HSc 460: Alternative & Complementary Health / Medicine

1. HSc 460: Alternative & Complementary Health / Medicine Winter 2006 Dr Don Morrow

2. 460 Students • The slides posted for each Module will be posted as we finish each module. Please note that for some of the material, below the slides, there is often text to explain the material. So, for example, the slides re Case Control research etc have full explanations below the slides • Any feedback on how useful this is or is not would be gratefully received

4. A Brief History of Medicine: 2000BCEto 2006CE "I have an ear ache...."   2000 BCE - Here, eat this root   1000 CE - That root is heathen, say this prayer   1850 CE - That prayer is superstition, drink this potion   1940 CE - That potion is snake oil, swallow this pill   1985 CE - That pill is ineffective, take this antibiotic   2006 CE - That antibiotic is artificial and ineffective ! Here, eat this root  

5. H O L I S T I C Do we treat the disease; OR, do we treat the patient ?

6. Altern methods Mainstream Medicine Human Body

7. The Nature of Evidence • Case studies • Testimonials • 1000s of years ~ 65-75% of world’s pop uses CAM-only • INTERNET ‘evidence’ ? ~ there is quackery; quackwatch.com • HUGE need for education about and inclusiveness of ‘new’ forms of CAM

8. How to assess health problem or diagnose/treat one • The classic approach ( The way your grandparents did ) • Identify the problem • Use your "experience" • Ask a "trusted" colleague • Consult a reference text • Read a review

9. How to assess health problem or diagnose/treat one • The E-BM approach • Formulate an appropriate clinical question • Conduct a literature search • Select the key articles • Critically appraise the articles • Apply the results of the search to the situation

10. What is Evidence-Based Medicine ( EBM ) ? • Using the best currently available research evidence combined with clinical judgmentandexperienceto make a medical / health decision

11. 5th step? Mindful Competence How welearn ?

12. E V I D E N C E What are the ways of evidence-based ‘knowing’ re CAM ?

13. http://www.cochrane.org/index0.htm

14. http://www.nccam.nih.gov/

16. British House of Lords – Nov 28/00 • Science experts in Britain's House of Lords called Tuesday for tougher regulation of alternative medicines, saying many practices offered no evidence of helping the ill. Peers in parliament's upper chamber said there was also a risk that patients would pursue alternative therapies at the expense of traditional treatment, endangering their health. ``One of the main dangers of complementary and alternative medicine (CAM) is that patients could miss out on conventional medical diagnosis and treatment because they choose only to consult a CAM practitioner,'' the Lords’ science and technology committee said in a report.

17. Canadian Disbelief • The goverment of Canada moves into the realm of woo woo medicine as it funds the Office of Natural Health Products. It's about to fund $100 million research institute to study alternative medicine in Hamilton, Ontario. Without the support of organized medicine, and the government, much of alternative medicine would be considered quackery and fraud. The derogation of the responsibility of science based medicine and their cooperation with pseudo-science based health gurus is a big mistake. Canadian medicine is hurting, our hospitals are starving for support and our patients are dying in ambulances in our major cities because our government funds alternative medicine. ~ Alt Med Newswatch, Dec 30/00

18. What is Evidence-Based Medicine ( EBM ) ? • Using the best currently available research evidence combined with clinical judgment and experience to make a medical / health decision • Your text, Preface: “As its central theme, integrative medicine advocates the treatment of both the patient and the disease while seeking to redraft the definition of healing. . . reshaping current practices into a more humanistic, scientifically rooted body of medicine”

19. ++ therapist’s values & experience !

21. The Gold Standard in Science • Randomized, Double-blind, control studies . . .

22. Randomized, controlled study

23. Double Blind Study

25. Case Series and Case Report Studies

26. Case Control Study

27. Cohort Study

28. Systematic Review or Meta-Analysis

29. Either / Or ?

30. Both / And b o t h a n d * * *

31. ?

32. Whether quantitative or qualitative… • Alt-comp therapies (like allopathic therapies) must be receptive to being studied for their: • Effectiveness • Potential harm • Unintended side-effects • Utility vs other therapy

33. What are Natural Health Products ? • Under the Natural Health Products Regulations, which came into effect on 1 January 2004, natural health products (NHPs) are defined as: • Vitamins and minerals • Herbal remedies • Homeopathic medicines • Traditional medicines such as traditional Chinese medicines • Probiotics, and other products like amino acids and essential fatty acids. • NHPs must be safe for consideration as over-the-counter products, be available for self-care and self-selection and not require a prescription to be sold. Products requiring a prescription will continue to be regulated under the Food and Drug Regulations

34. http://www.hc-sc.gc.ca/hpfb-dgpsa/nhpd-dpsn/index_e.html

35. The Caduceus Asclepius, God of healing

37. World Health Organization

44. Osteopathy

45. 1993 & 1998 Eisenberg US Studies • NEJM in ’93 nat’l phone survey to determine prevalence of use of “unconventional” therapies (eg acu or chiro) • 16 commonly used interventions • Random sample of 1539 adults • 1 in 3 persons used 1 or more U-therapies and 1/3 of these saw an U-therapy provider

46. 1993 Eisenberg US Study • This 1/3 made 19 visits per year with avg cost of $27.60 per visit • Use varied by SES: white, 25-49 yrs with hier educ & hier income leaders in usage • Majority used U-th’s for chronic conditions • 72% did not tell their MD about U-th visits • Extrap to US pop means 425 million visits to alt med vs 388 mill to allo med in 1990

47. 98 Eisenberg • JAMA follow-up from ’93 • Used same process as 93, w 2055 adults • Incr from 33 to 42 % in 97 – used herbal, massage, megavits, self-help groups, folk remedies, energy healing & homeopathy – chronic conditions • A 47 % incr in use of alt med

48. 98 Eisenberg • Incr was due to incr proportion seeking alt med, not to more visits by those already using alt med • 629 million total visits by US pop to alt med practitioners in 97 • Probably a $27 billion out-of-pocket on alt med in 97 thus equal to all out-of-pocket MD expenses in US

49. 1998 CMAJ Study • ’98 survey of all 16 Cdn med schools to determine what educ is provided re UG med ed in alt med • Covered 18 comp therapies selected from Office of Alt Med, Nat’l Institutes of Health (acupunc to reflex) • Most schools do teach alt med but in one course; done via lectures

50. 1998 CMAJ Study • Most consistently taught are acupunc and homeopathic med (10 schools) • Then, in descending order: herbal; chiro; naturop; TCM and biofeedback; osteopathy; shamanism, mass ther & therap touch; finally, yoga, aromatherapy, reflex and native trad healing – only 1 used spiritual healing