Malaysian Healthy Ageing Society Overview Of Complementary And - - PowerPoint PPT Presentation

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Dr Siva Poobalasingam Amrita Integrative Health Centre

Overview Of Complementary And Alternative Medicine

• Dr. Sivaneswaran Poobalasingam

Director of Integrative Medicine Amrita Integrative Health Centre TIL0303 Level 3 One IOI Square IOI Resort , Putrajaya

Complementary Medicine is used by up to 80% of the population

WHO

39% reported using some form of CAM therapy

2011 Millenium Cohort Study(United States)

Dr Siva Poobalasingam Amrita Integrative Health Centre

Expenditure

United States(2010)

USD 34 billion annually

Amrita Integrative Health Centre Dr Siva Poobalasingam

Dr Siva Poobalasingam Amrita Integrative Health Centre

Broad domain of healing resources that encompasses all health systems, modalities and practices and their accompanying theories and beliefs

• ther than those intrinsic to the

politically dominant health cycle of a particular society or culture in a give biological period

Cochrane Collaboration

Complementary Medicine

 CAM is a group of diverse medical and

health care systems, practices and products that are not presently considered part of conventional medicine

Amrita Integrative Health Centre Dr Siva Poobalasingam

Amrita Integrative Health Centre Dr Siva Poobalasingam

Complementary Medicine

 Holistic approach to health  Emphasis on disease prevention over

disease treatment

 Deals with patient as a whole  Treatment of the whole patient (body

mind and spirit) versus a single pathogen

Amrita Integrative Health Centre Dr Siva Poobalasingam

Complementary Medicine

 Mind and body linked  Disease stems from a disturbance at the

physical, mental, emotional and spiritual level

 Therapeutic intervention is to restore

balance and facilitate the body’s own healing response

Amrita Integrative Health Centre Dr Siva Poobalasingam

Complementary Medicine

 Complementary medicine dates back to 5000

years

 For centuries complementary medicine kept

people healthy

 Complementary medicine gave birth to modern

medicine

Amrita Integrative Health Centre Dr Siva Poobalasingam

Complementary Medicine

 Complementary medicine

Used together with conventional medicine

 Alternative medicine

Used in place of conventional medicine

 Integrative Medicine

Combines mainstream medicine and CAM therapies

Amrita Integrative Health Centre Dr Siva Poobalasingam

MAJOR TYPES OF COMPLEMENTARY AND ALTERNATIVE MEDICINE

Amrita Integrative Health Centre Dr Siva Poobalasingam

National Center for Complementary and Alternative Medicine

 Classification into 5 categories

 Alternative medicine systems  Mind-Body medicine  Biological based systems  Manipulation and body based methods  Energy medicine

Amrita Integrative Health Centre Dr Siva Poobalasingam

• 1. Alternative medicine

systems



Built upon complete systems of theory and practice



Evolved apart from and earlier than conventional medicine E.g. Homeopathy



Naturopathy



Traditional Chinese Medicine



Ayurveda

Amrita Integrative Health Centre Dr Siva Poobalasingam

• 2. Mind – Body Medicine

 Concept that the mind is important in treatment

is integral in many traditional therapies

 Hippocrates (400B.C) advocated this concept  Varieties of intervention techniques  E.g. Meditation

Yoga Prayer Therapies such as music

Dr Siva Poobalasingam Amrita Integrative Health Centre

Amrita Integrative Health Centre Dr Siva Poobalasingam

• 3. Biologically Based Therapies
• Use substances found in nature such as herbs,

vitamins and foods

• E.g. Dietary supplements

Herbal Products

Amrita Integrative Health Centre Dr Siva Poobalasingam

Amrita Integrative Health Centre Dr Siva Poobalasingam

• 4. Manipulation and Body Based

Methods

• Based on manipulation and/or movement of 1 or

more parts of the body

• E.g. chiropractic manipulation
• steopathic manipulation

massage

Amrita Integrative Health Centre Dr Siva Poobalasingam

• 5. Energy Medicine

 Deals with energy fields  Two types of energy fields:

 Bio-electromagnetic based

therapies(Veritable)

 Bio-fields(Putative)

Amrita Integrative Health Centre Dr Siva Poobalasingam

Energy Medicine

 Bio-electromagnetic based

therapies

• Can be measured
• Uses electromagnetic fields,

mechanical vibrations

• Uses specific wavelengths and

frequencies in therapies

• e.g. magnet therapy

Amrita Integrative Health Centre Dr Siva Poobalasingam

Energy Medicine

Bio-fields

Yet to be measured Based on concept that human beings are

infused with subtle forms of energy

Vital energy or life force Has various names E.g. Qi, ki, prana, orgone, etheric energy Illness results from disturbances of this

energy field

E.g. reiki, qi gong,yoga, healing touch

42% of Americans used CAM in 1998 as compared to 34% in 1990

JAMA

Amrita Integrative Health Centre Dr Siva Poobalasingam

Amrita Integrative Health Centre Dr Siva Poobalasingam

Dr Siva Poobalasingam Amrita Integrative Health Centre

“Less Than 5% of Patients Use CAM on Its Own. More Than 95% Use It Integrated With Modern Medicine.”

Gerard Bodeker, Global Initiative for Traditional Systems (GIFTS) of Health, Institute

• f Health Sciences, University of Oxford,

England.

Dr Siva Poobalasingam Amrita Integrative Health Centre

42% used complementary therapies Of the CAM users 74% used CAM with conventional medicine

Survey done by Landmark Health Care

Dr Siva Poobalasingam Amrita Integrative Health Centre

76% used CAM Among CAM users 95% used integrative medicine

Survey done by National University of Singapore

Malaysia

 65% use CAM  Indians 45% Chinese 32% Malays 22%  78% reported that their condition

improved

Amrita Integrative Health Centre Dr Siva Poobalasingam

Hassan et al. Use of complementary and alternative medicine among patients with chronic diseases at

• utpatient clinics.Complementary therapies in

clinical practice 2009

 Number of hospitals offering CAM has

tripled since 2000

 In 2000 14% of hospitals provided CAM

Amrita Integrative Health Centre Dr Siva Poobalasingam

Amrita Integrative Health Centre Dr Siva Poobalasingam

Commonly Used CAM in Adults

 Herbal remedies

 Echinacea-immune function  Gingko --- Cognitive Function  Saw Palmetto --- Prostrate Enlargement

 Mind-Body Medicine

 Meditation  Yoga

 Chiropractic Manipulation  Acupuncture  Massage

Amrita Integrative Health Centre Dr Siva Poobalasingam

Amrita Integrative Health Centre Dr Siva Poobalasingam

Malaysia

 Nutritional supplements (48%)  Herbal medicine (26%)  Traditional Chinese Medicine (4%)

Amrita Integrative Health Centre Dr Siva Poobalasingam

Hassan et al. Use of complementary and alternative medicine among patients with chronic diseases at outpatient clinics.Complementary therapies in clinical practice 2009

Amrita Integrative Health Centre Dr Siva Poobalasingam

Qi Gong and Taiji

Patients with early stage dementia can slow their physical, mental and psychological decline:

 Improved cognitive function  Improvement in self-esteem  Improvement in physical function

 E.g. balance

Burgeones et.al American Journal of Alzheimer’s Disease and other Dementia, 2008

Amrita Integrative Health Centre Dr Siva Poobalasingam

Amrita Integrative Health Centre Dr Siva Poobalasingam

Yoga

Improvement in sleep quality and mental health indicators

Chen K.M et.al.Sleep quality depression state and healthy status of older adults after Silver Yoga Exercises. Int J Nurs Stud 2008

Amrita Integrative Health Centre Dr Siva Poobalasingam

Yoga

Significant reduction in pain and improvement in energy levels

Groessl EJ et al. Yoga for veterans with chronic back pain. J Altern Complement Med 2008

Research

 CAM therapies not patentable which may

lead to reduced funding from the private sector

 Can be marketed without any proof of

efficacy in contrast to pharmaceuticals.

 Disinterest from manufacturers to fund

scientific research

Amrita Integrative Health Centre Dr Siva Poobalasingam

Amrita Integrative Health Centre Dr Siva Poobalasingam

Common Health Problems

 General Health  Musculoskeletal E.g.Back,hip,arthritis  Anxiety, depression  Sleep disorders  Gastro-intestinal disorders  Diabetes  Coronary artery disease  Hypertension  Allergies  Pain Management

Amrita Integrative Health Centre Dr Siva Poobalasingam

Dr Siva Poobalasingam Amrita Integrative Health Centre

What Are The Reasons For The Use Of CAM?

Dr Siva Poobalasingam Amrita Integrative Health Centre

Majority of patients choosing alternative medicine do so mainly because those approaches are more aligned with their values, beliefs and philosophical

• rientations towards health and life.

JAMA

Why Do People Use Cam?

 Changing needs and values in modern

society contributes to an increase in the popularity of CAM

 An increased sense of entitlement to quality

life

 Increase in public access to health

information

 Reduce tolerance to paternalism

Amrita Integrative Health Centre Dr Siva Poobalasingam

Reasons For The Use Of CAM

 More compatible with patient’s world

views, spiritual philosophy and belief

 80% are satisfied with the treatment they

• receive. Interestingly not always

dependent on a simultaneous improvement in their condition

Amrita Integrative Health Centre Dr Siva Poobalasingam

Amrita Integrative Health Centre Dr Siva Poobalasingam

Perceived effectiveness of alternative therapies

 Japan

 Alternative Therapies

83.5%

 Medical

54 %

 US

 Alternative Therapies

89%

 Medical

81.8%

Flaherty J.H et al.Use of Alternative Therapies in older outpatients in the United States and

• Japan. American Geriatric Society Meeting

2000

Amrita Integrative Health Centre Dr Siva Poobalasingam

Reasons For The Use Of CAM

 Value an emphasis of holistic care  To be actively involved in their own health

promotion and disease prevention

 To promote a sense of well being  To feel that all possible approaches have

been tried

 To improve the odds for total cure

Amrita Integrative Health Centre Dr Siva Poobalasingam

Reasons For The Use Of CAM

 Traditional therapies have been practiced

for centuries and are trusted as good medicine

 Herbs and spices are part of the diet  Have medicinal value

Amrita Integrative Health Centre Dr Siva Poobalasingam

Reasons For The Use Of CAM

 Conventional medicine not effective for the

specific problem

 Rise in prevalence of chronic diseases  Lack of cure for several chronic diseases  Increased side effects  Increased microbial resistance  Emergence of new diseases

Amrita Integrative Health Centre Dr Siva Poobalasingam

Reasons For The Use Of CAM

 High cost of new drugs  Cannot talk to the physician  Too impersonal

Dr Siva Poobalasingam Amrita Integrative Health Centre

“By concentrating on smaller and smaller fragments of the body modern medicine perhaps losses sight of the patient as a whole being, and by reducing health to mechanical functioning it is no longer able to deal with the phenomenon of healing.”

Prince Charles

Amrita Integrative Health Centre Dr Siva Poobalasingam

Amrita Integrative Health Centre Dr Siva Poobalasingam

Concerns

 Majority of patients do not inform their

physicians

 Majority of the physicians are not

educated about the alternative methods their patients are using

Amrita Integrative Health Centre Dr Siva Poobalasingam

Communications With CAM Providers About CAM Use

 Of those aged 50 or older who use CAM,

more than two-thirds (69%) did not talk to their physicians about it.

Amrita Integrative Health Centre Dr Siva Poobalasingam

Common reasons for not discussing with physician

 Physicians never asked them (42%)  They did not know they should (30%)  There was not enough time (19%)

Amrita Integrative Health Centre Dr Siva Poobalasingam

Concerns

 Practice of good medicine

 Working knowledge of treatments patients are using

and their effects

Amrita Integrative Health Centre Dr Siva Poobalasingam

Concerns

 Essential for physicians to have a

knowledge of CAM

 Beneficial, harmful, not of benefit  Reduce risk of unsafe methods, drug

interaction, delay in treatment

 Help patients avoid spending substantial

financial resources on ineffective treatments

Amrita Integrative Health Centre Dr Siva Poobalasingam

Concerns

 Patient delays in seeking medical care  Experienced success with one CAM therapy

for a certain ailment

 Convinced of its efficacy  Extrapolate that success for some other CAM

therapy for more serious life threatening disease

Amrita Integrative Health Centre Dr Siva Poobalasingam

Concerns

 Inadequate product quality control

 Product may be contaminated Other herbs Pesticides Heavy metals Eg.Lead,Mercury Prescription drugs

Amrita Integrative Health Centre Dr Siva Poobalasingam

Concerns

Potential interaction with propriety drugs

Amrita Integrative Health Centre Dr Siva Poobalasingam

Some Interactions

 Gingko

 Commonly used to improve circulation and

cognitive function

 Warfarin and Aspirin  Increased risk of bleeding

Amrita Integrative Health Centre Dr Siva Poobalasingam

Some Interactions

 St. John’s Wort  Commonly used for depression  Interaction:

 Theophylline

 May decrease effectiveness of Theophylline

 Cyclosporin

 May reduce effectiveness

 Oral Contraceptives

 Results in breakthrough bleeding and irregular menstrual

cycles

 Digoxin  May reduce efficacy

Amrita Integrative Health Centre Dr Siva Poobalasingam

Concerns

 Do not view supplements / herbal medicine as

drugs

 Believe they are natural and harmless  Toxicity can result in the way a herb metabolises,

from adulteration and contamination

 Can lead to hepatotoxicity and renal failure

 Eg. Kava

 Safety of herbs not established in pregnant women

and children

Amrita Integrative Health Centre Dr Siva Poobalasingam

Are CAM therapies safe?

 Each treatment needs to be considered on its

• wn

 Individuals respond differently to treatment  Response to CAM depends on:

 Patients state of health  Type of treatment

Amrita Integrative Health Centre Dr Siva Poobalasingam

Are CAM therapies safe?

 Natural does not mean safe  Eg. Mushrooms  Some safe some poisonous  Potential interaction with drugs  Adverse effects of herbs

Amrita Integrative Health Centre Dr Siva Poobalasingam

Are CAM therapies safe?

 1.CAM products sold over the counter

 Safety depends on: Components of the product Origin Quality of the manufacturing process

Amrita Integrative Health Centre Dr Siva Poobalasingam

Are CAM therapies safe?

 2.CAM therapies that are administered by a

CAM practitioner

 Safety depends on:  Training  Skill  Experience

Regulation

 Registration of a product  Registration of CAM practicioners

Amrita Integrative Health Centre Dr Siva Poobalasingam

Education

 United States

 Increasing number of medical colleges have

started offering courses in CAM

 Training of physicians in CAM

 Europe

 Many universities offer some form of CAM

training

Amrita Integrative Health Centre Dr Siva Poobalasingam

Amrita Integrative Health Centre Dr Siva Poobalasingam

Malaysia

 Malaysia is in the process of regulating CAM  Traditional and Complimentary Medicines Act will

integrate CAM practices into the National HealthCare system

 Ministry of Health has commenced a pilot

programme to integrate CAM at various hospitals and will be expanded

 Therapies that will be integrated are post-natal

massage, reflexology and acupuncture

Conclusion

 Popularity of CAM continues to grow  Past utilisation of CAM forecast a

promising future

 CAM is not a short-lived phenomenon or a

radical replacement of conventional medicine

Amrita Integrative Health Centre Dr Siva Poobalasingam

Conclusion

 Integration of complementary medicine

with conventional medicine will shape a healthcare of the future

 Health and wellness

Amrita Integrative Health Centre Dr Siva Poobalasingam

“The greatest remedy,the physician within”

Paracelsus

Dr Siva Poobalasingam Amrita Integrative Health Centre

Amrita Integrative Health Centre Dr Siva Poobalasingam

THANK YOU