chapter © 2011 the mcgraw-hill companies, inc. all rights reserved. 13 complementary and...

CHAPTER

© 2011 The McGraw-Hill Companies, Inc. All rights reserved.

13Complementary and Alternative Medicine


13-2

Learning Outcomes

13.1Explain CAM.

13.2Distinguish between complementary and alternative medicine and conventional medicine.

13.3Summarize how CAM and conventional medicine are used together.

13.4 Identify various types of complementary and alternative medicine.


13-3

Learning Outcomes (cont.)

13.5Describe how a medical assistant may use his or her knowledge of CAM.

13.6Explain why patients and health-care practitioners are turning to complementary treatments.

13.7Compare insurance and payment for CAM treatments.

13.8Explain how CAM is regulated.

13.9Describe health fraud.


13-4

Introduction

• More than 30% of adults use complementary and alternative therapies– Relieve problems– Promote wellness– No relief from traditional treatments

• Some physicians use a combination of CAM and traditional therapies


13-5

What Is CAM?

• A group of practices and products that are not part of conventional medicine

• Allopathy – conventional medicine or common and usual practice

• Complementary medicine – used with conventional medicine

• Alternative medicine – used instead of conventional medicine


13-6

What Is CAM? (cont.)

• Scientific evidence concerning safety and effectiveness – Available for some CAM therapies– Research continues, so information changes

• Integrative medicine – Evolves as CAM therapies are adopted by

conventional medicine– Combination of both


13-7

Apply Your Knowledge

Define CAM and state why these therapies are not in wide use by practitioners of conventional medicine.

ANSWER: CAM is a group of practices and products not considered part of conventional medicine. They are not widely used by physicians because there is not a lot of scientific evidence of their safety and effectiveness.


13-8

Types of CAM• Shared similarities

– Individualized treatments, good nutrition, and preventive health practices

– Holistic– Promote self-care and

self-healing– Recognition of one’s

spiritual nature

• Categories – Alternative medical

systems– Mind-body

interventions– Biologically-based

therapies– Manipulative and

body-based methods– Energy therapies


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Alternative Medical Systems

• Evolved apart from conventional medicine• Homeopathic medicine

– Treating syndromes and conditions with remedies that produce similar syndromes and conditions in healthy people

– Remedy • Produces the symptoms it is given to treat in order

to stimulate the body’s natural defenses to heal itself

• Must meet FDA standards


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Alternative Medical Systems (cont.)

• Homeopathic medicine– Looks at individuals, not diseases

• Initial in-depth assessment • Follow-up – how they are responding

– Medical assistant role• Similar to other medical offices• Have knowledge of common remedies


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• Naturopathic medicine – Relies on the healing power of the body to

establish, maintain, and restore health– Primary health care

• Nutritional/lifestyle counseling• Dietary supplements/medicinal plants• Exercise• Homeopathy/traditional Chinese medicine


13-12


• Naturopathic medicine– Medical assistant – understanding of

treatments– Traditional Chinese medicine

• Balanced qi (vital energy)• Flow of qi along meridians (energetic pathways)• Acupuncture – insertion of hollow needles along

meridians

– Ayurveda – provides guidance regarding food and lifestyle; India


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Mind-Body Interventions

• Enhance the mind’s capacity to affect bodily function and symptoms

• Support groups and cognitive-behavioral therapy now part of traditional medicine

• Scientific support – Placebo effect – WW II– 35% of therapeutic response is due to belief


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Mind-Body Interventions (cont.)

• Most commonly used forms of CAM

• Types– Prayer

– Yoga

– Meditation

– Hypnosis

– Biofeedback


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Biologically Based Therapies

• Use substances found in nature– Dietary supplements– Herbal products– Foods

• Medical assistant– Keep up-to-date about dietary and herbal

products– Be able to provide reliable resources for

patients


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Biologically Based Therapies (cont.)

• Dietary supplements– Manufacturers – no evidence of effectiveness

or safety

– No standardization to ensure consistency and quality

– Types • Vitamins• Minerals • Herbals – no established recommended daily

amount

Recommended daily amount established by the FDA


13-17

Biologically Based Therapies (cont.)

• Patient education for using supplements– Report all supplements as they would

prescription medications– Take supplement bottles to appointments

• Document patient’s use of supplements in the medical record


13-18

Manipulative and Body-Based Methods

• Based on the manipulation and/or movement of one or more parts of the body

• Types – Massage therapy– Chiropractic manipulation – Reflexology– Alexander technique– Bowen technique

– Craniosacral therapy– Feldenkrais method– Rolfing– Trager bodywork– Tui Na


13-19

Manipulative and Body-Based Methods (cont.)

• Massage – Pressure, kneading, stroking, vibration,

and tapping to positively affect health

– Effects • Relaxation• Counteracts effects

of stress• Lowers heart rate and

blood pressure

• Reduces pain/relaxes muscle spasms

• Improves concentration• Promotes restful sleep• Helps the mind relax


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• Swedish massage– Stimulates circulation

and lymph flow– 5 basic strokes

• Neuromuscular massage– Releases tension,

relieves pain and pressure on nerves, and increases blood flow

– Trigger point therapy

• Seated massage– Focuses on back and neck


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• Chiropractic medicine – Adjustments

• Manual treatments to re-align the vertebra and restore function of spinal nerves

• Chiropractor – Performs an exam

and takes a history– Tests

• X-rays• Muscle testing• Analyzes posture


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Energy Therapies

• Bioelectromagnetic-based therapies– Balances the electromagnetic fields of the

body– No scientific evidence of efficacy– Magnetic therapy

• Most common type• Magnets are used to correct disturbances of

electromagnetic fields and restore health • FDA – no medical value but relatively harmless• Avoid for patients with pacemaker or defibrillator


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Energy Therapies (cont.)

• Biofield therapies

• Manipulate energy field surrounding the body

• Reiki – Based on qi– Visualization and touch

balance energy flow to bring healing energyto organs and glands

• Therapeutic touch– “Laying-on of hands”

– Hands direct human energies to help or heal

– No scientific evidence of efficacy


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Match to types of CAM:

___ Therapeutic touch A. Energy therapies

___ Chiropractic medicine B. Mind-body therapies

___ Dietary supplements C. Body-based therapies

___ Yoga and meditation D. Biologically-based therapies

___ TCM E. Alternative medical systems

___ Herbal supplements

___ Homeopathy/naturopathy

___ Magnetic therapy

___ Hypnosis

___ Massage

E

E

D

D

ANSWER:

A

C

C

B

B

A


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Patients Seeking CAM Therapy

• Use is increasing

– Less expensive

– Have fewer side

effects

– More accessible

– Increase in spirituality

– Personal growth

– Environmentalism

– Preventive health care

• Reasons for seeking CAM therapy– Failure of traditional

medical interventions– Treat side effects of

conventional medicine’s treatments


13-26

Patients Seeking CAM Therapy (cont.)

• Patients with chronic debilitating conditions– Improve quality of life– Improve ability to cope with stress and illness

• Cultural differences in CAM use– Hispanics – Native Americans

• Accept patient’s right to choose CAM therapy


13-27

Patients Seeking CAM Therapy (cont.)

• Use of CAM in children on the increase– Safety – children

respond differently– Efficacy in children not

established– Identify and document

if CAM is used


13-28


Mr. State is complaining about chronic back pain. He says that the medication only helps a little and asks you if there is anything else you could recommend that will help him. What should you tell him?

ANSWER: If your employer is not averse to CAM therapies, you can tell him that there are CAM therapies that may help with the pain or at least help him cope better with it. He could try mind-body techniques, acupuncture, manipulative and body-based techniques, or energy therapies.


13-29

Insurance and CAM

• Coverage varies – Lack of research and documentation of

efficacy– Emphasis on physiological or biochemical

response to therapies

• Alternative health insurance companies emerging in response to need


13-30

Insurance and CAM (cont.)

• Medical assistant– Know whether or not CAM

treatments are covered by insurance

– Resources • Insurance companies• State agency that regulates the insurance industry


13-31

Regulation of CAM Therapies

• National Center for Complementary and Alternative Medicine (NCCAM)– Research – Training and career development– Conferences and educational programs– Integration of scientifically proven CAM

therapies into conventional medicine


13-32

Regulation of CAM Therapies (cont.)

• White House Commission on Complementary and Alternative Medicine Policy (WHCCAMP)

– Funding for research– Communication between CAM and

conventional practitioners– Availability of CAM practitioners– State review and evaluation of CAM

practitioners– Insurance coverage options


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1. Why do insurance companies not reimburse for most CAM therapies?

ANSWER: Insurance companies do not reimburse for CAM therapies because of the lack of research and documentation of effectiveness of these therapies.

2. What are the federal agencies tasked with regulation of CAM therapies?

ANSWER: They are the NCCAM and WHCCAMP.

Yippee! 2 for 2!

ANSWER: They are the NCCAM and WHCCAMP.


13-34

Health Fraud

• Articles of unproven effectiveness promoted to improve health, well-being, or appearance– Deception or trickery for profit– Plays on emotions and desperation

• Regulation – FDA – safety, manufacturing, and labeling– FTC – advertising


13-35

Health Fraud (cont.)

• Health claims–Unproven claims must

include a disclaimer

–FDA-approved claims for food and supplements• Based on scientific evidence

• Only reduces risk/does not treat or cure


13-36


FDA-Approved Health Claim

Supplement/Food

Reduce risk of some cancers

• Low-fat diets• Fruits, vegetables, fiber-containing grain products• Whole grains

Reduce risk for hypertension

• Low-sodium diets• Potassium

Reduce risk for osteoporosis

• Calcium


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FDA-Approved Health Claim

Supplement/Food

Reduce risk of heart disease

• Low-sodium diets• Decreased saturated fat and cholesterol• Soluble fiber and whole grains• Soy protein/plant sterols/stanol esters

Reduce risk for neural tube defects

• Adequate folate

Reduce tooth decay • Decreasing between-meal consumption of foods high in sugars and starches


13-38


• Recognizing health fraud – Check with the BBB or attorney general’s

office– Check with appropriate health-care group– Contact the FDA– If it sounds to good to be true, it probably is

not true– If unproven, get a second opinion– Beware of “secret cures”


13-39


Why do people fall victim to fraudulent health claims?

ANSWER: These claims target people who are emotional and desperate. They are hoping to find a cure, improve their health, or just look better.

Bravo!


13-40

In Summary

13.1 Complementary and alternative medicines are practices and products outside the scope of traditional or conventional medicine.

13.2 Complementary medicine is used in conjunction with conventional medicine. Alternative medicine is typically used as a replacement for conventional medicine.


13-41

In Summary (cont.)

13.3 A new type of medicine called integrative medicine has emerged, in which conventional medicine and scientifically proven CAM therapies are used together.

13.4 There are five classifications for CAM. They include alternative medical systems, mind-body interventions, biologically-based therapies, manipulative and body-based methods, and energy. Each of these classifications has various types of products and therapies associated with it.


13-42

In Summary (cont.)

13.5 As a medical assistant, it is your responsibility to have basic knowledge of CAM therapies. If you work with a practitioner that provides CAM therapies, you will be responsible to assist in many cases. Additionally, understanding insurance reimbursement for CAM and health fraud are important aspects of the medical assistant’s role.


13-43

In Summary (cont.)

13.6 In many cases, patients are looking for low-cost products and services that help to maintain health and prevent disease, so they turn to CAM. Other patients that are offered no effective treatment or cure from conventional medicine are turning to CAM for additional options. Health-care practitioners are using many types of complementary therapy as they become accepted and, in many cases, scientifically proven.


13-44

In Summary (cont.)

13.7 In general, the insurance industry provides little or no coverage for CAM therapies. To find out if coverage is provided, you can contact the insurance company directly, obtain information from the association’s web site for the type of therapy provided, or contact the state insurance commissioner.


13-45

In Summary (cont.)

13.8 The NCCAM conducts and supports CAM research and provides CAM information to health-care providers and the public. Some state and federal laws have been enacted to help regulate CAM, and more laws and regulations are expected as research is conducted.

13.9 Health fraud as defined by the FDA as “articles of unproven effectiveness that are promoted to improve health, well being, or appearance.” Health fraud is monitored by the FDA and the FTC.


13-46

There is a magnet in your heart that will attract true friends. That magnet is unselfishness, thinking of others first; when you learn to live for others, they will live for you.

~ Paramahansa Yogananda

End of Chapter 13

chapter © 2011 the mcgraw-hill companies, inc. all rights reserved. 13 complementary and...

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