CAM Self-care Fall 2014 9.2.14

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 non-mainstream 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 body-systems 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 botanicals- minerals, 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: Oscillococcinum- homeopathic 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 healing- naturopathy

• 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 healing- naturopathy

• 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 therapies- aid 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 well-being.

• 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 ephedra caused serious toxicity and death

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 world’s 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• Men’s Health• Women’s 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?



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



3. What is the purpose of the website?– “About the Site”



4. What is the original source of the information on the website?

– Most reputable websites post or reference the source of their information



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



6. How is the information selected for the websites?

– Credential of the contributors– Board or panel selects the material



7. How current is the information?– Updated on a regular basis



8. How does the site choose links to the other sites?

– Policy about linking to other websites• Asks or pays• Meet certain criteria



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.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_Bibliographies.aspx– Top research from peer reviewed journals

published annually

http://ods.od.nih.gov/Research/Annual_Bibliographies.aspx

http://ods.od.nih.gov/Research/Annual_Bibliographies.aspx

References

• National center for Complementary and Alternative Medicine (NCCAM)

• http://nccam.nih.gov/

-up to date literature on NCCAM funded studies on CAM therapies

http://nccam.nih.gov/

References

• ConsumerLab.com,LLC• http://www.consumerlab.com/index.asp

– Independent testing and information on nutrition products

http://www.consumerlab.com/index.asp

References

• HerbMed®

• http://www.herbmed.org• Online herbal database• Links to categorized summaries of

research studies• Contains information on the use of 30

herbs

http://www.herbmed.org/

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

http://www.naturalstandard.com/

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

CAM Self-care Fall 2014 9.2.14

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