Alternative Healing. Agenda Introducing CAM Evaluating Web Sites Recommended Websites Reviewing the Evidence.

Alternative

Healing

Agenda

• Introducing CAM

• Evaluating Web Sites

• Recommended Websites

• Reviewing the Evidence

Complementary and Alternative Medicine

•NHIS 2007 Results•>23,00 adults•> 9000 children•Hispanic subpopulation•administered by NIH/CDC•Self report•Interview one child if they are present

CAM STATISTICS

19th C Alternative Medicine

• Many medical sects emerged and challenged allopathic medicine– Thomsonianism– Eclectic movement– Hydropathy

• Most died out

Heroic Medicine

• Blood letting• Purgatives• Emetics• Sialogogues

Homeopathy

• Largest unorthodox sect in 19th c

• Samuel Christian Hahnemann

• German physician• Translated classical

medical texts• Rejected allopathic

medicine• Brought to US in 1825

Homeopathy

• A new system of medicine

• Employed an experimental pharmacology

• Self-experimentation or “provings”

• Initially popular in Europe– Spread to USA

Osteopathy

• Andrew Taylor Still– Son of pioneer dr and

Methodist minister

• Frontier physician– Kansas– Apprenticeship– Children died of meningitis

• 1874 conceives of osteopathy– Itinerant physician

• Created alternative to allopathic medicine– Human body like a

machine; Ought to function well if mechanically sound

– Treat body by improving natural functions

Osteopathic Medicine

Chiropractic Medicine

• 1895• Daniel David Palmer• Iowa• Cheir= hand• praxis= practice• First patient

– Deaf janitor

Chiropractic Medicine• Disease: joint-oriented nerve

interference– Obstructs flow of “innate

intelligence”• Innate Intelligence

– Regulates all vital functions as it flows through CNS

– Connects “man the spiritual” to “man the physical”

• Remove nerve interference caused by subluxations so that innate intelligence can maintain health and bodily equilibrium

What is CAM?

• Complementary and Alternative Medicine

• Complementary: together with – aromatherapy to help with pain after

surgery

• Alternative: in place of– using garlic to lower blood pressure

“Complementary and alternative medicine (CAM) is a broad domain of healing resources encompassing all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the dominant health system of a particular society or culture in a given historical period.”

“All practices and ideas defined by their users as preventing or treating illness or promoting health and well-being are included.”

“Boundaries within CAM and between the CAM domain and that of the dominant system are not always well defined.”

(Cochrane)

CAM becomes “legit”• 1990

– Wilk et al v. AMA

• 1991 – $2 million in funding to establish NIH

Office of Alternative Medicine

• 1994 – Dietary Supplement Health and

Education Act

CAM becomes “legit”• 1995

– NIH Office of Dietary Supplements– FDA declassifies Acupuncture

needles as experimental product

• 1996– NIH Consensus Conference on

Acupuncture

• 1997– First large trial of CAM therapy, St.

John’s Wort for depression

CAM becomes “legit”• 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)

• 2009 - $296 million in NIH CAM research

Complementary and Alternative Medicine

Impact of CAM

• CDC Report (2007)– 38% of adults used some form of CAM

– Children whose parent used CAM were 2x as likely to have used CAM

– CAM use more prevalent for: women, adults aged 30-69, higher levels of education, adults who were not poor, adults living in the West, and former smokers

• Full report: http://nccam.nih.gov/news/camstats/

Figure 17.2

The Domains of Complementary and Alternative Medicine

Diseases and Conditions

Top CAM Therapies

Top 10 Supplements

Types?

• Biologically based practices – supplementing a person's normal diet

• Manipulative and body-based therapies – focus on the body's various systems and structures

• Mind-body interventions – use the connection between a person's mind, body, and

spirit to enhance total well being• Energy therapies

– are meant to restore disturbances in the body's natural energy

Types? (Common)

• Acupuncture• Alexander Technique• Allergy testing• Aromatherapy • Art Therapy• Autogenic Training• Auricular Acupuncture• Ayuveda • Bodywork

• Bowen• Biofeedback• Chiropractic • Chinese Herbal Medicine• Counselling • Craniosacral Therapy• Crystal Therapy• Dowsing Flower Therapy• Healing Herbalism• Homeopathy

Types? (Common)• Hydrotherapy • Hypnotherapy• Indian Head Massage• Iridology• Kinesiology• Music Therapy• Naturopathy• Nutrition• Osteopathy

• Physiotherapy• Radionics• Reflexology• Reiki• Shiatsu• Tai Chi• TENS therapy• Traditional Chinese

Medicine• Thought Field Therapy• Yoga Therapy

Types? (Rarer)• Auricular Acupuncture• Australian Flower Essences Therapy• Bach Flower remedies• Bee Venom Therapy• Chelation Therapy • Colonic Hydrotherapy • Colour Therapy • Dream Therapy • Eye Movement Desensitization and

Reprogramming • Exercise Healing • Health Clubs • Health Screening • Juice Therapy • Light Therapy

• Light Touch Therapy • Magnotherapy • Marma Therapy• Meta-Aromatherapy• Microwave Resonanace Therapy• Naturotherapy• Oxygen Therapy• Panchakama Therapy• PIP scans• Raw Vegetable Juice Therapy• Rolfing• Spiritual Counselling• Stress Management• Swimming Therapy• Transdecendal Meditation• Tragerwork• Vegetable Juice Therapy

Categorization of Therapies

• Whole Medical Systems• Biologically Based Practices• Energy Medicine • Manipulative and Body-Based

Practices• Mind-Body Medicine

National Center of Complementary and Alternative Medicine

Whole Medical Systems

• Complete systems of theory and practice that evolved independently

• Traditional systems of medicine that are practiced by individual cultures throughout the world – Includes traditional Chinese

medicine, Ayurvedic medicine, homeopathy, naturopathy

National Center of Complementary and Alternative Medicine

Biologically Based Practices

• Includes: botanicals, animal-derived extracts, vitamins, minerals, fatty acids, amino acids, proteins, whole diets, and functional foods– Dietary supplements are a subset

of biologically based practices

National Center of Complementary and Alternative Medicine

Biologically Based - Supplements• What is a supplement?

• Regulated by FDA http://www.fda.gov– no requirements for FDA testing– manufacturers responsible for ensuring

product safety– label requirements

• Safety alerts: http://www.cfsan.fda.gov/~dms/ds-warn.html

Energy Medicine

• Veritable - energy that can be measured– Includes sound, visible light, magnetism

• Putative – energy that has yet to be measured– human beings are infused with a subtle

form of energy – Includes qi (ki in Japanese); doshas;

prana, homeopathic resonance

National Center of Complementary and Alternative Medicine

Energy Medicine - Acupuncture• Few complications • Scientific evidence?

– post chemotherapy management of nausea

– pain relief• NIH Consensus Statement (1997)

– http://consensus.nih.gov/1997/1997Acupuncture107html.htm

Manipulative and Body-Based

• Structures and systems of the body, including the bones and joints, the soft tissues, and the circulatory and lymphatic systems– Includes chiropractic manipulation,

massage therapy, reflexology, rolfing, Alexander technique,Feldenkrais method

*National Center of Complementary and Alternative Medicine

Mind-Body Medicine

• Interactions among the brain, mind, body, and behavior

• The ways in which emotional, mental, social, spiritual, and behavioral factors can directly affect health– Includes relaxation, hypnosis, visual

imagery, meditation, yoga, biofeedback, tai chi, group support, and spirituality

*National Center of Complementary and Alternative Medicine

Other CAM Therapies

• Aromatherapy• Colonic Irrigation• Therapeutic Touch• EDTA Chelation• Cupping• Primordial Sound Meditation

Specific Types?

• Aromatherapy– Used since Egyptian times– Distilled plant extracts

• 400 Oils• Varying quality (RCT)

– Improve well-being• Peppermint – digestive effects• Tea Tree Oil – antibacterial

– Massage, Baths, Inhalation

Specific Types?

• Bee Venom Therapy– Contain sulphur – Stimulates cortisol release – Applied to surface– Chronic inflammatory conditions– RA, Myositis– Applied for 5days with 2-3day interval– Normally haemorrhagic

Avoiding Bad Science• The “One Product Does It All” claim

http://www.emuoilcanada.com/• Personal Testimonials

http://www.getslimslippers.com/• Quick Fixes/Cures

http://www.improveyourhealthonline.com/ • The “No Risk Money Back Guarantee”

http://www.naturalhpvcure.com/ • The “Natural” claim

http://www.amtrueman.com/products.html

Evaluating Web Sites

• Accuracy

• Authority

• Bias

• Currency

• Coverage

Evaluation Exercises

Recommended Websites

About Herbs, Botanicals & Other Products

Examining the Research

• Observational Studies

• Clinical Trials/Studies– controlled– blind/double-blind– randomized

• ClinicalTrials.gov– Government and private clinical studies

involving humans– http://clinicaltrials.gov

Clinical Trials and CAM

• Drug companies vs. supplement

companies

• Customization of treatment in CAM

• CAM does not necessarily want to be

studied

• CAM has only recently become “legit” in

the scientific community

Money to fund CAM

• NCCAM: $121.7 million (2009)• OCCAM: $121.9 million (2009)

– Total all NIH: $296 million

• What about funding for pharmaceuticals? – $65.2 billion on R&D (2008) by drug

companies– $114.4 billion on R&D (2008) by NIH

(this includes NCCAM and OCCAM)

Figure 17.3

Assessing the Risks and Benefits of CAM Treatments

The other side

• Some say CAM research should not be funded– http://www.nccamwatch.org/ (Stephen

Barrett)

• Or some CAM research should not be funded– http://tinyurl.com/46ayhjj

Reviewing the Evidence

• Evidence Based Medicine: “What evidence do we have to justify the treatment…”

• National Center for Complementary and Alternative Medicine (NCCAM)

• CAM on PubMed http://pubmed.gov

CAM on PubMed Exercises