Safely Sailing Uncharted Waters - Holistic Health - CAM


	"Your playing small doesn't serve the world. There's nothing enlightened about shrinking so that other people won't feel insecure around you. We are all meant to shine, as children do. " Marianne Williamson

SAFELY SAILING UNCHARTED WATERS ™

Complementary and Alternative Medicine (CAM) is largely unregulated in the US. There are oceans of information on the Internet, much of which is confusing and conflicting. Regardless of manufacturer and treatment provider claims, most therapies and products remain scientificaly unproven. Importantly, some have been shown to be ineffective, and others are known to be harmful or potentially harmful, especially when taken in unnatural amounts or with specific prescription drugs.¹ In spite of this, over 36% of the U.S. population has used some type of CAM in the past 12 months.² How do you stay safe or keep your patients or clients safe when wading into this unproven, largely unregulated medical area?

As illustrated by the U.S. conducted peer-reviewed research listed below, it is becoming increasingly important for health care providers to have a basic understanding of Complementary & Alternative Medicine (CAM) therapies. In addition to asking about CAM use as part of the standard history and physical, health care providers need to know if any therapy used could harm the patient by changing the effective therapeutic dose of various medications, interfering with anesthesia or coagulation, or causing further damage to a physical injury. In addition to protecting them from potential harm, physicians may want to suggest the use of proven therapies, such as mind-body interventions, to patients who have not reached the level of health they desire using conventional treatment. Some CAM therapies are particularly useful for stress management, and may be a significant benefit to your patients who have medical conditions that are worsened by stress, including heart disease, diabetes, insomnia, multiple sclerosis, migraines, chronic pain syndromes, cancer, infertility, and addiction recovery.

Since over one third of Americans use CAM therapies, physicians and primary care providers need to inquire about this use in order to deliver quality health care to these individuals (see references below). Do you know if it is safe for your patient with a herniated disc to be rolfed, or should she only get Reiki? Is it safe for your patient with hepatitis to take blue-green algae? Can taking herbs disrupt the coagulation cascade or interfere with anesthesia? Some holistic therapies can make your patients' symptoms worse rather than better, contain toxins if not packaged or prepared properly, or can interfere with prescription drugs - making them more potent, less potent or creating a dangerous interaction. Natural often does not mean healthy, especially when taking unnatural amounts of something. Do you know the difference between homeopathy and herbology? Where would you go to find reliable, up-to-date information on holistic products if your patient tells you he is using an alternative therapy? This program is a two hour introductory course on CAM, taught by a former FDA fraud investigator. E-mail Dr. Koenig ( sharedpaths @ yahoo.com ) to set up a program for your office or hospital staff.

¹  CDC / NCHS (ADA #343)
According to this recently released Centers for Disease Control study, CAM use continues to increase in the U.S. In 2002, about 36% of U.S. adults used some form of CAM in the previous 12 months. CAM use increased to 62% when praying for one's health or another person's health was labeled as "alternative medicine." Other interesting findings include that only 11.8% of adults sought care from a licensed or certified CAM practitioner, suggesting that most individuals who use CAM self-prescribe and/or self-medicate. Although the majority of individuals used CAM in conjunction with conventional medicine (54.9%), the survey reported that almost 30% of individuals who use CAM believed that conventional medicine would not help their health care problem.

²  Am J Emerg Med. 2004 May;22(3):187-91.
The authors conducted a cross-sectional observational study by administering questionnaires to ED patients at a university teaching hospital. More than half (55%) of patients had tried at least one CAM therapy within the past 12 months, and 17% had tried CAM for their presenting medical problem.

³  Ann Oncol. 2004 May;15(5):733-42.
The authors analyzed 32 of the most popular CAM cancer websites and scored the quality of the sites. They found that most sites issued recommendations for a wide variety of treatments, which were typically not supported by valid scientific evidence. Importantly, they found 3 sites with the potential for harming patients through the advice issued. They concluded that these popular websites offered information of extremely variable quality, and claim that they endorsed unproven therapies including some that were considered outright dangerous.

⁴  Urol Nurs. 2004 Feb;24(1):49-52.
These authors discuss the effect of zinc on various prostate conditions. They conclude that excess intake of zinc, especially with individual supplements, has the potential to encourage the growth of prostate conditions from BPH to cancer, and discuss a large study that found a significantly higher risk of advanced prostate cancer in men consuming large intakes of zinc supplements. According to the authors, the negative side effects of large doses of zinc include: inhibit the benefits of bisphosphonate drugs, increase testosterone level, increase cholesterol, reduce levels of "good cholesterol" or HDL, and can promote immune dysfunction.

⁵  Anesth Analg. 2001 Oct;93(4):1062-8.
This study measured the prevalence and predictors of the use of alternative medicine supplements in surgical patients using a self-administered questionnaire. Patients were waiting for elective noncardiac surgery at five San Francisco Bay Area Hospitals. The authors conclude that the use of alternative medicine supplements by surgical patients is prevalent, and that documentation of the use of CAM is critical to determine the potential of drug or anesthetic interactions in the perioperative period.

⁶  J Am Coll Surg. 2004 Apr;198(4):583-90.
A self-administered questionnaire was given to patients undergoing elective surgery inquiring into the self-health perceptions, herbal medicine use, and communication of such usage to surgical health-care staff. Fifty-seven percent of respondents admitted to using herbal medicine at some point in their life, 38% in the past 2 years. One in six respondents continued the use of herbal medicine during the month of surgery. They concluded that documentation of the use of herbal medicines by surgical health-care staff is important to prevent, recognize, and treat potential problems that occur during the perioperative period.

⁷  Ann Pharmacother. 2002 Dec;36(12):1862-9.
The study determined the prevalence and characteristics of herbal and nonherbal alternative medicine use among adults living in the greater Toledo, Ohio area by surveying people entering conventional grocery stores. Forty percent of respondents used an herbal remedy during the last 12 months. The average number of herbs used was 2.3 per person. Sources of information on herbal therapies included: magazines (17%), health food stores (16%), and friends (14%). Only 50% of the surveyed population informed their physician of such use. Forty-one percent used an herbal remedy sometimes to always to self-treat before seeking medical care from a physician. They concluded that it is important for healthcare providers to acknowledge this growing trend of CAM therapy use and begin to incorporate open discussion about CAM into the patient-provider relationships.

⁸  Arch Intern Med. 2002 Aug 12-26;162(15):1697-704.
This study looked at military veteran CAM use seen by primary care providers. Almost 50% reported CAM use. Current high daily stress, perceived negative impact of military life on physical or mental health, and physician-diagnosed chronic illnesses such as gastrointestinal problems, insomnia, and asthma were associated with CAM use.

⁹  Arch Pediatr Adolesc Med. 2002 Oct;156(10):1042-4.
This study surveyed a population of urban adolescents with asthma.Overall, 80% of participants reported using CAM for asthma. People with daily or weekly symptoms were more likely to use CAM for each episode of asthma. They concluded that most adolescents with asthma in this study used CAM, with the prevalence of CAM use in this study population being twice the national average for adults.

¹⁰  Am J Drug Alcohol Abuse. 2003 May;29(2):401-13.
This study measured the prevalence and predictors of CAM use among persons with a history of intravenous drug use. Forty-five percent reported use of at least one CAM therapy. The top three therapies were mind-body modalities: religious healing, relaxation techniques, and meditation. There was a high level of self-perceived effectiveness (4.1 on a scale of 1-5).

¹¹  Fam Med. 2002 Mar;34(3):206-12.
This study looked at CAM use among primary care patients in a rural setting - adult patients in a family practice clinic in northern Pennsylvania. Forty-seven percent of patients reported using at least one form of CAM during the past year. Only 51% of patients told their physician about their use of CAM. The authors concluded by recommending that primary care physicians should routinely ask patients about their use of CAM and advise them accordingly.

NIH sponsored CAM Clinical Trials

The NIH lists over 120 ongoing CAM clinical trials (search), including herbs, Reiki and acupuncture.

Healthy Lifestyle and Holistic Health Education

Learn about other programs that can benefit your patients, family and friends: Shared Paths Programs

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