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| Friday, 4 July 2003 |
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US goes 'CAM' in medicine by Edward Arambewala A study on the use of medical therapies in the United States has revealed that its citizinery is now going in more for the "CAM" (complementary and alternative medicine) than allopathy.
Cindy McCanse, writing on this study in the US Family Physician Report Vol. 6 puts the figure at over 40 percent. He states "One widely known and well regarded study carried in the Journal of American Medical Association puts the number of Americans going in for 'CAM' therapy at more than 40 percent and several other studies done on the subject has put it at over 60 percent. McCanse adds - 'What is more surprising is the growing body of clinical evidence for the efficacy of these CAM medicine for a number of diseases.' We feel that the contents of this report which we are carrying today would make interesting reading both for the general public here in Sri Lanka and the medical profession as well owing to the recent doctors' strikes which the people had been subjected to undergo. Complementary and alternative medicine by Cindy McCanse Patient self-medication with herbal medicines and botanical may be one of the fastest-growing trends in healthcare today. In fact, more and more patients are turning to alternative medicine providers of all stripes. One widely known and well-regarded study published in the Journal of the American Medical Association puts the number of patients using complementary/alternative therapies at slightly more than 40 percent; other studies, at closer to 60 percent. What's perhaps even more surprising is the growing body of clinical evidence for the efficacy of many of these types of therapies. Examples of evidence Take ginkgo extract in the management of cerebral insufficiency, for example. Bandolier, one of the premier sources of systematic reviews of clinical trial evidence, upholds the effectiveness of ginkgo for this indication. Now contrast those results with findings published in the Cocbrane Reviews comparing the benefits of routine continuous electronic fetal heart rate monitoring during labour - a widespread and conventionally accepted practice - with intermittent auscultation. The evidence shows that although the number of neonatal seizures drops slightly with use of electronic fetal monitoring, the rates of Caesarean section and operative vaginal delivery increase markedly. Not a stellar performance, by any means. Yet fetal monitoring's the norm among Western practitioners. Why you need to know These and related issues were addressed at several sessions during the May 3-7 Society of Teachers of Family Medicine annual spring conference in Lake Buena Vista, Fla. Andrea Gordon, M.D., of Puyallup, Wash., discussed her experiences at the University of Washington, Tacoma, teaching about herbs using a case-oriented, evidence-based approach. "Some of them are useful tools," Gordon said. "Some of them are better tools than what we currently have. But some of them are potentially harmful." St. John's wort, for example, when used in conjunction with the protease inhibitor indinavir, has been shown to significantly decrease the effectiveness of the HIV-1 drug. Because so many patients are availing themselves of herbal products, Gordon added, it's important for physicians to ask patients about them and ask about them in the proper way. "It's not useful to say, 'You're not using any of that herbal crap, are you?" she said. "You have to ask in a way that shows patients you care. And it's not just patients with cancer, it's older women coming in for their yearly exam." Learning the ropes But there's far more to complementary and alternative medicine than just herbal and botanical products, and physicians need to keep pace with their patients, said Gordon's co-facilitator, Benjamin Kligler, M.D., M.P.H., of the Beth Israel Residency Program in Urban Health in Brooklyn, N.Y. Kligler cited a 1998 survey showing that 31 percent of U.S. medical schools required course work about various CAM topics. The percentage that offered elective CAM courses was more than double that. According to the survey, Kligler said, when CAM was taught in medical schools, it was more likely to be offered by departments of family medicine than any other specialty department. Not surprisingly, this appears to affect how family physicians perceive and react to CAM. ************************* Doctors oath and strikes A Health reader - K. Kumarasinghe from Gampaha last week invited our attention to the Medical Practitioners Oath that the doctors have to take before they are given registration to practice, by the Medical Council, and posed the question whether 'strikes' by doctors are in conformity with that oath and referred to the following pledge which is the third in the group: The pledge - "The health of my patient will be my primary cosideration and I will not use my profession for exploitation and abuse of my patient." He said he knew well that the doctors have always resorted to strike action as the last resort, when all other avenues failed. He said, the media including the Daily News Health Watch, now Health Page had given wide publicity to the GMOA proposal made five years ago to the government to set up an Arbitration Board for the health sector to resolve disputes amicably, without leading to strikes and other trade union actions, but so far the authorities responsible have failed to implement this for some reason or other. Two year ago the Sri Lanka Medical Council SLMA itself had taken it up with the authorities. But yet it appears to be receiving a blind eye from the health authorities, so can we totally blame the doctors for striking. In any case he requested us to publish the medical practitioners oath, which the doctors entering the profession have to take now, so that the public would also come to know what these pledges are. Here we oblige. At the time of registration each applicant is given a copy of the following declaration by the Registrar and applicant shall read and abide by the same: Medical Practitioner's Oath I, Dr................................... At the time of being admitted as a member of the medical profession: I solemnly pledge myself to dedicate my life to the service of humanity: The health of my patient will be my primary consideration and I will not use my profession for exploitation and abuse of my patient; I will practise my profession with conscience, dignity, integrity and honesty; I will respect the secrets which are confided in me, even after the patient has died; I will give to my teachers the respect and gratitude, which is their due; I will maintain by all means in my power, the honour and noble traditions of the medical profession; I will not permit considerations of religion, nationality, race, party politics, caste or social standing to intervene between my duty and my patient; I will maintain the utmost respect for human life from its beginning even under threat and I will not use my medical knowledge contrary to the laws of humanity; I make the promise solemnly, freely and upon my honour. Signature Date The oath was administered by registrar/Asst. ************************* Veddha Chief in Colombo on a medical issue
************************* Prof. Nimal Senanayake on re-birth One of Nature's foremost forces survive at all cost (Continued from last week) The mind, then, is the functional form or the programme, which operates utilising the hardware of this most advanced device. One of Nature's foremost (if not the foremost) forces is to survive-survive at all cost. Then, it does not stand to reason that Nature would let its most sophisticated programme, which is so unique to the given individual, perish simply because of a hardware malfunction. Knowing well that the brain - a physical structure, is predestined to perish, Nature would be at fault if it had not built in a safety mechanism (an escape mechanism) to save the mind (or at least certain crucial components of it) when the brain comes to its end. In our computer analogy, the precaution against such a disaster would be having a backup. With modern technology, this backing up can be done in a website. (When I first developed this concept 4 years ago this was only a theoretical possibility to me, but since then I understand that such websites have actually become available!) With an online connection to the internet and a highly developed hazard detecting system, this can be effected at a crucial point in time when the computer is threatened with extinction, for instance, by a deadly virus. The programmes and the data thus saved can, at a later time, be reinstalled in a new computer via internet itself. This process can continue, preserving, forever, the programmes and data including those added during subsequent operations. A parallel mechanism operates The hypothesis I propose is that a parallel mechanism operates in the case of human brain. This, in fact, is the most logical thing to expect if you accept that Nature is programmed to survive-survive at all cost. At a certain point in time, either as a result of ageing, or prematurely as a result of a fatal disease, the brain will perish. Will Nature accept defeat or would it save at least the essential programmes and information contained in the mind? My argument is that it will. As much as the computer transmits its programmes to a website, the brain, just before death, will transfer its vital information out of the physical body. Where? one may ask. Anywhere in the universe, outside the physical body, the exact location is not crucial to my argument. In what form, is the next question. In some form of energy, a form of energy hitherto undiscovered. Too easy an answer, you might say; but that is the answer. Telepathy Can we declare that the modern science, as at present, has discovered all energy forms that exist in the universe? Telepathy, for instance, indicates that such an energy form exists. What is transmitted out? Essential information contained in the mind. This presumably includes memories, learned skills, and also karmic forces, which are outside the domain of modern science. What happens next? At a right moment, this energy form will influence (using computer jargon: reinstall the programmes and the data in) a new developing brain, and the cycle will continue. In this hypothesis, it is not an athma that travels through physical space that enters another body, but an energy form that makes an imprint on a new developing brain (being). The selection of the host brain is unlikely to be at random, but governed by certain laws and forces, which, I presume, includes karmic forces. How much of the information transmitted from the previous personality would be incorporated in the development of the new personality (brain) would again depend on several factors, including karmic forces. As a result, the previous (mind) personality and the "new" (mind) personality would not be one and the same, at the same time, they would not be two different (minds) personalities either. ************************* Devil's brew and health by Dr. D.P. Atukorale At times in history, coffee has been hailed as a medicinal cure-all and at others condemned as a devil's brew in the latter case usually for political or religious reasons when coffee houses were at their height of popularity as meeting places. However in the last half century, scientific research has established the facts about coffee, caffeine (responsible for coffee's mild stimulant effect) and health. In moderation coffee consumption is in no way a health risk. De-caffeination processes Commercial decaffeination processed were initiated in Germany during the early part of the 20th century. The three main methods of decaffeination are water decaffeination, carbon-dioxide decaffeination and solvent decaffeination. The first 2 methods are usually used by manufacturers. What is caffeine? Caffeine is the major pharmacologically active ingredient in coffee and is the central nervous system stimulant and caffeine is known chemically as 1,3,7 - trimethylxanthine. The die-methyxanthine derivatives theophylline and theobromine are also found in a variety of plants. Caffeine occurs naturally in the leaves, seeds or fruit or more than 60 plant species of which cocoa - beans, tea coffee, cola and guarana are most well known. Caffeine is also added to many popular carbonated drinks and is a component of a number of pharmacological preparations and over-the-counter medications including analgesics, diet-aids and cold - flu remedies. In addition both caffenine and theophylline have bronchodilatory properties and are used in the treatment of neonatal apnoea (inability of new born to breath properly). Following consumption caffeine is readily absorbed into the blood and body tissue. Caffeine does not accumulate in the body being rapidly metabolised and excreted. Smokers break down caffeine more quickly than non-smokers while pregnancy tends to slow down the rate at which caffeine is broken down particularly during the last months. Women taking the contraceptive pill also metabolise caffeine more slowly. Alertness Caffeine can increase the speed of rapid information processing by 10% and a cup of regular coffee after lunch helps counteract normal "post-lunch dip" inability to sustain concentration aiding alertness. A couple of cups of coffee help to improve alertness and concentration during night shift hours and prevent many industrial accidents which usually occur late into the shift when workers become less attentive. There is evidence to show that caffeine helps to improve performance of raising fatigue related concentration and alertness and efficiency and decline in the levels of depression and anxiety. There is significant inverse association between coffee drinking and risk of suicide. Physical performance There is evidence to prove that caffeine can improve athletic performance e.g. swimming, cycling and women's tennis. Sleep Some people who drink coffee in the evening find that they take longer to get to sleep. Other people happily drink coffee before they go to bed without any such problems. (To be continued) *************************
On soya - Prof. Aponso informs: Prof. Herbert Aponso from Kandy has informed us that the article by him on the "Nutritional value of Soya" which we carried in this page on June 20, 2003 was in response to a readers request earlier in this page for information on that subject from a authoritative source as there had been an article in the print media (not the Lake House group) expressing doubt about the nutritional aspects of this product. Prof. Aponso said there is no doubt at all about the positive health and nutritional aspects of soya, which is accepted worldwide. Former Senior Advisor WHO on SIDS (cot deaths) I am passing on to you a copy of a letter I received from the United States Consumer Product Safety Commission, together with the poster, and one copy of the handouts, relating to Sudden Infant Deaths Syndrome. (SIDS), formerly called "cot deaths". In this regard, Professor Sanath Lamabadusuriya, Professor, and Head of the Department of Paediatrics of the University of Colombo, to whom I casually mentioned about these educational material, informed me, that as far as he is aware, not a single case of SIDS has been reported in our country, for some reason or another. This, to me is an interesting observation from Ann Brown chairman consumer product safety commission USA. Since 1988, there have been more than 200 babies who died while in playpens. In almost 100 of these deaths, soft bedding or extra mattresses were present in the playpen and the babies died of suffocation or SIDS. CPSC has today issued a study documenting this problem. Over the years, playpens, portable cribs and play yards have evolved into virtually identical products. Parents and caretakers use playpens today as places for infants and toddlers to both play and sleep. For that reason, we want to alert parents to the hazard of using soft bedding or extra mattresses in playpens. While CPSC has previously warned about the dangers of soft bedding in cribs for babies under 12 months, this is the first time we are warning about the same dangers in playpens. With the generous support of Mattel, we are undertaking a "Sleep Safe, Play Safe" campaign to bring this hazard to the attention of pediatricians, parents and other caregivers. I hope you will find the enclosed poster and handouts helpful in communicating this important safety information to your patients. |
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The Veddha Chief Uruwarige Vannila Aththo (Left) meeting Dr. Githanjan Mendis, Consultant Neurologist, Sports Medicine Unit head and member of the Medical Advisory panel in Colombo on Monday to arrange for the hole in the heart operation for a 4-year-old Veddha child in Dambane.The child’s condition was detected at a medical-clinic for the veddha community conducted last week in Dambane by a three-member medical teamled by Dr. Mendis.On his return to Colombo Dr. Mendis had arranged for the operation to be done in Colombo by Cardio Thoracic Surgeon Dr. Y. Lahir.Dr. Mendis said Presidents fund is helping with funds for the operation and Veddha Chief’s visit was to finalise details.
