460 ~ 11 April 2006: The Last Class

• Overview of course sequence & learnings for synthesis

• Integration & integrative medicine / health

• Exam materials etc

complementary AND alternative health

Health Canada’s Determinants of Health ~ how does integrative health fit ?

• Income & Social Status

• Social Support Networks

• Social Environments• Education• Employment &

Working Conditions• Physical

Environment

• Gender• Culture• Personal Health

Practices & Coping Skills

• Healthy Child Development

• Biology & Genetic Endowment

*** See Notes below if you do not know what each of these determinants means ***

A Brief History of Medicine: 2000 BCE to 2006 CE

"I have an ear ache...."  

2000 BCE - Here, eat this root   1000 CE - That root is heathen, say this prayer   1850 CE - That prayer is superstition, drink this

potion   1940 CE - That potion is snake oil, swallow this pill

  1985 CE - That pill is ineffective, take this

antibiotic   2006 CE - That antibiotic is artificial and

ineffective ! Here, eat this root  

What are the waysof evidence-based‘knowing’ re CAM ?

What is Evidence-Based Medicine ( EBM ) ?

• Using the best currently available research evidence combined with clinical judgment and experience to make a medical / health decision

The Gold Standard in Science

• Randomized, Double-blind, control studies . . .

http://www.cochrane.org/index0.htm

++ therapist’s values & experience !

Both / And

***

both

and

Imitative or Integrative ?

1993 & 1998 Eisenberg US Studies – “classic” in the

field

• NEJM in ’93 nat’l phone survey to determine prevalence of use of “unconventional” therapies (ex: acu or chiro)

• Random sample of 1539 adults• 16 commonly used interventions• 1 in 3 persons used 1 or more U-

therapies and 1/3 of these saw an U-therapy provider

Behavioural Interventions:Asking Questions

• Coaching as an Intervention

L I F E with Style

Stress & Struggles

Most fulfillinglife possibilities??

?

Fulfillment

Process

Balance

Designed Alliance

Curiosity

Listening

Intuition

Action / learning

Self-management

Dance in the moment

Agenda from client

Whole life is involved

NRCW© The Coaches Training Institute

The Co-Active Coaching Model ©

What is/are your choice/s ?

• _______________________________-10 0 +10

MUST eliminate really, REALLY want

The SIZE and quality of

the game you play designs who you are becoming

Balance in Ayurvedic

3 doshas energies

Vata or thin

Pitta or muscul

Kaphalarge

Body Thin, delicate

Medium Hvyset

Mind Hyperact

OrderlyPerfecist

relaxed

Soul Intuitive

Loving & passion8

forgiving

Ayurvedic

Tongue

Diagnosis

Areas

Major Meridians

• Lung ~ LU• Large intestine ~

LI• Stomach ~ ST• Spleen ~ SP• Heart ~ HT• Small Intestine ~

SI• Bladder ~ BL-UB

• Kidney ~ KI• Pericardium ~

CX P HC • Tri-heater ~

TH• Gall Bladder ~

GB• Liver ~ LIV• Conception

Vessel • Governing

vessel

Dr Su Ya Li

Body’s energy meridians & centers

Conclusions re Acupuncture Evidence ?

• Now working to standardize and do well administered studies

• Ex: in US, acu needles now classed by FDA as legit medical device rather than experimental device

• Greater funding for res now in the West which should help

• Also, better acceptance of case studies vs DB controlled ones

Dr Robert Dronyk

The Six Principles [ + 7th ] of Healing:

• Vis medicatrix naturae : the healing power of Nature• Identify and treat the cause• First, do no harm

• Treat the whole person• ND/Physician as Teacher• Prevention is the best “cure”• [ Wellness as proposed new principle ]

The Naturopathic Modalities

Botanical Medicine Homeopathy

HydrotherapyTraditional Chinese

Medicine

Nutrition Counselling

Bodywork (massage,

chiropractic)

Physical therapies (ultrasound etc)

Research

• Because it’s eclectic, research is on branches of Naturopathy

• Ex: how natural dietary remedies have increased by about 28% in Sweden in last two decades [ meta analysis, Johannsen, J of Internal Med, Aug 2001 ]

• Descriptive studies that look at cost and satisfaction factors of Nat as form of CAM

There are alternatives to conventional thinking

everywhere… I cdnuolt blveiee taht I cluod aulaclty

uesdnatnrd what I was rdanieg. The phaonmneal pweor of the hmuan mind … Aoccdrnig to rscheearch at Cmabrigde Uinervtisy, it deosn’t mttaer in waht oredr the ltteers in a wrod are, the olny iprmoatnt tihng is taht the frist and lsat ltteer be in the rghit pclae. The rset can be a taotl mses and you can still raed it wouthit a porbelm. This is bcuseae the human mnid deos not raed ervey lteter by istlef, but the wrod as a wlohe. Amzanig huh? Yaeh, and I awlyas tohuhgt slpeling was ipmorantt!

Homeopathic “Laws”

• 1. ‘Like Cures Like’ is basis for vaccines founded by Salk ( polio ) and Pasteur

• Concept is, same substance that in large amount/dosage can produce the symptoms of an illness, in minute dose, can cure it [ tuning fork ]

• Body does heal itself but idea here is to provide a chemical catalyst to stimulate immune defenses in healing process

Validating Homeopathic Research

• Has focused on succussion or tapping and how it works chemically

• Fair amount of D-Blind, cl-trial studies re successful H-treatment of diarrhea

• Other studies re +tive effect w anxiety reduction, reducing alcohol dependence, dermititis, some allergies, asthma

Jamie Richards, B.Kin, D.C.

•Café of LifeChiropractic Studio

The Scope of Chiropr Practice

• "The practice of chiropractic is the assessment of conditions related to the spine, nervous system and joints of the extremities and the diagnosis, treatment and prevention of dysfunctions or disorders arising from the structures or functions of the spine and the effects of those dysfunctions or disorders on the nervous system, primarily by the adjustment of the spinal column or other joints to enhance function."

• Bill 181, The Regulation of Chiropractic, Statutes of Ontario

Functional argument for Holistic chiropractic

Recognized forms of Manual Therapies

• Chiropractic• Massage therapy• Trager• Feldenkrais

method• Reiki• Rolfing

• Osteopathy• Cranial Osteopathy• Therapeutic Touch• Alexander

Technique• Chinese Qigong• [ Physical Therapy

& more with acupuncture ]

Robert Taylor

What is osteopathic palpation?

• It is a well defined sense of touch that allows the practitioner to feel restrictions within the body

• It is a hands on approach used to identify structural changes and rhythms of the body

• It is a gentle contact with powerful results• It is a skill that takes many years to develop• It sets the osteopathic approach apart from

other forms of manual therapy

Illustrations © 2004 Jeffrey Burch. All rights reserved. Used with permission from Jeffrey Burch.  For more information on his work, visit www.jeffreyburch.com/

Robert Taylor

Reflexologyor

‘Sole’ Searching !

John Fisher, "Healthy Benefits of Cobblestone-Mat Walking: Preliminary Findings," Journal of Aging and Physical Activity, 11(4), October 2003

“walking on a cobblestone mat surface resulted in significant reductions in bloodpressure and improvements in balance and physical performance among adults 60 and over”

Needs of Reflexology

• Better and more universal organization

• Self and Professional regulation• Better qualitative and

quantitative research support• Greater recogn of +tive effects

of R on stress reduction

Angelo Boulougouris

Assessment

• Selective Tissue Testing

• Strength Testing• Stability Testing• Observation• Range of Motion• Neurological Testing• Mental State• Palpation• Quality of

Movement• Previous Injury

Measuring Progress

-Outcome Measures

-Test-Re-Test

-Client Self-Report

-Observation

-Measurement Tools

Evidence Based Practice

• “Best practice recognizes that evidence-based physiotherapy practice incorporates knowledge generation, synthesis, transfer and adoption. In clinical practice, physiotherapists readily integrate the best current research with clinical expertise, client values, and available resources to achieve best results for their clients”

Integrative Medicine ? The Touch for Health Case

Herbal Gardens

                                           

Non-prescription drug makers association of Canada

Botanical Groups

• Cohosh: Abu-Romeh to Blanchette – 1

• Chamomile: Blommers to Connor – 2

• Chaste tree: Crowther to Eastwood – 3

• Echinacea: Fabian to Geddis – 4

• Garlic: Girvan to Hudders – 5

• Ginkgo: Jagielnik to Korczynski – 6

• Ginseng: Kusmider to Mazur – 7

• Saw Palmetto: McDonagh to Persico – 8

• Milk Thistle: Pone to Sklazeski – 9

• St John’s Wort: Snider to Zettler – 10

What are you to find out ?

• What is it ?• Where is it found ?• How prevalent ?• What is it used for and by

whom ?• What does Barrett (Quackwatch)

say about it ?• Evidence – what kinds, be critical• Would you take it ?

NHP ‘baseline’ survey march 2005

• You get to read and analyze this !

• At Links in pdf

• Pages 1-4; 61 - 85

• Précis here . . .

Natural Health Products DirectorateHealth Products and Food Branch, Health Canada

Natural Health Products Research Program

• Coordinated with the Cdn Institutes of Health re:

Biomedical research Product Quality Clinical research; Health systems and health services

research; Societal, cultural, environmental

influences on health and the health of populations;

Issues related to NHPs’ regulations; Information and knowledge transfer

Integrative Approaches re Common Health Issues

• Module VII – Integrative Approaches re Common Health Issues

• Examines 4 of the most common, chronic health issues:

~ Cardiovascular health (today) ~ Gastrointestinal System

~ Chronic fatigue syndrome~ Oncology (your choice

over psychiatry)

Cardiovascular health

• CV disease is now “the major cause of death and disability and of rising health care costs in Canada”

• In groups of 5, record what you know about CV disease / health and what you know re treatment / prevention – allopathic & less conventional or “alternative”

Integrative medicine re CHD

• “when applied to CV disease, preventative medicine in Western society is a concept most people accept, few people practice, and almost no one pays for” [ text 409 ]

• Most of the $200 billion annual US price tag is spent on the treatment of symptomatic disease & end-organ failure

Text & Integrative Approaches to GI System

• Complex terminology? • Know concepts, not host of medical

terms• Concept of dysbiosis or dys-symbiosis• Dysbiosis is re indigenous “flora” of

the gut start to promote illness [ NOT infection ]

• Discusses regulation of GI flora by diet, motility, secretions like HCl, immunity, antibiotics, and probiotics

Chronic Fatigue Syndrome

• “This illness is to fatigue what a nuclear bomb is to a match. It’s an absurd mischaracterization."

~ Laura Hillenbrand, battling CFS, bestselling author of book, Seabiscuit

At least 4 of these key symptoms are concurrently present for 6 months or

longer:

– substantial impairment in short-term memory or concentration (attention deficit, memory lapses, frequently using the wrong word, spatial disorientation)

– sore throat – extreme joint and muscle pain

without swelling or redness – headaches of a new type, pattern or

severity – Un-refreshing sleep (hypersomnia or

insomnia, nightmares)– painful lymph nodes– post-exertional malaise lasting more

than 24 hours

Text re CFS Treatment-Integrative:

• Mind-body interventions such as relaxation, meditation ~ note the RCTs in this area ~ goal in these is to help patient live functionally, not cure CFS

• One good RT study on +tive effect of homeopathic remedies

• Others in text: dietary, herbal, acupuncture, Ayurveda

• See the case study page 427 re text conclusions on CFS treatments

Cdn Cancer Statistics

• In 2005, 149,000 new cases of and 69,500 deaths from cancers

• Lung cancer is leading cause of death from cancer, more than breast & prostate combined

• 2nd leading is colorectal – new TV ads with bums with asterisk over rectal area [ ‘don’t die of embarrassment’ ]

Treatment & Canadian Cancer Society: re Alternative

• Advocate that this is personal decision and should consider/know:

~ diffs betw conventional & CAM therapies

~ all the info you can get on CAM forms

~ consulting with healthcare team re use and interaction of CAM forms with conventional

Final 2 Text chapters on Integration

• Two sub-populations:

~ Care of children

~ Common conditions in women’s health

30* not 31: “Well-Child Care”

• Very common sense chapter on use of integrative focus re children – fluoride, TV choices, food selection, immunizations, environmental health ~ note focus on decision-making

33: Integrative Approach to Common Conditions in Women’s

Health• Solid chapter with evidence-

based, CAM approaches for 3 common issues: PMS, vaginitis, fibroids

• Excellent chapter for showing integration

complementary AND alternative health

Health Canada’s Determinants of Health ~ how does integrative health fit ?

• Income & Social Status

• Social Support Networks

• Social Environments• Education• Employment &

Working Conditions• Physical

Environment

• Gender• Culture• Personal Health

Practices & Coping Skills

• Healthy Child Development

• Biology & Genetic Endowment

• Integrative medicine is here: 11,400,000 hits if you google Integrative Medicine

• Issues in CAM / Integration are universal ones: access, choice, rights, information, decision-making . . .

• Daily life, living issues of health, disease, prevention; just widening the net to be fully informed, fully inclusive

Where from here ?

Final Exam Materials

• All lecture material from March 7th to April 11 inclusive – Unit V cont’d re Systems II to today

• Text chapters for final exam: 8 (166-176 re Osteo), 11, 5, 6, 7, 18, 19, 21, 23, 30 (note, 30 replaces 31), & 33

• Links from website from Module V cont’d . . .

Links for Exam

• Module V cont'd:Reflexology Research Summary (*required reading)Easy Cancer Pain & Anxiety (*required reading)Massage therapy research article (required reading)

• Module VI Herbal/Pharmacological:Herbal Remedies: Adverse Effects and Drug Interactions (required reading) Herbal 'Health' Products: What Family Physicians Need to Know (required reading) Herbal Minefield (required reading) NHP 2005 Baseline Survey

• Module VII: Systems II – Integrative ApproachesUnderstanding Chronic Fatigue Syndrome (*NOT required reading)

Canadian Cancer Statistics & Info (*NOT required)

CAM & The Body

physical body

astringent

emotional body

sweet

mental body

bitter

erotic body

pungent

spiritual body

saltydrugs

remedies

touch

HEALTH

sour

vocal body