Complementary and Alternative Medicine Usage by Multiple Sclerosis Patients: Results from a Prospective Clinical Study.

OBJECTIVES: To investigate the factors associated with complementary and alternative medicine (CAM) usage by multiple sclerosis (MS) patients. Design, Setting/Location: Single-center, prospective clinical study at an academic MS center in the northeastern United States. METHODS: This study included CAM data from 524 MS patients and 304 healthy controls (HC) enrolled in a prospective study of clinical, neuroimaging, and environmental risk factors in MS at an academic MS Center. Clinical, neuroimaging, and disease-modifying treatment data were obtained. In addition, data on usage of CAM modalities, including acupuncture, aromatherapy, Ayurveda, Chinese herbal medicine, chiropractor, electromagnetic therapy, homeopathy, hypnosis, massage, naturopathy, Qi gong, Reiki, therapeutic touch, and bee stings were collected in an in-person interview. RESULTS: The percentages of HC reporting usage of any CAM (32%) was similar to that in MS patients after diagnosis (30.5%). The usage of any CAM was higher in MS patients after MS diagnosis compared to before MS diagnosis (p < 0.001). The three most frequently used CAM for MS patients after MS diagnosis and HC were chiropractor, massage, and acupuncture. The most frequent reasons for CAM use were MS symptom relief, back problems, and pain. In multivariate analysis, female gender, higher education level, MS disease course, and not currently on disease-modifying therapies (DMT) treatment status were associated with CAM usage. CONCLUSIONS: Gender, education level, DMT treatment status, and MS disease course are associated with CAM usage in MS patients. Ever-CAM usage patterns in MS patients are similar to those in HC.

Use of alternative therapies by a low income population.

Patients in a family health center clinic were surveyed about their use of alternative/complementary medicine. These were mostly low-income individuals on Medicaid. The aim was to estimate prevalence and patterns of use of medically unconventional therapies such as chiropractic, homeopathy, and acupuncture in this population. Nearly two hundred patients (N = 199) filled out questionnaires inquiring about medical conditions and illnesses, personal health habits (physical activity, tobacco smoking, alcohol intake, etc.), and use of preventive measures or therapies that are neither taught widely in US medical schools nor generally available in US hospitals, and which we refer to as 'alternative' therapies (ATs). The term 'alternative' is not intended to imply that ATs are necessarily chosen to replace, rather than to be used in combination with standard treatments, although that may indeed be so in specific cases. Twenty-nine percent of respondents (58/199) reported using at least one type of AT, as defined for the purposes of the survey. Frequency of use varied somewhat, with greatest AT use reported by those over 29 years of age with more education and higher incomes (p < 0.10, defined as chi 2 tests at p < 0.10). While no significant differences were found between AT users and nonusers with respect to exercise participation, alcohol intake or smoking, there was a difference with respect to the reporting of at least one medical condition (p < 0.01). Among those who have used ATs, 90% reported more than one medical condition. Of those reporting no AT use, 70% indicated only a single medical condition for which they had sought treatment. In conclusion, use of alternative therapy (AT) appears to be common in all socio-economic groups, although AT use is apparently slightly less among low-income persons than in the general population. It is therefore important for physicians and other medical providers to be aware that their patients may be using ATs. Obviously, such practices should be taken into account in case management.

Medicine in the USA: historical vignettes. IX. The AMA sets a new code of ethics.

KIE: This ninth in a series of historical vignettes describes how the adoption in 1882 of a new code of ethics by the Medical Society of the State of New York resulted in the Society's expulsion from the American Medical Association, the creation of a rival New York State Medical Association, and a schism in American medicine that lasted for 20 years. The cause of the schism was a clause in the Society's code which allowed "consultation with legally qualified practitioners of medicine," in effect including homeopaths. King traces the controversy over homeopathy to its extinction as an issue and its resolution in the new code of ethics adopted by the AMA in 1905.^ieng