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Toward Establishing Guidelines for Evaluating Cognitive Enhancement With Complementary and Alterative Medicines

Solomon, P. R., Michalczuk, D. E. — Wed, 18 Nov 2009 21:30:08 PST

The growing use of complementary and alternative medications (CAM) for cognitive enhancement in both healthy elderly and patients with Alzheimer’s disease (AD) and other dementing disorders has led to rapidly growing literature with conflicting results. There are studies that suggest benefit from CAM in both the healthy elderly and dementing patients as well as studies that suggest no benefit for either group. Because of the lack of regulatory oversight (e.g., Food and Drug Administration [FDA], European Medicines Agency [EMeA]), there are currently no generally accepted guidelines to standardize the types of studies that are conducted. Due to the absence of guidelines that set standards for study design, outcomes, and analysis, it is difficult to compare studies with conflicting results. For example, Ginkgo biloba has been shown both to provide benefit and no benefit on cognition in both healthy elderly and patients with AD. Reconciling these divergent studies has been challenging because both sides often use divergent methodologies and designs and widely varying cognitive measures that may or may not be validated in the populations being studied. In this article, the authors suggest a roadmap for establishing guidelines for the evaluation of CAM in cognition. They then apply these guidelines to the conflicting literature on Ginkgo to determine whether they might help resolve the conflicting results.

A Dutch View of the "Science" of CAM 1986-2003

Renckens, C. N. M. — Wed, 18 Nov 2009 21:30:08 PST

Between 1986 and 2003, research efforts on complementary and alternative medicine (CAM) were subsidized by the Dutch government. This led to 12 academic theses and a considerable number of papers in medical journals. In our review, we have summarized the results of this research, grouped by therapeutic category (that is, acupuncture, paranormal therapies, naturopathy, manual therapies, homeopathy and anthroposophical medicine.) Of the 12 theses, four were written in Dutch, three of which were not subsequently published in peer-reviewed journals, while the fourth, on enzyme therapy, led to a number of papers in Dutch medical journals. In three instances, mildly positive findings were reported: on the efficacy of manual therapies, the use of acupuncture analgesia in surgery, and an elimination diet against migraine and tension headaches. These positive conclusions can easily be explained by methodological shortcomings (e.g., not using credible placebo-control groups); in the other nine theses, the researchers themselves had drawn negative conclusions. The Dutch government ended its financial support for CAM research in 2006.

Advice Offered by Practitioners of Complementary/Alternative Medicine: An Important Ethical Issue

Ernst, E. — Wed, 18 Nov 2009 21:30:07 PST

The current popularity of complementary/alternative medicine (CAM) generates many challenges to medical ethics. The one discussed here is the advice offered by CAM practitioners. Using selected examples, the author tries to demonstrate that some of the advice issued through the popular media or provided by acupuncturists, chiropractors, herbalists, homeopaths, pharmacists, and doctors is misleading or dangerous. This, the author argues, can impinge on the main principle of medical ethics: beneficence, nonmaleficence, and autonomy. We should work toward correcting this deplorable situation.

In the Interest of All Who Value Their Purse and Their Health: A Brief History of the "Vereniging tegen de Kwakzalverij"--Society Against Quackery--of the Netherlands

Renckens, C. N. M. — Wed, 18 Nov 2009 21:30:07 PST

Discontentment with the massive violations of the influential Dutch Prime Minister’s (Johan Rudolf Thorbecke) health laws led to the foundation of the Dutch Society Against Quackery, in 1880. Within a few years, the Society had more than 1,100 members. Initially, quackery mostly consisted of the unauthorized practice of medicine and the peddling of industrially manufactured "secret remedies." Since the 50s however, the energy of the society focused mainly on magnetizers, especially after they gained support from the field of parapsychology, lay manipulators of the back and herb doctors. The most important object of the society since 1980 has been the fight against the so-called alternative medicine, of which Chinese acupuncture, homeopathy, manipulative therapy, anthroposophical medicine, and naturopathy are prominent targets. Despite numerous costly lawsuits, the society still survives and is probably the oldest as well as the largest of its kind in the world.

Are Positive Alternative Medical Therapy Trials Credible? Evidence From Four High-Impact Medical Journals

Bausell, R. B. — Thu, 08 Oct 2009 04:30:37 PDT

Forty-five complementary and alternative medicine (CAM) efficacy randomized controlled trials (RCTs) from high-impact medical journals (NEJM, JAMA, Annals of Internal Medicine, and Archives of Internal Medicine) were reviewed based on their meeting three validity criteria (the existence of a placebo control, moderate attrition rates, and 50 or more participants per group). Of the 26 efficacy trials meeting all three criteria, only 2 (7.7%) were judged to be positive (i.e., the alternative therapy was significantly superior to its placebo control), while over half (55.5%) of the 19 trials that failed to meet one or more of these criteria reported positive results (p < .001). Of the two positive high-validity trials, one was funded and authored by the herbal company marketing the product tested and one used a placebo-control group of questionable credibility. This analysis is consistent with the hypothesis that CAM therapies are no more effective than placebos when adequate experimental control is present.

Clinical Trials of Herbal Treatments

Turner, R. B. — Thu, 08 Oct 2009 04:30:37 PDT

The deregulation of the marketing of dietary supplements with health claims has increased interest in evaluating the clinical effectiveness of these products. Clinical trials of herbal treatments pose challenges of limited preclinical data, lack of product standardization and characterization, and difficulties of blinding, which are substantially different from those in studies of conventional medications. These issues must be recognized and addressed if studies of herbal remedies are to provide useful information.