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Integrative Medicine

“Integrative medicine recognizes the importance of the relationship with the patient, seeing it as the central therapeutic element.” – CURRENT Medical Diagnosis & Treatment 2014. Integrative Medicine. What is “integrative medicine”?.

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Integrative Medicine

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  1. “Integrative medicine recognizes the importance of the relationship with the patient, seeing it as the central therapeutic element.” – CURRENT Medical Diagnosis & Treatment 2014 Integrative Medicine

  2. What is “integrative medicine”? http://cowpu.com/april-meeting-seo-not-just-for-snake-oil-salesmen/ common misperception http://mydoctorsf.com/specialties/integrative-medicine.html actual clinical practice

  3. Definitions Understanding and dispelling the “buzzwords” of common practice • Alternative Medicine – therapies used in place of conventional care • Complementary Medicine – therapies used in conjunction with mainstream medical therapies; these therapies do not replace medical regimens for serious medical problems but are offered to support the patient and family • Integrative Medicine – integration of complementary and alternative medicine (CAM) therapies into mainstream medical practice based upon evidence of safety and effectiveness within the context of relationship-based care promoting optimal health and well-being UpToDate: Overview of complementary and alternative medicine in pediatrics.

  4. NIH Classifications of CAM • Biologically-based therapies (eg, use of natural products such as fish oil, probiotics, botanical medicines) • Mind-body medicine (eg, biofeedback, meditation, guided imagery) • Manual medicine (eg, osteopathy, massage therapy, chiropractic) • Energy medicine (eg, Reiki, therapeutic touch) • Whole systems (eg, traditional Chinese medicine, homeopathy) Barrows K. Chapter e5. Integrative Medicine. In: Papadakis MA, McPhee SJ, RabowMW. eds. CURRENT Medical Diagnosis & Treatment 2014. New York: McGraw-Hill; 2014.

  5. Current use of CAM therapiesData published in 2010 by the National Health Interview Survey conducted through the Centers for Disease Control • Nearly 40% of Americans reported some use of CAM therapies in the last year • The most common conditions people sought treatment for included back/neck pain, arthritis, cholesterol management and anxiety • An estimated $36 billion is spent annually on such practices, representing 11.2% of out-of-pocket medical expenditures

  6. Why is this important? • While you may not feel integrative medicine is applicable to your practice, one survey found nearly 70% of patients participating in CAM therapies did disclose this information to their physicians. Barrows K. Chapter e5. Integrative Medicine. In: Papadakis MA, McPhee SJ, RabowMW. eds. CURRENT Medical Diagnosis & Treatment 2014. New York: McGraw-Hill; 2014.

  7. As EBM becomes a more integral part of a clinician’s life, Integrative Medicine by definition strives to ensure patient safety through similar peer review. Evidence for the use of Integrative Medicine

  8. Mind-body medicine • Level of Evidence: • A = high quality (consistent from randomized trials or overwhelming evidence from other sources) • B = moderate quality (randomized trials w/ important limitations or very strong evidence from other sources • C = low quality (observational studies or randomized trials w/ serious methodological flaws Barrows K. Chapter e5. Integrative Medicine. In: Papadakis MA, McPhee SJ, RabowMW. eds. CURRENT Medical Diagnosis & Treatment 2014. New York: McGraw-Hill; 2014.

  9. Biologically-based therapies • Aged Garlic in the Tx of HTN • Patients w/ previously treated and still uncontrolled HTN (SBP>140mmHg) saw an average SBP 10mmHg lower than the placebo group over a 12wk treatment period – 2010 Australian double-blind parallel randomized placebo controlled trial Ried K et al. Aged garlic extract lowers blood pressure in patients with treated but uncontrolled hypertension: a randomized controlled trial: Maturitas. 2010 Oct;67(2):144-50. kid-reborn.blogspot.com

  10. Acupuncture • Studies have investigated use in many areas including post-operative pain, nausea/vomiting, headaches and addictions • A 2008 systematic review of 15 RCTs w/ sham control for acute post-operative pain showed a significant reduction in intensity and opioid consumption Sun Y et al. Acupunture and related techniques for postoperative pain: a systematic review of randomized controlled trials. Br J Anesth. 2008. Aug;101(2):151-60.

  11. Integrative Medicine Board Certification In 2013 it was announced that 2014 will be the first year the American Board of Physician Specialties will begin certifying physicians in the area of Integrative Medicine. www.prwed.com

  12. What will this SIG be for you? Integrative Medicine SIG

  13. Goals for the SIG • Meetings with practitioners of various CAM methods • SIG dinners • Community outreach endeavors • Julian Center • Wheeler Mission • Volunteer Opportunities • MS1&2s in leadership positions

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