460 – Module 2, Winter 2006

Philosophy and Basis for Alt / Comp

[ ** Note: there are a few slides with notes below them ]

Street Lamp Interference – SLI & SLIders

• Appliances such as lamps and TVs go on and off without being touched

• Light-bulbs constantly blow when the SLIder tries to turn them off or on

• Volume levels change on TVs, radios, and CD players

• Watches stop working• Children's electronic toys start by themselves

when the SLIder is present • Credit cards and other magnetically encoded

cards are damaged or erased when in their possession

• Mind-Body Medicine implications re chapter 3

ancientEgyptianvaginal speculum

Historical Background & Precedents re Health-

Medicine

• Flexner Report of 1910• Cited as THE most important event

in the history of Cdn and American med educ

• Abraham Flexner was sec school teacher who went on to do grad work in educ research w Carnegie Foundation

Historical Background & Precedents

• Report was effort to reform med schools that were without standards and more for-profit than educ

• Virtually guillotined all other forms of med ed toward German tradition of strong biomed sciences and hands-on clinical tr

• Thus in N America, western medicine flourished, trad medicine/healing went “underground”

1970s

• Resurgence of interest in altern ther’s

• Chiropractic med took initiative along with osteopathic MDs

• Mainstream allopathic med continued to ignore alt med

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

1993 Eisenberg US Study

• This 1/3 made 19 visits per year with avg cost of $27.60 per visit

• Use varied by SES: white, 25-49 yrs with hier educ & hier income leaders in usage

• Majority used U-th’s for chronic conditions

• 72% did not tell their MD about U-th visits

• Extrap to US pop means 425 million visits to alt med vs 388 mill to allo med in 1990

98 Eisenberg

• JAMA follow-up from ’93• Used same process as 93, w 2055

adults• Incr from 33 to 42 % in 97 – used

herbal, massage, megavits, self-help groups, folk remedies, energy healing & homeopathy – chronic conditions

• A 47 % incr in use of alt med

98 Eisenberg

• Incr was due to incr proportion seeking alt med, not to more visits by those already using alt med

• 629 million total visits by US pop to alt med practitioners in 97

• Probably a $27 billion out-of-pocket on alt med in 97 thus equal to all out-of-pocket MD expenses in US

The Prevalence of CAM in Cdn Med Schools: 1998 CMAJ Study

• ’98 survey of all 16 Cdn med schools to determine what educ is provided re UG med ed in alt med

• Covered 18 comp therapies selected from Office of Alt Med, Nat’l Institutes of Health (acupunc to reflex)

• Most schools do teach alt med but in one course; done via lectures

1998 CMAJ Study

• Most consistently taught are acupunc and homeopathic med (10 schools)

• Then, in descending order: herbal; chiro; naturop; TCM and biofeedback; osteopathy; shamanism, mass ther & therap touch; finally, yoga, aromatherapy, reflex and native trad healing – only 1 used spiritual healing

1998 CMAJ Study

• Only 2 schools provide instruction in use of alt meds (yoga, mt, chiro) w most stating MD could seek tr by pref

• Schools felt they should provide general conceptual overview

• **Need to understand alt med as part of patients’ health care belief system

• Very little alt med tr in UK; most of US’s 125 med schools incorp some alt courses

Readings to Date

Read for Module 1:• Text chapters 1 & 3• 1st reading on web site under Links, “Folk Remedies” (pdf)• Print the Glossary of Terms from Links on

web site

Read for Module 2:• Text chapters 2 & 4; read 2 for Thursday • “Are you Considering Using CAM” from Links• Irwin & Morrow article

Folk Remedies Among Ethnic Subgroups ~ reading

• “Folk medicine” in ’99 included ?• Data source for the study ?• Importance of individual’s cultural

beliefs and practices ~ used Health Belief Model (HBM) to summarize these [ perceived benefit vs perceived threat factor in selecting health action]

Folk Remedies Among Ethnic Subgroups ~

commonalities:

• Understanding illness & making decisions about treatment action:

~ cause of illness an imbalance ~ emphasis on personal responsibility ~ complex, multicausal or holistic view of dis-ease etiology ~ various kinds of energy

Folk Remedies Among Ethnic Subgroups ~

interpretations:

• Findings re SES factors ?• Effectiveness of Folk Rs ? • Note problems of cost in study

designs for effectiveness data• *”lack of scientific evidence”

- ? ?

Folk Remedies Among Ethnic Subgroups ~ clinical

implics:• Cultural beliefs MUST be considered• Open communic betw clinicians and patients

is critical• Safety and efficacy of concern to both• Major conclusion: “Folk medical practices

arise out of the synergy of individual beliefs, cultural beliefs, and biomedical concepts about illness and treatment”

• Most folk remedies “harmless” – bias? And some “serious” side effects

• Note the recommendations to the Am Medical Assoc

Text – chapter 1: Basic Principles

• The Hippocratic Oath ~ Dr Louis Lasagna! • “outdated, degrading, and inappropriate

for the modern reality of medicine” ?• Note distinctions betw holistic and

reductionistic; Flexner Report; Heroic medicine; resurgence of traditional med

• Key factors etc in the concept of Integrative Medicine ~ any questions about those ?

Text – chapter 3: Mind-Body Medicine

• What is the essence or basic premise of M-B Med ?

• How has it become AND how is it integrative ?

• What are some examples of M-B Med ?• What are the characteristics of M-B Med?• What evidence do we have re M-B Med ?• What can you interpret about M-B Med from

the 4 cases presented in the chapter ?

Text Chapter 3: Mind-Body Med: 4 Primary Human Intelligence Systems

• Thought; Emotions; Body; Perceptions

• These 4 are congruent• Means a change in one is mirrored in

all others• Just another way of looking at mind-

body as more than an intellectual mind in a physical body

Behavioural Interventions:Asking Questions

Coaching Example

For every winner, there are dozens of losers: odds areyou’re one of them

Defeat[ de-feet !]

The key to life is balance

Life Coaching

• Counselling, or therapy, often looks to the past in order to discover, heal and understand. Life coaching, on the other hand, looks to the future in order to make a good life even better. In coaching, the starting point is the client's desire for personal and /or professional change

• Coaching focuses on forwarding all aspects of the client's ordinary life toward an extraordinary life

• Coaching is not about how you came to be who you are; it's about getting you from where you are now to the future that you want

What we have in our lives

_______________________________-10 0 +10

MUST eliminate really, REALLY want

L I F E with Style

Stress & Struggles

Most fulfillinglife possibilities??

?

Client Coach

Relationship

Co-Active Coaching: Either/or vs AND

• Co-active means acting in concurrence, united in action

• Co-active coaching like hiring a friend, having a personal navigator

• Fundamental skill in co-active coaching is

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 ©

Evidence Base for Coaching ?

• Thousands of testimonials …

• Irwin-Morrow req’d reading

• What validates this model according to your reading ?

Fulfillment, Balance, & Process

• Person is always somewhere in her/his life and always in flow of that life

• Coach takes client somewhere juicy or rich or compelling, that is into:

~ Fulfillment, or ~ Balance, or

~ Process

©The Bigger Game Company

The SIZE and quality of

the game you play designs who you are becoming

So, what skills for coaching ?

• Listening• Curiosity• Intuition• Forwarding into action / deepening

athlete’s learning• [ self management ]• For the sake of what ? – living fully

into the life each person wants

Coaching and CAM / Integration

• Coaching as an alternative for ‘healthy’ living, living into full human potential

• More a behavioural intervention than a therapy

• reading offers a way of providing evidence for efficacy of coaching

• Cannot do randomized, double-blind study

• We do need more ways to validate coaching