chapter 11: the re-emergence of other healing paradigms Flashcards
biomedical model
illness is the result of a biological or physiological problem
behavioural model
illness is the result of poor choices made by individuals
socio-environmental model
encourages the examination of social and environmental factors that impact individuals
complementary and alternative medicine (CAM)
refers to a group of diverse healing approaches, many with origins in ancient healing systems and indigenous cultures (practices that are not presently considered to be part of conventional medicine)
Holism
- treating the individual within a systems framework
- guiding principle for most CAM
- implies that a person must be considered in their totality (greater than the sum of individual parts)
- to achieve balance and harmony between the individual and the broader environment
- attention to underlying causes
- to facilitate the body’s own healing response
- opposite of reductionism
“treat individual, not the disease”
therapeutic relationships
- healing through connection
- holistic approach assumes that the relationship between the practitioner and client is inherently beneficial and helps in healing
vitalism
- the source of healing
- the belief that the body is alive and well due to a special energy
- the concept that the body cannot be fully explained by scientific or mechanical laws
- vital energy allows for self-regulations and the ability for our mind and body to heal itself
Ayurveda
- originated in India more than 5000 years ago
- holistic approach
- incorporates treatments such as yoga, meditation, massage, diet, and herbs
homeopathy
- the belief that the body can cure itself
- use very small doses of a substance that causes symptoms to stimulate the body’s self-healing response
- like cures like
naturopathy
- non-invasive treatments to help your body heal itself
- embraces many therapies
- combines traditional treatments with some aspects of modern science (naturopathic physician - ND)
osteopathy
- aims to restore the normal function and stability of the joints to help the body heal itself
- physically manipulate the body’s muscle tissue and bones
- holistic approach
- osteopathic physician (DO)
physiotherapy
offers rehabilitation to all the major systems of the body, including neurological, respiratory, and cardio-vascular
chiropractic
deals primarily with spinal manipulation
history of CAM in Canada
- 1960s to 1990s: CAM is described as holistic, folk, traditional, or alternative
- 1990s: “alternative” medicine seen as an adjunct to, rather than replacement of, conventional medical care
- CAM reflects a growing social acceptance of these forms of care
integrative medicine
used to describe the health care system as seamless, pluralistic, and egalitarian, incorporating various forms of care
involves a collaborative team approach to care (imply conforming to biomedical standards)
medical pluralism
using more than one medical system
egalitarian
principle that all people are equal
diabetes
- a disease defined by random blood test > 200, three fasting blood tests > 125, and hemoglobin A1C ≥ 6.5
- first-line medication (metformin) is prescribed if one of the levels list above are reached
- diet and lifestyle changes are recommended
- if blood sugar levels are not controlled, second-line medication starts
- if not successful, other medications like insulin are used
- cinnamon or traditional remedies such as apply cider vinegar have been used to help with insulin resistance
- recommend taking vitamins B, magnesium, and vitamin D
chronic pain
- complex
- treatments are prescribed based on the strength of evidence for the efficacy of the approved treatment
conformity
requires that accepted therapies be scientifically proven, primarily through randomized controlled trials (clinical trials)
little evidence supports true integration of traditional biomedical practice and CAM
evidence-based medicine (EBM)
- applied the scientific method to medical practice, and aims for the ideal that healthcare professionals should make conscientious, explicit, and judicious use of current best evident
- requires that only therapies tested by scientific methods
- only therapies that demonstrate scientific evidence of safety and effectiveness are deemed “evidence based”
randomized controlled trial (clinical trial)
participants receive specific interventions (medical products, procedure, or behaviour changes) according to the research plan by the investigators (control group and experimental group)
the placebo effect
a beneficial effect produced by a placebo drug or treatment due to the individual’s belief in the treatment
regulation of CAM
Health Canada and U.S. Food & Drug Administration (FDA) are federal government departments responsible for the safety of food, health and pharmaceutical products
what are the challenges of conducting clinical trials of CAM
- use of multiple-modality complex intervention rather than a single intervention
- too focused on the symptoms of the disease rather than on the main biological problem
- gathering, randomizing and retaining enough patients with strong opinions favouring or rejecting CAM
- availability of standardized herbal preparations
What is CAM used for
- to prevent illness, maintain health and well-being, and treat chronic illnesses
- CAM use ranges from 30% to 75% of population in industrialized countries (most often used for back/neck pain or problem, head or chest colds, joint pain or stiffness, anxiety or depression)
- other common CAM therapies include: prayer for one’s own health, prayer by others for one’s own health, natural products, deep-breathing exercises, participation in a prayer group, meditation, chiropractic care, yoga, massage, diet-based therapies
- patient out-of-pocket spending for CAM increasing
- typically are women, older adults, those with higher education, and those suffering from chronic illnesses or conditions
push factors
factors motivating a person to move away from conventional medicine
pull factors
factors attracting a person to CAM
push factors toward CAM
- dissatisfied with conventional medicine
- unhappy with physician-patient relationship
- rejection of scientific authority
- consumerist attitude
- push towards personal responsibility
pull factors toward CAM
- treatments compatible with patient world views
- align with personal health beliefs
- being committed to a proactive approach to health
- taking a holistic view of health
- value unconventional, spiritual approaches
- compassionate alternative to techno-science
medical dominance of allopathic pratice
- in early 20th century, legislative acts restricted the practice of non-allopathic (CAM) health care providers, CAM fell victim to the medical dominance that gave allopathic practitioners power and control over health care
- medical dominance was achieved through standardization of medical school and expertise in scientific knowledge
- CAM healing practitioners resisted the dominance while working to gain professional status and recognition
the definition of CAM provided by the US National Centre for Complementary and Alternative Medicine (NCCAM)
a 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 system of a particular society or culture in a given historical period. Self-defined by users as preventing or treating illness or promoting well-being
integrative medicine
aims to work toward a form of health care that combines CAM and biomedicine
alternative health care system
complete systems of theory and practice including homeopathy, naturopathy, traditional Chinese medicine, and Ayurveda
what are the four categories NCCAM categorized CAM therapies based on the type of therapeutic intervention
- mind-body medicine
- biologically based therapies
- manipulation and body-based therapies
- energy therapies
mind-body medicine
patient support groups, meditation, prayer, spiritual healing, therapies that use creative outlets such as art, music, or dance
biologically based therapies
include the use of herbs, foods, vitamins, minerals, dietary supplements
manipulation and body-based methods
chiropractic or osteopathic manipulation, and massage
energy therapies
the use and manipulation of energy fields
what are the four categories of Tataryn’s typology based on the underlying philosophical similarities
- the body paradigm
- mind-body therapies
- body-energy therapies
- body-spirit therapies
the body paradigm
works through biological mechanisms
mind-body therapies
assumes that stress, psychological coping styles, and social supports primarily determine health and disease
body-energy therapies
asserts that health and disease are functions of the flow and balance of life energies
body-spirit therapies
presumes that forces beyond the material universe influence health and disease
subtle energy / bio-field energy
coined by CAM researchers that refer to the “life force energy” mentioned in vitalism
pluralistic
society accepted a wide variety of healing methods as being potentially beneficial (prior to 1900s)
medical dominance
introduced by Freidsen, refers to the power that the medical profession has over the health care system
professionalization
the process through which practitioners adhere to a set of legal requirements to create a uniformly regulated standard of quality, allows professions to assert their legitimacy and competence amid other vocations
holistic movement
encompasses various alternative medical systems and therapies, embraces “parapsychology, folk medicine, herbalism, nutritional therapies, homeopathy, yoga, massage, meditation, and the martial arts)
The New Age movement
part of the 1960s counterculture and has been termed an “American phenomenon”
revolves around the idea of a new planetary culture, claims that this comes about through the attainment of inner peace, wellness, unity, self-actualization, and the attainment of a higher level consciousness
emerged on the West Cost of the Us and Canada
emphasizes spirituality, self care, and personal transformation, it questions institutional authority while focusing on individual responsibility
New Age healing
giving the false, unfounded impression of using a scientific method or rationale
quackery
prevalence of CAM in industrialized countries
varies between 30 to 50 percent, and the public responses positively to CAM
rejects concepts of rationality, objectivity, and universal truth. Instead, it emphasizes the diversity of human experience and multiplicity of perspectives
it is also described as an era in which consumption is pervasive and collective meaning is replaced by individualism
postmodernism
calls for attempts to control one’s life as well as to cope with it
suffering
why do people find CAM enpowering
they receive recognition for their life concerns and validation for their experiences and values
