مراقبت‌های بهداشتیپزشکی و سلامتطب سنتی

Examining Complementary and Alternative Medicine

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Will duct tape cure my warts? Examining Complementary and Alternative Medicine Karen Vargas sumer Health Outreach Coordinator , onal Network of Libraries of Medicine South Central Region

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0 Agenda * Introducing CAM PE 4 ۰ ۴۷۵۱۷۵۲۱۱9 ۷۷/۵0 ‏5عغ51‎ ‎* Recommended Websit * Reviewing the Evidence

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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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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/ 2001 — CAM on PubMed (NCCAM and NLM) 2009 - $296 million in NIH CAM research ۰

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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 ¢ Full report: http://nccam.nih.gov/news/camstats/

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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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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 ens product safety — label requirements * Safety alerts: http://www.cfsan.fda.gov/~dms/ds-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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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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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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Questions? Karen Vargas karen.vargas@exch.library.tmc.edu National Network of Libraries of Medicine South Central Region 800-338-7657

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