Tài liệu Essentials of Complementary and Alternative Medicine - Wayne B. Jonas & Jeffrey S. Levin

Essentials of Complementary and Alternative MedicineWayne B. Jonas
Jeffrey S. Levin
Paperback: 605 pages
Publisher: Lippincott Williams & Wilkins (May 1999)
Language: English


FOREWORD
The publication of Essentials of Complementary and Alternative Medicine, the first comprehensive
textbook for physicians about these increasingly popular forms of medical treatment, is very timely. For the first time, information about the foundations of complementary and alternative medicine (CAM), the safety of CAM products and practices, and overviews of nearly two dozen CAM systems are available in one
place.
The purpose of this textbook is to provide mainstream medical professionals useful and balanced
information about CAM. The development of this type of book is an ambitious and difficult goal for several
reasons. Many CAM systems are claimed to have special patient benefits not met by either conventional
medicine or other CAM approaches. There are few unifying themes across these systems (other than the
belief that there are unmet patient benefits outside of conventional medicine). Faced with these problems,
the editors have sought the best individuals in these diverse areas and worked with them to produce a
balanced and useful book developed specifically for physicians. In many areas of CAM, there is a history
of long-term and vigorous antagonism with conventional medicine, as well as different educational
standards, training, and practices. Also, the basic concepts of what constitutes sufficient evidence of
safety and efficacy vary among CAM systems. Ultimately, the usefulness of this book will depend on its
success in addressing these issues in an objective, pragmatic, and convincing way.
Why is it important to publish this textbook? The main reason is the compelling evidence that medicine has
been changing both scientifically and culturally for several decades. Let us start with the changes in
conventional medicine since World War II.
The medicine of my childhood in a small rural town in Virginia was very different from the conventional
medicine of today. For example, my 80-year-old sister who had a heart attack was treated by removal of
the clot and insertion of a stent; both she and her husband viewed the procedure on television, and she
was up and walking the next day. In contrast, when my 59-year-old father suffered a heart attack over 50
years ago, medicine really had little to offer.
Although there are many reasons for these dramatic changes in medicine, the dominant force has been the
emergence of exact sciences underlying medicine (whereas once they were viewed as “soft sciences”).
The rewarding results have been an ever-increasing understanding of basic life processes. This
understanding, in turn, has allowed novel and successful approaches to disease control.
However, the advancement of science-based medicine has a downside: science-based specialty medicine
has become less personal and more costly. And, cost-containment efforts pay for procedures done, rather
than time spent with patients. For these and other reasons, patients seek to augment the benefits of
modern conventional medicine with CAM.
The initial striking evidence of the widespread use of CAM in the United States was reported by David
Eisenberg and colleagues in the New England Journal of Medicine in 1993. According to Eisenberg's
report, one in three Americans saw an alternative health care practitioner in 1990 (constituting more visits than to conventional primary care physicians), and they paid more than 10 billion dollars in out-of-pocket expenses for this care. In addition, patients did not tell their physicians of their use of CAM because they assumed the physicians would not be interested or would not approve. In a follow-up study now completed, the evidence of even greater use of CAM has been confirmed and is most striking: more than 40% of Americans currently use CAM (approaching European and Australian rates), and as much out-of-pocket
money is spent for CAM care as is out-of-pocket money spent for all of conventional medicine. These facts
confirm the need for readily available information to help physicians understand, evaluate, and address
CAM treatments that their patients are receiving. This textbook will help them do that.
A significant change occurred when the United States Congress mandated the opening of the Office of
Alternative Medicine (OAM) at the National Institutes of Health (NIH). Medical schools are now seeking
research support from this source. Research findings supported by the OAM can be expected to meet the
familiar standards of NIH. In addition to research, more than 70 medical schools have (or are planning)
courses in CAM for their medical student curriculum. And, although future physicians and other
conventional health care workers will be versed in the advantages and disadvantages of CAM, most of
those now in practice need accurate information.
Both conventional medicine and CAM share similar concerns in several important areas. Both systems
need always to be committed to eliminating fraudulent practice or practitioners who severely misguide
desperately ill patients. Therefore, a complete section on safety is provided in this book. However,
information about efficacy is likely the most needed. Over the last few decades, conventional medicine has
relied increasing on highly disciplined experimental methods to arrive at the most reasonable conclusions
about effective treatments. Even with complex, large-scale, double-blind, controlled clinical trials, the goal always is both to increase our understanding of life processes and to demonstrate a difference in health outcomes. NIH-supported studies of CAM share this approach. Yet, there is also interest in developing other methods for testing effectiveness. For example, in Germany and elsewhere, efforts are being made to collect and use carefully evidence of symptomatic and clinical improvement in patients with long-term problems. Demonstrating well-documented alleviation of troublesome chronic symptoms, improved
function, and better quality of life in satisfied patients using CAM would interest both the CAM and
conventional medical communities.
In summary, CAM is being used by large numbers of people who derive benefits they have not received
from conventional medicine. NIH-sponsored research is exploring the underlying scientific mechanisms of
these approaches as well as their clinical efficacy. Medical students are being educated in the advantages
and disadvantages of CAM systems and modalities. This textbook has been crafted to serve the growing
communities of professionals who need thorough and accurate information about CAM. A majority of the
authors are MDs or PhDs who have taught in medical schools. Only time will tell how useful any new
textbook will be, but this goal is timely and the effort is to be commended.
Emotions and opinions range widely on the subject of CAM, yet at such times it is well to remember the
words of Thomas Jefferson: “We are not afraid to follow the truth wherever it may lead, nor to tolerate any error so long as reason is left free to combat it.”
Robert Marston M.D.
Director, National Institutes of Health (1968–1973)


PREFACE
The publication of a medical textbook for a new or emerging field always signals a turning point—a shift
toward greater awareness of theories, basic science research, and modes of clinical practice at the cutting edge of medicine. Essentials of Complementary and Alternative Medicine represents just such a coming of age for an important new clinical and scientific field. With this book and the forthcoming and
comprehensive Textbook of Complementary and Alternative Medicine, information is available in one place
on the social and scientific foundations of complementary and alternative medicine (CAM) and the safety
of CAM products and practices, and providing detailed overviews of most CAM systems and modalities.
The primary purpose of these books is to provide medical and health care professionals with useful and
balanced information about CAM in general and about particular CAM systems and practices. This is an
ambitious and difficult task for several reasons. For one, the CAM systems detailed here offer benefits to
patients not entirely available from mainstream medicine and not easily described in conventional terms.
Further, the unifying themes or concepts across these systems are still undifferentiated from the dominant
perception that unmet patient needs can be addressed outside of conventional medicine. In addition, CAM
is characterized by a long-term history of vigorous antagonism; differing standards of education, training, and practice; and lack of consensus as to what constitutes sufficient evidence of safety and efficacy.
Faced with these challenges, we have sought the leading experts in these diverse areas to contribute to
this textbook, and have worked with them to provide balanced information for the conventional practitioner.
This book is designed to be a companion volume to the forthcoming Textbook of Complementary and
Alternative Medicine and to serve as a clinical resource for practicing physicians and health care
professionals and for medical and health professions students and postgraduates enrolled in courses on
CAM. Although originally envisioned as a condensed version of the Textbook, it quickly became apparent
that this objective would be served better by including profiles of only the most popular complementary
therapies and by focusing the first two parts of the book on safety, patient management issues, and social
and scientific foundations of CAM. With the clinical reader clearly in mind, this book provides an entire
section detailing the safety information needed in addressing CAM products and practices. The book also
includes an Indications and Precautions Chart (IPC), which provides information-at-a-glance along with
chapter references on CAM systems or modalities most highly supported by empirical evidence and most
likely to be efficacious in the treatment of the most common conditions presented to primary care
providers.
Part I, “The Social and Scientific Foundations of Complementary and Alternative Medicine,” includes five
chapters outlining the history and utilization patterns of CAM, issues related to professional ethics and
evaluation of efficacy claims, and how to practice in an evidence-based context. Part II, “The Safety of
Complementary and Alternative Products and Practices,” includes five chapters reviewing the safety of
herbal and animal products, dietary and nutrient products, and homeopathy, as well as the adverse effects
of acupuncture and manipulative therapies. Part III, “Overviews of Complementary and Alternative
Medicine Systems,” provides thorough summary overviews of key issues such as history, principal
concepts, patient assessment and diagnostic procedures, therapeutic options and treatment evaluation,
indications and contraindications, training, quality assurance, and future prospects for 20 major systems of CAM. These include osteopathy, naturopathy, homeopathy, chiropractic medicine, traditional Chinese
medicine, biofeedback, behavioral medicine, medical acupuncture, and a dozen other systems of therapy.
It is our hope that Essentials of Complementary and Alternative Medicine will provide a useful resource for clinicians and clinicians-in-training. We also hope that this book will serve to further the integration of safe, efficacious complementary and alternative therapies into the mainstream of primary care practice.
Wayne B. Jonas M.D.
Jeffrey S. Levin Ph.D., M.P.H.