Research Database -
International Updates

Alternative Medicine/
Complementary Therapies

Issue 93

PHIPPS, Division of Behavioral Medicine, St. Jude Children’s Research Hospital, 332 N. Lauderdale, Memphis, TN 38105-2794, USA, sean.phipps@stjude.org, has reviewed (64 references) complementary health promotion interventions in the reduction of distress associated with bone marrow transplants in children.
Abstract: Bone marrow transplant remains a prolonged and physically demanding procedure that can produce high levels of distress for patients and their families. The paper reviews work documenting the somatic distress and mood disturbances experienced by children undergoing this procedure and points to the necessity for strategies to reduce it. Research is reviewed to support the potential benefits of a number of complementary therapies (relaxation/imagery; massage; humour therapy; expressive therapies) for the reduction of transplant-related distress. A series of pilot studies are described assessing the outcomes of various such therapies. Based on these pilot studies, massage and humour therapy emerge as most promising and are currently in the randomized clinical trial stage.
Phipps S. Reduction of distress associated with paediatric bone marrow transplant: complementary health promotion interventions. Pediatric Rehabilitation 5 (4): 223-234, Oct-Dec 2002.

Issue 92

RAWLINGS and MEERABEAU, School of Health and Social Care, University of Greenwich, London, UK, report on the implementation of aromatherapy in Nursing and Midwifery.
Background: A small qualitative study was conducted among nurses and midwives who had taken a course in aromatherapy. It focussed particularly on obstacles to putting the knowledge into practice.
Methods: Participants had completed a course in aromatherapy between 9 months and 2 years previously. All were employed by an NHS Trust. They were interviewed for about 40 minutes each, and interviews were tape recorded. Data were analyzed according to published procedures.
Results and conclusions: The main themes that participants reported on were personal and professional benefits of the course, organizational issues, and the frustrations they experienced because of delays in implementing changes in their practice.
Rawlings F, Meerabeau L. Implementing aromatherapy in nursing and midwifery practice. Journal of Clinical Nursing 12 (3): 405-411, May 2003.
Comment: It is a great pity that the abstract for this study doesn’t reveal more detail regarding the content of the nurses’ aromatherapy training courses, what practices nurses attempted to apply to clinical practice and what obstacles were erected in implementing aromatherapy into patient care.

Issue 91

KELNER and colleagues, Institute for Human Development, Life Course and Aging, University of Toronto, ON, Canada, have found that complementary and alternative therapists contemplate the need for research into effectiveness, safety and cost-effectiveness.
Background: The aim of this study was to examine the views of different groups of CAM practitioners on the need to demonstrate the effectiveness and safety of their work.
Methods: Qualitative interviews were conducted with 22 representatives of three CAM professions (Chiropractic, Homeopathy, Reiki). Qualitative content analysis was used to identify the similarities and differences among and across groups.
Results: Chiropractors agreed that it was essential for their work to provide scientific evidence that their interventions work, are safe and cost-effective. Homeopaths were divided on the question, and Reiki practitioners showed no interest in undertaking such research.
Conclusions: CAM practitioners that are more formally organized are more likely to recognize the importance of scientific research regarding their therapies.
Kelner MJ, Boon H, Wellman B, Welsh S. Complementary and alternative groups contemplate the need for effectiveness, safety and cost-effectiveness research. Complementary Therapies in Medicine 10 (4): 235-239, Dec 2002.
Comment: It seems a bit rash to ascribe these differences to the degree of professional organization.

SARRELL and co-workers, Pediatric and Adolescent Ambulatory Community Clinic of the General Health Services, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, have conducted a trial on naturopathic treatment for ear pain in children.
Background: The object of this study was to determine the efficacy and
tolerability of naturopathic treatment of the ear pain commonly associated with otitis media, one of the most frequent diseases of early infancy.
Methods: In this controlled double-blinded study, 171 children presenting with ear pain and diagnosed with otitis media were divided into four groups. All patients received ear drops to be taken 3 times daily. Group A received Herbal Extract drops (allium sativum, verbascum thapsus, calendula flores, hypericum perfoliatum, lavender, and vitamin E in olive oil). Group B received the same herbal drops with added topical anaesthetic. Group C received the herbal drops and also oral antibiotic. Group D received the topical anaesthetic drops with oral antibiotic. Ear pain was assessed over 3 days using a VAS and also a scale consisting of faces.
Results: All groups showed a significant improvement over 3 days. Patients on ear drops alone had a better response than those on additional antibiotics. Results were best in group A (only herbal drops) as compared to the other groups.
Conclusions: No evidence was found that systemic antibiotics improved treatment outcomes. It is therefore recommended, in line with American guidelines, that in cases of otitis media, the main target of treatment should be the alleviation of the ear pain. This study shows that herbal extracts can be used very well for this, and indeed they have been shown to fulfil all the necessary criteria for good topical medicines: in vitro bacteriostatic and bactericidal activity, immune stimulation, antioxidant activity, and anti-inflammatory action. It is therefore recommended that such medicines be prescribed in general practice.
Sarrell EM, Cohen HA, Kahan E. Naturopathic treatment for ear pain in children. Pediatrics 111 (5 pt 1): e574-579, May 2003.
Comment: These results indicate that the best results were obtained in the group receiving only herbal drops and that systemic antibiotics did not improve outcome. A very passionate plea for common sense, and one that is the more relevant in the face of the increasing problem of antibiotic resistance.

Issue 90

MACKAY, Thorne Research, PO Box 25, Dover, ID 83825, USA, duffy@thorne.com, has reviewed (115 references) complementary and alternative therapies and antibiotic resistance.
Abstract: The Centers for Disease Control and Prevention (CDC) reported the consumption of 235 million doses of antibiotics in 2001. It is estimated that about 20% to 25% of these were prescribed unnecessarily, a large proportion of them by paediatricians treating common outpatient infectious diseases. Virtually all important bacterial infections are becoming resistant to antibiotics. Antibiotic resistance is therefore among the CDC’s top concerns. The overuse of antibiotics is beginning to be discouraged as scientific evidence is emerging to support the use of other therapies. An emphasis on accurate diagnosis, control of environmental risk factors, and use of complementary and alternative medicine is hoped to lead to a reduction in antibiotic prescribing and thus to a slowing down of the antibiotic resistance process worldwide.
MacKAy D. Can CAM therapies help reduce antibiotic resistance? Alternative Medicine Review 8(1): 28-42, Feb 2003.

Issue 89

BOON, University of Toronto, Ontario, Canada, heather.boon@utorotno.ca, reviewed (10 references) the regulation of complementary and
alternative medicine from a Canadian perspective.
Abstract: Increased use of CAM therapies in Canada has made the regulation of these practitioners an important issue for Canadian
policy makers. Regulatory structures that are difficult to change, fear of adding costs to an under-funded healthcare system, and the lack of internal cohesion of some CAM practitioner groups, all hinder attempts to implement new policies. However there appears to be at present a window of opportunity provided by an environmental health regulations review and public support for regulation. The biggest challenge appears to be the fact that currently in Canada, healthcare providers are regulated by individual provinces. Thus some professions (e.g. Chiropractors) are regulated in all provinces; some (e.g. Herbalists and Homeopaths) are not regulated in all provinces; and some (e.g. Naturopathic practitioners, Acupuncturists, Traditional Chinese Medicine practitioners) are regulated in some provinces but not in others. The harmonization of regulations and scopes of practice for all CAM practitioners is seen as highly desirable for the future.
Boon H. Regulation of complementary/alternative medicine: a Canadian perspective. Complementary Therapies in Medicine 10 (1): 14-19, Mar 2002.
Comments: It would appear that these issues are not limited to Canada, but are certainly pressing challenges for the UK as well.

Issue 89

POWER and co-workers, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5718, USA, rpower@leland.stanford.edu, review (70 references) the effectiveness of complementary and alternative medicine in HIV.
Abstract: Outcome studies on the efficacy of complementary and alternative medical (CAM) treatments in people living with HIV-AIDS are often of inferior quality: sample sizes are typically small, there is little follow-up and few time points, participants drop out at high rates. Several studies have been conducted that include control groups, double-blinded designs and randomization. These studies have yielded promising results for CAM treatment of HIV-AIDS, and further research with larger samples in a prospective research design are urgently needed. Many of the small studies reported trends – again, sample sizes need to be increased in order to verify these.
The psychological benefits of CAM treatments should not be underestimated; although in this review, psychological outcome measures were disregarded, there is some evidence that reducing depression can decrease HIV-related physical complaints.
There is a high prevalence of alternative supplement use amongst patients with HIV-AIDS, indicating a need to understand the health benefits, risks and interactions of these supplements. Health care providers need to be aware of the use of herbal and other alternative health practices of their patients in order to evaluate indications and contraindications. Research trials must include more ethnic minorities and be more gender-balanced.
Conclusions: Currently available studies indicate that many CAM interventions can improve the quality of life of people living with HIV-AIDS; however more studies using longitudinal, controlled designs are needed.
Power R, Gore-Felton C, Vosvick M, Israelski DM, Spiegel D. HIV: effectiveness of complementary and alternative medicine. Primary Care 19 (2): 361-378, Jun 2002.

EISENBERG and colleagues, Division for Research and Education
in Complementary an Integrative Medical Therapies, Osher Institute,
Harvard Medical School, Boston, Massachusetts 02215, USA, Osher_Institute@hms.harvard.edu, review (59 references) the credentialling of complementary and alternative medical practitioners.
Background: State legislation and professional organizations have developed mechanisms to license physicians and other medical practitioners, establish standards of practice, and protect healthcare consumers by establishing credentials as guarantees of competence. Complementary and alternative medicine (CAM) presents new challenges in this respect.
Results and discussion: The article describes the current status of efforts to create models for credentialling chiropractors, acupuncturists, naturopaths, massage therapists, and other CAM practitioners. It suggests a strategy of CAM credentialling for use by physicians, healthcare administrators, insurance companies, and professional organizations. It highlights the fact that more nationally uniform credentialling mechanisms are necessary to ensure high standards of practice and clinical research, but that such more uniform licensing may decrease the individuality of service and thus substantially alter CAM practice. It also takes into consideration that even licensed practitioners may deliver substandard care. Thus the two aims to ensure good therapy and to preserve individuality of service need to be balanced.
Eisenberg DM, Cohen MH, Hrbek A, Grayzel J, Van Rompay MI, Cooper RA. Credentialing complementary and alternative medical providers. Annals of Internal Medicine 137 (12): 965—973, Dec 2002.

MOERMAN, University of Michigan-Dearborn, USA, writes about the ‘meaning response’ and the ethics of avoiding placebos.
Abstract: The concept of the placebo effect is often thought to imply a deception and therefore disparaged and despised. Rethinking this leads to the realization that these benefits flow largely from the meaning given to medical encounters and are therefore far better understood as a ‘meaning response’. There need be no deception involved in eliciting meaning responses, and they are often very desirable and engage fundamental human biological pathways. All this puts the ethical dilemmas around placebo treatments in a new light. It seems unethical to avoid trying to understand more fully how meaning can so profoundly improve human well-being.
Moerman DE. The meaning response and the ethics of avoiding placebos. Evaluation and the Health Professions 25 (4): 399—409, Dec 2002.

Issue 87

DUVAL and co-workers, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Quebec, Canada, investigated the effect of Trager therapy on the level of evoked stretch responses in patients with Parkinson’s disease and rigidity.
Background: The aim of the study was to quantify changes in the evoked stretch responses in the most rigid arm of patients with Parkinson’s disease after Trager therapy, a gentle manual therapy.
Methods: Gentle rocking motion was imparted to the upper limbs and body of 30 patients for 20 minutes. A pre-treatment and two post-treatment (1 and 11 minutes) measurements were performed consisting of electromyographic recordings on two muscles in the patients’ forearms while their wrist were being passively flexed and extended to 60 degrees at a frequency of once per second. Patients received the treatment either on the more rigid side of their bodies or on the contralateral side. Half of the patients in each group were treated whilst lying down and the other half whilst sitting.
Results: Overall the level of evoked stretch response was lowered by the treatment by 36% at one minute and by 32% at eleven minutes (p = 0.05). Patients who received the treatment lying down benefited from a 42% reduction. The side on which patients received the treatment did not at first appear to influence results; however post-hoc analysis of the triple interaction revealed that the sitting position was much less efficient for a sustained contralateral effect.
Conclusions: These results strongly suggest that it is possible to modify the evoked stretch response using Trager therapy. This stretch reflex inhibition may induce a reduction of the muscular rigidity typically seen in Parkinson’s disease. The present results may eventually lead to the development of a specific manual therapy for patients with Parkinson’s disease and rigidity.
Duval C, Lafontaine D, Hebert J, Leroux A, Panisset M, Boucher JP, et al. The effect of Trager therapy on the level of evoked stretch responses in patients with Parkinson’s disease and rigidity. Journal of Manipulative and Physiological Therapeutics 25 (7): 455-464, Sep 2002.

Comment: In view of the difficulty of treating Parkinson’s disease, these types of drug-free therapies can make a difference to the quality of life of Parkinson’s patients.

STEURER-STEY and colleagues, Department of Internal Medicine, Medical Policlinic, University Hospital Zurich, Switzerland, claudia.stey@usz.ch, review (85 references) complementary and alternative medical treatments for asthma.
Background: Increasing numbers of asthma patients are attracted to CAM therapies, and it is therefore important to evaluate the scientific evidence of the efficacy of these treatments.
Methods: Medline, Embase, and the Cochrane Library for controlled trials were searched for controlled trials and systematic reviews of the most popular techniques for asthma treatment, i.e. acupuncture, homeopathy, breathing techniques, herbal and nutritional therapies.
Results: Claims that acupuncture is effective for asthma are not based on well-performed clinical trials. The role of homeopathy in the treatment of asthma needs further evaluation. Breathing techniques may contribute to the control of asthma symptoms but it is not possible to make firm judgements because of the small number of patients. Herbal remedies cannot be recommended based on the available evidence. Recommendations of a diet high in vitamin C and marine fatty acids are not harmful but evidence for clinically meaningful effects is scant.
Conclusions: So far solid scientific evidence is lacking to show that CAM therapies are effective in asthma treatment. This does not necessarily mean that the treatments are ineffective but could simply mean that they have not been adequately investigated. High-quality research in CAM therapies is to be fostered.
Steurer-Stey C, Russi EW, Steurer J, et al. Complementary and alternative medicine in asthma: do they work? Swiss Medical Weekly 132 (25-26): 338-344, Jun 2002.

STUTTART, Department of Nursing, Greenbank Building, University of Central Lancashire, Preston PR1 2HE, UK, writes about working in partnership to develop evidence-based practice within the massage therapy profession.
Background: In view of the moves towards regulatory frameworks and an evidence base for the practice of CAM, there is a need to establish to what extent this is happening and how it can happen in a way that will benefit individuals and organizations involved.
Results: The paper outlines the views of professional massage therapists at the Northern Institute of Massage in the North of England and discusses how a professional organization for massage can work in partnership with Higher Education to develop an evidence base for practice.
Conclusions: A significant number of practitioners at the Northern Institute of Massage are aware of the need for an evidence base for practice but need more support in finding, reading and applying research findings to their practice. A partnership between professional organizations and higher education institutions can benefit both parties.
Stuttard P. Working in partnership to develop evidence-based practice within the massage profession. Complementary Therapies in Nursing and Midwifery 8 (4): 185-190, Nov 2002.

Issue 85

LE FOLL and co-workers, Unité de Neurobiologie at Phamracologie Moléculaire de l’ INSERM, Centre Paul-Broca, 2ter, rue d’Alésia, 75014 Paris, France, lefoll@broca.inserm.fr, meta-analyze the use of cognitive and behavioural therapy for the cessation of smoking.

Background: Smoking is an addictive disease characterized by frequent relapse. Pharmacological and psychological factors are involved, and while physicians are familiar with pharmacological treatment using nicotine replacement therapy and bupropion, they are less familiar with psychological approaches. Various techniques have been evaluated such as aversion therapy, contracts, social support, stimulus control, relaxation, diet and nicotine fading. Such approaches are often complemented with cognitive strategies using motivational interviews, skills training and relapse prevention strategies.

Results: This article reviews cognitive and behavioural techniques in a meta-analysis evaluating their effectiveness. The results confirm the efficacy of cognitive and behavioural therapy in smoking cessation.

Le Foll B, Aubin HJ, Lagrue G. Behavioural and cognitive therapy to break the smoking habit. Review of the literature. annales de Médecine Interne 153 (3 Suppl): 1S32-40, May 2002.

FURLAN and co-workers, Institute for Work Health, Toronto, Canada, afurlan@iwh.on.ca, review (41 references) the use of massage for low back pain.

Background: Low back pain is a very costly and widespread health problem in modern society. Massage is often thought to alleviate the pain and disability and speed recovery. This study aimed to assess the effects of massage for non-specific low back pain.

Methods: A number of databases were searched: MEDLINE, EMBASE, Cochrane Controlled Trials Register, HealthSTAR, CINHAL, and dissertation abstracts through to May 2001. References included in studies found were screened. In addition, contact with massage associations and content experts was made. Studies included in the review had to be randomized or quasi-randomized trials investigating the use of any massage technique for non-specific low back pain. Two reviewers blinded to authors, journals and institutions selected the studies using the assessment criteria of the Cochrane Collaboration Back Review Group, and extracted the data using standardized forms.

Results: Nine publications reporting on eight randomized trials were included. Massage was compared with an inert treatment (sham laser) in one study that showed that massage was superior. In the other seven studies, massage was compared with other active treatments. They showed that massage was less efficient than manipulation and transcutaneous electrical nerve stimulation (TENS); equal to corsets and exercises; and better than relaxation therapy, acupuncture, and self-care education. The beneficial effects of massage with chronic low back pain lasted for at least 1 year post treatment. One study comparing two different massage techniques concluded in favour of acupuncture massage over Swedish massage.

Conclusions: Massage might be beneficial for patients with low back pain, especially when combined with exercises and education. The particular effectiveness of acupuncture massage needs confirmation, and more studies are needed to confirm these conclusions and to measure longer-term effects of massage therapy.

Furlan AD, Brosseau L, Imamura M, Irvin E. Massage for low back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine 27 (17): 1896-1910, Sep 2002.

QUINN and colleagues, Boulder College of Massage Therapy, 6255 Longbow Drive, Boulder, CO 80301, USA, cquinn@bcmt.org, studied massage therapy and the frequency of tension headaches.

Background: The effect of massage therapy on chronic nonmigraine headaches was investigated.

Methods: Chronic tension headache sufferers received structured massage therapy directed toward neck and shoulder muscles. Headache frequency, duration, and intensity were recorded and compared with baseline measures.

Results: Compared to baseline values, headache frequency was significantly reduced within the first week of the massage treatment and continued to decrease thereafter (p = 0.009). The duration of headaches tended to decrease (p = 0.058) and their intensity was essentially unaffected (p = 0.19).

Conclusions: The muscle-specific massage therapy technique used in this study has the potential to be a functional, nonpharmacological intervention for reducing the incidence of chronic tension headache.

Quinn C, Chandler C, Moraska A. Massage therapy and frequency of chronic tension headaches. American Journal of Public Health 92 (10): 1657-1661, Oct 2002.

Comments: Headache is one of the most common complaints suffered by a huge percentage of the general population. That massage, a non-drug, pleasurable therapy was demonstrated to significantly reduce both intensity and duration of nonmigraine headaches is encouraging. This treatment needs to incorporated into treatment regimes used by GPs; this is certainly a better option than the frequent use of painkillers, all of which have side effects.

Issue 84

RO and colleagues, College of Nursing, Catholic University of Korea, Seoul, Korea, studied the effects of aromatherapy on pruritus [itching] in patients undergoing hemodialysis.

Background: The study was designed to investigate the effects of aromatherapy on pruritus in patients with chronic kidney failure.

Methods: A group of 13 patients received an aromatherapy massage on the arm three times a week for four weeks. Pruritus score, skin pH, stratum corneum hydration, and pruritus-related biochemical markers were measured before and after treatment and compared with 16 patients who did not receive the treatment.

Results: Pruritus scores were significantly reduced after aromatherapy treatment. Skin pH showed no changes in either group, and skin hydration increased significantly in the treatment group.

Conclusions: Aromatherapy looks like a useful and effective method for managing pruritus in patients undergoing hemodialysis.

Ro YJ, Ha HC, Kim CG, Yeom HA. The effects of aromatherapy on pruritus in patients undergoing hemodialysis. Dermatology Nursing 14 (4): 231-234, Aug 2002.

WANG and co-workers, Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06520, USA, shu-ming.wang@yale.edu, surveyed the attitudes of patients undergoing surgery towards alternative medical treatment.

Background: The study aimed to survey the levels of interest and experience in complementary and alternative medical treat- ments (CAM) in patients presenting for surgery at a teaching hospital.

Methods: A Questionnaire was administered to 1000 patients awaiting surgery.

Results: 857 questionnaires were completed. 32% of respondents had experience with various CAM treatments: massage (15.2%), herbalism (9.7%), relaxation (8.3%), acupuncture (6.6%). 42% of patients expressed a willingness to use acupuncture as a treatment for preoperative anxiety. These patients were significantly younger (47 vs. 53, p < 0.0001) than those who were unwilling to try acupuncture. 66.3% of them had experience in other CAM modalities. Age and education levels were found to be significant predictors for interest in and experience of CAM treatments. Gender was not found to be such a predictor.

Conclusions: CAM therapies are commonly used prior to surgery. A significant number of patients are willing to use acupuncture as a treatment for preoperative anxiety.

Wang SM, Peloquin C, Kain ZN. Attitudes of patients undergoing surgery toward alternative medical treatment. The Journal of Alternative and Complementary Medicine 8 (3): 351-356, Jun 2002.

Issue 83

SCOENBERGER et al., Kessler Medical Rehabilitation Research and Education Corporation, West Orange, NJ, USA, E: nancysholland@bellsouth.net, surveyed the opinions and practices of medical rehabilitation professionals regarding prayer and meditation.

Background: The objective of the study was to assess the attitudes and practices of professionals in physical medicine and rehabilitation (PMR) with regards to prayer and meditation.

Methods: A survey including questions about the use of a number of complementary and alternative therapies was mailed to 7,479 professionals specializing in PMR. 1,221 completed surveys were returned.

Results: Although the majority of practitioners endorsed the use of prayer as a legitimate health care practice, there was greater faith in meditation. Older respondents were more likely to recommend meditation to patients and more likely to meditate themselves. Nurses and occupational therapists were more positive towards meditation and prayer than physicians and physical therapists. Personal use of a technique was the strongest predictor of professional behaviour. Correlation between attitudes and professional behaviour was generally weak: despite accepting prayer and meditation as health care practices, practitioners generally did not refer patients for meditation or religious consultation.

Conclusions: A large part of the variance in professional behaviour is not accounted for by the variables surveyed, indicating that unknown factors are more influential upon professional practice decisions.

Schoenberger NE, Matheis RJ, Shiglett SC, Cotter AC. Opinions and practices of medical rehabilitation professionals regarding prayer and meditation. The Journal of Alternative and Complementary Medicine 8 (1): 59-69, Feb 2002

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WILKINSON et al., Department of Psychology, Tennessee State University, Nashville 37209-1564, USA, E: dswilkinson@mindspring.com, evaluated the clinical effectiveness of healing touch.

Background: The study had two objectives: to determine the clinical effectiveness of healing touch on variables related to health enhancement, and to determine whether practitioner training levels modulated treatment effectiveness.

Methods: 22 clients who had never experienced healing touch (HT) were allocated to 3 different treatments: no treatment, HT, and HT+ (HT plus music plus guided imagery). Secreted Immunoglobulin A (sIgA) in saliva, self-report of stress levels, client perception of health enhancement were measured, as well as more qualitative questionnaires about health effects.

Results: Clients of experienced HT practitioners showed significant positive changes in sIgA levels while clients of inexperienced practitioners did not. Clients reported significantly reduced levels of stress after both HT treatments. Enhancement of health was reported by 59% of clients. 55% of clients reported pain relief.

Conclusions: The data support the clinical effectiveness of healing touch in health enhancement, specifically for raising sIgA levels, lowering stress and relieving pain. It is interesting that practitioners’ degree of experience had an impact on the most objectively measurable variable (sIgA).

Wilkinson DS, Knox PL, Chatman JE, Johnson TL, Barbour N, Myles Y, Reel A. The clinical effectiveness of healing touch. The Journal of Alternative and Complementary Medicine 8 (1): 33-47, Feb 2002.

Comment: The above research demonstrate, in different ways, the importance of attitude, experience and currently unknown factors upon both the acceptance of meditation and healing upon the medical profession, as well as the association between clinical effectiveness and change in sIgA levels and experience of practitioners.

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