Complementary and Alternative Medicine (CAM) Flashcards
What does the GMC state about CAM?
Outcomes for Graduates;
“respect patient choices about the use of complementary
therapies, and have a working knowledge of the existence
and range of these therapies, why patients use them, and
how this might affect the safety of other types of
treatment that patients receive”
What are the different CAM definitions ?
- Complementary Alternative Medicine - are treatments that fall outside of mainstream healthcare
- Complementary Medicine - CAM together with conventional medicine
- Integrative Medicine - Blends use of conventional and complementary approaches
- Alternative Medicine - Use of CAM in place of conventional medicine
- Naturopathy vs Allopathy - “Natural healing” vs “Treatment of disease vs conventional means”
What are the different classifications of CAM ?
- Alternative Medical systems - e.g Traditional Chinese Medicine (TCM), Ayurvedic Medicine, Homeopathy, Naturopathy, Indigenous healing systems
- Mind-body interventions - e.g Meditation, Yoga, Deep-Breathing exercise, Qi gong, Tai chi, Guided imagery, Biofeedback, Dream therapy
- Biologically based therapies - e.g Herbal Medicine, Bach flower remedies, Bee venom therapy, Chelation therapy, Vegetable juice therapy
- Manipulative and body-based methods - e.g Osteopathy, Chiropractic, Craniosacral therapy, Alexander technique, Acupuncture, Rolfing, Kinesiology
- Energy Therapies - e.g Therapeutic touch, Healing touch, Reiki, Magnet therapy, Light therapy, Crystal therapy, Qi gong
What are some ways that people will choose and use CAM?
See Image
How many people in the UK use CAM and what are the most common modalities ?
CAM use in the UK;
Difficult to accurately capture due to issues in study design.
Posadzki et al analysed 89 studies, total of 97,222
participants:
- Average one-year prevalence was 41.1%
- Average lifetime prevalence was 51.8%
- More methodological sound studies suggest rates of 26.3% and 44% respectively.
Most popular CAM modalities were found to be:
1. Herbal Medicine
2. Homeopathy
3. Aromatherapy
4. Massage
5. Reflexology
What CAM practitioners in the UK do people interact most with ?
Interaction with CAM practitioners in the UK:
- Massage practitioner - 19%
- Osteopath - 12%
- Acupuncturist - 11%
- Chiropractor - 11%
- Yoga teacher - 7%
- Physiotherapist-delivered CAM - 5%
- Pilates teacher - 4%
- Reflexologist - 3%
- Meditation and/or mindfulness teacher - 3%
- Homeopath - 3%
- Reiki practitioner - 2%
- Hypnotherapist - 2%
- Herbalist - 2%
- Chinese herbal medical practitioner - 2%
- Other - 10%
Some interact with people and some don’t. When involve practitioner is it the person they believe in or the actual treatment ?
What is the History behind Homeopathy ?
History of Homeopathy;
1796: Samual Hahnemann
- “similia similibus curentur”
- “Like cures like”
Causes of disease were “miasms” and homeopathic treatments could remedy these.
Consider the historical context (e.g. bloodletting, purging, theriaca andromachi)
- Is doing nothing better than doing something? Problematic cause patients wanting something but if you don’t nothing better outcome, placebo ?
How do you make a Homeopathic Preparation ?
How do you make a Homeopathic Preparation;
Principle of Similars
Preparations must undergo potentisation;
- Serial dilutions of a Mother Tincture (most concentrated form)
- Succussion (Beat against horse saddle to put “power” into it, ritual)
How to make Mother Tincture;
- More dilute something is the more potent it becomes in homeopathic terms
- Start with thing that makes someone ill (nettles, herbs), extract nature of it out, make very concentrated form (mother tincture)
- Do “X” solution which is 1 in 10, or “C” solution which is 1 in 100 C dilution weak by homeopathic standards (more dilute stronger)
So do a 2c dilution which it the 1C 1 in 100, diluted 1 drop into 100 again so 2C = 0.01/100 - Keep going doing 30 times to get 30C medication, most potent in homeopathic terms but pharmacologically there is not any originally molecules in to after however many dilutions - basically water or sugar pills
What are the Risks, Registration and Regulation of Homeopathy ?
Direct harm;
- No risk of interactions with ‘high potency’ medicines
Indirect harm;
- Delay in receiving appropriate treatment because trying this first
- Practitioner attitudes (e.g Homeopathy correlates with Antivax)
No legal regulation of homeopaths in the UK;
- Society of Homeopaths
- Faculty of Homeopathy
- British Homeopathic Association
Homeopathic products regulated by EU directive
Whats the difference between Herbal and Homeopathic ?
Its difficult to distinguish in supermarkets and papers and people always mix it up!
Herbal potentially has active ingredients that can do benefit to a patient
E.g - These are all arnica which reduce bruising from contact sport, 1st is herbal and has active amounts of arnica and the other 2 are homeopathic and are just sugar and water
Are herbal medications good or bad?
A Cochrane review for major depression showed St Johns Wort (Hypericum) to have some potential benefits.
Its proven to be just as good at treating depression with less side effects, so why wouldn’t we use it?
We don’t prescribe it because it has so many drug interactions;
— Hormonal contraceptives
— Anti-depressives
— Anti-coagulants
— Anti-epilepsy agents
— Heart medications
— Anti-cancer agents
— Anti-virals for HIV
.. the list continues
Another worry is that patients might just view as a supplement and not medication, and not know the interactions
What are the Risks, Registration and Regulation of Herbal Medicine?
Direct Harm;
- Adverse drug reactions
- Drug interactions
- Quality control
Indirect harm;
- Delay in receiving appropriate treatment
MHRA regulates herbal medicines in the UK market;
Safety, quality, efficacy as per any regular medication
- Marketing Authorisation (MA) “Major health conditions”
Safety & quality (not efficacy) based on traditional usage
- Traditional Herbal Medicines Registation (THR), “minor health conditions”, e”e.g a cold)
- Efficacy doesn’t need proven just safety and quality
Herbalist exemption;
- Regulation 3 of the Human Medicines Regulations 2012
- If went to a herbologist they can give you a medication without it needing to demonstrate safety, quality or efficacy
Who invented Chiropractic and what are the beliefs behind it?
D.D. Palmer 1895 - Originated in US
Straight (D.D Palmer believers) vs Mixer (More in line with Osteopathy);
- Original chiropractic believed that 95% of all diseases are caused by displaced vertebrae (D.D Palmer)
Detect ‘Subluxations’
- Block the flow of ‘innate intelligence’ through vertebrae
- Used of X-rays or gadgets
- BJ Palmer and Neuroclometers (Used in psychological assessment in scientologist group, Galvanic skin response: gives different readings depending on how sweaty)
Spinal manipulations (adjustments)
- Including high-velocity, low-amplitude thrusts
- Audible ‘crack’ (High component of massages as well)
DD Palmer - Apparently cured a guys deafness and that was enough
Massive antivax issues - still issues with this and Chiropractors in the US, UK not as much because regulated by a council with
Osteology more about massages; Invented by A.T Still in 1874;
AT Still thought treating the cause of peoples discomfort and not the symptoms particularly in the musculoskeletal system- still god father of preventative medicine. Used massages and manipulation and movement around MSK system would be useful around a range of health complains
What are the Risks, Registration and Regulation around Chiropractic and Osteopathy?
Chiropractic and osteopathy: Risks, registration and regulation;
Direct harm
- 50% of chiropractic patients suffer an adverse reaction (not as high, some is from people standing up from dark into light etc)
- Tearing of artery wall leading to stroke
- Injury to the spinal cord
- Chiropractic X rays
Indirect harm
- Delay in receiving appropriate treatment
- Attitudes of practitioner
- Anti-vaccination (UK agrees on vaccinations, and trained similar to medicine - osteopathy better name than chiropractor)
Only two CAM modalities under statutory regulation
— General Chiropractic Council (GCC)
— General Osteopathic Council (GOSC)
What are the features of Acupuncture?
Acupuncture;
Ch’i (Qi, “ch-ee”) as a ‘vital energy’
- Flows through ‘meridians’
- Meridians associated with major organs
- Illness due to disrupted flow of Ch’i
Insertion of needles along meridians
- Restores flow of Ch’i
- 1 — 10cm in depth, with/without rotation
- Left in place for seconds to hours
- Vitality restored to body
Diagnosis
- Inspection, auscultation, olfaction, palpitation and inquiring
- Often think been used since 600 BC - not true been banned in China 3 times
- Does have places of useful treatment
- Acupuncture itself can be beneficial, but the spiritual side etc can be trapping and an issue
- A lot of benefit can be from chat associated with it alone
- Didn’t come to US and UK until 1970’s, was good in 2006
What is Reflexology ?
Big in UK, similar to acupuncture, parts of foot can manipulate to alleviate systems
