Finding Reliable Information on Complementary and Alternative Medicine

(CAM)

Elise Cogo, BSc, ND, MLIS

Naturopathic Doctor & Information Specialist

Consultant, Ottawa

Ontario Library Association Super Conference,

February 2011, Toronto

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Complementary and Alternative Medicine (CAM)

• Complementary medicine • Alternative medicine • Integrative medicine • Traditional medicine • (W)holistic medicine • Unconventional medicine

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Types of CAM

• Natural products; and certain dietary therapies

• Energy medicine – e.g., Reiki, magnetic fields, etc.

• Manipulative and body-based practices – e.g., chiropractic, osteopathic manipulation, massage therapy

• Mind-body medicine – e.g., prayer, meditation, yoga, hypnotherapy, Tai Chi

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Types of CAM

• Movement therapies – e.g., Rolfing, pilates, etc.

• Traditional Chinese medicine (TCM) – including acupuncture, etc.

• Naturopathic medicine• Homeopathy• Ayurveda; & other whole medical

systems (Ref: NCCAM).

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Massage Therapy

• Registered Massage Therapy (RMT) is a regulated profession.

• Must have completed a 2-3 year diploma program from a recognized massage therapy school.

• Other forms of massage are not regulated professions.

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Chiropractic

• Doctor of Chiropractic (DC): 4 years post-grad. at recognized school.

• Regulated in all provinces.• Assess for disorders related to the

spine, pelvis, extremity joints, and their effect on the nervous system.

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Naturopathic Medicine

• Combines: botanical medicine, clinical nutrition, hydrotherapy, homeopathy, naturopathic manipulation, traditional Chinese medicine / acupuncture, and prevention and lifestyle counselling.

• Regulated profession in 4 provinces, including Ontario; (+ 1 pending).

• 2 accredited schools in Canada.• Naturopathic Doctor (ND): 4 years post-grad.

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Homeopathic Medicine

• Uses ultra-high dilutions of natural substances.

• Popular system of health care especially in Europe and South Asia.

• Product sale is regulated by Health Canada’s NHPD.

• Not a regulated profession in Canada.

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Traditional Chinese Medicine (TCM) & Acupuncture

• TCM includes acupuncture, traditional Chinese herbal medicine, etc.

• Ontario passed the TCM Act in 2006, to regulate the profession. A Transitional Council is currently establishing the new Regulations and standards.

• Regulated in 4 provinces.

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Some AdditionalCAM Terms

• Qi gong; Feldenkrais method; Trager;• Alexander technique; Therapeutic Touch;• Shaman; curandero; aromatherapy;• Unani medicine; Tibetan medicine;• Bowen technique; flower essences;• Biofeedback; art therapy; macrobiotics;• Shiatsu; reflexology, etc.

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CAM Use

• 20% of Canadians consulted a complementary or alternative health care provider in 2003 (Statistics Canada, 2005).

• 74% of Canadians have used at least one complementary or alternative therapy sometime in their lives (Fraser Institute, 2007).

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CAM Use

• Canadians spent over $5.6 billion out-of-pocket for complementary or alternative therapy treatments in one year (Fraser Institute, 2007).

• 71% of Canadians regularly take NHPs like vitamins and minerals, herbal products, and homeopathic medicines (NHPD: 2005 Ipsos-Reid survey).

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CAM Use

• Functional Foods and Natural Health Products Survey 2007 (Statistics Canada): industry revenue was $3.7 billion.

• 38% of adults use CAM in the USA (2007 National Health Interview Survey).

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CAM Use

• 2007 National Health Interview Survey:http://nccam.nih.gov/news/camstats/2007/camsurvey_fs1.htm

• 18% of American adults had used a non-vitamin/ non-mineral natural product (e.g., fish oil/ omega-3’s, echinacea, etc.) in the past year.

• These products were the most popular form of CAM among both adults and children.

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CAM Use

• Massage therapy use in women in America last year was 25% (American Massage Therapy Association survey 2010).

• 9% of American adults have used chiropractic or osteopathic manipulation (2007 National Health Interview Survey).

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CAM Use

• Mind-Body Practices: 13% of American adults had used deep-breathing exercises, 9% had practiced meditation, and 6% had practiced yoga.

• Progressive relaxation and guided imagery were also among the top 10 CAM therapies for adults (2007 National Health Interview Survey).

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Online CAMConsumer Resources

• NB - the focus of the online sources discussed below is on free access for consumers

• U.S. National Institute of Health’s (NIH) National Center for Complementary and Alternative Medicine (NCCAM)

• Provides many resources• List of Health Topics A-Z is very useful

for consumer health queries

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CAM Resources

• Health Canada’s (HC) Natural Health Products Directorate (NHPD)

• NHPD’s Compendium of Monographs (also available in French) give recommended directions of use for the market approval (licensing) of many products

• Guidance on how to report a product adverse reaction/ side-effect to HC’s MedEffect Canada at: www.healthcanada.gc.ca/medeffect

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Natural Health Products

• Natural health products (NHPs) are a subset of drugs in Canada, vs. “dietary supplements” as foods in USA.

• NHP Regulations under the Food and Drugs Act in Canada, since 2004.

• Natural Product Number (NPN); or DIN-HM (homeopathic).• Vitamins and minerals• Herbal remedies• Homeopathic medicines• Traditional medicines (e.g., TCM) • Probiotics• Other products like amino acids and essential fatty

acids.

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CAM Resources

• NIH’s Office of Dietary Supplements (ODS)• Natural Medicines Comprehensive

Database (NMCD)• MedlinePlus - Herbs & Supplements

(information from NMCD): consumer-friendly website with many products.

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CAM Resources

• NHS Evidence - complementary and alternative medicine specialist collection (formerly a Specialist Library of the UK National Library for Health)

• Provide Annual Evidence Updates of the high-quality types of research on acupuncture and homeopathy

• Also produces some Annual Evidence Updates of CAM for several health conditions

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CAM Resources

• U.S. National Cancer Institute’s (NCI) Office of Cancer Complementary and Alternative Medicine (OCCAM)

• Includes a FAQ webpage and general guidance for cancer patients

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CAM Resources

• The Research Council for Complementary Medicine (RCCM)

• Canadian Interdisciplinary Network Complementary and Alternative Medicine Research (IN-CAM)

• Pediatric Complementary and Alternative Medicine Research and Education Network (PedCAM)

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CAM Resources

• PedCAM website also provides a good list of CAM-specific research databases

• Natural Standard database (subscription)• Alberta CAM Research Network has a

good list of CAM research and professional organizations:http://people.ucalgary.ca/~dllorenz/#professional

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CAM Resources

• The Richard and Hinda Rosenthal Center for Complementary and Alternative Medicine

• Passeport Santé (French)• CARE Program: also provides

evidence-based CAM reviews for several childhood illnesses

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CAM Resources

• CAMline• Provides evidence-based reviews of

products (NHPs) in patient and professional versions

• Provides useful information on CAM professions in Canada

• Has a CAM dictionary

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CAM Resources

• CAM on PubMed (subset search limit)• PubMed’s Dietary Supplement (DS)

subset (search limit)

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CAM Resources

• The Cochrane Collaboration –

list of CM systematic reviews• Center for Integrative Medicine

(University of Maryland)/ Cochrane CAM Field - consumer summaries

• Cochrane CAM Field - glossary of CAM terms

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CAM Resources

• Integrative Health Institute (Mount Royal University) - list of CAM associations

• Board of Directors of Drugless Therapy - Naturopathy (Ontario)

• College of Chiropractors of Ontario• College of Massage Therapists of Ontario• Transitional Council of the College of

Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario

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CAM Resources

• World Health Organization (WHO) Traditional Medicine (TM) Fact Sheet

• Website includes details of the WHO TM global strategy

• Contains list of WHO Collaborating Centres for TM