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NIH Clinical Center Establishes Integrative Medicine Consult Service
The National Center for Complementary and Alternative Medicine (NCCAM) has established an Integrative Medicine Consult Service at the National Institutes of Health (NIH) Clinical Center. This service will provide physicians, nurses, and other members of the Clinical Center health care team the ability to discuss complementary and alternative medicine (CAM) therapies with knowledgeable medical staff from the consult service and learn how various CAM practices might complement or interact with a patient's care as a research participant at the Clinical Center.
The NIH Clinical Center already offers many CAM therapies. The Clinical Center's Pain and Palliative Care Service and the Rehabilitation Medicine Department offer acupuncture, reiki, hypnosis, guided imagery, massage therapy, acupuncture, tai chi, and qi gong training. The Pharmacy Department consults on herbals and herb/drug interactions and has conducted research in these areas. The Integrative Medicine Consult Service will coordinate the resources of these services to meet the needs of the Clinical Center staff and its patients. In addition to offering clinical consultation regarding CAM therapies, the service will establish a research program embedded in NIH's clinical and translational research structure and provide CAM education for NIH staff, patients, and their families.
The director of the consult service will be Patrick J. Mansky, MD, a clinical oncologist and researcher at NCCAM. Mansky joined NCCAM in 2001 as a staff clinician and clinical investigator leading the oncology program in NCCAM's Division of Intramural Research. He conducts research on the application of CAM interventions in the care and treatment of cancer patients and survivors, including electroacupuncture for nausea from chemotherapy, use of mistletoe in combination with gemcitabine for treating advanced cancers, and effects of tai chi and exercise in cancer survivors.
Many Physicians Know Little about Dietary Supplement Regulation, Study Says
Physicians could learn much more about dietary supplement regulation and adverse event reporting, according to a recent study.
Patients often rely on their physicians for education about herbs and other supplements since the passage of the Dietary Supplement Health and Education Act allowed supplements to be sold to the public without FDA approval or premarket evaluation, the researchers say. The researchers, however, wondered about the level of knowledge of the physicians in this area. To test this, they designed a study to evaluate physicians' level of understanding of dietary supplement regulation and the adverse event reporting process. The researchers also wanted to determine whether an interactive on-line curriculum could aid in improving knowledge.
After developing a multicenter on-line educational intervention, they administered it to physicians at 15 internal medicine residency programs throughout the United States between March 1, 2006, and June 30, 2006. The researchers used pretest performance to measure baseline knowledge, while posttest performance compared with pretest performance measured the effectiveness of the educational intervention.
A total of 335 physicians completed the module. Ninety percent of those completing the module were residents, while 10% were attending physicians. The researchers found that baseline knowledge of dietary supplement regulatory issues was poor, with a total average pretest score of only 59% (986/1,675). The average score rose to 91% (1,526/1,675) after completion of the curriculum. About one-third of physicians were unaware that dietary supplements did not require FDA approval or submission of safety and efficacy data before being marketed. Similar percentages believed that there are regulations in place to ensure supplement quality. Most physicians were unaware that serious adverse events due to the use of supplements should be reported through the FDA MedWatch system.
For more information about the study, see the May 14 issue of the Archives of Internal Medicine.
UK Physicians Recommend 'Unpacking' CAM Modalities
An exploratory qualitative study of physicians in the United Kingdom found that most would prefer incorporating "effective" complementary and alternative medicine (CAM) therapies into their practices in the National Health Service (NHS), rather than incorporating the wholesale practice of CAM.
The study was designed to look at the views of doctors, working primarily in general practice, about CAM. The results were published on May 30 on the BMC Complementary and Alternative Medicine web site (view the full text article at: www.biomedcentral.com/content/pdf/1472-6882-7-17.pdf).
Researchers interviewed nine doctors for the study. Eight were general practitioners, and one was a homeopathic doctor working in a hospital setting and receiving homeopathic referrals from primary care. The data revealed three groups of doctors regarding their attitudes towards CAM: the enthusiasts, the skeptics, and the undecided. Five key themes identified within the data were: the role of doctors' personal experiences of conventional medicine and CAM in shaping their views of CAM; doctor-patient communication about CAM and patient disclosure; doctors' information and training needs regarding CAM; perceptions of the evidence base for CAM; and the role of CAM within the NHS.
The doctors identified the value of "unpacking" the term complementary and alternative medicine to distinguish those modalities that may be effective from others that are not, or those that may be acceptable to doctors (or patients) from those that are not. They viewed wholesale incorporation of CAM within the NHS as unlikely and maybe undesirable. Yet, the researchers say, there may be elements of some CAM approaches that could be applied more widely within mainstream NHS practice, to enhance patients' overall quality of care and even increase doctors' fulfillment in their practice.