What is complementary alternative cancer treatment?

Introduction

Cancer is the second leading cause of death in the United
States (after heart disease), and its insidious nature gives it a special
terror. Most diseases give warning in the form of escalating symptoms, while
others strike suddenly. Cancer follows a different, stealthier path. A person who
feels perfectly well may come back from the doctor’s office with a diagnosis of
potentially fatal cancer and plenty of time to fear what comes next.

Conventional treatments for cancer also have frightening qualities to them,
including disfiguring surgery, arduous chemotherapy, and treatment with
invisible radiation. In many cases, when cancer is found early enough,
conventional treatment can lead to a permanent cure. Often, though, the prognosis
is given in statistics (a percentage chance of survival) or, worse, in months
remaining to live.

Some alternative therapies for cancer may truly work, even if they have not been proven. Most studies of alternative therapies for cancer have involved adding a natural treatment to a standard cancer regimen; alternatively, they enrolled persons who have already failed to respond to existing methods. These latter circumstances could potentially hide the benefits of an effective natural therapy. If a treatment only worked in the absence of chemotherapy, for example (as some alternative cancer therapy proponents claim about their methods) or could only cure early cases of cancer, these ethical obstacles would prevent researchers from finding out.

The relatively small amount of information that is known from a scientific perspective about alternative treatments for cancer is discussed here, as are natural options that may reduce side effects of standard cancer therapies. Possible interactions between herbs and supplements and drugs are also discussed.

Proposed Natural Treatments

Various natural supplements have shown some promise for improving the effectiveness of conventional cancer therapy (specifically surgery, chemotherapy, and radiation) or reducing its side effects. In most cases, however, the supporting evidence remains weak, and the most rigorous studies have often failed to find benefit. Persons receiving cancer treatment should not use any herbs or supplements except under the supervision of a physician.

Improving Effectiveness of Conventional Treatment

Numerous natural therapies have been proposed for enhancing the cancer-fighting effects of standard therapies. However, most of the supporting research falls short of the necessary standard for proof: a double-blind, placebo-controlled study.

Cancer survivors can find comfort by participating in support groups and events such as the cancer walk. (AP/Wide World Photos)

Shark cartilage. Based on the belief that sharks do not get
cancer, shark cartilage has been heavily marketed as a cure for cancer. While this
is a myth (sharks do get cancer), shark cartilage has shown some promise. Shark
cartilage tends to inhibit the growth of new blood vessels, a process called
angiogenesis. Because cancerous tumors must build new blood
vessels to feed themselves, this effect might be beneficial.

Shark cartilage also inhibits substances called matrix metalloproteases (MMPs). These little-understood enzymes affect the extracellular matrix, the framework of substances that lie between cells in the body. MMPs are thought to play a role in diseases of the cornea, gums, skin, blood vessels, and joints, and in cancer and illnesses that involve excessive fibrous tissue.

A number of test-tube experiments have found that shark cartilage extracts prevent new blood vessels from forming in chick embryos and other test systems. These findings have led to other test-tube experiments, animal studies, and preliminary human trials to investigate the possible anticancer effects of shark cartilage. The results appeared to suggest that a particular liquid shark cartilage extract might be useful in the treatment of various cancers, including lung, prostate, and breast cancer. However, the two most recent and best designed of these studies have failed to find benefit.

Social support and other psychological factors. Cancer treatment
puts tremendous stress, both physical and emotional, on those who undergo it.
Several studies have examined the potential benefits of social support for women
with breast
cancer. According to most studies, such support improves
survival and enhances quality of life. In one well-known study of women with
advanced breast cancer, participants who attended a support group twice weekly
doubled their survival time compared to study participants who did not attend the
group.

It is also commonly said that certain psychological coping styles (for example, fighting spirit versus helpless acceptance) can lead to longer life in people with cancer. However, a review of the evidence found that there is little to no evidence that psychological attitude makes much of a difference. People with cancer should not feel pressured into adopting particular coping styles to improve survival or reduce the risk of recurrence, the study’s authors concluded.

Relaxation therapies. One study evaluated guided imagery and
relaxation
therapy following surgery for colon cancer. The results
indicated no more than a short-term, mood-elevating benefit; those receiving the
treatment did not recover more quickly.

Another study on relaxation therapy involved 126 hospitalized persons with cancer pain. Researchers found that those who listened to relaxing music for thirty minutes and received pain medication had more relief than the group who received only the medication.

Vitamin C. Cancer treatment is one of the more controversial
proposed uses of vitamin C. An early study tested vitamin C in eleven hundred
terminally ill persons with cancer. One hundred persons received 10,000 milligrams
(mg) daily of vitamin C, while the other one thousand persons (the control group)
did not receive vitamin C. Those taking the vitamin C survived more than four
times longer on average (210 days) than those in the control group (50 days). A
large (1,826 subjects) follow-up study by the same researchers found a nearly
doubled survival rate (343 days versus 180 days) in vitamin C-treated persons
whose cancers were deemed incurable, compared to people not treated with vitamin
C. Benefits were also seen in a similarly designed Japanese study.

However, while these results seem promising and almost miraculous, they show next to nothing because they lacked a placebo group. When proper double-blind, placebo-controlled studies were performed on vitamin C for cancer, they failed to find any benefit. Vitamin C proponents have criticized these trials on various grounds, but the fact remains that there is no reliable positive evidence for vitamin C in cancer.

PC-SPES for prostate cancer. PC-SPES is a formulation of eight natural substances: seven are plants and one is a fungus. The name is derived from the common abbreviation for prostate cancer (PC) and the Latin word spes, meaning “hope.”

After its commercial launch in 1996, PC-SPES received increasing interest
from the general public and prostate cancer researchers. Preliminary evidence
suggested that it has significant effects on prostate cancer cells, perhaps
because of its estrogen-like action.

However, chemical analysis reported in 2002 showed that PC-SPES is not truly a
purely herbal product; samples of the product dating to 1996 have been found to
contain a form of pharmaceutical estrogen, diethylstilbestrol (DES), as well as indomethacin (an
anti-inflammatory medication in the ibuprofen family) and warfarin (a strong blood
thinner). Samples subsequent to 1999 contain less DES; but they also have shown
less effectiveness in treating prostate cancer.

There is little doubt that DES is active against prostate
cancer, but it presents a variety of risks, including blood
clots in the legs. The other two pharmaceutical contaminants might actually reduce
the risk of blood clots (which may be why they were covertly added), but present
various risks all on their own. For these reasons, PC-SPES use is not
recommended.

Other natural treatments. Hundreds of herbs and supplements have been shown in test-tube studies to fight cancer cells. However, it is a long way from a test tube to a human body, and such findings are not meaningful.

Several natural supplements that have received at least preliminary study in humans are discussed here. None of the positive studies cited here reached the level of rigor required to truly show a treatment effective. (Most lacked a control group, for example.) In contrast, several properly designed studies failed to find benefit.

A double-blind study of fifty-three people undergoing cancer treatment found equivocal evidence that treatment with a special form of Panax ginseng (modified to contain higher levels of certain constituents) could improve general well-being of people with cancer. Another study investigating the effects of P. ginseng on survival of persons being treated for lung cancer showed no additional benefit. One study provides indirect but promising evidence that a mixture of the supplements coenzyme Q10 (100 mg daily), riboflavin (10 mg daily), and niacin (50 mg daily) might help reduce the chance of breast cancer metastasis, or recurrence.

According to most of the highly preliminary trials, extracts of the fungus
Coriolus versicolor may enhance the effectiveness of various
forms of standard cancer therapy. Coriolus is thought to work by
stimulating the immune system. The fungi products active hexose correlated
compound and shiitake are also advocated for this purpose.

The supplement docosahexaenoic acid, a constituent of fish oil, has
shown promise for enhancing the effects of the cancer chemotherapy drug
doxorubicin. The herb Ginkgo biloba is thought to increase blood
flow. An uncontrolled study evaluated combination therapy with ginkgo extract and
the chemotherapy drug 5-FU for the treatment of pancreatic
cancer, on the theory that ginkgo might enhance blood flow to
the tumor and thereby help 5-FU penetrate better. The results were promising.
Scant preliminary evidence suggests that American ginseng may increase the
effectiveness of treatment for breast cancer and that Siberian ginseng (properly
known as Eleutherococcus senticosus) may be useful in the
treatment of breast cancer and other forms of cancer.

A small unblinded study using a no-treatment control group found indications
that the use of a standardized tomato extract containing the supplement
lycopene might slow the growth of prostate cancer. In a
small, double-blind, placebo-controlled study, a combination of soy, isoflavones,
lycopene, silymarin (from milk thistle), and antioxidants
showed some potential benefit for preventing recurrence of prostate cancer after
prostate cancer surgery. Another study enrolled men with rising PSA levels (a
symptom of worsening cancer) and found that the use of lycopene helped stabilize
these levels. Because this study failed to include a placebo control group, its
results fail to indicate that lycopene lowers PSA levels and therefore, by
inference, slows prostate cancer. However, researchers did compare lycopene alone
with lycopene plus isoflavones and found that the combined treatment seemed to be
less effective, as if the isoflavones somehow antagonized the effects of
lycopene.

Preliminary studies, including unblinded-controlled trials, suggest that the
hormone melatonin may enhance the effectiveness of standard therapy
for breast cancer, prostate cancer, brain glioblastomas, non-small-cell lung
cancer, and other forms of cancer. However, no double-blind studies have been
reported. Melatonin may also help decrease cancer chemotherapy side effects.

Mistletoe extract (Iscador) taken by injection has been evaluated as a cancer
treatment in a number of studies, including double-blind,
placebo-controlled trials. In general, though, these studies
failed to attain adequate levels of scientific rigor or clinical relevance. The
best studies found benefit; more rigorous studies found no improvement in survival
time, survival rate, or quality of life. A review of forty-one studies found
mistletoe use was associated with improved survival in persons with cancer. An
analysis of these studies limited to randomized trials showed no effect. The
safety of mistletoe is not established, and one report suggests that it can damage
the liver.

An uncontrolled study found that the use of a special spleen extract (spleen
peptide preparation) somewhat reduced side effects of chemotherapy for
head and neck
cancer. In a double-blind, placebo-controlled trial, neither
vitamin
A nor N-acetylcysteine proved helpful for enhancing survival
in head and neck cancer or lung cancer. Vitamin D may decrease
bone pain and increase muscle strength in men with prostate cancer.

Traditional
Chinese medicine has been evaluated in a number of studies in
persons being treated for cancer. In one such study, acupuncture
has shown some promise for reducing the sense of fatigue that commonly occurs in
cancer. Similarly, medical qigong (two ninety-minute sessions
weekly) was associated with improved quality of life, fatigue, and mood
disturbance in another study. A review of fifteen mostly poor-quality trials
involving 862 persons receiving chemotherapy for non-small-cell lung cancer
suggested that Chinese herbal medicine might improve quality of life. A 2010
review of seven studies, however, found insufficient evidence to conclude whether
or not Tai
Chi improves quality of life or psychological or physical
outcomes in persons with breast cancer. One study tested whether a diet very high
in vegetables, fruit, and fiber, and low in fat could enhance survival or reduce
recurrence rates in women diagnosed with breast cancer; no benefits were seen.

Reducing Side Effects of Chemotherapy

Various herbs and supplements have shown promise for reducing the side effects of chemotherapy. Many chemotherapy drugs work by interfering with rapidly dividing cells. Cancer cells, however, are not the only cells that divide rapidly. The intestinal tract constantly rebuilds its lining, and chemotherapy may interfere with that process. The result is gastrointestinal side effects, such as mouth sores, nausea, loss of appetite, and diarrhea. Several herbs and supplements have shown promise for alleviating these conditions, although none have been definitively proven effective.

Diarrhea and other gastrointestinal side effects. A
well-designed, double-blind, placebo-controlled trial of seventy participants
undergoing cancer chemotherapy with the drug 5-FU evaluated the potential benefits
of the supplement glutamine for reducing chemotherapy-induced diarrhea. The
results suggest that the use of glutamine at a dose of 18 grams daily may reduce
intestinal damage and diminish symptoms of diarrhea. These promising findings
indicate a need for larger trials to accurately determine the extent of
benefit.

A double-blind, placebo-controlled study of 150 people undergoing chemotherapy with 5-FU found some evidence that a probiotic (friendly bacterium) called Lactobacillus rhamnosus can reduce the diarrhea that is a common complication of this treatment. Another, more unusual probiotic, a special, nonpathogenic form of Escherichia coli, has also shown promise. Preliminary evidence hints that the supplement active hexose correlated compound and colostrum might help reduce chemotherapy-induced gastrointestinal side effects. In one study, the use of the supplement creatine failed to help maintain muscle mass in people undergoing chemotherapy for colon cancer.

Mouth sores. In an uncontrolled study, the use of the herb chamomile as a mouthwash appeared to help prevent mouth sores in people undergoing various forms of chemotherapy. However, uncontrolled studies prove nothing. A rigorous, double-blind, placebo-controlled trial of 164 people did not find chamomile mouthwash effective for treating the mouth sores caused by the chemotherapy drug 5-FU. Beta-carotene and vitamin E have also shown some promise for preventing mouth sores (caused by various forms of cancer treatment) in preliminary studies, but rigorous studies of adequate size have not been reported.

Nausea. A preliminary trial hints that ginger may reduce nausea caused by the chemotherapy drug 8-MOP. However, another study failed to find ginger helpful for nausea in people using the drug cisplatin. In a third trial, ginger did not add to the effectiveness of standard medications to treat chemotherapy-induced nausea and vomiting.

Massage has shown some benefit for reducing nausea caused by
chemotherapy. Psychological methods such as hypnosis and
relaxation therapy have also shown promise for nausea. One study found that the
use of aromatherapy massage (combined massage therapy and the use of fragrant
essential oils) reduced symptoms of anxiety or depression (or both) in people
undergoing treatment for cancer, at least for the short-term. However, the authors
of a review of ten massage therapy studies were unable to
draw firm conclusions about its benefits for a wide range of symptoms in persons
undergoing treatment for cancer. Studies of acupressure
or acupuncture for reducing nausea in people undergoing chemotherapy have reached
contradictory results, though on balance, there may be some benefit.

A double-blind study performed in Hong Kong evaluated the potential benefits in
cancer chemotherapy of personalized herbal formulas designed according to the
principles of traditional Chinese herbal medicine. In this study, 120
people undergoing chemotherapy for early-stage breast or colon cancer were given
either a personalized formula or placebo. Researchers evaluated numerous possible
effects of the treatment but found benefits in only one: reduction of nausea. Even
this single result is less meaningful than it may seem; it is statistically
questionable to use a multiplicity of outcome measures.

Other side effects of chemotherapy. In highly preliminary trials, the supplement N-acetylcysteine has shown promise for reducing various side effects of the drug ifosfamide. An animal study suggests that a constituent of fish oil called docosahexaenoic acid might decrease side effects caused by the drug irenotecan. The hormone melatonin has shown some promise for reducing the side effects of various chemotherapy drugs.

In preliminary studies, various antioxidants have shown promise for preventing
heart damage and other side effects of the drug doxorubicin.
One animal study hints that the herb milk thistle might protect against kidney
damage caused by the drug cisplatin. In addition, there is some
evidence that acetyl-L-carnitine, glutamine, and vitamin E supplementation might
each reduce peripheral neuropathy (painful damage to nerves outside the spinal
column) symptoms in persons receiving cisplatin or paclitaxel.

Sea buckthorn berry has been advocated for reducing side effects of chemotherapy, but the evidence that it works is far too preliminary to be relied upon. A review of thirty-three studies supports the view that antioxidants in general (with the exception of vitamin A) may reduce the toxic effects of chemotherapy. However, because of inconsistencies among these studies, it is unclear what antioxidants are best for this purpose.

Reducing Side Effects of Radiation Therapy

Although the symptoms are generally less intense than with chemotherapy,
radiation
therapy can also cause problems, such as diarrhea, skin
damage, and fatigue. Certain supplements and alternative therapies may offer
benefit.

Two double-blind, placebo-controlled studies enrolling a total of almost seven
hundred people undergoing radiation therapy found that the use of probiotics
significantly improved diarrhea. However, of eighty-five women receiving pelvic
radiation for cervical or uterine cancer, those who consumed a probiotic-enriched
yogurt had no less diarrhea than those who took a placebo drink.

An unblinded-controlled study of seventy-five people receiving radiation therapy for various forms of cancer found some evidence that soap enriched with aloe vera gel can help protect the skin from radiation damage. However, researchers had to use questionable statistical methods to find evidence of benefit, making the results less than fully reliable. A double-blind, placebo-controlled study that evaluated the effects of aloe gel in 225 women undergoing radiation therapy for breast cancer failed to find benefit. Another study failed to find aloe vera beneficial for reducing side effects of radiation therapy for head and neck cancer.

One study compared cream made from calendula flowers with the standard treatment trolamine for protecting the skin during radiation therapy and found calendula more effective. However, it is not known whether trolamine is beneficial, neutral, or harmful when used for this purpose, and for this reason it is not possible to draw firm conclusions from the study. Cream made from chamomile has also been tried for protecting the skin from damage caused by radiation therapy, but the one controlled trial on the subject failed to find benefit.

One study failed to find oligomeric proanthocyanidins from grape seed helpful for reducing the local side effects of radiation therapy for breast cancer. Radiation treatment in the vicinity of the mouth may cause alterations in taste sensation. In a small, double-blind, placebo-controlled trial, the use of zinc supplements tended to counter this symptom. However, a larger follow-up study failed to find this benefit. Another study did find that the use of zinc could modestly decrease inflammation of the mucous membranes and skin caused by radiation therapy.

Radiation treatment to the pelvic area can cause nausea, vomiting, and fatigue. A double-blind, placebo-controlled trial with fifty-six participants evaluated the potential effectiveness of proteolytic enzymes for reducing these symptoms. No benefits were seen. Another study failed to find proteolytic enzymes helpful for reducing mouth sores or other symptoms that occur during radiation therapy of head and neck cancers.

In a double-blind study of forty people undergoing radiation therapy for breast cancer, the use of a standard multivitamin preparation failed to reduce fatigue compared with placebo. People in the placebo group may have done somewhat better than those given the vitamin.

A large study failed to find aromatherapy more helpful than placebo
for reducing psychological distress among people undergoing radiation therapy for
cancer. A small randomized trial found that effleurage massage, a common massage
technique, had no significant effect on anxiety, depression,
or quality of
life among twenty-two women undergoing radiation therapy for
breast cancer.

As with chemotherapy, sea buckthorn berry has been advocated for reducing side effects of radiation therapy, but again, reliable evidence is lacking. The use of antioxidants during radiation therapy is controversial. One study found that the use of antioxidants decreased radiation therapy side effects but also may have decreased radiation therapy effectiveness. In a small trial, persons who wore acupressure bands for up to seven days following radiation therapy reported less nausea than persons who received only usual care.

Treating Side Effects Caused by Breast Cancer Surgery

Many women experience lymphedema (chronic arm swelling caused
by damage to the lymph drainage system) following breast cancer surgery. Natural
treatments for this condition include oxerutins, citrus bioflavonoids, and
oligomeric proanthocyanidins. Another small randomized trial of seventy persons
found that acupuncture may decrease dry mouth and pain after removing lymph nodes
in the neck for cancer treatment.

Hot flashes after mastectomy. Women who have had breast cancer surgery frequently experience annoying hot flashes. Estrogen treatment is not an option, as it might increase the risk of cancer recurrence.

In a two-month double-blind trial, eighty-five women who had undergone treatment for breast cancer received either the herb black cohosh or placebo. The results were not encouraging: Black cohosh did not reduce overall hot-flash symptoms. Four double-blind, placebo-controlled trials evaluated soy isoflavones as a treatment for hot flashes, but these also failed to find benefit.

A trial involving seventy-two women with breast cancer failed to find real acupuncture significantly more effective than sham acupuncture for treatment of hot flashes. A 2008 review of all existing studies on the subject concluded that the evidence does not support a beneficial effect for acupuncture in women with breast cancer who also have hot flashes. In a small randomized trial, hypnosis appeared to reduce hot flashes and improve mood and sleep among fifty-one breast cancer survivors.

Treating side effects caused by chemotherapy. In a small randomized trial of forty-three persons with breast cancer, six weeks of acupuncture twice weekly reduced joint pain attributed to aromatase-inhibitor therapy.

Treating Weight Loss Caused by Cancer or Cancer Treatment

Cancer can cause a condition called tumor-induced weight loss, in which symptoms of starvation occur despite apparently adequate nutrition. The cause is thought to be a particular form of inflammation caused by the cancer. Cancer chemotherapy can also cause weight loss.

Cancer Cures

Numerous herbs, including bloodroot, burdock, cat’s claw, flaxseed (based on lignan content), lapacho, maitake, noni, Oregon grape, pokeroot, red clover, and reishi, have been claimed effective for the treatment of cancer. However, there is no reliable evidence to indicate that these herbs actually help, and one, pokeroot, is actively toxic.

Various herbal combinations have also been promoted for the treatment of cancer, including the Hoxsey cancer cure, Essiac, and Jason Winter’s cancer-cure tea. Again, however, there is no reliable evidence that they really work. Similarly, various dietary approaches that have been claimed to help treat cancer, such as macrobiotics and raw foods, lack meaningful supporting evidence.

Herbs and Supplements to Use Only with Caution

Various herbs and supplements may interact adversely with drugs used to treat cancer. It is strongly recommend that persons under treatment for cancer not use any herb or supplement except under a physician’s supervision.

The herb St. John’s wort interacts with many medications, including various
chemotherapy drugs. The drug methotrexate causes the body to become
deficient in folate. For this reason, people who take methotrexate for rheumatoid
arthritis, juvenile rheumatoid arthritis, or psoriasis are sometimes advised to
take folate supplements. Studies indicate that in those conditions, the use of
folate does not impair the action of the drug. However, no studies have
established that folate supplements are safe to take with methotrexate when it is
used to treat cancer. The citrus bioflavonoid tangeretin may interact with the
breast cancer drug tamoxifen. One highly preliminary study found that black cohosh
might interfere with the action of the chemotherapy drug cisplatin.

The antioxidant controversy. Heated disagreement exists regarding
whether it is safe or appropriate to combine antioxidants (such as vitamin E,
vitamin C, and beta-carotene) with standard chemotherapy drugs. The reasoning
behind the concern is that some chemotherapy drugs may work in part by creating
free
radicals that destroy cancer cells, and antioxidants might
interfere with this beneficial effect.

There is little reliable evidence, though, that antioxidants interfere with chemotherapy drugs. Additionally, there is growing evidence that antioxidants may not cause harm and, in certain cases, may offer benefits. However, the effects are likely to vary with the specific situation (for example, type and stage of cancer and kind of treatment used), and there is far more research to be done. Therefore, it is strongly recommend that one not take antioxidants (or any other supplements) while undergoing cancer chemotherapy, except on the advice of a physician.

A similar situation exists regarding radiation therapy. One study found that the use of antioxidants decreased radiation therapy side effects but also may have decreased radiation therapy effectiveness. Another study found some evidence that people who both smoked cigarettes and used antioxidants while undergoing radiation therapy for head and neck cancer had increased risk of treatment failure compared to smokers who did not use antioxidants.

After reviewing much of the research on this controversial topic, one group of researchers published an article in the Journal of the National Cancer Institute, in which they conclude that antioxidants should be discouraged during either chemotherapy or radiation therapy because of their potential to reduce the effectiveness of these treatments.

Herbs that may increase breast cancer recurrence risk. Women who have had breast cancer are at high risk for a recurrence. The use of estrogen promotes the development of breast cancer, and for this reason it is “off limits.” However, certain natural products may present a similar risk. Numerous herbs and supplements have estrogen-like properties, including alfalfa, genistein, hops, licorice, red clover, resveratrol, and soy. Contrary to popular belief, black cohosh is probably not estrogenic.

Other supplements, such as androstenedione and boron, may raise estrogen levels in the body. Finally, although the herbs dong quai and P. ginseng do not appear to act in an estrogen-like manner, they may nonetheless stimulate the growth of breast cancer cells. Women who have undergone breast cancer surgery should use these herbs and supplements only under the advice of a physician.

The weak estrogen estriol is sometimes advocated by alternative practitioners as a safer choice than standard estrogen. However, test-tube studies suggest that estriol is just as likely to cause breast cancer as any other form of estrogen.

Bibliography

Billhult, A., I. Bergbom, and E. Stener-Victorin. “Massage Relieves Nausea in Women with Breast Cancer Who Are Undergoing Chemotherapy.” Journal of Alternative and Complementary Medicine 13 (2007): 53-58.

Block, K. I., et al. “Impact of Antioxidant Supplementation on Chemotherapeutic Toxicity.” International Journal of Cancer 123 (2008): 1227-1239.

Crew, K. D., et al. “Randomized, Blinded, Sham-Controlled Trial of Acupuncture for the Management of Aromatase Inhibitor-Associated Joint Symptoms in Women with Early-Stage Breast Cancer.” Journal of Clinical Oncology 28 (2010): 1154-1160.

Elkins, G., et al. “Randomized Trial of a Hypnosis Intervention for Treatment of Hot Flashes Among Breast Cancer Survivors.” Journal of Clinical Oncology 26 (2008): 5022-5026.

Horneber, M. A., et al. “Mistletoe Therapy in Oncology.” Cochrane Database of Systematic Reviews (2008): CD003297. Available through EBSCO DynaMed Systematic Literature Surveillance at http://www.ebscohost.com/dynamed.

Huang, S. T., M. Good, and J. A. Zauszniewski. “The Effectiveness of Music in Relieving Pain in Cancer Patients.” International Journal of Nursing Studies 47 (2010): 1354-1362.

Lee, M. S., T. Y. Choi, and E. Ernst. “Tai Chi for Breast Cancer Patients.” Breast Cancer Research and Treatment 120 (2010): 309-316.

Oh, B., et al. “Impact of Medical Qigong on Quality of Life, Fatigue, Mood, and Inflammation in Cancer Patients.” Annals of Oncology 21 (2010): 608-614.

Vaishampayan, U., et al. “Lycopene and Soy Isoflavones in the Treatment of Prostate Cancer.” Nutrition and Cancer 59 (2007): 1-7.

Wilkinson, S., K. Barnes, and L. Storey. “Massage for Symptom Relief in Patients with Cancer.” Journal of Advanced Nursing 63 (2008): 430-439.

Wilkinson, S., et al. “Effectiveness of Aromatherapy Massage in the Management of Anxiety and Depression in Patients with Cancer.” Journal of Clinical Oncology 25 (2007): 532-539.

Zick, S. M., et al. “Phase II Trial of Encapsulated Ginger as a Treatment for Chemotherapy-Induced Nausea and Vomiting.” Supportive Care in Cancer 17 (2009): 563-572.

How many atoms are in four moles of silicon?

The mole is a very commonly used unit of measurement of a substance. By convention, a mole of a substance contains 6.023 x 10^23 atoms or molecules of the substance. In other words, 1 mole of an element will contain 6.023 x 10^23 atoms of that element, while 1 mole of a compound will contain 6.023 x 10^23 molecules of that compound. The number "6.023 x 10^23" is also known as Avogadro's number.

In this case, we have to find the number of atoms in 4 moles of silicon, which is an element. Since 1 mole of silicon contains 6.023 x 10^23 atoms, 4 moles will contain:

(4 moles) x (6.023 x 10^23 atoms) = 2.4092 x 10^24 atoms.

Thus, 4 moles of the silicon element contains about 2.4 x 10^24 atoms.

Hope this helps. 

Explain two different ways that masters tried to "brainwash" their slaves .

As a black studies teacher, I have personally compiled a list from a variety of sources on slavery and black psychology that show how “to make a slave.”  Below is a list of experiences a slave could expect from slave owners who want to dominate and overpower the slave emotionally and physically. 

Steps to Control the Enslaved 

1. Take a slave out of his known environment so he is helpless. Africans had very little knowledge of the world outside their villages or immediate surroundings.  Many had never seen a white man, the ocean, or guns. 


2. Take away his customs, traditions, language, and religion.  Take him from his family. Give him a European name usually taken from the Bible. 


3. Subdue and break the spirit of leaders so slaves cannot be unified.  Make slaves distrust each other.  Isolate slaves from the same tribes from each other.


4. Establish and maintain strict discipline through fear. This is usually done with weapons, whippings, or even denying basic human needs like food. 


5. Convince the slave that he is inferior.  Emasculate him; treat him like an animal.  Use him/her for breeding and deconstruct the institution of family in the slave community.


6. Awe the enslaved with the slaveholder’s sense of power.  Again, weapons like whips and guns are often used.


7. Persuade the enslaved to take an active interest in the slaveholder’s well-being.  The more the slave owner obtains from a slave’s hard work, the more the slave might receive.


8. Brainwash the slave that the master is needed to survive; imbue a sense of helplessness; make the slave totally dependent.

All of these tactics break down the slave emotionally as well as physically.  “Brainwashing” becomes easier when one is subjected to cruelty, violence, and feelings of inferiority.   In addition, eliminating African culture and values makes a slave more submissive and more ready to adhere to European values.  The study of black psychology seeks to identify the effects of slavery on black behavior and the black psyche as many feel that there are lasting effects of the institution of slavery on the social, political, and economic landscape we see in modern America today. 

I’ve included a link to an article by Marcel Parker if you would want any more information on this topic.

What is anesthesia abuse?

Causes

As with any addiction, biological and environmental factors contribute to anesthesia abuse. Addicts have a genetic predisposition and a chronic, compulsive need for the substance of choice. For the anesthesia abuser, these substances include a variety of potentially addictive agents. Generally, insatiable cravings compel chronic use (abuse) of a particular drug, which results in damage to internal organs. However, because many anesthesia drugs have the potential to cause apnea or paralysis within seconds, abuse of anesthetic agents can lead to death.

Risk Factors

Although laypersons abuse anesthesia drugs, the most frequently cited anesthesia abusers are anesthesia providers such as certified registered nurse anesthetists, medical residents, and anesthesiologists. Easy access to anesthetic medications enables anesthesia providers to experiment with controlled substances such as fentanyl and other opioids, which are highly addictive.

Anesthesia providers often work long and irregular hours under stressful conditions with access to anesthetic agents. Propofol abuse is increasingly popular because the substance has a short half-life and is quickly eliminated from the body. Nitrous oxide, commonly known as laughing gas, is an inhaled anesthetic that also is abused. The primary risk of inhaled nitrous oxide is hypoxia, which results from inadequate oxygen supply to the body’s tissues and particularly the brain.

Symptoms

A variety of symptoms occur from using common anesthetic medications. These symptoms (and their symptom-producing medications) include amnesia and anxiolysis (midazolam), pain relief (opioids), and sedation and apnea (opioids and propofol). Abusers experience impaired functioning because of these drugs. The dose associated with abuse is often less than that required for general anesthesia. However, the effects of anesthetic medications are dose dependent and may also lead to dysphoria and mood changes. Therefore, abusers may exhibit behavioral changes; may appear fatigued, irritable, euphoric, dysphoric, drowsy, or depressed; or may simply appear out of character. Recognition of these signs is imperative to protect the abuser and to aid health care providers who have a legal responsibility to report colleagues known or suspected of chemical dependency. This not only protects the abusers but also the patients under their care.

Screening and Diagnosis

The screening test commonly used to confirm drug use is typically a urine drug screen. However, many anesthetic medications (such as fentanyl, propofol, naltrexone, and ketamine) are not included in standard drug screens and must be specifically requested. Because of the short half-lives of these anesthesia drugs, many are quickly eliminated from the body and, therefore, are difficult to detect. In some cases, the metabolites of these drugs can be detected in urine samples, while hair samples fulfill other testing needs. Although more expensive than urine testing, hair-sample testing can detect chronic exposure to certain drugs; urine drug screens are limited to detecting drug use only within hours or days of use.

Treatment and Therapy

The American Association of Nurse Anesthetists and the American Society of Anesthesiologists are two national organizations that govern the practice of anesthesia providers. These organizations and many others not affiliated with medical and nursing personnel recommend inpatient treatment for persons with chemical dependency.

Short- and long-term therapy combined with support-group attendance and abstinence monitoring offer the highest success rates. Various peer assistance groups are available to monitor and assist those undergoing treatment. Narcotics Anonymous offers a twelve-step program that protects anonymity and offers the addict a structured plan for recovery that includes admitting loss of control over the compulsion (the repeated use of anesthetics) and the aid of a sponsor to evaluate mistakes made by the addict. In return, the addict offers help to others who have the same type of addiction.

Prevention

The US Drug Enforcement Administration (DEA) establishes standards and substance schedules and enforces these standards to prevent and control drug abuse. The DEA has plans to treat propofol as a controlled substance, and doing so would institute more accountability and address the overwhelming availability of the drug to anesthesia providers. Random drug screening in accordance with the US Substance Abuse Mental Health Services Administration’s guidelines and employing the proper chain of custody are two methods that various organizations use to deter and detect drug abusers, including anesthesia abusers.

Bibliography

Bryson, Ethan O., and Jeffrey H. Silverstein. “Addiction and Substance Abuse in Anesthesiology.” Anesthesiology 109.5 (2008): 905–17. Print. An excellent overview that covers manifestations, legal issues, diagnosis and treatment, prognosis, prevention, and testing methodologies.

Sinha, Ashish C. “The Drug-Impaired Anesthesia Provider.” Audio-Digest Anesthesiology 50.7 (2007). Print. Through use of several studies, discusses incidence, influencing factors, reasons for suspicion, intervention, treatment, and therapy.

What is magnet therapy?

Overview

Long popular in Japan, magnet therapy has entered public awareness in the United States, stimulated by golfers and tennis players extolling the virtues of magnets in the treatment of sports-related injuries. Magnetic knee, shoulder, and ankle pads, and insoles and mattress pads, are widely available and are thought to provide myriad healing benefits.

Despite this enthusiasm, there is little scientific evidence to support the use of magnets for any medical condition. However, some small studies suggest that various forms of magnet therapy might have a therapeutic effect in certain conditions.

History of magnet therapy. Magnet therapy has a long history in
traditional folk
medicine. Reliable documentation indicates that Chinese
doctors have believed in the therapeutic value of magnets for two thousand years
or more. In sixteenth-century Europe, Paracelsus used magnets to treat a variety
of ailments. Two centuries later, Franz Mesmer became famous for treating various
disorders with magnets.

In the middle decades of the twentieth century, scientists in various parts of
the world began performing studies on the therapeutic use of magnets. From the
1940s on, magnets became increasingly popular in Japan. Yoshio Manaka, one of the
influential Japanese acupuncturists of the twentieth century, used magnets in
conjunction with acupuncture. Magnet therapy also became a commonly used
technique of self-administered medicine in Japan. For example, a type of plaster
containing a small magnet became popular for treating aches and pains, especially
among the elderly. Magnetic mattress pads, bracelets, and necklaces also became
popular, mainly among the elderly. During the 1970s, both magnets and
electromagnetic machines became popular among athletes in many countries for
treating sports-related injuries.

These developments led to a rapidly growing industry creating magnetic products for a variety of conditions. However, the development of this industry preceded any reliable scientific evidence that static magnets actually work for the purposes intended. In the United States, it was only in 1997 that properly designed clinical trials of magnets began to be reported. Subsequently, results of several preliminary studies suggested that both static magnets and electromagnetic therapy may indeed offer therapeutic benefits for several disorders. These findings have escalated research interest in magnet therapy.

Types of magnet therapy and their uses. The term “magnet therapy” usually refers to the use of static magnets placed directly on the body, generally over regions of pain. Static magnets are either attached to the body by tape or encapsulated in specially designed products such as belts, wraps, or mattress pads. Static magnets are also sometimes known as permanent magnets.

Static magnets come in various strengths. The units of measuring magnet strength are gauss (G) and tesla (T); 1 tesla equals 10,000 G. A refrigerator magnet, for example, is around 200 G. Therapeutic magnets measure anywhere from 200 to 10,000 G, but the most commonly used measure from 400 to 800 G.

Therapeutic magnets come in two different types of polarity arrangements: unipolar magnets and alternating-pole devices. Magnets that have north on one side and south on the other are known, rather confusingly, as unipolar magnets. Bipolar or alternating-pole magnets are made from a sheet of magnetic material with north and south magnets arranged in an alternating pattern, so that both north and south face the skin. This type of magnet exerts a weaker magnetic field because the alternating magnets tend to oppose each other. Each type of magnet has its own recommended uses and enthusiasts. (There are many heated opinions, with no supporting evidence, on this matter.)

More complex magnetic devices have also been studied, not for home use, but for
use in physicians’ offices and hospitals. A special form of electromagnetic
therapy, repetitive transcranial magnetic stimulation (rTMS), is undergoing
particularly close study. rTMS is designed specifically to treat the brain with
low-frequency magnetic pulses. A large body of small studies suggest that rTMS
might be beneficial for depression. It is also being studied for the treatment of
amyotrophic lateral sclerosis (ALS), Parkinson’s disease, epilepsy, schizophrenia,
and obsessive-compulsive disorder.

Scientific Evidence

Static magnets. In double-blind, placebo-controlled trials, static magnets have shown promise for a number of conditions, but in no case is the evidence strong enough to be relied upon. In a 2007 review of all studies of static magnets as a treatment for pain, researchers concluded that there is no meaningful evidence that they are effective; they further concluded that current evidence suggests that, for some pain-related conditions, static magnets are not effective (a much stronger statement than the first).

Some magnet proponents claim that it is impossible to carry out a truly double-blinded study on magnets because participants can simply use a metal pin or a similar object to discover whether they have a real magnet or not. Some researchers have gotten around this by using a weak magnet as the placebo treatment. Other researchers have designed more complicated placebo devices that participants have been found unable to identify as fake treatments.

Rheumatoid arthritis. A double-blind, controlled trial of
sixty-four people with rheumatoid arthritis of the knee
compared the effects of strong alternating polarity magnets with the effects of a
deliberately weak unipolar magnet. Researchers used the weakened magnet as a
control group so that participants would not find it easy to break the blind by
testing the magnetism of their treatment.

After one week of therapy, 68 percent of the participants using the strong magnets (the treatment group) reported relief, compared with 27 percent in the control group. This difference was statistically significant. Two of four other subjective measurements of disease severity also showed statistically significant improvements. However, no significant improvements were seen in objective evaluations of the condition, such as blood tests for inflammation severity or physician’s assessment of joint tenderness, swelling, or range of motion. This study suggests that magnet therapy may reduce the pain of rheumatoid arthritis without altering actual inflammation. However, the mixture of statistically significant and insignificant results indicates that a larger trial is necessary to factor out “statistical noise.”

Post-polio syndrome. A double-blind, placebo-controlled study of fifty people with post-polio syndrome found evidence that magnets are effective for relieving pain. The magnets or placebo magnets were placed on previously determined trigger points (one per person) for forty-five minutes. (Trigger points are sore areas within muscle that, when pressed, cause relief in other areas of the muscle and conversely, when inflamed, cause pain in other parts of the muscle.) In the treatment group, 76 percent of the participants reported improvement, compared with 19 percent in the placebo group.

Fibromyalgia. A six-month, double-blind, placebo-controlled trial
of 119 people with fibromyalgia compared two commercially
available magnetic mattress pads with sham treatment and no treatment. Group 1
used a mattress pad designed to create a uniform magnetic field of negative
polarity. Group 2 used a mattress pad that varied in polarity. In both groups,
manufacturer’s instructions were followed. Groups 3 and 4 used sham treatments
designed to match in appearance the magnets used in groups 1 and 2. Group 5
received no treatment.

On average, participants in all groups showed improvement in the six months of the study. Participants in the treatment groups, especially group 1, showed a trend toward greater improvement; however, the differences between real treatment and sham or no treatment failed to reach statistical significance in most measures. This outcome suggests that magnetic mattress pads might be helpful for fibromyalgia, but a larger study would be necessary to identify benefits.

An earlier double-blind, placebo-controlled study of thirty women with fibromyalgia did find significant improvement with magnets compared with placebo. The women slept on magnetic mattress pads (or sham pads for the control group) every night for four months. Of the twenty-five women who completed the trial, participants sleeping on the experimental mattress pads experienced a significant decrease in pain and fatigue compared with the placebo group, along with significant improvement in sleep and physical functioning.

A single-blind study of somewhat convoluted design provides weak evidence that a gown made from a special “electromagnetic shielding fabric” can reduce fibromyalgia symptoms. The rationale for using this fabric is, however, somewhat scientifically implausible.

Peripheral neuropathy. A four-month, double-blind, placebo-controlled, crossover study of nineteen people with peripheral neuropathy found a significant reduction in symptoms compared with placebo. Participants wore magnetic foot insoles during the day throughout the trial period. Reduction in the symptoms of burning, numbness, and tingling were especially marked in those cases of neuropathy associated with diabetes.

Based on these results, a far larger randomized, placebo-controlled, follow-up study was performed by the same researchers. This trial enrolled 375 people with peripheral neuropathy caused by diabetes and tested the effectiveness of four months of treatment with magnetic insoles. The results indicated that the insoles produced benefits beyond that of the placebo effect, reducing such symptoms as burning pain, numbness, tingling, and exercise-induced pain.

Surgery support. A double-blind, placebo-controlled study looked at the effect of magnets on healing after plastic surgery. The study examined the use of magnets on twenty persons who had suction lipectomy (liposuction). Magnets contained in patches were placed over the operative region immediately after surgery and left in place for fourteen days. The treatment group experienced statistically significant reduction of pain and swelling on postoperative days one through four, and of discoloration on days one through three, compared with the control group. Another study of 165 people, however, failed to find that the use of static magnets over the surgical incision reduced post-surgical pain. Furthermore, the positioning of static magnets at the acupuncture /acupressure point P6 in persons undergoing ear, nose, and throat or gynecological surgeries reduced nausea and vomiting no better than placebo in a randomized trial.

Low back pain and other forms of chronic musculoskeletal pain. A double-blind, placebo-controlled, crossover trial of fifty-four people with knee or back pain compared a complex static magnet array with a sham magnet array. Participants used either the real or the sham device for twenty-four hours; then, after a seven-day rest period, they used the opposite therapy for another twenty-four hours. Evaluations showed that the use of the real magnet was associated with greater improvements than the sham treatment.

Benefits were also seen in a double-blind, placebo-controlled trial of forty-three people with chronic knee pain who used fairly high-power but otherwise ordinary static magnets continuously for two weeks. In another placebo-controlled trial, the use of a magnetic knee wrap for twelve weeks was associated with a significant increase in quadriceps (thigh muscle) strength in persons with knee osteoarthritis.

A double-blind, placebo-controlled, crossover study of twenty people who had chronic low back pain for a minimum of six months failed to find any evidence of benefit. However, the alternating-pole magnet used in this study produced a very weak magnetic field. Another study found some benefit that failed to reach statistical significance.

In a double-blind study of 101 people with chronic neck and shoulder pain, the use of a magnetic necklace failed to prove more effective than placebo treatment. Another study failed to find magnetic insoles helpful for heel pain.

Osteoarthritis. A widely publicized twelve-week study of 194
people reportedly found that the use of magnetic bracelets reduced
osteoarthritis pain in the hip and knee. However, the study
actually found statistically similar benefits among participants given a placebo
treatment. The researchers suggest that this failure to show superior effects may
have been caused, in part, by an error: The study utilized weak magnets as the
placebo treatments, but thirty-four persons in the placebo group accidentally
received strong magnets instead. This would tend to decrease the difference in
outcome seen between the treatment and the placebo group and could therefore hide
a real treatment benefit. Nonetheless, this study does not provide evidence that
magnetic bracelets offer any benefit for osteoarthritis beyond that of the placebo
effect.

A much smaller study also failed to find statistically significant benefit, but it was too small to be able to produce statistically meaningful results. Rather, it was designed to evaluate a special placebo magnet device. After the study, researchers polled the participants to see if they could correctly identify whether they had been given the real treatment or the placebo: They could not.

Pelvic pain. A double-blind, placebo-controlled study of 14 women with chronic pelvic pain (from endometriosis or other causes) found no significant benefit when magnets were applied to abdominal trigger points for two weeks. However, statistical analysis showed that it would have been necessary to enroll a larger number of participants to detect an effect. A larger study did find some evidence of benefit after four weeks of treatment, but a high dropout rate and other design problems compromise the meaningfulness of the results. Another small study found possible evidence of benefit in menstrual pain.

Carpal tunnel syndrome. A double-blind, placebo-controlled study
of thirty people with carpal tunnel syndrome found that a
single treatment with a static magnet produced dramatic and long-lasting benefits.
However, identical dramatic benefits were seen in the placebo group. In two more
small, randomized trials, researchers again found that there were no differences
between the treatment and the placebo groups. Both groups experienced similar
improvements in symptoms.

In a small study involving thirty-one people with long-standing carpal tunnel syndrome, a combination of static magnet and pulsed electromagnetic field therapy modestly improved deep pain but had no significant effect on overall pain in a two-month period.

Sports performance. People who undergo intense exercise often experience muscle soreness afterwards. One study tested magnet therapy for reducing this symptom. However, while the use of magnets did reduce muscle soreness, so did placebo treatment, and there was no significant difference between the effectiveness of magnets and placebo. Another study, of more complex design, also failed to find benefit.

Magnetic insoles have been advocated for increasing sports performance. However, a study of fourteen college athletes failed to find that magnetic insoles improved vertical jump, bench squat, forty-yard dash, or performance of a soccer-specific fitness test.

Pulsed electromagnetic field therapy. Pulsed electromagnetic field therapy (PEMF) is quite distinct from magnet therapy itself. (The term “electromagnetic field” does not, in this case, refer to magnetism in the ordinary sense.) Nonetheless, for historical reasons, PEMF is often classified with true magnetic therapies.

Bone has a remarkable capacity to heal from injury. In some cases, though, the broken ends do not join, leading to what is called nonunion fractures. PEMF therapy has been used to stimulate bone repair in nonunion and other fractures since the 1970s; this is a relatively accepted use. More controversially, PEMF has shown promise for osteoarthritis, stress incontinence, and possibly other conditions.

Osteoarthritis. Three double-blind, placebo-controlled studies enrolling more than 350 people suggest that PEMF therapy can improve symptoms of osteoarthritis. For example, a double-blind, placebo-controlled study tested PEMF in eighty-six people with osteoarthritis of the knee and eighty-one people with osteoarthritis of the cervical spine. Participants received eighteen half-hour sessions with either a PEMF machine or a sham device. The treated participants showed significantly greater improvements in disease severity than those given placebo. For both osteoarthritis conditions, benefits lasted for a minimum of one month after treatment was stopped.

A later double-blind trial evaluated low-power, extremely low-frequency PEMF for the treatment of knee osteoarthritis. A total of 176 people received eight sessions of either sham or real treatment for two weeks. The results showed significantly greater pain reduction in the treated group.

Urinary incontinence. Many women experience stress incontinence, the leakage of urine following any action that puts pressure on the bladder. Laughter, physical exercise, and coughing can all trigger this unpleasant occurrence. A recent study suggests that PEMF treatment might be helpful. In this placebo-controlled study, researchers applied high-intensity pulsating magnetic fields to sixty-two women with stress incontinence. The intention was to stimulate the nerves that control the pelvic muscles.

The results showed that one session of magnetic stimulation significantly reduced episodes of urinary leakage over the following week, compared with placebo. In the treated group, 74 percent experienced significant improvement, compared with only 32 percent in the placebo group. Presumably, the high-intensity magnetic field used in this treatment created electrical currents in the pelvic muscles and nerves. This was confirmed by objective examination of thirteen participants, which found that magnetic stimulation was increasing the strength of closure at the exit from the bladder. However, there was one serious flaw in this study: It does not appear to have been double-blind. Researchers apparently knew which participants were getting real treatment and which were not and, therefore, might have unconsciously biased their observations to conform to their expectations. Thus, the promise of electromagnetic therapy for stress incontinence still needs to be validated in properly designed trials.

Similarly, magnetic stimulation has been studied for the treatment of bed-wetting (nocturnal enuresis). In a small preliminary study, the use of PEMF day and night for two months was helpful in girls.

Multiple sclerosis. A two-month, double-blind, placebo-controlled
study of thirty people with multiple sclerosis was conducted using
a PEMF device. Participants were instructed to tape the device to one of three
different acupuncture points on the shoulder, back, or hip. The study found
statistically significant improvements in the treatment group, most notably in
bladder control, hand function, and muscle spasticity. Benefits were seen in
another small study too.

Erectile dysfunction. In a three-week, double-blind, placebo-controlled trial, twenty men with erectile dysfunction received PEMF therapy or placebo. The magnetic therapy was administered by means of a small box worn near the genital area and kept in place as continuously as possible during the study period; neither participants nor observers knew whether the device was activated or not. The results showed that the use of PEMF significantly improved sexual function compared with placebo.

Migraines. In a double-blind trial, forty-two people with
migraine
headaches were given treatment with real or placebo PEMF
therapy to the inner thighs for one hour, five times per week for two weeks. The
results showed benefits in headache frequency and severity. However, the study
design was rather convoluted and nonstandard, so the results are difficult to
interpret.

Postoperative pain. In a small, randomized trial, eighty women undergoing breast augmentation surgery were divided into three groups. The first group received PEMF therapy for seven days after surgery to both breasts, the second group received fake PEMF therapy to both breasts as a control, and the third group received real and fake PEMF therapy to either breast. Compared to the control, women receiving PEMF therapy reported significantly less discomfort and used less pain medications by the third postoperative day.

Electromagnetic therapy. Unlike PEMF, repetitive transcranial magnetic stimulation (rTMS) involves magnetic fields and is, therefore, more closely related to standard magnet therapy. rTMS, which involves applying low-frequency magnetic pulses to the brain, has been investigated for treating emotional illnesses and other conditions that originate in the brain. The results of preliminary studies have been generally promising.

Depression. About twenty small studies have evaluated rTMS for the treatment of depression, including severe depression that does not respond to standard treatment and the depressive phase of bipolar illness, and most found it effective. In one of these studies, seventy people with major depression were given rTMS or sham rTMS in a double-blind setting of two weeks. The results showed that participants who had received actual treatment experienced significantly greater improvement than did those receiving sham treatment. In a far larger study involving 301 depressed persons, none of whom were being treated with antidepressant medications, real rTMS was significantly more effective than fake rTMS after four to six weeks of treatment.

In another trial involving ninety-two elderly persons whose depression had been linked to poor blood flow to the brain (vascular depression), actual rTMS was significantly more effective than sham rTMS. Benefits were more notable in younger participants. In a particularly persuasive piece of evidence, researchers pooled the results of thirty double-blind trials involving 1,164 depressed persons and determined that real rTMS was significantly more effective than sham rTMS.

Two separate studies suggest that rTMS may be an effective additional treatment
for the 20 to 30 percent of depressed people for whom conventional drug therapy is
not successful. Another group of researchers pooled the results of twenty-four
studies involving 1,092 persons and found rTMS to be more effective than sham for
treatment-resistant depression. Electroconvulsive therapy (shock
treatment) is often used for people in this category, but
rTMS may be an equally effective alternative.

Epilepsy. In a double-blind, placebo-controlled trial,
twenty-four people with epilepsy (technically, partial complex
seizures or secondarily generalized seizures) not fully responsive to drug
treatment were given treatment with rTMS or sham rTMS twice daily for one week.
The results showed a mild reduction in seizures among the people given real rTMS.
However, the benefits rapidly disappeared when treatment was stopped. Similarly
short-lived effects were seen in an open trial.

Schizophrenia. A double-blind, placebo-controlled, crossover
trial looked at the use of low-frequency rTMS in twelve people diagnosed with
schizophrenia and manifesting frequent and
treatment-resistant auditory hallucinations (hearing voices). Participants
received rTMS for four days, with the length of treatment building from four
minutes on the first day to sixteen minutes on the fourth day. Active stimulation
significantly reduced the incidence of auditory hallucinations compared with sham
stimulation. The extent of the benefit varied widely, lasting from one day in one
participant to two months in another. Possible benefits were seen in other small
studies. Researchers pooling the results of six controlled trials, which involved
232 persons with schizophrenia resistant to conventional treatment, found that
real, low-frequency rTMS was significantly better at reducing auditory
hallucinations than sham rTMS.

Parkinson’s disease. In a double-blind, placebo-controlled trial
of ninety-nine people with Parkinson’s disease, real rTMS was more
effective than sham rTMS delivered in eight weekly treatments. Similar benefits
were seen in three other small studies. Even more encouraging, the combined
results of ten randomized trials in persons with Parkinson’s indicated significant
benefit for rTMS (using higher frequencies).

Chronic pain syndromes. rTMS technology has also been applied to areas other than the brain. Myofascial pain syndrome is a condition similar to fibromyalgia but is more localized. Whereas fibromyalgia involves tender trigger points all over the body, myofascial pain syndrome involves trigger points clustered in one portion of the body only. One controlled trial found indications that a form of repetitive magnetic stimulation applied to the painful area may be effective for myofascial pain syndrome of the trapezius muscle.

In a placebo-controlled trial involving sixty-one people with long-standing diabetes, low-frequency repetitive magnetic stimulation failed to diminish the pain associated with diabetic peripheral neuropathy. However, in another study involving twenty-eight people with peripheral neuropathy, high-frequency rTMS applied to the brain was more effective at reducing pain and improving quality of life than was fake rTMS.

Tinnitus. One preliminary study found indications that rTMS may be helpful for tinnitus (ringing in the ear).

Post-traumatic stress disorder. A small, double-blind, placebo-controlled study found that the use of rTMS may be able to reduce symptoms of post-traumatic stress disorder.

Cigarette addiction. A small, double-blind, placebo-controlled study found evidence that rTMS may reduce the craving for cigarettes in people attempting to quit smoking.

Obsessive-compulsive disorder. A double-blind, placebo-controlled study of eighteen people with obsessive-compulsive disorder found no evidence of benefit with rTMS.

Amyotrophic lateral sclerosis. Amyotrophic lateral sclerosis, also called Lou Gehrig’s disease, is a nerve disorder that causes progressive muscle weakness. A small pilot study hinted that rTMS may be beneficial at least temporarily.

Andre-Obadia, N., et al. “Pain Relief by rTMS: Differential Effect of Current Flow but No Specific Action on Pain Subtypes.” Neurology 71 (2008): 833-840.

Bretlau, L. G., et al. “Repetitive Transcranial Magnetic Stimulation (rTMS) in Combination with Escitalopram in Patients with Treatment-Resistant Major Depression.” Pharmacopsychiatry 41 (2008): 41-47.

Cepeda, M. S., et al. “Static Magnetic Therapy Does Not Decrease Pain or Opioid Requirements.” Anesthesia and Analgesia 104 (2007): 290-294.

Chen, C. Y., et al. “Effect of Magnetic Knee Wrap on Quadriceps Strength in Patients with Symptomatic Knee Osteoarthritis.” Archives of Physical Medicine and Rehabilitation 89 (2008): 2258-2264.

Colbert, A. P., et al. “Static Magnetic Field Therapy for Carpal Tunnel Syndrome.” Archives of Physical Medicine and Rehabilitation 91 (2010): 1098-1104.

Heden, P., and A. A. Pilla. “Effects of Pulsed Electromagnetic Fields on Postoperative Pain: A Double-Blind Randomized Pilot Study in Breast Augmentation Patients.” Aesthetic Plastic Surgery 32 (2008): 660-666.

Klaiman, P., et al. “Magnetic Acupressure for Management of Postoperative Nausea and Vomiting.” Minerva Anestesiologica 74 (2008): 635-642.

Pittler, M. H., E. M. Brown, and E. Ernst. “Static Magnets for Reducing Pain.” CMAJ: Canadian Medical Association Journal 177 (2007): 736-742.

Wrobel, M. P., et al. “Impact of Low Frequency Pulsed Magnetic Fields on Pain Intensity, Quality of Life, and Sleep Disturbances in Patients with Painful Diabetic Polyneuropathy.” Diabetes and Metabolism 34 (2008): 349-354.

Choose two characters who are portrayed differently or the same in the play and movie adaptation of The Crucible.

Both John and Elizabeth Proctor are represented in much the same way in both the original play and the movie adaptation of it. John is conflicted: he feels terrible guilt for his marital infidelity, but he also is tired of feeling as though he is being judged for something he's admitted to and apologized for. He doubts his own goodness, but he cannot abide the thought that his wife doubts him as well (even though she assures him that she still considers him to be a good man). Likewise, Elizabeth is the same pious, unflinching woman in both play and film. She is unfailingly honest—except when she attempts to protect her husband, and she tells a crucial lie that paves the way to the accusation and conviction of John. He depended on her truthfulness to save them both, and—in this way—they both make one awful misstep that ends in his death (he, the affair with Abigail, and she the attempt to protect his reputation). Ultimately, the final scenes where John once again finds his own integrity and goodness and Elizabeth's unwillingness to take that knowledge from him remain intact, and these help to drive home the play's main messages in both mediums.

What is one symbol in Bharati Mukherjee's story "The Management of Grief"? Elaborate and explain it clearly and completely.

There is, when examining symbolism in Bharati Mukherjee’s short story "The Management of Grief," a very obvious example that one could choose to emphasize. That obvious example involves the role of roses and rose petals. Flowers are important in Hindu religious practices and in Indian culture. They symbolize purity and spirituality. When the protagonist and narrator of Mukherjee’s story, Shaila, travels to Ireland, where she encounters others of Indian heritage also mourning the loss of their loved ones in the horrific terrorist bombing of the aircraft on which these relatives were traveling, one of the relatives, Dr. Ranganathan, removes squashed roses from his jacket, explaining that his wife, who died in the disaster, loved pink roses, which she considered a symbol of her husband’s love. One could, then, use the role of flowers in "The Management of Grief" as an example of symbolism.  A more intriguing example of symbolism, however, is the package that Shaila abandons on a park bench in the story’s final passage:

“One rare, beautiful, sunny day last week, returning from a small errand on Young Street, I was walking through the park from the subway to my apartment. I live equidistant from the Ontario Houses of Parliament and the University of Toronto. The day was not cold, but something in the bare tress caught my attention. I looked up from the gravel, into the branches and the clear blue sky beyond. I thought I heard the rustling of larger forms, and I waited a moment for voices. Nothing. “What?” I asked. Then as I stood in the path looking north to Queen’s Park and west to the university, I heard the voices of my family one last time. Your time has come, they said. Go, be brave. I do not know where this voyage I have begun will end. I do not know which direction I will take. I dropped the package on a park bench and started walking.”

The reader does not know what is in this package. One can, however, surmise that the package contains items that belonged to her husband and sons, all of whom were killed in the airplane disaster. Earlier, returning to the part of the story when Shaila visits Ireland and stands on the coast with other surviving relatives, she mentions certain items that she has brought from Canada to deposit in the ocean as a form of memorial.  These items, a model of a B-52 military airplane that belonged to one son, the pocket calculator that belonged to her other son, a poem Shaila had just written for her departed husband, are her contributions to the collective act of grieving in which these Indians have gathered to participate. Shaila also references in this scene a “suitcase in the hotel [that] is packed heavy with dry clothes for my boys.” These references to physical items associated with her family provide an important clue to the contents of the mysterious package she abandons on the park bench.  When Shaila hears the voices of her departed family one last time, telling her to “go, be brave,” she can finally abandon those physical symbols of her husband and sons’ lives. The package symbolizes her family’s belongings—items that she no longer needs to hold onto in remembrance of her family, or in the unrealistic hope that they will someday return in the form in which she knew them. She leaves the package on the park bench because the items in that package represent the past, and she can finally look to the future.

In "The Monkey's Paw," from when they first hear the knocking up to when the husband ran outside to a quiet and deserted road, how does the writer...

Suspense is created by Mr. White’s desperation to get his wife’s wish cancelled with his wish.

Suspense is excitement created by the reader knowing that something is going to happen.  The author gives hints and uses foreshadowing to create interest in the story.  It can also make the story scary.

This story is about a talisman that gives a person three wishes, but is cursed.  The Whites use the first wish to ask for money, and they get it.  However, the catch is that their son dies a horrible death.  The knocking at the door is the White’s dead mangled son Herbert, brought back to life.  Mrs. White brought him back to life with the second of her wishes, supposedly.  Suspense is created by the fact that we never see what he looks like, and by Mr. White’s reaction to her wish.

The old man, with an unspeakable sense of relief at the failure of the talisman, crept back back to his bed, and a minute afterward the old woman came silently and apathetically beside him.

Mr. White’s comment that a rat passed him on the stairs, and his insistence that they not let “it” in both create suspense.  His wife is shouting.  It is scary and we feel like something terrible is about to happen.

Mr. White desperately tries to find the paw to make the third wish.  He does not want his wife to see their son.  He does not want to see him either.  He knows that she will not see what she expects to see.  She is sick with grief.  Seeing him, whatever will be at the door, will kill her.  He desperately wants to prevent that.

But her husband was on his hands and knees groping wildly on the floor in search of the paw. If only he could find it before the thing outside got in.

When Mr. White goes out to the street, it is empty.  We are relieved that no one was there, and the third wish worked, presumably.  Maybe the second wish didn’t work and the person knocking at the door just went away.  Either way, Mrs. White never saw a mangled zombie Herbert.  The suspense for the reader came from expecting to see one.

What is magnesium as a therapeutic supplement?

Overview

Magnesium is an essential nutrient, meaning that the body needs it for healthy
functioning. It is found in significant quantities throughout the body and used
for numerous purposes, including muscle relaxation, blood clotting, and the
manufacture of ATP (adenosine triphosphate, the body’s main
energy molecule).

Magnesium has been called nature’s calcium channel blocker because of its ability to block calcium from entering muscle and heart cells. A group of prescription heart medications work in a similar way, although much more powerfully. This may be the basis for some of magnesium’s effects when it is taken as a supplement in fairly high doses.

Requirements and Sources

Requirements for magnesium increase as people grow and age. The official U.S. and Canadian recommendations for daily intake are as follows: 30 milligrams (mg) for infants up to six months old, 75 mg for infants seven to twelve months old, 80 mg for children one to three years old, 130 mg for children four to eight years old, and 240 mg for persons nine to thirteen years old. For those fourteen to eighteen years old, the recommendations are 410 mg for males and 360 mg for females; for those nineteen to thirty years old, 400 mg for males and 310 for females; and for those aged thirty-one and over, 420 mg for males and 320 mg for women. The recommendations for pregnant women are 400 mg for those eighteen and younger, 350 mg for those nineteen to thirty years old, and 360 mg for those thirty-one to fifty years old; for nursing women, they are 360 mg for those aged eighteen and younger, 310 mg for those nineteen to thirty, and 320 mg for those thirty-one to fifty years old.

These recommendations refer to total intake from food plus supplements. The
average diet provides a daily intake of magnesium very close to these amounts. In
the United States, the average dietary intake of magnesium is lower than the
recommended daily allowance; however, it is unclear whether this truly indicates
deficiency, or if the recommended allowance is too high. Alcohol abuse, surgery,
diabetes, zinc supplements, certain types of diuretics (thiazide and
loop
diuretics, but not potassium-sparing diuretics), estrogen and
oral contraceptives, and the medications cisplatin and
cyclosporin have been reported to reduce the body’s level of magnesium or increase
magnesium requirements. Those taking potassium supplements may receive
greater benefit from them if they take extra magnesium as well. While it is
sometimes said that calcium interferes with magnesium absorption, this effect is
apparently too small to have a significant effect on overall magnesium status.

Kelp is very high in magnesium, as are wheat bran, wheat
germ, almonds, and cashews. Other good sources include blackstrap molasses,
brewer’s yeast (not to be confused with nutritional yeast), buckwheat, nuts, and
whole grains. One can also get appreciable amounts of magnesium from collard
greens, dandelion greens, avocado, sweet corn, cheddar cheese, sunflower seeds,
shrimp, dried fruit (figs, apricots, and prunes), and from many other common
fruits and vegetables.

Therapeutic Dosages

A typical supplemental dosage of magnesium ranges from the nutritional needs described above to as high as 600 mg daily. For premenstrual syndrome (PMS) and dysmenorrhea (painful menstruation), an alternative approach is to start taking 500 to 1,000 mg daily, beginning on day fifteen of the menstrual cycle and continuing until menstruation begins. Magnesium citrate may be slightly more absorbable than other forms of magnesium.

Therapeutic Uses

Preliminary double-blind studies suggest that regular use of magnesium supplements may help prevent migraine headaches, hearing loss caused by exposure to loud noises, and kidney stones and may help treat high blood pressure, angina, dysmenorrhea (menstrual cramps), pregnancy-induced leg cramps, and premenstrual syndrome (including menstrual migraines).

People with diabetes are often deficient in magnesium, and according to some (but not all) studies, magnesium supplementation may enhance blood sugar control and insulin sensitivity in people with diabetes or prediabetic conditions. Magnesium may also help control blood pressure in people with both hypertension and diabetes.

One study found that magnesium supplements might be helpful for people with mitral valve prolapse who also have low levels of magnesium in the blood. There is some evidence that magnesium may decrease the atherosclerosis risk caused by hydrogenated oils, the margarine-like fats found in many junk foods.

Magnesium supplements do not appear to be helpful for preventing preeclampsia. (Magnesium, taken by injection rather than orally, however, is probably helpful for treating preeclampsia that already exists.)

Magnesium is sometimes said to decrease symptoms of restless legs syndrome, but the evidence that it works consists solely of open trials without a placebo group, and such studies are not trustworthy. Weak evidence hints at possible benefits for insomnia.

It is often said that magnesium supplements are essential for preventing or treating osteoporosis, but there is only minimal supporting evidence for this claim. Studies on magnesium supplements for improving sports performance have returned contradictory results.

Magnesium has also been suggested as a treatment for Alzheimer’s disease, attention deficit disorder, fatigue, fibromyalgia, low high-density lipoproteins (HDL, or good cholesterol), periodontal disease, rheumatoid arthritis, and stroke. However, there is virtually no evidence that it is helpful for any of these conditions. Despite some early enthusiasm, combination therapy with vitamin B6 and magnesium has not been found helpful in autism. One double-blind, placebo-controlled study failed to find magnesium helpful in glaucoma.

Magnesium is sometimes advocated for stabilizing the heart after a heart attack, but one study actually found that use of magnesium slightly increased risk of sudden death, repeat heart attack, or need for bypass surgery in the year following the initial heart attack. However, magnesium may be helpful in congestive heart failure. In a well-designed trial involving seventy-nine patients with severe congestive heart failure, magnesium (as magnesium orotate) significantly improved survival and clinical symptoms after one year compared with a placebo.

Alternative medical literature frequently mentions magnesium as a treatment for asthma. However, this idea seems to be based primarily on the use of intravenous magnesium as an emergency treatment for asthma. Taking something by mouth is very different from having it injected into the veins. Studies of oral magnesium for asthma have shown more negative than positive results. Inhaled, aerosolized magnesium, however, has shown some promise.

Although magnesium is sometimes mentioned as a treatment to help keep the heart
beating normally, a six-month double-blind trial of 170 people did not find it
effective for preventing a particular heart rhythm abnormality called
atrial
fibrillation. However, a small double-blind,
placebo-controlled trial found that magnesium supplements reduced episodes of
arrhythmia in individuals with congestive heart failure (CHF). One possible
explanation: People with congestive heart failure often take drugs (loop
diuretics) that deplete magnesium. The combination of magnesium deficiency with
digoxin (another drug given for CHF) may cause
arrhythmias. Thus, it is possible that the benefits seen
here were caused by correction of that depletion.

Scientific Evidence

Migraine headaches. A double-blind study found that regular use
of magnesium helps prevent migraine headaches. In this twelve-week
trial, eighty-one people with recurrent migraines were given either 600 mg of
magnesium daily or a placebo. By the last three weeks of the study, the treated
group’s migraines had been reduced by 41.6 percent, compared with a reduction of
15.8 percent in the placebo group. The only side effects observed were diarrhea
(in about one-fifth of the participants) and, less often, digestive
irritation.

Similar results have been seen in other, smaller double-blind studies. One study found no benefit, but it has been criticized on many significant points, including using an excessively strict definition of what constituted benefit.

Noise-related hearing loss. One double-blind, placebo-controlled study on three hundred military recruits suggests that 167 mg of magnesium daily can prevent hearing loss due to exposure to high-volume noise.

Kidney stones. Magnesium inhibits the growth of calcium oxalate
stones in the test tube and decreases stone formation in rats. However, human
studies have had mixed results. In one two-year open study, 56 people taking
magnesium hydroxide had fewer recurrences of kidney stones
than 34 people not given magnesium. In contrast, a double-blind (and, hence, more
reliable) study of 124 people found that magnesium hydroxide was essentially no
more effective than a placebo.

Hypertension. Magnesium works with calcium and potassium to
regulate blood pressure. Several studies suggest that magnesium supplements can
reduce blood pressure in people with hypertension, although some studies
have not shown this.

In one study, eighty-two people (ages forty to seventy-five years) with diabetes, high blood pressure, and low levels of magnesium were randomized to receive 2.5 g of magnesium chloride or a placebo for four months. Those in the treatment group had lower blood pressure readings compared with those in the control group.

Angina. In a double-blind, placebo-controlled trial of 187 people
with angina, six months of treatment with magnesium at a dose of
730 mg daily improved exercise tolerance and enhanced overall quality of life.
Benefits were also seen in a similar, smaller double-blind trial.

After a heart attack. In a one-year double-blind, placebo-controlled trial of 468 individuals who had just experienced a heart attack, use of a magnesium supplement at a dose of 360 mg daily failed to prevent heart-related events (defined as heart attack, sudden cardiac death, or need for cardiac bypass) and actually may have increased the risk slightly.

Dysmenorrhea. A six-month double-blind, placebo-controlled study of fifty women with menstrual pain found that treatment with magnesium significantly improved symptoms. The researchers reported evidence of reduced levels of prostaglandin F 2 alpha, a hormone-like substance involved in pain and inflammation. Similarly positive results were seen in a double-blind, placebo-controlled study of twenty-one women.

Premenstrual syndrome (PMS). A double-blind, placebo-controlled study of thirty-two women found that magnesium taken from day fifteen of the menstrual cycle to the onset of menstrual flow could significantly improve PMS symptoms, specifically mood changes.

Another small, double-blind preliminary study found that regular use of magnesium could reduce symptoms of PMS-related fluid retention. In this study, thirty-eight women were given magnesium or placebo for two months. The results showed no effect after one cycle, but by the end of two cycles, magnesium significantly reduced weight gain, swelling of extremities, breast tenderness, and abdominal bloating. In addition, one small double-blind study (twenty participants) found that magnesium supplementation can help prevent menstrual migraines. Preliminary evidence suggests that the combination of magnesium and vitamin B6 might be more effective than either treatment alone.

Pregnancy-induced leg cramps. Pregnant women frequently experience painful leg cramping. One double-blind trial of seventy-three pregnant women found that three weeks of magnesium supplements significantly reduced leg cramps compared with a placebo.

Safety Issues

The U.S. government has set the following upper limits for use of magnesium supplements: 65 mg for children aged one to three, 110 mg for children four to eight, 350 mg for adults, and 350 mg for pregnant or nursing women. In general, magnesium appears to be quite safe when taken at or below recommended dosages. The most common complaint is loose stools. However, people with severe kidney or heart disease should not take magnesium (or any other supplement) except on the advice of a physician. Maximum safe dosages have not been established for children of all ages. There has been one case of death caused by excessive use of magnesium supplements in a developmentally and physically disabled child. Pregnant or nursing women should not exceed the nutritional dosages presented in the Requirements and Sources section.

If taken at the same time, magnesium can interfere with the absorption of
antibiotics in the tetracycline family and, possibly of
the drug nitrofurantoin. Also, when combined with oral diabetes drugs
in the sulfonylurea family, magnesium may cause blood sugar levels to fall more
than expected.

Important Interactions

Persons taking potassium supplements, manganese, loop and thiazide diuretics,
oral contraceptives, estrogen replacement therapy, cisplatin, digoxin, or
medications that reduce stomach acid may need extra magnesium. Persons taking
antibiotics in the tetracycline family or nitrofurantoin (Macrodantin) should
separate their magnesium dose from doses of these medications by at least two
hours to avoid absorption problems. Those taking oral diabetes medications in the
sulfonylurea family (Tolinase, Micronase, Orinase, Glucotrol, Diabinese, DiaBeta)
should work closely with their physicians when taking magnesium to avoid
hypoglycemia. Those taking amiloride should not take
magnesium supplements except on medical advice.

Bibliography

Guerrero-Romero, F., and M. Rodríguez-Morán. “The Effect of Lowering Blood Pressure by Magnesium Supplementation in Diabetic Hypertensive Adults with Low Serum Magnesium Levels.” Journal of Human Hypertension 23, no. 4 (2009): 245-251.

Hatzistavri, L. S., et al. “Oral Magnesium Supplementation Reduces Ambulatory Blood Pressure in Patients with Mild Hypertension.” American Journal of Hypertension 22, no. 10 (2009): 1070-1075.

Kazaks, A. G., et al. “Effect of Oral Magnesium Supplementation on Measures of Airway Resistance and Subjective Assessment of Asthma Control and Quality of Life in Men and Women with Mild to Moderate Asthma.” Journal of Asthma 47, no. 1 (2010): 83-92.

Stepura, O. B., and A. I. Martynow. “Magnesium Orotate in Severe Congestive Heart Failure (MACH).” International Journal of Cardiology 134, no. 1 (2009): 145-147.