… medical and health care practices and products outside the realm of conventional medicine, which are yet to be validated using scientific methods
*What Is Complementary Alternative Medicine?
Complementary: together with conventional practices ( aroma therapy for surgery patients)
Alternative: in place of conventional practices. Relies on certain stimuli for body’s natural healing
*Types of Therapies
*Homeopathy- “like cures like” Small amounts of substances can cure while larger amounts can cause symptoms (ex-allergy shots)
*Herbal therapy- most popular but not covered by law or tested by FDA
*Acupuncture - manipulation of energy flow by inserting needles into the meridians of this flow
*Naturopathic medicines- assists body’s natural healing; includes diet, massage, exercise, acupuncture
*Prayer
* The Big “Seven”
*Chinese herbal medicine
*Western herbalism
*Acupuncture
*Chiropractic care
*Massage
*Homeopathy
*Diet and nutrition therapy
*CAM Practices Now in Mainstream
Medicine*Codeine for pain
*Digitalis for heart failure
*Ipecac for poisoning
*Quinine for malaria
*Aspirin for fever
*Behavioral therapy for headache
*Hypnosis for smoking cessation
*Low fat, low cholesterol diets
*Exercise for diabetes
*Support groupsfor breast cancer
* The CAM Domains
*The Appeal of CAM
Patient empowerment Focus on spiritual and emotional well-being Therapist providing “touch, talk, time” Feeling of “natural” treatment Tradition
* CAM Use in the United States
*Phone poll- 62% of adults 18+ used CAM in the past year
*Who Is the Practitioner?
*Medical doctors *CAM practitioners*Traditional healers
*CAM Economics
*Americans spend more out-of-pocket for CAM than for all other health care needs*CAM is big business
*56% of Americans believe their health plans should cover CAM
Who uses CAM?
More educated More affluent Possess a holistic orientation to health Had a ‘transformational experience’ Identification with environmentalism, feminism,
spirituality Report chronic anxiety, pain, UTI, back
problems (Astin et al. JAMA ,1998)
*Communication *Many mainstream
doctors do no approve of CAM therapies
*Most patients do not report alternative therapies to their doctors
*Communication is key to prevent further damage especially with alternative meds
* The Research Portfolio: NCCAM’s Ongoing Phase III Trials
Therapy Condition Status Co-Sponsors
Glucosamine-Chondroitin Osteoarthritis Fully recruited; ongoing NIAMS, VA
Ginkgo Biloba Dementia Fully recruited; ongoing NIA, NHLBI, NINDS
Vitamin E-Selenium Prostate Cancer Fully recruited; ongoing NCI
Shark Cartilage Lung Cancer Recruiting NCI
EDTA Chelation Therapy Coronary Artery Disease Recruiting NHLBI
St. John’s Wort Minor Depression Recruiting NIMH, ODS
Vitamin E Down Syndrome Recruiting NICHD, NIA
Phytoestrogens Atherosclerosis Recruiting ODS, ORWH
SAMe Depression Recruiting
Acupuncture Low back pain Recruiting
* Dietary Supplements: DSHEA Definition
*Product intended to supplement the diet*Contains one or more of the following:* Vitamin* Mineral* Herb or other botanical (not
tobacco)* Amino acid* Any other dietary substance
*For oral intake as a concentrate, metabolite, extract, constituent, or combination
*Patterns of Supplement Use:The Slone Survey
*2590 participants 18 years +
*Telephone survey, random sampleFeb 1998 - Dec 1999
*In the preceding week:*14% of population used herbalsand/or supplements
*16% of prescription drug users used herbals and/or supplements
JAMA, 2002
Patterns of Supplement Use:
*Ginseng*Ginkgo biloba*Allium sativum*Glucosamine*St. John’s wort*Echinacea*Lecithin*Chondroitin*Creatine*Serenoa repens
Ten Most Commonly Used Herbals / Supplements
Patterns of Supplement Use
*General health/good for you (16%)*Arthritis (7%)*Memory improvement (6%)*Energy (5%)*Immune booster (5%)*Joints (4%)*Supplement diet (4%)*Sleep aid (3%)*Prostate (3%)*No reason (2%)*All other reasons (45%)
Ten Most Common Reasons for taking herbs / supplements
JAMA, 2002
*Challenges of Herbal Medicines
*Safety is assumed, not proven
*Lack of product standardization
*Contamination with drugs, heavy metals
*Allergic reactions
*Inherent toxicity
*Interactions with drugs
*Replacing proven therapies
*Herbal Therapy and Surgery
*Ephedra: Safety Concerns
*Ma huang (Ephedra sineca) – Short-term treatment for asthma, decongestion
*Contains L-ephedrine, pseudoephedrine
*Major current use in U.S. in combination with caffeine for weight loss, athletic performance
*Dozens of reports of severe and life-threatening adverse events in young people
*Echinacea
*Used as cold and flu remedy
*Some studies show it increasing phagocytosis and release of interferon
*Some studies have shown it to reduce duration of colds
*Problem- only anecdotal evidence and no consistency in dosage of product
*Lack of regulation of CAM
*Many alternative medications lack studies to verify their efficacies
*FDA approval not required so standards for dosage is not set
*Some dosages vary as much as 10X other dosages
*Alt meds cannot make claims or promoted as curing or preventing disease
*Acupuncture- What exactly is Chi?
*Chi is an energy that, according to ancient Chinese beliefs, permeates all things
*Chi must be able to flow freely throughout the body in order for a person to maintain overall health
*Chi flows along the meridians of the body
*Where do yin and yang fit in?
*Acupuncture needles are inserted in an attempt to balance the opposing forces of yin and yang
*Yin and yang are balanced when a person is healthy and chi is therefore able to flow freely
*Injury or illness cause yin and yang to become distressed and unbalanced
*Originally there were 365 acupuncture points, but through the years this number has increased to over 2,000
*Each point is believed to correspond with a particular illness or injury
* What is acupuncture used to treat?
*Depression
*Arthritis
*Kidney problems
*Flu
*Fatigue
*Chronic pain
*Migraines
*Paralysis
*Hypertension
*Tendonitis
*Vision problems
*Sexual Dysfunction
*And many others…
* Possible medical explanations
*Stimulation of natural painkilling chemicals such as endorphins
*Needles block the transmission of pain impulses to the CNS
*But there are risks…
*Bladder or lung puncture
*Allergic reaction to needles
*Infection from unsterilized needles
*Fainting
*Convulsions
*Nerve Damage
*Putting off treatments that are known to be effective
*History of Chiropractic
*Chiropractic- means “done by hand”, referring to manipulation of the spine.
*Greek words cheir (hand) and praxis (action)
*Chiropractic is a form of spinal manipulation, one of the oldest healing practices.
*Spinal manipulation was described by Hippocrates in ancient Greece.
* The Founder of the Modern Profession of Chiropractic
*Daniel David Palmer
*Healing philosophies
*Spiritualism
*Magnetic therapy
*Background in osteopathic training
* Basic Concepts of Chiropractic
*The body has a powerful self-healing ability.
*The body’s structure (primarily the spine) and its function are closely related, and this relationship affects health.
*Chiropractic therapy is given with the goals to normalize the relationship between structure and function and assisting the body as it heals.
* Conditions Commonly Treated by Chiropractors
*Back pain including low-back pain
*Neck pain
*Headaches including migraines
*Sports Injuries
*Repetitive strains
*Others*Asthma, Arthritis, Bursitis, Cerebral Palsy,
Flu symptoms, DM, Infertility, etc
*Controversies and Criticism
*Effectiveness of treatments
*Non-manual treatments
* heat and ice, magnetic therapy, nutrition counseling and dietary supplements
*Potential risks
*Presumed to be safe from what is known
*Potential Osteoporosis compared to healthier bone
*History of Massage*Natural reaction to when the body hurts is to rub it
*Dates back to at least the ancient Olympics
*Massage is derived from 2 sources
*Arabic verb mass “to touch”
*Greek word massein “to knead”
*Egyptians, Romans, Japanese& Chinese were known to practice massage
*What is Massage Therapy?
*Used to manipulate the body’s tissue
*Effective in promoting local & systemic relaxation, increasing local blood flow, encouraging venous return
*Act of rubbing, kneading, or stroking the superficial parts of the body with the hand or an instrument for the purpose of modifying nutrition, restoring power of movement
* Treatment Considerations & Guidelines
*Need to know underlying pathology
*Need to know basic massage
*Avoid constant hyperextension or hyperflexion of any joints
*Must obtain correct positioning that will allow for relaxation, prevent fatigue & permit free movement of arms, hands, & body.
*Physiological Effects of Massage Therapy
*Depending on the amount of pressure applied & the speed of the stroke*Light, slow stroking – evokes systemic relaxation
*Fast, deep strokes increase blood flow to the area
*Cardiovascular changes – deep friction or vigorous massage was thought to produce vascular changes
*Massage can produce decreased heart rate, breathing rate, & blood pressure if the purpose is for inducing system relaxation
*Acupressure- history*5000 year old healing
art
*First originated in China
*Used in preventative care, immune boosting and stress relief
*12 Meridians of healing energy pathways
*Blockages occur with illness or injury both physical and/or mental
*Acupressure Treatments*Can use fingers, hands,
palms, knuckles
*Shiatsu- Japanese massage- deep pressure held for 3-5 seconds
*Jin Shin- two points are held for a few seconds
*Reiki- channeling healing energy
*QiGong often combined with martial arts (breathing and slow fluid movement)
*Benefits of Acupressure*Increases circulation
*Reduces pain
*Releases stress
*Balance body energy
*Beauty treatments (improves muscle tone and skin circulation)
*Homeopathy *Homeopathy is a system of
medicine based on three principles:
* Like cures likeFor example, if the symptoms of your cold are similar to poisoning by mercury, then mercury would be your homeopathic remedy.
*Minimal DoseThe remedy is taken in an extremely dilute form; normally one part of the remedy to around 1,000,000,000,000 parts of water.
*The Single RemedyNo matter how many symptoms are experienced, only one remedy is taken, and that remedy will be aimed at all those symptoms.
* Homeopathic treatment- an example
*The symptoms between a bee sting and a rash are similar. A bee sting swells and itches.
*Hives, a rash or even another insect bite itch
*the homeopathic medicine is made from a tiny amount of a bee.
* Instead of masking symptoms, the medicine sends the body a signal to help it rebalance and heal.
*Another example
*Your eyes burn, itch and water when you peel an onion. You might have a runny nose too
*You have a runny nose and begin to sneeze during a cold or allergy attack,
*A homeopathic micro-dose of the remedy Allium cepa (red onion) would help your body heal itself.
*Homeopathic vs Herbalogy
*Not to be confused with herbalogy
*Homeopathic remedies are very dilute doses of natural ingredients including plants or minerals
*Herbal remedies are made solely from plants.
*The Controversy
*Remedies are so diluted, they are rendered useless for treatment
*Even in dilute cases, some treatments are made of toxic chemicals
*Nutrition Therapy
*Treatment of medical conditions with diet and nutrition
*Usually based on whole food diet with supplements
*Many feel diseases worsen by an improper diet
*History of Nutrition Therapy
*Relatively recent practice
*Dietetic Association began in the 1900s
*Began as treatment for surgery patients
*Now healthy patients seek diet therapy to remain healthy or even reverse aging effects
*Examples of conditions using Nutrition Therapy
*Cancer patients
*Obesity
*Diabetes
*Elderly
*Paralysis
*Intestinal diseases