Complementary and alternative medicine use and substitution for conventional therapy by HIV-infected patients

BACKGROUND: HIV-infected patients commonly use complementary and alternative medicine (CAM), but it is not known how often CAM is used as a complement or as a substitute for conventional HIV therapy. OBJECTIVES: To evaluate the prevalence and factors associated with CAM use with potential for adverse effects and CAM substitution for conventional HIV medication. DESIGN AND PARTICIPANTS: Cross-sectional survey of U.S. national probability sample of HIV-infected patients (2,466 adults) in care from December 1996 to July 1997. MAIN OUTCOME VARIABLES: Any CAM use, CAM use with potential for adverse effects, and use of CAM as a substitute for conventional HIV therapy. Substitution was defined as replacement of some or all conventional HIV medications with CAM. RESULTS: Fifty-three percent of patients had recently used at least one type of CAM. One quarter of patients used CAM with the potential for adverse effects, and one-third had not discussed such use with their health care provider. Patients with a greater desire for medical information and involvement in medical decision making and with a negative attitude toward antiretrovirals were more likely to use CAM. Three percent of patients substituted CAM for conventional HIV therapy. They were more likely to desire involvement in medical decision-making (odds ratio, 1.8; 95% confidence interval, 1.0-3.2) and to have a negative attitude toward antiretrovirals (odds ratio, 7.8; 95% confidence interval, 3.0-19.0). CONCLUSIONS: Physicians should openly ask HIV-infected patients about CAM use to prevent adverse effects and to identify CAM substitution for conventional HIV therapy.     

Complementary medicine regulations

There is a need for regulations in applying complementary and alternative medicine methods, especially in the case of oncology patients.     

Complementary medicine and health legislation

This review begins by explaining the meaning and purpose of health law in general. While legal regulations pertinent to mainstream medicine are functioning well, this project focuses on the legal situation that developed in Switzerland as a consequence of the increasing availability and use of services in complementary medicine. There are obvious gaps and deficits in our legislation concerning medical and paramedical providers of services in complementary medicine. Main emphasis of this project, therefore, was placed on the regulations dealing with health professionals in complementary medicine, in particular on standards of training, on licenses to practice, and on the compensation by health insurance funds. The project achieved a comprehensive stock-taking of the great variety of the Swiss federal and the 26 cantonal laws and regulations. It also drew conclusions on the necessity to formulate generally applicable rules and regulations for the field of complementary medicine and finally submitted a list of practical recommendations.     

Complementary/alternative and conventional medicine use amongst menopausal women: Results from the Australian Longitudinal Study on Women's Health

Large population-based studies of complementary and alternative medicine (CAM) and conventional medicine use amongst menopausal women are lacking. This study helps address this gap by analysing data from a nationally representative sample of 10 011 Australian women aged 59–64 years. Overall, 39% of menopausal women consulted CAM practitioners, 75% used self-prescribed CAM, 95% consulted general practitioners (GP) and 50% consulted specialists during the previous year, and 12% were current hormone replacement therapy (HRT) users. Our findings suggest that CAM is a significant healthcare option utilized by women to treat menopausal symptoms, and so requires attention from GPs and specialists.     

Complementary and alternative medicine for perinatal depression

INTRODUCTION: Perinatal Major Depressive Disorder (MDD) is common and poses particular treatment dilemmas. Complementary and Alternative Medicine (CAM) treatments are widely used, accessible, and understudied for well-defined psychiatric indications. Women are more likely than men to both suffer from MDD and use CAM. METHODS: A PubMed/Medline search was conducted to assess the evidence base for commonly utilized CAM treatments, MDD, and perinatal depression. RESULTS: Among CAM treatments, omega-3 fatty acids have received the most specific study in terms of epidemiological, preclinical, and clinical research for perinatal depression. Three randomized placebo-controlled trials have been conducted in which investigators assessed omega-3 fatty acids vs. placebo for perinatal depression, with conflicting results. CAM interventions that can be easily added to a treatment plan with little risk and general health benefits for most women include omega-3 fatty acids, exercise, and folate, although data are insufficient at this time to recommend any of these as monotherapy for perinatal depression. S-adenosyl-methionine (SAMe) and bright light therapy may be reasonable to consider based on the evidence in MDD. St. John's Wort requires further study with regard to safety in pregnancy, and drug interactions can be a potential problem. DISCUSSION: Further study is required to elucidate the role of CAM treatments for perinatal depression, and the clinical context of perinatal depression requires safe, effective, and accessible treatment options.     

Complementary and alternative medicine approaches to pain management

This article argues for and illustrates incorporating complementary and alternative medicine (CAM) interventions into pain treatment plans. Two CAM treatments, cranial electrotherapy stimulation (CES) and self-hypnosis training, are offered in a multidisciplinary pain treatment program. Because these interventions focus on pain relief, they may be of particular interest to patients who have chronic pain who begin treatment with a primary interest in pain reduction. Two cases that illustrate the clinical application of CES and self-hypnosis are presented. When effective, these interventions can help patients have greater confidence in treatments offered by psychologists for pain management and may help make them more open to participating in other psychological interventions that have established efficacy for pain management (e.g., cognitive-behavioral therapy). Because of their brevity, these treatments also can be offered alone to patients who may not have the resources or time to participate in more time-intensive treatment.