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Complementary and Alternative Medicine

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Title: PowerPoint Author: Last modified by: ntu Created Date: 3/24/2003 2:47:33 AM Document presentation format: – PowerPoint PPT presentation

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Title: Complementary and Alternative Medicine


1
Complementary and Alternative Medicine
  • ??????
  • ??? ???

2
??
3
?????
  • Unorthodox
  • Marginal
  • Unconventional
  • Unofficial
  • Outside biomedicine
  • Nonscientific
  • Orthodox
  • Mainstream
  • Conventional
  • Official
  • Inside biomedicine
  • Scientific

4
From Alternative to Complementary to Integrative
  • Alternative
  • ?????????????
  • ???????? ?????
  • Residual definitions are seldom satisfactory

  • (Wardwell, 19941061)
  • Complementary
  • ???????

5
??
  • What is not taught in medical schools or not
    covered by insurance (Eisenberg et al., 1993)
  • Interventions neither taught widely in medical
    schools nor generally available in U.S. hospitals

  • (Eisenberg et al., 1998)
  • Every strategy of healing outside mainstream
    medicine (Blecourt and Usborne, 1999)

6
Use David M. Eisenberg (1993, 1998)

  • 1990 1997
  • Use in previous year 33.8
    42.1
  • Probability of visit CAM 36.3
    46.3
  • Disclosure 39.8
    38.5
  • Entire out-of-pocket payment 64.0
    58.3
  • Total visit(extrapolation, million) 47.3? 427
    629
  • Total CAM professional exp (billion)( 45.2?)
    21.2
  • Out-of-pocket ( gt all US
    hospitalization) 12.2
  • Total out-of-pocket CAM expenditure (billion)
    27.0
  • (out-of-pocket for US physician
    service)

7
Medical education in US
  • AMA (1996-1997 survey)
    46 school
  • Wetzel et al. (1997-1998 survey)
  • Elective/topics in required courses
    75 school
  • Total courses
    123
  • Formats Lectures
  • Practitioner
    lecture/demonstration
  • Patients
    presentation
  • Topics chiropractic, acupuncture,
    homeopathy,
  • herbal therapy,
    mind-body techniques
  • AMA (1999-2000 survey)
    82 school

8
Research Institute
  • U.S. National Institutes of Health
  • Office of Alternative Medicine (1992)
  • 3 million
  • National Center for Complementary and Alternative
    Medicine (1995)
  • 50 million

9
complementary and alternative medicine (CAM)
NCCAM
  • CAM is a broad domain of healing resources
    that encompasses all health systems, modalities,
    and practices and their accompanying theories and
    beliefs, other than those intrinsic to the
    politically dominant health system of a
    particular society or culture in a given
    historical period. CAM includes all such
    practices and ideas self-defined by their users
    as preventing or treating illness or promoting
    well-being. Boundaries within CAM and between
    the CAM domain and the domain of the dominant
    system are not always sharp or fixed. (1995)

10
Taxonomy of CAM -- NCCAM
  • 1. Alternative medical systems
  • homeopathy, naturopathy, Chinese medicine,
    Ayurveda
  • 2. Mind-body interventions
  • meditation, prayer, mental healing,
    art/music/dance therapies
  • 3. Biologically based therapies
  • herbs, organic foods, dietary supplements,
    natural substance
  • 4. Manipulative and body-based methods
  • chiropractice, osteopathy
  • 5. Energy therapies
  • Biofield qi-gong, Reiki, therapeutic touch
  • Bioelectromagnetic-based electromagnetic
    fields/ current

11
????(Integrative medicine)
  • Integrative medicine combines mainstream
    medical therapies and CAM therapies for which
    there is some high-quality scientific evidence of
    safety and effectiveness.
    (NCCAM)

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22
Ayurveda
23
  • Metabolic body types
  • Vata
  • Doshas Pitta
  • Kapha
  • Physical constitution
  • Grasping ones body type
  • taking appropriate
  • measures

24
Ayurveda (disease treatment)
  • Health a soundness and balance b/w body, mind,
    and soul, and an equilibrium b/w the doshas
  • Harmony disruption, when
  • Genetic, congenital, internal/external trauma
  • Seasonal/natural tendencies or habits
  • Magnetic and electrical influences

25
Ayurveda (treatments)
  • Diet
  • Exercise
  • Meditation
  • Herbs
  • Massage
  • Sun
  • Breathing

26
Homeopathy
27
Homeopathy (??/????)
  • Hemeo similar Pathos suffering/disease
  • Premise
  • Disruption of vital force/self-healing ?
  • Health problems/diseases
  • Stimulating the bodys own healing responses

28
Like cures Like
  • Giving very small doses of substances (remedies)
    ? produce the same of similar
  • symptoms of illness in healthy people if given
    in larger doses
  • Individualized healing/Tailoring to each person
    symptoms, life style, emotion, and
  • mental states.

29
Naturopathy
30
Naturopathy (Naturopathic medicine)
  • Supporting health gt combating diseases
  • Premise
  • ? Nature has a healing power
  • ? Living organisms have the power to
  • maintain/return to a state of balance
  • and health, and to heal themselves

31
Nature cure movement
  • Benedict Lust (German USA)
  • Restoring health through a return to nature
  • Advocating therapies like gentle exercise,
    herbal medications, wholesome dietary, and
    exposure to sun and air.
  • Rise and fall and rise
  • ? Reaching its peak in the 1920s1930s
    (USA)
  • ? Declining while drug (antibiotics) and other
  • technologies developed
  • ? Reemerging in the 1970s under holistic health
  • movement

32
Chiropractic
33
Chiropractic(??????)
  • Cheir hand Praxis action
  • Premise
  • The body has a powerful self-healing ability
  • Structure (spine) and function of body are
    closely related? health
  • Normalizing the relationship b/w structure and
    function

34
Chiropractic
  • Daniel David Palmer in 1895 in Davenport, Iowa
  • Misalignments of the spine can interfere with the
    flow of energy needed to support health
  • Normalize the function of the nervous system,
    especially the spinal cord

35
Chiropractic (healing strategies)
  • Combining the use of spinal adjustments with
    several other treatments and approaches such as
  • Heat and ice
  • Electrical stimulation
  • Rest
  • Rehabilitative exercise
  • Counseling about diet, weight loss, and other
    lifestyle factors
  • Dietary supplements

36
Aromatherapy
37
Aromatherapy
  • A unique branch of herbal medicine
  • Use of essential oils from plants to support and
    balance the mind, body, and spirit ?
  • medicinal properties
  • The misleading term of aromatherapy ?
  • suggesting an exclusive role for the aroma in
    the healing process

38
Aromatherapy (essential oils)
Cold-pressing
Steam distillation
Volatile, fragrant essence
Flowers, leaves, Branches, roots
Very concentrated (220lbs lavender? 1 lb
essential oil)
Using energy from the sun and elements from the
air, soil, and water
39
Administering aromatherapy
  • Inhalation diffuser/placing drops of oils near
    the body
  • Topical/external treatment applying to the
    surface of the body ? diluted form
  • massage, add oils in bathwater, lotions, or
    dressings
  • Internal application oral, rectal, vaginal
    interfaces

40
Aromatherapy benefited conditions
  • Bacterial and viral infections
  • Skin conditions
  • Muscular disorders
  • Arthritis

41
Aromatherapy in the home
  • Daily hygiene
  • Digestive and stress-related discomfort
  • Bruises and sports injuries
  • Mosquito and other insect bites
  • Burns
  • Energy
  • Relaxation
  • Nausea

42
Reiki
43
Reiki
  • Rei Universal spirit Ki qi, life energy
  • Belonging to energy medicine
  • Improving the flow and balance of energy in a
    beneficial way

44
Energy medicine
  • Using forces of two types
  • Observable, measurable forces (related to
    electromagnetic fields)
  • Unobserved, unmeasured but believed to surround
    and penetrate the human body
  • The physical properties of biofields is waited to
    be studied

45
  • ????

46
New medical culture
  • Holistic health movement (1970s)
  • End of medicine, a new paradigm, a new
    medicine
  • The rise or the re-mergence of CAM phenomenon
  • A belief in holism
  • An emphasis on the integration of body, mind
    and spirit
  • A view of health as a positive state on a
    continuum with illness
  • A belief that the body is suffused with the
    flow of energy
  • A belief in vitalism
  • A distinctive view of the healing process

47
From Biomedical to Biocultural
  • Double coding
  • Charles Jencks
  • postmodernism in
  • Architecture
  • Two different codes
  • or style coexisting
  • in a single
  • composition.
  • A pluralistic age for
  • innovative hybrids or synergies

48
Medical pluralism
  • Multiplicity
  • Context lack of monopoly, dominance, and
    hegemony of biomedical system
  • Social and cultural organization of healing
    practitioners, also a political phenomenon
  • Pluralistic health seeking

49
?????
50
A survey
  • Title???????????????
  • Instrument development and pretest
  • Data collection telephone interview
  • Sample 1517

51
CAM??? (2002)
  • ????,????????????????????????(?????)
  • a.?? ?1.? ?2.? ?99.?????/??? (???????)
  • ???????/???????????????
  • ????/????????????????????
  • ??????????????????
  • ?????????,??????????????????,????
    _______________(?????)

52
  • Others
  • ??(n13)????????
  • ????(???????????????,n16)
  • ??????????(?????????,n7)
  • ?????????????(n2)
  • ??????

53
??
  • ???????
  • ??????????????
  • ??????????????
  • ?????

54
??????
55
???????
56
??????????????
57
??????????????
58
?????
59
Domain () 24.5
31.6 21.1
9.0 8.9
2.6
??????? ??????????? ?????????? ???? 0(35.8)?1(28
.1)?2(20.2)?3(16.0) 1.23/1.91
?????? ?????? ?? ???????? ??????? ?????? (23)
Modality () 0 24.5 1
18.4 2 15.9 3 12.1
4 8.7 5 7.2 6
13.2 2.56/3.39
?????????? ???? ??????????? ???????? 0(49.4)?1(2
0.6)?2(12.2)?3(8.2) 0.51/2.26
????? ???????? ??????? 0(86.1)?1(10.1)?2(3.8) 0
.14/1.38
60
??????
61
  • ?????? ????
  • ?????????????????
  • ????
  • ??????
  • ???????
  • ???
  • ????

62
???????CAM???
? ? ?
63
???????????????CAM???
? ? ?
64
?????????????CAM???
65
?????????????????????CAM???
66
?????????????CAM???
? ? ?
67
???????????????CAM???
68
???????????
?? ???? ??
???? ???????? ??????????????
???? ??? ?????????????????
???? ?????? ?????????
???? ???? ???????????????????????
???? ??? ???????????
?? ??? ???????????????
?????????? ????????? / ?????? ??????????????????????
?????????? ???????? ???????????????
?? ????? ??????????????????????
?? ??? ?????????????????
???? ??? ?????????
???? ????? ??????????
???? ??? ???????????????
?????? ??? ????????????????
??????? ??? ??????????????????????
69
?????????????
  • ?????????
  • ?????????????????????????
  • ?????????????????(?????X?),???????????
  • ???????????,????????????
  • ??????????(?????????),?????????
  • ?1.???? ?2.???,????
  • ???????????
  • ???????????

  • ??????????????

70
????????? ??
32.6 ???? 29.7 ???
27.8 ???/??? 9.9
?????????? ????
14.6 ???? 34.7 ????
19.4 ????? 1.9 ????
2.2 ??? 27.3
???????? ???????
???? 15.0 ????
19.8 ???? 60.0 ???/??? 5.2
71
????????? (adaptive use)
???????????
???? 48.5 ?????
51.4 ??/??? 0.1
?????????????????,?????? (n1343)

????
21.3 ???,??????????
21.2 ???,??????????
23.8 ???,???????????
17.6 ???
16.2
72
???
  • ??????????
  • ?????,???????
  • ??????????????
  • ???????????????
  • ???????????????
  • ????????????????
  • ?????????
  • ?????????????

73
Other issues
  • Adaptation/professionalization of CAM
    practitioners
  • Interactions of CAM mainstream medicine
  • Regulation of CAM practices safety quality

74
The End
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