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Projects
Technical Support for the National Center for Complementary and Alternative Medicine
Sponsor
Agency for Healthcare Research and Quality/National Center for Complementary and Alternative Medicine
Staff
Dr. Ian Coulter - Principal Investigator (RAND)
Dr. Mary Hardy - Co Principal Investigator (Medical Director, Cedars-Sinai Integrative Medicine Medical Group)
Dr. Paul Shekelle - Project Director (RAND)
Complementary and Alternative Medicine is defined as those health care practices that are not part of the dominant health care system in the United States but which may contribute to health by diversifying our approaches in medicine and extending our concepts in biology.
In 1992, the U.S. Congress established the Office of Alternative Medicine (now the National Center for Complementary and Alternative Medicine, NCCAM) with a mandate to investigate, evaluate, and provide information about complementary and alternative medicine to the public. Until 1998, the Office of Alternative Medicine was a component of the Office of the Director at the National Institutes of Health (NIH), working with the 22 NIH Institutes and Centers to support research on complementary and alternative medicine. In 1998, the Congress recognized the growing interest in complementary and alternative medicine in consumers' choices in health care and the parallel urgent need for evidence-based research on complementary and alternative medicine products. The Office of Alternative Medicine was elevated by the Congress to the status of Center and renamed NCCAM.
NCCAM supports research in such diverse areas as systems of medicine developed elsewhere in the world (e.g. Chinese and Ayurvedic medicine), approaches that are usually not investigated in conventional research organizations (e.g. homeopathy and prayer), and practices that are not available in most U.S. hospitals or taught at U.S. medical schools (e.g. chiropractic or naturopathic medicine).
Reliable objective independent information about complementary and alternative medicine is essential for good health care. Thus, NCCAM uses the same rigorous scientific methods used by all Institutes and Centers at NIH for evaluation of these practices. The role of NCCAM is to serve as an advocate for good science, objective information, and open rational inquiry.
In 2001, the Southern California EPC was awarded a 3-year contract to provide technical support for NCCAM in the following areas: (1) preparation of evidence reports; (2) methods research; and (3) presentations (as requested) of on-going or proposed work in conferences or seminars related to complementary and alternative medicine. The following reports were produced and activities conducted (in chronological order):
- Ayurvedic Interventions for Diabetes Mellitus: A Systematic Review/ Evidence Report. Ayurveda ("the science of life"), practiced in India for the past 5000 years, is a comprehensive system of medicine that emphasizes an individual approach to the prevention and treatment of disease. Ayurvedic theory states that all disease begins with an imbalance or stress in the individual's consciousness. Ayurvedic practitioners use lifestyle interventions and natural therapies to restore inner harmony. Currently, ten Ayurveda clinics exist in North America, including one hospital-based clinic that has served 25,000 patients since 1985. This report presents the findings of a comprehensive review of the published literature on the use of Ayurvedic medicine for treating diabetes.
- Mind-Body Interventions for Gastrointestinal Conditions. Many of the therapeutic techniques that make up our present understanding of complementary and alternative medicine consist of those that recognize and seek to harness the essential unity of the mind and physical body. This report presents the findings of a comprehensive review of the use of such therapies for treatment of gastrointestinal diseases and conditions.
- S-Adenosyl-L-Methionine (SAM-e) for Treatment of Depression, Osteoarthritis, and Liver Disease. The amino acid derivative, SAM-e has been promoted in supplement form for the treatment of a variety of conditions. This report presents the findings of a systematic review of the literature on the efficacy of SAM-e for three conditions for which the literature was adequate to support a detailed review.
- Best-Case Series for the Use of Immune Augmentation Therapy and Naltrexone for the Treatment of Cancer. Various alternative therapy modalities have been examined for the treatment of cancer. However none has been rigorously tested in randomized controlled clinical trials. Thus, the SCEPC was asked to test the value and ease of performance of case series reviews as a means of evaluating the efficacy of several proposed alternative forms of cancer therapy.
- Panel Meeting on Meta-Regression Approaches. The objective of this study was to conduct a systematic review of the literature on the use of meta-regression methods that model the heterogeneity among study treatment effects and to compare and contrast the leading approaches via simulation. Based on the systematic review and the consensus of an expert panel, five meta-regression approaches were selected: fixed effects with and without covariates; random effects with and without covariates; and control rate meta-regression. The expert panel also approved the use of the large-scale simulation modeling approach. The final report was completed in March 2004.
- A Review of the Effect of the Supplemental Use of Antioxidants Vitamin C, Vitamin E, and Coenzyme Q-10 for the Prevention and Treatment of Cancer. Based on epidemiological studies that showed reduced risk for some cancers in populations with higher dietary intakes of antioxidants, increasing the intake of various antioxidants has been promoted. This report presents the findings of a systematic review of the literature on the effect of antioxidant supplements on cancer prevention and treatment.
- A Review of the Effect of the Supplemental Use of Antioxidants Vitamin C, Vitamin E, and Coenzyme Q-10 for the Prevention and Treatment of Cardiovascular Disease. Based on epidemiological studies that showed reduced risk of cardiovascular diseases in populations with higher dietary intakes of antioxidants, increasing the intake of various antioxidants has been promoted. This report presents the findings of a systematic review of the literature on the effect of antioxidant supplements on cardiovascular disease prevention and treatment.
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