Director Argues for Rigorous CAM Research
The first director of the National Center for Complimentary and Alternative Medicine (NCCAM) in Bethesda, MD, has publicly called for rigorous research to evaluate complementary and alternative medicine (CAM) therapies. Stephen E. Straus, MD, and his National Institutes of Health colleagues wrote an article in the Feb. 4 Journal of the American Medical Association addressing ethical issues relating to CAM research.
In recent years, CAM use, as well as research on the safety and efficacy of CAM treatments, has increased dramatically, the researchers say. However, minimal attention has been devoted to the ethical issues relating to CAM research. "We argue that public health and safety demand rigorous research evaluating CAM therapies, research on CAM should adhere to the same ethical requirements for all clinical research, and randomized, placebo-controlled clinical trials should be used for assessing the efficacy of CAM treatments whenever feasible and ethically justifiable. In addition, we explore the legitimacy of providing CAM and conventional therapies that have been demonstrated to be effective only by virtue of the placebo effect."
WHO Issues Guidelines About Medicinal Plant Production and Collection
The World Health Organization (WHO) knows the medicinal plant industry is booming. Now the WHO wants to make sure the products are safe.
The Geneva, Switzerland, organization released guidelines last month for good agricultural and collection practices (GACP) for medicinal plants. The guidelines are intended for national governments to ensure production of herbal medicines is of good quality, safe, sustainable, and poses no threat to either people or the environment.
Some patients are reporting adverse effects caused by the use of herbal medicines, the WHO says. One major cause of adverse events is linked directly to poor quality herbal medicines, including raw medicinal plant materials, and to the wrong identification of plant species. For example, 14 cases of Podophyllum poisoning have been reported from Hong Kong Special Administrative Region of China following the inadvertent use of the roots Podophyllum hexandrum instead of the Gentiana and Clematis species for their antiviral qualities. It is reported that this accidental substitution arose because of the apparent similarity in the morphology of the roots.
Over-harvesting of the raw materials for herbal medicines and other natural health care products also may lead to the extinction of endangered species and the destruction of natural habitats and resources. One example is the wild types of the popular medicinal plant ginseng (Panax ginseng) used to address digestive conditions resulting from nervous disorders. The types currently are reported to be declining rapidly due to increasing demand and collection. Wild American ginseng, goldenseal, echinacea, black cohosh, slippery elm, and kava kava top the "at-risk list" of endangered species of medicinal plants.
The WHO’s guidelines cover many cultivation and collection activities, including site selection, climate and soil considerations, and identification of seeds and plants. Guidance also is given on the main post-harvest operations and includes legal components such as national and regional laws on quality standards, patent status, and benefits sharing.
For a copy of the guidelines, go to www.who.int/medicines/library/trm/medicinalplants/agricultural.shtml.
One-third of CAM Centers Have No Physician Involvement
Twenty-nine percent of complementary and alternative medicine (CAM) programs or centers have a medical director on staff, while 33% have no direct physician involvement, according to the American Hospital Association’s Annual Survey of Hospitals for 2002. Nineteen percent have physicians on staff. Most CAM centers have an average of two full-time employees.
Startup costs for 75% of hospital CAM programs were reported as less than $200,000, while budgeted revenues were under $150,000 for 49% of respondents. Forty percent stated their programs were losing money, while 32% said they were breaking even. Of those programs losing money, 15% indicated that they never expected to break even.
Patient self-pay is the predominant form of payment, survey results found. Nutritional counseling (56%), biofeedback (54%), and chiropractic (49%) were most likely to be covered by third-party reimbursement. Pastoral counseling (52%), music/art therapy (50%), and therapeutic touch (35%) were most often provided at no cost or through philanthropy.
The most popular reasons for offering CAM services were patient demand (83%), reflection of organizational mission (69%), clinical effectiveness (61%), and attracting new patients (58%). Of those hospitals not offering CAM services, 24% (approximately 171 hospitals) stated that they planned to do so in the future, with 27% of those hospitals planning on offering some CAM services within six months to a year.