Transcript Evaluation of Complementary and Alternative Therapies

*What Is Complementary
Alternative Medicine?
… medical and health care
practices and products
outside the realm of
Complementary: together with
conventional medicine,
conventional practices ( aroma
which are yet to be validated
therapy for surgery patients)
using scientific methods
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 (exallergy 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 groups
for 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)
* 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
*
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
*
*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
*
*2590 participants 18 years +
*Telephone survey, random sample
Feb 1998 - Dec 1999
*In the preceding week:
*14% of population used herbals
and/or supplements
*16% of prescription drug users
used herbals and/or
supplements
JAMA, 2002
Patterns of Supplement Use:
Ten Most Commonly Used Herbals / Supplements
*Ginseng
*Ginkgo biloba
*Allium sativum
*Glucosamine
*St. John’s wort
*Echinacea
*Lecithin
*Chondroitin
*Creatine
*Serenoa repens
Patterns of Supplement Use
Ten Most Common Reasons for
taking herbs / supplements
*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%)
JAMA, 2002
*
*Safety is assumed, not proven
*Lack of product standardization
*Contamination with drugs,
heavy metals
*Allergic reactions
*Inherent toxicity
*Interactions with drugs
*Replacing proven therapies
*
*
* 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
*
* 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
*
* 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
*
*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
*
* 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
* Depression
* Arthritis
* Kidney problems
* Flu
* Fatigue
* Chronic pain
* Migraines
*
* Paralysis
* Hypertension
* Tendonitis
* Vision problems
* Sexual Dysfunction
* And many others…
* Stimulation of natural
painkilling chemicals such as
endorphins
* Needles block the
transmission of pain impulses
to the CNS
*
* 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
*
*
*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.
*
* Daniel David Palmer
* Healing philosophies
* Spiritualism
* Magnetic therapy
* Background in osteopathic
training
* The body has a powerful selfhealing 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.
*
*
*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
*
* 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
*
*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
*
* 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
*
*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.
*
*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
*
*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
*
* Can use fingers, hands,
palms, knuckles
* Shiatsu- Japanese massagedeep 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)
*
* Increases circulation
* Reduces pain
* Releases stress
* Balance body energy
* Beauty treatments (improves
muscle tone and skin circulation)
*
* Homeopathy is a system of
medicine based on three
principles:
* Like cures like
For example, if the symptoms of
your cold are similar to poisoning
by mercury, then mercury would
be your homeopathic remedy.
* Minimal Dose
The 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 Remedy
No matter how many symptoms
are experienced, only one remedy
is taken, and that remedy will be
aimed at all those symptoms.
*
* 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.
*
* 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.
*
*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.
*
* Remedies are so diluted,
they are rendered useless
for treatment
* Even in dilute cases, some
treatments are made of
toxic chemicals
*
* Treatment of medical
conditions with diet and
nutrition
* Usually based on whole
food diet with
supplements
* Many feel diseases worsen
by an improper diet
*
* 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
*
* Cancer patients
* Obesity
* Diabetes
* Elderly
* Paralysis
* Intestinal diseases