Transcript Complementary and Alternative Medicine

CHAPTER
44
Complementary and
Alternative Medicine
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
44-2
Learning Outcomes
44.1 Explain CAM.
44.2 Distinguish between complementary and
alternative medicine and conventional
medicine.
44.3 Summarize how CAM and conventional
medicine are used together.
44.4 Identify various types of complementary and
alternative medicine.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
44-3
Learning Outcomes (cont.)
44.5 Describe how a medical assistant may use his
or her knowledge of CAM.
44.6 Explain why patients and health-care
practitioners are turning to complementary
treatments.
44.7 Compare insurance and payment for CAM
treatments.
44.8 Explain how CAM is regulated.
44.9 Describe health fraud.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
44-4
Introduction
• More than 30% of adults use
complementary and alternative therapies
– Relieve problems
– Promote wellness
– No relief from traditional treatments
• Some physicians use a combination of
CAM and traditional therapies
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What Is CAM?
• A group of practices and products that are
not part of conventional medicine
• Allopathy – conventional medicine or
common and usual practice
• Complementary medicine – used with
conventional medicine
• Alternative medicine – used instead of
conventional medicine
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What Is CAM? (cont.)
• Scientific evidence concerning safety and
effectiveness
– Available for some CAM therapies
– Research continues, so information changes
• Integrative medicine
– Evolves as CAM therapies are adopted by
conventional medicine
– Combination of both
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Apply Your Knowledge
Define CAM and state why these therapies are
not in wide use by practitioners of conventional
medicine.
ANSWER: CAM is a group of practices and products not
considered part of conventional medicine. They are not widely
used by physicians because there is not a lot of scientific
evidence of their safety and effectiveness.
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Types of CAM
• Shared similarities
– Individualized
treatments, good
nutrition, and
preventive health
practices
– Holistic
– Promote self-care and
self-healing
– Recognition of one’s
spiritual nature
• Categories
– Alternative medical
systems
– Mind-body
interventions
– Biologically-based
therapies
– Manipulative and
body-based methods
– Energy therapies
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Alternative Medical Systems
• Evolved apart from conventional medicine
• Homeopathic medicine
– Treating syndromes and conditions with
remedies that produce similar syndromes and
conditions in healthy people
– Remedy
• Produces the symptoms it is given to treat in order
to stimulate the body’s natural defenses to heal
itself
• Must meet FDA standards
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Alternative Medical Systems (cont.)
• Homeopathic medicine
– Looks at individuals, not diseases
• Initial in-depth assessment
• Follow-up – how they are responding
– Medical assistant role
• Similar to other medical offices
• Have knowledge of common remedies
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Alternative Medical Systems (cont.)
• Naturopathic medicine
– Relies on the healing power of the body to
establish, maintain, and restore health
– Primary health care
•
•
•
•
Nutritional/lifestyle counseling
Dietary supplements/medicinal plants
Exercise
Homeopathy/traditional Chinese medicine
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Alternative Medical Systems (cont.)
• Naturopathic medicine
– Medical assistant – understanding of
treatments
– Traditional Chinese medicine
• Balanced qi (vital energy)
• Flow of qi along meridians (energetic pathways)
• Acupuncture – insertion of hollow needles along
meridians
– Ayurveda – provides guidance regarding
food and lifestyle; India
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Mind-Body Interventions
• Enhance the mind’s capacity to affect
bodily function and symptoms
• Support groups and cognitive-behavioral
therapy now part of traditional medicine
• Scientific support
– Placebo effect – WW II
– 35% of therapeutic response is due to belief
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Mind-Body Interventions (cont.)
• Most commonly used forms
of CAM
• Types
– Prayer
– Yoga
– Meditation
– Hypnosis
– Biofeedback
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Biologically Based Therapies
• Use substances found in nature
– Dietary supplements
– Herbal products
– Foods
• Medical assistant
– Keep up-to-date about dietary and herbal
products
– Be able to provide reliable resources for
patients
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Biologically Based Therapies (cont.)
• Dietary supplements
– Manufacturers – no evidence of effectiveness
or safety
– No standardization to ensure consistency
and quality
– Types
• Vitamins Recommended daily amount established
• Minerals by the FDA
• Herbals – no established recommended daily
amount
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Biologically Based Therapies (cont.)
• Patient education for using supplements
– Report all supplements as they would
prescription medications
– Take supplement bottles to appointments
• Document patient’s use of
supplements in the
medical record
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Manipulative and Body-Based Methods
• Based on the manipulation and/or movement of
one or more parts of the body
• Types
–
–
–
–
–
Massage therapy
Chiropractic manipulation
Reflexology
Alexander technique
Bowen technique
–
–
–
–
–
Craniosacral therapy
Feldenkrais method
Rolfing
Trager bodywork
Tui Na
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Manipulative and Body-Based Methods
(cont.)
• Massage
– Pressure, kneading, stroking, vibration,
and tapping to positively affect health
– Effects
• Relaxation
• Counteracts effects
of stress
• Lowers heart rate and
blood pressure
• Reduces pain/relaxes
muscle spasms
• Improves
concentration
• Promotes restful sleep
• Helps the mind relax
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Manipulative and Body-Based Methods
(cont.)
• Swedish massage
– Stimulates circulation
and lymph flow
– 5 basic strokes
• Seated massage
– Focuses on back and neck
• Neuromuscular
massage
– Releases tension,
relieves pain and
pressure on nerves,
and increases blood
flow
– Trigger point therapy
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Manipulative and Body-Based Methods
(cont.)
• Chiropractic
medicine
– Adjustments
• Manual treatments
to re-align the
vertebra and
restore function of
spinal nerves
• Chiropractor
– Performs an exam
and takes a history
– Tests
• X-rays
• Muscle testing
• Analyzes posture
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Energy Therapies
• Bioelectromagnetic-based therapies
– Balances the electromagnetic fields of the
body
– No scientific evidence of efficacy
– Magnetic therapy
• Most common type
• Magnets are used to correct disturbances of
electromagnetic fields and restore health
• FDA – no medical value but relatively harmless
• Avoid for patients with pacemaker or defibrillator
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Energy Therapies (cont.)
• Biofield therapies
• Manipulate energy field surrounding the
body
• Reiki
• Therapeutic touch
– Based on qi
– Visualization and touch
balance energy flow to
bring healing energy
to organs and glands
– “Laying-on of hands”
– Hands direct human
energies to help or
heal
– No scientific evidence
of efficacy
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Apply Your Knowledge
Match to types of CAM:
A Therapeutic touch
___
ANSWER:
A. Energy therapies
C Chiropractic medicine
___
D Dietary supplements
___
B. Mind-body therapies
B Yoga and meditation
___
D. Biologically-based therapies
E TCM
___
D Herbal supplements
___
E. Alternative medical systems
C. Body-based therapies
E Homeopathy/naturopathy
___
A Magnetic therapy
___
B Hypnosis
___
C Massage
___
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Patients Seeking CAM Therapy
• Use is increasing
– Less expensive
– Have fewer side
effects
– More accessible
– Increase in spirituality
• Reasons for seeking
CAM therapy
– Failure of traditional
medical interventions
– Treat side effects of
conventional
medicine’s treatments
– Personal growth
– Environmentalism
– Preventive health care
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Patients Seeking CAM Therapy (cont.)
• Patients with chronic debilitating
conditions
– Improve quality of life
– Improve ability to cope with stress and illness
• Cultural differences in CAM use
– Hispanics
– Native Americans
• Accept patient’s right to choose CAM
therapy
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Patients Seeking CAM Therapy (cont.)
• Use of CAM in
children on the
increase
– Safety – children
respond differently
– Efficacy in children not
established
– Identify and document
if CAM is used
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Apply Your Knowledge
Mr. State is complaining about chronic back pain. He says
that the medication only helps a little and asks you if there
is anything else you could recommend that will help him.
What should you tell him?
ANSWER: If your employer is not averse to CAM therapies, you
can tell him that there are CAM therapies that may help with the
pain or at least help him cope better with it. He could try mindbody techniques, acupuncture, manipulative and body-based
techniques, or energy therapies.
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Insurance and CAM
• Coverage varies
– Lack of research and documentation of
efficacy
– Emphasis on physiological or biochemical
response to therapies
• Alternative health insurance companies
emerging in response to need
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Insurance and CAM (cont.)
• Medical assistant
– Know whether or not CAM
treatments are covered by
insurance
– Resources
• Insurance companies
• State agency that regulates the insurance industry
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Regulation of CAM Therapies
• National Center for Complementary and
Alternative Medicine (NCCAM)
– Research
– Training and career development
– Conferences and educational programs
– Integration of scientifically proven CAM
therapies into conventional medicine
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Regulation of CAM Therapies (cont.)
• White House Commission on
Complementary and Alternative Medicine
Policy (WHCCAMP)
– Funding for research
– Communication between CAM and
conventional practitioners
– Availability of CAM practitioners
– State review and evaluation of CAM
practitioners
– Insurance coverage options
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Apply Your Knowledge
1. Why do insurance companies not reimburse for most CAM
therapies?
ANSWER: Insurance companies do not reimburse for CAM therapies
because of the lack of research and documentation of effectiveness of
these therapies.
2. What are the federal agencies tasked with
regulation of CAM therapies?
ANSWER: They are the NCCAM and WHCCAMP.
Yippee! 2 for 2!
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Health Fraud
• Articles of unproven effectiveness
promoted to improve health, well-being, or
appearance
– Deception or trickery for profit
– Plays on emotions and desperation
• Regulation
– FDA – safety, manufacturing, and labeling
– FTC – advertising
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Health Fraud (cont.)
• Health claims
–Unproven claims must
include a disclaimer
–FDA-approved claims for food and
supplements
• Based on scientific evidence
• Only reduces risk/does not treat or
cure
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Health Fraud (cont.)
FDA-Approved Health
Claim
Supplement/Food
Reduce risk of some
cancers
• Low-fat diets
• Fruits, vegetables, fiber-containing
grain products
• Whole grains
Reduce risk for
hypertension
• Low-sodium diets
Reduce risk for
osteoporosis
• Calcium
• Potassium
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Health Fraud (cont.)
FDA-Approved
Health Claim
Supplement/Food
Reduce risk of heart
disease
• Low-sodium diets
• Decreased saturated fat and cholesterol
• Soluble fiber and whole grains
• Soy protein/plant sterols/stanol esters
Reduce risk for
neural tube defects
• Adequate folate
Reduce tooth decay
• Decreasing between-meal consumption
of foods high in sugars and starches
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Health Fraud (cont.)
• Recognizing health fraud
– Check with the BBB or attorney general’s
office
– Check with appropriate health-care group
– Contact the FDA
– If it sounds to good to be true, it probably is
not true
– If unproven, get a second opinion
– Beware of “secret cures”
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Apply Your Knowledge
Why do people fall victim to fraudulent health
claims?
ANSWER: These claims target people who are emotional and
desperate. They are hoping to find a cure, improve their health, or
just look better.
Bravo!
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In Summary
44.1 Complementary and alternative medicines are
practices and products outside the scope of traditional
or conventional medicine.
44.2 Complementary medicine is used in conjunction with
conventional medicine. Alternative medicine is
typically used as a replacement for conventional
medicine.
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In Summary (cont.)
44.3 A new type of medicine called integrative medicine
has emerged, in which conventional medicine and
scientifically proven CAM therapies are used
together.
44.4 There are five classifications for CAM. They include
alternative medical systems, mind-body interventions,
biologically-based therapies, manipulative and bodybased methods, and energy. Each of these
classifications has various types of products and
therapies associated with it.
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In Summary (cont.)
44.5 As a medical assistant, it is your responsibility to have
basic knowledge of CAM therapies. If you work with a
practitioner that provides CAM therapies, you will be
responsible to assist in many cases. Additionally,
understanding insurance reimbursement for CAM and
health fraud are important aspects of the medical
assistant’s role.
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44-43
In Summary (cont.)
44.6 In many cases, patients are looking for low-cost
products and services that help to maintain health
and prevent disease, so they turn to CAM. Other
patients that are offered no effective treatment or cure
from conventional medicine are turning to CAM for
additional options. Health-care practitioners are using
many types of complementary therapy as they
become accepted and, in many cases, scientifically
proven.
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44-44
In Summary (cont.)
44.7 In general, the insurance industry provides little or no
coverage for CAM therapies. To find out if coverage is
provided, you can contact the insurance company
directly, obtain information from the association’s web
site for the type of therapy provided, or contact the
state insurance commissioner.
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44-45
In Summary (cont.)
44.8 The NCCAM conducts and supports CAM research
and provides CAM information to health-care
providers and the public. Some state and federal laws
have been enacted to help regulate CAM, and more
laws and regulations are expected as research is
conducted.
44.9 Health fraud as defined by the FDA as “articles of
unproven effectiveness that are promoted to improve
health, well being, or appearance.” Health fraud is
monitored by the FDA and the FTC.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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End of Chapter 44
There is a magnet in your heart
that will attract true friends.
That magnet is unselfishness,
thinking of others first; when
you learn to live for others, they
will live for you.
~ Paramahansa Yogananda
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.