1 / 38

Bridging the Worlds of Allopathic and Alternative Therapies: Why Should We Try?

Bridging the Worlds of Allopathic and Alternative Therapies: Why Should We Try?. Jane L. Murray, MD Sastun Center of Integrative Health Care. Terminology. “Alternative” “Complementary” “Complementary and Alternative” (CAM) “Traditional” (vs “conventional”) “Holistic” “Integrative”.

kristyj
Télécharger la présentation

Bridging the Worlds of Allopathic and Alternative Therapies: Why Should We Try?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Bridging the Worlds of Allopathic and Alternative Therapies: Why Should We Try? Jane L. Murray, MD Sastun Center of Integrative Health Care

  2. Terminology • “Alternative” • “Complementary” • “Complementary and Alternative” (CAM) • “Traditional” (vs “conventional”) • “Holistic” • “Integrative”

  3. Becoming Mainstream • Eisenberg study: 42% of Americans use CAM techniques and practitioners • OAM (Office of Alternative Medicine) at NIH established in 1992, became NCCAM in 1999 • 9 Alternative Medicine Centers funded by NIH • WHO sponsors international research in traditional medicine

  4. Health Information - Renner • Folklore • Quackery • Untested • Investigational • Proven

  5. NIH NCCAM Categories • Mind/Body • Bioelectric • Other cultures’ medicine • Manual healing • Pharmacology and biologics • Herbal • Diet and Nutrition

  6. Mind-Body Medicine • Relaxation Response • Meditation • Biofeedback • Psychoneuroimmunology

  7. Energy Therapies • Body work - massage, reiki, etc • Movement - T’ai Chi, Yoga • TCM - acupuncture & herbs • Homeopathy • Therapeutic Touch • Magnets

  8. Cultural Medicine • Traditional Chinese Medicine • Herbs • Curandismo • Spiritual practices • Ayurvedic medicine

  9. Structural & Manipulative • Osteopathic medicine • Chiropractic • Deep tissue massage (rolfing, hellerwork, etc.) • Movement Therapy, Feldenkrais, Alexander, Trager, etc.

  10. Why patients use CAM • Not necessarily dissatisfied with conventional medicine • Alternatives are more congruent with personal values, beliefs about health & life • Poorer health status • More educated

  11. Evidence-Based Medicine • “The conscious, explicit, and judicious use of current best evidence in making decisions about the care of patients.” • David Sackett, MD

  12. Evidence-Based Medicine • Provides a level playing field for evaluation of both conventional and CAM therapies • Disease- Oriented Evidence (DOEs) vs Patient -Oriented Evidence that Matters (POEMs) • Cochrane Library - Controlled Trials Registry and Database of Systematic Reviews - http://archie.cochrane.co.uk

  13. Making EBM more relevant • Two kinds of outcomes: • Patient-oriented outcomes (e.g. morbidity, mortality, symptoms, duration,hospitalization, cost) • Disease-oriented/intermediate/surrogate outcomes (e.g. BP, Hgb A1c, peak flow rates, MIC in respiratory epithelium)

  14. EBM, POEM’s and Alternative Medicine • “We’ve always done it that way” does not mean it works: • patching corneal abrasions • 10 days of antibiotics instead of 5 for OM • Just because a pharmaceutical company develops a drug doesn’t mean it works: • antibiotics for most bronchitis

  15. Just because an intervention is considered non-traditional doesn’t mean it doesn’t work: • St. John’s Wort • glucosamine • acupuncture • saw palmetto • mangnets for painful diabetic neuropathy

  16. The “Golden Question” of EBM • What is the evidence that this herb/drug/surgery/device will help my patient live better and/or longer? • Not LDL or HDL - do patients live longer? • Not the MIC in respiratory epithelium - do patients feel better quicker? • Not sales of magnets - do they improve function and reduce pain?

  17. Some Examples

  18. Herbs & NutritionalsProbably Effective & Safe • Ginko biloba - cerebrovascular/memory • St. John’s wort - mild/moderate depression • Garlic - lower BP, decrease platelet aggregation, lower cholesterol • Ginger - anti-inflammatory • Valerian - sleep, anxiety • Saw Palmetto - BPH

  19. Cranberry - UTI • Echinacea - prophylaxis & treatment of viral symptoms • Feverfew - migraine headaches • Milk Thistle - hepatoprotective agent • Ginsing - antistress, general tonic • Glucosamine - joint disease

  20. Herbs & NutritionalsPossibly effective, safe if careful • Dong quai - menopause • Black cohosh - menopause • Melatonin - sleep • Passion flower - sleep • L-tryptophan - sleep • DHEA - energy level (androgenic SE’s)

  21. Herbs & NutritionalsPotentially dangerous • Ma huang (ephedra) - weight loss • Chaparral - hepatitis • Comfrey - topical use only • Germander - serious hepatotoxicity • Licorice - hypertension in high doses

  22. Other ModalitiesProbably safe & effective • Acupuncture for nausea, anesthesia, pain, fibromyalgia • Chiropractic for non-surgical acute LBP, minor ligamentous/facet alignment problems • T’ai Chi - osteoporosis, balance in elderly

  23. Biofeedback for hypertension, headache, TMJ, anxiety • Osteopathy - wide variety of ailments, especially musculoskeletal problems • Meditation and other Mind-body practices for stress-related conditions, chronic pain • Diet, nutrition, lifestyle

  24. Other ModalitiesPossibly effective, not harmful • Body work techniques for a variety of musculoskeletal problems • Energy therapies for pain syndromes, fibromyalgia, respiratory conditions, emotional stress (PTSD, depression, anxiety, etc.) • Homeopathy in general

  25. Other ModalitiesDangerous • Chiropractic with structural instability • Delay in appropriate diagnosis & treatment

  26. Why should we try? • Costs of health care continue to climb • Providers and patients are dissatisfied • Chronic disease is not being impacted effectively • Personal responsibility for health and health care decisions seems lacking • Many alternative therapies work

  27. Limits of Conventional Medicine • No “scientific” basis for 80% of treatments • Relatively poor results with chronic illness • Serious iatrogenic problems: e.g. adverse drug reactions responsible for 100,000 deaths in U.S. hospitals/year • High cost • Disease focus

  28. What Can “Bridging” Offer? • More personal responsibility for health (e.g. learning self-care techniques for stress, minor ailments, chronic conditions) • Utilizing less expensive prevention and treatment techniques (nutrition, mind-body modalities, movement therapies, etc.) • Admitting the limits of conventional therapies - takes some burden off!

  29. Target use of expensive therapies to those conditions that will actually benefit • Promote use of “alternative” approaches at the appropriate time (i.e. not “last resort”) • Overall provide better outcomes for patients

  30. Where from here? • Learn more - conferences, journals, try some new methods. • Consult with other practitioners as we would other specialists - phone calls, letters, etc. Share space as appropriate; form a group practice. • Create truly patient-centered environments - hospital, office, etc.

  31. Conduct research on empirically interesting interventions. • Change the medical school curriculum. • Standardize practices of various fields, so outcomes can be compared. • Change the health care payment system.

  32. Create a social culture that values and reinforces individual choice and responsibility about health. • Create health care environments that are healthy and supportive for those working in them.

  33. Challenges of Integration • Wide array of alternative therapies - some with an evidence base, some without • Lack of physician familiarity • Paradigm clashes • Western “scientific” concepts • Paying for it

  34. Personal Observations • Wide variety in practitioners of a given art • Lack of open-mindedness of some CAM therapists, as well as some physicians • Patients want their doctor to at least be open minded • Patients want to be heard and taken seriously • Patients want their practitioner to have hope

  35. CAM May Be Superior • Chronic fatigue syndrome • Fibromyalgia • Irritable bowel syndrome • Arthritis • Low back pain • Skin diseases

  36. RESOURCES • NIH Office of Alternative Medicine: http://altmed.od.nih.gov • Clearinghouse: (888) 644-6226 • FDA: http://www.fda.gov • American Botanical Council: http://www.herbalgram.org • Ask Dr. Weil: http://www.drweil.com

  37. Journal of Family Practice POEM’s feature http://jfp.msu.edu • Databases NAPRALERT (312) 996-2246 Herb research Foundation (303) 449-2265 • Cochrane Library: Controlled Trials Register & Database of Systemic Reviews http://archie.cochrane.co.uk

  38. Core Library for Evidence-Based Practice www.shef.ac.uk/~scharr/ir/core • National Health Service and Development Centre for Evidence-based Medicine www.cebm.jr2.ox.ac.uk • Patient-oriented Evidence that Matters www.infopoems.com

More Related