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November, 2002 - VOL. 8, NO. 6  November, 2002
The dark side of consciousness and the therapeutic relationship
Larry Dossey, MD
Following the publication of my 1993 book Healing Words: The Power of Prayer and the Practice of Medicine, I received several letters from religious individuals who were profoundly upset. The views of prayer and healing set forth in my book differed from theirs, and they wanted to set me straight. Some of the letters dripped with venom. The writers denounced me as a heretic and blasphemer. They often inserted religious tracts that described the fires of hell—my fate—in lurid detail. The angriest letters were unsigned with no return address—a postal drive-by in which the perpetrator could not be traced. Most of the letters concluded in the same way. Although my views on prayer were completely erroneous, the writers granted that this was not my fault. Standing outside their religion, I simply could not avoid being deluded. Therefore, because of their love and concern for me, they would pray that I would see the light and understand prayer and healing correctly. I am grateful to readers who take the time to write to me, and I usually answer their letters personally. So I initially responded to the critical letters by thanking the individuals for their concerns. Then one day I realized that these people weren’t praying for me. They were using prayer as a method of manipulation and control. They wanted to force me, through their prayers, to abandon my personal beliefs and come over to their side. From my perspective, their efforts were essentially a curse or hex.
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November, 2002 - VOL. 8, NO. 6  November, 2002
Preparing teachers of CAM therapies in conventional healthcare settings
Mary V Fenton, RN, DrPH, FAAN
Much has been written and discussed about the importance of preparing students of the health professions to be knowledgeable about complementary and alternative medical (CAM) therapies, but little has been said about preparing the faculty and teachers of these students. In this issue, Kathi Kemper and her colleagues discuss the evaluation of a volunteer faculty development program in pediatrics taught by experts in each of 4 CAM areas: herbs and dietary supplements, mind-body therapies, massage, and acupuncture. Dr Kemper’s article focuses on the experience of pediatric medical faculty in learning CAM from CAM practitioners through case-based, experiential seminars. Peter Curtis and his colleagues describe how to prepare CAM practitioners to teach conventional health-profession learners in a structured medical setting. Mary Jo Kreitzer et al also report that medical, nursing, and pharmacy faculty at the University of Minnesota have favorable attitudes toward CAM and desire training in CAM areas. Dr Kreitzer’s survey further supports the need for faculty development of CAM models. These articles are extremely relevant to the concerns of conventional healthcare providers whose patients are seeking more information about CAM. Patients want the information, but, until recently, mainstream health education did little to prepare conventional practitioners in CAM areas. The percentage of medical schools that either offer courses or integrate the teaching of CAM therapies in their curricula has increased over the past 5 years. Schools of nursing also are offering courses, continuing education, and even masters and doctoral programs that emphasize holistic nursing, healing, and complementary and alternative modalities. These efforts provide opportunities for students of the health professions to gain CAM knowledge and expertise. Faculty and other practitioners must seek other resources.
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November, 2002 - VOL. 8, NO. 6  November, 2002
Pediatric faculty development in integrative medicine
Lana Dvorkin, PharmD;  Ellen Silver Highfield, Lic Ac;  Kathi J Kemper, MD, MPH;  Mary McLellan, RN;  Mary Jane Ott, MN, MA, PNP;  Julia S Whelan, MS
As more patients use complementary and alternative medical (CAM) therapies, faculty may be asked to teach trainees about topics requiring faculty development training. Our purpose in this study was to evaluate qualitatively and quantitatively a new faculty development program covering 4 key areas of CAM: herbs and dietary supplements, mind-body therapies, massage, and acupuncture. Faculty members (N=6) volunteered for the program and were included in the study if they completed at least 3 of the 6 scheduled sessions. For each session, participants completed a pretest evaluating their knowledge and confidence about the topic, then they received background reading and focused discussion questions. Each session was a case-based, experiential seminar led by an expert in the content area. Participants completed post-session questionnaires measuring knowledge, confidence, and communication practices at the end of each session and at the end of the series of seminars. They also were asked for feedback and suggestions for the following year. All participants strongly agreed that they gained important knowledge; scores on tests about herbs increased from 62% at baseline to 84% at completion, and scores on knowledge of acupuncture increased from 60% before the session to 98% after. All participants strongly agreed that their confidence in talking with patients, colleagues, and trainees improved; on average, confidence scores improved an average of 1.8 out of a total of 5 possible points for all topics. Participants more frequently asked patients about their use of herbs (from 50% at baseline to 75% at the end) and increased the percentage of training encounters in which they discussed CAM with trainees or colleagues from 10% to 25%. We concluded that faculty development in integrative medicine is feasible and results in qualitative and quantitative improvements in knowledge, confidence, and clinical and teaching behaviors. (Altern Ther Health Med. 2002;8(6):70-73)
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November, 2002 - VOL. 8, NO. 6  November, 2002
Attitudes toward CAM among medical, nursing, and pharmacy faculty and students: a comparative analysis
Ilene Harris, PhD;  Mary Jo Kreitzer, PhD, RN;  Denise Mitten, MS;  Janet Shandeling, PhD
Context • As interest in CAM continues to increase, schools of medicine, nursing, and other health professional training programs are being encouraged to integrate content on CAM into curricula. Objective • To assess the attitudes of faculty and staff toward CAM in medicine, nursing, and pharmacy within an academic health center. Design • A survey was used to obain data on general attitudes toward CAM, personal use, training needs, and perceived barriers to use. Setting and Participants • The survey was taken of 627 faculty and students employed or enrolled at the University of Minnesota. The overall response rate exceeded 50% for both students and faculty. Results • More than 90% of faculty and students believe that clinical care should integrate the best of conventional and CAM practices and that health professionals should be prepared to advise patients about commonly used CAM methods; 88% of faculty and 84% of students indicated that CAM should be included in their school’s curriculum. While there were similarities between the 3 faculty groups, the nursing faculty expressed the greatest interest in practicing CAM. Conclusions • Faculty and students within medicine, nursing, and pharmacy have favorable attitudes toward the integration of CAM within education and clinical care. Personal use of CAM and training is limited. Lack of evidence is perceived to be the most significant barrier to integration of CAM into Western medicine. The high degree of receptivity suggests the need for both faculty trainng and curriculum development. (Altern Ther Health Med. 2002;8(6):44-53)
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November, 2002 - VOL. 8, NO. 6  November, 2002
Acupuncture treatment for osteoarthritic pain and inflammation of the knee
Adarsh M Kumar, PhD;  Xue-lan Wen, MD
Acupuncture, the ancient Chinese art and science of healing, is now accepted in the scientific community as one of the effective analgesic and anti-inflammatory modalities. The main principle of the therapeutic effect of acupuncture is the stimulation of selective acupoints, situated along meridians in the body. Stimulation is initiated by inserting needles of specific length and thickness. Performing acupuncture on specific points is believed to restore bodily functions by promoting the natural flow of vital energy throughout the system. Energy becomes obstructed in “dis-eased” body systems that are exposed to unavoidably stressful conditions. In addition to its anti-inflammatory effect, acupuncture is also becoming popular because of its effectiveness in the treatment of various physical and mental health conditions caused by dysregulation of neurohormonal and neurotransmitter systems (endorphins, monoamines, and stress hormones, such as cortisol). These conditions include obesity, ailments of the cardiovascular and respiratory systems, weight reduction, nausea, rheumatological conditions, depression, anxiety and nervousness, sleep problems, smoking cessation, and drug addiction. A number of reports also have described beneficial effects from acupuncture as a treatment of osteoarthritic pain of the hip and knee joints.
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November, 2002 - VOL. 8, NO. 6  November, 2002
Astragalus
Kerry Hughes, BSc;  Kenneth Jones;  Dennis J McKenna, PhD
Please note: CME credit is no longer being offered for this activity. OBJECTIVES Upon completion of this article, participants will be able to do the following: 1. Evaluate the preclinical and clinical literature on astragalus supplementation that supports (or in some cases does not support) its therapeutic use. 2. Describe the effects of astragalus on various bodily systems and functions such as the cardiovascular and circulatory systems, inflammation and immune diseases, hypertension, and digestive functions. 3. Recognize the recommended daily dosage, toxicity, formulation, and safety considerations related to the use of astragalus as an herbal supplement. 4. Apply this knowledge of the potential therapeutic applications and health benefits of astragalus supplementation to clinical practice.
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November, 2002 - VOL. 8, NO. 6  November, 2002
The effect of cranial manipulation on the Traube-Hering-Mayer oscillation as measured by laser-doppler flowmetry
Thomas Glonek, PhD;  Kenneth E Nelson, DO;  Nicette Sergueff, DO (France)
Context • A correlation has been established between the Traube-Hering-Mayer oscillation in blood-flow velocity, measured by laser-Doppler flowmetry, and the cranial rhythmic impulse. Objective • To determine the effect of cranial manipulation on the Traube-Hering-Mayer oscillation. Design • Of 23 participants, 13 received a sham treatment and 10 received cranial manipulation. Setting • Osteopathic Manipulative Medicine Department, Midwestern University, Downers Grove, Ill. Participants • Healthy adult subjects of both sexes participated (N=23). Intervention • A laser-Doppler flowmetry probe was placed on the left earlobe of each subject to obtain a 5-min baseline blood-flow velocity record. Cranial manipulation, consisting of equilibration of the global cranial motion pattern and the craniocervical junction, was then applied for 10 to 20 min; the sham treatment was palpation only. Main Outcome Measure • Immediately following the procedures, a 5-min posttreatment laser-Doppler recording was acquired. For each cranial treatment subject, the 4 major components of the blood-flow velocity record, the thermal (Mayer) signal, the baro (Traube-Hering) signal, the respiratory signal, and the cardiac signal, were analyzed, and the pretreatment and posttreatment data were compared. Results • The 10 participants who received cranial treatment showed a thermal signal power decrease from 47.79 dB to 38.49 dB (P<.001) and the baro signal increased from 47.40dB to 51.30 dB (P<.021), while the respiratory and cardiac signals did not change significantly (P>.05 for both). Conclusion • Cranial manipulation affects the blood-flow velocity oscillation in its low-frequency Traube-Hering-Mayer components. Because these low-frequency oscillations are mediated through parasympathetic and sympathetic activity, it is concluded that cranial manipulation affects the autonomic nervous system. (Altern Ther Health Med. 2002;8(6):74-76)
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November, 2002 - VOL. 8, NO. 6  November, 2002
Progress notes: a review of educational developments in CAM
Victor S Sierpina, MD
Over the last 2 years, Progress Notes has reported on complementary and alternative medicine (CAM) innovations in medical and nursing education at a variety of institutions around the United States. This report summarizes and reviews current CAM educational efforts.
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November, 2002 - VOL. 8, NO. 6  November, 2002
Medicaid reimbursements for alternative therapies
Gary L Freed, MD, MPH;  Paula M Lantz, MS, PhD;  Terrence E Steyer, MD
Context • A growing number of complementary and alternative therapies are eligible for reimbursement by third party payers in the United States. No studies have examined current trends in the use of public funds for the payment of complementary and alternative medicine (CAM). Objective • To determine the reimbursement polices of state Medicaid programs for CAM. Design • Cross-sectional study. Participants • 46 state Medicaid reimbursement specialists. Intervention • Telephone survey. Results • Of the 46 states participating in the study, 36 Medicaid programs (78.3%) provide coverage for at least 1 alternative therapy. The most commonly reimbursed therapies are chiropractic by 33 programs (71.7%), biofeedback by 10 programs (21.7%), acupuncture by 7 programs (15.2%), and hypnotherapy and naturopathy by 5 programs each (10.8%). Conclusions • Many Medicaid programs are paying for the use of CAM. Further research is needed to determine if Medicaid recipients are aware of these reimbursement policies and the extent to which recipients are using CAM for their healthcare. (Altern Ther Health Med. 2002;8(6):84-88)
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November, 2002 - VOL. 8, NO. 6  November, 2002
Mindfulness in the center: the Duke Center for Integrative Medicine
Bryna Block;  Kate Chilton
The Duke Center for Integrative Medicine (DCIM) in Durham, NC, has as its vision nothing less than the transformation of 21st century healthcare to a model that “understands and empowers the integration of body, mind, spirit, and community,” writes Linda Smith, PA-C, DCIM’s director of programs. Established in 2000 as part of the Duke University Medical Center and Health System, DCIM fulfills its vision through individual patient consultations; education programs for patients, the public, and professionals; research in the field of integrative medicine; and national leadership in the promotion of integrative healthcare.
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November, 2002 - VOL. 8, NO. 6  November, 2002
The heterogeneous pain personality: diverse coping styles among sufferers of chronic pain
Daisha J Cipher, PhD;  P. Andrew Clifford, PhD;  Randall E Schumacker, PhD
The utility of personality assessment in chronic pain populations can be greatly enhanced with the understanding of risk assessment and the heterogeneous nature of at-risk personality types. Simplistic, unidimensional notions of risk have not been useful in assessing psychosocial and functional impairment in those with chronic pain syndromes. Previous literature suggests that certain combinations of psychometric scales, as opposed to individual scales, may be more useful in predicting the multiplicity of factors associated with functional disability among chronic pain patients. A hierarchical cluster analysis was performed on the 8 coping scales of the Millon Behavioral Health Inventory. Analyses revealed 3 distinct groups. The first cluster, termed repressors, exhibited high introversive and cooperative scales, and low forceful scales. The second cluster, termed amplifiers, exhibited high inhibited and sensitive scales. The third cluster, termed social copers, exhibited high confident and social scales. Analyses of these 3 clusters with regard to measures of psychopathology (Minnesota Multiphasic Personality Inventory II), depression (Beck Depression Inventory), functional impairment (Chronic Illness Problem Inventory), and other measures (Multidimensional Pain Inventory) resulted in significantly different levels of psychosocial and functional impairment. These clusters identified those patients who are at risk for nondisclosure of psychosocial dysfunction, those who are most emotionally distressed, and those who are most likely to comply with treatment. Consequently, such classifications identify psychosocial variables that will dictate a differential treatment approach and thus have potentially important clinical applications. (Altern Ther Health Med. 2002;8(6):60-69)
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November, 2002 - VOL. 8, NO. 6  November, 2002
Preparing complementary and alternative practitioners to teach learners in conventional health professions
Peter Curtis, MD;  Susan Gaylord, PhD;  Douglas Mann, MD;  June McDermott, MSPharm, MBA;  Tom Motyka, DO;  Sally K Norton, MPH;  Carol Tresolini, PhD
Federal funding is supporting complementary and alternative medicine (CAM) educational programming in health-professions schools in the United States. CAM practitioners from a wide range of disciplines are now being invited to participate as instructors or content experts in this effort. The challenge is to promote effective and consistent teaching methods around appropriate content. This article describes the development of a series of 4 workshops intended to enhance the teaching skillsof 9 complementary medicine practitioners participating in an educational project at the University of North Carolina. Key issues addressed in the workshops included the interface between CAM and conventional medicine, a better understanding of the nature of conventional medical practice, styles and strategies in teaching complementary medicine, and building skills in accessing information from databases. (Altern Ther Health Med. 2002;8(6):54-59)
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November, 2002 - VOL. 8, NO. 6  November, 2002
Effects of an anthroposhophical remedy on cardiorespiratory regulation
Henrik Bettermann, PhD;  Dirk Cysarz, MSc;  Christian Heckmann, MD;  Hans-Christoph Kümmell, MD
Context • The human organism has the inherent ability to regulate and coordinate physiological functions to establish well-being. If this ability is disturbed, eg, in cases of orthostatic syndrome with purely functional disorders, an herbal remedy based on anthroposophical medicine may be able to regulate such rhythmic disturbances. Objective • To determine the effect of the anthroposophicalherbal remedy on stimulating the ability to regulate and coordinate physiological functions in healthy subjects. Design • Double-blind, placebo-controlled, randomized trial. Participants • Ninety-nine healthy subjects; 49 received the remedy, 50 received the placebo. Intervention • Oral administration of the remedy for 4 weeks, 20 drops 4 times daily. Main Outcome Measures • Cardiorespiratory interaction was analyzed by 2 measures: the heart-respiratory ratio and the phase-coordination ratio of heartbeat and respiration. They were calculated from heart rate and respiratory rate, which were derived from 24-hour electrocardiogram recordings before and after the administration of the remedy. Improved normalization of these measures during nighttime sleep after administration of the remedy indicates a stimulation of regulation. Results • Oral administration of the remedy resulted in animproved normalization of heart-respiratory ratio, phase-coordination ratio and heart rate during nighttime sleep. These results were not observed in the placebo group. Conclusions • The remedy stimulates the regulation of cardiorespiratory interaction during nighttime sleep. Furthermore, improved normalization indicates a general improvement of the regulatory processes of functional rhythms. (Altern Ther Health Med. 2002;8(6):78-83)
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November, 2002 - VOL. 8, NO. 6  November, 2002
Kenneth R. Pelletier, PhD, MD (hc): MindBody Medicine
Bonnie Horrigan
Kenneth R. Pelletier, PhD, MD (hc), is a clinical professor at the University of Maryland (UMMC) and the University of Arizona Schools of Medicine. He is also a medical and business advisor to the National Institutes of Health, The World Health Organization, and many major corporations, including American Airlines, Medtronic, Disney, Merck, Ford, Microsoft, and Blue Cross Blue Shield. Pelletier received his doctoral degree in clinical psychology from the University of California at Berkeley in 1974.
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November, 2002 - VOL. 8, NO. 6  November, 2002
Research centers' progress, concept proposals reviewed at 12th NACCAM meeting
Bryna Block
The 12th meeting of the National Advisory Council for Complmentary and Alternative Medicine (NACCAM), held on August 26 in Rockville, Md, featured the report of an expert panel on the progress of the National Center for Complementary and Alternative Medicine (NCCAM) national research centers, a review of 2 concept proposals for future funding, an introduction to the new Office of Clinical and Regulatory Affairs, and an update of the PC-Spes studies that were about to begin or in process when the prostate-cancer remedy was withdrawn from the market earlier this year.
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