Transcript Complementary and Alternative Medicine.

Bioethics
&
Complementary and Alternative
Medicine
by
Vidal Redulla, M.D.
Fellow, Philippine Pediatric Society
Chairman, Committee on Bioethics
Chairman, Bioethics Subcommittee on Organ Donation
Cebu Doctors’ University Hospital
OBJECTIVES:
1. To define complementary and alternative
treatment.
2. To state and describe the four categories of
CAM.
3. To discuss briefly the common alternative forms
of treatment in the Philippine context.
4. To state the common reasons why people avail
of alternative forms of treatment.
5. To discuss the bioethical implications of CAM.
INTRODUCTION
As physicians, we are obligated to have a
strong commitment:
 To pursue truth in our practice
 To seek the best interest and
welfare of our patients
 To be just in dealing with them
“If you hold on to my teaching, you
are really my disciples. Then you
will know the truth and the truth will
set you free.”
Jesus Christ
John 8:31,32
Rigorous Study and Training
• to understand the human body and how it
works, how the different organ systems
interact with each other
- to sustain a healthy life
- promote growth
- healing of disease
- repair of injuries
Medical Study and Training
• how to apply rational, scientific
knowledge and skills to treat
diseases whether by biochemical
agents, by surgery, and other
procedures that have benefited
countless patients
•
• how pharmacologic agents affect
the body, promote health, control
symptoms, and cure certain
diseases
Medical science
• research and experiment new approaches,
new modalities for diagnosis and treatment
• discover new, effective and safer ways to
practice medicine
• discard obsolete methods of treatment
Conventional Medicine
- standards of care are generally based on what
has been shown to work, or when sufficient data
is not yet available, what we as a profession
agree is likely to work.
- many written resources are available.
Evidence-Based Medicine
Complementary and Alternative Medicine
(CAM)
Do we have a working knowledge about
complementary and alternative medicine?
What answers can we give to patients who ask
about it?
What are the bioethical considerations with
regards to the practice of alternative medicine?
What should our attitude be towards alternative
medicine?
Complementary and Alternative Medicine
“a group of diverse medical and health care
systems, practices and products that are not
presently considered to be part of conventional
medicine.”
• National Center for Complementary and Alternative Medicine
(NCCCAM)
Complementary
- means the therapy is used together with
conventional medicine
Alternative
- means it is used in place of conventional
medicine
Both include therapies with a historical or cultural,
rather than a scientific, basis.
The Four Categories of CAM:
1.
2.
3.
4.
Biologically-based products
Energy therapies
Manipulative and Body-based methods
Mind – Body medicine
1. Biologically-based products
2. Energy Therapies
a. Verifiable energy – measurable like sound,
electromagnetic, light, radiation
b. Putative energy – non-measurable, used to
effect changes in the physical body and
influence health eg. Acupuncture
Reflexology
3. Manipulative & Body-Based Methods
- involves the manipulation of body parts
eg. Hilot or massage therapy
Chiropractic
Reflexology
4. Mind – Body Medicine
• 4. -MIND
– involves
BODY MEDICINE
method
focusing on “interactions”
among the brain, mind, body and behavior,
and the powerful ways in which mental,
emotional, social, spiritual and behavioral
factors can directly affect health.
Relaxation, Meditation, Hypnosis, Visual
imagery, Yoga, Biofeedback, Tai chi, Cognitive
behavioral therapies, Group support, and
Spirituality (faith healing)
Forms of CAM in the Philippines
1.
2.
3.
4.
5.
6.
7.
8.
9.
Herbal Therapy (Category 1)
Hilots/Arbularyos (Category 1,and 3)
Faith Healing
(Category 4)
Reflexology
(Category 2,3)
Acupuncture
(Category 2)
Naturopathy
(Category 1,2,3,4)
Chiropractic
(Category 3)
Ayurveda
(Category 4)
Iridology (Iridodiagnosis)
1. Herbal Therapy (Category 1)
• a traditional practice based on the use of
plants and plant extracts.
• also known as botanical medicine, herbal
medicine and phytotherapy.
• include fungal and bee products, as well as
minerals, shells and certain animal parts
• Plants are good sources not only of proteins,
carbohydrates, mineral, and vitamins but they
also synthesize substances that are useful to
the maintenance of health in humans and
other animals.
• Many of the herbs and spices used by humans
to season food yield useful medicinal
compounds.
Herbal Medicinal Plants
• lagundi (fever, asthma, headache, toothache, cough and as
wound wash and aromatic bath)
• sambong (gaseous distention, fever, headache, abscess and
as diuretic and aromatic bath)
• akapulko (wound wash and for itch)
• yerba buena (for cough, toothache, headache, dizziness,
fainting, hysteria, gaseous distention, arthritis and as
mouthwash)
•
•
•
•
•
•
tsaang gubat (anti-mutility)
bawang (garlic) (anti-cholesterol)
bayabas (for oral or skin antiseptic)
niyog-niyugan (anti-helminthic)
kulasimang bato (anti-pyreruricemia)
ampalaya (non-insulin dependent diabetes)
Is Mangagaw herb effective for Dengue?
2. Hilots/Mananambal (Category 1,and 3)
• the “general practitioners” among the folkloric
medicine men in the Philippines.
• Folkloric “diagnostic” terms: pi-ang, panuhot,
nabughat, napasmo, gisubaw, gikabuhi,
gibuyagan, gidaotan
• Most of the practitioners are either uneducated
or of low-educational background
Hilots/Mananambal (Category 1,and 3)
• Their armamentarium of “therapy” are ancient
and traditional with adopted ingredients of
western medicine.
• Local varieties of practitioners:
- tambalan, manghihilot
- totho-totho, tandok, bolo-bolo
• Main practice is in the rural areas.
3. Faith Healing (Category 4)
• religion and indigenous and tribal spiritualities
influence its healing modalities
• practice includes:
- prayers, incantations, massage, herbs; some
include "new-age" ingredients of magnets,
crystals, and prannic healing
• The most controversial is the so-called “psychic
bare-handed surgery.”
4. Reflexology (Category 2,3)
• massaging or applying pressure to parts of the
feet, or sometimes the hands and ears, with the
goal of encouraging a beneficial effect on other
parts of the body, or to improve general health.
• no consensus among practitioners on how
reflexology works but they hypothesize that the
blockage of an energy field, the invisible life force,
or Qi, can prevent healing.
• There is valid concern that treating
potentially serious illnesses with
reflexology, which has no proven
efficacy, could delay the seeking of
appropriate medical treatment.
5. Acupuncture (Category 2)
• The procedure of inserting and manipulating
filiform needles into various points of the body
to relieve pain or for therapeutic purposes.
• Acupuncture points are situated on meridians
along which Qi (“life energy”) flows
• No evidence to support their existence
• Not reconciled with contemporary knowledge
about biology, physics or chemistry
Acupuncture
Acupuncture Meridians and Points
The American Academy of Medical Acupuncture
(2004) states: "In the United States, acupuncture
has its greatest success and acceptance in the
treatment of musculoskeletal pain."
“…definitive conclusions based on research
findings are rare because the state of
acupuncture research is poor but improving."
Braverman S (2004). “Medical Acupuncture Review, Safety,
Efficacy, And Treatment Practices”. Medical Acupuncture 15 (3).
http:/www.medicalacupuncture.org/aama-marf/journal/vol153/article1.html.
“A review for the American Pain Society / American
College of Physicians found fair evidence that
acupuncture is effective for chronic low back
pain.”
Chou R, Huffman LH (2007). "Non-pharmacologic therapies for
acute and chronic low back pain: a review of the evidence for an
American Pain Society/American College of Physicians clinical
practice guideline". Ann Intern Med. 147 (7): 492–504
• Some scholarly reviews have concluded that the
effectiveness of acupuncture as a treatment can
be explained largely through the placebo effect.
• There is general agreement that acupuncture is
safe when administered by well-trained
practitioners using sterile needles and that
further research is appropriate.
6. Naturopathy (Category 1,2,3,4)
• focuses on naturally-occurring and minimallyinvasive methods, trusting the "healing power
of nature.
• "synthetic" drugs, radiation, and major surgery
are avoided
• rejection of biomedicine and modern science
in favor of the “healing power” of the body and
nature.
• Prevention of illness through stress reduction
and a healthy diet and healthy lifestyle is
emphasized.
•
• Naturopaths do not necessarily recommend
vaccines, antibiotics, and surgery
• may even provide inappropriate alternative
remedies even in cases where evidence-based
medicine has been shown effective.
• The effectiveness of naturopathy as a whole
system has not been systematically evaluated.
Methods of Naturopathic Practice:
• Acupuncture, Applied kinesiology, Herbal
medicine
• Chelation therapy for atherosclerosis, Colonic
enemas, Color therapy, Osteopathy, Hair
analysis, Homeopathy, Iridology, Live blood
analysis
• Exposure to natural elements such as sunshine,
fresh air, heat, or cold
Methods of Naturopathic Practice:
• Vegetarian and whole food diet, fasting, and
abstention from alcohol and sugar
• Physical medicine: osseous, and soft tissue
manipulative therapy, sports medicine, exercise
and hydrotherapy
• Stress management: meditation, relaxation
• Reflexology, Rolfing, and Traditional Chinese
medicine
• A 2004 survey showed the most commonly
prescribed naturopathic therapeutics in
Washington State and Connecticut:
- botanical medicines
- vitamins
- minerals
- homeopathy
- allergy treatments
7. Chiropractic (Category 3)
• emphasizes diagnosis, treatment and prevention
of mechanical disorders of the musculo-skeletal
system, especially the spine, under the
hypothesis that these disorders affect general
health via the nervous system..
• assumes that a vertebral subluxation or spinal
joint dysfunction interferes with the body's
function and its innate intelligence
• The efficacy and costeffectiveness of maintenance
chiropractic care are unknown.
• Spinal manipulation can have
serious complications in rare
cases.
• Chiropractic care is generally
safe when employed skillfully
and appropriately.
8. Ayurveda (Category 4)
• stresses a balance of three Humors or Energies:
wind/air, bile and phlegm
• when these three energies are in a balanced
state, the body is healthy, and when imbalanced,
the body has diseases
• focuses on exercise, yoga, meditation, and
massage
• body, mind, and spirit/consciousness need to be
addressed both individually and in unison for
health to ensue
9. Iridology (Iridodiagnosis)
• Technique whose proponents believe that
patterns, colors, and other characteristics of
the iris can be examined to determine
information about a patient's systemic health.
• Practitioners match their observations to iris
charts which divide the iris into zones
corresponding to specific parts of the human
body.
• Iris charts are used to distinguish between healthy
systems and organs in the body and those which
are overactive, inflamed, or distressed.
• This information indicates a patient's susceptibility
towards certain illnesses, to reflect past medical
problems, or to predict later consequences of
health problems which may be developing.
• Iridology is not a method of treatment
but a diagnostic tool.
• Its practitioners often engage in other
forms of alternative medicine, such as
naturopathy.
Why Do People Avail of CAM?
1. non-availability of conventional treatment either
due to location, kind of illness or terminal
condition
2. the “high cost” of conventional treatment
3. it is empowering especially its self-care aspect
such as diets, supplements and efforts at
prevention and health promotion
4. the potential for placebo effects
Methodology of Christian Moral Reasoning
Problem
Facts
Divine & Human
laws
Principles
Convictions
Rules
Judgment and Possible Actions
Laws
- divine commands for right conduct in human
relationships
• Law on honoring one’s parents (#5)
• Law against murder (#6)
• Law against adultery (#7)
• Law against stealing (#8)
• Law against false testimony (#9)
• Law against covetousness (#10)
Principles
• general and fundamental moral foundation
for the decision-maker.
• fundamental truths upon which others are
based
Convictions
- strongly held personal ethical beliefs borne
out of years of nurturing within family,
socio-cultural, educational and religious
backgrounds.
Rules
- certain actions ought to be done because
they are right or ought not to be done
because they are wrong
- an authoritative regulation for action and
conduct
Judgment
- a decision, verdict or conclusion about a
particular action
Reject or Accept CAM?
• Some scientists reject the use of the classification
of any therapy as “alternative medicine” other than
that which has been tested, proven and effective.
The Questions.
• Does the CAM practitioner really know the patient’s
condition?
• What is the basis for a patient’s belief in the
treatment?
• Is it founded on reasonable and logical basis?
• Are the claims of CAM truthful?
• Is the patient given truthful information before he
consents to the treatment?
• Is the patient informed of the risk and benefits, the
available conventional treatment for his condition?
• Are CAM practitioners legally accountable in case
the patient gets worse or dies during treatment?
Do people avail of CAM?
“A British telephone survey by the BBC of
1209 adults in 1998 shows that around 20%
of adults in Britain had used alternative
medicine in the past 12 months.”
Thomas KJ, Nicholl JP, Coleman P (March 2001). "Use and
expenditure on complementary medicine in England: a
population based survey". Complementary Therapies in Medicine
9 (1): 2–11.
Where Do Sick People Go?
Fraser Institute 1999
NEITHER
6%
14%
35%
DOCTOR ONLY
DOCTOR PLUS
ALT. MED
45%
45%
ALT. MED. ONLY
FRASER INSTITUTE, 1999
…Facts
A 1998 systematic review of studies assessing
its prevalence in 13 countries concluded that
about 31% of cancer patients use some form
of complementary and alternative medicine.
Ernst, E; Cassileth, BR (1998). "The prevalence of
complementary and alternative medicine in cancer: a
systematic review". Cancer 83 (4): 777–82.
The Question: How many of them survived?
What was the survival rate?
Naturopathy
#1 First, do no harm; provide the most effective
health care available with the least risk to
patients at all times.
#6 Promote well-being and to prevent diseases.
Yet it does not recommend immunization or
antibiotics or surgery even when they are
indicated.
…Facts
• In 1998, the U.S. Federal Trade Commission
found that "scientific studies do not prove that
EDTA chelation therapy is an effective
treatment for atherosclerosis.", and that the
statements by the ACAM were false. In 1999,
the ACAM agreed to stop misrepresenting
chelation therapy as effective in treating heart
disease, avoiding legal proceedings.
Psychic Surgery
"After study of the literature and other available
information, the American Cancer Society has
found no evidence that "psychic surgery" results
in objective benefit in the treatment of any
medical condition. Lacking such evidence, the
American Cancer Society strongly urges
individuals who are ill not to seek treatment by
psychic surgeon."
Psychic surgery. CA: a Cancer Journal for Clinicians
1990 May/June;40(3):184-188.
…Facts
On Iridology::
“The resulting frequency of false-positive and
false-negative diagnosis was not significantly
different from that expected from chance.”
Archives of Ophthalmology
Jan 2000
“Iridology fits into a category of disproved
alternative health care practices. These
practices have no basis in real anatomy and
physiology and have failed well-done trials
and studies. Practices that fall into this
category include applied kinesiology,
reflexology, therapeutic touch, homeopathy…”
Joshua David Mather Sr.,
Former Irirdology and Naturopathy Practitioner
[email protected]
“…many practitioners advise herbs without any
training of any kind in the science of
pharmacology… Few herb studies even exist to
indicate interactions in the delicate systems of
the kidneys and liver.”
Joshua David Mather Sr.,
Former Irirdology and Naturopathy Practitioner
[email protected]
CAM Practices accepted by
Conventional Medicine:
Plant extracts or components proven useful and effective
Use of verifiable energy: heat, sound, light
Massage therapy, Exercise, Group Support
Cognitive Behavioral therapy
Use of probiotics in diarrhea asso. with antibiotic Rx
Acupuncture for chronic low back pain
Healthy Diet and Healthy Lifestyle
Allowing the healing power of nature
Relaxation and avoidance of stress
Judicious use of supplemental vitamins and minerals
Prayer for the sick
DRUGS DERIVED FROM PLANTS
Atropine
Benzyl Benzoate
Caffeine
Codeine
Colchicine
Digoxin, digitoxin
Ephedrine
Methyl salicylate
(oil of wintergreen)
Morphine
Papaine
Quinidine
Quinine
Reserpine
Taxol
Theobromine
Theophylline
Thymol
Vinblastine
Vincristine
anticholinergic
antihelmitic
CNS stimulant
analgesic, antitussive
anti-gout
cardiotonic
antihistamine
rubefacient
atropa belladonna
areca Catechu
camellia seninsis
papaver somniferum
colchicum autumnale
digitalis purpurea
ephedra sinica
gauthelia procumbens
analgesic
proteolytic, mucolytic
anti-arrhythmic
anit-malarial
antihypertensive
antitumor
Diuretic, vasodilator
diuretic, vasodilator
antifungal
antitumor, antileukemic
antitumor, antileukemic
papaver somniferum
carica papaya
cinchona ledgeriana
cinchona ledgeriana
rauvolfia serpertina
taxus brevifolia
theobroma cacao
theobroma cacao
thymus vulgaris
catharanthus roseus
catharanthus roseus
…Facts
• “If scientific investigation establishes the safety
and effectiveness of an alternative medical
practice, it will therefore become widely adopted
by conventional practitioners.”
Angell M, Kassirer JP (September 1998). “Alternative medicine —
the risk of untested and unregulated remedies". The New England
Journal of Medicine 339 (12): 839–41.
…Facts
• The claims made by alternative medicine
practitioners are generally not accepted by the
medical community because evidence-based
assessment of safety and efficacy is either not
available or has not been performed for many
of these practices.
…Facts
• Conventional treatments are subjected to testing
for undesired side-effects, whereas alternative
treatments generally are not subjected to such
testing at all.
• Manufacturers of alternative medicine do not
have to prove that their product works, but they
must ensure that their product is not harmful.
Principles
• The God who created us designed our
• Based
on the
principle
autonomy,
consumers
intricate
bodies
to of
withstand
the
rigors
have the right to use alternative medicine
of our earthly life and overcome most
therapies, but they also have the duty not to
of our
health problems
throughand
built-in
harm
themselves
(non-maleficence)
the
mechanisms
of our(truth-telling)
immune systems
right
to be fully informed
of the
and healing
treatment
by CAM practitioners.
Principles
• To ensure their safety, alternative medicine
therapies must be evaluated in regards to
safety and efficacy. (Stewardship and
accountability, Justice, Beneficence and
Non-maleficence)
Rule: An Ethical Practitioner
• exert best effort to make a correct diagnosis of
the patient’s condition (Stewardship)
• inform the patient of his condition, explaining
adequately the recommended diagnostic and
therapeutic procedures (Truth-telling,
Informed consent)
• recommend treatment that benefits the patient
and avoids harming the patient (Beneficence,
Non-maleficence)
• does not recommend a diagnostic or
therapeutic procedure or product that the
patient does not need (Justice)
Rule
For a competent patient to submit to a diagnostic
procedure or treatment he must be adequately
informed about his condition, the procedure or
treatment being offered to him, the risks and
benefits and other possible options. The absence
of these elements violates his right to be told the
truth, informed consent, autonomy and the
principle of justice.
“Techniques currently labeled "alternative" should be
reclassified as "genuine, experimental, or questionable.
Genuine alternatives are comparable methods that
have met science-based criteria for safety and
effectiveness. Experimental alternatives are unproven
but have a plausible rationale and are undergoing
responsible investigation. ... Questionable alternatives
are groundless and lack a scientifically plausible
rationale. ... Blurring these distinctions enables
promoters of quackery to argue that because some
practices labeled "alternative" have merit, the rest
deserve equal consideration and respect. Enough is
known, however, to conclude that most questionable
"alternatives" are worthless.”
Stephen Barret, M.D., Retired Psychiatrist
Board Member of National Council Against
Health Fraud
Judgment / Action
• Reject and not recommend those forms of CAM
practices which are disproven, irrational or
implausible.
• Wait for reliable reviews of forms of CAM
treatment undergoing impartial testing before
considering.
• Accept, avail or utilize those practices of certain
forms of CAM treatment that have been proven
scientifically valid or has a rational basis.
“Those who have experienced or perceived
success with one alternative therapy for a
minor ailment may be convinced of its efficacy
and persuaded to extrapolate that success to
some other alternative therapy for a more
serious, possibly life-threatening illness. For
this reason, critics argue that therapies that
rely on the placebo effect to define success
are very dangerous.”
“New England Journal of Medicine – Drug Related
Hepatotoxicity”. Content.nejm.org. 2006-05-18.
Have a Nice Day!
Forms of CAM in the Philippines
1.
2.
3.
4.
5.
6.
7.
8.
9.
Herbal Therapy (Category 1)
Hilots/Arbularyos (Category 1,and 3)
Faith Healing
(Category 4)
Reflexology
(Category 2,3)
Acupuncture
(Category 2)
Naturopathy
(Category 1,2,3,4)
Chiropractic
(Category 3)
Ayurveda
(Category 4)
Iridology (Iridodiagnosis)
• Biofeedback is commonly used within the Physical
Medicine & Rehabilitation community, but is considered
alternative within the medical community as a whole, and
some herbal therapies are mainstream in Europe, but
are alternative in the United States.[26]
• CAM must develop and defend a rational and
coherent method for assessing causality and
efficacy, though not necessarily one based on
the results of controlled clinical trials."[37]
• Angell and Kassirer acknowledge that
"many treatments used in conventional
medicine have not been rigorously tested,
either" but say that the scientific
community is generally aware that this is a
failing that needs to be remedied."[10]
• In Africa, traditional medicine is used for
80% of primary health care, and in
developing nations as a whole over one
third of the population lack access to
essential medicines.[56]
• Vigorous opposition to CAM as "pseudo
science" based on "absurd beliefs" continues to
be voiced. CAM's deviation from basic scientific
principles, implicit, for example, in homeopathy
and therapeutic touch, are decried. A 1997 letter
to the US Senate Subcommittee on Public
Health and Safety signed by four Nobel
Laureates and other prominent scientists
deplored the lack of critical thinking and scientific
rigor in OAM-supported research."[29]
Facts
“More than 1/3 of American adults reported using
some form of CAM and that visits to CAM
providers exceed those to primary care
physicians.”
Book: “Complementary and Alternative Medicine.”
by the Institute of Medicine, 2005
Biofeedback
Biofeedback
A machine measures the activity of brain waves,
blood pressure, heart rate, skin temp, sweat
gland activity and muscle tension, conveying the
information to the patient in real-time. The
patient becomes aware of the changes in these
bodily activities which then allows him the
possibility of conscious control of those
functions.
Nugabed Thermal Massage
“slowly stretches and
aligns the spinal vertebrae
and hips to release
blockages in your
meridians caused by
stress, aging, calcification,
injury, and disease. The
massage may increase
your body's recuperative,
strengthening, and
detoxifying powers making
it possible for your body to
respond naturally and heal
itself.”
Nugabed Thermal Massage
• As you lie down and relax, helium heated jade
rollers slowly massage your back and neck,
loosening tense muscles. Your body is soothed
and bathed in beneficial far-infrared rays... the
Light of Life. You'll enter a deep state of
relaxation... stress, tension, aches and pains
melt away.
Wheatgrass
• young Agropyron plants, closely related to
wheat, but look like a typical lawn grass in its
early stages. Wheatgrass is most well known
for its health benefits, and is often crushed
into a juice for regular consumption.
Alleged Benefits from Wheatgrass
• high in a number of amino acids, enzymes, vitamins,
minerals, chlorophyll, fiber
• prevents heart disease by lowering blood cholesterol
• prevents diabetes by lowering blood sugar
• prevents cancer, relieves arthritis
• helps digestion, alleviates constipation
• cures hair loss
• filters heavy metal from the blood - natural detoxifier
• boosts energy, sex drive and the immune system
- very few reliable, scientific studies
Noni Fruit Juice
•
•
•
•
Morinda citrifolia, Tahitian noni, cheese fruit
has vitamin C at 33.6 mg per 100 g of juice
micronutrient content similar to a raw orange
a 100 g sample of the fruit powder contains 71%
carbohydrate and 36% fiber. The sample also
contained 5.2% protein and 1.2% fat
• explored unsuccessfully by medical researchers
for possible use in treating cancer.[8]
McClatchey, Will (2002). “From Polynesian Healers to Health
Food Stores: Changing Perspectives of Morinda citrifolia(Rubiaceae)
(PDF). Integrative Cancer Therapies 1 (2): 110–120
Noni Fruit
What are Oligosaccharides?
• are carbohydrates with 3-10 simple sugars
linked together, naturally found in small amounts
in many plants. Plants with large amounts of
oligosaccharides: chicory root, from which most
commercial inulin is extracted, and so-called
Jerusalem artichokes (the root of a member of
the sunflower family). They are also found in
onions, garlic, legumes, wheat, asparagus,
“singkamas”, and other plant foods.
Prebiotics
• The bacteria that feed on fermentable
carbohydrate produce many beneficial
substances, including short-chain fatty acids
(SCFAs) and certain B-vitamins. Additionally,
there is some evidence that they may promote
further absorption of some minerals that have
escaped the small intestine, including calcium
and magnesium.
Acupuncture
• The World Health Organization published a
review of controlled trials using acupuncture and
concluded it was effective for the treatment of 28
conditions and there was evidence to suggest it
may be effective for several dozen more, though
this review has been criticized by several
scientists for bias and a focus on studies with a
poor methodology.
• For acute low back pain there is insufficient
evidence to recommend for or against either
acupuncture, though for chronic low back pain
acupuncture is no more effective than
conventional and alternative treatments for
short-term pain relief and improving function.
However, when combined with other
conventional therapies, the combination is
slightly better than conventional therapy alone.[
Furlan AD, van Tulder MW, Cherkin DC (2005).
“Acupuncture for low back pain”
Manheimer E, White A, Berman B, Forys K, Ernst E
(2005). “Meta-analysis: acupuncture for low back pain”
(PDF). Ann. Intern. Med. 142 (8): 651–63.
What is Chelation Therapy
• Chelation therapy is the administration of
chelating agents to remove heavy metals from
the body. For the most common forms of heavy
metal intoxication—those involving lead, arsenic
or mercury—the standard of care in the United
States dictates the use of dimercaptosuccinic
acid(DMSA).
Chelation Therapy
• In 1998, the U.S. Federal Trade Commission
found that "scientific studies do not prove that
EDTA chelation therapy is an effective treatment
for atherosclerosis.", and that the statements by
the ACAM were false. In 1999, the ACAM
agreed to stop misrepresenting chelation
therapy as effective in treating heart disease,
avoiding legal proceedings.
: On treating an earache:
2000 BC – Here eat this root.
1000 AD – That root is heathen. Here, say this prayer.
1850 AD – That prayer is superstition. Here, drink this potion.
1940 AD – That potion is snake oil. Here, take this pill.
1985 AD – That pill is ineffective. Here, take this antibiotic.
2000 AD – That antibiotic is unnecessary. Here, eat this root.
A Short History of Medicine
(Author Unknown)
Psychic Surgery
"The National Council Against Health Fraud warns
consumers that psychic surgery (1) wastes
money - often in substantial amounts; (2) causes
psychological harm; (3) may cause needless
death by keeping people from timely, effective
health care; and (4) may result in needless,
avoidable suffering or discomfort by denying
patients good quality medical management of
terminal diseases.“
Psychic surgery. CA: a Cancer Journal for Clinicians
1990 May/June;40(3):184-188.
Psychic Surgery
“None of the psychic surgeons in the Philippines
"had any formal medical training and most have
not been educated beyond primary school.”
Azuma N, Stevenson I. "Psychic surgery" in the
Philippines as a form of group hypnosis.
American Journal of Clinical Hypnosis 1988
July;31(1):61-67.
Psychic Surgery
"Tissue allegedly removed from patients during
the surgery is usually disposed of quickly by
healers and their assistant. Analysis of tissue
samples has yielded specimens from chickens,
pigs, dogs, and other animals.“
Psychic surgery. CA: a Cancer Journal for Clinicians
1990 May/June;40(3):184-188.
Colon Cleansing
"There is absolutely no science to this
whatsoever. There is no such thing as
getting rid of quote-unquote 'toxins.' The
colon was made to carry stool. This is
total baloney."
Bennett Roth, M.D.
Gastroenterologist
University of California
Comfrey
• The herb contains allantoin, a cell proliferant that
speeds up the natural replacement of body cells.
It was used to treat a wide variety of ailments
ranging from bronchial problems, broken bones,
sprains, arthritis, gastric and varicose ulcers,
severe burns, acne and other skin conditions. It
was reputed to have bone and teeth building
properties in children, and have value in treating
"many female disorders". In past times comfrey
baths were popular to repair the hymen and thus
"restore virginity”."
Comfrey
Internal usage of comfrey should be avoided
because it contains hepatotoxic pyrrolizidine
alkaloids (PAs). Use of comfrey can, because of
these PAs, lead to veno-occlusive disease which
in turn, can lead to liver failure, and comfrey,
taken in extreme amounts, has been implicated
in at least one death. In 2001, the United States
Food and Drug Administration issued a warning
against internal usage of herbal products
containing comfrey.
Benefits of Malunggay
• Malunggay leaves helps strengthen the immune system, restores
skin condition, controls blood pressure, relieves headaches and
migraines.
• Malunggay tea can help strengthen the eye muscles, heal
inflammation of the joints and tendons, prevent intestinal worms,
used to treat fever and asthma.
• Malunggay can help increase semen count, normalize blood sugar
level therefore preventing diabetes, has anti-cancer compounds
(phytochemicals) that help stop the growth of cancer cells, helps
relax and promotes good night sleep.
• Malunggay help heals ulcers.
• Malunggay is high in calcium (4X the calcium in milk), therefore
lactating mothers are advised to consume malunggay leaves to
produce more milk for their babies. Malunggay contains three times
the potassium in bananas.
• Malunggay leaves contain four times the vitamin A in carrots and
two times the protein in milk. .
• An ounce of malunggay has the same Vitamin C content as seven
oranges.
Naturopath Advertisement
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Applied Kinesiology
• a chiropractic diagnostic method using manual
muscle-strength testing for medical diagnosis
and a subsequent determination of prescribed
therapy. According to followers of the theory, it
gives feedback on the functional status of the
body.
Applied Kinesiology
A double-blind study was conducted by the
ALTA Foundation for Sports Medicine Research
in Santa Monica, California and published in the
June 1988 Journal of the American Dietetic
Association. The study used 3 experienced AK
practitioners and concluded that, "The results of
this study indicated that the use of Applied
Kinesiology to evaluate nutrient status is no
more useful than random guessing."[
Kenney JJ, Clemens R, Forsythe KD (June 1988).
"Applied kinesiology unreliable for assessing nutrient
status". J Am Diet Assoc 88 (6): 698–704.
Homeopathy
• a form of alternative medicine, first proposed by
German physician Samuel Hahnemann in 1796,
that attempts to treat patients with heavily diluted
preparations which are claimed to cause effects
similar to the symptoms presented.
Homeopathic remedies are prepared by serial
dilution with shaking by forceful striking
("succussion") after each dilution under the
assumption that this increases the effect of the
treatment. Dilution often continues until none of
the original substance remains.
Homeopathy
• Claims of homeopathy's efficacy beyond the
placebo effect are unsupported by the collective
weight of scientific and clinical evidence. While
some studies have positive results, systematic
reviews of all the published trials fail to
conclusively demonstrate efficacy. Higher quality
trials tend to report less positive results.
AMA Council on Scientific Affairs (1997), “Alternative Medicine:
Report 12 of the Council on Scientific Affairs (A-97, American
Medical Association
Linde K, Clausius N, Ramirez G et al. (1997), "Are the clinical
effects of homeopathy placebo effects? A meta-analysis of placebocontrolled trials", Lancet 350 (9081): 834–43,
Ampalaya
• Health Secretary Francisco Duque has issued a
circular reinstating ampalaya as a scientifically
validated herbal medicinal plant that can lower
elevated blood sugar levels.
• recent clinical evidence on the efficacy of
ampalaya in capsule or tea form as a useful
dietary adjunct in the treatment of Type 2 (noninsulin dependent) diabetes.
• DOH cited a 10-year study that showed
ampalaya can effectively regulate blood sugar in
the same way as a regular anti-diabetes drug.
Ampalaya
“contains polypeptide-P, a plant insulin that can
lower elevated blood sugar level; rich in iron,
calcium, and Beta-carotene; some vitamin B, C,
and phosphorous.”
“also used as an emetic, laxative, aphrodisiac
and even as abortifacient.”
Ricardo Fernando, M.D.
Chief, Section of Endocrinology
St. Luke’s Medical Center
Mangosteen
• Contains xanthones which have anti-cancer,
anti-inflammatory, antimicrobial, antifungal, and
antiseptic properties in test tube studies.
• There are no clinical trials showing that oral
mangosteen extracts have any benefit in
humans. What happens in a test tube may not
occur when mangosteen is taken orally.
• “Research indicates that xanthones may
interfere with normal blood-clotting.”
Jiang DJ et al. "Pharmacological effects of xanthones as
cardiovascular protective agents." Cardiovascular Drug
Reviews. 22.2 (2004):91-102.
Cognitive Behavioral Therapy
• a psychotherapeutic approach that aims to solve
problems concerning dysfunctional emotions,
behaviors and cognitions through a goal-oriented,
systematic procedure.
• effective for the treatment of a variety of
problems, including mood, anxiety, personality,
eating, substance abuse, and psychotic disorders
Rolfing (Category 3)
• Ida Pauline Rolf theorized that 'bound up' fascia
often restricts opposing muscles from
functioning in concert with one another, much in
the way water, having crystallized, forms hard,
unyielding ice.
• the aim was to separate bound up fascia by
deeply separating the fibers manually to loosen
them and allow effective movement patterns. An
adequate knowledge of living human anatomy
and hands-on training were required in order to
safely negotiate the appropriate manipulations
and depths necessary to free the bound-up
fascia.
Live Blood Analysis
• the use of high-resolution dark field microscopy
to observe live blood cells in vitro. It is promoted
by some alternative medicine practitioners, who
assert that it can diagnose a range of diseases.
Live Blood Analysis
• Proponents believe that LBA provides
information "about the state of the immune
system, possible vitamin deficiencies, amount of
toxicity, pH and mineral imbalance, areas of
concern and weaknesses, fungus and yeast."
Some even claim it can "spot cancer and other
degenerative immune system diseases up to two
years before they would otherwise be
detectable" or say they can diagnose "lack of
oxygen in the blood, low trace minerals, lack of
exercise, too much alcohol or yeast, weak
kidneys, bladder or spleen." Practitioners include
herbologists, naturopaths, and chiropractors.
Vitamins
• Vitamin A – RDA Males – 3,OOO IU Children ½ adult ds
toxic dose is 25,000 IU/kg
highly teratogenic in pregnancy, especially in the first 8
weeks with daily intake more than 10,000 IU
• Vitamin D RDA 200 IU per day
• Vitamin E RDA 22.5 IU per day Children ½ adult ds
antioxidant and anticoagulant properties
decreases low-density lipoprotein (LDL) cholesterol
level at doses more than 400 IU/d
• Vitamin C adult male 90 mg per day; 75 mg for adult
females. Children aged 1-3 years 15 mg/day
• antioxidant and reducing agent
1. Biologically-based products
a. Prebiotics
- non-digestible food ingredients that affect
the host by selectively stimulating the growth
and/or activity of one or limited number of
bacteria in the colon e.g. oligosaccharides
... Prebiotics
• Oligosaccarides are difficult to break down by
the GIT.
• Almost 90% escapes digestion in the small
intestine and reaches the colon where it
performs a different function: that of a
prebiotic.
Chicory root
Wheat
…Biologically-based products
b. Probiotics
- live microbial food supplements which
beneficially affect the host animal by
improving its intestinal microbial balance
e.g lactobacillus
…Biologically-based products
c. Dietary supplement
- a botanical product taken orally and
intended for use to affect the structure or
function of the body.
e.g. Herbal products, Malunggay,
Ampalaya, Papaya
• Despite the increased popularity of herbal
treatments, the safety and effectiveness of
alternative medicines have not been
scientifically corroborated and remain largely
unknown.
Zinc
•
•
•
•
Functioning of many (over 200) enzymes
5.5 to 9.5 mg/day - men
4 to 7 mg/day – women
zinc is important for the production of semen. Up
to 5 mg of zinc is lost during ejaculation.
• Low Zinc – enlarged prostate, impaired sexual
functions, dandruff, hair loss, poor sense of taste
and smell, and stretch marks, dec sperm count,
dec sex drive
• High Zinc – dec Cu absorption and lead to
anemia and weakening of bones
Acupuncture Points
FACT
• WHILE MANY MEDICATIONS CAN HAVE
SERIOUS SIDE EFFECTS THEY ARE USED
ONLY WHEN THE POTENTIAL BENEFIT
OUTWEIGHS THE RISKS (eg. CHEMO
IF A TREATMENT HAS NO PROVEN BENEFIT,
THEN NO LEVEL OF RISK IS ACCEPTABLE
Where Do Sick People Go?
Fraser Institute 1999
NEITHER
6%
14%
35%
DOCTOR ONLY
DOCTOR PLUS
ALT. MED
45%
45%
ALT. MED. ONLY
FRASER INSTITUTE, 1999
Patient Visits
Millions
TYRELL DUECK
• 13 YO BOY WITH OSTEOGENIC
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• PARENTS DO ‘RESEARCH’ AND
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• REFUSE AMPUTATION WHILE CURE
RATE STILL 65%
• Joy abellana cel 0917-6688275
253-4580
www.doh.gov.ph/pitahc