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Intro to Complementary and

Alternative Medicine (CAM)


Anthony J Pattin, PharmD
Assistant Professor, Clinical
Fall 2014

What is CAM
Complementary/integrative- generally
refers to using a non-mainstream
approach ________ ______conventional
medicine
Alternative- refers to using a nonmainstream approach
________conventional medicine
True alternative medicine is not common

Integrative Medicine
Combines mainstream medicine with CAM
It is the growing trend among providers
and healthcare systems
The scientific evidence is limited but
growing- a lack of reliable data makes it
difficult for people to make informed
decisions about integrative care

Most common CAM health


systems
Ayurveda
Homeopathy
Naturopathy
Traditional Chinese Medicine (TCM)/
acupuncture
Chiropractic care
Massage

Why use CAM


Potential to treat disease for which
conventional therapies have failed
Provide a sense of patient empowerment
and participation
Example: some patients use meditation and
prayer to cope with chronic or untreatable
conditions

How do we categorize CAM?


Manipulative: These focus on bodysystems such as musculoskeletal,
circulatory, and lymphatic systems
Other: Movement therapies such as
Pilates; Traditional healers such as
shamans; Energy therapies- light,
magnetism
Based on the philosophy of the power
nature or presence of energy in the body

How do we categorize CAM?


Natural Products: herbals or botanicalsminerals, vitamins, and other natural
products such as probiotics
Mind-Body Medicine: focus on interactions
of the brain, mind, body, and behavior with
the intent to use the mind to affect
physical functioning and promote health
Examples include: acupuncture, guided
imagery, hypnotherapy, tai chi and yoga

Some Rx Drugs from Natural


Products
Digoxin- from foxglove plant
Paclitaxel- from the bark of the yew tree
Tamiflu- synthesized using shikimic acid
found in Chinese star anise (Illicium
verum)

What is CAM?
According to the Office of Dietary (ODS)
Supplements
Dietary supplements and Herbals are the
most commonly used CAM products.
Consumer spending on dietary supplements
and herbals far exceeds research dollars
Consumer Spending in 2007 $34 Billion

Homeopathy
Comes from two Greek words
-homoios(similar)
-pathos(suffering or disease)
Based on like cures like or the law of
similars
If a substance produces the symptoms of an
illness in large doses, the same substance
can cure it in very small doses

Homeopathy
The more dilute a homeopathic medicine
is, the greater the potency
The efficacy of these medicines is
believed to depend on the dilution factor
and the vigorous shaking (succussion)that is performed with each dilution

Homeopathy
Typically used to treat existing illness
An exception: Oscillococcinumhomeopathic preparation derived from
wild duck heart and liver- used to prevent
and treat influenza

Regulations
FDA regulates homeopathic medicines as
products recognized in the official United
States Pharmacopoeia (USP),
Homeopathic Pharmacopoeia of the
United States (HPUS), or National
Formulary (NF)

Safety/Evidence
Evidenced has not been demonstrated in
clinical trials
Cochrane Database of Systematic
Reviews suggest effects are similar to
placebo
For most products, toxicity is low-due to
extreme dilute nature

Naturopathy
A philosophy of life and an approach to
living that encourages lifestyles and
therapies as close to nature as possible
Focuses on building health than treating
disease

Six principles of healingnaturopathy


The body has an inherent ability to
maintain and restore health
Aims to treat the cause of disease rather
than the symptoms
States that the methods designed to treat
the symptoms are harmful and should be
avoided

Six principles of healingnaturopathy


Treats the whole person, taking into
account the physical, spiritual, mental, and
social aspects of the individual
Educate and encourage patients to take
responsibility for their own health
Assess risk factors and hereditary to
disease and interventions to avoid further
harm or risk to patients

Naturopathy
Nutritional counseling and support are
major components of treatments
Use therapeutic manipulation of muscles,
bones, and spine
Use hypnotherapy, biofeedback therapiesaid in psychological wellbeing
Methods- considered to be safer than
conventional drugs

Traditional Chinese Medicine


(TCM) is a broad term encompassing
many different modalities and traditions of
healing, including herbal medications and
acupuncture.
Dates back 5000 years to Taoism,
Confucianism, and Buddhism.
In China- this is considered central
medicine- although we consider it
alternative

Examples of herbs
Monascus purpureus fungus- found in red
yeast rice- a natural source of lovastatin
Syzygium claviflorum- class of drugs
called maturation inhibitors in clinical trials
for HIV

Traditional Chinese Medicine (TCM)


Herbs are usually given as pills, extracts,
capsules, tinctures, or powders and can
be used directly or combined with food or
other treatments.
Over 2000 herbs are used, 50 are
considered Fundamental herbs.
TCM also includes minerals, metals, and
animal products.

Acupuncture TCM
Acupuncture is regarded as more of a
Supportive treatment
Cupping- Use rapid skin pinching at
points in the back to break up congestion
and stimulate circulation
Moxibustion- burning of dried moxa, either
near or on the skin

Acupuncture TCM
Meditation and martial arts are also used
in TCM
Tai chi is practiced for improved balance,
coordination, and relaxation and over wellbeing.
Feng Shui are of arranging furniture to
increase health and prosperity

Safety
Acupuncture: avoid in patients with heart
disease, diabetes, seizures, infections,
bleeding disorders, or neurologic
disorders or patients on antithrombotic
drugs
Cupping and moxibustion may leave
temporary discoloration or even scars
Be careful with herbs! Ma huang or

Chiropractic Care
Chiropractic focuses on the relationship
between spinal structure and body
function mediated by the nervous system
Comes from the Greek words cheir(hand)
and praxis (practice)
Spinal manipulation or adjustment does
not define the profession: also provide
advice on diet, exercise, physician therapy
and rehab

Chiropractic
Diagnosis includes X-ray, computed
tomography, magnetic resonance imaging,
electrical current, and ultrasound therapy.
Thermography may also be used with ice
packs and heat packs.
More than 100 chiropractic and spinal
manipulative adjusting techniques may be
employed.

Chiropractic Care
Chiropractic is now one of the largest and
best-established professions of CAM in
the US.
The safety of chiropractic is controversial.
Adverse effects include arterial dissection,
myelopathy, vertebral disc extrusion and
epidural hematoma.

Ayurveda
Ayurveda originated in India more than
5000 years ago is the worlds oldest
system of natural medicine
Ayurveda means the science of life
The goal of Ayurveda is to achieve optimal
health on physical, psychological, and
spiritual levels.

Ayurveda Technique
Vital energy (prana) is the basis of all life
and healing
Prana circulates throughout the human
body and is governed by:
-earth
-air
-fire
-water
-ether

Ayurveda Technique
The regulation of ______ as a form of
therapy is central
Important principle- there is nothing in the
world that is not a food or medicine
Foods and herbs described for energy
properties rather than chemical properties
Also believe there are certain time periods
to consume food that correspond to nature
Herbs and spices are used: turmeric and
cumin

Safety
Ayurvedic herbs- depends on which herbs
and the preparations of the product
Therapeutic levels of sildenafil (Viagra)
have been found in aphrodisiac products
Found to have contaminants such as
arsenic, mercury, and zinc- 12 cases of
lead poisoning in US in early 2000s
Products with USP seals of approval of
quality should not contain unacceptable
levels of metals

Massage
Soft tissue manipulation has been
practiced for thousands of years.
Massage is the fifth most common CAM
therapy in the US.
It is safe and does help lower blood
pressure.

Who is using Dietary


Supplements?
According to the National Health and
Nutritional Examination Surveys
(NHANES)
Females
Age 60
Non-Hispanic White

Why are People Seeking Out CAM


Therapies??
News/Media
Seeking relief from conditions that lack conventional
treatments
Lack of health insurance coverage
Prescription medications too expensive
Recommendations by friends and family
They are perceived to be safer than prescription
medications
Direct to Consumer Advertising
Fears from scolding by healthcare providers
Seeking healing or a cure from incurable diseases
Cultural

Where Do You Think Patients are


Getting Medical Information?
Prevention Magazine
Good Morning
America
Today Show
CNN

Dr. Oz
Oprah
Mens Health
Womens Health

10 Things to Know When


Evaluating Medical Resources on
the Internet
(NCCAM)

1. Who runs the website?

This information should be easy to find

Is it government sponsored?
Is it sponsored by a national organization?
Is it sponsored by the investors?

10 Things to Know When


Evaluating Medical Resources on
the Internet
(NCCAM)

2. Who pays for the website?

The funding of the website should be readily


available

Federal government - .gov


Educational institutions - .edu
Noncommercial organizations - .org
Commercial organizations - .com

10 Things to Know When


Evaluating Medical Resources on
the Internet
(NCCAM)

3. What is the purpose of the website?


About the Site

10 Things to Know When


Evaluating Medical Resources on
the Internet
(NCCAM)

4. What is the original source of the


information on the website?

Most reputable websites post or reference


the source of their information

10 Things to Know When


Evaluating Medical Resources on
the Internet
(NCCAM)

5. How is the information on the website


documented?

The site should describe the evidence used


for the material posted
Medical facts and figures should have
references
Opinions and testimonials should be clearly
labeled

10 Things to Know When


Evaluating Medical Resources on
the Internet
(NCCAM)

6. How is the information selected for the


websites?
Credential of the contributors
Board or panel selects the material

10 Things to Know When


Evaluating Medical Resources on
the Internet
(NCCAM)

7. How current is the information?


Updated on a regular basis

10 Things to Know When


Evaluating Medical Resources on
the Internet
(NCCAM)

8. How does the site choose links to the


other sites?
Policy about linking to other websites

Asks or pays
Meet certain criteria

10 Things to Know When


Evaluating Medical Resources on
the Internet
(NCCAM)

9. What information about you does the site


collect, and why?
Some sites require memberships to access
information

Collect fee
Tailor the information for your needs

Clearly state why they are collecting your


personal information and what they plan to
do with

10 Things to Know When


Evaluating Medical Resources on
the Internet
(NCCAM)

10. How does the site manage interactions


between visitors?
Contact information for questions or
feedback

Chat rooms or discussions


Moderator

References
Office of Dietary Supplements, National
Institutes of Health
http://ods.od.nih.gov/Research/Annual_Bib
liographies.aspx
Top research from peer reviewed journals
published annually

References
National center for Complementary and
Alternative Medicine (NCCAM)
http://nccam.nih.gov/
-up to date literature on NCCAM funded
studies on CAM therapies

References
ConsumerLab.com,LLC
http://www.consumerlab.com/index.asp
Independent testing and information on
nutrition products

References
HerbMed
http://www.herbmed.org
Online herbal database
Links to categorized summaries of
research studies
Contains information on the use of 30
herbs

References
Natural Standard
http://www.naturalstandard.com/
- Tertiary resource on dietary supplements
and herbals
- Has summaries on the available literature
and evidence on natural products

References
Vickers, A, Zollman C. ABC of
complementary medicine. Massage
therapies. BMJ. 1999;319(719):1254-7
Merrell WC, Shalts E. Homeopathy:what
does the best evidence tell us? Med J
Aust. 2010;192:458-60
Sutian s, Zhang J, Louise W. New
exploration and understanding of TCM.Am
J Chin Med. 2009;37-411-26