Menstuff has compiled the following information on Alternative and Complementary Medicine.

There are many terms used to describe approaches to health care that are outside the realm of conventional medicine as practiced in the United States. This fact sheet explains how the National Center for Complementary and Alternative Medicine (NCCAM), a component of the National Institutes of Health, defines some of the key terms used in the field of complementary and alternative medicine (CAM). A dictionary of terms can be found at the end of this fact sheet. NCCAM is dedicated to exploring complementary and alternative medical practices in the context of rigorous science, training CAM researchers, and disseminating authoritative information to the public and professionals. A look at the alternative in medicine A $1 million study by the Institute of Medicine, part of the U.S. National Acadmeies, will examine the scientific and policy implications of complementary and alternative medicine by Americans. HealthScoutNews, November 9. -- A $1 million study lasting nearly two years will examine the scientific and policy implications of the use of complementary and alternative medicine by Americans. The study will be conducted by the Institute of Medicine (news - web sites) (IOM), a part of the U.S. National Academies For the study, the IOM will enlist about 16 experts from a variety of fields including behavioral medicine, internal medicine, nursing, epidemiology, pharmacology, healthcare research and administration, and education. The expert panel will assess research findings on complementary and alternative medicine, hold workshops and invite speakers to address the panel. When completed the study will: offer a comprehensive overview of the use of complementary and alternative therapies by Americans; identify important scientific and policy issues connected to complementary and alternative medicine research, regulation, certification, training and integration; and develop a conceptual framework to help with decisions being made in connection with those issues. About complementary and alternative medicine. The Basics: Acupuncture/Acupressure, Alexander Technique, Apitherapy, Aromatherapy, Ayurvedic Medicine, Biofeedback, Chiropractic, Herbal Medicine, Homeopathy, Macrobiotics, Massage, Naturopathic Medicine, Qi-Gong, Reflexology, Therapeutic Touch, Trager Mentastics, and Transcutaneous Electrical Nerve Stimulation What is complementary and alternative medicine? Complementary and alternative medicine, as defined by NCCAM, is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine.1,2 While some scientific evidence exists regarding

some CAM therapies, for most there are key questions that are yet to be answered through well-designed scientific studies questions such as whether they are safe and whether they work for the diseases or medical conditions for which they are used. The list of what is considered to be CAM changes continually, as those therapies that are proven to be safe and effective become adopted into conventional health care and as new approaches to health care emerge. Are complementary medicine and alternative medicine different from each other? Yes, they are different. Complementary medicine is used together with conventional medicine. An example of a complementary therapy is using aromatherapy to help lessen a patient's discomfort following surgery. Alternative medicine is used in place of conventional medicine. An example of an alternative therapy is using a special diet to treat cancer instead of undergoing surgery, radiation, or chemotherapy that has been recommended by a conventional doctor. What is integrative medicine? Integrative medicine, as defined by NCCAM, combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness. What are the major types of complementary and alternative medicine? NCCAM classifies CAM therapies into five categories, or domains: Alternative Medical Systems are built upon complete systems of theory and practice. Often, these systems have evolved apart from and earlier than the conventional medical approach used in the United States. Examples of alternative medical systems that have developed in Western cultures include homeopathic medicine and naturopathic medicine. Examples of systems that have developed in non-Western cultures include traditional Chinese medicine and Ayurveda. Mind-Body Interventions use a variety of techniques designed to enhance the mind's capacity to affect bodily function and symptoms. Some techniques that were considered CAM in the past have become mainstream (for example, patient support groups and cognitive-behavioral therapy). Other mind-body techniques are still considered CAM, including meditation, prayer, mental healing, and therapies that use creative outlets such as art, music, or dance.

Biologically Based Therapies use substances found in nature, such as herbs, foods, and vitamins. Some examples include dietary supplements,3 herbal products, and the use of other so-called "natural" but as yet scientifically unproven therapies (for example, using shark cartilage to treat cancer). Manipulative and Body-Based Methods are based on manipulation and/or movement of one or more parts of the body. Some examples include chiropractic or osteopathic manipulation, and massage. Energy Therapies involve the use of energy fields. They are of two types: 1. Biofield therapies are intended to affect energy fields that purportedly surround and penetrate the human body. The existence of such fields has not yet been scientifically proven. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in, or through, these fields. Examples include qi gong, Reiki, and Therapeutic Touch. 2. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields, or alternating current or direct current fields. What is NCCAM's role in the field of complementary and alternative medicine? NCCAM is the Federal Government's lead agency for scientific research on complementary and alternative medicine. NCCAM's mission is to explore complementary and alternative healing practices in the context of rigorous science, to train CAM researchers, and to inform the public and health professionals about the results of CAM research studies. Notes

1 Conventional medicine is medicine as practiced by holders of M.D. (medical doctor) or D.O. (doctor of osteopathy) degrees and by their allied health professionals, such as physical therapists, psychologists, and registered nurses. Other terms for conventional medicine include allopathy; Western, mainstream, orthodox, and regular medicine; and biomedicine. Some conventional medical practitioners are also practitioners of CAM. 2 Other terms for complementary and alternative medicine include unconventional, nonconventional, unproven, and irregular medicine or health care. 3 Some uses of dietary supplements have been incorporated into conventional medicine. For example, scientists have found that folic acid prevents certain birth defects, and a regimen of vitamins and zinc can slow the progression of an eye disease called agerelated macular degeneration (AMD).

Dictionary of Terms

Aromatherapy ("ah-roam-uh-THER-ah-py"): Aromatherapy involves the use of essential oils (extracts or essences) from flowers, herbs, and trees to promote health and well-being. Ayurveda ("ah-yur-VAY-dah") is a CAM alternative medical system that has been practiced primarily in the Indian subcontinent for 5,000 years. Ayurveda includes diet and herbal remedies and emphasizes the use of body, mind, and spirit in disease prevention and treatment. Chiropractic ("ki-roh-PRAC-tic") is a CAM alternative medical system. It focuses on the relationship between bodily structure (primarily that of the spine) and function, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. Dietary supplements: Congress defined the term "dietary supplement" in the Dietary Supplement Health and Education Act (DSHEA) of 1994. A dietary supplement is a product (other than tobacco) taken by mouth that contains a "dietary ingredient" intended to supplement the diet. Dietary ingredients may include vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, and metabolites. Dietary supplements come in many forms, including extracts, concentrates, tablets, capsules, gelcaps, liquids, and powders. They have special requirements for labeling. Under DSHEA, dietary supplements are considered foods, not drugs. Electromagnetic fields: Electromagnetic fields (EMFs, also called electric and magnetic fields) are invisible lines of force that surround all electrical devices. The Earth also produces EMFs; electric fields are produced when there is thunderstorm activity, and magnetic fields are believed to be produced by electric currents flowing at the Earth's core. Homeopathic ("home-ee-oh-PATH-ic") medicine is a CAM alternative medical system. In homeopathic medicine, there is a belief that "like cures like" meaning that small, highly diluted quantities of medicinal substances are given to cure symptoms, when the same substances given at higher or more concentrated doses would actually cause those symptoms. Massage ("muh-SAHJ") therapists manipulate muscle and connective tissue to enhance function of those tissues and promote relaxation and well-being. Naturopathic ("nay-chur-o-PATH-ic") medicine is a CAM alternative medical system in which practitioners work with natural healing forces within the body, with a goal of helping the body heal from disease and attain better health. Practices may include dietary modifications, massage, exercise, acupuncture, minor surgery, and various other interventions.

Osteopathic ("ahs-tee-oh-PATH-ic") medicine is a form of conventional medicine that, in part, emphasizes diseases arising in the musculoskeletal system. There is an underlying belief that all of the body's systems work together, and disturbances in one system may affect function elsewhere in the body. Some osteopathic physicians practice osteopathic manipulation, a full-body system of hands-on techniques to alleviate pain, restore function, and promote health and well-being. Qi gong ("chee-GUNG") is a component of traditional Chinese medicine that combines movement, meditation, and regulation of breathing to enhance the flow of qi (an ancient term given to what is believed to be vital energy) in the body, improve blood circulation, and enhance immune function. Reiki ("RAY-kee") is a Japanese word representing Universal Life Energy. Reiki is based on the belief that when spiritual energy is channeled through a Reiki practitioner, the patient's spirit is healed, which in turn heals the physical body. Therapeutic Touch is derived from an ancient technique called laying-on of hands. It is based on the premise that it is the healing force of the therapist that affects the patient's recovery; healing is promoted when the body's energies are in balance; and, by passing their hands over the patient, healers can identify energy imbalances. Are You Considering Using Complementary and Alternative Medicine?

Introduction Decisions about your health care are important including decisions about whether to use complementary and alternative medicine (CAM). The National Center for Complementary and Alternative Medicine (NCCAM) has developed this fact sheet to assist you in your decisionmaking about CAM. It includes frequently asked questions, issues to consider, and a list of sources for further information. Key Points Take charge of your health by being an informed consumer. Find out what scientific studies have been done on the safety and effectiveness of the CAM treatment in which you are interested. Decisions about medical care and treatment should be made in consultation with a health care provider and based on the condition and needs of each person. Discuss information on CAM with your health care provider before making any decisions about treatment or care. If you use any CAM therapy, inform your primary health care provider. This is for your safety and so your health care provider can develop a comprehensive treatment plan.

If you use a CAM therapy provided by a practitioner, such as acupuncture, choose the practitioner with care. Check with your insurer to see if the services will be covered. Questions to ask when evaluating Web site information: Who runs the site? Is it government, a university, or a reputable medical or healthrelated association? Is it sponsored by a manufacturer of products, drugs, etc.? It should be easy to identify the sponsor. What is the purpose of the site? Is it to educate the public or to sell a product? The purpose should be clearly stated. What is the basis of the information? Is it based on scientific evidence with clear references? Advice and opinions should be clearly set apart from the science. How current is the information? Is it reviewed and updated frequently? Questions and Answers

What is complementary and alternative medicine? How can I get reliable information about a CAM therapy? Are CAM therapies safe? How can I determine whether statements made about the effectiveness of a CAM therapy are true? Are there any risks to using CAM treatments? Are CAM therapies tested to see if they work? I am interested in a CAM therapy that involves treatment from a practitioner. How do I go about selecting a practitioner? Can I receive treatment or a referral to a practitioner from NCCAM? Can I participate in CAM research through a clinical trial?

What is complementary and alternative medicine? Complementary and alternative medicine (CAM) is a group of diverse medical and health care systems, practices, and products that are not presently considered to be a part of conventional medicine.1 People use CAM therapies in a variety of ways. CAM therapies used alone are often referred to as "alternative." When used in addition to conventional medicine, they are often referred to as "complementary." The list of what is considered to be CAM changes continually, as those therapies that are proven to be safe and effective become adopted into conventional health care and as new approaches to health care emerge. How can I get reliable information about a CAM therapy? It is important to learn what scientific studies have discovered about the therapy in which you are interested. It is not a good idea to use a CAM therapy simply because of something you have seen in an advertisement or on a Web site or because someone has told you that it worked for them. (See sidebar for some tips on evaluating the information you see on a Web site.)

Understanding a treatment's risks, potential benefits, and scientific evidence is critical to your health and safety. Scientific research on many CAM therapies is relatively new, so this kind of information may not be available for every therapy. However, many studies on CAM treatments are under way, including those that NCCAM supports, and our knowledge and understanding of CAM is increasing all the time. Here are some ways to find scientifically based information: Talk to your health care practitioner(s). Tell them about the therapy you are considering and ask any questions you may have about safety, effectiveness, or interactions with medications (prescription or non-prescription). They may know about the therapy and be able to advise you on its safety and use. If your practitioner cannot answer your questions, he may be able to refer you to someone who can. Your practitioner may also be able to help you interpret the results of scientific articles you have found. Use the Internet to search medical libraries and databases for information. One database called CAM on PubMed (see "For More Information"), developed by NCCAM and the National Library of Medicine (NLM), gives citations or abstracts (brief summaries) of the results of scientific studies on CAM. In some cases, it provides links to publishers' Web sites where you may be able to view or obtain the full articles. The articles cited in CAM on PubMed are peer-reviewed that is, other scientists in the same field have reviewed the article, the data, and the conclusions, and judged them to be accurate and important to the field. Another database, International Bibliographic Information on Dietary Supplements, is useful for searching the scientific literature on dietary supplements (see "For More Information"). If you do not have access to the Internet, contact the NCCAM Clearinghouse (see "For More Information"). The staff is available to discuss your needs with you and assist you in searching the peer-reviewed medical and scientific literature. Visit your local library or a medical library to see if there are books or publications that contain scientific articles discussing CAM in general or the treatment in which you are interested. Thousands of articles on health issues and CAM are published in books and scientific journals every year. A reference librarian can help you search for those on the therapy that interests you. Are CAM therapies safe? Each treatment needs to be considered on its own. However, here are some issues to think about when considering a CAM therapy. Many consumers believe that "natural" means the same thing as "safe." This is not necessarily true. For example, think of mushrooms that grow in the wild: some are safe to eat, while others are poisonous. Individuals respond differently to treatments. How a person might respond to a CAM treatment depends on many things, including the person's state of health, how the treatment is used, or the person's belief in the treatment.

For a CAM product that is sold over the counter (without a prescription), such as a dietary supplement,2 safety can also depend on a number of things:

The components or ingredients that make up the product Where the components or ingredients come from The quality of the manufacturing process (for example, how well the manufacturer is able to avoid contamination).

The manufacturer of a dietary supplement is responsible for ensuring the safety and effectiveness of the product before it is sold. The U.S. Food and Drug Administration (FDA) cannot require testing of dietary supplements prior to marketing. However, while manufacturers are prohibited from selling dangerous products, the FDA can remove a product from the marketplace if the product is dangerous to the health of Americans. Furthermore, if in the labeling or marketing of a dietary supplement a claim is made that the product can diagnose, treat, cure, or prevent disease, such as "cures cancer," the product is said to be an unapproved new drug and is, therefore, being sold illegally. Such claims must have scientific proof. For CAM therapies that are administered by a practitioner, the training, skill, and experience of the practitioner affect safety. However, in spite of careful and skilled practice, all treatments whether CAM or conventional can have risks. How can I determine whether statements made about the effectiveness of a CAM therapy are true? Statements that manufacturers and providers of CAM therapies may make about the effectiveness of a therapy and its other benefits can sound reasonable and promising. However, they may or may not be backed up by scientific evidence. Before you begin using a CAM treatment, it is a good idea to ask the following questions. Is there scientific evidence (not just personal stories) to back up the statements? Ask the manufacturer or the practitioner for scientific articles or the results of studies. They should be willing to share this information, if it exists. Does the Federal Government have anything to report about the therapy? How does the provider or manufacturer describe the treatment? The FDA advises that certain types of language may sound impressive but actually disguise a lack of science. Be wary of terminology such as "innovation," "quick cure," "miracle cure," "exclusive product," "new discovery," or "magical discovery." Watch out for claims of a "secret formula." If a therapy were a cure for a disease, it would be widely reported and prescribed or recommended. Legitimate scientists want to share their knowledge so that their peers can review their data. Be suspicious of phrases like "suppressed by government" or claims that the medical profession or research scientists have conspired to prevent a therapy from reaching the public. Finally, be wary of claims that something cures a wide range of unrelated diseases (for example, cancer, diabetes, and AIDS). No product can treat every disease and condition.

Are there any risks to using CAM treatments? Yes, there can be risks, as with any medical therapy. These risks depend upon the specific CAM treatment. The following are general suggestions to help you learn about or minimize the risks. Discuss with your health care practitioner any CAM treatment that you are considering or are using; it is important for your safety and for a comprehensive treatment plan. For example, herbal or botanical products and other dietary supplements may interact with medications (prescription or non-prescription). They may also have negative, even dangerous, effects on their own. Research has shown that the herb St. John's wort, which is used by some people to treat depression, may cause certain drugs to become less effective. And kava, an herb that has been used for insomnia, stress, and anxiety, has been linked to liver damage. If you have more than one health care provider, let all of them know about CAM and conventional therapies you are using. This will help each provider make sure that all aspects of your health care work together. Take charge of your health by being an informed consumer. Find out what the scientific evidence is about any treatment's safety and whether it works. If you decide to use a CAM treatment that would be given by a practitioner, choose the practitioner carefully to help minimize any possible risks. Are CAM therapies tested to see if they work? While some scientific evidence exists regarding the effectiveness of some CAM therapies, for most there are key questions that are yet to be answered through well-designed scientific studies questions such as whether they are safe, how they work, and whether they work for the diseases or medical conditions for which they are used. NCCAM is the Federal Government's lead agency on scientific research of CAM. NCCAM supports research on CAM therapies to determine if they work, how they work, whether they are effective, and who might benefit most from the use of specific therapies. I am interested in a CAM therapy that involves treatment from a practitioner. How do I go about selecting a practitioner? Here are a few things to consider when selecting a practitioner. Ask your physician, other health professionals, or someone you believe to be knowledgeable regarding CAM whether they have recommendations. Contact a nearby hospital or a medical school and ask if they maintain a list of area CAM practitioners or could make a recommendation. Some regional medical centers may have a CAM center or CAM practitioners on staff. Contact a professional organization for the type of practitioner you are seeking. Often, professional organizations have standards of practice, provide referrals to practitioners,

have publications explaining the therapy (or therapies) that their members provide, and may offer information on the type of training needed and whether practitioners of a therapy must be licensed or certified in your state. Professional organizations can be located by searching the Internet or directories in libraries (ask the librarian). One directory is the Directory of Information Resources Online (DIRLINE) compiled by the National Library of Medicine (dirline.nlm.nih.gov). It contains locations and descriptive information about a variety of health organizations, including CAM associations and organizations. Many states have regulatory agencies or licensing boards for certain types of practitioners. They may be able to provide you with information regarding practitioners in your area. Your state, county, or city health department may be able to refer you to such agencies or boards. Licensing, accreditation, and regulatory laws for CAM practices are becoming more common to help ensure that practitioners are competent and provide quality services. Can I receive treatment or a referral to a practitioner from NCCAM? NCCAM is the Federal Government's lead agency dedicated to supporting research on CAM therapies. NCCAM does not provide CAM therapies or referrals to practitioners. Can I participate in CAM research through a clinical trial? NCCAM supports clinical trials (research studies in people) of CAM therapies. Clinical trials of CAM are taking place in many locations worldwide, and study participants are needed. To find trials that are recruiting participants, go to the Web site nccam.nih.gov/clinicaltrials. You can search this site by the type of therapy being studied or by disease or condition. Herbs And Alternatives: They're Here To Stay (8.21.01) Most Americans are using some form of alternative medicine, and if a Harvard Medical School survey is any indication, our interest in non-traditional treatments isn't going to go away. Young adults are by far the most likely to use alternative treatments, the survey finds. This trend "suggests a continuing increased demand for complementary and alternative medicine therapies that will affect all facets of health care delivery over the next 25 years," the authors write in the August 2001 issue of the Annals Of Internal Medicine. Complementary and alternative medicine, as measured in the survey, includes a wide variety of therapies -- from acupuncture, massage and chiropractic care to spiritual healing, aromatherapy and imagery. Some of these techniques are recommended by some doctors. In general, alternative therapies are not used in mainstream medicine because they have not been adequately tested in controlled clinical trials, says Ronald C. Kessler, Ph.D., principal author of the report. Most of the therapies are not taught routinely in medical schools or widely available in U.S. hospitals, according to the article.

When enough people use an alternative therapy, mainstream medicine becomes interested enough to carry out these clinical trials to see if the treatments can be proven effective, says Kessler, a professor of health-care policy at Harvard Medical School. "This is occurring right now, for example, in a series of rigorous clinical studies of the effects of (the herb) St. John's wort as a treatment for depression," he says. "At the end of these trials, this therapy will no longer be alternative. It will either be accepted as a proven (mainstream) therapy or it will be proven to be ineffective." The article about alternative medicine is based on a 1997-98 telephone survey of 2,055 people in a nationally representative household sample. People were asked whether they ever had used any of 20 complementary and alternative therapies, their age at first use, and whether they continued to use the therapies. In an earlier article about the survey, Kessler and his colleagues reported that the most popular alternative therapies were relaxation techniques (used by 16 percent of respondents), herbal medicines (12 percent), massage and chiropractic techniques (11 percent each). The new report analyzes growth trends by decade and age group. Three of 10 respondents who were born before the baby boom had used an alternative therapy by age 33, compared with half of baby boomers and seven of 10 younger adults. One-third used some sort of alternative therapy at the time of the survey, and two-thirds had done so at some time in their lives. "The post-baby boom respondents had a higher rate of lifetime use by age 33 years than the pre-baby boom respondents had by age 79 years," the researchers write. The therapies with the largest increase in popularity during the 1960s were commercial and other diet programs, megavitamin therapy, and self-help groups, according to the survey. During the '70s, biofeedback, energy healing, folk remedies, herbal medicine, homeopathy, hypnosis, imagery and spiritual healing grew faster than in any other decade. Growth was slower in the 1980s, with only massage and naturopathy increasing faster than in earlier decades. In the '90s, "aromatherapy had the most dramatic growth," and energy healing, herbal medicine, massage and yoga also grew faster than they had during the '80s. At this point, Kessler says, none of the therapies in the survey can be considered "mainstream" -- that is, accepted as proven by most doctors. But a few of these techniques are covered by health insurance, with chiropractic care being the most common, Kessler says. Most medical schools are teaching about at least some alternative therapies, according to the article.

"In the past, mainstream medicine tried to ignore alternative therapies and hope they went away," Kessler says. "It's now clear that they are not going away. They have to be studied seriously." As more clinical trials occur, he predicts, some therapies will become more accepted and others will disappear. But there always will be new alternatives, he says. "People will continue to want to use new therapies before they are adequately tested." Finding a Doctor Who Understands Complementary And Alternative Medicine The use of complementary and alternative therapies has skyrocketed. Magazines, TV, bookstores and the Internet are now filled with information about herbal remedies, vitamins, dietary supplements, massage, relaxation techniques and more. One result: More and more people want medical care from a doctor who understands complementary and alternative medicine. You may seek out such a doctor for a number of reasons. For example, you may:

Want to explore complementary and alternative medicine under a doctor's guidance. Want care from a doctor who is open-minded about including complementary and alternative therapies in your care. Already be familiar with complementary and alternative medicine but want to discuss your options with a doctor trained in conventional medicine. Already be receiving care from a complementary and alternative medicine practitioner and want to discuss your therapy with a doctor.

Whatever your goals, you will benefit most from a doctor who neither condemns complementary and alternative medicine wholesale, nor blindly advocates it. Finding a doctor who understands complementary and alternative medicine is becoming easier. In the past, medical schools ignored complementary and alternative medicine. Today, more medical students are at least introduced to the topic. In 2000, 82 medical schools taught complementary and alternative topics, according a study published in the Journal of the American Medical Association. In addition, many practicing doctors now study common alternative therapies. Getting Started If you can, search for a doctor before you need one. A few years ago, all you could do was ask neighbors, relatives, and friends for a recommendation. Now, you can use the Internet. For example, the Web site for the American Medical Association Free Physician Select Service has information about a doctor's location, gender, medical school, year of graduation, residency training, board certification, and specialty. Local, state, and specialty medical societies also can give you information about practitioners in your area. These societies usually can be found in the telephone book, in the business section or

under social and human services. Keep in mind that, if you belong to a managed-care organization such as an HM0, your selection may be limited to participating doctors. The managed-care organization should provide a list of participating doctors to guide your search. Factors To Consider Here are factors to consider in selecting a doctor:

Board certificationTo help determine the quality of your doctor's training, find out whether he or she is board certified. Doctors who are board certified have met specific requirements for advanced training. If a doctor cares for adults, he or she may be board certified in internal medicine or family medicine. If the doctor cares for children, he or she may be certified in pediatrics or family medicine. You can get more information about board certification by clicking here. Hospital affiliationFind out which hospital your doctor uses. How easy is it to get to that hospital in an emergency? Have you or anyone you know received care at that hospital? If so, how was that experience? Associated health professionalsToday, most doctors are part of a group or team practice. What other health professionals are on staff? Physician's assistants, nurse practitioners, midwives, nutritionists, and physical therapists may be part of the practice. Find out if any complementary and alternative practitioners, such as acupuncturists, or massage therapists, also belong to the group.

Narrowing Your Choice Once you have located a doctor, contact the staff at the doctor's office. Ask the staff about the type of practice, the doctor's hospital affiliation, and the doctor's attitude toward questions about complementary and alternative medicine. Inquire whether any alternative health practitioners are associated with the doctor's office. Next, consider arranging an interview. Some doctors allow a 10- or 15-minute initial visit at no charge, but others don't. Instead, you may want to schedule a routine visit. During your visit, be open about how you plan to use any complementary and alternative therapies. Does the doctor's response give you the balanced advice you are seeking? Why Physical Activity And Exercise Are Important The Relationship Between Physical Activity And Exercise The terms physical activity and exercise may seem synonymous, but there are critical differences between the two. Physical activity encompasses any movement of the body in which your muscles contract and your metabolism increases. Everything from washing dishes to playing ice hockey falls under this umbrella.

Exercise is a subcategory of physical activity. It refers specifically to a structured program of activity geared toward achieving or maintaining physical fitness. Levels of physical activity can be viewed on a continuum. At one end of the spectrum is a sedentary lifestyle, an absence of any significant physical activity. On the other end is the peak level of exercise training exhibited by a well-conditioned athlete. How you move along this continuum depends on both your starting point and your exercise goals. If you are currently sedentary, simply upping the amount of physical activity in your daily life is an important push forward. At a certain point, however, you will need to establish an exercise program to continue making strides. And once you have a program in place, you should periodically review your fitness level and reexamine your personal goals to determine how you can continue to make progress. How Your Body Responds To Physical Activity And Exercise When you call on your body to perform any type of physical work even something as simple as walking across the room your cells are jolted out of their resting state of balance. What follows is a complicated set of physical processes that supply the cells with the extra energy they need. First and foremost, the cells require additional oxygen to fuel the metabolic functions necessary for sustained activity. To meet this demand, the respiratory and circulatory systems gear up to deliver oxygen-rich blood to the working muscles. This accelerated metabolism, in turn, produces greater amounts of waste products. These products are transported back to waste-removal sites, such as the lungs and kidneys, for expulsion from the body. It is because of these processes that you breathe more rapidly and your heart pumps more vigorously when you exert yourself. Another byproduct of increased energy production is heat. Sweating a telltale sign of strenuous exertion is your body's way of cooling your skin and keeping your body temperature at a safe level. The Benefits Of Physical Activity And Exercise Physical activity (and exercise) is a cornerstone of a healthy lifestyle. Not only does physical activity make you look and feel better, but it is also critical for improving your health and extending your life. Being active significantly lowers your chances of developing potentially fatal illnesses, including heart disease, diabetes and cancer. In addition, remaining active throughout your life can help you stay healthy and disabilityfree as you age. Here's a rundown on the benefits you can expect from regular activity:

Lower risk of early death

Lower risk of heart disease Lower risk of high blood pressure (If your blood pressure is already elevated, you can expect it to drop.) Better weight control Lower risk of diabetes Lower risk of colon cancer Increased bone strength Improved balance Lower risk of depression and anxiety Increased energy level Overall sense of well-being

Five Steps to Selecting the Best Alternative Medicine Step One: Learn Your Options Add to your M.D.'s recommendations by researching the latest resources to get all your treatment options. Knowledge is power. Whether you are looking for information to enhance your health or searching for the answer to reverse a terminal illness, you'll want all the credible information you can find about your condition. And you can do just that when you learn all your options. In order to do that, you'll need "The Seven Key Sources To Good Health Care Information." They are: 1. Your doctor and other health care providers 2. Other patients and their friends 3. Libraries 4. The Internet 5. Medical and Health Information Service Organizations 6. Advocacy Organizations and Support Groups 7. Professional Organizations and Trade Associations Further, when gathering health care information, it important to use "The Three Question Test For Complete And Dependable Health Care Information." 1. What are the best treatments available in the world today for my health care condition/diagnosis? 2. Are those treatment proven effective? 3. How do I know if the information is reliable? By using this test and the other strategies outlined in Chapter 1 of Five Steps To Selecting the Best Alternative Medicine, you can gain access to all the accurate and dependable health care information you need to make informed choice about your treatment options.

By getting informed you become a savvy health care consumer no longer bound to one doctor's opinion or one medical system's answers to meet yours and your family's health care needs. Remember, by learning all of your options, you increase your chances of getting the health care results you want. Step Two: Get Good Referrals Find referrals through various sources and verify that these referrals have the capability to really help you. An effective selection process is the key to locating a good health care professional. Getting high quality referrals of good candidates is the best way to start that process. Step Two provides you with the information and know how to get those high quality referrals and to begin a selection strategy which can be used in hiring almost any alternative health care provider. Remember -they work for you! Relying just on family and friends may not give you the selection choice you may need to find the alternative health professional that is right for you. You may need to rely on more than one referral source. Here are the seven key sources for getting good referrals: 1. Family, friends and colleagues 2. Local alternative practitioners 3. Local health-food stores 4. Support groups 5. Professional associations 6. Alternative health care schools and colleges 7. Referrals services and advertisements When getting a referral, you'll want to get as much information from your source as possible. Many times, with just a little extra information, you'll know immediately whether this referral has possibility for you or not. For this reason it is important to know the right questions to ask. In Chapter 2 of Five Steps To Selecting The Best Alternative Medicine you can discover what these questions are as well as specific details on how to use "The Seven Key Sources For Getting Good Referrals" to your best advantage. With a list of good referrals, you can feel confident that you have tipped the scales in your favor and you are now just a few steps away from finding a health care provider who you'll want to work with. Step Three: Screening the Candidate

Make use of an alternative practitioner's staff to get reliable information about the provider and how they work. The alternative health care provider's office staff is an invaluable information source to you. Without spending a penny in fees, you can get a more in-depth picture about a provider's personality, his or her expertise, his or her educational training, and which associations or professional organizations he or she belongs to. From this information, as well as additional information you will garner from asking some very specific, welltargeted questions, you will gain greater certainty as to whether this candidate could be your health care provider. In order to do that, you need to know what those questions are as well some other important information that can assist you in getting the answers you need to make an informed and educated health care decision about the practitioner. Here are some examples:

Can you provide me with literature about the health care provider's educational background and philosophy of treatment? What success has this alternative doctor had in treating patients with physical problems similar to mine? How long has this practioner/doctor been in practice? What is the practitioner's fee structure and your policy with insurance? How much can I expect to pay on my first visit, including tests, supplements, and prescriptions?

By using the information and the questions outlined in Chapter 3 of Five Steps To Selecting The Best Alternative Medicine, you can narrow your list of practitioner candidates to a select few whom you would like to meet personally. By doing this, you are only one step away from the alternative health care practitioner with whom you will want to develop a health care partnership. Step Four: Interviewing the Provider Ask the provider all the pertinent questions to know if you can confidently work with this professional. To successfully interview a health care provider, you must ask the right questions and use your own gut instincts to get a feel of who this person is and if they are right for you. A well conducted interview will provide you with the valuable data to determine if this is the health care professional you will want to work with. In order to do, it is best to first ask yourself, "What kind of personality do I need in a health care provider?"

Superbly trained health care providers come in a wide range of personalties. Some have nurturing bedside manners and are compassionate and sensitive with their patient/clients. Some are cold rationalist who don't really care about the thoughts and feelings of their patients. Others are somewhere in the middle. You need to determine which type of personality is best for you and your current health care needs. Knowing this will assist you during your interview process in determining if a particular health care provider is right for you. Also, you need to know the key strategies to make the most of your meeting. Here are some examples:

Be courteous, comfortable and frank during your meeting Describe clearly what you know about your condition Share what you have learned about treatment options Respond honestly yet courteously to the provider's recommendations, especially if you disagree. Pace the interview and remember to listen. Keep the details straight. Taking notes or bringing a tape recorder can help. Use your intuition as well as you mind when sizing up this professional.

This step requires that you make the effort and take the time to visit a health care provider. Sometimes you will also have to pay a small fee for the provider's time. You'll find, however, that the effort, time and money in a productive interview is a good investment in your health. Step Five: Forming a Partnership Maximize your healing potential by developing an active alliance with your alternative health care provider. A health care professional as a "partner" may be a new concept for you. As a result, you may feel like your are making up the rules as you go along. For the most part you will be. In order to have the best results from such a partnership, it is important to bring "The Four Cornerstones To All Good Health Care Relationships." into this special relationship. These cornerstones will help you form a relationship that will benefit both you and your health care provider. They are: 1. Mutual respect and caring 2. Honest communication 3. A shared commitment to healing 4. A treatment contract To ensure that your health care partnership produces the results you want, use "The Four Action Steps for Forming A Successful Health Care Partnership." They are:

1. Be responsible for agreeing to, monitoring, and evaluating the treatments you receive 2. Negotiate a "health care contract" with your provider 3. Support your healing physically, emotionally, mentally, and spiritually 4. Practice balancing flexibility with inflexibility Ancient DNA May Unlock Life's Secrets (4/18/03) Ancient plant and animal DNA found in undisturbed soil sediment can be used to unlock secrets about life hundreds of thousands of years ago, researchers say. Scientists analyzing soil from Siberian permafrost and from caves in New Zealand said they found evidence of DNA from animals that died out thousands of years ago and from plants that lived about 400,000 years ago. Eske Willerslev of the University of Copenhagen, a co-author of the study appearing in the journal Science, said the study found that soil fragments the size of a sugar cube can contain large amounts of DNA from those ancient life forms. "You can obtain a lot of information about that extinct biota from just two grams of material," Willerslev said. Permafrost is excellent at preserving the ancient DNA, the researchers said, because it is constantly cold. The scientists identified DNA from 19 categories of plants and from eight kinds of animals, including the extinct mammoth and steppe bison. The animal DNA was thought to be up to about 30,000 years old. Willerslev said that attempts to look further back in history, beyond 400,000 years, was unsuccessful. "We tried to look for DNA in sediments dated one and a half to two million years, but those tests came up negative," he said. "There may be some sort of barrier that makes that impossible." Age of the specimens was based on dating of the sediment layers, the authors said. In sediments drilled from the floor of a dry cave in New Zealand, Willerslev and his coauthors found DNA from an extinct animal and from plants that lived before humans colonized that island about 3,000 years ago. Much of the animal DNA found at the sites apparently is from feces and urine deposited by the creatures in ancient times. DNA from herbivorous animals is more common because that diet produces more feces, the researchers said. Analyzing the plant DNA, said Willerslev, gives insight into the types of plants that dominated ancient times and could indirectly give clues to the climate that then existed.

For instance, the plant DNA from Siberia suggests that tundra was once an area rich in plants that would have been able to support large herds of mammoths and other big animals. But about 11,000 years ago, the once plentiful grasses began to disappear, perhaps helping to cause the extinction of some of the large plant eaters that once roamed parts of Siberia and Alaska. Linking the soil DNA with specific times in the past may "have major implications for many fields," including the study of ancient peoples, the authors said in the study. Co-author Alan Cooper of Oxford University, England, said in Science that the study shows that DNA can be preserved for long periods of time and could free researchers "from the shackles of needing fossils to be able to look into the past." Other experts said that the technique needs to be proven in further study, but that it could lead to a better understanding of the plants that lived during the ice ages or during the era that humans first crossed from Asia into North America. "This technique truly will revolutionize our ability to reconstruct past flora and fauna," Glen MacDonald, an ancient life researcher at UCLA, said in Science. Tell Your Surgeon If You're Taking Herbal Supplements (7/11/01) People need to let their doctors know if they take herbal supplements, especially if they are going to have surgery, because these medicines can cause significant complications. In addition, patients who take certain herbal supplements should discontinue them 24 hours to a week before surgery, according to the authors of a report published in the July 11, 2001, issue of the Journal of the American Medical Association. This precaution can help to minimize potential negative effects or interactions with drugs used in the hospital, say the authors, who are anesthesiologists at the University of Chicago. For instance, ephedra can present a risk of irregular heart rhythms, gingko can increase bleeding and St. John's wort can interfere with the effects of other drugs, according to the authors. Surveys show that up to one-third of patients admitted to hospitals for surgery have been taking some sort of herbal product. Most of the time, however, they don't tell their doctors, and usually the doctors don't ask. Doctors generally ask their patients what other medicines they are taking. But patients may not mention herbs because they don't consider them medicines, or they believe their doctors are prejudiced against these products, according to the study. Therefore, the authors write, doctors should make a point of asking patients specifically about what herbs they are taking.

"This is a fairly significant issue for most hospitals," says Harold J. DeMonaco, a pharmacist and director of drug therapy management at Massachusetts General Hospital, an affiliate of Harvard Medical School. DeMonaco says problems have occurred at Massachusetts General when physicians have not been aware of herbal products their patients have been taking. He cited several cases of unexpected bleeding during a cardiac catheterization, a procedure in which a slender tube is inserted into a large blood vessel to evaluate heart function. "We've had problems with gingko especially, as at least a contributing factor to bleeding." The JAMA study listed these concerns, among others, for the eight most popular herbal preparations sold in the United States:

Echinacea -- Can stimulate the immune system during short-term use, but suppresses immune reactions if used longer than eight weeks. Ephedra -- Increases blood pressure and heart rate. Can lead to heart attack or stroke. Use with other drugs can produce abnormal heart rhythms. Garlic, gingko and ginseng -- Can increase bleeding. Kava and valerian -- Can increase the effects of sedatives. St. John's wort -- Can interfere with effects of other drugs.

Surgery and other procedures always put the body under some degree of stress and present the possibility of complications, including bleeding, blood-pressure and heartrhythm changes, infections and allergic reactions. Bleeding is a particularly delicate area of concern for many procedures, DeMonaco says. "You really want to control every factor you can control to prevent clotting, but not so much that you get bleeding." Certain herbal products represent "an unknown variable" that could upset the balance, he says. "The one that really scares me is ephedra, for a whole variety of reasons," he adds. "It's not a nice drug, and I use the word 'drug,' because that's what it is. In combination with other drugs, this produces arrhythmias. That can be a problem for an anesthesiologist during surgery because it may make some of the drugs used to maintain blood pressure less effective or ineffective." Educational materials from the American Society of Anesthesiologists recommend that patients discontinue herbal medicines two to three weeks before surgery, according to the JAMA study authors. But the authors recommend shorter intervals, noting that some herbal products are eliminated from the body quickly and that some surgeries are scheduled with only days' notice. DeMonaco says he generally agrees with the study's advice. But, although the authors urge people to stop taking ephedra 24 hours before surgery, DeMonaco recommends that people who have been taking it for a long time stop seven to 14 days before surgery, because ephedra depletes a very important chemical in the nervous system called

norepinephrine. If blood pressure falls during surgery, anesthesiologists use a drug that relies on the norepinephrine stores to work. Besides the potential effects during surgery, another reason to use caution with herbal products is that the U.S. Food and Drug Administration cannot regulate them unless it can demonstrate that they are unsafe, DeMonaco says. Manufacturers of conventional medicines have to prove that the drugs are safe before they are allowed to sell them. As the authors of the study also point out, the lack of regulation means that herbal products can vary in potency and can include unlisted ingredients. Many of these products work, DeMonaco acknowledges. "Why don't I take them? Because the manufacture is not regulated. If you're going to take drugs, the drugs need to be of the highest standards and produced with consistency and accuracy, and all the data indicate that is not the case with these products." In any case, if patients are going to use herbal preparations, they should tell their doctors, just as they would with any other medicine, DeMonaco says. "These are drugs," he says. "These are not safe in the absolute sense any more than aspirin is safe in the absolute sense." Effects of herbal medications and recommendations for discontinuation of use before surgery

Echinacea. Boosts immunity. Allergic reactions, impairs immune suppressive drugs, can cause immune suppression when taken long-term, could impair wound healing. Discontinue as far in advance as possible, especially for transplant patients or those with liver dysfunction. Ephedra (ma huang) Increases heart rate, increases blood pressure. Risk of heart attack, arrhythmias, stroke, interaction with other drugs, kidney stones. Discontinue at least 24 hours before surgery. Garlic (ajo) Prevents clotting. Risk of bleeding, especially when combined with other drugs that inhibit clotting. Discontinue at least 7 days before surgery. Ginkgo (duck foot, maidenhair, silver apricot) Prevents clotting. Risk of bleeding, especially when combined with other drugs that inhibit clotting. Discontinue at least 36 hours before surgery. Ginseng Lowers blood glucose, inhibits clotting, Lowers blood-sugar levels. Increases risk of bleeding. Interferes with warfarin (an anti-clotting drug). Discontinue at least 7 days before surgery.

Kava (kawa, awa, intoxicating pepper) Sedates, decreases anxiety. May increase sedative effects of anesthesia. Risks of addiction, tolerance and withdrawal unknown. Discontinue at least 24 hours before surgery. St. John's wort (amber, goatweed, Hypericum, klamatheweed) Inhibits re-uptake of neuro-transmitters (similar to Prozac). Alters metabolisms of other drugs such as cyclosporin (for transplant patients), warfarin, steroids, protease inhibitors (vs HIV). May interfere with many other drugs. Discontinue at least 5 days before surgery. Valerian Sedates. Could increase effects of sedatives. Long-term use could increase the amount of anesthesia needed. Withdrawal symptoms resemble Valium addiction. If possible, taper dose weeks before surgery. If not, continue use until surgery. Treat withdrawal symptoms with benzodiazepines. FDA Rules Would Set Standards On Remedies (4/23/03) For years, botanical experts have said echinacea might shorten the duration of your cold, ginkgo biloba may help keep your mind sharp as you age and garlic may do your heart a favor. But new research on many dietary supplements is conflicting. And even if some of the health benefits are true, it is difficult for the consumer to determine the right dosage or to figure out the differences between brands on the market. Part of that problem may be solved if new rules proposed by the Food and Drug Administration take effect in a year or so. The rules would set standards for making and labeling dietary supplements so consumers can make more informed choices. Herbal remedies have been widely used in other countries for centuries, and the products enjoyed a surge in popularity in the USA during the late '90s. Sales of herbal supplements tallied $4.18 billion in 2001, up from $4.12 billion in 2000, according to the Nutrition Business Journal, an industry newsletter. Still, herbs have been surrounded by controversy recently. Some studies have shown that the products aren't effective. And ephedra, promoted as a weight-loss aid, has been linked to health problems, including heart attacks and strokes. It also has been linked to a number of deaths. So are herbal products safe and effective? "In general, the record clearly shows that herbal products are relatively safe," says Mark Blumenthal, founder of the American Botanical Council, a research and education group that supports responsible use of supplements. A lot of research has been done that has shown the herbs are effective for various conditions, he says. For instance, he says, there is good evidence that saw palmetto helps

symptoms of benign enlarged prostates, a condition called benign prostatic hyperplasia, which causes urination difficulties. But others say the answers on the safety and effectiveness of herbs aren't in yet. "We're still trying to figure out what these herbs do and what they don't do," says David Schardt, senior nutritionist with the Center for Science in the Public Interest, a consumer group based in Washington, D.C. "It's clear they have some biological effect, but we really don't have a handle how significant that effect is." Herbs under the microscope Many studies have raised questions about the effectiveness of herbs. For instance, St. John's wort is said to ward off depression, but one large study in the USA found that it was not effective in treating moderate to severe depression. Botanical experts say the product is intended for mild depression. A government-funded study on mild depression is in the works. Garlic is supposed to lower cholesterol. One government agency reviewed the literature and concluded that garlic may lower cholesterol levels in the short term, but there's no evidence that it lowers cholesterol in the long term, Schardt says. Still, there are indications garlic may have other benefits for heart health, he says. "We need good research," Schardt says. "It's good that the government is getting into it, because they have the resources to do these studies properly." Maintaining the purity Physician Tod Cooperman, president of www.consumerlab.com, knows how much the quality of products can vary. His company has tested more than 700 products since 1999. Many products failed to meet the standards the company established after reviewing the scientific data on the herb. (Names of products that have passed are available to subscribers on the Web site.) "I see a place for herbals, but people have to be careful because the quality is variable from one brand to another," Cooperman says. Some herbal products didn't contain enough of the active ingredients to be effective, and some products were contaminated with pesticides, he says. Compared with vitamin and mineral supplements, herbals are the most ripe for problems because of the complexity of manufacturing them, he says. They need to have the right active ingredients that have been shown to be effective in clinical trials. They have to be made from the right species of plants and the right parts of the plants. And they have to be dried properly. Plus, they shouldn't be contaminated with metals from the soil or pesticides used on the herbs, Cooperman says.

"For the sake of the consumers and the manufacturers themselves, the quality of these products has to be consistently higher," he says. Blumenthal says when the FDA eventually issues final manufacturing rules, "consumers and health professionals will have a higher level of confidence in all of these supplement products."