Tabrah, F L

eVols at University of Hawaii at Manoa

Is There Any Evidence?Frank L. Tabrah. MDProfessor of Physiology and Emeritus Professor of Community Health, John A. Burns School ofMedicine, University of Hawaii at Manoa: Medical Affairs Department, Straub Clinic & HospitalAlternative and complementary medicine untilrecently lay outside standard medical schooltraining and hospial practice Semantically.alternative medicine is used “instead of andcomplementary medicme “in addition to.” TheAmerican Board of Medical Specialties recognizes 24 allopathic or “standard” medical caredisciplines such as Obstetrics and Gynecology,Pediatrics. General Surgery. Dermatology, andFamily Practice.Allopathic practitioners and basic science workers have tried tosystematically record treatment outcomes since the time of the earlyEgyptians and Greeks. Treatment results are published, workingwith these critically important scientific precepts:• Observe carefull• Form a theory that fits known facts• Set up trial or experiment with controls• Examine results statistically• Draw conclusions only from evidence• Correlate theory with results• Apply findings clinicallyMuch standard medical care in use today is based on clinical trialsreported in quality specialty ournal. the information carefullyreviewed by recognized experts in teaching centers, whose concernwith controls and pmof of treatment effectiveness arises directly outof these fundamental rules of science.The National Institutes of Health recognizes seven main classes ofalternative and complementary care:• Manual healing• Alternative systems• Bioelectric methods• Diet, nutrition, and lifest Ic changes• Herbal Medicine• Mind/Body Control• Pharmacologic and Biologic treatmentsand some 65 subsets of systems of care. of v hich these are a fe\• Acupuncture• Chiropractic• Lifestyle changes• Diet• Homeopathic Medicine• Cultural Practices• Chelation TherapyOur title. “Is There Any Evidence” tacitly invites a comparison oftherapeutic value between standard care and these other stems.For standard care, we can safely say’ yes, there is evidence, secure inthe worldwide application of the research principles noted above,.\sking the same question for alternative and complemcntarmedicine, we do not often find comparable controlled studies.agreement with long established physical and chemical facts. orconsistent results among many observers Strong psychosomaticeffects are rarely ruled out, when clinical studies are done at all, So,for a large number of our +/- 65 modes of alternative and complementary medicine outlined by the National Institutes of Health. thisrepl\ is “perhaps.” because of the sparsity of controlled researchith statistical validit . There lies ahead a long and controversialroad on which to test the myriad of treatments involved. Seeminglyoutrageous claims must be weighed against known basic science.and conclusions must be equally free of cultural bias and academicrigidity, NIH funding will accomplish some of these aims: only ifobjectivity prevails.A question—if alternatixe and complementary medicine systemsand medications are so controversial. why their incredible popularity’. costing about 27 billion dollars a year—more than all hospitalizations combined, with nearly 5O7 of patients seeking out non-conventional cures. Here are some of the reasons:3• Anecdotal accounts of success• Non-threatening care• Cultural “tugs”• Avoidance of costly, unpleasant tests• Defiance of “big science”• Lower cost• Faith is “easier” than scientific jargon• Compassionate practitioners.\ few cautions are advisable for those venturing into personalalternative or complementary care:• Try to have a firm diagnosis first• Beware of’ self—diagnosis and treatment• Try to understand the difference between true clinical studiesand sales pitches• Remember. much internet information is nonsenseAnd a warning on herhs:Avoid: GermanderChaparralComfrey’SkullcapExcessive vitamin dosagesSince much of the outstanding success of alternative and complementary medicine is clearly ps cliosomatic--that Is. siigestic andfaith—based. we should value these systems 6w what they really are.that they are systems of highly skilled interventional ps\chiatrv. andthat they do not need to rely’ on descriptions of imaginary force259fields, auras. and other concepts which defy known physical andbiochemical facts.Two examples: one, the use of small magnets near the hock forpain—we have done some controlled experiments on this, and as withprevious studies by others, find no effects, although one studyclaims relief of post polio pain. Therapeutic interaction with staticmagnetic fields is extremely unlikely, considering the vast energydifference of one billionth to one between an\ possible inductioneffects in tissues and normal thermal molecular activity.Similarl\ . the claims for Kirlian photography showing an auraaround people. plants. and animals are truly hizarre-in our lab weshowed changing “auras” with Kirlian equipment—around nickels,dimes, paper clips, and dead insects by varying the film, pressure.and current used.In considering alternative and complementar\ medicine, perhapswe should simply avoid the question “is there an’ evidence.” and sathat even if there isn’t an physically, or very little, that if patientssay they are improved or cured and no harm is done. why not goahead and use an\ thing that appears to work’? Two questions loom—first, safety, and second. who is going to pay for it’?In the real world, these questions are the thrust of toda’ s intensiveresearch. While much of value may lie undiscovered or unexplained.rationality is a must. As a British author said. “beware ot passinsthrough the gates of knowledge into the fields of fancy.”ReferencesNW OFhce of Alternatue Medscne Ceauoa douse, Mar ‘992. NCCAM Oearing Høuse. AvaaMe at: htto:I.’ncoam,nlluopw. Accessed Oct 2000.3. Austinj, Why Pahents UseAfternahue MedUde, Resuitsot Naticna Study. JAMA. I 998;279(191:I 5404. Onopa J. CompAmentary and Ahernahve Meddine (CAMI: A Reulew for the Phmary Care Phys Wan,HMJ. 1999:58:99...............S..D.L.UTI..Dt.9...S THAT SAVEEYDigital imaging of your documents is the advanced technologythat will save your practice time and money.fd Indexing of docunents provide digital search and retrieval capabilitiesImmediate access to patient filesIJ Quick and easy file sharing with other physiciansSYNTERATI. NI.E....... &.......... N1...D......NIJ? Affordable and cost effective0 Rapid turnaround260

Is there any evidence?

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Is there any evidence?

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