New book surveys CAM therapies

Townsend Letter for Doctors and Patients, August-Sept, 2006 by Elaine Zablocki

A newly published survey of complementary and alternative medicine (CAM) combines readability with useful details about various forms of CAM. Conversations in CAM: Insights and Perspectives from Leading Practitioners is based on interviews with leading CAM experts on a variety of therapies, including chiropractic, massage therapy, acupuncture, and herbal medicine. Each contributor answers the most commonly asked questions about their particular CAM specialty, including questions on practice, education, and research issues.

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The book's editor, Norma Cuellar, RN, DSN, CCRN, is an assistant professor at the University of Pennsylvania School of Nursing. She is currently doing research on CAM therapies for a sleep disorder called Restless Leg Syndrome, which can be very difficult to treat. Cuellar first became interested in CAM when she did her dissertation on cultural differences among home caregivers in rural Mississippi. "I realized that many of them used different practices based on their cultural backgrounds and traditional folklore. They might use herbs, or massage, or even something like drinking whiskey and lemon juice. They would say to me, 'you know, my grandma used to do this.'"

Then Cuellar was introduced to magnetic therapy; she began to do some work with magnets herself and saw some very interesting results. "These were just case reports, not full research studies, but I did see positive results using magnets for migraine headaches and for arthritis. I published a case study on one young woman with rheumatoid arthritis who used magnetic therapy and was able to stop using steroids and most other medications."

Conversations in CAM: Insights and Perspectives from Leading Practitioners is a valuable resource for anyone seeking an overview of the various CAM therapies. It's written in a question-and-answer format, so the information is easy to absorb. At the same time it offers a fairly detailed discussion of relevant questions for each therapy, including usage, insurance coverage, training, and licensure. The chapters include discussions of homeopathy, naturopathic medicine, biofeedback, yoga, traditional Chinese medicine, and Ayurveda.

In addition, there are several interesting overview chapters. James C. Whorton reviews the history of CAM and the changing relationships between allopathic physicians and CAM practitioners. Cynthia A. Parkman discusses trends in insurance and managed-care coverage for CAM, and the importance of informed consent. Mary Cipriano Silva and James J. Fletcher look at ethical considerations related to CAM practice, including the obligation to do no wrong, to act on behalf of others, and to offer complete, accurate information. Lyn Freeman discusses the traditional cultural roots of various CAM practices: "A cultural healing system is meant to treat the whole person and no 'piece' should be isolated from the rest of the healing components of that system." Freemen supports a team approach in which a patient may be seen by CAM practitioners as well as an MD: "Utilization studies at CAM clearly demonstrate that patients do not pick CAM over conventional care. Rather, they utilize conventional care alongside other forms of treatment.... In our country and in other countries, a new medical 'culture' is evolving, where conventional medicine and unconventional medicine systems must come to terms with each other."

Evidence-Based Research Will Influence CAM Practice

What makes this book particularly interesting is its emphasis on evidence-based practice and on research issues for future CAM studies. This is most evident in the chapter on research, but evidence-based practice is also mentioned frequently in the chapters on various therapies. This increased emphasis on research marks a shift over the past ten years, as research-oriented professionals have become more attuned to CAM and more funding for CAM research has become available.

The chapter on CAM research was written by Edzard Ernst, PhD, MD, FRCP (Edin.). He is a German physician, specializing in physical medicine and rehabilitation, as well as the founder and editor in chief of the medical journal FACT (Focus on Alternative and Complementary Therapies).

Ernst emphasizes the importance of high-quality CAM research. "Those CAM enthusiasts who want to use science to prove the worth of their therapy, and we have plenty of them about, often turn out to be useless when it comes to doing good science," he says. "The only approach is to test, not prove, whether CAM works."

While there are obstacles to CAM research, none of them are insurmountable, he says. CAM therapies are individualized, but so is surgery. Many CAM modalities are physical and cannot be blinded, but this is also true of physiotherapy. Ernst calls for many different research designs to evaluate CAM therapies, including clinical trials, qualitative studies, meta-analyses, cost-and-reimbursement studies, and extensive longitudinal studies with large sample sizes to control for variability. He stresses that "there are no intrinsically good or bad research tools in CAM or in any other research area. There are, however, a lot of bad matches between the research tool and the research question."