Volume 2, Issue 1

Review Methodology: Systematic Aggregation, Analysis, and Review of the Literature.Search Strategy: To prepare each Natural Standard monograph, electronic searches are conducted in nine databases, including AMED, CANCERLIT, CINAHL, CISCOM, the Cochrane Library, EMBASE, HerbMed, International Pharmaceutical Abstracts, Medline, and NAPRALERT. Search terms include the common name(s), scientific name(s), and all listed synonyms for each topic. Hand searches are conducted of 20 additional journals (not indexed in common databases), and of bibliographies from 50 selected secondary references. No restrictions are placed on language or quality of publications. Researchers in the field of complementary and alternative medicine (CAM) are consulted for access to additional references or ongoing research.Selection Criteria: All literature is collected pertaining to efficacy in humans (regardless of study design, quality, or language), dosing, precautions, adverse effects, use in regnancy/lactation, interactions, alteration of laboratory says, and mechanism of action (in vitro, animal research, human data). Standardized inclusion/exclusion criteria are utilized for selection.Data Analysis: Data extraction and analysis are performed by health care professionals conducting clinical work and/or research at academic centers, using standardized instruments that pertain to each monograph section defining inclusion/exclusion criteria and analytic techniques, including validated measures of study quality). Data are verified by a second reviewer.Review Process: Blinded review of monographs is conducted by multidisciplinary research-clinical faculty at major academic centers with expertise in epidemiology and biostatistics, pharmacology, toxicology, complementary and alternative medicine (CAM) research, and clinical practice. In cases of editorial disagreement, a three-member panel of the Editorial Board addresses conflicts, and consults experts when applicable. Authors of studies are contacted when clarification is required.

Probiotics is a field of science, medicine and business that is growing rapidly. Regulatory agencies, especially in North America, are slow to understand these concepts and embrace and enforce United Nations and World Health Organization Guidelines. In order to advance the science and efficacy of probiotics, industry needs to self-regulate and ensure that high standards of products are met, then trials must be performed on human subjects using appropriate sample size, design and target population. With the support of granting agencies, such studies will provide valuable information on the efficacy and limitations of probiotics, and the mechanisms by which they confer their activity. In addition, regulatory authorities need to establish and enforce a ‘standard of identity’ and only allow products to be called probiotic if sufficient documentation is generated.

The purpose of this review is to consider how the practice of public health could play a pivotal role towards enhancing chronic disease management by integrating and aiding the common goals shared between primary health care (PHC) and complementary and alternative medicine (CAM). While these three systems are by no means unified, they are also not totally separate systems either. Improving their collaboration, so as to better meet the health care needs of individuals with chronic disorders, may be facilitated through an enhanced integrative health care infrastructure.

The following are abstracts of oral and poster presentations given at the first annual IN-CAM Research Symposium: Building Research Capacity and Networking in Canada that was held on December 4 & 5, 2004 at the University of St. Michael’s College, University of Toronto, Toronto, Canada. For more information on the symposium, please visit: www.incamresearch.ca.

The following are abstracts of oral and poster presentations given at the second annual IN-CAM Research Symposium: CAM Research in Canada - Sharing Successes and Challenges that was held on November 12 & 13, 2005 at the University of St. Michael’s College, University of Toronto, Toronto, Canada. For more information on the symposium, please visit: www.incamresearch.ca.

Acute respiratory distress syndrome (ARDS) is a medical emergency, which may be precipitated by an acute injury to the lung. The injury can also follow direct chest trauma from aspiration of gastric contents or inhalation of toxic gasses. ARDS is not itself a specific disease but a syndrome - a group of symptoms and signs that make up one of the most important forms of respiratory failure.ARDS is devastating because it can develop quite suddenly in persons whose lungs had been perfectly normal - it kills at least 60% of its victims. The fundamental problem is the sudden appearance of large amounts of fluid in the lung preventing blood from entering the alveoli and decreasing oxygen extraction resulting in hypoxemia.The tragic feature of ARDS is that it drowns its victim. The appearance of fluid in the lungs – a lethal situation - is from neuro-inflammation.Important to keep in mind when treating ARDS are: a) Inflammation and Inflammatory exudates Gap Formation, b) Interstitial and Alveolar Inflammation, c) Inflammation and the Nervous System, d) Cholinergic anti-inflammatory pathway.Neuro-inflammation can be relieved by stimulation of the vagus nerve. Low-level laser therapy, a simple modality with few undesirable side effects, is used to relieve respiratory distress

Background: During the outbreak of severe acute respiratory syndrome (SARS) in the Spring 2003, we employed the theory of traditional Chinese medicine (TCM) to treat patients with SARS in China-Japan Friendship Hospital. Methods: According to our clinical observation with the “Pestilence” theory of TCM, the progress of SARS can be divided into five stages, i.e. the latent stage, the febrile stage, the cough and asthmatic stage, the prostration stage, and the recovery stage. TCM formulae were employed for the different stages of SARS. The time of allaying fever, the average absorption day of pulmonary infiltration, and the increase in white blood cell counts were used for evaluation of the treatment. Results: For those 4 patients with fever at the time of admitting to hospital, the time of allaying fever was 2, 3, 6 and 7 days respectively after the treatment of TCM. For 11 patients, the mean absorption time of chest infiltration was 14.56±6.71 days from the range of 5 days to 25 days. In addition, after treatment with TCM, total count of white blood cells and lymphocytes were all within normal range. Conclusion: Treatment with traditional Chinese medicine can be one of the choices for patients with SARS.

A new Chinese Quality of Life Instrument (ChQOL) based on the principles of diagnosis and practice in Chinese medicine has been developed. This paper describes the development of the ChQOL instrument using factor analysis and structural equation modeling. An initial pilot version of the 78 items instrument was field tested in a sample 273 subjects recruited from different areas in China. The objective of this study was to determine the factor structure and latent constructs of the ChQOL based on factor analysis. A series of confirmatory factor analysis and structural equation models were used to determine the final model of the ChQOL. The results showed that the application of factor analysis and structural equation modeling is an effective method to develop the new health-related quality of life instrument, ChQOL, even though the practice of Chinese medicine is quite different from the practice of conventional western medicine.

Purpose: To investigate the public attitudes towards Chinese medicine and the impact of the introduction of statutory practitioner registration in Melbourne, Australia. Method: A convenience sample of 575 participants (18-45 years of age) from three locations in Melbourne completed a self-administered, 60-question survey in August 2002. Results: In the previous 12 months, Chinese medicine had been used by 30.9% of the respondents and 17.3% had visited a Chinese medicine practitioner. For each of eight common conditions listed in the survey, between 61.2% and 92.7% of participants indicated that western medicine was their preferred therapeutic option, rather than Chinese medicine or combination of Western and Chinese medicine. However, substantial proportions of participants preferred Chinese medicine for stomach or internal problems (28.4%), cold/flu (18.8%) and dizziness (17.6%). Although 78.2% were aware that statutory practitioner registration had recently been introduced in the State, only 29.9% indicated that they would only visit a registered practitioner. Implication: More stringent surveillance of Chinese medicine service providers and a public education campaign may be necessary to protect against unauthorized Chinese medicine practice.

Background: A lack of research literacy and capacity has been identified as a key barrier to research in complementary and alternative medicine (CAM). Networks may enable multidisciplinary collaboration between academic researchers and CAM practitioners and provide opportunities for mentoring and capacity building. Little is known about how mentoring can operate within a network and what its potential is as a strategy to increase research literacy and capacity among CAM practitioners. Purpose: To explore how mentoring within a network can be used to build research literacy and capacity amongst CAM practitioners. Methodology: Qualitative method was used for data collection and content analysis. Participants were individuals with knowledge and/or experience in networks and/or mentoring, as well as CAM practitioners. Results: Background: A lack of research literacy and capacity has been identified as a key barrier to research in complementary and alternative medicine (CAM). Networks may enable multidisciplinary collaboration between academic researchers and CAM practitioners and provide opportunities for mentoring and capacity building. Little is known about how mentoring can operate within a network and what its potential is as a strategy to increase research literacy and capacity among CAM practitioners. Purpose: To explore how mentoring within a network can be used to build research literacy and capacity amongst CAM practitioners. Methodology: Qualitative method was used for data collection and content analysis. Participants were individuals with knowledge and/or experience in networks and/or mentoring, as well as CAM practitioners. Results: Some major categories derived from the data were: 1) A network must clearly define the role and goals of mentoring. 2) An infrastructure to support and maintain the mentoring relationship should be in place. 3) A number of barriers and enablers for successful mentoring within a network were addressed. 4) Some issues specific to CAM practitioners’ ability to conduct research were raised. Conclusion: Mentoring was seen as a potentially useful strategy. Ideas for mentoring were suggested, including cooperative models, job shadowing, perceptorship and role modeling. Innovative models were discussed.

Natural health products containing Echinacea have been used by many patient populations and although there are reports of adverse effects with products containing Echinacea, few clearly characterized the nature of the product with respect to constituent content, the nature of the products and the mechanism underlying the interaction. The objective of this study was to examine blended and single-entity Echinacea products containing ground plant material or extracts in commercial capsules, herbal teas, tablets, tinctures and soft gel liquid-filled capsule formulations in an attempt to correlate biomarker constituent content and effects on cellular and subcellular parameters of interest. HPLC analysis indicated significant variability in the major biomarker constituent content in extracts from these Echinacea products. These extracts were also examined for their potential to affect cytochrome P450 CYP1A1/2, 2C9*1, 2C9*2, 2C19, 2D6, 3A4, 3A5, 3A7, and flavin-containing monooxygenase 3 (FMO3); CYP3A5-mediated metabolism, and expression of CYP3A4 and ABCB1. The extracts of some products were also examined for their effect cellular processes such as cell proliferation, nitric oxide formation as a marker of immunostimulatory capacity, and lactate dehydrogenase release as a marker for cell toxicity. The present study indicated that key Echinacea constituents varied widely within and between the products tested and that these levels did not correlate with the ability of these products to markedly affect the cellular processes studied.

The United Nations Food and Agriculture Organization and World Health Organization in 2001, made a clarion call for efforts to be made to make probiotic products more widely available, especially for relief work and populations at high risk of morbidity and mortality. This strong and direct request to governments, funding agencies, corporate pharmaceutical and food industries has so far not had any impact in sub-Saharan Africa, where people are mired in poverty and stricken with gastro-intestinal and an escalating epidemic of sexually transmitted diseases including HIV/AIDS.The ability of certain probiotic strains to prevent and treat some gut and urogenital conditions, and the relative low cost and practical means by which this can be achieved, provides a potential addition to the armamentarium of methods to lower the impact of disease and enhance the quality of life of people in this part of the world.Companies selling reliable probiotic products have not yet entered sub-Saharan Africa, perhaps due to logistical reasons and low pricing. Nevertheless, in order to make a significant impact on the health and wellbeing of this large population, ways must be found to provide access to this technology. A community kitchen project in Tanzania, initiated by our group, is one way of taking the concept to the grass roots.