Biomedical subjects
Irwin Ziment
Publications and source records attributed to Irwin Ziment.
Time for tea?
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Use of alternative medicine among Hispanics.
OBJECTIVES: To determine the prevalence and patterns of use of alternative medicine among urban Hispanics. DESIGN: A cross-sectional survey. SETTINGS/LOCATION: Churches located in the northern part of Los Angeles and outpatients and inpatients in a county hospital in southern California. SUBJECTS: 179 Hispanic subjects. OUTCOME MEASURES: The following issues related to alternative medicine were evaluated: frequency and reasons for its use; perceived efficacy; safety; costs; sources of information; overall satisfaction; and subject-physician interaction with respect to alternative medicine. RESULTS: Sixty-three percent (63%) of respondents reported using or had used one or more types of alternative medicine. The majority of users were women (75%, 95% confidence interval [CI], 66%-83%). The most commonly reported alternative therapies were herbs (57%, 95% CI 47%-66%), prayer (43%, 95% CI 34%-53%), and dietary supplements (21%, 95% CI 14-30%). Compared to nonusers, users of alternative medicine had significantly lower yearly income, less proficiency in English language, and lower educational level. The main indications for using alternative medicine were pain (61.4%, 95% CI 51%-71%), lack of energy (38.6%, 95% CI 29%-49%), and overweight (22.8%, 95% CI 16%-33%). Only 5.2% of subjects (95% CI 2%-12%) believed that herbs are more effective than medications prescribed by physician. A majority of users (61%, 95% CI 50%-68%) had more confidence in their physicians than in their alternative medicine provider. Forty-five percent (45%) of users (95% CI 34%-56%) believed prescribed medication was safer than alternative medicine, whereas only 7% (95% CI 3%-15%) believed the reverse. Adverse effects related to herbs and dietary supplements were reported by 11 users. The majority of participants (78.9%, 95% CI 69-87%) did not speak to their physicians about alternative therapy. The mean score of overall satisfaction with conventional medicine was significantly higher than with alternative medicine. CONCLUSIONS: Despite the common use of alternative medicine among Hispanics, the majority of users believe that conventional medicine is superior to alternative medicine. There is a significant gap in communication between physicians and patients with respect to alternative medicine.
Alternative approaches to immunotherapy of allergy.
Alternative therapies for allergic diseases may be prescribed by physicians or provided by other practitioners or selected by patients without resorting to consultation with a health advisor. The most popular alternative therapies include dietary manipulation and exaggerated avoidance of allergens. Established medical therapies include herbs (Western and Asian), homeopathy and acupuncture; many publications suggest they are of value in allergic disease management. However, most studies lack sufficient power, do not have adequate controls, fail to duplicate standard clinical practices, or utilize a heterogeneous group of subjects. Careful analysis suggest that popular alternative therapies might offer a minimal benefit over placebos, but further studies are required for more rigorous evaluation of outcomes. Numerous esoteric or non-specific methods of treating allergic diseases are also available which may be promoted by enthusiastic practitioners or supported by satisfied patients. The majority of such therapies will never be scientifically evaluated, and the results of such modalities will be difficult to separate out from those of true placebo treatments. It is evident that while the "prose" of scientifically established therapies is appealing to a declining number of patients, the "poetry" of complementary therapies resonates with an increasing majority of the public who believe in the magic of alternative medicine.
Herbal antitussives.
The mechanisms of actions of cough medicines are not always known. The problem is exacerbated for herbal medicines, where the effectiveness of the plant or its phytochemicals have rarely been carefully evaluated. Moreover, the most active phytomedicinal constituent is difficult to identify, and the expense and difficulty of such studies discourages sponsors who may not be able to benefit by subsequent exclusive marketing of the herbal remedy. Most popular herbs used as cough medicines appear to be demulcents whose action is confined to the oropharynx. It is probable that the vast majority of allegedly effective herbal cough medicines act as non-specific emetic-expectorants. The proof of activity of even marketed herbal derivatives such as guaifenesin and codeine is difficult to obtain. It is therefore likely that herbal cough medications will never be shown to be more active than placebos. Nevertheless, these plant products will continue to be popular remedies for patients and their health care advisors.
Treatment of chronic obstructive pulmonary disease.
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