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Researching CAM Approaches
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NCCAM scientists contributed to the overarching NIH obesity strategic plan to ensure that it includes ways in which complementary and alternative medicine (CAM) approaches could be addressed. However, before the plan was completed, NCCAM had already begun to invest in obesity-related investigations, both in its intramural laboratories (on the NIH campus) and in extramural studies.
Reducing risks for obesity, as well as the health problems associated with it, involves making changes in diet and physical activity. An array of nutritional practices claim to prevent, treat, or manage these problems—ranging from
well-researched, biochemically understood treatments on which national public health recommendations are based (such as the U.S. Department of Agriculture's Food Pyramid), to scientifically unproven treatments advertised in the popular press. NCCAM is supporting studies to answer questions about the safety and effectiveness of some popular diets, such as:
In addition, NCCAM investigators are exploring the potential of some other complementary and alternative treatments, such as practices from traditional Chinese medicine, to yield new and better ways to control the obesity epidemic. Included are investigations of:
2Qi gong (pronounced "chee-GUNG") combines movement, meditation, and regulation of breathing to enhance the flow of qi (an ancient term given to what is believed to be vital energy) in the body, improve blood circulation, and enhance immune function. Acupressure ("ACK-you-preh-shur") is acupuncture using pressure applied by the hands instead of needles.
Dr. Straus added, "The obesity epidemic demands our best efforts. We at NCCAM are committed to helping the public determine whether CAM approaches can keep their promises of overcoming this threat to the public's health."
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Prevention and Treatment of Childhood Obesity in Primary Care Settings (RFA-HD-04-020). Sponsors: NCCAM and eight other components of NIH. These grants will support projects to test programs that aim to improve dietary and physical activity behaviors in children. Ancillary Studies to Obesity-Related Clinical Trials (RFA-DK-03-022). Sponsors: NCCAM, National Institute of Diabetes and Digestive and Kidney Diseases, and National Institute on Aging. These grants will support CAM studies investigating obesity-related research questions. Neurobehavioral Basis of Obesity (not yet released at press time). NCCAM will cosponsor this new NIH initiative, which will study how the brain, behavior, and environment interact to determine eating patterns, preferences, and food habits, and ultimately influence the development of overweight and obesity. |
Government Resources on Obesity
Weight-control Information Network (WIN)
National Institute of Diabetes and Digestive and Kidney Diseases
WIN provides information and distributes many publications on weight control, obesity, physical activity, and nutrition. A new brochure, "Diet Myths," addresses, among other topics, fad and special diets. Go to win.niddk.nih.gov or call 1-877-946-4627 (toll-free in the U.S.).
Obesity Education Initiative/Aim for a Healthy Weight
National Heart, Lung, and Blood Institute
This program offers publications and other resources to help people stay active and make healthy food choices. Go to www.nhlbi.nih.gov/about/oei or call 301-592-8573.
HealthierUS Initiative
The President's HealthierUS initiative is designed to help Americans, especially children, take steps to live longer, better, and healthier lives. Its Web site is www.healthierus.gov.
Obesity Research, National Institutes of Health
This NIH Web site is at www.obesityresearch.nih.gov and includes the Strategic Plan for NIH Obesity Research.
For more information about NCCAM or any aspect of complementary and alternative medicine, contact the Clearinghouse.
Evans M, Straus S. Ripe for study: complementary and alternative treatments for obesity. Critical Reviews in Food Science and Nutrition. 2001;41(1):35-37.
Foster GD, Wyatt HR, Hill JO, et al. A multicenter, randomized, controlled trial of a low-carbohydrate diet for obesity. New England Journal of Medicine. 2003;348(21):2082-2090.
Mokdad AH, Marks JS, Stroup DF. Actual causes of death in the United States, 2000. Journal of the American Medical Association. 2004;291(10):1238-1244.
National Institute of Diabetes and Digestive and Kidney Diseases Web site. Accessed at www.niddk.nih.gov on September 16, 2004.
U.S. Surgeon General's Web site. Accessed at www.surgeongeneral.gov on September 16, 2004.
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Are you one of the estimated 50 million Americans who will go on a diet this year? Before you spend money on products or programs that promise fast or easy weight loss, the Federal Trade Commission recommends that you consider these tips about typical claims, such as:
Source: www.ftc.gov/bcp/conline/pubs/alerts/paunch
Visit active funding announcements for more information on NCCAM funding opportunities and notices.
NCCAM's Office of Clinical and Regulatory Affairs has developed "Applying for NCCAM Clinical Trials Grants: Points To Consider," a policy document outlining important issues that applicants for phase II and III studies must consider.
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Research Centers Grants Available NCCAM announces the final year of funding for research centers for CAM. Letters of intent are due January 15, 2005. Receipt date is February 15, 2005. Grants will be for two types of centers:
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On September 20, 2004, Stephen E. Straus, M.D., NCCAM Director, hosted his second Web chat on "Complementary and Alternative Medicine and Cancer," sponsored by NCCAM, the American Society of Clinical Oncology, and CancerCare. He was joined by Patrick Mansky, M.D., an oncologist and researcher at NCCAM. An excerpt appears below. To read the full chat, go to www.plwc.org, select "Community Center," then "PLWC Live Chat Series"; or contact the NCCAM Clearinghouse.
Q: I would like to try some CAM therapies, but I am afraid my doctor will think I'm "crazy." How can I bring this up?
Dr. Straus: This is a very important question. It's common that there is a tension between patients and physicians. There are times that physicians are afraid their patients will ask them questions about CAM, because they don't know all the answers; and there are many patients who are afraid that their physician will think poorly of them. But this is a dialogue that must take place. As a physician, I may not agree with everything my patient believes in, but it is important that I understand and respect their beliefs. Patients should ask any questions they have about CAM, and physicians should do their best to try to help find good answers and work out a strategy that both should be comfortable with.
Q: My mother recently finished treatment for colorectal cancer and likes to self-medicate with various dietary and herbal supplements. How can I find out which of these are potentially dangerous?
Dr. Straus: The possibility of interactions is the first thing to consider. Herbs contain potent chemicals that can interact with cancer drugs, either to make the drug less effective or more toxic. Beyond that, it depends on the supplement. Some information sources are nccam.nih.gov, dietary-supplements.info.nih.gov, CAM on PubMed, and the Natural Medicines Comprehensive Database.
Q: Is there any evidence that acupuncture can boost a person's immunity?
Dr. Straus: No. There is a lot of belief that things can boost people's immunity. With some CAM systems, there is a little bit of evidence that the immune system is affected, but there is no evidence that the changes are beneficial.
Q: What cancer side effects respond the best to CAM treatments?
Dr. Mansky: The best research-based evidence exists for the treatment of pain and nausea. Acupuncture appears to have efficacy in the treatment of cancer-related pain, as well as chemotherapy-induced nausea and vomiting.
Q: My brother is only considering CAM to treat his lung cancer. What should I say to him to help him understand that traditional treatments are important, too?
Dr. Straus: I think you've said the important message. You care about your brother and his well-being and respect his decisions, but want to see him get the best care he can. There are proven treatments for cancer, and one should be hesitant to throw away things that are proven to be good in the hopes of something else that is unproven.
Q: What CAM approaches should be avoided before surgery?
Dr. Straus: There is a danger of doing too much of any one approach. (This is a general concern.) It 's common to believe that more is better, but too much of an herbal medicine, exercise regimen, or extreme diet, for example, can be harmful. Certain herbal medications (such as St. John's wort and ginkgo) can decrease the ability of blood to clot; good blood clotting is important for surgical recovery.
Q: I saw an article saying that doctors won't use the word "cure" when talking about cancer. Many CAM sites, however, promise a cure. Why the difference?
Dr. Straus: Things that sound too good to be true, in general, are. It's very appealing when patients are struggling desperately with cancer, their own cancer or in a loved one, and the promise of a cure sounds great—but it's not fair or reasonable. There are cancers that can be cured through conventional, proven therapies, and there are some cancers that are rarely cured. CAM approaches should not honestly promise to cure cancer.
Q: How effective is the mistletoe treatment in first or second occurrence of cancer and/or metastasis?
Dr. Mansky: NCCAM is currently conducting a study of a whole-plant mistletoe preparation given together with gemcitabine (Gemzar), a conventional chemotherapy drug. While there is a substantial body of laboratory studies suggesting a role for mistletoe extracts, in the stimulation of components of the immune system, there are currently no conclusive clinical studies published that would provide clear evidence of the effectiveness of mistletoe in the treatment of cancer. Mistletoe is generally well tolerated. The most frequent side effects include local rashes, sometimes low-grade fevers, and rarely generalized rashes or allergic reactions.
In October 2004, NCCAM announced the addition of six new centers to its research centers program. The centers are of two types:
The Centers of Excellence support established researchers in applying advanced technologies to explore the potential benefits and underlying mechanisms of CAM practices; the grantees and their topic areas are:
Alternative Therapies for Alcohol and Drug AbuseThe Developmental Centers provide a means for CAM institutions to partner with established research institutions to conduct exploratory and developmental CAM research projects, as follows:
See the full press release on these awards.
September 2004 marked the first anniversary of participant recruitment for the Chelation Therapy Study, cosponsored by NCCAM and the National Heart, Lung, and Blood Institute. Chelation (pronounced key-LAY-shun) is an investigational therapy that uses a manmade amino acid, EDTA, which is added to the blood through a vein. Some people consider using chelation therapy because of a belief that it may treat heart disease. However, this has not been scientifically proven. This large national research study is seeking to find out whether this therapy is safe and effective.
There are now more than 100 medical centers, clinics, and physicians' offices around the United States participating in the Chelation Therapy Study, and more than 375 patients have enrolled. Total enrollment is expected to be about 2,400. Participants are men and women who are 50 years of age or older and have had at least one heart attack. More information is available by calling 1-888-644-6226 (toll-free in the U.S.) or visiting nccam.nih.gov/chelation.
NCCAM is developing and posting new fact sheets and other information products on an ongoing basis. Titles recently posted include:
All NCCAM publications mentioned in this newsletter are also available from the NCCAM Clearinghouse.
 George Tucker, M.B.A. |
NCCAM thanks our readers who took time to respond to a recent survey on this newsletter. Starting with this issue, we are offering you an expanded publication. We appreciate the many suggestions readers provided.
NCCAM was selected by Prevention magazine as one of three "Best of the Web: Alternative Medicine" sites (as published in the September 2004 issue).
In March 2004, four components of NIH (including NCCAM) sponsored a conference on carnitine, technically a "conditionally essential" nutrient that is also sold as an over-the-counter supplement. Summary information from the conference is now available online.
U.S. Health and Human Services Secretary Tommy G. Thompson has appointed five new members to NCCAM's principal advisory body, the National Advisory Council for Complementary and Alternative Medicine (NACCAM).
Find out more about these new appointees, in the media advisory.
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New Version of IBIDS Database The NIH Office of Dietary Supplements and the U.S. Department of Agriculture have launched a new, improved version of the International Bibliographic Information on Dietary Supplements (IBIDS) database. IBIDS, which celebrates its fifth anniversary this year, contains over 730,000 citations to the scientific literature on dietary supplements, including vitamins, minerals, and botanicals (such as herbs). IBIDS is publicly available free of charge at dietary-supplements.info.nih.gov/health_information/ibids.aspx. |
This calendar lists events on complementary and alternative medicine (CAM) that are sponsored or organized by NCCAM or other components of NIH, and includes information available at press time.
December 2004
NIH State-of-the-Science Conference on Improving End-of-Life Care: December 6-8, 2004. Natcher Conference Center, NIH, Bethesda, Maryland. Primary sponsors: National Institute of Nursing Research and NIH Office of Medical Applications of Research. See upcoming meetings.
January 2005
Meeting of the National Advisory Council for Complementary and Alternative Medicine: January 28, 2005. NIH Neuroscience Building, 6001 Executive Boulevard, Rockville, Maryland. Find out more about the National Advisory Council for Complementary and Alternative Medicine (NACCAM).
Note: PDF files requires a viewer such as the free Adobe Reader.
The U.S. Department of Health and Human Services has identified obesity as a priority area for action. The National Institutes of Health (NIH) is playing a major role—through scientific research to better understand the forces contributing to obesity, the diseases that can develop from it, and strategies for prevention and treatment. NIH Director Elias A. Zerhouni, M.D., created the NIH Obesity Research Task Force (of which NCCAM is a member), which is charged with speeding the progress of this research. In August 2004, the Task Force released its