Complementary Therapies

The use of alternative/complementary medicine has been increasing considerably. Conventional medicine must begin to address issues related to the use, safety, regulation, research and education of alternative/complementary medicine. Integrative medicine combines conventional medicine and alternative complementary practices. Integrative medicine is an innovative approach to medicine and medical education. It involves the understanding of the interaction of the mind, body and spirit and how to interpret this relationship in the dynamics of health and disease. Integrative medicine shifts the orientation of the medical practice from disease based approach to a healing based approach. It does not reject conventional medicine nor uncritically accepts unconventional practices. Integrative medicine is an effective, more fulfilling human approach to medicine based on the benefit of the patient by following good medicine practices in a scientific manner.

Complementary treatments are often used by HIV-infected individuals. Yet little is known about their effectiveness. The aim of this systematic review was therefore to summarize the published evidence for or against the effectiveness of complementary therapies in HIV-positive people. A comprehensive literature search was conducted to locate all randomized clinical trials (RCTs) of complementary therapies. Data were extracted in a standardized fashion and evaluated critically. Fourteen studies met our pre-de® ned inclusion/exclusion criteria; 2 of herbal treatments, 5 of vitamins and other supplements, 5 of stress management, one of massage therapy, and one of acupuncture. They fall into 2 broad categories of ‘cure’ and ‘care’. While the former category yields few encouraging results, the latter group of studies is more promising. In particular, stress management may prove to be an effective way to increase the quality of life. It is concluded that few rigorous trials of complementary...

To determine frequency, perceived effectiveness, and cost of religious, physical, and other nonmedical practices, we interviewed all (n = 402; 100% participation) of our cystic fibrosis patients/families [age, O-45 (median, 18) years]. At least one type of nonmedical therapy was used by/on 264 (66%), two-this of which was religious. Most respondents perceived benefit (e.g., group prayer, 95%; religious articles, 81%; chiropractic, 69%). Only 17 (4.2%) invested over $200 lifetime (minimal compared with medical costs). These treatments, apparently used by most patients/families, rarely interfered with medical care. Physician openness and empathy toward patients' beliefs might enhance rapport and facilitate discussion of possible helpful or adverse effects of nonmedical treatment.

The study measured the prevalence and costs of complementary therapy use by women diagnosed with breast cancer in the South Thames NHS region. A postal questionnaire was sent to a sample of 1023 women from the Thames Cancer Registry who had been diagnosed with breast cancer in the previous 7 years. Just over a ®fth (22.4%) had consulted a complementary practitioner in the previous 12 months. Almost one third (31.5%) had done so since diagnosis. Almost £17 000 had been spent on visits in the previous year. The women using complementary medicine after diagnosis were slightly younger, more educated and more likely to have used complementary medicine before their diagnosis than non-complementary medicine users. In conclusion, signi®cant numbers of women are visiting complementary therapists for health reasons following a breast cancer diagnosis. The out of pocket costs per user, with notable exceptions, are modest. Use of practitioners of complementary therapies following diagnosis is a signi®cant and possibly growing phenomenon. #

Integration of conventional and complementary care in the United States is driven by the growing use of complementary therapies by patients, limitations in the effectiveness of conventional care for a variety of chronic conditions, a growing emphasis on patient satisfaction as a legitimate outcome of care, and an awareness on the part of insurers and practitioners that complementary approaches can offer a broad array of options that may significantly enhance healing and promote more active patient participation in health maintenance. Many models of integrative care are possible, ranging from the informed practitioner, to fully integrated group practices, to hospital-based and academic center systems of integration. A variety of barriers and challenges can slow the process of integration, including limited personal financial and temporal resources, negative peer opinion, legislative hindrances, and reimbursement shortfalls. This review describes seven models of integrative health car...

Background: Musculoskeletal disorders have serious impact on the profession of dentistry. There is common occurrence of pain due to incorrect posture in dental professionals. Complementary and alternative medicine (CAM) therapies may cast a new light on preventing and intercepting musculoskeletal disorders (MSD). An epidemiological study was conducted in an effort to contribute to the prevention of musculoskeletal disorders in dentistry. The purpose of this study was to determine the prevalence of MSD at dentists using CAM as a treatment and preventive modality for MSD and to compare job/career satisfaction between dentists who use CAM and conventional therapy (CT). Material and Methods: Dentists registered in Uttrakhand state, India, under the Dental Council of India and registered members of the Indian Dental Association, Uttrakhand branch (N = 1496) were surveyed. Statistical analysis was conducted using SPSS 17. Results: A response rate of 84% (N = 1257) was obtained, revealing that 90% (N = 1131) had the problem of MSD. Seventy three percentage (N = 826) of dentists with MSD reported the use of CAM and CT. Complementary and alternative medicine users reported greater overall health (72.7% vs. 51%, p < 0.001), job satisfaction (61.2% vs. 35%, p < 0.001) and work efficiency compared to CT users. Conclusion: Complementary and alternative medicine therapies may improve quality of life, reduce work interruption and enhance job satisfaction for dentists who suffers from MSD. Through the course of their studies, dentists should be equipped with knowledge on ergonomics and CAM therapies, such as yoga and others, to help them prevent musculoskeletal disorders more effectively.

Many mothers are inappropriately advised to discontinue breastfeeding or avoid taking essential medications because of fears of adverse effects on their infants. This cautious approach may be unnecessary in many cases, because only a small proportion of medications are contraindicated in breastfeeding mothers or associated with adverse effects on their infants. Information to inform physicians about the extent of excretion for a particular drug into human milk is needed but may not be available. Previous statements on this topic from the American Academy of Pediatrics provided physicians with data concerning the known excretion of specific medications into breast milk. More current and comprehensive information is now available on the Internet, as well as an application for mobile devices, at LactMed (https://toxnet.nlm.nih.gov). Therefore, with the exception of radioactive compounds requiring temporary cessation of breastfeeding, the reader will be referred to LactMed to obtain the most current data on an individual medication. This report discusses several topics of interest surrounding lactation, such as the use of psychotropic therapies, drugs to treat substance abuse, narcotics, galactagogues, and herbal products, as well as immunization of breastfeeding women. A discussion regarding the global implications of maternal medications and lactation in the developing world is beyond the scope of this report. The World Health Organization offers several programs and resources that address the importance of breastfeeding (see https:// www.who.int/topics/breastfeeding/en/). Pediatrics 2013;132:e796-e809 Hari Cheryl Sachs, MD, FAAP* and COMMITTEE ON DRUGS KEY WORD human milk ABBREVIATIONS AAP-American Academy of Pediatrics FDA-Food and Drug Administration HBV-hepatitis B vaccine HPV-human papillomavirus vaccine NSAID-nonsteroidal antiinflammatory drug This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication. The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. *The recommendations in this review are those of the authors and do not represent the views of the US Food and Drug Administration.

Background: Previous research indicates wide use of complementary and alternative medicine (CAM). While understanding this trend is certainly important, an equally meaningful although largely unexamined research question is: why do the majority of patients and individuals fail to avail themselves of such therapies? Understanding these factors may be particularly important given the increasing evidence suggesting that certain of these therapies may be efficacious.

The objectives of the study were: Wrst, to determine the prevalence of traditional medicine (TM) and complementary and alternative medicine (CAM) use in head and neck cancer patients in Ireland; second, to educate ourselves on the plethora of CAM/TM options available to patients outside the dominion of conventional medicine. The study design consisted of a cross-sectional survey carried out in three head and neck cancer centres. Self-administered questionnaires were distributed to 110 head and neck cancer patients attending the three cancer centres and data were collected for statistical analysis. A total of 106 patients completed the questionnaire; 21.7% of the participants used CAM/TM since their diagnosis with head and neck cancer. CAM/TM usage was higher in female (34.3%) than in male patients (16.2%). CAM/TM use was more common in the 41-50-year age group, in patients with higher educational levels and those holding strong religious beliefs, and also in married than single patients. The most common types of CAM/TM used were spiritual and laying on of hands. The most common reasons reported for using CAM/TM were to counteract the ill eVects of treatment and increase the body's ability to Wght cancer. Sources of information on CAM/TM were friends (65%), family (48%) and media (21%). This survey reveals a high prevalence of CAM/TM use in head and neck cancer patients, hence emphasising the need for otolaryngologists to educate themselves on the various therapies available to be able to provide informative advice. There is an urgent need for evidence-based investigation of various CAM/TM therapies currently oVered to patients.

A large quantity of research concerning issues of patient compliance with medications has been produced in recent years. The assumption in much of this work is that patients have little option but to comply with the advice and instructions they receive. Studies have shown, however, that between one third and one half of all patients are non-compliant, but different authors cite different reasons for this high level of non-compliance. In this paper, the concept of compliance is questioned. It is shown to be largely irrelevant to patients who carry out a 'cost-benefit' analysis of each treatment, weighing up the costs/risks of each treatment against the benefits as they perceive them. Their perceptions and the personal and social circumstances within which they live are shown to be crucial to their decision-making. Thus an apparently irrational act of non-compliance (from the doctor's point of view) may be a very rational action when seen from the patient's point of view. The solution to the waste of resources inherent in non-compliance lies not in attempting to increase patient compliance per se, but in the development of more open, co-operative doctor-patient relationships.

Postpartum depression affects an estimated 13% of women who have recently given birth. This article discusses several alternative or complementary therapies that may serve as adjuncts in the treatment of postpartum depression. The intent is to help practitioners better understand the treatments that are available that their clients may be using. Complementary modalities discussed include herbal medicine, dietary supplements, massage, aromatherapy, and acupuncture. Evidence supporting the use of these modalities is reviewed where available, and a list of resources is given in the appendix.

Genitourinary syndrome of menopause is a condition comprising the atrophic symptoms and signs women may experience in the vulvovaginal and bladder-urethral areas as a result of the loss of sex steroids that occurs with menopause. It is a progressive condition that does not resolve without treatment and can adversely affect a woman's quality of life. For a variety of reasons, many symptomatic women do not seek treatment and, of those who do, many are unhappy with their options. Additionally, many healthcare providers do not actively screen their menopausal patients for the symptoms of genitourinary syndrome of menopause. In this review, we discuss the clinical presentation of genitourinary syndrome of menopause as well as the treatment guidelines recommended by the major societies engaged in women's health. This is followed by a review of available treatment options that includes both hormonal and non-hormonal therapies. We discuss both the systemic and vaginal estrogen products that have been available for decades and remain important treatment options for patients; however, a major intent of the review is to provide information on the newer, non-estrogen pharmacologic treatment options, in particular oral ospemifene and vaginal prasterone. A discussion of adjunctive therapies such as moisturizers, lubricants, physical therapy/dilators, hyaluronic acid, and laser therapy is included. We also address some of the available data on both the patient and healthcare providers perspectives on treatment, including cost, and touch briefly on the topic of treating women with a history of, or at high risk for, breast cancer.

Goal of work To examine the frequency and types of complementary and alternative medicine use in patients undergoing radiotherapy and to analyze the effects these therapies have on the toxicities of radiotherapy. Materials and methods A total of 210 consecutive cancer patients undergoing radiation therapy were included. After radiation therapy, each patient completed a standard questionnaire, and the association between radiation toxicity and complementary and alternative medicine use was analyzed. Main results Among the study population, 44.3% of patients reported using at least one form of complementary and alternative medicine during radiotherapy. The most commonly chosen complementary and alternative medicine was stinging nettle. Complementary and alternative medicine use decreased lower gastrointestinal (F=3.26, P=.009) and genitourinary toxicities (F=2.38, P=.043), while it increased laryngeal toxicity (F=2.63, P=.028). A significant correlation between the type of complementary and alternative medicine used and the degree of these toxicities was not demonstrated. Conclusions Use of complementary and alternative medicine among cancer patients during radiation therapy may affect the degree of radiation toxicity. Further randomized controlled clinical trials are needed to determine the benefits and risks of complementary and alternative medicine use during radiation therapy.

Purpose: Interest in alternative/complementary therapies (A/CTs) is on the rise, yet little is known about adolescents' use of A/CTs. The study purpose was to examine A/CT utilization patterns among a clinic-based sample of adolescents. Methods: A cross-sectional survey of 401 adolescents, aged 12-18 years, was conducted in one Midwest urban adolescent ambulatory clinic in 2002. Results: Overall, 68.1% of the adolescents reported using one or more A/CT; most commonly, herbal medicines (27.2%), massage therapy (26.7%), and megavitamins (21.7%). Use by friends and family was the primary influence for adolescent A/CT use; lack of familiarity was the greatest reason for nonuse (53.9%). Alleviation of physical pain (66.3%) was the most common desired health outcome. Few adolescents (13.8%) disclosed A/CT use to their health care providers. Insurance coverage was provided for 10.2% of the therapies and out-of-pocket costs averaged $67/month. Age, race/ethnicity, having a health condition, taking medications, health responsibility, and work status were associated with overall A/CT use in bivariate analyses. Of these, only associations between A/CT use and race/ethnicity and health responsibility remained statistically significant after adjusting for the other variables. Conclusions: Use of A/CTs was common among these adolescents, yet very few disclosed their use to health care providers. Providers must ask about A/CT use to gain a more complete understanding of health practices among adolescents in clinical settings. Future research is needed to better understand representative patterns of A/CT use.

This paper provides an overview of the rapidly evolving paradigm of "Integrative Mental Health (IMH)." The paradigm of contemporary biomedical psychiatry and its contrast to nonallopathic systems of medicine is initially reviewed, followed by an exploration of the emerging paradigm of IMH, which aims to reconcile the bio-psycho-socio-spiritual model with evidencebased methods from traditional healing practices. IMH is rapidly transforming conventional understandings of mental illness and has significant positive implications for the day-to-day practice of mental health care. IMH incorporates mainstream interventions such as pharmacologic treatments, psychotherapy, and psychosocial interventions, as well as alternative therapies such as acupuncture, herbal and nutritional medicine, dietary modification, meditation, etc. Two recent international conferences in Europe and the United States show that interest in integrative mental health care is growing rapidly. In response, the International Network of Integrative Mental Health (INIMH: www.INIMH. org) was established in 2010 with the objective of creating an international network of clinicians, researchers, and public health advocates to advance a global agenda for research, education, and clinical practice of evidence-based integrative mental health care. The paper concludes with a discussion of emerging opportunities for research in IMH, and an exploration of potential clinical applications of integrative mental health care.

www.bjcancer.com ª 2002 Cancer Research UK 'Alternative' cancer cures (ACCs) continue to be heavily promoted (Ernst et al, 1999). Conventional oncologists often have limited knowledge about ACCs (Newell et al, 2000), and compelling evidence is usually not available (Ernst et al, 2001). Cancer patients tend to get confused in the maze of claims and counter-claims and often turn to the 'Internet' for information. Following advice obtainable via the 'world wide web' can, however, be hazardous. Tragic instances where this brought considerable harm, even death, to cancer patients are on record (e.g. Hainer et al, 2000). It is therefore reasonable to ask whether the advice offered to cancer patients by some of the most prominent 'web sites' might put cancer patients at risk. We identified eight popular search engines (Mansoor, 2001; Sullivan and Nielsen (www.searchenginewatch.com)), and searched for the following terms between 18th and 25th September, 2001: 'complementary medicine' or 'alternative medicine' or 'complementary therapy' or 'alternative therapy' and 'cancer'. The first 30 hits from each search engine were compared. All 'web sites' which were listed on at least three search engines were evaluated and rated on a scale of 0-14 (Sandvik, 1999). Table 1 summarises our evaluation of the 13 'sites' that could be included in our analysis. Three of the 'sites' overtly discouraged cancer patients to employ conventional therapies. Most 'sites' recommended a multitude of treatments with little consensus between them. Cancer prevention was advocated on all 'sites'. In our judgement, five 'sites' had the potential to harm cancer patients if the advice provided was followed. Our overall rating for the 'sites' ranged from medium to good (Table 1). These findings suggest that the quality of the information of the 'web sites' offered to cancer patients is highly variable. The vast majority recommends ACCs for which there is no evidence of efficacy (Ernst et al, 2001). More worryingly perhaps, some 'sites' overtly discourage patients to use conventional cancer therapies. No 'website' warns cancer patients about ACCs that have been demonstrated to be ineffective. Some of the recommended treatments are not curative but palliative or supportive by nature, e.g. aromatherapy, music therapy, massage, and this approach is undoubtedly more promising (Ernst, 2001).

This review examines the educational accreditation standards of four licensed complementary and alternative medicine (CAM) disciplines (naturopathic medicine, chiropractic health care, acupuncture and oriental medicine, and massage therapy), and identifies public health and other competencies found in those standards that contribute to cooperation and collaboration among the health care professions. These competencies may form a foundation for interprofessional education. The agencies that accredit the educational programs for each of these disciplines are individually recognized by the United States Department (Secretary) of Education. Patients and the public are served when healthcare practitioners collaborate and cooperate. This is facilitated when those practitioners possess competencies that provide them the knowledge and skills to work with practitioners from other fields and disciplines. Educational accreditation standards provide a framework for the delivery of these competencies. Requiring these competencies through accreditation standards ensures that practitioners are trained to optimally function in integrative clinical care settings.

Studies suggest that between 30% and 50% of the adult population in industrialized nations use some form of complementary and/or alternative medicine (CAM) to prevent or treat a variety of health-related problems. A comprehensive literature search identified 25 surveys conducted between 1982 and 1995 that examined the practices and beliefs of conventional physicians with regard to 5 of the more prominent CAM therapies: acupuncture, chiropractic, homeopathy, herbal medicine, and massage. Six studies were excluded owing to their methodological limitations. Across surveys, acupuncture had the highest rate of physician referral (43%) among the 5 CAM therapies, followed by chiropractic (40%) and massage (21%). Rates of CAM practice by conventional physicians varied from a low of 9% for homeopathy to a high of 19% for chiropractic and massage therapy. Approximately half of the surveyed physicians believed in the efficacy of acupuncture (51%), chiropractic (53%), and massage (48%), while f...

The inclusion of prayer-for-health (PFH) in the definition of complementary alternative medicine (CAM) has resulted in higher levels of CAM use. The objective of this study was to assess PFH and CAM use among breast cancer patients undergoing chemotherapy.

Increasing use of complementary and alternative medicine (CAM) therapies such as chiropractic, massage therapy, and herbal medicine, raises questions about the clinically appropriate use of CAM in pediatrics. Nonjudicious use of CAM therapies may cause either direct harm or, by creating an unwarranted financial and emotional burden, indirect harm. When advising patients concerning CAM therapies, pediatricians face 2 major legal risks: medical malpractice and professional discipline. Pediatricians can incorporate these considerations into advising and clinical decision-making about CAM therapies to address the best interest of the pediatric patient while helping to manage potential liability risk. This article provides a suggested framework, including asking the following questions: (1) Do parents elect to abandon effective care when the child's condition is serious or life-threatening? (2) Will use of the CAM therapy otherwise divert the child from imminently necessary conventional treatment? (3) Are the CAM therapies selected known to be unsafe and/or ineffective? (4) Have the proper parties consented to the use of the CAM therapy? (5) Is the risk-benefit ratio of the proposed CAM therapy acceptable to a reasonable, similarly situated clinician, and does the therapy have at least minority acceptance or support in the medical literature? Such an approach ideally can help guide the pediatrician toward clinical conduct that is clinically responsible, ethically appropriate, and legally defensible.

Herbal medicine is widely used by individuals with mental health problems, although research on their health characteristics and health care utilization patterns—including concomitant treatment with conventional mental health care and psychotropic medication—remains limited. We gathered data from the National Comorbidity Survey Replication (NCS-R), a representative survey of US adults in which diagnoses of mental disorders were based on a fully structured diagnostic interview. Our analysis found that NCS-R respondents with mental disorders were significantly more likely to have used herbal medicines for mental health problems than respondents who did not meet criteria for a mental disorder. Users of herbal medicines for mental health problems were likely to utilize conventional health care as well, particularly conventional psychiatric medication. Herbal use also was associated with having multiple comorbid medical problems. A substantial proportion of US adults use herbal medicine ...

This paper provides an overview of the rapidly evolving paradigm of "Integrative Mental Health (IMH)." The paradigm of contemporary biomedical psychiatry and its contrast to nonallopathic systems of medicine is initially reviewed, followed by an exploration of the emerging paradigm of IMH, which aims to reconcile the bio-psycho-socio-spiritual model with evidencebased methods from traditional healing practices. IMH is rapidly transforming conventional understandings of mental illness and has significant positive implications for the day-to-day practice of mental health care. IMH incorporates mainstream interventions such as pharmacologic treatments, psychotherapy, and psychosocial interventions, as well as alternative therapies such as acupuncture, herbal and nutritional medicine, dietary modification, meditation, etc. Two recent international conferences in Europe and the United States show that interest in integrative mental health care is growing rapidly. In response, the International Network of Integrative Mental Health (INIMH: www.INIMH. org) was established in 2010 with the objective of creating an international network of clinicians, researchers, and public health advocates to advance a global agenda for research, education, and clinical practice of evidence-based integrative mental health care. The paper concludes with a discussion of emerging opportunities for research in IMH, and an exploration of potential clinical applications of integrative mental health care.

The term &quot;evidence-based medicine&quot; (or EBM) was introduced about ten years ago, and there has been considerable debate about the value of EBM. However, this debate has sometimes been obscured by a lack of conceptual clarity concerning the nature and status of EBM. First, we note that EBM proponents have obscured the current debate by defining EBM in an overly broad, indeed almost vacuous, manner; we offer a clearer account of EBM and its relation to the alternative approaches to medicine. Second, while EBM proponents commonly cite the philosophical work of Thomas Kuhn and claim that EBM is a Kuhnian &#39;paradigm shift,&#39; we argue that such claims are seriously mistaken and unduly polarize the EBM debate. Third, we suggest that it is much more fruitful to understand the relationship between EBM and its alternatives in light of a different philosophical metaphor: W.V. Quine&#39;s metaphor of the web of belief. Seen in this way, we argue that EBM is an approach to medical...

Rett syndrome (RS) is a neurological disorder affecting mainly females. RS is considered the second most frequent cause for severe and complex neurological dysfunction in females after Down syndrome. Patients with RS are characterized by an array of neurological and orthopedic difficulties that mandate an intensive therapeutic intervention program for the duration of the individual&#39;s life. Many aspects of the client&#39;s well-being and functional status depend on the therapeutic intervention she receives and on her compliance to it. This article will briefly review common intervention approaches for individuals with RS and their present day&#39;s application. Due to the notion that individual intervention is the foundation on which progress and development of the functional gains rests, the present article will place basic guidelines for individual intervention with clients with RS. The article is mainly based on the clinical experience of the author and others working with ind...

Influenza virus remains among the most important pathogens infecting elderly people. Vaccination is the most cost-effective strategy to reduce morbidity and mortality due to influenza. For persons who are not vaccinated or for whom vaccines fail to prevent influenza, there are 2 classes of efficacious drugs for treatment or chemoprophylaxis: M2 channel inhibitors and neuraminidase inhibitors. Effective treatment, however, must commence within 48 h of the onset of symptoms, which can create problems for patients who wait to see whether their symptoms worsen or improve. Older adults who have relocated to the congregate housing environments of assisted living and long-term care facilities deserve special consideration, because influenza exposure risks are different for this group. Strategies for control of influenza must combine preventive approaches, such as vaccination, educational approaches, and the introduction of policies that allow health care professionals anticipate, identify, and efficiently respond to influenza outbreaks.

Background: Complementary and Alternative Medicine (CAM) is widely used throughout the UK and the Western world. CAM is commonly used for children and the decision-making process to use CAM is affected by numerous factors. Most research on CAM use lacks a theoretical framework and is largely based on bivariate statistics. The aim of this review was to identify a conceptual model which could be used to explain the decision-making process in parental choice of CAM.

BACKGROUND: Complementary and alternative medicines often are advocated for infantile colic, yet there has been no synthesis of the evidence to inform current practice about their use. OBJECTIVE: To critically evaluate all randomized clinical trials of nutritional supplements and other complementary and alternative medicines as a treatment for infantile colic. METHODS: Five electronic databases were searched from their inception to February 2010 to identify all relevant randomized clinical trials of complementary and alternative medicines and supplements for infantile colic. Reference lists of retrieved articles were hand searched. Data were extracted by two independent reviewers, and methodological quality was assessed using the Jadad score and key aspects of the Cochrane risk of bias. RESULTS: Fifteen randomized clinical trials met the inclusion criteria and were included. Thirteen studies were placebo controlled. Eight were of good methodological quality. Eleven trials indicated ...

To test the hypothesis that there is a reviewer bias against publication of a test of an unconventional drug. Design: Randomized, controlled, double-blind study of peer review. Participants: Convenience sample of 291 medical doctors from a wide variety of specialties drawn from a list of conference participants. Methods: Reviewers were randomly assigned to receive one of two versions of a manuscript.Version M related to an in-vitro experiment on a mainstream drug (Metoprolol).The otherwise identical versionV used a highly unconventional drug (beef spleen cell extract) for the same experiment. Reviewers were asked to complete a standardised evaluation sheet including visual analogue scales (VASs) on a set of predefined quality criteria.All participants were debriefed after completion of the study. Results:The response rate was 61%.There were no significant differences inVAS ratings between the two versions of the manuscript. Ratings covered the entire range of the VASs. Conclusion: In the present setting, there was no evidence for a reviewer-bias against testing an unconventional drug.The low inter-rater reliability, however, suggested inadequate validity of peer review.

Objectives. To critically evaluate the evidence regarding complementary and alternative medicine (CAM) taken orally or applied topically (excluding glucosamine and chondroitin) in the treatment of OA. Methods. Randomized clinical trials of OA using CAMs, in comparison with other treatments or placebo, published in English up to January 2009, were eligible for inclusion. They were identified using systematic searches of bibliographic databases and manual searching of reference lists. Information was extracted on outcomes, and statistical significance, in comparison with alternative treatment of placebo, and side effects were reported. The methodological quality of the primary studies was determined. Results. The present review found consistent evidence that capsaicin gel and S-adenosyl methionine were effective in the management of OA. There was also some consistency to the evidence that Indian Frankincense, methylsulphonylmethane and rose hip may be effective. For other substances with promising evidence, the evidence base was either insufficiently large or the evidence base was inconsistent. Most of the CAM compounds studied were free of major adverse effects. Conclusion. The major limitation in reviewing the evidence is the paucity of randomized controlled trials in the area: widening the evidence base, particularly for those compounds for which there is promising evidence, should be a priority for both researchers and funders.

Allergic rhinitis (AR) is one of the most common diseases affecting adults. It is the most common chronic disease in children in the United States today and the fifth most common chronic disease in the United States overall. AR is estimated to affect nearly 1 in every 6 Americans and generates $2 to $5 billion in direct health expenditures annually. It can impair quality of life and, through loss of work and school attendance, is responsible for as much as $2 to $4 billion in lost productivity annually. Not surprisingly, myriad diagnostic tests and treatments are used in managing this disorder, yet there is considerable variation in their use. This clinical practice guideline was undertaken to optimize the care of patients with AR by addressing quality improvement opportunities through an evaluation of the available evidence and an assessment of the harm-benefit balance of various diagnostic and management options. The primary purpose of this guideline is to address quality improvem...

Refractory gastroesophageal reflux disease may affect up to one-third of the patients that consume proton pump inhibitor (PPI) once daily. Treatment in clinical practice has been primarily focused on doubling the PPI dose, despite lack of evidence of its value. In patients who failed PPI twice daily, medical treatment has been primarily focused on reducing transient lower esophageal sphincter relaxation rate or attenuating esophageal pain perception using visceral analgesics. In patients with evidence of reflux as the direct trigger of their symptoms, endoscopic treatment or antireflux surgery may be helpful in remitting symptoms. The role of psychological interventions, as well as non-traditional therapeutic strategies remains to be further elucidated.