Alternative Medicine

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Alternative Medicine
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What is Alternative Medicine

• the various disease treating or
  disease-preventing practices whose methods and
  efficacy differ from traditional or conventional
  biomedical knowledge (Kaplan Sadock, 1998, p.
  829)
• Complementary Medicine
• Holistic Medicine

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OAM Classification of Alternative Medicine
Practices (Table 29-1 in text)

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Methods of AM
Megavitamin and Orthomolecular Therapy Diet
Therapy Biologics Clinical Ecology and
Environmental Medicine Hypnotherapy Relaxation
Meditation and Mindfulness Transcendental
Meditation Imagery Radionics Music
Therapy Sound Healing Art Therapy Light
Therapy Prolotherapy EDTA Chelation
Therapy Behavioral Kinesiology Electrodermal
Diagnostics Magnetic Therapy Natural
Hygiene Cayce-Based Therapy
Psychic Surgery Medical Acupuncture Phytomedici
ne Shamanistic Practices Spiritual
Healing Bioelectricmagnetic Effects on Health
and Disease Massage Other Bodywork
Approaches (Rolfing, Alexander, Feldenkrais,
Orthobionomy, Trager, Reflexology) Therapeutic
Touch Qigong Yoga Other Energy
Approaches (Reiki, Shen, Polarity, Wirkus,
Brennan) Cranial/Sacral Therapies Bioenergetics
and Orgonomic Medicine Biofeedback Neurobiofeedb
ack Behavioral Medicine
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Unconventional Medicine

• Popular
• 1/3 of Americans use
• more visits than to primary care (425M)
• "minor" - self care, weight loss, pediatrics
• 50 of cancer patients
• Sophisticated AIDS users
• More than 15 billion a year spent in the US
• Concealed - 72 don't talk about it to doctor
• Combined - 83 used conventional treatment

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Physician Use of CAM
N572
Blumberg DL, ATHM, 1(3)31 (1995)
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Physician Use of CAM
N572
Blumberg DL, ATHM, 1(3)31 (1995)
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Growth of CAM Studies
9000
8000
7000
MEDLINE Citations Under Alternative Medicine 196
6-1995
6000
5000
4000
12 per year
3000
2000
1000
0
66-74
75-79
80-84
85-89
90-95
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Is AM "Non-scientific" Practice?

• Conventional scientific base
• 20 - 50 backed by quality research
• Herbal medicine
• Ginkgo biloba
• Hypericum
• garlic, ginseng, echineacca, ginger, cranberry
• Mind/Body and Behavioral medicine Diet and
  Nutritional Supplements
• Homeopathic
• 150 controlled clinical trials
• 15-20 of studies "good"

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Why Patients Use Complementary Medicine

• Value whole person emphasis
• Orthodox treatment didnt work
• Adverse effects of orthodox medicine
• Active participation in treatment
• Poor doctor communication

Vincent, C. 1996 Why do patients turn to
complementary medicine? An empirical study.
British Journal of Clinical Psychology 3537-48
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Myths About Complementary Medicine Users

• Disillusioned with medicine in general
• Anti-science
• Largely motivated by lower cost
• Using it because it was available only
• Unusual characteristics or attitudes from
  non-users

Vincent, C. 1996 Why do patients turn to
complementary medicine? An empirical study.
British Journal of Clinical Psychology 3537-48
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Concerns with Conventional Medicine

• Cost (14 of GNP)
• Safety (11 of hospitalizations iatrogenic)
• The Burden of Chronic Illness
• Depersonalization
• Role of Science in Medicine

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Is AM Safe?

• Natural Medicine
• Direct toxicity occurs
• Indirect effects
• Little is known

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Independent Laboratory Analysis of Leading Garlic
Products
Product
allicin/tablet
allicin/tablet
S-allylcysteine/tablet
19,800 mcg
7,500 mcg
6,500 mcg
A
4,920 mcg
10,853 mcg
234 mcg
B
C
4,625 mcg
12,837 mcg
3,055 mcg
7,370 mcg
508 mcg
D
3,300 mcg
E
3,150 mcg
8,480 mcg
1,750 mcg
F
1,45 8 mcg
3,240 mcg
378 mcg
G
740 mcg
1,560 mcg
185 mcg
H
0 mcg
0 mcg
1,500 mcg
I
0 mcg
0 mcg
0 mcg
Murray, M.T. The American Journal of Natural
Medicine. 1995 2(5)5-7.
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Is AM Personal?

• Understandable Esthetic
• Time - 7 vs. 30 minutes
• Psychological - 60
• High - touch? - care and healing
• Partnership? - complementary

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Evaluation Guidelines

• Get a three part education
• Understand the concepts thoroughly
• Evaluate the data critically
• Experience the practice openly
• Take a deeper look
• Scientific - strength/likelihood of attribution
• Pragmatic - benefit/magnitude of effect
• Use good methods of evaluation
• Define the detail, not just label the system
• Distinguish underevaluated from ineffective

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Look at the Research

• Evaluate the study
• Efficacy?
• Randomized trial?
• all outcomes reported?
• clinical significance?
• statistical significance?
• complete follow-up achieved?
• study patients broad or similar
• to yours?
• treatment feasible?

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Office of Alternative Medicine (OAM)

• General - facilitate research in CAM
• Evaluation
• Investigation
• Validation
• Specific
• Information Clearinghouse
• Research Training Program
• Good resource for researching and evaluating AM

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OAM Clearinghouse Information Requests by
Disease/Condition December 1996 -September 1997
AIDS/HIV 1
Arthritis 2
Respiratory Condtions 1
Chronic Pain 2
Other 37
Cancer 57
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Physician Responsibilities

• Protect
• toxic therapies - meditation vs. megavitamins
• ineffective therapies - if substituted for
  effective
• Permit
• safe, inexpensive - homeopathy vs. herbalism vs.
  clinical ecology
• chronic disease management (non-specific effects)
• Promote
• safe and effective? - P6 for nausea relaxation
  for pain
• mechanism ? - endogenous opiods in acupuncture
• Partner
• communicate with patient
• co-manage illness provide the input on
  evidence

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Hypernicum (St. Johns Wart)

• 50-80 of depressed patients have significant
  decrease in symptoms of depression and a
  corresponding increase in well-beingsimilar to
  traditional antidepressants
• Side effects are few and mild
• Lower cost than prescription antidepressants
• Available without a prescription
• Regularly taken in Germany
• One of the most widely researched (and
  promising?) herbal medicines
• Do not take with MAOIs.
• Cautionadvise against taking with other
  antidepressants.may work as an SRI???

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Hypericum vs. Imipramine
Harrer, G. Phytomedicine. 199413-8.
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Misc.

• Kava Kava
• Ginkgo Biloba
• Others?
• What have people tried?
• What are your experiences with alternative
  medicine?
• Supplements?
• Massage?
• Yoga, Tai Chi, Relaxation, Hypnosis?