Health PSYCHOLOGY Complementary, Alternative, and Integrative Medicine
It is more important what patient has the disease, than what disease the patient has. William Osler, MD
What Is Integrative Medicine? • Integrative Medicine • is a partnership between practitioner and patient. • uses best of conventional, complementary, and alternative medicine. • approaches a person in a holistic way: body, mind, spirit, and social. • maximizes each individual’s ability to experience optimal vitality and wellness, whatever their current state of health.
Complementary and Alternative Medicine (CAM) Complementary and Alternative Medicine (CAM) • The use and practice of natural and holistic therapies or diagnostic techniques that fall outside of conventional biomedicine.
CAM: Classification • Mind-body medicine (e.g., meditation, art & music therapy) • Biologically based practices – uses substances found in nature (e.g., herbs, foods, and vitamins) • Manipulative and body-based practices (e.g., massage, chiropractic, Feldenkrais) • Energy medicine (use of energy fields) • Biofield therapies (e.g., Reiki, qi gong) • Bioelectromagnetic-based therapies (e.g.,pulsed fields, magnet fields)
CAM: Classification (cont) • Whole medical systems cut across the four domains • Built upon complete systems of theory and practice. (Often, these systems have evolved apart from and earlier than the conventional medical approach used in the United States.) • Examples: Homeopathic, Naturopathic, Traditional Chinese, Ayurvedic
How Widespread Is CAM? • According to one JAMA report, 4 out of 10 Americans use some form of CAM • CAM is used most often by 25- to 49-year-olds • CAM is used primarily for back problems, anxiety, depression, and headaches • Most users say they believe that combining alternative and traditional medicine will produce faster results • 72% of CAM users do not tell their physicians
Efficacy and safety of CAM • What is “natural?” • Natural Safe • Natural Benign • Natural Effective • Evidence of safety and efficacy (how determined?)
What Constitutes Evidence? • Anecdotal vs. research-based • Evidence from controlled clinical trials • NEJM (1998) editorial: “There cannot be two kinds of medicine – conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the onset. If it is found to be reasonably safe and effective, it will be accepted.” • Is funding sufficient for rigorous testing?
Why controlled studies are necessary • Possible causes of improvement in a condition: • Treatment is effective • Patient was misdiagnosed • The illness improved on its own over time • spontaneous remission • cyclical conditions (arthritis) • Placebo/Hawthorne Effect
Examining controlled studies • Assignment: • Go to http://nccam.nih.gov/ • Follow the links to Clinical Trials • Find a clinical trial (completed, ongoing, or enrolling) and describe the study as per the handout/worksheet