Complementary Health Practice Review recent issues

New York and Colorado as Critical States in the Diffusion of State Licensing of Naturopathic Physicians

Albert, D. — 2009-08-18

Purpose: Since 2003, 4 more states have joined the ranks of now 15 states licensing naturopathic physicians (NDs). Qualified NDs residing in unlicensed jurisdictions sometimes obtain licenses from other states licensing NDs. The purpose of this study is to implement a methodology based on number of out-of-state licenses to gauge the demand for licensing among NDs in unlicensed states and to identify likely candidates for successful legislative efforts regarding licensure. Methods: Counts of out-of-state ND licenses issued through Arizona, Connecticut, Oregon, and Washington, the four states with naturopathic medical schools, were used as a surrogate for interest in licensing among states not offering licensing of NDs. Results: In 2005, a total of 457 U.S. NDs obtained out-of-state licenses from the states of Washington (159), Oregon (159), Arizona (79), and Connecticut (60), with 59% of these out-of-state NDs applying from nonlicensed states. States with low (1—13) or moderate (18—27) numbers of out-of-state licensures constituted 69% of the NDs, while the remaining 31% of NDs who fell into the high (43—58) out-of-state licensure category were from only three states: California, Colorado, and New York. Discussion: Of the three states with high out-of-state licensure, California has recently passed licensure legislation. Previous studies have indicated that New York and Colorado scored high on legislative innovativeness. Should licensing of NDs be passed in these two states, the possibility exists that legislation would spread to adjacent and other proximal states.

The Medical Education Priorities of Parents Who Use Complementary and Alternative Medicine

O'Keefe, M., Coat, S., Jones, A. — 2009-08-18

Many parents use complementary and alternative medicine (CAM) for their children. A number of medical schools are introducing CAM teaching, and this study was undertaken to explore the medical education priorities of parents who use CAM for their children. A total of 27 parents (25 females, 2 males) participated in 1 of 6 focus group discussions. Transcripts were analyzed using an iterative process of concept identification, hypothesis testing, and detailed comparisons. Participant preferences for health care for their children were complex and informed by previous health care experiences and current family health care needs. Using CAM allowed parents choice and control in managing their family’s health care. Many participant priorities for medical education in CAM echoed key principles of patient-centered care in addition to specific suggestions for curriculum development. Participating parents believed that it was important to increase medical students’ knowledge and understanding of both CAM modalities and the perspectives of parents.

Ayurvedic Management of Unilateral Loss of Vision Following a Blunt Injury to Eye: A Case Report

Rastogi, S., Chawla, S., Singh, R.P. — 2009-08-18

A 45-year-old previously healthy male suffered a major visual setback following a blunt injury to his left eye. The vision in the affected eye was lost immediately and did not return after the resolution of initial inflammation. His retinal examination revealed a subretinal hemorrhage with an area of chorioretinal atrophy in the left macula. A 3-month trial of conventional therapy, consisting of hemostatics, antioxidants, steroids, and vitamin A, was of no avail except for the return of vision to finger-counting ability. An optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) conducted at 3 months revealed hyper-reflectivity and irregularity at retinal pigment epithelium (RPE) Bruch’s membrane complex and decreased retinal thickness. Ayurvedic therapy was started at this time. At a 3-month treatment follow-up (6 months following the injury), there was a remarkable improvement in vision in the left eye, which was observed as 6/18 on the Snellen chart. After a total of 6 months of Ayurvedic therapy followed by 6 months of withdrawal, a subsequent follow-up found the vision in the patient’s left eye to be 6/12. OCT and an FFA done at this time was marked by substantial improvements in the RPE Bruch’s membrane complex. Ayurvedic therapy seems to have contributed substantially to the improved vision, which had been lost completely following a blunt injury to the left eye.

Yoga in Brazil and the National Health System

Siegel, P., de Barros, N. F. — 2009-08-18

Background: Yoga is practiced in almost all Brazilian urban centers by people of various social, economic, and cultural strata. Practitioners use yoga for health promotion and illness prevention, as well as for developing self-knowledge and self-care. Objective: This article explores the perceptions of yoga leaders regarding the potential contributions of yoga to the Brazilian National Health System (BNHS). Methods: Leaders of the 15 most developed yoga traditions in São Paulo, Brazil, were interviewed regarding their perceptions of potential contributions of yoga to the National Health System. Interviews were recorded, transcribed, and analyzed according to qualitative methodology. Results: Areas in which yoga was perceived as being able to make important contributions included the concept of body-mind-soul; vegetarianism; postural correction and integration of movements; peace culture; the cultivation of virtuous values (e.g., abstention from addictive substances); spiritual consciousness; integration of the self; cultivation of awareness; brain oxygenization; cultivation of discipline and improved quality of life. Conclusion: Yoga is seen as a group of useful physical, social, and philosophical practices for the health field. However, challenges to its integration into the BNHS include its maintenance as an alternative culture practice and its distance from the epistemological bases of present complementary and integrative medicine.

Envisioning a Future Contemplative Science of Mindfulness: Fruitful Methods and New Content for the Next Wave of Research

Garland, E., Gaylord, S. — 2009-03-24

Mindfulness is an ancient spiritual practice as well as a unique behavioral technique involving the cultivation of non-judgmental, non-reactive, metacognitive awareness of present-moment experience. Given the growing interest in mindfulness across numerous academic and clinical disciplines, an agenda is needed to guide the next wave of research. Here, we suggest four areas that, in our view, are important for a future contemplative science of mindfulness: performance-based measures of mindfulness, scientific evaluation of Buddhist claims, neurophenomenology of mindfulness, and measuring changes in mindfulness-induced gene expression. By exploring these domains, the wisdom of the meditative traditions may be complemented by leading-edge empirical research methodologies.

Mindfulness Research Update: 2008

Greeson, J. M. — 2009-03-24

Objective: To briefly review the effects of mindfulness on the mind, the brain, the body, and behavior. Methods: Selective review of MEDLINE, PsycINFO, and Google Scholar databases (2003—2008) using the terms ``mindfulness,'' ``meditation,'' ``mental health,'' ``physical health,'' ``quality of life,'' and ``stress reduction.'' A total of 52 exemplars of empirical and theoretical work were selected for review. Results: Both basic and clinical research indicate that cultivating a more mindful way of being is associated with less emotional distress, more positive states of mind, and better quality of life. In addition, mindfulness practice can influence the brain, the autonomic nervous system, stress hormones, the immune system, and health behaviors, including eating, sleeping, and substance use, in salutary ways. Conclusion: The application of cutting-edge technology toward understanding mindfulness— an ``inner technology''—is elucidating new ways in which attention, awareness, acceptance, and compassion may promote optimal health—in mind, body, relationships, and spirit.

The Tong Ren Healing Method: A Survey Study

Sullivan, A. M., Bauer-Wu, S., Miovic, M. — 2009-03-24

Tong Ren (TR) is an untested energy healing modality with anecdotally-reported effectiveness for a variety of disorders. Study objective: To describe participant reports of effectiveness and safety. Design: Cross-sectional, anonymous survey. Setting: Weekly group sessions in the Northeast US. Participants: Adults attending group sessions. Measures: Changes in conditions attributed to TR. Results: Response rate 89% (n = 265). Cancer (30.6%), endocrine/autoimmune (17.5%) and musculoskeletal disorders (17.2%) were the most commonly reported conditions. Among respondents who had attended more than one session (n = 216), 30% used superlatives (e.g., ``amazing'') to describe TR's impact, and one-third noted improved quality of life. No adverse effects were described. Anxiety, depression, cancer, and autoimmune disorders appeared to have the greatest treatment responses, with 63.8%, 61.0%, 60.3%, and 58.1% of participants with these conditions reporting substantial improvements. Conclusion: This first study documenting self-reported effects of TR shows subjective benefits and no adverse effects. Further research on this approach is warranted.

Chiropractors and Vaccinations: Ethics is the Real Issue

Vernon, L. F., Kent, C. — 2009-03-24

This article traces the historical and philosophical roots of the provaccination and anti-vaccination movements through to the present day, with a focus on the role of chiropractic within those movements. Political, legal, and scientific issues are considered. Attempts to portray the anti-vaccination chiropractors as unscientific extremists, by both orthodox medicine and from within the chiropractic community itself, clouds the informed consent and freedom of choice aspect relating to health care that they espouse, and scapegoats the so-called extremists rather than facing the ethical issues surrounding fully informed consent. The authors conclude that would-be medical ethicists promote their own political agendas that aid profit before safety and breed distrust within the community that is meant to be served in a balanced and ethical manner.

Research Into Complementary/Alternative Medicine: A Personal Comment

Ernst, E. — 2009-03-24

A Literature Review of Health Care Professional Attitudes Toward Complementary and Alternative Medicine

Sewitch, M. J., Cepoiu, M., Rigillo, N., Sproule, D. — 2008-10-13

Objective. To summarize health care professionals' attitudes toward complementary and alternative medicine (CAM).

Methods. In October 2006, we searched Allied and Complementary Medicine Database (AMED; 1985—2006), Excerpta Medica Database (EMBASE; 1980—2006), and MED-LINE (1960—2006) for Canadian or US studies of health care professionals' attitudes toward CAM, published in English or French.

Results. A total of 21 surveys of physicians, nurses, public health professionals, dietitians, social workers, medical/nursing school faculty, and pharmacists were included that focused on beliefs about CAM efficacy, personal use, clinical practice use and referrals, communication with patients about CAM, level of knowledge, and the need for information regarding various CAM therapies. Physicians were more negative compared to other health care professionals. Positive attitudes toward CAM did not correlate with CAM referral or prescription patterns. Health care professionals of all disciplines wanted more information about CAM.

Conclusions. Heterogeneity in the CAM definition and questionnaire items precluded summarizing health care professionals' attitudes toward CAM. Providing CAM education to health care professionals may help to integrate CAM into mainstream medical care.

Allied Health and Nursing Academic Programs at New Jersey county colleges: Holistic Health and Complementary and Alternative Medicine Content

Bruguier, E. — 2008-10-13

Rising public interest in and use of holistic health (HH) practices and complementary and alternative medicine (CAM) has created a need for health care providers to become knowledgeable in these areas. HH/CAM content is increasingly included in curricula of professional health education, a trend less clear in associate, certificate, and diploma programs of 2-year colleges. A survey of directors and coordinators of allied health and nursing programs at New Jersey county colleges was conducted to determine curricular presence of HH/CAM and program constituency awareness of institutionally accessible HH/CAM information resources. Results indicated: rising interest in HH/CAM instruction; multiple forces influencing HH/CAM inclusion; HH/CAM strengthening programs; and uncertainty regarding knowledge of and perceived use of library HH/CAM resources. By including HH/CAM, New Jersey's allied health and nursing programs are progressively aligned with consumer use, and trends of professional health schools.

Participant Perspectives on a Yoga Intervention for Menopausal Symptoms

Taylor, M. R., Booth-LaForce, C., Elven, E., McGrath, B. B., Thurston, R. C. — 2008-10-13

A pilot study of the effects of 10 weeks of yoga practice on 11 midlife women's menopausal symptoms was conducted. Qualitative analysis of participants' exit interviews provided information not captured in quantitative measures, including perceptions of the yoga intervention and suggestions for improving the study protocol. The women reported feeling relaxed and physically better after yoga class. Many viewed yoga as a skill they could incorporate into daily life to reduce stress and manage their menopausal symptoms. The class setting provided an opportunity for individualized instruction, peer interaction, and a structured time for self-care. Factors that made it more challenging to practice yoga at home included responsibilities to others as well as limited time, space, and energy. Women suggested providing a more flexible class schedule, increasing peer support, and providing more instruction on developing a home practice. This information will be incorporated into plans for future studies.

Comparison of Treatment of HIV Patients in Naturopathic and Biomedical Settings

Baer, H. — 2008-10-13

Patients diagnosed with HIV/AIDS have turned to a variety of complementary and alternative medicine (CAM) in seeking relief from their illnesses and a better quality of life. Many of them have adopted an integrative approach in which they simultaneously use biomedicine and CAM. Naturopathic physicians, are one category of CAM practitioners upon which some HIV/AIDS patients rely. This article describes naturopathic philosophy and therapeutics; examines naturopathic medical treatment of HIV/AIDS patients in two CAM treatment centers in a Western US metropolitan area; describes treatment of HIV/AIDS patients in a biomedical treatment center frequented by many of the HIV patients who have opted for an integrative approach; and compares these approaches in terms of models of practitioner-patient relationship. I argue that the naturopathic physician-patient relationship constitutes a form of social support that generally cannot be facilitated in the biomedical physician-patient relationship due to time, and perhaps philosophical, constraints.

CAM Management of Peripheral Arterial Occlusive Disease (PAOD): A Case Report

Rastogi, S. — 2008-10-13

Peripheral Arterial occlusive Disease is one among many conditions where a dependable cure is still elusive. Despite of availability of various treatment options on medical and surgical grounds, these many options does not with stand to the complexity, generalization and rapid progression inherent to the disease. Cost of diagnosis and cost of therapy also acts as a constraint in its quick management. In these conditions, any CAM approach addressing to all these intricacies of PAOD is a welcoming thought. We tried to intervene with CAM therapy in a patient diagnosed as having PAOD. The clinical improvements observed in this single case are warranting for more serious studies to define the role of CAM in these conditions.

Mechanisms of Action in the Inverse Relationship Between Mindfulness and Psychological Distress

Coffey, K. A., Hartman, M. — 2008-04-29

Both dispositional mindfulness and mindfulness-based interventions have been found to be associated with less psychological distress. The current study investigated three mechanisms by which mindfulness might exert its beneficial effects: emotion regulation, nonattachment, and reduced rumination. Correlational self-report data were collected from two independent, nonclinical samples of undergraduates. Structural equation modeling was then used to test the role of these three mechanisms in mediating the relationship between mindfulness and a psychological distress factor, consisting of measures for depressive and anxious symptomatology. The model was respecified based on the first sample and retested in the second sample. Results confirmed an inverse relationship between mindfulness and psychological distress. Furthermore, emotion regulation, nonattachment, and rumination significantly mediated this relationship.

Safe Effective Nondrug Treatment of Chronic Depression: A Review of Research on Low-Voltage Cranial Electrical Stimulation and Other Adjunctive Therapies

Shealy, C. N., Thomlinson, P. — 2008-04-29

Although clinical practice guidelines tend to emphasize pharmacological treatments for chronic depression, safe and effective nondrug treatments are available. This article reviews three decades of research at the Shealy Institute on nonpharmacological treatments for chronic depression in chronic pain patients via low-voltage electrical stimulation and other adjunctive therapies. More than 30,000 chronically depressed patients have been treated with cranial electrical stimulation at 1 to 2 mA at 15,000 Hz, modulated at 500 and 15 Hz. Approximately half of patients treated with this approach experienced marked clinical improvement. When combined with photostimulation at 1 to 7 Hz, 85% of patients improved adequately without use of antidepressant drugs and without complications. Magnesium replacement and nutrition education are useful adjuncts. This program is cost effective and can be carried out by a nurse practitioner and an assistant. Further controlled clinical research and research on mechanisms of action would strengthen the validity of these findings and increase the application of these therapeutic approaches.

Uninformed Complementary and Alternative Supplement Use: A Risky Behavior for Cardiovascular Patients

Bristol, M. N., Sonnad, S. S., Guerra, C. — 2008-04-29

Growing use of complementary and alternative supplements (CAS) is of concern because of the potential for herb—drug interaction among cardiovascular patients. Literary searches were conducted on PubMed to identify reports of extent and purpose of CAS use, disclosure of use by patients, physician knowledge, and possible drug—CAS interactions for cardiovascular patients. Additional published studies were located through the Web sites of various organizations. Further searches of case reports, case series, controlled trials, and laboratory evidence were performed for each of the top 10 CAS and their possible cardiovascular drug interactions. More research is needed to understand supplement—drug interactions, particularly in terms of how this potentially affects patients taking cardiovascular drugs. With this lack of research and clarity on supplement—dug interactions and the underreporting of CAS use by many patients, physician education is also in need of improvement.

A Dialogue-Building Pilot Intervention Involving Traditional and Biomedical Health Providers Focusing on STIs and HIV/AIDS Care in Zambia

2008-04-29

Collaboration between traditional and biomedically trained health workers is regarded as key in HIV/AIDS control. However, few studies have focused on exploring ways of enhancing this collaboration. Using a pre- and postintervention questionnaire, the authors assessed changes in attitudes to and practices of collaboration among 19 biomedical and 28 traditional health care providers following a 12-month dialogue-building intervention in Ndola, Zambia. The intervention consisted of peer group discussions, interactive group discussions, training sessions, and peer-influenced networking. The results show that although both groups of providers had fairly positive attitudes toward each other before the intervention, further improvements in attitudes were observed after the intervention. Referrals between the two sectors and cross visits increased. However, some attitudes to collaboration became more negative and cautious after the intervention. Dialogue-building interventions involving traditional and biomedical providers are not only feasible but also complex. Intersectoral collaboration needs time and coordination between all relevant actors in the community.

CAM Curriculum Activities to Enhance Professionalism Training in Medical Schools

Elder, W.G., Hustedde, C., Rakel, D., Joyce, J. — 2008-04-29

Enhancing the professionalism of graduates is a major objective of most health care education institutions today. Educating conventional health care providers about complementary and alternative medicine (CAM) may directly and indirectly improve trainee professionalism by expanding trainees' knowledge and appreciation of diverse health care beliefs and practices, improving physician—patient communication, enhancing self-care, and increasing sense of competence and job satisfaction. A survey based on professional competencies proposed by the Consortium of Academic Health Centers for Integrative Medicine was administered to the grantees of the National Institutes of Health, National Center for Complementary and Alternative Medicine R-25 CAM education project initiative. The survey's aim was to identify project activities that taught professionalism skills. All projects reported curricular features that enhanced trainee professionalism, with substantial percentages of project effort directed toward professionalism-related activities.