Alternative Medicine. A news report about concerns with a dietary alternative medicine practices such as. pharmacological and biological preparations …
Complementary and Alternative Medicine
On the Fringe or Cutting Edge?
Barbara Lohse Knous, PhD, RD, LD Kansas State University A news report about concerns with a dietary supplement catches your attention Two months ago in an effort to lose weight you started taking this dietary supplement recommended by your friend Over the last week youve felt some nausea and abdominal pain Perhaps its the flu Is it possible that your symptoms are due to this dietary supplement? Having lost 12 pounds, you want to keep using it, but are uncertain if you should The increased use of complementary and alternative medicine CAM has made this a common dilemma for consumers Why the dilemma? What can you do to be safe yet not miss out on a potentially helpful practice? This publication seeks to encourage critical thinking about CAM and help you answer these tough questions Complementary and Alternative Medicine, or CAM for short, has been defined as treatments and health care practices not taught widely in
medical schools, not generally used in hospitals, and not usually reimbursed by medical insurance companies Therapies are diverse and include mind-body interventions, energy therapies eg, bioelectromagnets alternative medical systems eg, folk medicine, Ayurveda, Homeopathy, Traditional Chinese Medicine, manipulative and bodybased methods, and complementary and alternative medicine practices such as pharmacological and biological preparations eg, Sharks Cartilage, herbs, nutrient supplements and special diets Using these practices in place of traditional medicine is termed alternative; use in addition to or as part of a traditional treatment is termed 1 complementary or integrative medicine
Kansas State University Agricultural Experiment Station and Cooperative Extension Service
Complementary and alternative medicine users include men and women of all ages, from varied incomes, education and ethnic backgrounds Contrary to popular belief, users are not against science, disillusioned
with medicine, motivated by lower cost, or driven by unusual attitudes Alternative therapies appeal to those who value the environment, feminism, spirituality and personal growth2,3 CAM users may be your friends, family, or you In fact, CAM use is big business In 1997, 42 percent of Americans used these therapies and spent 27 billion dollars4 In a recent national survey, 16 percent of prescription drug users also took herbal or dietary supplements5 Safety concerns, extensive CAM practice, mixed reports of benefits, serious side effects, and risk from interactions with prescription medications prompted the National Center for Complementary and Alternative Medicine NCCAM to promote and fund research on several CAM practices Consumers unwittingly accept that the traditional, natural or holistic aspect of these therapies imply safety,6 and labels with structure or function claims suggest effectiveness For example, a label claiming that Ginkgo helps increase blood circulation to the brain
may be incorrectly interpreted to mean that scientific research has shown memory and cognition improvement with Ginkgo use National Center for Complementary and Alternative Medicine Phone: 1-888-644-6226 E-mail: info@nccamnihgov Web site: nccamnihgov
Confusion over safety stems from the Dietary Supplement and Health Education Act DSHEA of 1994, which addresses labeling, manufacturing, marketing, and administration of dietary supplements Unlike pharmaceutical medications that must be rigorously tested before marketing, this act does not require dietary supplements to be shown safe or effective before they are marketed This act also broadened the definition of a dietary supplement, making more products subject 7 to less scrutiny The FDA can restrict or recall a supplement only after the FDA has proven that the product is unsafe; a process that may require considerable time and money Consider label claims when evaluating CAM products For example, calcium fortified soft drinks cannot
claim to help osteoporosis if they do not naturally contain specific levels of either vitamin A, vitamin C, iron, protein, or fiber
Why use CAM? These practices may be effective, economical, convenient, and less invasive with fewer side effects than conventional approaches A holistic approach to health care encourages a preventive approach with self-responsibility for health decisions and well-being Sound Information Sources The HealthCare Reality Check Encyclopedia wwwhcrcorg/faqs/claimshtml Consumer Labs wwwconsumerlabscom/ Tips for the Savvy Supplement User wwwcfsanfdagov/dms/ds-savvyhtml Supplement Watch wwwsupplementwatchcom More sources are in the Leaders Guide or at: wwwoznetksuedu/humannutrition/CAMhtm
Approved Health Claims for Nutrients and Disease 8
calcium and osteoporosis sodium or potassium and hypertension dietary fat and cancer dietary saturated fat and cholesterol and risk of coronary heart disease dietary fiber, plant sterols or soy protein and cancer or
coronary heart disease fruits or vegetables and cancer folate and neural tube defects sugar and dental caries whole grains and cancer or heart disease
If you use or are planning to use CAM therapies: Keep your doctor and health care providers informed to avoid drug interactions For example, St Johns Wort may reduce the effectiveness of prescription medications, including birth control pills Some products increase bleeding risk and should be discontinued three weeks prior to surgery Precautions are especially important for infants and children, or if you are pregnant, trying to conceive, or breast-feeding You and/or your health care provider will want to report side effects to the FDA, 1-800-FDA-1088 or wwwfdagov/medwatch/howhtm Remember your food intake is important CAM therapies are not intended to replace a healthy diet or lifestyle, only to supplement them Eating a variety of foods in moderation, getting regular exercise and sleep are important with or without these
treatments
Look at a supplement label Is there a health claim? A structure/function claim?
2
Refrain from experimenting with the latest craze Be skeptical about products and claims Remember, if it sounds too good to be true, it probably is Information from persons with no formal training in health and nutrition or from Web sites that sell supplements may be questionable Dont assume that a product will be safe to use, even if there are no precautions on the label Many products can be harmful especially if consumed in large amounts over a long time It cant hurt to try it, may be a serious mistake in judgment CAM Scenarios
Products with several extra ingredients may be costly and lead you to take more supplements than planned Use Web site information with caution9 Be wary of Web sites that focus on sales rather than education Sound Web sites clearly denote authorship, scientific findings, references, posting or renewal dates and a point of contact Avoid Web sites with highly
emotional writing that attempts to manipulate10 NCCAM lists 10 Things to Know about Evaluating Medical Resources on the Web at: nccamnihgov/health/webresources/
Before you start your study, review the Action Report form Select one or more scenarios to study Using materials supplied by your leader, study and discuss the scenario, then decide on the best way this person should approach the situation Complete the Action Report as a group Tear or cut the page as shown and return the top half to the leader
A Carla is a 30-year-old woman, breast-feeding her 3-month-old son Since the birth of the baby, she has been feeling depressed She has decided to start taking St Johns Wort, an herbal supplement to help her feel better
B Nate, a 42-year-old male with a striking family history of cancer, has decided to start taking Shark Cartilage to prevent him from getting this dreaded disease C Carl, a 68-year-old male, plans to start Coenzyme Q10 to help his heart He is recuperating from a heart
attack Current medications include Atenolol for high blood pressure D Nancy is considering acupuncture treatment of her 3-year-old childs ear infections that are resistant to antibiotic therapy E Margaret is 70 years old and plans to continue her regimen of Ginkgo, Kava and vitamin B12 to ward off senility, memory loss and anxiety
Critical Thinking Decisions to use complementary and alternative medical and nutrition therapies require critical thinking Critical thinking has been defined as reasonable and reflective thinking that is focused upon deciding what to believe or do To think critically, four skills are essential The ability to 1 develop a large knowledge base, 2 evaluate this knowledge base using reason and analysis, 3 think about and evaluate our own thinking skills and abilities, 4 adopt a critical attitude/spirit and practice using a disposition toward critical thinking The following critical thinking dispositions are key to making sound CAM choices: 11
Seek reasons Try
to be well informed Use credible resources and mention sources of information Take into account the total situation Look for alternatives Be open minded, seriously considering other points of view than ones own, withholding judgment until evidence and reasons are sufficient Take a position and change a position when evidence and reasons are sufficient Seek as much precision as the subject permits Deal in an orderly manner with the parts of a complex whole Be sensitive to the feelings, level of knowledge, and degree of sophistication of others Which critical thinking dispositions do you use?
3
Action Report
County
Group Leaders Other Dont Use it Other
Date
Scenario Studied: circle A B C D E all info sources used: Web sites Handouts Books Group members ______ Product labels What should the person in the scenario do? Use the treatment No Decision Identify what you learned from this lesson
What are some things you need to study further?
What critical thinking disposition
or ability did you use to address this scenario? Comments:
Scenario Studied: circle A B C D E all info sources used: Web sites Handouts Books Group members ______ Product labels What should the person in the scenario do? Use the treatment No Decision Identify what you learned from this lesson Other
Leaders Other Dont Use it
What are some things you need to study further? What critical thinking disposition or ability did you use to address this scenario? Comments:
Return section above this line to: Barbara Lohse Knous, 203 Justin Hall, Manhattan, KS 66506
1 wwwnccamnihgov/health/whatiscam/ National Center for Complementary and Alternative Medicine Accessed July 17, 2002 2 Vincent, C British Journal of Clinical Psychology 1996;35:37-48 3 Astin, JA JAMA 1998;279:1548-1553 4 Eisenberg, DM, Davis, RB, Ettner, SL, et al JAMA 1998;280:1569-1575 5 Kaufman, DW, Kelly, JP, and Rosenberg, L, et al JAMA 2002;287:337-344 6 Straus, SE Academic Medicine 2000; 756:572-573 7 DSHEA of 1994, Public
Law 103-417 103rd Congress wwwfdagov/opacom/laws/dsheahtml 8 American Dietetic Assoc American Pharmaceutical AssocA Healthcare Professionals Guide to Evaluating Dietary Supplements Chicago, IL:ADA; 2000 9 Veronin, MA, Ramirez, G American Journ Health Promot 2000:15:21-28 10 Kapica, C Nutrition in Complementary Care Newsletter 1998; 1:11 11 Norris, SP and Ennis, RH Evaluating Critical Thinking Pacific Grove, CA: Midwest Publications; 1989
Thank you to the following reviewers: Sarah Harding Laidlaw, MS, RD, MPA Debra Robison, RPh Adrienne Moore Baxter, MS, RD, LD
Brand names appearing in this publication are for product identification purposes only No endorsement is intended, nor is criticism implied of similar products not mentioned Publications from Kansas State University are available on the World Wide Web at: http://wwwoznetksuedu Publications from Kansas State University may be freely reproduced for educational purposes All other rights reserved In either case, credit Barbara
Lohse Knous, PhD,RD, LD Complementary and Alternative Medicine, September 2002
Kansas State University Agricultural Experiment Station and Cooperative Extension Service , Manhattan, Kansas MF-2558 SEPTEMBER 2002 It is the policy of Kansas State University Agricultural Experiment Station and Cooperative Extension Service that all persons shall have equal opportunity and access to its educational programs, services, activities, and materials without regard to race, color, religion, national origin, sex, age, or disability Kansas State University is an equal opportunity organization These materials may be available in alternative formats Issued in furtherance of Cooperative Extension Work, Acts of May 8 and June 30, 1914, as amended Kansas State University, County Extension Councils, Extension Districts, and United States Department of Agriculture Cooperating, Marc A Johnson, Director
4
