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Consider mind and body to be single entity. Good health is a positive state, ... Atropine- belladonna. Penicillin- mold. Aspirin- salicin in the willow bark ... – PowerPoint PPT presentation

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Title: Complementary

Complementary Alternative Medicine (CAM) Navee
n Mehrotra, MD, MPh, FAAP Clinical Assistant
Professor Department of Pediatrics RWJMS
BELIEFS About CAM Providers
  • Consider mind and body to be single entity
  • Good health is a positive state, not merely the
    absence of disease
  • Body can often heal without medication
  • Look at the whole patient rather than one organ
  • Impact of the total environment on body

CAM use among Asian-Americans J Altern Complement
Med 2006 12(10)1003-10
  • Nearly three quarters of 9187 Asian Americans
    surveyed reported at least one type of CAM in the
    past 12 months
  • Chinese Americans had the highest prevalence
    (86) of any CAM use whereas South Asians had a
    prevalence of 67
  • Spirituality was the strongest predictor of any
    CAM use for most Asian-American subgroups

CAM use among Asian-Americans Results of the
National Health Interview Survey for 917 Asian
Americans and 20,442 Non Hispanic Whites J Gen
Intern Med. 2007 22(6) 762-7
  • 42 of Asian Americans were likely to use some
    sort of CAM therapy
  • Use of Mind/Body therapies in Asian Indians
    (31), Chinese (21) and Filipinos (22)
  • Herbal Medicines in Chinese (32), Filipinos
    (26), and Asian Indians (19)
  • Among Asian Americans, CAM use was associated
    with being female, higher education, and having a
    chronic medical condition

CAM use among Chinese Americans Findings from a
community mental health service
population Psychiatr Serv. 2007 58(3)402-4
  • 82 of people surveyed reported current use of
  • 46 reported megavitamin therapy
  • 43 reported herbal medicine
  • 25 each reported use of massage, acupuncture,
    and spiritual healing
  • CAM users were older, female, employed, less well
    functioning physically and less acculturated

CAM use in developmental disabilities Ment Retard
Dev Disabil Res Rev. 2005 11(2)107-9
  • Reported rates for CAM use in children with
    developmental disabilities may be higher
  • May relate to hope for amelioration of symptoms
  • May be related to concerns regarding side effects
    of conventional treatments
  • Need on the part of families to participate in
    decision making

Types of Alternative Therapies Used by Children
in an Indigent Population Results of a Pilot
study at SIUH. Mehrotra
  • Massage Therapy 11.7
  • Spiritual Healing 4.9
  • Lifestyle Diets 1.0
  • Herbal Medicine 3.9
  • Megavitamin Therapy 4.9
  • Folk/Home Remedies 17.5
  • Others 2.9
  • Total 46.8

Factors Influencing Use of CAM
  • Word of Mouth 32
  • Fear of drug side effects 21
  • Chronic medical problem 19
  • Dissatisfaction with
  • conventional medicine 14
  • More personalized attention 9
  • Other reasons 5

National Projections of Expenditures for CAM
  • Category of Expenditures Dollars (Billions)
  • Services of Providers of CAM 11.7
  • Megavitamin supplements 0.8
  • Commercial Diet Supplements 1.2
  • Estimated Total 13.7
  • Eisenberg DM Unconventional medicine in
    the US. N Engl J Med. 1993 328 246-252

Common Disorders Treated by CAM
  • Asthma Acupuncture, Herbal
  • Cancer Hypnosis, Relaxation, Megavitamins
  • Arthritis Copper bracelets, dietary
  • Other disorders like stroke, cystic fibrosis,
    Downs syndrome, atopic dermatitis

CAM Therapeutic Wheel Kathi Kemper Model
Biochemical Therapies
  • Herbal Remedies, Nutritional supplements
  • Herbal medicine extracts used from flowers,
    fruit, leaves, roots, stems, and seeds one of
    the oldest form of medicine used all over the
    world (Ayurveda in India, Chinese herbal medicine)

Medications with Plant Origin
  • Digoxin- foxglove
  • Vincristine and Vinblastine- periwinkle plant
  • Morphine, codeine, and other opioids-opium poppy
  • Atropine- belladonna
  • Penicillin- mold
  • Aspirin- salicin in the willow bark
  • Ephedrine- ephedra plant
  • Senna- laxative from the senna plant
  • Caffeine- coffee beans
  • Taxol- anticancer from the yew tree

Commonly used Herbal Products
  • Teas green and black tea- polyphenols in tea
    protect body cells from damage, the fluoride
    wards off dental decay, tannins have antiviral
    and antibacterial properties, theophylline and
    theobromine dilate the airways, and the caffeine
    acts as a stimulant
  • Studies suggest that 4 to 6 cups of green tea a
    day have a decreased incidence of cancer of
    lungs, liver, pancreas, esophagus, breast, and

Commonly used Herbal Products
  • Echinacea
  • a herb found in the midwest used by the American
    Indians as an anti-infective agent
  • taken orally to stimulate the immune system
    (causes the WBCs to migrate to the wound area,
    increases the T4 helper cells, the interferon
    levels, and increases the formation of

Commonly used Herbal Products
  • Chamomile
  • A Eurasian variety Marticaria recutita is more
    widely used in the US.
  • Used to get a better nights sleep,
    antiflatulent, inhaled chamomile tea relieves
    bronchial congestion, a sitz bath relieves
    hemorrhoids, improves eczema, moistens dry skin,

Commonly used Herbal Products
  • Feverfew
  • Comes from Tanacetum parthenium, a member of the
    chrysanthemum family and is found all over the
    United States
  • Used against inflammation, fever, menstrual
    cramps, and migraines. (Migraine attacks are
    preceded by the clumping of platelets which
    produce excess serotonin a chemical in the name
    of parthenolide found in feverfew acts by
    interfering with the aggregation of platelets.

Commonly used Herbal Products
  • Others
  • Ginger used for nausea and motion sickness
  • Ginseng used to increase sex drive, longevity,
    energy, and appetite
  • Purity of herbal products, the processing, the
    age of the product all play a role in the
    effectiveness of the product.

Lifestyle Therapies
  • Megavitamin and Megamineral Therapy
  • Vitamins and minerals in large doses are used as
    primary therapy for certain medical conditions
    (based on Paulings orthomolecular theory of the
    provision of the optimum concentration of
    substances normally present in the human body)
  • Ex use of Vit C and the common cold

Lifestyle Therapies
  • Macrobiotic Diet
  • A diet that promotes physical, mental,
    emotional, and spiritual health and harmony to
    live life to the full potential
  • Diet aims to balance foods for their yin-yang
    qualities of the individual
  • Primary goal is to eat foods in the middle range
    such as grains, which are neither extreme yin nor
    yang and thereby achieve a healthy and harmonious

Lifestyle Therapies
  • Mind-Body Therapies
  • Biofeedback (use of electrical or mechanical
    devices to increase the awareness of the
    physiological activity of a muscle by providing
    the patient with visual, verbal, and/or auditory
  • Patient learns to recognize the physiological
    activity of a muscle, a response that was
    previously not recognized but is under the
    patients control, and he/she can learn to
    respond appropriately and gain control over his
    muscle by trial and error (e.g. functional
  • Hypnosis used in nocturnal enuresis

Biomechanical Therapies
  • Massage Therapies
  • Aim to relax and relieve the body, mobilize stiff
    joints, improve blood, muscular, and nervous
  • Swedish types of massage
  • Effleurage (slow, rhythmic, light and
    deep-pressure fingertip, hand, knuckle, and
    thumbs massage strokes- often used in conjunction
    with aromatherapy oils)
  • Friction (use fingertips, thumb pads, and the
    heels of the hand in small, circular pressure
    movements to free stiff and locked joints,
    improve circulation, and treat damaged or
    strained ligaments)
  • Percussion (vigorous drumming massage in which
    the sides of the hand deliver fast, rhythmic
    chops to well-padded parts of the body, such as
    the back, buttocks, and thighs)
  • Petrissage (kneading dough like movements hands
    grasp, squeeze, roll, and release whole sections
    of muscles, used to improve circulation and to
    relax controlled muscles.

Biomechanical Therapies
  • Chiropractic
  • Manipulation of spine and extremities by the
    hands to stretch muscles, unlock joint, and
    correct problems in other parts of the body that
    have originated from the spine. In addition,
    heat, ice, or ultrasound waves may be used.

Bioenergetic Therapies
  • Acupuncture
  • Ancient Chinese form (life force called qi
    dominates every living being)
  • Yin and yang must be in balance or harmony before
    qi can get our vital functions to work normally
  • Qi flows along fourteen invisible, interconnected
    main channels on each side of the body.
  • These meridians surface at various locations on
    the body, called acupuncture points (about 360
    have been identified)
  • Imbalance between the yin and yang and the five
    elements of the universe (wood, fire, earth,
    water, and metal) cause lactic acid and carbon
    monoxide to build up in the muscles
  • Stimulating the appropriate acupoints dissipates
    the buildup and restores the yin and yang
  • Western scientists have shown that stimulating an
    acupoint releases endorphins which reduces the
    perception of pain

Bioenergetic Therapies
  • Homeopathy
  • Based on the theory that a substance that
    produces symptoms in a healthy individual could
    cure symptoms in a sick person
  • Substance is diluted into infinitessimal amounts
    (expressed as C1, C2, etc) and given to the
    patient as treatment
  • Homeopathic doctor studies the whole person and
    takes into account the idiosyncrasies, reactions
    to heat and cold, weather, and food, sleep and
    work patterns, age and environment, before he
    prescribes any medication

CAM Therapeutic Wheel Kathi Kemper Model
Practitioners Approach to Alternative Medicine
  • Should be aware of the use of CAM in their
  • Should ask about it as part of the medical
  • Should have an open attitude and be