An Introduction to Complementary and Alternative Medicine (CAM) 2008

Transcription

1 An Introduction to Complementary and Alternative Medicine (CAM) 2008 Charles Palmer MB ChB, DCH, FCP,FAAP Professor of Pediatrics Division of Newborn Medicine Penn State Children s Hospital

2 The Cape Peninsula South Africa

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4 Medical Systems Mainstream (allopathic ) Traditional Alternative Complementary Integrative Integral

5 Definitions Mainstream medicine ( allopathic medicine) or regular medicine Alternative to mainstream medicine CAM is used to describe a variable set of diagnostic and therapeutic modalities that are considered to be non-conventional

6 Alternative Medical Therapies Alternative medical therapies may be functionally defined as interventions neither taught widely in medical schools or generally available in US hospitals Alternative medicine is popular throughout the industrialized world». Eisenberg 1998

7 Complementary Medicine Complementary medicine; combines mainstream medicine with alternative approaches ( adjunctive use) Integrative Medicine It is a blending of both mainstream and alternative medicine (with proven beneficial effect) to provide a broader range of tools to assist the patient.

8 Common tenets of CAM The body has an inherent ability to maintain and restore health. Treat the whole person: psyche - soma First do no harm: methods designed to suppress symptoms without removing the underlying causes are considered harmful Identify and treat cause: not just symptoms Prevention: build health and wellness The Physican as Teacher: doctor patient relationship. Philosophical emphasis on mental,emotional, and spiritual side of ill health-and an altered perception of disease

9 Re emergence of CAM Novey D CAM Mainstream /scientific (allopathic) medicine 1800 Dawn of Scientific method AMA licensure Laws Flexner Report 1910 Eisenberg CAM counterculture

10 Alternative therapies Mind body interventions Biofeedback, hypnotherapy,meditation,yoga, prayer, spiritual healing Electromagnetic therapy Alternative systems of medical practice Acupuncture, traditional Chinese herbal medicine, ayurveda, homeopathy, qi gong, shamanism, native American, traditional medicine, naturopathy Manual healing/energy methods Chiropractic, massage, osteopathic, reiki, therapeutic touch Biologic Treatments Herbal medicine, flower essences,

11 Prevalence of CAM use 1990 one in every four patients used CAM 1997 one in every three patients used CAM For patients aged 35-49yrs one in every two patients used CAM Eisenberg 1998

12 Showed Increases in the following: Herbal medicine (380%) Massage, Megavitamins (130%) Self-help groups, Folk remedies, Energy healing, Homeopathy Eisenberg 1998 Only a minority of Alternative therapies Were discussed with their Doctors don t ask don t tell

13 Eisenberg study % of general public used some form of alternative therapy By 1997 visits to alternative therapy exceeded total visits to all US primary care physicians. Out of pocket expenditures for alternative medicine equaled those for all physician services and exceed those for hospitalizations in the US.

14 Why do patients use CAM % to treat existing disease 58% to prevent future illness from occurring or to maintain health and vitality The greater emphasis on psychosocial or mind body factors made by CAM practitioners.

15 The CAM marketplace is currently valued at $24billion or more, with a growth rate close to 15% per year. Rauber: Modern Healthcare Sept 7, 1998 In 2007 almost $64 Billion is spent on CAM

16 Why study CAM & Traditional Medicine Patients are interested and need to be able to discuss CAM with their physicians Patients are self treating-empowered In % of alternative therapy was used without the supervision of an alternative practitioner or physician CAM fills a therapeutic gap /less expensive Research and funding opportunities Awareness of belief system/traditional medicine & healers Mainstream medicine is expensive and limited It provides satisfaction and meaning to practitioner

17 A physician can harm a patient with what he knows : but even more so, with what he doesn t Ken Wilber

18 Current situation It seems that our patients have moved ahead in their interest and we are playing catch up! Ask what is best for our patients? There are opportunities for integration. Choose modalities where the science is convincing and side effects acceptable.!

19 Institute of Medicine Patient Centered Approach care should be based on continuous healing relationships should be customized according to the patient needs and values, and the patient should be the source of control Institute of Medicine Crossing the Quality Chasm: a new helath system for the 21st Centaury,National Academy Press, 2001

20 NIH NIH National Center for Complementary and Alternative Medicine NCCAM s International Centers for Research on CAM Functional bowel disorders Indigenous phytotherapy studies Traditional Chinese Medicine for cancer >$100M funding a year Integrative Medicine consult service at NIH Clinical Center NIH News 5/14/07

21 An All inclusive Framework Interior -Individual Emotion, perception, Sensation, concepts, Beliefs, attitudes, Mind stuff Exterior individual Behavior Body Brain Interior - Collective (Cultural/ Moral) Doc-Patient relations Cultural judgments Meaning of an illness Support groups Exterior collective Families Systems/insurance Tribes Economic factors Healthcare policy Ken Wilber Forward to Consciousness and Healing

22 Dr- Patient communication skills The four quadrants of Integral Medicine From; the Integral Vision by Ken Wilber The aim of integral medicine is to utilize as complete and as comprehensive an approach as possible in treating any illness

23 The Cape Peninsula South Africa

24 An Integral Framework Interior -Individual Meditation, Relaxation therapy Guided imagery Biofeedback Hypnosis Contemplative prayer Interior - Collective (Cultural/ Moral) Supportive network Physican patient, Family, friends Support groups Group therapy Exterior individual Surgery, Pharmacology Massage,touch Electomagnetic Acupucture Subtle energy Exterior collective Social systems Environmental Toxins -lead Ecological systems Health policy Insurance systems Ken Wilber Forward to Consciousness and Healing

25 Colombo Sri Lanka Third World Congress on Alternative Medicine 1982

26 Acupuncture Electro stimulation of acupuncture needles

27 Dr Voll performing Electroacupuncture 1982

28 Dr Voll performing Electroacupuncture 1982

29 Acupuncture analgesia for vaginal hysterectomy

30 Acupuncture Meridians

31 Biophotonics in the infrared spectra range reveal acupuncture meridian structure of the body J Alternative and Complementary Medicine 2005 pp

32 Biophotonics in the infrared spectra range reveal acupuncture meridian structure of the body J Alternative and Complementary Medicine 2005 pp

33 Electromagnetic therapy: Pulsed electromagnetic fields Energy Medicine in Therapeutics and Human Performance pg 9 James Oschman

34 Spectrum of Dis-ease Urgent Chronic Trauma Medical emergencies Metabolic disorders Surgical emergencies Intensive care conditions Organ failure Sepsis Chronic conditions Allergies Arthritis Degenerative conditions Fatigue Stress disorders

35 Spectrum of Patient Wishes High Tech Mind body approaches High Touch Urgent Eg surgical trauma Important Eg. Stress disorders The Desired Health and Wellness Peak performance Optimal Health Self Mastery Community Awareness Sustainability

36 Your therapeutic toolbox High Tech High Touch (Professionalism) Diagnostic Devices Therapeutic Devices Surgery Medications Complimentary practices Tools of the trade Accumulate technology You Empathy/connection Compassion/kindness Integrity/validation Intuition Develop Wisdom

37 One basic way to expand our efficacy is through modern science and technology. But another is through integrated (emotional, mental, physical, and spiritual) growth and enhanced wisdom. Peter Senge

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39 Humanity (Wisdom) &Technology

40 Quite apart from what Is purely technical and Instrumental about medical Practice there is embodied In it an inescapable Moral element Doctoring: From Art to Engineering William A Silverman Copied from The Doctor Luke Fildes

41 Mediators include Hormones, cytokines, neurotransmitters, sympathetic nervous system, immune system

42 Mouse Model of Restraint Stress Psychological Stress 16hrs restraint Without food or Water per day Increased adrenal corticosteroid levels Impaired immune response Increased morbidity

43 Stress Increases Mortality Associated With Intranasal HSV-2 Infection 100 Control (n = 15) Stress (n = 19) Percent Su urvival p = < Days Post Infection Slide provided by Rob Bonneau PhD

44 Beliefs Mind Perceptions Neuroendocrine pathway Autonomic pathway Mediators include Hormones, cytokines, neurotransmitters, sympathetic nervous system, immune system

45 The toolbox High Tech High Touch Diagnostic Devices Therapeutic Devices Surgery Medications Complimentary practices Tools of the trade Accumulate technology You Empathy/connection Compassion/kindness Integrity/validation Intuition Burn t out

46 Stress Burnout 1.Personal resources and work demands become imbalanced: Longer working hours, little time with family, hurried meals 2.Short term response to stress: angry outbursts, tired all the time, irritability, anxiety about physical health. 3. Terminal burn out: balance between demands and personal resources cannot be re-established, deals with people and tasks mechanically, by the book, late for appointments, derogatory about patients, Uses superficial stereotypes, communication is authoritarian David Peters Self Care Stress and the Practitioner in Mind Body Medicine ed Watkins

47 Systems Approach: shifting the burden dynamic From Presence Human purpose and the field of the future Peter Senge pg 211

48 It is easy to shift the burden to technological solutions and thereby lose sight of developing our own capacities Develop your clinical skills Develop and retain your capacity for being fully human You are the best form of complimentary medicine

49 Western culture s growing reliance on reductionistic science and technology over the past two hundred years fits the shifting- the burden dynamic remarkably well, revealing a play of forces that create growing technological power and diminishing human development and Wisdom Senge

50 Humanity (Wisdom) &Technology

51 (Treat a sick child ) From Presence Human purpose and the field of the future Peter Senge pg 213

52 Like many shifting the burden situations, the dangerous aspect of our growing reliance on modern technology is the way it distracts attention from more fundamental sources of progress. The growing gap between technological power and wisdom arises not from technological progress alone but from the way it interacts with more integrative human Development. After a while, the very need for such development is all but forgotten Peter Senge in Presence pg 214

53 The Dilemma of Evidence Any new or different therapy should be supported by well designed studies documenting effectiveness = Evidenced Based Medicine For many alternative approaches evidence is lacking: finances for research, public domain, experimental design. Look for empirical evidence

54 The New Medicine DVD and Book

55 Challenges to the Current Paradigm in Medicine Evidenced based Paradigm Challenges Era I, II, III Larry Dossey Reinventing Medicine

56 Era 1: Mechanical Medicine Space Time : Local Synonym: Mechanical, material or physical medicine. Body based Description: Started around Causal Description: Started around Causal deterministic. Encompasses therapies that dominate Western medicine: drugs, surgery radiation. Newtonian physics-what matters is energy and matter, not mind. Mind is a result of brain mechanisms

57 Era 1 Mechanical Medicine Benefits Effective Foundation for orthodox medicine Vaccines, antibiotics Victory over illness possible. Confidence in high tech solutions Changed the way we think about disease Limitations Ineffective in chronic, degenerative and age related illnesses Does not explain a lot

58 Era II: Mind-Body Medicine Space Time : Local ( one s own mind and one s own body) Mind is a major factor in healing within the single person: mind has causal powers. Examples of therapy: any therapy emphasizing the effects of consciousness solely within the individual body: psychoneuroimmunology, counseling, hypnosis, biofeedback, imagery based

59 Mind-Body Medicine Post World War II-psychosomatic disease- stress effects on body- mind body effects then noted to have positive as well as negative effects placebo effect-( suggestion, expectation, and positive thinking)- Era I and II view mind or consciousness as generally equated with the brain or is assumed to be a by product of the brains chemistry and physiology In contrast alternative therapy or complimentary therapists do not view mind to be identical with the physical brain treat illness within a larger context of spirituality and life meaning- L Dossey Reinventing Medicine

60 Era III : Non Local Medicine Today, just as physicians are getting used to mind-body medicine, another great transition is taking shape. We are facing a constitutional crisis in medicine-a crisis over our own constitution, the nature of our mind and its relationship to our physical body Larry Dossey Reinventing Medicine

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62 Summary of Healing Practices that use Mental or Spiritual Techniques Mind Mater Interactions (MMI) 516 experiments,216 articles,91 first authorsover 41 years meta-analysis Attempts by individuals to influence random systems ( random event generators) Magnitude small <1% Highly statistically significant P= < Accordingly mind and matter interact in ways that are consistent with distant and spiritual healing. Evidence level A

63 Healing Intention and Energy Medicine Wayne B Jonas & Cindy C Crawford

64 Direct Mental Interactions with Living Systems (DMILS)

65 Restoring Meaning back into Medicine To view the patient simply as an assembly of physical parts will lead to a sense of disillusionment stress and burn out To view the patient as an interconnected multidimensional being that contains developing physical, emotional, mental, and spiritual aspects provides a fresh context in which to practice the art of medicine.

66 Thank you To be continued

67 Why Non Local Non local medicine does not confine or localize the mind to the brain and body. It grants the mind freedom to roam freely in space and time. Mind acts outside body in space and time Directing consciousness to escape its confinement to the brain and body and to act anywhere, regardless of distance.

68 Non-Local Mind Expressions of non Local Mind Non Local = Infinite ( natural part of who we are) Sharing of thoughts and feelings at a distance, Knowing the future Radical breakthroughs in creativity Can be used for healing illness and disease in Era III Healing

69 Many studies reveal that healing can be achieved at a distance by directing loving and compassionate thoughts, intentions, and prayers to others, who may even be unaware these efforts are being extended to them. Dossey

70 Challenges to the Current Paradigm ( World View) Evidenced based Paradigm Challenge Non local effects The effect of remote intention - projection of awareness with purpose and efficacy, towards some object or outcome. Effectiveness of other systems of medicine : TCM, Homeopathy, Intuitive diagnosis Modern physics: quantum theory

71 Individuals and institutions fail to see how their capacities for fundamental solutions are Eroding until the dependency and side effects build to overwhelming Proportions, eventually leading to unavoidable breakdowns Senge

72 Energy Medicine in Therapeutics and Human Performance pg 9 James Oschman

73 Art & Science & Technology