6: CAM, Integrative Medicine & Early Pioneers Flashcards
CAM
Complementary & alternative medicine
= group of diverse medical and healthcare systems, practices, and products that are not generally considered to be part of conventional medicine
(acupuncture, acupressure, massages, reflexology)
Qi (chi)
bodily energy that flows through unseen channels in the body called meridians - TCM
IN TCM, illness is believed to occur when ____ is blocked
qi
NCCIH & NHIS survey on complementary health approaches (2002, 2007, 2012) - what were most commonly used approaches
- non-vitamins
- deep-breathing
- yoga, tai chi, qigong
- chiropractic/osteopathic
The American Association for Retired Persons (AARP) conducted a study to assess the use of CAM among people 50 y/o+
○ Dietary supplements/herbals were used most
○ massage and chiropractic manipulations next
college study @Columbia
Nonvitamin, nonmineral products, massage, meditation, yoga, deep breathing = most used
clinical nurse specialists at a large Midwestern academic medical center
humor, massage, spirituality/prayer, healing touch, acupuncture, music therapy
highschool & college CAM use in past 12 months
- herbal products/dietary supplements
- massage, chiro
- mind-body practices
- naturopathy, acupuncture, homeopathy
2012 CDC/NHIS survey:
approximately ___ million Americans spent $____billion out of pocket on CAM
○ mean out of pocket expense = $___/person
59 million
30.2 billion
$510/person
we can assume that in the future there will be an decrease in CAM costs
F: increaese
People Seek Alternative Forms of Medical Care due to dissatisfaction with conventional treatment as ______, _________, and ___________
expensive, impersonal, and ineffective
Why Do People Seek Alternative Forms of Medical Care
- Alternative forms of treatment may be compatible with users’ own values and spiritual beliefs regarding the nature of their illness
- may desire a greater sense of control over their treatment, seeking a doctor who allows them choices about their own health
Many individuals who use CAM tend to be innovative and at the cutting edge of cultural change
tend to be interested in the ______/_____ and possess a great sense of ________
environment/world
spirituality
4 major elements of CAM’s persuasive appeal (Kaptchuk and Eisenberg)
- Nature
- pure vs synthetic
- CAM is ‘more natural’
- ex. organic vs processed = desirable - Vitalism
- body’s capacity to heal itself
- key theme: energy within capable of healing (qi)
- patient appeal in non-invasiveness - Science
- some similarities to biomedical process but depends on observation
- person-friendly, holism (Mi, Bo, Sp) - Spirituality
- not exclusively religion (can be)
- bridges gap between medical science and spirituality
what is the theory on underlying motives for using people using CAM
patients being neurotic, therefore drawn to multiple therapies
= Those with chronic diseases have higher stress and neurosis levels
Barriers to CAM Use
- Expense
- insurance coverage is increasing for CAM therapies, but many aren’t covered - Lack of knowledge
- no knowledge on alternative methods - skeptical on their efficacy
- fear of their safety
- ex. use herbal supplements yet research doesn’t show results
Integrative medicine / integrative health care
combines treatments from conventional medicine and CAM for which there is evidence of safety and effectiveness
Bringing conventional and complementary approaches together in a coordinated way
takes account of the whole person (body, mind, and spirit)
Integrative medicine movement was driven by
consumers who sought alternative healing methods
Eventually integrative medicine gained attention of academic health centers
2004 - movement produced the formation of ……
the Academic Consortium for Integrative Medicine & Health
Movement also produced national summit convened by Bravewell Collaboration and Institute of Medicine (2009) to
explore integrative medicine’s potential to improve US healthcare system
where are most integrative medicine/health clinics are located
hospital setting
T or F: Integrative healthcare may be implemented in doctor’s offices and clinics
T: Some Drs set up integrative medicine network within community = refer their own patients to alternative practitioners
Chiropractor, acupuncturist, MT etc.
similar characteristics of integrative medicine and health structural models
- Embrace best of both scientific-based medicine and evidence-validated alternative medicine
- Aim for a patient-centered and interdisciplinary mix of traditional and alternative medical treatments
Herbert Benson
- research using monkeys that linked stress to physical health
- Researched effects of Transcendental Meditation on blood pressure
- Studied other meditative techniques found to produce a relaxed state
= labeled it the relaxation response = foundation of mind-body medicine
Transcendental Meditation
Herbert Benson
= technique wherein people repeat a phrase to help themselves relax during medication
- Found TM had decreased metabolism, rates of breathing, heart rate, brain waves
- Useful for treating insomnia, anxiety, hypertension, chronic pain
David Eisenberg
- First US medical exchange student to the People’s Republic of China
- Learned Eastern healing modalities (acupuncture, Tai Chi)
Bernard Siegel
- Taught techniques to help cancer patients use their own body energy to help in the healing process
○ Meditation, positive imagery, humour - Founded ECaP (Exceptional Cancer Patients) to further belief in patients’ self-healing power
○ Individual and group therapy support using drawings, dreams, positive imagery, etc.
Andrew Weil
Established Foundation for Integrative Medicine
○ website features “Ask Dr. Weil,” a popular venue accessed by individuals wanting information about CAM therapies, including botanicals
Deepak Chopra
- Indian-trained biomedical physician
- Cofounder of the Chopra Center for Wellbeing:
○ training programs in physical, emotional, and spiritual healing ○ workshops utilizing Ayurveda medicine and practical tools of mind–body healing (energy healing, guided meditation, visualization, writing exercises)
Historical Milestones of Integrative Medicine and Health
Development of Wellness Programs
Development of Health Promotion Programs
Development of Wellness Programs
journey to integrative medicine began with the development of wellness programs= people became more proactive about preventing diseases and taking responsibility for their own health
- 1950s - Halbert Dunn was one of the first to develop employee wellness programs
- 1960s/70s - “wellness” became a buzzword as people became aware of the benefits of exercise and nutrition (preventing high cholesterol levels, heart attacks, stroke)
- 1980s - union health insurance wellness programs
- 1990s- more companies began developing as an incentive to employees to lose excess pounds and quit smoking
Development of Health Promotion Programs
+ 2 important developments @ government level
- 1990 study showed that lifestyle changes can eventually reverse heart disease
○ Gave legitimacy to wellness programs = they proliferated in the 1990s and 2000 - began to be called “health promotion programs,” more strategies than educational programs were being incorporated into the programming ( use of media, health fairs, laws)
- 2 important developments @ government level
a. establishment of the NCCIH
b. formation of the White House Commission on Complementary and Alternative Medicine Policy
Establishment of the National Center for Complementary and Integrative Health (NCCIH)
= one of the most important milestones that give scientific credence to CAM practices
1992 - Office of Alternative Medicine (OAM) created
○ U.S. Congress passed legislation to provide $2 million to establish the OAM to assess the worth of promising unconventional medical practices
1999 - OAM = National Center for Complementary and Alternative Medicine (NCCAM)
2014 - NCCAM = present day NCCIH
main mission of NCCIH
remained the same: to fund and conduct research about complementary health approaches
The White House Commission on Complementary and Alternative Medicine Policy
2000 - President Clinton appointed 20 people (physicians, registered nurses, PhDs, CAM practitioners) to the White House Commission on Complementary and Alternative Medicine Policy
commission = make legislative/ administrative recommendations to aid public policy in ensuring the safety of products and practices that had been/might be labelled “CAM” and to identify potential benefits for the public
What recommendations about the role of the federal government emerged from The White House Commission on Complementary and Alternative Medicine Policy
- should disclose research findings
- ensure the safety of products
- help assess the appropriate levels of training of various CAM practitioners and the research regarding their practice
- aid in evaluating the different ways that states are regulating CAM practitioners
- facilitate dialogue among CAM and conventional providers, scientists, and the public
the White House Commission on Complementary and Alternative Medicine Policy is advocating that…
the education and training of conventional health professionals should include CAM and that the training of CAM practitioners should include conventional health care
Several health professionals have outlined CAM educational curricula needs:
- focus on critical thinking and critical reading of the literature
- identify thematic content and express topics in clear language
- formulate concise learning objectives
- include an experiential component
- promote a willingness to communicate professionally with CAM clinicians
- teach students to talk with patients about alternative therapies
How Do Practicing Physicians View CAM
more accepting = many refer their patients to alternative practitioners (chiro, MT, acupuncturists)
The American Medical Association has issued a proclamation to all members encouraging them to …..
become involved in scientific evaluation of alternative medicine
Conventional medicine historically opposed CAM therapies
- Belief that patient’s role was to be compliant and physician knew all
- Disease was only considered the result of a pathogen entering the body
The Affordable Care Act
- mandates that certain licensed health care practitioners (massage therapist, acupuncturists) should not be discriminated against
- does NOT require that the insurance company is mandated to cover the payment
T or F: almost all insurance plans cover a wide variety of alternative treatments
F: Some health plans cover chiropractic, acupuncture, traditional Chinese medicine etc. whereas others offer only chiropractic care
T or F: Insurance companies do not recognize that more people are seeking out alternative practitioners
F: do - are responding to that by offering health insurance
Medicare agreed to cover Dr. Dean Ornish’s lifestyle program
demonstrated that comprehensive lifestyle changes (exercise, nutrition) may begin to reverse coronary heart disease/prostate cancer without surgery/medication
comprehensive lifestyle changes affect gene expression—“turning on” disease-preventing genes and “turning off” genes that promote cancer and heart disease
T or F: Studies have found integrative medicine to be cost effective
T
How to be responsible consumers of our health care when making decisions while selecting alternative health care therapies
- Advance safe integrative medicine practices by researching a particular integrative medicine clinic
- # and type of traditional and alternative practitioners should be identified
- Learn the academic background of each individual
- anyone who uses herbal supplements/engaging in alternative therapy should inform their family physician
