LESSON PLAN

 Topic : Alternative system of medicine.

 Name of Student:
 Batch/Class:
 Place:
 Subject :
 Duration:
 Previous Knowledge:
 Method of Teaching:
Shubhangi kewat
MSc. Nursing 1st year.
Government Nursing College.
Nursing education.
45 minute.
There is little bit knowledge about the topic.
Lectures cum discussion.

 A.V. Aids: Leaflets, Poster, Flip Chart.

Objectives:
1. General objective: By the end of lecture the group will gain in-depth knowledge on alternative
systems of medicine and apply those knowledge in providing care to the patients in needy and give
proper counseling to them.

2. Specific objectives: The group will be able to

 Define Alternative systems of medicine
 Discuss the commonalities and differences between biomedicine and CAM
 Describe the uses/importance of CAM
 Explain the types of CAM
 Emphasize on regulations for CAM
 Enumerate the safety issues of CAM
 Discuss the future of CAM
Time Specific Content Teaching Audio
objective and visual Evaluation
learning aids
activity
3min To Introduction:
introduce There are a large number of diverse, therapeutic or preventive, medical practices and therapies, Lecture White What do
the topic cum board you mean
that are not part of the conventional (Allopathic) medicinal system, existing today. These are
discussion
generally known as Alternative / Complimentary systems and therapies. by CAM?

India is home to several alternative systems of medicine such as the Ayurveda, Siddha and
so on. Knowledge of medicine in India has been considered as the out-come of the great power
of observation, experimentation and analysis, with the patient effort of hundreds of
investigators spread over thousands of years. This knowledge has been documented in an
integrated form in the 'Vedas'-the most ancient document about Indian wisdom and
knowledge.
Alternative medicine is a conventional method of healing the disease by examining the
symptoms without collecting clinical evidences.

Alternative medicine is a term that describes medical treatments that are used instead of
traditional (mainstream) therapies. Some people also refer to it as “integrative,” or
“complementary” medicine.

About 40% of adults in the United States say they use some form of alternative medicine. But
exactly what types of therapies are considered alternative? The definition changes as doctors
test and move more of them into the mainstream.

Meaning of medicine is
1. any drug or remedy.
2. the art and science of the diagnosis and treatment of disease and the maintenance of health.
3. the nonsurgical treatment of disease.
A large and diverse set of systems of diagnosis, treatment, and prevention based on
philosophies and techniques other than those used in conventional Western medicine, often
derived from traditions of medical practice used in other, non-Western cultures. Such practices
 may be described as alternative, that is, existing as a body separate from and as a replacement
for conventional Western medicine, or complementary, that is, used in addition to
conventional Western practice.

Definition:
Alternative medicine is defined as any of a range of medical therapies that are not regarded as Lecture
orthodox by the medical profession, such as herbalism, naturopathy, and crystal healing. cum White Can you
To define (Based on WordNet 3.0, Farlex clipart collection.) discussion board define
alternative CAM?
systems of A variety of health care practices, such as homeopathy, naturopathy, and Reiki, whose tenets
medicine often differ from those of mainstream medicine and are not generally taught in conventional
medical schools. (American Heritage® Dictionary of the English Language, Fifth Edition.)
A health care practice that does not follow generally accepted medical methods and may not
have a scientific explanation for its effectiveness. Examples of alternative medicines are
homeopathy and herbal medicine.( Random House Kernerman Webster's College Dictionary)

It can be defined as "a variety of therapeutic or preventive health care practices, such as
homeopathy, naturopathy, chiropractic, and herbal medicine that do not follow generally
accepted medical methods and may not have a scientific explanation for their effectiveness”
Complementary and alternative medicine (CAM) is the term for medical products and
practices that are not part of standard care. Standard care is what medical doctors, doctors of
osteopathy and allied health professionals, such as registered nurses and physical therapists,
practice.
According to the definition used by the Cochrane Collaboration, ‘complementary and
alternative medicine’ is a broad domain of healing resources that encompasses all health
systems, modalities, practices and their accompanying theories and beliefs, other than those
intrinsic to the politically dominant health system of a particular society or culture in a given
historical period.

According to Eskinazi, alternative medicine can be defined as a broad set of health-care

3min
practices (i.e. already available to the public) that are not readily integrated into the dominant
health care model, because they pose challenges to diverse societal beliefs and practices
(cultural, scientific, medical and educational). This definition brings into focus factors that
may play a major role in the prior acceptance or rejection of various alternative health care
 practices by any society. Unlike criteria of current definitions, those of the proposed definition
would not be expected to change significantly without significant societal change.

Conceptual differences and commonalities between biomedicine and CAM

The characteristic common to traditional (alternative) system of health (vital force, spirituality Lecture
and holism) seems to distinguish it from biomedicine. Biomedicine is founded in part on cum
materialism (in contrast to the vital force explanation). Materialism, in this context, refers to discussion Chart
the theory that ‘physical matter is the only or fundamental reality, and that all beings and What are the
To discuss processes and phenomena are manifestation or result of matter’. While biomedicine does not commonaliti
the necessarily reject religion or spirituality, it does not routinely incorporate these aspects into es between
difference diagnosis and treatment (unlike the traditional system). It negates any evidence of the role of biomedicine
and the spirit, and the mind is viewed as merely a product of the brain. and CAM?
commonaliti
es between Traditional medicine teaches that energy flows within, around and through all things in the
biomedicine universe. Energy cannot be destroyed, but can be affected negatively, leading to flow
and CAM imbalance or disease. Traditional medicine does not exclusively view disease as an invasion or List the
poisoning of the body by a foreign organism. Instead it sees the disease as a condition when differences
the human body is out of balance with its milieu. Healing, therefore, is the art of manipulating between
the flow of energy to re-establish balance in the whole person, rather than just the area of biomedicine
complaint. Spirituality, unlike in allopathy, is an integral part of traditional medicine and, as a and CAM?
result, traditional medicine therapy can be very individualized, with no two people receiving
the same treatment, despite similar complaints or the same disease.
In contrast, Western medicine tends to divide the body into systems and compartments and
measures functions by evaluating tissues and examining body fluids. Although there is a great
deal of knowledge regarding the body’s complex interactions, abnormalities are often
diagnosed and treated as individual entities apart from the patient. Western physicians
frequently sub-specialize and view disease as an invasion of the body by foreign organisms or
a proliferation or death of individual cells. The focus of Western medicine is therefore to
provide a cure for a specific ailment. The Western scientific method is applied rigorously and
claims of its efficacy are documented and proved by repeated independent studies. Like
traditional medicine, biomedicine also now advocates some changes in diet, environment and
lifestyle to promote health
Why do people use CAM ?/ importance of CAM :
 The increasing popularity of CAM reflects changing needs and values in modern society in Lecture
general. This includes a rise in prevalence of chronic diseases, an increase in public access to cum
worldwide health information, reduced tolerance for paternalism, an increased sense of discussion OHP
entitlement to quality life, declining faith that scientific breakthrough will have relevance for And
the personal treatment of disease, and an increased interest in spiritualism. In addition, concern pump let Why do
about the adverse effect and skyrocketing cost of conventional health care are fuelling the people use
To describe search for alternative approaches to the prevention and management of illness. CAM?
the uses/
importance As there are many factors like the socio-cultural and personal (health status, belief, attitude,
of CAM motivation, etc.), underlying a person’s decision to use alternative therapies, at present, there is
no clear or comprehensive theoretical model to account for the increased use of alternative
forms of health care. Three assumptions have been proposed to explain the use of alternative
medicine:
(1) Dissatisfaction: Patients are dissatisfied with conventional treatment because it has been
ineffective, has produced adverse side effects, or is seen as impersonal, too technologically-
oriented, and/or too costly.
(2) Need for personal control: Patients seek alternative therapies because they see them as
less authoritarian with more personal autonomy and control over their health care decisions.

(3) Philosophical congruence: Alternative therapies are attractive because they are seen as
5min more compatible with patients’ values, world-view, spiritual/religious philosophy or beliefs
regarding the nature and meaning of health and illness.

Surveys of users of complementary medicine indicate that about 80% are satisfied with the
treatment they receive. Interestingly, this is not always dependent on a simultaneous
improvement in their condition. For example, one survey of cancer patients in the UK
suggested that the users were more hopeful about their future and were emotionally stronger
and less anxious, even if the cancer remained unchanged. Previous research has indicated that
patients with higher levels of education and poor health status are likely to be alternative
medicine users.

Types of Alternative systems of Medicine:

Lecture
cum
 discussion
Five categories of alternative medicine are generally recognized:
LCD
1. Alternative whole medical systems projector What are the
2. Mind-body medicine
types of
3. Biologically based practices
To explain 4. Manipulative and body-based practices And flip CAM?
the different 5. Energy medicine chart
types of
CAM 1. Alternative Whole Medical Systems:

Alternative medical systems are complete systems with explanation of disease, diagnosis, and
therapy. They include the following:

 Ayurveda
 Homeopathy
 Naturopathy
 Traditional Chinese medicine

 Ayurveda: Ayurveda, the traditional medical system of India, originated > 4000 yr
ago. It is based on the theory that disease results from an imbalance of the body’s life
force (prana). It aims to restore balance within the body. The balance of prana is
determined by equilibrium of the 3 bodily qualities (doshas): vata, pitta, and kapha.
Most people have a dominant dosha; the specific balance is unique to each person.

Can you say

the uses and
Evidence for Ayurveda
adverse
Few well-designed studies of Ayurvedic practices have been done. Use of Ayurvedic herbal affects of
combinations to relieve symptoms in patients with RA has been studied. A 2005 systematic Ayurveda?
review1 identified randomized controlled trials that studied the efficacy of Ayurvedic herbal
combinations for treatment of RA. Only a few high-quality studies were identified, but
existing evidence did not demonstrate efficacy for treatment of RA. Use of Ayurvedic
practices to treat diabetes is being studied.

Uses for Ayurveda

 After determining the balance of doshas, practitioners design a treatment specifically tailored
to each patient. Ayurveda uses diet, herbs, massage, meditation, yoga, and therapeutic
detoxification (panchakarma)—typically with enemas, oil massages, or nasal lavage—to
3min restore balance within the body and with nature.

Possible Adverse Effects

In some of the herbal combinations used, heavy metals (mainly lead, mercury, and arsenic) are
included because they are thought to have therapeutic effects. Several studies 1,2 found that
about 20% of Ayurvedic herbal supplements were contaminated with heavy metals in doses
that, if taken as directed, could cause toxicity; cases3of heavy metal toxicity have been
reported.

 Homeopathy:

Developed in Germany in the late 1700s, homeopathy is a medical system based on the
principle that like cures like (the law of similars). A substance that, when given in large doses,
causes a certain set of symptoms is believed to cure the same symptoms when it is given in
minute to nonexistent doses. The minute dose is thought to stimulate the body’s healing
mechanisms. What is the
principle of
Treatments are based on the patient’s unique characteristics, including personality and
lifestyle, as well as symptoms and general health. Homeopathy aims to restore the flow of the treatment
body's innate life force (vitalism); it is not based on principles of chemistry or physiology. behind
homeopathy
Remedies used in homeopathy are derived from naturally occurring substances, such as plant ?
extracts and minerals. Extremely low concentrations are prepared in a specific way. The more
dilute the homeopathic remedy, the stronger it is considered to be. Many solutions are so dilute
that they contain no molecules of the active ingredient. For example, 30C dilution is diluted 1
to 100 in 30 serial dilutions, resulting in a final dilution of 1 x 1060.

Regulation of Homeopathy

Unlike herbal and nutritional supplements, homeopathic remedies are regulated by the FDA.
Only homeopathic remedies that are approved by the FDA can be manufactured. Because so
little active ingredient is left after dilution, active ingredients are tested before dilution.
 The FDA exempts homeopathic remedies from several requirements that exist for other drugs:

 The identity and strength of each active ingredient do not have to be confirmed by a
laboratory before the remedy is distributed.
 Manufacturers of homeopathic products are not required to provide evidence of
efficacy.
 Homeopathic remedies have been temporarily exempted from limits on the amount of
alcohol (the usual diluent) that they can contain.

However, the label is required to list the following:

 Manufacturer
 The label “homeopathic”
 At least one indication
 Instructions for safe use
 Unless specifically exempted, the active ingredient and degree of dilution

Evidence for Homeopathy

The principles of homeopathy—like cures like and diluting makes preparations stronger—
have no scientific basis. Expecting a preparation diluted so much that it has no active
ingredient to have physiologic effects other than those of a placebo is biologically and
chemically implausible. However, some homeopathic preparations do contain active
ingredients in concentration sufficient to have physiologic effects (eg, Zicam, which contains a
measurable amount of zinc).
15min
Efficacy of homeopathic remedies for various disorders has been extensively studied. A 2010
analysis1 of systematic reviews found that homeopathy is no more efficacious than placebo for
any indication, as did the United Kingdom's House of Commons Science and Technology
Committee2 after an exhaustive review of systematic reviews and meta-analyses of
homeopathy (2010). The Australian government's exhaustive review of the clinical evidence
for homeopathy3 (2013) found that for 61 indications, there was evidence of lack of efficacy
for homeopathy, and for another 7 indications, there was no good-quality evidence.

Proponents often cite the preliminary evidence in 3 studies4 published in 2003 supporting the
efficacy of homeopathy for diarrhea in children. However, an independent review of that
evidence found it unconvincing, and a larger, more rigorous follow-up study5 in 2006
concluded that homeopathy did not effectively treat diarrhea in children. Critics also point out
that because all 3 studies were done by the same researcher, there has been no independent
replication.

Uses of Homeopathy

Homeopathy is commonly used in Europe and India, largely because of a long history of use;
as a result, the practice has become part of the culture.

Homeopathy has been used to treat various disorders, such as allergies, rhinitis, digestive
problems, musculoskeletal pain, and vertigo.

Possible Adverse Effects

Homeopathy is well-tolerated and has few risks; rarely, an allergic or toxic reaction occurs.

A 2012 review1 of reported cases of adverse effects identified 38 reports involving 1159
patients. Adverse effects included

 Direct reactions to homeopathic treatments, presumably due to active ingredients

 Indirect harm caused by substituting homeopathy for effective conventional treatment

Conventional clinicians should not assume that a homeopathic remedy taken by a patient is
biologically inactive and thus could not have adverse effects. Also, some homeopathic
remedies contain other active ingredients that can have physiologic effects. Whether patients
are taking homeopathic remedies may be unclear because patients often use the term
homeopathic erroneously in reference to a dietary supplement they are taking. Also, the FDA
allows many medicinal herbs to be registered and labeled as homeopathic if they undergo a
particular pharmaceutical process.

 Naturopathy:

Naturopathy began as a formal health care system in the US during the early 1900s. Founded
on the healing power of nature, naturopathy emphasizes

 Prevention and treatment of disease through a healthy lifestyle

 Treatment of the whole patient
  Use of the body’s natural healing abilities

Some of this system’s principles are not that different from those of traditional healing systems
such as Ayurveda and traditional Chinese medicine. What do
you mean
Naturopathy uses a combination of therapies, including acupuncture, counseling, exercise
therapy, medicinal herbs, homeopathy, hydrotherapy, natural childbirth, nutrition, physical by
therapies (eg, heat or cold therapy, ultrasound, massage), guided imagery, and stress naturopathy
management. ?

The American Association of Naturopathic Physicians tends to discourage childhood

vaccinations.

Evidence for Naturopathy

Many naturopathic diagnostic and treatment methods are unproved or even disproved. An
example is hydrotherapy (application of cold or hot water compresses), which is used to treat
many conditions; this therapy is specific to naturopathy. Despite a wide range of claims made
for hydrotherapy, no published studies demonstrate its efficacy.

 Traditional Chinese Medicine:

Originating > 2000 yr ago, traditional Chinese medicine (TCM) is a medical system based on
the philosophy that illness results from improper flow of the life force (qi). The movement of
qi is restored by balancing the opposing forces of yin and yang, which manifest in the body as
cold and heat, internal and external, and deficiency and excess.

Various practices are used to preserve and restore qi and thus health. Most commonly used are

 Medicinal herbs
What are the
 Acupuncture
uses for
Other practices include diet, massage, and meditative exercise called qi gong. traditional
Chinese
TCM often uses diagnostic categories that do not correspond to current scientific medicine?
understanding of biology and illness (eg, general deficiency, excess of yin or yang).

Evidence for Traditional Chinese Medicine

Obtaining high-quality evidence is difficult, mainly because the active ingredients in TCM
herbs are not purified, are often unidentified, and may be numerous. Thus, determining the
dose is difficult or impossible, and the dose may vary from one source of herbs to another.
Information about bioavailability, pharmacokinetics, and pharmacodynamics is usually
unavailable. Also, active ingredients may interact with each other in complex and variable
ways.

Chinese herbal medicine traditionally uses formulas containing mixtures of herbs to treat
various disorders. Traditional formulas can be studied as a whole, or each herb in the formula
can be studied separately. One herb, used by itself, may not be as effective and may have
adverse effects. Nevertheless, current conventional research favors study of single herbs to
better control for variables. Another problem is the large number of herbal mixtures that could
be studied.

Studies of TCM herbs and herbal mixtures for irritable bowel syndrome have had mixed
results, and reviews of these studies conclude that more rigorous studies are required.

Preliminary studies of Tripterygium wilfordii(thunder god vine) has demonstrated anti-

inflammatory properties and suggested clinical efficacy in treating RA, but reviews 1 have
found that existing evidence is insufficient to prove efficacy and concluded that more research
is needed.

Preliminary studies2 show that Astragalus may improve quality of life for patients being
treated with chemotherapy for lung cancer, but it does not prolong survival or slow
progression of cancer, as assessed by biomarkers.

Possible Adverse Effects

One problem is the standardization and quality control of Chinese herbs. Many are unregulated
in Asia; they may be contaminated with heavy metals from polluted ground water or may be
adulterated with drugs such as antibiotics or corticosteroids. Ingredients are often substituted,
partly because the names of the herbs are translated incorrectly. A 2013 study1 found that 32%
of herbal supplements did not contain the main active ingredient on the label, 20% contained
contaminants (physiologically active compounds other than the ingredients desired or on the
label), and another 21% contained fillers not listed on the label. However, high-quality
products are available through certain manufacturers that comply with FDA Good
Manufacturing Practices.
2. Mind-Body Medicine:

Mind-body medicine is based on the theory that mental and emotional factors regulate
physical health through a system of interdependent neuronal, hormonal, and immunologic
connections throughout the body. Behavioral, psychologic, social, and spiritual techniques are
used to enhance the mind’s capacity to affect the body and thus to preserve health and to
prevent or cure disease.

Because scientific evidence supporting the benefits of mind-body medicine is abundant, many
of these approaches are now considered mainstream. For example, the following techniques
are used in the treatment of chronic pain, coronary artery disease, headaches, insomnia, and
incontinence and as aids during childbirth: List the
mind-body
 Biofeedback
 Guided imagery medicine
 Hypnotherapy types?
 Meditation
 Relaxation

These techniques are also used to help patients cope with disease-related and treatment-related
symptoms of cancer and to prepare patients for surgery.

Efficacy of mind-body techniques in patients with asthma, hypertension, or tinnitus is not as

clear.

The benefits of relaxation are well-established and science-based; generally, the other mind-
body techniques have no well-established specific benefit other than promoting relaxation.

 Biofeedback:

For biofeedback, a type of mind-body medicine, electronic devices are used to provide
information to patients about biologic functions (eg, heart rate, BP, muscle activity, skin
temperature, skin resistance, brain surface electrical activity) and to teach patients to control
these functions.

Uses for Biofeedback

With the help of a therapist or with training, patients can then use information from
biofeedback to modify the function or to relax, thereby lessening the effects of conditions such
as pain, stress, insomnia, and headaches.

Biofeedback is also used in patients with fecal or urinary incontinence, chronic abdominal
pain, tinnitus, Raynaud syndrome, or attention or memory disorders (eg,
attention-deficit/hyperactivity disorder, traumatic brain injury).

Generally, biofeedback does not seem to be useful in asthma; a possible exception is heart rate
variability biofeedback, which may help reduce asthma symptoms and drug use and improve
pulmonary function.
Can you tell
 Guided Imagery:
the uses of
Guided imagery, a type of mind-body medicine, involves using mental images, self-directed or biofeedback
guided by a practitioner, to help patients relax (eg, before a procedure) and to promote technique of
wellness and healing (to try to effect physical changes—eg, by mobilizing the immune CAM?
system). The images can involve any of the senses.

Uses for Guided Imagery

Imagery used with relaxation techniques (muscle relaxation and deep breathing) may help
reduce pain and improve quality of life in patients with cancer. Imagery has also been used in
patients with psychologic trauma.

 Hypnotherapy: Describe
guided
Hypnotherapy, a type of mind-body medicine, is derived from western psychotherapeutic imagery?
practice. Patients are put into an advanced state of relaxation and focused concentration to help
them change their behavior and thus improve their health. They become absorbed in the
images presented by the hypnotherapist and are relatively distracted from but not unconscious
of their surroundings and the experiences they are undergoing. Some patients learn to
hypnotize themselves.

Uses for Hypnotherapy

Hypnotherapy is used to treat pain syndromes, phobias, and conversion disorders and has been
used with some success to manage smoking cessation and weight loss. It can reduce pain and What is the
anxiety during medical procedures in adults and children. It may be useful in irritable bowel importance
syndrome, headaches, asthma, and some skin disorders (eg, warts, psoriasis). It may help of
lower BP.
hypnotherap
Hypnotherapy helps control nausea and vomiting (particularly anticipatory) related to y?
chemotherapy and is useful in palliative cancer care. Some evidence suggests that
hypnotherapy helps lessen anxiety and improve quality of life in patients with cancer.

 Meditation:

In meditation, a type of mind-body medicine, patients regulate their attention or systematically

focus on particular aspects of inner or outer experience. The most highly studied forms of
meditation are transcendental meditation (TM) and mindfulness meditation. Although research
is incomplete, results to date suggest that meditation could work via at least 2 mechanisms:

 Producing a relaxed state that counters excessive activation of neurohormonal

pathways resulting from repeated stress
 Developing the capacity for metacognitive awareness (the ability to stand back from
and witness the contents of consciousness), thus theoretically helping patients not react
to stress automatically (with highly conditioned, learned patterns of behavior) and
helping them tolerate and regulate emotional distress better

Most meditation practices were developed in a religious or spiritual context; their ultimate
goal was some type of spiritual growth, personal transformation, or transcendental experience.
However, studies suggest that as a health care intervention, meditation can often be beneficial
regardless of a person’s cultural or religious background.

Uses for Meditation

Meditation has been used to relieve anxiety, pain, depression, stress, insomnia, and symptoms
of chronic disorders such as cancer or cardiovascular disorders. It is also used to promote
wellness.

 Relaxation Techniques:
How
Relaxation techniques, a type of mind-body medicine, are practices specifically designed to
 meditation
relieve tension and strain. The specific technique may be aimed at helps?

 Reducing activity of the sympathetic nervous system

 Lowering BP
 Easing muscle tension
 Slowing metabolic processes
 Altering brain wave activity

Relaxation techniques may be used with other techniques, such as meditation, guided imagery,
or hypnotherapy.

3. Biologically Based Practices

Biologically based practices use naturally occurring substances to affect health. These
practices include the following: What do
you mean
1. Chelation therapy by
2. Diet therapies relaxation
3. Herbalism technique?
4. Orthomolecular medicine
5. Biologic therapies

 Chelation Therapy:

In chelation therapy, a biologically based practice, a drug is used to bind with and remove
hypothesized excess or toxic amounts of a metal or mineral (eg, lead, copper, iron, calcium)
from the bloodstream. In conventional medicine, chelation therapy is a widely accepted way to
treat lead and other heavy metal poisoning. List the
Biologically
Chelation therapy with EDTA (ethylene diamine tetraacetic acid) has also been suggested as a
based
way to remove calcium and thus treat atherosclerosis;. However, despite > 50 yr of study,
researchers have not identified any theoretical mechanism to explain how chelation therapy practices?
could treat atherosclerosis or prevent heart attacks or strokes.

Also, until recently, clinical trials showed no significant benefit from chelation therapy, and
systematic reviews1 have all concluded that EDTA chelation therapy is ineffective. In 2012, a
large randomized, placebo-controlled trial of alternative medicine (the Trial to Assess
Chelation Therapy [TACT])2 found a barely significant benefit for chelation over placebo for
aggregated outcomes (26.5% vs 30% for placebo), but not for individual outcomes (eg, death, What do
cardiovascular events, stroke, hospitalizations). However, this study had a high drop-out rate, you mean
and there were questions about blinding and the heterogeneity of treatment centers; thus, this
study did not end the controversy over chelation therapy. by chelation
therapy?
Risks of chelation therapy include hypocalcemia (which is potentially serious) and delay of
more effective treatment.

 Hypocalcemia (which is potentially serious)

 Delay of more effective treatment

 Diet Therapy:

Diet therapy, a biologically based practice, uses specialized dietary regimens (eg, Gerson
therapy, macrobiotic diets, Pritikin diet) to

 Treat or prevent a specific disorder (eg, cancer, cardiovascular disorders)

 Generally promote wellness
 Detoxify the body (ie, neutralize or eliminate toxins from the body)

Some diets (eg, Mediterranean diet) are widely accepted and encouraged in traditional western
medicine.

Diet therapy usually takes months or years for its maximal effects to occur and is more likely
to have effects if started at a young age.

Ornish diet

This very low-fat vegetarian diet aims to help reverse arterial blockages that cause coronary
artery disease and may help prevent or slow the progression of prostate and other cancers.
However, its efficacy is not yet clear because definitive clinical trials have not been done.

Gerson diet What are the

uses of diet
This diet involves consuming the equivalent of 15 to 20 lb of fruits and vegetables (in solid therapy?
food and juices) each day, plus taking supplements and using coffee enemas. Proponents claim
that this protocol is effective for treating cancer, heart disease, arthritis, autoimmune disorders,
and diabetes; however, there are no rigorous clinical trials to support any of these claims. Also,
claims of detoxification are not based on identification and measurement of any specific toxin.

One risk with this therapy is that its unsubstantiated claims for efficacy (eg, against cancer)
can delay treatment with efficacious conventional therapies and worsen outcome.

Macrobiotic diet

This diet consists mainly of vegetables, whole grains, fruits, and cereals. Some proponents
claim that this diet can prevent and treat cancer and other chronic disorders; however, no
evidence supports efficacy of a macrobiotic diet for treatment of cancer.

Risks include inadequate nutrition if the diet is not followed carefully.

Paleo diet

This diet consists of types of food allegedly consumed during the Paleolithic era, when food
was hunted or gathered (ie, animals and wild plants). Thus, the diet includes

 Increased protein intake

 Decreased carbohydrate intake (with intake consisting mainly of nonstarchy fresh fruits
and vegetables)
 Increased fiber intake
 A moderate to higher fat intake (with intake mainly of monounsaturated and
polyunsaturated fats)

Foods thought not to be available during the Paleolithic era (eg, dairy products, grains,
legumes, processed oils, refined sugar, salt, coffee) are avoided. Proponents claim that human
metabolism has not adapted to handle many of these foods.

Proponents of the Paleo diet claim that it reduces the risk of coronary artery disease, type 2
diabetes, and many chronic degenerative disorders. They also claim it promotes weight loss in
overweight people, improves athletic performance, enhances sleep, and improves mental
function. However, there is no good-quality evidence concerning the efficacy of this diet.

Risks include inadequate nutrition (due to decreased intake of whole grains and dairy) and
possibly an increased risk of coronary artery disease (due to increased intake of fat and
protein).

Knowledge of what was eaten in the Paleolithic era is limited; however, some evidence
suggests that the diet of the Paleolithic era was not as limited as the modern Paleo diet.

 Herbalism/ Dietary Supplements:

Dietary supplements are the most commonly used of all complementary and alternative
therapies, primarily because they are widely available, relatively inexpensive, and can be
bought without consulting a health care practitioner.

The Food and Drug Administration (FDA) regulates dietary supplements differently from
drugs. The FDA regulates only quality control and good manufacturing processes but does not
ensure standardization of the active ingredients or efficacy.

Definition

The Dietary Supplement Health Education Act (DSHEA) of 1994 defines a dietary supplement
as

 Any product (except tobacco)—in pill, capsule, tablet, or liquid form—containing a

vitamin, mineral, herb or other plant product, amino acid, or other known dietary
substance that is intended as a supplement to the normal diet

In addition, certain hormones, such as dehydroepiandrosterone (DHEA, a precursor to

androgens and estrogens) and melatonin, are regulated as dietary supplements and not as
prescription drugs.
What do
Labeling
you mean
The DSHEA requires that the product label identify the product as a dietary supplement and by
notify the consumer that the claims for the supplement have not been evaluated by the FDA. herbalism?
The label must also list each ingredient by name, quantity, and total weight and identify plant
parts from which ingredients are derived. Manufacturers are permitted to make claims about
the product’s structure and function (eg, good for urinary tract health) but cannot make or
imply claims for the product as a drug or therapy (eg, treats UTIs). Expiration dates should
also be included on the standardized product labels.

Safety and efficacy

Most people who use dietary supplements assume that they are good for health generally, are
safe and effective for treating and/or preventing specific conditions, or both because dietary
supplements are natural (ie, derived from plants or animals) and because some are supported
by centuries of use in traditional systems of medicine. However, the FDA does not require
manufacturers of dietary supplements to prove safety or efficacy (although supplements must
have a history of safety). Most supplements have not been rigorously studied. For most,
evidence suggesting safety or efficacy comes from

 Traditional use
 In vitro studies
 Certain case reports
 Animal studies

However, manufacturers and distributors of supplements now must report serious adverse
events to the FDA through the MedWatch system. There are a few supplements (eg, fish oil,
chondroitin/glucosamine, St. John's wort) now proved to be safe and useful complements to
standard drugs.

Evidence concerning the safety and efficacy of dietary supplements is increasing rapidly as
more and more clinically based studies are being done.

Purity and standardization

Lack of regulation and government monitoring also means that supplements are not monitored
to ensure that they contain the ingredients or amount of active ingredient the manufacturer
claims they contain. The supplement may have unlisted ingredients, which may be inert or
harmful (eg, natural toxins, bacteria, pesticides, lead or other heavy metals, unapproved dyes),
or it may contain variable amounts of active ingredients, especially when whole herbs are
ground or made into extracts. Consumers are at risk of getting less, more, or, in some cases,
none of the active ingredient, if the active ingredient(s) is even known. Most herbal products
are mixtures of several substances, and which ingredient is the most active is not always
known.
The lack of standardization means not only that products from different manufacturers may
vary, but also that separate batches produced by the same manufacturer may differ. This
product variability is a particular source of difficulty in conducting rigorous clinical trials and
comparing the results among different trials. However, some supplements have been
standardized and may include a designation of standardization on the label.

New regulations governing supplement production in the US include rules for Good
Manufacturing Practices (GMPs). These rules strengthen standards for keeping manufacturing
facilities and equipment clean and raw materials pure and uncontaminated. GMPs also ensure
proper labeling, packaging, and storage of the finished product.

Other concerns

Additional areas of concern include

 Use of dietary supplements instead of conventional drugs

 Stability of supplements (especially herbal products) once manufactured
 Toxicity
 Interactions between supplements and drugs
 Contribution to incorrect diagnosis

Common concerns about the use of supplements include the following:

 Placebo effects can simulate true efficacy, particularly if the patient and/or physician
strongly believes in the supplement.
 Therapeutic responses to supplements, placebo-mediated or otherwise, could be
mistaken as evidence that confirms a particular, possibly incorrect, diagnosis.

 Orthomolecular Medicine:

Orthomolecular medicine, also called nutritional medicine, is a biologically based practice. It

aims to provide the body with optimal amounts of substances that naturally occur in the body
(eg, hormones, vitamins) as a way to treat disease and promote wellness. Nutrition is the focus
in diagnosis and treatment.

This therapy differs from diet therapy because it uses supradietary doses of individual
micronutrients. High doses of vitamins, minerals, enzymes, hormones (eg, melatonin), amino
acids, or various combinations may be used. Practitioners believe that people’s nutritional
needs far exceed the recommended daily allowances and that nutritional therapy must be
individualized based on each patient’s medical profile. High doses of micronutrients are also
used as biologic response modifiers in an attempt to modulate inflammation and other disease
processes. Doses may be administered orally or, far less often, intravenously.

Evidence and Uses

Treatment claims include benefit for a wide range of disorders (eg, cancer, cardiovascular
disease, chronic fatigue, chronic pain, autism, psychiatric disorders). These treatments are
widely used, and many patients report clinical improvement. However, no clinical study data
support the usefulness of most of these practices. Exceptions include use of high-dose fish oil
to treat hypertriglyceridemia (and possibly inflammatory and mood disorders); however, high
doses of fish oil have been linked to increased risk of prostate cancer.

Preliminary evidence supported use of high-dose antioxidants to prevent macular

degeneration, but later studies found no benefit. In addition, high doses of antioxidants may
increase cardiovascular risk.
What are the
Preliminary studies of high-dose melatonin for the prevention or treatment cancer have had
adverse
mixed results; further study is necessary.
effects of
If sufficient evidence of usefulness is shown, treatments (eg, high-dose fish oils to treat orthomolecu
hypertriglyceridemia) become part of conventional medicine. lar
medicine?
Possible Adverse Effects

Clinicians should be aware that high-dose micronutrients may cause harm; eg, some
micronutrients may increase the risk of developing prostate cancer or blunt the effects of
certain cancer treatments.

 Biologic Therapies:

Biologic therapies use substances that occur naturally in animals to treat disease. These
substances include the following:

 Shark cartilage to treat cancer

  S-adenosyl-l-methionine (SAMe) to treat depression or osteoarthritis
 Glucosamine to treat osteoarthritis

4. Manipulative and Body-Based Practices:

Manipulative and body-based practices focus primarily on the body’s structures and systems
(eg, bones, joints, soft tissues). These practices are based on the belief that the body can
regulate and heal itself and that its parts are interdependent. They include

 Chiropractic
 Massage therapy
 Postural reeducation
 Reflexology
What is
 Structural integration
biologic
Several lesser known therapies are used in various cultures. They include the following: therapy?

 Cupping
 Scraping (eg, coining, spooning)
 Moxibustion

Some of these therapies result in lesions that may be mistaken for signs of child abuse. These
therapies are thought to stimulate the body’s energy and to enable toxins to leave the body.
However, no research has verified their efficacy.

 Chiropractic:

n chiropractic (a manipulative and body-based practice), the relationship between the structure List the
of the spine and function of the nervous system is thought to be the key to maintaining or manipulativ
restoring health. The main method for restoring this relationship is spinal manipulation. Other
e and body
joints and soft tissues may also be manipulated. Chiropractors may provide physical therapies
(eg, heat and cold, electrical stimulation, rehabilitation strategies), massage, or acupressure based
and may recommend exercises, ergonomic measures, or lifestyle changes. practices?

Some chiropractors, called straight chiropractors, practice a form of vitalistic medicine. They
use manipulation to correct hypothesized misalignments in the vertebrae in an attempt to
restore the flow of a life energy (called innate). They believe that this method can heal most
disorders. Other chiropractors reject this notion to various degrees; some of them restrict
themselves to evidence-based musculoskeletal treatments.

Uses for Chiropractic

Evidence for chiropractic manipulation is sufficient only for

 Short-term relief of acute uncomplicated low back strain

After the acute stage, continuing adjustments may not provide additional benefit. Thus, the
usefulness of chiropractic for chronic back pain is unclear. Chiropractic is sometimes useful in
treating headache disorders (although data are inconsistent) and nerve impingement
syndromes; it has also been used to treat neck pain.

Some chiropractors treat other disorders (eg, asthma in adults and children; enuresis, colic,
torticollis, and otitis media in children), although only a few studies of chiropractic as
treatment for these disorders have been done, and they do not support efficacy.

The usefulness of manipulation for conditions not directly related to the musculoskeletal
system has not been established.

Possible Adverse Effects

Serious complications resulting from spinal manipulation (eg, low back pain, damage to
cervical nerves, damage to arteries in the neck) are rare. Spinal manipulation is not
recommended for patients with osteoporosis or symptoms of neuropathy (eg, paresthesias, loss
of strength in a limb). Whether it is safe for patients who have had spinal surgery or stroke or
who have a vascular disorder is unclear.

 Massage Therapy:
What are the
In massage therapy (a manipulative and body-based practice), body tissues are manipulated to uses of
promote wellness and reduce pain and stress. The therapeutic value of massage for many chiropractic
musculoskeletal symptoms and stress is widely accepted. Massage has been shown to help ?
relieve the following:
  Muscle soreness
 Pain due to back injuries
 Fibromyalgia
 Anxiety, fatigue, pain, nausea, and vomiting in cancer patients

Massage therapy is reported to be effective in treating low-birth-weight infants, preventing

injury to the mother’s genitals during childbirth, relieving chronic constipation, and
controlling asthma. A 2004 Cochrane review of massage therapy for low-birth-weight infants
concluded that the evidence for efficacy was weak and wider use is not warranted. Evidence
for the other reported uses is preliminary only; further study is required.

Massage can cause bruising and bleeding in patients with thrombocytopenia or bleeding
disorders. Therapists must avoid putting pressure on bones affected by osteoporosis or
metastatic cancer.

 Postural Reeducation:

Postural reeducation (a manipulative and body-based practice) uses movement and touch to
help people relearn healthy posture, move more easily, and become more aware of their body. How
The therapies involved seek to release habitual, harmful ways of holding the body by focusing massage
on awareness through movement.
therapy used
The effectiveness of postural reeducation is not clear. to relieve
pain?
 Reflexology:

Reflexology (a manipulative and body-based practice) is a variant of massage therapy that

relies on manual pressure applied to specific areas of the foot; these areas are believed to
correspond to different organs or body systems via meridians. Stimulation of these areas is
believed to eliminate the blockage of energy responsible for pain or disease in the
corresponding body part.

Reflexology is considered a homunculus-based therapy because it presumes that the entire

body is represented on the bottom of the feet. No homunculus-based therapy, including
reflexology, has any basis in science. In most clinical studies of reflexology, methodology has
been poor, and findings tend to be nonspecific effects on subjective symptoms (eg, causing
relaxation, indistinguishable from that caused by massage). A systematic review of
randomized clinical trials concluded that the best available clinical evidence does not support
the efficacy of reflexology as treatment for any indication; the review also noted that
methodology in studies of reflexology is often poor.

 Structural Integration:
What is
Structural integration (a manipulative and body-based practice) is based on the theory that postural
good health depends on correct body alignment. It is a form of deep tissue manipulation that is reeducation?
typically done over a series of sessions. Practitioners believe that they can correct the
alignment of bone and muscle and thus restore good health by manipulating and stretching
muscles and fascia. However, neither the basic principles nor efficacy of this therapy has been
proved.

 Cupping

Cupping is used in traditional Chinese medicine and in Middle Eastern, Asian, Latin
American, and Eastern European cultures. The practice derives from older traditions of What do
bloodletting, which is still done in some cultures. you mean
by
The air inside a cup is heated, often using a cotton ball soaked in alcohol, then ignited. The reflexology?
heated cup is immediately inverted and placed on the skin. The resulting vacuum sucks the
skin partway into the cup, which may be left in place for several minutes.

Cupping has been used to treat bronchitis, asthma, digestive disorders, and certain types of
pain.

Cupping may redden or burn the skin.

 Scraping

Scraping involves rubbing an implement across lubricated (oiled or wet) skin, usually on the
back, neck, and shoulders. Coining uses a coin; spooning uses a spoon.

These therapies are used to treat the common cold, influenza, muscle pain and stiffness, and What is
other disorders. structural
integration?
Coining results in linear red marks; spooning results in ecchymosis.

 Moxibustion

Dried moxa herb (a mugwort) is burned usually just above but sometimes directly on the skin
over acupuncture points. The herb may be in the form of incense sticks.
Can you say
Moxibustion is used to treat fever, digestive problems, and pain due to injury or arthritis. meaning of
Moxibustion can result in circular burns (which resemble burns from cigarette tips) and cupping?
vesicobullous lesions.

5. Energy Medicine:

Energy medicine intends to manipulate subtle energy fields (also called biofields) thought to
exist in and around the body and thus affect health. All energy therapies are based on the belief
that a universal life force (qi) or subtle energy resides in and around the body (vitalism).
Historically, a vitalistic force was posited to explain biologic processes that were not yet
understood. As science advanced, a vitalistic force was discarded as an unnecessary notion. No
scientific evidence supports the existence of a universal (vitalistic) life force.

Energy therapies include the following:

What do
 Acupuncture you mean
 Magnets by scraping?
 Therapeutic touch (eg, Reiki)
 External qi gong

In external qi gong, master healers use the energy of their own biofield to bring the patient’s
energy into balance. Qi gong is used in traditional Chinese medicine.
What is the
 Acupuncture:
use of
Acupuncture, a therapy within traditional Chinese medicine, is one of the most widely moxibustion
accepted alternative therapies in the western world. Specific points on the body are stimulated, ?
usually by inserting thin needles into the skin and underlying tissues. Stimulating these
specific points is believed to unblock the flow of qi along energy pathways (meridians) and
thus restore balance. In classic acupuncture, there were 365 defined points that corresponded
to the 365 days of the year and reflected the historical connection between acupuncture and
astrology. Over time, the number of points has increased to > 2000.

The procedure is generally not painful but may cause a tingling sensation. Sometimes
List the
stimulation is increased by twisting or warming the needle.
energy
Acupuncture points may also be stimulated by medicines?

 Pressure (called acupressure)

 Lasers
 Ultrasound
 A very low voltage electrical current (called electroacupuncture) applied to the needle

Evidence and Uses

Despite extensive study, no high-quality evidence supports clinically meaningful efficacy of

acupuncture for any indication. High-quality studies compare true (verum) acupuncture with
sham acupuncture (needle insertion at points not used in acupuncture) or placebo acupuncture
(use of opaque sheaths containing a blunt needle or toothpick that is pressed against the skin
but not inserted). Because placebo acupuncture studies also use opaque sheaths for true
acupuncture, neither patient nor acupuncturist know which treatment is being used (double-
blinding). Such high-quality studies generally show no differences in efficacy. Therefore, the
best evidence indicates that neither where the needle is inserted nor whether it is inserted
affect outcome and that acupuncture has only nonspecific placebo effects.

In some cultures, publication bias tends to favor efficacy for acupuncture; for example, 99% of
studies published in China supported efficacy, despite a worldwide average of about 75%.
Thus, positive results of existing studies should be interpreted carefully.

Systematic reviews of acupuncture for pain, the most commonly promoted indication, show What are the
either no differences between verum, sham, and placebo acupuncture or a small statistical uses of
difference that is clinically insignificant or imperceptible. Proponents also claim efficacy of acupuncture
acupuncture for specific disorders (eg, carpal tunnel syndrome, addiction, asthma, stroke, RA); ?
however, in all cases, systematic reviews conclude that the evidence is negative or that
methodology is too poor to produce conclusive results.

Possible Adverse Effects and Contraindications

Reliable data are uncommon and often nonexistent, and adverse effects of acupuncture are
probably underreported. A 2012 review1 of adverse effects that were reported after
acupuncture noted the following:

 Retained needles (31%)

 Dizziness (30%)
 Loss of consciousness or unresponsiveness (19%)
 Falls (4%)
 Bruising or soreness at the needle site (2%)
 Pneumothorax (1%)
 Other adverse effects (12%)

Most (95%) were classified as causing little or no harm.

When correctly done, acupuncture is fairly safe, but skill and care vary among practitioners;
also, some do not follow antiseptic standards.

 Magnets:

Energy therapy may rely on static magnetic fields (constant fields produced by permanent
magnets) or pulsed electromagnetic fields (intermittent magnetic fields produced by an
electromagnet). Practitioners place magnets on the body or place injured body parts in an
induced electrical field to reduce pain or enhance healing.

Evidence and Uses

Magnets, in particular, are a popular treatment for various musculoskeletal disorders, although
multiple studies have shown no effectiveness, especially for pain relief, one of their most
common applications.

For static magnetic therapy, systematic reviews1 found no benefit for chronic pain, and high-
quality studies found no benefit for osteoarthritis and RA.

The biologic effect of pulsed electromagnetic therapy is significantly different from that of
static magnetic. Preliminary evidence suggests that pulsed electromagnetic therapy may
relieve pain. Using pulsed electromagnetic fields to speed healing of nonunion fractures is
well-established.
Possible Contraindications

Possible contraindications for magnets include pregnancy (effects on the fetus are unknown)
and use of implanted cardiac devices, an insulin pump, or a drug given by patch.

 Therapeutic Touch:

Therapeutic touch, sometimes referred to as laying on of hands, is a type of energy medicine.

It claims to use the therapist’s healing energy to identify and repair imbalances in a patient’s
biofield. Usually, practitioners do not touch the patient; instead, they move their hands back
and forth over the patient. Therapeutic touch has been used to lessen anxiety and improve the
sense of well-being in patients with cancer, but these effects have not been rigorously studied.
In the US, nurses have introduced therapeutic touch into ICUs and other hospital settings.

Existing evidence does not support the claim that therapeutic touch practitioners can detect a How
human biofield nor that a human biofield even exists. For example, a 1998 study1 found that magnets
therapeutic touch practitioners could not detect the presence of a biofield. High-quality clinical
helps in
studies are lacking, but systematic reviews2 of existing studies have not found sufficient
evidence to support therapeutic touch's effectiveness for treating for any disorder. treating the
symptoms?
Reiki Lecture
cum
Reiki, which originated in Japan, is similar to therapeutic touch; in Reiki, practitioners channel discussion
energy through their hands and transfer it into the patient’s body to promote healing.
Practitioners are thought to have special healing powers, which are required for these
treatments.

High-quality clinical trials of Reiki are lacking. Preliminary evidence is mixed. A blinded
controlled trial of Reiki for fibromyalgia found no benefit.

Regulation of CAM:
The interaction of politics and science in the arena of health care, one of the most lucrative
industries in the US, has played a significant role in the recent development of alternative
medicine there. In October 1991, the US Congress instructed the NIH to create an Office of
 Unconventional Medical Practices, later renamed the Office of Alternative Medicine (OAM).
The mandate was met with a less-than enthusiastic response from the NIH, but simultaneously
with high public expectation. Compounding the difficulties other key governmental agencies,
in particular the Food and Drug Administration (FDA), were overlooked in the mandate,
although their role was necessary and complementary to that of the OAM. Similar to other
federal programmes, the activities of the OAM must comply with FDA regulations and
policies. Yet, FDA regulations designed for conventional drugs are devices not applicable for
alternative medicine products Many contemporary cures are not pills and potions, but lifestyle- What do
oriented remedies. These remedies are usually beyond the regulatory responsibility of the you mean
FDA. Often the remedies of CAM are masked under the label of ‘dietary supplements’. by
White therapeutic
Regulation of CAM practitioners varies widely. In most countries only registered health board touch?
To professionals may practice, but in the UK practice is virtually unregulated, except for
emphasize osteopathic and chiropractic. The General Osteopathy Council and the General Chiropractic
on Council have been established by the act of parliamentary and statutory self-regulation status
regulations with similar powers and functions as those of the General Medical Council. A small number of Lecture
of CAM other disciplines, such as acupuncture, herbal medicine and homeopathy, have a single main cum
discussion
regulatory body and are working towards statutory self regulation. Germany and some
Scandinavian countries have intermediate systems. Belgium’s parliament has recently paved
the way for formal recognition of four types of complementary medicine, viz. acupuncture,
homeopathy, osteopathy and chiropractic. What is
Since independence, four Indian systems of medicine, viz. Ayurveda, Homeopathy, Unani and reiki?
Siddha have received considerable encouragement from both the central and state
governments. These systems are regulated by national health services. In India there are more
than 500,000 Ayurvedic practitioners and 100,000 homeopathic physicians.
Safety issues of CAM:

CAM remedies are popular among patients with chronic diseases such as cancer, AIDS,
arthritis, asthma, diabetes, epilepsy, etc. Cancer patients throughout the world use alternative
medical methods. Treatments include vitamins, herbs, diet, healing, ‘psychological treatment,
folk medicines and homeopathy. However, the recent failure of the Luigi Di Bella cancer What are the
therapy and the wonder anti-cancer drug advocated by Asru Kumar Sinha has raised questions regulations
on the effectiveness of alternative therapies in dealing with chronic diseases like cancer. for CAM?
 According to Durant, most of the alternative cancer therapies are nothing but an attractive
nuisance. However, there are remarkable anecdotal cure and survival up to five years in cancer
patients treated with CAM, which need to be studied.
All medicines can be toxic under specific circumstances, there is always a risk that an adverse
reaction will present a hazard to patients with licensed medicines. However, regulations are
expected to ensure that the risk is small and the pharmaceutical industries monitor the
medicine’s efficacy, safety and quality. No such global control over natural medicine or herbal OHP
medicine exists.
India has Ayurvedic and herbal pharmacopoeias and the approval process for manufacturers of
CAM. Patients with cancer and AIDS should be warned that some of the adverse effects of
To natural medicines are often similar to symptoms of problems associated with their disease or
enumerate treatment, thus making it difficult to discern if the disease or the ‘remedy’ is the problem. The
the safety harm caused by unproven therapies or poor quality CAM is not only medical, but also societal
issues of and can be summarized as follows:
CAM  Economic harm–through loss of resources. It is estimated that four times more money
is spent on quackery than on cancer research. In 1983 an estimated $200 million was to
have been spent on cancer chemotherapy, and in 1981, $1billion was estimated to have
been spent on laetrile, which was found to be ineffective, despite anecdotal success.
 Direct harm–cyanide toxicity death related to laetrile; metabolic disturbances caused
by some diet, harmful effect of some megavitamin regimens and ruptured colons with
coffee enemas. Transmission of viral and bacterial diseases with contaminated
serologic product, etc. can recur.
 Indirect harm–the harm of omission, total avoidance or delay in seeking responsible Lecture
therapy while pursuing alternative therapies. Utilization of diet for cure rather than cum
nutritional preservation. The psychological effect of prolonged denial, guilt associated discussion
with inability to self-control the disease and feelings of inadequacy. The incorrect
diagnosis of cancer by iridology, kinesiology or a variety of serologic tests, and the
resultant questionable treatment with its consequences.
 Societal harm–the impact of large groups advocating mistrust of established What are
institutions, frequently supported by the media, legislative bodies, etc., distorts safety issues
progress by altering expenditure of funds, delaying public health measures and keep in
formation of laws. mind while
using CAM?
Future of CAM:
Throughout the world, patients in unprecedented numbers are going outside of conventional
medicine to look for help. This is a movement that has been building up since the late 1960s
 and it is now reaching the point that visits to alternative practitioners exceed visits to primary
care providers. Many alternative therapies are now moving to the hospital sector. The review
by Austin suggests that a large number of physicians are either referring to or practicing some
of the more prominent and well known forms of CAM and that many physicians believe that
these therapies are useful or efficacious. Yoga, for example, is being tried out for the
management of carpal tunnel syndrome. Yoga lifestyle intervention is also found to increase
the regression of coronary atherosclerosis in patients with severe coronary artery disease.
Hypnosis is being tried out in cancer clinics for the management of pain. The American
Medical Association (AMA) and other medical associations have formally recognized
hypnosis as a viable medical treatment.
Clinical outcome and research papers in several areas of complementary therapies now find a
place in orthodox medical journals, and it is no longer possible to maintain the traditional
medical stance that referring patients to complementary therapists is unethical. The Union
Ministry for Health and Family Welfare has asked the Medical Council of India to include the White
basic principles and concept of the Indian System of Medicine and Homeopathy in the course board
content of MBBS.
The rapid increase in public interest and use of complementary and alternative therapies is
To discuss exerting a powerful influence on medical education and has gained ground in several medical
the future of universities. A significant number of medical students want instructions in complementary
CAM therapies. Medical educators increasingly realize that it is not a question of whether to address
these issues in the education of future physicians, but rather how to respond to these relentless
challenges.
The AMA has recognized the need for medical schools to respond to the growing interest in
alternative health care practices. The result of the 1996–97 and 1997–98 Annual Medical
School Questionnaire Part II distributed by the Liaison Committee on Medical Education
indicated a notable increase in instruction in ‘alternative medicine’. Although no medical
school reported offering a separate required course in complementary health care practice,
medical schools covering these areas as part of a required course increased to 63 (from 46 in
1996–97) and medical schools offering a separate elective course increased to 54 (from 47 in
1996–97). In the 1996–97 academic year, 34 medical schools offered instruction as part of an
elective course, and 28 offered other educational experiences.
Multi-centric clinical trials and research on CAM are lacking due to paucity of specific
funding. In the UK, the Medical Research Council spent no money researching
complementary therapies in 1998–99 and in 1999, the UK medical research charities spent How could
only 0.05% of their total budget. In the past 12 years, the Indian Council of Medical Research be the future
has set up a unique network through-out the country for carrying out controlled clinical trails of CAM?
for herbal medicines. Using this network, the council has shown the efficacy of several
traditional medicines, including Picrorhizia kurroain hepatitis and Pterocarpus marsupium in
diabetes. As a result of the trials, these medicines can now be used in allopathic hospitals.
Double-blinded and well-designed clinical trials have also been conducted with
Arogyawardhini in viral hepatitis, Mucuna pruriens in Parkinson’s disease, Phyllanthus
amarus in hepatitis and Tinospora cordifolia in obstructive jaundice. But these have not been
widely emulated. Key policy issue of integrating CAM with mainstream medicine has been
outlined by Common wealth health ministers. The ministers established the Common -wealth
Working Group on Traditional and Complementary Health Systems to promote the integration
of traditional health systems and complementary medicine into national health care.

Summary: Today we were discussed indetile about CAM in that meaning, definition of
CAM, commonalities and differences between biomedicine and CAM, uses and importance of
CAM, different types of CAM therapies its mechanism of therapy, uses and adverse effects,
regulations involved in taking CAM and future of CAM.
3min
5min
5min
2min
1min
 Conclusion

Nearly 80% of the world’s population does not have access to modern medicine.
Most of the money for health care in the developing world goes to the remaining
20% of the population. Health care costs are predicted to double in the next 10
years. Low cost intervention such as lifestyle changes, diet, supplement therapy
and behavioral medicine can be delivered as substitute for high-cost drugs and
technological intervention.
 Bibliography

1. Gupta & Mahajan (2003), Textbook of Preventive and Social Medicine, 3 rd Edition, Jaypee brothers
publications, Pg.467-469.
2. K. Park’s Text book of Preventive and Social Medicine, 19th Edition, Mosby publications, New Delhi,
Pg. 814-816.
3. Ergil, K. V., in Fundamentals of Complementary and Alternative Medicine (ed. Micozzi, M. S. ),
Livingstone, New York, 1996, pp.185–223.
4. D.P. Agarwal “Review: Complementary and alternative medicine: an overview”. Pal, S.K. 2002.
Current Science 82(5): 518-524
5. Haija AJ, Schulz SW. The role and effect of complementary and alternative medicine in systemic lupus
erythematosus. Rheum Dis Clin North Am. 2011;37(1):47–62.
6. Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and
children: United States, 2007. Natl Health Stat Report. 2008;(12):1–23.Google Scholar

Webliography

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 www.actuaries.org/HongKong2012/Presentations/TBR11_McLeod.pdf · PDF file
 www.indianscience.org/reviews/t_rv_agraw_pal.shtml
 www.iisc.ernet.in/currsci/mar102002/518.pdf · PDF file
 https://bmcmededuc.biomedcentral.com/articles/10.1186/1472-6920-14-40
 https://nccih.nih.gov/health/integrative-health
 www.desertharvest.com/physicians/documents/Gastro7.pdf · PDF file
 https://www.webmd.com/balance/guide/what-is-alternative-medicine