Complementary

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Complementary Alternative Medicine(CAM)Navee
n Mehrotra, MD, MPh, FAAPClinical Assistant
Professor Department of Pediatrics RWJMS
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BELIEFS About CAM Providers

• Consider mind and body to be single entity
• Good health is a positive state, not merely the
  absence of disease
• Body can often heal without medication
• Look at the whole patient rather than one organ
• Impact of the total environment on body

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CAM use among Asian-AmericansJ Altern Complement
Med 2006 12(10)1003-10

• Nearly three quarters of 9187 Asian Americans
  surveyed reported at least one type of CAM in the
  past 12 months
• Chinese Americans had the highest prevalence
  (86) of any CAM use whereas South Asians had a
  prevalence of 67
• Spirituality was the strongest predictor of any
  CAM use for most Asian-American subgroups

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CAM use among Asian-AmericansResults of the
National Health Interview Survey for 917 Asian
Americans and 20,442 Non Hispanic WhitesJ Gen
Intern Med. 2007 22(6) 762-7

• 42 of Asian Americans were likely to use some
  sort of CAM therapy
• Use of Mind/Body therapies in Asian Indians
  (31), Chinese (21) and Filipinos (22)
• Herbal Medicines in Chinese (32), Filipinos
  (26), and Asian Indians (19)
• Among Asian Americans, CAM use was associated
  with being female, higher education, and having a
  chronic medical condition

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CAM use among Chinese AmericansFindings from a
community mental health service
populationPsychiatr Serv. 2007 58(3)402-4

• 82 of people surveyed reported current use of
  CAM
• 46 reported megavitamin therapy
• 43 reported herbal medicine
• 25 each reported use of massage, acupuncture,
  and spiritual healing
• CAM users were older, female, employed, less well
  functioning physically and less acculturated

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CAM use in developmental disabilitiesMent Retard
Dev Disabil Res Rev. 2005 11(2)107-9

• Reported rates for CAM use in children with
  developmental disabilities may be higher
• May relate to hope for amelioration of symptoms
• May be related to concerns regarding side effects
  of conventional treatments
• Need on the part of families to participate in
  decision making

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Types of Alternative Therapies Used by Children
in an Indigent PopulationResults of a Pilot
study at SIUH. Mehrotra et.al.

• Massage Therapy 11.7
• Spiritual Healing 4.9
• Lifestyle Diets 1.0
• Herbal Medicine 3.9
• Megavitamin Therapy 4.9
• Folk/Home Remedies 17.5
• Others 2.9
• Total 46.8

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Factors Influencing Use of CAM

• Word of Mouth 32
• Fear of drug side effects 21
• Chronic medical problem 19
• Dissatisfaction with
• conventional medicine 14
• More personalized attention 9
• Other reasons 5

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National Projections of Expenditures for CAM

• Category of Expenditures Dollars (Billions)
• Services of Providers of CAM 11.7
• Megavitamin supplements 0.8
• Commercial Diet Supplements 1.2
• Estimated Total 13.7
• Eisenberg DM et.al. Unconventional medicine in
  the US. N Engl J Med. 1993 328 246-252

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Common Disorders Treated by CAM

• Asthma Acupuncture, Herbal
• Cancer Hypnosis, Relaxation, Megavitamins
• Arthritis Copper bracelets, dietary
  restrictions
• Other disorders like stroke, cystic fibrosis,
  Downs syndrome, atopic dermatitis

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CAM Therapeutic WheelKathi Kemper Model
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Biochemical Therapies

• Herbal Remedies, Nutritional supplements
• Herbal medicine extracts used from flowers,
  fruit, leaves, roots, stems, and seeds one of
  the oldest form of medicine used all over the
  world (Ayurveda in India, Chinese herbal medicine)

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Medications with Plant Origin

• Digoxin- foxglove
• Vincristine and Vinblastine- periwinkle plant
• Morphine, codeine, and other opioids-opium poppy
• Atropine- belladonna
• Penicillin- mold
• Aspirin- salicin in the willow bark
• Ephedrine- ephedra plant
• Senna- laxative from the senna plant
• Caffeine- coffee beans
• Taxol- anticancer from the yew tree

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Commonly used Herbal Products

• Teas green and black tea- polyphenols in tea
  protect body cells from damage, the fluoride
  wards off dental decay, tannins have antiviral
  and antibacterial properties, theophylline and
  theobromine dilate the airways, and the caffeine
  acts as a stimulant
• Studies suggest that 4 to 6 cups of green tea a
  day have a decreased incidence of cancer of
  lungs, liver, pancreas, esophagus, breast, and
  skin.

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Commonly used Herbal Products

• Echinacea
• a herb found in the midwest used by the American
  Indians as an anti-infective agent
• taken orally to stimulate the immune system
  (causes the WBCs to migrate to the wound area,
  increases the T4 helper cells, the interferon
  levels, and increases the formation of
  fibroblasts)

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Commonly used Herbal Products

• Chamomile
• A Eurasian variety Marticaria recutita is more
  widely used in the US.
• Used to get a better nights sleep,
  antiflatulent, inhaled chamomile tea relieves
  bronchial congestion, a sitz bath relieves
  hemorrhoids, improves eczema, moistens dry skin,
  etc.

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Commonly used Herbal Products

• Feverfew
• Comes from Tanacetum parthenium, a member of the
  chrysanthemum family and is found all over the
  United States
• Used against inflammation, fever, menstrual
  cramps, and migraines. (Migraine attacks are
  preceded by the clumping of platelets which
  produce excess serotonin a chemical in the name
  of parthenolide found in feverfew acts by
  interfering with the aggregation of platelets.

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Commonly used Herbal Products

• Others
• Ginger used for nausea and motion sickness
• Ginseng used to increase sex drive, longevity,
  energy, and appetite
• Purity of herbal products, the processing, the
  age of the product all play a role in the
  effectiveness of the product.

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Lifestyle Therapies

• Megavitamin and Megamineral Therapy
• Vitamins and minerals in large doses are used as
  primary therapy for certain medical conditions
  (based on Paulings orthomolecular theory of the
  provision of the optimum concentration of
  substances normally present in the human body)
• Ex use of Vit C and the common cold

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Lifestyle Therapies

• Macrobiotic Diet
• A diet that promotes physical, mental,
  emotional, and spiritual health and harmony to
  live life to the full potential
• Diet aims to balance foods for their yin-yang
  qualities of the individual
• Primary goal is to eat foods in the middle range
  such as grains, which are neither extreme yin nor
  yang and thereby achieve a healthy and harmonious
  life

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Lifestyle Therapies

• Mind-Body Therapies
• Biofeedback (use of electrical or mechanical
  devices to increase the awareness of the
  physiological activity of a muscle by providing
  the patient with visual, verbal, and/or auditory
  information)
• Patient learns to recognize the physiological
  activity of a muscle, a response that was
  previously not recognized but is under the
  patients control, and he/she can learn to
  respond appropriately and gain control over his
  muscle by trial and error (e.g. functional
  constipation)
• Hypnosis used in nocturnal enuresis

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Biomechanical Therapies

• Massage Therapies
• Aim to relax and relieve the body, mobilize stiff
  joints, improve blood, muscular, and nervous
  systems
• Swedish types of massage
• Effleurage (slow, rhythmic, light and
  deep-pressure fingertip, hand, knuckle, and
  thumbs massage strokes- often used in conjunction
  with aromatherapy oils)
• Friction (use fingertips, thumb pads, and the
  heels of the hand in small, circular pressure
  movements to free stiff and locked joints,
  improve circulation, and treat damaged or
  strained ligaments)
• Percussion (vigorous drumming massage in which
  the sides of the hand deliver fast, rhythmic
  chops to well-padded parts of the body, such as
  the back, buttocks, and thighs)
• Petrissage (kneading dough like movements hands
  grasp, squeeze, roll, and release whole sections
  of muscles, used to improve circulation and to
  relax controlled muscles.

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Biomechanical Therapies

• Chiropractic
• Manipulation of spine and extremities by the
  hands to stretch muscles, unlock joint, and
  correct problems in other parts of the body that
  have originated from the spine. In addition,
  heat, ice, or ultrasound waves may be used.

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Bioenergetic Therapies

• Acupuncture
• Ancient Chinese form (life force called qi
  dominates every living being)
• Yin and yang must be in balance or harmony before
  qi can get our vital functions to work normally
• Qi flows along fourteen invisible, interconnected
  main channels on each side of the body.
• These meridians surface at various locations on
  the body, called acupuncture points (about 360
  have been identified)
• Imbalance between the yin and yang and the five
  elements of the universe (wood, fire, earth,
  water, and metal) cause lactic acid and carbon
  monoxide to build up in the muscles
• Stimulating the appropriate acupoints dissipates
  the buildup and restores the yin and yang
• Western scientists have shown that stimulating an
  acupoint releases endorphins which reduces the
  perception of pain

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Bioenergetic Therapies

• Homeopathy
• Based on the theory that a substance that
  produces symptoms in a healthy individual could
  cure symptoms in a sick person
• Substance is diluted into infinitessimal amounts
  (expressed as C1, C2, etc) and given to the
  patient as treatment
• Homeopathic doctor studies the whole person and
  takes into account the idiosyncrasies, reactions
  to heat and cold, weather, and food, sleep and
  work patterns, age and environment, before he
  prescribes any medication

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CAM Therapeutic WheelKathi Kemper Model
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Practitioners Approach to Alternative Medicine

• Should be aware of the use of CAM in their
  patients
• Should ask about it as part of the medical
  history
• Should have an open attitude and be
  non-judgemental