Tài liệu Complementary and Alternative Medicine An Evidence- Based Approach

By: John W. Spencer, Joseph J. Jacobs

Audience: Professional
Language: English
Number Of Pages: 648
Published: March 2003
Publisher: Elsevier - Health Sciences Division

This popular, evidence-based overview of complementary and alternative medicine (CAM) emphasizes clinical research, analyzes the effectiveness of each therapy, and presents practical information on how these therapies can be used to treat health conditions and diseases. It not only acquaints the reader with information about CAM, but provides evidence for the effectiveness of various therapies used to treat medical conditions ranging from allergies to psychiatric conditions - in all populations relevant to CAM including children, women and the elderly. Summary tables embedded throughout highlight clinical data, statistics, and major research findings. More thorough documentation in this edition is achieved through new tables and added commentary on the quality of studies, making research findings more relevant and useful.



Chapters are grouped according to condition and special populations rather than treatment, so readers can easily compare all possible treatments for a specific condition.
Up-to-date tables allow the reader to see what studies have been done for a certain condition, and what the findings are.
Extensive references and suggested reading lists refer the reader to the most up-to-date or historically relevant sources.
An emphasis on research and clinical studies gives the book a comprehensive focus on CAM treatments and results.
The evidenced-based approach clearly details which therapies are most effective and safe.
Up-to-date tables focusing on critical needs related to demographics, safety, and areas of clinical pain allow summary information to be quickly referenced.
Comprehensive, reliable content presents an unbiased account of CAM that allows the reader to follow the data without excessive commentary from the authors.
A focus on major medical conditions for which there is the most detailed and up-to-date information available allows the reader to learn about the major critical issues of CAM.
The ways in which research methodology can be used to practice evidence-based medicine is reviewed in several chapters.
A focus on special populations, including women, children, and the elderly, presents important CAM considerations for these groups.
A new chapter on Legal and Ethical Issues addresses important professional considerations for practice related to CAM, including physician liability, malpractice issues, patient responsibility, and accreditation and licensing of CAM providers.
A new chapter on Integration of Clinical Practice and Medical Training with Complimentary and Alternative and Evidence-Based Medicine evaluating use of the case history approach; information and evidence in clinical practice and a model for integration of CAM used at the University of Arizona School of Medicine.
Significant content updates are provided for timely issues such as the use of herbs for depression, the use of massage for anxiety, CAM in pediatric and nursing care situations, and multi-modal therapies for pain.
Each table throughout the book has been extensively updated with the latest facts and information.
A final summary chapter at the end of the book presents emerging CAM treatments and suggests goals for CAM studies.
Much more attention has been paid in this edition to evaluating the quality of research, which allows for concrete and valid conclusions that are supported by science.
Appendices have been updated with much more information on research databases, listings, and organizations






Basic Foundations p. 1
Essential Issues in Complementary and Alternative Medicine p. 2
Preclinical Research in Complementary and Alternative Medicine p. 40
Clinical Research Outcomes: Use of Complementary and Alternative Therapies in General Medicine p. 69
Asthma and Allergies p. 70
Cancer p. 93
Atherosclerotic Vascular Disease p. 153
Diabetes Mellitus p. 173
Neurologic Disorders p. 195
Psychiatric Disorders p. 236
Alcohol and Chemical Dependency p. 278
Pain p. 311
Select Populations: Children p. 409
Select Populations: Women p. 458
Select Populations: Elderly Patients p. 482
Future Directions and Goals for Complementary and Alternative Medicine p. 503
Legal and Ethical Issues p. 504
Integration of Clinical Practice and Medical Training with Complementary and Alternative and Evidence-Based Medicine p. 517
Complementary and Alternative Medicine in the Twenty-First Century: Future Trends and Key Focuses p. 543
Final Summary: Goals for Complementary and Alternative Medicine p. 565
Definitions of Complementary and Alternative Therapies Described in the Text p. 572
Selected Resources for Complementary and Alternative Medicine p. 584
Selected Research Databases p. 595
Informed Consent Process Checklist for Physicians Integrating Complementary and Alternative Medicine p. 598
Glossary p. 600
Index p. 606
Table of Contents provided by Rittenhouse. All Rights Reserved.



Preface
The initial reason for writing Complementary and Alternative Medicine: An Evidence-
Based Approach was the need to examine research evidence and claims purported by
advocates, clinicians, and researchers of complementary and alternative medicine
(CAM) regarding its effectiveness. Both of us had previous experience with certain of
these therapies since we had worked with American Indians who used alternative spiritual-
indigenous medical approaches to health-related problems. Joseph Jacobs, a
Mohawk, grew up using many of these healing practices. Later, we were involved at a
national level establishing the first Office of Alternative Medicine (OAM) at the
National Institutes of Health (NIH).The office was set up as a mandate from Congress
to scientifically evaluate the claims made by the CAM community regarding treatment
efficacy and safety.
We have attempted to be sensitive to and aware of the continuing debate over
the need to study CAM.An early concern voiced by conventionally trained physicians,
health providers, and scientists that its evaluation was a waste of time, partially
because CAM had no scientific basis and partially because it simply was not useful,
and in some cases, safety concerns could be raised, is still heard today. Our first edition
evaluated many CAM therapies used for a variety of medical conditions.While there
was no definitive or consensual finding regarding treatment efficacy, this should not
be surprising given the paucity of research effort and financial expenditure for CAM
evaluation. Therapies such as acupuncture, massage, and “psychological” (biofeedback,
meditation-relaxation) have been increasingly used by consumers and also
studied and evaluated, and a pattern of valid and reliable outcomes, under certain
conditions, appears to be evolving.
Our second edition provides updated information on CAM since the late 1990s,
as well as several new areas that are both important and relevant to the practice of
CAM.Our goals for this second edition remain unchanged from our earlier work.
We want the book to contain the most recent and updated material concerning
CAM and to be able to serve as a reference for physicians, health care providers, and
scientists.We recognize that this is a formidable task because of the huge and not very
well-defined areas of CAM. It is not possible to cover every study or therapy, but
we tried to establish some general guidelines within which therapies and medical
conditions were evaluated based on reported usage, recent demographic evaluations,
and study quality.We hope by providing an evidence base for CAM that we continue
to contribute to a database that allows the consumer, clinical scientist, and practicing
healthcare provider to make knowledgeable decisions about CAM usage. That knowledge
about healthcare practices regarding their integration with conventional medicine,
where appropriate,will benefit patients and make available the safest and highest
quality of medicine.
ORGANIZATION OF THE BOOK
We, as editors, have sought to allow the various chapter contributors the freedom to
review and discuss those therapies that in their opinion merit the most focus. We
have encouraged the use of as many databases as possible pursuant to establishing a
firm evidence base. Besides using the federal Medline NIH Database, each author
has supplemented their chapters differently. One major addition is our attempt to
allow for more discussion(s) regarding the quality of the studies with less emphasis on
simple quantity. We have also attempted in Appendices B and C to provide readers
with more information about where clinical and research data regarding CAM exist.
With such a quickly and continuously growing field, however, today’s information
about CAM is almost outdated by tomorrow.
Complementary and Alternative Medicine: An Evidenced-Based Approach is
organized around three major themes. The first part, Basic Foundations (Chapters 1
and 2), evaluates what is known about CAM focusing on definitional, usage,
and research (clinical and preclinical) strategies; positioning of evidence-based
medicine; and education/training. During the late 1990s, the movement by the
Cochrane group to provide more systematic reviews for CAM therapies is an encouraging
sign to place more emphasis on stronger research methodology.Although there
are clear and major differences of opinion regarding the usefulness of certain research
methodologies, by allowing for closer scrutiny of many different types of designs we
suggest that a more relevant clinical and scientific outcome may evolve. The debate
concerning the “placebo response” is a noteworthy example of the many research and
clinical questions reviewed in this text. Its place in the healing process as well as its
“control” attributes cannot and should not be ignored.A greater knowledge base concerning
the potentially strong influence of the mindrain in many healthcare issues
may be an outgrowth of the “placebo” study and debate.
The second and largest part, Clinical Research Outcomes: Use of Complementary
and Alternative Therapies in General Medicine, evaluates and reviews clinical research.
In Chapter 3, CAM’s role in treating asthma and allergies is presented carefully,
reviewing the evidence and allowing readers to form their own conclusions regarding
CAM contributions.Chapter 4 reviews and updates what has been done in the area of
cancer. Although there is no major change in the reported efficacy of CAM in the
treatment of cancer, potentially useful approaches may be on the horizon.Noteworthy
is the American Cancer Society’s recent contribution of common herbal use with cancer.
Chapter 5 reviews atherosclerotic vascular disease, focusing on the importance of
both prevention and the integration of CAM to maximize benefit.Chapter 6 has more
x Preface
information on the use of herbs with diabetes mellitus. Quality of life remains an
important issue. Chapter 7 reviews CAM therapies in the treatment of neurological
conditions with an appropriate focus on rehabilitation issues. Chapter 8 evaluates
CAM in the field of psychiatry. Importantly, the continued tracking and review of the
use of St. John’s wort for the treatment ofmild to moderate depression and the issue of
safety with kava-kava for anxiety management is featured.Chapter 9 discusses the use
of CAM in the treatment of alcohol and chemical dependency.While many therapies
have at times produced “positive findings,” there still remains a challenge in producing
consistency and replicable results. The complexity of many factors that are associated
with substance abuse and its treatment needs much more evaluation and clarification
in all treatment protocols. Chapter 10 directs attention to the ubiquitous area of pain
control by the use of CAM methods. Recent studies that have evaluated manipulation
procedures or the use of massage points to some useful findings. Also encouraging is
the work of acupuncture in the treatment of fibromyalgia. Chapters 11 to 13 feature
populations that increasingly constitute significant numbers of CAM consumers:
children, women, and the elderly. The uniqueness of these populations and their
importance in more accurately framing research questions around specific targeted
areas needs strong emphasis. Of special concern are attention-deficit disorder as a
possible medically overtreated health problem, the nausea and vomiting associated
with pregnancy, and Alzheimer’s and osteoarthritis and the important realm of quality-
of-life issues.
In the final part, Future Directions and Goals for Complementary and Alternative
Medicine, a new chapter, Legal and Ethical Issues (Chapter 14), directs attention to
the impact and interaction(s) that must occur between CAM and the legal field, as
well as updating and reviewing the important issues of accreditation and licensing
of CAM providers. This is extremely relevant to the validation of CAM as being
clinically trustworthy and safe. A second new chapter, Integration of Clinical
Practice and Medical Training with Complementary and Alternative and Evidence-
Based Medicine (Chapter 15), features the place for CAM in the context of
integrative medicine and its part for healthcare and society. While one aspect of
an evidence-based medicine may arguably be the inclusion of science and experimentally
driven procedures such as statistics, the individual patient should not be
“left out of the equation.” Importantly, this concept and evidence-based medicine
as one part of CAM should be directed at medical students at various levels or stages
of training. Chapter 16 provides a review of the importance and needs of the consumer
in a driven business market. At the federal level, regulation of CAM for
both consumer protection and validation of usefulness and safety is necessary.A final
summary (Chapter 17) puts forward potential emerging CAM therapies that
should be tracked and watched for future outcomes. A list of goals that are attainable
and relevant to the development of CAM and evidence-based medicine is
provided.
Note: John Spencer and Joseph Jacobs are writing as individuals, and as such
anything contained within does not reflect any present or past policy of the NIH or
any other organization/association they have been or are currently affiliated with.