Alternative medicine, Does it really work? Annual Conference/Sunday_Omari.pdf · • Prevention is...

Alternative medicine,Does it really work?

Ibrahim Omari MDClinical Associate-AUMC-Family Medicine

Alternative medicine is any practice claiming to heal "that does not fall within the realm of conventional medicine

Bratman, MD, Steven (1997). The Alternative Medicine Sourcebook. Lowell House. p. 7

Alternative medicine is frequently grouped with complementary medicine under the umbrella termcomplementary and alternative medicine, or CAM

(Integrative medicine)

As using tai chi or massage in addition to prescription medicine for anxiety.

Cassileth BR, Deng G (2004). "Complementary and alternative therapies for cancer". The Oncologist 9 (1): 80–9.

In 1992, Congress established an Office of Alternative Medicine, now renamed the National Center for Complementary

and Alternative Medicine(NCCAM), at the National Institutes of Health (NIH), with a substantial annual budget.

nccam.nih.gov

The US National Center for Complementary and Alternative Medicine (NCCAM) defines CAM as "a group of diverse medical and healthcare systems, practices, and products, that are not currently part of conventional medicine.

"What is Complementary and Alternative Medicine (CAM)?". National Center for Complementary and Alternative Medicine. Archived from the original on 2005-12-08. Retrieved 2006-07-11.

CAM Overview

• Many Americans are turning to CAM therapies for themselves and their children.

• Healthcare providers should understand the theories behind CAM and have some knowledge regarding the professional practice of CAM

Ann Intern Med 1997; 127:61

• In US ~ 38% of adults(4 in 10)• ~ 12% of children(1 in 9) are using some

form of CAM

nccam.nih.gov/

CAM Modalities Now in Mainstream Medicine

Behavioral therapy for headache

Hypnosis for smoking cessation

Exercise for diabetes Support groups for breast

cancer Low fat, low cholesterol diets

Codeine for pain

Digitalis for heart failure

Quinine for malaria

Aspirin for fever

What are the principles of

complementary and alternative medicine?

• Prevention is key to good health. Taking steps to better your health before you get sick is the best way to keep yourself healthy.

• Self healingCAM practitioners see themselves as facilitators. The body does the healing work, and treatment encourages natural

healing processes.

• Learning and healing go hand in hand. CAM practitioners see themselves as teachers and mentors who offer guidance.

To the practitioner, you're the one who does the healing. • Holistic care. The focus is on treating you as a whole person —

recognizing that physical health, mental well-being, relationships and

spiritual needs are interconnected and play a part in your overall health.1998-2009 Mayo Foundation for Education and Research

What are some examples of complementary and alternative medicine

1998-2009 Mayo Foundation for Education and Research

1. Healing systemsHealing systems are complete sets of theories and practices.

Ayurveda

The ancient Hindu art of medicine(5000yr) and of prolonging life. It includes yoga, meditation, massage, diet and herbs to restore balance within the body and with nature

2.Homeopathy

Treating disease by drugs given in minute doses that produce symptoms similar to the disease to stimulate the body's self-healing response( Poison ivy leave)


Homeopathy cont’d…

• Developed in Germany(Hahnemann) during the late 1800s

• Popular in USA, Europe, Russia, India and South America

• Based on Law of Similarities and Dilutions• Like Cures Like: Homeopathic remedy that

causes Sx in a healthy person is used to treat same Sx in a sick person(e.g. poison ivy to treat Eczema)

• Energy frequency of remedy is usually used

J Am Board Fam. Pract. 1995;8:361

Types of CAM(healing) ..cont`d

3. Naturopathy: Founded on the healing power of Nature

Treating disease without surgery or drugs, but by using massage, acupuncture, herbal remedies, exercise , lifestyle counseling, homeopathy and stress management, to assist the natural healing processes


Healing …cont`d4. Traditional Chinese MedicineOriginating in China for more than 2000 yr ago. It

usesAcupuncture, Herbs, Massage, and Meditative exercise (qi gong) to restore balance within the body and with nature

Traditional Chinese medicine (TCM) is based on Yinyangism (i.e., the combination of Five Phases theory with Yin-yang theory)


Acupuncture…

Hojama

Qigong(Chi gung)

• Qigong is an ancient Chinese system of postures, exercises, breathing techniques, and meditations.

• to improve and enhance the body's qi.• the fundamental life energy responsible for

health and vitality.• Treat Asthma, Hypertension, Stress, Obesity

Jahnke, R.; Larkey, L.; Rogers, C.; Etnier, J; Lin, F. (2010). "A comprehensive review of health benefits of qigong and tai chi".American Journal of Health Promotion 24 (6): e1-e25.

Tai Chi

• A slow-motion, moving meditative exercise for relaxation, health and self-defense

• Researchers have found some favorable effects on the promotion of balance control, flexibility, cardiovascular fitness, and has shown to reduce the risk of falls in both healthy elderly patients,

Wolf, SL; Sattin RW & Kutner M (2003). "Intense tai chi exercise training and fall occurrences in older, transitionally frail

II. Mind-body connections-Mind-body techniques to strengthen the communication between mind and body. -Must be in harmony to stay healthy.Examples of mind-body connection techniques

include:


Meditation Yoga Biofeedback Prayer Hypnosis Relaxation and art therapies, such as

poetry, music and dance Guided imagery


Yoga (Yoke or union in Sanskrit)The union between the Mind, Body and Spirit.To join the self with the Cosmic ConsciousnessPhysical Level: yoga postures, are designed to tone, strengthen, and align the body

Mental Level: yoga uses breathing techniques and meditation to quiet, clarify, and discipline the Mind.

yoga is not a religion, but a way of living with health and peace of mind as its aims.

• HypnotherapyDeliberate use of the imagination, paralleled with strong focus and relaxation. Same way as dreaming(REM sleep) - the mind's 'Reality Simulator'.

• Relaxation techniques These techniques are specifically designed to elicit

a psycho physiologic state of hypo arousal. They may be aimed at reducing sympathetic nervous system activity and BP, easing muscle tension, slowing metabolic processes, or altering brain wave activity

Merck online Medical Library

This suggests that the Brain will see what you told them to see.In other words, believing is seeing

III.Biologically based treatmentsDiet therapies

Specialized dietary regimens (e.g., Mediterr, macrobiotic diet )are used to treat or prevent a specific disease

e.g., cancer, cardiovascular disorders or to generally promote health


Importance of the Mediterranean Diet• A meta-analysis comprising more than 1.5 million

healthy subjects and 40,000 fatal and non-fatal events was carried out by Sofi and colleagues, who analyzed the relation between adherence to a Mediterranean diet, and mortality from cardiovascular diseases, cancer and the incidence of chronic diseases such as Parkinson`s and Alzheimer`s.

BMJ 2008;337:a 1344

The Mediterranean diet has been widely reported to be the model of healthy eating resulting in a better quality of life

The adherence to the whole diet rather than individual components,

9% reduction in the overall mortality 9% reduction in mortality from neoplasm 13% reduction in Parkinson`s and Alzheimer`s

BMJ 2008;337: a 1344

IV. Manipulative and body-based methodsChiropracticChiropractic is based on the relationship between structure of the spine and function of the nervous system; bones and joints are manipulated to restore balance to the bodyMassage Tissues are manipulated to promote wellness and

to reduce pain and stress


Osteopathy

It is a hands-on, medicine free technique to restore structural integrity of the bodyby manipulation of joints, bones,soft tissues, muscles and spine

Reflexology

V. Energy therapies

Invisible energy force flows through our body, and when this energy flow is blocked orunbalanced we become sick. Called Qi(Chi) of Live Force


Acupuncture, restores your natural energy. Other energy therapies include: • External qi gong• Therapeutic touch • Reiki • Magnet therapy • Polarity therapy • Light therapy• NAET• Pulsed electrical field


AUBMC Introduces to Mideast Region Non-invasive Treatment for Depression Using Magnets

ReikiJapanese technique for stress reduction and relaxation that also promotes healing. Practitioners channel "life force energy” through their body and into a patient’s body to promote healing

Therapeutic(Quantum) Touch:Turbo or Reiki


Naet…..cont’d• A holistic treatment for the permanent

elimination of food and environmental allergies, which may be the cause of a wide range of illness

• By using acupuncture/acupressure, , chiropractic, nutritional, and kinesiology techniques(study of human movements)

Muscle Testing:Applied Kinesiology

NAET and Autism

• Improving Communication Skills in Children With Allergy-related Autism Using Nambudripad’s AllergyEliminationTechniques: A Pilot Study

• Integrative Medicine • Vol. 10, No. 5 • Oct/Nov 2011• This article is protected by copyright. To share or copy this article, please visit copyright.com. Use

ISSN#10786791. To subscribe, visit imjournal.com• Teitelbaum, et al—NAET Effective for Autism

Glucosamine and Osteoarthritis

• 2 large studies on glucosamine for osteoarthritis in the knee

• One, a functional and pain study and the other, a study using imaging methods to assess the kneecartilage

Neither achieved clear evidence of benefitnccam.nih.gov

.

Fish oil and omega-3s

• Omega-3s have a positive effect on Triglycerides

and certainly• seem to be overall beneficial on

cardiovascular risk factors• in some of the systematic

reviews, seem to have at least inferential evidence for effects on harder outcomes like cardiovascularevents and mortality. nccam.nih.gov

Take home Message…

• Teach people the proper care of the human frame • Prevent disease processes from starting in the first place

•To use mainly natural therapies derived from herbs, vitamins and Chinese acupuncture principles to facilitate healing in a person who has already manifested a disease process.

•To instill the principle of health maintenance, rather than disease management.

The doctor of the future will give no medicine, but will interest her or his patients in the care of the human frame, in a proper diet, and in the cause and prevention of disease.

Thomas A. Edison

The Old Belief

• Complementary and Alternative medicine (CAM) includes various healing approaches and therapies that originate from the world and that are:

• Not based on conventional western medicine.• Not usually taught at American Medical schools• Not provided in hospitals• Not reimbursed by 3rd party payers• Lack evidence of effectiveness

JAMA 1998;280:1569

Present Status of CAM

• More than one-half of American Medical schools NOW offer courses on Alternative medicine.

• Many therapies that formerly considered alternative, now are offered in medical settings, including hospitals.

• E.g. Massage for newborn infantsAcupuncture for patients with severe pain

JAMA 1998;280:784

A survey of patients followed in private and university-based rheumatologypractices found that roughly two-thirds had used some form of complementary or alternative therapy

Ann Int Med 1999;131:409

A 1998 systematic reviewin 13 countries concluded that about 31% of cancer patients use some form of complementary and alternative medicine

Ernst E, Cassileth BR (August 1998). "The prevalence of complementary/alternative medicine in cancer: a systematic review". Cancer 83 (4)

Epidemiology• The annual number of OPD visits to CAM

providers is greater than the number of OPD visits to mainstream physicians in US.

• Out -of –pocket expenditures for CAM are greaterthan those spent for hospitalization

N Engl J Med 1993;328:246

• Increasing numbers of CAM reimbursement by 3rd party payers

• New evidence is emerging regarding the safety and effectiveness of a variety of dietary supplements, massage and other therapies.

• Research…..Evidence….Understanding…..Acceptance

1998-2009Mayo Foundation for Education and Research

WHO Practices CAM

1. In Austria and Germany CAM is mainly in the hands of physicians2. At least half of American alternative practitioners are physicians3. Practitioners in UK, France, Netherlands…etc4. Traditional healers, patients

External qi gong In this subset of Chinese medical qi gong practice, master healers use the energy of their own biofield to bring the patient’s energy into balance

Magnets Magnets are placed on the body to reduce pain

Pulsed electrical field Injured body parts are placed in an induced electrical field to facilitate healing


1925 An Incredible Discovery Was Made.E=MC2 : Energy = EVERYTHING Albert Einstein(subatomic) vs. Newtonian physics(solid atom)

The ancient Chinese called this flow chi(Qi); the ancient Hindus called it prana.

•Reinhold Voll, (1950s)a German medical doctor, developed an electronic testing device for finding acupuncture points electrically(EAV)

• These Acupuncture points, had a different resistance to a tiny electrical current passed through the body, than did the adjacent tissues

. Voll R: Twenty Years of ElectroAcupuncture Diagnosis in Germany. A Progress Report. Am J Acupuncture 1975; 3(19):7-17.

Voll discovered that certain acupuncture points showed abnormal readings when subjects were reacting allergically.

He discovered that the glass bottle of medicine could change the readings when it was in contact with the skin

He assumed that there must be some kind ofelectro-magnetic energy being emitted from the substances, and that these energy fields somehow traveled along the electric circuit to the body (perhaps like the energy waves representing a person's voice travels along the electric circuitry of a telephone line).

In 1984, researchers from the University of Hawaii compared 6 different diagnostic modalities for assessing food allergies. These tests included history, food challenge,skin,RAST, IgE antibodies,and Meridian Stress Assessment (MSA) on 30 volunteers.

MSA data showed the highest degree of compatibility with the food challenge test

MSA results were comparable with both skin and RAST tests

Tsuei JJ, Lehman CW, Lam FMK, Zhu DAH: A Food Allergy Study Utilizing the EAV Acupuncture Technique.

Am J Acupuncture 1984; 12(2):105-116.

Good health is believed to be achieved by a balance

between yin and yang.

Phenomenon Yin Yang

Celestial bodies moon sun

Gender female male

Location inside outside

Temperature cold hot

Direction downward upward

Degree of humidity damp/moist dry

Phenomenon Wood Fire Earth Metal Water

Direction east south center west north

Color green/blue red yellow white black

Climate wind heat damp dryness cold

Taste sour bitter sweet acrid salty

Zang Organ Liver Heart Spleen Lung Kidney

Fu Organ Gallbladder Small Intestine Stomach Large

Intestine Bladder

Sense organ eye tongue mouth nose ears

Facial part above bridge of nose

between eyes, lower part bridge of nose between eyes,

middle partcheeks (below

cheekbone)

Eye part irisinner/outer corner of the

eye

upper and lower lid sclera pupil

Correspondences between the body and the universe have historically not only been seen in terms of the Five Elements, but also of the "Great Numbers”

For example, the number of acu-points has at times been seen to be 365, in correspondence with the number of days in a year; and the number of main meridians – 12 – has been seen in correspondence with the number of rivers flowing through the ancient Chinese empire

• BiofeedbackMechanical devices are used to provide

information about physiologic signals (e.g., BP, muscle activity) and to teach patients methods of regulating these processes through intention

• Guided imageryMental images are used to promote relaxation or wellness or to promote healing of a particular condition (e.g., cancer, psychological trauma). The images can involve any of the senses and may be self-directed or guided by the practitioner


MeditationMediation is intentional self-regulation of attention or a systematic mental focus on particular aspects of inner or outer experience.

Most meditation practices were developed in a religious or spiritual context; their ultimate goal was some type of spiritual growth, personal transformation, or transcendental experience.

However, some practitioners suggest that as a health care intervention, meditation may be effective regardless of a person’s cultural or religious background


Biologic therapies Substances (e.g., shark cartilage) or molecules

(e.g., S-adenylosyl-Lmethionine[SAMe], glucosamine) naturally occuring in animals are used to treat disease

HerbalismPlants are used to treat disease and promote

healthOrthomolecular therapiesMolecules normally found in the body (e.g.,

hormones, vitamins, nutrients) are used to treat disease and promote health


Postural reeducation Movement and touch are used to help patients relearn

healthy posture. Techniques include Alexander, Feldenkrais, and Trager. Therapies seek to release habitual, harmful ways of holding the body by focusing on awareness through movement

Reflexology Manual pressure is applied to specific areas of the foot that theoretically correspond to different organs or systems of the body

Rolfing The fascia are manipulated and stretched to reestablish healthy bone and muscle alignment


Are conventional doctors opposed to

complementary and alternative medicine?

• No training in CAM• Exaggerated claims about curing diseases• CAM lacks solid research• Carefully controlled studies are costly• Role of government and drug companies• Currently number of studies are under way ,on

Herbs, Yoga ,Naet , etc• National Center for CAM (NCCAM), to guide the

public and for research.


Relationship between CAM and Mainstream Medicine• Families who use CAM rarely abandon their

mainstream physicians.• CAM is usually used as an adjunct rather than an

alternative to mainstream medical care• Example: majority of consultations to holistic

medicine team in a tertiary care Ped. Hosp. were for management of symptoms, rather than cure ( 70% vs. 9%)

Arch Pediatr Adolesc Med 2001;155:449

WHY PATIENTS USE ALTERNATIVE MEDICINE?

• Families seek care from providers who respect themAs individuals and offer them time and

attention• They seek information on healthy lifestyle choices,

dietary supplements, and environmental therapies

Ann Intern Med 1998;129:1061

• They turn to CAM therapists who offer them personal, attention, hope, time , and therapies consistent with their values, worldview and culture

JAMA 1998;279:1548 BMJ 1998;317:260

• CAM treatments aren't a substitute or replacement for conventional medical care.

• CAM used to alleviate stress, pain and anxiety, manage your symptoms, maintain strength and flexibility, and promote a sense of well-being


The Six Phases of Homotoxicology in overview:

Acute Phases1. Excretion – An increase of body secretions such as saliva, sweat and bowel2.Reaction – Inflammation, “itis” such as fever, pain and vomiting3. Deposition – Toxins depositing in the matrix

Chronic Phases4. Impregnation – Toxins causing changes in systems and creating a burden forthe body5.Degeneration – Degenerative and catabolic (breaking down) changes6. Dedifferentiation– Most severe phase involving cellular changes

E=MC2Cosmos --> Universe --> Galaxy --> Earth --> Individuals --> Organ Systems --> Cells --> Molecules --> Atoms --> Subatomic Particles = Energy

One Energy for everything

Quantum Physics

The study of the building blocks of the Universe.( nature, sounds, thoughts, motions, success)

How EVERYTHING in the cosmos has come to exist beginning at the atomic and sub-atomic levels

We "Really Are ONE”

All things is nothing more than a vibrating mass of pure energy that is intricately interconnected to everything else...EVERYTHING else( Einstein. Nils Bohr, nobel price 1922

"Science without religion is lame, religion without science is blind."- Albert Einstein

T’ai chi and yoga, are based on the art of tuning in to the flow of energy and

using it to centre the self.

Definition of CAM

-CAM represents a change of direction-No clear definition of CAMBecausemany ideas come from native healing practicesor non-mainstream sources and gradually move into the

Mainstream( TCM and Ayurvedic medicine)

Alternative medicine practices not typically used in conventional medicine.

What's considered alternative medicine changes constantly as more and more treatments undergo rigorous study and are proved to be effective or not


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