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Complementary alternative medicine: popular and, at times, problematic

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American Association of Clinical Endocrinologists 17th Annual Meeting & Clinical Congress

Complementary and alternative medicine is widely used and appealing to men and women in the United States, despite scarce evidence regarding the safety and efficacy of certain types, according to Marc R. Blackman, MD.

“Complementary and alternative medicine is big business. Americans spend more out-of-pocket for complementary and alternative medicine than from all other health care needs. That is a sobering and to many people a surprising fact,” he said today at the American Association of Clinical Endocrinologists 17^th Annual Meeting and Clinical Congress.

Part of the appeal, as Blackman described, are claims of dramatic results, their “all natural” makeup and the once-forgotten “touch, talk and time” provided by therapists. In some cases, results from studies like the Women’s Health Initiative, which showed an increase in the risk of cardiovascular disease and dementia in postmenopausal women taking estrogen and progestin, caused women to search for alternative treatments.

While there is not enough evidence from large clinical trials to support complementary and alternative medicine as an alternative to hormone therapy, compounds like bioidentical hormones have become popular and very problematic, according to Blackman, who is professor of medicine at Johns Hopkins University School of Medicine.

“Popular prescribing for bioidenticals has achieved a higher art form; that is one euphemistic way of saying it is pandemic and a real problem,” he said.

Bioidentical hormones are claimed to be customized to individual needs based on hormone levels. Blackman highlighted that the measurement of hormone levels, particularly serum estrogen assays like salivary assays, are inaccurate due to the fact that they are not standardized in menopausal women.

“As health care providers, we need to school ourselves so we can educate our patients, who are understandably confused. The plural of all of these anecdotal bits of information do not add up to what you or I would call evidence,” he said.

Future research

As with many issues, there is a need for further research. In this case, research that uses the same designs as those used for conventional practices including randomized, double-blind clinical trials is necessary, according to Blackman.

Studies for complementary and alternative medicine should incorporate social value, scientific validity, fair subject selection and favorable risk to benefit relationships, among others, just as every other type of clinical study, according to Blackman.

“Unethical studies, of which there are a number, including in the field of bioidentical hormones, need to be stopped. Practices or a placebo arm that would replace life-saving therapies, irreproducible products, unsafe products and practices have to become part of history, not reality,” said Blackman. – by Stacey L. Adams

For more information:

• Blackman MR. Alternative medicine and endocrinology. Presented at: the American Association of Clinical Endocrinologists 17^th Annual Meeting & Clinical Congress; May 14-18, 2008; Orlando, Fla.