Alternative Medicine

1
Alternative Medicine

• November 29th 2002
• Gil C. Grimes, MD

2
General Data

• The Diagnosis, treatment and/or prevention which
  complements mainstream medicine by contributing
  to a common whole, satisfying a demand not met by
  orthodoxy, or diversifying the conceptual
  frameworks of medicine
• Ernst E et al. Complementary medicine- a
  definition. BJ Gen Prac 1995, 45506

3
General Data

• Landmark Report 1998 random sample adults USA
• 42 used CAM in last year
• 17 herbal therapy
• 16 chiropractic
• 14 massage

4
General Data

• Austin 1998
• Random sample 1500 adults (80 white, 51 female
  30 high school ed or less)
• Have you used CAM in last year
• 40 Yes
• 16 chiropractic
• 8 lifestyle diet
• 7 exercise
• 7 relaxation

5
General Data

• Who is using?
• People with chronic health problems
• More common caucasian
• More common women
• More educated

6
General Data

• 13.7 billion unconventional therapy
• 10.3 billion (75) out of pocket
• 12.8 billion out of pocket for all
  hospitalizations in the United States
• 1990 data
• Eisenberg DM et al, N Engl J Med 1993 Jan
  28328(4)246-52

7
General Data

• Increase 45.2 between 1990 and 1997
• estimated at 21.2 billion 1997
• 12.2 billion paid out of pocket
• Eisenberg DM et al, JAMA 1998 2801569-1575

8
Getting the Truth

• Inforetriever
• Cochrane review
• National Center for Complementary and Alternative
  Medicine
• Alternative Medicine Homepage University of
  Pittsburgh
• British Homeopathic Library
• Natural Medicine Database

9
Type of CAM

• Herbal Medicine
• Acupuncture
• Nutrition
• Exercise
• Homeopathy
• Manipulation
• Massage
• Meditation

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Herbal Medicine

• Various Forms
• Crude plant preparations
• Dried specimen
• Aqueous extract
• Tinctures
• Active ingredients

11
Herbal Medicine

• Choosing the product
• Degree of purity
• Variation in potency
• Look for the following
• Lot number
• Expiration date
• Analysis of ingredients

12
Acupuncture

• 2000 year tradition
• Osler was aware of acupuncture
• Alters conduction of electromagnetic signals
• Alters neurotransmitters in brain
• TCM relates this to a release of the Qi that is
  blocked

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Acupuncture

• Efficacy
• Adult postoperative N/V (1b) JAMA
  19982801518-24
• Chemotherapy N/V (1b) JAMA 20002842755-61
• Chronic neck pain (1b)BMJ 20013221574
• Headache (cochrane)
• Menstrual cramps (cochrane)
• Tennis elbow, myofascial pain, carpal tunnel
  syndrome
• National Center for Complimentary and Alternative
  Medicine

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Acupuncture

• Trouble with blinding
• Sham Needles
• Blinding Evaluators

15
Exercise

• Benefits
• Improved respiratory
• Lower BP
• More efficient CO
• Increases insulin sensitivity
• Improves utilization of FFA from adipose

16
Exercise

• Physician advice
• Meta-analysis DARE abstract 971480 demonstrate
  efficacy of counseling
• Exercise Rx
• Type of activity (aerobic etc)
• Intensity (60-90 Max Heart rate)
• (220-Age) x 0.60 or 0.90 gives low and high end
  of target heart rate
• Work longer low end and short bursts in high end

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Exercise

• Exercise Rx
• Duration
• Inversely proportional to the intensity
• Rate fatigue one hour after exercise to judge
• Frequency
• 3-5 sessions per week
• No greater than 48 hours off

18
Exercise

• Three phases of exercise
• Warm up
• Conditioning
• Cool down
• Stretch some before and always after

19
Homeopathy

• Treats illness with progressively dilute
  substances that produce similar pattern of injury
• Treating like with like
• Therapy is individualized to the patient
• Meta-analysis of homeopathy trials Lancet
  1997350834-43

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Cystitis

• Cranberry
• Randomised trial of cranberry-ligonberry juice
  and Lactobacillus GG drink for the prevention of
  UTI in women. BMJ20013221-5 (LOE 1c)
• Glass of unsweetened cranberry juice a day
• NNT5 at 12 months to reduce frequnecy of UTI
  from 36 to 16

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Migraine

• Riboflavin
• 400 mg Riboflavin daily (LOA 1b)
• NNT 2.8 to reduce frequency of attacks per month
  (56 to 19)
• NNT 2.3 reduce headache days (59 to 15)
• Effectiveness of high-dose riboflavin in migraine
  prophyloaxis a randomized controlled trial.
• Neurology 1988 50466-70

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Morning Sickness

• Ginger root (LOE 1b)
• 250 mg powdered ginger root before meals and
  bedtime (1 gm per day)
• Small double blinded placebo controlled
  randomized trial
• Decreased vomiting
• Obstet Gynecol 2001 97577-82

23
Morning Sickness

• Vitamin B6
• 25- 50 mg 2-3 times daily
• Acupressure
• Wrist band on P6 point
• Reduced severity of nausea
• Cochrane Library, Issue 2, 2002

24
Osteoporosis

• Calcium and Vitamin D
• 500mg Ca and 700 IU Vit D (LOE 1b)
• Better bone density
• Fewer fractures over 3 years (5.9 vs 12.9)
• Effect of calcium and vitamin D supplementation
  on bone mineral density in men and women 65 years
  of age or older. NEJM 1997 337 670-6

25
Menopause

• Soy supplementation
• 60 gm soy protein daily (LOE 1b)
• Decreased frequency and severity of hot flushes
• The effect of dietary soy supplementation on hot
  flushes Ob Gyn 1998916-11

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Warts

• Podophyllum
• The rhizomes are used as a cathartic
• Resin extracted used as an irritant

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Closing

• Ask your patients
• Ask more than once
• Ask about vitamins or supplements