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Consumer Health

Complementary and Alternative Medicine (CAM)


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Prayer

I got behind and forgot to tell people about what happened with him......the morning after the 'global prayer circle' (for lack of a better name for it) he improved dramatically! In fact the doctors decided against the surgery they were planning (and dreading as he has so much 'scar tissue' inside) and sent him home! He's doing amazingly well - went out and bought a Christmas tree and decorated it! Thanks for asking and Happy New Year to you! J


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BMJ VOLUME 324 13 APRIL 2002 bmj.com


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Prayer

I got behind and forgot to tell people about what happened with him......the morning after the 'global prayer circle' (for lack of a better name for it) he improved dramatically! In fact the doctors decided against the surgery they were planning (and dreading as he has so much 'scar tissue' inside) and sent him home! He's doing amazingly well - went out and bought a Christmas tree and decorated it! Thanks for asking and Happy New Year to you! J


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Complementary and Alternative Medicine

  • Defining CAM

  • History of CAM

  • Major Domains of CAM

  • Extent of Use

  • Organizations, Certification, Training

  • Selecting Practitioner


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Defining CAMOriginal Definition

  • National Library of Medicine

  • Unrelated group of non-orthodox therapeutic practices

    • Often with explanations not following conventional biomedical explanations

    • No satisfactory scientific explanation for effectiveness

  • Another old definition

    • Medical interventions not taught in US


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Defining CAMNew Definition

  • National Library of Medicine

  • Complementary Medicine

    • Alternative

  • Therapeutic practices not considered an integral part of conventional allopathic medical practice

    • May lack biomedical explanation

    • Could become accepted or not


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Defining CAM

  • Complementary Medicine

    • Therapies used in addition to conventional treatments

  • Alternative

    • Therapies used instead of conventional treatment


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Conventional

High Tech

Pharmacological

Surgical and

other technological approaches

Prevention and wellness underemphasized

CAM

Low Tech

Prevention

Treating the whole person

Promoting self-care

Recognizing a spiritual nature of each individual

Individualized treatment

Defining CAMDifferences in Emphasis


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Major Domains of CAMAlternative Health Care Systems

  • Ayurvedic Medicine

  • Chiropractic

  • Homeopathic Medicine

  • Native American Medicine

  • Naturopathic Medicine

  • Traditional Chinese Medicine


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Major Domains of CAMMind-Body Interventions

  • Meditation

  • Hypnosis

  • Guided Imagery

  • Dance Therapy

  • Music Therapy

  • Art Therapy

  • Prayer and Mental Healing


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Major Domains of CAMBiological Based Therapies

  • Herbal Therapies

  • Special Diets

  • Orthomolecular Medicine


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Major Domains of CAMTherapeutic Massage, Body Work and Somatic Therapies

  • Massage

  • Feldenkrais

  • Alexander Method


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Major Domains of CAMTwo Additional Domains

  • Energy Therapies

    • Qigong

    • Reiki

    • Therapeutic Touch

  • Bioelectromagnetic

    • Magnet Therapy


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History of CAM

  • Mid-19th Century

    • Botanical healers, midwives, chiropractors, homeopaths

  • 1892

    • The Principles and Practice of Medicine

  • 1910

    • Flexner Report


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History of CAM

  • Early 20th Century

    • Drugs and antibiotics introduced

    • CAM: “unscientific relics of the past”

  • Mid-20th Century

    • Chronic, degenerative diseases

    • Significantly longer lives

    • Health care costs (See next slide)


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History of CAM

  • Mid-20th Century

    • Chronic, degenerative diseases

    • Significantly longer lives

    • Health care costs


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History of CAM

  • 1950s – 1970s

    • Medical pluralism reemerges

    • Whole foods and dietary supplement movements

    • Exposure to traditional health care systems

    • Counterculture movement

    • Holistic health care movement

    • Nurses and family physicians


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History of CAM

  • 1970s – 1980s

    • Self-care movements

      • For individual and family to increase wellness

      • Diet and exercise to reduce risk of onset of illness

      • Personal fitness

        • Increased use of yoga, tai chi, massage


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Consumer Use of CAM

  • 43% of US population

  • Due to chronic conditions

    • Most frequent users

      • Cancer, chronic pain, HIV

      • Ethnic populations

  • Dietary Supplements

    • 158 million users

    • $17,000,000


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Reasons for Using CAM

  • Characteristics of users

    • Interest in spirituality and personal growth

    • Commitment to environmentalism

    • Feminism

    • Internal locus of control

    • Transformational experiences


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Reasons for Using CAM

  • Perception of conventional medicine is ineffective

  • Believe it will work

  • Recommendations from friends

  • Desire to avoid side effects of conventional treatments

  • Failure of conventional treatment


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Reasons for Using CAM

  • Perceived poor health status

  • Perceived poor emotional functioning

  • Musculoskeletal disorder

    • Back pain


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CAMs Used

  • Chiropractic: 35%

  • Herbal Remedies and supplements: 27%

  • Massage Therapy: 17%


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Cancer and CAM

  • At least one CAM approach: 63% to 75%

    • Women more than men

    • More use for surgery, chemotherapy or both than neither

  • Most frequent approaches

    • Nutritional: 63%, Massage: 53%, Herbs: 44%

    • Spiritual approaches, relaxation, imagery, exercise, lifestyle, diet, nutritional supplementation therapies

  • Reasons for use

    • “stimulate an immune response:” 73%

  • Outcomes

    • QAL, coping, decrease discomforts, sense of control


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HIV and CAM

  • Frequent Substances

    • Vitamin C: 63%, Multiple vitamin supplements: 53%, Garlic: 53%

  • Frequent practitioners

    • Massage: 49%, acupuncturists: 45%, nutritionists: 37%

  • Frequent activities

    • Aerobic exercise: 63%, prayer: 58%, massage: 53%, meditation: 46%


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Ethnic Differences in Use of CAM

  • Mexican-American and Hispanic, and Native Americans

    • At least once in last year: ~50%

    • Herbal medicine, spiritual healing, traditional healers


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Conventional Medicine Use of CAM

  • Give referrals to:

    • Acupuncture: 43%

    • Chiropractic: 40%

    • Massage: 21%

  • Practiced by them:

    • Chiropractic: 19%

    • Massage: 19%

    • Homeopathy: 9%


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Conventional Medicine Belief in Efficacy of CAM

  • Believe in efficacy of:

    • Acupuncture: 51%

    • Chiropractic: 53%

    • Massage: 48%

  • Others

    • Homeopathy: 25%

    • Herbal approaches: 13%


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Conventional Medicine Use of CAM

  • Insurance Companies

  • Medical Schools

  • Hospitals


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Organizations

  • American Holistic Nurses Association

    • http://ahna.org

  • National Certification Commission for Acupuncture and Oriental Medicine

    • www.nccaom.org

  • Complementary and Alternative Medical Association

    • http://www.camaweb.org

  • British Complementary Medicine Association

    • http://www.bcma.co.uk


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CAM Certification and Education

  • Council of Colleges of Acupuncture and Oriental Medicine

    • www.ccaom.org

  • American Association of Naturopathic Physicians

    • www.naturopathic.org

  • Tai Sophia Institute

    • www.tai.edu

  • East West Institute of Healing Arts

    • www.eastwestqi.com

  • American Academy of Acupuncture and Oriental Medicine

    • www.aaaom.org


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Selecting Practitioners

  • Speak with primary provider

  • Make a list of CAM providers and check

    • Training

    • Licenses and certifications

    • Costs

  • Check insurance coverage

  • List questions to ask at visit

  • At visit answer questions about MX

  • Assess visit for comfort and reasonableness


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Research

  • NCCAM and NIH

    • nccam.nih.gov/research/priorities/index.htm

  • Cochrane Collaboration

    • www.cochrane.org

  • AltHealthWatch

    • www.epnet.com/TitleLists/html/aw_h1.htm

  • AMED

    • www.bl.uk/services/information/amed.html

  • eBMJ

    • http://bmj.bmjjournals.com/cgi/collection/complementary_medicine


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    Major Domains of CAMAlternative Health Care Systems

    • Ayurvedic Medicine

    • Chiropractic

    • Homeopathic Medicine

    • Native American Medicine

    • Naturopathic Medicine

    • Traditional Chinese Medicine


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    Major Domains of CAMMind-Body Interventions

    • Meditation

    • Hypnosis

    • Guided Imagery

    • Dance Therapy

    • Music Therapy

    • Art Therapy

    • Prayer and Mental Healing


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    Major Domains of CAMBiological Based Therapies

    • Herbal Therapies

    • Special Diets

    • Orthomolecular Medicine


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    Major Domains of CAMTherapeutic Massage, Body Work and Somatic Therapies

    • Massage

    • Feldenkrais

    • Alexander Method


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    Major Domains of CAMTwo Additional Domains

    • Energy Therapies

      • Qigong

      • Reiki

      • Therapeutic Touch

    • Bioelectromagnetic

      • Magnet Therapy


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    Future Prospects for CAM

    • Depends on evidence-base for safety and efficacy

    • Conventional and CAM may merge

      • Collaborative

      • Independent

    • Challenges

      • Communication

      • Certification and training

      • Insurance reimbursement


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    Summary

    • Defining CAM

    • History of CAM

    • Major Domains of CAM

    • Extent of Use

    • Organizations, Certification, Training

    • Selecting Practitioner


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    Acupuncture and Chinese Medicine

    Reflexology

    Chiropractic

    Naturopathy

    Natural Hygiene

    Iridology

    Homeopathy

    Psychic Healing

    Occult Practices

    Astrology

    Biorhythms

    Meditation

    Yoga Therapy

    Visual Training

    Guided Imagery

    Types of CAM


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    Alexander Technique

    Aromatherapy

    Feldenkrais Method

    Magnet Therapy

    Polarity Therapy

    Radionics and Radiesthesia

    Reiki

    Rolfing

    Clinical Ecology

    Chelation Therapy

    Holistic Medicine

    Types of CAM


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