for such studes has been clearly indicated by the National Center for Complementary and Alternative Medicine program of funding for CAM research. It is, however, difficult to find canons by which "mechanistic" studies should be analyzed, and even harder to find a good definition of "mechanism." Social scientists have well-developed ways of approaching these issues, but their methods suffer from a fatal flaw, the ecologic mechanistic fallacy. Basic scientists fare even worse, often conducting mechanistic studies that may have no plausible mechanistic content, and that also commit the ecologic mechanistic fallacy. More methodological work on the concept of mechanism is needed at a fundamental level.     

Efficacy of selected complementary and alternative medicine interventions for chronic pain

Complementary and alternative medicine (CAM) is a group of diverse medical and healthcare systems, therapies, and products that are not presently considered part of conventional medicine. This article provides an up-to-date review of the efficacy of selected CAM modalities in the management of chronic pain. Findings are presented according to the classification system developed by the National Institutes of Health National Center for Complementary and Alternative Medicine (formerly Office of Alternative Medicine) and are grouped into four domains: biologically based medicine, energy medicine, manipulative and body-based medicine, and mind-body medicine. Homeopathy and acupuncture are discussed separately as "whole or professionalized CAM practices." Based on the guidelines of the Clinical Psychology Division of the American Psychological Association, findings indicate that some CAM modalities have a solid track record of efficacy, whereas others are promising but require additional research. The article concludes with recommendations to pain practitioners.     

Use of complementary and alternative medicine by pediatric oncology patients during palliative care

Purpose

Although the popularity of complementary and alternative medicine (CAM) has risen in the last decade, information about its use by pediatric patients in palliative care is still scarce. The purpose of the study was to assess the frequency and types of CAM administered by parents with children suffering from cancer during the palliative phase.

Methods

All parents who lost their child due to cancer in the federal state North Rhine Westfalia/Germany were eligible for the study. The first group of eligible parents was contacted in 1999–2000 and a second group of parents in 2005–2006. Upon agreement, parents were asked to complete a semi-structured questionnaire about the frequency of CAM use and the specific treatments that had been used. The types of CAM were categorized according to the National Center for Complementary and Alternative Medicine (NCCAM).

Results

A total of 96 parents participated in the study (48 in each cohort). Forty-three percent of all parents in both groups reported CAM use. The results show an increase of CAM use from 38 % in the first group to 49 % in the second cohort of pediatric patients during palliative care. The most common types of CAM used in both groups were homeopathy and treatment with mistletoe preparations.

Conclusions

The study provides information about usage of CAM in children suffering from cancer during the palliative phase of the disease. Further research is required to investigate benefits, potential adverse effects, and the potential efficacy of CAM in this population.

     

Response to a proposal for an integrative medicine curriculum

BACKGROUND: A paper entitled "Core Competencies in Integrative Medicine for Medical School Curricula: A proposal," published in Academic Medicine, stimulated a broad discussion among complementary and alternative medicine (CAM) educators. This discussion led to a formal process for responding to the issues raised by the paper. METHODS: Representatives from the Academic Consortium for Complementary and Alternative Health Care (ACCAHC) and the Oregon Collaborative for Complementary and Integrative Medicine (OCCIM) formed the ACCAHC/OCCIM Task Force to participate in a Delphi process of consultation and deliberation. This process led to a broad, cross-discipline agreement on important points to include in a response to the integrative medicine (IM) curriculum proposal. RESULTS: Five key areas of concern emerged: (1) the definition of IM as presented in the paper; (2) lack of clarity about the goals of the proposed IM curriculum; (3) lack of recognition of the breadth of whole systems of health care; (4) omission of competencies related to collaboration between MDs and CAM professionals in patient care; and (5) omission of potential areas of partnership in IM education. CONCLUSIONS: A major overall theme emerging from the Delphi process was a desire for closer collaboration between conventional medical schools and CAM academic institutions in developing IM curricula. Several cross-disciplinary venues for addressing the Delphi Task Force themes include the National Center for Complementary and Alternative Medicine's R-25 Initiatives, and the National Education Dialogue. OCCIM is presented as an example of a successful lateral integration approach.     

Complementary and alternative medicine in the scientific literature

OBJECTIVE: To analyze the frequency and typology of scientific papers on complementary and alternative medicine (CAM) published in the period 1997-2002. METHODS: We performed a systematic literature search of MEDLINE in order to identify all articles dealing with CAM, in the human setting, published from January 1, 1997 to December 31, 2002. Our attention was focused on randomized controlled trials conducted on CAM and on the impact factor (IF) of the journals in which CAM articles were published. RESULTS: During the period 1997-2002, a total of 20,209 articles about CAM were published, representing the 0.7% of the total number of MEDLINE-listed articles. Approximately 50% of CAM articles published in 1996-2002 appeared on journals with no IF. The proportion of randomized clinical trials was 7.6% of total CAM articles. CONCLUSIONS: There is an upward trend in the number of CAM articles but the number of experimental studies is low and over half of articles are published in journals without an IF. We believe there is an urgent need to conduct rigorous research in the field of CAM in order to support, for the need of the public, an evidence-based approach to these therapies.     

American Adult Use of Complementary and Alternative Medicine

Editor's Note: In 2004, a study of usage of complementary and alternative medicine among 31,000 American adults revealed that 36% of the population now uses CAM. CAM is defined and usage patterns are described. The survey instrument was developed by the National Center for Complementary and Alternative Medicine and the Center for Disease Control and Prevention National Center for Health Statistics.     

The Complementary and Alternative Medicine Information Source Book

Alan M. Rees (ed.). The Complementary and Alternative MedicineInformation Source Book. Oryx Press, Westport, CT, 2001. ISBN:1-57356-388-9. During the past decade, American doctors and patients have increasinglycome to rely on complementary and alternative medicine (CAM).Still, this highly heterogeneous collection of therapies remainsunfamiliar to many people. Consumers, medical librarians andprofessional health researchers have a pressing need for reliableand authoritative information they can consult before makingimportant medical decisions. Edited by Alan Rees, The Complementaryand Alternative Medicine Information Source Book does much     

Complementary and Alternative Treatments for Chronic Pelvic Pain

Chronic pelvic pain (CPP) is a significant clinical entity that affects both men and women alike. The etiologies of CPP are multifactorial, and treatments are myriad. Complementary and Alternative Medicine (CAM) refers to non-allopathic health systems, and its use is popular in the United States. In particular, several recent studies have investigated the efficacy of various CAM practices in the treatment of CPP. The authors systematically evaluated recent literature in this area by searching the PubMed database for English-language studies published between January 2007 and August 2012.