Malaysian Healthy Ageing Society

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1 Organised by: Co-Sponsored: Malaysian Healthy Ageing Society

2 Overview Of Complementary And Alternative Medicine Dr. Sivaneswaran Poobalasingam Director of Integrative Medicine TIL0303 Level 3 One IOI Square IOI Resort, Putrajaya

3 Complementary Medicine is used by up to 80% of the population WHO

4 39% reported using some form of CAM therapy 2011 Millenium Cohort Study(United States)

5 Expenditure United States(2010) USD 34 billion annually

6 Broad domain of healing resources that encompasses all health systems, modalities and practices and their accompanying theories and beliefs other than those intrinsic to the politically dominant health cycle of a particular society or culture in a give biological period Cochrane Collaboration

7 Complementary Medicine CAM is a group of diverse medical and health care systems, practices and products that are not presently considered part of conventional medicine

8 Complementary Medicine Holistic approach to health Emphasis on disease prevention over disease treatment Deals with patient as a whole Treatment of the whole patient (body mind and spirit) versus a single pathogen

9 Complementary Medicine Mind and body linked Disease stems from a disturbance at the physical, mental, emotional and spiritual level Therapeutic intervention is to restore balance and facilitate the body s own healing response

10 Complementary Medicine Complementary medicine dates back to 5000 years For centuries complementary medicine kept people healthy Complementary medicine gave birth to modern medicine

11 Complementary Medicine Complementary medicine Used together with conventional medicine Alternative medicine Used in place of conventional medicine Integrative Medicine Combines mainstream medicine and CAM therapies

12 MAJOR TYPES OF COMPLEMENTARY AND ALTERNATIVE MEDICINE

13 National Center for Complementary and Alternative Medicine Classification into 5 categories Alternative medicine systems Mind-Body medicine Biological based systems Manipulation and body based methods Energy medicine

14 1. Alternative medicine systems Built upon complete systems of theory and practice Evolved apart from and earlier than conventional medicine E.g. Homeopathy Naturopathy Traditional Chinese Medicine Ayurveda

15 2. Mind Body Medicine Concept that the mind is important in treatment is integral in many traditional therapies Hippocrates (400B.C) advocated this concept Varieties of intervention techniques E.g. Meditation Yoga Prayer Therapies such as music

16

17 3. Biologically Based Therapies Use substances found in nature such as herbs, vitamins and foods E.g. Dietary supplements Herbal Products

18

19 4. Manipulation and Body Based Methods Based on manipulation and/or movement of 1 or more parts of the body E.g. chiropractic manipulation osteopathic manipulation massage

20 5. Energy Medicine Deals with energy fields Two types of energy fields: Bio-electromagnetic based therapies(veritable) Bio-fields(Putative)

21 Energy Medicine Bio-electromagnetic based therapies Can be measured Uses electromagnetic fields, mechanical vibrations Uses specific wavelengths and frequencies in therapies e.g. magnet therapy

22 Energy Medicine Bio-fields Yet to be measured Based on concept that human beings are infused with subtle forms of energy Vital energy or life force Has various names E.g. Qi, ki, prana, orgone, etheric energy Illness results from disturbances of this energy field E.g. reiki, qi gong,yoga, healing touch

23 42% of Americans used CAM in 1998 as compared to 34% in 1990 JAMA

24

25 Less Than 5% of Patients Use CAM on Its Own. More Than 95% Use It Integrated With Modern Medicine. Gerard Bodeker, Global Initiative for Traditional Systems (GIFTS) of Health, Institute of Health Sciences, University of Oxford, England.

26 42% used complementary therapies Of the CAM users 74% used CAM with conventional medicine Survey done by Landmark Health Care

27 76% used CAM Among CAM users 95% used integrative medicine Survey done by National University of Singapore

28 Malaysia 65% use CAM Indians 45% Chinese 32% Malays 22% 78% reported that their condition improved Hassan et al. Use of complementary and alternative medicine among patients with chronic diseases at outpatient clinics.complementary therapies in clinical practice 2009

29 Number of hospitals offering CAM has tripled since 2000 In % of hospitals provided CAM

30 Commonly Used CAM in Adults Herbal remedies Echinacea-immune function Gingko --- Cognitive Function Saw Palmetto --- Prostrate Enlargement Mind-Body Medicine Meditation Yoga Chiropractic Manipulation Acupuncture Massage

31

32

33 Malaysia Nutritional supplements (48%) Herbal medicine (26%) Traditional Chinese Medicine (4%) Hassan et al. Use of complementary and alternative medicine among patients with chronic diseases at outpatient clinics.complementary therapies in clinical practice 2009

34 Qi Gong and Taiji Patients with early stage dementia can slow their physical, mental and psychological decline: Improved cognitive function Improvement in self-esteem Improvement in physical function E.g. balance Burgeones et.al American Journal of Alzheimer s Disease and other Dementia, 2008

35

36 Yoga Improvement in sleep quality and mental health indicators Chen K.M et.al.sleep quality depression state and healthy status of older adults after Silver Yoga Exercises. Int J Nurs Stud 2008

37 Yoga Significant reduction in pain and improvement in energy levels Groessl EJ et al. Yoga for veterans with chronic b pain. J Altern Complement Med 2008

38 Research CAM therapies not patentable which may lead to reduced funding from the private sector Can be marketed without any proof of efficacy in contrast to pharmaceuticals. Disinterest from manufacturers to fund scientific research

39 Common Health Problems General Health Musculoskeletal E.g.Back,hip,arthritis Anxiety, depression Sleep disorders Gastro-intestinal disorders Diabetes Coronary artery disease Hypertension Allergies Pain Management

40

41 What Are The Reasons For The Use Of CAM?

42 Majority of patients choosing alternative medicine do so mainly because those approaches are more aligned with their values, beliefs and philosophical orientations towards health and life. JAMA

43 Why Do People Use Cam? Changing needs and values in modern society contributes to an increase in the popularity of CAM An increased sense of entitlement to quality life Increase in public access to health information Reduce tolerance to paternalism

44 Reasons For The Use Of CAM More compatible with patient s world views, spiritual philosophy and belief 80% are satisfied with the treatment they receive. Interestingly not always dependent on a simultaneous improvement in their condition

45 Japan Perceived effectiveness of alternative therapies Alternative Therapies 83.5% Medical 54 % US Alternative Therapies 89% Medical 81.8% Flaherty J.H et al.use of Alternative Therapies in older outpatients in the United States and Japan. American Geriatric Society Meeting 2000

46 Reasons For The Use Of CAM Value an emphasis of holistic care To be actively involved in their own health promotion and disease prevention To promote a sense of well being To feel that all possible approaches have been tried To improve the odds for total cure

47 Reasons For The Use Of CAM Traditional therapies have been practiced for centuries and are trusted as good medicine Herbs and spices are part of the diet Have medicinal value

48 Reasons For The Use Of CAM Conventional medicine not effective for the specific problem Rise in prevalence of chronic diseases Lack of cure for several chronic diseases Increased side effects Increased microbial resistance Emergence of new diseases

49 Reasons For The Use Of CAM High cost of new drugs Cannot talk to the physician Too impersonal

50 By concentrating on smaller and smaller fragments of the body modern medicine perhaps losses sight of the patient as a whole being, and by reducing health to mechanical functioning it is no longer able to deal with the phenomenon of healing. Prince Charles

51

52 Concerns Majority of patients do not inform their physicians Majority of the physicians are not educated about the alternative methods their patients are using

53 Communications With CAM Providers About CAM Use Of those aged 50 or older who use CAM, more than two-thirds (69%) did not talk to their physicians about it.

54 Common reasons for not discussing with physician Physicians never asked them (42%) They did not know they should (30%) There was not enough time (19%)

55 Concerns Practice of good medicine Working knowledge of treatments patients are using and their effects

56 Concerns Essential for physicians to have a knowledge of CAM Beneficial, harmful, not of benefit Reduce risk of unsafe methods, drug interaction, delay in treatment Help patients avoid spending substantial financial resources on ineffective treatments

57 Concerns Patient delays in seeking medical care Experienced success with one CAM therapy for a certain ailment Convinced of its efficacy Extrapolate that success for some other CAM therapy for more serious life threatening disease

58 Concerns Inadequate product quality control Product may be contaminated Other herbs Pesticides Heavy metals Eg.Lead,Mercury Prescription drugs

59 Concerns Potential interaction with propriety drugs

60 Some Interactions Gingko Commonly used to improve circulation and cognitive function Warfarin and Aspirin Increased risk of bleeding

61 Some Interactions St. John s Wort Commonly used for depression Interaction: Theophylline May decrease effectiveness of Theophylline Cyclosporin May reduce effectiveness Oral Contraceptives Results in breakthrough bleeding and irregular menstrual cycles Digoxin May reduce efficacy

62 Concerns Do not view supplements / herbal medicine as drugs Believe they are natural and harmless Toxicity can result in the way a herb metabolises, from adulteration and contamination Can lead to hepatotoxicity and renal failure Eg. Kava Safety of herbs not established in pregnant women and children

63 Are CAM therapies safe? Each treatment needs to be considered on its own Individuals respond differently to treatment Response to CAM depends on: Patients state of health Type of treatment

64 Are CAM therapies safe? Natural does not mean safe Eg. Mushrooms Some safe some poisonous Potential interaction with drugs Adverse effects of herbs

65 Are CAM therapies safe? 1.CAM products sold over the counter Safety depends on: Components of the product Origin Quality of the manufacturing process

66 Are CAM therapies safe? 2.CAM therapies that are administered by a CAM practitioner Safety depends on: Training Skill Experience

67 Regulation Registration of a product Registration of CAM practicioners

68 Education United States Increasing number of medical colleges have started offering courses in CAM Training of physicians in CAM Europe Many universities offer some form of CAM training

69 Malaysia Malaysia is in the process of regulating CAM Traditional and Complimentary Medicines Act will integrate CAM practices into the National HealthCare system Ministry of Health has commenced a pilot programme to integrate CAM at various hospitals and will be expanded Therapies that will be integrated are post-natal massage, reflexology and acupuncture

70 Conclusion Popularity of CAM continues to grow Past utilisation of CAM forecast a promising future CAM is not a short-lived phenomenon or a radical replacement of conventional medicine

71 Conclusion Integration of complementary medicine with conventional medicine will shape a healthcare of the future Health and wellness

72 The greatest remedy,the physician within Paracelsus

73 THANK YOU

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