Audio version - CAM

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Complementary and Alternative Medicine (CAM)
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What is CAM?

• Complementary together with
• e.g., aromatherapy to help with pain after
  surgery
• Alternative in place of
• e.g., using garlic to lower blood pressure
  instead of meds

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Evidence-based vs. Holistic Medicine

• Focuses on outcomes
• Lowered BP via medication exercise

• Focuses on the whole person
• Lowered BP via herbs and meditation

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Integrative Medicine

• Combines traditional medicine CAM therapies -
  scientific evidence of safety effectiveness.
• Uses high-tech medicine sparingly
• Employs nutrition, exercise, stress-reduction and
  other simple, low-cost (or free) interventions
• Goal is to foster long-term health resilience
• E.g., acupuncture to lessen nausea along with an
  anti-nausea prescription medication

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Homeopathy

• Based on the principle that you can treat like
  with like.
• E.g., Coffeein small dosesuse to treat
  agitation sleeplessness
• Attempts to make the patients body more
  efficient at handling the problem at hand
• E.g., Desensitization therapy for allergies

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CAM Becomes Legit

• 1990
• Wilk et al v. AMA docs refer patients to CAM
  practitioners (e.g., chiropractors)
• 1991
• 2 million in funding to establish NIH Office of
  Alternative Medicine
• 1994
• Dietary Supplement Health and Education Act
• 1995
• NIH Office of Dietary Supplements
  http//ods.od.nih.gov/
• FDA declassifies Acupuncture needles as
  experimental product
• 1996
• NIH Consensus Conference on Acupuncture
• 1997
• First large trial of CAM therapy, St. Johns Wort
  for depression

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CAM Becomes Legit (contd)

• 1998
• National Center for Complementary Alternative
  Medicine (NCCAM) established http//nccam.nih.gov/
  
• First full scale article in JAMA on herbal
  medicine
• Office of Cancer Complementary and Alternative
  Medicine (OCCAM) established http//www.cancer.gov
  /cam/
• 2001
• CAM on PubMed (NCCAM and NLM)

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Diseases Conditions

1. Back pain or problem
2. Head or chest cold
3. Neck pain or problem
4. Joint pain or stiffness
5. Anxiety/depression
6. Arthritis, gout, lupus or fibromyalgia
7. Stomach or intestinal illness
8. Severe headache or migraine
9. Pregnancy (e.g., morning sickness)

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Top 6 CAM Remedies

• Prayer/spiritual healing
• Natural products dietary supplements
• Deep-breathing exercises
• Meditation
• Chiropractic medicine
• Yoga

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Top 10 Supplements

• Echinacea
• Ginseng
• Ginkgo biloba
• Garlic
• Glucosamine (e.g., osteoarthritis)

• St. Johns Wort
• Peppermint
• Fish oil/Omega 3
• Ginger
• Soy

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Supplement Safety

• Regulated by FDA
• No requirements for FDA clinical testing trials
• Manufacturers responsible for ensuring product
  safety
• Label requirements (not always consistent)
• Safety alerts http//www.cfsan.fda.gov/dms/ds-wa
  rn.html

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Avoiding Bad Science

• The One Product Does It All claim
• http//www.emuoilcanada.com/
• Personal Testimonials http//www.getslimslippers.c
  om/
• Quick Fixes/Cures
• http//www.cure-your-asthma.com
• The No Risk, Money-Back Guarantee
  http//www.naturalhpvcure.com/
• The Natural claim
• http//www.amtrueman.com/products.html

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Clinical Trials CAM

• Why are there so few CAM clinical trials?
• Drug companies must do studies to go on the
  marketsupplement companies do not.
• Alternative treatments are often customized for a
  specific person--clinical trials try to prove
  something works for most people.
• Belief systems of some CAM practitioners do not
  agree with the idea of Western studies.
• CAM has only recently become legit in the
  scientific community.

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Shelley et al. (2009) Patient-provider
Communication

• Patient-centered communication
• Results in closer agreement re treatment plans.
• Reduce misunderstandings btwn P-C.
• Uncover potential herb-drug interactions.
• Strengthen quality of P-C relationship.
• Provide opportunity to discuss TM/CAM.

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Shelley et al. (2009) Themes

• Acceptance non-judgment
• Rebuke by a clinician for using TM/CAM.
• Patients did not expect clinicians to be experts
  on CAM.
• Recognized limited access to knowledge about
  TM/CAM.
• Cultural differences
• Caution toward the efficacy, cost safety of
  TM/CAM (e.g., self-care vs. loss of patient).
• Clinicians commitment to do no harm open
  honest.
• Avoid contraindications

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Shelley et al. (2009) Themes re Perceptions
(contd)

• Initiation of Communication
• Patients preferred clinicians to initiate TM/CAM
  discussion.
• If they dont ask, I dont tell them.
• Docs dont perceive high levels of TM/CAM use.
• Insufficient provider understanding to discuss
  practices.
• Phrasing of specific questions is important to
  patients.
• Time constraints in brief clinical encounter.

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Shelley et al. (2009) Themes re Perceptions
(contd)

• Safety and Efficacy Concerns
• Views re safety efficacy of TM/CAM
• Lack of scientific evidence re effectiveness
• Dissuading patient use of TM/CAM all together