Subclasses of IM Subclasses of IM Overview of Overview of 1. Complete Medical Systems Integrative Medicine Integrative Medicine - Traditional Chinese Medicine (acupuncture, herbs, energy therapies) - Ayurveda y 2. Mind-body Therapies Linda Chun MD - meditation OSU Center for Integrative Medicine - hypnosis, guided imagery - art or music therapy - yoga, tai chi What is integrative What is integrative Subclasses of CAM Subclasses of CAM medicine? medicine? 3. Biologically-Based Therapies - herbal and dietary supplements • Evolved from Complementary and - nutrition Alternative Medicine (CAM) - functional medicine • Combines mainstream medical therapies C bi i t di l th i 4. Manipulative & Body-Based Methods & and CAM therapies - massage - osteopathic or chiropractic manipulation • Goal of incorporating complementary therapies for which there is high-quality 5. Energy Therapies scientific evidence of safety and efficacy - Reiki - Qi Gong • Different from alternative medicine - Therapeutic Touch 1
Why Integrative? Why Integrative? Integrative Medicine Integrative Medicine • Economic burden of chronic disease • Healing-oriented medicine worsening with aging population • Attention to patient’s whole being • Conventional medicine too dependent on Conventional medicine too dependent on • Consideration of spiritual and emotional costly high-tech approaches, including aspects pharmaceuticals • Focus on supportive and preventative care • CAM provide patients with greater autonomy Why Integrative? Why Integrative? Integrative Medicine Integrative Medicine • Emphasis on physician-patient relationship • Patients may desire more natural or less- as partnership invasive therapies • Exploration of natural approaches to Exploration of natural approaches to • Current medical system not sustainable healing • Neither rejects conventional medicine nor • Need to shift towards disease prevention accepts complementary therapies uncritically 2
History of CAM and History of CAM and Integrative Medicine and Academics Integrative Medicine and Academics Integrative Medicine Integrative Medicine • Long history of “hostile” relations between • Multiple centers now with integrative allopathic and “irregular” practitioners medicine programs or services • 3 waves of popularity: � Mid 1800’ � Mid 1800’s (homeopathy), • Consortium of Academic Health C ti f A d i H lth (h th ) Centers for Integrative Medicine � 1890’s to early 1920’s (naturopathic, osteopathic, currently with 44 members chiropractic practices), � 1960’s and 70’s (massage and acupuncture arise) • OSU joined in 2008 • Renewed interest through 1990’s, with growing challenges of chronic disease and high costs of medical care Increasing Interest Increasing Interest Who is using CAM? Who is using CAM? • National Center for Complementary and • 2007 survey conducted by NCCAM – National Health Interview Survey Alternative Medicine (NCCAM) in 1999 • More than 23,300 interviews with American • Recognition of new discipline of integrative adults, and more than 9,400 adults on behalf a medicine medicine child • Full NIH research center with $127.2 million • Included detailed questions on CAM use in prior 12 months budget for 2010 • Released December 2008: • Commitment to studying CAM with well- http://nccam.nih.gov/news/camstats/2007/ designed randomized trials 3
http://nccam.nih.gov/news/camstats/2007 http://nccam.nih.gov/news/camstats/2007 http://nccam.nih.gov/news/camstats/2007 http://nccam.nih.gov/news/camstats/2007 4
Issues of Concern Issues of Concern • Toxic or detrimental effects of CAM • Drug-herb interactions • Lack of regulation of herbal/dietary supplements • Reduction of effectiveness of conventional • Reduction of effectiveness of conventional therapy • Physicians unaware of patient CAM use • True effectiveness versus placebo • Lack of reimbursement for costly therapies • Ethics of a consumer-driven market http://nccam.nih.gov/news/camstats/2007 Spending on CAM Spending on CAM • 2007 governmental survey Complete Medical Complete Medical p p • U.S. public spent approx $33.9 billion out- of-pocket on CAM over previous 12 months • 11.2% of total out-of-pocket expenditures Systems Systems • $22 billion on CAM self-care costs • 354.2 million visits to CAM practitioners = one-quarter of total out-of-pocket spending on physician visits ($11.9 billion) 5
Acupuncture Acupuncture Complete Medical Systems Complete Medical Systems • Key component of Traditional Chinese Medicine • Traditional Chinese Medicine (TCM) • Practiced for 1000’s of years • Ayurveda Ayurveda • Health achieved by maintaining balance of yin Health achieved by maintaining balance of yin and yang • Naturopathy • Flow of Qi (vital energy) through meridians • Homeopathy can be blocked, deficient, excessive, imbalanced • Influence Qi at acupuncture points with thin, metallic needles Common Indications for Common Indications for Traditional Chinese Medicine Traditional Chinese Medicine Acupuncture Acupuncture • Chemotherapy-induced nausea and vomiting • Nutrition • Post-op pain Lower back pain • • Chinese herbs Myofascial pain y p • • Tai Chi • Osteoarthritis • Headaches • QiGong • Menstrual cramps • Acupuncture • Tennis elbow • Carpal tunnel syndrome Addiction • Asthma • 6
Acupuncture Techniques Acupuncture Techniques Medical Acupuncture Medical Acupuncture Moxibustion – therapeutic application of heat to • acupuncture points by burning herb ( Artemesia • Combination of Western medicine and TCM vulgaris ) concepts • Cupping – applying suction to skin with small • Treats wide scope of conditions including eats de scope o co d t o s c ud g glass jars glass jars prevention • Acupressure – manual pressure applied to • Looks at both medical paradigms acupressure points and meridians • Affords more holistic approach • Electroacupuncture – electric current applied to needle • American Board of Medical Acupuncture Ayurveda Ayurveda Acupuncture Acupuncture • Culturally based healing tradition, originated in India • Education and training requirements for licensure vary from state to state • Emphasis on maintain balance of doshas • In Ohio, acupuncture considered an extension of branch of medicine • Digestion considered root of all health • Medical license or licensed acupuncturist • Diet, lifestyle, herbs, meditation, yoga, (following training at accredited school) panchakarma (detoxification), jyotisha, Chinese herbal medicine excluded from scope of • abhyanga (oil massage) practice of acupuncture in Ohio 7
Ayurveda Ayurveda Naturopathy Naturopathy • Ayurvedic training in India either • 4 naturopathic medical schools in U.S. bachelor’s or doctorate degree • Accredited by Council on Naturopathic • U.S currently without educational or Medical Education Medical Education certification standard tifi ti t d d • Doctor of Naturopathic Medicine (N.D.) • Some states with approved Ayurvedic educational institutions • Licensing requirements vary across states • Current NCCAM-funded studies on: • No laws regulating naturopathy in Ohio curcuminoids/turmeric, ginger, boswellia Naturopathy Naturopathy • Holistic approach, rooted in Germany • Central belief that living organisms have power to heal themselves po e to ea t e se es Mind Body Therapies Mind Body Therapies Mind-Body Therapies Mind-Body Therapies • Practitioners prefer most natural and least invasive treatments • Seek to treat cause of disease, not symptoms 8
Mind-Body Therapies Mind-Body Therapies Movement Related Meditations Movement Related Meditations • Focus on inducing state of physiological • Yoga relaxation and stillness • Enhance mental and physical awareness • Tai chi T i hi • Help recognize negative emotions and patterns of thought • Restore physical and psychological well- • Qi gong being • 2 nd highest used CAM therapy Mind-Body Therapies Mind-Body Therapies • Biofeedback • Breathwork • Guided imagery Energy Therapies Energy Therapies Energy Therapies Energy Therapies • Expressive writing • Expressive writing • Art, music, dance therapy • Hypnosis • Meditation • Movement-related meditations • Progressive muscle relaxation (PMR) 9
Energy Therapies Energy Therapies Energy Therapies Energy Therapies • Reiki • Concept of physical body as an energy • Polarity therapy field suffused with “life force” • Johrei • Two types of energy fields: • QiGong • QiGong • Veritable = can be measured • Therapeutic touch • Putative = have yet to be measured • Healing Touch • Qi (TCM) or prana (Ayurveda) • Yoga • Free balanced flow of energy necessary for • Acupuncture health • Zero balancing Energy Therapies Energy Therapies Reiki Reiki • Potential adjunctive therapies to medical • Japanese based energy field therapy management • Idea of universal energy that supports the body’s • Negligible negative side effects if properly innate healing abilities used used • Practitioners channel this energy through hands • Useful to match patient’s belief system to into patient’s body available modalities • Self-care • Certification guidelines and directories of • Current NIH funded studies of Reiki: fibromyalgia, practitioners available on-line for most AIDS, prostate cancer, DM II modalities 10
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