More than one-third of patients use CAM, yet many do not disclose their use of supplements or complementary modalities (e.g., chiropractic, acupuncture) because they doubt their healthcare providers’ professional knowledge of the subject, explained Catherine Ulbricht, PharmD, MBAc, co-founder and chief editor of Natural Standard Research Collaboration, Journal of Dietary Supplements.
“We started in a journal club fashion—a group of academic clinicians critiqued all other resources available at the time and concluded that none of them met our standards for quality, reliability, being unbiased, peer-reviewed,” she recalled. “Natural Standard Research Collaboration set out to consolidate the world’s efficacy and safety data into an evidence-based, point-of-care, decision-support tool for healthcare providers and consumers.”
Most aspects of complementary and alternative care fall within the purview of Natural Standard. “We conduct rigorous evidence-based systematic reviews on natural products, modalities like chiropractic, acupuncture, special diets like Atkins, Zone, sports medicine, genomics and proteomics, environmental and global health, animal health—everything that impacts health and wellness beyond drugs and surgeries,” explained Dr. Ulbricht.
To prepare each Natural Standard monograph, electronic searches are conducted in many databases, including AMED, CANCERLIT, CINAHL, CISCOM, the Cochrane Library, EMBASE, HerbMed, International Pharmaceutical Abstracts, Medline and NAPRALERT. Restriction-free hand searches are conducted of 20 additional journals and of bibliographies from 50 selected secondary references, and researchers in the CAM field are also consulted for access to additional references or ongoing research. All literature is collected pertaining to efficacy in humans (regardless of study design, quality or language), dosing, precautions, adverse effects, use in pregnancy/lactation, interactions, alteration of laboratory assays and mechanism of action (in vitro, animal research, human data). Standardized inclusion/exclusion criteria are utilized for selection.
Blinded review of monographs is conducted by multidisciplinary research-clinical faculty at major academic centers with expertise in epidemiology and biostatistics, pharmacology, toxicology, CAM research and clinical practice. In cases of editorial disagreement, a three-member panel of the Editorial Board addresses conflicts and consults experts when applicable. Authors of studies are contacted when clarification is required.
When the research is concluded, Natural Standard issues letter grades—much like a school would—that reflects the strength of medical evidence for or against the use of each therapy for a specific medical condition. “We follow a validated, reproducible grading scale based on that of USPTF to consolidate efficacy data and allow for comparative effectiveness screening between all therapies for all medical conditions,” affirmed Dr. Ulbricht, who went on to note that the group’s safety findings are turned into easy-to-use, interactive tools including patient handouts, and comparative efficacy charts on interactions, nutrient depletions, symptoms and adverse effects to aid clinicians, open lines of communication and encourage patients to participate actively in their healthcare. For a content example, follow this link.
The alternative health industry is driven by its focus on prevention and the willingness and freedom to explore all potential beneficial health options, said Dr. Ulbricht. “Accurate information about dietary supplements and other integrative therapies is imperative to all health industry stakeholders,” she said, acknowledging the importance of fostering open communication among multidisciplinary healthcare providers and consumers, making affordable healthcare available to all, alongside safe, effective therapeutic choices.
In addition to its research efforts, Natural Standard has been recognized by Dr. Oz and the World Health Organization as a “dietary supplements expert.” Its Journal of Dietary Supplements is Medline listed and welcomes submissions. It also participates in a robust academic rotation program for allied health, science and journalism students, and offers certificate/degree programs, as well as CME programs.
The Natural Standard team also recently launched a new Therapy Finder, and is currently working on new apps, checkers and multi-lingual content.
When asked to describe the current state of the integrative medicine from her vantage point, Dr. Ulbricht said she likes the way the industry is progressing but there is still more work to be done. “All stakeholders have a lot of work to do but are improving—more education is needed,” she said. “I am not personally for or against any therapy, I'm for uncovering the best evidence and applying it to patient care using all resources available—a multidisciplinary, collaborative approach founded on high quality research.”
Natural Standard has offered Nutraceuticals World readers two free weeks of access to its monographs and related services from Monday, October 26 through Monday, November 5. To begin your complimentary access, log on to www.naturalstandard.com (username: nutraceuticals, password: world).