460 – Module 2, Winter 2006
Philosophy and Basis for Alt / Comp
[ ** Note: there are a few slides with notes below them ]
Street Lamp Interference – SLI & SLIders
• Appliances such as lamps and TVs go on and off without being touched
• Light-bulbs constantly blow when the SLIder tries to turn them off or on
• Volume levels change on TVs, radios, and CD players
• Watches stop working• Children's electronic toys start by themselves
when the SLIder is present • Credit cards and other magnetically encoded
cards are damaged or erased when in their possession
• Mind-Body Medicine implications re chapter 3
ancientEgyptianvaginal speculum
Historical Background & Precedents re Health-
Medicine
• Flexner Report of 1910• Cited as THE most important event
in the history of Cdn and American med educ
• Abraham Flexner was sec school teacher who went on to do grad work in educ research w Carnegie Foundation
Historical Background & Precedents
• Report was effort to reform med schools that were without standards and more for-profit than educ
• Virtually guillotined all other forms of med ed toward German tradition of strong biomed sciences and hands-on clinical tr
• Thus in N America, western medicine flourished, trad medicine/healing went “underground”
1970s
• Resurgence of interest in altern ther’s
• Chiropractic med took initiative along with osteopathic MDs
• Mainstream allopathic med continued to ignore alt med
1993 & 1998 Eisenberg US Studies – “classic” in the
field
• NEJM in ’93 nat’l phone survey to determine prevalence of use of “unconventional” therapies (ex: acu or chiro)
• Random sample of 1539 adults• 16 commonly used interventions• 1 in 3 persons used 1 or more U-
therapies and 1/3 of these saw an U-therapy provider
1993 Eisenberg US Study
• This 1/3 made 19 visits per year with avg cost of $27.60 per visit
• Use varied by SES: white, 25-49 yrs with hier educ & hier income leaders in usage
• Majority used U-th’s for chronic conditions
• 72% did not tell their MD about U-th visits
• Extrap to US pop means 425 million visits to alt med vs 388 mill to allo med in 1990
98 Eisenberg
• JAMA follow-up from ’93• Used same process as 93, w 2055
adults• Incr from 33 to 42 % in 97 – used
herbal, massage, megavits, self-help groups, folk remedies, energy healing & homeopathy – chronic conditions
• A 47 % incr in use of alt med
98 Eisenberg
• Incr was due to incr proportion seeking alt med, not to more visits by those already using alt med
• 629 million total visits by US pop to alt med practitioners in 97
• Probably a $27 billion out-of-pocket on alt med in 97 thus equal to all out-of-pocket MD expenses in US
The Prevalence of CAM in Cdn Med Schools: 1998 CMAJ Study
• ’98 survey of all 16 Cdn med schools to determine what educ is provided re UG med ed in alt med
• Covered 18 comp therapies selected from Office of Alt Med, Nat’l Institutes of Health (acupunc to reflex)
• Most schools do teach alt med but in one course; done via lectures
1998 CMAJ Study
• Most consistently taught are acupunc and homeopathic med (10 schools)
• Then, in descending order: herbal; chiro; naturop; TCM and biofeedback; osteopathy; shamanism, mass ther & therap touch; finally, yoga, aromatherapy, reflex and native trad healing – only 1 used spiritual healing
1998 CMAJ Study
• Only 2 schools provide instruction in use of alt meds (yoga, mt, chiro) w most stating MD could seek tr by pref
• Schools felt they should provide general conceptual overview
• **Need to understand alt med as part of patients’ health care belief system
• Very little alt med tr in UK; most of US’s 125 med schools incorp some alt courses
Readings to Date
Read for Module 1:• Text chapters 1 & 3• 1st reading on web site under Links, “Folk Remedies” (pdf)• Print the Glossary of Terms from Links on
web site
Read for Module 2:• Text chapters 2 & 4; read 2 for Thursday • “Are you Considering Using CAM” from Links• Irwin & Morrow article
Folk Remedies Among Ethnic Subgroups ~ reading
• “Folk medicine” in ’99 included ?• Data source for the study ?• Importance of individual’s cultural
beliefs and practices ~ used Health Belief Model (HBM) to summarize these [ perceived benefit vs perceived threat factor in selecting health action]
Folk Remedies Among Ethnic Subgroups ~
commonalities:
• Understanding illness & making decisions about treatment action:
~ cause of illness an imbalance ~ emphasis on personal responsibility ~ complex, multicausal or holistic view of dis-ease etiology ~ various kinds of energy
Folk Remedies Among Ethnic Subgroups ~
interpretations:
• Findings re SES factors ?• Effectiveness of Folk Rs ? • Note problems of cost in study
designs for effectiveness data• *”lack of scientific evidence”
- ? ?
Folk Remedies Among Ethnic Subgroups ~ clinical
implics:• Cultural beliefs MUST be considered• Open communic betw clinicians and patients
is critical• Safety and efficacy of concern to both• Major conclusion: “Folk medical practices
arise out of the synergy of individual beliefs, cultural beliefs, and biomedical concepts about illness and treatment”
• Most folk remedies “harmless” – bias? And some “serious” side effects
• Note the recommendations to the Am Medical Assoc
Text – chapter 1: Basic Principles
• The Hippocratic Oath ~ Dr Louis Lasagna! • “outdated, degrading, and inappropriate
for the modern reality of medicine” ?• Note distinctions betw holistic and
reductionistic; Flexner Report; Heroic medicine; resurgence of traditional med
• Key factors etc in the concept of Integrative Medicine ~ any questions about those ?
Text – chapter 3: Mind-Body Medicine
• What is the essence or basic premise of M-B Med ?
• How has it become AND how is it integrative ?
• What are some examples of M-B Med ?• What are the characteristics of M-B Med?• What evidence do we have re M-B Med ?• What can you interpret about M-B Med from
the 4 cases presented in the chapter ?
Text Chapter 3: Mind-Body Med: 4 Primary Human Intelligence Systems
• Thought; Emotions; Body; Perceptions
• These 4 are congruent• Means a change in one is mirrored in
all others• Just another way of looking at mind-
body as more than an intellectual mind in a physical body
Behavioural Interventions:Asking Questions
Coaching Example
For every winner, there are dozens of losers: odds areyou’re one of them
Defeat[ de-feet !]
The key to life is balance
Life Coaching
• Counselling, or therapy, often looks to the past in order to discover, heal and understand. Life coaching, on the other hand, looks to the future in order to make a good life even better. In coaching, the starting point is the client's desire for personal and /or professional change
• Coaching focuses on forwarding all aspects of the client's ordinary life toward an extraordinary life
• Coaching is not about how you came to be who you are; it's about getting you from where you are now to the future that you want
What we have in our lives
_______________________________-10 0 +10
MUST eliminate really, REALLY want
L I F E with Style
Stress & Struggles
Most fulfillinglife possibilities??
?
Client Coach
Relationship
Co-Active Coaching: Either/or vs AND
• Co-active means acting in concurrence, united in action
• Co-active coaching like hiring a friend, having a personal navigator
• Fundamental skill in co-active coaching is
Fulfillment
Process
Balance
Designed Alliance
Curiosity
Listening
Intuition
Action / learning
Self-management
Dance in the moment
Agenda from client
Whole life is involved
NRCW© The Coaches Training Institute
The Co-Active Coaching Model ©
Evidence Base for Coaching ?
• Thousands of testimonials …
• Irwin-Morrow req’d reading
• What validates this model according to your reading ?
Fulfillment, Balance, & Process
• Person is always somewhere in her/his life and always in flow of that life
• Coach takes client somewhere juicy or rich or compelling, that is into:
~ Fulfillment, or ~ Balance, or
~ Process
©The Bigger Game Company
The SIZE and quality of
the game you play designs who you are becoming
So, what skills for coaching ?
• Listening• Curiosity• Intuition• Forwarding into action / deepening
athlete’s learning• [ self management ]• For the sake of what ? – living fully
into the life each person wants
Coaching and CAM / Integration
• Coaching as an alternative for ‘healthy’ living, living into full human potential
• More a behavioural intervention than a therapy
• reading offers a way of providing evidence for efficacy of coaching
• Cannot do randomized, double-blind study
• We do need more ways to validate coaching