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Complementary

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'Natural' Medicine. Direct toxicity occurs. Indirect effects ... Have you used any herbal or natural remedies that you have bought from a ... – PowerPoint PPT presentation

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Title: Complementary


1
Complementary Alternative Medicine
  • Rosalie C. Diaz, Psy.D. UTMB-SAHS 2006

2
What is it?
  • Complementary and alternative medicine, as
    defined by NCCAM, is a group of diverse medical
    and health care systems, practices, and products
    that are not presently considered to be part of
    conventional medicine. While some scientific
    evidence exists regarding some CAM therapies, for
    most there are key questions that are yet to be
    answered through well-designed scientific
    studies--questions such as whether they are safe
    and whether they work for the diseases or medical
    conditions for which they are used (NCCAM 2003).

3
CAM Practices
  • Biologically based practices use substances found
    in nature, such as herbs, special diets, or
    vitamins (in doses outside those used in
    conventional medicine). 
  • Energy medicine involves the use of energy
    fields, such as magnetic fields or biofields
    (energy fields that some believe surround and
    penetrate the human body). 
  • Manipulative and body-based practices are based
    on manipulation or movement of one or more body
    parts. 
  • Mind-body medicine uses a variety of techniques
    designed to enhance the mind's ability to affect
    bodily function and symptoms. 
  • Whole medical systems are built upon complete
    systems of theory and practice. Often, these
    systems have evolved apart from and earlier than
    the conventional medical approach used in the
    United States.

4
Methods of CAM
  • Megavitamin and Orthomolecular Therapy
  • Diet Therapy
  • Acupressure
  • Acupuncture
  • Hypnotherapy
  • Relaxation
  • Meditation and Mindfulness
  • Transcendental Meditation
  • Imagery
  • Music Therapy
  • Sound Healing
  • Art Therapy
  • Light Therapy
  • Aromatherapy
  • Chelation Therapy
  • Behavioral Kinesiology
  • Psychic Surgery
  • Medical Acupuncture
  • Phytomedicine
  • Shamanistic Practices
  • Spiritual Healing
  • Massage, Rolfing, Reflexology
  • Therapeutic Touch
  • Qigong
  • Yoga
  • Cranial/Sacral Therapies
  • Bioenergetics and Orgonomic Medicine
  • Biofeedback
  • Behavioral Medicine
  • Magnetic Therapy
  • Iridology
  • Electrodermal Diagnostics

5
Factors that influence the spectrum
  • Availability
  • Research Support
  • Medical Evaluation
  • Licensing
  • Reimbursement
  • Feasibility
  • Theoretical/Explanatory Model

6
Unconventional Medicine
  • Popular
  • 1/3 of Americans use
  • more visits than to primary care (425M)
  • "minor" - self care, weight loss, pediatrics
  • 50 of cancer patients
  • Sophisticated AIDS users
  • More than 15 billion a year spent in the US
  • Concealed - 72 don't talk about it to doctor
  • Combined - 83 used conventional treatment

7
Myths About Complementary Medicine Users
  • Disillusioned with medicine in general
  • Anti-science
  • Largely motivated by lower cost

Vincent, C. 1996 Why do patients turn to
complementary medicine? An empirical study.
British Journal of Clinical Psychology 3537-48
8
Why Patients Use Complementary Medicine
  • The following variables emerged as predictors of
    alternative health care use more education
    poorer health status a holistic orientation to
    health having had a transformational experience
    that changed the person's worldview any of the
    following health problems anxiety back
    problems chronic pain urinary tract problems
    and classification in a cultural group
    identifiable by their commitment to
    environmentalism, commitment to feminism, and
    interest in spirituality and personal growth
    psychology. Dissatisfaction with conventional
    medicine did not predict use of alternative
    medicine.

9
NCCAM, National Institutes of Health 2004
10
Concerns with Conventional Medicine
  • Cost (14 of GNP)
  • Safety (11 of hospitalizations iatrogenic)
  • The Burden of Chronic Illness
  • Depersonalization
  • Role of Science in Medicine

11
Is CAM Personal?
  • Understandable Esthetic
  • Time - 7 vs. 30 minutes
  • Psychological - 60
  • High - touch? - care and healing
  • Partnership? - complementary

12
Is CAM "Non-scientific" Practice?
  • Conventional scientific base
  • 20 - 50 backed by quality research
  • Mind/Body and Behavioral Medicine
    Diet and Nutritional
    Supplements
  • Homeopathic
  • 150 controlled clinical trials
  • 15-20 of studies "good"
  • Herbal medicine
  • Ginkgo biloba
  • Hypericum
  • Garlic, Ginseng, Echinacea, Ginger, Cranberry

13
Is CAM Safe?
  • Natural Medicine
  • Direct toxicity occurs
  • Indirect effects
  • Little is still known lots of unknowns

14
NCCAM, National Institutes of Health 2004
15
Physician Use of CAM
16
Physician Use of CAM
17
Evaluation Guidelines
  • Get a three part education
  • Understand the concepts thoroughly
  • Evaluate the data critically
  • Experience the practice openly
  • Take a deeper look
  • Scientific - strength/likelihood of attribution
  • Pragmatic - benefit/magnitude of effect
  • Use good methods of evaluation
  • Define the detail, not just label the system
  • Distinguish under evaluated from ineffective

18
Look at the Research
  • Evaluate the study
  • Efficacy?
  • Randomized trial?
  • all outcomes reported?
  • clinical significance?
  • statistical significance?
  • complete follow-up achieved?
  • study patients broad or similar
  • to yours?
  • treatment feasible?

19
National Center for Complementary Alternative
Medicine (NCCAM)
  • General - facilitate research in CAM
  • Evaluation
  • Investigation
  • Validation
  • Specific
  • Information Clearinghouse
  • Research Training Program
  • Good resource for researching and evaluating AM
  • http//nccam.nih.gov
  • www.nationalstandard.com
  • www.mdanderson.org
  • http//www.drweil.com
  • http//cam.utmb.edu/resources.asp

20
Supplements of vitamins A, C, or E multivitamins
with folic acid or antioxidant combinations for
the prevention of cancer or cardiovascular
disease.
  • The USPSTF found poor evidence to determine
    whether supplementation with these vitamins
    reduces the risk for cardiovascular disease or
    cancer. The available evidence from randomized
    trials is either inadequate or conflicting, and
    the influence of confounding variables on
    observed outcomes in observational studies cannot
    be determined. As a result, the USPSTF could not
    determine the balance of benefits and harms of
    routine use of supplements of vitamins A, C or E
    multivitamins with folic acid or antioxidant
    combinations for the prevention of cancer or
    cardiovascular disease.
  • US Preventive Services Task Force (USPSTF) 2003

21
  • Hoodia Gordonii
  • New miracle pill from the Kalahari desert
  • Kava Kava
  • Safety is a concern for users of kava. People,
    especially those with liver disease or liver
    problems, or persons who are taking drugs that
    can affect the liver, should talk with their
    health care practitioner before using kava. (July
    23, 2002)
  • Star Anise Teas
  • The Food and Drug Administration (FDA) today is
    advising consumers not to consume "teas" brewed
    from star anise. It has come to FDAs attention
    that brewed "teas" containing star anise have
    been associated with illnesses affecting about 40
    individuals, including approximately 15 infants.
    The illnesses, which occurred over the last two
    years, ranged from serious neurological effects,
    such as seizures, to vomiting, jitteriness and
    rapid eye movement. (9/10/2003)

22
Hypericum (St. Johns Wart)
  • Some use for depression and have good results
  • Side effects are few and mild but new information
    has led to serious interaction with P450 Enzyme
  • Lower cost than prescription antidepressants
  • Available without a prescription
  • Regularly taken in Germany
  • Do not take with MAOIs.
  • Cautionadvise against taking with other
    antidepressant warfarin, or retrovirals

23
Physician Responsibilities
  • Protect
  • Toxic therapies - meditation vs. megavitamins
  • Ineffective therapies - if substituted for
    effective
  • Permit
  • Safe, inexpensive - homeopathy vs. herbalism vs.
    clinical ecology
  • Chronic disease management (non-specific effects)
  • Promote
  • Safe and effective - P6 for nausea relaxation
    for pain
  • Mechanism - endogenous opioids in acupuncture
  • Partner
  • Communicate with patient
  • Co-manage illness provide the input on evidence

24
Advising patients about CAM
  • Have you tried any other treatment approaches for
    this problem?
  • Have you ever seen a CAM practitioner for this
    problem?
  • Have you ever tried changing your diet because
    you thought it might help this problem?
  • Have you used any herbal or natural remedies that
    you have bought from a pharmacy or health food
    shop?
  • What was it that encouraged you to try CAM?
  • What are your goals in using this treatment?
  • Why did you choose this particular intervention
    or treatment?
  • How did you select this particular provider?
  • Did the intervention help?
  • Did the intervention result in new problems?
  • Would you like to ask your CAM therapist to let
    me know about your treatment and progress?
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