صفحه 1:
-
طب
“ 2000
صفحه 2:
Complementary and
Alternative Medicine:
Science, Pseudoscience, and
Ethics
Martin Donohoe, MD,
FACP
Karen Adams, MD, FACOG
صفحه 3:
Outline
= What is CAM?
™ Philosophies of CAM and “Western
medicine”
™ Recognizing Quackery, Pseudoscience
and Bogus Discoveries
™ Risks and Benefits of Herbal Remedies
™ Why Herbs are Not Regulated
™ Conclusions and Recommendations
صفحه 4:
What is CAM?
™ Any health care intervention not
offered by traditional “Western”
physicians
-E.g., chiropractic, massage,
acupuncture, homeopathy, distance
healing, therapeutic touch, Reiki
therapy, aromatherapy,
herbs/nutraceuticals
صفحه 5:
CAM
=™ Some are recommended by physicians
for certain conditions or people:
- Chiropractic, massage, acupuncture,
aromatherapy
™ Proven benefit - e.g., acupuncture for
certain types of chronic pain,
chemotherapy-induced nausea and
vomiting; guided imagery to reduce
stress of surgery in children and adults
صفحه 6:
No Such Thing as CAM
™ Good medicine
- 116
- Evidence-Based
- Quality Control
- Peer Reviewed
- Humanistic and Caring
صفحه 7:
No Such Thing as CAM
™ Bad Medicine
- Non-scientific
- Poor or No Quality Control
- Non-Peer Reviewed
- Impersonal, Uncaring
صفحه 8:
CAM is Not Unique
in Its Emphasis on:
=™Humanistic health care
=Empathy and Compassion
=Emphasis on healing the mind
and body / recognizing the
powerful links between the two
صفحه 9:
CAM is Not Unique
in Its Emphasis on:
™Care involving family, friends,
religious practitioners
™Care emphasizing the “whole
patient” or the provider-patient
relationship
صفحه 10:
CAM Versus Western
Medicine
These attributes are the
characteristics of quality
medicine and public health, yet
have been co-opted by the CAM
movement
صفحه 11:
Don’t get scAMmed by CAM
™Some CAM is without benefit,
some harmful
=™Therefore, it is important to
be able to recognize
quackery, pseudoscience and
bogus discoveries
صفحه 12:
How Quackery Harms
™ Economic harm -individual costs
= Direct harm
- Medical - e.g., cyanide toxicity from
laetrile, electrolyte imbalances from
coffee enemas, quadriplegia from
cervical spine manipulations
- Psychological - e.g., unjustified guilt,
distortion of perspective
صفحه 13:
How Quackery Harms
™ Indirect harm:
-E.g., delay in seeking care
™ Harm to Society:
- Perpetuates pseudoscience, puts
other contemporary and future
patients at risk
صفحه 14:
Warning Signs of a Bogus
Scientific Discovery
= The discoverer pitches the claim
directly to the media
= The discoverer says that a powerful
establishment is trying to suppress
تا el
= The scientific effect involved is
always at the very limit of detection
™ Evidence for a discovery is anecdotal
صفحه 15:
Warning Signs of a Bogus
Scientific Discovery
=™The discoverer says a belief is
credible because it has endured
for centuries
™The discoverer has worked in
isolation
=™The discoverer must propose new
laws of nature to explain an
observation
صفحه 16:
Characteristics of
Pseudoscience
= Indifferent to facts
™ Looks only for evidence supporting
۱۷00۲۳۱655
= Indifferent to criteria of valid evidence
™ Relies heavily on subjective validation
™ Depends on arbitrary conventions of
human culture, rather than on
unchanging regularities of nature
صفحه 17:
Characteristics of
Pseudoscience
™ Avoids putting its claims to
meaningful tests
= Often contradictory
™ Deliberately creates mystery where
none exists, sometimes by omitting
important details
™ Does not progress
= Attempts to persuade with rhetoric,
propaganda and misrepresentation
صفحه 18:
Characteristics of
Pseudoscience
™ Appeals to false authority, emotion,
sentiment, or distrust of established facts
™ Extraordinary claims and fantastic theories
™ Often described by an invented vocabulary
of words with ambiguous meanings
™ Relies on anachronistic thinking
™ Appeals to vanity, fear, magical thinking or
desperation
صفحه 19:
Characteristics of
Pseudoscience
™ Relies on anecdotes and testimonials
= Products often claim to be effective
against a wide range of unrelated
diseases
™ Quick, dramatic results promised for
one-time therapies; frequent re-
treatments/maintenance treatments
required for ongoing therapies
=$
صفحه 20:
Characteristics of
Pseudoscience
™ Disclaimers couched in pseudo-
medical jargon
= Claims that “Western Medicine” is
dangerous
™ Practitioners advise, “Don’t trust
your doctor”
صفحه 21:
Characteristics of
Pseudoscience
™Claims of “no side effects”
™ Products claimed to be “natural”
- uSually are not
صفحه 22:
Misconceptions re Cancer
Anglos Latinos عكناقك
Sugar Substitutes 4297 58%
53% 2490 1102 11010 كع5أن81
Microwaves Ovens 229 90
Eating Pork ۷۵ 31%
Eating Spicy Food 8% 15%
Breast Feeding 69 149
Antibiotics 120 306
صفحه 23:
Misconceptions re Cancer
Anglos Latinos
(“fatalismo”)
۱9 ۰ تفت وت 26% 46۹0
(eco Ra لاع 2% ۵
Largely Unpreventable 1806 26%
Uncomfortable to touch CA pt. 8% ۳
3223 -268:3219 :1992 الم جاک بط
صفحه 24:
Ban Dihydrogen Monoxide?
™ lowa junior high school student
science fair project
= 100 adults surveyed at State Fair
صفحه 25:
Would you sign a petition to
ban dihydrogen monoxide?
. It can cause excessive sweating and vomiting
. It is a major component in acid rain
. It can cause severe burns in its gaseous state
. It can kill you if accidentally inhaled
. It contributes to erosion
. It decreases effectiveness of automobile brakes
. It has been found in tumors of terminal cancer
patients
بم رم بن حك صن ته ال
صفحه 26:
Ban Dihydrogen Monoxide?
" C=O LW)
-90 - yes
-8 - “Get away from me kid! | don’t
sign petitions.”
-2 - “Are you kidding - that is
Vc) k=)
صفحه 27:
One Reason Why
Pseudoscientific Beliefs are
Common: Public Education is in
Disarray
™U.S. Schools ranked lowest among
western nations, particularly in
science
= J funding, infrastructure decaying
= 1/4 of U.S. Schools have no library
= 1/4 of schools use textbooks from the
1980s or earlier
صفحه 28:
Herbal Remedies
=™=$17.8 billion on herbs and supplements in
2001
- $58 billion on pharmaceuticals
™12% use herbs in one year (vs. 2.5% in 1990)
™E.g., between 1996 and 1998, 8% of normal-
weight women and 28% of obese women
used non-prescription weight loss products
صفحه 29:
Herbal Remedies -
Disclaimer
= More than % of current prescription and OTC
medications come from plant products
- Many herbs, in pure form, may be
beneficial
- Studies poor, no incentives for industry to
rigorously investigate
™ Less than 0.5% of the world’s vanishing
tropical plant species have been investigated
for their medicinal qualities
صفحه 30:
What is All Natural?
= “Natural” means eating a
balanced diet, favoring organic,
local foods, and protecting the
environment
صفحه 31:
Gauging Risks Of Herbal
Remedies
™FDA: Manufacturer may claim that the
product affects the structure or
function of the body, as long as there
is no claim of effectiveness for the
prevention or treatment of a specific
disease, and provided there is a
disclaimer informing the user that the
FDA has not evaluated the agents
= Multiple violations / near violations
صفحه 32:
Why Herbs Are Not Regulated
By The FDA
™1974: (Senator William
“Golden Fleece Award”)
Proxmire Amendment:
-“Nutritional supplements
are not drugs”
صفحه 33:
Why Herbs Are Not Regulated
By The FDA
= 1994: Dietary Supplement Health and
Education Act
-supplements excluded from purity,
composition, effectiveness and safety review
-supported by Orrin Hatch (R-Utah), recipient
(oli ۹4 000 from pharm and nutraceutical
ind. in 2000, more than any other Senator;
Utah home to more herbal/nutraceutical
companies than any other state
= Established Office of Dietary Supplements
صفحه 34:
FDA Oversight
™2100 scientists in 40 labs
™1100 investigators and inspectors
-Monitor and inspect 95,000 businesses
-Visit >15,000 facilities per year
-Collect 80,000 domestic and imported
product samples for label checks
صفحه 35:
Risks of Herbal
Remedies
™Products unregulated/untested
™Variable
- collection
- processing
- storage
- naming
7
صفحه 36:
Risks of Herbal Remedies
=™Adulterants and contaminants include:
-Botanicals - e.g., digitalis, belladonna
-Microorganisms - Staph aureus, E coli,
Salmonella, Shigella, Pseudomonas
-Microbial toxins - aflatoxins, bacterial
endotoxins
-Pesticides
صفحه 37:
Risks of Herbal Remedies
™ Adulterants and contaminants include:
- Fumigation agents
- Toxic metals - lead, cadmium, mercury,
علاوت ول
- Drugs - analgesics and anti-inflammatories,
corticosteroids, benzodiazepines, warfarin,
fenfluramine, sildenafil
™ 1998: 32% of Asian patent medicines sold
in the US contained undeclared
pharmaceuticals or heavy metals
صفحه 38:
Risks of Herbal And
“Naturopathic” Remedies
™Est. less than 1% of adverse reactions
reported to FDA (vs. 10% est. for prescription
drugs)
™ 19,468 adverse events reports to poison
control centers in 1998, vs. 500 to FDA
™ Potential toxicities: cardiac, CNS, liver, kidney
صفحه 39:
High Risk Users of
“Naturopathic” Remedies
™Elderly, pregnant and nursing
women, infants
™Poor overall health status
™Chronic users, prescription drug
users
صفحه 40:
Risks of Herbal Remedies
=™Dietary supplements containing
ephedrine, caffeine
-HTN, MI, CVA, psychosis,
seizures
=™=Chapparal, germander, comfrey,
skullcap, sassafras
-Hepatotoxic, carcinogenic
صفحه 41:
Risks of Herbal and
“Naturopathic” Remedies
™ GE-L- 2 =) ا Myalgia
Syndrome (1989): 5,000 in US affected, 37
deaths, 1500 permanently disabled
™ Ephedra - heart attacks, dysrhythmias,
strokes and seizures
™ Garlic, gingko, and ginseng - bleeding
™ Ginseng - hypoglycemia
صفحه 42:
Risks of Herbal and
“Naturopathic” Remedies
™Kava and valerian - potentiation of
anesthetic effects
™St. John’s wort - increased
metabolism of many drugs
- LCyA effectiveness > transplant
2269و
صفحه 43:
Conclusions
= CAM is widespread: some may be
ات۱
™ Caveat emptor - know how to
recognize quackery and pseudoscience
= Do not confuse or conflate CAM with
humanistic / integrative / whole person
care
صفحه 44:
Conclusions
= Traditional medicine is not
immune from bad science,
misleading advertisements,
excessive corporate influence,
corruption and support of some
therapies offering limited benefit.
صفحه 45:
Conclusions
™ Medical education and training
curricula should include greater
emphasis on professionalism, ethics,
the humanities, public health, social
justice, communication skills, legal
issues, and cultural and religious
understanding and sensitivity
صفحه 46:
Conclusions
= Visit lengths, which have become
shorter in the face of financial
pressures, need to be increased to
allow more time for the development
of rapport between doctor and
patient, comprehensive screening,
accurate diagnosis, and patient
counseling and education
صفحه 47:
صفحه 48:
The National Center for CAM
= Established 1998, 7 yrs. after its
predecessor (Office of Alternative
Medicine)
- Annual budget = $110 million/yr
™ Role of lowa Senator Tom Harkin,
Chairman/Ranking Member of Labor,
Health and Human Services and
Education Subcommittees - “held
entire NIH budget hostage”
صفحه 49:
NCCAM
™ Board populated with discredited,
fringe practitioners
™ Culture of fear among academics
needing funding and universities
establishing “Centers of Alternative
Medicine” to not anger NCCAM and
۱0299 ملكا
صفحه 50:
Unethical NCCAM Studies
™ Fringe studies of discredited and
highly implausible techniques exploit
patients and deplete health care
resources
- Homeopathy
- psychic healing
- therapeutic touch
صفحه 51:
Unethical NCCAM Studies
™ Dangerous studies with inadequate
informed consent forms
™E.g., decreased effectiveness of
protease inhibitors not mentioned
- St John’s Wort for HIV
- Garlic for hyperlipidemia due to HAART
treatment for HIV
صفحه 52:
NCCAM
™ After 10 years and $200 million,
NCCAM-sponsored research has not
demonstrated efficacy for any CAM
method, nor has the Center informed
the public that any method is useless
or harmful
صفحه 53:
Reference
™ Adams KE, Cohen MH, Eisenberg DA,
Jonsen AR. Ethical considerations of
complementary and alternative
medicine in conventional medical
settings. Annals of Internal Medicine,
October 2002; 137:660-664.
صفحه 54:
Contact Information
Public Health and Social Justice
Website
http://www.phsj.org
martindonohoe@phsj.org
