(CAM = Conventional / Alternative Medicine)

1. Alternative medical therapy is increasingly popular

1. 1/3 of Americans use it (1 in 3 people)
2.  More visits for CAM than to primary care (@ 425 Million)
3. Used for "minor" ailments such as self care, weight loss, pediatrics, and also for common ailments such as back problems, headaches, anxiety and depression.
4. Used by 50% of cancer patients
5. Also used by sophisticated AIDS patients (e.g. diet to put on weight).
   
    

1. People in the US spend between 13.7 Billion (1990) and 15 Billion (1998) a year on 
   CAM, in 1990 10.3 Billion of this was not reimbursed by insurance.
2. 72% of patients don’t reveal use of alternative medicine to their physicians.
3. 83% of individuals who use CAM also used conventional treatment.

Physicians most frequently refer patients out for relaxation and biofeedback training.

Physicians most often are able to use/trained in Relaxation and Diet.

(RCT = recent/current running clinical trials)

Cancer Research

Scientific Basis

The research base of CAM practices varies greatly:

Of these are considered good studies.

(Homeopathic Medicine = the use of highly diluted medications/substances. Studies have demonstrated that these medications have no effect in Conventional Medicine.

No pharmacological research studies have demonstrated the contrary. However, it is interesting to note that the sales of Homeopathic medicine were over $200 Million in 1992, most of which can be bought over the counter. Also, the last homeopathic medical school in the US closed in 1994.)

tested for effectiveness in treating enlarged prostate and non-cancerous growths in the same.

There are currently 14 RCT’s with Hypericum (St. John’s Wort) on depression.
 

What is CAM?

CAM includes various disease treating or disease-preventing practices whose methods

And efficacy differ from traditional/conventional biomedical knowledge.

Additional to waster medicine

Usually lies outside the official health sector (World Health Organization).

Practices of unregistered/non-licensed practitioners.

Complementary Medicine = some approaches can be used in conjunction with

traditional therapeutic methods.

Holistic Medicine = treatment of a patient as a whole rather than focusing on a   specific disease/disorder which requires the evaluation of psychosocial, environmental, and lifestyle factors in health and disease.

CAM covers:

12 major health care system

26 categories of practice

10,000 ways of using these methods

Traditional Chinese Medicine

Aryuveda

Kampo

Tibetan Medicine

Osteopathy

Anthroposophical

Science-Based Nursing

Some of the alternative medicine methods include:

Relaxation Training

Imagery

Art Therapy

Medical Acupuncture

Yoga

Biofeedback

Spectrum of Alternative Medical Practice

Factors that influence where on the spectrum a practice/method is located include:

1. Research support – has the treatment received empirical support, is there a basis for it’s validity (does the treatment really do what it says it does).
2. Medical education – do the individuals who provide the treatment have relevant education and training in the area.
3. Licensing – do the professionals who provide the treatment required to meet certain standards of education, training and practice. Is there a regulatory body that protects the standard of care and overseas the licensing and certification of professionals.
4. Reimbursement – is the treatment covered by insurance.
5. Feasibility – can the treatment actually be carried out/completed.
6. Theoretical/Explanatory model – does the treatment stem from an overlying theoretical model that explains the reasons for it’s implementation.

1. Biofeedback
2. Hypnosis
3. Relaxation training
4. Behavioral medicine

1. Pastlife medicine
2. Shamanism
3. Ozone therapy

1. Conventional medicine is demonstrated by the lowest portion of the graph

indicating the last 20 years (most likely with the advances in technology).

2. Homeopathy - the last 200 years
3. Acupuncture – 2,000 years
4. Spiritual and Shamanism – 20,000 years
5. Herbalism – 200,000 years

Emphasis upon the whole person.

Adverse effects of orthodox/conventional medicine.

Poor communication with doctor.

In general, are disillusioned with medicine.

Are principally motivated by lower cost.

Those who use alternative medicine posses unusual/different characteristics apart from non-users.

Cost, conventional medicine represents 14% of the Gross National Product.

The burden of chronic illness.

Depersonalization – not being treated as a unique person, rather as a problem, data, study, etc.

Example of Research: Hypericum vs. Imipramine

Imipramine demonstrates a greater amount of side effects than Hypericum.

Hypericum is the principal component of St. John’s Wort.

Safety of Alternative Medicine

Alternative medicine may be considered "Natural" medicine –it employs the bodies natural healing processes/capacities.

Indirect effects may be the same.

Herbal Medicine – Regulation, Laws and Safety

Some of the criticisms may be motivated by a fear that many in the medical establishment are experiencing about trends in medicine today (patients may be asking questions that physicians are simply not trained to answer).

However, the criticisms are also founded on particular weaknesses present in Alternative Medicine.  In the absence of trustworthy information, people are left to get information from any source they can –in some cases this information is good, many times it is NOT.

Also, regulation of the dietary supplement/herbal industry is needed. Currently, too many products on the market are of questionable value/quality and too many make misleading and unsupported claims.

The table demonstrates one of the problems within the industry. The content of the different products varies greatly, some contain almost nothing at all –this contrary to the claims made by the companies who produce the product.

A wide range of product quality exists, indicating a lack of standardization.

Can be understandable and Esthetic (more socially acceptable/less stigmatizing, especially with psychopharmacology issues).

1. Time – 7 minutes (with a physician) vs. 30 minutes with alternative care provider.
2. An estimated 60% of the effect of Alternative Medical methods may be psychological.
3. Alternative medicine may involve even touch/contact in care and healing (social/
psychological contact and physical with massage, etc.).
4. Relationship with provider may be viewed as a partnership and the treatment is usually described as complementary to conventional methods.

3 part education:

Evaluate research data critically.

Maintain an open attitude/mind the experience of the practice.

Look at 2 aspects:

Pragmatic – what are the practical effects associated with the treatment.

SEC

Employ good/effective methods of evaluating the form of treatment.

Differentiate between those methods that have been identified as ineffective and those that have been underevaluated (2 different things).

The questions should address the validity and efficacy of the method being examined (does the treatment actually do what it claims it does, and how well does it do this).

Clinical significance – does the method/treatment significantly impact the patient and result in some type of change in their status.

Is a follow-up completed? To assess long-term effectiveness of treatment.

Is the method of treatment feasible? (availability of treatment, practitioner, cost, etc.).

In general the office facilitates the research of Alternative Medicine by engaging in the following: evaluation, investigation and validation of CAM methods.

History

The Advisory Counsel for the OAM was formed in September 1994.

Samples of Research

A post-surgical care group who received 45 minute therapeutic massage had significantly lower mean systolic blood pressure and cortisol level as compared to the group receiving standard post-surgical care. Anxiety, depression, and activity restriction were also lower in the massage group.

Both traditional psychodynamic group therapy and hatha yoga treatment contributed to a regimen that significantly reduced drug using and criminal activity (there were no significant differences between the two treatments).

Information Requests Received by OAM Clearinghouse.

Current Areas of Research: St. John’s Wort

Protect

include the low effect of toxicity associated with meditation and possible/unknown effects of high doses of megavitamins.

Responsibility also extends to guiding patients toward those types of treatments which are effective rather than ineffective.

Health care professionals need to allow patients to consider safe or inexpensive forms of treatment.

Assist in developing a focus that allows for the management of chronic disease.

Promote

An understanding of the mechanisms by which treatment approaches function and their effect upon the body.

Communicate effectively with the patient in a open manner that allows for disclosure and the patient’s comfort in sharing other treatment approaches they may be considering.

Assist in co-managing illness with patient where the health care professional provides input concerning evidence of effectiveness and safety.

What to Examine When Considering Alternative Therapies

Assess the safety and effectiveness of the therapy

Safety means that the benefits outweigh the risks of a treatment or therapy.

Effectiveness is the likelihood of benefit from a practice, treatment, or technology applied under typical conditions. 

The patient should ask the health care practitioner about the safety and effectiveness of the therapy/treatment they use.

Research public libraries, university and medical libraries, online computers services, U.S. National Library of Medicine and the NIH, etc.

Whenever possible research studies should be controlled, scientific trials, these usually provide the best information about a therapy’s effectiveness.

Take a close look into the background, qualifications and competence of any potential health care practitioner.

Check to see if the practitioner is licensed to deliver the services he/she says they deliver.

Most types of complementary and alternative practices have national organizations of practitioners that are familiar with legislation, state licensing, certification, or registration laws.

Talk with those who have had experience with a particular practitioner, both health practitioners and other patients.

The education process and dialogue between you and your practitioner should become an ongoing aspect of health care.

How treatment/therapy is given and under what conditions.

How many patients he/she typically sees in a day or week and how much time the practitioner spends with a patient.

Can the service be obtained only in one place, is travel required?

Consider whether the service delivery adheres to regulated standards for medical safety and care.

Many complementary/alternative treatments are not currently reimbursed by health

insurance. Ask your practitioner and health insurer which treatments/therapies are reimbursable.

Find out what several practitioners charge for the same treatment to better assess the appropriateness of costs.

Discuss all issues concerning treatments and therapies with your health care provider (physician or practitioner of CAM).

Competent health care management requires knowledge of both conventional and alternative therapies for the practitioner to have a complete picture of your treatment plan.

Herbal Medicine

Clinical studies (mostly outside the U.S.) have been conducted on St. John’s Wort, including more than 2000 subjects in controlled, double-blind studies, where neither subject nor research knows who is receiving the actual substance being tested.

The same average success rate was achieved with the prescription antidepressants, but without the side effects.

Dr. Baker currently doing study with Cardiothoracic patients in a double blind study for recovery from surgery.

Currently popular and undergoing testing for treatment of conditions associated with benign prostatic hyperplasia (enlargement of prostate). Does receive some initial support.

From a small shrub native to Mexico with a reputation as a female aphrodisiac and remedy for wide range of urinary and sexual problems.

Research on this herbal remedy is basically non-existent, no current support.

Ginkgo (Gindgo Biloba)

It may have an effect on brain function and cerebral circulation, resulting in a delay of deterioration of cognitive functioning.

Currently at the initial stages of research.

Ketogenic Diet

The diet is high in fat, and low in carbohydrate and protein, which results in ketosis (a pathological accumulation of ketone bodies in the body).

Additionally, fluids are limited, which helps contribute to the diet’s success.

The diet appears to be effective for multiple types of seizures. It is found most effective  for myoclonic seizures and "minor motor seizures". It also appears helpful for tonic-clonic and complex partial seizures.

90% had a 50% or greater reduction in seizures, 19% became seizure free.

No patient had any serious complications. Common complications included: poor linear growth, hypercholestrolemia, poor weight gain, constipation.

Massage Therapy (Manual Healing)

Significantly lower levels of anxiety at mid-treatment.

Immediately following massage, significant lower scores on the State-Trait Anxiety Inventory, Numerical Scales of Distress, Nausea, and Diastolic blood pressure measures.

Yoga was used in treatment with OCD (Obsessive Compulsive Disorder).

Music Therapy

Regardless of severity level, all patients showed improvement in music, cognitive and social behavior.