Complementary medicine use by men with prostate cancer: a systematic review of prevalence studies.

Men with prostate cancer are reported as commonly using complementary and alternative medicine (CAM) but surveys have not recently been subjected to a rigorous systematic review incorporating quality assessment. Six electronic databases were searched using pre-defined terms. Detailed information was extracted systematically from each relevant article. Study reporting quality was assessed using a quality assessment tool, which demonstrated acceptable inter-rater reliability and produces a percentage score. In all, 42 studies are reviewed. All were published in English between 1999 and 2009; 60% were conducted in the United States. The reporting quality was mixed (median score = 66%, range 23-94%). Significant heterogeneity precluded formal meta-analysis. In all, 39 studies covering 11,736 men reported overall prevalence of CAM use; this ranged from 8 to 90% (median=30%). In all, 10 studies reported prevalence of CAM use specifically for cancer care; this ranged from 8 to 50% (median = 30%). Some evidence suggested CAM use is more common in men with higher education/incomes and more severe disease. The prevalence of CAM use among men with prostate cancer varies greatly across studies. Future studies should use standardised and validated data collection techniques to reduce bias and enhance comparability.

Who Uses CAM? A Narrative Review of Demographic Characteristics and Health Factors Associated with CAM Use.

Complementary and Alternative Medicines (CAM) are used by an extensive number of patients in the UK and elsewhere. In order to understand this pattern of behavior, it is helpful to examine the characteristics of people who use CAM. This narrative review collates and evaluates the evidence concerning the demographic characteristics and health status factors associated with CAM use in community-based non-clinical populations. A systematic literature search of computerized databases was conducted, and published research papers which present evidence concerning associations between CAM use and demographic and health characteristics are discussed and evaluated. The evidence suggests that people who use CAM tend to be female, of middle age and have more education. In terms of their health, CAM users tend to have more than one medical condition, but might not be more likely than non-users to have specific conditions such as cancer or to rate their own general health as poor. The multivariate studies that have been conducted suggest that both demographic and health characteristics contribute independently to CAM use. In conclusion, demographic characteristics and factors related to an individual's health status are associated with CAM use. Future research is needed to address methodological limitations in existing studies.

A systematic review of vanadium oral supplements for glycaemic control in type 2 diabetes mellitus.

OBJECTIVE: To assess the effectiveness of oral vanadium supplementation for glycaemic control in type 2 diabetes by conducting a systematic review of the literature. DESIGN AND METHODS: Eligible studies were identified by searching 14 databases using standardized terms. Experts, study authors and manufacturers were also contacted. Hand-searching was not undertaken. Selection criteria for inclusion in the review were controlled human trials of vanadium vs. placebo in adults with type 2 diabetes of minimum 2 months duration, and a minimum of 10 subjects per arm. Data extraction, assessment of study quality and outcome analysis were undertaken by two independent reviewers. RESULTS: One hundred and fifty one studies were found but none met the inclusion criteria. We proceeded to summarize the state of existing evidence and plan for a future clinical trial by applying revised, less restrictive criteria to our search, for clinical trials of 30-150 mg daily oral vanadium supplementation in diabetic humans. Only five were identified. These demonstrated significant treatment-effects, but due to poor study quality, must be interpreted with caution. Treatment with vanadium often results in gastrointestinal side-effects. CONCLUSION: There is no rigorous evidence that oral vanadium supplementation improves glycaemic control in type 2 diabetes. The routine use of vanadium for this purpose cannot be recommended. A large-scale randomized controlled trial is needed to address this clinical question.

Presentiment or entanglement? An alternative explanation for apparent entanglement in provings.

A number of authors have recently discussed the possible role entanglement in homeopathy. Walach et al have published a homeopathic proving which they interpreted as demonstrating entanglement between placebo and verum groups in a proving. The lack of a 'run-in' period was a weakness of this trial. We present further results of our proving of Belladonna which show that subjects who reported symptoms during the placebo run-in period ('presentiment provers') were more likely to report symptoms during the treatment period. This data suggests and the observations of Walach et al may be explicable by conventional mechanisms including differential reporting and constitutional type.

The Buteyko breathing technique for asthma: a review.

Breathing exercises and breathing retraining are often used in the management of asthma. One specific form of breathing therapy, known as the Buteyko breathing technique (BBT) has received considerable attention, but there is a paucity of rigorous research evidence to support its recommendation for asthma patients. There are only four published clinical trials and two conference abstracts evaluating BBT. Although all have reported improvements in one or more outcome measures, results have not been consistent. This article provides the background to the BBT, reviews the available evidence for its use and examines the physiological hypothesis claimed to underpin it. In common with other therapies, BBT is not a standardised treatment modality. The BBT 'package' is complex, as it also includes advice and education about medication use, nutrition and exercise, and general relaxation. This makes it difficult, and possibly inappropriate, to attempt to tease out a single mechanism. Buteyko's theory relating to carbon dioxide levels and airway calibre is an attractive one, and has some basis in evidence from experimental studies. However, it is not known whether altering breathing patterns can raise carbon dioxide levels significantly, and there is currently insufficient evidence to confirm that this is the mechanism behind any effect that BBT may exert. Further research is necessary to establish unequivocally whether BBT is effective, and if so, how it may work.

Can we evaluate electrodermal testing?

Electrodermal testing (ED testing) is an acupuncture-based approach and was developed to refine homeopathic prescriptions. It is currently being used to advise patients about their "allergies". The evidence for its use in "allergy testing" is limited and often misrepresented. This article addresses the research and clinical issues involved in investigating the reliability and validity of various ED testing machines.

Developing a measure of attitudes: the holistic complementary and alternative medicine questionnaire.

We have developed an 11-item scale, the Holistic Complementary and Alternative Medicine Questionnaire (HCAMQ). Six of the HCAMQ items relate to beliefs about the scientific validity of complementary and alternative medicine (CAM), and five to beliefs about holistic health (HH). The HCAMQ was completed by 50 patients attending a CAM clinic and 50 attending rheumatology outpatients; the former completed it twice. Factor analysis (oblique rotation) showed that the CAM and HH items measured distinct but related constructs. The HCAMQ has good test retest reliability (r=0.86, 0.82 and 0.77 for the total, CAM subscale and HH subscale, respectively). The individuals attending CAM clinics were significantly more positive on the CAM but not the HH subscale of the HCAMQ and also used less antibiotics than those attending rheumatology outpatients. Positivity towards CAM on the total HCAMQ and subscales was significantly associated with lower age, increased vitamin use, reduced painkiller use, and, other than on the HH subscale, less antibiotic use. The reason why the HH subscale failed to distinguish between the two patient groups or predict less antibiotic use is unknown. The HCAMQ appears to have good internal validity, but its external validity remains to be established.

An exploratory qualitative study to investigate how patients evaluate complementary and conventional medicine.

OBJECTIVE: We wish to determine the constructs used by patients to evaluate conventional and complementary medicine (CAM), prioritise these constructs and determine how these characterise patients' choice for CAM and conventional medicine. METHODS: A repertory grid technique was employed, in interviews of 20 patients, 10 from a general practice and 10 from a CAM clinic. RESULTS: CAM was used with greater frequency in chronic illness and generated more constructs than conventional medicine, although the constructs were similar. The priorities for these constructs were different: specificity of treatment and severity of illness were prioritised for conventional medicine and lack of science was prioritised for CAM. The CAM characteristic most commonly cited was non-chemical. CONCLUSION: This exploratory initial study suggests that people use very similar criteria to evaluate CAM and conventional medicine. Their choice of treatment was based largely on the type of illness from which they were suffering. Further research is needed in this area.

Complementary cancer care in Southampton: a survey of staff and patients.

BACKGROUND: Complementary and alternative medicine (CAM) is used by one in ten of the UK population yearly and 47% during their lifetime. One-third of cancer patients seek some form of CAM treatment during their illness. AIM: To evaluate the use of and attitudes to CAM among patients and all healthcare staff in the Southampton Cancer Care Directorate (UK). SETTING: The Royal South Hants Hospital, Countess Mountbatten and Oakhaven Hospices. METHOD: A questionnaire-based survey performed between January 2001 and March 2001. RESULTS: Two hundred and seventy questionnaires were distributed to patients and 162 responses received. The distribution of cancers within this population was generally typical of those in the community. Thirty-two percent (n = 52) were receiving some form of CAM, half of those receiving CAM were in hospice care. Forty-nine percent of those not receiving CAM would like to, and 76% of all patients would be prepared to pay for this treatment. The five most popular treatments were massage, nutrition, aromatherapy, relaxation and reflexology. While most patients expected CAM to palliate their symptoms (n = 149, 92%), some had unrealistic expectations that CAM would cure their cancer (n = 13, 8%). Four hundred and forty-eight staff questionnaires were distributed and 196 responses were received: 148 (75.5%) from nurses. Twenty-one percent of staff responding had CAM training and two-thirds would like to receive training. The most popular therapies used by staff were the same as those identified by the patients. Ninety-nine percent of staff and 98.5% of patients wished to see CAM treatments introduced into service provision within the Cancer Care Directorate. CONCLUSIONS: The use of CAM for cancer care in Southampton is widespread and consistent with its use nationally. There is a clearly expressed need for CAM treatments by patients and a willingness to pay. Two-thirds of the cancer care staff responding wished to receive training in and provide these therapies. There are some misconceptions among patients about the role of CAM in cancer care which need to be discussed and resolved. We believe that all cancer care units should have clear policies on the use of CAM for cancer patients.

Oscillatory effects in a homeopathic clinical trial: an explanation using complexity theory, and implications for clinical practice.

Four double-blind, randomised, placebo-controlled clinical trials of asthma or rhinitis treated with homeopathic immunotherapy (HIT) at a 30C potency have been published. The most recent study, involving house dust mite allergic asthmatics, failed to confirm a therapeutic improvement at the end of the study, but did provide preliminary evidence for an oscillation in outcome (both physiological and subjective) in with verum treatment to placebo. In this paper we show how such an oscillation is consistent with a complexity theory interpretation of how the body functions as a whole, and speculate on why different studies have produced different results. If the complexity theory interpretation is correct, then this will have a significant impact on the design of clinical trials in homeopathy and, possibly, other complementary medical interventions.

Oscillatory effects in a homeopathic clinical trials: an explanation using complexity theory, and implications for clinical practice

Four double-blind, randomised, placebo-controlled clinical trials of asthma or rhinitis treated with homeopathic immunotherapy (HIP) at a 30C potency have been published. The most recent study, involving... (AU)

Use of ultramolecular potencies of allergen to treat asthmatic people allergic to house dust mite: double blind randomised controlled clinical trial.

OBJECTIVE: To evaluate the efficacy of homoeopathic immunotherapy on lung function and respiratory symptoms in asthmatic people allergic to house dust mite. DESIGN: Double blind randomised controlled trial. SETTING: 38 general practices in Hampshire and Dorset. PARTICIPANTS: 242 people with asthma and positive results to skin prick test for house dust mite; 202 completed clinic based assessments, and 186 completed diary based assessments. INTERVENTION: After a four week baseline assessment, participants were randomised to receive oral homoeopathic immunotherapy or placebo and then assessed over 16 weeks with three clinic visits and diary assessments every other week. OUTCOME MEASURE: Clinic based assessments: forced expiratory volume in one second (FEV(1)), quality of life, and mood. DIARY BASED ASSESSMENTS: morning and evening peak expiratory flow, visual analogue scale of severity of asthma, quality of life, and daily mood. RESULTS: There was no difference in most outcomes between placebo and homoeopathic immunotherapy. There was a different pattern of change over the trial for three of the diary assessments: morning peak expiratory flow (P=0.025), visual analogue scale (P=0.017), and mood (P=0.035). At week three there was significant deterioration for visual analogue scale (P=0.047) and mood (P=0.013) in the homoeopathic immunotherapy group compared with the placebo group. Any improvement in participants' asthma was independent of belief in complementary medicine. CONCLUSION: Homoeopathic immunotherapy is not effective in the treatment of patients with asthma. The different patterns of change between homoeopathic immunotherapy and placebo over the course of the study are unexplained.

Flavonoids--a new direction for the treatment of fluid retention?

Flavonoid extracts are important for the health of the micro-blood vessel network and are clinically exploited in this way by medical herbalists and physicians in mainland Europe. In the present review, we provide preliminary evidence that suggests that plant flavonoid extracts from dietary sources facilitate the repair of vessel damage responsible for 'small blood vessel permeability'. Correction of this pathophysiological abnormality is known to lead to a reduction in symptoms of diffuse benign fluid retention including swollen limbs, fingers, breasts and the tissue surrounding the eye area. There is currently little orthodox treatment for this type of fluid retention except diuretics which are not without side effects and fail to address the underlying cause of the disorder. This paper marshals available data including some preliminary studies that suggest that detailed scientific study of this clinical area and its treatment through flavonoid intervention is warranted.

Is electrodermal testing as effective as skin prick tests for diagnosing allergies? A double blind, randomised block design study.

OBJECTIVE: To evaluate whether electrodermal testing for environmental allergies can distinguish between volunteers who had previously reacted positively on skin prick tests for allergy to house dust mite or cat dander and volunteers who had reacted negatively to both allergens. DESIGN: Double blind, randomised block design. SETTING: A general practice in southern England. PARTICIPANTS: 15 volunteers who had a positive result and 15 volunteers who had a negative result on a previous skin prick test for allergy to house dust mite or cat dander. INTERVENTION: Each participant was tested with 6 items by each of 3 operators of the Vegatest electrodermal testing device in 3 separate sessions (a total of 54 tests per participant). For each participant the 54 items comprised 18 samples each of house dust mite, cat dander, and distilled water, though these were randomly allocated among the operators in each session. A research nurse sat with the participant and operator in all sessions to ensure blinding and adherence to the protocol and to record the outcome of each test. OUTCOME: The presence or absence of an allergy according to the standard protocol for electrodermal testing. RESULTS: All the non-atopic participants completed all 3 testing sessions (810 individual tests); 774 (95.5%) of the individual tests conducted on the atopic participants complied with the testing protocol. The results of the electrodermal tests did not correlate with those of the skin prick tests. Electrodermal testing could not distinguish between atopic and non-atopic participants. No operator of the Vegatest device was better than any other, and no single participant's atopic status was consistently correctly diagnosed. CONCLUSION: Electrodermal testing cannot be used to diagnose environmental allergies.

Attitudes to traditional Chinese medicine amongst Western trained doctors in the People's Republic of China.

This study analyses the attitudes of Western trained doctors to traditional Chinese medicine (TCM) in Shenyang, Northern China. Research methodology involved a series of structured interviews as well as developing a questionnaire. Two hundred and fifty questionnaires were distributed in four centres, 177 were returned. Ninety-eight percent of respondents had some theoretical and practical TCM training; the older doctors having significantly more than their recently qualified colleagues. There was clear consensus that TCM (mainly herbal medicine) was useful and safe in treating patients with chronic or intractable illness. Doctors were influenced in their choice of treatment by their training, clinical experience and the available published research. TCM was not practiced in isolation, but in conjunction with Western medicine; 76% treating their patients with TCM, 90% treating their friends or family and 82% referring patients to TCM specialists.

Complementary and alternative medicine (CAM) in the undergraduate medical curriculum: the Southampton experience.

OBJECTIVE: We describe the planning, development and evaluation of a special study module (SSM) on Complementary and Alternative Medicine (CAM) as part of the Southampton Medical School undergraduate curriculum. AIM: To address how the module was received by students, the themes that emerged, the effect on student attitudes to CAM and how the teaching aims developed into learning objectives. METHOD: Student feedback questionnaires and regular teaching staff meetings over a period of 3 years. RESULTS: The course resulted in a significant change in student attitudes to CAM and was well received by the students. It offered a reflective insight into conventional medicine. We have developed and validated core teaching objectives. CONCLUSIONS: We hope that our well validated and well received core teaching objectives will provide a broadly applicable base for those who wish to run similar courses.

Attitudes to and use of complementary medicine among physicians in the United Kingdom.

OBJECTIVES: To evaluate the use of attitudes to complementary and alternative medicine (CAM) among UK physicians. DESIGN: Postal questionnaire. SUBJECTS: All Members and Fellows of the Royal College of Physicians. RESULTS: Twelve thousand, one hundred and sixty eight Members and Fellows were surveyed and a response rate of 23% (n = 2,875) was obtained. Responses from the small numbers of general practitioners (n = 127) were not included in the analyses, resulting in a sample size of 2,748: 79% of respondents were in NHS practice, 32% of respondents practised CAM themselves, and 41% referred patients to CAM; of those who referred patients, 78% referred between 0-3 patients per month. CAM is used by physicians more frequently in private as compared to NHS practice. Acupuncture, aromatherapy and manipulative medicine (osteopathy and chiropractic) are the most commonly referred to and the most commonly practised therapies. Eighty seven percent of those using CAM themselves, or as part of their clinical team's commitment, had not had any CAM training. Attitudes to CAM were generally positive, particularly among those in palliative care, rehabilitation, nuclear medicine, and genito-urinary medicine. CONCLUSIONS: Our conclusions must be tempered by the limited response rate, but assuming all non-responders were disinterested in CAM, then at least one in ten UK specialist physicians are actively involved in CAM treatments, although only 13% of our sample had received any CAM training.

A pilot project to assess the methodological issues involved in evaluating acupuncture as a treatment for disabling breathlessness.

OBJECTIVES: This pilot study explores the methodological implications of evaluating the use of acupuncture in the treatment of disabling breathlessness. DESIGN: A randomized, controlled trial involving three treatments that were used on one occasion, each in random order. SETTINGS: The study was designed to evaluate the feasibility of providing acupuncture treatment on a domiciliary basis, in Southampton (United Kingdom) to patients with disabling breathlessness. SUBJECTS: Sixteen (16) subjects with disabling breathlessness caused by chronic lung disease (primarily chronic obstructive pulmonary disease [COPD]) were recruited from the respiratory medicine clinics of Southampton University Hospitals Trust. INTERVENTIONS: The treatments were real acupuncture, dummy acupuncture, and mock transelectrical nerve stimulation (TENS). OUTCOMES: To evaluate the respiratory outcome measures, to look at the credibility of the three treatments (using a previously validated Borkovec and Nau scale), and to calculate the sample size for a larger, more definitive study. RESULTS: Twelve (12) subjects completed the study. The acupuncture was a predefined point prescription that had been found previously to be of value in this condition, an approach that could be taught to health professionals and provided on a domiciliary basis. The treatment was provided only on one occasion, therefore, we did not expect a clear therapeutic benefit to emerge, but some nonsignificant benefit was noted as a consequence of acupuncture treatment. The shuttle test that we used as an objective measure of breathlessness was impractical in a domiciliary environment and will not be used in further studies. Each of the three treatments was equally credible at the outset, although real and dummy acupuncture were considered by the patients to be preferable choices after the completion of treatment. CONCLUSIONS: It was possible to carry out this study on a domiciliary basis. The information obtained will allow us to design a much clearer definitive study and the small, but statistically insignificant, response to acupuncture has allowed us to estimate sample size.

Complementary medicine: the Southampton undergraduate experience.

We describe our experiences in the development of a complementary and alternative medicine familiarization special study module for a multidisciplinary group of students, involving medical students, nurses and chiropractors. Our observations suggest that the model we have developed is an effective, interesting and exciting experience for both students and teachers. We have defined, by consensus between students and teachers, a series of clear educational objectives. The course is now established, having run for 4 academic years, but we are concerned about its sustainability, particularly in relation to ongoing funding.