1. Complementary And Alternative Therapies Dinesh Sirisena

2. “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 particular society or culture in a given historical 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)

3. Complementary - together with conventional medicine Alternative - in place of conventional medicine Some providers practice both

5. Topics? Why do people use them? Who uses them? Frequency of use? Types? Costs? Evidence? Problems?

6. Why?

7. Positive motives –Perceived effectiveness or safety –Spiritual –Holism –All things natural –Active role –Control over treatment –Pleasant therapeutic experience –Good patient/therapist relationship Fewer time restraints (£) On equal terms (£) Empathy (£) –Non-invasive –Accessibility (£) –Affluence (£)

8. Why? Negative motives –Dissatisfaction with conventional health care Ineffective Adverse effects –Doctor-patient relationship insufficient time waiting lists –Reject science and technology –Reject “the establishment” –Desperation

9. Why? Other Motives –Not an alternative –What is available for their health care

10. Who? Women>Men Well educated + affluent Middle aged Ethnic population –Afro- Caribbean>Asian>Cau casian Chronic Ill Health –Cancer –AIDS –Long term conditions Worried well Myalgic Encephalopathy –33% use CAM

11. Frequency? 46% UK population will try at some point 1999 –50,000 CAM practitioners (UK) –5 million patients consulted a CAM practitioner in one year More uptake in Europe –France & Germany USA –629 million visits in one year alone (?%pop)

12. Frequency? Use of CAM in the United Kingdom 1999 (%) –Herbal medicine (34) –Aromatherapy (21) –Homeopathy (17) –Acupuncture / acupressure (14) –Massage (6) –Reflexology (6) –Osteopathy (4) –Chiropractic (3)

13. Costs?

14. Not necessarily actual cost Cost effectiveness Royal Pharmaceutical Society (1999) – £231.8 million was spent on non-prescription medicine Aromatherapy session (£40-60+) Acupuncture (£40-60+) Massage (£30-40+)

15. How Many Types?

16. Types? Biologically based practices –supplementing a person's normal diet Manipulative and body-based therapies –focus on the body's various systems and structures Mind-body interventions –use the connection between a person's mind, body, and spirit to enhance total well being Energy therapies –are meant to restore disturbances in the body's natural energy

17. Types? (Common) Acupuncture Alexander Technique Allergy testing Aromatherapy Art Therapy Autogenic Training Auricular Acupuncture Ayuveda Bodywork Bowen Biofeedback Chiropractic Chinese Herbal Medicine Counselling Craniosacral Therapy Crystal Therapy Dowsing Flower Therapy Healing Herbalism Homeopathy

18. Types? (Common) Hydrotherapy Hypnotherapy Indian Head Massage Iridology Kinesiology Music Therapy Naturopathy Nutrition Osteopathy Physiotherapy Radionics Reflexology Reiki Shiatsu Tai Chi TENS therapy Traditional Chinese Medicine Thought Field Therapy Yoga Therapy

19. Types? (Rarer) 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 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

20. Specific Types? Aromatherapy –Used since Egyptian times –Distilled plant extracts 400 Oils Varying quality (RCT) –Improve well-being Peppermint – digestive effects Tea Tree Oil – antibacterial –Massage, Baths, Inhalation

21. Specific Types? Bee Venom Therapy –Contain sulphur –Stimulates cortisol release –Applied to surface –Chronic inflammatory conditions –RA, Myositis –Applied for 5days with 2-3day interval –Normally haemorrhagic

22. Evidence? Circumstantial Past attempts at investigations Little research –Difficulty with RCT –Outcomes dependant on social, cultural and spiritual beliefs

23. Evidence? Evidence Based Complementary and Alternative Medicine (eCAM) –Yoga Improve risk in adults with DM 2 Prevention and management of cardiovascular complications May be useful in the management of stress (post tsunami victims) –Massage Benefits in chronic pain conditions –Sanfujiu (herbal ointments into pressure points) moderately effective in treating allergic symptoms

24. Evidence? eCAM –Green Tea Regular intake (>3 cups per day) may reduce the lung cancer in smokers –Gentle Touch Therapy (strong) circumstantial evidence Improved psychological well-being Self-reported psychological problems

25. Evidence? eCAM –Electro-acupuncture Relieving labour pain Synergism of the CNS with a direct impact on the uterus through release of ß-EP and 5-HT into the blood –Tai Chi 15 week course effective in reducing headache symptoms and perception of physical and mental health –Music Therapy Benefited patients in hospice and palliative care

26. Evidence? (2007) NHS trial in Belfast –£200,000 for GP to use alternative therapies –Was it a success? –Reduced use of conventional therapy –Effective?

27. Problems?

28. Safety risk –Especially during pregnancy –Ayurvedic treatments Heavy metals (Lead, Mercury, Arsenic) –Unknown purities –Reactions are not routinely monitored –Dietary supplements can interact with prescribed medications Difficulty establishing reliability/efficacy

29. Problems? Significant lack of evidence/research –Speculative –Small trials –Often biased Financial motivations Lack of regulation –Some with registered Osteopaths (GOsC) and Chiropractors (GCC) –Remaining registration is voluntary

30. Problems?

31. Topics? Why do people use them? Who uses them? Frequency of use? Types? Costs? Evidence? Problems?

32. Useful Links? http://www.bcma.co.uk/ http://www.cancerbackup.org.uk/Treatments/Complementarytherapi es/Generalinformation/Complementaryalternativetherapies http://www.therapiesguide.co.uk/ http://www.holisticpages.co.uk/ http://www.dh.gov.uk/en/Publichealth/Healthimprovement/Complem entaryandalternativemedicine/index.htm http://www.medicine.ox.ac.uk/bandolier/booth/booths/altmed.html http://www.nlm.nih.gov/medlineplus/complementaryandalternativeth erapies.html http://www.cancer.org/docroot/ETO/ETO_5.asp http://www.nhsdirectory.org/ http://nccam.nih.gov/

33. Useful Links? http://www.library.nhs.uk/cam/ http://www.internethealthlibrary.com/Prime-pages/A- ZDirAltTherapies.htm http://www.arc.org.uk/arthinfo/patpubs/6007/6007.asp http://diabetes.niddk.nih.gov/dm/pubs/alternativetherapies/ http://www.publications.parliament.uk/pa/ld199900/ldselect/ldsctech/ 123/12301.htm http://homeopathy4health.wordpress.com/ http://ecam.oxfordjournals.org/ http://www.bmj.com/cgi/content/full/319/7211/693 http://www.cancerhelp.org.uk/help/default.asp?page=216 http://www.medicalnewstoday.com/sections/complementary_medici ne/

34. A = Lavender –calming effect, aiding relaxation and anxiety B = Lemon Grass –antiseptic, bactericidal, deodorant and antifungal C = Sandalwood –Stress and anxiety, itching and skin inflammation, aphrodisiac The Three Oils