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