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Week of November 11, 1998
American Medical Association Science News Updates are made available to the public after 3 p.m. Central time (U.S.) on the first four Tuesdays of each
month. We also provide a list of previous news releases.
THIS WEEK'S CONTENTS
JAMA REPORTS: ALTERNATIVE MEDICINE THEME ISSUE
ARCHIVES REPORT (Alternative Medicine Articles)
SPECIAL RELEASE
WASHINGTON, D.C.— Four out of 10 Americans used alternative medicine
therapies in 1997; total visits to alternative medicine practitioners increased
by almost 50 percent from 1990 and exceeded the visits to all U.S. primary care
physicians. Americans paid an estimated $21.2 billion for services provided by
alternative medicine practitioners, according to an article in the November 11
issue of The Journal of the American Medical Association (JAMA), a theme
issue on alternative medicine.
David M. Eisenberg, M.D., of Beth Israel Deaconess Medical Center in Boston,
and colleagues surveyed 2,055 adults by telephone in 1997 to study trends in
alternative medicine use in the United States. They compared the 1997 data with
results from their similar 1990 telephone survey of 1,539 adults. Dr. Eisenberg
presented the findings of the study at an American Medical Association media
briefing on alternative medicine here today.
The study reports that between 1990 and 1997, the prevalence of alternative
medicine increased by 25 percent, with the total number of visits increasing by
47 percent from an estimated 427 million in 1990 to 629 million in 1997 -
exceeding total visits to all primary care physicians in the United States (386
million in 1997). During this same period, expenditures for alternative
medicine professional services increased by 45 percent. Expenses for these
services, conservatively estimated at $21.2 billion, $12.2 billion of which were
out-of-pocket, exceeded out-of-pocket expenses for all hospitalizations in 1997.
The researchers surveyed adults on the use of 16 alternative therapies,
which included relaxation techniques, herbal medicine, massage, chiropractic,
spiritual healing by others, megavitamins, self-help, imagery, commercial diet,
folk, lifestyle diet, energy healing, homeopathy, hypnosis, biofeedback and
acupuncture.
They report that in both the 1990 and 1997 surveys, alternative medicine was
used most frequently for chronic conditions, including back and neck problems,
anxiety, arthritis and headaches. The use of at least one of 16 alternative
therapies increased from 33.8 percent in 1990 to 42.1 percent in 1997. The
therapies that saw the largest increase in usage included herbal medicine,
massage, megavitamins, self-help groups, folk remedies, energy healing and
homeopathy.
Despite the dramatic increase, the researchers point out that the extent to
which patients disclose their use of alternative therapies to their physicians
remains low (less than 40 percent in both 1990 and 1997), a cause for some
concern because an estimated 15 million Americans in 1997 took prescription
medications and herbal remedies concurrently. With one in five people who take
prescription medications also taking herbs, high-dose vitamin supplements, or
both, the researchers report that millions of adults may be at risk for
potential, unintended interactions involving prescription medications and herbs
or high-dose vitamins.
"The market for alternative medicine is vast and growing," Dr.
Eisenberg said in a separate interview. "This trend must be guided by
scientific inquiry, clinical judgment, regulatory authority and shared
decision-making. The 'don't ask and don't tell' approach to communication in
this area must be abandoned."
Use of alternative therapies was significantly more common among women (48.9
percent) than men (37.8 percent) and less common among African Americans (33.1
percent) than other racial groups (44.5 percent). People aged 35 to 49 years
reported higher rates of use (50.1 percent) than people either older (39.1
percent) or younger (41.8 percent) Use was higher among college-educated people
(50.6 percent than people with no college education (36.4 percent), and more
common among people with annual incomes above $50,000 (48.1 percent) than with
lower incomes (42.6 percent). Use also was higher in the West (50.1 percent)
than elsewhere in the United States (42.1 percent).
The total out-of-pocket expenditures for alternative therapies in 1997,
including professional services, herbal products, vitamins, diet products, books
and classes, were conservatively estimated to be $27 billion.
Because the demand for alternative therapies depends on how much patients
must pay out-of-pocket, current use is likely to underrepresent utilization
patterns if insurance coverage for alternative medicine increases in the future.
Researchers also found that 42 percent of all alternative therapy use is
attributed to the treatment of existing illness, while 58 percent is attributed
to prevention of illness and/or health maintenance.
Data from this survey, reflective of the U.S. population, are representative
of a predominantly white population, according to the researchers. The authors
note that parallel surveys modified to include therapies unique to minority
populations and translated when appropriate should be conducted using necessary
sampling strategies. The authors write: "As alternative medicine is
introduced by third-party payers as an attractive insurance product, it would be
unfair for individuals without health insurance and those with less expendable
income to be excluded from useful alternative medical services or consultation
(e.g., professional advice on use or avoidance of alternative therapies)."
Alternative medicine, functionally defined in the study as interventions
that are neither taught widely in medical schools nor generally available in
U.S. hospitals, have garnered increasing attention from the media, the medical
community, government agencies and the public in recent years. Surveys and
public opinion polls conducted since 1990 have confirmed the extensive use of
alternative therapies in the United States.
As a result, an increasing number of U.S. insurance companies and managed
care organizations now offer some alternative medicine programs and benefits,
and the majority of U.S. medical schools now offer courses in alternative
therapies.
The authors conclude: "In light of these observations, we suggest that
federal agencies, private corporations, foundations and academic institutions
adopt a more proactive posture concerning the implementation of clinical and
basic science research, the development of relevant educational curricula,
credentialing and referral guidelines, improved quality control of dietary
supplements, and the establishment of postmarket surveillance of drug-herb (and
drug-supplement) interactions."
Read the abstract or full text of the article.
(JAMA. 1998;280:1569-1575)
Note: This study was supported in part by the National Institutes
of Health, the John E. Fetzer Institute, the American Society of Actuaries, the
Friends of Beth Israel Deaconess Medical Center, the Kenneth J. Germeshausen
Foundation and the JE and ZB Butler Foundation. Read the
JAMA Patient Page
regarding this article.
Go back to the top.
WASHINGTON, D.C.—A traditional Chinese medical practice which involves
the burning of herbs to stimulate acupuncture points (moxibustion) is found to
be effective in stimulating fetal movement and in correcting breech
presentation, according to an article in the November 11 issue of The
Journal of the American Medical Association (JAMA), a theme issue on
alternative medicine.
Francesco Cardini, M.D., a private practice physician in Verona, Italy, and
Huang Weixin, M.D., of the Jiangxi Women's Hospital in Nanchang, China, found
that 75 percent of fetuses in the group treated with moxibustion changed their
position to the correct "head-first" position compared to 48 percent
of the fetuses in the control group. Dr. Cardini presented the findings of this
study here today at an American Medical Association media briefing on
alternative medicine.
The researchers conducted the study to evaluate the efficacy of moxibustion
to increase fetal activity and correct breech position. According to the
authors: "Among primigravidas [women who are pregnant for the first time]
with breech presentation during the 33rd week of gestation, moxibustion for one
to two weeks increased fetal activity during the treatment period and cephalic
[head first] presentation after the treatment period and at delivery."
The researchers found that there was more fetal activity on average for
fetuses in the treatment group. The average fetal movement reported for a
one-hour period for seven days was 48.4 for the treatment group compared to 35.4
for the control group. The researchers state: "The mechanism of action of
moxibustion appears to be increased active fetal movements, which proved
significantly stronger in the treated subjects." Although studies in China
have investigated the neurologic effects of moxibustion therapy, the mechanism
of action of moxibustion is still not entirely clear.
All 260 study participants from the outpatient department of two hospitals
in Jiangxi Province, China, were pregnant for the first time and in the 33rd
week of pregnancy. All participants had fetuses in the breech position, which
was determined by ultrasound. The researchers prescribed moxibustion to
stimulate an acupuncture point located on the pregnant woman's foot (located
beside the outer corner of the fifth toenail). The therapy was performed on
each foot for 15 minutes daily for 7 days in the first 87 participants and twice
daily in the last 43 participants. The control group received routine care but
no moxibustion treatment.
The first moxibustion treatment was in the hospital and after that the
treatments took place in the home. If the fetus was not in the head-first
position after the first week, a second week of the moxibustion treatment
followed. Study participants whose fetuses continued to be in the breech
position after two weeks (in either the treatment or control group) could choose
external cephalic version (ECV) to correct the fetus's position. ECV is an
attempt to change the fetus's position by placing the hands on the abdomen to
slowly and firmly turn the fetus into the cephalic position.
Moxibustion is the use of heat generated by burning herbal preparations
containing Artemisia vulgaris (the Japanese name is moxa), rather than needles,
to stimulate acupuncture points. Moxibustion is a popular treatment for breech
position in China. As the researchers note: "Moxibustion in the early
third trimester and ECV in late pregnancy are the standard care for breech
presentation in both the centers involved in the trial." According to the
researchers, this is the first randomized controlled clinical trial to evaluate
the efficacy of this therapy for correcting breech position.
Breech occurs when the fetus is in a position other than the head-first
position, usually with the buttocks, legs or feet emerging first for delivery.
Breech position at the time of delivery is associated with complications and
risks including physical injury for both the mother and the fetus or newborn.
The complications of a breech birth are usually diminished by a cesarean
delivery.
According to the authors: "If the results of this trial are confirmed,
moxibustion should be extensively used on account of its noninvasiveness, low
cost and ease of execution. In fact, it is easy to train expectant mothers
(either alone or with their partners) to administer the therapy at home."
(JAMA.
1998;280:1580-1584)
Note: The research performed in China was financed by Centro di
Orientamento Educativo in Milan, Italy, and by the Commission des Communautées
Européennes, Brussels in Belgium.
Go back to the top.
WASHINGTON, D.C.—A widely used herbal compound failed to produce
significant weight loss and fat mass loss beyond that observed with placebo in a
study among overweight men and women, according to an article in the November 11
issue of The Journal of the American Medical Association (JAMA), a theme
issue on alternative medicine.
Steven B. Heymsfield, M.D., and colleagues from the Obesity Research Center
of St. Luke's-Roosevelt Hospital in New York conducted a randomized,
double-blind, placebo-controlled study to find out if the herbal compound
Garcinia cambogia would produce a greater reduction in body weight and total
body fat mass than placebo. The use of herbal weight loss products is a rapidly
growing therapeutic area, and one widely embraced by the general public. Dr.
Heymsfield presented the findings here today at an American Medical Association
media briefing on alternative medicine.
The authors write: "The present study, carried out during a 12-week
evaluation period and using accepted experimental design and in vivo analytic
methods, failed to support the hypothesis that hydroxycitric acid [the active
ingredient in G cambogia] as prescribed promotes either additional weight or fat
mass loss beyond that observed with placebo. Specifically, body weight and fat
mass change during the 12-week study period did not differ significantly between
placebo and treatment groups."
According to the authors, at least 14 separate products containing
hydroxycitric acid are currently sold over-the-counter to consumers, even though
before this study the effectiveness of hydroxycitric acid was unclear.
The researchers enlisted 135 overweight, but otherwise healthy, men and
women, aged 18 to 65. After an evaluation that included a physical examination,
electrocardiogram and screening blood studies, 66 subjects were randomized to
receive a total of 1,500 milligrams daily of hydroxycitric acid taken in caplet
form 30 minutes before meals. The other 69 study participants followed the same
protocol, but the active compound was replaced with a placebo. Both groups were
prescribed a high-fiber, low-energy diet, and were asked to maintain a stable
physical activity level.
Forty-two patients taking hydroxycitric acid and 42 from the placebo group
completed 12 weeks of treatment. Their body weight was evaluated every other
week, and fat mass was measured at the beginning and end of the treatment
period. The researchers found that patients in both groups lost a significant
amount of weight. There were no significant differences between the two groups
in weight loss or the estimated percentage of body fat loss. The estimated mean
weight loss for the placebo group was nine pounds (4.1 kg) and for the treatment
group was seven pounds (3.2 kg).
Hydroxycitric acid is obtained from plants native to India. Investigators
have demonstrated that the effects of hydroxycitric acid on animals include the
suppression of food intake and decreasing body weight gain. Previous studies in
humans have been limited, and results have been contradictory.
The authors conclude: "Our findings, obtained in a prospective,
randomized, double-blind study, failed to detect either weight loss or
fat-mobilizing effects of hydroxycitric acid beyond those of placebo. These
observations, the first, to our knowledge, to appear in a peer-reviewed article
using currently accepted experimental and statistical methods, do not support a
role as currently prescribed for the widely used herb G cambogia as a
facilitator of weight loss."
(JAMA.
1998;280:1596-1600)
Note: This study was supported by grants from the National
Institutes of Health and a contract with Thompson Medical Company, manufacturer
of products that include G cambogia.
Go back to the top.
WASHINGTON, D.C.—Patients with irritable bowel syndrome (IBS) report
improvement in symptoms after using Chinese herbal medicine (CHM), according to
an article in the November 11 issue of The Journal of the American Medical
Association (JAMA), a theme issue on alternative medicine.
Alan Bensoussan, M.Sc., of the University of Western Sydney Macarthur in
Australia, and colleagues studied the impact of Chinese herbal medicine in the
treatment of irritable bowel syndrome. The study also sought to determine the
effectiveness of an individual therapy plan against the standard Chinese herbal
formulation.
Bensoussan presented the findings here today at a America Medical
Association media briefing on alternative medicine.
The researchers found: "For all five main outcome measures - total mean
Bowel Symptom Scale (BSS) scores [measurement of the overall severity of the
main symptoms of IBS for each patient] and global improvement [did a patient's
condition improve, stay the same or worsen since beginning the trial] as
assessed by patients and gastroenterologists, and interference with life as
assessed by patients, patients receiving the standard CHM formulation responded
significantly better than patients in the placebo group. Patients receiving the
individualized CHM treatment also responded significantly better on four of five
scores than patients receiving the placebo."
The 116 participants were screened by a gastroenterologist, and met the
standard diagnosis of IBS. They were further diagnosed, according to Chinese
medicine principles (treatment should be tailored to the individual clinical
presentation of patients, even though they may all have the same medical
diagnosis), and treated in three Chinese herbal clinics by three different
Chinese medicine practitioners.
Patients were randomly selected to receive one of three treatments: an
individualized Chinese herbal formulation, a standard Chinese herbal
formulation, or placebo. Patients received five capsules three times daily for
16 weeks and were evaluated regularly by a traditional Chinese herbalist and by
a gastroenterologist.
According to the authors, Chinese herbal formulas are complex and are viewed
as a number of active ingredients working together, rather than one active
substance. The standard formulation used in this study is not a sedative or
anxiolytic preparation in traditional CHM terms but is a formulation considered
to regulate and strengthen bowel function.
The Bowel Symptom Scale was the major instrument used to assess change and
measure severity of IBS symptoms during the course of treatment. The authors
found: "Patients receiving the standard herbal formulation improved by 44
percent (according to patients) and 59 percent (according to
gastroentrologists), in contrast to patients in the placebo group who improved
22 percent (according to patients) and 19 percent (according to
gastroenterologists.) Patients receiving the individualized preparations
improved by 42 percent (according to patients) and 40 percent (according to
gastroenterologists.)"
The researchers write: "There was a significant association between the
active treatment groups and the change in the degree to which IBS symptoms
caused interference with life and activities by the end of treatment. Of
patients receiving the standard formulation and of those receiving individual
formulations, 63 percent and 54 percent, respectively, stated that treatment
resulted in IBS causing less interference in their lives and activities,
compared with 37 percent of patients in the placebo group."
The researchers comment: "There was significant association between the
treatment group and how patients felt at the 14-week follow-up. Of patients who
had received the standard CHM formulation and of those who had received
individual CHM formulations, 63 percent and 75 percent, respectively, stated
that they still felt an improvement compared with 32 percent of patients who
received placebo."
According to the authors, herbalism, acupuncture, homeopathic medicine, and
manual therapies (e.g., chiropractic) frequently rely on a second diagnosis
process distinct from Western medicine and on a high degree of interaction
between patient and practitioner during the treatment. These alternative
therapies lead to a clinical distinction between what seem to be similar
diagnostic cases in Western medicine (individualization of therapy), which
demands that the therapeutic invention be continuously modified in response to
patient feedback.
The researchers continue: "Treatment needs to be tailored to the
individual at the outset and also modified at differing stages of the patient's
illness. Rigorous clinical trial methods frequently impose standardization of
treatment for trial subjects. To our knowledge, this is the first clinical trial
in Chinese herbal medicine that fully adheres to the traditional Chinese
diagnostic and treatment processes while using a strict and accepted
methodological protocol."
The authors write: "We conclude that Chinese herbal formulations may
offer symptom improvement to some patients with IBS. In this randomized,
double-blinded, placebo controlled trial CHM was shown to be effective in the
management of IBS. Patients receiving the standard CHM formulation fared the
best during the course of the treatment, while patients receiving the
individualized treatments found that the benefit gained lasted beyond the
treatment period. Although not all patients responded to this therapy, our
findings support the consideration of further investigation of Chinese herbal
medicine as a treatment option for IBS."
According to information cited in the study, irritable bowel syndrome is a
common functional bowel disorder that accounts for a significant proportion of
patients seen in gastroenterology offices and is characterized by chronic and
recurrent abdominal pain and disturbed defecation. Studies in the United States
and Australia suggest that between 10 percent and 20 percent of the population
have this disorder. No single available treatment is reliably effective for this
condition, and patients use a variety of approaches for symptom management,
including drugs, dietary modifications, counseling, and recently, Chinese herbal
medicine.
The authors add that before this study, no strong scientific evidence
available supported the use of Chinese herbal agents in IBS. However, CHM has
been used for centuries in the treatment of functional bowel disorders and is
routinely used for this purpose in China.
(JAMA.
1998;280:1585-1590)
Note: This study was supported a contribution from the University of
Western Sydney Macarthur, Sydney, Australia. Mei Yu Imports supplied the herbal
medicines and Pan Laboratories prepared the placebo.
Go back to the top.
WASHINGTON, D.C.—Spinal manipulation — as an isolated intervention
— does not significantly improve the outcome for episodic tension-type
headaches (ETTH), according to an article in the November 11 issue of The
Journal of the American Medical Association (JAMA), a theme issue on
alternative medicine.
Geoffrey Bove, D.C., Ph.D., formerly of Odense University, Odense, Denmark,
now at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston,
and Niels Nilsson, D.C., M.D., Ph.D., from Odense University, studied 75 people
with episodic tension-type headaches to determine the effects of spinal
manipulation therapy on tension headache.
Dr. Bove discussed the findings of the study here today at an American
Medical Association media briefing on alternative medicine.
The researchers said: "This study showed that spinal manipulation did
not significantly improve the outcome of ETTH. ... In practice, ETTH and
cervicogenic headache can be difficult to differentiate, and often occur
together. Our conclusions are in stark contrast to those of an earlier and very
similar study of cervicogenic headache, in which the effect of spinal
manipulation was quite dramatic. These data thus underline the importance of
accurate diagnosis in the selection of headache patients for spinal
manipulation."
In the study, participants were randomized into two groups, one receiving
soft tissue therapy and spinal manipulation (the manipulation group), and the
other receiving soft tissue therapy and a placebo laser treatment (the control
group).
The researchers write: "Based on intent-to-treat analysis, no
significant differences between the manipulation and control groups were
observed in any of the three outcome measures [daily hours of headache, pain
intensity per episode and analgesic use]. However, by week seven, each group
experienced significant reductions in mean daily headache hours (manipulation
group, reduction from 2.8 to 1.5 hours; control group, reduction from 3.4 to 1.9
hours) and mean number of analgesics per day (manipulation group, reduction from
0.66 to 0.38; control group, reduction from 0.82 to 0.59)."
The participants reported between five and 15 tension-type headaches (TTHs)
a month with a reported headache intensity between 25 and 85 on a scale of 100.
The patients were divided into the manipulation group or the control group. The
manipulation group received cervical joint manipulation based on the
chiropractor's exam and massage to the upper back muscles. The control group
received the massage plus an application of laser light, as placebo, to the
upper neck. Both groups received eight treatments over four weeks. All
treatments were performed by the same chiropractor and lasted approximately 15
minutes. The entire trial including follow-up lasted 19 weeks.
Tension-type headaches are extremely common, affecting more than one-third
of the population and accounting for more than two-thirds of all headache
episodes. Tension headaches are described as pressing or tightening, and the
pain is typically mild to moderate and is felt on both sides of the head. The
one-year prevalence of episodic tension-type headache is more than 38 percent.
Episodic tension-type headache interferes with lifestyle and has a significant
socioeconomic impact, according to the study. Though episodic tension-type
headache is typically medically treated with nonprescription analgesics, many
people with ETTH seek hands-on therapy, delivered by various groups of
practitioners.
In a separate interview Dr. Bove said: "This study shows that
tension-type headaches do respond to hands-on therapy, but that cervical spinal
manipulation is unlikely to be the factor that effects the change."
(JAMA.
1998;280:1576-1579)
Note: This project was supported by the Nordic Institute of
Chiropractic and Clinical Biomechanics, Odense, Denmark; The foundation for
chiropractic research and postgraduate education, Copenhagen, Denmark; the
Faculty of Health Science of Odense University; and the Foundation for
Chiropractic Education and Research, Boston.
Go back to the top.
ECHINACEA NO MORE EFFECTIVE THAN PLACEBO IN PREVENTING COLDS
The investigated root extracts from E angustifolia and E purpurea could not
be shown to prevent upper respiratory tract infections, according to an article
in the November/December issue of the AMA's Archives of Family Medicine.
The authors noted that participants in the treatment groups believed that they
had more benefit from the medication than those in the placebo group. Based on the results of this and two other studies, one could speculate that there might
be an effect of echinacea products in the order of magnitude of 10 percent to 20
percent relative risk reduction.
(Arch
Fam Med. 1998;7:541-545)
MAJORITY OF PEDIATRICIANS BELIEVE SOME OF THEIR PATIENTS SEEK ALTERNATIVE CARE
Approximately 84 percent of pediatricians believe a small percentage of
their patients use complementary and alternative medicine (CAM) therapies,
according to an article in the November issue of the AMA's Archives of
Pediatrics & Adolescent Medicine. Half would consider referring
patients for CAM, and most were interested in continuing medical education
courses on CAM.
(Arch
Pediatr Adolesc Med. 1998;152:1059-1064)
SMOKING MARIJUANA NOT RECOMMEND BECAUSE OF HEALTH HAZARDS
Smoking marijuana to reduce intraocular pressure in glaucoma is not
advised because of its toxicological profile, according to an article in the
November issue of the AMA's Archives of Ophthalmology. Clinical effects
associated with long-term marijuana use include respiratory, hormonal and
pulmonary toxic effects, because tars, carcinogens and other volatile materials
are more concentrated in marijuana smoke than in tobacco smoke. The authors
call for development of drugs based on the cannabinoid molecule for use as
topical or oral antiglaucoma medications.
(Arch
Ophthalmol. 1998;116:1433-1437)
An accompanying editorial states: "To rationally determine
marijuana's potential place in the antiglaucoma armamentarium, we should study
cannabinoids as we would any other interesting class of compounds, rather than
simply allowing or abandoning their use at present. ... In short, science
rather than emotion should set the standard."
(Arch
Ophthalmol. 1998;116:1512-1513)
HOME-BASED REMEDIES COMMONLY USED TO TREAT CHILDHOOD COLDS
Home-based remedies for colds in childhood are commonly used by a
variety of ethnic groups, according to an article in the November issue of the
AMA's Archives of Pediatrics & Adolescent Medicine. Many of the
treatments used, such as over-the-counter cold remedies and fluids, are
complementary to biomedical treatment. Mothers from ethnic minorities use
similar amounts of home-based therapies when compared with mothers from the
majority culture.
(Arch
Pediatr Adolesc Med. 1998;152:1083-1088)
HOMELESS YOUTHS FREQUENTLY USE AND ACCEPT COMPLEMENTARY AND ALTERNATIVE
MEDICINE
Complementary and alternative medicine (CAM) was used by 70 percent of
homeless youths who filled out a survey at a youth health clinic in Seattle,
according to an article in the November issue of the AMA's Archives of
Pediatrics & Adolescent Medicine. Approximately 44 percent of the
youths reported using CAM because it was "natural." Most believed it helped "some" or "a lot." When given a choice of providers
to seek care from when they were ill, approximately 52 percent would see a
physician, about 40 percent would visit a CAM provider and about 11 percent
would treat themselves. The authors conclude: "Integrating CAM into
allopathic health centers may serve as an incentive to entice youth into
mainstream health care."
(Arch
Pediatr Adolesc Med. 1998;152:1071-1075)
MAJORITY OF PHYSICIANS REFER THEIR PATIENTS TO CLERGY AND PASTORAL CARE PROVIDERS
More than 80 percent of the physicians studied reported that they refer or
recommend their patients to clergy and pastoral care providers, according to an
article in the November/December issue of the AMA's Archives of Family
Medicine. More than 30 percent stated that they refer more than 10 times a
year. Approximately 75 percent chose conditions associated with end-of-life
care as reasons for referral; and approximately 73 percent of physicians
referred patients for marital and family counseling. In addition, physicians
who were in practice for more than 15 years were more likely to refer to clergy.
(Arch
Fam Med. 1998;7:548-553)
PATIENTS NEED TO BE AWARE OF BENEFITS AND SIDE EFFECTS OF MEDICINAL
HERBS
An article in the November/December issue of the AMA's Archives of
Family Medicine reviews existing data on history, safety and efficacy of the
following 12 commonly used medicinal herbs: chamomile, echinacea, feverfew,
garlic, ginger, ginkgo, ginseng, goldenseal, milk thistle, St. John's wort, saw
palmetto and valerian.
(Arch
Fam Med. 1998;7:523-536)
WHICH HERBAL PREPARATIONS WORK IN DERMATOLOGICAL THERAPEUTICS
An article in the November issue of the AMA's Archives of Dermatology
reviews herbal approaches to four common dermatological conditions: acne,
dermatitis, psoriasis, and herpes simplex labialis. The authors conclude: "Many
herbs are already being used by patients who seek care by dermatologists.
Understanding their use and action helps the dermatologist integrate all
elements of the patient's skin care regimen."
(Arch
Dermatol. 1998;134:1401-1404)
ALTERNATIVE STRATEGIES IN MANAGEMENT OF PRIMARY BREAST CANCER
An article in the November issue of the AMA's Archives of Surgery
reviews current alternative strategies in the management of primary breast
cancer with an emphasis on the reasons particular strategies are preferred. The
researchers also forecast new alternatives expected to emerge from molecular
biology, as well as other technological advances. They warn: "One should
be particularly wary of alternative treatments when their proponents claim they
have an unusual or secret treatment, or a treatment that has been overlooked by
medical
science."
(Arch
Surg. 1998;133:1182-1186)
DIFFICULT-TO-CONTROL SEIZURES CAN BE EFFECTIVELY DECREASED BY THE
KETOGENIC DIET
Fifty-five percent of children with difficult-to-control seizures decreased
their seizures by at least 50 percent after six months on the ketogenic diet,
according to an article in the November issue of the AMA's Archives of
Neurology. Developed in the 1920s, the ketogenic diet is an individually
calculated and rigidly controlled, high-fat, low-protein, low-carbohydrate diet
used for the treatment of difficult-to-control seizures. As new anticonvulsant
medications became available, the diet was used less frequently and lack of
experience led to widespread opinion that the diet did not work and was
difficult to tolerate. The researchers conclude: "The ketogenic diet is
effective in substantially decreasing difficult-to -control seizures and can
successfully be administered in a wide variety of settings."
(Arch
Neurol. 1998;55:1433-1437)
An accompanying editorial states: "Many parents are initially drawn
to the ketogenic diet because they assume that a diet must somehow be more
natural and less risky than a medication. They are soon to find that there is
nothing at all normal or natural about the ketogenic diet! But it is a
reasonable option, particularly for children who have not responded to
medication or who have excessive adverse effects from medication ... If the
ketogenic diet can be systematically examined, then other forms of
nontraditional therapy could and should also be investigated. Those who
champion new tests and treatments ultimately have an obligation to study these
procedures thoroughly before promoting them for general use with patients."
(Arch Neurol. 1998;55:1403-1404)
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CHICAGO—Visitors to the AMA's World Wide Web site (www.ama-assn.org) can now register to receive tables of contents from the Association's
scientific journals, plus news summaries from American Medical News,
via e-mail.
The new service is free of charge. There is a short registration process
that requires users to provide limited personal information, such as their
profession and e-mail address. This information is collected for internal AMA
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