Consumer Health

1
Consumer Health

• Complementary and Alternative Medicine (CAM)

2
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

3
BMJ VOLUME 324 13 APRIL 2002 bmj.com
4
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

5
Complementary and Alternative Medicine

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

6
Defining CAMOriginal Definition

• National Library of Medicine
• Unrelated group of non-orthodox therapeutic
  practices
• Often with explanations not following
  conventional biomedical explanations
• No satisfactory scientific explanation for
  effectiveness
• Another old definition
• Medical interventions not taught in US

7
Defining CAMNew Definition

• National Library of Medicine
• Complementary Medicine
• Alternative
• Therapeutic practices not considered an integral
  part of conventional allopathic medical practice
• May lack biomedical explanation
• Could become accepted or not

8
Defining CAM

• Complementary Medicine
• Therapies used in addition to conventional
  treatments
• Alternative
• Therapies used instead of conventional treatment

9
Defining CAMDifferences 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

10
Major Domains of CAMAlternative Health Care
Systems

• Ayurvedic Medicine
• Chiropractic
• Homeopathic Medicine
• Native American Medicine
• Naturopathic Medicine
• Traditional Chinese Medicine

11
Major Domains of CAMMind-Body Interventions

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

12
Major Domains of CAMBiological Based Therapies

• Herbal Therapies
• Special Diets
• Orthomolecular Medicine

13
Major Domains of CAMTherapeutic Massage, Body
Work and Somatic Therapies

• Massage
• Feldenkrais
• Alexander Method

14
Major Domains of CAMTwo Additional Domains

• Energy Therapies
• Qigong
• Reiki
• Therapeutic Touch
• Bioelectromagnetic
• Magnet Therapy

15
History of CAM

• Mid-19th Century
• Botanical healers, midwives, chiropractors,
  homeopaths
• 1892
• The Principles and Practice of Medicine
• 1910
• Flexner Report

16
History of CAM

• Early 20th Century
• Drugs and antibiotics introduced
• CAM unscientific relics of the past
• Mid-20th Century
• Chronic, degenerative diseases
• Significantly longer lives
• Health care costs (See next slide)

17
History of CAM

• Mid-20th Century
• Chronic, degenerative diseases
• Significantly longer lives
• Health care costs

18
History of CAM

• 1950s 1970s
• Medical pluralism reemerges
• Whole foods and dietary supplement movements
• Exposure to traditional health care systems
• Counterculture movement
• Holistic health care movement
• Nurses and family physicians

19
History of CAM

• 1970s 1980s
• Self-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

20
Consumer Use of CAM

• 43 of US population
• Due to chronic conditions
• Most frequent users
• Cancer, chronic pain, HIV
• Ethnic populations
• Dietary Supplements
• 158 million users
• 17,000,000

21
Reasons for Using CAM

• Characteristics of users
• Interest in spirituality and personal growth
• Commitment to environmentalism
• Feminism
• Internal locus of control
• Transformational experiences

22
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

23
Reasons for Using CAM

• Perceived poor health status
• Perceived poor emotional functioning
• Musculoskeletal disorder
• Back pain

24
CAMs Used

• Chiropractic 35
• Herbal Remedies and supplements 27
• Massage Therapy 17

25
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

26
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

27
Ethnic Differences in Use of CAM

• Mexican-American and Hispanic, and Native
  Americans
• At least once in last year 50
• Herbal medicine, spiritual healing, traditional
  healers

28
Conventional Medicine Use of CAM

• Give referrals to
• Acupuncture 43
• Chiropractic 40
• Massage 21
• Practiced by them
• Chiropractic 19
• Massage 19
• Homeopathy 9

29
Conventional Medicine Belief in Efficacy of CAM

• Believe in efficacy of
• Acupuncture 51
• Chiropractic 53
• Massage 48
• Others
• Homeopathy 25
• Herbal approaches 13

30
Conventional Medicine Use of CAM

• Insurance Companies
• Medical Schools
• Hospitals

31
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

32
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

33
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

34
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/compleme
  ntary_medicine

35
Major Domains of CAMAlternative Health Care
Systems

• Ayurvedic Medicine
• Chiropractic
• Homeopathic Medicine
• Native American Medicine
• Naturopathic Medicine
• Traditional Chinese Medicine

36
Major Domains of CAMMind-Body Interventions

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

37
Major Domains of CAMBiological Based Therapies

• Herbal Therapies
• Special Diets
• Orthomolecular Medicine

38
Major Domains of CAMTherapeutic Massage, Body
Work and Somatic Therapies

• Massage
• Feldenkrais
• Alexander Method

39
Major Domains of CAMTwo Additional Domains

• Energy Therapies
• Qigong
• Reiki
• Therapeutic Touch
• Bioelectromagnetic
• Magnet Therapy

40
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

41
Summary

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

42
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

43
Types of CAM

• Alexander Technique
• Aromatherapy
• Feldenkrais Method
• Magnet Therapy
• Polarity Therapy

• Radionics and Radiesthesia
• Reiki
• Rolfing
• Clinical Ecology
• Chelation Therapy
• Holistic Medicine