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Alternative Medicine

Alternative Medicine. November 29 th 2002 Gil C. Grimes, MD. General Data. The Diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, satisfying a demand not met by orthodoxy, or diversifying the conceptual frameworks of medicine

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Alternative Medicine

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  1. Alternative Medicine November 29th 2002 Gil C. Grimes, MD

  2. General Data The Diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, satisfying a demand not met by orthodoxy, or diversifying the conceptual frameworks of medicine Ernst E et al. Complementary medicine- a definition. BJ Gen Prac 1995, 45:506

  3. General Data • Landmark Report 1998 random sample adults USA • 42% used CAM in last year • 17% herbal therapy • 16% chiropractic • 14% massage

  4. General Data • Austin 1998 • Random sample 1500 adults (80% white, 51% female 30% high school ed or less) • Have you used CAM in last year • 40% Yes • 16% chiropractic • 8% lifestyle diet • 7% exercise • 7% relaxation

  5. General Data • Who is using? • People with chronic health problems • More common caucasian • More common women • More educated

  6. General Data • $13.7 billion unconventional therapy • $10.3 billion (75%) out of pocket • $12.8 billion out of pocket for all hospitalizations in the United States • 1990 data Eisenberg DM et al, N Engl J Med 1993 Jan 28;328(4):246-52

  7. General Data • Increase 45.2% between 1990 and 1997 • estimated at $21.2 billion 1997 • $12.2 billion paid out of pocket Eisenberg DM et al, JAMA 1998; 280:1569-1575

  8. Getting the Truth • Inforetriever • Cochrane review • National Center for Complementary and Alternative Medicine • Alternative Medicine Homepage University of Pittsburgh • British Homeopathic Library • Natural Medicine Database

  9. Type of CAM • Herbal Medicine • Acupuncture • Nutrition • Exercise • Homeopathy • Manipulation • Massage • Meditation

  10. Herbal Medicine • Various Forms • Crude plant preparations • Dried specimen • Aqueous extract • Tinctures • Active ingredients

  11. Herbal Medicine • Choosing the product • Degree of purity • Variation in potency • Look for the following • Lot number • Expiration date • Analysis of ingredients

  12. Acupuncture • 2000 year tradition • Osler was aware of acupuncture • Alters conduction of electromagnetic signals • Alters neurotransmitters in brain • TCM relates this to a release of the Qi that is blocked

  13. Acupuncture Efficacy • Adult postoperative N/V (1b) JAMA 1998;280:1518-24 • Chemotherapy N/V (1b) JAMA 2000;284:2755-61 • Chronic neck pain (1b)BMJ 2001;322:1574 • Headache (cochrane) • Menstrual cramps (cochrane) • Tennis elbow, myofascial pain, carpal tunnel syndrome National Center for Complimentary and Alternative Medicine

  14. Acupuncture • Trouble with blinding • Sham Needles • Blinding Evaluators

  15. Exercise • Benefits • Improved respiratory • Lower BP • More efficient CO • Increases insulin sensitivity • Improves utilization of FFA from adipose

  16. Exercise • Physician advice • Meta-analysis DARE abstract 971480 demonstrate efficacy of counseling • Exercise Rx • Type of activity (aerobic etc) • Intensity (60-90% Max Heart rate) • (220-Age) x 0.60 or 0.90 gives low and high end of target heart rate • Work longer low end and short bursts in high end

  17. Exercise • Exercise Rx • Duration • Inversely proportional to the intensity • Rate fatigue one hour after exercise to judge • Frequency • 3-5 sessions per week • No greater than 48 hours off

  18. Exercise • Three phases of exercise • Warm up • Conditioning • Cool down • Stretch some before and always after

  19. Homeopathy • Treats illness with progressively dilute substances that produce similar pattern of injury • Treating like with like • Therapy is individualized to the patient • Meta-analysis of homeopathy trials Lancet 1997;350:834-43

  20. Cystitis • Cranberry • Randomised trial of cranberry-ligonberry juice and Lactobacillus GG drink for the prevention of UTI in women. BMJ2001;322:1-5 (LOE 1c) • Glass of unsweetened cranberry juice a day • NNT=5 at 12 months to reduce frequnecy of UTI from 36% to 16%

  21. Migraine • Riboflavin • 400 mg Riboflavin daily (LOA 1b) • NNT= 2.8 to reduce frequency of attacks per month (56% to 19%) • NNT= 2.3 reduce headache days (59% to 15%) • Effectiveness of high-dose riboflavin in migraine prophyloaxis: a randomized controlled trial. Neurology 1988; 50:466-70

  22. Morning Sickness • Ginger root (LOE 1b) • 250 mg powdered ginger root before meals and bedtime (1 gm per day) • Small double blinded placebo controlled randomized trial • Decreased vomiting Obstet Gynecol 2001; 97:577-82

  23. Morning Sickness • Vitamin B6 • 25- 50 mg 2-3 times daily • Acupressure • Wrist band on P6 point • Reduced severity of nausea Cochrane Library, Issue 2, 2002

  24. Osteoporosis • Calcium and Vitamin D • 500mg Ca++ and 700 IU Vit D (LOE 1b) • Better bone density • Fewer fractures over 3 years (5.9% vs 12.9%) Effect of calcium and vitamin D supplementation on bone mineral density in men and women 65 years of age or older. NEJM 1997; 337: 670-6

  25. Menopause • Soy supplementation • 60 gm soy protein daily (LOE 1b) • Decreased frequency and severity of hot flushes The effect of dietary soy supplementation on hot flushes Ob Gyn 1998;91:6-11

  26. Warts • Podophyllum • The rhizomes are used as a cathartic • Resin extracted used as an irritant

  27. Closing • Ask your patients • Ask more than once • Ask about vitamins or supplements

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