Alternative Medicine Theme Issue
Edited by Phil B. Fontanarosa, MD, and George D. Lundberg, MD
One year ago, the editors of JAMA and the AMA Archives Journals selected alternative medicine as the topic for their annual coordinated theme issues. This month, these 10 journals present more than 80 articles on a wide range of topics in alternative medicine.
Use of Alternative Therapies Increases in the US
Results of a nationwide survey indicate a marked increase in the number of individuals using alternative therapies between 1990 and 1997. Eisenberg and colleagues report that most use of alternative therapies is not supervised by either physicians or alternative therapy practitioners, and estimate total out-of-pocket expenditures for alternative therapies at $27 billion.
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Scientific Scrutiny Applied to Alternative Medicine
This issue of JAMA features 6 randomized trials of alternative therapies for common clinical problems.
Bove and Nilsson (SEE ARTICLE) found that patients with episodic tension-type headaches treated with chiropractic spinal manipulation or an active control had similar reductions in daily headache hours and analgesic use.
Cardini and Weixin (SEE ARTICLE) report that moxibustion, the application of heat from burning herbs to an acupuncture point, for primigravida women with fetuses in breech presentation at 33 weeks' gestation significantly increased cephalic presentation at 35 weeks' gestation and at birth.
Bensoussan and colleagues (SEE ARTICLE) found that patients with irritable bowel syndrome treated with Chinese herbal medicine formulations had significant improvements in symptoms compared with those treated with placebo.
Shlay and colleagues (SEE ARTICLE) report that neither a standardized acupuncture regimen nor amitriptyline hydrochloride afforded effective pain relief for patients with HIV-related peripheral neuropathy.
Heymsfield and colleagues (SEE ARTICLE) found that losses in body weight and fat mass were no different in overweight patients treated with a high-fiber, low-energy diet and Garcinia cambogia than in those treated with diet and placebo.
Garfinkel and colleagues (SEE ARTICLE) report that patients with carpal tunnel syndrome treated with yoga and relaxation techniques had significant improvements in grip strength and pain reduction compared with baseline.
Malpractice and Alternative Medicine
Studdert and colleagues report that between 1990 and 1996 malpractice claims against chiropractors, massage therapists, and acupuncturists occurred less frequently than against physicians and the injuries were less severe.
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No Alternatives for Knowledge and Science
In an editorial critically examining the relationship between alternative medicine and conventional medicine, Jonas (SEE ARTICLE) describes the promise for advancing knowledge about diseases and healing that resides at the interface of these practices. In a related editorial, Fontanarosa (SEE ARTICLE) and Lundberg emphasize that alternative therapies must be evaluated by rigorous empirical testing.
The Cover
"Neither the formulas of the past nor the technology of the present proved to have any effect, beyond, perhaps, a certain reassurance for user and receiver." Johannes de Ketham, Fasciculus Medicinae, 1495, German.
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Medical News & Perspectives
Doings at the Office of Alternative Medicine, what's brewing among proponents of botanicals, and who's queueing for light therapy.
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A Piece of My Mind
"People in the United States are rushing toward alternative therapies. What's going on?" From "Leeches, Spiders, and Astrology: Predilections and Predictions."
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Policy Perspectives
Definitions, cultural aspects, and economic and political factors have limited research on nonallopathic practices. (SEE ARTICLE)
Ethical principles define the professional obligations of physicians in relation to alternative medicine. (SEE ARTICLE)
Complex methodological issues beset randomized controlled trials to evaluate alternative therapies. (SEE ARTICLE)
Progress is being made in the development of a registry of clinical trials and a database of systematic reviews in complementary medicine. (SEE ARTICLE)
JAMA Patient Page
For your patients: A primer on alternative therapies.
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