… medical and health care practices and products outside the realm of conventional medicine, which are yet to be validated using scientific methods

*What Is Complementary Alternative Medicine?

Complementary: together with conventional practices ( aroma therapy for surgery patients)

Alternative: in place of conventional practices. Relies on certain stimuli for body’s natural healing

*Types of Therapies

*Homeopathy- “like cures like” Small amounts of substances can cure while larger amounts can cause symptoms (ex-allergy shots)

*Herbal therapy- most popular but not covered by law or tested by FDA

*Acupuncture - manipulation of energy flow by inserting needles into the meridians of this flow

*Naturopathic medicines- assists body’s natural healing; includes diet, massage, exercise, acupuncture

*Prayer

* The Big “Seven”

*Chinese herbal medicine

*Western herbalism

*Acupuncture

*Chiropractic care

*Massage

*Homeopathy

*Diet and nutrition therapy

*CAM Practices Now in Mainstream

Medicine*Codeine for pain

*Digitalis for heart failure

*Ipecac for poisoning

*Quinine for malaria

*Aspirin for fever

*Behavioral therapy for headache

*Hypnosis for smoking cessation

*Low fat, low cholesterol diets

*Exercise for diabetes

*Support groupsfor breast cancer

* The CAM Domains

*The Appeal of CAM

Patient empowerment Focus on spiritual and emotional well-being Therapist providing “touch, talk, time” Feeling of “natural” treatment Tradition

* CAM Use in the United States

*Phone poll- 62% of adults 18+ used CAM in the past year

*Who Is the Practitioner?

*Medical doctors *CAM practitioners*Traditional healers

*CAM Economics

*Americans spend more out-of-pocket for CAM than for all other health care needs*CAM is big business

*56% of Americans believe their health plans should cover CAM

Who uses CAM?

More educated More affluent Possess a holistic orientation to health Had a ‘transformational experience’ Identification with environmentalism, feminism,

spirituality Report chronic anxiety, pain, UTI, back

problems (Astin et al. JAMA ,1998)

*Communication *Many mainstream

doctors do no approve of CAM therapies

*Most patients do not report alternative therapies to their doctors

*Communication is key to prevent further damage especially with alternative meds

* The Research Portfolio: NCCAM’s Ongoing Phase III Trials

Therapy Condition Status Co-Sponsors

Glucosamine-Chondroitin Osteoarthritis Fully recruited; ongoing NIAMS, VA

Ginkgo Biloba Dementia Fully recruited; ongoing NIA, NHLBI, NINDS

Vitamin E-Selenium Prostate Cancer Fully recruited; ongoing NCI

Shark Cartilage Lung Cancer Recruiting NCI

EDTA Chelation Therapy Coronary Artery Disease Recruiting NHLBI

St. John’s Wort Minor Depression Recruiting NIMH, ODS

Vitamin E Down Syndrome Recruiting NICHD, NIA

Phytoestrogens Atherosclerosis Recruiting ODS, ORWH

SAMe Depression Recruiting

Acupuncture Low back pain Recruiting

* Dietary Supplements: DSHEA Definition

*Product intended to supplement the diet*Contains one or more of the following:* Vitamin* Mineral* Herb or other botanical (not

tobacco)* Amino acid* Any other dietary substance

*For oral intake as a concentrate, metabolite, extract, constituent, or combination

*Patterns of Supplement Use:The Slone Survey

*2590 participants 18 years +

*Telephone survey, random sampleFeb 1998 - Dec 1999

*In the preceding week:*14% of population used herbalsand/or supplements

*16% of prescription drug users used herbals and/or supplements

JAMA, 2002

Patterns of Supplement Use:

*Ginseng*Ginkgo biloba*Allium sativum*Glucosamine*St. John’s wort*Echinacea*Lecithin*Chondroitin*Creatine*Serenoa repens

Ten Most Commonly Used Herbals / Supplements

Patterns of Supplement Use

*General health/good for you (16%)*Arthritis (7%)*Memory improvement (6%)*Energy (5%)*Immune booster (5%)*Joints (4%)*Supplement diet (4%)*Sleep aid (3%)*Prostate (3%)*No reason (2%)*All other reasons (45%)

Ten Most Common Reasons for taking herbs / supplements

JAMA, 2002

*Challenges of Herbal Medicines

*Safety is assumed, not proven

*Lack of product standardization

*Contamination with drugs, heavy metals

*Allergic reactions

*Inherent toxicity

*Interactions with drugs

*Replacing proven therapies

*Herbal Therapy and Surgery

*Ephedra: Safety Concerns

*Ma huang (Ephedra sineca) – Short-term treatment for asthma, decongestion

*Contains L-ephedrine, pseudoephedrine

*Major current use in U.S. in combination with caffeine for weight loss, athletic performance

*Dozens of reports of severe and life-threatening adverse events in young people

*Echinacea

*Used as cold and flu remedy

*Some studies show it increasing phagocytosis and release of interferon

*Some studies have shown it to reduce duration of colds

*Problem- only anecdotal evidence and no consistency in dosage of product

*Lack of regulation of CAM

*Many alternative medications lack studies to verify their efficacies

*FDA approval not required so standards for dosage is not set

*Some dosages vary as much as 10X other dosages

*Alt meds cannot make claims or promoted as curing or preventing disease

*Acupuncture- What exactly is Chi?

*Chi is an energy that, according to ancient Chinese beliefs, permeates all things

*Chi must be able to flow freely throughout the body in order for a person to maintain overall health

*Chi flows along the meridians of the body

*Where do yin and yang fit in?

*Acupuncture needles are inserted in an attempt to balance the opposing forces of yin and yang

*Yin and yang are balanced when a person is healthy and chi is therefore able to flow freely

*Injury or illness cause yin and yang to become distressed and unbalanced

*Originally there were 365 acupuncture points, but through the years this number has increased to over 2,000

*Each point is believed to correspond with a particular illness or injury

* What is acupuncture used to treat?

*Depression

*Arthritis

*Kidney problems

*Flu

*Fatigue

*Chronic pain

*Migraines

*Paralysis

*Hypertension

*Tendonitis

*Vision problems

*Sexual Dysfunction

*And many others…

* Possible medical explanations

*Stimulation of natural painkilling chemicals such as endorphins

*Needles block the transmission of pain impulses to the CNS

*But there are risks…

*Bladder or lung puncture

*Allergic reaction to needles

*Infection from unsterilized needles

*Fainting

*Convulsions

*Nerve Damage

*Putting off treatments that are known to be effective

*History of Chiropractic

*Chiropractic- means “done by hand”, referring to manipulation of the spine.

*Greek words cheir (hand) and praxis (action)

*Chiropractic is a form of spinal manipulation, one of the oldest healing practices.

*Spinal manipulation was described by Hippocrates in ancient Greece.

* The Founder of the Modern Profession of Chiropractic

*Daniel David Palmer

*Healing philosophies

*Spiritualism

*Magnetic therapy

*Background in osteopathic training

* Basic Concepts of Chiropractic

*The body has a powerful self-healing ability.

*The body’s structure (primarily the spine) and its function are closely related, and this relationship affects health.

*Chiropractic therapy is given with the goals to normalize the relationship between structure and function and assisting the body as it heals.

* Conditions Commonly Treated by Chiropractors

*Back pain including low-back pain

*Neck pain

*Headaches including migraines

*Sports Injuries

*Repetitive strains

*Others*Asthma, Arthritis, Bursitis, Cerebral Palsy,

Flu symptoms, DM, Infertility, etc

*Controversies and Criticism

*Effectiveness of treatments

*Non-manual treatments

* heat and ice, magnetic therapy, nutrition counseling and dietary supplements

*Potential risks

*Presumed to be safe from what is known

*Potential Osteoporosis compared to healthier bone

*History of Massage*Natural reaction to when the body hurts is to rub it

*Dates back to at least the ancient Olympics

*Massage is derived from 2 sources

*Arabic verb mass “to touch”

*Greek word massein “to knead”

*Egyptians, Romans, Japanese& Chinese were known to practice massage

*What is Massage Therapy?

*Used to manipulate the body’s tissue

*Effective in promoting local & systemic relaxation, increasing local blood flow, encouraging venous return

*Act of rubbing, kneading, or stroking the superficial parts of the body with the hand or an instrument for the purpose of modifying nutrition, restoring power of movement

* Treatment Considerations & Guidelines

*Need to know underlying pathology

*Need to know basic massage

*Avoid constant hyperextension or hyperflexion of any joints

*Must obtain correct positioning that will allow for relaxation, prevent fatigue & permit free movement of arms, hands, & body.

*Physiological Effects of Massage Therapy

*Depending on the amount of pressure applied & the speed of the stroke*Light, slow stroking – evokes systemic relaxation

*Fast, deep strokes increase blood flow to the area

*Cardiovascular changes – deep friction or vigorous massage was thought to produce vascular changes

*Massage can produce decreased heart rate, breathing rate, & blood pressure if the purpose is for inducing system relaxation

*Acupressure- history*5000 year old healing

art

*First originated in China

*Used in preventative care, immune boosting and stress relief

*12 Meridians of healing energy pathways

*Blockages occur with illness or injury both physical and/or mental

*Acupressure Treatments*Can use fingers, hands,

palms, knuckles

*Shiatsu- Japanese massage- deep pressure held for 3-5 seconds

*Jin Shin- two points are held for a few seconds

*Reiki- channeling healing energy

*QiGong often combined with martial arts (breathing and slow fluid movement)

*Benefits of Acupressure*Increases circulation

*Reduces pain

*Releases stress

*Balance body energy

*Beauty treatments (improves muscle tone and skin circulation)

*Homeopathy *Homeopathy is a system of

medicine based on three principles:

* Like cures likeFor example, if the symptoms of your cold are similar to poisoning by mercury, then mercury would be your homeopathic remedy.

*Minimal DoseThe remedy is taken in an extremely dilute form; normally one part of the remedy to around 1,000,000,000,000 parts of water.

*The Single RemedyNo matter how many symptoms are experienced, only one remedy is taken, and that remedy will be aimed at all those symptoms.

* Homeopathic treatment- an example

*The symptoms between a bee sting and a rash are similar. A bee sting swells and itches.

*Hives, a rash or even another insect bite itch

*the homeopathic medicine is made from a tiny amount of a bee.

* Instead of masking symptoms, the medicine sends the body a signal to help it rebalance and heal.

*Another example

*Your eyes burn, itch and water when you peel an onion. You might have a runny nose too

*You have a runny nose and begin to sneeze during a cold or allergy attack,

*A homeopathic micro-dose of the remedy Allium cepa (red onion) would help your body heal itself.

*Homeopathic vs Herbalogy

*Not to be confused with herbalogy

*Homeopathic remedies are very dilute doses of natural ingredients including plants or minerals

*Herbal remedies are made solely from plants.

*The Controversy

*Remedies are so diluted, they are rendered useless for treatment

*Even in dilute cases, some treatments are made of toxic chemicals

*Nutrition Therapy

*Treatment of medical conditions with diet and nutrition

*Usually based on whole food diet with supplements

*Many feel diseases worsen by an improper diet

*History of Nutrition Therapy

*Relatively recent practice

*Dietetic Association began in the 1900s

*Began as treatment for surgery patients

*Now healthy patients seek diet therapy to remain healthy or even reverse aging effects

*Examples of conditions using Nutrition Therapy

*Cancer patients

*Obesity

*Diabetes

*Elderly

*Paralysis

*Intestinal diseases