Navigation

Springfield Family Medicine

Byline: Michael Irwin

Michael Irwin, a professor at the UCLA Neuropsychiatric Institute specializing in mind-body medicine, was online Tuesday, July 12, at 11:30 a.m. ET to answer your questions about complementary and alternative medicine treatments.

Washington Post staff writer January W. Payne reports in Tuesday's article "What Really Works?" (Post, July 12):

"Out of frustration with conventional medicine or in hopes of preventing or treating disease, health consumers continue to turn to complementary and alternative medicine (CAM) treatments such as acupuncture, chiropractic care, herbs and supplements.

"But of the many treatments in the rapidly growing, frequently bewildering field, what really works? With little gold-standard evidence to go by, that's been a hard question to answer. Long-standing attempts to perform high-quality research continue.

"There is a 'real effort to use state-of-the-art methodology -- using randomized, controlled trials [to determine] whether a [nonconventional] treatment is efficacious or not,' said Michael Irwin, a professor at the UCLA Neuropsychiatric Institute specializing in mind-body medicine, including meditation and yoga."

The transcript follows.

____________________

Arlington, Va.: Is alternative medicine becoming more mainstream/popular? What do you see it's future as in this country?

Michael Irwin: Alternative and complementary medicine is becoming more popular in the country due to public demand for health care to provide treatments that consider the whole person. However, for these treatments to be incorporated into medical care, we need evidence that they are safe and effective. The National Center for CAM (NCCAM) provides funds to help support such studies that will determine what treatments do and do not work.

_______________________

Washington, D.C.: Can you explain more about the research into alternative medicine? What's being done to test it? Thanks for the information.

Michael Irwin: Research in CAM is using state of the art methods to understand how mind-body treatments and other CAM approaches alter the brain and the body's physiology. Studies that are supported by NCCAM are carefully conducted to evaluate whether the effect of the treatments are safe and whether there are benefits of the treatment that are beyond nonspecific factor. Importantly, these studies are using a randomized controlled design in which the active treatment is being compared to control condition or inactive treatment. Such studies are the standard by which medicine can determine whether or not a treatment is effective.

_______________________

Chevy Chase, Md.: Where can I find Tai Chi classes?

Michael Irwin: There are a variety of Tai Chi approaches that can be taught, and such classes re offered in a number of community centers across the country. It is important to find the Tai Chi methods that is most accessible to you, so that these approaches can be readily integrated into your daily routine. In order for practices such as Tai Chi to have any potential health benefit, they must be practiced and many teachers recommend daily practice.

_______________________

Washington, D.C.: Are there different forms of alternative medicine in the United States than there are in the rest of the world? What are some of the similarities and differences?

Michael Irwin: The practice of certain mind-body treatments in the United States can differ from the methods used in other parts of the world. For example, certain forms of Tai Chi from China have been westernized to allow persons to learns these practice more readily. Likewise, yoga practice that originated in India have altered to make them more accessible for persons in the United States. While such modification may allow the novice practitioner in the United States to learn such practices more quickly, it is possible that some aspects of the treatments may have been "diluted" and are less potent. NCCAM is working to ensure collaborative research efforts between the US and foreign sites so that the original practices can be studied within the frame of the biomedical model here in the US.

_______________________

Waldorf, Md.: When will health insurance cover some of the alternative methods? It seems they have the possibility to reduce a lot of more expensive treatments by preventing the illness in the first place.

Michael Irwin: Evidence must be gathered, as is currently being done by NIH and NCCAM supported studies, to determine whether mind-body treatments are effective. As with other treatments, health care insurance provide reimbursement once there is an evidence base regarding safety and efficacy of the treatment for a specific condition.

_______________________

Herndon, Va.: Dr. Irwin: I believe one reason "alternative" medicine is looked at skeptically by so many (including myself) is that most of the time all evidence is anecdotal -- no testing is done. How do you test when checking "alternative" claims?

Michael Irwin: There are many claims about the health benefits of CAM and mind-body approaches, and most of these claims rest with anecdotal information. However, with the funding of NCCAM by Congress several years ago and the interest of NIH in general in testing the efficacy of these approaches, controlled trials are beginning to be conducted and are now being published in biomedical journals which report on what treatment are effective. A list of such studies can be readily found by accessing the NCCAM Web site www.nccam.nih.gov.

_______________________

Los Angeles, Calif.: I have rheumatoid arthritis (for 10 years) and am unable to work. I am in pain much of the time, don't sleep well at night, and have little energy for family or friends. I discussed this with my doctor who provided me with prescriptions for medications to help with my sleep and pain (Vicodin and Ambien). My wife thinks I am addicted to the pain meds and sent me to her homeotherapist. For the past month I have been taking: glucosamine and chondroitin, SAM-e, melatonin and co-enzyme Q-10. I feel a little better, but I am wondering what the effect of the supplements might be and whether there are additional risk to my health from taking these supplements?

Michael Irwin: Rheumatoid arthritis is an inflammatory disorder, and there is emerging new data to show that the practice of a mind-body treatment such as Tai Chi might decrease inflammation. There are several studies, to my knowledge, that are supported by NCCAM to test the efficacy of Tai Chi in the management of pain and poor sleep in RA patients. Since you are from Los Angeles, there are two studies being conducted at UCLA Neuropsychiatic Institute specifically for RA patients.

_______________________

Dupont Circle, Washington, D.C.: I've never been a good sleeper and have a very hard time sleeping well lately. Is there anything in alternative medicine that might help me?

Michael Irwin: Insomnia is one of the most prevalent symptoms in the general population throughout the US, and is associated with considerable disability and daytime dysfunction. Insomnia also carries health risks with increases in cardiovascular disease, for example. There is much interest in using mind-body treatments as a method to reduce levels of daytime arousal which have been associated with insomnia. One study published in the Journal of the American Geriatric Society showed that the Tai Chi reduced symptoms of insomnia and improved sleep in older adults.

_______________________

Springfield, Ill.: Concerning meditation if you reach a state of complete calm can the mind slow down and begin to target specific areas of concern.

Michael Irwin: The mechanisms of action of meditation are not yet known, but are increasingly a topic of investigation. For example, in the five-year strategic plan of NCCAM, there is a emphasis on understand the brain and neural mechanisms of action of meditation and other forms of mind-body treatments. Such studies, when coupled with an evaluation of physiological signals or measures taken from the body, will provide insights into how the brain and mind during the practice of meditation can communicate with the body and alter certain aspects of its function, potentially with impacts on disease.

Thank you for sending me so many very interesting questions within this limited time. Unfortunately, I have only been able to answer a fraction of the questions and to those who did not receive a reply, I apologize.

_______________________

Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.

COPYRIGHT 2005 Washingtonpost Newsweek Interactive
COPYRIGHT 2005 Gale Group