Dr' Tawfik A' M' Khoja

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The role of evidence in complementary
alternative medicine
Dr. Tawfik A. M. Khoja MBBS, DPHC, FRCGP,
FFPH,FRCP (UK) Director General HMC/GCC States
Dr. Abdulrahman Kamel MBBS, MSc. Card., D.TQM.
Technical Affair Dept. GCC
EBM CAM 1-2 Dhual-Qadah 1430H 20-21 October
2009 Kuwait
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Introduction The growth of alternative medicine
raises a number of questions about the nature of
evidence. Calls for gold standard randomised
controlled trial evidence, by both biomedical and
political establishments, to legitimise the
integration of alternative medicine into
healthcare systems, can be interpreted as deeply
political. In this presentation, the supposed
objectivity of scientific, biomedical forms of
evidence is questioned through an illumination of
the multiple rhetorics embedded in the
evidence-based medicine phenomenon, both within
biomedicine itself and in calls for its use to
evaluate alternative therapeutic systems.
4
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???? ????? (??? 22)
Is then one who Walks headlong, with his face
Grovelling, better guided, Or one who walks
Evenly on a Straight Way ?
Holy Quran
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Evidence-Based Medicine

• Evidence-based medicine has become one of the
  major driving forces in the (National health
  system) NHS, with an impact on education, policy
  making, development and research.

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What Is EBM?

• EBM is the conscientious, explicit and judicious
  use of current best evidence in making decisions
  about the care of individual patients.

(Sackett, et al 1992)
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Evidence Based Medicine

• "Evidence-based medicine (EBM) is an approach to
  health care that promotes the collection,
  interpretation, and integration of valid,
  important and applicable patient-reported,
  clinician-observed, and research-derived
  evidence. The best available evidence, moderated
  by patient circumstances and preferences, is
  applied to improve the quality of clinical
  judgments, and facilitate cost-effective health
  care".
• Source  McKibbon, K.A. et al. (1995) The
  medical literature as a resource for evidence
  based care. from the Health Information Research
  Unit, McMaster University, Ontario, Canada.

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Evidence-based medicine

• Involves evaluating rigorously the effectiveness
  of healthcare interventions, disseminating the
  results of evaluation and using those findings to
  influence clinical practice.  It can be a complex
  task, in which the production of evidence, its
  dissemination to the right audiences, and the
  implementation of change can all present
  problems".
• Source Appleby J, Walshe K and Ham C (1995). 
  Acting on the Evidence (NAHAT Research Paper No.
  17). Birmingham NAHAT.

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Clinical knowledge, experience, skills, guts, flai
r
Patient Preferences, Values and expectations
Best Evidence
Clinical Decision
Flowchart of evidence-based medicine
E.B Public Health. Brownson RC etal. 2003
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Evidence Based Clinical Practice (EBCP)

• EBCP is an approach to health care practice in
  which the clinician is aware of the evidence that
  bears on her clinical practice, and the strength
  of that evidence".
• http//hiru.mcmaster.ca/ebm/default.htmWhat_is_E
  vidence_Based_Medicine (McMaster University)

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Evidence-Based Health Care

• Extends the application of the principles of
  Evidence-Based Medicine to all professions
  associated with health care, including purchasing
  and management". Centre for Evidence Based
  Medicine Glossary. http//cebm.jr2.ox.ac.uk/docs/g
  lossary.html

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Evidence Based Healthcare .

• Quotation "Evidence-based healthcare is the
  conscientious use of current best evidence in
  making decisions about the care of individual
  patients or the delivery of health services.
  Current best evidence is up-to-date information
  from relevant, valid research about the effects
  of different forms of health care, the potential
  for harm from exposure to particular agents, the
  accuracy of diagnostic tests, and the predictive
  power of prognostic factors.
• First Annual Nordic Workshop on how to
  critically appraise and use evidence in decisions
  about healthcare, National Institute of Public
  Health, Oslo, Norway, 1996.

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Scientific Evidence
Population Needs and Values
Resources
Broad considerations for enhancing decision
making in Public Health
E.B Public Health. Brownson RC etal. 2003
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Evidence-based decision making
Draws heavily upon the findings of scientific
research (including social scientific research)
that has been gathered and critically appraised
according to explicit and sound principles of
scientific inquiry. The opinions and judgments
of experts that are based upon up-to-date
scientific research clearly constitute high
quality valid and reliable evidence.
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How research and evaluation evidence contributes
to policy making
Davies, P.T. 1999. Brit. Educ. Stud 47(2)
108-121 Gray, J.A.M. 1997. EB Healthcare How to
Make Health Policy and Management Decisions
Evidence is one factor that contributes to policy
making, implementation and delivery. The
following diagram indicates other important
factors
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The Need for Evidence-Based CAM
???? ?????? (??? 111)
say produce your proof if ye are truthful.
Holy Quran
If we did not respect the evidence, we would have
very little Leverage in our quest for the truth.


Carl Sogan.
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Quality.. continue
EBHC
EBPH
We Need Strategic Plan For EBM In Health
EBM
To BE Internalize Institutionalize in Health
System
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The Scientific Role of EB-CAM
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Key Differences between Evidence-Based Medicine
and Evidence-Based Public Health (CAM)
E.B Public Health. Brownson RC etal. 2003
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Is Evidence-based Medicine Sufficient For
Complementary And Alternative Medicine
Research? Evidence-based medicine (EBM), is
widely accepted among researchers as the
"gold-standard" for scientific approaches. Over
the years, EBM has both supported and denied the
value of allopathic medicine practices, while
having less association with complementary and
alternative medicine (CAM) practices. Since most
CAM practices are complex and focus on healing
rather than cure the question arises as to
whether EBM principles are sufficient for making
clinical decisions about CAM.
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"While evidence-based medicine's emphasis on
randomized controlled trials has many benefits,
researchers and clinicians have found that this
focus may be too limited for complex systems such
as complementary and alternative medicine (CAM),
and other approaches to healing,. The
Presentation focus on special issue of some
Integrative Therapies that explore EBM and
alternative strategies to EBM for evaluating CAM.
This issue discusses whether clinical research
on CAM using randomized placebo-controlled trial
designs is the best strategy for making
evidence-based decisions in clinical practice,
and describes strategies that use "whole systems"
and "integrated evaluation models" as potential
new standards for research on CAM.
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Message to complementary and alternative medicine
evidence is a better friend than power
Andrew J Vickers BMC Complementary and
Alternative Medicine 2001, 11doi10.1186/1472-688
2-1-1
Background Evidence-based medicine (EBM) is being
embraced by an increasing number of practitioners
and advocates of complementary and alternative
medicine (CAM). A significant constituency
within CAM, however, appears to have substantive
doubts about EBM and some are expressly hostile.
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Discussion Many of the arguments raised against
EBM within the CAM community are based on a
caricature radically at odds with established,
accepted and published principles of EBM
practice. Contrary to what has sometimes been
argued, EBM is not cookbook medicine that ignores
individual needs. Neither does EBM mandate that
only proven therapies should be used. Before
EBM, decisions on health care tended to be based
on tradition, power and influence. Such modes
usually act to the disadvantage of marginal
groups. Conclusion By placing CAM on an equal
footing with conventional medicine - what matters
for both is evidence of effectiveness - EBM
provides an opportunity for CAM to find an
appropriate and just place in health care.
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A systematic review of how homeopathy is
represented in conventional and CAM peer reviewed
journals
Timothy Caulfield and Suzanne DeBow BMC
Complementary and Alternative Medicine 2005,
512doi10.1186/1472-6882-5-12
Background Some suggest that publication biases
occur in mainstream medicine, and may also occur
in CAM. The purpose of this study was to compare
the representation of homeopathic clinical trials
published in traditional science and CAM journals.
Results Forty-six peer-reviewed articles
published in a total of 23 different journals
were compared (26 in CAM journals and 20 in
conventional journals).
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Conclusion A considerable difference exists
between the number of clinical trials showing
positive results published in CAM journals
compared with traditional journals. It was found
only 30 of those articles published in CAM
journals presented negative findings, whereas
over twice that amount were published in
traditional journals. These results suggest a
publication bias against homeopathy exists in
mainstream journals. Conversely, the same type
of publication bias does not appear to exist
between review and meta-analysis articles
published in the two types of journals.
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A scoping review of research on complementary and
alternative medicine (CAM) and the mass media
Looking back, moving forward
Laura C Weeks and Tina Strudsholm BMC
Complementary and Alternative Medicine 2008,
843doi10.1186/1472-6882-8-43
Background Media reports are a primary
information source regarding decisions to use
CAM. Research on CAM related media reports is
becoming increasingly relevant and important
however, identifying key concepts to guide future
research is problematic due to the dispersed
nature of completed research in this field. A
scoping review was conducted to 1) determine the
amount, focus and nature of research on CAM and
the mass media and 2) summarize and disseminate
related research results.
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Results Of 4,454 studies identified through
various search strategies, 16 were relevant to
the objectives and included in a final
sample. The tone of media reports appears
generally positive, which may be related to a
lack of reporting on issues related to risk and
safety.
Conclusion Research on CAM and the mass media
spans multiple disciplines and strategies of
inquiry however, despite the diversity in
approach, it is clear that issues related to
production and reception of media content are in
need of research attention. To address the
varied issues in a comprehensive manner, future
research needs to be collaborative, involving
researchers across disciplines, journalists and
CAM users.
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A systematic review of the clinical effectiveness
of acupuncture for allergic rhinitis
Jonathan Roberts, Aarnoud Huissoon, Janine
Dretzke, Dechao Wang Christopher Hyde BMC
Complementary and Alternative Medicine 2008,
813doi10.1186/1472-6882-8-13
Background The aim assessed the evidence for the
clinical effectiveness of acupuncture in patients
with AR by performing a systematic review of the
literature.
Results A meta-analysis failed to show any
summary benefits of acupuncture treatment for
symptom severity scores or serum IgE measures
which could not have been accounted for by chance
alone.
Conclusion There is currently insufficient
evidence to support or refute the use of
acupuncture in patients with AR. A large well
conducted RCT, which overcomes identified
methodological problems in the existing RCTs,
would be required to resolve this question.
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How parents choose to use CAM a systematic
review of theoretical models
Ava Lorenc1 , Yael Ilan-Clarke2 , Nicola
Robinson1 and Mitch Blair3 BMC Complementary and
Alternative Medicine 2009, 99doi10.1186/1472-688
2-9-9
Background CAM is commonly used for children and
the decision-making process to use CAM is
affected by numerous factors. Most research on
CAM use lacks a theoretical framework and is
largely based on bivariate statistics. The aim
of this review was to identify a conceptual model
which could be used to explain the
decision-making process in parental choice of CAM.
Results Seven different models were identified.
The most commonly used and successful model was
Andersen's Sociobehavioural Model (SBM). Two
papers proposed modifications to the SBM for CAM
use.
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Conclusion The SBM modified for CAM use, which
incorporates both psychological and pragmatic
determinants, was identified as the best
conceptual model of CAM use. This model provides
a valuable framework for future research, and
could be used to explain child CAM use. An
understanding of the decision making process is
crucial in promoting shared decision making
between healthcare practitioners and parents and
could inform service delivery, guidance and
policy.
31
Eurythmy Therapy in clinical studies a
systematic literature review
Arndt Büssing, Thomas Ostermann, Magdalena
Majorek and Peter F Matthiessen BMC Complementary
and Alternative Medicine 2008, 88doi10.1186/1472
-6882-8-8
Background The aim to overview the current
literature on eurythmy therapy (EYT) which is an
integral part of Anthroposophic Medicine. EYT
can be described as a movement therapy in which
speech movements are transposed into exercises
which address the patient's capability to soul
expression and strengthen his salutogenetic
resources.
Results In most studies, EYT was used as an
add-on, not as a mono-therapy. The studies
described positive treatment effects with
clinically relevant effect sizes in most cases.
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Conclusion Indications, study designs and the
usage of additional treatments within the
identified studies were quite heterogeneous.
Despite of this, EYT can be regarded as a
potentially relevant add-on in a therapeutic
concept, although its specific relevance remains
to be clarified. Well performed controlled
studies on this unique treatment are highly
recommended.
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Role of EB-CAM In Cancer
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Complementary and alternative medicine use among
women at increased genetic risk of breast and
ovarian cancer
Christine M Mueller, Phuong L Mai, Jaime Bucher,
June A Peters, Jennifer T Loud Mark H
Greene BMC Complementary and Alternative Medicine
2008, 817doi10.1186/1472-6882-8-17
Background Complementary and alternative medicine
(CAM) use is well documented among breast cancer
patients and survivors, but little evidence is
available to describe rates and patterns of use
among women at increased genetic risk of breast
cancer.
Results Among the 164 BRCA1 or BRCA2
mutation-positive (BRCA) women in this analysis,
78 reported CAM use, with prayer and lifestyle
diet being the two most commonly reported
modalities.
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Many subjects used multiple CAM therapies, with
34 reporting use of three or more modalities.
The most commonly used modalities were mind-body
therapies and biologically-based practices, 61.6
and 51.8, respectively.
Conclusion This study suggests that the
prevalence of CAM use is high among BRCA mutation
carriers, with frequency of use comparable to
that of breast cancer patients and survivors.
Given the high prevalence of CAM use in these
subjects, especially biologically-based therapies
including herbal supplements, whose safety and
efficacy in relation to cancer risk are
unknown. The study suggests that future research
is necessary to clarify these risks, and that it
is important for providers to inquire about and
to discuss the pros and cons of CAM use with
their BRCA patients.
36
Studies of the in vitro anticancer, antimicrobial
and antioxidant potentials of selected Yemeni
medicinal plants from the island Soqotra
Ramzi A Mothana, Ulrike Lindequist, Renate
Gruenert and Patrick J Bednarski BMC
Complementary and Alternative Medicine 2009,
97doi10.1186/1472-6882-9-7
Background Recent years have witnessed that there
is a revival of interest in drug discovery from
medicinal plants for the maintenance of health in
all parts of the world. The aim of this work was
to investigate 26 plants belonging to 17 families
collected from a unique place in Yemen (Soqotra
Island) for their in vitro anticancer,
antimicrobial and antioxidant activities.
37
Conclusion The results show once again that
medicinal plants can be promising sources of
natural products with potential anticancer,
antimicrobial and antioxidative activity. The
results will guide the selection of some plant
species for further pharmacological and
phytochemical investigations.
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Evidence-based effect size estimation An
illustration using the case of acupuncture for
cancer-related fatigue
Ramzi Michael F Johnston, Ron D Hays and Ka-Kit
Hui BMC Complementary and Alternative Medicine
2009, 91doi10.1186/1472-6882-9-1
Background Estimating a realistic effect size is
an important issue in the planning of clinical
studies of complementary and alternative medicine
therapies. When a minimally important difference
is not available, researchers may estimate effect
size using the published literature. This
evidence-based effect size estimation may be used
to produce a range of empirically-informed effect
size and consequent sample size estimates. The
study provide an illustration of deriving
plausible effect size ranges for a study of
acupuncture in the relief of post-chemotherapy
fatigue in breast cancer patients.
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Results Suggests that an adequately-powered phase
III randomized controlled trial comprised of two
arms would require at least 101 subjects (52 per
arm) if a strong effect is assumed for
acupuncture and 235 (118 per arm) if a moderate
effect is assumed. Conclusion Evidence-based
effect size estimation helps justify assumptions
in light of empirical evidence and can lead to
more realistic sample size calculations, an
outcome that would be of great benefit for the
field of complementary and alternative medicine.
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The Role of Pharmacutical Care
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Exploring consumer and pharmacist views on the
professional role of the pharmacist with respect
to natural health products a study of focus
groups
Della Kwan, Heather S Boon, Kristine Hirschkorn,
Sandy Welsh, Tannis Jurgens, Lynda Eccott,
Shirley Heschuk, Glenn G Griener and Jillian C
Cohen-Kohler BMC Complementary and Alternative
Medicine 2008, 840doi10.1186/1472-6882-8-40
Background Natural health products (NHPs) such as
herbs, vitamins and homeopathic medicines, are
currently available for sale in most Canadian
pharmacies. However, most pharmacists report
that they have limited knowledge about these
products which have been regulated in Canada as a
specific sub-category of drugs. In this study,
consumers' and practicing pharmacists'
perceptions of pharmacists' professional
responsibilities with respect to NHPs are
examined.
42
Results Illustrate the ways in which pharmacists'
professional responsibilities are impacted by
changing consumer needs. Many consumers in the
study utilized a wide range of information
resources that may or may not have included
pharmacists. Nevertheless, the majority of
consumers and pharmacists agreed that pharmacists
should be knowledgeable about NHPs and felt that
pharmacists should be able to manage drug-NHPs
interactions as well as identify and evaluate the
variety of information available to help
consumers make informed decisions. Conclusion This
paper demonstrates that consumers' expectations
and behaviour significantly impact pharmacists'
perceptions of their professional
responsibilities with respect to NHPs.
43
Does pharmaceutical advertising affect journal
publication about dietary supplements?
Kathi J Kemper and Kaylene L Hood BMC
Complementary and Alternative Medicine 2008,
811doi10.1186/1472-6882-8-11
Background Advertising affects consumer and
prescriber behaviors. The relationship between
pharmaceutical advertising and journals'
publication of articles regarding dietary
supplements (DS) is unknown.
Conclusion These data are consistent with the
hypothesis that increased pharmaceutical
advertising is associated with publishing fewer
articles about DS and publishing more articles
with conclusions that DS are unsafe. Additional
research is needed to test alternative hypotheses
for these findings in a larger sample of more
diverse journals.
44
Attitudes and perceptions of Australian pharmacy
students towards Complementary and Alternative
Medicine a pilot study
Evelin Tiralongo and Marianne Wallis BMC
Complementary and Alternative Medicine 2008,
82doi10.1186/1472-6882-8-2
Background The incorporation of CAM into health
professional curricula is handled quite
differently by different institutions and
countries.
The study aimed to describe the attitudes,
perceptions and beliefs of second, third and
fourth year pharmacy students towards
complementary and alternative medicine (CAM) and
to explore factors that might affect attitudes
such as learning, preceptors and placements.
45
Results Overall, 95.5 of pharmacy students
believe that pharmacists should be able to advise
patients about CAM and most (93.7) have used CAM
prior to course enrolment. The majority of
pharmacy students (89.2) perceive education
about CAM as a core and integral part of their
professional degree and favour it over an
additional postgraduate degree. However, they
see a greater need for education in complementary
medicines (such as herbal medicines, vitamins and
minerals) than for education in complementary
therapies (such as acupuncture, meditation and
bio-magnetism).
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Conclusion Pharmacy students perceive education
about CAM as a core and integral part of their
professional degree. Students' attitudes towards
CAM can be influenced by learning, lecturers,
preceptors and practice experience. The content
and focus of CAM education has to be further
investigated and tailored to meet the
professional needs of our future health
professionals.
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Quality Safety In EB-CAM
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Knowledge and beliefs concerning evidence-based
practice amongst complementary and alternative
medicine health care practitioners and allied
health care professionals A questionnaire survey
Julie Hadley1 , Ismail Hassan1 and Khalid S
Khan BMC Complementary and Alternative Medicine
2008, 845doi10.1186/1472-6882-8-45
Background Evidence-based practice (EBP) has
become an important competency in many allied and
complementary and alternative medicine (CAM)
health care practitioners' professional standards
of proficiency.
49
Conclusion The results demonstrate that
practitioner's learning needs do vary according
to the type of profession, time since graduation
and prior research experience. The survey
findings are exploratory and will benefit from
further replication, however, we do believe that
they warrant consideration by allied health care
and CAM tutors and trainers when planning EBP
teaching curricula as it is important to tailor
teaching to meet the needs of specific subgroups
of trainees to ensure that specific learning
needs are met.
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Patient satisfaction and side effects in primary
care An observational study comparing homeopathy
and conventional medicine
Florica Marian, Kerstin Joost, Krishan D Saini,
Klaus von Ammon, André Thurneysen André
Busato BMC Complementary and Alternative Medicine
2008, 852doi10.1186/1472-6882-8-52
Background This study is part of a nationwide
evaluation of complementary medicine in
Switzerland (Programme Evaluation of
Complementary Medicine PEK). The main objective
of this study is to investigate patient
satisfaction and perception of side effects in
homeopathy compared with conventional care in a
primary care setting.
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Results Statistically significant differences
were found with respect to health status (higher
percentage of chronic and severe conditions in
the homeopathic group), perception of side
effects (higher percentage of reported side
effects in the conventional group) and patient
satisfaction (higher percentage of satisfied
patients in the homeopathic group). Conclusion Ov
erall patient satisfaction was significantly
higher in homeopathic than in conventional care.
Homeopathic treatments were perceived as a
low-risk therapy with two to three times fewer
side effects than conventional care
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The square curve paradigm for research in
alternative, complementary, and holistic
medicine a cost-effective, easy, and
scientifically valid design for evidence-based
medicine and quality improvement.
Ventegodt S, Andersen NJ, Merrick
J. ScientificWorldJournal. 2003 Nov 1331117-27.
October1, 2003 Accepted Oct.3, 2003
The aim is to find the simplest, cheapest, and
most practical way to collect data of sufficient
quality and validity to determine
(1) which kinds of treatment give a clinically
relevant improvement to quality of life, health,
and/or functionality (2) which groups of
patients can be aided by alternative,
complementary, or holistic medicine and (3)
which therapists have the competence to achieve
the clinically relevant improvements.
53
If a global, generic, quality-of-life
questionnaire like QOL5 or, even better, a
QOL-Health-Ability questionnaire (a
quality-of-life questionnaire combined with a
self-evaluated health and ability to function
questionnaire) is administered to the patients
before and after the intervention, it is possible
to document the effect of an intervention to a
cost.
A general acceptance of this new research design
will solve the problem that there is not enough
money in alternative, complementary, and holistic
medicine to pay the normal cost of a biomedical
Cochrane study. As financial problems must not
hinder the vital research in nonbiomedical
medicine, the researchers ask the scientific
community to accept this new research standard.
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The Role of EBM in CAM
Some Examples
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Clinically relevant safety issues associated with
St. John's wort product labels
Kevin A Clauson1 , Marile L Santamarina2 and
Jennifer C Rutledge BMC Complementary and
Alternative Medicine 2008, 842doi10.1186/1472-68
82-8-42
Background The aim of this study was to evaluate
the clinically relevant safety information
included on labeling in a nationally
representative sample of SJW products from the
USA.
Conclusion The vast majority of SJW products fail
to adequately address clinically relevant safety
issues on their labeling. A few products do
provide an acceptable amount of information on
clinically relevant safety issues which could
enhance the quality of counseling by HCPs and
health store clerks. HCPs and consumers may
benefit if the FDA re-examined labeling
requirements for dietary supplements.
57
Attitudes towards fibromyalgia A survey of
Canadian chiropractic, naturopathic, physical
therapy and occupational therapy students
Jason W Busse1,2 , Abhaya V Kulkarni3 , Parminder
Badwall4 and Gordon H Guyatt1 for the Medically
Unexplained Syndromes Study Group BMC
Complementary and Alternative Medicine 2008,
824doi10.1186/1472-6882-8-24
Background The frequent use of chiropractic,
naturopathic, and physical and occupational
therapy by patients with fibromyalgia has been
emphasized repeatedly, but little is known about
the attitudes of these therapists towards this
challenging condition.
58
Methods A cross-sectional survey to 385 senior
Canadian chiropractic, naturopathic, physical and
occupational therapy students in their final year
of studies, that inquired about attitudes towards
the diagnosis and management of
fibromyalgia. Conclusion The majority of senior
Canadian chiropractic, naturopathic, physical and
occupational therapy students, and in particular
those with naturopathic training, believe that
effective treatment for fibromyalgia exists and
that they possess the clinical skillset to
effectively manage this disorder. The majority
place high priority on both symptom relief and
functional gains when treating fibromyalgia.
59
Alternative vs. conventional treatment given
on-demand for gastroesophageal reflux disease a
randomised controlled trial
Per G Farup , Mathis Heibert3 and Victor Høeg BMC
Complementary and Alternative Medicine 2009,
93doi10.1186/1472-6882-9-3
Background On-demand treatment of
gastroesophageal reflux disease (GERD) with
pharmaceutical products is an established,
cost-effective strategy. Comparisons between
alternative medicine and pharmaceutical products
are rare. The aim of this trial was to compare
on-demand treatment with a pectin-based,
raft-forming, natural, anti-reflux agent (PRA)
with that of esomeprazole 20 mg (Eso20) in
patients with mild/moderate GERD.
60
Conclusion On-demand treatment with esomeprazole
20 mg was clearly superior to the pectin-based
raft-forming agent. Most patients preferred
on-demand treatment to regular treatment. Those
preferring regular therapy had significantly more
symptoms at inclusion.
61
TCMGeneDIT a database for associated traditional
Chinese medicine, gene and disease information
using text mining
Yu-Ching Fang1 , Hsuan-Cheng Huang2 , Hsin-Hsi
Chen3 and Hsueh-Fen Juan BMC Complementary and
Alternative Medicine 2008, 858doi10.1186/1472-68
82-8-58
Background In recent years, many herbal medicines
were found to exhibit a variety of effects
through regulating a wide range of gene
expressions or protein activities. As available
TCM data continue to accumulate rapidly, an
urgent need for exploring these resources
systematically is imperative, so as to
effectively utilize the large volume of
literature.
62
Results A database, developed TCMGeneDIT, to
provide association information about TCMs,
genes, diseases, TCM effects and TCM ingredients
mined from vast amount of biomedical literature.
Integrated protein-protein interaction and
biological pathways information are also
available for exploring the regulations of genes
associated with TCM curative effects. In
addition, the transitive relationships among
genes, TCMs and diseases could be inferred
through the shared intermediates. Furthermore,
TCMGeneDIT is useful in understanding the
possible therapeutic mechanisms of TCMs via gene
regulations and deducing synergistic or
antagonistic contributions of the prescription
components to the overall therapeutic effects.
63
Conclusion TCMGeneDIT is a unique database that
offers diverse association information on TCMs.
This database integrates TCMs with biomedical
studies that would facilitate clinical research
and elucidate the possible therapeutic mechanisms
of TCMs and gene regulations. The database is
now available at http//tcm.lifescience.ntu.edu.tw
/ webcite.
64
The use of biomedicine, complementary and
alternative medicine, and ethnomedicine for the
treatment of epilepsy among people of South Asian
origin in the UK
Penny J Rhodes , Neil Small , Hanif Ismail and
John P Wright BMC Complementary and Alternative
Medicine 2008, 87doi10.1186/1472-6882-8-7
Background Studies have shown that a significant
proportion of people with epilepsy use
complementary and alternative medicine (CAM). CAM
use is known to vary between different ethnic
groups and cultural contexts however, little
attention has been devoted to inter-ethnic
differences within the UK population. The aim
study the use of biomedicine, complementary and
alternative medicine, and ethnomedicine in a
sample of people with epilepsy of South Asian
origin living in the north of England.
65
Results All those interviewed were taking
conventional anti-epileptic drugs. Most had also
sought help from traditional South Asian
practitioners, but only two people had tried
conventional CAM. Decisions to consult a
traditional healer were taken by families rather
than by individuals with epilepsy. No-one had
discussed the use of traditional therapies with
their doctor. The patterns observed in the UK
mirrored those reported among people with
epilepsy in India and Pakistan.
66
Conclusion The appeal of traditional therapies
lay in their religious and moral legitimacy
within the South Asian community, especially to
the older generation who were disproportionately
influential in the determination of treatment
choices. As a second generation made up of
people of Pakistani origin born in the UK reach
the age when they are the influential decision
makers in their families, resort to traditional
therapies may decline.
People had long experience of navigating plural
systems of health care and avoided potential
conflict by maintaining strict separation between
different sectors. Health care practitioners
need to approach these issues with sensitivity
and to regard traditional healers as potential
allies, rather than competitors or quacks.
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For you for everyone we have something more
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Advantages of EB-CAM

• It helps integrating the best available medical
  interventions with clinical practice whenever an
  acceptable evidence about its effectiveness is
  attained.
• It helps to best recruit resources through
  defining necessary interventions and those which
  must be postponed, waiting for an evidence for
  its effectiveness.
• It helps securing a common language and general
  rules for determining the usefulness of all
  medical intervention.
• It provides a means for improving the graduate
  studies as well as the continuous medical
  education.

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Benefits of EB-CAM Practice and Implementation

• Clinical Health professionals upgrade their
  knowledge base
• It improves health professionals understanding
  of research and its methods
• It improves confidence in managing clinical
  situations
• It improves computer literacy and data searching
  skills

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• It allows group problem solving and teaching
• For patients, it is a more effective use of
  resources
• It allows better communication with the patient
  about the rationale behind treatment.
• Juniors can contribute as well as seniors
  improve team work.

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Barriers to evidence based practice in CAM
People with health problems deserve a service
that is based on best available evidence and is
possible within obtainable resources. No credible
health professional could deny that sound
evidence should be an integral part of clinical
decision making. The demand for up to date
information to inform care and treatment
highlights the crucial role of research and
development in the modern health service.
However, within ordinary health system,
practitioners have not always been able to
underpin their actions with robust research
findings.
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Conclusion

• By placing CAM on an equal footing with
  conventional medicine - what matters for both is
  evidence of effectiveness - EBM provides an
  opportunity for CAM to find an appropriate and
  just place in health care.
• To address the varied issues in a comprehensive
  manner, future research needs to be
  collaborative, involving researchers across
  disciplines, journalists and CAM users.
• The SBM modified for CAM use, which incorporates
  both psychological and pragmatic determinants,
  was identified as the best conceptual model of
  CAM use.

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In addition, the research activities within CAM
atmosphere are limited to a small number of
enthusiasts. It shows that CAM research has
been the poor relation in terms of research
funding and this has resulted is a dearth of high
quality research results to underpin practice.
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• Thank you for your
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