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CHAPTER
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
44Complementary and Alternative Medicine
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
44-2
Learning Outcomes
44.1Explain CAM.
44.2Distinguish between complementary and alternative medicine and conventional medicine.
44.3Summarize how CAM and conventional medicine are used together.
44.4 Identify various types of complementary and alternative medicine.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
44-3
Learning Outcomes (cont.)
44.5Describe how a medical assistant may use his or her knowledge of CAM.
44.6Explain why patients and health-care practitioners are turning to complementary treatments.
44.7Compare insurance and payment for CAM treatments.
44.8Explain how CAM is regulated.
44.9Describe health fraud.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
44-4
Introduction
• More than 30% of adults use complementary and alternative therapies– Relieve problems– Promote wellness– No relief from traditional treatments
• Some physicians use a combination of CAM and traditional therapies
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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What Is CAM?
• A group of practices and products that are not part of conventional medicine
• Allopathy – conventional medicine or common and usual practice
• Complementary medicine – used with conventional medicine
• Alternative medicine – used instead of conventional medicine
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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What Is CAM? (cont.)
• Scientific evidence concerning safety and effectiveness – Available for some CAM therapies– Research continues, so information changes
• Integrative medicine – Evolves as CAM therapies are adopted by
conventional medicine– Combination of both
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Apply Your Knowledge
Define CAM and state why these therapies are not in wide use by practitioners of conventional medicine.
ANSWER: CAM is a group of practices and products not considered part of conventional medicine. They are not widely used by physicians because there is not a lot of scientific evidence of their safety and effectiveness.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Types of CAM• Shared similarities
– Individualized treatments, good nutrition, and preventive health practices
– Holistic– Promote self-care and
self-healing– Recognition of one’s
spiritual nature
• Categories – Alternative medical
systems– Mind-body
interventions– Biologically-based
therapies– Manipulative and
body-based methods– Energy therapies
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Alternative Medical Systems
• Evolved apart from conventional medicine• Homeopathic medicine
– Treating syndromes and conditions with remedies that produce similar syndromes and conditions in healthy people
– Remedy • Produces the symptoms it is given to treat in order
to stimulate the body’s natural defenses to heal itself
• Must meet FDA standards
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Alternative Medical Systems (cont.)
• Homeopathic medicine– Looks at individuals, not diseases
• Initial in-depth assessment • Follow-up – how they are responding
– Medical assistant role• Similar to other medical offices• Have knowledge of common remedies
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Alternative Medical Systems (cont.)
• Naturopathic medicine – Relies on the healing power of the body to
establish, maintain, and restore health– Primary health care
• Nutritional/lifestyle counseling• Dietary supplements/medicinal plants• Exercise• Homeopathy/traditional Chinese medicine
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Alternative Medical Systems (cont.)
• Naturopathic medicine– Medical assistant – understanding of
treatments– Traditional Chinese medicine
• Balanced qi (vital energy)• Flow of qi along meridians (energetic pathways)• Acupuncture – insertion of hollow needles along
meridians
– Ayurveda – provides guidance regarding food and lifestyle; India
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Mind-Body Interventions
• Enhance the mind’s capacity to affect bodily function and symptoms
• Support groups and cognitive-behavioral therapy now part of traditional medicine
• Scientific support – Placebo effect – WW II– 35% of therapeutic response is due to belief
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Mind-Body Interventions (cont.)
• Most commonly used forms of CAM
• Types– Prayer
– Yoga
– Meditation
– Hypnosis
– Biofeedback
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Biologically Based Therapies
• Use substances found in nature– Dietary supplements– Herbal products– Foods
• Medical assistant– Keep up-to-date about dietary and herbal
products– Be able to provide reliable resources for
patients
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Biologically Based Therapies (cont.)
• Dietary supplements– Manufacturers – no evidence of effectiveness
or safety
– No standardization to ensure consistency and quality
– Types • Vitamins• Minerals • Herbals – no established recommended daily
amount
Recommended daily amount established by the FDA
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Biologically Based Therapies (cont.)
• Patient education for using supplements– Report all supplements as they would
prescription medications– Take supplement bottles to appointments
• Document patient’s use of supplements in the medical record
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
44-18
Manipulative and Body-Based Methods
• Based on the manipulation and/or movement of one or more parts of the body
• Types – Massage therapy– Chiropractic manipulation – Reflexology– Alexander technique– Bowen technique
– Craniosacral therapy– Feldenkrais method– Rolfing– Trager bodywork– Tui Na
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Manipulative and Body-Based Methods (cont.)
• Massage – Pressure, kneading, stroking, vibration,
and tapping to positively affect health
– Effects • Relaxation• Counteracts effects
of stress• Lowers heart rate and
blood pressure
• Reduces pain/relaxes muscle spasms
• Improves concentration• Promotes restful sleep• Helps the mind relax
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Manipulative and Body-Based Methods (cont.)
• Swedish massage– Stimulates circulation
and lymph flow– 5 basic strokes
• Neuromuscular massage– Releases tension,
relieves pain and pressure on nerves, and increases blood flow
– Trigger point therapy
• Seated massage– Focuses on back and neck
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
44-21
Manipulative and Body-Based Methods (cont.)
• Chiropractic medicine – Adjustments
• Manual treatments to re-align the vertebra and restore function of spinal nerves
• Chiropractor – Performs an exam
and takes a history– Tests
• X-rays• Muscle testing• Analyzes posture
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
44-22
Energy Therapies
• Bioelectromagnetic-based therapies– Balances the electromagnetic fields of the
body– No scientific evidence of efficacy– Magnetic therapy
• Most common type• Magnets are used to correct disturbances of
electromagnetic fields and restore health • FDA – no medical value but relatively harmless• Avoid for patients with pacemaker or defibrillator
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
44-23
Energy Therapies (cont.)
• Biofield therapies
• Manipulate energy field surrounding the body
• Reiki – Based on qi– Visualization and touch
balance energy flow to bring healing energyto organs and glands
• Therapeutic touch– “Laying-on of hands”
– Hands direct human energies to help or heal
– No scientific evidence of efficacy
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Apply Your Knowledge
Match to types of CAM:
___ Therapeutic touch A. Energy therapies
___ Chiropractic medicine B. Mind-body therapies
___ Dietary supplements C. Body-based therapies
___ Yoga and meditation D. Biologically-based therapies
___ TCM E. Alternative medical systems
___ Herbal supplements
___ Homeopathy/naturopathy
___ Magnetic therapy
___ Hypnosis
___ Massage
E
E
D
D
ANSWER:
A
C
C
B
B
A
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Patients Seeking CAM Therapy
• Use is increasing
– Less expensive
– Have fewer side
effects
– More accessible
– Increase in spirituality
– Personal growth
– Environmentalism
– Preventive health care
• Reasons for seeking CAM therapy– Failure of traditional
medical interventions– Treat side effects of
conventional medicine’s treatments
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Patients Seeking CAM Therapy (cont.)
• Patients with chronic debilitating conditions– Improve quality of life– Improve ability to cope with stress and illness
• Cultural differences in CAM use– Hispanics – Native Americans
• Accept patient’s right to choose CAM therapy
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Patients Seeking CAM Therapy (cont.)
• Use of CAM in children on the increase– Safety – children
respond differently– Efficacy in children not
established– Identify and document
if CAM is used
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Apply Your Knowledge
Mr. State is complaining about chronic back pain. He says that the medication only helps a little and asks you if there is anything else you could recommend that will help him. What should you tell him?
ANSWER: If your employer is not averse to CAM therapies, you can tell him that there are CAM therapies that may help with the pain or at least help him cope better with it. He could try mind-body techniques, acupuncture, manipulative and body-based techniques, or energy therapies.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Insurance and CAM
• Coverage varies – Lack of research and documentation of
efficacy– Emphasis on physiological or biochemical
response to therapies
• Alternative health insurance companies emerging in response to need
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Insurance and CAM (cont.)
• Medical assistant– Know whether or not CAM
treatments are covered by insurance
– Resources • Insurance companies• State agency that regulates the insurance industry
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Regulation of CAM Therapies
• National Center for Complementary and Alternative Medicine (NCCAM)– Research – Training and career development– Conferences and educational programs– Integration of scientifically proven CAM
therapies into conventional medicine
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Regulation of CAM Therapies (cont.)
• White House Commission on Complementary and Alternative Medicine Policy (WHCCAMP)
– Funding for research– Communication between CAM and
conventional practitioners– Availability of CAM practitioners– State review and evaluation of CAM
practitioners– Insurance coverage options
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Apply Your Knowledge
1. Why do insurance companies not reimburse for most CAM therapies?
ANSWER: Insurance companies do not reimburse for CAM therapies because of the lack of research and documentation of effectiveness of these therapies.
2. What are the federal agencies tasked with regulation of CAM therapies?
ANSWER: They are the NCCAM and WHCCAMP.
Yippee! 2 for 2!
ANSWER: They are the NCCAM and WHCCAMP.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Health Fraud
• Articles of unproven effectiveness promoted to improve health, well-being, or appearance– Deception or trickery for profit– Plays on emotions and desperation
• Regulation – FDA – safety, manufacturing, and labeling– FTC – advertising
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Health Fraud (cont.)
• Health claims–Unproven claims must
include a disclaimer
–FDA-approved claims for food and supplements• Based on scientific evidence
• Only reduces risk/does not treat or cure
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Health Fraud (cont.)
FDA-Approved Health Claim
Supplement/Food
Reduce risk of some cancers
• Low-fat diets• Fruits, vegetables, fiber-containing grain products• Whole grains
Reduce risk for hypertension
• Low-sodium diets• Potassium
Reduce risk for osteoporosis
• Calcium
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Health Fraud (cont.)
FDA-Approved Health Claim
Supplement/Food
Reduce risk of heart disease
• Low-sodium diets• Decreased saturated fat and cholesterol• Soluble fiber and whole grains• Soy protein/plant sterols/stanol esters
Reduce risk for neural tube defects
• Adequate folate
Reduce tooth decay • Decreasing between-meal consumption of foods high in sugars and starches
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Health Fraud (cont.)
• Recognizing health fraud – Check with the BBB or attorney general’s
office– Check with appropriate health-care group– Contact the FDA– If it sounds to good to be true, it probably is
not true– If unproven, get a second opinion– Beware of “secret cures”
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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Apply Your Knowledge
Why do people fall victim to fraudulent health claims?
ANSWER: These claims target people who are emotional and desperate. They are hoping to find a cure, improve their health, or just look better.
Bravo!
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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In Summary
44.1 Complementary and alternative medicines are practices and products outside the scope of traditional or conventional medicine.
44.2 Complementary medicine is used in conjunction with conventional medicine. Alternative medicine is typically used as a replacement for conventional medicine.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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In Summary (cont.)
44.3 A new type of medicine called integrative medicine has emerged, in which conventional medicine and scientifically proven CAM therapies are used together.
44.4 There are five classifications for CAM. They include alternative medical systems, mind-body interventions, biologically-based therapies, manipulative and body-based methods, and energy. Each of these classifications has various types of products and therapies associated with it.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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In Summary (cont.)
44.5 As a medical assistant, it is your responsibility to have basic knowledge of CAM therapies. If you work with a practitioner that provides CAM therapies, you will be responsible to assist in many cases. Additionally, understanding insurance reimbursement for CAM and health fraud are important aspects of the medical assistant’s role.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
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In Summary (cont.)
44.6 In many cases, patients are looking for low-cost products and services that help to maintain health and prevent disease, so they turn to CAM. Other patients that are offered no effective treatment or cure from conventional medicine are turning to CAM for additional options. Health-care practitioners are using many types of complementary therapy as they become accepted and, in many cases, scientifically proven.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
44-44
In Summary (cont.)
44.7 In general, the insurance industry provides little or no coverage for CAM therapies. To find out if coverage is provided, you can contact the insurance company directly, obtain information from the association’s web site for the type of therapy provided, or contact the state insurance commissioner.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
44-45
In Summary (cont.)
44.8 The NCCAM conducts and supports CAM research and provides CAM information to health-care providers and the public. Some state and federal laws have been enacted to help regulate CAM, and more laws and regulations are expected as research is conducted.
44.9 Health fraud as defined by the FDA as “articles of unproven effectiveness that are promoted to improve health, well being, or appearance.” Health fraud is monitored by the FDA and the FTC.