Edited by Phil B. Fontanarosa, MD, and George D. Lundberg, MD
One year ago, the editors of JAMA and the AMA Archives Journals
selected alternative medicine as the topic for their annual coordinated
theme issues. This month, these 10 journals present more than 80 articles on a wide range of topics in alternative medicine.
Results of a nationwide survey indicate a marked increase in the number
of individuals using alternative therapies between 1990 and 1997.
Eisenberg and colleagues report that most use of alternative therapies
is not supervised by either physicians or alternative therapy
practitioners, and estimate total out-of-pocket expenditures for
alternative therapies at $27 billion.
This issue of JAMA features 6 randomized trials of alternative
therapies for common clinical problems.
Bove and NilssonArticle found that patients with
episodic tension-type headaches treated with chiropractic spinal
manipulation or an active control had similar reductions in daily
headache hours and analgesic use.
Cardini and WeixinArticle report that moxibustion, the
application of heat from burning herbs to an acupuncture point, for
primigravida women with fetuses in breech presentation at 33 weeks'
gestation significantly increased cephalic presentation at 35 weeks'
gestation and at birth.
Bensoussan and colleaguesArticle found that patients
with irritable bowel syndrome treated with Chinese herbal medicine
formulations had significant improvements in symptoms compared with
those treated with placebo.
Shlay and colleaguesArticle report that neither a
standardized acupuncture regimen nor amitriptyline hydrochloride
afforded effective pain relief for patients with HIV-related peripheral
Heymsfield and colleaguesArticle found that
losses in body weight and fat mass were no different in overweight
patients treated with a high-fiber, low-energy diet and Garcinia
cambogia than in those treated with diet and placebo.
Garfinkel and colleaguesArticle report that patients
with carpal tunnel syndrome treated with yoga and relaxation techniques
had significant improvements in grip strength and pain reduction
compared with baseline.
Studdert and colleagues report that between 1990 and 1996 malpractice
claims against chiropractors, massage therapists, and acupuncturists
occurred less frequently than against physicians and the injuries were
In an editorial critically examining the relationship between
alternative medicine and conventional medicine, JonasArticle describes
the promise for advancing knowledge about diseases and healing that
resides at the interface of these practices. In a related editorial,
FontanarosaArticle and Lundberg emphasize that alternative therapies must be
evaluated by rigorous empirical testing.
"Neither the formulas of the past nor the technology of the
present proved to have any effect, beyond, perhaps, a certain
reassurance for user and receiver." Johannes de Ketham,
Fasciculus Medicinae, 1495, German.
Doings at the Office of Alternative Medicine, what's brewing among
proponents of botanicals, and who's queueing for light therapy.
"People in the United States are rushing toward alternative
therapies. What's going on?" From "Leeches, Spiders, and
Astrology: Predilections and Predictions."
Definitions, cultural aspects, and economic and
political factors have limited research on nonallopathic practices.Article
Ethical principles define the professional
obligations of physicians in relation to alternative medicine.Article
Complex methodological issues beset randomized
controlled trials to evaluate alternative therapies.Article
Progress is being made in the development of a
registry of clinical trials and a database of systematic reviews in
For your patients: A primer on alternative therapies.
This Week in JAMA. JAMA. 1998;280(18):1551. doi:10.1001/jama.280.18.1551