consumer health complementary and alternative medicine (cam)

Consumer HealthComplementary and Alternative Medicine (CAM)

Prayer

I got behind and forgot to tell people about what happened with him......the morning after the 'global prayer circle' (for lack of a better name for it) he improved dramatically! In fact the doctors decided against the surgery they were planning (and dreading as he has so much 'scar tissue' inside) and sent him home! He's doing amazingly well - went out and bought a Christmas tree and decorated it! Thanks for asking and Happy New Year to you! J

BMJ VOLUME 324 13 APRIL 2002 bmj.com

Prayer

I got behind and forgot to tell people about what happened with him......the morning after the 'global prayer circle' (for lack of a better name for it) he improved dramatically! In fact the doctors decided against the surgery they were planning (and dreading as he has so much 'scar tissue' inside) and sent him home! He's doing amazingly well - went out and bought a Christmas tree and decorated it! Thanks for asking and Happy New Year to you! J

Complementary and Alternative Medicine

Defining CAM History of CAM Major Domains of CAM Extent of Use Organizations, Certification, Training Selecting Practitioner

Defining CAM

Original Definition

National Library of Medicine Unrelated group of non-orthodox

therapeutic practicesOften with explanations not following

conventional biomedical explanationsNo satisfactory scientific explanation

for effectiveness Another old definition

Medical interventions not taught in US

Defining CAM

New Definition

National Library of Medicine Complementary Medicine

Alternative Therapeutic practices not considered

an integral part of conventional allopathic medical practiceMay lack biomedical explanationCould become accepted or not

Defining CAM

Complementary MedicineTherapies used in addition to

conventional treatments Alternative

Therapies used instead of conventional treatment

Defining CAM

Differences in Emphasis

Conventional High Tech Pharmacological Surgical and other technological

approaches Prevention and

wellness underemphasized

CAM Low Tech Prevention Treating the whole

person Promoting self-care Recognizing a

spiritual nature of each individual

Individualized treatment

Major Domains of CAM

Alternative Health Care Systems Ayurvedic Medicine Chiropractic Homeopathic Medicine Native American Medicine Naturopathic Medicine Traditional Chinese Medicine

Major Domains of CAM

Mind-Body Interventions

Meditation Hypnosis Guided Imagery Dance Therapy Music Therapy Art Therapy Prayer and Mental Healing

Major Domains of CAM

Biological Based Therapies

Herbal Therapies Special Diets Orthomolecular Medicine

Major Domains of CAM

Therapeutic Massage, Body Work and Somatic Therapies Massage Feldenkrais Alexander Method

Major Domains of CAM

Two Additional Domains

Energy TherapiesQigongReikiTherapeutic Touch

BioelectromagneticMagnet Therapy

History of CAM

Mid-19th CenturyBotanical healers, midwives,

chiropractors, homeopaths 1892

The Principles and Practice of Medicine

1910Flexner Report

History of CAM

Early 20th CenturyDrugs and antibiotics introducedCAM: “unscientific relics of the past”

Mid-20th CenturyChronic, degenerative diseasesSignificantly longer livesHealth care costs (See next slide)

History of CAM

Mid-20th CenturyChronic, degenerative diseasesSignificantly longer livesHealth care costs

1965 $ 41,000,000,000

1975 $ 130,000,000,000

2000 $ 1,200,000,000,000

2010 $ 2,600,000,000,000

History of CAM

1950s – 1970sMedical pluralism reemergesWhole foods and dietary supplement

movementsExposure to traditional health care

systemsCounterculture movementHolistic health care movementNurses and family physicians

History of CAM

1970s – 1980sSelf-care movements

• For individual and family to increase wellness

• Diet and exercise to reduce risk of onset of illness

• Personal fitness• Increased use of yoga, tai chi, massage

Consumer Use of CAM

43% of US population Due to chronic conditions

Most frequent users• Cancer, chronic pain, HIV• Ethnic populations

Dietary Supplements158 million users$17,000,000

Reasons for Using CAM

Characteristics of usersInterest in spirituality and personal

growthCommitment to environmentalismFeminismInternal locus of controlTransformational experiences

Reasons for Using CAM

Perception of conventional medicine is ineffective

Believe it will work Recommendations from friends Desire to avoid side effects of

conventional treatments Failure of conventional treatment

Reasons for Using CAM

Perceived poor health status Perceived poor emotional functioning Musculoskeletal disorder

Back pain

CAMs Used

Chiropractic: 35% Herbal Remedies and supplements:

27% Massage Therapy: 17%

Cancer and CAM

At least one CAM approach: 63% to 75% Women more than men More use for surgery, chemotherapy or both than

neither Most frequent approaches

Nutritional: 63%, Massage: 53%, Herbs: 44% Spiritual approaches, relaxation, imagery, exercise,

lifestyle, diet, nutritional supplementation therapies Reasons for use

“stimulate an immune response:” 73% Outcomes

QAL, coping, decrease discomforts, sense of control

HIV and CAM

Frequent Substances Vitamin C: 63%, Multiple vitamin

supplements: 53%, Garlic: 53% Frequent practitioners

Massage: 49%, acupuncturists: 45%, nutritionists: 37%

Frequent activities Aerobic exercise: 63%, prayer: 58%,

massage: 53%, meditation: 46%

Ethnic Differences in Use of CAM

Mexican-American and Hispanic, and Native AmericansAt least once in last year: ~50%Herbal medicine, spiritual healing,

traditional healers

Conventional Medicine Use of CAM Give referrals to:

Acupuncture: 43%Chiropractic: 40%Massage: 21%

Practiced by them:Chiropractic: 19%Massage: 19%Homeopathy: 9%

Conventional Medicine Belief in Efficacy of CAM

Believe in efficacy of:Acupuncture: 51%Chiropractic: 53%Massage: 48%

OthersHomeopathy: 25%Herbal approaches: 13%

Conventional Medicine Use of CAM

Insurance Companies Medical Schools Hospitals

Organizations

American Holistic Nurses Association http://ahna.org

National Certification Commission for Acupuncture and Oriental Medicine www.nccaom.org

Complementary and Alternative Medical Association http://www.camaweb.org

British Complementary Medicine Association http://www.bcma.co.uk

CAM Certification and Education Council of Colleges of Acupuncture and Oriental

Medicine www.ccaom.org

American Association of Naturopathic Physicians www.naturopathic.org

Tai Sophia Institute www.tai.edu

East West Institute of Healing Arts www.eastwestqi.com

American Academy of Acupuncture and Oriental Medicine www.aaaom.org

Selecting Practitioners

Speak with primary provider Make a list of CAM providers and check

Training Licenses and certifications Costs

Check insurance coverage List questions to ask at visit At visit answer questions about MX Assess visit for comfort and reasonableness

Research

NCCAM and NIH nccam.nih.gov/research/priorities/index.htm

Cochrane Collaboration www.cochrane.org

AltHealthWatch• www.epnet.com/TitleLists/html/aw_h1.htm

AMED• www.bl.uk/services/information/amed.html

eBMJ http://bmj.bmjjournals.com/cgi/collection/complementary_medicine

Major Domains of CAM

Alternative Health Care Systems Ayurvedic Medicine Chiropractic Homeopathic Medicine Native American Medicine Naturopathic Medicine Traditional Chinese Medicine

Major Domains of CAM

Mind-Body Interventions

Meditation Hypnosis Guided Imagery Dance Therapy Music Therapy Art Therapy Prayer and Mental Healing

Major Domains of CAM

Biological Based Therapies

Herbal Therapies Special Diets Orthomolecular Medicine

Major Domains of CAM

Therapeutic Massage, Body Work and Somatic Therapies Massage Feldenkrais Alexander Method

Major Domains of CAM

Two Additional Domains

Energy TherapiesQigongReikiTherapeutic Touch

BioelectromagneticMagnet Therapy

Future Prospects for CAM

Depends on evidence-base for safety and efficacy

Conventional and CAM may merge Collaborative Independent

Challenges Communication Certification and training Insurance reimbursement

Summary

Defining CAM History of CAM Major Domains of CAM Extent of Use Organizations, Certification, Training Selecting Practitioner

Types of CAM

Acupuncture and Chinese Medicine

Reflexology Chiropractic Naturopathy Natural Hygiene Iridology Homeopathy

Psychic Healing Occult Practices Astrology Biorhythms Meditation Yoga Therapy Visual Training Guided Imagery

Types of CAM

Alexander Technique

Aromatherapy Feldenkrais

Method Magnet Therapy Polarity Therapy

Radionics and Radiesthesia

Reiki Rolfing Clinical Ecology Chelation Therapy Holistic Medicine