Alternative medicines need more study

January 23, 2017 by Sharon Adams

Serving military members and veterans with chronic health conditions frequently look beyond traditional medicine in their search for something—anything—to relieve symptoms that are making their lives miserable, or in bureaucratese, “affecting their quality of life.”

Often they’re forking out their own money (or veterans’ advocacy groups are doing so on their behalf) to pay for treatments and remedies that do not meet the bureaucratic standard of “evidence-based treatments.” Yet stories abound of veterans whose symptoms have been relieved or at least eased by a service dog, communing with nature, meditation, music, art—even recreational drugs.

But how can veterans tell before they pony up whether it will be money well spent…or money down the drain?

It’s not easy, assuming no one wants to rely solely on product advertising.

Anyone who wants to check on new mainstream medical treatments and drugs can find published results of trials in peer-reviewed journals, often online. But a review published in 2014 of the state of research into complementary and alternative medicine (CAM) practices used by serving military and veterans says there hasn’t been much research on this anywhere in the world. And there’s a dearth of randomized control trials, which show how randomly-chosen patients do with one treatment compared to others receiving different treatment, or no treatment at all. Since no one knows which patients are being treated, the results are less biased.

“Evidence suggests that many CAM practices are beneficial for individuals with a wide range of health care problems,” said the report. But suggestion is a long way from validation.

Although there are a few Canadian studies, most of the research into military and veteran use of CAM is being done in the United States, which has a pool of 22 million veterans and 1.3 million currently in uniform, not to mention a huge concentration of researchers. Aside from concern about protecting and promoting health, there is an economic angle, too: if use of a complementary medicine technique bestows even a small benefit on the hundreds of thousands in medical treatment, it can have a big effect on budgets of the defence and veterans departments. 

Use of CAM techniques is common and increasing among U.S. military and veterans with mental health problems, says the U.S. Department of Veterans Affairs National Center for PTSD website. Although there is not much evidence to prove its effectiveness, CAM, particularly biofeedback and relaxation techniques, are used by veterans with PTSD. The website discusses research into acupuncture, meditation, relaxation, yoga and EFT (emotional freedom techniques) therapy.

Another VA website has updates on recent research supporting or disproving effectiveness of various CAM methods. But what if no conclusion has been reached about a particular method, or it’s not been researched?

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“Sound health advice,” says a Mayo Clinic website on assessing CAM methods, “is generally based on a body of research, not a single study.” So more information from more sources is better. It advises being open-minded, but skeptical about claims, since not all have been studied to determine how effective they are, or how safe.

Online sources are usually the first stop in personal health research. The clinic advises beginning by weeding out bad information.
Is the information provided recent, and if not, is there something more recent? Is it provided by a health professional whose credentials should be listed and can be checked, or an actor dressed in a white coat with a stethoscope draped around the neck?

Is [health information] provided by
a health professional whose credentials
should be listed and can be checked, or
an actor dressed in a white coat?

 

The Integrative Health Institute web page at Mount Royal University in Calgary advises caution with anonymous testimonials: “Could you locate any of these people if you wanted to follow up?”

Check studies listed on websites, but beware of recommendations based on animal studies (results may not be the same in humans) or on a small number of people. Results from long, large or repeated randomized control studies are best. The U.S. study mentioned earlier looked at 1,819 studies; one on utilization of CAM by U.S. veterans used data from a study of 20,563 subjects. A study verifying the effectiveness of prolonged exposure therapy for military PTSD looked at results of 1,931 veterans and 804 clinicians. Alas, there are few such large-scale studies on veterans’ use of many complementary and alternative methods.

The first tenet of medical practice is “do no harm,” and that’s a good place to start when considering complementary and alternative practices, too.

If you are on any medication, talk to your doctor before taking dietary supplements or herbal remedies—even if there is good evidence to support their use. There could be drug interactions. Even vitamins and minerals can reduce effectiveness of some prescribed medications—or make them more potent. A pharmacist is also a good resource for advice on whether a supplement will help—or just be an added expense.

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