Complementary & Alternative Medicine (CAM) Naveen Mehrotra, MD, MPh, FAAP Clinical Assistant Professor Department o

1. Complementary & Alternative Medicine(CAM)Naveen Mehrotra, MD, MPh, FAAPClinical Assistant Professor Department of Pediatrics RWJMS

2. BELIEFS About CAM Providers • Consider mind and body to be single entity • Good health is a positive state, not merely the absence of disease • Body can often heal without medication • Look at the whole patient rather than one organ • Impact of the total environment on body

3. CAM use among Asian-AmericansJ Altern Complement Med 2006; 12(10):1003-10 • Nearly three quarters of 9187 Asian Americans surveyed reported at least one type of CAM in the past 12 months • Chinese Americans had the highest prevalence (86%) of any CAM use whereas South Asians had a prevalence of 67% • Spirituality was the strongest predictor of any CAM use for most Asian-American subgroups

4. CAM use among Asian-AmericansResults of the National Health Interview Survey for 917 Asian Americans and 20,442 Non Hispanic WhitesJ Gen Intern Med. 2007; 22(6): 762-7 • 42% of Asian Americans were likely to use some sort of CAM therapy • Use of Mind/Body therapies in Asian Indians (31%), Chinese (21%) and Filipinos (22%) • Herbal Medicines in Chinese (32%), Filipinos (26%), and Asian Indians (19%) • Among Asian Americans, CAM use was associated with being female, higher education, and having a chronic medical condition

5. CAM use among Chinese Americans:Findings from a community mental health service populationPsychiatr Serv. 2007; 58(3):402-4 • 82% of people surveyed reported current use of CAM • 46% reported megavitamin therapy • 43% reported herbal medicine • 25% each reported use of massage, acupuncture, and spiritual healing • CAM users were older, female, employed, less well functioning physically and less acculturated

6. CAM use in developmental disabilitiesMent Retard Dev Disabil Res Rev. 2005; 11(2):107-9 • Reported rates for CAM use in children with developmental disabilities may be higher • May relate to hope for amelioration of symptoms • May be related to concerns regarding side effects of conventional treatments • Need on the part of families to participate in decision making

7. Types of Alternative Therapies Used by Children in an Indigent PopulationResults of a Pilot study at SIUH. Mehrotra et.al. • Massage Therapy 11.7% • Spiritual Healing 4.9% • Lifestyle Diets 1.0% • Herbal Medicine 3.9% • Megavitamin Therapy 4.9% • Folk/Home Remedies 17.5% • Others 2.9% • Total 46.8%

8. Factors Influencing Use of CAM • Word of Mouth 32% • Fear of drug side effects 21% • Chronic medical problem 19% • Dissatisfaction with conventional medicine 14% • More personalized attention 9% • Other reasons 5%

9. National Projections of Expenditures for CAM Category of Expenditures Dollars (Billions) Services of Providers of CAM 11.7 Megavitamin supplements 0.8 Commercial Diet Supplements 1.2 Estimated Total 13.7 Eisenberg DM et.al. Unconventional medicine in the US. N Engl J Med. 1993; 328: 246-252

10. Common Disorders Treated by CAM • Asthma Acupuncture, Herbal • Cancer Hypnosis, Relaxation, Megavitamins • Arthritis Copper bracelets, dietary restrictions • Other disorders like stroke, cystic fibrosis, Downs’ syndrome, atopic dermatitis

11. CAM Therapeutic WheelKathi Kemper Model

12. Biochemical Therapies Herbal Remedies, Nutritional supplements Herbal medicine: extracts used from flowers, fruit, leaves, roots, stems, and seeds: one of the oldest form of medicine used all over the world (Ayurveda in India, Chinese herbal medicine)

13. Medications with Plant Origin • Digoxin- foxglove • Vincristine and Vinblastine- periwinkle plant • Morphine, codeine, and other opioids-opium poppy • Atropine- belladonna • Penicillin- mold • Aspirin- salicin in the willow bark • Ephedrine- ephedra plant • Senna- laxative from the senna plant • Caffeine- coffee beans • Taxol- anticancer from the yew tree

14. Commonly used Herbal Products Teas: green and black tea- polyphenols in tea protect body cells from damage, the fluoride wards off dental decay, tannins have antiviral and antibacterial properties, theophylline and theobromine dilate the airways, and the caffeine acts as a stimulant Studies suggest that 4 to 6 cups of green tea a day have a decreased incidence of cancer of lungs, liver, pancreas, esophagus, breast, and skin.

15. Commonly used Herbal Products Echinacea • a herb found in the midwest used by the American Indians as an anti-infective agent • taken orally to stimulate the immune system (causes the WBC’s to migrate to the wound area, increases the T4 helper cells, the interferon levels, and increases the formation of fibroblasts)

16. Commonly used Herbal Products Chamomile A Eurasian variety Marticaria recutita is more widely used in the US. Used to get a better night’s sleep, antiflatulent, inhaled chamomile tea relieves bronchial congestion, a sitz bath relieves hemorrhoids, improves eczema, moistens dry skin, etc.

17. Commonly used Herbal Products Feverfew Comes from Tanacetum parthenium, a member of the chrysanthemum family and is found all over the United States Used against inflammation, fever, menstrual cramps, and migraines. (Migraine attacks are preceded by the clumping of platelets which produce excess serotonin; a chemical in the name of parthenolide found in feverfew acts by interfering with the aggregation of platelets.

18. Commonly used Herbal Products Others Ginger: used for nausea and motion sickness Ginseng: used to increase sex drive, longevity, energy, and appetite Purity of herbal products, the processing, the age of the product all play a role in the effectiveness of the product.

19. Lifestyle Therapies Megavitamin and Megamineral Therapy Vitamins and minerals in large doses are used as primary therapy for certain medical conditions (based on Pauling’s orthomolecular theory of the provision of the optimum concentration of substances normally present in the human body) Ex: use of Vit C and the common cold

20. Lifestyle Therapies Macrobiotic Diet A diet that promotes physical, mental, emotional, and spiritual health and harmony to live life to the full potential Diet aims to balance foods for their yin-yang qualities of the individual Primary goal is to eat foods in the middle range such as grains, which are neither extreme yin nor yang and thereby achieve a healthy and harmonious life

21. Lifestyle Therapies Mind-Body Therapies Biofeedback (use of electrical or mechanical devices to increase the awareness of the physiological activity of a muscle by providing the patient with visual, verbal, and/or auditory information) Patient learns to recognize the physiological activity of a muscle, a response that was previously not recognized but is under the patient’s control, and he/she can learn to respond appropriately and gain control over his muscle by trial and error (e.g. functional constipation) Hypnosis used in nocturnal enuresis

22. Biomechanical Therapies Massage Therapies Aim to relax and relieve the body, mobilize stiff joints, improve blood, muscular, and nervous systems Swedish types of massage: Effleurage (slow, rhythmic, light and deep-pressure fingertip, hand, knuckle, and thumbs massage strokes- often used in conjunction with aromatherapy oils) Friction (use fingertips, thumb pads, and the heels of the hand in small, circular pressure movements to free stiff and locked joints, improve circulation, and treat damaged or strained ligaments) Percussion (vigorous drumming massage in which the sides of the hand deliver fast, rhythmic chops to well-padded parts of the body, such as the back, buttocks, and thighs) Petrissage (kneading dough like movements: hands grasp, squeeze, roll, and release whole sections of muscles, used to improve circulation and to relax controlled muscles.

23. Biomechanical Therapies Chiropractic Manipulation of spine and extremities by the hands to stretch muscles, unlock joint, and correct problems in other parts of the body that have originated from the spine. In addition, heat, ice, or ultrasound waves may be used.

24. Bioenergetic Therapies Acupuncture Ancient Chinese form (life force called “qi” dominates every living being) Yin and yang must be in balance or harmony before qi can get our vital functions to work normally Qi flows along fourteen invisible, interconnected main channels on each side of the body. These meridians surface at various locations on the body, called acupuncture points (about 360 have been identified) Imbalance between the yin and yang and the five elements of the universe (wood, fire, earth, water, and metal) cause lactic acid and carbon monoxide to build up in the muscles Stimulating the appropriate acupoints dissipates the buildup and restores the yin and yang Western scientists have shown that stimulating an acupoint releases endorphins which reduces the perception of pain

25. Bioenergetic Therapies Homeopathy Based on the theory that a substance that produces symptoms in a healthy individual could cure symptoms in a sick person Substance is diluted into infinitessimal amounts (expressed as C1, C2, etc) and given to the patient as treatment Homeopathic doctor studies the whole person and takes into account the idiosyncrasies, reactions to heat and cold, weather, and food, sleep and work patterns, age and environment, before he prescribes any medication

26. CAM Therapeutic WheelKathi Kemper Model

27. Practitioner’s Approach to Alternative Medicine • Should be aware of the use of CAM in their patients • Should ask about it as part of the medical history • Should have an open attitude and be non-judgemental