Complementary and Alternative Medicine

1. 13 Complementary and Alternative Medicine

2. Learning Outcomes 13.1 Explain CAM. 13.2 Distinguish between complementary and alternative medicine and conventional medicine. 13.3 Summarize how CAM and conventional medicine are used together. 13.4 Identify various types of complementary and alternative medicine.

3. Learning Outcomes (cont.) 13.5 Describe how a medical assistant may use his or her knowledge of CAM. 13.6 Explain why patients and health-care practitioners are turning to complementary treatments. 13.7 Compare insurance and payment for CAM treatments. 13.8 Explain how CAM is regulated. 13.9 Describe health fraud.

4. Introduction • More than 30% of adults use complementary and alternative therapies • Relieve problems • Promote wellness • No relief from traditional treatments • Some physicians use a combination of CAM and traditional therapies

5. What Is CAM? • A group of practices and products that are not part of conventional medicine • Allopathy – conventional medicineor common and usual practice • Complementary medicine– used with conventional medicine • Alternative medicine– used instead of conventional medicine

6. What Is CAM? (cont.) • Scientific evidence concerning safety and effectiveness • Available for some CAM therapies • Research continues, so information changes • Integrative medicine • Evolves as CAM therapies are adopted by conventional medicine • Combination of both

7. Apply Your Knowledge Define CAM and state why these therapies are not in wide use by practitioners of conventional medicine. ANSWER: CAM is a group of practices and products not considered part of conventional medicine. They are not widely used by physicians because there is not a lot of scientific evidence of their safety and effectiveness. Impressive!

8. Shared similarities Individualized treatments, good nutrition, and preventive health practices Holistic Promote self-care and self-healing Recognition of one’s spiritual nature Categories Alternative medical systems Mind-body interventions Biologically-based therapies Manipulative and body-based methods Energy therapies Types of CAM

9. Alternative Medical Systems • Evolved apart from conventional medicine • Homeopathic medicine • Treating syndromes and conditions with remedies that produce similar syndromes and conditions in healthy people • Remedy • Produces the symptoms it is given to treat in order to stimulate the body’s natural defenses to heal itself • Must meet FDA standards

10. Alternative Medical Systems (cont.) • Homeopathic medicine • Looks at individuals, not diseases • Initial in-depth assessment • Follow-up – how they are responding • Medical assistant role • Similar to other medical offices • Have knowledge of common remedies

11. Naturopathic medicine Relies on the healing power of the body to establish, maintain, and restore health Primary health care Nutritional/lifestyle counseling Dietary supplements/medicinal plants Exercise Homeopathy/traditional Chinese medicine Alternative Medical Systems (cont.)

12. Alternative Medical Systems (cont.) • Naturopathic medicine • Medical assistant – understanding of treatments • Traditional Chinese medicine • Balanced qi(vital energy) • Flow of qi along meridians (energetic pathways) • Acupuncture– insertion of hollow needles along meridians • Ayurveda – provides guidance regarding food and lifestyle; India

13. Mind-Body Interventions • Enhance the mind’s capacity to affect bodily function and symptoms • Support groups and cognitive-behavioral therapy now part of traditional medicine • Scientific support • Placebo effect – WW II • 35% of therapeutic response is due to belief

14. Mind-Body Interventions (cont.) • Most commonly used forms of CAM • Types • Prayer • Yoga • Meditation • Hypnosis • Biofeedback

15. Biologically Based Therapies • Use substances found in nature • Dietary supplements • Herbal products • Foods • Medical assistant • Keep up-to-date about dietary and herbal products • Be able to provide reliable resources for patients

16. Recommended daily amount established by the FDA Biologically Based Therapies (cont.) • Dietary supplements • Manufacturers – no evidence of effectiveness or safety • No standardization to ensure consistency and quality • Types • Vitamins • Minerals • Herbals – no established recommended daily amount

17. Biologically Based Therapies (cont.) • Patient education for using supplements • Report all supplements as they would prescription medications • Take supplement bottles to appointments • Document patient’s use of supplements in the medical record

18. Craniosacral therapy Feldenkrais method Rolfing Trager bodywork Tui Na Manipulative and Body-Based Methods • Based on the manipulation and/or movement of one or more parts of the body • Types • Massagetherapy • Chiropractic manipulation • Reflexology • Alexander technique • Bowen technique

19. Reduces pain/relaxes muscle spasms Improves concentration Promotes restful sleep Helps the mind relax Manipulative and Body-Based Methods (cont.) • Massage • Pressure, kneading, stroking, vibration, and tapping to positively affect health • Effects • Relaxation • Counteracts effects of stress • Lowers heart rate and blood pressure

20. Swedish massage Stimulates circulation and lymph flow 5 basic strokes Neuromuscular massage Releases tension, relieves pain and pressure on nerves, and increases blood flow Trigger point therapy Seated massage Focuses on back and neck Manipulative and Body-Based Methods (cont.)

21. Chiropractic medicine Adjustments Manual treatments to re-align the vertebra and restore function of spinal nerves Chiropractor Performs an exam and takes a history Tests X-rays Muscle testing Analyzes posture Manipulative and Body-Based Methods (cont.)

22. Energy Therapies • Bioelectromagnetic-based therapies • Balances the electromagnetic fields of the body • No scientific evidence of efficacy • Magnetic therapy • Most common type • Magnets are used to correct disturbances of electromagnetic fields and restore health • FDA – no medical value but relatively harmless • Avoid for patients with pacemaker or defibrillator

23. Therapeutic touch “Laying-on of hands” Hands direct human energies to help or heal No scientific evidence of efficacy Energy Therapies (cont.) • Biofield therapies • Manipulate energy field surrounding the body • Reiki • Based on qi • Visualization and touchbalance energy flow to bring healing energyto organs and glands

24. Apply Your Knowledge ANSWER: Match to types of CAM: ___ Therapeutic touch A. Energy therapies ___ Chiropractic medicine B. Mind-body therapies ___ Dietary supplements C. Body-based therapies ___ Yoga and meditation D. Biologically-based therapies ___ TCM E. Alternative medical systems ___ Herbal supplements ___ Homeopathy/naturopathy ___ Magnetic therapy ___ Hypnosis ___ Massage A C D B E D E Excellent! A B C

25. Use is increasing Less expensive Have fewer side effects More accessible Increase in spirituality Personal growth Environmentalism Preventive health care Reasons for seeking CAM therapy Failure of traditional medical interventions Treat side effects of conventional medicine’s treatments Patients Seeking CAM Therapy

26. Patients Seeking CAM Therapy (cont.) • Patients with chronic debilitating conditions • Improve quality of life • Improve ability to cope with stress and illness • Cultural differences in CAM use • Hispanics • Native Americans • Accept patient’s right to choose CAM therapy

27. Patients Seeking CAM Therapy (cont.) • Use of CAM in children on the increase • Safety – children respond differently • Efficacy in children not established • Identify and document if CAM is used

28. Apply Your Knowledge Mr. State is complaining about chronic back pain. He says that the medication only helps a little and asks you if there is anything else you could recommend that will help him. What should you tell him? ANSWER: If your employer is not averse to CAM therapies, you can tell him that there are CAM therapies that may help with the pain or at least help him cope better with it. He could try mind-body techniques, acupuncture, manipulative and body-based techniques, or energy therapies. Super job!

29. Insurance and CAM • Coverage varies • Lack of research and documentation of efficacy • Emphasis on physiological or biochemical response to therapies • Alternative health insurance companies emerging in response to need

30. Insurance and CAM (cont.) • Medical assistant • Know whether or not CAM treatments are covered by insurance • Resources • Insurance companies • State agency that regulates the insurance industry

31. Regulation of CAM Therapies • National Center for Complementary and Alternative Medicine (NCCAM) • Research • Training and career development • Conferences and educational programs • Integration of scientifically proven CAM therapies into conventional medicine

32. Regulation of CAM Therapies (cont.) • White House Commission on Complementary and Alternative Medicine Policy (WHCCAMP) • Funding for research • Communication between CAM and conventional practitioners • Availability of CAM practitioners • State review and evaluation of CAM practitioners • Insurance coverage options

33. Apply Your Knowledge • Why do insurance companies not reimburse for most CAM therapies? ANSWER: Insurance companies do not reimburse for CAM therapies because of the lack of research and documentation of effectiveness of these therapies. • What are the federal agencies tasked with regulation of CAM therapies? ANSWER: They are the NCCAM and WHCCAMP. ANSWER: They are the NCCAM and WHCCAMP. Yippee! 2 for 2!

34. Health Fraud • Articles of unproven effectiveness promoted to improve health, well-being, or appearance • Deception or trickery for profit • Plays on emotions and desperation • Regulation • FDA – safety, manufacturing, and labeling • FTC – advertising

35. Health Fraud (cont.) • Health claims • Unproven claims must include a disclaimer • FDA-approved claims for food and supplements • Based on scientific evidence • Only reduces risk/does not treat or cure

36. Health Fraud (cont.)

37. Health Fraud (cont.)

38. Health Fraud (cont.) • Recognizing health fraud • Check with the BBB or attorney general’s office • Check with appropriate health-care group • Contact the FDA • If it sounds to good to be true, it probably is not true • If unproven, get a second opinion • Beware of “secret cures”

39. Apply Your Knowledge Why do people fall victim to fraudulent health claims? ANSWER: These claims target people who are emotional and desperate. They are hoping to find a cure, improve their health, or just look better. Bravo!

40. In Summary 13.1 Complementary and alternative medicines are practices and products outside the scope of traditional or conventional medicine. 13.2 Complementary medicine is used in conjunction with conventional medicine. Alternative medicine is typically used as a replacement for conventional medicine.

41. 13.3 A new type of medicine called integrative medicine has emerged, in which conventional medicine and scientifically proven CAM therapies are used together. 13.4 There are five classifications for CAM. They include alternative medical systems, mind-body interventions, biologically-based therapies, manipulative and body-based methods, and energy. Each of these classifications has various types of products and therapies associated with it. In Summary (cont.)

42. 13.5 As a medical assistant, it is your responsibility to have basic knowledge of CAM therapies. If you work with a practitioner that provides CAM therapies, you will be responsible to assist in many cases. Additionally, understanding insurance reimbursement for CAM and health fraud are important aspects of the medical assistant’s role. In Summary (cont.)

43. In Summary (cont.) 13.6 In many cases, patients are looking for low-cost products and services that help to maintain health and prevent disease, so they turn to CAM. Other patients that are offered no effective treatment or cure from conventional medicine are turning to CAM for additional options. Health-care practitioners are using many types of complementary therapy as they become accepted and, in many cases, scientifically proven.

44. 13.7 In general, the insurance industry provides little or no coverage for CAM therapies. To find out if coverage is provided, you can contact the insurance company directly, obtain information from the association’s web site for the type of therapy provided, or contact the state insurance commissioner. In Summary (cont.)

45. 13.8 The NCCAM conducts and supports CAM research and provides CAM information to health-care providers and the public. Some state and federal laws have been enacted to help regulate CAM, and more laws and regulations are expected as research is conducted. 13.9 Health fraud as defined by the FDA as “articles of unproven effectiveness that are promoted to improve health, well being, or appearance.” Health fraud is monitored by the FDA and the FTC. In Summary (cont.)

46. End of Chapter 13 There is a magnet in your heart that will attract true friends. That magnet is unselfishness, thinking of others first; when you learn to live for others, they will live for you. ~ Paramahansa Yogananda