Home > Librarianship > Evidence, Bias, and Use…Oh, My! (MLA12 Seattle: Complementary and Alternative Medicine Section)

Evidence, Bias, and Use…Oh, My! (MLA12 Seattle: Complementary and Alternative Medicine Section)

So at the meeting, librarians present their papers that were accepted to the conference.  These are organized into groups of four sponsored by one of the MLA’s sections.  I’m pleased to say that on Monday I made it to an entire session.  Complementary and Alternative Medicine includes everything from yoga to special diets (veg*nism, gluten-free) to acupuncture to traditional Chinese medicine to etc….  I appreciate CAM because it tends to look at the patient as a whole instead of just the diseased body part.  Plus I was curious as to what the presentations would have to say.  One thing that it is important to know.  Cochrane is a database of systematic reviews.  A systematic review is a study of the studies done.  It then summarizes what we know so far.  Think of it as centralized scientific study information.  The other thing to know is that in Western medicine, a treatment is come up with and then tested before it is used with people.  In CAM, the treatments are already in practice, so traditional randomized control trials (RCTs) used in Western medicine aren’t super-applicable.

“Cochrane Complementary and Alternative Medicine Systematic Reviews: An Analysis of Authors’ Comments on the Quality and Quantity of Evidence and Efficacy Conclusions” by Robin A. Paynter

  • CAM limited by RCT-driven evidence-based practice
  • 10% of database are CAM topics
  • Cochrane has a project to develop a classification scheme of CAM topics.
  • 47 out of 53 Cochrane groups have at least one review on a CAM topics
  • Treatment ares cover everything from vitamins to yoga
  • dietary intervention has 37 studies
  • Cochrane expresses concern over poor study designs.
  • Difficult to determine active content in plant-based meds
  • Significant groupage of comments around insufficient evidence and no effect.
  • cross-cultural issues

“Alternative Research Education in a Post-R25 World: Assessing Acupuncture and Oriental medicine (AOM) Student Attitudes Toward Research and the Scientific Method” by Candise Branum

  • Acupuncture and Oriental Medicine–AOM
  • R25 grants intend to develop research literacy and view research as a bridge between Western medicine and CAM
  • Acupuncture Practitioner Research Education Enhancement (APREE)
  • AOM student interest in research declined with years in school, a 2006 study found
  • Do students recognize the benefits of AOM research? Overwhelming yes.
  • Students at schools without dedicated research departments were very unsure about the impact of research.
  • Feelings about research slope toward the negative over time.
  • Students see the benefits of research but that doesn’t necessarily mean they like it
  • A lot of students want to stay alternative and not become complementary
  • If they don’t want to be attached, they’re not gonna want to use the bridge of research.

“Complementary and Alternative Medicine’s (CAM’s) Research Agenda and Its Unique Challenges” by Jane D. Saxton

  • In 2007: 38.4% of adults used CAM over the previous 12 months.  Also, adults spent $33.9 billion out of pocket on CAM.
  • NIH funding to CAM is only 0.5% of the overall budget.
  • CAM is individualized not standardized.  (It’s adjusted to fit the patient not one standard applied to all patients).
  • Whole Systems Research (WSR) is a term coined in 2002.  It is an approach to studying non-linear, whole systems of care.
  • Use of pragmatic RCTs: measure effectiveness, don’t use placebos, patient-centered outcomes (transformational change)
  • CAM is the opposite of Western meds.  The treatment is already in use, whereas Western medicine is proposed, tried, then used.
  • You don’t need to know the biological mechanism in order to know its effectiveness.
  • MeSH terms currently available: complementary therapies, nonlinear dynamics, systems integration
  • We need more funding, different approaches, Whole Systems Research!
  • Please take a moment to check out the libguide of this presentation.

“Hitchhiker’s Guide to One Corner of the Complementary and Alternative Medicine (CAM) Universe” by  Ron LeFebvre

  • Vitalists are more interested in information (they “know” it works).
  • Empiricists value EBM but may not be great at finding what they’re looking for.
  • Chiropractors don’t like to be associated with medicine.  Use terms like “health care” and “practice” with them.
  • A good chiropractic search string: spinal manipulation OR chiropractic OR manual therapy
  • New graduates are more likely to be EBP savvy.
  • “There’s nothing that makes you more skeptical about research than studying it.”
  • There is no widely-used, well-regarded point-of-service tool to serve chiropractic interests specifically.  They do use Dynamed though.
  • PEDRO–database for physical therapy/exercise therapy that is also useful to chiropractors

Q and A

  • Diet is odd.  Sometimes it is viewed as an alternative medicine, sometimes not.  If it’s a non-western diet, though, it’s considered alternative.
  • NIH funded PROMIS is focused on patient-reported outcomes, particularly in treating anxiety/depression.
  • N-CAM databse has outcome scales and measures
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