Alternative Medicine

1
Alternative Medicine

• Stevan Cordas DO MPH

2
Stevan Cordas DO MPH

• Certified internal medicine
• Certified disability examiner
• Certified occupational medicine
• Certified allergy-immunology
• CME committee on Bioterrorism Texas Department of
  Health
• Private practice Hurst, Texas

3
Alternative Practices

• Complementary and alternative practices (CAM) are
  those healthcare and medical practices that are
  not currently an integral part of conventional
  medicine.

4
Definition of CAM

• NIH definition is
• Those treatments and healthcare practices not
  taught widely in medical schools,
• not generally used in hospitals, and.
• not usually reimbursed by medical insurance
  companies.

5
Also Known As

• Quackery
• Unscientific
• Integrative
• Complementary
• Non-traditional
• Non-conventional

6
Complementary Verses Alternative

• Complementary or integrative medicine implies
  that the provider does not reject the standard
  medical system but employs both orthodox and
  alternative methods.
• Alternative medicine implies that an alternate
  method of non-traditional healing is being used
  which excludes orthodox medical methods.

7
NIH NCCAMDefinition of Conventional Medicine

• The term conventional medicine refers to
  medicine as practiced by holders of M.D.(medical
  doctor) or D.O. (doctor of osteopathy) degrees,
  some of whom may also practice complementary and
  alternative medicine.

8
Economics of CAM

• Probability of users visiting a CAM practitioner
  rose from 36.3 (427 million users) in 1990 to
  46.3 (629 million users) in 1997.
• CAM visits exceeded those of total visits to all
  US primary physicians.
• Out of pocket payments (non-reimbursable) was
  58.3 in 1997.

9
Economics of CAM

• The use of CAM therapies is a secular trend that
  began at least 50 years ago. (Kessler Ann Int Med
  2001135(4)262).
• Expenditures for services provided by CAM
  practitioners increased by 45.2 between 1990 and
  1997 and were estimated at 21.2 billion in 1997
  with 12.2 billion paid out of pocket.

10
Economics of CAM

• Total 27 Billion Dollars in out of pocket
  expenditures related to CAM therapies is
  comparable to out of pocket expenditures for all
  US physician services.
• More insurers are adding certain CAM services.
  Included are chiropractic biofeedback,
  psychotherapy, osteopathy and preventive
  medicine, nutritional counseling and acupuncture.

11
Economics of CAM

• Largest increases in public demand were in energy
  medicine, herbal medicine, homeopathy, massage,
  self-help groups and megavitamins.
• Greater than 60 of CAM users do not disclose
  their use to their physician.
• 15 million users using herbs or high dose
  vitamins and drugs are at risk for
  drug-medication interactions.

12
Changing Attitudes

• Currently about half of primary care internists
  and family physicians indicated that they would
  encourage their patients who have an interest in
  CAM. Nearly 60, in fact, have made referrals to
  CAM practitioners (Doyle A. Journal of Legal
  Medicine 2001 22534).
• The per capita supply of CAM practitioners is
  projected to grow by 88 from 1994 to 2010 and
  that of non- CAM physicians by only 16.

13
CAM Education

• In 1997, out of 117 US medical schools, 75 (64)
  taught some aspect of CAM.
• In 1997, only 31 of the courses taught were
  required. By 2000-2001, 91 schools now have CAM
  as a required course. (LCME Annual
  questionnaire.).
• Osteopathic schools were not interviewed and none
  was known to have CAM training at that time but
  were considering it. Osteopathic philosophy, as
  stated by the AOA, is already CAM. An AOA Task
  force on CAM exists.

14
Principles of Osteopathic Philosophy

• Structure and function are reciprocally
  interrelated.
• The person is a unit of body, mind and spirit.
• The body is capable of self-regulation,
  self-healing and health maintenance.
• Rational treatment is based upon an understanding
  of basic principles of body unity,self regulation
  and the importance of structure and function.

15
National Center for Complementary Medicine

• 1992 Office for the Study of Unconventional
  Medicine.
• Office of Alternative Medicine.
• Office of Complementary and Alternative Medicine.
• NCCAM.

16
NCCAM Classification

• Alternative medical systems
• Mind body interventions
• Biologically - based systems
• Manipulative and body based systems
• Energy therapies

17
Alternative Medical Systems

• Oriental qi philosophy including acupuncture, qi
  gong, Chinese herbs, massage and manipulation,
  meditation.
• Native Indian medicine and other tribal methods
  worldwide.
• Ayurvedic philosophy.
• Homeopathy, (Voll and other variants).

18
Mind-body Interventions

• Hypnosis
• Music and art therapy
• (Thought field therapy)
• Psychokinesiology
• EMDR and energy psychology
• Prayer and mental healing
• (Biofeedback)

19
Biologically - Based Systems

• Dietary therapy Pritican, Weil, Ornish etc.
• Herbal remedies.
• Vitamins.
• Orthomolecular therapy.
• Naturopathy.
• (Clinical ecology).
• (Chelation).

20
Manipulative and Body-based Therapy

• Chiropractic
• Osteopathic manipulation
• Massage
• Applied Kinesiology
• (Feldenkrais)
• (Alexander techniques)

21
Energy Therapies

• Reiki
• Qi gong
• (Applied Kinesiology)
• (Craniosacral therapy)
• Magnets
• Therapeutic touch

22
Dr. Cordas Method

• Triage.
• Judge medical condition traditionally.
• Judge desires, expectation and beliefs of the
  patient.
• Judge which system would be most effective
  regarding outcome and cost.
• Respect the placebo effect dont get caught up
  in the religion of medicine.

23
Summary

• There is an increasing public demand for
  Integrated Medicine. They believe that it is
  effective when surveyed. A high touch verses a
  high tech trend will continue.
• Alternative methods were used by a 1/3 of
  Americans in 1997, often in combination with
  their traditional medical care.

24
Summary

• More Americans seeking medical care, in 1997
  sought alternative practitioners than primary
  care family physicians or internists.
• More individuals worldwide are being treated by
  alternative medical systems then conventional
  medical systems.

25
Summary

• A majority of US medical schools now teach basic
  classes in alternative medicine.
• About 80 of people surveyed perceived that a
  combination of CAM and traditional medicine is
  best.
• There are many types of alternative medicine and
  the margins of acceptability into the mainstream
  shifts .