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Integrative Medicine Complementary and Alternative Medicine. Ma. Stephanie Fay S. Cagayan, MD Associate Professor. Objectives. By the end of this presentation, you should be able to... Define “Integrative Medicine ” and other terms

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integrative medicine complementary and alternative medicine

Integrative MedicineComplementary and Alternative Medicine

Ma. Stephanie Fay S. Cagayan, MD

Associate Professor

objectives
Objectives
  • By the end of this presentation, you should be able to...
    • Define “Integrative Medicine” and other terms
    • Describe the difference between traditional and western medicine
    • Describe the different types of CAM
    • Understand how Integrative Medicine (especially the use of herbal medicine) relates to Modern Philippine Medicine and therapeutics
    • Prepare to practice Integrative Medicine in the future
presentation outline
Presentation Outline
  • Definitions
  • Why Should We Care About CAM?
  • What Do Patients Want?
  • What Can We Provide to Meet the Demand?
slide4

35 year-old female

  • peripheral neuropathy, shoulder tendonitis, and carpal tunnel syndrome about 15 months after completing chemotherapy for cancer.
  • in complete remission
  • Currently exercising, doing physical therapy, taking a multi-vitamin and following all of the recommendations of her physicians

What more do you want to know?

What options would come to mind foryou?

How would you find information about those options?

slide6

“Imagine a world - oriented toward healing rather than disease, where physicians believed in the natural healing capacity of human beings, and emphasized prevention above treatment.

In such a world, doctors and patients would be partners working toward the same ends.”

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”

National Center for Complementary and Alternative Medicine

definitions1
Definitions
  • “Complementary Medicine is Used TogetherWith Conventional Medicine.”
  • “Alternative Medicine is Used in Place of Conventional Medicine.”
definitions2
Definitions

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

NCCAM

5 domains of cam1
5 Domains of CAM

As Defined by NCCAM

why should we care
Why Should We Care?
  • 60% of Filipinos still lack access to doctors
  • Majority of Filipinos are below poverty level and cannot afford cost of health care
why should we care1

33%

15%

25-50%

40%

25%

>80%

>90%

50-75%

75%

60-70%

60%

>80%

40%

~60%

40-70%

60-80%

55%

~50%

>80%

70%

www.WHO.org

Why Should We Care?
  • 600 Million Visits a Year to CAM Providers – More Than to Primary Care Providers
  • Why? What is Mainstream Medicine Not Offering to Our Patients?

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/No choice
  • 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
  • No choice

Stephen Strauss, M.D., NCCAM Director

what about communication
What about communication?
  • Between 40 and 70% of CAM users do notdisclose their use to their physician.

WHY?

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.”

70% of patients see their Physician before or concurrent with their visits to a CAM provider

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

why would we not trust cam
Why Would We Not Trust CAM?

- quackery

“Doctors concerned because several cases reported of liver failure with Kava Kava, a widely used natural remedy for anxiety”

historical developments global
Historical Developments: Global
  • World Health Organization (WHO): 1978 Alma Ata Declaration on Primary Health Care (PHC): Integration of Traditional Medicine in PHC
  • 1999: US Congress established the National Center for Complementary and Alternative Medicine (NCCAM) in the National Institutes of Health (NIH) Bethesda, Maryland.
worldwide perspective
Worldwide perspective
  • Complementary
  • Alternative
  • Traditional
  • Primary medical care
  • Treatment of minor ailments
  • Health maintenance

www.WHO.org

goals of use treatment with cam
Goals of Use/Treatment with CAM
  • Promotion and maintenance of health
  • Prevention of disease and injury
  • Relief of pain and suffering
  • Cure of curable diseases and illnesses
  • Care of people who are ill
  • Avoidance of premature death
  • Peaceful death
regulations
Varied from stringent to none

Canada

Federal and provincial regulations

2004 National Health Products Regulations

European Union

Directive to register and license products

Mexico

Traditional birth attendants, homeopathic practitioners, chiropractors licensed

Registry of traditional practitioners

China and India

Integrated with allopathic medicine, regulated

Regulations
philippine experience in integrative medicine 1972 2008
Philippine Experience in Integrative Medicine 1972-2008
  • Mid-70’s: Private physicians started training in acupuncture in China
  • Early 1980’s: DOH physicians trained acupuncture in China; herbal medicine production started
  • 1993-95: DOH established the Traditional Medicine Unit which promoted the use of medicinal plants, acupuncture and therapeutic massage
integrative medicine policy and practice in the philippines
Integrative Medicine Policy and Practice in the Philippines
  • 1995 -De La Salle University inaugurated the Center for Indigenous Medicine in Dasmarinas, Cavite -the 1st Philippine university to do so.
  • 1997 -Republic Act 8423 established the Philippine Institute for Traditional and Complementary Health Care (PITAHC) in as an attached agency of the Department of Health (DOH).
what is traditional and alternative medicine as defined by r a 8423
What is Traditional and Alternative Medicine as defined by R.A. 8423 ?
  • The scope of alternative health care modalities as other forms of non-allopathic, occasionally non-indigenous or imported healing methods, though not necessarily practiced for centuries nor handed down from one generation to another.
slide31

1999-2000 Filipino physicians have organized the Philippine Association of Medical Acupuncturists Inc (PAMAI) and the Philippine College for the Advancement of Medicine (PCAM) to promote the practice of Integrative Medicine.

  • 2001 -The UP College of Medicine started an elective course on Integrative Medicine in both graduate and undergraduate courses. The UP-Philippine General Hospital inaugurated the Traditional and Integrative Medicine Clinic.
slide32

2008 -The Philippine Institute of Traditional and Alternative Medicine (PITAHC) started the accreditation of acupuncturists practicing in the Philippines, both for medical and non-medical practitioners.

world view of health in filipino traditional medicine
World View of Health in Filipino Traditional Medicine
  • Theory of macrocosm and microcosm (“kalawakan” at “sangkatauhan”)
  • The balance, synergy and harmony:
    • Between Humankind and the Universe
    • Between Humankind and Nature
    • Between and Amongst people
    • Within his body, mind and spirit
world view of health in filipino traditional medicine1
World View of Health in Filipino Traditional Medicine
  • Theory of nature elements Theory of body humours
  • fire (kalikasanngapoy) Init (hot) and lamig (cold)
  • earth (kalikasannglupa) Wet (basa) at Dry (tuyo)
  • water (kalikasanngtubig)
  • air (kalikasannghangin)
  • Belief in nature spirits/guardians of nature and spirit ancestors
folk or traditional medicine
Folk or Traditional Medicine
  • 80% of Third World countries utilize folkloric medicine
  • Formal training vs apprenticeships vs observation, imitation, practice
    • Skill may be inherited
  • Range of remedies
    • prayer, touch, charms, rituals, teas, tinctures, poultice, etc
  • All cultures
herbal medicine in the philippines
Herbal Medicine in the Philippines
  • 8,000 to 12,000 flowering plants
  • 1,500 species actively utilized by traditional healers
    • About 40% of medicinal plants used in indigenous communities have not been documented
  • There are about 250,000 traditional medical practitioners in the Philippines
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
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
challenges to the filipino community
Challenges to the Filipino Community

1. Majority of Philippine medicinal plants remain undocumented and untapped.

2. Scientific studies supporting Philippine traditional medicine practices is still in the early phase and full potential has not been explored.

3. Lack of collaboration among research institutions, private sector and academe

*NIRPROMP

national integrated research program on medicinal plants
National Integrated Research Program on Medicinal Plants
  • A multidisciplinary research team established in 1976 under the Department of Science and Technology
  • Tasked to validate scientifically certain folkloric uses of medicinal plants and to propagate the use of herbal medicines rationally by the majority of the people (for example, sambong has a folkloric use for cough but upon scientific validation, it is now used as a diuretic)
slide45

4.Lack of investments in research and development, raw material production, post harvest processing and herbal manufacturing.

5.Low level of scientific technology in herbal medicine research and manufacture among small and medium enterprises.

6. Low support for traditional medicine research in the academic community.

slide46

7. Need for market and government incentives like the ones given to rice, corn, coconut, sugar, bananas, pineapples and mangoes.

8. Need for standardized procedures/ accreditation/recognition in Filipino traditional medicine/herbal medicine practices.

answers to challenges
Answers to Challenges
  • A wareness raising
  • N etworking among groups
  • T echnical capacity building
  • I nformation exchange/monitoring
  • D eepening of understanding
  • O rganizing concerned people
  • T ransformative action
  • E mpowerment of people
slide48

Awareness, understanding and appreciation of resources

  • Capability for a relevant and self-reliant research and development program
  • Recognition and respect of community rights and indigenous knowledge
  • Strong national policies and laws to protect indigenous resources
  • Active defense against immediate threats to biodiversity (mining, deforestation)
  • Preventive action against potentially destructive technologies/activities (developmental aggression)
  • Confronting structural causes of unsustainable use (political system)
slide50

35 year-old female

  • peripheral neuropathy, shoulder tendonitis, and carpal tunnel syndrome about 15 months after completing chemotherapy for cancer.
  • in complete remission
  • Currently exercising, doing physical therapy, taking a multi-vitamin and following all of the recommendations of her physicians

What more do you want to know?

What options would come to mind foryou?

How would you find information about those options?

the future of integrative medicine
The Future of Integrative Medicine

The Future Is Sometimes Curing,

But Always Caring

integrative medicine
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

the future of integrative medicine1
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 medicine2
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 medicine3
The Future of Integrative Medicine
  • Integrative Medicine Will Be A Skill Set Added on Just Like:
    • Electronic Health Records
    • New Medications
    • New Procedures
how do we add on these skills
How do We Add On These Skills?
  • Build your database.
  • Build a referral team.
  • Ask your patients whom they see.
  • Look for summaries of available data.
  • Have an open dialogue with your patients.
resources
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
resources1
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
the future of integrative medicine4
The Future of Integrative Medicine
  • What Cannot Be Added On is Empathy, Open-mindedness and Respect for Other People’s Beliefs
summary
Summary
  • Know what integrative medicine is
  • Dialogue with your patients
  • Build your database
  • Build your referral base
  • Develop patient care teams
  • Consider all available options
  • Be open-minded
  • Be an agent of change in your community
  • Above all: be caring, concerned and compassionate