dras knowledge

Monday, March 28, 2005

Peer reviewed journals

I think it's become a tactic for Alt Med radio hoststo quote Journals the way a radio minister quotes Scripture. Perhaps both sources are equally misquotedor miss applied.Alternative Therapies in Health and Medicine is an NLMlisted, peer-reviewed journal and is nowhere near someof the worst "scientific peer-reviewed journals"available on PubMED. It "is a forum for sharinginformation concerning the practical use ofalternative therapies in preventing and treatingdisease, healing illness, and promoting health."In my experience, the journal is a source oflegitimate information -taken in context. Most of theclinical studies published will advocate some type ofAlternative modality or declare statistical healthimprovements by them. However, as powerful as theconclusions in some of the abstracts seem, it isusually very apparent why the study is not in otherrecognized scientific publications. Many are pilotstudies on small, narrowed populations. Others havenarrow or limited outcomes measures that will lend topositive outcomes, or cannot be extrapolated to theclinical care arena. Based on information in just the abstracts versus theentire text of a study, it's very easy to see howproponents can use the reference to trump up stuff as"scientifically proven." Let the list know whatstudies are referenced, I'm sure you'll get somespecifics in reply.You can Journal-bash over the different studies andthe evidence or lack of it, but this usually ends upin claims of conspiracy to suppress the "truth,"claims that something is to too revolutionary andgroundbreaking to yet be widely accepted, or claimsthat a differing analysis of the science is equallylegitimate.My analogous reply is "If this is so great, why can'tI buy it at Wal-Mart?" Or, if this alt therapy is sogood, I'm sure it will be offered/advocated bymainstream medicine in no time.Dalehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed

Thursday, March 17, 2005

CAM written into state Nurse Practice Act

http://www.arsbn.org/pdfs/complementary_alternative_therapies.pdf
Can someone tell me what the difference is between a nurse practicing alternative medicine and> someone else practicing alternative medicine?
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I can speculate that someone, or group, was concerned about the professional liability of nurses who engage in some alt-med therapies. So, they had it formally addressed in an addendum or update to the State's Nurse Practice Act at the state licensing board of Arkansas. Judging by the language, it was strongly influenced by alt-med proponents. There are phrases that firmly legitimze alt-med practice in nursing by licensed nurses. It does seem to subtlely, but plainly explain that the licensed nurse is subject to language already in the act (i.e., creating and carrying out a careplan based on physician orders, and not doing sCAM when it can be perceived as the "practice of medicine" as restricted to MD's and other licensed professionals.)

First paragraph: "The competency of a nurse to perform complementary and alternative therapies begins with nursing education and ends with the safe nursing practice of those skills in such a way that ensures the safety, comfort and protection of clients. Nurses using complementary or alternative therapies in their practice should follow the ASBN “Position Statement98-6 Decision Making Model.” Particular attention should be paid to the definition of nursing in theASBN “Nurse Practice Act,” and statements in the ASBN“Position Statement 95-1 Scopes of Practice.” Otherprofessional practice acts may require additionalcertification and/or licensure to perform a particulartherapy."

My translation: So-called Complimentary andAlternative medicine (sCAM) is legitimate because licensed nurses learn about it, it helps people, andit can be used in the nursing plan of care or "decision making model". Much of sCAM can be done under established language in the Nursing Practice Act. Some of sCAM is so specialized, it may require you to have a special certification or other licenseto perform them. (By the way, this is subtle warning for you to know what your doing if you choose to do sCAM as part of Nursing practice.)

Next sentences: "Most nurses have been exposed tosystems, holistic and humanistic theories. These theories are the essence of nursing practice and may include complementary and alternative therapies.Nurses must practice within the scope of practice of their license. In basic nursing education,nurses learn to complement physician ordered treatments with techniques such as focusedbreathing and relaxation, massage, guided imagery,music, humor and distraction.

"My translation: sCAM theories are legitimate because they are a fundamental basis for Nursing practice andare a part of Nursing education. In fact, basicnursing education is all about "complementing" aphysicians ordered treatment using techniques that areall associated with sCAM.

Next sentences: "The more complex complementary and alternative therapies are a part of advanced practice nursing. Advanced practice nurses may be qualified to recommend or prescribe vitamins, herbs, mineralsor other over-the-counter products.

"My translation: Advanced practice nurses arequalified, and maybe should be prescribingover-the-counter products.

Next sentences: "The registered nurse practitioner and the registered nurse may follow protocols to recommendthese products. These protocols shall be reviewed annually by the licensed physician and nurse and beprovided to the Board upon request.

"My translation: Established Nursing care plans shouldincorporate the use of over-the-counter products. (Adoctor must sign off on these.)

Next sentences: "The practice of applied kinesiology, herbal medicine, homeopathy, and ayurveda may require formal educational preparation and possibly even certification. State licensure laws regulate therapies such as chiropractic, massage, acupuncture andphysical therapy.

"My translation: If you are a Nurse, and you are using sCAM in Nursing practice, (which maybe you can do -because they may be a part of the Nursing PracticeAct) you better make sure you know what you are doing, because if something bad happens you will be held tothe standard of a licensed healthcare professional. By the way, some sCAM is regulated under other licenses, so as a nurse, maybe you hadn't aught to do those things.

Last paragraph: "Carefully following the SBN “Position Statement 98-6 Decision Making Model” will ensure that nurses are practicing within their scope of practice. Nurses who choose to use complementary or alternative therapies in their practices may be requested to provide documentation that they have followed the “Position Statement 98-6 Decision Making Model” in making their decisions.

"My translation: If you (the nurse) are naming anddoing sCAM, you better make sure it is in your formalNursing care plan that has been signed off by aphysician.

Friday, March 04, 2005

Great Plains Lab fest

Great Plains Lab is a mail-order lab that uses massspectrometry to analyze urine. The lab is a Medicare provider but does not appear to be CLIAA certified. According to the Lab Website information, organic acid testing and other mass spectrometry based urinetesting are used to diagnose attention deficit disorder, ADHD, depression, food allergies, chronicfatigue syndrome, Alzheimer's disease, autism, vitamin deficiency, dermatitis, yeast infection, just to name a few conditions on a long list.

The Lab director, William Shaw, PhD is a biochemist and not a medical doctor or pathologist. He is not a clinical specialist in the pathophysiology or treatment of medical conditions.

Mass spectrometers are mainstay equipment in larger medical pathology labs. Organic acid testing of urine is routine in the work-up for inborn errors of metabolism. There are few other established reasonsto do urine organic acid testing, especially routinely. Most of the associations made by the Website concerning the listed illnesses' with yeast infections, diet deficiencies, allergies and measured organic substances in the urine are speculative at best. There is little correlation of these relationships with established clinical practice, and the scientific literature. Most references on the Website are of books, reviews and case studies by Shaw himself.

As evidenced by sites linking to the Great Plains LabWebsite, the mainstay of business appears to be inalternative medicine that use testing results to ultimately market brand name nutritional supplements, or to establish a pathology for which an advocated alternative medicine treatment can address.

There is no compelling evidence that organic acid urine testing as advocated by Great Plains Lab is linked to most of the listed clinical conditions, that such testing is useful for the diagnosis of the disease or condition, or (most importantly) that such testing assists in making treatment decisions. Much of the site information may be based on good science that has been taken to the fringe of clinical applicability; science that is stretched and mixedwith authoritative sounding speculation in an attempt to legitimize or substantiate unneeded or even whimsical treatment.

Labs like this one provide a very essential service within alternative medicine. Those health conditions for which mainstream medicine often seems at a loss are (allegedly) quantified, measured and substantiated via a real live scientific lab test, making the malady appear legitimate, understandable and/or curable. I find myself wishing it could always be that simple. (no vested interests)
1.http://www.greatplainslaboratory.com/
2.http://www.aruplab.com/home/pediatric_testing/testing_services.jsp
3. Practice parameter: Evaluation of the child withglobal developmental delay. Report of the QualityStandards Subcommittee of the American Academy ofNeurology and The Practice Committee of the ChildNeurology Society. Neurology. 60:3 February 11, 2003 5. Practice Parameters for Allergen ImmunotherapyAAAI - V90 Number 1t January 2003 6. PubMed search "urine organic acid testing"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed