Subclasses of IM Overview of 1. Complete Medical Systems - Traditional Chinese Medicine (acupuncture, Integrative Medicine herbs, energy therapies) - Ayyurveda 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 Subclasses of CAM medicine? 3. Biologically-Based Therapies - herbal and dietary supplements • Evolved from Complementary and - nutrition Alternative Medicine (CAM) - functional medicine • CbiCombines ma itinstream me dilthidical therapies 4. Manipulative & Body-Based Methods and CAM therapies - massage • Goal of incorporating complementary - osteopathic or chiropractic manipulation therapies for which there is high-quality 5. Energy Therapies scientific evidence of safety and efficacy - Reiki • Different from alternative medicine - Qi Gong - Therapeutic Touch 1 Integrative Medicine Why Integrative? • Economic burden of chronic disease • Healing-oriented medicine worsening with aging population • Attention to patient’s whole being • 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 Integrative Medicine Why Integrative? • Emphasis on physician-patient relationship • Patients may desire more natural or less- as partnership invasive therapies • Exploration of natural approaches to healing • Current medical system not sustainable • Neither rejects conventional medicine nor • Need to shift towards disease prevention accepts complementary therapies uncritically 2 History of CAM and Integrative Medicine Integrative Medicine and Academics • Long history of “hostile” relations between allopathic and “irregular” practitioners • Multiple centers now with integrative • 3 waves of popularity: medicine programs or services 9 Mid 1800’ s (h omeopath y) , • CtifAdiHlthConsortium of Academic Health 9 1890’s to early 1920’s (naturopathic, osteopathic, Centers for Integrative Medicine chiropractic practices), currently with 44 members 9 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 Who is using CAM? • National Center for Complementary and • 2007 survey conducted by NCCAM – National Alternative Medicine (NCCAM) in 1999 Health Interview Survey • Recognition of new discipline of integrative • More than 23,300 interviews with American adults, and more than 9,400 adults on behalf a medicine child • Full NIH research center with $127.2 million • Included detailed questions on CAM use in prior budget for 2010 12 months • Commitment to studying CAM with well- • Released December 2008: designed randomized trials http://nccam.nih.gov/news/camstats/2007/ 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 • Toxic or detrimental effects of CAM • Drug-herb interactions • Lack of regulation of herbal/dietary supplements • 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 • 2007 governmental survey • U.S. public spent approx $33.9 billion out- of-pocket on CAM over previous 12 months Complete Medical • 11.2% of total out-of-pocket expenditures • $22 billion on CAM self-care costs Systems • 354.2 million visits to CAM practitioners = one-quarter of total out-of-pocket spending on physician visits ($11.9 billion) 5 Complete Medical Systems Acupuncture • Key component of Traditional Chinese Medicine • Traditional Chinese Medicine (TCM) • Practiced for 1000’s of years • Ayurveda • 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 Traditional Chinese Medicine Acupuncture • Chemotherapy-induced nausea and vomiting • Nutrition • Post-op pain • Chinese herbs • Lower back pain • Myypofascial pain • Tai Chi • Osteoarthritis • Headaches • QiGong • Menstrual cramps • Acupuncture • Tennis elbow • Carpal tunnel syndrome • Addiction • Asthma 6 Acupuncture Techniques 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 glass jars • Treats wi de scope of con di ti on s in cl uding prevention • Acupressure – manual pressure applied to acupressure points and meridians • Looks at both medical paradigms • Electroacupuncture – electric current applied to • Affords more holistic approach needle • American Board of Medical Acupuncture Acupuncture Ayurveda • Culturally based healing tradition, • Education and training requirements for licensure originated in India 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 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 certifica tion st and ard Medical Education • Some states with approved Ayurvedic • Doctor of Naturopathic Medicine (N.D.) educational institutions • Licensing requirements vary across states • Current NCCAM-funded studies on: curcuminoids/turmeric, ginger, boswellia • No laws regulating naturopathy in Ohio Naturopathy • Holistic approach, rooted in Germany • Central belief that living organisms have powe r to hea l t he mse lves Mind-Body Therapies • Practitioners prefer most natural and least invasive treatments • Seek to treat cause of disease, not symptoms 8 Mind-Body Therapies Movement Related Meditations • Focus on inducing state of physiological relaxation and stillness • Yoga • Enhance mental and physical awareness • Help recognize negative emotions and • TiTai c hi patterns of thought • Restore physical and psychological well- • Qi gong being • 2nd highest used CAM therapy Mind-Body Therapies • Biofeedback • Breathwork • Guided imagery • Expressive writing Energy Therapies • Art, music, dance therapy • Hypnosis • Meditation • Movement-related meditations • Progressive muscle relaxation (PMR) 9 Energy Therapies Energy Therapies • Reiki • Concept of physical body as an energy field suffused with “life force” • Polarity therapy • Two types of energy fields: • Johrei • Veritable = can be measured • QiGong • 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 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 • 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 practitioners available on-line for most • Current NIH funded studies of Reiki: fibromyalgia, modalities AIDS, prostate cancer, DM II 10 Healing Touch Biologically Based Therapies • Assists in balancing physical, emotional, mental, and spiritual well-being • These therapies use substances found in • Supports natural healing ability nature to treat illness or promote wellness. • Transfer of energy by laying of hands above or 9 Nutrition on the body 9 Supplements • Based in the chakra system 9 Botanicals • Initially developed for nurses 9 Functional Medicine Nutrition • Health effects of food are related to specific Biologically Based interactions on molecular level • Dietary constituents participate in the Therapies regultilation o f gene express ion 9 Modulating the activity of transcription Ruslana Kurpita MD factors through the secretion of OSU Center for Integrative Medicine hormones that in turn interfere with a transcription factor 11 Nutrition - Diets Nutrition • Environmental Nutritional Medicine • Western • Anti-inflammatory 9 Food Additives and Preservatives • Vegetarian • Elimination 9 Food Pesticides, Toxins and • Mediterranean • DASH Conta mina nts • High Fiber • Low Fat 9 Food Storage, Processing and Preparation • High Protein Low Carbohydrate • Drug-Nutrient Interactions (Statins deplete body of CoQ-10) • Inter-Nutrient Interactions (Absorption of Magnesium is hindered by excess fat) Nutrition Supplements • From the mid 1800s to 1980: – Fiber content of Western Diets fell 75% • Vitamins – Sugar consumption rose five-fold to 25% of • Minerals calories • Essential Fatty Acids – Fat intake rose four-fold, replacing starch • Non-essential Amino Acids • According