Alternative Approaches to Healing

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Alternative Approaches to Healing

• Ronald Schneeweiss MBChB
• Professor, Family Medicine
• MHE501 2007

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HERE'S WHAT YOU NEED TO KNOW A Short History of
Medicine

• I have an earache
• 2000 B.C. -Here, eat this root.
• 1000 A.D. -That root is heathen. Here, say this
  prayer.
• 1850 A.D. -That prayer is superstition. Here,
  drink this potion.
• 1920 A.D. -That potion is snake oil. Here,
  swallow this pill.
• 1965 A.D. -That pill is ineffective. Here, take
  this antibiotic.
• 2000 A.D. -That antibiotic is artificial. Here,
  eat this root.
• (Nutrition News Focus, October 29, 1999.)

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Kifwebe witch doctor mask Congo
Masks of Iroquois False Face Society worn to aid
recovery when visiting sick
Nail Fetish figure. Congo
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What is CAM?(Complementary/Alternative Medicine)

• Complementary and alternative medicine is a group
  of diverse medical and health care systems,
  practices, and products that are not presently
  considered to be part of conventional medicine.
• NCCAM definition www.nccam.nih.gov

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CAM Use in the USA

• 42 of US population used CAM in 1997 (vs 30 in
  1990).
• In 97 there were 629 million visits to CAM
  providers vs 386 million visits to 10 MDs
• In 2002 expenditures on CAM exceeded 26 billion
  (58 were out-of-pocket expenses).
• Use of dietary supplements has skyrocketed over
  the past 10-15 years (5 billion in 2002).

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• Why do Patients Use CAM?

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Why do Patients Use CAM?

• More congruent with values, beliefs,
  philosophical orientation towards health.
• More active participation in care.
• Perceived safety and lower cost.
• Conventional medicine options are exhausted, pose
  significant risks or are of indeterminate
  effectiveness.
• (terminal illness, chronic diseases, ill-defined
  painful conditions, chronic refractory symptoms
  of aging - arthritis, benign forgetfulness,
  dementia)

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Characteristics of Adult CAM Users

• In USA
• Highly educated
• Holistic orientation to health
• FemaleMale31
• Higher SES
• WHO data indicates that 65-80 of the worlds
  population (developing countries) depend chiefly
  on
• plant medicine for their primary health care

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CAM Therapies/Domains (NCCAM)

• 1. Mind-Body Interventions
• 2. Biologically-based therapies
• 3. Manipulative/Body-Based
• Methods
• 4. Alternative Medical Systems
• 5. Energy Therapies
• Biofield therapies
• (reiki, therapeutic touch, qi gong)
• Biolectromagnetic
• (static magnets, pulsed
  electromagnetic therapy)

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60 of patients do not tell their physician about
their CAM use?

Why Not????
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Why do patients not tell their physician about
their CAM use?

• 60 - My doctor never asked.
• 60 - It wasnt important for my doctor to
  know.
• 20 - My doctor wouldnt understand.
• 14 - My doctor would disapprove.
• 70 of patients see their MD before or
  concurrent
• with their visits to a CAM provider
• Eisenberg DM. Ann Int Med 2001135(5)344-51

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What do physicians need to know about CAM?

• Ask/counsel patients about their CAM use
• Collaboration with alternative providers
• Philosophy of the major CAM disciplines
• TCM (AOM) chiropractic, homeopathy, massage,
  naturopathy
• Mind-Body approaches to self-care and patient
  care
• Herbals/supplements (OTC use)
• proven efficacy, commonly used, herb-drug
  interactions, safety issues
• regulation of nutraceuticals
• issues of contamination and adulteration
• Placebo Effect
• Nutrition

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Fundamentals Alternative Medicine vs
Conventional Medicine

• Avoid treatments that might inhibit the healing
  power of nature (Vis medicatrix naturae
  -Hippocrates).
• Reliance on Nature - heal by supporting and
  stimulating nature.

• Active intervention - doing something active vs
  waiting.
• Heroic therapy - purgatives like calomel
  (mercurous chloride, emetics, bleeding,
  blistering).

Removing excess humors by vomiting. 400 B.C.
Barber-surgeon bleeding a patient. (removing
excess red bile) 1340 A.D.
Whorton JC. Nature Cures the History of
Alternative Medicine in America. 2002, Oxford
University Press.
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Removing excess humors by vomiting. 400 B.C
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Barber-Surgeon bleeding a patient. 1340 AD
(removing excess red bile)
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Historic Background of Alternative medicine
vs Conventional medicine

• Illness is a condition unique to each individual.
• Natural physiological integrity maintained
  through proper diet, adequate rest and other
  correct habits of life is the only sure
  resistance to disease agents.

• Specific pathologies each produce a distinct
  disease that affects all its victims essentially
  in the same way.
• Focus on pathological changes that disease caused
  in specific organs. Disease characterized in
  terms of its localized organic pathology.

Whorton JC. Nature Cures the History of
Alternative Medicine in America. 2002, Oxford
University Press.
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Historic Background of Alternative medicine
vs Conventional medicine

• Alternative medicine follows an alternative
  science based on intuition, common sense,
  patience and observation.
• Restores people spiritually as well as
  physically.
• Approach is confident and definite.
• Patients given time and personal attention.

• Treatments change over time based on scientific
  studies RCTs, empirical clinical research
• Patients subjective experience subordinate to
  objective evidence of pathology.
• Scientific approach often with uncertainty about
  outcome.
• Increasing time constraints.

Thomas KB. General practice consultations Is
there a point in being positive?
BMJ 19872941200-2
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The Placebo Effect

• In various studies the placebo effect ranged
  from 5-70
• On average the placebo effect is about 35

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Assessing Evidence

• Levels of Evidence
• 1-Good quality patient oriented evidence (high
  quality RCTs, systematic reviews and
  meta-analyses of RCTs with consistent results)
• ------------
• 2-Lower quality patient-oriented evidence
  (retrospective cohort studies, case control
  studies, case series)
• -------------
• 3-Other evidence (consensus guidelines, clinical
  experience, expert opinion)

• Strength of Recommendation (SOR)
• A
• -----------------------
• B
• ---------------------------
• C

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Dietary Supplements include

• Herbals e.g. Gingko, Saw palmetto
• Supplements e.g. Glucosamine, Co-Q10,
• Trace minerals e.g. Selenium, chromium, zinc
• Vitamins e.g. Vits B6, A, C, E, folic acid
• Hormones e.g. Melatonin, DHEA
• Amino-acids e.g. L-tryptophan,

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Dietary Supplement and Health Education Act
(DSHEA) - 1994

• If they occur naturally, products can go to
  market without testing of safety or efficacy.
• Companies do not have to prove that their
  products are safe only reasonable assurance
• Supplements do not have to be manufactured
  according to any standards
• (CGMPsCurrent Good Manufacturing Practices
  FDA regulation)
• Labeling claims almost any claim can be made as
  long as no disease is named.
• FDA to have a very limited role in regulating the
  quality of individual products. (can prohibit if
  safety concerns identified)

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Safe and Effective Herbals and Supplements(based
on good quality evidence)

• Echinacea (?) -------------- Treat URI
• Garlic powder-------------- Lower cholesterol
  (modest effect, bad
  odor)
• Ginger root ---------------- Nausea
• Glucosamine, chondroitin- Osteoarthritis
• Horse chestnut -------------- Venous
  insufficiency
• Peppermint oil -------------- Irritable bowel
  syndrome
• Saw palmetto -------------- BPH
• St. Johns wort ---------- Depression
• Serious drug interactions coumadin
• SSRIs, CCB, Anti-retrovirals, BCP

http//www.fammed.washington.edu/predoctora
l/CAM/
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Safe and Likely Effective Herbals(based on
moderately good quality evidence)

• Black cohosh -------- Menopausal hot flushes
• CoenzymeQ10 (CoQ10)--- Ischemic heart disease
  (CHF)
• Feverfew ---------- Migraine
• Gingko ---------- Dementia, PVD
• Milk thistle ---------- Cirrhosis,
  alcoholic hepatitis
• Omega-3 fatty acids---- Prevent CAD
• Valerian ------------ Insomnia, (anxiety)

http//www.fammed.washington.edu/predoctor
al/CAM/
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1. Alternative Medical Systems

• a. Traditional Chinese Medicine (TCM)
• b. Homeopathy
• c. Naturopathy

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1a. Traditional Chinese Medicine (TCM)

• Emphasizes the proper balance or disturbance of
  qi (chee) or vital energy, in health and disease.
• Consists of a group of techniques and methods
  including acupuncture, Chinese herbal medicine,
  oriental massage, and qi gong (combines movement,
  meditation, and regulation of breathing to
  enhance immune function).

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Diagnostic statuette
Detailed history Tongue examination
Taking the pulse - a key diagnostic tool
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1b. HOMEOPATHY

• Founded in1770 by Dr. Samuel Hahnemann
• Like cures like (Law of Similars)
• the more a remedy is diluted the greater its
  potency (Law of Infinitesimal Dose)
• An illness is specific to an individual
• Similar cures exist for similar diseases
  dilution and succussion (shaking) potentiates
  medicines

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1c. NATUROPATHY

• Views disease as manifestation of alterations in
  the processes by which the body heals itself.
• Emphasizes health restoration, prevention, and
  self-responsibility.
• Examples of naturopathic treatments include
• diet, homeopathy, herbs, hydrotherapy,
  massage detoxification, counseling, soft tissue
  and spinal manipulation.

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2. Manipulative and Body-based Methods

• ?Chiropractic and Osteopathic manipulation
• Massage therapy (conventional therapeutic
  massage, Feldenkrais, Alexander, Heller, Rolfing).

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CHIROPRACTIC

• Founded in 1895 by D.D. Daniel David Palmer-
  (restored sense of hearing to a deaf janitor in
  Davenport, Iowa by adjusting a single cervical
  vertebra).
• Relates disease to mal-alignments (subluxations)
  of vertebrae which create nerve interference and
  block the innate intelligence of the body to
  heal itself. This is a controversial theory even
  among Chiropractors.

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3. Mind-body Interventions

• Employs a variety of techniques designed to
  facilitate the minds capacity to affect bodily
  functions and symptoms
• hypnosis, biofeedback,
• meditation, yoga, dance,
• music and art therapy,
• prayer,mental healing

Greek Music Therapy 600 B.C.
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4. Biologically-based Therapies

• Examples are herbals, special diets (Atkins,
  Ornish, Pritikin),
• Orthomolecular therapies employ vitamins,
  minerals and amino acids to create optimum
  nutritional content and balance in the body.
• Other biologic therapies include
• Shark cartilage to treat arthritis and cancer.
• Bee pollen to treat auto-immune and inflammatory
  disease.
• Chelation therapy with EDTA (IV) - purported to
  reverse atherosclerosis by removing calcium from
  atheromatous plaques

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5. Energy Therapies

• Biofields
• At this time, the existence of bio-fields has not
  been proven.
• Qi gong- combines movement, meditation, and
  regulation of breathing to enhance immune
  function.
• Reiki (universal life energy) by channeling
  spiritual energy through the practitioner, the
  spirit is healed which then heals the body.
• Therapeutic touch-the healing force of the
  therapist that affects the patients recovery and
  healing is promoted when the bodys energies are
  in balance.

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Energy Therapies

• Bioelectromagnetic
• Involves the use of
• Pulsed electromagnetic fields to treat diseases
  such as depression, migraine headaches, multiple
  sclerosis (experimental).
• Static magnets to treat
• painful musculo-skeletal
• conditions (no convincing
• evidence of efficacy).

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Integrative Medicine

• 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 conventional and CAM approaches to
  achieve optimal health and healing.
• Consortium of Academic Health Centers in
  Integrative Medicine 2004

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INFORMATION RESOURCES
ConsumerLab.com
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Reliable Information Sources

• A. UW Healthlinks
• http//healthlinks.washington.edu/clinical/alt_me
  d.html
• Natural Medicines Comprehensive Database
• Natural Standards
• B. UW CAM website
• www.uwcam.org
• C. National Center for Complementary and
  Alternative Medicine
• www.nccam.nih.gov
• D. Consumerlab
• www.consumerlab.com
• E. Memorial Sloan-Kettering Cancer Center
• http//www.mskcc.org/mskcc/html/11570.cfm