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Integrative Medicine: How Best to Evaluate Treatment Efficacy?

Americans are turning to integrative medicine in record numbers (an estimated 71 million people to the tune of $44 billion last year) to replace or complement more mainstream biomedical treatments. And the Bay Area leads the country — Bay Area residents are 25% more likely to use complementary medicine than anywhere else. Yet, as integrative medicine grows in popularity, many are calling for allopathic standards like the evidence-based model and for peer review or scientific validation to be used in evaluating treatment efficacy.

While integrative medicine has been mainstreamed by insurance companies, doctors and consumers alike, recent controversies like the Airborne suit and a study indicating the high level of toxicity in certain herbal remedies has some wondering how best to evaluate the effectiveness of a wide range of integrative treatments.

We’ll also discuss what evidence and or resources consumers should use to inform their integrative medical choices.

Well, it’s been yet another exciting week in the world of CAM.  To begin, Vitamin D has been cited in two separate studies this week.  In the first, the American Academy of Pediatrics has recommended that children, even those whom are still breastfeeding, receive 400 units of Vitamin D per day in order to prevent several serious diseases.  This is double their previous recommendations.  The second Vitamin D discovery, made by researchers at Emory University, found that 55% of Parkinson’s patients were low in Vitamin D.  That said, more research is necessary to determine whether Parkinson’s is affecting Vitamin D absorption or whether the deficiency is affecting the onset or severity of Parkinson’s.

On another front, researchers at the University of Dundee are reevaluating the common practice of prescribing diabetics aspirin as prevention against heart attacks.  According to their findings, whereas aspirin was shown to have no notable benefits, it does cause gastrointestinal bleeding which is one of the most common causes for hospital admission.

Vitamin B-12 got some face-time this week as well.  According to epidemiological studies, low levels of B12 were linked to bone loss in men and women, frailty, and shrinkage of the brain.  More specific trials are needed to verify these findings.

Lastly, research developments in the areas of spinal cord injury treatment and cerebral palsy prevention are of notable significance this week.

To begin, there may be new hope for people suffering from spinal cord injuries or paralysis.  The “brain machine interface” which was created by scientists at the University of Washington, involves the re-routing of motor cortex control signals from the brains into the arm muscles of temporarily paralyzed monkeys.  Although research is still in its early stages, the aim, say researchers, is to develop implantable circuits which will allow for movement without the need for robotics.

Finally, in a recent article published in the New England Journal of Medicine it was found that giving mothers magnesium sulfate during labor cut the risk of their child developing cerebral palsy in half.  Given the disabling nature of cerebral palsy, this comes as wonderful news to expectant mothers at risk.

Contemplating a home yoga practice? View one woman’s experience here:

Given that Americans spent almost $1000 each on spa services in 2005 alone, it’s no surprise that the Huffington Post’s Oasis - a suite of offices magically transformed into a veritable sanctuary for attendees of the Denver Democratic Convention - was teeming with visitors this week.

Offering massages, facials, yoga instruction, healthy vegan food, green smoothies, and some good old fashioned R & R, the Oasis became a home away from home for many of the ever-busy journalists, delegates, and bloggers who have been running about making news, covering news, and writing news.

Said Don Hazen of Alternet.org:

I had a fabulous massage there by Naveena Valley, who along with a bevy of body workers and instructors, was volunteering her time for the cause. I sent Mother Jones’ David Corn for a visit; he got a hand massage and some yoga instruction. We were followed by Timesman David Carr, who got body work.

Among the many well-known (and appreciative) visitors who visited the spot were Katie Couric, Deidre Hall, Darryl Hannah, Larry Brilliant, Barbara Marx Hubbard, Lesley Jane Seymour, and Mr. Bobby Kennedy himself.

On the ICAM front, of course, this is all good news. It looks like yoga, massage, healthy living and the recognition that, even in such a land of drive and determination, health and wellbeing is, in fact, very much worth making time for.

This year’s Olympians are no strangers to alternative medicine. From the funny looking “tattoo” that US volleyball champ, Kerri Walsh, has been sporting on her right shoulder, to the magnificent display of Tai Chi dancers during the opening ceremony, and Yao Ming’s faith in Traditional Chinese Medicine, ICAM is really making headlines.

So what’s the deal anyways? Does it really work? Well apparently it does. Last April, following surgery to repair a stress fracture in his left foot, Houston Rockets center Yao Ming received Traditional Chinese Therapies in order to ensure that he would recover in time to play for the Olympics - I guess the proof is in the pudding; Yao Ming is playing as magnificent as ever.

Similarly, Kerri Walsh, who underwent rotator cuff surgery last November, has been seen wearing kinesio tape during these Olympic trials in order to improve circulation, reduce pain, and support her shoulder. Walsh is not the only proponent; Kinesio taping, first developed in 1973 by a Japanese Chiropractor Dr. Kenzo Kase, has also been used by world class athletes such as Lance Armstrong, Serena Williams, David Beckam, and tennis champion Robby Ginepri.

I suppose it’s no great surprise that ICAM is finally seeing some significant face time. In fact, according to the National Institutes of Health’s latest statistics, over 36 percent of Americans use ICAM every year. Of course, countries such as India and China boast even higher statistical significance as their traditional medical practices (Ayurveda and TCM) are deeply rooted in their cultural habits.

But US Olympians aren’t the only superstars to tout the benefits of alternative medicine. Jennifer Aniston swears by yoga, Oprah by detoxification, and everyone knows that 50 year old Madonna, hot as she is, has been a proponent of the macrobiotic diet for years.

All this is good news for ICAM. It works. People are recognizing the value. Scientific evidence supports it. What more it there to say?

Well it proved to be another exciting week for CAM. To begin, CNN.com covered 5 alternative medicine treatments that have been proven to work. These include acupuncture for pain; calcium, magnesium and vitamin B6 for PMS; glucosamine for joint pain; guided imagery for pain and anxiety; and St. John’s Wort for depression. - On the aside, a number of clinical trials have indicated that St. John’s Wort is actually MORE effective then anti-depressants in the treatment of depression. It also has fewer side effects. Exercise has also been shown to be as effective as anti-depressants in trials, so if you’re feeling down, there are a couple of viable, non-pharmaceutical options for you.

In research: Some interesting discoveries were made in the area of soy and memory. In a preliminary trial performed by researchers at Loughborough University in the UK which studied the effect of both tofu and tempe (both soy-derived products) on memory, high tofu consumption led to a decline in memory whereas, high tempe consumption was found to protect individuals from memory decline. Apparently it’s the phytoestrogens and folate in tempe that proves so effective, so load up on those if you’re beginning to suspect that your memory just isn’t what it used to be.

We also found some good news in the wire for male diabetics that choose to stay fit. According to study performed by researchers at the George Washington University Hospital, it was found that high levels of physical activity in men with type 2 diabetes can reduce the risk of death by up to 40 percent. In addition, physical fitness appears to be more important than weight in estimating a diabetic’s longevity.

In the area of upcoming research, we were happy to discover that the Mount Sinai School of Medicine just received a grant to the tune of $8 million from the National Center for Complementary and Alternative Medicine (NCCAM). The study, which will take place over a span of five years, will focus on the effect of grape-derived compounds in the prevention and onset of Alzheimer’s disease.

Last but not least, being a great lover of the light of day, I was delighted to read that researchers at UC San Diego have found that increasing one’s intake of vitamin D may reduce the risk of breast, colon, and ovarian cancer by up to 50 percent.

My suggestion of the day?: Get your winter-white bodies out into the sun people!! (But don’t forget your sunblock)

CAM has been in the news this week!! To begin, things really got stirred up when the NY Times broke their article about natural options to ADHD (See Charles Hua’s blog on this site for more information on this).

In addition, there has been some really exciting research that bodes well for those of us that prefer not to medicate. One such research study, led by well-known author and researcher Dean Ornish, showed that healthy changes in lifestyle and diet may improve the prognosis for men suffering from prostate cancer. In this study, Ornish found that a healthy diet and exercise regime effectively increased the activity of disease-preventing genes while shutting down disease-promoting genes. These genes are linked to both prostate and breast cancer. The implications of this study, I think, are most promising.

Another study that I think is worth pointing out focused on the use of testosterone gel in the treatment of men with diabetes. According to the results, treatment with this gel not only improved sexual function in these men (always a plus), it also improved insulin-sensitivity which can prevent against cardiovascular and other complications associated with diabetes. The study was performed by researchers at Barnsley Hospital and the University of Sheffield.

Lastly, I was glad to read the latest on coffee in the LA Times. Apparently research from a study which followed over 100,000 people for over 15 years found that women who consume two to three cups of caffeinated coffee a day have a “25% lower risk of death from heart disease” and an “18% lower risk of death caused by something other than heart disease or cancer.” Also interesting is the fact that it doesn’t seem to make any difference at all for men. Sorry guys.

First off, I do not have children. Secondly, if I did, I would never wish upon them A.D.H.D, a disorder that is currently diagnosed in over 4.4 million children in the U.S of which 2.5 million are taking stimulant drugs to curb the symptoms. But if I did have children, and they had A.D.H.D, I would make sure they had every option of treatment available to them, including holistic and integrative therapies.

Tara Parker-Pope of the New York Times writes today on stimulant drugs

“The drugs have been life-changing for many children. But nearly one-third experience worrisome side effects, and a 2001 report in The Canadian Medical Association Journal found that for more than 10 percent, the effects could be severe — including decreased appetite and weight loss, insomnia, abdominal pain and personality changes. Although the drugs are widely viewed as safe, many parents were alarmed when the Food and Drug Administration ordered in 2006 that stimulants like Adderall, Ritalin and Concerta carry warnings of risk for sudden death, heart attacks and hallucinations in some patients.”

This I understand because as a child, I was medically diagnosed with A.D.H.D. After undergoing several trials with stimulant drugs, I decided against using them because of these unfortunate side effects. Think Zach Braff in Garden State on and off the drugs. Hyperbole maybe, but you get the idea. Can conventional treatments be useful and powerful, absolutely, but given the knowledge now available, in retrospect I would have explored other avenues for treatments with potentially less side effects

“While some studies of alternative treatments show promise, there is little solid research to guide parents. That is unfortunate, because for some children, prescription drugs aren’t an option.”

The lack of readily available research on alternative treatments is one of the many problems rVita is trying to solve. By aggregating scientific data from trusted sources and pooling or crowdsourcing efficacy data from real people like you and me, we hope to solve this. Also in connecting people to others suffering through similar circumstances we hope to become a better resource for those looking for alternative treatment - not only for ourselves but also our children. Stay tuned!

rVita released a press release last week, read below for some highlights and additional news coverage.

Santa Clara, CA (PRWEB) May 13, 2008 — What do Steve Young, Madonna, Sheryl Crow, Sir Paul McCartney and 71 million adult Americans have in common? The answer — they are turning to integrative medicine in record numbers (at a cost of $44 billion dollars a year) for help with everything from allergies and insomnia to chronic pain and adjunctive care for cancer. Yet, most Americans cannot easily separate science from snake oil when evaluating alternative therapies – making them susceptible to “trial and error” and scientifically unsupported claims. rVita today unveiled Health 2.0’s first integrative medicine community – designed to give users quick and easy access to tried and true therapies.

Also in Mashable

In the same way that online health sites needed to ensure the quality of their content for user safety, so too does the specific integrated health sector. rVita is an integrated health search engine that combines expert content with user-generated comments for the purpose of separating the signal from the noise, or the true remedy from the snake oil.

Killerstartup

rVita provides a wealth of reputable information about alternative medicines and therapies gathered from trusted practitioners and other reputable sources.

What do you think about rVita?  Let us know!

About a year ago when I was finalizing the rVita business plan, one prominent silicon valley VC asked me (probably to test my knowledge on the subject) - “does a pinch of turmeric with warm milk cure sore throat?” he heard this on one of his conference calls with entrepreneurs in India. Obviously it was clear that my VC friend was having trouble on the con call and they told him a traditional Ayurvedic remedy. My answer was “YES, DEFINITELY”; why? because my mom and grandma swear by it. That’s what kids in India got when I was growing up there - a safe, effective and nutritious therapy passed down from generation to generation. No scientific trials were needed, we knew it just worked. His follow-up question was “where do I buy it?” - More on that later.

My second run in with Turmeric for rVita came a few months ago. When I had mentioned my business idea to another CEO in the Valley, he said “good idea”. He had already been practicing alternative medicine. As it turns out, his wife makes him take turmeric capsules (he had the bottle in his briefcase). Apparently she’s a Dr. Andrew Weil follower and had read on drweil.com that the anti-inflammatory properties of Turmeric prevent skin cancer. Guess golf has its side effects!

Just yesterday, my wife Dr. Shashwati Kale, a family medicine doctor and co-founder of rVita.com got another comment on Turmeric from one of her patients. “If turmeric can prevent Alzheimer’s why are there not any medical trials on this? Why don’t they publish this? Why aren’t Indian pharmaceutical companies packaging it and selling in the US?”

Here’s the background for her comment: Folks see news articles like “Turmeric can prevent Alzheimer’s”, but the article leaves them hanging. The article’s logic goes like this - India has 1/4 the amount of Alzheimer’s cases per capita than the US and Indians eat meals with at least some amount of curry everyday, and turmeric is the main ingredient, so that’s it! Turmeric prevents Alzheimer’s, right? The scientific minded reader is probably going to say “no, no no, not so fast, this doesn’t prove anything; what about other factors genetics, climate, etc.; i.e. there is no causal relationship between eating turmeric and preventing Alzheimer’s”. OK, so we need scientific trials, but don’t hold your breath, efficacy data won’t be available right away for most of these remedies. Why? Because no one has a vested interest in testing a commodity product on a medical condition. No patents, no Billion Dollar (or Euro or Rupee) revenue streams, so no quick controlled Phase III trials. As a result, it’s left to research funded by the government, and non-profits grants to find out whether it “really” works. We know that things move much slower in absence of “pure” profit motivated endeavors. Also, given nature of Alzheimer’s (or cancer for that matter) things will take a long time to prove, but the scientific community IS on it. (See research from UCLA neurology department).

But what about something less serious; sore throat. We think this is where the wisdom of the many can help us. Wouldn’t it be nice if moms and grandmas told us which herbal remedies they know will work based on their backgrounds and cultures? This is the power of rVita; to provide a complete 360 degree view on remedies for various conditions from the scientific, practitioner, and user communities. It may no be a substitute for scientific trials, but we have to ask ourselves if these natural remedies with minimal side effects really need detailed trials for conditions such as a sore throat. Also, we do not necessarily recommend you run to the store and buy supplements. In most cases, it is best to visit an Ayurvedic or Herb clinician who can evaluate you and give you a personalized dose for your condition. This is our goal; to get you educated and get you in touch with Trusted practitioners. In addition, there may not be obvious side effects to natural remedies, but sometimes there can be interactions with conventional medication, so seeing a knowledgeable CAM provider or working with your PCP can eliminate that risk.

At rVita, we believe that consumers need to be empowered to take control of their health. In this vein, we hope to give users the complete picture from the Integrative, complementary, and alternative medicine (ICAM) perspective, as well as provide you with all the tools need to pursue the right path towards better health.

To your Health (Vita)!

Niteen