Date post: | 10-Apr-2018 |
Category: |
Documents |
Upload: | stephen-holt-md |
View: | 217 times |
Download: | 0 times |
8/8/2019 Stephen Holt MD-Integrative Medicine Definitions and Initiatives
http://slidepdf.com/reader/full/stephen-holt-md-integrative-medicine-definitions-and-initiatives 1/23
Stephen Holt, MD, LLD (Hon.)Stephen Holt, MD, LLD (Hon.)
INTEGRATIVE MEDICINE:DEFINITIONS AND
INITIATIVES
8/8/2019 Stephen Holt MD-Integrative Medicine Definitions and Initiatives
http://slidepdf.com/reader/full/stephen-holt-md-integrative-medicine-definitions-and-initiatives 2/23
WHAT IS INTEGRATIVE MEDICINE?
Lost in ³terms´ e.g. integrated, holistic,
eclectic, alternative etc.
Large consumer lobby for alternativemedicine.
Increasing requests by patients for
what they perceive to be simple, gentle
natural options for health.
Conversations in Integrative Medicine
8/8/2019 Stephen Holt MD-Integrative Medicine Definitions and Initiatives
http://slidepdf.com/reader/full/stephen-holt-md-integrative-medicine-definitions-and-initiatives 3/23
PLURALISTIC MEDICINE CONVENTIONAL MEDICINE
Natural approaches integratedPhysician interventions drugs or surgery
Nutrition of primaryimportance
Nutrition of secondaryimportance
Healing orientated Disease orientated
Body and mind Physical focus
Blends of synthetic andnatural treatments
Synthetic, single drugs
Sympathetic to belief Ignores belief systems
Changing traditions Fixed traditions
All disciplines Exclusive ownership
8/8/2019 Stephen Holt MD-Integrative Medicine Definitions and Initiatives
http://slidepdf.com/reader/full/stephen-holt-md-integrative-medicine-definitions-and-initiatives 4/23
ALTERNATIVE MEDICINE?
Licensed healthcare givers are
governed by ³scopes of practice.´
Increasing numbers of clinicians
operate in eclectic medical facilities
and ³wellness centers´ or ³spas´. Many alternative medicine
interventions do not require any
licensure or educational standard for their application or ³practice´.
Need for defined standards of
education and agreed curricula.
8/8/2019 Stephen Holt MD-Integrative Medicine Definitions and Initiatives
http://slidepdf.com/reader/full/stephen-holt-md-integrative-medicine-definitions-and-initiatives 5/23
ALTERNATIVE MEDICINE
Simple definition: non-allopathic andoften not ³usual and customary´.
Attempts to define evidence-based
vs. non-evidence based alternatives. Medicine has been described as
³At The Crossroads´: ³Spaghetti
Junction´ Regulators wrestle with licensure of
several disciplines of alternativemedicine.
8/8/2019 Stephen Holt MD-Integrative Medicine Definitions and Initiatives
http://slidepdf.com/reader/full/stephen-holt-md-integrative-medicine-definitions-and-initiatives 6/23
COMPLEMENTARY MEDICINE
More than semantics
The use of general principles of
care for disease management,involving positive lifestyle
change, specific nutritional
interventions or the use of dietarysupplements etc.
8/8/2019 Stephen Holt MD-Integrative Medicine Definitions and Initiatives
http://slidepdf.com/reader/full/stephen-holt-md-integrative-medicine-definitions-and-initiatives 7/23
PODIATRIC POETRY IN POOR TASTE!
³The podiatrist can play all day
In attempts to heal the foot.
Wasting some of their time as they may
Not tending to the underlying disease.How focused and clever we are
Engaged in this activity with ease.
Did it occur to the profession
To extend their scope of practice
And overcome their minor obsession.´
³ A Bad Poet´, Anon.
8/8/2019 Stephen Holt MD-Integrative Medicine Definitions and Initiatives
http://slidepdf.com/reader/full/stephen-holt-md-integrative-medicine-definitions-and-initiatives 8/23
EMERGING CONCEPTS: 1
Natural medicine cannot integrate
into general medical practice
without a scientific base.
Botanicals or herbs are ³drugs´ andmany drugs are botanicals or herbs,
or synthetic copies.
Dietary supplement manufacturersexhibit widespread ignorance about
pharmaceutical science.
8/8/2019 Stephen Holt MD-Integrative Medicine Definitions and Initiatives
http://slidepdf.com/reader/full/stephen-holt-md-integrative-medicine-definitions-and-initiatives 9/23
EMERGING CONCEPTS: 2
Some natural clinicians baulk at
attempts to explain the bioactivity of
natural therapies within the
framework of scientific knowledge. While sympathy exists for this
position, our understanding of
pharmacodynamic effects of herbs,botanicals or nutrients must be
based on scientific principles.
8/8/2019 Stephen Holt MD-Integrative Medicine Definitions and Initiatives
http://slidepdf.com/reader/full/stephen-holt-md-integrative-medicine-definitions-and-initiatives 10/23
HISTORIC PERSPECTIVES
Pharmacognosy: the study of
natural products used in medicine
Ancient discipline of medicalscience
Pharmakon = drug, Gnosis =
knowledge
8/8/2019 Stephen Holt MD-Integrative Medicine Definitions and Initiatives
http://slidepdf.com/reader/full/stephen-holt-md-integrative-medicine-definitions-and-initiatives 11/23
GENERAL ISSUES
Dietary Supplements are the main stay of alternative and complementary medicine
Growth overall in OTC sales
Contemporary switch to natural remedies
The natural remedy is the ³first lineoption´ as well as the ³last line option´
8/8/2019 Stephen Holt MD-Integrative Medicine Definitions and Initiatives
http://slidepdf.com/reader/full/stephen-holt-md-integrative-medicine-definitions-and-initiatives 12/23
DRUG OR NUTRACEUTICAL
DISPOSITION If dietary supplements are to be used as
therapeutic agents, there must be somerespect for basic pharmacologic concepts.
The concepts are A, D, M and E
One may look critically at some dietarysupplements by simply consideringfactors that influence absorption,
distribution, metabolism and excretion of chemical compounds [drugs or nutraceuticals] e.g. fish oil
8/8/2019 Stephen Holt MD-Integrative Medicine Definitions and Initiatives
http://slidepdf.com/reader/full/stephen-holt-md-integrative-medicine-definitions-and-initiatives 13/23
DIETARY SUPPLEMENT
DISPENSATION
Declining revenue for cognitiveactivity in clinical practice
Dietary supplement dispensaries are
incorporated increasingly intopractice
Supplement dispensation improvescontinuity and quality of care
Supporting literature savesconsultation time
8/8/2019 Stephen Holt MD-Integrative Medicine Definitions and Initiatives
http://slidepdf.com/reader/full/stephen-holt-md-integrative-medicine-definitions-and-initiatives 14/23
CHANGE IN HEALTHCARE
PARADIGMS
Lifestyle medicine combined with
nutritional interventions have
overshadowed allopathic approaches for
many public health problems First line options for disease prevention
are not rooted in drugs or surgery
Many factors have moved consumers of
health care to the new paradigm of
simple, gentle and more ³natural´
interventions
8/8/2019 Stephen Holt MD-Integrative Medicine Definitions and Initiatives
http://slidepdf.com/reader/full/stephen-holt-md-integrative-medicine-definitions-and-initiatives 15/23
KEY PUBLIC HEALTH
INITIATIVES Adult obesity
Childhood obesity
Cardiovascular health Cancer
Arthritis
Osteoporosis Metabolic Syndrome X/ Diabetes
THERE MUST BE A CONDITION SPECIFIC APPROACH
8/8/2019 Stephen Holt MD-Integrative Medicine Definitions and Initiatives
http://slidepdf.com/reader/full/stephen-holt-md-integrative-medicine-definitions-and-initiatives 16/23
THE KEY PUBLIC HEALTH
INITIATIVE The metabolic syndrome
(SYNDROME X)
A complex disorder caused bygenetics, adverse lifestyle,environmental influence and poor
nutritional practices
Defining Syndrome X
8/8/2019 Stephen Holt MD-Integrative Medicine Definitions and Initiatives
http://slidepdf.com/reader/full/stephen-holt-md-integrative-medicine-definitions-and-initiatives 17/23
8/8/2019 Stephen Holt MD-Integrative Medicine Definitions and Initiatives
http://slidepdf.com/reader/full/stephen-holt-md-integrative-medicine-definitions-and-initiatives 18/23
THE PUBLIC HEALTH RISK
Syndrome X increases risk for :
Maturity Onset Diabetes Mellitus
Cardiovascular Disease
Cardiovascular Deaths
Deaths from ALL CAUSES
Am.J.Epidemiol, 148, 958, 1998.
UNDERLIES THE CONCEPT OF SYNDROME X,Y,Z«
8/8/2019 Stephen Holt MD-Integrative Medicine Definitions and Initiatives
http://slidepdf.com/reader/full/stephen-holt-md-integrative-medicine-definitions-and-initiatives 19/23
SYNDROME X : THERAPEUTICS
Positive lifestyle change Soluble fiber e.g. oat beta glucan hydrocolloid
Soy Protein 25 g/day
Omega 3 fatty acids (EPA)
Chromium Alpha lipoic acid
Vanadium
Antioxidants e.g. ellagic acid, bioflavonoids
Starch blockers
Cinnamon Maitake
Green coffee bean extract
Hoodia gordonii/ Caralluma/ Fucoxanthin
8/8/2019 Stephen Holt MD-Integrative Medicine Definitions and Initiatives
http://slidepdf.com/reader/full/stephen-holt-md-integrative-medicine-definitions-and-initiatives 20/23
8/8/2019 Stephen Holt MD-Integrative Medicine Definitions and Initiatives
http://slidepdf.com/reader/full/stephen-holt-md-integrative-medicine-definitions-and-initiatives 21/23
8/8/2019 Stephen Holt MD-Integrative Medicine Definitions and Initiatives
http://slidepdf.com/reader/full/stephen-holt-md-integrative-medicine-definitions-and-initiatives 22/23
WEIGHT MANAGEMENT
A holistic management approach that isaddressed by integrative medicine
Multifactorial causes requiring
multipronged approaches Weight loss must not be the sole target.
The real issue is obesity related disease,disability and death
8/8/2019 Stephen Holt MD-Integrative Medicine Definitions and Initiatives
http://slidepdf.com/reader/full/stephen-holt-md-integrative-medicine-definitions-and-initiatives 23/23
CONCLUSION
The interface between alternativemedicine and allopathic medicine is
increasingly indistinct (INTEGRATIVE)
At least three quarters of all patientsin an out-patient, hospital, clinic are
taking supplements
Healthcare professionals should be
highly educated in dietary supplement
counseling and lifestyle medicine
³Edutherapies´ will improve health