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September, 2002 - VOL. 8, NO. 5  September, 2002
The effects of harp music in vascular and thoracic surgical patients
Daleen Aragon, PhD;  Jacqueline F Byers, PhD, RN;  Carla Farris, MSN, RN, ARNP
Context • Music has been used in the acute clinical care setting as an adjunct to current treatment modalities. Previous studies have indicated that some types of music may benefit patients by reducing pain and anxiety, and may have an effect on physiological measures. Objective • To evaluate the scientific foundation for the implementation of a complementary therapy, harp playing. The research questions for this pilot study were: Does live harp playing have an effect on patient perception of anxiety, pain, and satisfaction? Does live harp playing produce statistically and clinically significant differences in physiological measures of heart rate, systolic and diastolic blood pressure, respiratory rate, and oxygen saturation? Design • A prospective, quasiexperimental, repeated measures design was used with a convenience sampling. Setting • Orlando Regional Medical Center, Orlando Fla. Patients • Subjects were eligible for the study if they were postoperative and admitted to a hard-wired-bedside–monitored room of the Vascular Thoracic Unit within the 3 days of the study period. Intervention • A single 20-minute live harp playing session. Main Outcome Measures • Visual analog scales (VAS) were used to measure patient anxiety and pain. Patient satisfaction was measured with a 4-item questionnaire. Physiological measures (heart rate, systolic and diastolic blood pressure, respiratory rate, and oxygen saturation) were recorded from the bedside monitor. Methods • Visual analog scales (VAS) were completed just before harp playing, 20 minutes after harp playing was started, and 10 minutes after completion. Patient satisfaction with the experience was measured with a 4-item questionnaire. Physiological measures (heart rate, systolic and diastolic blood pressure, respiratory rate, and oxygen saturation) were recorded from the bedside monitor at baseline (5 minutes before study setup), at zero, 5, 10, 15, and 20 minutes after harp playing began, and at 5 and 10 minutes after harp playing stopped. Results • Seventeen patients were used in this study, with a retrospective power of .91. Results indicate that listening to live harp music has a positive effect on patient perception of anxiety (P=.000), pain (P=.000) and satisfaction. Live harp playing also produced statistically significant differences in physiological measures of systolic blood pressure (P=.046), and oxygen saturation (P=.011). Although all values over time trended downward, the changes of other variables were not adequate to achieve statistical or clinical significance. Conclusion • Subjects in this study experienced decreased pain and anxiety with the harp intervention, and slight reductions in physiologic variable values. It is not possible in this study to determine if the results were due to the harp music, the presence of the harpist and data collector, or both. Future research is recommended using a control group and comparison of live versus recorded harp music with a wider variety of diagnoses and procedures. (Altern Ther Health Med. 2002;8(5):52-60)
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September, 2002 - VOL. 8, NO. 5  September, 2002
Testing the bioelectric shield
Susan J Blackmore, PhD, MSc;  Nicholas Rose, BSc
A pendant was claimed to provide numerous health benefits, including reduced stress, increased strength, and protection from electromagnetic radiation from computers and mobile phones. Three experiments tested the effectiveness of this pendant’s effect as a bioelectric shield. In the first experiment, 12 subjects who work with computers wore shields (6 real, 6 sham) for several weeks and were regularly tested for hand strength and mood changes. Both types of shield increased calmness, but the real shields did not have any greater effect. In 2 further studies (in each N=40) hand strength was measured at baseline, with mobile phone, and with mobile phone and bioelectric or sham shield. The shields did not differ in their effects. Both studies showed a significant correlation between the change in strength with and without the shield and subjects’ scores on a questionnaire concerning their belief in and use of alternative therapies. The shields appear to produce a measurable placebo effect but are otherwise ineffective. (Altern Ther Health Med. 2002;8(5):62-67)
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September, 2002 - VOL. 8, NO. 5  September, 2002
Broadening the base: treating people together
Kate Chilton
In 1989, volunteers got together in Boston’s Back Bay to form the AIDS Care Project Acupuncture Clinic (ACP). Within 10 years, ACP had grown to a sizable main clinic and 6 satellite clinics throughout Massachusetts. The expanded program is now called Pathways to Complementary Medicine, and it treats all chronic diseases. Despite drastic state and municipal spending cuts in 2001, Pathways continues to offer acupuncture, herbal treatments, and body work; conduct research; educate the public; and help train new healers.
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September, 2002 - VOL. 8, NO. 5  September, 2002
Nothing
Larry Dossey, MD
Growing up, when my twin brother and I misbehaved, which was most of the time, and Mom demanded, “What are you boys doing?” we invariably replied, “Nothing.” Our little lie usually worked. I therefore learned early on that nothing had, as biologists say, survival value or at least could prevent punishment, which to my brother and me were pretty much the same thing. This meant that nothing was actually something—my first exposure to paradox. The dictionary defines nothing as that which is nonexistent, insignificant, unimportant, trivial, useless, or empty, all of which reflect our culture’s blindness to the value and power of nothing. In America, to achieve nothing is to fail. If we stand for nothing or believe in nothing, we are considered cowardly and weak-willed. We equate doing nothing with sin itself: “Idle hands are the devil’s workshop.” When nothing makes a token appearance—as in the lyric from Porgy and Bess, “I got plenty of nothing/Nothing’s plenty for me”—no one takes it seriously. When people actually celebrate nothing and not-doing as a way of life, such as bohemians, beats, and hippies, they are invariably considered subversive and are marginalized by the wider culture.
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September, 2002 - VOL. 8, NO. 5  September, 2002
The uncertainties of medicine: a cause for celebration
Larry Dossey, MD
During recent weeks, many of the rules of good health that have guided patients and physicians for decades have taken a beating from which they may not recover. Consider: • Long-term hormone replacement therapy, long touted as a way of promoting health in postmenopausal women, has recently been shown not to reduce cardiovascular events in women with coronary heart disease, and actually appears to increase the rates of deep-vein thrombosis, pulmonary embolism, and biliary tract surgery. • Mammograms have been called into question as a way to reduce mortality from breast cancer. • Arthroscopic knee surgery appears to be no more effective than sham surgery in the treatment of osteoarthritic knee problems. • The role of low-fat diets in reducing coronary artery disease has been seriously challenged. Reversals of medical opinion are hardly new. As author-surgeon Sherwin B. Nuland notes, Is radical mastectomy the best treatment for breast cancer? Is drinking coffee associated with an increased risk of pancreatic malignancy? Should every ruptured spleen be removed? Is a low-fiber diet the best treatment for chronic diverticulitis? Is acid production by the stomach the key factor in peptic ulcer? Should every man, or nearly all men, with prostate cancer have surgery? Are most cases of impotence psychosomatic? The answer to every one of these questions was once “Yes” and is now “No.”
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September, 2002 - VOL. 8, NO. 5  September, 2002
Lipophil-mediated reduction of toxicants in humans: an evaluation of an ayurvedic detoxification procedure
John B Fagan, PhD;  Robert E Herron, PhD
Context • Lipophilic toxicants have been associated with hormone disruption, immune system suppression, reproductive disorders, several types of cancer, and other diseases. Due to environmental persistence and bioaccumulation, body burdens of certain toxicants, such as dichlorodiphenyldichloroethylene (DDE) and polychlorinated biphenyls (PCBs), appear to be a health risk despite the toxicants’ having been banned for decades. Objective • To determine whether a safe, standardized, Ayurvedic detoxification procedure can mobilize lipid-soluble toxicants and stimulate their excretion. Design • Cross-sectional and longitudinal evaluations. Setting • Southeastern Iowa. Participants • In the cross-sectional study, 48 participants who had undertaken lipophil-mediated detoxification were compared with 40 control subjects. In the prospective, longitudinal evaluation, serum levels were measured in 15 subjects before and after they underwent the detoxification procedure. These 15 subjects served as their own controls. Intervention(s) • Ayurvedic lipophil-mediated detoxification procedure. Main Outcome Measure • Gas chromatographic analysis of 17 serum toxicant levels (9 PCB congeners and 8 pesticides or metabolites) on a lipid-adjusted and wet-weight basis (ng/g) as parts per billion. Results • In the cross-sectional study, gas chromatographic analysis of 9 PCB congeners and 8 pesticides revealed that serum PCB levels were significantly lower in the detoxification subjects than in controls. Trans-nonachlor (TNC), p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE), oxychlordane, and hexachlorobenzene (HCB) levels were also markedly lower in the detoxification group. All subjects had undetectable levels of p,p'-DDT, lindane, and a-hexachlorocyclohexane (a-HCH). Beta-hexachlorocyclohexane (ß-HCH) levels were significantly higher in detoxification subjects than in controls. In the longitudinal evaluation, after treatment, mean levels of PCBs (46%) and ß-HCH (58%) declined significantly in the subjects. Conclusions • The higher ß-HCH levels in the subjects in the longitudinal study appear to be an anomaly related to diet. The results of the 2 studies generally suggest that lipophil-mediated detoxification may be effective in reducing body burdens of fat-soluble toxicants. As numerous people worldwide are at risk from high body burdens of such lipid-soluble agents, further studies to evaluate this procedure appear warranted. (Altern Ther Health Med. 2002;8(5):40-51)
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September, 2002 - VOL. 8, NO. 5  September, 2002
Kenny Ausubel: ecological medicine
Bonnie Horrigan
Kenny Ausubel, an award-winning journalist, film-maker, and environmental entrepreneur, is founder and president of Bioneers, an organization that “unites nature, culture, and spirit in service of the restoration of Earth and our relationship to the web of life.” Ausubel also founded the nonprofit Collective Heritage Institute and cofounded Seeds of Change, an organic seed company that promotes biodiversity. Ausubel is the author of 3 books: Seeds of Change: The Living Treasure; The BIONEERS: Visionary Solutions for Restoring the Earth, a book profiling the Bioneers culture; and When Healing Becomes a Crime: The Amazing Story of the Hoxsey Cancer Clinics and the Return of Alternative Therapies. His feature non-fiction film, Hoxsey: How Healing Becomes a Crime, was chosen for the Best Censored Stories award in 1990. Alternative Therapies interviewed Ausubel at his home in Santa Fe, NM.
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September, 2002 - VOL. 8, NO. 5  September, 2002
Greening healthcare: practicing as if the natural environment really mattered
Katherine N Irvine, MS;  Sara L Warber, MD
Objective • The natural world’s role in human well-being is an essential, yet often forgotten, aspect of healthcare. Of particular importance are the benefits one can derive through interaction with natural environments. While health is an obvious goal of allopathic medicine, many healthcare settings are neither nurturing nor healing. Reincorporating the natural world into the design of settings in which medicine is practiced is one way to complement conventional healing modalities and move healthcare toward being more “green.” This article discusses the breadth of existing knowledge available on the positive aspects of interaction with nature and provides a comprehensive theoretical perspective for future research. Data Sources • Computerized searches were conducted using MEDLINE, PsycINFO, the Social and Scientific Science Indices, Dissertation Abstracts, Lexus-Nexus, the University of Michigan library, and the Internet. Searches were conducted from June 2001 through March 2002. Study Selection • Keywords used included health, well-being, stress, attention, nature, garden, landscape, restorative, and healing. The literature, published between 1960 and 2001, came from various disciplines, including medicine, public health, nursing, psychology, natural resources, history, and landscape architecture. Four components of well-being were used as a framework for literature selection: physical, psychological-emotional, social, and spiritual. Data Extraction • Articles were qualitatively reviewed to extract theories, hypotheses, and experimental evidence. Data Synthesis • Interaction with nature positively affects multiple dimensions of human health. Physiological effects of stress on the autonomic nervous system are lessened. Psychologically, deficits in attention can be restored or minimized, and people report feeling greater satisfaction with a variety of aspects of life. The presence of the natural world promotes social health by encouraging positive social interaction and lessening the frequency of aggressive behavior. Spiritual well-being is enhanced through the experience of greater interconnectedness, which occurs when interacting with the natural world. Conclusions • The literature reviewed provides evidence to support the intuitive belief that interaction with the natural world is a vital part of biopsychosocial-spiritual well-being. Incorporating the natural world into healthcare could provide health benefits and improve the design of healthcare facilities. Applied morebroadly to society,this knowledge may change the way we approach public health, guard and manage natural resources, and design environments for human use. (Altern Ther Health Med.2002;8(5):76-83)
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September, 2002 - VOL. 8, NO. 5  September, 2002
Ginger syrup as an antiemetic in early pregnancy
Ronald A Chez, MD;  Angela Keating, MD
Context • Ginger (Zingiber officinale) has been used to ameliorate symptoms of nausea. A beverage containing ginger in a syrup may be easier to consume than a capsule or solid food. Objective • To determine if ginger syrup mixed in water is an effective remedy for the relief of nausea and vomiting in the first trimester of pregnancy. Design • Double-blind, placebo-controlled, randomized clinical trial. Setting • Subjects were enrolled from the University of South Florida department of obstetrics and gynecology private practice office. Patients • 26 subjects in the first trimester of pregnancy. Intervention • Subjects ingested 1 tablespoon of commercially prepared study syrup (or placebo) in 4 to 8 ounces of hot or cold water 4 times daily. Main Outcome Measures • Duration and severity of nausea and vomiting over a 2-week period measured on a 10-point scale. Results • After 9 days, 10 of the 13 (77%) subjects receiving ginger had at least a 4-point improvement on the nausea scale. Only 2 of the 10 (20%) remaining subjects in the placebo group had the same improvement. Conversely, no woman in the ginger group, but 7 (70%) of the women in the placebo group, had a 2-point or less improvement on the nausea scale. Eight of the 12 (67%) women in the ginger group who were vomiting daily at the beginning of the treatment stopped vomiting by day 6. Only 2 of the 10 (20%) women in the placebo group who were vomiting stopped by day 6. Conclusion • The ingestion of 1 g of ginger in syrup in a divided dose daily may be useful in some patients experiencing nausea and vomiting in the first trimester of pregnancy. (Altern Ther Health Med. 2002;8(5):89-91)
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September, 2002 - VOL. 8, NO. 5  September, 2002
Micronesian massage and massage oils: ancient practice and contemporary medical therapy
Michael J Balick, PhD;  Roberta Lee, MD
The journey of exploration continues on Pohnpei, a tropical island in the Federated States of Micronesia. On this particular day, we paddled our traditional outrigger canoe through the openings in the reef, toward the rocky shore of the island. Immediately before us lay the mountain known as Sokesh Rock, one of the higher points on Pohnpei, and a key feature of its landscape. Today, instead of turning our view upward, we focused on the shoreline, at a small, simple wooden house surrounded by graceful coconut palms—a typical island setting. To one side of the house a young man grated coconut pulp on a stool using a flattened, sharpened, serrated piece of tin affixed to the seat. In ancient times this same type of stool was used to grate coconut, but with a sharpened shell as its blade. Times have certainly changed. As his older brother grated the white coconut pulp, the younger sibling carried the shavings to a cauldron of boiling water and poured them in carefully. This is the traditional way in which coconut oil is made in Pohnpei and elsewhere in the Pacific. The boiling water releases the coconut oil from the pulp, and the oil rises to the surface where it is scooped off and saved in another container.
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September, 2002 - VOL. 8, NO. 5  September, 2002
Leech therapy for symptomatic treatment of knee osteoarthritis: results and implications of a pilot study
Gustav J Dobos, MD;  Tobias Esch, MD;  Jost Langhorst, MD;  Andreas Michalsen, MD;  Susanne Moebus, PhD, MPH;  Günther Spahn, MD
Context • Leech therapy was a mainstay in conventional treatment for pain from antiquity until the mid-19th century. Its use is still widespread in traditional healing procedures in Asia, Africa, and Arabic countries. There is renewed interest in leech therapy in the field of complementary medicine and empirical evidence for specific benefit in knee osteoarthritis. Objectives • To determine the effect of leech therapy as an adjunctive treatment in painful knee osteoarthritis, to investigate the onset of action, to evaluate patients’ acceptance of this treatment, and to investigate the side effects of the procedure. Design • Observational, controlled, nonrandomized pilot-study. Setting • Subjects were inpatients of an academic teaching hospital of the University of Essen, Department of Internal and Integrative Medicine, Essen, Germany. Patients • 16 inpatients (mean age 69±9 years) with a confirmed diagnosis of osteoarthritis of the knee joint; 10 patients were treated with leeches and 6 served as controls. Intervention • A single trial of 4 leeches (Hirudo medicinalis) applied topically at painful periarticular sites of the knee joint in the experimental group (n=10). Both groups received conventional treatment for pain with the exclusion of nonsteroidal anti-inflammatory drugs. Main Outcome Measures • Self-reported general knee pain, assessed by visual analog scale for 10 days daily and in a follow-up after 28 days. Frequency of adverse effects also was recorded. Results • Periarticular application of 4 leeches led to rapid relief of pain with sustained improvement after 4 weeks in the absence of major complications. Conclusion • Leech therapy may be an effective treatment for rapid reduction of pain associated with osteoarthritis of the knee. Its efficacy should be tested in larger randomized controlled trials with assessment of expectation bias. (Altern Ther Health Med. 2002;8(5):84-88)
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September, 2002 - VOL. 8, NO. 5  September, 2002
When to disbelieve the believable
David Moher, MSc;  David S Riley, MD
Science is often slow moving and, at times, not particularly exciting. We all are used to the familiar bias of healthcare journals, that is, the publication of findings whereby the authors extol the benefits of an intervention under investigation. Sometimes the unexpected happens, namely, the publication of results suggesting that the current “recommended” clinical practice may not be beneficial after all. Recently we found a good case in point. What happened? First, decades of assumed wisdom concerning the utility of estrogen and progesterone for long-term hormonal replacement therapy in postmenopausal women was called into question, at least for the use of Premarin and progesterone. Then the long-touted benefits of arthroscopic knee surgery for osteoarthritis were found to have no benefit at all. In the August 3, 2002, British Medical Journal, Italian pharmacologists Silvio Garattini and Vittorio Bertele noted that new anticancer drugs marketed in Europe since 1995 offered few or no advantages over existing drugs, yet cost up to 350 times more. An accompanying editorial mused as to whether conventional Western medicine might be a confidence trick driven by the drug industry. Finally, a growing body of data suggests that “the more the merrier” may not be a useful approach to the delivery of health care; all it seems to provide is more unpleasant interventions and worse healthcare. The rate of usage of medical care is driven by supply not necessity, not rates of illness, and certainly not evidence-based medicine.
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September, 2002 - VOL. 8, NO. 5  September, 2002
The precautionary principle
Michael Pollan, MA
The precautionary principle had its coming out party in the United States in 1998. This took place at the Wingspread Conference, a gathering of environmentalists in Racine, Wisc, organized by Carolyn Raffensperger, director of the Science and Environmental Health Network. Raffensperger has probably done more than any other individual to promote the precautionary principle in America and unify the US environmental movement behind it. The Wingspread Statement has become its most frequently cited formulation: “When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause-and-effect relationships are not fully established scientifically.”
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September, 2002 - VOL. 8, NO. 5  September, 2002
The precautionary principle: bearing witness to and alleviating suffering
Carolyn Raffensperger, MA, JD
The precautionary principle states that if it is within our power, we have an ethical imperative to prevent rather than merely to treat disease, even in the face of scientific uncertainty. In this paper, I present an overview of what we know about changing patterns of disease, which provides an argument for implementing the precautionary principle, particularly concerning children’s environmentally related developmental disabilities. These statistics are an indicator of the suffering of the world. Healthcare practitioners have an opportunity to use the precautionary principle both to bear witness to suffering and to alleviate suffering.
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September, 2002 - VOL. 8, NO. 5  September, 2002
Jin shin jyutsu outcomes in a patient with multiple myeloma
Ann R Shannon, BA
Jin Shin Jyutsu (JSJ), a Japanese energetic healing art that shares ancient roots with acupuncture and acupressure, was sought by a 56-year-old white patient for uncontrolled rib pain, subsequently diagnosed as multiple myeloma. JSJ treatment was received, without charge, from the author-practitioner, a relative of the patient, while she was still in training to become a certified practitioner. Treatment occurred (1) intermittently during the 4 months before diagnosis, (2) each day of the patient’s initial hospitalization at diagnosis, (3) for side effects arising from the patient’s first autologous peripheral stem cell bone marrow transplant (BMT) preconditioning regimen, and (4) throughout his 12-day BMT hospitalization.Numerous symptoms were treated in uncontrolled field and hospital settings with JSJ flows. Treatment primarily addressed active, troubling symptoms and, during BMT hospitalization, included prophylactic treatment for the most immediately anticipated side effects. JSJ’s contribution to the patient’s quality of life was readily acknowledged by his oncologist and treating BMT physician.
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September, 2002 - VOL. 8, NO. 5  September, 2002
Progress notes: Tufts University School of Medicine
Victor S Sierpina, MD
Tufts University School of Medicine (TUSM), located in the heart of Chinatown in Boston, Mass, is developing a robust educational effort in complementary and alternative medicine (CAM) under the leadership of Mary Y. Lee, MD. She was born and raised in an environment in which herbal medicine and traditional healing practices were used routinely—her parents were Chinese immigrants. While growing up, she saw her uncle, trained in both western and traditional Chinese medicine, use acupuncture for anesthesia in obstetrics and gynecology. Now in her internal medicine practice, Dr Lee recognizes her patients’ interest in CAM practices. They regularly ask her and her colleagues about such topics as herbal medicine, massage, and Reiki. Dr Lee holds positions as Dean for Educational Affairs, Associate Provost of Tufts University, and Principal Investigator of the Tufts Evidence-based Complementary and Alternative Medicine (EBCAM) project. Tokeep pace with the needs of the clinical environment, and in response to increased student interest in CAM, TUSM has been adding CAM-related content to the medical school curriculum over the past 5 years
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September, 2002 - VOL. 8, NO. 5  September, 2002
Complementary and alternative medical treatment of breast cancer: a survey of licensed North American naturopathic physicians
Käri Greene, MPH;  Heather Greenlee, ND;  Cheryl Grosshans, ND;  Jung G Kim;  Leanna J Standish, ND, PhD
Context • Complementary and alternative medicine (CAM) use is on the rise in the United States, especially for breast cancer patients. Many CAM therapies are delivered by licensed naturopathic physicians using individualized treatment plans. Objective • To describe naturopathic treatment for women with breast cancer. Design • Cross-sectional mail survey in 2 parts: screening form and 13-page survey. Setting •Bastyr University Cancer Research Center, Kenmore, Wash. Participants • All licensed naturopathic physicians in the United States and Canada (N=1,356) received screening forms; 642 (47%) completed the form. Of the respondents, 333 (52%) were eligible, and 161 completed the survey (48%). Main Outcome Measures • Demographics of naturopathic physicians, development of treatment plans, CAM therapies used, perceived efficacy of therapeutic interventions. Results • Of those respondents screened, 497 (77%) had provided naturopathic care to women with breast cancer, and 402 (63%) had treated women with breast cancer in the previous 12 months. Naturopaths who were women were more likely than men to treat breast cancer (P=.004). Of the survey respondents, 104 (65%) practiced in the United States, and 57 (35%) practiced in Canada; 107 (66.5%) were women, and 54 (33.5%) were men. To develop naturopathic treatment plans, naturopathic physicians most often considered the stage of cancer, the patient’s emotional constitution, and the conventional therapies used. To monitor patients clinically, 64% of the naturopathic physicians used diagnostic imaging, 57% considered the patient’s quality of life, and 51% used physical examinations. The most common general CAM therapies used were dietary counseling (94%), botanical medicines (88%), antioxidants (84%), and supplemental nutrition (84%). The most common specific treatments were vitamin C (39%), coenzyme Q-10 (34%), and Hoxsey formula (29%). (Altern Ther Health Med. 2002;8(5):68-75)
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