Finding Reliable Information on Complementary and Alternative Medicine (CAM)

1. Finding Reliable Information on Complementary and Alternative Medicine (CAM) Elise Cogo, BSc, ND, MLIS Naturopathic Doctor & Information Specialist Consultant, Ottawa Ontario Library Association Super Conference, February 2011, Toronto

2. Complementary and Alternative Medicine (CAM) • Complementary medicine • Alternative medicine • Integrative medicine • Traditional medicine • (W)holistic medicine • Unconventional medicine

3. Types of CAM • Natural products; and certain dietary therapies • Energy medicine – e.g., Reiki, magnetic fields, etc. • Manipulative and body-based practices – e.g., chiropractic, osteopathic manipulation, massage therapy • Mind-body medicine – e.g., prayer, meditation, yoga, hypnotherapy, Tai Chi

4. Types of CAM • Movement therapies – e.g., Rolfing, pilates, etc. • Traditional Chinese medicine (TCM) – including acupuncture, etc. • Naturopathic medicine • Homeopathy • Ayurveda; & other whole medical systems (Ref: NCCAM).

5. Massage Therapy • Registered Massage Therapy (RMT) is a regulated profession. • Must have completed a 2-3 year diploma program from a recognized massage therapy school. • Other forms of massage are not regulated professions.

6. Chiropractic • Doctor of Chiropractic (DC): 4 years post-grad. at recognized school. • Regulated in all provinces. • Assess for disorders related to the spine, pelvis, extremity joints, and their effect on the nervous system.

7. Naturopathic Medicine • Combines: botanical medicine, clinical nutrition, hydrotherapy, homeopathy, naturopathic manipulation, traditional Chinese medicine / acupuncture, and prevention and lifestyle counselling. • Regulated profession in 4 provinces, including Ontario; (+ 1 pending). • 2 accredited schools in Canada. • Naturopathic Doctor (ND): 4 years post-grad.

8. Homeopathic Medicine • Uses ultra-high dilutions of natural substances. • Popular system of health care especially in Europe and South Asia. • Product sale is regulated by Health Canada’s NHPD. • Not a regulated profession in Canada.

9. Traditional Chinese Medicine (TCM) & Acupuncture • TCM includes acupuncture, traditional Chinese herbal medicine, etc. • Ontario passed the TCM Act in 2006, to regulate the profession. A Transitional Council is currently establishing the new Regulations and standards. • Regulated in 4 provinces.

10. Some AdditionalCAM Terms • Qi gong; Feldenkrais method; Trager; • Alexander technique; Therapeutic Touch; • Shaman; curandero; aromatherapy; • Unani medicine; Tibetan medicine; • Bowen technique; flower essences; • Biofeedback; art therapy; macrobiotics; • Shiatsu; reflexology, etc.

11. CAM Use • 20% of Canadians consulted a complementary or alternative health care provider in 2003 (Statistics Canada, 2005). • 74% of Canadians have used at least one complementary or alternative therapy sometime in their lives (Fraser Institute, 2007).

12. CAM Use • Canadians spent over $5.6 billion out-of-pocket for complementary or alternative therapy treatments in one year (Fraser Institute, 2007). • 71% of Canadians regularly take NHPs like vitamins and minerals, herbal products, and homeopathic medicines (NHPD: 2005 Ipsos-Reid survey).

13. CAM Use • Functional Foods and Natural Health Products Survey 2007 (Statistics Canada): industry revenue was $3.7 billion. • 38% of adults use CAM in the USA (2007 National Health Interview Survey).

14. CAM Use • 2007 National Health Interview Survey: http://nccam.nih.gov/news/camstats/2007/camsurvey_fs1.htm • 18% of American adults had used a non-vitamin/ non-mineral natural product (e.g., fish oil/ omega-3’s, echinacea, etc.) in the past year. • These products were the most popular form of CAM among both adults and children.

15. CAM Use • Massage therapy use in women in America last year was 25% (American Massage Therapy Association survey 2010). • 9% of American adults have used chiropractic or osteopathic manipulation (2007 National Health Interview Survey).

16. CAM Use • Mind-Body Practices: 13% of American adults had used deep-breathing exercises, 9% had practiced meditation, and 6% had practiced yoga. • Progressive relaxation and guided imagery were also among the top 10 CAM therapies for adults (2007 National Health Interview Survey).

18. Online CAMConsumer Resources • NB - the focus of the online sources discussed below is on free access for consumers • U.S. National Institute of Health’s (NIH) National Center for Complementary and Alternative Medicine (NCCAM) • Provides many resources • List of Health Topics A-Z is very useful for consumer health queries

22. CAM Resources • Health Canada’s (HC) Natural Health Products Directorate (NHPD) • NHPD’s Compendium of Monographs (also available in French) give recommended directions of use for the market approval (licensing) of many products • Guidance on how to report a product adverse reaction/ side-effect to HC’s MedEffect Canada at: www.healthcanada.gc.ca/medeffect

23. Natural Health Products • Natural health products (NHPs) are a subset of drugs in Canada, vs. “dietary supplements” as foods in USA. • NHP Regulations under the Food and Drugs Act in Canada, since 2004. • Natural Product Number (NPN); or DIN-HM (homeopathic). • Vitamins and minerals • Herbal remedies • Homeopathic medicines • Traditional medicines (e.g., TCM) • Probiotics • Other products like amino acids and essential fatty acids.

27. CAM Resources • NIH’s Office of Dietary Supplements (ODS) • Natural Medicines Comprehensive Database (NMCD) • MedlinePlus - Herbs & Supplements (information from NMCD): consumer-friendly website with many products.

29. CAM Resources • NHS Evidence - complementary and alternative medicine specialist collection (formerly a Specialist Library of the UK National Library for Health) • Provide Annual Evidence Updates of the high-quality types of research on acupuncture and homeopathy • Also produces some Annual Evidence Updates of CAM for several health conditions

30. CAM Resources • U.S. National Cancer Institute’s (NCI) Office of Cancer Complementary and Alternative Medicine (OCCAM) • Includes a FAQ webpage and general guidance for cancer patients

31. CAM Resources • The Research Council for Complementary Medicine (RCCM) • Canadian Interdisciplinary Network Complementary and Alternative Medicine Research (IN-CAM) • Pediatric Complementary and Alternative Medicine Research and Education Network (PedCAM)

32. CAM Resources • PedCAM website also provides a good list of CAM-specific research databases • Natural Standard database (subscription) • Alberta CAM Research Network has a good list of CAM research and professional organizations: http://people.ucalgary.ca/~dllorenz/#professional

33. CAM Resources • The Richard and Hinda Rosenthal Center for Complementary and Alternative Medicine • Passeport Santé (French) • CARE Program: also provides evidence-based CAM reviews for several childhood illnesses

35. CAM Resources • CAMline • Provides evidence-based reviews of products (NHPs) in patient and professional versions • Provides useful information on CAM professions in Canada • Has a CAM dictionary

36. CAM Resources • CAM on PubMed (subset search limit) • PubMed’s Dietary Supplement (DS) subset (search limit)

37. CAM Resources • The Cochrane Collaboration – list of CM systematic reviews • Center for Integrative Medicine (University of Maryland)/ Cochrane CAM Field - consumer summaries • Cochrane CAM Field - glossary of CAM terms

40. CAM Resources • Integrative Health Institute (Mount Royal University) - list of CAM associations • Board of Directors of Drugless Therapy - Naturopathy (Ontario) • College of Chiropractors of Ontario • College of Massage Therapists of Ontario • Transitional Council of the College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario

41. CAM Resources • World Health Organization (WHO) Traditional Medicine (TM) Fact Sheet • Website includes details of the WHO TM global strategy • Contains list of WHO Collaborating Centres for TM