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Translating CAM Research Results into Clinical Practice
In an initial investigation of the potential for information from CAM research to influence clinical practice, a 2007 national survey asked acupuncturists, naturopaths, internists, and rheumatologists about their awareness of CAM clinical trials, ability to interpret research results, and use of research evidence in decision making. The survey was conducted by researchers affiliated with the National Institutes of Health, the Mayo Clinic, the University of Chicago, Harvard Medical School, and the University of Massachusetts. The survey focused on awareness of two major NCCAM-funded clinical trials that studied acupuncture or glucosamine/chondroitin for osteoarthritis of the knee.
More than half (59%) of the 1,561 respondents were aware of at least one of the two clinical trials, but only 23% were aware of both trials. The acupuncture trial was most familiar to acupuncturists and rheumatologists, the glucosamine/chondroitin trial to internists and rheumatologists. Overall, awareness was greatest among rheumatologists and those practicing in institutional or academic settings.
A majority of respondents said they were "moderately confident" in their ability to interpret research literature; few20% of acupuncturists, 25% of naturo-paths, 17% of internists, and 33% of rheumatologistssaid they were "very confident."
All groups regarded clinical experience as "very important" in their decision making, although CAM providers were more likely to rate it "most important." Physicians were much more likely than CAM providers to consider research results very important or "very useful" in their clinical decision making. CAM providers were more likely than physicians to say that patient preferences were very important. CAM providers were much more likely than physicians to rank research results as "least important," whereas physicians were much more likely to rate patient preferences as least important.
Awareness of CAM clinical trials was greatest among respondents with research experience, confidence in their ability to interpret results, and favorable opinions about the role of research in their practice.
The survey team concluded that CAM research has the potential to make a difference in both conventional and alternative medicine clinical practice. They recommend concerted efforts to better train all clinicians in interpretation and use of evidence from research studies, and to improve the dissemination of research results.
Grape Seed Extract May Help Neurodegenerative Diseases
Tauopathiesa group of neurodegenerative conditions such as Alzheimer's diseasehave been linked to the build-up of "misfolded" tau proteins in the brain. (Tau proteins are associated with microtubules, which help to regulate important cellular processes.) In light of previous studies indicating that grape-derived polyphenols may inhibit protein misfolding, an NCCAM-funded research center at the Mount Sinai School of Medicine recently examined the potential role of a particular grape seed polyphenol extract (GSPE) in preventing and treating tau-associated neurodegenerative disorders.1
The results of their in vitro study showed that GSPE is capable of interfering with the generation of tau protein aggregates and also disassociating preformed aggregates, suggesting that GSPE may affect processes critical to the onset and progression of neurodegeneration and cognitive dysfunctions in tauopathies.
An earlier study by the Mount Sinai researchers found that this GSPE reduced Alzheimer's-type neuropathology and cognitive decline in a mouse model of Alzheimer's disease and inhibited an Alzheimer's-linked process called cerebral amyloid deposition.2 In another recent study, the researchers used a variety of analytical techniques to further clarify how the GSPE affects Alzheimer's-related processes; an important finding was the extract's protective effects against cellular toxicity.3
The researchers concluded that their laboratory findings, together with indications that this GSPE is likely to be safe and well-tolerated in people, support its development and testing as a therapy for Alzheimer's disease.
1. Ho L, et al. Grape seed polyphenolic extract as a potential novel therapeutic agent in tauopathies. J Alzheimer's Dis 2009;16:433-439.
2. Wang J, et al. Grape-derived polyphenolics prevent Aß oligomerization and attenuate cognitive deterioration in a mouse model of Alzheimer's disease. J Neurosci 2008;28;6388-6392.
3. Ono K, et al. Effects of grape seed-derived polyphenols on amyloid ß-protein self-assembly and cytotoxicity. J Biological Chem 2008;238:32176-32187.