What really works

Some of the biggest and best-designed trials are funded by the federal government, through the National Center for Complementary and Alternative Medicine NCCAM, a unit of the National Institutes of Health. One NCCAM-funded trial, for example, is investigating whether massaging premature infants three times a day for 10 days speeds weight gain. Another trial, expected to produce results late this year, is studying the effectiveness of the dietary supplements glucosamine and chondroitin in treating osteoarthritis pain.

CAM therapies such as acupuncture, herbal medicine, osteopathy, massage and chiropractic care generated 36.5 billion in revenue last year, according to Nutrition Business Journal, an industry publication, up 67.4 percent from 1997, the first year it tallied such data.

In a survey of 34,000 readers of Consumer Reports, published in its August 2005 issue, nearly half reported using complementary or alternative treatments during the last two years. But such self-reports don8217;t constitute convincing evidence that a therapy is safe or effective, say experts.

Below is a survey of some CAM treatments that have been the subject of the most rigorous studies. Some widely used therapies that have undergone little scientific scrutiny, such as homeopathy and intercessory prayer, are not included:

Manipulative Therapies
NCCAM counted 537 clinical trials involving manipulative and body-based therapies as chiropractic manipulation between 1994 and 2004; 422 were randomized, controlled trials.

Chiropractic: Studies of chiropractic treatments, which involve manipulation of the spine, joints and muscles, for low-back pain have been of 8220;uneven quality and insufficient to allow firm conclusions8221;, reports NCCAM.

A 2003 Annals of Internal Medicine meta-analysis of 39 randomized clinical trials found chiropractic care more effective than sham treatments for acute and chronic low-back pain. No difference in effectiveness was found compared to such treatment categories as doctor8217;s care, physical therapy and exercises.

NCCAM says more research is needed to determine the value of chiropractic care for other medical conditions, such as arthritis. More research is also necessary to understand what happens in the body during and after chiropractic treatments.

Supplements
More evidence supports the efficacy of dietary supplements comprised of single ingredients vitamins and minerals, for example than for botanical extracts, whose chemical composition may differ from product to product.

Chondroitin Sulfate and Glucosamine: Natural and synthetic versions of chemicals produced in the body and known to be involved in cartilage repair and maintenance, these two supplements are often sold in combination as a treatment for osteoarthritis. More evidence supports benefit from glucosamine than chondroitin sulfate, according to the University of California8217;s Berkeley Wellness Letter, which evaluates research on herbs and supplements. Glucosamine supplements have been shown to slow the deterioration of cartilage and relieve pain in some patients with knee osteoarthritis.

Saw Palmetto:-No gold-standard clinical trials support claims that this plant supplement shrinks enlarged prostates or provides other benefits, reports the Berkeley publication. So far, the studies showing effectiveness have been small. Saw palmetto supplementation can alter the results of PSA tests, making prostate cancer harder to diagnose, says the Berkeley letter. If you8217;re taking it, let your doctor know.

St. John8217;s Wort:-Some evidence suggests that this extensively studied supplement may help relieve milder forms of depression, but the research is not conclusive. Berkeley advises that patients 8220;think twice before taking it8221; and consult first with their doctor or therapist, particularly if they8217;re also taking any prescription medications. For example, it is believed to interact with birth control pills and selective serotonin reuptake inhibitor SSRI drugs, used to treat depression, according to the ODS.

Echinacea: Studies have produced conflicting findings on this herb8217;s purported ability to boost the immune system and shorten the duration or ease the severity of colds, according to the Berkeley Wellness Letter. Echinacea supplements contain a mix of chemicals and since little is known about the product8217;s toxicity, the letter advises, echinacea should not be taken by people who are HIV-positive, pregnant or have lupus, rheumatoid arthritis, tuberculosis or multiple sclerosis.

Cure
Acupuncture
A facet of traditional Chinese medicine, acupuncture is one of the most thoroughly researched CAM therapies. Developed more than 2,000 years ago, this treatment involves inserting thin needles into the skin at specific points on the body, and manipulating them by hand or electrical stimulation.

A meta-analysis of 33 randomized, controlled trials, published in last month8217;s Annals of Internal Medicine, found acupuncture more effective than sham treatment for short-term relief of chronic low-back pain. Not enough data existed to compare acupuncture to other therapies. Little is known about the mechanism by which acupuncture relieves pain.

Another study, published in 2004 in the Annals of Internal Medicine, found that acupuncture appeared to help relieve pain and improve function for patients with knee osteoarthritis.

Mind-Body Medicine
Considerable evidence suggests mind-body therapies can improve postsurgical outcomes and reduce mortality rates from coronary artery disease by using various techniques to reduce anger, hostility and stress. Mind-body therapies have also been shown effective in treating incontinence, chronic low-back pain, headaches, insomnia, and nausea, vomiting, pain and functioning problems caused by chemotherapy, according to an extensive 2003 review published in the Journal of the American Board of Family Practice.

Meditation:This technique has been found to activate parts of the brain used for attention and control of the nervous system. In a 2003 study in the journal Psychosomatic Medicine, researchers used magnetic resonance imagery MRI to show that meditation increased left-brain activity, which is associated with positive emotional states.

Biofeedback: Using sensors that track bodily changes, patients learn to relieve stress and chronic pain by controlling functions such as heart rate, muscle tension, breathing, skin temperature and blood pressure through relaxation, imagery and other techniques. Biofeedback has been proven helpful in treating about 150 medical conditions, including migraines, arthritis and fibromyalgia, according to the Mayo Clinic.

Cognitive Behavioral Therapy: Evidence suggests that this technique, a form of psychotherapy used to help patients change dysfunctional patterns of thinking, may be useful as a complementary treatment for coronary artery disease and some chronic pain conditions because it can help patients learn to deal with stress.

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