It is time to protect patients from 'vile and cynical exploitation' by the alternative medicines industry, argues a cancer expert in this week's BMJ.
It is estimated that up to 80% of all patients with cancer take a complementary treatment or follow a dietary programme to help treat their cancer, writes Jonathan Waxman, Professor of Oncology at Imperial College London.
Yet the rationale for the use of many of these approaches is obtuse - one might even be tempted to write misleading, he says.
Indeed the claims made by companies to support the sales of such products may be overtly and malignly incorrect and, in many cases, the products may be doctored by chemicals borrowed from the conventional pharmaceutical industry. The reason that these products are accessible to patients is that they are not subject to the testing of pharmaceuticals because they are classified as food supplements.
So why do patients take alternative medicines" Why is science disregarded" How can it be that treatments that don't work are regarded as life saving"
Waxman believes that it is because the complementary therapists offer something that doctors cannot offer - hope. If you eat this, take that, avoid this, and really believe this then we can promise you sincerely that you will be cured.
And if the patient is not cured, it is the patient who has failed, not the alternative therapy. The patient has let down the alternative practitioner and disappointed his family who have encouraged his 'treatment.'
As well as the complementary medicines they take, many patients will have changed their diets in order to cure their cancers, says the author. But although there is a strong dietary basis to the development of cancer, once cancer has been diagnosed no change in diet will lead to any improvement in cancer outcomes, he writes.
Why do patients change their diet" For some it is a way of taking back some control of a situation that is entirely out of their control, says Waxman. For others it is because of the pressure put on them by families, friends or vested interest groups to 'go organic.'
"It's time for legislation to focus on a particularly vulnerable section of our society and do something to limit the exploitation of our patients," he says. Why not subject the alternative medicines industry to the level of scrutiny that defines pharmaceuticals"
"Reclassify these agents as drugs - for this is after all how they are marketed - and protect our patients from vile and cynical exploitation whose intellectual basis, at best, might be viewed as delusional. The current EU initiative to bring forward legislation on this matter is welcomed."
Contact: Emma Dickinson
BMJ-British Medical Journal
четверг, 20 октября 2011 г.
понедельник, 17 октября 2011 г.
Brief Training In Meditation May Help In Pain Management
Living with pain is stressful, but a surprisingly short investment of time in mental training can help you cope.
A new study examining the perception of pain and the effects of various mental training techniques has found that relatively short and simple mindfulness meditation training can have a significant positive effect on pain management.
Though pain research during the past decade has shown that extensive meditation training can have a positive effect in reducing a person's awareness and sensitivity to pain, the effort, time commitment, and financial obligations required has made the treatment not practical for many patients. Now, a new study by researchers at the University of North Carolina at Charlotte shows that a single hour of training spread out over a three day period can produce the same kind of analgesic effect.
The research appears in an article by UNC Charlotte psychologists Fadel Zeidan, Nakia S. Gordon, Junaid Merchant and Paula Goolkasian, in the current issue of The Journal of Pain.
"This study is the first study to demonstrate the efficacy of such a brief intervention on the perception of pain," noted Fadel Zeidan, a doctoral candidate in psychology at UNC Charlotte and the paper's lead author. "Not only did the meditation subjects feel less pain than the control group while meditating but they also experienced less pain sensitivity while not meditating."
Over the course of three experiments employing harmless electrical shocks administered in gradual increments, the researchers measured the effect of brief sessions of mindfulness meditation training on pain awareness measuring responses that were carefully calibrated to insure reporting accuracy. Subjects who received the meditation training were compared to controls and to groups using relaxation and distraction techniques. The researchers measured changes in the subjects' rating of pain at "low" and "high" levels during the different activities, and also changes in their general sensitivity to pain through the process of calibrating responses before the activities.
While the distraction activity - which used a rigorous math task to distract subjects from the effects of the stimulus - was effective in reducing the subject's perception of "high" pain, the meditation activity had an even stronger reducing effect on high pain, and reduced the perception of "low" pain levels as well.
Further, the meditation training appeared to have an effect that continued to influence the patients after the activity was concluded, resulting in a general lowering of pain sensitivity in the subjects - a result that indicated that the effect of the meditation was substantially different from the effect of the distraction activity.
The finding follows earlier research studies that found differences in pain awareness and other mental activities among long-time practitioners of mindfulness meditation techniques.
"We knew already that meditation has significant effects on pain perception in long-term practitioners whose brains seem to have been completely changed - we didn't know that you could do this in just three days, with just 20 minutes a day," Zeidan said.
In assessing the first experiment, the researchers were not terribly surprised to discover that meditation activity appeared to be affecting the experimental subjects' perception of pain because the researchers assumed that the change was mainly due to distraction, a well-known effect. However, subsequent findings began to indicate that the effect continued outside of the periods of meditation.
" When we re-calibrated their pain thresholds after the training had started and we found that they felt less pain, compared to the control subjects," Zeidan noted. "This was totally surprising because a change in general sensitivity was not part of our hypothesis at all.
"We were so surprised after the first experiment that we did two more. We thought that no one was going to listen to us because no one had done this before??¦ and we got a robust finding across the three experiments."
Zeidan stresses that the effect the researchers measured in the meditation subjects was a lessening of pain but not a lessening of sensation. The calibration results showed little change in the meditation subjects' sensitivity to the sensation of electricity, but a significant change in what level of shock was perceived to be painful.
"The short course of meditation was very effective on pain perception," Zeidan said. "We got a very high effect size for the periods when they were meditating.
"In fact, it was kind of freaky for me. I was ramping at 400-500 milliamps and their arms would be jolting back and forth because the current was stimulating a motor nerve. Yet they would still be asking, 'A 2?' ('2' being the level of electrical shock that designates low pain) It was really surprising," he said.
Zeidan suspects that the mindfulness training lessens the awareness of and sensitivity to pain because it trains subjects' brains to pay attention to sensations at the present moment rather than anticipating future pain or dwelling on the emotions caused by pain, and thus reduces anxiety.
"The mindfulness training taught them that distractions, feelings, emotions are momentary, don't require a label or judgment because the moment is already over," Zeidan noted. "With the meditation training they would acknowledge the pain, they realize what it is, but just let it go. They learn to bring their attention back to the present."
Though the results are in line with past findings regarding mindfulness practitioners, Zeidan says that the findings are important because they show that meditation is much easier to use for pain management than it was previously believed to be because a very short, simple course of training is all that is required in order to achieve a significant effect. Even self-administered training might be effective, according to Zeidan.
"What's neat here is that this is the briefest known way to promote a meditation state and yet it has an effect in pain management. People who want to make use of the technique might not need a meditation facilitator - they might be able to get the necessary training off the internet, " Zeidan said. "All you have to do is use your mind, change the way you look at the perception of pain and that, ultimately, might help alleviate the feeling of that pain."
The research was funded in part by a grant from the National Science Foundation. The article is available online in Pain, via sciencedirect.
A new study examining the perception of pain and the effects of various mental training techniques has found that relatively short and simple mindfulness meditation training can have a significant positive effect on pain management.
Though pain research during the past decade has shown that extensive meditation training can have a positive effect in reducing a person's awareness and sensitivity to pain, the effort, time commitment, and financial obligations required has made the treatment not practical for many patients. Now, a new study by researchers at the University of North Carolina at Charlotte shows that a single hour of training spread out over a three day period can produce the same kind of analgesic effect.
The research appears in an article by UNC Charlotte psychologists Fadel Zeidan, Nakia S. Gordon, Junaid Merchant and Paula Goolkasian, in the current issue of The Journal of Pain.
"This study is the first study to demonstrate the efficacy of such a brief intervention on the perception of pain," noted Fadel Zeidan, a doctoral candidate in psychology at UNC Charlotte and the paper's lead author. "Not only did the meditation subjects feel less pain than the control group while meditating but they also experienced less pain sensitivity while not meditating."
Over the course of three experiments employing harmless electrical shocks administered in gradual increments, the researchers measured the effect of brief sessions of mindfulness meditation training on pain awareness measuring responses that were carefully calibrated to insure reporting accuracy. Subjects who received the meditation training were compared to controls and to groups using relaxation and distraction techniques. The researchers measured changes in the subjects' rating of pain at "low" and "high" levels during the different activities, and also changes in their general sensitivity to pain through the process of calibrating responses before the activities.
While the distraction activity - which used a rigorous math task to distract subjects from the effects of the stimulus - was effective in reducing the subject's perception of "high" pain, the meditation activity had an even stronger reducing effect on high pain, and reduced the perception of "low" pain levels as well.
Further, the meditation training appeared to have an effect that continued to influence the patients after the activity was concluded, resulting in a general lowering of pain sensitivity in the subjects - a result that indicated that the effect of the meditation was substantially different from the effect of the distraction activity.
The finding follows earlier research studies that found differences in pain awareness and other mental activities among long-time practitioners of mindfulness meditation techniques.
"We knew already that meditation has significant effects on pain perception in long-term practitioners whose brains seem to have been completely changed - we didn't know that you could do this in just three days, with just 20 minutes a day," Zeidan said.
In assessing the first experiment, the researchers were not terribly surprised to discover that meditation activity appeared to be affecting the experimental subjects' perception of pain because the researchers assumed that the change was mainly due to distraction, a well-known effect. However, subsequent findings began to indicate that the effect continued outside of the periods of meditation.
" When we re-calibrated their pain thresholds after the training had started and we found that they felt less pain, compared to the control subjects," Zeidan noted. "This was totally surprising because a change in general sensitivity was not part of our hypothesis at all.
"We were so surprised after the first experiment that we did two more. We thought that no one was going to listen to us because no one had done this before??¦ and we got a robust finding across the three experiments."
Zeidan stresses that the effect the researchers measured in the meditation subjects was a lessening of pain but not a lessening of sensation. The calibration results showed little change in the meditation subjects' sensitivity to the sensation of electricity, but a significant change in what level of shock was perceived to be painful.
"The short course of meditation was very effective on pain perception," Zeidan said. "We got a very high effect size for the periods when they were meditating.
"In fact, it was kind of freaky for me. I was ramping at 400-500 milliamps and their arms would be jolting back and forth because the current was stimulating a motor nerve. Yet they would still be asking, 'A 2?' ('2' being the level of electrical shock that designates low pain) It was really surprising," he said.
Zeidan suspects that the mindfulness training lessens the awareness of and sensitivity to pain because it trains subjects' brains to pay attention to sensations at the present moment rather than anticipating future pain or dwelling on the emotions caused by pain, and thus reduces anxiety.
"The mindfulness training taught them that distractions, feelings, emotions are momentary, don't require a label or judgment because the moment is already over," Zeidan noted. "With the meditation training they would acknowledge the pain, they realize what it is, but just let it go. They learn to bring their attention back to the present."
Though the results are in line with past findings regarding mindfulness practitioners, Zeidan says that the findings are important because they show that meditation is much easier to use for pain management than it was previously believed to be because a very short, simple course of training is all that is required in order to achieve a significant effect. Even self-administered training might be effective, according to Zeidan.
"What's neat here is that this is the briefest known way to promote a meditation state and yet it has an effect in pain management. People who want to make use of the technique might not need a meditation facilitator - they might be able to get the necessary training off the internet, " Zeidan said. "All you have to do is use your mind, change the way you look at the perception of pain and that, ultimately, might help alleviate the feeling of that pain."
The research was funded in part by a grant from the National Science Foundation. The article is available online in Pain, via sciencedirect.
пятница, 14 октября 2011 г.
More Americans Turn To Lower-Cost Alternative Meds, Especially Whites
The use of complementary and alternative medicine (CAM) therapies experienced a significant growth in the United States in the last decade, and a new analysis finds that CAM use becomes more likely when access to conventional care has been restricted.
"In both 2002 and 2007, having unmet needs in medical care, or delayed care due to cost, was associated with a higher chance of CAM use," said lead author Dejun Su, Ph.D. "Importantly, for Americans without health insurance, who cannot afford medical care, CAM might be their last and only resort."
Su is director of the South Texas Border Health Disparities Center at the University of Texas-Pan American. He and his colleagues analyzed data from the 2007 National Health Interview Survey. Based on interviews with more than 23,000 adults, the NHIS showed more pronounced growth in CAM use among whites than among racial and ethnic minorities. This increased an already existing white-minority gap in CAM use, Su said.
Without counting prayer for health purposes, 33 percent of whites report using at least one CAM therapy, while 31.8 percent of Asian Americans, 20.1 percent of African-Americans and 16.9 percent of Hispanics report using these therapies.
The use of CAM rose across all these populations between 2002 and 2007, but at different rates. The increase was highest among whites and Asian Americans, at 18.1 percent and 17.2 percent, respectively. Use among African-Americans increased only 6.6 percent. Use among Hispanics increased only 1.01 percent.
"So far, we know little about how the difference in CAM use has influenced racial and ethnic disparities in health and mortality," Su said. "Research is urgently needed to understand the effectiveness, side effects and interactions of CAM therapies with conventional medicine."
Richard Nahin, Ph.D., senior advisor for Scientific Coordination and Outreach at the National Center for Complementary and Alternative Medicine (NCCAM), says that this study provides clarity to some differences in the use of CAM by various populations. However, he said, the authors neglected to mention one, perhaps crucial, explanation for these differences.
"There is, in fact, some evidence to suggest that the 2007 NHIS underestimated CAM use among Hispanics and non-Hispanic blacks," Nahin said. "For instance, some CAM products for which minority groups report substantial use in small local or regional surveys were not included in the 2002 or 2007 NHIS."
Nahin, whose research on CAM contributed to the 2007 NHIS, said, "Understanding this possibility, NCCAM is redesigning the CAM supplement to the 2012 NHIS. They hope to better capture the use of various unconventional therapies more likely to be used by minority groups."
Su D, Li L. Trends in the use of complementary and alternative medicine in the United States. J Health Care Poor Underserved 22(1), 2011.
"In both 2002 and 2007, having unmet needs in medical care, or delayed care due to cost, was associated with a higher chance of CAM use," said lead author Dejun Su, Ph.D. "Importantly, for Americans without health insurance, who cannot afford medical care, CAM might be their last and only resort."
Su is director of the South Texas Border Health Disparities Center at the University of Texas-Pan American. He and his colleagues analyzed data from the 2007 National Health Interview Survey. Based on interviews with more than 23,000 adults, the NHIS showed more pronounced growth in CAM use among whites than among racial and ethnic minorities. This increased an already existing white-minority gap in CAM use, Su said.
Without counting prayer for health purposes, 33 percent of whites report using at least one CAM therapy, while 31.8 percent of Asian Americans, 20.1 percent of African-Americans and 16.9 percent of Hispanics report using these therapies.
The use of CAM rose across all these populations between 2002 and 2007, but at different rates. The increase was highest among whites and Asian Americans, at 18.1 percent and 17.2 percent, respectively. Use among African-Americans increased only 6.6 percent. Use among Hispanics increased only 1.01 percent.
"So far, we know little about how the difference in CAM use has influenced racial and ethnic disparities in health and mortality," Su said. "Research is urgently needed to understand the effectiveness, side effects and interactions of CAM therapies with conventional medicine."
Richard Nahin, Ph.D., senior advisor for Scientific Coordination and Outreach at the National Center for Complementary and Alternative Medicine (NCCAM), says that this study provides clarity to some differences in the use of CAM by various populations. However, he said, the authors neglected to mention one, perhaps crucial, explanation for these differences.
"There is, in fact, some evidence to suggest that the 2007 NHIS underestimated CAM use among Hispanics and non-Hispanic blacks," Nahin said. "For instance, some CAM products for which minority groups report substantial use in small local or regional surveys were not included in the 2002 or 2007 NHIS."
Nahin, whose research on CAM contributed to the 2007 NHIS, said, "Understanding this possibility, NCCAM is redesigning the CAM supplement to the 2012 NHIS. They hope to better capture the use of various unconventional therapies more likely to be used by minority groups."
Su D, Li L. Trends in the use of complementary and alternative medicine in the United States. J Health Care Poor Underserved 22(1), 2011.
вторник, 11 октября 2011 г.
Research Promotes Pro-Active Vitamin D Regimen In Patients With Osteoporosis
New data indicates an aggressive Vitamin D treatment plan should be considered when caring for all Osteoporosis patients. Doing so may help decrease their likelihood of developing Vitamin D deficiency. These findings will be presented at the American Association of Clinical Endocrinologists (AACE) 17th Annual Meeting & Clinical by Harinder Singh, MD on Friday, May 16th at the Walt Disney World Dolphin Resort in Orlando.
"Our research suggests that Vitamin D deficiency is quite prevalent in patients with Osteoporosis," Dr. Singh said. "Much more so than was originally believed."
Singh will present how his research showed an alarming rate of Vitamin D deficiency amongst patients being treated for Osteoporosis and furthermore, how it should be met with an "aggressive" treatment regimen.
Research on the topics of Vitamin D and Osteoporosis will be a major highlight at this year's meeting. Two major sessions include "Osteoporosis: What's New and What's Next," where AACE Member Nelson Watts MD, FACP, MACE will discuss a possible once-a-year treatment for Osteoporosis. The other session, "Vitamin D Deficiency: A Near Universal Health Problem," will focus on how adequate vitamin D intake may help reduce the severity of chronic endocrine-related diseases.
Media Registration
About the AACE Annual Meeting
American Association of Clinical Endocrinologists
"Our research suggests that Vitamin D deficiency is quite prevalent in patients with Osteoporosis," Dr. Singh said. "Much more so than was originally believed."
Singh will present how his research showed an alarming rate of Vitamin D deficiency amongst patients being treated for Osteoporosis and furthermore, how it should be met with an "aggressive" treatment regimen.
Research on the topics of Vitamin D and Osteoporosis will be a major highlight at this year's meeting. Two major sessions include "Osteoporosis: What's New and What's Next," where AACE Member Nelson Watts MD, FACP, MACE will discuss a possible once-a-year treatment for Osteoporosis. The other session, "Vitamin D Deficiency: A Near Universal Health Problem," will focus on how adequate vitamin D intake may help reduce the severity of chronic endocrine-related diseases.
Media Registration
About the AACE Annual Meeting
American Association of Clinical Endocrinologists
суббота, 8 октября 2011 г.
Link Found Between Selenium Supplements And Increased Risk For Diabetes
A new analysis of data from a large national study found that people who took a 200 microgram selenium supplement each day for almost eight years had an increased risk of developing type 2 diabetes than those who took a placebo or dummy pill.
The data came from the Nutritional Prevention of Cancer Trial (NPC), a large randomized, multi-center, clinical trial from the eastern United States, designed to evaluate whether selenium supplements prevent skin cancer. In the study being published, researchers selected 1,202 participants who did not have diabetes when they were enrolled in the NPC Trial. Half received a 200 microgram selenium supplement and half received a placebo pill for an average of 7.7 years.
Saverio Stranges, MD, PhD, lead author of the study, says that the findings from this study suggest that selenium supplements do not prevent diabetes and that they might be harmful. "At this time, the evidence that people should take selenium supplements is extremely limited. We have observed an increased risk for diabetes over the long term in the group of participants who took selenium supplements."
Dr. Stranges is currently working at Warwick Medical School, UK, but previously worked at the State University of New York at Buffalo. Other authors of the article include Mary E. Reid, PhD, and James R. Marshall, PhD, researchers at the Roswell Park Cancer Institute in Buffalo.
Selenium is a naturally occurring trace mineral present in soil and foods. The body need selenium in minute amounts to aid in metabolism. Selenium supplements are widely promoted on the Internet for conditions ranging from cold sores and shingles to arthritis and multiple sclerosis. They are sold to prevent aging, enhance fertility, prevent cancer and get rid of toxic minerals such as mercury, lead and cadmium.
Selenium supplements have shown some promise in preventing prostate cancer. Because of selenium's antioxidant activities, some scientists feel it might be effective against diabetes.
In the current study, 58 out of 600 participants in the selenium group and 39 out of 602 participants in the placebo group developed type 2 diabetes. After 7.7 years of follow-up, the relative risk rate was approximately 50 percent higher among those randomly selected for the selenium group than among those randomly placed in the placebo group.
The results consistently showed higher risks of disease among participants receiving selenium across subgroups of baseline age, gender, and smoking status. However, the selenium supplements had no impact on the most overweight participants. The risk of developing diabetes tended to be higher in people who had higher blood selenium levels at the start of the study.
Dr. Stranges said, "No single study can provide the answer to a scientific question, but at this time, selenium supplementation does not appear to prevent type 2 diabetes, and it may increase risk of the disease. However, our understanding of the mechanisms whereby selenium would increase risk of diabetes is very limited at this time and this issue needs to be further explored. Nevertheless, I would not advise patients to take selenium supplements greater than those in multiple vitamins."
About 60 percent of Americans take multivitamin pills, many of which contain between 33 and 200 micrograms of selenium, in addition to the selenium taken in from food and the air. The RDA (recommended dietary allowance) for selenium varies by age. For people aged 14 and over, 55 micrograms per day is recommended for the body to function normally.
Dr. Stranges said that selenium levels in soil in United States are higher than the minimum needed to optimize metabolism, so people in the United States should not need to take selenium supplements greater than those in multivitamin supplements.
In an accompanying editorial, Eliseo Guallar, MD, DrPH, from Johns Hopkins University Bloomberg School of Public Health, says the article is "more bad news for supplements." He says that the NPC trial is the largest and longest experimental study available comparing selenium supplements to placebo, that selenium has a narrow therapeutic range and that at high levels, it can be toxic.
"What the U.S. public needs to know," Dr. Guallar says, "is that most people in the United States have adequate selenium in their diet. Moreover, taking selenium supplements on top of an adequate dietary intake may cause diabetes."
The study, "Effects of Long-Term Selenium Supplementation on the Incidence of Type 2 Diabetes," and the editorial, "Selenium and Diabetes: More Bad News for Supplements," is on the Web site of Annals of Internal Medicine (annals/) and in the Aug. 21, 2007, print edition of the journal.
Annals of Internal Medicine (annals/) is one of the most widely cited peer-reviewed medical journals in the world. The journal has been published for 80 years and accepts only seven percent of the original research studies submitted for publication. Annals of Internal Medicine is published by the American College of Physicians (acponline/), the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 123,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection, and treatment of illness in adults.
1. Dr. Stranges: Clinical Sciences Research Institute, Warwick Medical School, University Hospital Coventry & Warwickshire, Clifford Bridge Road, Coventry CV2 2DX (UK)
2. Eliseo Guallar, MD, DrPH, department of epidemiology, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University Bloomberg School of Public jhsph/communications/
The data came from the Nutritional Prevention of Cancer Trial (NPC), a large randomized, multi-center, clinical trial from the eastern United States, designed to evaluate whether selenium supplements prevent skin cancer. In the study being published, researchers selected 1,202 participants who did not have diabetes when they were enrolled in the NPC Trial. Half received a 200 microgram selenium supplement and half received a placebo pill for an average of 7.7 years.
Saverio Stranges, MD, PhD, lead author of the study, says that the findings from this study suggest that selenium supplements do not prevent diabetes and that they might be harmful. "At this time, the evidence that people should take selenium supplements is extremely limited. We have observed an increased risk for diabetes over the long term in the group of participants who took selenium supplements."
Dr. Stranges is currently working at Warwick Medical School, UK, but previously worked at the State University of New York at Buffalo. Other authors of the article include Mary E. Reid, PhD, and James R. Marshall, PhD, researchers at the Roswell Park Cancer Institute in Buffalo.
Selenium is a naturally occurring trace mineral present in soil and foods. The body need selenium in minute amounts to aid in metabolism. Selenium supplements are widely promoted on the Internet for conditions ranging from cold sores and shingles to arthritis and multiple sclerosis. They are sold to prevent aging, enhance fertility, prevent cancer and get rid of toxic minerals such as mercury, lead and cadmium.
Selenium supplements have shown some promise in preventing prostate cancer. Because of selenium's antioxidant activities, some scientists feel it might be effective against diabetes.
In the current study, 58 out of 600 participants in the selenium group and 39 out of 602 participants in the placebo group developed type 2 diabetes. After 7.7 years of follow-up, the relative risk rate was approximately 50 percent higher among those randomly selected for the selenium group than among those randomly placed in the placebo group.
The results consistently showed higher risks of disease among participants receiving selenium across subgroups of baseline age, gender, and smoking status. However, the selenium supplements had no impact on the most overweight participants. The risk of developing diabetes tended to be higher in people who had higher blood selenium levels at the start of the study.
Dr. Stranges said, "No single study can provide the answer to a scientific question, but at this time, selenium supplementation does not appear to prevent type 2 diabetes, and it may increase risk of the disease. However, our understanding of the mechanisms whereby selenium would increase risk of diabetes is very limited at this time and this issue needs to be further explored. Nevertheless, I would not advise patients to take selenium supplements greater than those in multiple vitamins."
About 60 percent of Americans take multivitamin pills, many of which contain between 33 and 200 micrograms of selenium, in addition to the selenium taken in from food and the air. The RDA (recommended dietary allowance) for selenium varies by age. For people aged 14 and over, 55 micrograms per day is recommended for the body to function normally.
Dr. Stranges said that selenium levels in soil in United States are higher than the minimum needed to optimize metabolism, so people in the United States should not need to take selenium supplements greater than those in multivitamin supplements.
In an accompanying editorial, Eliseo Guallar, MD, DrPH, from Johns Hopkins University Bloomberg School of Public Health, says the article is "more bad news for supplements." He says that the NPC trial is the largest and longest experimental study available comparing selenium supplements to placebo, that selenium has a narrow therapeutic range and that at high levels, it can be toxic.
"What the U.S. public needs to know," Dr. Guallar says, "is that most people in the United States have adequate selenium in their diet. Moreover, taking selenium supplements on top of an adequate dietary intake may cause diabetes."
The study, "Effects of Long-Term Selenium Supplementation on the Incidence of Type 2 Diabetes," and the editorial, "Selenium and Diabetes: More Bad News for Supplements," is on the Web site of Annals of Internal Medicine (annals/) and in the Aug. 21, 2007, print edition of the journal.
Annals of Internal Medicine (annals/) is one of the most widely cited peer-reviewed medical journals in the world. The journal has been published for 80 years and accepts only seven percent of the original research studies submitted for publication. Annals of Internal Medicine is published by the American College of Physicians (acponline/), the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 123,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection, and treatment of illness in adults.
1. Dr. Stranges: Clinical Sciences Research Institute, Warwick Medical School, University Hospital Coventry & Warwickshire, Clifford Bridge Road, Coventry CV2 2DX (UK)
2. Eliseo Guallar, MD, DrPH, department of epidemiology, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University Bloomberg School of Public jhsph/communications/
среда, 5 октября 2011 г.
Antioxidants May Improve Chances Of Conceiving In Male Subfertility
Antioxidant supplements may benefit couples who have difficulty conceiving naturally, according to a new systematic review published today in The Cochrane Library. The review provides evidence from a small number of trials that suggest the partners of men who take antioxidants are more likely to become pregnant.
Male subfertility affects one in 20 men. Chemicals called reactive oxygen species (ROS) are said to cause damage to cells, and in particular sperm cells, which may result in lowered sperm counts and interfere with their ability to fertilise eggs. Antioxidants include natural and synthetic chemicals, including certain vitamins and minerals, which help to reduce the damage caused by ROS.
The review focused on 34 trials involving 2,876 couples undergoing assisted reproductive techniques such as in vitro fertilisation and sperm injections. Most men in the trials had low sperm counts or low sperm motility. The trials explored the use of many different types of oral antioxidants, including vitamin E, L-carnitine, zinc and magnesium.
Compared to controls, a couple was more likely to have a pregnancy or live birth if the man took antioxidants. However, these results are based on just 964 of the couples in the review for pregnancies and 214 couples for live births. Other trials tested the effects of antioxidants on sperm motility and concentration and showed mostly positive effects, although study group sizes were small.
"When trying to conceive as part of an assisted reproductive program, it may be advisable to encourage men to take oral antioxidant supplements to improve their partners' chances of becoming pregnant," said lead researcher Marian Showell, who works in Obstetrics and Gynaecology at the University of Auckland in Auckland, New Zealand. "However, these conclusions are currently based on limited evidence."
There were not enough data comparing different antioxidants to reach any conclusions about the relative effectiveness of supplements. "We need more head-to-comparisons to understand whether any one antioxidant is performing better than any other," said Showell.
Full citation: Showell MG, Brown J, Yazdani A, Stankiewicz MT, Hart RJ. Antioxidants for male subfertility. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD007411. DOI: 10.1002/14651858.CD007411.pub2
Article
Male subfertility affects one in 20 men. Chemicals called reactive oxygen species (ROS) are said to cause damage to cells, and in particular sperm cells, which may result in lowered sperm counts and interfere with their ability to fertilise eggs. Antioxidants include natural and synthetic chemicals, including certain vitamins and minerals, which help to reduce the damage caused by ROS.
The review focused on 34 trials involving 2,876 couples undergoing assisted reproductive techniques such as in vitro fertilisation and sperm injections. Most men in the trials had low sperm counts or low sperm motility. The trials explored the use of many different types of oral antioxidants, including vitamin E, L-carnitine, zinc and magnesium.
Compared to controls, a couple was more likely to have a pregnancy or live birth if the man took antioxidants. However, these results are based on just 964 of the couples in the review for pregnancies and 214 couples for live births. Other trials tested the effects of antioxidants on sperm motility and concentration and showed mostly positive effects, although study group sizes were small.
"When trying to conceive as part of an assisted reproductive program, it may be advisable to encourage men to take oral antioxidant supplements to improve their partners' chances of becoming pregnant," said lead researcher Marian Showell, who works in Obstetrics and Gynaecology at the University of Auckland in Auckland, New Zealand. "However, these conclusions are currently based on limited evidence."
There were not enough data comparing different antioxidants to reach any conclusions about the relative effectiveness of supplements. "We need more head-to-comparisons to understand whether any one antioxidant is performing better than any other," said Showell.
Full citation: Showell MG, Brown J, Yazdani A, Stankiewicz MT, Hart RJ. Antioxidants for male subfertility. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD007411. DOI: 10.1002/14651858.CD007411.pub2
Article
воскресенье, 2 октября 2011 г.
Efficacy Of Glucosamine And Chondroitin Sulfate May Depend On Level Of Osteoarthritis Pain
In a study published in the New England Journal of Medicine*, the popular dietary supplement combination of glucosamine plus chondroitin sulfate did not provide significant relief from osteoarthritis pain among all participants. However, a smaller subgroup of study participants with moderate-to-severe pain showed significant relief with the combined supplements. This research was funded by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), components of the National Institutes of Health (NIH). Researchers led by rheumatologist Daniel O. Clegg, M.D., of the University of Utah, School of Medicine, Salt Lake City, conducted the 4-year study known as the Glucosamine/chondroitin Arthritis Intervention Trial (GAIT) at 16 sites across the United States.
"GAIT is another example of NIH's commitment to exploring the potential of complementary and alternative medicine to prevent and treat disease in a manner that is fair, unbiased, and scientifically rigorous," said Elias A. Zerhouni, M.D., NIH Director.
GAIT enrolled nearly 1,600 participants with documented osteoarthritis of the knee. Participants were randomly assigned to receive one of five treatments daily for 24 weeks: glucosamine alone (1500 mg), chondroitin sulfate alone (1200 mg), glucosamine and chondroitin sulfate combined (same doses), a placebo, or celecoxib (200 mg). Celecoxib is an FDA-approved drug for the management of osteoarthritis pain and served as a positive control for the study. (A positive control is a treatment that investigators expect participants to respond to in a predictable way; it helps validate study results.) A positive response to treatment was defined as a 20 percent or greater reduction in pain at week 24 compared to the start of the study.
The researchers found that participants taking celecoxib experienced statistically significant pain relief, as expected, versus placebo--about 70 percent of those taking celecoxib versus 60 percent taking placebo had a 20 percent or greater pain reduction. For all participants, there were no significant differences between the other treatments tested and placebo. However, for participants in the moderate-to-severe pain subgroup, glucosamine combined with chondroitin sulfate provided statistically significant pain relief compared to placebo--about 79 percent in this group had a 20 percent or greater pain reduction compared to 54 percent for placebo. In the subgroup of participants with mild pain, glucosamine and chondroitin sulfate together or alone did not provide statistically significant relief compared to placebo.
"This rigorous, large-scale study showed that the combination of glucosamine and chondroitin sulfate appeared to help people with moderate-to-severe pain from knee osteoarthritis, but not those with mild pain," said Stephen E. Straus, M.D., NCCAM Director. "It is important to study dietary supplements with well-designed research in order to find out what works and what does not."
"Because of the small size of the moderate-to-severe pain subgroup, the findings in this group for glucosamine plus chondroitin sulfate should be considered preliminary and need to be confirmed in a study designed for this purpose," said Dr. Clegg, Professor of Medicine and Chief of Rheumatology at the University of Utah, School of Medicine.
On entering the study, a participant's level of pain was assessed as either mild or moderate to severe using standard pain assessment tools and scales, such as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Of the 1,583 study participants, 78 percent were in the mild pain subgroup and the other 22 percent were in the moderate-to-severe pain subgroup. Level of pain was evaluated at weeks 4, 8, 16, and 24 using the WOMAC scale and other tools. In addition to taking their daily study treatment, participants could take up to 4000 mg of acetaminophen daily for pain, except for the 24 hours before they were assessed by study staff. The use of acetaminophen, however, was low, overall averaging fewer than two 500 mg tablets per day. Participants could not take other non-steroidal anti-inflammatory medicines or narcotic (opioid-based) pain relievers during the study.
"More than 20 million Americans have osteoarthritis, making it a frequent cause of physical disability among adults," said Stephen I. Katz, M.D., Ph.D., NIAMS Director. "We are excited to support studies looking at new treatment options that could improve the symptoms and quality of life of people with osteoarthritis."
GAIT was conducted under an Investigational New Drug application filed with the U.S. Food and Drug Administration. Thus, all of the products used in the study were subject to the FDA's pharmaceutical regulations and evaluated and manufactured by an FDA-licensed clinical research pharmacy center. The glucosamine and chondroitin sulfate used were tested for purity, potency, quality, and consistency among batches. Products were retested for stability throughout the study. The dosages selected were based on the prevailing doses in the scientific literature. Few side effects from any of the treatments were reported. Those reported were generally mild, such as upset stomach, and distributed evenly across the treatment groups.
"The GAIT team's goal was to assess whether glucosamine and chondroitin sulfate, which we saw our osteoarthritis patients using, provided pain relief," said Dr. Clegg. "I urge people with osteoarthritis to follow a comprehensive plan for managing their arthritis pain--eat right, exercise, lose excess weight, and talk to your physician about appropriate treatment options."
The GAIT team continues their research with a smaller study to see whether glucosamine and chondroitin sulfate can alter the progression of osteoarthritis, such as delaying the narrowing of the joint spaces. About one-half of the participants in the larger GAIT study were eligible to enroll in this ancillary study. The results are expected in about a year.
The National Center for Complementary and Alternative Medicine's mission is to explore complementary and alternative medical practices in the context of rigorous science, train CAM researchers, and disseminate authoritative information to the public and professionals. For additional information, call NCCAM's Clearinghouse toll free at 1-888-644-6226, or visit the NCCAM Web site at nccam.nih. NCCAM is 1 of 27 institutes and centers at the National Institutes of Health, the Federal focal point for medical research in the United States.
The National Institute of Arthritis and Musculoskeletal and Skin Diseases, a component of the National Institutes of Health, DHHS, supports research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. For additional information, call NIAMS's clearinghouse at (301) 495-4484 or visit NIAMS's Web site at niams.nih/.
*Clegg D, et al. Glucosamine, Chondroitin Sulfate, and the Two in Combination for Painful Knee Osteoarthritis. New England Journal of Medicine, 2006; 354:795-808.
The following is a companion Q&A document for the above release. It provides additional details about the GAIT trial.
Questions and Answers: NIH Glucosamine/chondroitin Arthritis Intervention Trial (GAIT)
ABOUT THE STUDY
* What is the Glucosamine/chondroitin Arthritis Intervention Trial (GAIT)?
* What was the purpose of the study?
* What was the basic design of the study?
* What did GAIT cost?
STUDY BACKGROUND
* What is osteoarthritis?
* What are glucosamine and chondroitin sulfate?
* What is celecoxib?
* What doses were used for the various treatments?
* Who provided the source materials for making the glucosamine and chondroitin sulfate products used in GAIT?
* Where did the other study products come from?
* Where was the study conducted?
KEY RESULTS
* What were the key results of the study?
* How many people participated in the study and who were they?
* Were there any side effects from the treatments?
CONSUMER INFORMATION AND NEXT STEPS
* Should people with osteoarthritis use glucosamine and chondroitin sulfate?
* Can U.S. consumers get the glucosamine and chondroitin sulfate products used in GAIT?
* Will the GAIT team continue to do research on glucosamine and chondroitin sulfate?
* For More Information
ABOUT THE STUDY
What is the Glucosamine/chondroitin Arthritis Intervention Trial (GAIT)? GAIT is the first, large-scale, multicenter clinical trial in the United States to test the effects of the dietary supplements glucosamine hydrochloride (glucosamine) and sodium chondroitin sulfate (chondroitin sulfate) for treatment of knee osteoarthritis. The study tested whether glucosamine and chondroitin sulfate used separately or in combination reduced pain in participants with knee osteoarthritis.
The University of Utah, School of Medicine coordinated this study, which was conducted at 16 rheumatology research centers across the United States. The National Center for Complementary and Alternative Medicine (NCCAM) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), two components of the National Institutes of Health (NIH), funded GAIT.
What was the purpose of the study?
Previous studies in the medical literature had conflicting results on the effectiveness of glucosamine and chondroitin sulfate as treatments for osteoarthritis. GAIT was designed to test the short-term (6 months) effectiveness of glucosamine and chondroitin sulfate in reducing pain in a large number of participants with knee osteoarthritis.
What was the basic design of the study?
In GAIT, participants were randomly assigned to one of five treatment groups: (1) glucosamine alone, (2) chondroitin sulfate alone, (3) glucosamine and chondroitin sulfate in combination, (4) celecoxib, or (5) a placebo (an inactive substance that looks like the study substance). Glucosamine and chondroitin sulfate and their combination were compared to a placebo to evaluate whether these substances significantly improve joint pain. Celecoxib, which is a prescription drug effective in managing osteoarthritis pain, was also compared to placebo to validate the study design.
To reduce the chance of biased results, the study was double-blinded--neither the researchers nor the participants knew which of the five treatment groups the participants were in. Participants received treatment for 24 weeks. Participants were evaluated at the start of the study and at weeks 4, 8, 16, and 24 and closely monitored for improvement of their symptoms as well as for any possible adverse reactions to the study agents. X-rays documented each participant's diagnosis of osteoarthritis. Participants were also stratified into two pain subgroups--mild pain 1,229 participants (78 percent) and moderate-to-severe pain 354 participants (22 percent).
The primary outcome of the study was defined as at least a 20 percent reduction in pain at 24 weeks. All participants had the option to use up to 4000 mg of acetaminophen, as needed, to control pain from osteoarthritis throughout the study, except for the 24 hours prior to having their knee assessed. Acetaminophen use was low: on average, participants used fewer than two 500 mg tablets per day.
What did GAIT cost?
The primary GAIT study cost just over $12.5 million.
STUDY BACKGROUND
What is osteoarthritis?
More than 20 million adults in the United States live with osteoarthritis--the most common type of arthritis. Osteoarthritis, also called degenerative joint disease, is caused by the breakdown of cartilage, which is the connective tissue that cushions the ends of bones within the joint. Osteoarthritis is characterized by pain, joint damage, and limited motion. The disease generally occurs late in life, and most commonly affects the hands and large weight-bearing joints, such as the knees. Age, female gender, and obesity are risk factors for this condition.
What are glucosamine and chondroitin sulfate?
Glucosamine and chondroitin sulfate are natural substances found in and around the cells of cartilage. Glucosamine is an amino sugar that the body produces and distributes in cartilage and other connective tissue and chondroitin sulfate is a complex carbohydrate that helps cartilage retain water. In the United States, glucosamine and chondroitin sulfate are sold as dietary supplements, which are regulated as foods rather than drugs.
What is celecoxib?
Celecoxib (brand name Celebrex) is a type of nonsteroidal anti-inflammatory drug (NSAID), called a COX-2 inhibitor. Like traditional NSAIDS, celecoxib blocks the COX-2 enzyme in the body that stimulates inflammation. Unlike traditional NSAIDS, however, celecoxib does not block the action of COX-1 enzyme, which is known to protect the stomach lining. As a result, celecoxib reduces joint pain and inflammation with reduced risk of gastrointestinal ulceration and bleeding. Recent reports have linked possible cardiovascular side effects to COX-2 inhibitors. Although GAIT was not designed to study the safety of celecoxib, participants were monitored for adverse events and no increase in such side effects was observed.
What doses were used for the various treatments?
The doses used in GAIT were based on the doses seen in the prevailing scientific literature.
* Glucosamine alone: 1500 mg daily given as 500 mg three times a day
* Chondroitin sulfate alone: 1200 mg daily given as 400 mg three times a day
* Glucosamine plus chondroitin sulfate combined: same doses--1500 mg and 1200 mg daily
* Celecoxib: 200 mg daily
* Acetaminophen: participants were allowed to take up to 4000 mg (500 mg tablets) per day to control pain, except for the 24 hours before pain was assessed.
Who provided the source materials for making the glucosamine and chondroitin sulfate products used in GAIT?
* Glucosamine was donated in part by Ferro Pfanstiehl Laboratories, Inc., Waukegan, IL, through Wilke Resources
* Chondroitin sulfate was donated by Bioiberica, S.A., Barcelona, Spain
The study agents were manufactured by Albuquerque Veterans Affairs (VA) Cooperative Studies Program Clinical Research Pharmacy.
Where did the other study products come from?
* Acetaminophen was donated by McNeil Consumer and Specialty Pharmaceuticals, Fort Washington, PA
* Celecoxib was purchased from Pfizer
Where was the study conducted?
The University of Utah, School of Medicine, Salt Lake City, UT, served as the coordinating study center and oversaw the research and recruitment efforts of the 16 study centers. The study was led by Daniel O. Clegg, M.D., a Professor of Medicine and Chief of Rheumatology, Division of Rheumatology, University of Utah School of Medicine. The GAIT biostatistician was Domenic J. Reda, Ph.D., from the Hines VA Cooperative Studies Program, which served as the study data management and analysis center. The GAIT Clinical Research Pharmacist was Crystal L. Harris, Pharm.D., at the Albuquerque VA Cooperative Studies Program Clinical Research Pharmacy, which manufactured, packaged, distributed, and provided analytical testing of the study agents along with regulatory support for GAIT. The 16 study centers and their lead investigators were:
* University of Alabama at Birmingham, Birmingham, AL; Larry W. Moreland, M.D.
* University of Arizona, Tucson, AZ; David Yocum, M.D.
* Cedars-Sinai Medical Center, Los Angeles, CA; Michael Weisman, M.D.
* University of California Los Angeles, Los Angeles, CA; Daniel Furst, M.D.
* University of California San Francisco, San Francisco, CA; Nancy Lane, M.D.
* Northwestern University, Chicago, IL; Thomas J. Schnitzer, M.D.
* Indiana University, Indianapolis, IN; John Bradley, M.D.
* The Arthritis Research and Clinical Centers, Wichita, KS; Frederick Wolfe, M.D.
* University of Nebraska Medical Center, Omaha, NE; James O'Dell, M.D.
* Hospital for Joint Diseases, New York, NY; Clifton Bingham, III, M.D.
* Case Western Reserve University, Cleveland, OH; Michele Hooper, M.D.
* University of Pennsylvania, Philadelphia, PA; H. Ralph Schumacher, Jr., M.D.
* University of Pittsburgh, Pittsburgh, PA; Chester Oddis, M.D.
* Presbyterian Hospital of Dallas, Dallas, TX; John J. Cush, M.D.
* University of Utah, Salt Lake City, UT; Christopher G. Jackson, M.D.
* Virginia Mason Medical Center, Seattle, WA; Jerry Molitor, M.D.
KEY RESULTS
What were the key results of the study? Researchers found that:
* Participants taking the positive control, celecoxib, experienced statistically significant pain relief versus placebo--about 70 percent of those taking celecoxib had a 20 percent or greater reduction in pain versus about 60 percent for placebo.
* Overall, there were no significant differences between the other treatments tested and placebo.
* For a subset of participants with moderate-to-severe pain, glucosamine combined with chondroitin sulfate provided statistically significant pain relief compared to placebo--about 79 percent had a 20 percent or greater reduction in pain versus about 54 percent for placebo. According to the researchers, because of the small size of this subgroup these findings should be considered preliminary and need to be confirmed in further studies.
* For participants in the mild pain subset, glucosamine and chondroitin sulfate together or alone did not provide statistically significant pain relief.
How many people participated in the study and who were they?
A total of 1,583 people participated in the study. People age 40 or older with knee pain and documented x-ray evidence of osteoarthritis were eligible to participate. Participants could not have used glucosamine for 3 months and chondroitin sulfate for 6 months prior to entering the study. Participants were about 59 years of age, on average, and nearly two-thirds of participants were women. Of the 1,583 study participants 78 percent (1,229) were in the mild pain subgroup and 22 percent (354) were in the moderate-to-severe pain subgroup.
Were there any side effects from the treatments?
There were 77 reports of serious adverse effects during the study. Of those 77, only 3 were attributed to study treatments. Most side effects were mild, such as upset stomach, and were spread evenly across the different treatment groups. In addition, although GAIT was not designed to evaluate these risks, no change in glucose tolerance was seen for glucosamine nor was an increased incidence of cardiovascular events seen with celecoxib.
CONSUMER INFORMATION AND NEXT STEPS
Should people with osteoarthritis use glucosamine and chondroitin sulfate?
People with osteoarthritis should work with their health care provider to develop a comprehensive plan for managing their arthritis pain: eat right, exercise, lose excess weight, and use proven pain medications. If people have moderate-to-severe pain, they should talk with their health care provider about whether glucosamine plus chondroitin sulfate is an appropriate treatment option.
Can U.S. consumers get the glucosamine and chondroitin sulfate products used in GAIT?
Identical products may not be commercially available. GAIT was conducted under an Investigational New Drug application filed with the U.S. Food and Drug Administration (FDA). All of the products used in the study were developed for the study and subject to the FDA's pharmaceutical regulations. The products were evaluated and manufactured by the VA Cooperative Studies Program Clinical Research Pharmacy, an FDA-licensed clinical research pharmacy center. The glucosamine and chondroitin sulfate used were tested for purity, potency, quality, and consistency among batches. Products were retested for stability throughout the study.
Will the GAIT team continue to do research on glucosamine and chondroitin sulfate?
GAIT includes an ancillary study, which is still ongoing, that will assess whether glucosamine and chondroitin sulfate can reduce or halt the progression of knee osteoarthritis following additional treatment. About one-half of the participants enrolled in GAIT will be treated for an additional 18 months. As in the primary study, participants will not know to which treatment group they belong. Researchers will compare x-rays taken at the beginning of the study and after 1 and 2 years of treatment to identify changes in the knee joints as a result of treatment. Results are expected in about a year.
For More Information
NCCAM Clearinghouse
The NCCAM Clearinghouse provides information on CAM and NCCAM, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.
Toll-free in the U.S.: 1-888-644-6226
International: 301-519-3153
TTY (for deaf and hard-of-hearing callers): 1-866-464-3615
Web site: mailto:nccam.nih
E-mail: infonccam.nih
National Institute of Arthritis and Musculoskeletal and Skin Diseases For information on rheumatic diseases such as osteoarthritis and diseases of the musculoskeletal and skin systems, contact the NIAMS Information Clearinghouse.
Toll-free in the U.S.: 1-877-22-NIAMS
Telephone: 301-495-4484
Web site: niams.nih/hi/index.htm
Address: NIAMS/National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
NIH Office of Dietary Supplements (ODS)
For scientific citations and abstracts on dietary supplements, visit the ODS Web site for access to the International Bibliographic Information on Dietary Supplements database.
Web site: ods.od.nih/
U.S. Food and Drug Administration
For information on dietary supplement labeling requirements and safety monitoring, order the FDA Guide to Dietary Supplements from the U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition.
Toll-free in the U.S.: 1-800-FDA-4010
Web site: cfsan.fda/
Contact: NCCAM Press Office
nccampressmail.nih
NIH/National Center for Complementary and Alternative Medicine
"GAIT is another example of NIH's commitment to exploring the potential of complementary and alternative medicine to prevent and treat disease in a manner that is fair, unbiased, and scientifically rigorous," said Elias A. Zerhouni, M.D., NIH Director.
GAIT enrolled nearly 1,600 participants with documented osteoarthritis of the knee. Participants were randomly assigned to receive one of five treatments daily for 24 weeks: glucosamine alone (1500 mg), chondroitin sulfate alone (1200 mg), glucosamine and chondroitin sulfate combined (same doses), a placebo, or celecoxib (200 mg). Celecoxib is an FDA-approved drug for the management of osteoarthritis pain and served as a positive control for the study. (A positive control is a treatment that investigators expect participants to respond to in a predictable way; it helps validate study results.) A positive response to treatment was defined as a 20 percent or greater reduction in pain at week 24 compared to the start of the study.
The researchers found that participants taking celecoxib experienced statistically significant pain relief, as expected, versus placebo--about 70 percent of those taking celecoxib versus 60 percent taking placebo had a 20 percent or greater pain reduction. For all participants, there were no significant differences between the other treatments tested and placebo. However, for participants in the moderate-to-severe pain subgroup, glucosamine combined with chondroitin sulfate provided statistically significant pain relief compared to placebo--about 79 percent in this group had a 20 percent or greater pain reduction compared to 54 percent for placebo. In the subgroup of participants with mild pain, glucosamine and chondroitin sulfate together or alone did not provide statistically significant relief compared to placebo.
"This rigorous, large-scale study showed that the combination of glucosamine and chondroitin sulfate appeared to help people with moderate-to-severe pain from knee osteoarthritis, but not those with mild pain," said Stephen E. Straus, M.D., NCCAM Director. "It is important to study dietary supplements with well-designed research in order to find out what works and what does not."
"Because of the small size of the moderate-to-severe pain subgroup, the findings in this group for glucosamine plus chondroitin sulfate should be considered preliminary and need to be confirmed in a study designed for this purpose," said Dr. Clegg, Professor of Medicine and Chief of Rheumatology at the University of Utah, School of Medicine.
On entering the study, a participant's level of pain was assessed as either mild or moderate to severe using standard pain assessment tools and scales, such as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Of the 1,583 study participants, 78 percent were in the mild pain subgroup and the other 22 percent were in the moderate-to-severe pain subgroup. Level of pain was evaluated at weeks 4, 8, 16, and 24 using the WOMAC scale and other tools. In addition to taking their daily study treatment, participants could take up to 4000 mg of acetaminophen daily for pain, except for the 24 hours before they were assessed by study staff. The use of acetaminophen, however, was low, overall averaging fewer than two 500 mg tablets per day. Participants could not take other non-steroidal anti-inflammatory medicines or narcotic (opioid-based) pain relievers during the study.
"More than 20 million Americans have osteoarthritis, making it a frequent cause of physical disability among adults," said Stephen I. Katz, M.D., Ph.D., NIAMS Director. "We are excited to support studies looking at new treatment options that could improve the symptoms and quality of life of people with osteoarthritis."
GAIT was conducted under an Investigational New Drug application filed with the U.S. Food and Drug Administration. Thus, all of the products used in the study were subject to the FDA's pharmaceutical regulations and evaluated and manufactured by an FDA-licensed clinical research pharmacy center. The glucosamine and chondroitin sulfate used were tested for purity, potency, quality, and consistency among batches. Products were retested for stability throughout the study. The dosages selected were based on the prevailing doses in the scientific literature. Few side effects from any of the treatments were reported. Those reported were generally mild, such as upset stomach, and distributed evenly across the treatment groups.
"The GAIT team's goal was to assess whether glucosamine and chondroitin sulfate, which we saw our osteoarthritis patients using, provided pain relief," said Dr. Clegg. "I urge people with osteoarthritis to follow a comprehensive plan for managing their arthritis pain--eat right, exercise, lose excess weight, and talk to your physician about appropriate treatment options."
The GAIT team continues their research with a smaller study to see whether glucosamine and chondroitin sulfate can alter the progression of osteoarthritis, such as delaying the narrowing of the joint spaces. About one-half of the participants in the larger GAIT study were eligible to enroll in this ancillary study. The results are expected in about a year.
The National Center for Complementary and Alternative Medicine's mission is to explore complementary and alternative medical practices in the context of rigorous science, train CAM researchers, and disseminate authoritative information to the public and professionals. For additional information, call NCCAM's Clearinghouse toll free at 1-888-644-6226, or visit the NCCAM Web site at nccam.nih. NCCAM is 1 of 27 institutes and centers at the National Institutes of Health, the Federal focal point for medical research in the United States.
The National Institute of Arthritis and Musculoskeletal and Skin Diseases, a component of the National Institutes of Health, DHHS, supports research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. For additional information, call NIAMS's clearinghouse at (301) 495-4484 or visit NIAMS's Web site at niams.nih/.
*Clegg D, et al. Glucosamine, Chondroitin Sulfate, and the Two in Combination for Painful Knee Osteoarthritis. New England Journal of Medicine, 2006; 354:795-808.
The following is a companion Q&A document for the above release. It provides additional details about the GAIT trial.
Questions and Answers: NIH Glucosamine/chondroitin Arthritis Intervention Trial (GAIT)
ABOUT THE STUDY
* What is the Glucosamine/chondroitin Arthritis Intervention Trial (GAIT)?
* What was the purpose of the study?
* What was the basic design of the study?
* What did GAIT cost?
STUDY BACKGROUND
* What is osteoarthritis?
* What are glucosamine and chondroitin sulfate?
* What is celecoxib?
* What doses were used for the various treatments?
* Who provided the source materials for making the glucosamine and chondroitin sulfate products used in GAIT?
* Where did the other study products come from?
* Where was the study conducted?
KEY RESULTS
* What were the key results of the study?
* How many people participated in the study and who were they?
* Were there any side effects from the treatments?
CONSUMER INFORMATION AND NEXT STEPS
* Should people with osteoarthritis use glucosamine and chondroitin sulfate?
* Can U.S. consumers get the glucosamine and chondroitin sulfate products used in GAIT?
* Will the GAIT team continue to do research on glucosamine and chondroitin sulfate?
* For More Information
ABOUT THE STUDY
What is the Glucosamine/chondroitin Arthritis Intervention Trial (GAIT)? GAIT is the first, large-scale, multicenter clinical trial in the United States to test the effects of the dietary supplements glucosamine hydrochloride (glucosamine) and sodium chondroitin sulfate (chondroitin sulfate) for treatment of knee osteoarthritis. The study tested whether glucosamine and chondroitin sulfate used separately or in combination reduced pain in participants with knee osteoarthritis.
The University of Utah, School of Medicine coordinated this study, which was conducted at 16 rheumatology research centers across the United States. The National Center for Complementary and Alternative Medicine (NCCAM) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), two components of the National Institutes of Health (NIH), funded GAIT.
What was the purpose of the study?
Previous studies in the medical literature had conflicting results on the effectiveness of glucosamine and chondroitin sulfate as treatments for osteoarthritis. GAIT was designed to test the short-term (6 months) effectiveness of glucosamine and chondroitin sulfate in reducing pain in a large number of participants with knee osteoarthritis.
What was the basic design of the study?
In GAIT, participants were randomly assigned to one of five treatment groups: (1) glucosamine alone, (2) chondroitin sulfate alone, (3) glucosamine and chondroitin sulfate in combination, (4) celecoxib, or (5) a placebo (an inactive substance that looks like the study substance). Glucosamine and chondroitin sulfate and their combination were compared to a placebo to evaluate whether these substances significantly improve joint pain. Celecoxib, which is a prescription drug effective in managing osteoarthritis pain, was also compared to placebo to validate the study design.
To reduce the chance of biased results, the study was double-blinded--neither the researchers nor the participants knew which of the five treatment groups the participants were in. Participants received treatment for 24 weeks. Participants were evaluated at the start of the study and at weeks 4, 8, 16, and 24 and closely monitored for improvement of their symptoms as well as for any possible adverse reactions to the study agents. X-rays documented each participant's diagnosis of osteoarthritis. Participants were also stratified into two pain subgroups--mild pain 1,229 participants (78 percent) and moderate-to-severe pain 354 participants (22 percent).
The primary outcome of the study was defined as at least a 20 percent reduction in pain at 24 weeks. All participants had the option to use up to 4000 mg of acetaminophen, as needed, to control pain from osteoarthritis throughout the study, except for the 24 hours prior to having their knee assessed. Acetaminophen use was low: on average, participants used fewer than two 500 mg tablets per day.
What did GAIT cost?
The primary GAIT study cost just over $12.5 million.
STUDY BACKGROUND
What is osteoarthritis?
More than 20 million adults in the United States live with osteoarthritis--the most common type of arthritis. Osteoarthritis, also called degenerative joint disease, is caused by the breakdown of cartilage, which is the connective tissue that cushions the ends of bones within the joint. Osteoarthritis is characterized by pain, joint damage, and limited motion. The disease generally occurs late in life, and most commonly affects the hands and large weight-bearing joints, such as the knees. Age, female gender, and obesity are risk factors for this condition.
What are glucosamine and chondroitin sulfate?
Glucosamine and chondroitin sulfate are natural substances found in and around the cells of cartilage. Glucosamine is an amino sugar that the body produces and distributes in cartilage and other connective tissue and chondroitin sulfate is a complex carbohydrate that helps cartilage retain water. In the United States, glucosamine and chondroitin sulfate are sold as dietary supplements, which are regulated as foods rather than drugs.
What is celecoxib?
Celecoxib (brand name Celebrex) is a type of nonsteroidal anti-inflammatory drug (NSAID), called a COX-2 inhibitor. Like traditional NSAIDS, celecoxib blocks the COX-2 enzyme in the body that stimulates inflammation. Unlike traditional NSAIDS, however, celecoxib does not block the action of COX-1 enzyme, which is known to protect the stomach lining. As a result, celecoxib reduces joint pain and inflammation with reduced risk of gastrointestinal ulceration and bleeding. Recent reports have linked possible cardiovascular side effects to COX-2 inhibitors. Although GAIT was not designed to study the safety of celecoxib, participants were monitored for adverse events and no increase in such side effects was observed.
What doses were used for the various treatments?
The doses used in GAIT were based on the doses seen in the prevailing scientific literature.
* Glucosamine alone: 1500 mg daily given as 500 mg three times a day
* Chondroitin sulfate alone: 1200 mg daily given as 400 mg three times a day
* Glucosamine plus chondroitin sulfate combined: same doses--1500 mg and 1200 mg daily
* Celecoxib: 200 mg daily
* Acetaminophen: participants were allowed to take up to 4000 mg (500 mg tablets) per day to control pain, except for the 24 hours before pain was assessed.
Who provided the source materials for making the glucosamine and chondroitin sulfate products used in GAIT?
* Glucosamine was donated in part by Ferro Pfanstiehl Laboratories, Inc., Waukegan, IL, through Wilke Resources
* Chondroitin sulfate was donated by Bioiberica, S.A., Barcelona, Spain
The study agents were manufactured by Albuquerque Veterans Affairs (VA) Cooperative Studies Program Clinical Research Pharmacy.
Where did the other study products come from?
* Acetaminophen was donated by McNeil Consumer and Specialty Pharmaceuticals, Fort Washington, PA
* Celecoxib was purchased from Pfizer
Where was the study conducted?
The University of Utah, School of Medicine, Salt Lake City, UT, served as the coordinating study center and oversaw the research and recruitment efforts of the 16 study centers. The study was led by Daniel O. Clegg, M.D., a Professor of Medicine and Chief of Rheumatology, Division of Rheumatology, University of Utah School of Medicine. The GAIT biostatistician was Domenic J. Reda, Ph.D., from the Hines VA Cooperative Studies Program, which served as the study data management and analysis center. The GAIT Clinical Research Pharmacist was Crystal L. Harris, Pharm.D., at the Albuquerque VA Cooperative Studies Program Clinical Research Pharmacy, which manufactured, packaged, distributed, and provided analytical testing of the study agents along with regulatory support for GAIT. The 16 study centers and their lead investigators were:
* University of Alabama at Birmingham, Birmingham, AL; Larry W. Moreland, M.D.
* University of Arizona, Tucson, AZ; David Yocum, M.D.
* Cedars-Sinai Medical Center, Los Angeles, CA; Michael Weisman, M.D.
* University of California Los Angeles, Los Angeles, CA; Daniel Furst, M.D.
* University of California San Francisco, San Francisco, CA; Nancy Lane, M.D.
* Northwestern University, Chicago, IL; Thomas J. Schnitzer, M.D.
* Indiana University, Indianapolis, IN; John Bradley, M.D.
* The Arthritis Research and Clinical Centers, Wichita, KS; Frederick Wolfe, M.D.
* University of Nebraska Medical Center, Omaha, NE; James O'Dell, M.D.
* Hospital for Joint Diseases, New York, NY; Clifton Bingham, III, M.D.
* Case Western Reserve University, Cleveland, OH; Michele Hooper, M.D.
* University of Pennsylvania, Philadelphia, PA; H. Ralph Schumacher, Jr., M.D.
* University of Pittsburgh, Pittsburgh, PA; Chester Oddis, M.D.
* Presbyterian Hospital of Dallas, Dallas, TX; John J. Cush, M.D.
* University of Utah, Salt Lake City, UT; Christopher G. Jackson, M.D.
* Virginia Mason Medical Center, Seattle, WA; Jerry Molitor, M.D.
KEY RESULTS
What were the key results of the study? Researchers found that:
* Participants taking the positive control, celecoxib, experienced statistically significant pain relief versus placebo--about 70 percent of those taking celecoxib had a 20 percent or greater reduction in pain versus about 60 percent for placebo.
* Overall, there were no significant differences between the other treatments tested and placebo.
* For a subset of participants with moderate-to-severe pain, glucosamine combined with chondroitin sulfate provided statistically significant pain relief compared to placebo--about 79 percent had a 20 percent or greater reduction in pain versus about 54 percent for placebo. According to the researchers, because of the small size of this subgroup these findings should be considered preliminary and need to be confirmed in further studies.
* For participants in the mild pain subset, glucosamine and chondroitin sulfate together or alone did not provide statistically significant pain relief.
How many people participated in the study and who were they?
A total of 1,583 people participated in the study. People age 40 or older with knee pain and documented x-ray evidence of osteoarthritis were eligible to participate. Participants could not have used glucosamine for 3 months and chondroitin sulfate for 6 months prior to entering the study. Participants were about 59 years of age, on average, and nearly two-thirds of participants were women. Of the 1,583 study participants 78 percent (1,229) were in the mild pain subgroup and 22 percent (354) were in the moderate-to-severe pain subgroup.
Were there any side effects from the treatments?
There were 77 reports of serious adverse effects during the study. Of those 77, only 3 were attributed to study treatments. Most side effects were mild, such as upset stomach, and were spread evenly across the different treatment groups. In addition, although GAIT was not designed to evaluate these risks, no change in glucose tolerance was seen for glucosamine nor was an increased incidence of cardiovascular events seen with celecoxib.
CONSUMER INFORMATION AND NEXT STEPS
Should people with osteoarthritis use glucosamine and chondroitin sulfate?
People with osteoarthritis should work with their health care provider to develop a comprehensive plan for managing their arthritis pain: eat right, exercise, lose excess weight, and use proven pain medications. If people have moderate-to-severe pain, they should talk with their health care provider about whether glucosamine plus chondroitin sulfate is an appropriate treatment option.
Can U.S. consumers get the glucosamine and chondroitin sulfate products used in GAIT?
Identical products may not be commercially available. GAIT was conducted under an Investigational New Drug application filed with the U.S. Food and Drug Administration (FDA). All of the products used in the study were developed for the study and subject to the FDA's pharmaceutical regulations. The products were evaluated and manufactured by the VA Cooperative Studies Program Clinical Research Pharmacy, an FDA-licensed clinical research pharmacy center. The glucosamine and chondroitin sulfate used were tested for purity, potency, quality, and consistency among batches. Products were retested for stability throughout the study.
Will the GAIT team continue to do research on glucosamine and chondroitin sulfate?
GAIT includes an ancillary study, which is still ongoing, that will assess whether glucosamine and chondroitin sulfate can reduce or halt the progression of knee osteoarthritis following additional treatment. About one-half of the participants enrolled in GAIT will be treated for an additional 18 months. As in the primary study, participants will not know to which treatment group they belong. Researchers will compare x-rays taken at the beginning of the study and after 1 and 2 years of treatment to identify changes in the knee joints as a result of treatment. Results are expected in about a year.
For More Information
NCCAM Clearinghouse
The NCCAM Clearinghouse provides information on CAM and NCCAM, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.
Toll-free in the U.S.: 1-888-644-6226
International: 301-519-3153
TTY (for deaf and hard-of-hearing callers): 1-866-464-3615
Web site: mailto:nccam.nih
E-mail: infonccam.nih
National Institute of Arthritis and Musculoskeletal and Skin Diseases For information on rheumatic diseases such as osteoarthritis and diseases of the musculoskeletal and skin systems, contact the NIAMS Information Clearinghouse.
Toll-free in the U.S.: 1-877-22-NIAMS
Telephone: 301-495-4484
Web site: niams.nih/hi/index.htm
Address: NIAMS/National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
NIH Office of Dietary Supplements (ODS)
For scientific citations and abstracts on dietary supplements, visit the ODS Web site for access to the International Bibliographic Information on Dietary Supplements database.
Web site: ods.od.nih/
U.S. Food and Drug Administration
For information on dietary supplement labeling requirements and safety monitoring, order the FDA Guide to Dietary Supplements from the U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition.
Toll-free in the U.S.: 1-800-FDA-4010
Web site: cfsan.fda/
Contact: NCCAM Press Office
nccampressmail.nih
NIH/National Center for Complementary and Alternative Medicine
четверг, 29 сентября 2011 г.
Yoga Benefits Women With Gynaecological Cancers
Women who have had gynaecological cancer are invited to learn more about how yoga can benefit them at Yeovil District Hospital later this month.
The GOSSIP patient support group provides advice and information for women with gynaecological cancer. It was founded by the Gynaecological Cancer Specialist Nurses based in Yeovil and Taunton in partnership with women from across Somerset and Dorset who have had gynaecological cancers (i.e. cancers of the ovary, womb, vulva or cervix).
Attending meetings enables patients to meet with other women who have a similar diagnosis and may have had similar treatments. Partners, family members and friends are welcome to go along as well. A specialist nurse is present at meetings and will be happy to answer questions and discuss concerns on a one-to-one basis.
The talk on the benefits of yoga will be given by Carol Watkins, at Yeovil Women's Hospital on Monday 23 August between 5 and 6.30pm.
Please telephone the gynaecology department at Yeovil District Hospital on 01935 384454 for more information.
The GOSSIP patient support group provides advice and information for women with gynaecological cancer. It was founded by the Gynaecological Cancer Specialist Nurses based in Yeovil and Taunton in partnership with women from across Somerset and Dorset who have had gynaecological cancers (i.e. cancers of the ovary, womb, vulva or cervix).
Attending meetings enables patients to meet with other women who have a similar diagnosis and may have had similar treatments. Partners, family members and friends are welcome to go along as well. A specialist nurse is present at meetings and will be happy to answer questions and discuss concerns on a one-to-one basis.
The talk on the benefits of yoga will be given by Carol Watkins, at Yeovil Women's Hospital on Monday 23 August between 5 and 6.30pm.
Please telephone the gynaecology department at Yeovil District Hospital on 01935 384454 for more information.
понедельник, 26 сентября 2011 г.
Tai Chi And Qigong Show Significant Health Benefits
An across-the-board review of the health effects of Qigong and Tai Chi finds these practices offer many physical and mental health advantages with benefits for the heart, immune system and overall quality of life.
The review, which appears in the July/August issue of the American Journal of Health Promotion, included 77 randomized controlled trials (RCTs) on Qigong or Tai Chi interventions published in peer-reviewed journals between 1993 and 2007. Taken together, there were 6,410 participants in the studies.
"We see this as moving the understanding of the potential of Qigong and Tai Chi forward, with an emphasis on combining the evidence across these practices," said co-author Linda Larkey, Ph.D., of Arizona State University College of Nursing and Healthcare Innovation.
The authors say that the review provides a "stronger evidence base" for bone health, cardio-respiratory fitness, physical function, balance, quality of life, fall prevention and psychological benefits.
Qigong is a "very general term to describe exercises that will enhance qi flow or balance," said Shin Lin, Ph.D., a professor at the Center for Integrative Medicine at the University of California, Irvine. Qigong combines "qi" for energy and "gong" for work or exercise.
Tai Chi is much more specific, focusing on a series of 24 to 108 movements that have a long written history over 19 generations, said Lin, a member of the National Advisory Council for Complimentary and Alterative Medicine
"The research studies reviewed here showed that simplified routines that are more practical for RCTs are in fact quite effective in health enhancement." With that in mind, individuals could "forego learning complicated routines except for cultural or artistic purposes," said Lin, who had no affiliation with the review.
Of the studies analyzed 27 considered psychological symptoms, 23 looked at falls and related risk factors, 19 looked at cardiopulmonary effects and 17 evaluated quality of life. Other included studies looked at bone density, physical function and immune function. Participants' average age was 55, and for studies that looked at balance, 80 was the average age.
Larkey said that there was not a way to "combine the studies statistically and determine effect sizes that is, how strong the evidence is for many of the outcomes reviewed since the interventions, study design quality and measures were so wide ranging."
Nevertheless, she said, the authors found quite consistent evidence of several benefits from this particular category of exercise.
"Tai Chi and Qigong have many health benefits and therefore should be considered a high priority when one is selecting an exercise to practice," Lin said.
Jahnke R, et al. A comprehensive review of health benefits of Qigong and Tai Chi. Am J Health Promot 24(6), 2010.
The review, which appears in the July/August issue of the American Journal of Health Promotion, included 77 randomized controlled trials (RCTs) on Qigong or Tai Chi interventions published in peer-reviewed journals between 1993 and 2007. Taken together, there were 6,410 participants in the studies.
"We see this as moving the understanding of the potential of Qigong and Tai Chi forward, with an emphasis on combining the evidence across these practices," said co-author Linda Larkey, Ph.D., of Arizona State University College of Nursing and Healthcare Innovation.
The authors say that the review provides a "stronger evidence base" for bone health, cardio-respiratory fitness, physical function, balance, quality of life, fall prevention and psychological benefits.
Qigong is a "very general term to describe exercises that will enhance qi flow or balance," said Shin Lin, Ph.D., a professor at the Center for Integrative Medicine at the University of California, Irvine. Qigong combines "qi" for energy and "gong" for work or exercise.
Tai Chi is much more specific, focusing on a series of 24 to 108 movements that have a long written history over 19 generations, said Lin, a member of the National Advisory Council for Complimentary and Alterative Medicine
"The research studies reviewed here showed that simplified routines that are more practical for RCTs are in fact quite effective in health enhancement." With that in mind, individuals could "forego learning complicated routines except for cultural or artistic purposes," said Lin, who had no affiliation with the review.
Of the studies analyzed 27 considered psychological symptoms, 23 looked at falls and related risk factors, 19 looked at cardiopulmonary effects and 17 evaluated quality of life. Other included studies looked at bone density, physical function and immune function. Participants' average age was 55, and for studies that looked at balance, 80 was the average age.
Larkey said that there was not a way to "combine the studies statistically and determine effect sizes that is, how strong the evidence is for many of the outcomes reviewed since the interventions, study design quality and measures were so wide ranging."
Nevertheless, she said, the authors found quite consistent evidence of several benefits from this particular category of exercise.
"Tai Chi and Qigong have many health benefits and therefore should be considered a high priority when one is selecting an exercise to practice," Lin said.
Jahnke R, et al. A comprehensive review of health benefits of Qigong and Tai Chi. Am J Health Promot 24(6), 2010.
пятница, 23 сентября 2011 г.
NHS Should Stop Funding Alternative Therapies, Say UK Top Doctors
Some eminent British doctors are urging the National Health Service (NHS) to stop paying for alternative therapies. They argue that these 'bogus' therapies are not proven according to 'solid evidence'. While UK patients are being denied such drugs as Herceptin, the NHS, which is strapped for cash, should not be paying for 'unproven or disproved treatments', such as homeopathy.
Prince Charles disagrees. In a speech at the World Health Assembly, Geneva, he said there should be a proper mix of proven complementary, traditional and modern remedies. He believes a proper mix can help create a powerful healing force in the world. He explained that several complementary therapies used today are rooted in ancient traditions. Traditions which understood how important it is to have good balance and harmony with our minds, bodies and the natural world. Orthodox medicine, he said, has much to learn from proven alternative therapies.
Thirteen top doctors sent a letter, organised by Michael Baum, emeritus professor of surgery at University College London, to 476 acute and primary care trusts in the UK.
The letter criticises a government-funded guide on homeopathy for patients. It also attacks the Smallwood report, which was commissioned by Prince Charles. The report said there should be more access to NHS funded complementary therapies - therapies which would bring about enormous benefits.
The thirteen doctors said homeopathy reviews have never produced any convincing evidence of effectiveness. They went on to say that modern medicine must be open to new discoveries. But it should not be open to everything just as a matter of principle. They argued that as the NHS has limited resources, they would be better spent on therapies that are based on solid evidence.
The thrust of their argument is that all therapies should undergo the same strict rules for approval as modern drugs and orthodox medical procedures.
There was criticism regarding ??20 million for the refurbishment of the Royal London Homoeopathic Hospital.
The UK Department of Health leaves it up to doctors and trusts to decide what NHS treatments their patients should have. As decisions on alternative therapies are taken locally, central government does not know exactly how much is spent nationally on alternative and complementary medicines. It is estimated that about 50% of UK general practitioners (GPs) use alternative therapies or refer their patients to alternative therapists.
Editor's Opinion:
If doctors are allowed to decide whether to use alternative therapies for themselves, why not let them continue to do so.
We have received many emails on this theme. Perhaps the ones below reflect the opinions of most people who have written in:
(Name withheld - England)
"I am not trying to knock orthodox medicine. It is wonderful and has saved many lives. However, there are times it is blind to what can be done to improve the health of people. Five years ago my GP, who is a personal friend, found that I was pre-diabetic. He arranged for me to go to a local gym three times a week. I had a personal trainer who also helped me improve my eating habits. Within a year I was no longer pre-diabetic. I paid for the gym and the trainer out of my own pocket. I am sure, had I not taken this preventive action, that today I would be a diabetes 2 patient and a very expensive burden on the NHS for the rest of my life. I am 62 - I could have been an NHS burden for the next 20 years. I call what I did 'alternative treatment'. Orthodox medicine would more likely have helped me with drugs when diabetes 2 arrived. Surely, funding what I did would, in the long term, make for a healthier nation and save the NHS money."
(Name Withheld - Ireland)
"Proven therapies are fine. However, they are only effective for people who have become very sick. They do nothing for people to prevent the sickness from coming in the first place or helping the person from getting sick again. Yes, statins can deal with cholesterol build up and prevent strokes and heart attacks. But there are many people out there who are not genetically predisposed to cholesterol build up who would have benefited from lifestyle training from their doctors - rather than just being given drugs. Orthodox medicine is weak in this area."
View drug information on Herceptin.
Prince Charles disagrees. In a speech at the World Health Assembly, Geneva, he said there should be a proper mix of proven complementary, traditional and modern remedies. He believes a proper mix can help create a powerful healing force in the world. He explained that several complementary therapies used today are rooted in ancient traditions. Traditions which understood how important it is to have good balance and harmony with our minds, bodies and the natural world. Orthodox medicine, he said, has much to learn from proven alternative therapies.
Thirteen top doctors sent a letter, organised by Michael Baum, emeritus professor of surgery at University College London, to 476 acute and primary care trusts in the UK.
The letter criticises a government-funded guide on homeopathy for patients. It also attacks the Smallwood report, which was commissioned by Prince Charles. The report said there should be more access to NHS funded complementary therapies - therapies which would bring about enormous benefits.
The thirteen doctors said homeopathy reviews have never produced any convincing evidence of effectiveness. They went on to say that modern medicine must be open to new discoveries. But it should not be open to everything just as a matter of principle. They argued that as the NHS has limited resources, they would be better spent on therapies that are based on solid evidence.
The thrust of their argument is that all therapies should undergo the same strict rules for approval as modern drugs and orthodox medical procedures.
There was criticism regarding ??20 million for the refurbishment of the Royal London Homoeopathic Hospital.
The UK Department of Health leaves it up to doctors and trusts to decide what NHS treatments their patients should have. As decisions on alternative therapies are taken locally, central government does not know exactly how much is spent nationally on alternative and complementary medicines. It is estimated that about 50% of UK general practitioners (GPs) use alternative therapies or refer their patients to alternative therapists.
Editor's Opinion:
If doctors are allowed to decide whether to use alternative therapies for themselves, why not let them continue to do so.
We have received many emails on this theme. Perhaps the ones below reflect the opinions of most people who have written in:
(Name withheld - England)
"I am not trying to knock orthodox medicine. It is wonderful and has saved many lives. However, there are times it is blind to what can be done to improve the health of people. Five years ago my GP, who is a personal friend, found that I was pre-diabetic. He arranged for me to go to a local gym three times a week. I had a personal trainer who also helped me improve my eating habits. Within a year I was no longer pre-diabetic. I paid for the gym and the trainer out of my own pocket. I am sure, had I not taken this preventive action, that today I would be a diabetes 2 patient and a very expensive burden on the NHS for the rest of my life. I am 62 - I could have been an NHS burden for the next 20 years. I call what I did 'alternative treatment'. Orthodox medicine would more likely have helped me with drugs when diabetes 2 arrived. Surely, funding what I did would, in the long term, make for a healthier nation and save the NHS money."
(Name Withheld - Ireland)
"Proven therapies are fine. However, they are only effective for people who have become very sick. They do nothing for people to prevent the sickness from coming in the first place or helping the person from getting sick again. Yes, statins can deal with cholesterol build up and prevent strokes and heart attacks. But there are many people out there who are not genetically predisposed to cholesterol build up who would have benefited from lifestyle training from their doctors - rather than just being given drugs. Orthodox medicine is weak in this area."
View drug information on Herceptin.
вторник, 20 сентября 2011 г.
AMTA Consumer Survey Shows Men Neglecting Massage Therapy In Past Year
Results from the 14th annual consumer survey conducted by the American Massage Therapy Association® (AMTA®) indicate the use of massage among men has dropped from 18 percent in 2009 to 10 percent in 2010, a drop that is attributed to the lagging economy these past two years. The survey results were announced at the AMTA National Convention in Minneapolis, September 22-25, 2010.
Recent statistics have indicated men have been putting off their healthcare appointments this year including visits for regular check-ups, screenings and vaccinations. According to the Agency for Healthcare Research and Quality (AHRQ) about 57 percent of men have visited a physician within the past year, compared with about 74 percent of women. This trend is now impacting massage therapy in men.
Massage use among women only dropped from 26 percent in 2009 to 25 percent in 2010. Because of the lower use of massage by men, the percentage of all adults who had a massage in the previous 12 months dropped from 22 percent in 2009 to 18 percent in 2010.
"We know from our AMTA survey results in the last 14 years that massage therapy usage has been on an overall upward trend, as people are realizing the health benefits of massage to manage pain and keep them active, as well as being an excellent means to relieve stress" says Kathleen Miller-Read, AMTA president. "We believe that as the economic climate improves, men will return to massage therapy as part of their regular health maintenance plan."
Americans Are Reaching to Massage for Pain Relief
There have been a growing number of people in recent years seeking massage as part of health care and an increase in physician referrals to massage therapists. Because of this trend and a steadily rising number of massage therapists working in health care environments, this year's AMTA convention includes educational sessions on massage for the relief of pain stemming from a variety of causes, as well as for pregnancy, sports injuries and cancer. The vast majority of Americans, 86 percent, still agree that massage can be effective in reducing pain, a number that has held strong from 2009, while 84 percent agree massage can be beneficial for health and wellness. More than half of the men and women surveyed said they have had a massage to relieve pain.
Americans Still See the Benefits of Massage, Particularly Those Who are Stressed
About 40 percent of stressed out Americans are getting massages to relieve their stress, which has increased from 32 percent in 2009.
"Stress, among other factors, is a popular reason why people get massage," says Miller-Read. "In a year where the economy is such a stress inducer, AMTA is pleased that people are increasingly turning to massage for stress relief."
Recent statistics have indicated men have been putting off their healthcare appointments this year including visits for regular check-ups, screenings and vaccinations. According to the Agency for Healthcare Research and Quality (AHRQ) about 57 percent of men have visited a physician within the past year, compared with about 74 percent of women. This trend is now impacting massage therapy in men.
Massage use among women only dropped from 26 percent in 2009 to 25 percent in 2010. Because of the lower use of massage by men, the percentage of all adults who had a massage in the previous 12 months dropped from 22 percent in 2009 to 18 percent in 2010.
"We know from our AMTA survey results in the last 14 years that massage therapy usage has been on an overall upward trend, as people are realizing the health benefits of massage to manage pain and keep them active, as well as being an excellent means to relieve stress" says Kathleen Miller-Read, AMTA president. "We believe that as the economic climate improves, men will return to massage therapy as part of their regular health maintenance plan."
Americans Are Reaching to Massage for Pain Relief
There have been a growing number of people in recent years seeking massage as part of health care and an increase in physician referrals to massage therapists. Because of this trend and a steadily rising number of massage therapists working in health care environments, this year's AMTA convention includes educational sessions on massage for the relief of pain stemming from a variety of causes, as well as for pregnancy, sports injuries and cancer. The vast majority of Americans, 86 percent, still agree that massage can be effective in reducing pain, a number that has held strong from 2009, while 84 percent agree massage can be beneficial for health and wellness. More than half of the men and women surveyed said they have had a massage to relieve pain.
Americans Still See the Benefits of Massage, Particularly Those Who are Stressed
About 40 percent of stressed out Americans are getting massages to relieve their stress, which has increased from 32 percent in 2009.
"Stress, among other factors, is a popular reason why people get massage," says Miller-Read. "In a year where the economy is such a stress inducer, AMTA is pleased that people are increasingly turning to massage for stress relief."
суббота, 17 сентября 2011 г.
Painful Menstrual Cramps May Be Relieved By Chinese Herbal Medicine
Women with menstrual cramps are often offered either non steroidal anti-inflammatory drugs or oral contraceptives. Many women, however, find that this treatment does not work or they can not take the drugs, and more women would prefer a non-drug alternative.
Chinese herbal medicine (CHM) has been used for centuries in China, being used in public hospitals to treat unexplained cramps that occur during menstruation (primary dysmenorhoea). A team of Cochrane Researchers has found evidence that CHM may provide one possible form of treatment.
This evidence came from studying 39 randomised controlled trials that together involved 3,475 women. CHM gave significant improvements in pain relief when compared to pharmaceutical drugs. It also reduced overall symptoms. The research revealed that CHM was also better at alleviating pain than acupuncture or heat compression.
"All available measures of effectiveness confirmed the overall superiority of Chinese herbal medicine to placebo, no treatment, NSAIDs OCP, acupuncture and heat compression, and, at the same time, there were no indications that CHM caused any adverse events," says lead author Xiaoshu Zhu who works at the Center for Complementary Medicine Research at the University of Western Sydney, Australia.
Chinese herbal medicine (CHM) has been used for centuries in China, being used in public hospitals to treat unexplained cramps that occur during menstruation (primary dysmenorhoea). A team of Cochrane Researchers has found evidence that CHM may provide one possible form of treatment.
This evidence came from studying 39 randomised controlled trials that together involved 3,475 women. CHM gave significant improvements in pain relief when compared to pharmaceutical drugs. It also reduced overall symptoms. The research revealed that CHM was also better at alleviating pain than acupuncture or heat compression.
"All available measures of effectiveness confirmed the overall superiority of Chinese herbal medicine to placebo, no treatment, NSAIDs OCP, acupuncture and heat compression, and, at the same time, there were no indications that CHM caused any adverse events," says lead author Xiaoshu Zhu who works at the Center for Complementary Medicine Research at the University of Western Sydney, Australia.
среда, 14 сентября 2011 г.
Older People In Pain Receive Relief From Drug-Free Treatments
Mind-body therapies, which focus on the interactions between the mind, body and behavior, and the ways in which emotional, mental, social and behavioral factors can affect health, may be of particular benefit to elderly chronic pain sufferers. A new study published in Pain Medicine provides a structured review of eight mind-body interventions for older people, including progressive muscle relaxation, meditation, hypnosis, tai chi and yoga.
All eight treatments were found to be feasible for older adults, and no adverse events or safety issues were reported. The article finds evidence that, in particular, progressive muscle relaxation may be effective for older people with osteoarthritis pain, while meditation and tai chi appear to improve function and coping with low back pain and osteoarthritis.
Chronic pain is common among older people. Sufferers are often unable to receive adequate treatment because of limited physician training in pain management for the elderly and the increased likelihood of side effects from pain medication.
"The trials we reviewed indicated that mind-body therapies were especially well suited to the older adult with chronic pain," concludes lead author Natalia E. Morone, M.D., MSc. "This was because of their gentle approach, which made them suitable for even the frail older adult. Additionally, their positive emphasis on self-exploration was a potential remedy for the heavy emotional, psychological and social burden that is a hallmark of chronic pain."
This study is published in Pain Medicine.
Natalia E. Morone, M.D., MSc is an Assistant Professor in the Department of Medicine at the University of Pittsburgh. Dr. Morone has written extensively on the treatment of chronic pain in older people, and has conducted research on complementary therapies for pain.
Pain Medicine is a multi-disciplinary journal dedicated to the pain clinician, teacher and researcher. It is the Official Journal of the American Academy of Pain Medicine and of the Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists. The journal is devoted to the advancement of pain management, education and research. For more information, please visit blackwell-synergy/loi/pme.
All eight treatments were found to be feasible for older adults, and no adverse events or safety issues were reported. The article finds evidence that, in particular, progressive muscle relaxation may be effective for older people with osteoarthritis pain, while meditation and tai chi appear to improve function and coping with low back pain and osteoarthritis.
Chronic pain is common among older people. Sufferers are often unable to receive adequate treatment because of limited physician training in pain management for the elderly and the increased likelihood of side effects from pain medication.
"The trials we reviewed indicated that mind-body therapies were especially well suited to the older adult with chronic pain," concludes lead author Natalia E. Morone, M.D., MSc. "This was because of their gentle approach, which made them suitable for even the frail older adult. Additionally, their positive emphasis on self-exploration was a potential remedy for the heavy emotional, psychological and social burden that is a hallmark of chronic pain."
This study is published in Pain Medicine.
Natalia E. Morone, M.D., MSc is an Assistant Professor in the Department of Medicine at the University of Pittsburgh. Dr. Morone has written extensively on the treatment of chronic pain in older people, and has conducted research on complementary therapies for pain.
Pain Medicine is a multi-disciplinary journal dedicated to the pain clinician, teacher and researcher. It is the Official Journal of the American Academy of Pain Medicine and of the Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists. The journal is devoted to the advancement of pain management, education and research. For more information, please visit blackwell-synergy/loi/pme.
воскресенье, 11 сентября 2011 г.
Warning Over Unlicensed 'Herbal Valium'
The Medicines and Healthcare products Regulatory Agency (MHRA) is warning people of the dangers of taking unlicensed herbal medicines containing aconite.
Aconite has recently been portrayed in the media as 'herbal valium', however, it is actually an extremely poisonous plant that is toxic to the heart.
It is also known as monkshood and herbal products containing this ingredient could be fatal or cause serious illness if consumed.
The MHRA has received two reports of suspected adverse reactions to aconite, one where a patient suffered kidney problems and another where the person was hospitalised after suffering dizziness and paresthesia.
MHRA Head of Herbal Policy, Richard Woodfield, said it was vital people did not confuse herbal medicines and homeopathic ones.
"Registered homeopathic products that contain aconite are considered acceptably safe as the active ingredient, aconite, is sufficiently diluted," he said.
"Herbal medicines are made from plants and so can have a very significant effect on the body. In certain cases, such as with aconite, the medicine can be extremely potent.
"This is a classic case where 'natural' does not mean 'safe'."
Mr Woodfield said recent media attention focused on a celebrity who allegedly took a product containing aconite to calm wedding day nerves.
"With unlicensed herbal medicines, people need to be aware that the standards vary widely and can be poor.
"However, an increasing range of herbal medicines made to assured standards are available on the UK market."
Registered and licensed herbal medicines can be identified by the traditional herbal registration (THR) or the product licence (PL) number on the label.
Registered homeopathic products can also be identified by checking the label which should say 'Homeopathic medicinal product without approved therapeutic indications', as well as a homeopathic registration number prefixed with the letters HR.
Any side effects to herbal and homeopathic products can be reported to the MHRA via the Yellow Card Scheme yellowcard.mhra.uk/
Source
Medicines and Healthcare products Regulatory Agency
Aconite has recently been portrayed in the media as 'herbal valium', however, it is actually an extremely poisonous plant that is toxic to the heart.
It is also known as monkshood and herbal products containing this ingredient could be fatal or cause serious illness if consumed.
The MHRA has received two reports of suspected adverse reactions to aconite, one where a patient suffered kidney problems and another where the person was hospitalised after suffering dizziness and paresthesia.
MHRA Head of Herbal Policy, Richard Woodfield, said it was vital people did not confuse herbal medicines and homeopathic ones.
"Registered homeopathic products that contain aconite are considered acceptably safe as the active ingredient, aconite, is sufficiently diluted," he said.
"Herbal medicines are made from plants and so can have a very significant effect on the body. In certain cases, such as with aconite, the medicine can be extremely potent.
"This is a classic case where 'natural' does not mean 'safe'."
Mr Woodfield said recent media attention focused on a celebrity who allegedly took a product containing aconite to calm wedding day nerves.
"With unlicensed herbal medicines, people need to be aware that the standards vary widely and can be poor.
"However, an increasing range of herbal medicines made to assured standards are available on the UK market."
Registered and licensed herbal medicines can be identified by the traditional herbal registration (THR) or the product licence (PL) number on the label.
Registered homeopathic products can also be identified by checking the label which should say 'Homeopathic medicinal product without approved therapeutic indications', as well as a homeopathic registration number prefixed with the letters HR.
Any side effects to herbal and homeopathic products can be reported to the MHRA via the Yellow Card Scheme yellowcard.mhra.uk/
Source
Medicines and Healthcare products Regulatory Agency
четверг, 8 сентября 2011 г.
Acupuncture Relieves Symptoms Of Fibromyalgia, Mayo Clinic Study Finds
Evidence suggests acupuncture reduces the symptoms of fibromyalgia, according to a Mayo Clinic study.
Fibromyalgia is a disorder considered disabling by many, and is characterized by chronic, widespread musculoskeletal pain and symptoms such as fatigue, joint stiffness and sleep disturbance. No cure is known and available treatments are only partially effective.
Mayo's study involved 50 fibromyalgia patients enrolled in a randomized, controlled trial to determine if acupuncture improved their symptoms. Symptoms of patients who received acupuncture significantly improved compared with the control group, according to the study published in the June issue of Mayo Clinic Proceedings.
"The results of the study convince me there is something more than the placebo effect to acupuncture," says David Martin, M.D., Ph.D., lead author of the acupuncture article and a Mayo Clinic anesthesiologist. "It affirms a lot of clinical impressions that this complementary medical technique is helpful for patients."
Increasingly, patients are interested in pursuing complementary medicine techniques in conjunction with their mainstream medical care, Dr. Martin says. But often, such techniques lack scientific evidence to justify a patient's expense and time.
The study lends credence to patients' belief that nontraditional methods may improve their health. In Mayo's trial, patients who received acupuncture to counter their fibromyalgia symptoms reported improvement in fatigue and anxiety, among other symptoms. Acupuncture was well tolerated, with minimal side effects.
Mayo's acupuncture study is one of only three randomized and controlled studies involving fibromyalgia patients. Of the other studies, one found acupuncture to be helpful, while the other reported it was ineffective for pain relief.
Dr. Martin says Mayo's study demonstrates that acupuncture is helpful, and also proves physicians can conduct a rigorous, controlled acupuncture study. Future research could help physicians understand which medical conditions respond best to acupuncture, how to apply it to best relieve symptoms, and how long patients can expect to their symptoms to decrease after each treatment.
Dr. Martin performed the study at Mayo Clinic Rochester with co-authors Ines Berger, M.D.; Christopher Sletten, Ph.D.; and Brent Williams.
A peer-review journal, Mayo Clinic Proceedings publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research and clinical epidemiology. Mayo Clinic Proceedings is published monthly by Mayo Foundation for Medical Education and Research as part of its commitment to the medical education of physicians. The journal has been published for more than 75 years and has a circulation of 130,000 nationally and internationally. Articles are available online at mayoclinicproceedings/
To obtain the latest news releases from Mayo Clinic, go to mayoclinicproceedings/. MayoClinic (mayoclinic) is available as a resource for your health stories.
Contact: John Murphy
Mayo Clinic
Fibromyalgia is a disorder considered disabling by many, and is characterized by chronic, widespread musculoskeletal pain and symptoms such as fatigue, joint stiffness and sleep disturbance. No cure is known and available treatments are only partially effective.
Mayo's study involved 50 fibromyalgia patients enrolled in a randomized, controlled trial to determine if acupuncture improved their symptoms. Symptoms of patients who received acupuncture significantly improved compared with the control group, according to the study published in the June issue of Mayo Clinic Proceedings.
"The results of the study convince me there is something more than the placebo effect to acupuncture," says David Martin, M.D., Ph.D., lead author of the acupuncture article and a Mayo Clinic anesthesiologist. "It affirms a lot of clinical impressions that this complementary medical technique is helpful for patients."
Increasingly, patients are interested in pursuing complementary medicine techniques in conjunction with their mainstream medical care, Dr. Martin says. But often, such techniques lack scientific evidence to justify a patient's expense and time.
The study lends credence to patients' belief that nontraditional methods may improve their health. In Mayo's trial, patients who received acupuncture to counter their fibromyalgia symptoms reported improvement in fatigue and anxiety, among other symptoms. Acupuncture was well tolerated, with minimal side effects.
Mayo's acupuncture study is one of only three randomized and controlled studies involving fibromyalgia patients. Of the other studies, one found acupuncture to be helpful, while the other reported it was ineffective for pain relief.
Dr. Martin says Mayo's study demonstrates that acupuncture is helpful, and also proves physicians can conduct a rigorous, controlled acupuncture study. Future research could help physicians understand which medical conditions respond best to acupuncture, how to apply it to best relieve symptoms, and how long patients can expect to their symptoms to decrease after each treatment.
Dr. Martin performed the study at Mayo Clinic Rochester with co-authors Ines Berger, M.D.; Christopher Sletten, Ph.D.; and Brent Williams.
A peer-review journal, Mayo Clinic Proceedings publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research and clinical epidemiology. Mayo Clinic Proceedings is published monthly by Mayo Foundation for Medical Education and Research as part of its commitment to the medical education of physicians. The journal has been published for more than 75 years and has a circulation of 130,000 nationally and internationally. Articles are available online at mayoclinicproceedings/
To obtain the latest news releases from Mayo Clinic, go to mayoclinicproceedings/. MayoClinic (mayoclinic) is available as a resource for your health stories.
Contact: John Murphy
Mayo Clinic
понедельник, 5 сентября 2011 г.
Green Tea Slows Down Plaque Formation In Huntington's Disease
She was able to show in an in vitro experiment that the substance epigallocatechin-3-gallate (EGCG), extracted from green tea, interferes with very early events in the aggregation process of the mutant huntingtin protein. Cytoxicity is also reduced.
Moreover, the mobile function of transgenic flies carrying the Huntington's gene improved when
they were fed the green tea substance. The journal Human Molecular Genetics has now published these research findings (Vol. 15, Nr. 18, 15. September 2006, pp. 2743-2751; advanced online access on August 7, 2006). Dr. Wanker, who is also a professor at the Charit? - Universit?tsmedizin Berlin, and his colleagues hope that these findings can be a starting point for the development of a medical treatment for Huntington's disease and related diseases.
Huntington's disease, along with Alzheimer's and Parkinson's, belong to the family of
neurodegenerative diseases caused by protein misfolding.
Jerky, uncontrolled movements, an unsteady gait and grimaces have given Huntington's disease
(HD) its original common name that is still in use today: Huntington's chorea (Old Greek for
"dance").
"Huntington's" in the name goes back to the American doctor George Huntington, who became
the first to publish a detailed description of the disease in 1872.
The incurable disease is hereditary and has a prevalence of 1 in every 15,000 persons. In Germany, about 8,000 cases are currently known whereas in the US, 30,000 people have HD.
If a child inherits a mutated Huntington's gene from one affected parent, the disease inevitably
develops, usually between the ages of 30 and 50. As a result, the nerve cells progressively
degenerate in the areas of the brain that control movement and that are involved in memory and emotions. Ten to 30 years after the onset of the disease, Huntington's chorea leads to death. Foundation under Public Law Directors: Prof. Walter Birchmeier, PhD., Dr. jur. Stefan Schwartze Member of the Hermann von Helmholtz Association of National Research Centres
In 1993, scientists discovered the gene that encodes the protein huntingtin. A mutation in this
protein causes the disease and results in the aggregation of the mutant huntingtin protein within the cell nuclei of brain neurons.
In 1997, Dr. Wanker was able to demonstrate that these deposits or aggregates consist of
misfolded huntingtin molecules. In the protein factories of the nerve cells of people with
Huntington's disease, too many glutamine building blocks have been inserted into the amino acid sequence of huntingtin.
Due to the elongated polyglutamine chains which are formed, the protein loses its normal structure and can no longer be disposed of. Scientists hypothesize that these protein aggregates are toxic to nerve cells.
According to the findings of Dagmar Ehrnhoefer and Dr. Wanker, however, the substance
epigallocatechin-3-gallate (EGCG) extracted from green tea slows down this aggregation process.
The research group hopes that these findings will be the starting point for developing a novel drug treatment for HD and related diseases in which misfolded proteins occur.
At the four-day conference, which began in Berlin-Buch on September 6th, around 200 genome
researchers and clinicians from Canada, Europe, Japan, and the US discuss the latest findings on neurodegenerative diseases achieved with the aid of gene and protein research.
The organizers of the conference under the umbrella of the National Genome Research Network
(NGFN), which is sponsored by the German Federal Ministry for Education and Research, were
the MDC, the Charit? - University Medical School, and the University of Bonn.
Max Delbr?ck Center for Molecular Medicine (MDC) Berlin-Buch
mdc-berlin.de
Moreover, the mobile function of transgenic flies carrying the Huntington's gene improved when
they were fed the green tea substance. The journal Human Molecular Genetics has now published these research findings (Vol. 15, Nr. 18, 15. September 2006, pp. 2743-2751; advanced online access on August 7, 2006). Dr. Wanker, who is also a professor at the Charit? - Universit?tsmedizin Berlin, and his colleagues hope that these findings can be a starting point for the development of a medical treatment for Huntington's disease and related diseases.
Huntington's disease, along with Alzheimer's and Parkinson's, belong to the family of
neurodegenerative diseases caused by protein misfolding.
Jerky, uncontrolled movements, an unsteady gait and grimaces have given Huntington's disease
(HD) its original common name that is still in use today: Huntington's chorea (Old Greek for
"dance").
"Huntington's" in the name goes back to the American doctor George Huntington, who became
the first to publish a detailed description of the disease in 1872.
The incurable disease is hereditary and has a prevalence of 1 in every 15,000 persons. In Germany, about 8,000 cases are currently known whereas in the US, 30,000 people have HD.
If a child inherits a mutated Huntington's gene from one affected parent, the disease inevitably
develops, usually between the ages of 30 and 50. As a result, the nerve cells progressively
degenerate in the areas of the brain that control movement and that are involved in memory and emotions. Ten to 30 years after the onset of the disease, Huntington's chorea leads to death. Foundation under Public Law Directors: Prof. Walter Birchmeier, PhD., Dr. jur. Stefan Schwartze Member of the Hermann von Helmholtz Association of National Research Centres
In 1993, scientists discovered the gene that encodes the protein huntingtin. A mutation in this
protein causes the disease and results in the aggregation of the mutant huntingtin protein within the cell nuclei of brain neurons.
In 1997, Dr. Wanker was able to demonstrate that these deposits or aggregates consist of
misfolded huntingtin molecules. In the protein factories of the nerve cells of people with
Huntington's disease, too many glutamine building blocks have been inserted into the amino acid sequence of huntingtin.
Due to the elongated polyglutamine chains which are formed, the protein loses its normal structure and can no longer be disposed of. Scientists hypothesize that these protein aggregates are toxic to nerve cells.
According to the findings of Dagmar Ehrnhoefer and Dr. Wanker, however, the substance
epigallocatechin-3-gallate (EGCG) extracted from green tea slows down this aggregation process.
The research group hopes that these findings will be the starting point for developing a novel drug treatment for HD and related diseases in which misfolded proteins occur.
At the four-day conference, which began in Berlin-Buch on September 6th, around 200 genome
researchers and clinicians from Canada, Europe, Japan, and the US discuss the latest findings on neurodegenerative diseases achieved with the aid of gene and protein research.
The organizers of the conference under the umbrella of the National Genome Research Network
(NGFN), which is sponsored by the German Federal Ministry for Education and Research, were
the MDC, the Charit? - University Medical School, and the University of Bonn.
Max Delbr?ck Center for Molecular Medicine (MDC) Berlin-Buch
mdc-berlin.de
пятница, 2 сентября 2011 г.
Non-White Med Students Reject Therapies Associated With Their Culture
Non-white medical students are more likely to embrace orthodox medicine and reject therapies traditionally associated with their cultures. That is one finding from an international study that measures the attitudes of medical students toward complementary and alternative medicine (CAM). While seemingly counter-intuitive, white students view CAM more favorably than their non-white counterparts, the study authors say.
CAM is the common, collective term that describes non-orthodox therapies considered not intrinsic to the politically dominant health system of a particular society or culture.
Despite the growing popularity of CAM, many medical schools do not include CAM teachings within basic medical education. So researchers at four medical schools (Peninsula, UK; Birmingham, UK; Georgetown, USA; and Auckland, NZ) conducted two surveys to measure the attitudes of medical students toward CAM during their first and fourth year of medical training in schools that offer some CAM education either at the undergraduate or graduate level. The study is published online in Medical Teacher.
"The first study we conducted with first-year medical students indicated that overall, students wanted more information about CAM in their curriculum," said Hakima Amri, PhD, director of the Complementary and Alternative Medicine Program at Georgetown University Medical Center, the only science-based CAM Master's program at an academic institution in the United States. Amri is a co-investigator and the lead author of the US component of the study. "Our follow-up study measured attitude changes about CAM during medical training. We didn't observe a significant change in overall attitude between the first and fourth year, but we did spot some other interesting trends."
Amri says in the first study, U.S. medical students wanted more courses about CAM than students in Hong Kong, for example. (The Hong Kong school was not included in the 2nd survey of fourth year students.) The second study continued to support that trend with the least interest in CAM measured in Asian and black students.
Amri also noted the polarization observed in the second survey. She says, overall, females, older students and those who had used CAM had more positive attitudes towards holistic treatment of health conditions and became more positive in their attitude over time. However, males and non-CAM users had more negative tendencies toward the effectiveness of CAM therapies and continued to become more negative over time.
"One explanation for the decrease in positive attitude about CAM may result from the students' increased medical knowledge and contact with skeptical clinicians, which are not counter-balanced by CAM teaching," Amri explains.
Survey Methodology
Researchers used a survey called Integrative Medicine Attitude Questionnaire (IMAQ), which included 28 questions relevant to CAM, with each item accompanied by a 7-point Likert scale (point scale with responses ranging from strongly disagree to absolutely agree plus don't know). The IMAQ include three major foci: Attitudes toward holism; effectiveness, credibility and value of CAM; and focus on the doctor-patient relationship, reflection and self-care.
The IMAQ also asked questions about students' age, gender, race, specialty choice, whether they had used CAM or seen a CAM practitioner previously and whether they were interested in or had already undertaken a CAM course.
A total of 604 first-year medical students at six schools completed the questionnaire. Only students who indicated willingness to complete the second questionnaire were contacted to participate in the second survey three years later. A total of 154 out of 487 (31.6 percent) of fourth year students at four schools completed the questionnaire.
The authors note limitations of the study and recommend additional research to understand more about attitude change over time with respect to CAM practices.
In addition to Amri, authors include
Charlotte Rees, Peninsula Medical School, UK;
Sheila Greenfield, University of Birmingham, UK;
Andy M. Wearn, University of Auckland, NZ, and
Ian Dennis, University of Plymouth, UK.
Amri's work is supported by a grant from the National Institutes of Health's National Center for Complementary and Alternative Medicine. The authors report no disclosures.
About Georgetown University Medical Center
Georgetown University Medical Center is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through our partnership with MedStar Health). Our mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis -- or "care of the whole person." The Medical Center includes the School of Medicine and the School of Nursing and Health Studies, both nationally ranked, the world-renowned Lombardi Comprehensive Cancer Center and the Biomedical Graduate Research Organization (BGRO), home to 60 percent of the university's sponsored research funding.
CAM is the common, collective term that describes non-orthodox therapies considered not intrinsic to the politically dominant health system of a particular society or culture.
Despite the growing popularity of CAM, many medical schools do not include CAM teachings within basic medical education. So researchers at four medical schools (Peninsula, UK; Birmingham, UK; Georgetown, USA; and Auckland, NZ) conducted two surveys to measure the attitudes of medical students toward CAM during their first and fourth year of medical training in schools that offer some CAM education either at the undergraduate or graduate level. The study is published online in Medical Teacher.
"The first study we conducted with first-year medical students indicated that overall, students wanted more information about CAM in their curriculum," said Hakima Amri, PhD, director of the Complementary and Alternative Medicine Program at Georgetown University Medical Center, the only science-based CAM Master's program at an academic institution in the United States. Amri is a co-investigator and the lead author of the US component of the study. "Our follow-up study measured attitude changes about CAM during medical training. We didn't observe a significant change in overall attitude between the first and fourth year, but we did spot some other interesting trends."
Amri says in the first study, U.S. medical students wanted more courses about CAM than students in Hong Kong, for example. (The Hong Kong school was not included in the 2nd survey of fourth year students.) The second study continued to support that trend with the least interest in CAM measured in Asian and black students.
Amri also noted the polarization observed in the second survey. She says, overall, females, older students and those who had used CAM had more positive attitudes towards holistic treatment of health conditions and became more positive in their attitude over time. However, males and non-CAM users had more negative tendencies toward the effectiveness of CAM therapies and continued to become more negative over time.
"One explanation for the decrease in positive attitude about CAM may result from the students' increased medical knowledge and contact with skeptical clinicians, which are not counter-balanced by CAM teaching," Amri explains.
Survey Methodology
Researchers used a survey called Integrative Medicine Attitude Questionnaire (IMAQ), which included 28 questions relevant to CAM, with each item accompanied by a 7-point Likert scale (point scale with responses ranging from strongly disagree to absolutely agree plus don't know). The IMAQ include three major foci: Attitudes toward holism; effectiveness, credibility and value of CAM; and focus on the doctor-patient relationship, reflection and self-care.
The IMAQ also asked questions about students' age, gender, race, specialty choice, whether they had used CAM or seen a CAM practitioner previously and whether they were interested in or had already undertaken a CAM course.
A total of 604 first-year medical students at six schools completed the questionnaire. Only students who indicated willingness to complete the second questionnaire were contacted to participate in the second survey three years later. A total of 154 out of 487 (31.6 percent) of fourth year students at four schools completed the questionnaire.
The authors note limitations of the study and recommend additional research to understand more about attitude change over time with respect to CAM practices.
In addition to Amri, authors include
Charlotte Rees, Peninsula Medical School, UK;
Sheila Greenfield, University of Birmingham, UK;
Andy M. Wearn, University of Auckland, NZ, and
Ian Dennis, University of Plymouth, UK.
Amri's work is supported by a grant from the National Institutes of Health's National Center for Complementary and Alternative Medicine. The authors report no disclosures.
About Georgetown University Medical Center
Georgetown University Medical Center is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through our partnership with MedStar Health). Our mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis -- or "care of the whole person." The Medical Center includes the School of Medicine and the School of Nursing and Health Studies, both nationally ranked, the world-renowned Lombardi Comprehensive Cancer Center and the Biomedical Graduate Research Organization (BGRO), home to 60 percent of the university's sponsored research funding.
вторник, 30 августа 2011 г.
Program Trains Ugandan Health Care Workers To Administer Acupuncture To People Living With HIV/AIDS, Boston Globe Reports
The Boston Globe on Monday examined the Brookline, Mass.-based Pan-African Acupuncture Project, a not-for-profit group that trains Ugandan health care workers to administer acupuncture to people living with HIV/AIDS (Jeltsen, Boston Globe, 7/16). There are about 1.1 million HIV-positive people in Uganda, and the number of cases is expected to increase to 1.8 million by 2012 (Kaiser Daily HIV/AIDS Report, 1/29).
The program -- established in 2003 by Richard Mandell, an instructor at the New England School of Acupuncture -- was created in response to the "overwhelming" number of people living with the disease in the country, the Globe reports. To train students on acupuncture techniques, Mandell wrote a manual with simplified instructions that teaches students how to find acupuncture points on the body and how to use needles. The manual allows students to practice acupuncture even if they do not understand why a point on the body correlates with a particular disorder or illness, the Globe reports. According to NIH, acupuncture significantly helps relieve chronic insomnia and diarrhea, two symptoms often experienced by HIV-positive people.
According to Mandell, introducing acupuncture in developing countries such as Uganda has many benefits, including economic ones. Providing acupuncture treatment to one person once weekly for one month in the country -- where the average annual salary is $280 -- costs $6, Mandell said. The program has trained 120 Ugandan health care workers in three districts, the Globe reports. Mandell said he hopes to expand the program to Malawi and other African countries (Boston Globe, 7/16).
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
The program -- established in 2003 by Richard Mandell, an instructor at the New England School of Acupuncture -- was created in response to the "overwhelming" number of people living with the disease in the country, the Globe reports. To train students on acupuncture techniques, Mandell wrote a manual with simplified instructions that teaches students how to find acupuncture points on the body and how to use needles. The manual allows students to practice acupuncture even if they do not understand why a point on the body correlates with a particular disorder or illness, the Globe reports. According to NIH, acupuncture significantly helps relieve chronic insomnia and diarrhea, two symptoms often experienced by HIV-positive people.
According to Mandell, introducing acupuncture in developing countries such as Uganda has many benefits, including economic ones. Providing acupuncture treatment to one person once weekly for one month in the country -- where the average annual salary is $280 -- costs $6, Mandell said. The program has trained 120 Ugandan health care workers in three districts, the Globe reports. Mandell said he hopes to expand the program to Malawi and other African countries (Boston Globe, 7/16).
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
суббота, 27 августа 2011 г.
Ginseng Just Got Better -- Not As Bitter
University of Illinois scientists have learned to mask the bitterness of ginseng, a common ingredient of energy drinks.
"Consumers like to see ginseng on a product's ingredient list because studies show that it improves memory, enhances libido and sexual performance, boosts immunity, and alleviates diabetes. But the very compounds that make ginseng good for you also make it taste bitter," said Soo-Yeun Lee, a U of I associate professor of food science and human nutrition.
In an earlier study, Lee and U of I professor of food chemistry Shelly J. Schmidt found that ginseng contributes more to the bitter perception in energy drinks than caffeine, an indispensable component of these beverages and the very compound that sensory scientists use as their reference for bitter perception.
"Ginseng has over 30 bitter compounds, and scientists still don't know which compound or group of compounds is responsible for the bitter taste," Lee said.
While experimenting with five possible solutions to ginseng's bitterness problem, they discovered that cyclodextrins - hydrophobic compounds made of glucose molecules that occur in a ring form - were able to capture the bitter flavor compounds and reduce bitterness by more than half.
Lauren Tamamoto, a graduate student who worked on the study, assembled a group of 13 non-smokers who also lacked allergies that would affect their bitter perception. Panelists had to be able to detect a chemical called 6-n-propyl-2-thiouracil (PROP) on a piece of filter paper (some people can, some people can't) and also pass basic taste tests for sweet, sour, bitter, and salty perceptions. They then participated in 12 training sessions and taste-tested 84 samples, rating each on a 16-point scale.
The researchers used the panelists to test these potentially effective bitterness-reducing treatments:
adding a related complementary flavor (in this case, citrus) as a sensory distraction
incorporating a bitterness blocking agent that neutralizes the taste buds
using ingredient interaction (the scientists added large amounts of taurine because research indicated that it might be useful in blocking bitterness)
utilizing an enzyme that would break down the peptide bonds of bitter components
experimenting with complexation, or the use of cyclodextrins to form inclusion complexes with the bitter compounds, which masks the bitter taste
"Cyclodextrins were by far the most effective method of reducing the bitterness of ginseng solutions. We also found that gamma-cyclodextrins were more successful than beta-cyclodextrins and were more cost-effective," Schmidt said.
These compounds have been used to mask bitterness before, but not at the level of ginseng used in a typical energy drink, she said.
Lee and Schmidt intend to continue studying ginseng's bitterness compounds to learn which are most responsible for producing objectionable flavors, and to gain insight into exactly how these compounds interact with cyclodextrins.
That knowledge would facilitate the use of ginseng as a functional ingredient in energy drinks and allow their manufacturers to add health benefits to the beverages beyond general nutrition and the calories they provide, Lee said.
"The U.S. energy drink industry is expected to reach $19.7 billion in sales by 2013, even though these beverages often have a medicinal taste because of their functional ingredients. If we can create more palatable products, manufacturers will be able to expand this market even further.
"But, beyond that, this new method for masking bitterness in ginseng gives food scientists an opportunity to improve the health of consumers," she said.
The study was published in the September 2010 issue of the Journal of Food Science. Lee, Schmidt, and Tamamoto were co-authors of the paper.
"Consumers like to see ginseng on a product's ingredient list because studies show that it improves memory, enhances libido and sexual performance, boosts immunity, and alleviates diabetes. But the very compounds that make ginseng good for you also make it taste bitter," said Soo-Yeun Lee, a U of I associate professor of food science and human nutrition.
In an earlier study, Lee and U of I professor of food chemistry Shelly J. Schmidt found that ginseng contributes more to the bitter perception in energy drinks than caffeine, an indispensable component of these beverages and the very compound that sensory scientists use as their reference for bitter perception.
"Ginseng has over 30 bitter compounds, and scientists still don't know which compound or group of compounds is responsible for the bitter taste," Lee said.
While experimenting with five possible solutions to ginseng's bitterness problem, they discovered that cyclodextrins - hydrophobic compounds made of glucose molecules that occur in a ring form - were able to capture the bitter flavor compounds and reduce bitterness by more than half.
Lauren Tamamoto, a graduate student who worked on the study, assembled a group of 13 non-smokers who also lacked allergies that would affect their bitter perception. Panelists had to be able to detect a chemical called 6-n-propyl-2-thiouracil (PROP) on a piece of filter paper (some people can, some people can't) and also pass basic taste tests for sweet, sour, bitter, and salty perceptions. They then participated in 12 training sessions and taste-tested 84 samples, rating each on a 16-point scale.
The researchers used the panelists to test these potentially effective bitterness-reducing treatments:
adding a related complementary flavor (in this case, citrus) as a sensory distraction
incorporating a bitterness blocking agent that neutralizes the taste buds
using ingredient interaction (the scientists added large amounts of taurine because research indicated that it might be useful in blocking bitterness)
utilizing an enzyme that would break down the peptide bonds of bitter components
experimenting with complexation, or the use of cyclodextrins to form inclusion complexes with the bitter compounds, which masks the bitter taste
"Cyclodextrins were by far the most effective method of reducing the bitterness of ginseng solutions. We also found that gamma-cyclodextrins were more successful than beta-cyclodextrins and were more cost-effective," Schmidt said.
These compounds have been used to mask bitterness before, but not at the level of ginseng used in a typical energy drink, she said.
Lee and Schmidt intend to continue studying ginseng's bitterness compounds to learn which are most responsible for producing objectionable flavors, and to gain insight into exactly how these compounds interact with cyclodextrins.
That knowledge would facilitate the use of ginseng as a functional ingredient in energy drinks and allow their manufacturers to add health benefits to the beverages beyond general nutrition and the calories they provide, Lee said.
"The U.S. energy drink industry is expected to reach $19.7 billion in sales by 2013, even though these beverages often have a medicinal taste because of their functional ingredients. If we can create more palatable products, manufacturers will be able to expand this market even further.
"But, beyond that, this new method for masking bitterness in ginseng gives food scientists an opportunity to improve the health of consumers," she said.
The study was published in the September 2010 issue of the Journal of Food Science. Lee, Schmidt, and Tamamoto were co-authors of the paper.
среда, 24 августа 2011 г.
Latest Research Shows How Mantrams Can Even Tackle Post-traumatic Stress Disorder
Repeating mantrams can help control the symptoms of post-traumatic stress disorder, have a calming effect in traffic and even ease the boredom of exercise, according to a study in the latest issue of Journal of Advanced Nursing.
83 per cent of veterans and hospital staff surveyed after a five-week mantram course told researchers from the US Department of Veterans Affairs that they found the technique ??" which involves silently and continuously repeating calming words or phrases throughout the day - useful on a number of occasions.
Just under a quarter of these occasions (24 per cent) related to traffic and work-related stress, 13 per cent to insomnia and 12 per cent to unwanted thoughts. More than half (51 per cent) related to emotional situations.
"Repeating the mantram seemed to stop post-traumatic stress disorder-type dreams that had occurred for 10 to 11 years" said a former veteran and one of the 66 people taking part in the survey.
"I have racing thoughts. I think about a ton of things ??" what I'm going to do about this and what I'm going to do about that ??" and then I start the mantram and it helps" added another.
A third found that using a mantram had an unexpectedly healthy side effect, commenting: "I use it sometimes when I'm on the treadmill at the gym. When I'm wishing that the time would go a little faster. And I'll just start using my mantram and then I forget about it and it helps me exercise a little longer."
"The people taking part in the study found that silently repeating a specific word or phrase helped them to handle a number of difficult situations" explains lead researcher Jill E Bormann, Research Nurse Scientist at the Veterans Affairs San Diego Healthcare System in California.
Dr Bormann and her fellow researchers ??" from the Universities of California and North Carolina ??" deliberately chose two highly stressed groups to take part in the study.
"Veterans are well known to have many chronic physical and mental health symptoms that interfere with their quality of life and their ability to live normal everyday lives. Similarly, hospital employees have high levels of job stress, leading to decreased job satisfaction and subsequent increases in healthcare costs" she explains.
People taking part in the five-week course, which comprised a one-and-a-half hour session a week, were taught to choose and repeat a cue word or mantram frequently during the day, using guidelines drawn from The Mantram Handbook by Eknath Easwaran of the Blue Mountain Center of Meditation in Tomales, California.
Easwaran describes mantrams as a "spiritual formula for transformation". Dr Bormann calls them a "jacuzzi for the mind", adding that "using a word that embodies spirituality helps to initiate the relaxation response and centeredness."
"People taking part in our study were encouraged to use the mantram during ordinary and relaxing times, so that they associated it with a calming effect when they needed to use it during times of turmoil" she explains. "Easwaran advises that people use it when they need it and use it when they don't!"
Most of the volunteers from southern California who took part chose words or phrases that reflected their religious beliefs. People without specific beliefs chose other soothing phrases.
29 of the 30 veterans were male, with an average age of 63. Seven had been diagnosed with a psychiatric disorder and six suffered from post-traumatic stress disorder.
31 of the 36 hospital staff were female with an average age of 50 and two had a psychiatric diagnosis.
"Mantram repetition may be useful in diverse modern populations for managing a variety of internal emotional states that sometimes appear endemic to technological society, such as anger, frustration and impatience" says Dr Bormann.
Dr Bormann has just received research funding from the Department of Veterans Affairs to carry out further investigation into the benefits of mantram repetition for veterans suffering from post-traumatic stress disorder.
She has also been working on a project to see if mantram repetition decreases anger and increases spiritual faith in adults with HIV.
Further information and press copies of the full paper are available from Annette Whibley, Wizard Communications wordwizardclara.co.uk
Notes to editors
# Mantram repetition for stress management in veterans and employees: a critical incident study. Bormann et al. VA San Diego Healthcare System, San Diego, California, USA. Journal of Advanced Nursing. Volume 53.5. Pages 502-512. (March 2006).
# The Veterans Affairs San Diego Healthcare System provides acute and primary care to San Diego veterans through its medical center and community clinics. It is a designated Center of Excellence for Post-Traumatic Stress Disorder.
# Journal of Advanced Nursing, which is celebrating its 30th anniversary in 2006, is read by experienced nurses, midwives, health visitors and advanced nursing students in over 80 countries. It informs, educates, explores, debates and challenges the foundations of nursing health care knowledge and practice worldwide. Edited by Professor Alison Tierney, it is published 24 times a year by Blackwell Publishing Ltd, part of the international Blackwell Publishing group. journalofadvancednursing/
Contact: Annette Whibley
wordwizardclara.co.uk
Blackwell Publishing Ltd.
83 per cent of veterans and hospital staff surveyed after a five-week mantram course told researchers from the US Department of Veterans Affairs that they found the technique ??" which involves silently and continuously repeating calming words or phrases throughout the day - useful on a number of occasions.
Just under a quarter of these occasions (24 per cent) related to traffic and work-related stress, 13 per cent to insomnia and 12 per cent to unwanted thoughts. More than half (51 per cent) related to emotional situations.
"Repeating the mantram seemed to stop post-traumatic stress disorder-type dreams that had occurred for 10 to 11 years" said a former veteran and one of the 66 people taking part in the survey.
"I have racing thoughts. I think about a ton of things ??" what I'm going to do about this and what I'm going to do about that ??" and then I start the mantram and it helps" added another.
A third found that using a mantram had an unexpectedly healthy side effect, commenting: "I use it sometimes when I'm on the treadmill at the gym. When I'm wishing that the time would go a little faster. And I'll just start using my mantram and then I forget about it and it helps me exercise a little longer."
"The people taking part in the study found that silently repeating a specific word or phrase helped them to handle a number of difficult situations" explains lead researcher Jill E Bormann, Research Nurse Scientist at the Veterans Affairs San Diego Healthcare System in California.
Dr Bormann and her fellow researchers ??" from the Universities of California and North Carolina ??" deliberately chose two highly stressed groups to take part in the study.
"Veterans are well known to have many chronic physical and mental health symptoms that interfere with their quality of life and their ability to live normal everyday lives. Similarly, hospital employees have high levels of job stress, leading to decreased job satisfaction and subsequent increases in healthcare costs" she explains.
People taking part in the five-week course, which comprised a one-and-a-half hour session a week, were taught to choose and repeat a cue word or mantram frequently during the day, using guidelines drawn from The Mantram Handbook by Eknath Easwaran of the Blue Mountain Center of Meditation in Tomales, California.
Easwaran describes mantrams as a "spiritual formula for transformation". Dr Bormann calls them a "jacuzzi for the mind", adding that "using a word that embodies spirituality helps to initiate the relaxation response and centeredness."
"People taking part in our study were encouraged to use the mantram during ordinary and relaxing times, so that they associated it with a calming effect when they needed to use it during times of turmoil" she explains. "Easwaran advises that people use it when they need it and use it when they don't!"
Most of the volunteers from southern California who took part chose words or phrases that reflected their religious beliefs. People without specific beliefs chose other soothing phrases.
29 of the 30 veterans were male, with an average age of 63. Seven had been diagnosed with a psychiatric disorder and six suffered from post-traumatic stress disorder.
31 of the 36 hospital staff were female with an average age of 50 and two had a psychiatric diagnosis.
"Mantram repetition may be useful in diverse modern populations for managing a variety of internal emotional states that sometimes appear endemic to technological society, such as anger, frustration and impatience" says Dr Bormann.
Dr Bormann has just received research funding from the Department of Veterans Affairs to carry out further investigation into the benefits of mantram repetition for veterans suffering from post-traumatic stress disorder.
She has also been working on a project to see if mantram repetition decreases anger and increases spiritual faith in adults with HIV.
Further information and press copies of the full paper are available from Annette Whibley, Wizard Communications wordwizardclara.co.uk
Notes to editors
# Mantram repetition for stress management in veterans and employees: a critical incident study. Bormann et al. VA San Diego Healthcare System, San Diego, California, USA. Journal of Advanced Nursing. Volume 53.5. Pages 502-512. (March 2006).
# The Veterans Affairs San Diego Healthcare System provides acute and primary care to San Diego veterans through its medical center and community clinics. It is a designated Center of Excellence for Post-Traumatic Stress Disorder.
# Journal of Advanced Nursing, which is celebrating its 30th anniversary in 2006, is read by experienced nurses, midwives, health visitors and advanced nursing students in over 80 countries. It informs, educates, explores, debates and challenges the foundations of nursing health care knowledge and practice worldwide. Edited by Professor Alison Tierney, it is published 24 times a year by Blackwell Publishing Ltd, part of the international Blackwell Publishing group. journalofadvancednursing/
Contact: Annette Whibley
wordwizardclara.co.uk
Blackwell Publishing Ltd.
воскресенье, 21 августа 2011 г.
Integrative Medicine For Children Is "a Useful Reference For A Medical Library."
According to a new review published in The Ulster Medical Journal, the Integrative Medicine for Children is "a useful reference for a medical library."
The book aims to help caregivers safely and effectively prescribe complementary and alternative (CAM) therapies along with standard treatment.
It is divided into two main parts. The first section covers a wide range of CAM therapies that are most commonly used among children, including hypnosis, massage, nutrition and Qi gong. Natural Standard authored chapter seven: Herbs and Biological Agents. In this chapter, the history, theory, evidence and safety of Chinese herbs are comprehensively presented.
The second section of the book covers more than 50 of the most common childhood conditions, first with a focus on conventional diagnostic and treatment information, then with authoritative information on the most effective and evidence-based CAM therapies available for treatment of the condition.
In the review article, Nuala M Flanagan states that the reference book "certainly offers an encyclopedic base to broaden knowledge of CAM and would be a useful starting point for further research into CAM options available for a specific patient."
References:
1. Flanagan, NM. Book Reviews. Ulster Med J 2009;78(2):140.
2. Natural Standard: The Authority on Integrative Medicine. naturalstandard. Copyright © 2009.
Source
Natural Standard
The book aims to help caregivers safely and effectively prescribe complementary and alternative (CAM) therapies along with standard treatment.
It is divided into two main parts. The first section covers a wide range of CAM therapies that are most commonly used among children, including hypnosis, massage, nutrition and Qi gong. Natural Standard authored chapter seven: Herbs and Biological Agents. In this chapter, the history, theory, evidence and safety of Chinese herbs are comprehensively presented.
The second section of the book covers more than 50 of the most common childhood conditions, first with a focus on conventional diagnostic and treatment information, then with authoritative information on the most effective and evidence-based CAM therapies available for treatment of the condition.
In the review article, Nuala M Flanagan states that the reference book "certainly offers an encyclopedic base to broaden knowledge of CAM and would be a useful starting point for further research into CAM options available for a specific patient."
References:
1. Flanagan, NM. Book Reviews. Ulster Med J 2009;78(2):140.
2. Natural Standard: The Authority on Integrative Medicine. naturalstandard. Copyright © 2009.
Source
Natural Standard
четверг, 18 августа 2011 г.
York Study Maps The Effects Of Acupuncture On The Brain
Important new research about the effects of acupuncture on the brain may provide an understanding of the complex mechanisms of acupuncture and could lead to a wider acceptability of the treatment.
The study, by researchers at the University of York and the Hull York Medical School published in Brain Research, indicates that acupuncture has a significant effect on specific neural structures. When a patient receives acupuncture treatment, a sensation called deqi can be obtained; scientific analysis shows that this deactivates areas within the brain that are associated with the processing of pain.
Dr Hugh MacPherson, of the Complementary Medicine Research Group in the University's Department of Health Sciences, says: "These results provide objective scientific evidence that acupuncture has specific effects within the brain which hopefully will lead to a better understanding of how acupuncture works."
Neuroscientist Dr Aziz Asghar, of the York Neuroimaging Centre and the Hull York Medical School, adds: "The results are fascinating. Whether such brain deactivations constitute a mechanism which underlies or contributes to the therapeutic effect of acupuncture is an intriguing possibility which requires further research."
Last summer, following research conducted in York, acupuncture was recommended for the first time by the National Institute for Health and Clinical Excellence (NICE) as a treatment option for NHS patients with lower back pain. NICE guidelines now state that GPs should 'consider offering a course of acupuncture comprising a maximum of 10 sessions over a period of up to 12 weeks' for patients with this common condition.
Current clinical trials at the University of York are investigating the effectiveness and cost-effectiveness of acupuncture for Irritable Bowel Syndrome (IBS) and for depression. Recent studies in the US have also shown that acupuncture can be an effective treatment for migraines and osteoarthritis of the knee.
The York team believe that the new research could help to clear the way for acupuncture to be more broadly accepted as a treatment option on the NHS for a number of medical conditions.
The study, by researchers at the University of York and the Hull York Medical School published in Brain Research, indicates that acupuncture has a significant effect on specific neural structures. When a patient receives acupuncture treatment, a sensation called deqi can be obtained; scientific analysis shows that this deactivates areas within the brain that are associated with the processing of pain.
Dr Hugh MacPherson, of the Complementary Medicine Research Group in the University's Department of Health Sciences, says: "These results provide objective scientific evidence that acupuncture has specific effects within the brain which hopefully will lead to a better understanding of how acupuncture works."
Neuroscientist Dr Aziz Asghar, of the York Neuroimaging Centre and the Hull York Medical School, adds: "The results are fascinating. Whether such brain deactivations constitute a mechanism which underlies or contributes to the therapeutic effect of acupuncture is an intriguing possibility which requires further research."
Last summer, following research conducted in York, acupuncture was recommended for the first time by the National Institute for Health and Clinical Excellence (NICE) as a treatment option for NHS patients with lower back pain. NICE guidelines now state that GPs should 'consider offering a course of acupuncture comprising a maximum of 10 sessions over a period of up to 12 weeks' for patients with this common condition.
Current clinical trials at the University of York are investigating the effectiveness and cost-effectiveness of acupuncture for Irritable Bowel Syndrome (IBS) and for depression. Recent studies in the US have also shown that acupuncture can be an effective treatment for migraines and osteoarthritis of the knee.
The York team believe that the new research could help to clear the way for acupuncture to be more broadly accepted as a treatment option on the NHS for a number of medical conditions.
понедельник, 15 августа 2011 г.
Morning Sickness, Still No Relief
There are currently no reliably safe and effective treatments for morning sickness, according to Cochrane researchers who conducted a systematic review of the available evidence. There was very limited evidence for all pharmaceutical and alternative medicines tested.
Morning sickness is the term used to describe vomiting and feelings of nausea in pregnant women. Symptoms can in fact occur at any time of the day and affect more than half of all women in the early stages of pregnancy. Due to concerns that pharmaceutical medicines may damage their unborn children, women are increasingly turning to non-drug treatments, including complementary and alternative therapies, to treat these symptoms. However, there is less evidence that alternative therapies work and they tend to be less well-regulated.
The review included 27 randomised controlled trials, which together involved 4,041 women who were up to 20 weeks pregnant. Benefit was measured by various scales commonly used to gauge the severity of nausea at a time as close as possible to three days after treatment. In six studies of acupressure and two of acupuncture there were no significant differences in benefit compared to control groups. One study of acustimulation did, however, report some improvement over three weeks. There was limited evidence of an effect of ginger in relieving nausea, as there was for vitamin B6, antihistamines and antiemetic (anti-vomiting) drugs including the antenatal drug Debendox.
In addition, some of the treatments caused adverse effects including drowsiness in those taking antiemetics. Ginger caused heartburn in some people.
"A number of the studies we looked at appeared to show benefits, but in general the results were inconsistent and it was difficult to draw firm conclusions about any one treatment in particular," said lead researcher Dr Anne Matthews, of the School of Nursing at Dublin City University in Dublin Ireland. "We were also unable to obtain much information about whether these treatments are actually making a difference to women's quality of life."
"Despite the wealth of different treatments available, it is not possible currently to identify with confidence any safe and effective interventions for nausea and vomiting in early pregnancy," said Matthews. "The difficulties in interpreting the results of the studies highlight the need for further, more rigorous trials in this area."
Sources: Wiley - Blackwell, AlphaGalileo Foundation.
Morning sickness is the term used to describe vomiting and feelings of nausea in pregnant women. Symptoms can in fact occur at any time of the day and affect more than half of all women in the early stages of pregnancy. Due to concerns that pharmaceutical medicines may damage their unborn children, women are increasingly turning to non-drug treatments, including complementary and alternative therapies, to treat these symptoms. However, there is less evidence that alternative therapies work and they tend to be less well-regulated.
The review included 27 randomised controlled trials, which together involved 4,041 women who were up to 20 weeks pregnant. Benefit was measured by various scales commonly used to gauge the severity of nausea at a time as close as possible to three days after treatment. In six studies of acupressure and two of acupuncture there were no significant differences in benefit compared to control groups. One study of acustimulation did, however, report some improvement over three weeks. There was limited evidence of an effect of ginger in relieving nausea, as there was for vitamin B6, antihistamines and antiemetic (anti-vomiting) drugs including the antenatal drug Debendox.
In addition, some of the treatments caused adverse effects including drowsiness in those taking antiemetics. Ginger caused heartburn in some people.
"A number of the studies we looked at appeared to show benefits, but in general the results were inconsistent and it was difficult to draw firm conclusions about any one treatment in particular," said lead researcher Dr Anne Matthews, of the School of Nursing at Dublin City University in Dublin Ireland. "We were also unable to obtain much information about whether these treatments are actually making a difference to women's quality of life."
"Despite the wealth of different treatments available, it is not possible currently to identify with confidence any safe and effective interventions for nausea and vomiting in early pregnancy," said Matthews. "The difficulties in interpreting the results of the studies highlight the need for further, more rigorous trials in this area."
Sources: Wiley - Blackwell, AlphaGalileo Foundation.
пятница, 12 августа 2011 г.
Absorption Of Curcuminoids Increased 29-Fold With Meriva(R)
In a new comparative absorption study[1] published in the Journal of Natural Products Meriva®, an Indena proprietary formulation of curcumin with soy lecithin, has shown a marked increase of absorption in comparison to plain curcumin.
In this randomized, double-blind, crossover study, a collaboration between USANA and Indena scientists, the plasma concentration of the three curcuminoids present in commercial curcumin (curcumin, demethoxycurcumin and bisdemethoxycurcumin) was measured in nine volunteers after supplementation with two dosages of Meriva® and one dosage of a corresponding curcuminoid mixture. Subjects consumed five (low-dose) or nine (high-dose) capsules of Meriva®, corresponding to 209 and 376 mg total curcuminoids, or, alternatively, five capsules of the corresponding non-formulated curcuminoid mixture containing 1799 mg of total curcuminoids.
The results showed that the overall curcuminoid absorption was about 29-fold higher for Meriva® compared to the unformulated curcuminoid mixture, while a 50 to 60-fold higher absorption was observed for demethoxycurcumin and bisdemethoxycurcumin. The improved absorption, and possibly also a better plasma curcuminoid profile, might underlie the clinical efficacy of Meriva® at doses significantly lower than unformulated curcuminoid mixtures. [2-4]
Commenting on the results of the study Giovanni Appendino, Professor of Organic Chemistry at the University of Eastern Piedmont and Indena Scientific Advisor, said: "this Meriva® study represents one of the more significant advances in turmeric research. For the first time, a dramatic formulation-dependent increase in the bioavailability of curcuminoids in humans has been demonstrated, highlighting that curcuminoids have different absorption properties, and that the presence of lipids, as in Meriva® and in the traditional culinary use of turmeric, critically magnifies them. These results will open up new areas of clinical research on curcumin, rationalizing the clinical efficacy of Meriva®at dosages much lower than those of curcumin, and successfully addressing the issue of megadoses that has plagued the clinical research on curcumin."
About curcumin
Curcumin is the yellow pigment of turmeric (Curcuma longa L.), the most important spice of the Indian cuisine, and a major ingredient of curry powders. In Asian Medicine, turmeric is used for the treatment of inflammation and joint pain. In Western countries, it is mainly employed as a food additive to color dairy products (cheese and yogurts), margarine and canned food. With over 100 molecular targets identified and almost 3,000 pre-clinical investigations, curcumin is one of the best investigated natural products of the whole biomedical literature; these studies have demonstrated its action as a master switch of inflammation. Nevertheless, just like most dietary phenolics, curcumin shows a very poor oral absorption. These problems have now been largely overcome by the patented formulation of curcumin with soy phospholipids that is capitalizing the basic tenets of the Phytosome® strategy to improve the bioavailability by offering a higher stability and oral absorption in comparison with unformulated curcumin.
About Meriva®
Meriva® is a patented formulation of curcumin, a dietary phenolic, with soy phospholipids. The two ingredients are combined in a 1:2 weight ratio, and two parts of microcrystalline cellulose are then added to improve the flowability, with an overall content of curcumin of 20%. Meriva® is already included as an ingredient in food supplements marketed in USA, Canada and EU.
Meriva® has been elected "Best New Product" of the year by the judging panel of the European Outsourcing Awards.
References:
1. Cuomo, J., et al., Comparative Absorption of a Standardized Curcuminoid Mixture and Its Lecithin Formulation. J Nat Prod, 2011. Full study available here.
2. Belcaro, G., et al., Product-evaluation registry of Meriva(R), a curcumin-phosphatidylcholine complex, for the complementary management of osteoarthritis. Panminerva Med, 2010. 52(2 Suppl 1): p. 55-62. Full study available here.
3. Belcaro, G., et al., Efficacy and safety of Meriva(R), a curcumin-phosphatidylcholine complex, during extended administration in osteoarthritis patients. Altern Med Rev, 2010. 15(4): p. 337-44. Full study available here.
4. Allegri, P., A. Mastromarino, and P. Neri, Management of chronic anterior uveitis relapses: efficacy of oral phospholipidic curcumin treatment. Long-term follow-up. Clin Ophthalmol, 2010. 4: p. 1201-6. Full study available here.
In this randomized, double-blind, crossover study, a collaboration between USANA and Indena scientists, the plasma concentration of the three curcuminoids present in commercial curcumin (curcumin, demethoxycurcumin and bisdemethoxycurcumin) was measured in nine volunteers after supplementation with two dosages of Meriva® and one dosage of a corresponding curcuminoid mixture. Subjects consumed five (low-dose) or nine (high-dose) capsules of Meriva®, corresponding to 209 and 376 mg total curcuminoids, or, alternatively, five capsules of the corresponding non-formulated curcuminoid mixture containing 1799 mg of total curcuminoids.
The results showed that the overall curcuminoid absorption was about 29-fold higher for Meriva® compared to the unformulated curcuminoid mixture, while a 50 to 60-fold higher absorption was observed for demethoxycurcumin and bisdemethoxycurcumin. The improved absorption, and possibly also a better plasma curcuminoid profile, might underlie the clinical efficacy of Meriva® at doses significantly lower than unformulated curcuminoid mixtures. [2-4]
Commenting on the results of the study Giovanni Appendino, Professor of Organic Chemistry at the University of Eastern Piedmont and Indena Scientific Advisor, said: "this Meriva® study represents one of the more significant advances in turmeric research. For the first time, a dramatic formulation-dependent increase in the bioavailability of curcuminoids in humans has been demonstrated, highlighting that curcuminoids have different absorption properties, and that the presence of lipids, as in Meriva® and in the traditional culinary use of turmeric, critically magnifies them. These results will open up new areas of clinical research on curcumin, rationalizing the clinical efficacy of Meriva®at dosages much lower than those of curcumin, and successfully addressing the issue of megadoses that has plagued the clinical research on curcumin."
About curcumin
Curcumin is the yellow pigment of turmeric (Curcuma longa L.), the most important spice of the Indian cuisine, and a major ingredient of curry powders. In Asian Medicine, turmeric is used for the treatment of inflammation and joint pain. In Western countries, it is mainly employed as a food additive to color dairy products (cheese and yogurts), margarine and canned food. With over 100 molecular targets identified and almost 3,000 pre-clinical investigations, curcumin is one of the best investigated natural products of the whole biomedical literature; these studies have demonstrated its action as a master switch of inflammation. Nevertheless, just like most dietary phenolics, curcumin shows a very poor oral absorption. These problems have now been largely overcome by the patented formulation of curcumin with soy phospholipids that is capitalizing the basic tenets of the Phytosome® strategy to improve the bioavailability by offering a higher stability and oral absorption in comparison with unformulated curcumin.
About Meriva®
Meriva® is a patented formulation of curcumin, a dietary phenolic, with soy phospholipids. The two ingredients are combined in a 1:2 weight ratio, and two parts of microcrystalline cellulose are then added to improve the flowability, with an overall content of curcumin of 20%. Meriva® is already included as an ingredient in food supplements marketed in USA, Canada and EU.
Meriva® has been elected "Best New Product" of the year by the judging panel of the European Outsourcing Awards.
References:
1. Cuomo, J., et al., Comparative Absorption of a Standardized Curcuminoid Mixture and Its Lecithin Formulation. J Nat Prod, 2011. Full study available here.
2. Belcaro, G., et al., Product-evaluation registry of Meriva(R), a curcumin-phosphatidylcholine complex, for the complementary management of osteoarthritis. Panminerva Med, 2010. 52(2 Suppl 1): p. 55-62. Full study available here.
3. Belcaro, G., et al., Efficacy and safety of Meriva(R), a curcumin-phosphatidylcholine complex, during extended administration in osteoarthritis patients. Altern Med Rev, 2010. 15(4): p. 337-44. Full study available here.
4. Allegri, P., A. Mastromarino, and P. Neri, Management of chronic anterior uveitis relapses: efficacy of oral phospholipidic curcumin treatment. Long-term follow-up. Clin Ophthalmol, 2010. 4: p. 1201-6. Full study available here.
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