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www.tabaye.ir
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Agenda
* Introducing CAM PE
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۰ ۴۷۵۱۷۵۲۱۱9 ۷۷/۵0 5عغ51
* Recommended Websit
* Reviewing the Evidence
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Complementary and
Alternative Medicine
CAM
STATISTICS
*NHIS 2007 Results
*>23,00 adults
*> 9000 children
*Hispanic subpopulation
sadministered by
NIH/CDC
Self report
«Interview one child if
they are present
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19% C Alternative Medicine
* Many medical sec
emerged and
challenged
allopathic medicin
— Thomsonianism
— Eclectic movement
— Hydropathy
* Most died out
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Heroic Medicine
* Blood letting
* Purgatives
+ Emetics
* Sialogogues
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Homeopathy
A new system of
medicine
Employed an
experimental
pharmacology
Self-experimentation
or “provings”
Initially popular in
Europe
— Spread to USA
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Osteopathy
+ Andrew Taylor Still
— Son of pioneer dr and
Methodist minister
* Frontier physician
— Kansas
— Apprenticeship
— Children died of
meningitis
* 1874 conceives of
osteopathy
— Itinerant physician
Andrew Taylor Still
Establishes Osteopathy
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* Created alternative
to allopathic
medicine
— Human body like a
machine; Ought to
function well if
mechanically sound
— Treat body by
improving natural
functions
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Chiropractic Medicine
1895
Daniel David
Palmer
lowa
Cheir= hand
praxis= practice
First patient
— Deaf janitor
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Chiropractic Medicine
+ Disease: joint-oriented
nerve interference
— Obstructs flow of “innate
intelligence”
۰ Innate Intelligence
— Regulates all vital functions
as it flows through CNS
= Connects “man the
spiritual” to “man the
physical”
Remove nerve interference
caused by subluxations so
that innate intelligence can
maintain health and bodily
equilibrium
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What is CAM?
Complementary and Alternative Me ۷
٠ Complementary: together with 7 an
— aromatherapy to help with pain after
surgery
: أ»
Alternative: in place of 2
—using garlic to lower blood pres:
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“Complementary and alternative medicine
(CAM) is a broad domain of healing resources
encompassing all health systems, modalities,
and practices and their accompanying
theories and beliefs, other than those
intrinsic to the dominant health system of a
pa ular society or culture in a given
istorical period.”
“All practices and ideas defined by their users
as preventing or treating illness or promoting
health and well-being are included.”
“Boundaries within CAM and between the
CAM domain and that of the dominant system
are not always well defined.”
(Cochrane)
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© Original Artist
Reproduction rights obtainable from
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AROMATHERAPY
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CAM becomes “legit”
1990 er
— Wilk et al v. AMA Ne
ol
1991
-—$2 million in funding to establish NIH
Office of Alternative Medicine
1994
— Dietary Supplement Health and
Education Act
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CAM becomes “legit”
2711995
—NIH Office of Dietary ۹
— FDA declassifies Acupuncture
needles as experimental prod إل
٠ 06
—NIH Consensus Conference on
Acupuncture
* 1997
— First large trial of CAM therapy, St. John’s
Wort for depression
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CAM becomes “legit”
* 1998
— National Center for Complementary &
Alternative Medicine (NCCAM) established
http://nccam.nih.gov/
— First full scale article in JAMA on herbal
medicine
— Office of Cancer Complementary and
Alternative Medicine (OCCAM) established
http://www.cancer.gov/cam/
٠ 1
- 02۵ on PubMed (NCCAM and NLM)
* 2009 - $296 million in NIH CAM research
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Complementary and
Alternative Medicine
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Impact of CAM
* CDC Report (2007)
— 38% of adults used some form of CAM
— Children whose parent used CAM were 2x
as likely to have used CAM
— CAM use more prevalent for: women, adults
aged 30-69, higher levels of education,
adults who were not poor, adults living in
the West, and former smokers
* Fullreport: ۰
http://nccam.nih.gov/news/camstats/
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tne Domains or
Complementary and
"9 9 هي 1> 6
Energy
medicine
Biologically
based practices
Figure 17.2
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Diseases/Conditions for Which CAM
كرا Most Frequently Used Among Adults - 2007
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Top CAM Therapies
10 Most Common CAM Therapies Among Adults - 2007
Therapies with significant increases
between 2002 a 2007 are
20022007
Deep brea a7
Meditation 5 9a
Massage Oe eae
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Top 10 Supplements
of ff ی 07
ف 5
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Types?
— use the connection between a person's mind,
to enhance total well being
— are meant to restore disturbances in the body's
natural energy
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Types? (Common)
— Bowen
Biofeedback
Chiropractic
Chinese Herbal Medicine
Counselling
Craniosacral Therapy
Crystal Therapy
Dowsing Flower Therapy
Healing Herbalism
Homeopathy
Acupuncture
Alexander Technique
Allergy testing
Aromatherapy
Art Therapy
Autogenic Training
Auricular Acupuncture
Ayuveda
Bodywork
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Types? (Common)
Physiotherapy
Radionics
Reflexology
Reiki
Shiatsu
Tai Chi
TENS therapy
Traditional Chinese
Medicine
Thought Field Therapy
Yoga Therapy
Hydrotherapy
Hypnotherapy
Indian Head Massage
Iridology
Kinesiology
Music Therapy
Naturopathy
Nutrition
Osteopathy
5 6 ۲۱ 5 8 8
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Types? (Rarer)
Light Touch Therapy
Magnotherapy
Marma Therapy
Meta-Aromatherapy
Microwave Resonanace Therapy
Naturotherapy
Oxygen Therapy
Panchakama Therapy
PIP scans
Raw Vegetable Juice Therapy
Rolfing
Spiritual Counselling
Stress Management
Swimming Therapy
Transdecendal Meditation
Tragerwork
Vegetable Juice Therapy
Auricular Acupuncture
Australian Flower Essences
Therapy
Bach Flower remedies
Bee Venom Therapy
Chelation Therapy
Colonic Hydrotherapy
Colour Therapy
Dream Therapy
Eye Movement Desensitization
and Reprogramming
Exercise Healing
Health Clubs
Health Screening
Juice Therapy
Light Therapy
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Categorization of
Therapies
* Whole Medical Systems
* Biologically Based Practices
* Energy Medicine
* Manipulative and Body-Based
Practices
٠ Mind-Body Medicine
9
creed Orcier of Onamecaraay ont Olen Decker 1-4
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Whole Medical Systems
* Complete systems of theory and
practice that evolved independently
* Traditional systems of medicine that
are practiced by individual cultures
throughout the world
— Includes traditional Chines4.¢
medicine, Ayurvedic medi:
homeopathy, naturopathy
ered Crater مها له رو ماو Dede
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Biologically Based
Practices
Includes: botanicals, animal-derived
extracts, vitamins, minerals, fatty
acids, amino acids, proteins, whole
diets, and functional foods
— Dietary supplements are a subset
of biologically based 2 = or
&
ee et
cere 26
ered Crater مها له رو ماو Dede
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Biologically Based -
Supplements
* What is a supplement?
* Regulated by FDA http://www.fda.gov
—no requirements for FDA testing
— manufacturers responsible for ensuri
product safety
— label requirements
+ Safety alerts: Raa
1 4ن رومو ل
warn.html
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Energy Medicine +
* Veritable - energy that can hs
measured
—Includes sound, visible light, magnetism
۰ Putative - energy that has yet to be
measured
— human beings are infused with a subtle
form of energy
—Includes qi (ki in Japanese); doshas;
prana, homeopathic resonance
ered Crater مها له رو ماو Dede
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Energy Medicine -
Acupuncture
* Few complications
* Scientific evidence?
— post chemotherapy management of
nausea
— pain relief
* NIH Consensus Statement (1997)
—http://consensus.nih.
TAST ALSO TACUpUNEE دج
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Manipulative and Body-
Based
Structures and systems of the body,
including the bones and joints, the
soft tissues, and the circulatory and
lymphatic systems زر أ
—Includes chiropractic manipula لذ قار
massage therapy, reflexology,
rolfing, Alexander technique,
Feldenkrais method
مت ما لو اون خن لس
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Mind-Body Medicine
* Interactions among the bri
mind, body, and behavior
* The ways in which emotional, mental,
social, spiritual, and behavioral factors
can directly affect health
— Includes relaxation, hypnosis, visual
imagery, meditation, yoga, biofeedback,
tai chi, group support, and spirituality
مت ما لو اون خن لس
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Other CAM Therapies
* Aromatherapy
* Colonic Irrigation
۰ Therapeutic Touch
* EDTA Chelation
Cupping =
Primordial Sound Meditatiui
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Specific Types?
* Aromatherapy
— Used since Egyptian times
— Distilled plant extracts
* 400 Oils
* Varying quality (RCT)
— Improve well-being
٠ Peppermint - digestive effec
* Tea Tree Oil - antibacterial ,
— Massage, Baths, Inhalatio
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Specific Types?
* Bee Venom Therapy G
— Contain sulphur \
— Stimulates cortisol release
— Applied to surface
—Chronic inflammatory conditi
—RA, Myositis
— Applied for 5days with 2-3day interval
—Normally haemorrhagic
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Avoiding Bad Science
* The “One Product Does It All” claim
http://www.emuoilcanada.com/
* Personal Testimonials
http://www.getslimslippers.com/
* Quick Fixes/Cures
http://www.improveyourhealthonline.com/
* The “No Risk Money Back Guarantee”
http://www.naturalhpvcure.com/
* The “Natural” claim
http://www.amtrueman.com/products.html
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Evaluating Web Sites
* Accuracy
٠ Authority
* Bias
* Currency
* Coverage
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Evaluation Exercises
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cours اریز راد زج
for Complementa
ative Medicine
Office of ۱۰۱/۰
Dietary Supplements ما caren ee sca
ial Institutes of Health
Memorial Sloan -Kestering
ers, Dons & مس
One thru
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Examining the Research
* Observational Studies
* Clinical Trials/Studies
— controlled
—blind/double-blind
—randomized
* ClinicalTrials.gov
— Government and private clinical studies
involving humans
—http://clinicaltrials.gov
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Clinical Trials and CAM
+ Drug companies vs. supplement companies
* Customization of treatment in CAM
* CAM does not necessarily want to be
studied
* CAM has only recently become “legit” in
the scientific community
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Money to fund CAM
* NCCAM: $121.7 million (2009)
* OCCAM: $121.9 million (2009)
—Total all NIH: $296 million
* What about funding for
pharmaceuticals?
—$65.2 billion on R&D (2008) by drug
companies
—$114.4 billion on R&D (2008) by NIH (this
includes NCCAM and OCCAM)
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Assessing the Risks and
Benefits of CAM Treatments
fe; Likely safe and effective
sTreatment examples: ا Treatment examples:
Acupuncture for chronic pain; @ Chiropractic care for acute low-back
homeopathy for seasonal allergies; W تمتدم acupuncture for nausea from
low-fat diet for some cancers; § chemotherapy; acupuncture for
massage therapy for low-back pain; {dental pain; mind-body techniques
mind-body techniques for cancer; for chronic pain and insomnia
self-hypnosis for cancer pain Advice: Treatment is reasonable;
= Advice: Physician monitoring physician monitoring advisable
recommended
LESS EFFECTIVE MORE EFFECTIVE
MAdvice: Avoid treatment
Dangerous or ineffective May work, but safety uncertain
Treatment examples: Injections Treatment examples: St. John’s
of unapproved substances; use of wort for depression; saw palmetto for
toxic herbs; delaying/replacing an enlarged prostate; chondroitin
essential medical treatments; taking sulfate for osteoarthritis; ginkgo biloba
herbs that are known to interact for improving cognitive function in
dangerously with conventional |
medications (e.g., St. John’s wort #_-MAdvice: Physician monitoring is
and indinavir) و important
نا
=
117.3
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The other side
* Some say CAM research should not be
funded
—http://www.nccamwatch.org/ (Stephen
Barrett)
* Or some CAM research should not be
funded
—http://tinyurl.com/46ayhjj
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Reviewing the Evidence
۰ Evidence Based Medicine: “What
evidence do we have to justify the
treatment...”
* National Center for Complementary
and Alternative Medicine (NCCAM)
* CAM on PubMed http://pubmed.gov
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CAM on PubMed Exercises
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