Complementary and Alternative Medicine Reference: Text pp.428-462 1. What is CAM? Any therapies that are currently outside “conventional” medicine. Very diverse group Goal is to provide treatment that is natural, holistic and promotes wellness. Often more emphasis on patient taking an active role in their own care. “Complementary medicine is used together with conventional medicine. An example of a complementary therapy is using aromatherapy to help lessen a patient's discomfort following surgery. Alternative medicine is used in place of conventional medicine. An example of an alternative therapy is using a special diet to treat cancer instead of undergoing surgery, radiation, or chemotherapy that has been recommended by a conventional doctor.” NCCAM Characteristic Features Traditional Medicine Relies heavily on the role of the mind and natural products Any and all changes, mind or drug or surgery induced are all welcomed and attributed to the treatment “Conventional” Med. Relies more on chemical and surgical interventions Placebo-induced benefits are considered a confounder that just makes it harder to detect the “real” effects Origin of Increasing Popularity Image of conventional medicine as profit-driven, costly, arrogant. Use more options for rapid treatment. Better listeners. Popularity of chiropractic, massage, diet supplements and meditation. Non-Disclosed Use is High Advantages of CAM Conventional medicine does not satisfy most people’s needs Most elderly have unresolved chronic diseases Many sick people do not like the side effects of conventional medicine and are willing to try CAM in hopes of a cure People without health insurance often think it is cost-effective Challenges to CAM Mixed ancient empiricism, modern baseless charlatanism, and naïve biological hypotheses Ayurveda and Yinyang Theories Caffeine + herb pills with an exciting label Linus Pauling and vitamin C Skepticism is justified because of so many fakes and failures Challenges to CAM Many patients fear being looked down upon or reprimanded for using CAM by their doctors So they don’t communicate Communication is needed! e.g. drug-herb interactions Challenges to CAM Conventional medicine tends to focus much more on effects on symptoms while CAM strongly emphasizes vague concepts of “overall balance” and “spiritual fulfillment” Hard to get objective outcome measures to test for short-term effects in a clinical trial Modernization of CAM Scientific testing “Whole system” randomized clinical trials Combination with modern technologies Electroaccupuncture Combination with regular medicine Many M.D. doctors are involved Starting Systematic Study For/Against CAM For : Popularity, because of increased longevity, increased chronic disease and pain Poor attitude of some physicians who don’t listen to patients, little knowledge of nutrition Increased public interest in spiritualism, power of positive attitude Against : Little scientific basis, few controlled studies, anecdotal evidence Mostly self report studies, “Hawthorne Effect”, placebo effect Remedies not backed by FDA safety regulations (e.g. herbal treatments) Patients may delay legitimate medical procedures Does “It” Work ? Scientific basis is weak overall Sometimes just because the good ones aren’t “Alternative” anymore (25% of drugs derive from/discovered from natural products) One list of “helpful” types: Doesn’t mean everything in each category is helpful though Quality of Evidence Lowest quality Testimonials + some plausible rationale Very, very common in internet advertising Medium quality Some lab studies showing effects published in scientific journals Some pilot studies in humans published in scientific journals High quality Overall consistency of effects from numerous published studies (meta-analysis says yes) If There’s Evidence, Rank Each Therapy Known Benefits, But Risky Too Safe and Proven Beneficial Risky, Little Evidence of Benefits Safe but No Strong Benefits Safety Efficacy Examples from Conventional Medicine Chemotherapy for Cancer Statins for High Cholesterol If it’s this bad, Conventional Medicine bans it! (see Vioxx, etc.) Aspirin for Chronic Pain Safety Known Efficacy Examples from Complementary Medicine ? Acupuncture for Certain Pains Ephedra for Long-term Weight Loss Echinacea to Prevent Common Cold Safety Known Efficacy Effective Examples Acupuncture: Licensed in many States; seems helpful for treating pain and addictions. MRI studies indicate decreased hypothalamic, hippocampal, SNS activity with this, suggesting activity of descending pain pathways. Mind/Body: Hypnosis, spiritual involvement, relaxation methods (PRT), Yoga, Tai Chi, prayer, etc. are helpful for reducing stress, lowering blood pressure, may upregulate immune system and increase life expectancy. Chiropractic and osteopathy : Involve manipulation of joints, spinal column.Some evidence of effectiveness in treating arthritis, lower back pain,migraine headaches and hypertension. Naturopathic Medicine:Supplements, herbs,diets: Some benefits in treating CV and metabolic diseases.Concerns about unregulated supply. The Future Conventional medicine is taking serious notice of mind/body, dietary contributions to health. However, training in these areas and documentation of benefits is scarce. Combined training in conventional and some alternative practices appears likely. Note increasing use by physicians of alternative treatments: Text, Table14.2, p.433.You will go over effects in young and old (pages 457-459 ) in practicum.