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Evidence Incorporating Patients’ ValuesEvidence Incorporating Patients’ Values FREE TO VIEW

Kun Hyung Kim, OMD; Jung Won Kang, OMD, PhD; Tae-Hun Kim, OMD; Myeong Soo Lee, PhD
Author and Funding Information

From the Division of Clinical Medicine (Dr K. H. Kim), School of Korean Medicine, Pusan National University; the Department of Acupuncture and Moxibustion (Dr Kang), College of Oriental Medicine, Kyung Hee University; the Division of Standard Research (Dr T.-H. Kim), Korea Institute of Oriental Medicine; and the Brain Disease Research Center (Dr Lee), Korea Institute of Oriental Medicine.

Correspondence to: Jung Won Kang, OMD, PhD, Department of Acupuncture and Moxibustion, College of Oriental Medicine, Kyung Hee University, Seoul, 130-702, South Korea; e-mail: doctorkang@naver.com


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts: Dr K. H. Kim was supported by the Australia Endeavor Research Fellowship 2011. Drs Kang, T.-H. Kim, and Lee report that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(3):831-832. doi:10.1378/chest.11-0852
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To the Editor:

In their recent correspondence in CHEST (February 2011), Goodwin and McIvor1 described the case of a patient with poorly controlled severe asthma who had been noncompliant with physician visits and had inadequate self-management, with an emphasis on the use of cupping therapies. Empiric studies have suggested links between the use of complementary and alternative medicine (CAM) and poor medical outcomes and nonadherence to conventional medicine. Incorporating patients’ views and preferences to create a shared decision-making process between physicians and patients has been suggested as an essential way to address nonadherence and improve outcomes.2 Thus, patients’ views and motivations for using CAM, despite lacking relevant information would be worth exploring to improve the shared decision-making process with patients with strong preferences for CAM over conventional medicine.3

The authors also mentioned that none of the alternative therapies for asthma, including cupping, was efficacious. Previous research has shown little benefit of CAM compared with sham or placebo interventions. However, evidence of overall effectiveness, including the nonspecific effects of CAM compared with no treatment that might be important in a patient’s perspective, was lacking and was noted as a subject of future research in the Cochrane review.4 Because culture-specific interventions have shown promising results for patients with asthma compared with usual care regimens,5 it would be plausible to use evidence of CAM from pragmatic studies in those interventions for cultural minorities or for those with a preference to CAM. Given the definition of evidence-based medicine as “the integration of best research evidence with clinical expertise and patient values” by Sackett et al,6 the evidence for CAM, including cupping therapies for patients with severe asthma, should not be judged solely on placebo-controlled studies. Rather, decisions about CAM should also incorporate evidence from pragmatic trials that reflect patients’ values and preferences and culture-specific contexts in a real-world clinical practice. Last, but not least, evidence of cupping for asthma regardless of the comparison type was evaluated neither by the authors of this study1 nor in any existing systematic review that we are aware of, implying a huge gap between the evidence of the success of cupping and its widespread use.

Overall, this clinical vignette demonstrates the necessity of further research to build comprehensive evidence about CAM therapies in patients with asthma. Such research would take into account patient preferences and would improve shared decision making about whether to use CAM, rather than just concluding that CAM is not rational based on evidence of “no efficacy.”

Goodwin J, McIvor RA. Alternative therapy: cupping for asthma. Chest. 2011;1392:475-476 [CrossRef] [PubMed]
 
Wilson SR, Strub P, Buist AS, et al; Better Outcomes of Asthma Treatment (BOAT) Study Group Better Outcomes of Asthma Treatment (BOAT) Study Group Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. Am J Respir Crit Care Med. 2010;1816:566-577 [CrossRef] [PubMed]
 
Horne R, Price D, Cleland J, et al. Can asthma control be improved by understanding the patient’s perspective? BMC Pulm Med. 2007;7:8 [CrossRef] [PubMed]
 
McCarney RW, Brinkhaus B, Lasserson TJ, Linde K. Acupuncture for chronic asthma. Cochrane Database Syst Rev. 2004;1:CD000008
 
Bailey EJ, Cates CJ, Kruske SG, Morris PS, Brown N, Chang AB. Culture-specific programs for children and adults from minority groups who have asthma. Cochrane Database Syst Rev. 2009;2:CD006580
 
Sackett DL, Straus SE, Richardson WS. Evidence Based Medicine: How to Practice and Teach EBM. 2000;
 

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References

Goodwin J, McIvor RA. Alternative therapy: cupping for asthma. Chest. 2011;1392:475-476 [CrossRef] [PubMed]
 
Wilson SR, Strub P, Buist AS, et al; Better Outcomes of Asthma Treatment (BOAT) Study Group Better Outcomes of Asthma Treatment (BOAT) Study Group Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. Am J Respir Crit Care Med. 2010;1816:566-577 [CrossRef] [PubMed]
 
Horne R, Price D, Cleland J, et al. Can asthma control be improved by understanding the patient’s perspective? BMC Pulm Med. 2007;7:8 [CrossRef] [PubMed]
 
McCarney RW, Brinkhaus B, Lasserson TJ, Linde K. Acupuncture for chronic asthma. Cochrane Database Syst Rev. 2004;1:CD000008
 
Bailey EJ, Cates CJ, Kruske SG, Morris PS, Brown N, Chang AB. Culture-specific programs for children and adults from minority groups who have asthma. Cochrane Database Syst Rev. 2009;2:CD006580
 
Sackett DL, Straus SE, Richardson WS. Evidence Based Medicine: How to Practice and Teach EBM. 2000;
 
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