The document discusses complementary and alternative medicine (CAM) and its increasing use. It defines CAM and describes some common types like herbalism, acupuncture, chiropractic, and homeopathy. The document also provides statistics on CAM use in Saudi Arabia, finding high rates of use in Riyadh and Qassim regions. It discusses the WHO's role in developing national CAM policies and ensuring safety, efficacy, quality, access, and rational use of CAM therapies.

1. Saudi Diploma in Family Medicine

4.  Physicians are deeply divided over the efficacy of
complementary & alternative medicine (CAM).
 Many believe that such
treatments have a place
within everyday medical
treatment;
 others feel that
prescribing them is not
responsible medicine.

5.  the physician needs to decide how to respond.
o Whatever our own belief, we are regularly
faced with patients who are using or who ask
for (CAM)treatments

7.  Studies show that CAM is the fastest growing
area in health care today .
 In 1997, an estimated 42% of the U.S. population
used some form of alternative therapy .
 50% of patients seeing family physicians are using
some form of (CAM), according to a 1997 study .
 the percentage is more higher in K.S.A
o Riyadh region (68%) .
o in qassim region (74%) .

9. Complementary and alternative medicine (CAM)
 is defined by the (NCCAM)* as
"a group of diverse medical and healthcare systems, practices, and products
that are not presently considered to be part of conventional medicine"
 is defined by the WHO as
“a broad set of health care practices that are not part of that country’s own
tradition or conventional medicine and are not fully integrated into the dominant
health-care system”
• They are used interchangeably with traditional medicine (TM) in some
countries.
(http://www.who.int/medicines/areas/traditional/definitions/en/).
* (NCCAM) is branch of the National Institutes of Health(NIH) that specializes in CAM
therapies

11. CAM Use Among Adults and Children:
United States, 2007
 In 2007,almost 4 out of 10 adults had used
CAM therapy in the past 12 months.
 Approximately 1 in 9 children used CAM
therapy in the past 12 months.

12.  Between 2002 and 2007 increased use was seen among
adults for acupuncture, deep breathing exercises,
massage therapy, meditation, naturopathy, and yoga.

13.  Children whose parent used CAM were almost 5 times
as likely (23.9%) to use CAM as children whose parent
did not use CAM (5.1%).

14.  68 % of the respondents had used CAM during
the last 12 months.
 Factors independently associated with CAM use
included:
 perceived failure of medical treatment,
 the perceived success of CAM,
 a preference for natural materials,
 and long appointment intervals to see
physicians.

15.  The Holy Quran as a therapy was the most
frequently used CAM (50.3%), followed by
honey (40.1%),
black seed (39.2%)
myrrh (35.4%).

16. The use of and out-of-pocket spending on CAM
In Qassim province, Saudi Arabia
 A total of 74% of subjects had visited CAM
providers in past 12 months.
This percentage decreased to 47.6% when
spiritual healers were excluded.
The specific CAM providers who were visited
were :
o spiritual healers (26.7%),
o herbalists (23.2%),
o providers of honeybee products (14.9%),
o and hijama (wet cupping; 13%).
Ann Saudi Med 2013; 33(3): 282-289

18. the total out-of-pocket spending on CAM was
2 435 580 SAR (≈650 000 US$) per year
including 350 000 US$ on CAM visits
and 300 000 US$ purchasing CAM products.
Chronic illnesses were the main reason for the visits.
Physicians were the providers of CAM for 11.3% of
the participants.
 More than 75% of the subjects used herbs in the
previous 12 months for medical and health reasons,
while only 25% used vitamins or minerals.
 Relaxation (10.3%) was the most common self-CAM
practice followed by meditation (6.7%).

25.  pharmacological categories :
(e.g. herbalism or homeopathy).
 physical remedies :
(acupuncture, cupping or chiropractic).
 dietary approaches :
(e.g. macrobiotics and vegetarianism).
 cognitive therapy :
(e.g., hypnosis).

26.  inserting fine needles into selected points
located along meridians, or energy
pathways, in the body.
 clear evidence supports its effectiveness for
the treatment of
o postoperative and chemotherapy-induced
nausea and vomiting.
o nausea associated with pregnancy.
o postoperative dental pain.

27.  Derived from two Greek words meaning “done by
hand”
 “the diagnosis, treatment and rehabilitation of
conditions that affect the neuromuscular system.”
 There is strong evidence that chiropractic treatment is
as beneficial for low back pain as treatment given by
primary care providers, orthopedists and physical
therapists.

28. * Today, herbs are widely used in Europe and are again
gaining popularity in the United States.
* Some of the most popular herbal remedies include:
 St. John’s Wort for depression.
 Kava-Kava for anxiety.
 Saw Palmetto for benign prostate disease.
 Ginkgo biloba for memory.
 Echinacea for viral illnesses.
* Ancient Egyptians used herbs for the treatment
of disease as early as 3000 B.C .

30.  From the Greek words homios (“like”) and
pathos (“suffering”),
 The word homeopathy simply means
( Treating like with like ).
 a substance that causes symptoms in well
individuals can also be used to treat the
same symptoms in sick individuals.

31. * The theory is based on 3 principles of
Hahnemann’s :
1. the “law of similars,”
2. the “principle of the minimum dose,”
by diluting a substance, its curative properties
are enhanced and its side effects minimized;
3. prescribing for the individual,
which advocates basing treatment not only on
the medical diagnosis but also,
the patient’s personality and emotional and
physical responses.

32.  one of the oldest and most effective methods of releasing
toxins from the body’s tissues and organs.
 Cupping is a safe, non-invasive and inexpensive technique.
 It is used to alleviate the pain arising from internal organs,
muscle spasms, joint pains, and numerous other conditions.
 The ancient Egyptians were the first to use cupping therapy
* Cupping in the Middle East and the Muslim World
 known as ‘Hajama’ which means ‘to restore to basic
size’ or ‘to diminish in volume’.
 The Prophet Muhammed -PBUH -is reported to have been a
user and advocate of cupping therapy.
Cupping (hijamah)

33. Massage therapy
* Involves stroking and kneading the skin, muscles, and connective
tissues.
 There are several types of massage therapy:
1. Classic or Swedish massage:
It reduces tension and increases blood flow to muscles.
2. Reflexology:
Is massage of the hands and feet based on a system of
points that are claimed to correlate to other areas of the body.
3. Chair massage:
is done while the patient sits fully clothed in a special chair
that slopes forward, allowing the therapist access to the back,
neck, and shoulders.
4. Deep tissue massage:
is a form of intense tissue manipulation.

34. Germany is considered the home of naturopathy.
Naturopathy include a wide range of natural medicines. e.g:
nutrition, homeopathy, herbal remedies, hydrotherapy, massage,
acupuncture, fasting and breathing.
six basic philosophies:
1. The healing power of nature:
the body has the inherit nature to heal itself;
2. Treat the whole person:
health and disease result from the interaction of a person’s physical,
mental, emotional, genetic, environmental and social components;
3. First, do no harm.
4. Identify and treat the cause:
one should treat the cause of disease, not merely the symptoms;
5. Prevention is the best cure.
6. The physician is a teacher:
A physician’s major role is to educate, empower and motivate patients to
take responsibility for their own health.

38.  Whole-person treatments
 Potential cost savings
 Focus on prevention
 Limited scientific research.
 Confusing marketing.
 Potentially dangerous
interactions.

39. Assessing the Risks and Benefits of CAM
Treatments

41. CONVENTIONAL CAM

43. ASK EVERY PATIENT ABOUT1

44. AVOID USING THE WORDS2

45. DON’T DISMISS3

46. DISCUSS
As Well As
4

47. WE RISK POOR OUTCOMES

48.  Emphasize to patient that all herbs have pharmacologic
properties just as do conventional pharmaceuticals.
 Explain that there is the possibility of adverse interaction
between herbs and any pharmaceutical.
 Review each herb with the patient in detail and ask him not
to take any herb that needs more time to review.
 Try to reach a joint decision with the patient regarding what
would be safe for him to take.

58.  policy :
by developing and implementing national CAM policies
and programmes.
 Safety, efficacy and quality :
by expanding the knowledge base, and providing guidance
on regulatory and quality assurance standards.
 Access :
Increase the availability and affordability of CAM, with an
emphasis on access for poor populations.
 Rational use :
promote therapeutically sound use of appropriate CAM by
practitioners and consumers.