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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
Announcement: 2012 Reading Project!
I decided I won’t make you guys wait as long as I originally said to find out what my 2012 project is going to be. I made the reading list, the button, and created the page, so why not announce it now and get participation commitments going?
So! The Opinions of a Wolf hosted 2012 reading project is…..*drum-roll*
Woo! *Applause*
The gist of it is, I am concerned and downright fed up with the state of health in America. Congress just declared pizza a vegetable! It is time we took the power over our own health out of the hands of the government, society, the FDA, hospitals, and put it back where it belongs. With us! To this end, using my librarian and book blogger skills, I carefully selected 12 nonfiction titles to read addressing a variety of topics from how your diet can prevent and reverse heart disease to how the food industry manipulates science to how to avoid processed foods. It’s a great list that I’m really excited to explore!!
The third Saturday of every month will be dedicated to a discussion (hosted by me) of the book of the month. In addition, I will do my best to also review one healthy cookbook or fitness book each month, and I invite you to do so as well!
You’ve got a month to get yourself signed up, spread the word, and gather the first couple of books on the list. You don’t have to have a blog to participate, but it would be awesome if you at least had a LibraryThing or GoodReads account to help create the buzz this information needs.
Just head on over to the dedicated Diet for a New America Reading Project 2012 page and leave a comment noting your intent to participate and a link to either your blog post announcing your participation or to your account on LibraryThing or GoodReads.
I’m super-excited for this project and hope you all are too!!
Diet Terminology
It’s not easy to live in America and not follow the traditional American diet. As a vegetarian I am highly aware of this. Therefore I tend to try to send nothing but happy thoughts to my fellow non-traditional foodies, be they gluten-free, vegan, kosher, etc…. However I kind of have a beef (pun intended) with one group of them right now. I’m looking at you pescetarians.
It is absolutely cool that you choose to abstain from all meat but fish. I don’t agree with it, but I respect it. What really pisses me the fuck off though is those of you who are running around claiming to be vegetarians. You are not vegetarians!!
From Merriam-Webster: vegetarian: one whose diet consists wholly of vegetables, fruits, grains, nuts, and sometimes eggs or dairy products
Do you see fish listed in there? Are fish vegetables, fruits, grains, nuts, eggs, or dairy products? No? Then you are not a vegetarian! You are a pescetarian.
Here’s Merriam-Webster to help you out again: pescetarian: one whose diet includes fish but no meat
I know. You’re sitting there going Why does this woman have such a problem with what I call myself, right?
How you label yourself directly impacts me. It’s hard enough to be a vegetarian and have to explain to people things like it’s not appropriate to give your vegetarian niece marinara sauce cooked with meatballs in it, even though you’re not giving her meatballs there is still meat juice all up in that. I know you face things like that yourself when you explain that you don’t eat chicken. Pescetarians running around calling themselves vegetarians means I now repeatedly have this conversation:
Me: “I’m sorry. I can’t eat that. It has fish in it, and I’m a vegetarian.”
Person: “Vegetarians eat fish.”
Me: “Um, no they don’t.”
Person: “But I know someone who’s vegetarian, and she totally eats fish!”
You are making things more difficult for us vegetarians. It’d be like if I ran around calling myself vegan and gnawing down cheese. Vegans already are a bit confusing to the public, how much more would that confuse them then? You are just wrong. You are using the wrong word for your diet. Even freaking Merriam-Webster says so. I know pescetarian is a funky-sounding word and you will probably have to explain it a bit more to the public since it is not as well-known as vegetarian. Do it anyway. It’s what you are. If you really want to call yourself a vegetarian stop eating damn fish!