October 31, 2007

COMPLEMENTARY & ALTERNATIVE MEDICINE

by Myron J. Talbert M.D.

Assembly Room, A. K. Smiley Public Library

The subject is important because the public is spending

billions of dollars a year on these treatments; .Furthermore many of the substances can react to medications taken for other purposes. Medical schools have recognized this and therefore many schools have added the subject to their curriculum.

The office of complementary and alternative medicine ( CAM) was founded

in 1991. At first much of the research was done by people with less than adequate credentials, many of whom, had a financial interest in the outcome of the research. In 1999 Dr Stephen Straus, who was recognized as an accomplished scientist, took over as the director of the national center for CAM. The budget was 122 million a year and he was able to apply more vigorous tests for pharmaceuticals and medical devices. (1)

Some of the alternative treatments include; homeopathy, chiropractic & naturopathy.

Homeopathy operates on the theory of treating like with like. in which a substance that creates the same symptoms as the disease is given in infinitesimal doses, as little as a molecule, supposedly, to stimulate the body’s defense (2)mechanism.. This mode of practice still exists to some degree in this country but in countries such as the UK, India and other third world countries, it is more prevalent.. The bulk of studies show it is no better than a placebo.

Chiropractic involves the laying on of hands with manipulation of the spine.. The founder of the method was Daniel D. Palmer who was a self trained healer in the1890s who believed that the body had a natural healing power and that when an organ did not function properly it was due to impaired nerve supply due to a subluxation of the spine and by adjusting it the flow is improved and would allow the body to heal itself. There is no scientific evidence to support this theory. The danger of manipulation is that osteoporosis or bone tumors might be missed and injury could be the result. The incidence of injury has not been great but most of the reported injuries relate to neck manipulation; Stroke, (4)vertebral artery clotting or hemorrhage and nerve damage being the most common.

As far as successful treatment of back pain is concerned there is not a large difference in conventional treatment vs chiropractic although the ability of conventional treatment to relieve pain with medication gives it the edge.

Massage therapy for back and extremity arthritis appears to have good results and has generally a fair amount of patient satisfaction. There are four types of massage; Swedish, deep tissue, trigger point and shiatsu. Each is (6)different related to location and depth of pressure and there is only a few contra indications to it’s use. The contra indications are; blood clots in the legs, bleeding disorders or patients on blood thinners such as coumadin. Inflammation, fragile skin or recent fractures in the area also preclude its use. Pregnant women should consult their doctor .before using that treatment.

Naturopathy was devised in the 19 th century. It deals with diet,(7)supplemental herbs and, I understand, some manipulation. Examination of their literature is pseudoscientific, ineffective and even dangerous. They like to call it natural but that doesn’t mean it is safe. I will address some of the herbs later. The training of a naturopath is a fraction of that of medical doctors and the content of training is suspect.

Herbs are common complementary medications and are found in the best drug stores next to over the counter drugs. Dietary supplements may not advertise that it will diagnose, treat, prevent or cure any condition otherwise the substance would have to go through all the expensive trials that are required of drugs.

Echinacea is a commonly used herb related to what is touted to shorten and even prevent colds and other upper respiratory infections. It is related to the daisy family which includes ragweed, chrysanthemums and marigolds and therefore might cause allergic reactions in those who are allergic to those plants. Controlled studies have shown that the herb neither prevents nor shortens the duration of colds.(9)

On the subject of treatment of colds, complementary medicines are lemon, menthol, zinc and vitamin C. some of which may make you feel a little better but there is no scientific evidence that they cure the common cold. Ma huang is an effective decongestant but it is ephedra and should not be used by anyone with heart disease or high blood pressure. The drugs containing ephedrine have been taken off the open market because people have been making speed out of them.

.Ginseng is a common herb that supposed to cure many things. It’s botanical name is panax ginseng. It is said to be beneficial for stress, hypertension, ulcers, diabetes, depression, atherosclerosis, edema, impaired memory, menopause as well as a tonic. Anything that is claimed to cure such a variety of conditions is questionable from the beginning. It is sold under the name of ginsana as well as American and Korean ginseng. Consumer Reports in 1995 tested many of the brands and found variation in the content of pills from almost nothing (0.4 mg), up to 23.2 mg. This herb should not be taken by people on MAOI drugs as well as several other herbs including ginkgo biloba although it is sometimes combined with that herb. In doses of 200 milligrams abnormal cardiac rhythms may occur.(10)

Garlic is a popular herb which comes in various forms, dried or powdered. in pills or capsules. It may have a slight benefit for hypertension but conclusive studies have not confirmed it. It is of no value as a treatment or prevention of cancer. It has the drawback of impairing the coagulation of blood especially when given to patients on coumodin or aspirin.(11)

St John’s wart has been suggested for depression and sleep disorders but it has not been proven to be of any value in several studies. In addition It may affect the break down of digitalis HIV drugs and chemo therapy drugs in patients who are on them. There may be a prolongation of the bleeding time when taken with coumadin. It may speed or slow breakdown the absorption of birth control medication or antidepressants. (12)

Saw palmetto has been advocated for enlarged prostates without any evidence of value and shark cartilage which is said to treat and prevent cancer based on the thought that sharks don’t get cancer. This caused the demise of many sharks but the truth is that sharks do get cancer even in their cartilage.

Glucosamine and chondroitin has been promoted to restore damaged cartilage to the hip and knee. It may afford some pain relief but there is no evidence that it can restore the cartilage. A supplement called DHEA was supposed to slow down the effects of aging. The NIH proved it to be useless. In 1994 congress passed a law that allowed manufacturers of these items to continue doing so provided it didn’t kill anyone.

Valerian and melatonin may have slight, if any, help for insomnia. Warnings have been placed on Kava, Comfrey, aristolocolic acid and a substance known as ASPES.

Antioxidants such as Vitamin C and E and coenzyme 10 have been thought to help prevent cancer and cardiovascular disease however analysis of the literature according to NCCAM has been disappointing.(15)

Complementary herbs are often used to treat various functional or stress related conditions such as irritable bowel syndrome and dyspepsia. Probiotics which are, so called, good bacteria, which have been typically used for people who have been on antibiotics and, as a result, killed off the normal bacteria that are needed in the bowel. Probiotics have become one of the most popular dietary supplements, outselling iron, magnesium and garlic. The problem with them is that many of the products don’t have the needed one billion viable bacteria per dose according to Dr Ted Cooperman who is the president of consumer lab.. He found only 9 of the thirteen products tested contained that amount. This points out the dangers of using many of the herbs because the quality control as to the amount and known content of any given pill or capsule is often deficient or even, in some cases, not present at all .(16)

Chelation therapy Is used as a conventional treatment for heavy metal poisoning such as lead, mercury and arsenic but there are some practitioners

that sell the treatment at a high. cost to treat hardening of the arteries and even cancer for which there is no evidence of any benefit. Laetrel is another substance sold by questionable practitioners that has no benefit in treating cancer.

Acupuncture is an enigma to me. The practice is over 2000 years old. The treatment consists of the insertion of sterile, one use only, very fine stainless steel needles into one or more of some 400 acupuncture points. The theory is that disease is caused by imbalances in the energetic flow of life through pathways, or meridians. This is known as Qi, pronounced chee and the needles are placed in one or more of these meridians. The needles may be rotated or given electrical stimulation. This, supposedly, allows the body’s natural healing to occur. Acupuncture also has been used as an anesthetic for surgical procedures and as a treatment for arthritis and other chronic pain. This mode of therapy is used by several medical centers such as the Mayo Clinic and Loma Linda. Acupressure is also used whereby the practitioner merely presses over the known meridians used for acupuncture.

Western medicine tries to explain how it works. According to the National Institute of Health; there are three possibilities; first by opioid like release of endorphins into the brain and spinal cord. This is part of our natural pain control system. The second is called the gate theory which involves release of pain suppressing neurotransmitters when the spinal cord is stimulated and the third involves the blood flow stimulating effect of the needles which may supply additional nutrients or remove toxic substances. (17)

In a study of 632 patients in Berlin, Germany with hip and knee osteoarthritis, which is the wear and tear type of arthritis, 34.5% had good results against 6.5% of the control group. At three months the benefit persisted.

It appears that acupuncture is effective although 34.5% is in the realm of placebo effect that is thought to be in 30% of patients with organic disease, at least as far as pain is concerned.

Besides osteoarthritis acupuncture seems to have symptomatic relief for a number of conditions such as headaches, including migraine, fibromyalgia and other pain related conditions. Scientific research in studying this treatment modality has been difficult and often inadequate.

. There have been surgical procedures that were tried such as the ligation of the internal mammary arteries to relieve anginal heart pain. Sham operations which involved only a skin incision proved to have the same result as the actual ligation of the arteries and so the procedure was abandoned.

. In studying the benefits of dummy pills one has to remember that many conditions are going to get well by the normal resistance of the body without any medication. as well as the effect of a person wearing a white coat and giving a positive statement about what to expect from the treatment.

Traditional Chinese medicine, TCM, makes use of the mind to heal the body in several ways; Guided imagery, yoga and some form of biofeedback are examples. Guided imagery has been used even in children. David E, Bresler PhD,a neuro scientist and director of the pain clinic at UCLA,has used it. since 1970. It is hard to evaluate benefit of this form of therapy, especially in children but is felt to be helpful. The procedure makes use of tapes and encourages the patient to visualize their favorite place and describe sights, sounds and smells of the location. Not everyone is able to conjure up the images but at least there aren’t any serious side effects. (19)

Mind body therapy includes several modalities. Group support organizations such as cancer support are legitimate and helpful. In a paper put out by NCCAM they were able to see changes in PET scans and fMRI in patients using meditation techniques. This is called relaxation response. and involved activation of centers related to the autonomic nervous system as well as increases in activity in the left anterior brain which is associated with positive emotional states. In the same study they found increases in antibody titers to influenza vaccine suggesting improved immune function as well.(20)

Hypnotism can be quite effective yet not everyone can be hypnotized. Operations have been done while under the influence of it, however, so it can have quite a powerful effect.

One cannot overlook the effect of prayer on health. Studies are being done but are hard to assess its effect. Certainly anyone with a healthy philosophy of life as many religious people have will, perhaps, be better able to face illness with less stress.

There was a more scientific measurement done by Barry Rosenfeldt PhD, Coleen McClain MA of Fordham University and William Breitbart, M.D. of Sloan Kettering Cancer Center (CAM of NIH winter 2005) involving the immune system in which a protein called interleukin 6 is elevated in some patients using prayer but again the effect is difficult to measure. Certainly it helps the patient relieve stress and develop a sense of meaning to life.(22)

Close to half the population take vitamins, minerals or dietary supplements regularly. Drugs that treat or prevent disease are under the regulation of the Food and drug administration and in order to be dispensed they must undergo expensive proof of safety, effectiveness and proof of good manufacturing practices, where as food supplements, herbs, vitamins and minerals only have to measure up to existing manufacturing requirements for foods. The FDA does monitor supplements that are on the market but pre market supplements are not. The Dietary supplement Health and Education Act (DSHEA] was passed by congress in 1994 in which they said that claims of benefit of a supplement in existing literature was sufficient evidence of effectiveness although, often times the claims were anecdotal and often poorly controlled. The Federal Trade Commission has been assigned to monitoring truth in advertising for supplements. Recently the FTC leveled fines for weight loss claims for xenadrine FX, one a day weight smart, cortislim and trim spa. Ephedra or ma huang which has been used for weight reduction had been barred in 2004. In November 2001 the FTC cracked down on bogus bioterrorism products especially those claiming to prevent and treat anthrax. The following is a list of warnings for dietary supplements: by the FDA: Androstenedione, Anthrax treatments, aristolochic acid, comfrey, ephedrine alkaloids, kava which can cause liver injury, lipokinetix (weight loss), liqiang 4, PC spes and spes, st. john’s wart and indinavir, tiractricol, triax metabolic accelerator, and Chinese diet pills containing fenfluramine. The FDA also advises against buying on line.(24)

In conclusion I gather that it isn’t a bad idea to take a multivitamin a day, What you don’t use is flushed down the toilet and, currently, some authorities are recommending two omega 3 fish oil capsules daily. Large doses of vitamin A,D and C can have side affects, however. In general there is a lot of fraudulent advertising involving dietary supplements, especially related to weight reduction diets and the number of conflicting theories of what constitutes a reasonable diet is especially confusing. Calories do count and a diet is worthless without exercise to burn up the calories. Conventional treatments must not be replaced by an alternative and one’s physician should be consulted before starting a complementary regimen because of the frequently encountered reactions with other medications.

BIBLIOGRAPHY FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE