Reports

This report is based on medical evidence presented at sanctioned medical congress, from peer reviewed literature or opinion provided by a qualified healthcare practitioner. The consumption of the information contained within this report is intended for qualified Canadian healthcare practitioners only.

North American Research Conference on Complementary and Integrative Medicine

Edmonton, Alberta / May 24-27, 2006

The Consortium of Academic Health Centers for Integrative Medicine brought together experts from around the world in complementary and alternative medicine (CAM) for the North American Research Conference on Complementary and Integrative Medicine. Integrative care (IC) or integrative medicine (IM) modalities combine CAM therapies with more traditional biomedical care.

According to Dr. Marja Verhoef, Canada Research Chair in Complementary Medicine, and Professor, Department of Community Health Sciences, University of Calgary, Alberta, “The large number of people attending attests to how much CAM research has matured over the past years.” She added, “The range of topics was truly impressive and it was great to see how new, innovative, cutting-edge research was represented at the conference.”

Dr. David M. Eisenberg, Director, Division for Research and Education in Complementary and Integrative Medical Therapies, and Bernard Osher Associate Professor of Medicine, Harvard Medical School, Boston, Massachusetts, also noted the broad range of CAM and IC therapies. “This covers an enormous spectrum from basic science of specific molecules to looking at models of IC.” Dr. Eisenberg has been credited with bringing a “steady approach” to the topic of CAM therapies (Goodman W. New York Times Feb 22, 1993), and his work has helped revolutionize the IM field in a groundbreaking study that observed the widespread use of CAM therapies across the US, alerting the medical profession to the need of an integrated approach (Eisenberg et al. New Engl J Med 1993;328:246-52).

Finding New Methodologies

Many changes and benefits of CAM “whole systems” interventions are not captured in the current definitions of health outcome measures. The changes in the meaning of health and wellness for patients, such as a shift from fixing the problem to increasing health, identify the importance of taking an active role in healing and of broadening the context for healing. As one patient described the effect of CAM therapies, “I feel different; I even think I look different. This has been a very profound and wonderful experience for me.”

As an example of this trend, Dr. Eisenberg and colleagues tested a pilot study for the use of IC in an academic health centre. They undertook the study because they posited that there are few studies comparing the relative effectiveness of a multidisciplinary care approach which combines both conventional and CAM practice, i.e. IC, to the outcomes of conventional practices alone, what they term “usual care” (UC), for common medical problems.

The study involved 19 patients with subacute low back pain randomized in a 1:2 ratio to UC or UC plus CAM/IC regimens. CAM therapies included access to acupuncture specialists, chiropractors, massage therapists and neurologists, among others. Patients were treated for up to 12 weeks. The researchers found differences in pain scores (0-10 scale) and functional status measured by the Roland score (0-23 scale) was taken at baseline, two, five and 12 weeks’ post-randomization. In addition, the 13 patients in the IC group had an average of 12.2 visits (range, five to 17) and experienced a significantly greater reduction in pain scores (0.37 per week for IC vs. 0.14 per week for UC, P=0.04). Functional status was higher for IC patients when compared to UC patients (1.11 per week vs. 0.49 per week for UC, P=0.03). From these results, the researchers concluded, “It was feasible for a multidisciplinary integrative care team to deliver a co-ordinated, integrative care intervention to patients with subacute low back pain.”

Dr. Robert Graham, Division for Research and Education in Complementary and Integrative Medical Therapies, Harvard Medical School, and colleagues sought to describe CAM use among the 38 million Hispanics in the US, as well as to understand how the patterns of CAM use differ from the population at large for common medical conditions. Analyzing data from the Alternative Health Supplement to the 2002 National Health Interview Survey, the researchers found that approximately 27% of Hispanics used at least one CAM therapy (excluding prayer) over a one-year period. Most commonly used therapies included herbal medicine (17%), relaxation techniques (10%) and chiropractic services (4%), and were often used to treat back problems (13%), colds (10%) and stomach/intestinal illness (10%). When compared to Whites, Hispanic populations were more likely to use CAM therapies for stomach/intestinal illness (10% vs. 3%, P<0.001), anxiety/depression (6% vs. 4%, P<0.001) and diabetes (2% vs. 0.6%, P<0.001), respectively. The authors reported, “CAM therapies were used by one in four Hispanics in the past year, representing an estimated 10 million Hispanic adults in the US.”

A study led by researcher Ali Benhaddou-Andaloussi, Université de Montréal, Quebec, and colleagues evaluated the efficacy of Nigella sativa seeds, commonly known as black seed or black cumin, as used in the pharmacopeia of North African and Middle Eastern traditions for diabetes therapy. Despite its widespread use, the seed’s cellular mechanisms of action are not well understood. Western blot immunoassays of insulin signal transduction pathways revealed that N. sativa increases activation of insulin-independent pathways in both muscle and fat cells, leading the researchers to conclude that N. sativa mimics and enhances the action of insulin in muscle and fat cells. In addition, they posited that the effect of N. sativa on adipogenesis suggested that it could affect the gene expression that regulates insulin sensitivity.

IM acquires its knowledge base from the broad range of therapies used across the globe and in diverse communities. Dr. Steven Aung, Associate Clinical Professor of Medicine and Family Medicine, University of Alberta, Edmonton, emphasized, “No single medicine is perfect. We have to talk about more than healing: we have to talk about harmonizing with the environment.”

Building Networks

Dr. Sunita Vohra, Advisory Board, the Interdisciplinary Network for CAM Research (InCAM), and Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, commented, “To have 650 people from 29 countries is remarkable. I think it really speaks to the importance of these issues.” Added Dr. Heather Boon, Co-Director, InCAM, and Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, concurred, “Each time we’ve seen more people, more countries represented and a lot more high-quality rigorous research.”

The conference brought together members from many CAM networks across North America. The Canadian Health Network (CHN), the national, bilingual Web-based health information service, comprises a network of health information providers, including the Public Health Agency of Canada, Health Canada, as well as universities, hospitals, libraries and community organizations. The National Center for Complementary and Alternative Medicine (NCCAM), a branch of the National Institutes of Health (NIH) in the US, also participated.

Stated Dr. Alan Bensoussan, Director, Centre for Complementary Medicine Research, and Head, Chinese Medicine Unit, University of Western Sydney, Penrith South, New South Wales, Australia, “Health Canada has [shown its support] in contributing to this conference, and that, to me, is a very special signal.”

Some of the other large CAM networks across Canada included InCAM; PedCAM, the pediatric CAM network; and CAMera, the CAM Education and Research Network of Alberta. InCAM’s major activities consist of building research capacity, developing research priorities and a research agenda, promoting knowledge transfer and linking with relevant networks. PedCAM seeks to foster collaboration and advance the safe and effective use of CAM therapies in children and youth. The CAMera Network sponsors workshops, education and training for those interested in conducting research into CAM therapies.

Dr. Pierre S. Haddad, Professor, Department of Pharmacology, Université de Montréal, indicated, “We have a new Natural Health Products [NHP] research society in Canada,” adding that some of the initiatives are also supported by the Canadian Institutes of Health Research.

Expanding Therapeutic Options

Among the biggest causes of disease in North America can be attributed to the deleterious effects of smoking. Dr. Hilary Tindle, Division of General Medicine, University of Pittsburgh Medical Center, Pennsylvania, and colleagues evaluated the efficacy of guided imagery in a smoking cessation program. Guided imagery includes visualization and other techniques that help lead patients to a desired outcome. The study recruited 34 smokers not using pharmacotherapy to one of two arms: to undergo guided imagery using a weekly instructional group session for six weeks and a CD-ROM-based home program; or to be wait-listed to a control (CTL) group. The primary end point was cotinine-validated seven-day point prevalence tobacco abstinence assessed at six weeks, 12 weeks and one year. The results, while not statistically significant, showed that verified seven-day abstinence rates were higher in the intervention (INT) group when compared to the CTL group (36% vs. 18%, P=0.43). Abstinence rates in the INT vs. CTL groups were 30% vs. 12% (P=0.40) at 12 weeks and 24% vs. 6% (P=0.34) at one year. Based upon their findings, the authors concluded, “A guided imagery program for smoking cessation was feasible and may improve factors integral to the cessation process,” thereby offering a non-pharmacologic alternative for smoking cessation.

A study presented by Shelly Vik, Department of Community Health Sciences, University of Calgary, and colleagues explored the prevalence of selected potential drug-herb interactions among patients with osteoporosis. The study sampled patients participating in the Canadian Multicentre Osteoporosis Study (CaMos), designed to evaluate the characteristics of osteoporosis in Canada. The researchers examined the incidence of potentially dangerous drug-herb combinations based upon those reported in the literature. Among the incidence of potentially harmful events, researchers found that only 14 out of 1,069 patients (1.3%) were using at least one contraindicated drug-herb combination and that 13 out of 514 patients (2.5%) on cardiovascular medications were concomitantly using a contraindicated herb. The authors reported, “We found a relatively low rate of potential drug-herb interactions, most of which were among subjects using specific cardiovascular medications.”

Regarding young patients, Dr. Sunita Vohra, Director, Complementary and Alternative Research and Education (CARE) Program, Department of Pediatrics, University of Alberta, and her team assessed the knowledge, attitudes and behaviour of osteopaths, naturopaths and chiropractors with reference to pediatric patients in their practice. Using surveys for osteopathy, naturopathy, chiropractice, pediatrics and survey methodology, the researchers examined provider demographics, practice patterns, knowledge, attitudes to common pediatric issues and behaviour towards children. In addition, each respondent was also asked to comment on how they might manage three case scenarios of common pediatric conditions. Their results demonstrated that out of a total of 488 respondents (osteopaths, naturopaths, chiropractors), most respondents identified one semester or less of formal pediatric education and many had attended additional pediatric courses or seminars. Almost all practitioners treated children of all ages (newborn through to adolescence), albeit infrequently (less than 10 pediatric patients per week). The researchers indicated, “Since nearly all providers see children in their practice, it is important for pediatric institutions to work with CAM colleges to ensure important issues in pediatric health care are covered during their curriculum.”

Another study by Dr. Hakima Amri, Assistant Professor, Department of Physiology and Biophysics, Georgetown University School of Medicine, Washington, DC, and colleagues investigated the effects of homeopathic preparations of saw palmetto (Sabal serrulata) on human prostate cancer cell lines. Some urologists rely upon the compound as a complementary treatment for the symptoms of benign prostatic hyperplasia, given that homeopaths have advocated saw palmetto’s role in the treatment of prostate disorders ranging from hyperplasia to cancer. The researchers made use of methodology tailored to evaluate the efficacy of homeopathic methods. Pharmacological and homeopathic dilutions of saw palmetto were administered to the androgen receptor-negative prostate cancer lines (DU-145 and PC-3), as well as the androgen receptor-positive prostate cancer line (LNCaP). A 1:100 dilution of mother tincture, referred to as 1C, was used as the pharmacological dose; the homeopathic doses were the centesimal dilutions 100C, 200C and 300C. The cells were grown in 96-well plates, treated three times at four-hour intervals for one day and allowed to recover for three days prior to biochemical testing. Controls included human brain tumour cell lines. Their results demonstrated that while the 1C pharmacologic dose caused cytotoxicity, the homeopathic treatments of the DU-145 and PC-3 prostate cancer cell lines reduced cell proliferation without affecting cell viability. The researchers observed, “Saw palmetto used at homeopathic dilutions decreased androgen receptor-negative human prostate cancer cell proliferation.”

Future Directions

Dr. Eisenberg challenged delegates to take the CAM therapies and their research work to the next level. Expressing his pleasure to delegates for their conference, he also referred to the clinical and research implications of CAM and IC therapies. He noted that there might be a need for additional, more focused discussions about the practice of CAM therapies, and that future conferences might wish to focus exclusively on “the process, the outcomes and the financial stability obstacles and solutions,” he offered.

The future of healthcare may likely be multimodal, with patients increasingly taking charge of their own healthcare and choosing from a variety of biomedical and CAM therapies. Dr. Aung stressed, “Therapists have to be walking hand-in-hand with patients towards the goal of well-being, and this is our next century medicine.” Concurred Dr. Boon, “We all want the same thing: we all want patients to get better.”