Adverse events associated with the use of complementary and alternative medicine in children.

OBJECTIVE: To determine the types of adverse events associated with the use of complementary and alternative medicine (CAM) that come to the attention of Australian paediatricians. DESIGN: Monthly active surveillance study of CAM-associated adverse events as reported to the Australian Paediatric Surveillance Unit between January 2001 and December 2003. RESULTS: There were 39 reports of adverse events associated with CAM use, including four reported deaths. Reports highlighted several areas of concern, including the risks associated with failure to use conventional medicine, the risks related to medication changes made by CAM practitioners and the significant dangers of dietary restriction. The reported deaths were associated with a failure to use conventional medicine in favour of a CAM therapy. CONCLUSION: CAM use has the potential to cause significant morbidity and fatal adverse outcomes. The diversity of CAM therapies and their associated adverse events demonstrate the difficulty addressing this area and the importance of establishing mechanisms by which adverse effects may be reported or monitored.

Patterns of complementary and alternative medicine use among United States stroke survivors.

BACKGROUND: Americans are increasingly searching for complementary and alternative remedies. Some data suggest that persons who use Complementary and Alternative medicine (CAM) are at a higher risk for interactions with prescription medications. We assessed CAM use among American stroke survivors as little is known about CAM in this population. METHODS: We compared CAM use in adults with and without stroke who participated in the most comprehensive national survey on CAM use to date, the 2002 National Health Interview Survey. Independent predictors of CAM use among stroke survivors were assessed with logistic regression. RESULTS: Of 30,992 adults, 2.6% indicated a history of stroke, with 46% of these stroke survivors reporting CAM use. Acupuncture was the only CAM therapy used more frequently in stroke survivors (OR 1.53, 95% CI=1.07-2.19, p=0.02). In multivariable analyses among stroke survivors, CAM use was more frequent among those who reported delays in seeking medical care due to cost (OR 2.28, 95% CI=1.28-4.07, p=0.005) or those with recent neck pain, (OR 2.28, 95% CI=1.48-3.52, p=0.002) and less frequent among those >65 years (OR 0.54, 95% CI=0.31-0.96, p=0.035), non-Hispanic Blacks (OR 0.57, 95%CI=0.33-1.0, p=0.049), and those with less than high school education (OR 0.33, 95% CI=0.22-0.51, p<0.001). CONCLUSIONS: Approximately half the stroke survivors in the United States engage in some form of CAM therapy, with those reporting delays in seeking medical care due to cost, or recent neck pain being more likely to pursue CAM treatment.

Does use of alternative medicine predict survival from cancer?

This study examines the association between alternative medicines (AM) and cancer survival. A national multicentre study was carried out in Norway in December 1992 to assess the prevalence of AM use among cancer patients. One of the aims of this study was to assess the association between AM and long-time survival. In January 2001, survival data were obtained with a follow-up of 8 years for 515 cancer patients. A total of 112 (22%) assessable patients used AM. During the follow-up period, 350 patients died. Death rates were higher in AM users (79%) than in those who did not use AM (65%). In a Cox regression model adjusted for demographic, disease and treatment factors, the hazard ratio of death for any use of AM compared with no use was 1.30, (95% Confidence Interval (CI) 0.99, 1.70; P=0.056), suggesting that AM use may predict a shorter survival. Sensitivity analyses strengthened the negative association between AM use and survival. AM use had the most detrimental effect in patients with an ECOG (Eastern Cooperative Oncology Group) performance status (PS) of 0 (hazard ratio for use=2.32, 95% CI, 1.44, 3.74, P=0.001), when compared with an ECOG PS of 1 or higher. The use of AM seems to predict a shorter survival from cancer. The effect appears predominantly in patients with a good PS.

The prevalence and effectiveness of complementary and alternative medicine: what has been learned and what it may be telling us about our patients, ourselves, and conventional medical treatment.

Complementary and alternative medicine (CAM) has been popular in numerous countries around the world. The fairly large range of prevalence may be partially due to different definitions of CAM from a variety of researchers, patients, and the general public. Beyond prevalence issues, few studies have specifically explored the reasons for the use of CAM. Studies that have attempted to answer this question have found that issues such as distress and quality of life issues are some partial reasons for its use. Despite the fact that few, if any, CAM therapies have prolonged survival, encouraging future research into potential benefits seems warranted because some CAM therapies have preliminary encouraging results, and overall, CAM therapies are just in need of more randomized trials. Perhaps, at this time, the central focus of studies should revolve around potential improvements in quality of life issues. Some therapies have been found to potentially improve this parameter. However, during the course of certain conventional medical treatments, many CAM therapies, such as dietary supplements, should be discouraged. These could theoretically reduce the oxidative stress caused by effective treatments, such as radiation or chemotherapy, thus reducing their efficacy. Other basic lifestyle changes, such as simple dietary changes and exercise, should be encouraged during the course of treatment because of the potential benefits already demonstrated. In addition, these simple lifestyle changes may improve overall health, which is a serious issue for many patients. The prevalence of CAM should provide a challenge to health care professionals as a call to improve already existing services and communication between patients. Rather than perceiving CAM as a potential hindrance to proper conventional treatment, the reality could be that CAM is providing a unique opportunity and insight to health care professionals on how to make our current system that much better.