Practice Drift: Are There Risks When Integrative Medicine Physicians Exceed Their Scope?

Editor´s Note: This is the third commentary from the JACM column partnership with the Osher Collaborative for IntegrativeMedicine. These quarterly columns from leaders of the seven prominent academic centers that constitute the Collaborative are meant to stimulate and enliven thinking about the paradigm, practice, and policy to advance integrative health. In this column, two members at the Osher Center for Integrative Medicine in Chicago, Illinois and San Francisco, California, take on a challenge pioneering field face as they move from the Wild West into professional formation.

The severity of autism is associated with toxic metal body burden and red blood cell glutathione levels.

This study investigated the relationship of children's autism symptoms with their toxic metal body burden and red blood cell (RBC) glutathione levels. In children ages 3-8 years, the severity of autism was assessed using four tools: ADOS, PDD-BI, ATEC, and SAS. Toxic metal body burden was assessed by measuring urinary excretion of toxic metals, both before and after oral dimercaptosuccinic acid (DMSA).

Safety and efficacy of oral DMSA therapy for children with autism spectrum disorders: part B - behavioral results.

Background: This study investigated the effects of oral dimercapto succinic acid (DMSA) therapy on the behavioural symptoms of children with autism spectrum disorders (ASD) ages 3-8 years.

Methods: Phase 1 involved 65 children with ASD who received one round of DMSA (3 days). Participants who had high urinary excretion of toxic metals were selected to continue on to phase 2.

Safety and efficacy of oral DMSA therapy for children with autism spectrum disorders: Part A--medical results.

Background: This study investigated the effect of oral dimercapto succinic acid (DMSA) therapy for children with autism spectrum disorders ages 3-8 years.

Methods: Phase 1 involved 65 children who received one round of DMSA (3 days). Participants who had high urinary excretion of toxic metals were selected to continue on to phase 2.

Complementary and alternative medical therapies for attention-deficit/hyperactivity disorder and autism.

Complementary and alternative medical (CAM) therapies are commonly used by parents for their children who have attention deficit hyperactivity disorder (ADHD) or autism spectrum disorders. The use of these therapies is well documented, yet the evidence of the safety and efficacy of these treatments in children is limited. This article describes the current evidence-based CAM therapies for ADHD and autism, focusing on nutritional interventions; natural health products, including essential fatty acids, vitamins, minerals, and other health supplements; biofeedback; and reducing environmental toxins.

Thyrotoxicosis-induced congestive heart failure in an urban hospital.

Thyrotoxicosis has been associated with several cardiac complications, including atrial fibrillation (AF), functional cardiomyopathy, and congestive heart failure (CHF). Thyrotoxicosis-induced CHF has been considered an unusual complication of thyrotoxicosis, occurring generally in older patients. To determine the nature and frequency of this complication of thyrotoxicosis in an adult, hospitalized population, the authors consecutively evaluated all admissions to a 535-bed urban hospital during a 14-month period.

Fluid and electrolyte replacement in the ultramarathon runner.

We studied three male runners during three separate ultramarathon races. Serial blood samples were tested for electrolytes, renal function, albumin, calcium, phosphorus, and magnesium. Two runners had aldosterone levels measured during the race and one runner had blood lactate levels measured.

Metabolic profiles in patients with acute neurosurgical injuries.

Twenty-seven patients with acute neurosurgical injuries were compared with 23 patients with neurosurgical and multisystem injuries and 10 patients with multi-system injuries without neurosurgical injuries. Patients with isolated acute neurosurgical injuries did not demonstrate a hypermetabolic state with increased loss of nitrogen and decreased circulating levels of albumin, prealbumin, and retinol-binding protein when compared to multisystem-injured patients. Patients with demonstrated hypermetabolism on day 1 were supported with parenteral nutrition which decreased their protein losses and stabilized other metabolic variables such as calcium and phosphorus.

Prevalence of gallstones in obese Caucasian American women.

Although the association between gallstones and obesity is well known, no attempt has been made to quantitate the increased risk for gallstone formation associated with moderate obesity commonly seen in clinical practice. To determine the prevalence of both asymptomatic and symptomatic gallstones, screening oral cholecystograms were combined with prior documented history in 249 consecutive obese Caucasian women aged 20-59 yr who were seeking treatment for obesity in an out-patient clinic. To ascertain the relative risk of moderate obesity for gallstone formation, the results were compared with a control group of 60 consecutive women who were undergoing screening health examinations in the same clinic.