Heather Zwickey

Is Prayer CAM

BACKGROUND Alternative medicine researchers and policy makers have classified prayer as a mind-body intervention, and thus, a modality of complementary and alternative medicine (CAM). As such, numerous epidemiological surveys of CAM utilization-which have included prayer-depict increasing CAM use, particularly in specific racial and ethnic groups. OBJECTIVES This paper discusses the implications of conflating prayer and CAM, especially regarding the definitions of both concepts and the resulting statistics of CAM utilization.

One method for objective adherence measurement in mind-body medicine.

OBJECTIVES Home practice is frequently prescribed as part of mind-body medicine interventions, although rarely objectively measured. This brief methods report describes one method for objectively measuring home practice adherence using a custom monitoring software program. DESIGN Methods for objectively measuring adherence were developed as part of a randomized controlled trial on the mechanisms of mindfulness meditation. SETTINGS/LOCATION The study was conducted at Oregon Health & Science University, Portland, Oregon. SUBJECTS The subjects comprised 11 combat veterans with post-traumatic stress disorder. INTERVENTIONS The method used was mindfulness meditation. OUTCOME MEASURES There were subjective and objective adherence measurements of mindfulness meditation home practice. RESULTS The first iteration of objective adherence monitoring used an iPod device and had limitations in participant usage and correctly capturing data. In the second iteration, objective data were easily collected, uploaded, and viewed using the custom software application, iMINDr. Participants reported that iMINDr was straightforward to use, and they returned the monitoring units as directed. CONCLUSIONS The iMINDr is an example of a simple objective adherence measurement system that may help mind-body researchers examine how home practice adherence may affect outcomes in future clinical trials.

A train the trainer model for integrating evidence-based medicine into a complementary and alternative medicine training program

BACKGROUND Public interest in complementary and alternative medicine (CAM) has grown over the past decade, accompanied by increased demand for evidence-based approaches to CAM practice. In order to define the role evidence-based decision making has in CAM practice, CAM professionals must have a full understanding of evidence-based medicine (EBM) concepts. OBJECTIVE This paper describes the design, implementation, and evaluation of a week-long intensive EBM short course for CAM faculty at a naturopathic and classical Chinese medicine institution. INTERVENTION This 20-hour course, entitled Principles of EBM for CAM Professionals, teaches participants how to access and appraise biomedical literature, apply it to their work, and teach these concepts to their students. RESULTS Results from precourse and postcourse evaluations suggest that, in a small group of participants, there were significant changes in EBM practice attitudes, self-appraised skills, and objectively assessed skills as a result of this course. Participants indicated they were committed to increasing their use of EBM in practice, enhancing EBM skills, using EBM in teaching, and working to change the culture at their institution to support use of EBM. At six months, 80% of participants had fully or partially followed through on their commitment to change plans.

Mind-Body Medicine and Immune System Outcomes: A Systematic Review

This study is a systematic review of mind-body interventions that used immune outcomes in order to: 1) characterize mind-body medicine studies that assessed immune outcomes, 2) evaluate the quality of mind-body medicine studies measuring immune system effects, and 3) systematically evaluate the evidence for mind-body interventions effect on immune system outcomes using existing formal tools. 111 studies with 4,777 subjects were reviewed. The three largest intervention type categories were Relaxation Training (n=25), Cognitive Based Stress Management (n=22), and Hypnosis (n=21). Half the studies were conducted with healthy subjects (n=51). HIV (n=18), cancer (n=13) and allergies (n=7) were the most prominent conditions examined in the studies comprising of non-healthy subjects. Natural killer cell and CD4 T lymphocyte measures were the most commonly studied outcomes. Most outcome and modality categories had limited or inconclusive evidence. Relaxation training had the strongest scientific evidence of a mind-body medicine affecting immune outcomes. Immunoglobulin A had the strongest scientific evidence for positive effects from mind-body medicine. Issues for mind-body medicine studies with immune outcomes are discussed and recommendations are made to help improve future clinical trials.

In Vivo Effects of Ashwagandha (Withania somnifera) Extract on the Activation of Lymphocytes

OBJECTIVE This study investigated the immunologic effects of Ashwagandha (Withania somnifera) on four types of immune cells in a human sample to determine the immunologic mechanism. DESIGN Five (5) participants consumed 6 mL of an Ashwagandha root extract twice daily for 96 hours. Ashwagandha was administered with anupana (whole milk). Peripheral blood samples were collected at 0, 24, and 96 hours and compared for differences in cell surface expression of CD4, CD8, CD19, CD56, and CD69 receptors by flow cytometry. RESULTS Significant increases were observed in the expression of CD4 on CD3+ T cells after 96 hours. CD56+ NK cells were also activated after 96 hours as evidenced by expression of the CD69 receptor. At 96 hours of use, mean values of receptor expression for all measured receptor types were increased over baseline, indicating that a major change in immune cell activation occurred across the sample. CONCLUSIONS Effects on immune cell activation with use of Ashwagandha warrant further study.

Teaching evidence-based medicine at complementary and alternative medicine institutions: strategies, competencies, and evaluation.

BACKGROUND As evidence-based medicine (EBM) becomes a standard in health care, it is essential that practitioners of complementary and alternative medicine (CAM) become experts in searching and evaluating the research literature. In support of this goal, the National Institutes of Health (NIH) National Center for Complementary and Alternative Medicine (NCCAM) provided R25 funding to nine CAM colleges to develop individual programs focused on teaching EBM. An overarching goal of these research education grants has been to provide CAM faculty and students with the skills they need to apply a rigorous evidence-based perspective to their training and practice. METHODS/RESULTS This paper reviews the competencies and teaching strategies developed and implemented to enhance research literacy at all nine R25-funded institutions. While each institution designed approaches suitable for its research culture, the guiding principles were similar: to develop evidence-informed skills and knowledge, thereby helping students and faculty to critically appraise evidence and then use that evidence to guide their clinical practice. Curriculum development and assessment included faculty-driven learning activities and longitudinal curricular initiatives to encourage skill reinforcement and evaluate progress. CONCLUSION As the field of integrative medicine matures, the NIH-NCCAM research education grants provide essential training for future clinicians and clinician-researchers. Building this workforce will facilitate multidisciplinary collaborations that address the unique needs for research that informs integrative clinical practice.

Effect of the Probiotic Saccharomyces boulardii on Cholesterol and Lipoprotein Particles in Hypercholesterolemic Adults: A Single-Arm, Open-Label Pilot Study

OBJECTIVES Elevated blood cholesterol levels are a major risk factor for coronary artery disease, the leading cause of death worldwide. Probiotics have been investigated as potential cholesterol-lowering therapies, but no previous studies have assessed the effect of the probiotic yeast Saccharomyces boulardii on cholesterol levels in human volunteers. The objective of this study was to examine the effect of S. boulardii on serum cholesterol and lipoprotein particles in hypercholesterolemic adults. DESIGN This study was a single-arm, open-label pilot study. SUBJECTS Twelve hypercholesterolemic participants were recruited into the study; one dropped out. INTERVENTION Participants took 5.6×10(10) colony forming unit (CFU) encapsulated S. boulardii (Saccharomyces cerevisiae var. boulardii CNCM I-1079) twice daily for an 8-week period. OUTCOME MEASURES Fasting concentrations of cholesterol (total cholesterol, low-density lipoprotein-cholesterol [LDL-C], high-density lipoprotein-cholesterol [HDL-C], and triglycerides), lipoprotein particles (very-low-density lipoprotein-particle [VLDL-P], remnant lipoprotein particle [RLP-P], total LDL-P, LDL III-P, LDL IV-P, total HDL-P, and HDL 2b-P), and additional cardiovascular biomarkers (apo B-100, lipoprotein [a], high-sensitivity C-reactive protein, homocysteine, fibrinogen, and insulin) were measured at baseline, after 4 weeks, and after 8 weeks. RESULTS Remnant lipoprotein particles decreased by 15.5% (p=0.03) over the 8-week period. The remaining outcome measures were not significantly altered. CONCLUSIONS In this pilot study, 8 weeks of daily supplementation with S. boulardii lowered remnant lipoprotein, a predictive biomarker and potential therapeutic target in the treatment and prevention of coronary artery disease.

Proinflammatory cytokines and DHEA-S in women with fibromyalgia: impact of psychological distress and menopausal status

Though fibromyalgia is not traditionally considered an inflammatory disorder, evidence for elevated inflammatory processes has been noted in this disorder in multiple studies. Support for inflammatory markers in fibromyalgia has been somewhat equivocal to date, potentially due to inattention to salient patient characteristics that may affect inflammation, such as psychiatric distress and aging milestones like menopause. The current study examined the relationships between proinflammatory cytokines and hormone levels, pain intensity, and psychological distress in a sample of 34 premenopausal and postmenopausal women with fibromyalgia. Our results indicated significant relationships between interleukin-8 and ratings of pain catastrophizing (r=0.555, P<0.05), pain anxiety (r=0.559, P<0.05), and depression (r=0.551, P<0.05) for postmenopausal women but not premenopausal women (r,0.20 in all cases). Consistent with previous studies, ratios of interleukin-6 to interleukin-10 were significantly lower in individuals with greater levels of depressive symptoms (r=−0.239, P<0.05). Contrary to previous research, however, dehydroepiandrosterone sulfate did not correlate with pain intensity or psychological or biological variables. The results of the current study highlight the importance of psychological functioning and milestones of aging in the examination of inflammatory processes in fibromyalgia.

A telemetric study of physiologic changes in mice with induced autoimmune encephalomyelitis.

Dysfunction of the autonomic nervous system may be an important component of disease progression in multiple sclerosis (MS), a paralytic inflammatory autoimmune disease of the central nervous system. Using the experimental autoimmune encephalomyelitis mouse model of MS, the authors carried out a pilot study to investigate whether telemetric monitoring might be a feasible approach for detecting disturbances in the autonomic control of heart rate and blood pressure after disease induction. Telemetric monitoring devices that were implanted in mice provided useful information regarding the physiologic changes that accompanied disease induction and progression. Changes were observed in heart rate, blood pressure, heart rate variability and diurnal rhythm immediately before and after disease onset. The device implantation procedure did not seem to alter the course of disease. Further investigation may establish these methods as a system for studying the relationships between MS progression and autonomic regulation of physiological status.

The Sugar Study: A Monograph for In-Class Research with Medical Students

Introduction Evidence based medicine (EBM) calls for physicians to read and understand research, and EBM training has been integrated in medical education.1,2 After many years of EBM education in medical schools, studies are starting to demonstrate the ineffectiveness of certain methods of EBM training.3-5 Although lectures in EBM can address research knowledge, they may not change clinician skills and behavior.6 If students do not understand the research process, they many not fully grasp the quality of the research they are reading.