The authors point out how Mill's method of difference underlies the reigning group-statistical and randomized clinical trial approaches to causality assessment. I would add that in emphasizing the method of difference, we have overlooked some of the other methods developed by John Stuart Mill (1806-1873) that hold great promise in our scientific and clinical endeavors. In addition to the method of difference, Mill developed at least four additional methods (or "canons," as he called them) of inductive inference: the method of agreement, the joint method of agreement and difference, the method of residues, and the method of concomitant variation.1 In its general form, the method of concomitant variation suggests that whatever phenomenon varies in any manner whenever another phenomenon varies in some particular manner is either a cause or an effect of that phenomenon or is connected with it through some fact of causation.2 Much of what Kiene and von Schön-Angerer present in their article could be viewed as variations of this method. What seems unique in Kiene and von Schön-Angerer's treatment is their emphasis on the use of this general principle within a single case. Used across many cases, the method supports the well-known correlational approach to empirical research. In place of seeking patterns among many cases—as group-statistical and correlational approaches advocate—Kiene and von Schön-Angerer recommend searching carefully for causality-indicating patterns within single cases or individuals. I contend that much can be learned using such an approach. Besides the illustrations given by Kiene and von Schön-Angerer, additional ones come to mind: the diagnostic and prescriptive powers in homeopathy's careful and wide-ranging observations of patterns of diverse symptoms; the general principles of learning, memory, and psychological functioning discerned in single cases by Ebbinghaus, Freud, Watson, and even by Pavlov and Skinner; and veridical evidence for paranormal functioning, in a single anecdote, that comes from a large number of rare and specific correspondences. A more superficial use of large numbers of cases is abandoned in favor of a more intense, deep, and careful study of patterns within the complexity of a single case or instance. Aided by a mindful, discerning stance—ever alert to possible confounds,
An in-treatment web-based survey was conducted in 2005 with 50 New York World Trade Center rescue and recovery workers, volunteers, and area residents and workers who were treated with Ayurvedic herbs for post-9/11 symptoms. The survey documented pretreatment efforts at symptom relief, post-treatment symptom impact, and the context for using the herbal intervention. Herbal treatment was administered and monitored by a private non-profit organization. The natural detoxification and immune-strengthening program consists of 4 herbal supplements developed by an Ayurvedic physician. A minimum 6-month basic program was recommended, but many participants continued to 1 year and longer. All 50 respondents reported high incidence of alleviation of previously intractable symptoms, chiefly respiratory symptoms, fatigue, and depression.
Depression is common after coronary artery bypass graft (CABG) surgery, but little is known about its effect on post-CABG inflammation or infection or about the most effective treatment for post-CABG depression.
(1) To determine ifpost-CABG depression is associated with increased infectious illness and (2) to test effects of cognitive behavioral therapy (CBT) on depressive symptoms, inflammatory biomarkers, and post-CABG infections in depressed post-CABG women.
Randomized, controlled trial.
Two urban tertiary care centers.
Fifteen clinically depressed women in the first month after CABG, along with a comparison group of 37 non-depressed postCABG women, were studied. Inclusion criteria were: < or = 75 years old, English-speaking, undergoing first-time CABG, available for 6 months offollow-up, and without malignancy or autoimmune disorders.
Eight weeks of individual home-based CBT.
(1) Depressive symptoms measured by the Beck Depression Inventory, (2) natural killer cell cytotoxicity (NKCC) measured by 51Cr-release assay, (3) infectious illness episodes measured by the Modified Health Review, (4) interleukin (IL)-6 and C reactive protein (CRP) measured by enzyme immunoabsorbent assay.
Clinically depressed post-CABG women exhibited decreased NKCC and a higher incidence of in-hospital fevers and infectious illness in the first 6 months after CABG. Among depressed women, CBT yielded moderate to large effects for improved NKCC (D=0.67) and decreased IL-6 (D=0.61), CRP (D=0.85), and postoperative infectious illnesses (D=0.93). CBT holds promise for improving depression and immunity and reducing infection and inflammation after CABG.
The positive effects of physical activity on the well-being of older adults have been well documented. Tai chi is a suitable form of physical activity, with known physical and psychological benefits for older adults.
The objective of the current study was to compare the effects of participation in a 16-wk tai chi program on the functional fitness of older adults with and without previous tai chi experience.
The research team designed a prospective cohort study. Participants who had practiced tai chi previously for ≥1 y at baseline were classified as experienced; all others were considered inexperienced.
The study took place at 2 community centers in 2 locations in the Greater Toronto area of Ontario, Canada.
Participants were residents of the 2 communities.
Participants were instructed to attend two 1-h sessions of Yang-style tai chi per wk.
Data on functional fitness- strength, endurance, speed, and flexibility-were collected at baseline and after completion of the tai chi program.
Of the 143 participants who completed the study, 20.5% were classified as experienced. Experienced participants had significantly higher ratings on functional fitness tests at baseline compared with the inexperienced group. At the end of the study, inexperienced participants had experienced significant improvements in all measures of functional fitness, although experienced participants had shown significant improvements only in measures of endurance and speed.
Tai chi appears to be an optimal mode of physical activity for older adults regardless of previous experience with tai chi.
To undertake a systematic analysis of case reports involving religious or spiritual issues published between 1980 and 1996.
MEDLINE, the National Library of Medicine's bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, and the preclinical sciences.
A search of 4,306,906 records indexed on MEDLINE from 1980 to 1996.
A total of 364 abstracts were found, then subjected to coding analysis.
Categories were developed for (1) types of healthcare situations involving religious/spiritual issues, (2) religious and spiritual interventions, (3) collaboration between healthcare and religious professionals, (4) psychopathology and sensitivity themes, and (5) religious faith/spiritual path. Although all of these case reports involved religious and spiritual issues, only 45 (12%) explicitly mentioned a religious professional. Of these, only 8 (2%) indicated any collaboration between healthcare and religious professionals.
A paucity of published case report literature exists on religious and spiritual issues (.008% of the MEDLINE records), indicating that the increasing acceptance of these factors by patients and healthcare professionals is not yet reflected in scientific and clinical journals. A need exists for more documented examples of collaboration between healthcare and religious professionals.
All eight publications since 1984 that have reported a total of 10 clinical studies of the treatment of common colds with zinc are reviewed. The reasons for the puzzling mix of diametrically opposite results in these studies are elucidated and related to independent in vitro investigations. A theoretical framework is put forth that explains the beneficial effects of zinc and that has a solid foundation based on the known molecular structures of the surface of human rhinovirus and intercellular adhesion molecule-1, the docking point for human rhinovirus present on the surfaces of cells of the nasal epithelium. The results of clinical investigations and theory suggest that consistently beneficial therapeutic effects can be expected of zinc ions from zinc gluconate with glycine in lozenges prepared according to homeopathic principles and procedures. The latest study published used an "intent to treat" statistical model, and the highly beneficial effects of zinc found in that study could not be compared directly with results from any earlier studies. Raw data from that study were therefore reanalyzed on the basis of assessable patients, and the results show an even better effect and can be compared directly with earlier findings. No side effects or adverse experiences due to zinc that were serious, disturbing, or persistent were found in any of the 10 studies.
The chiropractic profession is the largest, most established complementary and alternative medical (CAM) profession in the United States. The use of unconventional healthcare in the United States has increased in recent years, yet little is known about the market for specific CAM professions such as chiropractic.
To evaluate the market for US chiropractors between 1996 and 2005.
We conducted a descriptive study of the chiropractic profession from 1996 to 2005 using data from the Medical Expenditure Survey, the National Center for Education Statistics, and the US Bureau of Labor Statistics.
The amount and proportion of outpatient healthcare expenditures on chiropractic care in the United States, total chiropractors, number of chiropractors per adult population (>18 years), graduates from chiropractic schools, and professional income of chiropractors.
From 1996 to 2005 the proportion of outpatient US healthcare expenditures spent on chiropractic care increased from 2.15% to 3.26%. The total number of US chiropractors increased from 43 663 to 52 687 in 2004, but growth slowed between 2002 and 2004, resulting in a decrease in the number of chiropractors per 10000 US adults. Between academic years 1996 and 2001, chiropractic schools graduated about 3700 students each year; however, between 2001 and 2003, the annual number of chiropractic graduates decreased by 28%. Between 1998 and 2005, the inflation-adjusted median self-reported annual income of employed chiropractors fell from $76598 to $67200.
From 1996 to 2005, relative expenditures on chiropractic care increased; however, the number of chiropractic graduates, the rate of growth of chiropractors, and the incomes of chiropractors have declined. Future research is needed to investigate why national expenditures on chiropractic care have increased despite an apparent decrease in the supply of US chiropractors.
Complementary and alternative medicine (CAM) use by US adults increased substantially between 1990 and 1997, yet little is known about more recent trends.
Compare CAM therapy use by US adults in 2002 and 1997.
Comparison of two national surveys of CAM use by US adults: (1) the Alternative Health/Complementary and Alternative Medicine supplement to the 2002 National Health Interview Survey (NHIS, N = 31,044) and (2) a 1997 national survey (N = 2055), each containing questions about 15 common CAM therapies.
Prevalence, sociodemographic correlates, and insurance coverage of CAM use.
The most commonly used CAM modalities in 2002 were herbal therapy (18.6%, representing over 38 million US adults) followed by relaxation techniques (14.2%, representing 29 million US adults) and chiropractic (7.4%, representing 15 million US adults). Among CAM users, 41% used two or more CAM therapies during the prior year. Factors associated with highest rates of CAM use were ages 40-64, female gender, non-black/non-Hispanic race, and annual income of dollar 65,000 or higher. Overall CAM use for the 15 therapies common to both surveys was similar between 1997 and 2002 (36.5%, vs. 35.0%, respectively, each representing about 72 million US adults). The greatest relative increase in CAM use between 1997 and 2002 was seen for herbal medicine (12.1% vs.18.6%, respectively), and yoga (3.7% vs. 5.1%, respectively),while the largest relative decrease occurred for chiropractic (9.9% to 7.4%, respectively).
The prevalence of CAM use has remained stable from 1997 to 2002. Over one in three respondents used CAM in the past year, representing about 72 million US adults.
To assess the status of managed care and insurance coverage of complementary and alternative medicine (CAM) and the integration of such services into managed care.
A literature review and information search were conducted to determine which new insurers had special policies for CAM from 1999 to 2000. Telephone interviews were conducted with a sample of 6 new managed care organizations (MCOs) or insurers identified in 2000 and a nonrepresentative cohort of 4 of the original 18 MCOs and insurers who responded both to the original survey in 1997 and again in 1998 to determine trends.
This study constitutes the results of the third year of an ongoing annual survey. For the year 2000, a total of 14 new companies were identified as offering some CAM coverage. Survey results were analyzed for 6 of these who responded to the current survey as well as the results of the cohort mentioned above.
Most of the insurers interviewed offer some coverage for the following: nutrition counseling, biofeedback psychotherapy, acupuncture, preventive medicine, chiropractic, osteopathy, and physical therapy. All new companies indicated that market demand was a primary motivator for covering CAM. Factors determining whether insurers would offer coverage for additional therapies included potential cost-effectiveness, consumer interest, and demonstrable clinical efficacy. Among the most common obstacles listed for incorporating CAM into mainstream healthcare were lack of research on clinical or cost-effectiveness, economics, ignorance about CAM, provider competition, and lack of standards of practice.
Consumer demand for CAM is motivating more MCOs and insurance companies to assess the clinical and cost benefits of incorporating CAM. Outcomes studies for both conventional and CAM therapies are needed to help create a healthcare system based on treatments that work, whether they are conventional, complementary, alternative, or integrative medicine.