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European physicians treat benign prostatic hyperplasia (BPH) with saw palmetto extract (SPE), while American physicians generally disregard SPE because "research is lacking." The authors investigated this discrepancy with a literature search and a clinical trial. The literature search began with MEDLINE, then expanded to "alternative" databases, including AGRICOLA, EMBASE, IBIS, and Cochrane, plus a manual search of unindexed herbal journals. The clinical trial was an experimental case study in which a 67-year-old man with symptomatic BPH was randomly administered SPE (160 mg standardized extract twice daily) or placebo. Outcome measures included the American Urological Association Symptom Index (AUASI), serum prostate-specific antigen, and prostate volume. Our expanded literature search revealed 58 clinical trials, whereas MEDLINE yielded only 19 clinical trials, or 33% of the total. Our clinical trial measured a baseline AUASI score of 20, which improved to 7 after unblinded administration of SPE. Subsequent double-blinded placebo produced a score of 14, and final single-blinded allotment of SPE produced a score of 11. Prostate-specific antigen was 10.3 ng/mL at baseline and 10.7 ng/mL at trial's conclusion. Baseline prostatic volume was 92 mL, and end volume was 75 mL. In conclusion, MEDLINE proved inadequate as a stand-alone search engine for locating information about an herbal medicine. Our experimental case study, similar to N = 1 research methodology, proved suitable for clinical evaluation of an herbal medicine in a rural private practice. SPE improved the patient's BPH. Unstandardized look-alike herbs may act as nontherapeutic placebos and may undermine consumer confidence in herbal medicine.

The authors surveyed 191 allopathic physicians (MDs), registered nurses (RNs), and allied health professionals (AHPs) regarding their opinions toward osteopathic medicine and alternative therapies. A self-administered questionnaire was distributed to these healthcare professionals practicing in a rural region of west-central Vermont. Participants responded to six questions concerning osteopathic medicine and 18 types of alternative therapies. These questions addressed safety issues, efficacy, personal experience, patient referrals, interest in learning more about alternative medicine, and whether alternative medicine should be provided at the regional hospital. The number of positive responses was totaled as a positive opinion score (POS) for each respondent. Survey results indicated that MDs' general acceptance of osteopathic medicine was less than that of relaxation techniques, massage therapy, self-help groups, and acupuncture. Allopathic physicians' opinions toward osteopaths mirrored that shown toward chiropractors. Nevertheless, MDs responded more positively to osteopathy than did RNs and AHPs. Overall, RNs had a higher opinion of alternative therapies (mean POS 50.4) than did AHPs (mean POS 41.7) or MDs (mean POS 36.0; F = 4.98; P-value = 0.009). Among MDs, primary care providers averaged a POS of 41.1, while specialists had a mean POS of 24.0 (F = 6.85; P-value = 0.012). Overall, female respondents had a mean POS of 45.7 and men had a mean POS of 37.0 (F = 3.91; P-value = 0.051). The POS did not correlate with age (Pearson's r test; r = -0.105).

Craniosacral findings were recorded for all patients with traumatic brain injury entering an outpatient rehabilitation program between 1978 and 1992. The average cranial rhythmic impulse was low in all 55 patients (average, 7.2 c/min). At least one cranial strain pattern was exhibited by 95%, and 87% had one or more bony motion restrictions. Sacral findings were similar to those in patients with low back pain. Although craniosacral manipulation has been found empirically useful in patients with traumatic brain injury, three cases of iatrogenesis occurred. The incidence rate is low (5%), but the practitioner must be prepared to deal with the possibility of adverse reactions.