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Complementary & Alternative Medicine: 8 Integrative Elements

Complementary & Alternative Medicine: 8 Integrative Elements


  • Complementary: a nonmainstream practice used together with conventional medicine. Alternative: a nonmainstream practice used in place of conventional medicine. Integrative health care: bringing conventional and complementary approaches together in a coordinated way. Main subgroups: natural products and mind-body practices. Potential benefits of integrative health: pain management for military personnel and veterans, symptom relief in cancer patients and survivors, programs to promote healthy behaviors.

  • Alternative Medicine No Longer Has a Bad Name. In a recent editorial in The Journal of Family Practice, Editor-in-Chief John Hickner, MD, MSc, said:So widely used, alternative therapies are no longer “alternative.” 1991: NIH Office of Alternative Medicine created; official recognition that alternative treatments might have scientific basis and so “valid” therapeutic effects. RCTs by 100s have studied the value of herbal treatments, vitamin therapies, magnet therapy, acupuncture, tai chi, aromatherapy, and other modalities. Evidence supports many therapies once called “alternative”: eg, acupuncture has shown positive effects for musculoskeletal problems and is an evidence-based Rx option for functional dyspepsia, IBS. Functional medicine: the next new alternative combines holistic medicine with the theory that a variety of ills can be treated with supplements and other dietary measures.

  • “Natural Products” Lead the Way. 2012 National Health Interview Survey Says: 17.7% of American adults had used the most popular complementary health approach, “natural products”—a dietary supplement other than vitamins and minerals—in the past year. Other most common approaches: Deep breathing, 10.9%; Yoga, Tai Chi, or Qi Gong, 10.1%; Chiropractic or osteopathic manipulation, 8.4%; Meditation, 8.0%; Massage, 6.9%.

  • Healing Both Body and Mind. The ongoing shift in health care includes a focus on the whole person, on preventive care, and on an array of nontraditional healing modalities outside of biomedical practice. Integrative medicine is the result: blends biomedicine with a broader understanding of patients and illness, including elements of mind, body, and spirit that may be contributing to an ailment. Mind-body techniques are used to strengthen communication between the mind and body to keep the systems in harmony, which promotes health: meditation, prayer, relaxation, art therapy. Tension continues between practitioners of IM and biomedical medicine, centered on different training, philosophies, and a healthcare system rooted in and that favors the biomedical model.

  • On Dietary Supplements: Be Well, But Beware. NEJM study: CDC/FDA estimated ≥23,000 ED visits/year in the US (2004-2013) for adverse events related to use of dietary supplements. More than one-fourth of the ED visits involved young adults aged 20 to 34 years.Weight loss products or energy products were involved in more than half of those visits, mostly because of cardiac symptoms. Dietary supplement health risks: interactions with prescription drugs, contamination by synthetic prescription drugs, and unknown contaminants with unknown production quality. “Natural” does not always mean safe.

  • Yoga for General Wellness, Disease Prevention. ~ 31 million US adults have used yoga, and about 21 million practiced yoga in the past 12 months. In a study of prevalence, patterns, predictors of yoga use in the general population, lifetime and 12-month prevalence of yoga use were 13.2% and 8.9%, respectively. Lifetime practitioners were more likely than nonpractitioners to be female, younger, non-Hispanic white, college educated, higher earners, living in the West, and of better health status.

  • Yoga for Wellnes: Of those who practiced in the past 12 months: 51.2% attended yoga classes, 89.9% used breathing exercises, and 54.9% used meditation. Reasons for practice: general wellness, disease prevention, 78.4%; improve energy, 66.1%; improve immune function, 49.7%. Main specific health problems: back pain, 19.7%; stress, 6.4%; and arthritis, 6.4%.

  • CAM and Cardiovascular Disease in Review. 2006 study analyzed 2002 NHIS data on CAM use among >10,000 patients with CVD. 36% had used CAM (excluding prayer) in the previous 12 months. Most commonly used therapies reported: herbal products (echinacea, garlic, ginseng, ginkgo biloba, and glucosamine), 18%; mind-body therapies (deep-breathing exercises and meditation), 17%. CAM use among these patients mirrored use in the general population. The most common reasons for use: musculoskeletal complaints, anxiety/depression, and stress/emotional health and wellness. Only 10% used CAM specifically for CV conditions (5% for hypertension, 2% for coronary disease, 3% for vascular insufficiency,

  • Body-based Evidence is Building. Manipulation and body-based practices, using human touch to move or manipulate a specific part of the body, include chiropractic and osteopathic manipulation and massage. A review of the sports/exercise medicine literature looked at trends in levels of evidence for manipulative and body-based therapies. FIndings: increase in the quantity and quality of published manipulative and body-based therapy articles in the literature over the past 60 years. Level-1 evidence was available for acupuncture, manipulation, massage, and Pilates.

More and more Americans are adopting health care approaches that lie outside of mainstream medicine. Traditionally called complementary and alternative medicine, or CAM, these approaches are gaining acceptance from many physicians as well, mainly because they are now combining them with biomedical therapies under the umbrella of integrative medicine. But because scientific evidence about safety and effectiveness often is lacking, doctors are exercising caution about their use.

This brief slideshow summarizes some of the key points about CAM and integrative medicine so that you can share the benefits—and risks—with your patients.

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