Alternative Healing
Agenda
• Introducing CAM
• Evaluating Web Sites
• Recommended Websites
• Reviewing the Evidence
Complementary and Alternative
Medicine
CAM
STATISTICS
•NHIS 2007 Results
•>23,00 adults
•> 9000 children
•Hispanic subpopulation
•administered by NIH/CDC
•Self report
•Interview one child if they
are present
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/
The Domains of Complementary
and Alternative Medicine
Figure 17.2
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/1997/1997Acupuncture1
07html.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)
Assessing the Risks and Benefits of
CAM Treatments
Figure 17.3
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