The Program for Integrative Medicine and Health Care Disparities conducts research in several areas relevant to underserved or ethnic minority populations.
Complementary and Alternative Medicine (CAM) therapies such as supplements, meditation, yoga, massage, and acupuncture are increasingly popular in the U.S. Studies estimate over one-third of U.S. adults use CAM therapies while approximately one of ten children use them. Well-designed research studies need to be carried out to determine which of these complementary therapies are safe and effective and should be therefore integrated into mainstream clinical care. Conversely, if research identifies practices that may be ineffective or unsafe, their use should be strongly discouraged and not combined with conventional medicine.
National surveys also show, however, disparities in CAM use based upon race, income, and education. For example, CAM use is much less common in non-whites, Hispanics, the poor, and people with less education. Although CAM research has increased dramatically in the previous two decades, relatively little has been done with minority or low income individuals.
Our research at the Program for Integrative Medicine and Health Disparities focuses on why these disparities in CAM use exist, their implications, and strategies to address them. As federal, private, and academic stakeholders invest millions of dollars into CAM research, it is imperative that we study the feasibility and effectiveness of CAM and integrative medicine in multicultural communities and vulnerable populations.
Yoga Use in the United States
Yoga will teach you how to use your mind as a resource for healing, instead of feeling at the mercy of an unpredictable body.
Yoga originated in India over 2000 years ago as a complex system of physical, moral, and spiritual principles. Yoga means ‘unify’ in Sanskrit and its traditional purpose was to help the practitioner attain unity of “mind, body, and spirit.” Hatha yoga became popular in the United States during the 1960s. Hatha yoga consists of three core components: physical postures (asanas), breathing techniques (pranayama), and an inward meditative focus.
Dr. Saper and colleagues published the first analysis of U.S. yoga use in their 2004 publication in Alternative Therapies in Health and Medicine. Data from a 1998 national survey of American CAM use were analyzed and they found that 3.8% of the U.S. adult population used yoga in 1998. Twenty-three percent of yoga users were non-white and 21% had an annual income less than $20,000. Ninety percent of respondents who used yoga for specific health conditions perceived it as helpful. Back pain was the most common health condition for the use of yoga: 21% of yoga users reported using yoga for back pain. Gurjeet Birdee MD of Harvard Medical School, Dr. Saper, and colleagues also analyzed data from the 2002 National Health Interview Survey showing that yoga use is increasing: 5.1% of American adults reported using yoga in 2002, making it the fifth most common CAM therapy.
Yoga for Chronic Low Back Pain
Back pain contributes substantially to morbidity, disability, and cost in our society. The impact of low back pain on poor ethnic minority patients may be compounded by health care disparities that impact access to medical providers, CAM providers, adequate pain medications and specialty referrals. Yoga for Low Back Pain (YLBP) was a pilot randomized controlled trial of hatha yoga versus usual medical care for 30 predominantly minority adults with chronic low back pain conducted at two Boston community health centers, Dorchester House Multiservice Center and Codman Square Health Center. We were interested in whether a diverse urban population of back pain sufferers with little previous experience with yoga would enroll in such a study. The results were extremely promising. We had over 200 inquiries and completed enrollment within two months. YLBP found that participants receiving yoga in comparison to those who did not receive yoga had less pain, improved back-related function, and took less pain medication. Our results were presented at the 2009 North American Research Conference in Complementary & Integrative Medicine and was published in the November-December 2009 issue of Alternative Therapies in Health and Medicine. The study was funded through a Career Development Award to Robert Saper, MD MPH from the NIH National Center for Complementary Alternative Medicine.In 2010 Dr. Saper received another NCCAM grant to conduct a comparative effectiveness randomized controlled trial of hatha yoga, physical therapy, and education for chronic low back pain in low income minority populations. In 2011 he conducted a Yoga Dosing Study, Yoga for Low Back Pain 2, which was designed to determine the best dose of yoga for chronic low back pain.
Traditional Systems of Indian Medicine
These Indian systems of medicine and homeopathy received a major boost about a decade ago when they were given an independent identity under the health and family welfare ministry. In 2003, the department was renamed AYUSH.
Traditional Indian Systems of Medicine (TISM) such as Ayurveda and Siddha originated in South Asia over 2000 years ago and are practiced by an estimated 80% of India’s 1.1 billion population. TISM are widely believed in India to be safe and effective. However, we reported in the Journal of American Medical Association in 2004 that 20% of imported South Asian herbal remedies sold in Boston ethnic markets contained potentially harmful levels of lead, mercury, and/or arsenic. A follow-up study published in 2008 also in the Journal of American Medical Association found 21% of TISM medicines sold on the Internet contained detectable levels of these metals. These products were manufactured in both India and the U.S. with similar percentages containing metals.
The CDC reported 12 cases of lead poisoning associated with TISM medicines in five U.S. states between 2000-2003. Contamination from the environment and manufacturing processes are likely partly responsible for the problem. However, TISM experts also describe intentionally adding to herbal formulations bhasmas, which are compounds made with mercury, lead, arsenic, iron, zinc, and other metals. Bhasmas are prepared through an elaborate process that is claimed to change the form of the metal rendering it nontoxic and therapeutic. Recent press resulting from our publications and others have raised global safety concerns and prompted import bans by Canada, USA, Australia, and others. This has generated debate and controversy among key stakeholders within India including TISM practitioners, allopathic physicians, public health professionals, TISM industry, and government.
Our findings were a major impetus causing the Government of India to establish new standards for toxic contaminants in exported Ayurvedic medicines. We have subsequently developed numerous collaborations with traditional practitioners and scientists in the U.S., Canada, and India. We are committed to safe and effective traditional medicine use throughout the world. However, modern scientific methods need to be applied to determine which parts of these traditions are safe, effective, and therefore should be disseminated and promoted; and conversely which aspects are unsafe or ineffective and should therefore be stopped.
Herbs and Dietary Supplements
Many people take herbs and dietary supplements in an effort to stay healthy. A 2007 study found that 52% of adults took at least one supplement as part of their daily regimen. In addition to vitamins like vitamin E, C and B, common supplements include fish oil, glucosamine, and flaxseed oil. Research has shown that some dietary supplements may be effective in preventing or treating disease. For example, folic acid helps prevent certain birth defects, and vitamin D and calcium can help prevent and treat bone loss and osteoporosis (Source: http://nccam.nih.gov/health/supplements/wiseuse.htm). Dr. Gardiner researches herbs and dietary supplements, with particular focus on adverse event reporting of dietary supplements and dietary supplements and pregnancy.
The Society for Oncology Massage (S4OM) addresses the varying needs of the touch practitioner, consumer, and health professional, and provides resources for advancing the knowledge and understanding of oncology massage.
The majority of cancer patients receiving chemotherapy undergo implantation of a permanent central venous access device, often referred to as a port. The port serves as a permanent intravenous device (IV) to deliver chemotherapy. Implantation of the port is an outpatient surgical procedure using local anesthetic only. Patients remain conscious, must keep their head rotated 90 degrees to one side and remain very still during this delicate procedure, which takes approximately 60 minutes. Although the port carries obvious multiple benefits for ease of treatment, after the procedure patients often complain of headaches, muscle stiffness and neck and shoulder pain that lasts for several days. Pain medication is the only therapy commonly offered for this and is often inadequate. Furthermore, since this is often the first surgical procedure for cancer patients at the beginning of their treatment, they often have significant levels of pre-procedure anxiety. Safe, efficacious, and cost-effective interventions that can reduce the anxiety and pain related to port placement are needed.
We are conducting a nine-month pilot RCT of 60 predominantly low-income, minority, cancer patients at Boston Medical Center undergoing Port-a-Catheter placement to assess the feasibility and efficacy of massage therapy for reducing pre-operative anxiety and post-operative pain. The study is supported by a grant from the Massage Therapy Foundation.
Acupuncture is among the oldest healing practices in the world. Acupuncture is one of a number of techniques that comprise a whole medical system called traditional Chinese medicine (TCM). Traditional Chinese Medicine considers the health and balance of the entire system: body, mind, spirit, emotions and environment. The body is understood to be a balance of two opposing and inseparable forces: yin and yang. According to TCM, health is achieved by maintaining the body in a “balanced state” of these two forces. In acupuncture the stimulation of specific points on the body by a variety of techniques, including the insertion of thin metal needles though the skin helps the body maintain or regain it’s balance. According to the 2007 National Health Interview Survey, which included a comprehensive survey of CAM use by Americans, an estimated 3.1 million U.S. adults and 150,000 children had used acupuncture in the previous year. Relatively few complications from the use of acupuncture have been reported to the FDA, in light of the millions of people treated each year and the number of acupuncture needles used.
In 2007 we published a paper describing the establishment of free-care acupuncture clinics within Boston Medical Center with an underserved minority adolescent population. During 2004-2006 the acupuncture clinic had 544 visits for a wide range of conditions, including headaches, a wide variety of pain syndromes, gynecological issues, and gastro-intestinal problems. Visits increased 65 % from the first to the third year of operation. In 2008-2009 we surveyed adult users of two free-care acupuncture clinics at Boston Medical Center. This pilot study surveyed patients satisfaction and perceived helpfulness of acupuncture. Over 24 months, a total of 720 acupuncture treatments were administered, consisting of 144 new patient visits and 576 follow-up visits. Overall satisfaction with acupuncture was reported as either “Very Good” or “Good” in 95% of all surveys. Only 1% of respondents reported that they would not use acupuncture again and 93% stated they would recommend acupuncture to friends or family.This health blog has been provided to you by www.myreliever.com