1. Consumer Health Complementary and Alternative Medicine (CAM)

2. Prayer I got behind and forgot to tell people about what happened with him......the morning after the 'global prayer circle' (for lack of a better name for it) he improved dramatically! In fact the doctors decided against the surgery they were planning (and dreading as he has so much 'scar tissue' inside) and sent him home! He's doing amazingly well - went out and bought a Christmas tree and decorated it! Thanks for asking and Happy New Year to you! J

3. BMJ VOLUME 324 13 APRIL 2002 bmj.com

4. Prayer I got behind and forgot to tell people about what happened with him......the morning after the 'global prayer circle' (for lack of a better name for it) he improved dramatically! In fact the doctors decided against the surgery they were planning (and dreading as he has so much 'scar tissue' inside) and sent him home! He's doing amazingly well - went out and bought a Christmas tree and decorated it! Thanks for asking and Happy New Year to you! J

5. Complementary and Alternative Medicine Defining CAM History of CAM Major Domains of CAM Extent of Use Organizations, Certification, Training Selecting Practitioner

6. Defining CAM Original Definition National Library of Medicine Unrelated group of non-orthodox therapeutic practices Often with explanations not following conventional biomedical explanations No satisfactory scientific explanation for effectiveness Another old definition Medical interventions not taught in US

7. Defining CAM New Definition National Library of Medicine Complementary Medicine Alternative Therapeutic practices not considered an integral part of conventional allopathic medical practice May lack biomedical explanation Could become accepted or not

8. Defining CAM Complementary Medicine Therapies used in addition to conventional treatments Alternative Therapies used instead of conventional treatment

9. Defining CAM Differences in Emphasis Conventional High Tech Pharmacological Surgical and other technological approaches Prevention and wellness underemphasized CAM Low Tech Prevention Treating the whole person Promoting self-care Recognizing a spiritual nature of each individual Individualized treatment

10. Major Domains of CAM Alternative Health Care Systems Ayurvedic Medicine Chiropractic Homeopathic Medicine Native American Medicine Naturopathic Medicine Traditional Chinese Medicine

11. Major Domains of CAM Mind-Body Interventions Meditation Hypnosis Guided Imagery Dance Therapy Music Therapy Art Therapy Prayer and Mental Healing

12. Major Domains of CAM Biological Based Therapies Herbal Therapies Special Diets Orthomolecular Medicine

13. Major Domains of CAM Therapeutic Massage, Body Work and Somatic Therapies Massage Feldenkrais Alexander Method

14. Major Domains of CAM Two Additional Domains Energy Therapies Qigong Reiki Therapeutic Touch Bioelectromagnetic Magnet Therapy

15. History of CAM Mid-19 th Century Botanical healers, midwives, chiropractors, homeopaths 1892 The Principles and Practice of Medicine 1910 Flexner Report

16. History of CAM Early 20 th Century Drugs and antibiotics introduced CAM: “unscientific relics of the past” Mid-20 th Century Chronic, degenerative diseases Significantly longer lives Health care costs (See next slide)

17. History of CAM Mid-20 th Century Chronic, degenerative diseases Significantly longer lives Health care costs 1965$ 41,000,000,000 1975$ 130,000,000,000 2000$ 1,200,000,000,000 2010$ 2,600,000,000,000

18. History of CAM 1950s – 1970s Medical pluralism reemerges Whole foods and dietary supplement movements Exposure to traditional health care systems Counterculture movement Holistic health care movement Nurses and family physicians

19. History of CAM 1970s – 1980s Self-care movements For individual and family to increase wellness Diet and exercise to reduce risk of onset of illness Personal fitness Increased use of yoga, tai chi, massage

20. Consumer Use of CAM 43% of US population Due to chronic conditions Most frequent users Cancer, chronic pain, HIV Ethnic populations Dietary Supplements 158 million users $17,000,000

21. Reasons for Using CAM Characteristics of users Interest in spirituality and personal growth Commitment to environmentalism Feminism Internal locus of control Transformational experiences

22. Reasons for Using CAM Perception of conventional medicine is ineffective Believe it will work Recommendations from friends Desire to avoid side effects of conventional treatments Failure of conventional treatment

23. Reasons for Using CAM Perceived poor health status Perceived poor emotional functioning Musculoskeletal disorder Back pain

24. CAMs Used Chiropractic: 35% Herbal Remedies and supplements: 27% Massage Therapy: 17%

25. Cancer and CAM At least one CAM approach: 63% to 75% Women more than men More use for surgery, chemotherapy or both than neither Most frequent approaches Nutritional: 63%, Massage: 53%, Herbs: 44% Spiritual approaches, relaxation, imagery, exercise, lifestyle, diet, nutritional supplementation therapies Reasons for use “stimulate an immune response:” 73% Outcomes QAL, coping, decrease discomforts, sense of control

26. HIV and CAM Frequent Substances Vitamin C: 63%, Multiple vitamin supplements: 53%, Garlic: 53% Frequent practitioners Massage: 49%, acupuncturists: 45%, nutritionists: 37% Frequent activities Aerobic exercise: 63%, prayer: 58%, massage: 53%, meditation: 46%

27. Ethnic Differences in Use of CAM Mexican-American and Hispanic, and Native Americans At least once in last year: ~50% Herbal medicine, spiritual healing, traditional healers

28. Conventional Medicine Use of CAM Give referrals to: Acupuncture: 43% Chiropractic: 40% Massage: 21% Practiced by them: Chiropractic: 19% Massage: 19% Homeopathy: 9%

29. Conventional Medicine Belief in Efficacy of CAM Believe in efficacy of: Acupuncture: 51% Chiropractic: 53% Massage: 48% Others Homeopathy: 25% Herbal approaches: 13%

30. Conventional Medicine Use of CAM Insurance Companies Medical Schools Hospitals

31. Organizations American Holistic Nurses Association http://ahna.org National Certification Commission for Acupuncture and Oriental Medicine www.nccaom.org Complementary and Alternative Medical Association http://www.camaweb.org British Complementary Medicine Association http://www.bcma.co.uk

32. CAM Certification and Education Council of Colleges of Acupuncture and Oriental Medicine www.ccaom.org American Association of Naturopathic Physicians www.naturopathic.org Tai Sophia Institute www.tai.edu East West Institute of Healing Arts www.eastwestqi.com American Academy of Acupuncture and Oriental Medicine www.aaaom.org

33. Selecting Practitioners Speak with primary provider Make a list of CAM providers and check Training Licenses and certifications Costs Check insurance coverage List questions to ask at visit At visit answer questions about MX Assess visit for comfort and reasonableness

34. Research NCCAM and NIH nccam.nih.gov/research/priorities/index.htm Cochrane Collaboration www.cochrane.org AltHealthWatch www.epnet.com/TitleLists/html/aw_h1.htm AMED www.bl.uk/services/information/amed.html eBMJ http://bmj.bmjjournals.com/cgi/collection/complementary_medicine

35. Major Domains of CAM Alternative Health Care Systems Ayurvedic Medicine Chiropractic Homeopathic Medicine Native American Medicine Naturopathic Medicine Traditional Chinese Medicine

36. Major Domains of CAM Mind-Body Interventions Meditation Hypnosis Guided Imagery Dance Therapy Music Therapy Art Therapy Prayer and Mental Healing

37. Major Domains of CAM Biological Based Therapies Herbal Therapies Special Diets Orthomolecular Medicine

38. Major Domains of CAM Therapeutic Massage, Body Work and Somatic Therapies Massage Feldenkrais Alexander Method

39. Major Domains of CAM Two Additional Domains Energy Therapies Qigong Reiki Therapeutic Touch Bioelectromagnetic Magnet Therapy

40. Future Prospects for CAM Depends on evidence-base for safety and efficacy Conventional and CAM may merge Collaborative Independent Challenges Communication Certification and training Insurance reimbursement

41. Summary Defining CAM History of CAM Major Domains of CAM Extent of Use Organizations, Certification, Training Selecting Practitioner

42. Types of CAM Acupuncture and Chinese Medicine Reflexology Chiropractic Naturopathy Natural Hygiene Iridology Homeopathy Psychic Healing Occult Practices Astrology Biorhythms Meditation Yoga Therapy Visual Training Guided Imagery

43. Types of CAM Alexander Technique Aromatherapy Feldenkrais Method Magnet Therapy Polarity Therapy Radionics and Radiesthesia Reiki Rolfing Clinical Ecology Chelation Therapy Holistic Medicine