alternative healing. agenda introducing cam evaluating web sites recommended websites reviewing the...
TRANSCRIPT
Alternative
Healing
Agenda
• Introducing CAM
• Evaluating Web Sites
• Recommended Websites
• Reviewing the Evidence
Complementary and Alternative Medicine
•NHIS 2007 Results•>23,00 adults•> 9000 children•Hispanic subpopulation•administered by NIH/CDC•Self report•Interview one child if they are present
CAM STATISTICS
19th C Alternative Medicine
• Many medical sects emerged and challenged allopathic medicine– Thomsonianism– Eclectic movement– Hydropathy
• Most died out
Heroic Medicine
• Blood letting• Purgatives• Emetics• Sialogogues
Homeopathy
• Largest unorthodox sect in 19th c
• Samuel Christian Hahnemann
• German physician• Translated classical
medical texts• Rejected allopathic
medicine• Brought to US in 1825
Homeopathy
• A new system of medicine
• Employed an experimental pharmacology
• Self-experimentation or “provings”
• Initially popular in Europe– Spread to USA
Osteopathy
• Andrew Taylor Still– Son of pioneer dr and
Methodist minister
• Frontier physician– Kansas– Apprenticeship– Children died of meningitis
• 1874 conceives of osteopathy– Itinerant physician
• Created alternative to allopathic medicine– Human body like a
machine; Ought to function well if mechanically sound
– Treat body by improving natural functions
Osteopathic Medicine
Chiropractic Medicine
• 1895• Daniel David Palmer• Iowa• Cheir= hand• praxis= practice• First patient
– Deaf janitor
Chiropractic Medicine• Disease: joint-oriented nerve
interference– Obstructs flow of “innate
intelligence”• Innate Intelligence
– Regulates all vital functions as it flows through CNS
– Connects “man the spiritual” to “man the physical”
• Remove nerve interference caused by subluxations so that innate intelligence can maintain health and bodily equilibrium
What is CAM?
• Complementary and Alternative Medicine
• Complementary: together with – aromatherapy to help with pain after
surgery
• Alternative: in place of– using garlic to lower blood pressure
“Complementary and alternative medicine (CAM) is a broad domain of healing resources encompassing all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the dominant health system of a particular society or culture in a given historical period.”
“All practices and ideas defined by their users as preventing or treating illness or promoting health and well-being are included.”
“Boundaries within CAM and between the CAM domain and that of the dominant system are not always well defined.”
(Cochrane)
CAM becomes “legit”• 1990
– Wilk et al v. AMA
• 1991 – $2 million in funding to establish NIH
Office of Alternative Medicine
• 1994 – Dietary Supplement Health and
Education Act
CAM becomes “legit”• 1995
– NIH Office of Dietary Supplements– FDA declassifies Acupuncture
needles as experimental product
• 1996– NIH Consensus Conference on
Acupuncture
• 1997– First large trial of CAM therapy, St.
John’s Wort for depression
CAM becomes “legit”• 1998
– National Center for Complementary & Alternative Medicine (NCCAM) established http://nccam.nih.gov/
– First full scale article in JAMA on herbal medicine
– Office of Cancer Complementary and Alternative Medicine (OCCAM) established http://www.cancer.gov/cam/
• 2001– CAM on PubMed (NCCAM and NLM)
• 2009 - $296 million in NIH CAM research
Complementary and Alternative Medicine
Impact of CAM
• CDC Report (2007)– 38% of adults used some form of CAM
– Children whose parent used CAM were 2x as likely to have used CAM
– CAM use more prevalent for: women, adults aged 30-69, higher levels of education, adults who were not poor, adults living in the West, and former smokers
• Full report: http://nccam.nih.gov/news/camstats/
Figure 17.2
The Domains of Complementary and Alternative Medicine
Diseases and Conditions
Top CAM Therapies
Top 10 Supplements
Types?
• Biologically based practices – supplementing a person's normal diet
• Manipulative and body-based therapies – focus on the body's various systems and structures
• Mind-body interventions – use the connection between a person's mind, body, and
spirit to enhance total well being• Energy therapies
– are meant to restore disturbances in the body's natural energy
Types? (Common)
• Acupuncture• Alexander Technique• Allergy testing• Aromatherapy • Art Therapy• Autogenic Training• Auricular Acupuncture• Ayuveda • Bodywork
• Bowen• Biofeedback• Chiropractic • Chinese Herbal Medicine• Counselling • Craniosacral Therapy• Crystal Therapy• Dowsing Flower Therapy• Healing Herbalism• Homeopathy
Types? (Common)• Hydrotherapy • Hypnotherapy• Indian Head Massage• Iridology• Kinesiology• Music Therapy• Naturopathy• Nutrition• Osteopathy
• Physiotherapy• Radionics• Reflexology• Reiki• Shiatsu• Tai Chi• TENS therapy• Traditional Chinese
Medicine• Thought Field Therapy• Yoga Therapy
Types? (Rarer)• Auricular Acupuncture• Australian Flower Essences Therapy• Bach Flower remedies• Bee Venom Therapy• Chelation Therapy • Colonic Hydrotherapy • Colour Therapy • Dream Therapy • Eye Movement Desensitization and
Reprogramming • Exercise Healing • Health Clubs • Health Screening • Juice Therapy • Light Therapy
• Light Touch Therapy • Magnotherapy • Marma Therapy• Meta-Aromatherapy• Microwave Resonanace Therapy• Naturotherapy• Oxygen Therapy• Panchakama Therapy• PIP scans• Raw Vegetable Juice Therapy• Rolfing• Spiritual Counselling• Stress Management• Swimming Therapy• Transdecendal Meditation• Tragerwork• Vegetable Juice Therapy
Categorization of Therapies
• Whole Medical Systems• Biologically Based Practices• Energy Medicine • Manipulative and Body-Based
Practices• Mind-Body Medicine
National Center of Complementary and Alternative Medicine
Whole Medical Systems
• Complete systems of theory and practice that evolved independently
• Traditional systems of medicine that are practiced by individual cultures throughout the world – Includes traditional Chinese
medicine, Ayurvedic medicine, homeopathy, naturopathy
National Center of Complementary and Alternative Medicine
Biologically Based Practices
• Includes: botanicals, animal-derived extracts, vitamins, minerals, fatty acids, amino acids, proteins, whole diets, and functional foods– Dietary supplements are a subset
of biologically based practices
National Center of Complementary and Alternative Medicine
Biologically Based - Supplements• What is a supplement?
• Regulated by FDA http://www.fda.gov– no requirements for FDA testing– manufacturers responsible for ensuring
product safety– label requirements
• Safety alerts: http://www.cfsan.fda.gov/~dms/ds-warn.html
Energy Medicine
• Veritable - energy that can be measured– Includes sound, visible light, magnetism
• Putative – energy that has yet to be measured– human beings are infused with a subtle
form of energy – Includes qi (ki in Japanese); doshas;
prana, homeopathic resonance
National Center of Complementary and Alternative Medicine
Energy Medicine - Acupuncture• Few complications • Scientific evidence?
– post chemotherapy management of nausea
– pain relief• NIH Consensus Statement (1997)
– http://consensus.nih.gov/1997/1997Acupuncture107html.htm
Manipulative and Body-Based
• Structures and systems of the body, including the bones and joints, the soft tissues, and the circulatory and lymphatic systems– Includes chiropractic manipulation,
massage therapy, reflexology, rolfing, Alexander technique,Feldenkrais method
*National Center of Complementary and Alternative Medicine
Mind-Body Medicine
• Interactions among the brain, mind, body, and behavior
• The ways in which emotional, mental, social, spiritual, and behavioral factors can directly affect health– Includes relaxation, hypnosis, visual
imagery, meditation, yoga, biofeedback, tai chi, group support, and spirituality
*National Center of Complementary and Alternative Medicine
Other CAM Therapies
• Aromatherapy• Colonic Irrigation• Therapeutic Touch• EDTA Chelation• Cupping• Primordial Sound Meditation
Specific Types?
• Aromatherapy– Used since Egyptian times– Distilled plant extracts
• 400 Oils• Varying quality (RCT)
– Improve well-being• Peppermint – digestive effects• Tea Tree Oil – antibacterial
– Massage, Baths, Inhalation
Specific Types?
• Bee Venom Therapy– Contain sulphur – Stimulates cortisol release – Applied to surface– Chronic inflammatory conditions– RA, Myositis– Applied for 5days with 2-3day interval– Normally haemorrhagic
Avoiding Bad Science• The “One Product Does It All” claim
http://www.emuoilcanada.com/• Personal Testimonials
http://www.getslimslippers.com/• Quick Fixes/Cures
http://www.improveyourhealthonline.com/ • The “No Risk Money Back Guarantee”
http://www.naturalhpvcure.com/ • The “Natural” claim
http://www.amtrueman.com/products.html
Evaluating Web Sites
• Accuracy
• Authority
• Bias
• Currency
• Coverage
Evaluation Exercises
Recommended Websites
About Herbs, Botanicals & Other Products
Examining the Research
• Observational Studies
• Clinical Trials/Studies– controlled– blind/double-blind– randomized
• ClinicalTrials.gov– Government and private clinical studies
involving humans– http://clinicaltrials.gov
Clinical Trials and CAM
• Drug companies vs. supplement
companies
• Customization of treatment in CAM
• CAM does not necessarily want to be
studied
• CAM has only recently become “legit” in
the scientific community
Money to fund CAM
• NCCAM: $121.7 million (2009)• OCCAM: $121.9 million (2009)
– Total all NIH: $296 million
• What about funding for pharmaceuticals? – $65.2 billion on R&D (2008) by drug
companies– $114.4 billion on R&D (2008) by NIH
(this includes NCCAM and OCCAM)
Figure 17.3
Assessing the Risks and Benefits of CAM Treatments
The other side
• Some say CAM research should not be funded– http://www.nccamwatch.org/ (Stephen
Barrett)
• Or some CAM research should not be funded– http://tinyurl.com/46ayhjj
Reviewing the Evidence
• Evidence Based Medicine: “What evidence do we have to justify the treatment…”
• National Center for Complementary and Alternative Medicine (NCCAM)
• CAM on PubMed http://pubmed.gov
CAM on PubMed Exercises