Transcript COMPLEMENTARY/ALTERNATIVE MEDICINE INTEGRATED …

RICHARD E. FREEMAN MD MPH
LOCK HAVEN UNIVERSITY
2013
INTEGRATED MEDICINE
FOR THE CANCER PATIENT
TO
MAKE
MAN
WHOLE
 CASE OF DR. FREEMAN
 AND
 MRS. ANDERSON
COMPLEMENTARY MEDICINE VS.
ALTERNATIVE MEDICINE
 COMPLEMENTARY MEDICINE - therapies,
treatments, products that are employed to
complement or be used with conventional
medicine
 ALTERNATIVE MEDICINE – therapies,
treatments, products are employed to take
the place of conventional medicine
INTEGRATIVE MEDICINE
 INTEGRATIVE MEDICINE- comprehensive,
evidence-based approach to care that
addresses ALL participants at ALL levels of
their being and experience
INTEGRATIVE ONCOLOGY CARE
 A COMPREHENSIVE EVIDENCE BASED
APPROACH TO CANCER CARE THAT
ADDRESSES ALL PARTICIPANTS AT ALL
LEVELS OF THEIR BEING AND EXPERIENCE
WITH DEFINABLE AND DESIRABLE OUTCOMES
IN PREVENTIVE, SUPPORTIVE AND
ANTINEOPLACTIC SPHERES
 BASED ON or INCLUDING:
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WESTERN MEDICAL PRACTICES
CONVENTIONAL MEDICINE
COMPLEMENTARY MEDICINE
ALTERNATIVE MEDICINE
SPHERE OF ACTION-THE LADDER
 PREVENTION
 PRIMARY, SECONDARY, TERTIARY
 SUPPORTIVE
 SYMPTOMS, SIDE EFFECTS
 ANTINEOPLASTIC
 DIRECT ACTION
WHY INTEGRATIVE ONCOLOGY??
 POSITIVES:
 Significant decrease in death rates
 ~70% patients with 5 yr survival
 Technical and therapeutic advances
 -diagnostic and treatment
 Screening program successes
 Population education
 Oncological expertise advancements
 Public Health/Environmental Improvements
WHY INTEGRATIVE ONCOLOGY??
 NEGATIVES:
 HIGH COSTS-THIRD PARTY PAYER DEPENDANCY
 ~$200 BILLION/ YEAR
 ~ $70 BILLION/ YEAR – DIRECT MEDICAL
 ~$30 BILLION/YEAR – INDIRECT MORBIDITY COSTS
 ~$100 BILLION/YEAR- INDIRECT MORTALITY COSTS
 LIFETIME CANCER RISK STILL HIGH
 MEN – 50%; WOMEN – 30%
 CUREENTLY – 10 MILLION + CANCER SURVIVORS
 SPECIAL NEEDS- MEDICAL, PSYCHOSOCIAL, LIFESTLE
 LOSS OF THERAPEUTIC RELATIONSHIPS
 ONCOLOGIST – NOT TRAINED IN NON-CONVENTIONAL
APPROACHES
 MISTRUST OF THE MEDICAL ESTABLISHMENT
RESULTS:
 BILLIONS SPENT OUT OF POCKET ON CAM
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TREATMENTS
UNDER UTILIZATION OF BENEFICIAL
CHEAPER PROVEN CAM MODALITIESPREVENTION AND SUPPORT
DANGEROUS INTERACTIONS BETWEEN
CAM-CONVENTIONAL TREATMENTS
DELAYS IN SEEKING CONVENTIONAL
TREATMENTS
PROVIDER BURNOUT
CANCER SURVIVORS
 PRAYER AND SPIRITUAL PRACTICES 60%
 RELAXATION TECHNIQUES 45%
 FAITH AND SPIRITUAL HEALING 40%
 NUTRITIONAL SUPPLEMENTS 40%
SOLUTIONHEALING IN ADDITION TO CURING
ALL PARTICIPANTS
ALL LEVELS OF BEING
 PATIENTS
 MIND
 FAMILIES
 PROVIDERS
 COMMUNITIES
 SOCIETY
 THOUGHTS, FEELINGS,
EMOTIONS, INTELLECT
 BODY
 BIOLOGIC, CHEMICAL,
ENERGETIC BEING
 SOUL
 PERSONAL EXPERIENCE OF
SELF
 SPIRIT
 ONE’S UNIFYING /UNIVERSAL
APPROACH TO LIFE
THE PRECAUTIONARY PRINCIPLE
 A LACK OF SCIENTIFIC CERTAINTY SHALL NOT
BE USED AS A REASON FOR NOT ACTING IN A
WAY THAT PREVENTS HARM TO HUMAN
HEALTH OR THE ENVIRONMENT.
 USE WHEN DATA IS LIMITED OR NONEXISTANT
 ONLY WITH INFORMED CONSENT
 PERCEIVED BENEFITS OUTWEIGHT RISKS
 PREVENTIVE/SUPPORTIVE INTERVENTIONS
 JUDGEMENT CALL-
CAM/IM – “RED FLAGS”
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“CURES”-OFFERED
CAN NOT PROVIDE EVIDENCE- BASED DATA
FDA NOT APPROVED
USES “TESTIMONIALS” FOR PROMOTION
 PHYSICIANS, INFLUENTIAL INDIVIDUALS
 DEROGATORY/ DEGRADING COMMENTS ABOUT
CONVENTIONAL THERAPIES
 REFUSES TO WORK AS A TEAM
 RISKS OF THERAPY NOT ADDRESSED
 REFUSE INSURANCE – CASH ONLY
 MOST IMPORTANT – “GUT FEELING”
SPHERE OF ACTION - LADDER
 PREVENTION
 PRIMARY, SECONDARY, TERTIARY
 SUPPORTIVE
 SYMPTOMS, SIDE EFFECTS
 ANTINEOPLASTIC
 DIRECT ACTION
TYPES OF INTERVENTIONS
ADJUNCTIVE/ALTERNATIVE SYSTEM
CHINESE
ACUPUNCTURE
MIND/BODY
SPIRITUAL
MEDITATION/YOGA
NUTRITIONAL
SPECIAL VEGETABLE
HIGH FIBER
PHARMOCOLOGICAL/BIOLOGICAL
BOTANICALS
HERBS
VACCINES
HORMONES
 ALTERNATIVE
&
 ADJUNCTIVE
 SYSTEMS
ACUPUNCTURE
 SUPPORTIVE:
 WELL ESTABLISHED AS A MEANS TO
CONTROL CHEMOTHERAPY RELATED
NAUSEA AND VOMITING.
 PROBLEMS: NOT ENOUGH PRACTITIONERS
AYURVEDIC Medicine
 India:
 Balance of Body, Mind Spirit
CHINESE MEDICINE
 CHINA & EASTERN ASIA:
 BALANCE OF TWO FORCES:
HOMEOPATHY
 VERY SMALL DOSES OF A SUBSTANCE
 TRIGGERS BODY TO HEAL ITSELF
NATUROPATHIC MEDICINE
 SEVERAL “NATURAL” MODALITIES
 ENHANCING “SELF HEALING”
MIND – BODY
MODALITIES
RELAXATION TECHNIQUES
 PROGRESSIVE RELAXATION
 YOGA
 TAI CHI/
 REICHI/THERAPUETIC TOUCH
 MEDITATION
 HYPNOSIS
 IMAGERY
 BIOFEEDBACK
 STRESS MANAGEMENT/Creative outlets
SUPPORT GROUPS
 Shown to:
 Reduce anxiety/depression/
loniness/suicide
 Provide resource for education
Improve nutritional/physical wellbeing
 Reduce the dependency on
providers/caregivers for support
 Reduce caregiver burden
SPIRITUALITY
 MOST POWERFUL COPING TOOL
 yet MOST UNDERUTILIZED PATIENT/PROVIDER AMBIVALENCE
 SHOWN TO:
 Improve overall QUALITY OF LIFE through
creation of a positive mental attitude, hope,
and sense of well being/inner peace.
Healing AttributesSpiritual Belief System
 ATTRIBUTES:
 Decrease anxiety, depression, anger and discomfort
 Decrease sense of isolation and suicide risk
 Decrease alcohol and drug usage
 Lowers blood pressure/decreases co morbidities
 Aids in adjustment to cancer and treatment
 Increases ability to enjoy life during treatment
 Freedom from regret/satisfaction with life
 May extend life!!!
 Spiritual Distress- harder to cope
SPIRITUAL ASSESSMENT
 EXPLORES SPIRITUAL BELIEFS/PRACTICES
 HELP PREDICT COPING MECHANISMS
 OPENS DIALOG PATIENT-PROVIDER
SPIRITUAL ASSESSMENT
 INCLUDE QUESTIONS REGARDING:
 DENOMINATION
 BELIEF OR PHILOSOPHY OF LIFE & DEATH
 SPIRITUAL PRACTICES/RITES/RITUALS
 USE OF RELIGION AS SOURCE OF STRENGTH
 INTERNAL RELIGIOUS SUPPORT STRUCTURE
 CONFLICTS BETWEEN BELIEFS AND TREATMENTS
 PRAYER AS PART OF TREATMENT
 LOSS OF FAITH/TRUST/ABANDONMENT
 INTERACTIONS BETWEEN PROVIDERS AND SPIRITUAL
LEADERS-CONFIDENTIALITY
 END OF LIFE PLANNING
NUTRITIONAL
SUPPLEMENTATION
MODALITIES
FIBER AND CANCER
 HIGH FIBER DIET – PREVENTIVE 1
 DECREASE IN TRANSIT TIME
 LESS TIME FOR BACTERIAL ACTIONMETABOLITES
 LESS TIME FOR MUCOSA CELL TOXIN
EXPOSURE
 USUALLY HIGH IN ANTI-OXIDANTS
 LESS NITROSAMINE INGESTION
 AFRICANS AND SEVENTH-DAY
ADVENTISTS- Burkitt / SDA Studies
 Vegetarian/Vegans
 NURSES HEALTH STUDY-HARVARD
ANTIOXIDANT THEORY
 MECHANISM OF ACTION: Controversial
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Free radicals produced by normal metabolism
Radicals – genetic mutations
Antioxidants – scavanger of radicals
Transit time theory
 FOODS: Green teas, mushrooms, green/orange vegetables,
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Omega 3 FA, walnuts, flax lignans
Lycopene-containing foods
VITAMINS: A,C,E
Minerals: selenium
DEBATE: USE WITH CHEMOTHERAPY
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PROPONENTS- LESSENS SIDE EFFECTS
DETRACTORS- TUMOR PROTECTED DURING CHEMO
DIETS
GONZALEZ/GERSON REGIMENS
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SPHERE: SUPPORTIVE/ ANTINEOPLASTIC
INGREDIENTS:
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PANCREATIC ENZYMES-(FREEZE-DRIED PORCINE)-MAJOR COMPONENT
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COFFEE ENEMAS
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VITS, MINERALS, TRACE ELEMENTS, AMINO ACIDS & ORGAN EXTRACTS(COW THYMUS)
SPECIAL DIET- 10 BASIC AND 90 VARIATIONS
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2x / DAY – DETOXIFICATION- LIVER- IMPROVE FUNCTION/EMPTY GB
NUTRITIONAL SUPPLEMENTS
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ELIMINATE ABNORMAL CELLS, TOXIC WASTE PRODUCTS & ABNORMAL PROTEINS
BASED ON UNBALANCED METABOLIC PROFILES
MECHANISM: see above
EFFICACY: CONFLICTING
TRIALS: one ongoing
FDA STATUS: PPE – new and under investigation; rest dietary supplement
MILK THISTLE
 SPHERE: ANTINEOPLASTIC
 SOURCE: MILK THISTLE
SILYMARINS-SILYBIN, ISOSILBIN, SILYCHRISTIN, SILYDIANIN
 MECHANISM:ANTIOXIDANT
 CELLULAR MEMBRANE STABILIZER
 STIMULATES DETOXIFICATION PATHWAYS-LIVER
 STIMLATES REGENERATION OF LIVER CELLS
 INHIBITS GROWTH OF SPECIFIC CELL LINE
 CYTOTOXIC TO CERTAIN CANCER LINES,
 INCREASES EFFICACY OF SOME CHEMOTHERAPT AGENTS
 TRIALS: obgoing
 FDA STATUS: DIETARY SUPPLEMENT
PHARMACOLOGICAL
AND BIOLOGICAL
MODALITIES
COENZYME Q 10
 SPHERE: PREVENTIVE 1,2,3/SUPPORTIVE(ADJUNCTIVE)
 SOURCE: Made naturally in the Human Body(Decrs c Age)
 HEART, LIVER, KIDNEY, PANCREAS
 MECHANISM:ANTIOXIDANT
 CELLULAR –AEROBIC-METABOLISM
 IMMUNE STIMULANT
 LOW LEVELS SEEN IN CANCER PATIENTS
 CARDIO-PROTECTIVE (CHEMOTHERAPY-ANTHRACYCLINES)
 EFFICACY: POTENTIAL
 TRIALS; NONE
 FDA STATUS: DIETARY SUPPLEMENT
CARTILAGE (SHARK & BOVINE)
 SPHERE: ANTINEOPLASTIC
 INGREDIENTS:CARTILAGE-SHARK/COW
 MECHANISM:
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DIRECTLY KILLS CELLS
STIMULATES IMMUNE SYSTEM
 Collagens /glycoaminoglycans
 Anti-inflammatory/ immune stimulators – may tumor cell toxic
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BLOCKS ANGIOGENESIS
 Angiogenesis inhibitors - chondrocytes
 No blood vessels in cartilage
 EFFICACY:
 TRIALS: ONGOING – animal and human – oral, topical, enema,
SQ
 FDA STATUS:DIETARY SUPPLEMENT ONLY
AMYGDALIN/LAETRILE
MANDELONITRILE
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SPHERE: ANTINEOPLASTIC
SOURCE:
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MECHANISM: Cancer cell inhibitors
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CYANIDE(cyanogenic glycoside)- CYANIDE POISONING (orally)
PRUNASIN & BENZALDEHYDE
EFFICACY: Animal – very little; human- NONE
HISTORY: Russia – 1840’s; US – 1920’s;
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FRUIT PITS – APRICOTS, PEACHES
LIMA BEANS, CLOVER, SORGHUM
Usage stopped 1970- FDA – Not safe nor effective
1970’s –challenged & legalized in 20 states
1980- US Supreme Court overturned lower courts- Laetril – illegal in US
TRIALS: NONE
FDA STATUS: NOT APPROVED IN US
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Common in other countries - Mexico
ANTINEOPLASTINS-Bruzinski
 SPHERE: ANTINEOPLASTIC
 SOURCE:
 ORIGINAL-HUMAN URINE SYNTHETIC- mixture of amino acids, peptides and derivatives
 MECHANISM:
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Antineoplastins are part of normal “surveillance” system of body
necessary to switch abnormal cells to normal state of differentiation
 Nonimmunological process
 Peptides act as information carriers Antineoplastics are deficient in the cancer patient
 EFFICACY: Specific to the Antineoplastin (many subtypes) and
tumor type
 IV, IM, PR, TOPICAL,INTRAPLEURAL, BLADDER INSTILLATION,
PO,
 TRIALS:
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NO RANDOMIZED TO DATE
NONRANDOMIZED TRIAL AT DEVELOPERS INSTITUTE
 FDA STATUS: NOT APPROVED
BOTANTICALS & CANCER
FOODS AND CANCER
 GREEN /BLACK TEAS
 SOY
 OMEGA 3- FATTY ACIDS
 LYCOPENE
Great clinicial and patient
resources
 http://www.cancer.gov/cancertopics/cam
 http://cam.cancer.gov
 QUESTIONS?