GINKGO ROOT, MISTLETOE WARRANT ADDITIONAL CLINICAL RESEARCH

GINKGO ROOT, MISTLETOE WARRANT ADDITIONAL CLINICAL RESEARCH into their potential efficacy in treating memory loss and cancer, respectively, Paul Knipschild, MD, University of Limberg, Netherlands, suggested in a presentation at a July 11-13 conference sponsored by NIH's Office of Alternative Medicine.

Ginkgo has demonstrated favorable results in over 40 trials in the treatment of short-term memory loss, attention deficiency and dizziness, Knipschild said. However, he noted that "it is unclear whether ginkgo works at more advanced stages of dementia"; "whether a higher dosage than usual...can speed the effects; and whether these effects last more than three months."

Knipschild evaluated research regarding the effect of mistletoe on cancer patients and suggested that the herbal product may slow the progression of cancer and improve the quality of life of cancer patients. Knipschild assessed 11 randomized clinical trials that indicated a "prolongation of survival time among cancer patients." However, he cautioned that "all [of the studies] have serious methodological flaws." He recommended "new, more vigorous research in this area."

Knipschild also encouraged further research into ginseng, another traditional herbal remedy. This root is reputed to have a vitalizing effect on elderly people with decreased stamina. After reviewing 20 studies, some of which he said were of "reasonable quality," Knipschild concluded that "middle-aged and elderly patients with subjective symptoms such as fatigue appeared to benefit substantially." He added that larger clinical trials of ginseng "made sense."

He was more skeptical of other alternative medicine practices. Regarding acupuncture, Knipschild reported that "the number of studies with a favorable result...is low." He also said acupuncture has no basis in laboratory evidence, noting that "no one has ever found the meridians along which energy is supposed to flow around the body influenced by needles." Regarding homeopathy, Knipschild claimed that the therapy's principles are "pure nonsense."

Research data on alternative treatments may become more accessible with the inclusion of a complementary medicine field group into the Cochrane Collaboration data analysis network, according to Klaus Linde, MD, Ludwig-Maximilians University, Munich. Cochrane groups, with several locations in Europe and one at Johns Hopkins University, provide researchers electronic access to systematic reviews of randomized clinical trials. Inclusion in the Cochrane Collaboration would "allow both doctors and patients to evaluate trials and treatments," Linde said.

An "exploratory meeting" is scheduled for April 1995 to gauge possible interest in forming a complementary medicine Cochrane field group, Linde reported.

Richard Pavek of the SHEN Therapy Institute, Sausalito, Calif., after reviewing current HHS funding for alternative medicine research, noted that "there is at least some willingness of the agencies across the spectrum of the National Institutes of Health to engage in the study of at least some new alternative practices."

Mind/body research topped the list receiving 38 awards for a total of over $4.4 mil. Biologics/pharmacologics was second with 16 awards and $2.2 mil. in grant money. OAM awarded the highest number of grants with 34, while the National Institute on Drug Abuse and the National Heart, Lung and Blood Institute provided the most funding at $3.2 mil. and $2.2 mil., respectively.

Andrew Vickers, Research Council for Complementary Medicine, UK, proposed a two-stage implementation program for alternative medicine practices. If randomized controlled trials yielded evidence of validity, he said, clinical tests should be conducted in "innovative practice clinics."

As envisioned by Vickers, the clinics would be incorporated into traditional hospital communities and patients would randomly receive either traditional or alternative therapies. If the alternative practice continued to demonstrate efficacy above and beyond traditional methods, it would be incorporated into conventional practice.

One form of implementation already under way is the Munchener Model, based in Munich. According to Project Director Dieter Melthart, MD, Munchener "aims to implement complementary medicine into mainstream medicine."

The project is a cooperative effort between the Ludwig- Maximilians University and four specialized clinics. Patients are diagnosed at the Munich center and then can be referred to one of the participating satellite clinics. The project receives a portion of its funding from the German government and insurance companies. The companies have agreed to cover patients for inpatient treatment for five years.