Debriefing: Updates in Integrative Medical Research

Richard Palmquist, DVM
The Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) sponsored a One-Day Symposium in Integrative Medicine and Health on October 26, 2011. The event occurred at the beautiful Palomar Hotel in West Los Angeles conveniently located near the UCLA campus. I thoroughly enjoyed this event. I was delighted when I was invited, and I thought I'd share my enthusiasm by providing a debriefing for your enjoyment and information.

In 1999, representatives of eight academic medical institutions met in Michigan and strove to improve and develop the field of integrative medicine. Since that time the Consortium has grown to 51 esteemed academic health centers (Yale, Harvard, Boston University, Duke University, etc.) and is supported by a private philanthropic grants and memberships.

CAHCIM has three stated goals:

• Support and mentor academic leaders, faculty, and students to advance integrative healthcare curricula, research, and clinical care.
• Disseminate information on rigorous scientific research, educational curricula in integrative health and sustainable models of clinical care.
• Inform health care policy

For further information visit www.imconsortium.org

This year was the first time for the CAHCIM to put on the One-Day Symposium and it seemed to be very well received. Over 80 representatives of various academic medical centers attended.

The event began with a Keynote address by John (Jack) Killen, Jr., M.D. who is currently the Deputy Director of National Center for Complementary and Alternative Medicine (NCCAM). He is board certified in internal medicine and oncology and has pursued additional training in end-of-life care and mind-body medicine. His career as a researcher involved work on HIV/AIDS. He is an award winning public health professional. NCCAM is part of the NIH and is involved in funding research in CAM. He began his talk by saying, "Trust me, I am from the government," which got a big laugh. He proceeded to explain how excited NCCAM is to apply the agency's $129 million budget in its work with qualified CAM researchers and practitioners. He pointed out that the NCCAM goals and those of private CAM providers were well aligned as our successes in CAM research are their successes as well.
Information on NCCAM is available at www.nccam.nih.gov

Dr Killen stated that the vision of NCCAM is to use scientific evidence to inform decision-making by health professionals, patients and health care policymakers. He explained several parts of the 2011 Strategic Plan for NCCAM (http://nccam.nih.gov/about/plans/2011/).

Some salient points of this include:

• The overall goal is simply to improve science and develop effective, practical and personalized strategies for providing better health care.
• NCCAM is interested in two basic categories of research: (1) Natural products, and (2) Mind-Body Interventions. They fund research on only these two categories unless very special concerns. Other CAM research is done under other NIH areas but NCCAM is limited in its scope to these two areas.
• Due to restriction in governmental funding NCCAM's budget reduced by about 1.5% this year and the budget for 2012 is unclear. For this reason it is focusing its efforts to more specific areas. Two areas of special interest are pain and hospice as these areas directly benefit from CAM. 
• The Department of Defense is highly interested in CAM treatments for PTSD, brain injury and are spending large amounts of money to improve care of veterans with these health challenges.
• Generally NCCAM is mapping this path for each request: (1) Is there science or evidence for the intervention?; (2) Can the intervention be studied with proper scientific method?; (3) Can the modality or intervention be integrated into health care procedures?; and (4) Is the intervention important to medical consumers, professional care givers or policy makers?
• NCCAM is very interested in augmenting and improving all spheres of medical research including: (1) Basic science research; (2) Translational medicine; (3) Efficacy studies; (4) Outcome and Effectiveness research. We can view the professional and patient inside a circle of these spheres of knowledge as they explore each area, become informed, and assess risk and efficacy of each potential therapy. By approaching health care in this patient centered, evidence informed model, we hope to improve health care outcomes and budgetary efficiency.

Following Dr Killen's lecture we heard a series of oral presentations covering several topics:

• Dr Jain of UC San Diego, Samueli Institute presented "Complementary medicine for fatigue and cortisol variability in breast cancer survivors: A Randomized Controlled Trial" (Cancer. 2011 Aug 5. doi: 10.1002/cncr.26345). Fatigue is a major problem for women recovering from breast cancer. These patients can suffer with severely debilitating fatigue even 10 years after treatment. Dr Jain concluded that nonspecific factors are important in responses to biofield interventions for fatigue. Belief predicts QOL responses but not fatigue or cortisol variability. Biofield therapies increase cortisol variability independent of belief and other nonspecific factors. There is a need to further examine the effects of specific processes of biofield healing on outcomes for cancer populations. (http://www.ncbi.nlm.nih.gov/pubmed/21823103)
• Yale researcher and naturopath Ather Ali presented, "Massage therapy for osteoarthritis of the knee: A randomized dose-finding trial," which determined the optimal massage dose for management of osteoarthritis of the knee to be 60-minute sessions once weekly. Now that the dose finding study is done larger studies are planned to determine more data regarding this simple and safe procedure. Study participants showed improvement in pain scores, subjective parameters and timed 50-foot walk.
• Maria Chaio, DrPH, MPA of UCSF Osher Center for Integrative Medicine examined "Disparate Use of Complementary and Alternative Medicine: Unrealized Public Health Opportunities."
• Daniel Dickerson, DO, MPH of UCLA, Integrative Substance Abuse Program presented groundbreaking research in "The Development of Drum-Associated Recovery Therapy for Native Americans (DARTNA)." The use of drumming is an ancient spiritual practice for Native Americans and is being examined as part of an integrated program involving spiritual education, community connectivity and a 12-step approach. Results are ongoing.
• Several other oral papers were presented as researchers examine unique delivery systems such as community based acupuncture clinics and a university program involving spiritual training for third- and fourth-year medical students at University of Minnesota.

While we ate lunch, we broke into special discussion groups. I lunched with a group of people working on mixed research methods for examination of CAM. It was fascinating to hear all the work that is being done and also heartening to see interdisciplinary cooperation and community involvement in this work. Each group has its abilities and strengths and we are seeing incredible cooperation and group building to accomplish the work.

After lunch I spent a long time in poster sessions. There were several papers on pancreatic cancer and the use of Apigenin and Baicalien from UCLA, and some in vitro research involving colloidal silver and polymorphonuclear leukocytes of healthy humans from Vitaline Educational Centre. These were interesting but not sufficient to base any new therapies upon at this time.

As a veterinarian who has long used high dose ascorbic acid in treatment of neoplasia in animals, I was very happy to see a study by Garrett Sullivan, MD at University of Kansas Medical Center, which examined the concurrent use of glutathione and high dose ascorbic acid. These two agents interfere with one another and should not be used concurrently, and this is a great example of how veterinarians would never see this article as we don't read the publication as a common source.

Here is the abstract:

Free RadicBiol Med. 2011 Aug 1;51(3):681-7. Epub 2011 May 30.
Anti-cancer effect of pharmacologic ascorbate and its interaction with supplementary parenteral glutathione in preclinical cancer models
Chen P, Stone J, Sullivan G, Drisko JA, Chen Q.Source: Program in Integrative Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA.
Abstract: Two popular complementary, alternative, and integrative medicine therapies, high-dose intravenous ascorbic acid (AA) and intravenous glutathione (GSH), are often coadministered to cancer patients with unclear efficacy and drug-drug interaction. In this study we provide the first survey evidence for clinical use of iv GSH with iv AA. To address questions of efficacy and drug-drug interaction, we tested 10 cancer cell lines with AA, GSH, and their combination. The results showed that pharmacologic AA induced cytotoxicity in all tested cancer cells, with IC(50) less than 4 mM, a concentration easily achievable in humans. GSH reduced cytotoxicity by 10-95% by attenuating AA-induced H(2)O(2) production. Treatment in mouse pancreatic cancer xenografts showed that intraperitoneal AA at 4 g/kg daily reduced tumor volume by 42%. Addition of intraperitoneal GSH inhibited the AA-induced tumor volume reduction. Although all treatments (AA, GSH, and AA+GSH) improved survival rate, AA+GSH inhibited the cytotoxic effect of AA alone and failed to provide further survival benefit. These data confirm the pro-oxidative anti-cancer mechanism of pharmacologic AA and suggest that AA and GSH administered together provide no additional benefit compared with AA alone. There is an antagonism between ascorbate and glutathione in treating cancer, and therefore iv AA and iv GSH should not be coadministered to cancer patients on the same day.
 

Overall this was a lovely and informative day. We have great help developing in improving the evidence available to all branches of medicine and it is nothing but wonderful to see science being more fully applied. The future of medicine is bright indeed as formerly isolated professions open up, reach out and exchange vital information. It is an exciting time for all involved.

I left invigorated and fully revitalized to get more support for the AHVMA Foundation (www.foundation.ahvma.org) and its mission to raise $20 million for veterinary school program enhancement and improved research in CAVM and integrative veterinary practice.

It's great to be here at CIVT where evidence-based approaches to learning are so well supported. Enjoy your courses and help lots of people and their animals. In the end that is what this is all about!