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Integrative Medicine. Caroline Oczachowski, PGY 2 Emory Family Medicine. Adapted from Dr. J. Michelfelder at Loyola University in Chicago.

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integrative medicine

Integrative Medicine

Caroline Oczachowski, PGY 2

Emory Family Medicine

Adapted from Dr. J. Michelfelder at Loyola University in Chicago

slide2

54 year-old female presents with peripheral neuropathy, shoulder tendonitis, and carpal tunnel syndrome about 15 months after completing chemotherapy for breast cancer. She is believed to be in complete remission currently. She states that she is exercising, doing physical therapy, taking a multi-vitamin and following all of the recommendations of her physicians, but feels like she could be doing more for her issues.

What more do you want to know?

What options would come to mind for you?

How would you find information about those options?

slide3

Approximately 38 percent of adults in the United States aged 18 years and over and nearly 12 percent of U.S. children aged 17 years and under use some form of complementary and alternative medicine (CAM), according to a 2007 nationwide government survey

definitions
Definitions

“Complementary and Alternative Medicine is a Group of Diverse Medical and Health Care Systems, Practices, and Products That are Not Presently Considered Part of Conventional Medicine”

NCCAM

definitions1
Definitions
  • “Complementary Medicine is Used TogetherWith Conventional Medicine.”
  • “Alternative Medicine is Used in Place of Conventional Medicine.”

NCCAM

definitions2
Definitions

“Integrative Medicine Combines Mainstream Medical Therapies and CAM Therapies for Which There is Some High-Quality Scientific Evidence of Safety and Effectiveness.”

“Healing-oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.”

NCCAM

http://www.integrativemedicine.arizona.edu/about2.html

slide7

The National Center for Complementary and Alternative Medicine (NCCAM) is the Federal Government's lead agency for scientific research on CAM.

  • They are 1 of the 27 institutes and centers that make up the National Institutes of Health (NIH) within the U.S. Department of Health and Human Services.
slide8

The mission of NCCAM is to:

  • Explore complementary and alternative healing practices in the context of rigorous science.
  • Train complementary and alternative medicine researchers.
  • Disseminate authoritative information to the public and professionals.
5 domains of cam
5 Domains of CAM

As defined by NCCAM

other cam therapies
Other CAM therapies
  • Aromatherapy
  • Colonic Irrigation
  • Therapeutic Touch
  • EDTA Chelation
  • Cupping
  • Primordial Sound Meditation
definitions3
Definitions
  • Ayurveda - India's traditional, natural system of medicine that has been practiced for more than 5,000 years. Ayurveda provides an integrated approach to preventing and treating illness through lifestyle interventions and natural therapies. Ayurvedic theory states that all disease begins with an imbalance or stress in the individual's consciousness. Lifestyle interventions are a major ayurvedic preventive and therapeutic approach. Ayurvedic practices is to cleanse the body of substances that can cause disease, and this is believed to help reestablish harmony and balance.
definitions4
Definitions
  • Homeopathy - a system of medical practices based on the theory that any substance that can produce symptoms of disease or illness in a healthy person can cure those symptoms in a sick person. For example, someone suffering from insomnia may be given a homeopathic dose of coffee. Administered in diluted form, homeopathic remedies are derived from many natural sources—including plants, metals, and minerals.
definitions5
Definitions
  • Naturopathy – an alternative medical system. Naturopathic medicine proposes that there is a healing power in the body that establishes, maintains, and restores health. Practitioners work with the patient with a goal of supporting this power through treatments such as nutrition and lifestyle counseling, dietary supplements, medicinal plants, exercise, homeopathy, and treatments from traditional Chinese medicine.
definitions6
Definitions
  • Qi gong - A component of traditional Chinese medicine that combines movement, meditation, and regulation of breathing to enhance the flow of qi (an ancient term given to what is believed to be vital energy) in the body, improve blood circulation, and enhance immune function.
definitions7
Definitions
  • Reiki - A Japanese word representing Universal Life Energy. Reiki is based on the belief that when spiritual energy is channeled through a reiki practitioner, the patient's spirit is healed, which in turn heals the physical body.
why should we care
Why Should We Care?
  • 30,000 herbs on the market currently
  • Estimates of $30-40 billion dollars spent annually Eisenberg D. et al, JAMA, Nov 11, 1998(18) 1569-1575
  • Sales of Metabolite 356 approached $1billion in 1999 Alternative Medicine Alert, January 2000
  • Avlimil – est. $100 million in sales in 2003 

Herbal entrepreneur proving that sex sells: Local business reaps millions from supplementsThe Cincinnati Enquirer

  • Relacor $23 Million; 900,000 bottles by July 06
  • Enzyte has 21,400 repeat customers at $99.95 a month for a whopping $2,138,930.00 a month in sales ($25,667,160.00 annually)USA today
why should we care1
Why Should We Care?
  • 600 Million Visits a year to CAM Providers – More Than to Primary Care Providers
  • An estimated 15 million adults took prescription medications concurrently with herbal remedies and/or high-dose vitamins

Eisenberg D. et al, JAMA, Nov 11, 1998(18) 1569-1575

have we missed the boat
Have We Missed the Boat?
  • Dissatisfaction with health care providers and medical outcomes
  • Side effects of drugs and treatments
  • High health costs
  • Technology
  • Lack of control in their own health care practices
  • Time spent with practitioner

Stephen Strauss, M.D., NCCAM Director

have we missed the boat1
Have We Missed the Boat?
  • Looking for “cures”
  • Want to use “natural” products
  • Patient feels empowered
  • Focus on spirituality and emotional well-being
  • Health Care Provider provides the 3 T’s: touch, talk, time

Stephen Strauss, M.D., NCCAM Director

what about communication
What about communication?

Between 40 and 70% of CAM users do not disclose their use to their physician.

Eisenberg 2001

why do patients not tell their physician about their cam use
Why do patients not tell their physician about their CAM use?
  • 60% - “My doctor never asked.”
  • 60% - “It wasn’t important for my doctor to know.”
  • 20% - “My doctor wouldn’t understand.”
  • 14% - “My doctor would disapprove.”

Eisenberg DM. Ann Int Med 2001;135(5):344-51

slide37

PRESS RELEASE:

  • Medication errors are among the most common medical errors, harming at least 1.5 million people every year, says a new report from the Institute of Medicine of the National Academies.  The extra medical costs of treating drug-related injuries occurring in hospitals alone conservatively amount to $3.5 billion a year, and this estimate does not take into account lost wages and  productivity or additional health care costs, the report says.

- IOM July 2006

evidence based medicine
Evidence Based Medicine
  • Difficulties With CAM Research
    • Sham Acupuncture
    • Non Standardized Herbal Formulations
    • Difficult to Blind Patients and Practitioners
    • Treatments Very Individualized – Difficult to Formulate Protocols
    • Drug companies have to do studies to go on the market—supplement companies do not, so clinical trials sponsored by supplement companies are rare
comparison
Comparison
  • Mainstream Medicine
    • Large Double Blind Placebo Controlled Trials
      • Many Exclusions Such As Multiple Medicines, Other Illnesses, Female, Pregnant, Children, Race
      • “Placebo Effect” Discounted
      • Apply These Narrow Results to The Individual
    • Integrative Medicine
      • Very Individualized
      • “Placebo Effect” Not Discounted
physician s attitudes
Physician’s Attitudes
  • Survey sent to 660 physicians at the Mayo Clinic (233 responded)
  • Three areas: utilization, familiarity and attitudes
  • Utilization:
    • 75% had never referred to CAM practitioner
    • 44% said they would consider if available at Mayo (<46 years or female more likely)
    • Less than 25% discussed benefits or risks with CAM
    • 57% thought incorporation of CAM would have a positive impact on pt satisfaction
physician s attitudes1
Physician’s Attitudes
  • Familiarity:
    • Biofeedback, massage, chiropractic and relaxation therapies were the most familiar
    • 59% were unfamiliar with energy healing, 53% with naturopathic medicine
    • Of the 13 herbs listed, only 3 were commonly listed as familiar
    • 66% were not familiar with feverfew and 52% were not familiar with Kava
    • 49% of the physicians felt it was difficult or very difficult to find reliable information about herbs
physician s attitudes2
Physician’s Attitudes
  • 41% of the physicians neither agreed or disagreed that physician knowledge had an impact on patient’s health
  • 52% felt physicians’ spiritual beliefs were important and 87% felt patients’ spiritual beliefs and practices were important
  • 67% agreed some CAM therapies hold promise but 70% felt current practices of CAM was a “threat” to the public health
  • Most important factors in changing physicianss attitudes were RCT’s and evidence demonstrating mechanism
  • 70% of the physicians felt Mayo clinic should provide proven CAM therapies

eCAM 2006;3(4) 495-501

where are we today
Where Are We Today?
  • Clinical Fellowships:
    • University of Arizona (Founding Program)
    • University of Michigan
    • University of Maryland
    • University of Wisconsin
    • Maine Medical Center
    • Cooper Health System (NJ)
    • Lawrence MA
    • Beth Israel Medical Center
    • UCLA
  • Academic Fellowships (Research)
    • Harvard University
    • Tufts
    • Boston University
    • Stanford
    • Duke
  • Residencies in Integrative Medicine
    • Oregon Health Sciences University
    • Montefiore Medical Center (NY)
cahcim members
CAHCIM Members
  • Albert Einstein/Beth Israel
  • Columbia University
  • Duke University
  • George Washington
  • Georgetown
  • Harvard
  • Laval University
  • Mayo Clinic
  • OHSU
  • Stanford University
  • Yale University
  • Wake Forest University
  • University of Alberta
  • University of CA/Irvine
  • Thomas Jefferson
  • UMDNJ
  • University of Arizona
  • University of Calgary
  • University of Hawaii
  • University of Washington
  • University of California/LA
  • University of California/SF
  • University of Colorado
  • University of Connecticut
  • University of Kansas
  • University of Maryland
  • University of Massachusetts
  • University of New Jersey
  • University of New Mexico
  • University of North Carolina-Chapel Hill
  • University of Michigan
  • University of Minnesota
  • University of Pennsylvania
  • University of Pittsburgh
  • University of Texas-Galveston
  • University of Vermont
  • University of Wisconsin
the future of integrative medicine
The Future of Integrative Medicine
  • Definition of Integrative Medicine From the CAHCIM

“Integrative medicine is the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches to achieve optimal health and healing.”

the future of integrative medicine1
The Future of Integrative Medicine
  • The Term “Integrative Medicine” Will Die
    • Our Patients Will Demand Integrative Medicine From All of Us
    • Training Will Be Demanded by Medical Students
    • Training Will Be Demanded by Residents
the future of integrative medicine2
The Future of Integrative Medicine
  • Integrative Medicine Will Be A Skill Set Added on Just Like:
    • Electronic Health Records
    • New Medications
    • New Procedures
real patient
Real Patient

54 year-old female presents with peripheral neuropathy, shoulder tendonitis, and carpal tunnel syndrome about 15 months after completing chemotherapy for breast cancer. She is believed to be in complete remission currently. She states that she is exercising, doing physical therapy, taking a multi-vitamin and following all of the recommendations of her physicians, but feels like she could be doing more for her issues.

What more do you want to know?

What options would come to mind for you?

How would you find information about those options?

integrative medicine1
Integrative Medicine

requires a paradigm shiftfrom

the disease-centered approach of conventional biomedicine

to

an approach in which patient values and participation of patients are central.

Maizes 1999

integrative medicine2
Integrative Medicine
  • Integrative Medicine is healing-oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle.
  • It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.

www.integrativemedicine.ariazona.edu

PIM – U of Arizona

the future of integrative medicine3
The Future of Integrative Medicine
  • Epocrates Rx Pro
  • Micromedex
  • Commission E
  • Plus Many Other Databases
resources
Resources
  • Commission E
    • Germany
    • Ranks Quality of Evidence
    • Evaluates Benefits and Risks
integrative medicine3
Integrative Medicine
  • Donald Novey, M.D. – Lutheran General Hospital
    • Evidence Based Review of Each Modality
integrative medicine4
Integrative Medicine
  • David Rakel, M.D., University of Wisconsin
    • Instructions on how to put CAM into your own medical practice
resources1
Resources
  • National Center for Complementary and Alternative Medicine
    • http://nccam.nih.gov/
  • Agency for Healthcare Research and Quality
    • http://www.ahrq.gov/clinic/epcindex.htm
resources2
Resources
  • American Academy of Medical Acupuncture
    • www.medicalacupuncture.org
  • Online Resource
    • http://www.altmedicine.com
where should we go for information
Where Should We Go for Information?
  • Product claims
    • www.quackwatch.com
    • www.snopes.com
  • Product quality assurance
    • www.consumerlab.com
  • Product ingredients
    • Natural Medicines Databasewww.naturaldatabase.com
  • Product safety and efficacy
    • www.cfsan.fda.gov/~dms/ds-ind.html
    • www.naturaldatabase.com
    • The Natural Pharmacistwww.iherb.com or www.consumerlab.com
slide66

Dr. Ou completed an Internal Medicine Residency at Emory.

  • He was the first doctor in the world to be certified in Field Control Therapy by its creator, Savely Yurkovsky, M.D.
  • Dr. Ou was one of the first medical doctors to become certified in NES Health and Matrix Energetics.
slide68

Dr. Clairborne began her journey at Emory University completing her BA in Psychology then went on to complete her medical degree at Morehouse School of Medicine. Finishing her Family Medicine Residency at Florida Hospital in Orlando, FL., she ventured on to complete pose graduate trainings in acupuncture with The Academy of Pain Research Acupuncture and the International Academy of Medical Acupuncture. 

slide73

http://students.sfu.ca/health/audio/Prog%20Musc%20Relax%20Feb%2028%20Mzk%20128k.mp3http://students.sfu.ca/health/audio/Prog%20Musc%20Relax%20Feb%2028%20Mzk%20128k.mp3

http://students.sfu.ca/health/healthpromotion/yourhealth-videoandaudio.html