Evidence-based alternative medicine?

The validity of evidence-based medicine (EBM) is the subject of ongoing controversy. The EBM movement has proposed a "hierarchy of evidence," according to which randomized controlled trials (RCTs) and meta-analyses of RCTs provide the most reliable evidence concerning the efficacy of medical interventions. The evaluation of alternative medicine therapies highlights problems with the EBM hierarchy. Alternative medical researchers-like those in mainstream medicine-wish to evaluate their therapies using methods that are rigorous and that are consistent with their philosophies of medicine and healing. These investigators have three ways to relate their work to EBM. They can accept the EBM hierarchy and carry out RCTs when possible; they can accept the EBM standards but argue that the special characteristics of alternative medicine warrant the acceptance of "lower" forms of evidence; or they can challenge the EBM approach and work to develop new research designs and new standards of evidence that reflect their approach to medical care. For several reasons, this last option is preferable. First, it will best meet the needs of alternative medicine practitioners. Moreover, because similar problems beset the evaluation of mainstream medical therapies, reevaluation of standards of evidence will benefit everyone in the medical community--including, most importantly, patients.     

Is personalized medicine finally arriving?

It's no gold rush, but dozens of players are emerging in personalized medicine, with biotechs, big and small, leading the way. Some big pharma companies and even payers remain skeptical, but economics aside, the real winners will be patients.     

Memory enhancement by traditional Chinese medicine?

Abstract

Cognitive repair by insulin-like growth factor-I (IGF-I) through activation of insulin-like growth factor-I receptor (IGF-IR) is well established, but not used for clinical therapy due to its link to cancer. We hypothesize that IGF-IR activation rather than IGF-I per se may be essential for cognitive repair and attempted to identify ligands from traditional Chinese medicine (TCM) with drug-like potential towards IGF-IR. TCM ligands, 3-(2-carboxyphenyl)-4(3H)-quinazolinone from Isatisin digotica, (+)-N-methyllaurotetanine from Lindera aggregate, and (+)-1(R)-Coclaurine from Nelumbonucifera Gaertn, exhibited high binding affinities and good blood brain barrier (BBB) penetration crucial for accessing IGF-IR. Stable complex formation of the candidates was observed during molecular dynamics (MD) simulation. Interactions with Leu975 and Gly1055 or Asp1056 were important for ligand binding. Amino acid distance analysis revealed residues 974/975, 984–986, 996–1006, 1040–1056, and 1122–1135 as “hotspots” for ligand binding in IGF-IR. Versatile entry pathways for the TCM candidates suggest high accessibility to the binding site. Blockage of the binding site opening by the TCM candidates limits binding site access by other compounds. Multiple linear regression (R²?=?0.9715), support vector machine (R²?=?0.9084), Bayesian network (R²?=?0.8233) comparative molecular field analysis (CoMFA, R²?=?0.9941), and comparative molecular similarity indices analysis (CoMSIA, R²?=?0.9877) models consistently suggest that the TCM candidates might exert bioactivity on IGF-IR. Contour of representative MD conformations to CoMFA and CoMSIA maps exhibits similar results. Properties including BBB passage, evidence of ability to form stable complexes with IGF-IR by MD simulation, and predicted bioactivity suggest that the TCM candidates have drug-like properties and might have potential as cognitive-enhancing drugs.

An animated interactive 3D complement (I3DC) is available in Proteopedia at http://proteopedia.org/w/Journal:JBSD:38     

Treat Alzheimer's disease by traditional Chinese medicine?

Upregulated phosphodiesterase 4D (PDE4D) disrupts the regulation of calcium ion channel in the central nerve system, and hence it is considered as one of the causes of Alzheimer's disease. We employed structure-based drug design techniques and the world's largest traditional Chinese medicine (TCM) database for identifying potential TCM-based PDE4D inhibitors. We then applied multiple linear regression (MLR) and support vector machine (SVM) for quantitative structure–activity relationship model, as well as for molecular dynamics simulation analysis. Screening results suggested that metal cations, Zn²⁺ and Mg²⁺, played key roles in mediating stable protein–ligand interactions with the ligand-binding residues, Asp367 and Asp484. In addition, each ligand was shown to interfere with the active residue His326 that suggested inhibitory effects. The MLR and SVM prediction models further implied the PDE4D inhibitory effect of each TCM compound. The molecular simulation further suggested the binding stability of each compound in the PDE4D binding site. We identified three TCM compounds, such as mumefural, 2-O-feruloyl tartaric acid and kainic acid, as potential PDE4D inhibitors. In addition, we further identified the key interaction features associated with the protein–ligand-binding stabilities.     

In what sense is contemporary medicine dualistic?

Medicine's inability to humanely respond to the concerns of its patients has often been attributed to its Cartesian dualism of mind and body. More recently, this inability has been ascribed to medicine's penchant for isolating biological disease as its sole proper concern to the exclusion of experienced illness. This dualism of disease and illness is claimed to be an outgrowth of the Cartesian dualism but the differences and similiarities between these two forms of dualism is not clear. This paper seeks to clarify their relationship through an examination of their historical origins.Disease is currently identified and characterized by a process of clinico-pathological correlation. By this means clinical impressions are corrected in light of autopsy findings. Our current mode of clinico-pathological correlation originated in Paris in the early nineteenth century with the work of Xavier Bichat and others. The theory of knowledge implicit within this clinico-pathological approach to the body is described and compared to that of Descartes. Though medicine does pursue certain Cartesian goals for knowledge, such as knowledge of the patient that does not rely upon his candor, it ultimately espouses neither a Cartesian theory of knowledge nor a Cartesian theory of the body. With pathological inquiry modeled after the autopsy as the final word in the identification and characterization of disease, the patient's capacity for self-knowledge and interpretation — not an entity called mind — is isolated away from his body. This approach to the body means that objective evidence of disease is valued to the exclusion of subjective evidence.If the shortcomings of modern biomedicine are to be effectively addressed, not only must the interdependence of disease and illness be acknowledged. The very canons of medical evidence must be revised. Subjective evidence must be rehabilitated and rejuvenated with better methods of subjective clinical investigation. Host factors relevant to the healing and knowing of sickness must be elucidated so that medicine may rediscover the sentience of its patients. Department of Psychiatry and Behavioral Sciences University of Washington Seattle, WA 98195, U.S.A.     

Pollen as food and medicine—A review

Pollen, the male gametophyte of flowering plants, is a high energy material, which is collected by insects and stored as food reserve. Pollen has been used traditionally by humans for religious purposes and as supplementary food. Pollen is a concentrated, energy and vitamin rich food that in contemporary times is not only consumed as a dietary component, but also is used in alternative medical treatments. Pollen has potential imporiance as a supplementary and survival food, and for conditioning of athletes. Pollen has been used medically in prostatitis, bleeding stomach ulcers and some infectious diseases, although such use has been questioned by the medical profession. Pollen may also be used for treatment and prevention of the high-altitude-sickness syndrome. Because some individuals are allergic to pollen, and various pollen species contain specific allergens, individual sensitivities must be tested before pollen is used as a treatment or as a supplementary food.