Posts Tagged "alternative medicine"

Wednesday Bubble: Are you dazed and confused?

Posted by Liz on Dec 22, 2010 in women's health | 6 comments

Every now and then I like to reach into the Flashfree archives and repost a piece that either has lasting relevance or is a must-read for those of you who are new to the blog. This post originally ran in May of 2008 but continues to occupy the top ten list of importance in my mind. The topic? How do you discern information in a study and what do you need to look for. Plus, there’s an added bonus for all you Led Zeppelin fans.

Today’s Bubble – are you dazed and confused?

[youtube=http://youtube.com/watch?v=Xajqf-PhO8s&feature=related]

A gal pal mentioned to me this morning that she often feels so confused about study findings proving or disproving the value of certain medications or herbs that she often just throws up her hands and does nothing. Many of us are as dazed and confused as she is so that I thought that a few key points about clinical studies might help.

Mike Clarke from the School of Nursing and Midwifery at Trinity College in Dublin wrote a great article last year about the need to standardize results of studies for a specific disease ( in this case, rheumatoid arthritis). He defined the problem as follows:

“Every year, millions of journal articles are added to the tens of millions that already exist in the health literature, and tens of millions of web pages are added to the hundreds of millions currently available. Within these, there are many tens of thousands of research studies which might provide the evidence needed to make well-informed decisions about healthcare. The task of working through all this material is overwhelming enough without then finding the studies of relevance to the decision you wish to make…”

So what do you do? A few key points:

• Consider that every study has the potential for bias. Perhaps researchers are using 7 instruments to measure depression and only highlight findings from 3 of these in order to preserve the most positive or significant results. Clearly, the reader is being led towards certain outcomes and away from others.
• Study designs, types of patients studied, age of patients studied, gender, you name, can differ so it’s difficult, if not impossible to draw definitive conclusions when comparing results of one to another.
• Another issue of great interest to practitioner of Western medicine is whether or not a study is controlled. This means that two groups are compared that are identical in every way except one group is given an experimental treatment and the other, a placebo or standardized treatment. Note that often, real world conditions are often recreated rather than conducted in a real world setting and many studies are not controlled, meaning that the science behind the findings is questionable.
• Alternative and complementary medicines are still incompletely understood among many practitioners of Western medicine. What’s more, products are not regulated as carefully as medicinal agents and manufacturing practices vary. Consequently, studies of these agents or modalities are often inconclusive. And of course, often underfunded and under-appreciated.

No wonder we all feel so dazed and confused!

I’ve written several times about the importance of consulting a practitioner or medical expert before embarking on any regimen for perimenopausal symptoms. Even if you only see someone once, at least that dialogue may be useful for defining a regimen that may work best for you and what you’re going through. And if you live off the beaten track without access toa good practitioner, well then excellent resources like Medline or the American Botanical Council may be be of help in discerning what’s what.

The short answer is that there are no short answers. But with careful guidance and a bit of prudence, you may just be able see the light and smooth out the bumps on this rollercoaster ride we’re all on.

Dazed and Confused – Revisited

Posted by Liz on May 31, 2010 in herbal medicine, menopause | 2 comments

Two years ago i wrote a post about the confusion surrounding therapies, effectiveness, and discerning right from wrong when it comes to clinical trials. Herbal and integrative therapies are perfect examples of the grey areas; many trials have not incorporated some of the most important tenets supporting the use of these strategies, most important of which is individualization. Hence, I wanted to share the post with you again, and hopefully, spark some dialogue that might lead to improvements in how we study and write about the therapies that are offered to patients.

[youtube=http://www.youtube.com/watch?v=pau8Zf7srlU]

A gal pal mentioned to me this morning that she often feels so confused about study findings proving or disproving the value of certain medications or herbs that she often just throws up her hands and does nothing. Many of us are as dazed and confused as she is so that I thought that a few key points about clinical studies might help.

Mike Clarke from the School of Nursing and Midwifery at Trinity College in Dublin wrote a great article a few years ago about the need to standardize results of studies for a specific disease ( in this case, rheumatoid arthritis). He defined the problem as follows:

“Every year, millions of journal articles are added to the tens of millions that already exist in the health literature, and tens of millions of web pages are added to the hundreds of millions currently available. Within these, there are many tens of thousands of research studies which might provide the evidence needed to make well-informed decisions about healthcare. The task of working through all this material is overwhelming enough without then finding the studies of relevance to the decision you wish to make…”

So what do you do? A few key points:

• Consider that every study has the potential for bias. Perhaps researchers are using 7 instruments to measure depression and only highlight findings from 3 of these in order to preserve the most positive or significant results. Clearly, the reader is being led towards certain outcomes and away from others.
• Study designs, types of patients studied, age of patients studied, gender, you name, can differ so it’s difficult, if not impossible to draw definitive conclusions when comparing results of one to another.
• Another issue of great interest to practitioner of Western medicine is whether or not a study is controlled. This means that two groups are compared that are identical in every way except one group is given an experimental treatment and the other, a placebo or standardized treatment. Note that often, real world conditions are often recreated rather than conducted in a real world setting and many studies are not controlled, meaning that the science behind the findings is questionable.
• Alternative and complementary medicines are still incompletely understood among many practitioners of Western medicine. What’s more, products are not regulated as carefully as medicinal agents and manufacturing practices vary. Consequently, studies of these agents or modalities are often inconclusive. And of course, often underfunded and under-appreciated.

No wonder we all feel so dazed and confused!

I’ve written several times about the importance of consulting a practitioner or medical expert before embarking on any regimen for perimenopausal symptoms. Even if you only see someone once, at least that dialogue may be useful for defining a regimen that may work best for you and what you’re going through. And if you live off the beaten track without access toa good practitioner, well then excellent resources like Medline or the American Botanical Council may be be of help in discerning what’s what.

The short answer is that there are no short answers. But with careful guidance and a bit of prudence, you may just be able see the light and smooth out the bumps on this rollercoaster ride we’re all on.

My Dream: West Meets East…Someday

Posted by Liz on Sep 4, 2008 in herbal medicine, Meditation/mindfulness therapy, women's health | 3 comments

In 2005, a panel convened by the National Institutes of Health issued a statement emphasizing that menopause is not a disease. Yet, only yesterday, I ran across a newly-issued primer on menopause that is geared towards primary care physicians. In the introductory paragraph, I found the following statement:

“Managing menopausal health requires an ongoing effort to keep up with date with data on medical management of menopausal symptoms and treatments designed to prevent a number of disabling conditions associated with menopause and aging…”

Delving deeper,  I found only eight paragraphs devoted to alternative therapies (namely, phytogestrogens, black cohosh and bioidentical hormones). What jumps out on the one full page on which they are reviewed are statements such as:

“…controversy regarding long-term safety issues.” (black cohosh)

“…these same hormones are used in less expensive, FDA-approved estrogen products.” (bioidentical hormones)

“…evidence to date suggests that phytoestrogens do not ameliorate hot flushes or other menopausal symptoms. In addition there are not data to support the safety of long-term therapy with phytoestrogens and other herbal medications.” (phytoestrogens).

I’ve got a few bones to pick.

1. Historically, controlled studies with herbal preparations have been underfunded and undersupported by national institutions in this country, which is why the Western practitioner often claims “scant evidence.” Yet, if you do a search on alternative therapies on PubMed, there appears to be a growing interest in their utility and an increasing amount of time and resources devoted to studying them. Studies are published regularly in peer-reviewed journals such as Menopause. I’ve blogged about controlled evidence on a regular basis for months now. And, even the Nationa l Institutes of Health is in on the act; with trials currently underway evaluating the role of meditation, soy estrogens, herbal alternatives (e.g. black cohosh, red clover) for menopausal symptoms.
2. The controversy over long-term safety issues and black cohosh is being seriously addressed. I blogged about this only a week ago, noting that the National Institutes of Health Office of Dietary Supplements has publicly stated that millions of individuals have safely used black cohosh with no ill effects.
3. The North American Menopause Society-sponsored monograph highlights several advantages that bioidentical/compounded hormones might offer over conventional products, including greater dosing flexibility, lower doses for women who are especially sensitive and the avoidance of potential allergens.

The primer to which I refer was developed specifically to help primary care physicians understand the challenges that their menopausal patients face so that they can provide better care. However, the monograph does a great disservice by its sole emphasis on Western medical approaches verses Eastern whole-body approaches.

Physicians- if you’re listening, hear this:

MENOPAUSE IS NOT A DISEASE AND SHOULDN’T BE TREATED OR APPROACHED AS ONE.

A few thoughts:

• Please review your data, read alternative peer-reviewed journals and educate yourselves about  alternatives for your patients who have been scared off by the negative findings surrounding HRT and antidepressants and other pharmaceuticals.
• Pay attention to the fact that well-respected journals such as Menopause and Climacteric and the Journal of the British Menopause Society actually devote pages to alternative therapies that have been evaluated in well-controlled studies.
• Embrace multidisciplinary collaboration and invite educated and credentialled alternative practitioners into your fold who might be able to offer you and your patients important solutions when Western ways fail.

Over 5,000 women enter menopause daily. Many of these women are going to call on your for help with managing this very natural transition that we call the menopause. Why not take a moment and meet the challenge without pigeonholing it?

Thoughts anyone?

Bones Bones Bones…Again!

Posted by Liz on Aug 26, 2008 in bone health | 1 comment

Something is in the air. Is it the moon moving into Virgo? The end of August, when fruit is ripe and bursting on the vine? What IS IT about late summer that makes me want to hold onto the old and challenge the new?

I’ve uncovered more news about bone loss as it relates to menopause. Early data suggest that fruit, namely Korean raspberries (better known as Rubus coreanus) may hold an important key to preventing bone loss.

Results of a study in rats that appears in the Menopause journal suggests that Rubus coreanus extract prevented bone loss caused by estrogen deficiency by enhancing the function of cells the form bone (osteoclasts) and promoting the death of cells (osteoclasts) that cause bone to break down.

The researchers caution that more study is needed but point to the mineral compositon of Rubus coreanus, which contains potassium, magnesium, and vitamins D and B2. They also suggest that Rubus coreanus extract improves bone density through an antioxidant effect.

A bit of wisdom goes a long way

Posted by Liz on Jul 13, 2008 in Uncategorized | 2 comments

I went up to Philly to visit an old friend this weekend. She turned me on to this book, a pretty amazing overview of menopause. What I like most about it is that its author, Dr. Christine Northrup, is an MD who isn’t afraid of holistic and Chinese medicine. Personally, I’m fortunate because my gyno is open to alternative medicine and in fact, recommended topical progesterone before my acupuncturist did. But not every MD is well-versed in East meets West and as a result, many patients are short-changed on strategies that might help them.

If you are looking for an alternative path, check out the book. It’s definitely a must-see.