Alternative Medicine

November 29th 2002

Gil C. Grimes, MD

General Data

The Diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, satisfying a demand not met by orthodoxy, or diversifying the conceptual frameworks of medicine

Ernst E et al. Complementary medicine- a definition. BJ Gen Prac 1995, 45:506

General Data

Landmark Report 1998 random sample adults USA42% used CAM in last year17% herbal therapy16% chiropractic14% massage

General Data

Austin 1998Random sample 1500 adults (80% white,

51% female 30% high school ed or less)Have you used CAM in last year

40% Yes16% chiropractic8% lifestyle diet7% exercise7% relaxation

General Data

Who is using?People with chronic health problemsMore common caucasianMore common womenMore educated

General Data

$13.7 billion unconventional therapy

$10.3 billion (75%) out of pocket

$12.8 billion out of pocket for all hospitalizations in the United States

1990 data

Eisenberg DM et al, N Engl J Med 1993 Jan 28;328(4):246-52

General Data

Increase 45.2% between 1990 and 1997

estimated at $21.2 billion 1997

$12.2 billion paid out of pocket

Eisenberg DM et al, JAMA 1998; 280:1569-1575

Getting the Truth

InforetrieverCochrane reviewNational Center for Complementary and Alternative MedicineAlternative Medicine Homepage University of PittsburghBritish Homeopathic LibraryNatural Medicine Database

Type of CAM

Herbal Medicine

Acupuncture

Nutrition

Exercise

Homeopathy

Manipulation

Massage

Meditation

Herbal Medicine

Various Forms Crude plant preparations Dried specimen Aqueous extract Tinctures Active ingredients

Herbal Medicine

Choosing the product Degree of purity Variation in potency

Look for the following Lot number Expiration date Analysis of ingredients

Acupuncture

2000 year tradition

Osler was aware of acupuncture

Alters conduction of electromagnetic signals

Alters neurotransmitters in brain

TCM relates this to a release of the Qi that is blocked

Acupuncture

EfficacyAdult postoperative N/V (1b) JAMA 1998;280:1518-24 Chemotherapy N/V (1b) JAMA 2000;284:2755-61Chronic neck pain (1b)BMJ 2001;322:1574Headache (cochrane)Menstrual cramps (cochrane)Tennis elbow, myofascial pain, carpal tunnel syndrome

National Center for Complimentary and Alternative Medicine

Acupuncture

Trouble with blinding

Sham Needles

Blinding Evaluators

Exercise

Benefits Improved respiratoryLower BPMore efficient CO Increases insulin sensitivity Improves utilization of FFA from adipose

Exercise

Physician advice Meta-analysis DARE abstract 971480

demonstrate efficacy of counseling

Exercise Rx Type of activity (aerobic etc) Intensity (60-90% Max Heart rate)

(220-Age) x 0.60 or 0.90 gives low and high end of target heart rate

Work longer low end and short bursts in high end

Exercise

Exercise RxDuration

Inversely proportional to the intensityRate fatigue one hour after exercise to judge

Frequency3-5 sessions per weekNo greater than 48 hours off

Exercise

Three phases of exerciseWarm upConditioningCool downStretch some before and always after

Homeopathy

Treats illness with progressively dilute substances that produce similar pattern of injury

Treating like with like

Therapy is individualized to the patient

Meta-analysis of homeopathy trials Lancet 1997;350:834-43

Cystitis

CranberryRandomised trial of cranberry-ligonberry

juice and Lactobacillus GG drink for the prevention of UTI in women. BMJ2001;322:1-5 (LOE 1c)

Glass of unsweetened cranberry juice a day

NNT=5 at 12 months to reduce frequnecy of UTI from 36% to 16%

Migraine

Riboflavin 400 mg Riboflavin daily (LOA 1b) NNT= 2.8 to reduce frequency of attacks per

month (56% to 19%) NNT= 2.3 reduce headache days (59% to 15%) Effectiveness of high-dose riboflavin in migraine

prophyloaxis: a randomized controlled trial.

Neurology 1988; 50:466-70

Morning Sickness

Ginger root (LOE 1b)250 mg powdered ginger root before meals

and bedtime (1 gm per day)Small double blinded placebo controlled

randomized trialDecreased vomiting

Obstet Gynecol 2001; 97:577-82

Morning Sickness

Vitamin B625- 50 mg 2-3 times daily

Acupressure Wrist band on P6 point

Reduced severity of nausea

Cochrane Library, Issue 2, 2002

Osteoporosis

Calcium and Vitamin D500mg Ca++ and 700 IU Vit D (LOE 1b)Better bone densityFewer fractures over 3 years (5.9% vs

12.9%)

Effect of calcium and vitamin D supplementation on bone mineral density in men and women 65 years of age or older. NEJM 1997; 337: 670-6

Menopause

Soy supplementation

60 gm soy protein daily (LOE 1b)Decreased frequency and severity of hot

flushes

The effect of dietary soy supplementation on hot flushes Ob Gyn 1998;91:6-11

Warts

PodophyllumThe rhizomes are used as a catharticResin extracted used as an irritant

Closing

Ask your patients

Ask more than once

Ask about vitamins or supplements