APNs Need to Learn More About Complementary and Alternative Medicine

April Goley, RN, BSN

Disclosures

Topics in Advanced Practice Nursing eJournal. 2004;4(2) 

Modern Western medicine is increasingly challenged by complementary and alternative medicine (CAM). According to a recent study by Caplan and Griffin,[1] 42.1% of Americans used some form of CAM in 1997.[1] The World Health Organization (WHO) estimates that 80% of the world's population presently uses herbal medicine for some aspect of primary healthcare.[2] With such a dramatic increase in the use of CAM, it is essential that advanced practice nurses (APNs) be informed about the evidence supporting the safety and effectiveness of various forms of CAM.

I was excited to see CAM mentioned as a trend in nursing in an article published in the January 2004 issue of Medscape's Topics in Advanced Practice Nursing. Stokowski[3] discussed how the recent flurry of interest in CAM stimulated movements to integrate CAM into the conventional healthcare system and has led to funding for clinical trials to determine safety and efficacy of CAM therapies. In May 2002, the WHO released the first global strategy on traditional and alternative medicine, advocating for its integration with conventional medicine.[2] The National Center for Complementary and Alternative Medicine (NCCAM), which is part of the National Institutes of Health, is the Federal government's center for scientific research on CAM.[4] NCCAM has a mission to explore complementary and alternative healing practices through rigorous science.

Articles such as the one published in this journal are important and serve to emphasize the need for clinicians to review research findings in an effort to provide holistic care to their patients. In the United States, herbal and other dietary supplements are regulated as foods by the US Food and Drug Administration (FDA). This means that such supplements do not have to meet the same standards as drugs and over-the-counter medications for proof of safety, effectiveness, and what the FDA calls "Good Manufacturing Practices." Herbal medicines are often advertised to the public as less toxic and more effective than conventional drugs for various ailments because they are "natural" and because their efficacy is based on knowledge gained over thousands of years. Although one can dispute that theory and claim the potential for allergic reactions, cytotoxicity, and other concerns, clinicians cannot afford to ignore the reality that CAM is entering the medical mainstream.

Advanced practice nurses have a variety of evidence-based options available to increase their knowledge of CAM. The NCCAM Web site, available at https://nccam.nih.gov, reviews clinical trials of CAM specific to a variety of diseases and conditions. The National Institutes of Health's Office of Dietary Supplements Web site, at https://dietary-supplements.info.nih.gov/, provides safety notices and fact sheets on dietary supplements, and also reviews research findings on CAM. Because patients are likely to search the Internet for information on CAM, it is also essential that clinicians educate patients on the pros and cons of available data. The FDA, available at https://www.cfsan.fda.gov, offers tips for Internet searches as well as updated safety information on supplements. On this site, practitioners and consumers can also report questionable false advertisements or adverse effects from CAM.

I believe that advanced practice nurses need to push for additional training in CAM. This could be accomplished by increasing the number of continuing-education classes offered on CAM, or by lobbying for classes on CAM to be offered in the curriculum of advanced practice nursing programs. Regardless, in order to serve the public's best interests, it is crucial that all clinicians take responsibility to become educated on the efficacy and evidence supporting CAM.

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