The fascination of complementary and alternative medicine (CAM)

Complementary and alternative medicine (CAM) is more popular than ever before; at least this is what syrvey data seems to imply, yet we need to keep in mind that, for a range of reasons, such data are notoriously soft. CAM is by no means a well-defined entity; the prevalence of and reasons for using acupuncture are almost certainly different from those relating to crystal healing. Moreover, we tend to forget that virtually none of the questionnaires used to study these phenomeana are validated, and we all know that answers depend on how questions are being formulated. It seems to follow that surveys are of only limited value and might even distract us from the much more important question whether CAM generates more good than harm.     

Prevalence of complementary and alternative medicine (CAM) use by menopausal women: A systematic review of surveys

Large proportions of women have turned to complementary and alternative medicine (CAM) for relief from their menopausal symptoms. This highlights the need for more rigorous research into CAM. This article is aimed at critically reviewing surveys that examine the prevalence of CAM use by menopausal women worldwide. Eleven databases were searched for peer-reviewed surveys published in any language between 01 January 2000 and 27 October 2012. The bibliographies of the retrieved articles and relevant book chapters were also hand searched. Twenty-six surveys were identified, and they included a total of 32,465 menopausal women. The majority of these surveys were of poor methodological quality. Based on 6 surveys, 32.9% of women stated they were current/regular CAM users. Based on 9 surveys, 50.5% of women reported that they used CAM specifically for their menopausal symptoms. The average 12-month prevalence of CAM use was 47.7% (range: 33.1–56.2). Fifty-five percent of women did not disclose their use of CAM to their healthcare professional. The majority of women sought information about CAM from the media. The most popular CAM modality was herbal medicine, followed by soy/phytoestrogens, evening primrose oil, relaxation and yoga. There are a large number of predominantly low-quality surveys monitoring the prevalence of CAM use among menopausal women worldwide. The available evidence suggests that the prevalence of CAM use is high.     

Use of selected complementary and alternative medicine (CAM) treatments in veterans with cancer or chronic pain: a cross-sectional survey

Background  

Complementary and alternative medicine (CAM) is emerging as an important form of care in the United States. We sought to measure the prevalence of selected CAM use among veterans attending oncology and chronic pain clinics and to describe the characteristics of CAM use in this population.     

Understanding, perceptions and self-use of complementary and alternative medicine (CAM) among Malaysian pharmacy students

Background

Complementary and alternative medicines (CAMs) are being used increasingly across the world. In Australia, community pharmacists are a major supplier of these products but knowledge of the products and interactions with other medicines is poor. Information regarding the use of CAMs by metropolitan pharmacists has been documented by the National Prescribing Service (NPS) in Australia but the views of rural/regional community pharmacists have not been explored. The aim of this pilot study was to explore the knowledge, attitudes and information seeking of a cohort of rural community pharmacists towards CAMs and to compare the findings to the larger NPS study.

Methods

A cross sectional self-administered postal questionnaire was mailed to all community pharmacists in one rural/regional area of Australia. Using a range of scales, data was collected regarding attitudes, knowledge, information seeking behaviour and demographics.

Results

Eighty eligible questionnaires were returned. Most pharmacists reported knowing that they should regularly ask consumers if they are using CAMs but many lacked the confidence to do so. Pharmacists surveyed for this study were more knowledgeable in regards to side effects and interactions of CAMs than those in the NPS survey. Over three quarters of pharmacists surveyed reported sourcing CAM information at least several times a month. The most frequently sought information was drug interactions, dose, contraindications and adverse effects. A variety of resources were used to source information, the most popular source was the internet but the most useful resource was CAM text books.

Conclusions

Pharmacists have varied opinions on the use of CAMs and many lack awareness of or access to good quality CAMs information. Therefore, there is a need to provide pharmacists with opportunities for further education. The data is valuable in assisting interested stakeholders with the development of initiatives to address the gaps in attitudes, knowledge and to improve effectiveness of information seeking behaviour.     

Complementary and alternative medicine (CAM) in genetics

Complementary and alternative medicine (CAM) is increasingly popular among families. Approximately 50% of children are on herbal preparations, 30% of adolescents take herbal medications, and 70% of adults are involved in some aspect of complementary medicine. The true incidence of CAM use by families who have a family member with special needs or a genetic condition is unknown. Anecdotal evidence suggests that usage may be higher in this group than in the general population. Geneticists and genetic counselors need to be aware of CAM practices with their families and to provide anticipatory guidance.     

Use of complementary and alternative medicine by food-allergic patients.

BACKGROUND: Interest in complementary and alternative medicine (CAM) is increasing. Use of CAM in food-allergic patients has not previously been evaluated. OBJECTIVES: To determine the prevalence of CAM use, the types of CAM modalities used, and opinions about CAM in food-allergic patients. METHODS: A questionnaire was distributed to attendees at a patient conference in 2002 and to patients at pediatric food allergy clinics in 2005. RESULTS: Surveys were completed by 380 families. Respondents were mainly white, parents of children with multiple food allergies, and from the tri-state (New York, New Jersey, Connecticut) area. Diagnostic modalities considered unproven or disproven (such as serum IgG4, electrodermal skin testing, and kinesiology) were used by 22% of respondents; CAM therapies were used by 18%. Participants used several types of CAM practitioners, the most common being chiropractors, homeopaths, and acupuncturists. Only 49% of patients using CAM disclosed this to their physicians. Efficacy ratings for CAM were poor. Regarding participants' opinions, an herbal therapy of equal efficacy, safety, and cost was preferred to a pharmaceutical drug (37% vs 12%; P = .001), but most participants (51%) had no preference or were unsure. CONCLUSION: Unproven or disproven diagnostic methods and CAM treatments were used by approximately 1 in 5 respondents. Those using CAM noted poor efficacy, but if given a choice, many would prefer herbal therapies to pharmaceutical drugs. Education regarding reliable testing for food allergy and further research on CAM therapies are warranted.     

Cross-sectional analysis of specific complementary and alternative medicine (CAM) use by racial/ethnic group and menopausal status: the Study of Women's Health Across the Nation (SWAN)

OBJECTIVE: To examine the relationships of race/ethnicity, menopausal status, health characteristics, and symptoms with use of 21 types of complementary and alternative medicine (CAM) in midlife women. DESIGN: Cross-sectional, multiple logistic regression analyses of 2,118 women completing the sixth annual visit in the Study of Women's Health Across the Nation, a multisite, multiethnic, longitudinal study. RESULTS: More than half of women used some type of CAM. Use of most types of CAM differed significantly by race/ethnicity, except the use of ginkgo biloba and glucosamine. Significantly more African Americans at most sites and Chinese women used ginseng. Use of most types of CAM did not differ significantly by menopausal status or vasomotor symptoms, except the use of soy supplements, which was significantly greater among women who reported vasomotor symptoms. Women reporting somatic symptoms were significantly more likely to use glucosamine. Women reporting psychological symptoms were significantly more likely to use ginkgo biloba and soy supplements. The number of comorbidities, moderate or high socioeconomic status, number of healthy behaviors, symptom sensitivity, age, and dietary genistein intake were significantly positively associated with use of several types of CAM. CONCLUSIONS: The use of most types of CAM is not related to menopausal status or symptom reporting but to sociodemographic factors, comorbidities, and health behaviors. Given the large proportion of midlife women who use CAM and the potential for interactions with prescribed medications, healthcare practitioners should inquire about CAM use and be aware of which factors influence the use of different types of CAM.     

Message to complementary and alternative medicine: evidence is a better friend than power

Background  

Evidence-based medicine (EBM) is being embraced by an increasing number of practitioners and advocates of complementary and alternative medicine (CAM). A significant constituency within CAM, however, appears to have substantive doubts about EBM and some are expressly hostile.     

Determination of parameters affecting the use of complementary and alternative medicine in cancer patients and detection of prevalence of use

This study was conducted to find out the frequency of complementary and alternative medicine (CAM) use that could lead to troubles in patient health and in applied standard therapy protocols when used improperly, which method is used, the reasons for use and from which resources the information about this topic were obtained. A questionnaire consisting of 28 questions was applied to 195 patients with cancer diagnosis by a face-to-face interview. The obtained data were assessed with SPSS 11.5 program. Out of 195 cancer patients, 100 (51.3%) were using CAM and 48.7% (n=95) were not. The most commonly used agent was nettle (72%). This was followed by herbal teas (21%), grape molasses (20%) and black seed (20%). The frequency of CAM use was found higher in those under age 50, in literate people, in those working during the diagnosis stage and having disease at the later stage. While CAM was commonly recommended by friends and relatives of the patients (73%), this ratio was only 5% for health professionals. While 51.3% of all patients were gathering information about CAM, 75% of those actually using CAM gathered information about it. Whilst information was gathered mostly from the relatives of patients and tamperers (47%), it can be gathered from physicians only with a ratio of 10%. Cancer patients use CAM and they gather information mainly from unreliable sources rather than physicians. Although the primary information source should be physicians, the ratio for this was very low (10%). We suggest that physicians should spend more time in gathering correct information and sharing them with their patients for a better guidance.     

Teaching patients how to talk with biomedical providers about their complementary and alternative medicine use

ObjectiveThe goal was to examine the feasibility and impact of a face-to-face communication skills training intervention based on a current public health campaign to encourage patients to talk about complementary and alternative medicine (CAM) with their biomedical health providers.MethodsCurrent CAM users were invited to complete a survey about current/past CAM use and communication with biomedical providers before beginning a communication skills training workshop. In the 6-month period following the training, participants were asked to record information on any CAM conversations with those providers.ResultsOf the 38 participants who received training, 32 finished the entire study. Over half of those participants reported discussing CAM in post-training visits with biomedical providers. Participants initiated the conversation in most cases, and were more likely to disclose CAM use than they were to ask questions about CAM. Participants who talked about CAM were significantly more likely to perceive CAM as relevant to their visit, compared with individuals who did not talk about CAM.ConclusionsParticipants positively evaluated this patient communication workshop. Consistent with previous research, most CAM conversations were patient-initiated.Practice implicationsThese findings reinforce the importance of patient education interventions for improving patient–provider communication in general, and CAM communication specifically.     

Teaching patients how to talk with biomedical providers about their complementary and alternative medicine use

Objective

The goal was to examine the feasibility and impact of a face-to-face communication skills training intervention based on a current public health campaign to encourage patients to talk about complementary and alternative medicine (CAM) with their biomedical health providers.

Methods

Current CAM users were invited to complete a survey about current/past CAM use and communication with biomedical providers before beginning a communication skills training workshop. In the 6-month period following the training, participants were asked to record information on any CAM conversations with those providers.

Results

Of the 38 participants who received training, 32 finished the entire study. Over half of those participants reported discussing CAM in post-training visits with biomedical providers. Participants initiated the conversation in most cases, and were more likely to disclose CAM use than they were to ask questions about CAM. Participants who talked about CAM were significantly more likely to perceive CAM as relevant to their visit, compared with individuals who did not talk about CAM.

Conclusions

Participants positively evaluated this patient communication workshop. Consistent with previous research, most CAM conversations were patient-initiated.

Practice implications

These findings reinforce the importance of patient education interventions for improving patient–provider communication in general, and CAM communication specifically.     

The use of complementary and alternative medicine by patients with diabetes mellitus in Bahrain: a cross-sectional study

Background  

CAM use is widespread, especially among patients with diabetes. The Gulf States have a high prevalence of diabetes, alongside a long tradition of CAM use. The aim of this study is to establish the prevalence of CAM use among patients with diabetes mellitus in Bahrain and to examine the characteristics of the CAM users.     

Negotiating complementary and alternative medicine use in primary care visits with older patients

Objective

To empirically investigate the ways in which patients and providers discuss Complementary and Alternative Medicine (CAM) treatment in primary care visits.

Methods

Audio recordings from visits between 256 adult patients aged 50 years and older and 28 primary care physicians were transcribed and analyzed using discourse analysis, an empirical sociolinguistic methodology focusing on how language is used to negotiate meaning.

Results

Discussion about CAM occurred 128 times in 82 of 256 visits (32.0%). The most frequently discussed CAM modalities were non-vitamin, non-mineral supplements and massage. Three physician–patient interactions were analyzed turn-by-turn to demonstrate negotiations about CAM use. Patients raised CAM discussions to seek physician expertise about treatments, and physicians adopted a range of responses along a continuum that included encouragement, neutrality, and discouragement. Despite differential knowledge about CAM treatments, physicians helped patients assess the risks and benefits of CAM treatments and made recommendations based on patient preferences for treatment.

Conclusion

Regardless of a physician's stance or knowledge about CAM, she or he can help patients negotiate CAM treatment decisions.

Practice implications

Providers do not have to possess extensive knowledge about specific CAM treatments to have meaningful discussions with patients and to give patients a framework for evaluating CAM treatment use.     

Academic doctors' views of complementary and alternative medicine (CAM) and its role within the NHS: an exploratory qualitative study

Background  

There has been a marked increase in the use of complementary and alternative medicine (CAM) in the UK population in recent years. Surveys of doctors' perspectives on CAM have identified a variety of views and potential information needs. While these are useful for describing the proportions of doctors who hold particular attitudes towards CAM, they are less helpful for understanding why. In addition, while the views of non-academic doctors have begun to be studied, the perspective and rationales of academic doctors remains under-researched. It seems important to investigate the views of those with a research-orientation, given the emphasis on the need for more scientific evidence in recent debates on CAM.     

Negotiating complementary and alternative medicine use in primary care visits with older patients

ObjectiveTo empirically investigate the ways in which patients and providers discuss Complementary and Alternative Medicine (CAM) treatment in primary care visits.MethodsAudio recordings from visits between 256 adult patients aged 50 years and older and 28 primary care physicians were transcribed and analyzed using discourse analysis, an empirical sociolinguistic methodology focusing on how language is used to negotiate meaning.ResultsDiscussion about CAM occurred 128 times in 82 of 256 visits (32.0%). The most frequently discussed CAM modalities were non-vitamin, non-mineral supplements and massage. Three physician–patient interactions were analyzed turn-by-turn to demonstrate negotiations about CAM use. Patients raised CAM discussions to seek physician expertise about treatments, and physicians adopted a range of responses along a continuum that included encouragement, neutrality, and discouragement. Despite differential knowledge about CAM treatments, physicians helped patients assess the risks and benefits of CAM treatments and made recommendations based on patient preferences for treatment.ConclusionRegardless of a physician's stance or knowledge about CAM, she or he can help patients negotiate CAM treatment decisions.Practice implicationsProviders do not have to possess extensive knowledge about specific CAM treatments to have meaningful discussions with patients and to give patients a framework for evaluating CAM treatment use.     

The prevalence of complementary and alternative medicine use among Turkish patients with primary headache

Background/aim The use of complementary and alternative medicine (CAM) is common in patients with primary headache. However, no study has been reported in which standardized modalities were questioned in a Turkish population. The aim of the present study was to investigate the frequency of CAM use and factors related to it in these patients. Materials and methods Patients with a diagnosis of primary headache were included in this cross-sectional observational study. Demographic and disease specific characteristics were recorded. The use and effect of 15 CAM modalities were evaluated in accordance with the Traditional and Complementary Medicine Regulations. The patients were categorized into two groups according to their use of CAM procedures. Logistic regression analysis was further performed to assess the association between CAM use and related factors.Results One hundred twenty patients [101 (84.2%) female, mean age 38.20 ± 12.24 years] were included. Use of CAM was reported in 33.3% of the patients. The most frequently used CAM modalities were phytotherapy (37.5%), cupping (27.5%), and chiropractic adjustment (17.5%). Compared with nonusers, CAM users showed a longer duration of disease (respectively mean 5.68 ± 4.96 years and 10.97 ± 8.57 years, p = 0.000). There were no differences with respect to age, sex, education, presence of systemic disease, headache subtypes, number of headache days in a month, or headache severity. Patients who underwent cupping reported that they benefited more than those who tried phytotherapy and multiple CAM methods (respectively 45.5%, 33.3%, 16.6%, p = 0.039). Subsequently, the logistic regression analysis showed a significant association between only disease duration and CAM use [respectively p value, OR (95% CI), and confidence intervals = 0.002 (1.143 (1.050–1.243)]. Conclusion Our results suggest that Turkish patients with primary headache, especially those with long disease duration, use CAM modalities. Larger population-based studies are required to clarify the safety and efficacy of these methods.     

A scoping review of research on complementary and alternative medicine (CAM) and the mass media: Looking back, moving forward

Background

With the increased usage of CAM worldwide comes the demand for its integration into health professional education. However, the incorporation of CAM into health professional curricula is handled quite differently by different institutions and countries. Furthermore, the evaluation of CAM curricula is complicated because students' ability to learn about CAM may be influenced by factors such as student's prior knowledge and motivation, together with the perceptions and attitudes of clinical preceptors. The study aimed to describe the attitudes, perceptions and beliefs of second, third and fourth year pharmacy students towards complementary and alternative medicine (CAM) and to explore factors that might affect attitudes such as learning, preceptors and placements.

Methods

Pharmacy students from a University in South East Queensland, Australia participated in the study. The study consisted of a cross-sectional survey (n = 110) and semi-structured interviews (n = 9).

Results

The overall response rate for the survey was 75%, namely 50% (36/72) for second year, 77.3% (34/44) for third year and 97.6% (40/41) for fourth year students. Overall, 95.5% of pharmacy students believe that pharmacists should be able to advise patients about CAM and most (93.7%) have used CAM prior to course enrolment. Students' attitudes to CAM are influenced by the use of CAM by family, friends and self, CAM training, lecturers and to a lesser degree by preceptors. The majority of pharmacy students (89.2%) perceive education about CAM as a core and integral part of their professional degree and favour it over an additional postgraduate degree. However, they see a greater need for education in complementary medicines (such as herbal medicines, vitamins and minerals) than for education in complementary therapies (such as acupuncture, meditation and bio-magnetism). Knowledge and educational input rationalised rather than marginalised students' attitudes towards CAM.

Conclusion

Pharmacy students perceive education about CAM as a core and integral part of their professional degree. Students' attitudes towards CAM can be influenced by learning, lecturers, preceptors and practice experience. The content and focus of CAM education has to be further investigated and tailored to meet the professional needs of our future health professionals.