Integrative Medicine Flashcards
What is complementary/ alternative medicine?
medical and health care systems, practices, and products that aren’t part of conventional/allopathic medicine OR have historic origins outside of mainstream medicine
Often abbreviated as “CAM”
Complementary - used together with conventional therapies
Alternative - used in place of conventional therapies
What is integrative medicine?
Evidence-based and patient-centered
Chooses safest therapies first
Emphasizes relationship with patient
Patient goals help guide treatment
What does integrative medicine focus on?
Strong emphasis on foundational health
Goal to prevent disease, not just treat it
Utilizes a holistic approach
Incorporates CAM when clinically indicated, in a way that is safe and synergistic with conventional therapies
Why choose CAM or integrative?
Limits of Modern Medicine:
Recognition that allopathic (conventional) medicine cannot solve many symptoms of acute and chronic illness
Relationship with Patient: CAM providers may show…
More optimism
Greater personal attention
Patient Goals:
CAM approaches reflect a “self-help” approach to wellness
CAM satisfies a search for “natural”/less invasive alternatives
Who is most likely to use CAM?
Middle age
almost a 50/50 chance they are using alternative therapy
What is the MC complementary health adults use?
Natural products (herbals)
What are the 10 MC complementary health proportions?
Natural products
Chiropractics
What are the main reasons that patients use CAM?
Prevent illness
Help reduce pain
Treat specific health conditions
Supplement conventional medicine
MC medical conditions to use CAM
MSK
What is the typical CAM patient?
Female
Middle-age
Higher educational level
Multiple medical conditions
What is the education level for CAM use?
Herbals are MC
Highschool or less = less CAM
What is the mind-body medicine?
- the health of one part influences the other
Behavioral, psychological, social and spiritual approaches to medicine not commonly used.
What are common forms of mind-body spirit medicine?
Biofeedback
Hypnosis
Meditation
Relaxation techniques
Yoga, Tai Chi, Qi Gong
Is mind-body medicine evidence-based?
Yes
Cardiovascular disease
Cancer
HIV infection
Nervous system
Endocrine system
Immune system
Brain function and even structure
What is osteopathic medicine? Are they required to have licensing?
For DOs
Manipulation of soft tissue and bone
Treatment of wide range of diseases
Primarily musculoskeletal
Training nearly identical to MDs
Required to have licensure, credentialing, ongoing certification similar to MDs
Generally low risk
Controversial efficacy
What does chiropractic medicine focus on?
MSK
sometimes they step over boundaries
If they stick to their scope though, it can be useful
What is the training of a chiropractic medicine?
5 yrs of training; board exams
Often postgrad training as well
Most states require CME
Is chiropractics safe?
For the most part
Neck manipulations and infant chiropractics are the highest risk
What is naturopathy?
Belief the body has powerful means of self-healing
4 yrs ed in basic & clinical sciences
Conventional & unconventional diagnostic tests and medications
Emphasis on relatively low doses of drugs, herbal medications, special diets, exercises
Is naturopathy safe?
Natural does not always equal safe!
May conflict with western medicine or lead patients to eschew western medicine
Why is it difficult to know whether or not naturopathy is useful?
Efficacy varies because there are so many forms
What are naturopathic physician degrees?
ND, NMD
4 yr graduate level program at an accredited school
Need bachelor’s degree and standard premed courses
What does naturopathy focus on?
Do not use prescription drugs, x-rays, surgery
Emphasize lifestyle changes and noninvasive tx
Not subject to licensing
Programs often distance learning, not accredited by a unifying body
Other Providers (MD, DO, Chiropractor, Dentist, Nurse)
Have pursued additional naturopathic/holistic training after their degree
What does ancupunture work on?
Belief that a vital energy, chi, circulates in the body through 12 pathways (meridians)
MOA not well understood
Physiologic effects are noted
Thin, solid stainless steel sterile and disposable needles at selected points
Requires training, national exam, licensure
4 yrs of school for non-physicians
Low overall risk (as long as it uses sterile needles)
Controversial efficacy
What is massage therapy? Are they effective? When should you not do massage therapy?
Thousands of years old - used widely today
18 mil. US adults in the past 12 months
Various techniques
Swedish massage (wide strokes)
Sports massage (by athletic trainers)
Lymphatic massage like Swedish, adapted for athletes
Deep Tissue/Trigger Point massage
Variety of health-related purposes - MSK, pain
Generally considered to have at least some efficacy
Few risks if done by properly trained provider
Avoid - blood clots, open/healing wounds, infections, weakened bones, low platelets, directly over tumors
Requires generally 500 hrs of training, exam and licensing
46 states and DC have laws for licensing
What is oriental medicine? What are the risks?
Incorporates a lot of different practices: acupunture
Based on belief in opposing energies (“yin and yang”), life force energy (“qi”) and energy pathways in the body (“meridians”)
Imbalanced energies or blocked flow of qi → illness
Commonly used modalities
Acupuncture/acupressure
Moxibustion
Chinese herbal medicine
Nutrition and Exercise
Chinese massage
Training varies - many have completed masters/doctoral-level training
43 states require certification with the NCCAOM
Risks vary with modalities used
Chinese herbal medications have especially high risk (often not pure form medicine)
What is homeopathy? What are the risks?
Very little evidence
“The Doctrine of Similars”
Compounds diluted to 10^60 or more
Accepted less in the US than other countries
Little-no evidence to support
Do not have to prove efficacy to FDA
Generally low risk - specific concerns
contamination
improper dilution
Only 3 states with licensure laws
What is herbal medicine/dietary supplements? Useful? Risks?
Cannot claim to prevent or treat any disease
Can claim that they maintain “normal structure and function” of body systems.
Potency varies widely
Efficacy controversial - some benefits noted
Risk - interactions, contamination, questionable potency
NIH - “Herbs at a Glance”
What are some common herbal therapies?
Echinacea
Ginseng
Ginkgo Biloba
Garlic
Sae Palmetto
St John Wort
Black Cohosh
Kava Kava
Saw Palmetto
Use - benign prostatic hypertrophy (BPH)
Risks - dizziness, HA, hormonal effects
Echinacea
Use - improve immunity, prevent/fight colds and flu
Risks - worsening of autoimmune disease
Ginseng
Use - general improvement in phys/mental state, ↓ stress, ↑energy
Risks - agitation, HTN
Garlic
Use - heart disease, HLD, prevent/fight colds
Risks - bleeding, GI, garlic odor
Ginkgo Biloba
Use - improve memory and circulation
Risks - bleeding, seizures
Saw Palmetto
Use - benign prostatic hypertrophy (BPH)
Risks - dizziness, HA, hormonal effects
St. John’s Wort
Use - depression, topical antimicrobial
Risks - numerous DDIs, dizziness, serotonin syndrome
Black Cohosh
Use - menopausal symptoms, PMS
Risks - stimulating hormone sensitive tissue (CA, endometriosis, fibroids)
Kava Kava
se - anxiety, insomnia
Risks - hepatotoxicity
What are commonly used non-herbal supplements?
Glucosamine and Chondroitin
Fish Oil
Melatonin
Coenzyme Q10
Glucosamine and Chondroitin
Use - joint pain/OA
Risks - D/C, drowsiness, warfarin DDI, shellfish allergy
Fish Oil
Use - CHD, HF, HTN, hypertriglyceridemia
Risks - GI, oily stool, burping, bleeding
Melatonin
Use - insomnia, jet lag
Risks - fatigue, depression, drowsiness, irritability
Coenzyme Q10
Use - HF, HTN, statin-induced myopathy, migraine
Risks - mild heartburn, GI
What is THC vs CBD
THC is what makes you high
CBD is not psychoactive (2nd MC ingredient)
What is CBD therapy
Usually administered topically or orally
Reported to treat a wide variety of disease, including promotion of overall wellness
Good evidence for epilepsy
Mild evidence for insomnia, anxiety, chronic pain
No evidence for more grandiose claims (e.g., cancer, overall wellness)
Not regulated by FDA - not legal in every state!
Varying strengths, THC content
Generally low-moderate risk
Nausea, fatigue, irritability, anxiety
Numerous DDIs
What are essential oils?
Steam-distilled or cold-pressed, concentrated extract of herbs (often aromatic herbs)
Aromatherapy, topical, oral
Oral use often not recommended
Reported to treat a wide variety of disease, including promotion of overall wellness
Very little research has been conducted
Mild evidence for insomnia, psych, pain
May be helpful as adjunct for infections
Not regulated by FDA - varying content
Often anecdotal evidence from salespeople
Risk varies depending on type
Often used inappropriately in place of EBM
Hormonal effects - lavender, tea tree oil
Can worsen dyspnea, especially in children and pets
What is urine therapy?
Often touted as a panacea as well as a “wellness booster”
Multiple methods of use - topical, ocular/otic, ingestion, injection, enema
Contamination of urine; consumption of waste; avoidance of medical therapy
What is miracle mineral solution?
LIQUID BLEACH!
Also reported as a panacea - especially targeted at autistic pts, cancer pts
Strong warnings from FDA - is essentially a bleach solution
Most commonly given orally or as an enema
Life-threatening side effects possible!
What is Laetrile (“Vitamin B17”, “Amygdalin”)
cyanide
Often touted as a cancer remedy
Typically orally administered - apricot pits/kernels
Highly toxic - basically cyanide
What is turpentine?
very toxic
Often seen as “natural”
Based on an essential oil distilled from pine tree sap
Often recommended for “Candidal infections,” but multiple benefits claimed
Multiple methods of use - topical, inhaled, enema, or ingestion
Can cause serious toxicity - as little as 1 tsp fatal in children, 3 tsp in adults
What is black salve?
Blood root, corrosive agent
Compound containing sanguaranine (bloodroot) and/or zinc chloride
Highly corrosive - often touted as a topical tx to “draw out” cancer and spare normal tissue
Actually destroys both normal and diseased tissue
Direct damage to tissue - infection, extensive scarring, disfigurement
Delay to appropriate diagnosis and treatment
CAM to use or not to use
questions you should ask
Is there research to support the use of this particular therapy?
Does the therapy require that you stop conventional medical treatments?
Are there substantial SE that can interfere with your ongoing medical tx?
Does the tx or practitioner make unfounded claims (i.e. curing cancer)?
Does the treatment require travel to another country?
Is tx available to the general public or is it a secret, exclusive therapy?
Is the CAM practitioner licensed by the state to provide that specific therapy?
Is tx offered by established medical institution or only by one individual?
How expensive is the tx and does it require substantial out-of-pocket expense?
Do patients tell you if they use CAM?
1/3 mention it
the other 2/3 need to be asked - which is why you need to ask them
Why do patients not tell you about CAM?
1 PCP never asked
didn’t know they should
did not feel comfortable
etc
