BACKGROUND: The increasing popularity of complementary and alternative medicines in Canada has led to regulatory reforms in Ontario and British Columbia. Yet the evidence for efficacy of these therapies is still a source of debate. Those who are supportive of naturopathic medicine often support the field by claiming that the naturopathic treatments are supported by science and scientific research. METHODS: To compare provinces that are regulated and unregulated, we examined the websites of 53 naturopathic clinics in Alberta and British Columbia to gain a sense of the degree to which the services advertised by naturopaths are science based. RESULTS: There were very few differences between the provinces in terms of the types of services offered and conditions treated. Many of the most common treatments--such as homeopathy, chelation and colon cleanses--are viewed by the scientific community to be of questionable value and have no scientific evidence of efficacy beyond placebo. CONCLUSIONS: A review of the therapies advertised on the websites of clinics offering naturopathic treatments does not support the proposition that naturopathic medicine is a science and evidence-based practice.

Allergy Asthma Clin Immunol. 2011 Sep 15;7:14. Caulfield T, Rachul C. Health Law and Science Policy Group, University of Alberta, Edmonton, Canada. tcaulfld@law.ualberta.ca.

BACKGROUND: complementary and alternative medicine (CAM) use is common among breast cancer patients. Several CAM therapies may have negative side effects or interact with conventional therapies. We studied biologically based CAM use with and without vitamins/minerals in relation to patient and tumor characteristics as well as treatment in an ongoing prospective cohort of 855 primary breast cancer patients. METHODS: patients from two hospitals in southern Sweden were included. Pre-operative and follow-up questionnaires containing questions on food intake, lifestyle, and concomitant medications, including natural remedies, were completed up to five years postoperatively. Clinical information was obtained from clinical records and tumor characteristics from pathology reports.

RESULTS: CAM and/or vitamins/minerals were used by 34.2% pre-operatively and by 57.9% during at least one visit. Over 100 different preparations were reported. At least eight of the commonly used preparations may interact with conventional breast cancer therapies. CAM users more often had a BMI <25 kg/m(2) (OR 1.76; 95%CI 1.33-2.33), were more often nulliparous (OR 1.59; 1.08-2.34), alcohol (OR 2.13; 1.44-3.14), antidepressants (OR 1.48; 1.02-2.15), and hormone therapy users (OR 1.57; 1.18-2.07), less often smokers (OR 0.71; 0.50-0.99), and consumed less coffee (OR 0.88; 0.82-0.95) than non CAM users. Tumor characteristics were not associated with CAM use. CAM use was more common among tamoxifen (OR 1.32; 1.00-1.75) and less common among chemotherapy (OR 0.63; 0.42-0.92) treated patients. Vitamins/minerals use was more common in aromatase inhibitor treated patients (OR 1.84; 1.33-2.53). There was no significant association between short-term disease-free survival and CAM use.

CONCLUSION: CAM use was common and associated with certain patient characteristics. CAM use may cause clinically significant drug interactions and it is therefore of clinical interest to identify potential CAM users.

Acta Oncol. 2011 Jan;50(1):134-43. Epub 2010 May 25. Hietala M, Henningson M, Ingvar C, Jönsson PE, Rose C, Jernström H. Department of Oncology, Clinical Sciences, Lund University, Sweden.

Full Title: Integration of complementary and alternative medicine into medical schools in Austria, Germany and Switzerland - Results of a cross-sectional study.

BACKGROUND: The results of a survey of decision makers (directors of clinical departments, along with research and education institutes) at German medical schools in 1997 demonstrated that although most respondents were in favour of integrating complementary and alternative medicine (CAM) into medical school curricula, only a minority had implemented these into their medical schools. The aims of this study were to evaluate the current opinions on CAM from decision makers at medical schools in three German-speaking countries and the present extent to which it has been integrated. METHODS: In 2004 we sent a standardised questionnaire to 1,017 department directors at medical schools in Austria (A, n = 75), Germany (G, n = 873) and Switzerland (CH, n = 69). RESULTS: 487 questionnaires (overall response rate: 48%, country-specific response rate: A 39%; G 49%; S 42%) were returned. 40% of respondents had a positive opinion on CAM, whereas 28% had a neutral and 29% a negative opinion and 3% were unsure with a significant difference between Germany (44% positive opinion) in favour for CAM vs. Switzerland (22%; p = 0,021). The CAM therapies rated most positively were acupuncture (53%), osteopathy (52%) and naturopathy (38%) with no statistical differences between the countries. Naturopathy (39%) and herbal medicine (34%) were viewed more positively in Germany compared to Austria (4%, p = 0.001 and 8%, p = 0.01), but not to Switzerland (27%, p = 0.289 and 24%, p = 0.353). The majority of respondents favoured the integration of CAM into the medical system (research 85%, teaching 84% and treatment 60%). However, only 162 respondents (34%) indicated that CAM therapies had already been integrated into the curriculum at their medical schools (treatment 26%, research 19% and education 18%) with no significant differences between the countries. Respondents of Switzerland indicated lower activity of CAM integration (treatment 10% and research 10%) compared to Austria (28%, p = 0.016 and 28%, p = 0.016) and Germany (27%, p = 0.01 and 20%, p = 0.174). CONCLUSIONS: The majority of respondents favoured the integration of CAM into the medical system. However, this integration remains limited and does not reflect the high usage of CAM in the population.

Wien Med Wochenschr. 2010 Nov 16. Brinkhaus B, Witt CM, Jena S, Bockelbrink A, Ortiz M, Willich SN. Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin, Germany, benno.brinkhaus@charite.de.

Some environmental toxins like DDT and other chlorinated compounds accumulate in the body because of their fat-soluble nature. Other compounds do not stay long in the body, but still cause toxic effects during the time they are present. For serious health problems to arise, exposure to these rapidly-clearing compounds must occur on a daily basis. Two such classes of compounds are the phthalate plasticizers and parabens, both of which are used in many personal care products, some medications, and even foods and food preservation. The phthalates are commonly found in foods and household dust. Even though they have relatively short half-lives in humans, phthalates have been associated with a number of serious health problems, including infertility, testicular dysgenesis, obesity, asthma, and allergies, as well as leiomyomas and breast cancer. Parabens, which can be dermally absorbed, are present in many cosmetic products, including antiperspirants. Their estrogenicity and tissue presence are a cause for concern regarding breast cancer. Fortunately, these compounds are relatively easy to avoid and such steps can result in dramatic reductions of urinary levels of these compounds.

Altern Med Rev. 2010 Sep;15(3):190-6. Crinnion WJ. Environmental Medicine, Southwest College of Naturopathic Medicine, Tempe, AZ, USA. w.crinnion@scnm.edu

AIM: The primary aim was to study the effect of naturopathy and yoga interventions in treatment of mild to moderate hypertension. DESIGN: The variables of interest were measured at the beginning and end of the intervention using a pre-post design. SETTING: The study was conducted by INYS medical research society in Jindal Nature Cure Institute, Bangalore. SUBJECTS: A total of 104 subjects, already diagnosed with mild to moderate hypertension and on treatment with antihypertensive medicines were included in study. INTERVENTIONS: The intervention consisted of various inpatient administration of different naturopathy treatments, yoga therapies, low calorie and low sodium diet for 21 days. Antihypertensive medicines were withdrawn for some patients in one week based upon response to the treatment. OUTCOME MEASURES: The outcome measures were values of diastolic and systolic blood pressure and body weight. Subjects were followed for a period of one year after every 3 months. RESULTS: After starting nonpharmacological approach of naturopathy and yoga, Systolic blood pressure came down from mean of 139.6 to 129.6 where as it came down from 91.2 to 86.1 for diastolic blood pressure. At the same time favorable effect was also seen in other variables like lipid profile and body weight. At the end of one year out of 57 patients who came for follow-up, 14 cases were found to have blood pressure within normal ranges without any medication over the previous 12 months. CONCLUSION: Naturopathy and yoga therapy can be considered as a valuable nonpharmacoloical approach in treatment of hypertension.

Complement Ther Clin Pract. 2011 Feb;17(1):9-12. Murthy SN, Rao NS, Nandkumar B, Kadam A. INYS Medical Research Society, Jindal Naturecure Institute, Jindal Nagar, Bangalore 560073, India.

Even in the palliative context complementary therapy has a high value for patients and their relatives. In contrast to the methods of conventional medicine naturopathy as a holistic system has positive meanings for patients and their family. Complementary medicine in the palliative setting can be used as a supportive therapy in carefully selected cases. Doctors and patients should be careful regarding effect and side effects and should make sure that supportive therapy is given adequately and in effective doses. Complementary therapy should not be used in order to avoid the question of life and death. An adequate approach to the topic is mandatory, which acknowledges the needs of patients but also looks for their safety. Patients following alternative therapies sometimes neglect helpful therapeutic options. Carefully providing information on these therapies is mandatory. Physicians should avoid losing patients' confidence in their competence and attention in their final course of disease. Also in palliative medicine a sensitive approach to the topic of complementary medicine is mandatory, which accounts for the eligible wishes of patients and their relatives but puts the patients safety first.

Internist (Berl). 2010 Dec 24. [Article in German] Hübner J, Stoll C. Palliativmedizin, supportive und komplementäre Onkologie, Universitäres Centrum für Tumorerkrankungen, Klinikum der J.W. Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60595, Frankfurt am Main, Deutschland, Jutta.Huebner@kgu.de.

Naturopathy is a distinct type of primary care medicine that blends age-old healing traditions with scientific advances and current research. Naturopathy is guided by a unique set of principles that recognize the body's innate healing capacity, emphasize disease prevention, and encourage individual responsibility to obtain optimal health. Naturopathic treatment modalities include diet and clinical nutrition, behavioral change, hydrotherapy, homeopathy, botanical medicine, physical medicine, pharmaceuticals, and minor surgery. Naturopathic physicians (NDs) are trained as primary care physicians in 4-year, accredited doctoral-level naturopathic medical schools. At present, there are 15 US states, 2 US territories, and several provinces in Canada, Australia, and New Zealand that recognize licensure for NDs.

Fleming SA, Gutknecht NC. Prim Care. 2010 Mar;37(1):119-36. Department of Family Medicine, University of Wisconsin-Madison, 1100 Delaplaine Court Madison, WI 53715-1896, USA. sara.fleming@fammed.wisc.edu

Full Title Teaching research literacy: a model faculty development program at Oregon College of Oriental Medicine.

Content on integrative healthcare and complementary and alternative medicine is being taught in hundreds of educational programs across the country. Nursing, medical, osteopathic, chiropractic, acupuncture, naturopathic, and other programs are finding creative and innovative ways to include these approaches in new models of education and practice. This column spotlights such innovations in integrative healthcare and CAM education and presents readers with specific educational interventions they can adapt into new or ongoing educational efforts at their institution or programs. We invite readers to submit brief descriptions of efforts in their institutions that reflect the creativity, diversity, and interdisciplinary nature of the field. Please submit to Dr Sierpina at vssierpi@utmb.edu or Dr Kreitzer at kreit003@umn.edu. Submissions should be no more than 500 to 1,500 words. Please include any Web site or other resource that is relevant, as well as contact information.

Kreitzer MJ, Sierpina V, Fleishman S. Explore (NY). 2010 Mar-Apr;6(2):112-4.

Cancer diseases demand diagnostic and therapeutic measures with proven quality, safety and efficacy. Bases for evaluation of new clinical and therapeutic measures are clinical studies representing level I (randomised controlled trials [RCTs]) or level II (epidemiological cohort studies), in accordance with recommendations of the Centre for Evidence-Based Medicine, University of Oxford, UK. Evidence-based treatment of cancer follows recommendations of international expert panels and includes indication-based surgery, chemotherapy, radiotherapy, hormone and antibody therapy. These therapies have all proven their potency to destroy cancer and their curative feasibility. This review provides an overview of some of the complementary therapies that are also recommended to support and optimise the standard evidence based cancer treatments.

Beuth J. Anticancer Res. 2010 May;30(5):1767-71. Institute of Naturopathy, University of Cologne, Cologne, Germany. hans.beuth@uk-koeln.de

FOR IMMEDIATE RELEASE

Full Headline: Women Sufferers of the Incurable Fibromyalgia Syndrome Targeted in a New Program Developed by The International Hypnosis Research Institute Founder

Anniston, Alabama. (October 21, 2010) - The International Hypnosis Research Institute announced its approval of a nine-week hypnotherapy program specifically designed to achieve symptom reduction for the over 5 million women in the United States who suffer from the incurable Fibromyalgia Syndrome (FMS). The program was authored and produced by Tim Brunson, PhD, the Institute's Executive Director and founder. He is a leading authority on complementary health care issues.

[More]

Full Title 'Becoming accepted': The complementary and alternative medicine practitioners' response to the uptake and practice of traditional medicine therapies by the mainstream health sector.

This Australian study sought to understand how practitioners of the traditional systems of what is now termed complementary and alternative medicine (CAM) are responding to the adoption of their traditional medicine therapies by the mainstream health care system, and the practice of these therapies by mainstream health care practitioners. A grounded theory approach was used for this study. In-depth interviews were conducted with 19 participants who were non-mainstream practitioners from five traditional systems of medicine - Traditional Chinese Medicine,Ayurveda, Naturopathy, Homeopathy and Western Herbal Medicine. Four main conceptual categories were identified: Losing Control of the CAM Occupational Domain (the participants' main concern); Personal Positioning; Professional Positioning (the core category); and Legitimacy.These categories formed the elements of the substantive theory of 'becoming accepted' as a legitimate health care provider in the mainstream health system, which explained the basic social process that the study's participants were using to resolve their main concern.

Wiese M, Oster C. Health (London). 2010 Jul;14(4):415-33. Flinders University, Australia. marlenewiese@bigpond.com

Full Title Multifactorial lifestyle interventions in the primary and secondary prevention of cardiovascular disease and type 2 diabetes mellitus--a systematic review of randomized controlled trials.

This systematic review aims to summarize the available randomized trials of multifactorial lifestyle interventions in the primary and secondary prevention of coronary heart disease and type 2 diabetes mellitus. Randomized trials investigating the effects of lifestyle interventions including the elements of diet, physical activity, and stress management in people at increased risk for or with manifest coronary heart disease or type 2 diabetes mellitus were searched for in five electronic database and by citation tracking. Quality was assessed using the Cochrane Collaboration's risk of bias tool. Exploratory effect size calculations were performed for a variety of laboratory and clinical outcome measures. Twenty-five trials including a total of 7,703 participants met the inclusion criteria. Fifteen trials were in patients with coronary heart disease, seven in patients with type 2 diabetes mellitus, and three on primary prevention. The interventions varied greatly regarding concept, intensity, and providers. Compared to participants in "usual care" control groups, there were no consistent effects on lipid levels and blood pressure and small effects on body mass index and glycated hemoglobin (HbA1c). Composite cardiac event rates were significantly less in the intervention groups of the few trials reporting these outcomes. Mortality was also lower in the intervention groups, but the difference was not statistically significant, and confidence intervals were wide. The evidence base for multifactorial lifestyle interventions is weak. Effects on surrogate measures seem minor, but there may be clinically relevant effects on major clinical endpoints.

Angermayr L, Melchart D, Linde K. Ann Behav Med. 2010 Aug;40(1):49-64. Competence Centre of Complementary Medicine and Naturopathy, Technische Universität München, Kaiserstr 9, 80801, Munich, Germany. Lucia.Angermayr@mnet-online.de

Full Title The CDC fourth national report on human exposure to environmental chemicals: what it tells us about our toxic burden and how it assist environmental medicine physicians.

The Centers for Disease Control (CDC) conducts ongoing assessments of the levels of environmental chemicals in the U.S. population. This ongoing study utilizes lab samples from the individuals who are part of the National Health and Nutrition Examination Survey (NHANES). The NHANES samples from the years 1999-2000, 2001-2002, and 2003-2004 (each representing about 2,400 individuals) were used for the CDC's national reports. In the CDC Fourth National Report on Human Exposure to Environmental Chemicals ("the fourth report") complete data from the above sample years were included. Each year additional chemicals are measured; the fourth report contains information on 75 previously untested compounds, for a total of 212 compounds measured. In the fourth report, blood and urinary levels of eight different forms of arsenic are reported. The fourth report, for the first time, also includes levels of solvents (30 different compounds) and provides adult rather than juvenile values for mercury. In the majority of individuals tested, acrylamides, cotinine, trihalomethanes, bisphenol A, phthalates, chlorinated pesticides, triclosan, organophosphate pesticides, pyrethroids, heavy metals, aromatic hydrocarbons, polybrominated diphenyl ethers, benzophenone from sunblock, perfluorocarbons from non-stick coatings, and a host of polychlorinated biphenyls and solvents were found. This review provides many of the ranges for xenobiotic toxins so a clinician can identify a patient's current exposure and toxic load compared to the national averages and monitor the effectiveness of prescribed treatments.

Crinnion WJ. Altern Med Rev. 2010 Jul;15(2):101-9. Environmental Medicine, Southwest College of Naturopathic Medicine, Tempe AZ, USA. w.crinnion@scnm.edu

by Blanc Greenberg, ND

The molecules in the body are constantly recreating. We can clearly comprehend this when we analyze the organ of the skin and how the layers of cells are constantly in motion of reproduction and rejuvenation. Intellectually, though, we do not always apply this fundamental truth to the rest of the structure --specifically when it deals with illness and/or disharmony in the body or the mind.

[More]

OBJECTIVE: To determine the cost-effectiveness of naturopathic care (acupuncture, relaxation exercises, exercise and dietary advice, and a back care booklet) compared to standardized physiotherapy education and a back care booklet (control treatment) for low back pain in a sample (N = 70) of warehouse workers. DESIGN: Economic evaluation based upon the results of a pragmatic randomized controlled trial to determine the cost-effectiveness of naturopathic care to society as a whole, to the employer, and to participants. RESULTS: Naturopathic care (as compared to the control treatment) significantly improved quality-adjusted life-years over the 6-month study period (3-month intervention period and 3-month follow-up period) by 0.0256 (95% CI: 0.0075, 0.0437)--roughly equivalent to 9.4 "perfect health" days. Naturopathic care also significantly reduced societal costs by $1212 per participant. From the perspective of the employer, the intervention cost $154 per absentee day avoided (compared to employer costs of lost productivity of $172 per day) and had a return on investment of 7.9% under the healthcare coverage limits set by this employer and assuming the employer paid the full cost of naturopathic care. Participants experienced savings in adjunctive care of $1096 per participant. CONCLUSIONS: This economic evaluation alongside a pragmatic randomized control trial shows naturopathic care to be more cost-effective than a standardized physiotherapy education regimen in the treatment of chronic low back pain. Further studies of the economic impact of naturopathic medicine are warranted.

Herman PM, Szczurko O, Cooley K, Mills EJ. Department of Psychology, University of Arizona, Tucson, Arizona, USA. Altern Ther Health Med. 2008 Mar-Apr;14(2):32-9.

Past few decades have witnessed explosion of knowledge in almost every field. This has resulted not only in the advancement of the subjects in particular but also have influenced the growth of various allied subjects. The present paper explains about the advancement of science through efforts made in specific areas and also through discoveries in different allied fields having an indirect influence upon the subject in proper. In Naturopathy this seems that though nothing particular is added to the basic thoughts or fundamental principles of the subject yet the entire treatment understanding is revolutionised under the influence of scientific discoveries of past few decades. Advent of information technology has further added to the boom of knowledge and many times this seems impossible to utilize these informations for the good of human being because these are not logically arranged in our minds. In the above background, the author tries to define documentation stating that we have today ocean of information and knowledge about various things- living or dead, plants, animals or human beings; the geographical conditions or changing weather and environment. What required to be done is to extract the relevant knowledge and information required to enrich the subject. The author compares documentation with churning of milk to extract butter. Documentation, in fact, is churning of ocean of information to extract the specific, most appropriate, relevant and defined information and knowledge related to the particular subject . The paper besides discussing the definition of documentation, highlights the areas of Naturopathy requiring an urgent necessity to make proper documentations. Paper also discusses the present status of Naturopathy in India, proposes short-term and long-term goals to be achieved and plans the strategies for achieving them. The most important aspect of the paper is due understanding of the limitations of Naturopathy but a constant effort to improve the same with the growth made in various discipline of science so far.

Rastogi R. Central Council for Research in Yoga & Naturopathy, 61-65, Institutional Area, Janakpuri, New Delhi-110058. Bull Indian Inst Hist Med Hyderabad. 2006 Jan-Jun;36(1):75-82.

OBJECTIVES: Naturopathic physicians' interest in participating in pediatric observational studies or clinical trials is unknown. Complementary and alternative medicine research may need to be conducted in the settings where these therapies are commonly used to fully understand their effects. Optimally, naturopathic physicians will participate in the research of naturopathic medical practice. A survey was conducted to ascertain naturopathic physicians' interest in participating in pediatric research studies and characteristics of those most interested. DESIGN, SETTING, AND SUBJECTS: In July 2004, a survey designed to assess pediatric research interests and a one-dollar incentive was mailed to all Washington state-licensed naturopathic physicians with in-state mailing addresses (n = 513). A second survey and one-dollar incentive were sent to nonresponders in November 2004. Surveys were collected through January 2005. RESULTS: From the 499 surveys delivered as addressed, 251 completed surveys were returned (50.3%). Of the 204 naturopathic physicians in current practice who completed surveys, 59 (28.9%) indicated they would not recommend or advertise an observational, open-label, or placebo-controlled trial to their pediatric patients, and 85 (41.7%) indicated they had no interest in being involved with research studies themselves. Of the 204 respondents in practice, 83 (40.7%) would recommend placebo-controlled trials to their pediatric patients, and 52 (25.5%) were willing to recruit for such a trial in the office. CONCLUSIONS: Characteristics of naturopathic physicians most interested in active pediatric research involvement included fewer years in practice, greater number of pediatric patients treated per week, and having shared office space.

Weber W, McCarty RL. School of Naturopathic Medicine, Bastyr University, Kenmore, WA 98028-4966, USA. J Altern Complement Med. 2008 May;14(4):445-8.

This cross-sectional study assessed the sociodemographic characteristics of families whose children used naturopathic medicine, the reasons for use, and whether naturopathic and conventional medicine were combined in treating children's conditions. Data were collected in British Columbia, Alberta and Ontario, Canada. Ninety-eight completed questionnaires were analyzed. The results showed that participants (parents) were most likely to be females, university educated, had household income >$60,000, and also saw a naturopathic doctor for themselves. The most common conditions for which children saw a naturopathic doctor included allergies, digestive problems and skin problems, and the most important reasons for use included using all possible options and having a more holistic approach to care. Most parents reported combining naturopathic and conventional care for their children. Study limitations, in particular, selection bias, were discussed.

Leung B, Verhoef M. Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. bleun@ucalgary.ca Complement Ther Clin Pract. 2008 May;14(2):98-104.

Herbal drugs constitute a major share of all the officially recognised systems of health in India viz. Ayurveda, Yoga, Unani, Siddha, Homeopathy and Naturopathy, except Allopathy. More than 70% of India's 1.1 billion population still use these non-allopathic systems of medicine. Currently, there is no separate category of herbal drugs or dietary supplements, as per the Indian Drugs Act. However, there is a vast experiential-evidence base for many of the natural drugs. This offers immense opportunities for Observational Therapeutics and Reverse Pharmacology. Evidence-based herbals are widely used in the diverse systems and manufactured, as per the pharmacopoeial guidelines, by a well-organised industry. Significant basic and clinical research has been carried out on the medicinal plants and their formulations, with the state-of-the-art methods in a number of Institutes/Universities. There are some good examples. Indian medicinal plants also provide a rich source for antioxidants that are known to prevent/delay different diseased states. The antioxidant protection is observed at different levels. The medicinal plants also contain other beneficial compounds like ingredients for functional foods. Hence, the global knowledge about Ayurveda and Indian herbals will hopefully be enhanced by information on the evidence-base of these plants. This will yield rich dividends in the coming years.

Vaidya AD, Devasagayam TP. Bharatiya Vidya Bhavan's Swami Prakashananda Ayurveda Research Centre, University of Mumbai, 13th North-South Road, Vithalnagar, Juhu Scheme, Mumbai 400 049, India. J Clin Biochem Nutr. 2007 Jul;41(1):1-11.

Historically, herbs and spices have enjoyed a rich tradition of use for their flavor enhancement characteristics and for their medicinal properties. The rising prevalence of chronic diseases worldwide and the corresponding rise in health care costs is propelling interest among researchers and the public for multiple health benefits related to these food items, including a reduction in cancer risk and modification of tumor behavior. A growing body of epidemiological and preclinical evidence points to culinary herbs and spices as minor dietary constituents with multiple anticancer characteristics. This review focuses on the antimicrobial, antioxidant, and antitumorigenic properties of herbs and spices; their ability to influence carcinogen bioactivation; and likely anticancer contributions. While culinary herbs and spices present intriguing possibilities for health promotion, more complete information is needed about the actual exposures to dietary components that are needed to bring about a response and the molecular target(s) for specific herbs and spices. Only after this information is obtained will it be possible to define appropriate intervention strategies to achieve maximum benefits from herbs and spices without eliciting ill consequences.

J Nutr Biochem. 2008 Jun;19(6) Kaefer CM, Milner JA. Nutritional Science Research Group, National Cancer Institute, Rockville, MD 20892, USA.

BACKGROUND: Questions about the risks and regulatory requirements of naturopathy and western herbal medicine (WHM) in Australia prompted research by the Department of Human Services Victoria. This article offers findings from a survey of education providers, which was one of several studies carried out for the report. (The full report can be found at http://www.health.vic.gov.au/pracreg/naturopathy.htm.) METHOD: Questionnaires were sent to 43 Australian providers of naturopathy and WHM education. RESULTS: Unsustainable variation was found in award types, contact hours, clinical education, length of courses, and course content. CONCLUSIONS: Naturopaths and WHM practitioners are primary contact health professionals but educational standards vary widely, with some practitioners not likely to be adequately prepared. The degree of risk in their practice, and the need for better integration of complementary care with mainstream healthcare, require education at least to the level of a bachelor degree. Courses should be subject to independent external accreditation. However, attempts to determine appropriate minimum educational standards are unlikely to succeed without the support of a regulatory system that can mandate those minimum requirements.

McCabe P. School of Public Health, La Trobe University, Bundoora 3086, Victoria, Australia. Complement Ther Clin Pract. 2008 Aug;14(3):168-75.

Iodine deficiency is generally recognized as the most commonly preventable cause of mental retardation and the most common cause of endocrinopathy (goiter and primary hypothyroidism). Iodine deficiency becomes particularly critical in pregnancy due to the consequences for neurological damage during fetal development as well as during lactation. The safety of therapeutic doses of iodine above the established safe upper limit of 1 mg is evident in the lack of toxicity in the Japanese population that consumes 25 times the median intake of iodine consumption in the United States. Japan's population suffers no demonstrable increased incidence of autoimmune thyroiditis or hypothyroidism. Studies using 3.0- to 6.0-mg doses to effectively treat fibrocystic breast disease may reveal an important role for iodine in maintaining normal breast tissue architecture and function. Iodine may also have important antioxidant functions in breast tissue and other tissues that concentrate iodine via the sodium iodide symporter.

Patrick L. Bastyr University graduate 1984; private practice, Durango, CO, specializing in environmental medicine and chronic hepatitis C; faculty, Postgraduate Certification Course in Environmental Medicine, Southwest College of Naturopathic Medicine; contributing editor, Alternative Medicine Review; physician-member of the Hepatitis C Ambassadors Team. Correspondence address: 117 CR 250 Suite A, Durango, CO 81301. Email: lpatrick@frontier.net. Altern Med Rev. 2008 Jun;13(2):116-127.

A 67-year-old woman with proven diagnosis of giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) was admitted to stationary treatment twice to receive a complex therapy with methods of natural medicine comprising fasting as its main treatment element. Both times, a discrepancy between the course of markers of the acute phase on the one hand, and subjective as well as objective clinical outcome on the other hand could be observed.This may point to special conditions of this chronic inflammatory disease as compared to e.g.rheumatoid arthritis, but also to specific problems in assessing possible effects of the treatments chosen, particularly fasting therapy, as compared to effects of conventional therapies.

lement Med (2006). 2007 Aug;14(4):235-9. Epub 2007 Jul 20. Stange R, Pflugbeil C. Abteilung für Naturheilkunde, Immanuel-Krankenhaus Berlin-Wannsee, Königstrasse 63, 14109 Berlin-Wannsee, Germany. r.stange@immanuel.de

INTRODUCTION: Herbal products have gained increasing popularity in the last decade, and are now used by approximately 20% of the population. Herbal products are complex mixtures of organic chemicals that may come from any raw or processed part of a plant, including leaves, stems, flowers, roots, and seeds. Under the current law, herbs are defined as dietary supplements, and manufacturers can therefore produce, sell, and market herbs without first demonstrating safety and efficacy, as is required for pharmaceutical drugs. Although herbs are often perceived as "natural" and therefore safe, many different side effects have been reported owing to active ingredients, contaminants, or interactions with drugs. RESULTS: Unfortunately, there is limited scientific evidence to establish the safety and efficacy of most herbal products. Of the top 10 herbs, 5 (ginkgo, garlic, St. John's wort, soy, and kava) have scientific evidence suggesting efficacy, but concerns over safety and a consideration of other medical therapies may temper the decision to use these products. CONCLUSIONS: Herbal products are not likely to become an important alternative to standard medical therapies unless there are changes to the regulation, standardization, and funding for research of these products.

J Gen Intern Med. 2008 Jun;23(6) Bent S. Osher Center for Integrative Medicine, University of California, San Francisco, CA, USA. Stephen.Bent@ucsf.edu

OBJECTIVES: To assess the feasibility and acceptability of studying whole systems of Traditional Chinese Medicine (TCM) and Naturopathic medicine (NM) in the treatment of temporomandibular disorders (TMD), and to determine whether there is indication to support further research. DESIGN: A pilot study using a randomized controlled clinical trial design of whole system TCM and NM versus state-of-the-art specialty care (SC). SETTING/LOCATION: Kaiser Permanente Northwest (KPNW), and practitioner offices in Portland, Oregon. SUBJECTS: One hundred and sixty (160) women 25-55 years of age attending a KPNW TMD specialty clinic. INTERVENTIONS: Whole system TCM and NM, and KPNW TMD clinic SC; the intervention protocols were designed to model the individually tailored type of community care offered in alternative medicine practices in Portland and in the KPNW TMD clinic, using protocols that enhanced similarities among practitioners within each system and permitted full descriptions of the treatments provided. OUTCOME MEASURES: TMD was ascertained using the Research Diagnostic Criteria/TMD; outcomes were self-reported worst and average facial pain and interference with activities (scaled 0-10 where 10 is worst). RESULTS: Of 948 consecutive eligible patients, 160 were randomized to one of three arms; 128 provided endpoint data. TCM and NM demonstrated significantly greater in-treatment reductions for worst facial pain compared to SC (adjusted regression analysis; higher negative values indicate greater improvement, = -1.11 +/- 0.43, p = 0.010 and -1.02 +/- 0.45, p = 0.025 for TCM and NM, respectively, compared to SC) and at 3 months post-treatment (-1.07 +/- 0.51, p = 0.037 and -1.27 +/- 0.54, p = 0.019 for TCM and NM versus SC, respectively). Additionally, TCM provided significantly greater decreases in average pain than SC; NM provided significantly greater decreases than SC or TCM in TMD-related psychosocial interference. CONCLUSIONS: These alternative medicine approaches each resulted in significantly greater reduction of pain and psychosocial interference than SC. Further research on the potential benefits of traditional whole systems of medicine for TMD appears warranted.

Ritenbaugh C, Hammerschlag R, Calabrese C, Mist S, Aickin M, Sutherland E, Leben J, Debar L, Elder C, Dworkin SF. Department of Family and Community Medicine, The University of Arizona, Tucson, AZ 85719, USA. ritenbau@email.arizona.edu J Altern Complement Med. 2008 Jun;14(5):475-87.

ABSTRACT Objectives: Naturopathic physicians' interest in participating in pediatric observational studies or clinical trials is unknown. Complementary and alternative medicine research may need to be conducted in the settings where these therapies are commonly used to fully understand their effects. Optimally, naturopathic physicians will participate in the research of naturopathic medical practice. A survey was conducted to ascertain naturopathic physicians' interest in participating in pediatric research studies and characteristics of those most interested. Design, setting, and subjects: In July 2004, a survey designed to assess pediatric research interests and a one-dollar incentive was mailed to all Washington state-licensed naturopathic physicians with in-state mailing addresses (n = 513). A second survey and one-dollar incentive were sent to nonresponders in November 2004. Surveys were collected through January 2005. Results: From the 499 surveys delivered as addressed, 251 completed surveys were returned (50.3%). Of the 204 naturopathic physicians in current practice who completed surveys, 59 (28.9%) indicated they would not recommend or advertise an observational, open-label, or placebo-controlled trial to their pediatric patients, and 85 (41.7%) indicated they had no interest in being involved with research studies themselves. Of the 204 respondents in practice, 83 (40.7%) would recommend placebo-controlled trials to their pediatric patients, and 52 (25.5%) were willing to recruit for such a trial in the office. Conclusions: Characteristics of naturopathic physicians most interested in active pediatric research involvement included fewer years in practice, greater number of pediatric patients treated per week, and having shared office space.

J Altern Complement Med. 2008 May;14(4):445-8. Weber W, McCarty RL. School of Naturopathic Medicine, Bastyr University, Kenmore, WA.

In management of metabolic syndrome, the traditional Chinese medicine (TCM) is an excellent representative in alternative and complementary medicines with a complete theory system and substantial herb remedies. In this article, basic principle of TCM is introduced and 25 traditional Chinese herbs are reviewed for their potential activities in the treatment of metabolic syndrome. Three herbs, ginseng, rhizoma coptidis (berberine, the major active compound) and bitter melon, were discussed in detail on their therapeutic potentials. Ginseng extracts made from root, rootlet, berry and leaf of Panax quinquefolium (American ginseng) and Panax ginseng (Asian ginseng), are proved for anti-hyperglycemia, insulin sensitization, islet protection, anti-obesity and anti-oxidation in many model systems. Energy expenditure is enhanced by ginseng through thermogenesis. Ginseng-specific saponins (ginsenosides) are considered as the major bioactive compounds for the metabolic activities of ginseng. Berberine from rhizoma coptidis is an oral hypoglycemic agent. It also has anti-obesity and anti-dyslipidemia activities. The action mechanism is related to inhibition of mitochondrial function, stimulation of glycolysis, activation of AMPK pathway, suppression of adipogenesis and induction of low-density lipoprotein (LDL) receptor expression. Bitter melon or bitter gourd (Momordica charantia) is able to reduce blood glucose and lipids in both normal and diabetic animals. It may also protect beta cells, enhance insulin sensitivity and reduce oxidative stress. Although evidence from animals and humans supports the therapeutic activities of ginseng, berberine and bitter melon, multi-center large-scale clinical trials have not been conducted to evaluate the efficacy and safety of these herbal medicines.

Endocr Metab Immune Disord Drug Targets. 2008 Jun;8(2) Yin J, Zhang H, Ye J. Pennington Biomedical Research Center, Louisana State University System, Baton Rouge, LA 70808, USA.

ABSTRACT Background: Complementary and alternative medicine (CAM) use is high in people with multiple sclerosis (MS), yet there are limited reports on safety and effectiveness of CAM in MS. Naturopathic medicine encompasses a broad range of CAM modalities and may improve quality of life in patients with MS. Objective: To assess quality of life in MS subjects who received interventions designed to "model" the "whole practice" of naturopathy. Design: A pilot, randomized, controlled study with a 6-month intervention period. Participants: Participants who met criteria for clinically definite MS. Interventions: The 3 intervention arms were usual care, naturopathic medicine plus usual care, and MS education plus usual care. Outcome measures: The primary outcome measure was quality of life (36-item short form health survey [SF-36]). Secondary outcome measures included fatigue (Modified Fatigue Impact Scale); depression (Beck Depression Inventory); cognition battery (Stroop test and Paced Auditory Serial Addition Test 3), and neurologic impairment (Expanded Disability Status Scale [EDSS] and Multiple Sclerosis Functional Composite). Adverse event reporting and laboratory measures were used to assess safety. Results: Forty-five (45) participants (15 per group) were randomized and all completed the 6-month intervention. There were no significant differences between groups on any outcome measure. There was a trend in favoring the naturopathic group in the General Health subscale of the SF-36 (p = 0.11), Timed Walk (p = 0.11), and neurologic impairment (EDSS) (p = 0.07). There was a trend favoring the Education group in the Stroop attention test (p = 0.07). There was no difference between groups in adverse events or laboratory changes. Conclusions: Naturopathic medicine combined with usual care for MS showed a trend in improvement in the General Health subscale of the SF-36, Timed Walk, and neurologic impairment. Evaluation of naturopathic medicine, as a multimodality regimen, warrants further investigation.

J Altern Complement Med. 2008 Jun;14(5):489-96. Shinto L, Calabrese C, Morris C, Yadav V, Griffith D, Frank R, Oken BS, Baldauf-Wagner S, Bourdette D. Department of Neurology, Oregon Health & Science University, Portland, OR.

There is increasing clinical evidence that reflex therapies such as massage, Gua Sha, cupping, wet packs, acupuncture etc. are helpful in reducing symptoms of chronic pain. However, the neurobiological basis of these effects has rarely been investigated even though the increasing knowledge of the pathophysiology of chronic pain syndromes allows for specific hypotheses. Reflex therapies are likely able to influence chronic pain at the level of the nociceptor and the spinal cord. Moreover, it can be speculated that these therapies have a strong impact on relaxation and maybe understood as a social, comforting interaction. Since it is well accepted that the positive effect of grooming has a neurobiological basis in non-human primates, its biosocial impact on wellbeing and pain processing in humans may be underestimated. A synopsis of the neurobiological foundations of pain perception, from the nociceptor up the spinal cord to brain mechanisms provides the basis for the investigation of the 'way of action' of reflex therapies. Specific hypotheses on their neurobiological bases and methods suitable for their investigation are outlined. Further clarification of the mechanisms of action of reflex therapies will support their clinical evidence and add to our understanding of the neurobiology of complementary medicine. Copyright 2008 S. Karger AG, Basel.

Forsch Komplement Med (2006). 2008 Apr;15(2):97-103. Epub 2008 Apr 7. Musial F, Michalsen A, Dobos G. Alfried Krupp von Bohlen und Halbach Foundation, University of Duisburg-Essen, Germany. f.musial@kliniken-essen-mitte.de

Trace and major elements were determined in medicinal herbs (Cynara scolymus, Matricaria chamomilla, Artemisia absinthium L., Achillea millefolium, and Inula britannica) as well as in rhizosphere soil samples. Based on the results obtained after microwave-acid-assisted digestion (nitric acid + hydrogen peroxide) and single-step extraction (ammonium acetate), the real and potential acidity and redox potential of the soils, uptake, mobility, and bioavailability of potassium, calcium, magnesium, iron, manganese, copper, zinc, nickel, chromium, lead, and cadmium are discussed. By calculating the bioconcentration factors and their deviation from the recommended values, elevated concentrations, were explained in terms of contamination and pollution. The concentrations measured in both plants and soil samples were below maximum allowable concentration ranges considered for the European Union.

Nat Med (Tokyo). 2008 Jul;62(3) Razic S, Dogo S, Slavkovic L. Institute of Analytical Chemistry, Faculty of Pharmacy, University of Belgrade, P.O. Box 146, 11221, Belgrade, Serbia. snsn@sezampro.yu

CONTEXT: Stimulant medication can effectively treat 60% to 70% of youth with attention-deficit/hyperactivity disorder (ADHD). Yet many parents seek alternative therapies, and Hypericum perforatum (St John's wort) is 1 of the top 3 botanicals used. OBJECTIVE: To determine the efficacy and safety of H. perforatum for the treatment of ADHD in children. DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind, placebo-controlled trial conducted between March 2005 and August 2006 at Bastyr University, Kenmore, Washington, among a volunteer sample of 54 children aged 6 to 17 years who met Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria for ADHD by structured interview. INTERVENTION: After a placebo run-in phase of 1 week, participants were randomly assigned to receive 300 mg of H. perforatum standardized to 0.3% hypericin (n = 27) or a matched placebo (n = 27) 3 times daily for 8 weeks. Other medications for ADHD were not allowed during the trial. MAIN OUTCOME MEASURES: Performance on the ADHD Rating Scale-IV (range, 0-54) and Clinical Global Impression Improvement Scale (range, 0-7), and adverse events. RESULTS: One patient in the placebo group withdrew because of an adverse event. No significant difference was found in the change in ADHD Rating Scale-IV scores from baseline to week 8 between the treatment and placebo groups: inattentiveness improved 2.6 points (95% confidence interval [CI], -4.6 to -0.6 points) with H. perforatum vs 3.2 points (95% CI, -5.7 to -0.8 points) with placebo (P = .68) and hyperactivity improved 1.8 points (95% CI, -3.7 to 0.1 points) with H. perforatum vs 2.0 points (95% CI, -4.1 to 0.1 points) with placebo (P = .89). There was also no significant difference between the 2 groups in the percentage of participants who met criteria for improvement (score < or = 2) on the Clinical Global Impression Improvement Scale (H. perforatum, 44.4%; 95% CI, 25.5%-64.7% vs placebo, 51.9%; 95% CI, 31.9%-71.3%; P = .59). No difference between groups was found in the number of participants who experienced adverse effects during the study period (H. perforatum, 40.7%; 95% CI, 22.4%-61.2% vs placebo, 44.4%; 95% CI, 25.5%-64.7%; P = .78). CONCLUSION: In this study, use of H. perforatum for treatment of ADHD over the course of 8 weeks did not improve symptoms. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00100295.

JAMA. 2008 Jun 11;299(22):2633-41. Weber W, Vander Stoep A, McCarty RL, Weiss NS, Biederman J, McClellan J.

School of Naturopathic Medicine, Bastyr University, Kenmore, Washington, USA. wendyw@bastyr.edu

ABSTRACT Objectives: To assess the feasibility and acceptability of studying whole systems of Traditional Chinese Medicine (TCM) and Naturopathic medicine (NM) in the treatment of temporomandibular disorders (TMD), and to determine whether there is indication to support further research. Design: A pilot study using a randomized controlled clinical trial design of whole system TCM and NM versus state-of-the-art specialty care (SC). Setting/location: Kaiser Permanente Northwest (KPNW), and practitioner offices in Portland, Oregon. Subjects: One hundred and sixty (160) women 25-55 years of age attending a KPNW TMD specialty clinic. Interventions: Whole system TCM and NM, and KPNW TMD clinic SC; the intervention protocols were designed to model the individually tailored type of community care offered in alternative medicine practices in Portland and in the KPNW TMD clinic, using protocols that enhanced similarities among practitioners within each system and permitted full descriptions of the treatments provided. Outcome measures: TMD was ascertained using the Research Diagnostic Criteria/TMD; outcomes were self-reported worst and average facial pain and interference with activities (scaled 0-10 where 10 is worst). Results: Of 948 consecutive eligible patients, 160 were randomized to one of three arms; 128 provided endpoint data. TCM and NM demonstrated significantly greater in-treatment reductions for worst facial pain compared to SC (adjusted regression analysis; higher negative values indicate greater improvement, = -1.11 +/- 0.43, p = 0.010 and -1.02 +/- 0.45, p = 0.025 for TCM and NM, respectively, compared to SC) and at 3 months post-treatment (-1.07 +/- 0.51, p = 0.037 and -1.27 +/- 0.54, p = 0.019 for TCM and NM versus SC, respectively). Additionally, TCM provided significantly greater decreases in average pain than SC; NM provided significantly greater decreases than SC or TCM in TMD-related psychosocial interference. Conclusions: These alternative medicine approaches each resulted in significantly greater reduction of pain and psychosocial interference than SC. Further research on the potential benefits of traditional whole systems of medicine for TMD appears warranted. J Altern Complement Med. 2008 Jun;14(5):475-87.

J Altern Complement Med. 2008 Jun;14(5):475-87. Ritenbaugh C, Hammerschlag R, Calabrese C, Mist S, Aickin M, Sutherland E, Leben J, Debar L, Elder C, Dworkin SF.

Department of Family and Community Medicine, The University of Arizona, Tucson, AZ., Department of Nutritional Sciences, The University of Arizona, Tucson, AZ., Department of Anthropology, The University of Arizona, Tucson, AZ.

In the last decade, there has been dramatic changes in all areas of integrative patient care. None has been more dramatic than those in the field of cancer care, which has gone from alternative and complementary treatments delivered outside the conventional setting to the integration of many of these approaches into the care of the cancer patient. In many cases, these changes have been driven by patient demand and supported by private funding and out-of-pocket payments by patients themselves. Virtually all major medical centers have departments devoted to integrative patient care--whether true stand-alone centers or departments with a research interest in this area. This is particularly true of the major cancer centers, many of which-including Memorial Sloan Kettering Cancer Center, New York; M.D. Anderson Cancer Center, Houston, Tex; Johns Hopkins University, Baltimore, Md; Duke University, Durham, NC; and the Dana Farber Cancer Institute, Boston, Mass--have developed integrative cancer programs. In addition, programs such as the Cancer Treatment Centers of America have inpatient and outpatient programs with teams of practitioners, including medical oncologists, surgeons, and radiation therapists, as well as credentialed naturopathic doctors, nutritionists, mind-body specialists and other integrative practitioners. Despite the increased interest in developing integrative approaches to cancer, many medical oncologists remain skeptical about the value of these modalities.

Altern Ther Health Med. 2007 Jan-Feb;13(1):56-64.

Boyd DB.

Program in Integrative Medicine, Greenwich Hospital-Yale, New Haven Health System, USA.

Content on integrative healthcare and complementary and alternative medicine is being taught in hundreds of educational programs across the country. Nursing, medical, osteopathic, chiropractic, acupuncture, naturopathic, and other programs are finding creative and innovative ways to include these approaches in new models of education and practice. This column spotlights such innovations in integrative healthcare and CAM education and presents readers with specific educational interventions they can adapt into new or ongoing educational efforts at their institution or programs. We invite readers to submit brief descriptions of efforts in their institutions that reflect the creativity, diversity, and interdisciplinary nature of the field. Please submit to Dr Sierpina at vssierpi@utmb.edu or Dr Kreitzer at kreit003@umn.edu. Submissions should be no more than 700 to 800 words. Please include any Web site or other resource that is relevant, as well as contact information.

Explore (NY). 2007 Mar-Apr;3(2):174-6.

Sierpina VS, Kreitzer MJ, Burke A, Verhoef M, Brundin-Mather R.

University of Texas Medical Branch, TX, USA. vssierpi@utmb.edu

Saunas can be used very effectively for certain cardiovascular problems and as a means to enhance the mobilization of fat-soluble xenobiotics. When saunas are used to reduce blood pressure and enhance blood flow and cardiac functioning, only short sauna sessions (15 minutes) are necessary. When one wants to enhance the mobilization of heavy metals and chemical xenobiotics, longer sessions are needed and those should be medically monitored. But, for either use, saunas are safe and effective and should be used more frequently to benefit the health of our patients and ourselves.

Altern Ther Health Med. 2007 Mar-Apr;13(2):S154-6.

Crinnion W.

Environmental Medicine Center of Excellence, Southwest College of Naturopathic Medicine in Tempe, Arizona, USA.

INTRODUCTION: The National Institutes of Health provided grants to the Oregon Health & Science University (OHSU) and 14 other allopathic academic health centers for the development of curricula in complementary and alternative medicine (CAM). A key component of the curriculum evaluation for OHSU was provided by a survey assessing attitudes toward CAM and selected personality characteristics of entering students in chiropractic, naturopathic, Oriental, and allopathic medicine in the Pacific Northwest and Upper Midwest. METHODS: A survey containing a variety of assessments of attitudes toward CAM and the personality traits of adventurousness and tolerance to ambiguity was administered to students entering four Portland, Oregon doctoral-level health professional schools and an allopathic medical school in the Upper Midwest (University of Nebraska College of Medicine) during the 2004-2005 academic year. RESULTS: Students of naturopathy (n = 63) and Oriental Medicine (n = 71) were the most "CAM positive," adventurous and tolerant of ambiguity, and Midwestern allopathic medical students (n = 58) the least. In general, chiropractic students (n = 89) and allopathic medical students from the Pacific Northwest (n = 95) were intermediate in CAM attitudes between these two groups (all p < 0.05). Female students were more "CAM positive" in all schools compared to male students. CONCLUSIONS: Students have high levels of interest in CAM upon entrance to their schools. Health professional discipline, geographic location, personality qualities, and gender appear to influence CAM attitudes in entering students.

J Altern Complement Med. 2007 Apr;13(3):381-6.

Nedrow AR, Istvan J, Haas M, Barrett R, Salveson C, Moore G, Hammerschlag R, Keenan E.

Oregon Health & Science University School of Medicine, Portland, OR 97239, USA.