They said nurses should integrate Alternative remedies in a formal nursing care plan

Dear Editor:

I believe your article: Regulatory issues in CAM (TheCase Manager Volume 16, Issue 1 , January-February 2005, Pages 17-23) challenges the integrity of our profession when it seems to encourage the case manager to consider offering and integrating CAM modalities into the formal medical care plan.

While using the word "ethics" to associate patient safety risks the common shallow suggestion that herbal supplements are safer than prescription drugs appears.

The article presents CAM as another alternative to "orthodox" medicine and states that "subtle forms of harm can manifest" when this option is ignored in clinical decision making.

Nothing is said about the subtle harm done by advocating costly, and potentially useless modalities. Or of the ethics of mixing vitalistic beliefs and pseudo-scientific terms with science-based practice so they are no longer discernible. Or of the risks associated with the passing-off to the patient faith-based rituals as one would a prescription pill.

The author goes on to suggest fault of the clinician in a communication rift for not "understanding" a CAMmodality.

Ethically, it becomes the responsibility of the casemanager to help the patient understand why a CAM therapy is not "orthodox." That it doesn't fit within a medical care plan as a standard of practice because clinical outcomes are not predictable or established, carry unknown health and monetary risks, or are just not based on known physiologic or scientific principles. At the same time, the case manager should not hesitate to agree that there are things that are done individually to compliment the clinical careplan, that may help with the chances for success. Not the least of which could be associated with some formof "complimentary" intervention.

-dras

Comments on Hypnotherapy research

The point I'm making is that increased activity in the HPA-axis (as well as the frontal lobes) is observed with subjects under hypnosis along with a corresponding increase in HgH. Is that necessarily a good thing? How do we know the body doesn't just flush out the increased levels of growth hormone? Well, I think I am on safe ground to hypothesise that it results in some health benefits, though I recognise more studies need to be undertaken:
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I think this is great research. We just now need toplot the relationship between increased HGH andactivity in the HPA-axis with different hypnosisprotocols and disease conditions and correlate thesefindings with objective clinical outcomes. Part ofthis understanding will tell us more about how HGH andHPA-axis activity impacts different health and diseaseconditions. Along the line, we'd probably also liketo find out if and how other non-hypnosisinterventions influence HGH and HPA-axis activity fordifferent health conditions.

That there are abstracts and references listed on aPubmed database does not equate or serve to createscientific legitimacy. Tons of stuff there boils downto "junk" studies and reviews that attempt to do justthat. Often, it's hard to tell, especially fornon-experts in research and for those not acquaintedwith the particular field of study (like myself.)

In a look at Pubmed published meta-analysis' forhypnotherapy (not that meta-analysis' are anymoretelling than assembled individual studies -they tendto compound their faults), I found four (in English)that addressed hypnosis in particular and that werepublished in non CAM-type journals. Two suggestedthat hypnosis may have some medical/clinical benefit. Ironically, they support the diagnoses Medicare usesto allow coverage of hypnotherapy.

Is there a stigma associated with hypnotherapy? Maybethere's more than the illusive predictable objectiveoutcomes and the lack of common techniques andstandardized protocols for therapy. Maybe hypnosis isstill seen as merely parlor entertainment, orassociated with the occult. Even more, there may be afear of hypnotherapy being advocated as a perpetualintervention for about any condition or, worse,non-condition. Perhaps in overcoming any stigma,hypnotherapy approaches mainstream medicine.
-dras

Chamomile tea, the new study

I speculate whether this new report is a result ofrolling-over-rocks to find redeeming qualities of a"natural" health product. I wonder if they couldanalyze the urine of 14 people who, for 14 days, ate 5handfuls/day of alf-alfa sprouts, beeswax, or pasturebiscuits and then find increased levels of somethingbeneficial. But, nothing wrong with that, it's acurrent fad to commercially pump the health benefitsof a vested product, be it soy, milk, grape juice,whatever. But, for some reason, you don't see thegrape juice research hyped-up on the altie websiteslike chamomile. Go figure. -dras
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Reported by Reuters from a study (today) in American Chemical Society’s Journal of Agricultural and FoodChemistry and already picked up by mercola and severalother popular health sites.Drinking chamomile tea (FIVE cups/day for 14 days)produced changes in the urine including an increase inhippurate, an antibacterial substance producednaturally in the gut that may also have antiinflammatory properties as well. And also higherlevels of glycine, an amino acid found mostly inconnective tissue (and nutritional supplements.)The study based at Imperial College London and wasfunded by Oxford Natural Products plc.

brain mapping is cool

> Brain mapping leads to optimal function > > Offers holistic way of treating mental woes> > Pat Whitney> Special for The Republic> Jan. 5, 2005 12:00 AM]
http://www.azcentral.com/php-bin/clicktrack/print.php?referer=http://www.azcentral.com/community/westvalley/articles/0105wvbrainmap0105Z1.html>
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Brain mapping, also called quantitative EEG (QEEG),has been around since at least the 70's. Today, itconsists basically of a computerized analysis andtopographic display of EEG rhythms and evokedpotential data. Computers create really cool-lookingdigital graphics on the screen. Historically usedmostly as a research tool, technology is quicklycreating a market for QEEG that may be ahead of it'sproven usefulness.

The idea for using QEEG in the treatment for ADHD is aQEEG observation of increased presence oflow-frequency theta brain waves in the prefrontalcortex in children when they struggle to concentrate. It's been suggested that comparative abnormalities inboth theta and beta brain wave rhythms are associatedwith attention–or lack of it. But, that is where thereally good science stops at present. Currentguidelines available at www.guidelines.gov do notmention QEEG, or brain mapping, in the diagnosis ortreatment protocols for ADHD.

Practitioners using QEEG in treatment for ADHD useresults as neurobiofeedback to guide whateverintervention is advocated with the intent to reducethe measured amount of (attention-disrupting) betabrain waves. Reports of success of QEEGneurobiofeedback in the treatment of ADHD areanecdotal. Biofeedback, including neurobiofeedbackhas not been scientifically established asparticularly integral in guiding therapy for any kindof condition, and there is not yet good data to createa meaningful QEEG/ADHD connection.

Are ADHD kids likely to improve with QEEGneurobiofeedback therapy? I would say yes; but, I amskeptical that it is better than established orcomparative non-QEEG therapy protocols. Does thescience suggest $3,500/mo QEEG treatment programs areworthwhile? No. But, I think this treatment has somekey ingredients for placebo treatment success: highcost, intensive intervention, and innovative gadgetrythat can suggest exactly what's wrong and even measureprogress.

Is using QEEG to treat ADHD healthfraud? I would saythis has more to do with the credentials, experience(with ADHD) and reputation of the practitioner. Insurers probably won't readily identify QEEG-basedtreatment for ADHD on a claim, I doubt many wouldintentionally cover it.

These are optimistic review articles of QEEG with theabsolutely most current information for thoseinterested:
Chabot RJ, di Michele F, Prichep L. The role ofquantitative electroencephalography in child andadolescent psychiatric disorders. Child AdolescPsychiatr Clin N Am. 2005 Jan;14(1):21-53, v-vi. PMID:15564051Monastra VJ. Electroencephalographic biofeedback(neurotherapy) as a treatment for attention deficithyperactivity disorder: rationale and empiricalfoundation. Child Adolesc Psychiatr Clin N Am. 2005Jan;14(1):55-82, vi. PMID: 15564052
The most referrenced report in support of QEEGbiofeedback:
Monastra VJ, Monastra DM, George S. The effects ofstimulant therapy, EEG biofeedback, and parentingstyle on the primary symptoms ofattention-deficit/hyperactivity disorder. ApplPsychophysiol Biofeedback. 2002 Dec;27(4):231-49.PMID: 12557451 Recent work:El-Sayed E, Larsson JO, Persson HE, Rydelius PA.Altered cortical activity in children withattention-deficit/hyperactivity disorder duringattentional load task. J Am Acad Child AdolescPsychiatry. 2002 Jul;41(7):811-9. PMID: 12108806