Complementary and Alternative Medicine
- 1. COMPLEMENTARY,ALTERNATIVE AND INTEGRATED HEALTH PRACTICES DR BHAVIN S MANDOWARA MD MEDICINE RESIDENT
- 2. –“Imagine a world - oriented toward healing rather than disease, where physicians believed in the natural healing capacity of human beings, and emphasized prevention above treatment. – In such a world, doctors and patients would be partners working toward the same ends.”
- 3. OUTLINE •LEARNING OBJECTIVES •DEFINITION AND SCOPE •TRMINOLOGY OF CAM PRACTICES •PATTERN OF USE •PRACTIONER BASED DISCIPLINES •MIND-BODY INTERVENTIONS •DIETARY SUPPLEMENTS •PATIENT AND PROVIDER RESOURCES •INTEGRATED MEDICINE •TAKE HOME MESSAGES •
- 4. WHY A PHYSICIAN SHOULD KNOW ABOUT CAM ? • Physicians are important sources for information and guidance about health matters, but our patients also rely on a wide range of other sources including family and friends, cultural traditions, alternative practitioners, and increasingly the Internet, popular media, and advertising. It is essential for physicians to understand what patients are doing to seek health, as this under-standing is important to harness potential benefits and to help patients avoid harm. • •
- 5. LEARNING OBJECTIVES • COMPARE CAM TO CONVENTIONAL MEDICINE • HOW CAM AND CONVENTIONAL MEDICINE CAN BE USED TOGETHER (INTEGRATED MEDICINE) • VARIOUS TYPES OF CAM • HOW A PHYSICIAN USE HIS KNOWLEDGE OF CAM • WHY ARE PATIENTS AND HEATH CARE PRACTIONERS TURNING AWAY FROM CONVENTIONAL MEDICINE • REGULATIONS OF CAM
- 6. •Figure 17.1 l Reasons Adults Use CAM
- 7. WHY ARE PEOPLE TURNING AWAY FROM MAINSTREAM MEDICINE ? • CAM offer optimism or greater personal attention and provide 3 T’s : Time , Talk and Touch • CAM is less expensive , have fewer side effects and is more easily accessible • Patient has“self-help” approach to health and wellness • It satisfies a search for “NATURAL” or less invasive alternatives • Promise of “MIRACLE CURES” and quick results.
- 8. WHY ARE PEOPLE TURNING AWAY FROM MAINSTREAM MEDICINE ?(…cont inued) • Symptoms often poorly controlled by conventional care, particularly back pain and other painful musculoskeletal complaints, anxiety, and insomnia. • Failure or dissatisfaction with conventional healh provider • High health costs • To treat side effects of drugs and treatment • Focus on spirituality and emotional well being • Ignorance and inadequate knowledge regarding disease . • • •
- 9. IS THERE A COMMON FRAME OF REFERENCE WHICH WILL EXPLAIN BASIS OF WORKING OF ALL MEDICAL SCIENCES?
- 10. Why do patients not tell their physician about their CAM use? • 60% - “My doctor never asked.” • 60% - “It wasn’t important for my doctor to know.” • 20% - “My doctor wouldn’t understand.” • 14% - “My doctor would disapprove.” 70% of patients see their Physician before or concurrent with their visits to a CAM provider Eisenberg DM. Ann Int Med 2001;135(5):344-51 •
- 11. DEFINITION AND SCOPE •The phrase complementary and alternative medicine (CAM) is used to describe group of diverse medical and health care systems , practices and products that have historic origins outside mainstream medicine . •Alternative medicine is any practice that is perceived by its users to have healing effects of medicine but does not originate from evidence based scientific method and is not a part of biomedicine •
- 12. DEFINITION AND SCOPE • Alternative Medicine differs in that it is not used as a complement but as a “substitute” for conventional therapy . • Complementary Medicine is alternative medicine used together with conventional medicine. i.e. it “complements” the treatment • Integrated medicine …discussed later •
- 13. HOW MANY PEOPLE ARE USING CAM WORLDWIDE ? • In United states surveys, approximately 40% of adults report using some form of complementary therapy or health practice. In the 2007 study, 38% of adults and 12% of children had used one or more modalities. These surveys yield the estimate that non-vitamin and non-mineral dietary supplements are used by approximately 18% of the population. The most prevalent mind-body practices are relaxation techniques and meditation, chiropractic, and therapeutic massage.
- 14. HOW MANY PEOPLE ARE USING CAM WORLDWIDE ? • Americans are willing to pay for these services; the estimated out-of-pocket expenditure for complementary health practices in 2007 was $34 billion, representing 1.5% of total health expenditures and 11% of out-of-pocket costs. • 30,000 herbs on the market currently • Estimates of $30-40 billion dollars spent annually. • 600 Million Visits a Year to CAM Providers – More Than to Primary Care Providers •
- 15. Complementary and Alternative MedicineCAM STATISTICS
- 17. Complementary and Alternative MedicineCAM STATISTICS
- 18. Complementary and Alternative MedicineCAM STATISTICS
- 19. TERMINOLOGY OF CAM PRACTICES •MIND BODY PRACTICES •TRADITIONAL MEDICAL SYSTEMS •MODERN MEDICAL SYSTEMS
- 20. MIND BODY PRACTICES •ACCUPUNCTURE AND ACUPRESSURE •ALEXANDER TECHNIQUE •GUIDED IMAGERY •HYPNOSIS •MASSAGE •MEDIDATION •REFLEXOLOGY •ROFLING / STRUCTURAL INTEGRATION •SPINAL MANIULATION •TAI CHI •THERAPEUTIC TOUCH •YOGA
- 21. TRADITIONAL MEDICAL SYSTEMS •AYURVEDIC MEDICINE •CURANDERISMO •NATIVE AMERICAN MEDICINE •SIDDHA MEDICINE •TIBETIAN MEDICINE •TRADITIONAL CHINESE MEDICINE •UNANI MEDICINE
- 22. MODERN MEDICAL SYSTEMS •ANTHROOSOHIC MEDICINE •CHIROPRACTIC •HOMEOPATHY •NATUROPATHY •OSTEOPATHY
- 23. ACCUPUNCTURE AND ACUPRESSURE ACCUPUNCTURE STIMULATION OF DEFINED ANATOMIC POINTS ACUPRESSURE INSERTION OF AND MANIPULATION OF THIN METALLIC NEEDLES
- 24. ACUPRESSURE
- 25. ACUPRESSURE
- 26. ACCUPUNCTURE
- 27. ALEXANDER TECHNIQUE A MOVEMENT THERAY THAT USES GUIDANCE AND EDUCATION TO IMROVE POSTURE , MOVEMENT AND EFFICIENT USE OF MUSCLES FOR IMPROVEMENT OF BODY FUCNTIONING .
- 28. GUIDED IMAGERY The use of relaxation techniques followed by the visualization of images, usually calm and peaceful in nature, to invoke specific images to alter neurologic function or physiologic states
- 29. HYPNOSIS The induction of an altered state of consciousness characterized by increased responsiveness to suggestion
- 30. MASSAGE Manual therapies that manipulate muscle and connective tissues to promote muscle relaxation, healing, and sense of well being
- 31. MEDITATION A group of practices, largely based in Eastern spiritual traditions, intended to focus or control attention and obtain greater awareness of the present moment, or mindfulness
- 32. REFLEXOLOGY Manual stimulation of points on hands or feet that are believed to affect organ function
- 33. ROFLING/STRUCTURAL INTEGRATION A manual therapy that attempts to realign the body by deep tissue manipulation of fascia
- 34. SPINAL MANIPULATION A range of manual techniques, employed by chiropractors and osteopaths, for adjustments of the spine to affect neuromuscular function and other health outcomes
- 35. TAI-CHI A mind-body practice originating in China that involves slow, gentle movements and sometimes is described as “moving meditation”
- 36. THERAPEUTIC TOUCH Secular version of the laying on of hands, described as “healing meditation”
- 37. YOGA An exercise practice, originally East Indian, that combines breathing exercises, physical postures, and meditation
- 38. AYURVEDIC MEDICINE The major East Indian traditional medicine system; treatment includes meditation, diet, exercise, herbs, and elimination regimens using emetics and diarrheals
- 39. CURENDERISMO A spiritual healing tradition common in Latin American communities that uses ritual cleansing, herbs, and incantations
- 40. NATIVE AMERICAN MEDICINE Diverse traditional systems that incorporate chanting, shaman healing ceremonies, herbs, laying on of hands, and smudging (ritual cleansing with smoke from sacred plants)
- 41. SIDDHA MEDICINE An East Indian medical system (prevalent among Tamil-speaking people
- 42. TIBETIAN MEDICINE A medical system that uses diagnosis by pulse and urine examination; therapies include herbs, diet, and massage
- 43. TRADITIONAL CHINESE MEDICINE A medical system that uses acupuncture, herbal mixtures, massage, exercise, and diet
- 44. UNANI MEDICINE An East Indian medical system, derived from Persian medicine, practiced primarily in the Muslim community; also called ‘hikmat’.
- 45. Anthroposophic medicine A spiritually based system of medicine that incorporates herbs, homeopathy, diet, and a movement therapy called Eurythmy
- 46. CHIROATHY Chiropractic care involves the adjustment of the spine and joints to alleviate pain and improve general health; primarily used to treat back problems, musculoskeletal complaints, and headaches
- 47. HOMEOPATHY A medical system with origins in Germany that is based on a core belief in the theory of “like cures like”—compounds that produce certain syndromes, if administered in very diluted solutions, will be curative
- 48. HOMEOPATHY Homeopathic medicine Treating syndromes and conditions with remedies that produce similar syndromes and conditions in healthy people Produces the symptoms it is given to treat in order to stimulate the body’s natural defenses to heal itself Looks at individuals , not diseases
- 49. NATUROPATHY A clinical discipline that emphasizes a holistic approach to the patient, herbal medications, diet, and exercise; practitioners have degrees as doctors of naturopathy
- 50. OSTEPOATHY A clinical discipline, now incorporated into mainstream medicine, that historically emphasized spinal manipulative techniques to relieve pain, restore function, and promote overall health
- 51. Integrative Medicine •“Integrative medicine is the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches to achieve optimal health and healing.”
- 52. The Future of Integrative Medicine Our Patients Will Demand Integrative Medicine From All of Us Training Will Be Demanded by Medical Students Training Will Be Demanded by Residents Integrative Medicine Will Be A Skill Set Added on Just Like: Electronic Health Records New Medications New Procedures
- 53. •Figure 17.3 l ASSESSING THE RISKS AND BENEFITS OF CAM TREATMENTS
- 55. TAKE HOME MESSAGES 1.Be non-judgmental despite personal opinions 2. Build rapport by showing patient respect – if not, he may be afraid to tell about CAM use 3. Understand that C.A.M. can be beneficial, when used correctly 4. Be aware that C.A.M. can be dangerous if it interacts or interferes with conventional treatment 5. Be willing to teach the public about the positive and negative information regarding C.A.M. 6. Be aware that use of C.A.M. is popular and increasing and must be included in the history & physical 7. Know that Herbals, in particular, can have significant effect on prescription drugs and body function
Editor's Notes
- #52: Acupuncture Consult in the HTU