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November 11, 1998, Vol 280, No. 18 Pages 1549-1640
To promote the science and art of medicine and the betterment of the public health.
Original Contributions
Trends in Alternative Medicine Use in the United States,
115 Years of Continuous Publication
1990-1997: Results of a Follow-up National Survey ............................... 1569
D. M. Eisenberg, R. B. Davis, S. L. Ettner, S. Appel, S. Wilkey,
World Wide Web Address: http: //www.ama-assn.org/jama
EDITORIAL STAFF
M. Van Rompay, R. C. Kessler, Boston, Mass
Editor: George D. Lundberg, MD
Deputy Editor: Richard M. Glass, MD Spinal Manipulation in the Treatment of Episodic
Deputy Editor (West): Drummond Rennie, MD
Senior Editors: Phil B. Fontanarosa, MD, Margaret A. Winker, MD
Tension-Type Headache: A Randomized Controlled Trial ................. 1576
Senior Contributing Editor: M. Therese Southgate, MD G. Bove, N. Nilsson, Odense, Denmark
Contributing Editors: Charles B. Clayman, MD, Helene M.
Cole, MD, Thomas B. Cole, MD, MPH, David S. Cooper, MD, David Moxibustion for Correction of Breech Presentation:
H. Mark, MD, MPH, Harriet S. Meyer, MD, Carin M. Olson, MD,
Ronna Henry Siegel, MD, Jeanette M. Smith, MD, Jody W. Zylke, MD A Randomized Controlled Trial .......................................................................... 1580
Consulting Editors: Robert A. Clark, MD, Deborah J. Cook, MD F. Cardini, Verona, Italy; H. Weixin, Nanchang, China
Statistical Editor: Naomi Vaisrub, PhD
Associate Senior Editor: Annette Flanagin
Associate Editors: Charlene Breedlove, Roxanne K. Young
Treatment of Irritable Bowel Syndrome With Chinese
Fishbein Fellow: Thomas C. Jefferson, MD Herbal Medicine: A Randomized Controlled Trial ................................... 1585
Medical News & Perspectives: Marsha F. Goldsmith (editor);
Charles Marwick, Mike Mitka, Andrew Skolnick, Joan Stephenson, A. Bensoussan, N. J. Talley, M. Hing, R. Menzies, A. Guo, M. Ngu, Sydney, Australia
PhD (associate editors); Rebecca Voelker (contributing editor)
Assistant Editor: Juliana M. Walker Acupuncture and Amitriptyline for Pain Due to HIV-Related
EDITORIAL BOARD
Daniel M. Albert, MD, Madison, Wis
Peripheral Neuropathy: A Randomized Controlled Trial ..................... 1590
Kenneth A. Arndt, MD, Boston, Mass J. C. Shlay, Denver, Colo; K. Chaloner, St Paul, Minn; M. B. Max, Bethesda, Md;
H. David Banta, MD, Amsterdam, the Netherlands B. Flaws, Boulder, Colo; P. Reichelderfer, Bethesda, Md;
Jack D. Barchas, MD, New York, NY
Michael Berger, MD, Du ¨sseldorf, Germany D. Wentworth, S. Hillman, Minneapolis, Minn; B. Brizz, Rockville, Md;
Robert J. Blendon, ScD, Boston, Mass D. L. Cohn, Denver, Colo; for the Terry Beirn Community Programs
Marjorie A. Bowman, MD, MPA, Philadelphia, Pa
Iain Chalmers, MBBS, MSc, Oxford, England for Clinical Research on AIDS
James E. Dalen, MD, Tucson, Ariz
Catherine D. DeAngelis, MD, Baltimore, Md Garcinia cambogia (Hydroxycitric Acid) as a Potential
Lois DeBakey, PhD, Houston, Tex
Ronald G. Evens, MD, St Louis, Mo Antiobesity Agent: A Randomized Controlled Trial ............................... 1596
Michael E. Johns, MD, Atlanta, Ga S. B. Heymsfield, D. B. Allison, J. R. Vasselli, A. Pietrobelli,
Colin I. Johnston, MB,BS, Melbourne, Australia
Donald A. B. Lindberg, MD, Bethesda, Md
D. Greenfield, C. Nunez, New York, NY
Herve Maisonneuve, MD, Paris, France
´
Kenneth D. McClatchey, MD, DDS, Maywood, Ill
C. David Naylor, MD, North York, Ontario, Canada Preliminary Communication
Claude H. Organ, Jr, MD, Oakland, Calif
Edmund D. Pellegrino, MD, Washington, DC Yoga-Based Intervention for Carpal Tunnel Syndrome:
Reed E. Pyeritz, MD, PhD, Pittsburgh, Pa
Uwe E. Reinhardt, PhD, Princeton, NJ A Randomized Trial .................................................................................................. 1601
Povl Riis, MD, Copenhagen, Denmark M. S. Garfinkel, A. Singhal, W. A. Katz, D. A. Allan, R. Reshetar,
William L. Roper, MD, MPH, Chapel Hill, NC
Roger N. Rosenberg, MD, Dallas, Tex H. R. Schumacher, Jr, Philadelphia, Pa
Rene Solomon, MD, New York, NY
´e
Masaaki Terada, MD, Tokyo, Japan
INTERNATIONAL ADVISORY COMMITTEE Review
Bassel Atallah, MD, JAMA--Middle East
Mauro Bologna, MD, JAMA--Italy Saw Palmetto Extracts for Treatment
Carlos R. Gherardi, MD, JAMA--Argentina
Yuichiro Goto, MD, JAMA--Japan
of Benign Prostatic Hyperplasia: A Systematic Review ...................... 1604
Evin Kantemir, MD, JAMA--Turkey T. J. Wilt, A. Ishani, G. Stark, R. MacDonald, Minneapolis, Minn;
A. J. Khan, SI, FRCP, JAMA--Pakistan J. Lau, Boston, Mass; C. Mulrow, San Antonio, Tex
Jin-Pok Kim, MD, JAMA--Korea
C. R. Kumana, MBBS, JAMA--Southeast Asia
Li Chengyi, MD, JAMA--China
Alexandra Livaditou, MD, JAMA--Greece Health Law and Ethics
Maria S. P. da Silva, MD, JAMA--Brazil
Miguel Vilardell Tarres, MD, JAMA--Spain Medical Malpractice Implications of Alternative Medicine ................. 1610
Ivan Vidmar, MD, JAMA--Slovenia D. M. Studdert, D. M. Eisenberg, F. H. Miller, D. A. Curto,
Jir´ Widimsky MUDr, DrSc, JAMA--Czech/Slovak
i ´,
Alexei Yurenev, MD, JAMA--Russia T. J. Kaptchuk, T. A. Brennan, Boston, Mass
JAMA(ISSN 0098-7484) is published weekly by theAmerican Medi-
cal Association, except for 4 combined issues in months with 5
Wednesdays. Address: 515 N State St, Chicago, IL 60610.
Editorials
SUBSCRIPTION RATES--The subscription rate for AMA members
($20 per year) is included in and is not deductible from the annual
Alternative Medicine--Learning From the Past,
AMA membership dues. The annual subscription rates for nonmem- Examining the Present, Advancing to the Future .................................... 1616
bers are $145 in the United States and US possessions, $195 in the
Americas, and £125 outside the Americas. The rate for nonmember
W. B. Jonas, Bethesda, Md
medical students and resident physicians is $48 in the United States.
The annual institution rates are $245 in the United States, $345 in the Alternative Medicine Meets Science ............................................................... 1618
Americas, and £195 outside the Americas. Address all subscription P. B. Fontanarosa, G. D. Lundberg, Chicago, Ill
communications to Subscriber Services Center, American Medical
Association, PO Box 10946, Chicago, IL 60610-0946. Phone: (800)
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CHANGE OF ADDRESS--POSTMASTER, send all address
This Week in JAMA ................................................................................................. 1551
changes to: JAMA, The Journal of theAmerican MedicalAssociation,
attention: Subscription Department, PO Box 10946, Chicago, IL
60610. Notification of address change must be made at least 6 weeks
The Cover ........................................................................................................................ 1552
in advance; include both old and new addresses and a recent mailing Johannes de Ketham, Fasciculus Medicinae M. T. Southgate
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JAMA Registered in the US Patent and Trademark Office. Abstracts ...................................................................................................................... 1522 e
Copyright 1998 by the
American Medical Association (Table of Contents continued on next page.)
1549
©1998 American Medical Association. All rights reserved.
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JAMA 100 Years Ago ......................................................................................... 1552 o
Ginseng in Korea.
Medical News & Perspectives ...................................................................... 1553
Alterations Are Ahead at the OAM . . . FDA Never Promised an Herb Garden--But Sellers and Buyers
Eager to See One Grow . . . Dawn's Early Light to Twilight's Last Gleaming . . . . . . Miscellanea Medica
SCIENTIFIC INFORMATION AND MULTIMEDIA STAFF
The World in Medicine ......................................................................................... 1559 Medical News and New Media Division: William M. Silberg
(editorial director); Renee Roberts (manager, editorial graphics);
´
World AIDS Day . . . Genetics and HIV Dementia . . . Improving Stroke Outcomes . . . Marty Suter (associate editor); Deborah Flapan, Neal Shankman
Smoking and Hip Fractures . . . Malnutrition Risks . . . Partnerships Continue (assistant editors); Marla A. Hall (staff assistant)
Editorial Systems andAdministration: Elaine Williams (director),
Vee Bailey (electronic input supervisor), Celina Canchola, Lenette
A Piece of My Mind ............................................................................................ 1560 Gardner-Gullens (electronic input specialists)
Staff Assistant: Helga Fritz
Editorial Assistants: Linda Baker, Patricia Joworski, Gale
Leeches, Spiders, and Astrology: Predilections and Predictions T. Delbanco
Saulsberry (group supervisors); Kemberly Evans (letters coordi-
nator); Mary Cannon, Susan Collister,Audrey Forman, Shirley Gogins,
Gwenn Gregg, Lisa Hardin, Carmina Landeros, Mary Ann Lilly,
Poetry and Medicine .............................................................................................. 1562 Christina Myers, Kathie Owens, Ethel Pinkston, Jeni Reiling, Raul
Serrato, Gloria Tate
Six Prescriptions J. Coulehan Editorial Processing Division: Cheryl Iverson (director), Diane
L. Cannon (freelance manager), Connie Manno (freelance coor-
Letters ................................................................................................................................. 1563 dinator), Paul Frank (electronic editing specialist), Monica Mungle
(assistant electronic editing specialist)
Copy Editing: Stacy L. Christiansen (director); Susan R. Benner,
Personal Use of Alternative Medicine Therapies by Health Science Center Faculty Jane C. Lantz (senior copy editors); Coleen Adamson, Joy Jaeger,
M. A. Burg, S. G. Kosch, A. H. Neims, E. P. Stoller Brande Martin, Beverly Stewart
Adverse Events Related to Acupuncture H. Yamashita, H. Tsukayama, Y. Tanno, K. Nishijo PRODUCTION AND DISTRIBUTION STAFF
Production and Distribution Division: Vanessa Hayden (direc-
Evidence Influencing British Health Authorities' Decisions in Purchasing Complementary Medicine tor), Diane Darnell (publishing manufacturing analyst), Bonnie Van
R. van Haselen, P. Fisher Cleven (manager, budgets and costs), Karen Adams-Taylor (direc-
Quality Control of Dehydroepiandrosterone Dietary Supplement Products tor, advertising and production), Linda Knott (director, electronic
J. Parasrampuria, K. Schwartz, R. Petesch production), Paul Gasiecki (manager, distribution), Debbie Camp
(production services supervisor), Betty Frigerio (production ser-
Advising Patients About Herbal Therapies M. Cirigliano, A. Sun vices supervisor), Terri Hanley (production specialist)
Managers: Phil Arko (composition), Mary Ellen Johnston (data-
St John's Wort During Pregnancy L. R. Grush, A. Nierenberg, B. Keefe, L. S. Cohen base and new media), Teresa Omiotek (proofreading), Carole
Cardiac Complications and Delirium Associated With Valerian Root Withdrawal Piszker (advertising), Susan Price (print production), Charl Richey
H. P. Garges, I. Varia, P. M. Doraiswamy (color and graphics)
Proofreaders: David Antos, Daniel James, Mary Kay Tinerella,
Cutaneous Anthrax Associated With the Kombucha "Mushroom" in Iran J. Sadjadi Barbara Wojtowicz
Effect of Garlic on Serum Lipids L. D. Lawson; H. K. Berthold, T. Sudhop, K. von Bergmann Production Associates and Operators: Joseph Amft, Gail Barrett,
Karen Branham, Regina Brownlee, Victoria Buckner, Brenda Chandler,
Heather Crego, La'son J. Diggs, Shannon Epplett, Amy Evers, Kathy
Resident Forum ...................................................................................................... 1620 e Gaydar, Mari Guizzetti, Maria Kowalkowski, Mary Ann Kuranda, San-
dra Lopez, Michael McGraw, Melanie Parenti, Sarah Powell, Denise
Integrating Alternative Medicine Into Practice J. Udani Steinhauser, Jo Anne Turner, Carmela Ware, JoAnne Weiskopf, Alicja
Wojcik-Dunn
Production Assistants: Bryan Irzyk, Ruth Sprague
Policy Perspectives CIRCULATION AND CONTENT MARKETING STAFF
Director, Division of Circulation and Content Marketing:
Factors That Shape Alternative Medicine D. P. Eskinazi ............................................................. 1621 James A. Skowrenski
Circulation Processing: Beverly Martin (director)
Physicians' Ethical Obligations Regarding Alternative Medicine J. Sugarman, L. Burk .................. 1623 Circulation Development: Bina Oza (director)
Licensing and Permissions: Norman Frankel (director),
Investigating Alternative Medicine Therapies in Randomized Controlled Trials Ada Jiminez-Walker (permissions)
A. Margolin, S. K. Avants, H. D. Kleber ....................................................................................... 1626 Reprint Coordinator: Joseph Rekash
AMA Officers
Complementary Medicine and the Cochrane Collaboration President: Nancy W. Dickey, MD*
J. Ezzo, B. M. Berman, A. J. Vickers, K. Linde ............................................................................. 1628 President-Elect: Thomas R. Reardon, MD*
Immediate Past President: Percy Wootton, MD
Secretary-Treasurer: Timothy T. Flaherty, MD*
Speaker, House of Delegates: Richard F. Corlin, MD
JAMA NetSight: A Guide to Interactive Medicine ................. 1631 Vice-Speaker, House of Delegates: John A. Knote, MD
AMA Trustees
Researching Alternatives R. Sikorski, R. Peters Herman I. Abromowitz, MD; Susan Hershberg Adelman, MD; Yank
D. Coble, MD*; Palma E. Formica, MD; J. Edward Hill, MD; Donald
T. Lewers, MD* (Vice Chair); William H. Mahood, MD; John C.
Books, Journals, New Media ......................................................................... 1633 Nelson, MD*; Donald J. Palmisano, MD, JD; William G. Plested III,
MD; Bruce A. Scott, MD (Young Physician); Randolph D. Smoak,
Alternative Medicine and Ethics (Humber, Almeder, eds) Reviewed by K. V. Iserson Jr, MD* (Chair); Andrew M. Thomas, MD (Resident); Jeffrey A.
Complementary and Alternative Medicine: Legal Boundaries and Regulatory Perspectives Towson (Student). *Executive Committee.
(Cohen) Reviewed by L. Uzych AMA EXECUTIVE STAFF
Executive Vice President, Chief Executive Officer:
Kindly Medicine: Physio-Medicalism in America, 1836-1911 (Haller, Jr) Reviewed by L. M. Barnett E. Ratcliffe Anderson, Jr, MD
Alternative Medicine: What Works (Fugh-Berman) Reviewed by J. M. McPartland Chief Operating Officer: Lynn Jensen, PhD
Editor in Chief, Scientific Information and Multimedia:
The Alternative Medicine Handbook: The Complete Reference Guide of Alternative George D. Lundberg, MD
and Complementary Therapies (Cassileth) Reviewed by J. M. McPartland Interim Senior Vice President, Publishing & Business:
Robert L. Kennett
Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine Publisher: Peter J. Murphy
(Radley, ed) Reviewed by R. Santos, M. Sullivan Director of Advertising Sales: Stuart H. Williams
ADVERTISING OFFICES--Eastern: 119 Cherry Hill Rd, 3rd Floor,
Obituary Listing ....................................................................................................... 1636 f Parsippany, NJ 07054 (Representatives: Susan J. Carollo, Alice H.
Herman [973-263-9191]); Midwest/Farwest: 515 N State St, Chi-
cago, IL 60610 (Representative: Jeffery J. Bonistalli [312-464-2551]);
Clasified Advertising: 312-464-2456
Classified Advertising and Announcements ................................. 1639 ADVERTISING PRINCIPLES--Advertisements in this issue have
been reviewed to comply with the principles governing advertising
in AMA publications. A copy of these principles is available on re-
Index to Advertisers ............................................................................................ 1639 r quest. The appearance of advertising in AMA publications is not an
AMA guarantee or endorsement of the product or the claims made
for the product by the manufacturer.
JAMA Patient Page: Alternative Medicine ........................................ 1640 MANUSCRIPT SUBMISSION--Send manuscripts to the Editor,
George D. Lundberg, MD, JAMA, 515 N State St, Chicago, IL 60610.
All articles published, including editorials, letters, and book
JAMA Instructions for Authors .................................. See July 1, 1998, p 19. reviews, represent the opinions of the authors and do not
reflect the official policy of theAmerican MedicalAssociation
or the institution with which the author is affiliated, unless
JAMA Reader's Choice: Continuing Medical Education .... 1637 this is clearly specified.
1550 JAMA, November 11, 1998--Vol 280, No. 18
©1998 American Medical Association. All rights reserved.
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