1. Finding Quality Online Information about Complementary and Alternative Medicine (CAM) National Network of Libraries of Medicine New England Region

2. The headlines….

3. With the constant flux of new information on CAM… 1) How can we find information that is evidence based? 2) What are the top consumer health and clinical resources to find quality information about CAM? 3) How can we help our patrons evaluate CAM information?

4. Agenda Definitions History and Impact Usage and Therapies Evaluating Web Sites Avoiding Bad Science Recommended Websites Reviewing the Evidence

5. How do you get rid of a wart? raw meat banana peel potato witch hazel duct tape silk thread alfalfa pills apple cider toothpaste castor oil quarters windex dandelion juice cigarette ashes garlic pills cabbage orange peel nail polish iodine aloe c e

6. What is CAM? Complementary and Alternative Medicine Complementary: together with –aromatherapy to help with pain after surgery Alternative: in place of –using garlic to lower blood pressure

7. CAM becomes “legit” 1990 –Wilk et al v. AMA 1991 –$2 million in funding to establish NIH Office of Alternative Medicine 1994 –Dietary Supplement Health and Education Act

8. CAM becomes “legit” 1995 –NIH Office of Dietary Supplements http://ods.od.nih.gov/ http://ods.od.nih.gov/ –FDA declassifies Acupuncture needles as experimental product 1996 –NIH Consensus Conference on Acupuncture 1997 –First large trial of CAM therapy, St. John’s Wort for depression

9. CAM becomes “legit” 1998 –National Center for Complementary & Alternative Medicine (NCCAM) established http://nccam.nih.gov/ http://nccam.nih.gov/ –First full scale article in JAMA on herbal medicine –Office of Cancer Complementary and Alternative Medicine (OCCAM) established http://www.cancer.gov/cam/ http://www.cancer.gov/cam/ 2001 –CAM on PubMed (NCCAM and NLM)

10. Impact of CAM CDC Report (2004) –36% of adults used some form of CAM –55% CAM + conventional treatments –26% used CAM because a medical professional suggested it –$36-47 billion on CAM therapies in 1997 –$5 billion on herbal remedies JAMA (1998) –12.1% of population use herbal medicine

11. Impact of CAM According to the National Health Statistics Report of the CDC, in 2007: 4 out of 10 adults used a CAM therapy in the last 12 months 1 out of 9 children used CAM therapies in the last 12 months Between 2002 and 2007 increased use was seen among adults for acupuncture, deep breathing, massage therapy, meditation, naturopathy, and yoga

12. Diseases and Conditions 2002 1.Back pain or problem 2.Head or chest cold 3.Neck pain or problem 4.Joint pain or stiffness 5.Anxiety/depression 6.Arthritis, gout, lupus or fibromyalgia 7.Stomach or intestinal illness 8.Severe headache or migraine *Barnes PM,et al. Complementary and alternative medicine use among adults: United States 2002; CDC

13. Diseases and Condition 2007 1.Back pain 2.Neck pain 3.Joint pain or stiffness 4.Arthritis 5.Other, specify 6.Anxiety 7.Cholesterol 8.Head or Chest Cold

14. Top 5 CAM Therapies 2002 1.Natural products, dietary supplements 2.Deep breathing exercises 3.Meditation 4.Chiropractic 5.Yoga *Barnes PM,et al. Complementary and alternative medicine use among adults: United States 2002; CDC Top 5 CAM Therapies 2007: Same as 2002

15. Top 10 Supplements 2002 1.Echinacea 2.Ginseng 3.Ginkgo biloba 4.Garlic 5.Glucosamine 6.St. John’s Wort 7.Peppermint 8.Fish oil/Omega 3 9.Ginger 10.Soy *Barnes PM,et al. Complementary and alternative medicine use among adults: United States 2002; CDC Top supplement for 2007?

16. Top 10 Supplements 2007 1.Fish Oil or Omega 3 or DHA 2.Glucosamine 3.Echinacea 4.Flaxseed oil or pills 5.Ginseng 6. Combination herb pill 7. Ginkgo biloba 8. Chondrotin 9.Garlic Supplements 10.Coenzyme Q-10

17. Categorization of Therapies* Whole Medical Systems Biologically Based Practices Energy Medicine Manipulative and Body-Based Practices Mind-Body Medicine *National Center of Complementary and Alternative Therapy

18. Whole Medical Systems Complete systems of theory and practice that evolved independently Traditional systems of medicine that are practiced by individual cultures throughout the world –Includes traditional Chinese medicine, Ayurvedic medicine, homeopathy, naturopathy *National Center of Complementary and Alternative Therapy

19. Biologically Based Practices Includes: botanicals, animal-derived extracts, vitamins, minerals, fatty acids, amino acids, proteins, whole diets, and functional foods –Dietary supplements are a subset of biologically based practices *National Center of Complementary and Alternative Therapy

20. Biologically Based - Supplements What is a supplement? Regulated by FDA http://www.fda.govhttp://www.fda.gov –no requirements for FDA testing –manufacturers responsible for ensuring product safety –label requirements –safety alerts: http://www.cfsan.fda.gov/~dms/ds-warn.html http://www.cfsan.fda.gov/~dms/ds-warn.html

21. Energy Medicine Biofield therapies: qi gong, Reiki, Therapeutic touch, Bioenergetics Bioelectricmagnetic based therapies: Electromagnetic fields, magnetic fields *National Center of Complementary and Alternative Therapy

22. Manipulative and Body-Based Structures and systems of the body, including the bones and joints, the soft tissues, and the circulatory and lymphatic systems. Includes:  chiropractic manipulation  massage therapy  reflexology  Alexander technique  Feldenkrais method *National Center of Complementary and Alternative Therapy

23. Mind-Body Medicine Interactions among the brain, mind, body, and behavior The ways in which emotional, mental, social, spiritual, and behavioral factors can directly affect health. Includes: –relaxation –hypnosis –visual imagery –meditation – yoga –biofeedback –tai chi –group support and –spirituality *National Center of Complementary and Alternative Therapy

24. Other CAM Therapies Aromatherapy Colonic Irrigation Therapeutic Touch EDTA Chelation Cupping Primordial Sound Meditation

25. Avoiding Bad Science The “One Product Does It All” claim http://www.emuoilcanada.com/ Personal Testimonials http://www.getslimslippers.com/ http://www.getslimslippers.com/ Quick Fixes/Cures http://www.cure-your-asthma.com The “No Risk Money Back Guarantee” http://www.naturalhpvcure.com/ http://www.naturalhpvcure.com/ The “Natural” claim http://www.amtrueman.com/products.html

26. Evaluating Web Sites Accuracy Authority Bias Currency Coverage User Friendliness

27. Examining the Research Observational Studies Clinical Trials/Studies –controlled –blind/double-blind –randomized ClinicalTrials.gov –Government and private clinical studies involving humans –http://clinicaltrials.govhttp://clinicaltrials.gov

28. Clinical Trials and CAM Why are there so few CAM clinical trials? –Drug companies have to do studies to go on the market—supplement companies do not, so clinical trials sponsored by supplement companies are rare –Alternative treatments are often customized for a specific person. Clinical trials try to prove something works for most people. –Belief systems of some CAM practitioners do not agree with the idea of Western studies, so they do not participate –CAM has only recently become “legit” in the scientific community

29. National Center for Complementary and Alternative Medicine (NCCAM) http://nccam.nih.gov

30. MedlinePlus.gov

31. http://www.mskcc.org/mskcc/html/11570.cfm

32. http://nccam.nih.gov/research/camonpubmed/

33. http://dietarysupplements.nlm.nih.gov

34. http://www.cancer.gov/CAM/

35. http://www.noah-health.org/en/alternative/index.html

36. http://amfoundation.org

37. Questions???

38. Take home points Learn more about commonly used CAM to help you better serve your library users Familiarize yourself with quality online resources for CAM Be a “selective searcher”…evaluate online CAM information carefully

39. Thank You! Michelle Eberle Consumer Health Information Coordinator michelle.eberle@umassmed.edu National Network of Libraries of Medicine New England Region 800-338-7657