Alternative Medicine
November 29th 2002
Gil C. Grimes, MD
General Data
The Diagnosis, treatment and/or
prevention which complements
mainstream medicine by contributing to
a common whole, satisfying a demand
not met by orthodoxy, or diversifying the
conceptual frameworks of medicine
Ernst E et al. Complementary medicine- a definition. BJ Gen Prac
1995, 45:506
General Data
Landmark Report 1998 random sample
adults USA
42% used CAM in last year
 17% herbal therapy
 16% chiropractic
 14% massage

General Data
Austin 1998
Random sample 1500 adults (80% white,
51% female 30% high school ed or less)
 Have you used CAM in last year

40% Yes
 16% chiropractic
 8% lifestyle diet
 7% exercise
 7% relaxation

General Data
Who is using?
People with chronic health problems
 More common caucasian
 More common women
 More educated

General Data
$13.7 billion unconventional therapy
$10.3 billion (75%) out of pocket
$12.8 billion out of pocket for all
hospitalizations in the United States
1990 data
Eisenberg DM et al, N Engl J Med 1993 Jan 28;328(4):246-52
General Data
Increase 45.2% between 1990 and
1997
estimated at $21.2 billion 1997
$12.2 billion paid out of pocket
Eisenberg DM et al, JAMA 1998; 280:1569-1575
Getting the Truth
Inforetriever
Cochrane review
National Center for Complementary and
Alternative Medicine
Alternative Medicine Homepage
University of Pittsburgh
British Homeopathic Library
Natural Medicine Database
Type of CAM
Herbal Medicine
Acupuncture
Nutrition
Exercise
Homeopathy
Manipulation
Massage
Meditation
Herbal Medicine
Various Forms
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


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Crude plant preparations
Dried specimen
Aqueous extract
Tinctures
Active ingredients
Herbal Medicine
Choosing the product


Degree of purity
Variation in potency
Look for the following



Lot number
Expiration date
Analysis of ingredients
Acupuncture
2000 year tradition
Osler was aware of acupuncture
Alters conduction of
electromagnetic signals
Alters neurotransmitters in brain
TCM relates this to a release of
the Qi that is blocked
Acupuncture
Efficacy
Adult postoperative N/V (1b) JAMA
1998;280:1518-24
Chemotherapy N/V (1b) JAMA
2000;284:2755-61
Chronic neck pain (1b)BMJ 2001;322:1574
Headache (cochrane)
Menstrual cramps (cochrane)
Tennis elbow, myofascial pain, carpal tunnel
syndrome
National Center for Complimentary and Alternative Medicine
Acupuncture
Trouble with blinding
Sham Needles
Blinding Evaluators
Exercise
Benefits
Improved respiratory
 Lower BP
 More efficient CO
 Increases insulin sensitivity
 Improves utilization of FFA from adipose

Exercise
Physician advice

Meta-analysis DARE abstract 971480
demonstrate efficacy of counseling
Exercise Rx


Type of activity (aerobic etc)
Intensity (60-90% Max Heart rate)


(220-Age) x 0.60 or 0.90 gives low and high end of target
heart rate
Work longer low end and short bursts in high end
Exercise
Exercise Rx

Duration
Inversely proportional to the intensity
 Rate fatigue one hour after exercise to judge


Frequency
3-5 sessions per week
 No greater than 48 hours off

Exercise
Three phases of exercise
Warm up
 Conditioning
 Cool down
 Stretch some before and always after

Homeopathy
Treats illness with progressively dilute
substances that produce similar pattern
of injury
Treating like with like
Therapy is individualized to the patient
Meta-analysis of homeopathy trials
Lancet 1997;350:834-43
Cystitis
Cranberry
 Randomised
trial of cranberry-ligonberry
juice and Lactobacillus GG drink for the
prevention of UTI in women.
BMJ2001;322:1-5 (LOE 1c)
 Glass of unsweetened cranberry juice a
day
 NNT=5 at 12 months to reduce frequnecy
of UTI from 36% to 16%
Migraine
Riboflavin

400 mg Riboflavin daily (LOA 1b)
 NNT= 2.8 to reduce frequency of attacks per
month (56% to 19%)
 NNT= 2.3 reduce headache days (59% to 15%)
 Effectiveness of high-dose riboflavin in migraine
prophyloaxis: a randomized controlled trial.
Neurology 1988; 50:466-70
Morning Sickness
Ginger root (LOE 1b)
 250
mg powdered ginger root before meals
and bedtime (1 gm per day)
 Small double blinded placebo controlled
randomized trial
 Decreased vomiting
Obstet Gynecol 2001; 97:577-82
Morning Sickness
Vitamin B6
 25-
50 mg 2-3 times daily
Acupressure
 Wrist
band on P6 point
Reduced severity of nausea
Cochrane Library, Issue 2, 2002
Osteoporosis
Calcium and Vitamin D
500mg Ca++ and 700 IU Vit D (LOE 1b)
 Better
bone density
 Fewer fractures over 3 years (5.9% vs
12.9%)
Effect of calcium and vitamin D
supplementation on bone mineral
density in men and women 65 years of
age or older. NEJM 1997; 337: 670-6
Menopause
Soy supplementation
60 gm soy protein daily (LOE 1b)
 Decreased
frequency and severity of hot
flushes
The effect of dietary soy supplementation on
hot flushes Ob Gyn 1998;91:6-11
Warts
Podophyllum
 The
rhizomes are used as a cathartic
 Resin extracted used as an irritant
Closing
Ask your patients
Ask more than once
Ask about vitamins or supplements