Understanding Complementary and Alternative Medicine

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Chapter 28

Understanding Complementary and Alternative Medicine

The natural healing force within each of us is the greatest force in getting well.

Hippocrates (460–377 BCE)

General Considerations

Studies have shown that the frequency of use of complementary or alternative medical therapy in the United States is far greater than previously reported. These therapies include relaxation techniques, imagery, chiropractic, massage, spiritual healing, herbal medicine, acupuncture, homeopathy, folk remedies, and prayer, to name a few. It has been estimated that 42% of the American population uses at least one of these and other alternative healing methods to satisfy their medical needs. The most common users of complementary and alternative therapy are more affluent people, women, those better educated, individuals born after 1950, and those who are concerned about emotional stress and the environment. The most common therapies were relaxation techniques (18%), massage (12%), herbal medicine (10%), and megavitamin therapy (9%). The perceived efficacy of these therapies ranged from 76% (hypnosis) to 98% (energy healing). The number of visits to providers of this health care is greater than the number of visits to all primary care medical doctors nationwide. More than 70% of these patients never mention using alternative therapy to their clinicians. Out-of-pocket expenditures of more than $34 billion per year in the United States are a testament to a widely held belief that complementary and alternative medicine (CAM) therapies have benefits that outweigh their costs. This figure is in contrast to the $12.8 billion spent out of pocket annually for all hospitalizations in the United States.

One of the reasons patients seek complementary and alternative therapies may be a failure in the doctor-patient relationship. Health care providers often fail to discuss the use of these therapies because they lack adequate knowledge in this area and have poor insight into the cultures and beliefs of those who practice CAM. To many health care providers, “alternative medicine” entails the threat of displacing conventional medicine for the sake of unproven therapies. It may lack organization and the rigorous, scientific standards of Western, evidence-based medicine. The response of the health care providers ranges from outright dismissal of the practices to a gradual recognition that their extensive use can no longer be ignored. A lack of communication and knowledge in this area may also prove to be detrimental to the patient because the use of some forms of these therapies, if unsupervised, may be dangerous.

There has been an increasing interest throughout the world in the use of natural ingredients for health, especially tea. Tea is the world’s second most popular beverage after water. Green tea accounts for approximately 20% of all tea consumed. It has been claimed that overall health of the body, especially the oral cavity, can be maintained by the consumption of green tea. Green tea is not fermented; therefore, it contains polyphenols that are inactivated in the fermentation process of black tea production. Green tea has been consumed in East Asia, where its benefits have been claimed for centuries. Green tea polyphenols possess antioxidant and antiviral properties that account for its benefits; these benefits have been touted to include lowering blood pressure, lowering cholesterol, stabilizing blood glucose, inhibiting bacterial growth, and blocking many carcinogenic agents. Polyphenols have been shown to inhibit the growth of Streptococcus mutans, the major etiologic bacterium associated with dental caries, and Porphyromonas gingivalis, the bacterium associated with periodontal disease.

In April 1995, the National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (NIH) defined CAM as “a broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period.” This group of diverse medical and health care systems, practices, and products is not currently part of conventional (i.e., allopathic) medicine, although some conventional medical practitioners (those with an MD, DO, or other health-related degrees) are also practitioners of CAM. The CAM marketplace is currently valued at $24 billion or more, and the growth rate is close to 15% per year. Since the inception of the NCCAM, Congress has provided almost $550 million to promote CAM and CAM research. In fiscal year 2004, the funding for NCCAM was $117.7 million.

In December 1995, the American Medical Association (AMA) passed the resolution “Unconventional Medical Care in the United States.” The AMA encourages NCCAM to determine by objective scientific evaluation the efficacy and safety of practices and procedures of unconventional medicine and encourages its members to become better informed regarding the practices and techniques of alternative or unconventional medicine.1

What is CAM? Complementary medicine, such as aromatherapy, is used in conjunction with conventional medicine, for example, to lessen a patient’s postoperative discomfort. Alternative medicine, such as some herbal medicines, is used instead of conventional medicine to treat cancer. Alternative therapies include, but are not limited to, the following disciplines: folk medicine, herbal medicine, diet fads, homeopathy, faith healing, new age healing, chiropractic, acupuncture, naturopathy, reflexology, massage, and music therapy. Integrative medicine combines conventional medical and CAM therapies for which there is some scientific evidence of safety and effectiveness, regardless of their origin.

The purpose of this chapter is to educate the reader about CAM. Medical schools in the United States are now including courses in which CAM is taught, but 80% of medical students polled have indicated that they would like more information. Because 29 health care insurance companies in the United States now cover CAM therapies and 67% of health maintenance organizations now offer at least one form of CAM, it is crucial for health care providers to become more cognizant about these therapies. In the future, there will be more well-designed, randomized, controlled studies that will provide answers to many of today’s questions regarding CAM.

Classifications of Complementary and Alternative Medicine

The NCCAM has classified CAM therapies into five major but overlapping categories:

Alternative medical systems are complete, complex systems of health care practices that incorporate natural products, spiritual elements, diet, and other modalities. Some systems, such as homeopathic medicine and naturopathic medicine, have evolved in the Western world, whereas others, such as Chinese medicine and Ayurvedic medicine, have developed in non-Western cultures. Ayurvedic medicine was developed in India more than 5000 years ago and is the best known of the traditional approaches associated with Indian medicine. The system involves the use of diet and herbal remedies, with emphasis on the mind, body, and spirit in disease prevention and treatment. Homeopathic medicine is based on the belief that “like cures like”: minute doses of highly diluted animal, vegetable, and mineral substances can cure the symptoms that would be caused by higher concentrations of the same substance in a healthy person. It is believed that these minute doses stimulate the body’s own defense mechanism to fight off illness. These natural substances are nontoxic and nonaddictive and have no known side effects. Homeopathic medications are regulated by federal law, and most are sold over the counter. Naturopathic medicine is based on the concept of natural healing and uses only natural, gentle, nontoxic treatments with the goal of having the body heal itself. Some of the naturopathic processes include dietary modifications, mineral and herbal supplements, exercise, massage, and acupuncture.

Mind-body interventions entail a wide variety of techniques to improve the mind’s capacity to affect bodily function and symptoms. Cognitive therapies, biofeedback, meditation, hypnosis, prayer, and creative outlets such as dance, music, and art are common examples of mind-body interventions.

Biologically based therapies involve herbs, vitamins, dietary supplements, and foods to treat disease. Around the world, these products are extraordinarily popular, and billions of dollars are spent on them in the United States alone. The assumption is that natural products are healthier and better than synthetic chemicals for treating disease. Dietary supplements are not considered drugs and therefore are not regulated and do not require U.S. Food and Drug Administration approval.

Manipulative and body-based methods include modalities that move one or more parts of the body. These methods include massage, chiropractic, osteopathy, and reflexology. Chiropractic is concerned with the relationship between structure and function. The primary structure is the spine, and the function is the nervous system; this relationship is thought to affect the restoration and preservation of health. The first chiropractic adjustment was given in 1895. The basic principle of chiropractic is that any interference with the transmission, reception, or application of impulses that travel over the nervous system causes functional abnormalities or disease. This interference may be the result of a vertebral subluxation. Over the years, numerous definitions have been formulated to describe the nature of subluxation. In all of these, there are at least four main criteria or characteristics:

The vertebral subluxation may be the result of any of the following causes: trauma, toxins (infections, poisons), and autosuggestion (psychologic factors). Vertebral subluxation is treated with a chiropractic manipulation referred to as an adjustment. The chiropractic adjustment is a specific form of direct articular manipulation characterized by a dynamic, forceful, high-velocity thrust of controlled amplitude. These adjustments may be administered by hand or instruments directed at specific articulations. It is believed that chiropractic adjustments energize the life force that connects the spine to all parts of the body to promote healing and restore health. Chiropractic has become one of the largest drug-free healing professions. According to a survey released by the Centers for Disease Control and Prevention, nearly 20% of the adult population in the United States has used chiropractic at least once.

Osteopathy focuses on diseases arising in the musculoskeletal system. The belief is that all the body’s systems work together, and disturbances in one system affect functions in another. The field involves understanding the entire patient, physically, psychologically, and emotionally, to uncover the underlying causes of symptoms. Osteopathic physicians use musculoskeletal manipulation, recommendations about diet and exercise, and general preventive medicine to alleviate pain, restore function, and promote health.

Reflexology is a body-based therapy in which pressure is applied to the feet, hands, ears, and cranium to treat a variety of ailments and promote well-being and improved health. The therapist applies the tips of the fingers, the thumb, the elbow, and the hand firmly to areas of the recipient’s body to assess the state of health and treat every part of the body. Dating back to as early as 2700 BCE, reflexology is believed to link every organ or gland in the body to a reflex point on the foot or hand; these areas are linked through a series of longitudinal and transverse zones that run from the feet or hands through the legs and arms, respectively, to the organ or gland. By manipulating the reflex area, most of which are found on the soles of the feet, as shown in Figure E28-1A, the therapist can treat that area of the body. It is believed that foot reflexology, which is not a simple foot massage, can relieve tension and blockages by stimulating sensory receptors in the nerves of the foot (see Fig. E28-1B). As a result, energy is created that extends to the spinal cord and dispersed throughout the nervous system. Reflexology has been used for many conditions, including, among other things, improving the immune system, paralysis, arthritis, diabetes, and sleep disorders; lowering blood pressure; and stimulating circulation.

Energy therapies, which involve the use of energy fields, are categorized into three types: biofield therapies, bioelectromagnetic-based therapies, and acupuncture. The term biofield was coined in 1994 at a meeting at the NIH, and the biofield hypothesis purports that all objects radiate an electromagnetic field. If an object such as part of a healer’s body, a nutritional supplement, or an externally applied electromagnetic field is brought near to or inside the body of an individual, the frequencies radiated by the object or field interact with the individual’s field. Biofields have been described traditionally by the ancient Indians as prana, by the Chinese as qi (or chi), by the Japanese as ki, by Jewish mysticism as “astral light,” and by Christian painters as “halos.” Current practices involving biofield therapies are intended to affect a patient’s energy field for the purpose of healing by having a healer place his or her hands in or through them; the therapist’s healing force restores the patient. Examples of this type of energy therapy include Reiki, qi gong, and therapeutic touch. Reiki, a Japanese word meaning “universal life energy,” is an ancient form of healing by touch and is based on the belief that when spiritual energy is channeled through a Reiki practitioner, the patient’s spirit is healed. It is a way of channeling this energy through one’s hands, enabling the body to accelerate its own healing process. Qi gong is a Chinese technique that combines slow-moving meditative postures, meditation, stretching, and regulation of breathing to enhance the flow of qi in the body to enhance immune function and improve circulation.

Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields. Positioning external magnetic fields near or around the person, usually by placing magnets on the body, into clothing, or in mattresses, is an example of this type of therapy.

Acupuncture is a healing art in which needles are placed into the body to allow qi (energy) to flow unimpeded. Advances in acupuncture allow for the attachment of electrodes to the needles through which small currents are passed. The dominant form of therapy in traditional Chinese medicine is acupuncture. To understand acupuncture, the reader must first understand the concept of meridians. Meridians are a unique part of Chinese medical theory; they are the channels through which qi

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