Complementary and alternative medicine in US family medicine practices: a pilot qualitative study.

CONTEXT: The growth of complementary and alternative medicine (CAM) has led some family medicine practices to include CAM. Acupuncture or herbal medicine, for example, may be offered at such practices. When a practice incorporates both CAM and conventional treatments, its goals and values may differ from those found in traditional primary care. Little is known about the development of these integrated practices, which may be expected to become more widespread. OBJECTIVE: To identify some of the concepts and challenges shaping family medicine practices that incorporate CAM. DESIGN: Comparative case study. METHOD: Multi-method assessment process including participant observation, key informant interviews, semi-structured depth interviews, and observation of patient-provider encounters. SETTING: Four family medicine/CAM practices in the mid-Atlantic region of the United States. RESULTS: Key themes that influence these practices' organization include dimensions of health, the selection of therapies used, the practices' approach to evidence, their perspective on the amount of time spent with patients, and their adaptations to financial concerns. Each practice emphasized long patient visits. In each, physicians had expertise that enabled them to draw on both conventional medicine and CAM. CONCLUSION: Successful incorporation of CAM modalities within a family medicine framework requires adaptation not only at the practice level but also by individual physicians.

Three generations of ongoing controversies concerning the use of short acting beta-agonist therapy in asthma: a review.

An increase in asthma mortality in 1960s noted by British authors stirred a debate about the use of beta-adrenergic therapy that has persisted in the medical literature. The cause appears to be isoproterenol and fenoterol overuse. A second debate evolved around the possible deleterious, pro-inflammatory effects, of the albuterol distomer. Most clinical studies showed improved bronchodilatation, but limited benefits from using levalbuterol. Recently, genotyping has uncovered a single nucleotide polymorphism at codon 16 that appears to affect the long term response to both regular and as needed use of albuterol, calling for a new genotype based therapeutic approach in asthma.

Association of codon 16 and codon 27 beta 2-adrenergic receptor gene polymorphisms with obesity: a meta-analysis.

OBJECTIVE: To search for an association between the Glu27Gln (rs1042714; B27) and the Arg16Gly (rs1042713; B16) polymorphisms of the beta 2-adrenergic receptor (ADRB2) gene and obesity. METHODS: Meta-analysis of published studies, included if subjects were genotyped at either codon 27 ("B27") or codon 16 ("B16") of the ADRB2 gene and both obese and nonobese subjects were selected, based on a reported cutoff BMI limit. Initial selection included 14,444 subjects genotyped at B27 (rs1042714) and 6,825 genotyped at B16 (rs1042713). After testing each control group for Hardy-Weinberg equilibrium, the final selection included 10,404 subjects and 4,328 subjects, respectively. Studies were published before 18 August 2006. RESULTS: The frequency of Glu27 allele carriers, either homozygous or heterozygous, ranged from 6.71% in Aymara American Indians to 78.29% in a Dutch population. The frequency of Arg16 allele carriers varied from 51.4 to 64.6% in Europeans and from 71.1 to 85.6% in East Asians. The summary odds ratio (OR) from overall analyses showed no association between either rs1042714 or rs1042713 and obesity. In race groups with low Glu27 allele frequency (Asians, Pacific Islanders, and American Indians), ORs revealed a significant obesity risk associated with rs1042714. These results were not found in East Asians for rs1042713. DISCUSSION: The presence of the Glu27 allele in the ADRB2 gene appears to be a significant risk factor for obesity in Asians, Pacific Islanders, and American Indians, but not in Europeans. Obesity does not appear to be associated with the Arg16 allele.