Complementary and alternative medicine (CAM) refers to medical systems and practices that are not part of conventional medicine. Around 40% of adults in the United States report using some form of CAM. Common reasons for using CAM include dissatisfaction with conventional medicine, a preference for natural treatments, and a focus on overall wellness rather than just disease treatment. Physicians should be knowledgeable about CAM practices their patients may use, as some can interact harmfully with conventional treatments or be dangerous if used incorrectly. The document outlines various CAM modalities like herbal supplements, acupuncture, yoga and traditional medical systems; discusses integrated medicine approaches; and emphasizes the importance of physicians maintaining open and non-judgmental discussions with patients about all treatment options.

1. COMPLEMENTARY,ALTERNATIVE
AND INTEGRATED HEALTH
PRACTICES
DR BHAVIN S MANDOWARA
MD MEDICINE RESIDENT

2. –“Imagine a world - oriented toward healing rather
than disease, where physicians believed in the
natural healing capacity of human beings, and
emphasized prevention above treatment.
– In such a world, doctors and patients would
be partners working toward the same ends.”

3. OUTLINE
•LEARNING OBJECTIVES
•DEFINITION AND SCOPE
•TRMINOLOGY OF CAM PRACTICES
•PATTERN OF USE
•PRACTIONER BASED DISCIPLINES
•MIND-BODY INTERVENTIONS
•DIETARY SUPPLEMENTS
•PATIENT AND PROVIDER RESOURCES
•INTEGRATED MEDICINE
•TAKE HOME MESSAGES
•

4. WHY A PHYSICIAN SHOULD KNOW
ABOUT CAM ?
• Physicians are important sources for information
and guidance about health matters, but our
patients also rely on a wide range of other
sources including family and friends, cultural
traditions, alternative practitioners, and
increasingly the Internet, popular media, and
advertising. It is essential for physicians to
understand what patients are doing to seek
health, as this under-standing is important to
harness potential benefits and to help patients
avoid harm.
•
•

5. LEARNING OBJECTIVES
• COMPARE CAM TO CONVENTIONAL MEDICINE
• HOW CAM AND CONVENTIONAL MEDICINE CAN
BE USED TOGETHER (INTEGRATED MEDICINE)
• VARIOUS TYPES OF CAM
• HOW A PHYSICIAN USE HIS KNOWLEDGE OF CAM
• WHY ARE PATIENTS AND HEATH CARE
PRACTIONERS TURNING AWAY FROM
CONVENTIONAL MEDICINE
• REGULATIONS OF CAM

6. •Figure 17.1
l
Reasons Adults Use CAM

7. WHY ARE PEOPLE TURNING AWAY
FROM MAINSTREAM MEDICINE ?
• CAM offer optimism or greater personal attention
and provide 3 T’s : Time , Talk and Touch
• CAM is less expensive , have fewer side effects
and is more easily accessible
• Patient has“self-help” approach to health and
wellness
• It satisfies a search for “NATURAL” or less invasive
alternatives
• Promise of “MIRACLE CURES” and quick results.

8. WHY ARE PEOPLE TURNING AWAY FROM
MAINSTREAM MEDICINE ?(…cont inued)
• Symptoms often poorly controlled by conventional
care, particularly back pain and other painful
musculoskeletal complaints, anxiety, and
insomnia.
• Failure or dissatisfaction with conventional healh
provider
• High health costs
• To treat side effects of drugs and treatment
• Focus on spirituality and emotional well being
• Ignorance and inadequate knowledge regarding
disease .
•
•
•

9. IS THERE A COMMON FRAME OF
REFERENCE WHICH WILL EXPLAIN BASIS OF
WORKING OF ALL MEDICAL SCIENCES?

10. Why do patients not tell their
physician about their CAM use?
• 60% - “My doctor never asked.”
• 60% - “It wasn’t important for my doctor to
know.”
• 20% - “My doctor wouldn’t understand.”
• 14% - “My doctor would disapprove.”
70% of patients see their Physician
before or concurrent with their visits to
a CAM provider
Eisenberg DM. Ann Int Med 2001;135(5):344-51
•

11. DEFINITION AND SCOPE
•The phrase complementary and alternative
medicine (CAM) is used to describe group of
diverse medical and health care systems ,
practices and products that have historic origins
outside mainstream medicine .
•Alternative medicine is any practice that is
perceived by its users to have healing effects of
medicine but does not originate from evidence
based scientific method and is not a part of
biomedicine
•

12. DEFINITION AND SCOPE
• Alternative Medicine differs in that it is not
used as a complement but as a “substitute”
for conventional therapy .
• Complementary Medicine is alternative
medicine used together with conventional
medicine. i.e. it “complements” the
treatment
• Integrated medicine …discussed later
•

13. HOW MANY PEOPLE ARE USING CAM
WORLDWIDE ?
• In United states surveys, approximately 40% of
adults report using some form of complementary
therapy or health practice. In the 2007 study, 38%
of adults and 12% of children had used one or
more modalities. These surveys yield the estimate
that non-vitamin and non-mineral dietary
supplements are used by approximately 18% of
the population. The most prevalent mind-body
practices are relaxation techniques and
meditation, chiropractic, and therapeutic massage.

14. HOW MANY PEOPLE ARE USING CAM
WORLDWIDE ?
• Americans are willing to pay for these services;
the estimated out-of-pocket expenditure for
complementary health practices in 2007 was
$34 billion, representing 1.5% of total health
expenditures and 11% of out-of-pocket costs.
• 30,000 herbs on the market currently
• Estimates of $30-40 billion dollars spent annually.
• 600 Million Visits a Year to CAM Providers –
More Than to Primary Care Providers
•

15. Complementary and Alternative
MedicineCAM STATISTICS

16. Complementary and Alternative
Medicine

17. Complementary and Alternative
MedicineCAM STATISTICS

18. Complementary and Alternative
MedicineCAM STATISTICS

19. TERMINOLOGY OF CAM PRACTICES
•MIND BODY PRACTICES
•TRADITIONAL MEDICAL SYSTEMS
•MODERN MEDICAL SYSTEMS

20. MIND BODY PRACTICES
•ACCUPUNCTURE AND ACUPRESSURE
•ALEXANDER TECHNIQUE
•GUIDED IMAGERY
•HYPNOSIS
•MASSAGE
•MEDIDATION
•REFLEXOLOGY
•ROFLING / STRUCTURAL INTEGRATION
•SPINAL MANIULATION
•TAI CHI
•THERAPEUTIC TOUCH
•YOGA

21. TRADITIONAL MEDICAL SYSTEMS
•AYURVEDIC MEDICINE
•CURANDERISMO
•NATIVE AMERICAN MEDICINE
•SIDDHA MEDICINE
•TIBETIAN MEDICINE
•TRADITIONAL CHINESE MEDICINE
•UNANI MEDICINE

22. MODERN MEDICAL SYSTEMS
•ANTHROOSOHIC MEDICINE
•CHIROPRACTIC
•HOMEOPATHY
•NATUROPATHY
•OSTEOPATHY

23. ACCUPUNCTURE AND
ACUPRESSURE
ACCUPUNCTURE
STIMULATION OF DEFINED
ANATOMIC POINTS
ACUPRESSURE
INSERTION OF AND
MANIPULATION OF THIN
METALLIC NEEDLES

24. ACUPRESSURE

25. ACUPRESSURE

26. ACCUPUNCTURE

27. ALEXANDER TECHNIQUE
A MOVEMENT THERAY
THAT USES GUIDANCE
AND EDUCATION TO
IMROVE POSTURE ,
MOVEMENT AND
EFFICIENT USE OF
MUSCLES FOR
IMPROVEMENT OF BODY
FUCNTIONING .

28. GUIDED IMAGERY
The use of relaxation
techniques followed by
the visualization of
images, usually calm and
peaceful in nature, to
invoke specific images to
alter neurologic function
or physiologic states

29. HYPNOSIS
The induction of an
altered state of
consciousness
characterized by increased
responsiveness to
suggestion

30. MASSAGE
Manual therapies that
manipulate muscle and
connective tissues to
promote muscle
relaxation, healing, and
sense of well being

31. MEDITATION
A group of practices,
largely based in Eastern
spiritual traditions,
intended to focus or
control attention and
obtain greater awareness
of the present moment, or
mindfulness

32. REFLEXOLOGY
Manual stimulation of
points on hands or feet
that are believed to affect
organ function

33. ROFLING/STRUCTURAL
INTEGRATION
A manual therapy that
attempts to realign the
body by deep tissue
manipulation of fascia

34. SPINAL MANIPULATION
A range of manual techniques, employed by
chiropractors and osteopaths, for adjustments of the
spine to affect neuromuscular function and other health
outcomes

35. TAI-CHI
A mind-body practice
originating in China that
involves slow, gentle
movements and
sometimes is described as
“moving meditation”

36. THERAPEUTIC TOUCH
Secular version of the
laying on of hands,
described as “healing
meditation”

37. YOGA
An exercise practice, originally East Indian, that combines
breathing exercises, physical postures, and meditation

38. AYURVEDIC MEDICINE
The major East Indian
traditional medicine
system; treatment
includes meditation, diet,
exercise, herbs, and
elimination regimens
using emetics and
diarrheals

39. CURENDERISMO
A spiritual healing
tradition common in Latin
American communities
that uses ritual cleansing,
herbs, and incantations

40. NATIVE AMERICAN MEDICINE
Diverse traditional
systems that incorporate
chanting, shaman healing
ceremonies, herbs, laying
on of hands, and
smudging (ritual cleansing
with smoke from sacred
plants)

41. SIDDHA MEDICINE
An East Indian medical
system (prevalent among
Tamil-speaking people

42. TIBETIAN MEDICINE
A medical system that
uses diagnosis by pulse
and urine examination;
therapies include herbs,
diet, and massage

43. TRADITIONAL CHINESE MEDICINE
A medical system that
uses acupuncture, herbal
mixtures, massage,
exercise, and diet

44. UNANI MEDICINE
An East Indian medical
system, derived from
Persian medicine,
practiced primarily in the
Muslim community; also
called ‘hikmat’.

45. Anthroposophic medicine
A spiritually based system
of medicine that
incorporates herbs,
homeopathy, diet, and a
movement therapy called
Eurythmy

46. CHIROATHY
Chiropractic care involves
the adjustment of the
spine and joints to
alleviate pain and improve
general health; primarily
used to treat back
problems, musculoskeletal
complaints, and
headaches

47. HOMEOPATHY
A medical system with
origins in Germany that is
based on a core belief in
the theory of “like cures
like”—compounds that
produce certain
syndromes, if
administered in very
diluted solutions, will be
curative

48. HOMEOPATHY
Homeopathic medicine
Treating syndromes and conditions with
remedies that produce similar syndromes
and conditions in healthy people
Produces the symptoms it is given to treat
in order to stimulate the body’s natural
defenses to heal itself
Looks at individuals , not diseases

49. NATUROPATHY
A clinical discipline that emphasizes a holistic approach
to the patient, herbal medications, diet, and exercise;
practitioners have degrees as doctors of naturopathy

50. OSTEPOATHY
A clinical discipline, now
incorporated into
mainstream medicine,
that historically
emphasized spinal
manipulative techniques
to relieve pain, restore
function, and promote
overall health

51. Integrative Medicine
•“Integrative medicine is the practice of
medicine that reaffirms the importance of the
relationship between practitioner and patient,
focuses on the whole person, is informed by
evidence, and makes use of all appropriate
therapeutic approaches to achieve optimal
health and healing.”

52. 
The Future of Integrative
Medicine
Our Patients Will Demand Integrative Medicine From All
of Us
Training Will Be Demanded by Medical Students
Training Will Be Demanded by Residents
Integrative Medicine Will Be A Skill Set Added on Just
Like:
Electronic Health Records
New Medications
New Procedures

53. •Figure 17.3
l
ASSESSING THE RISKS AND BENEFITS OF CAM TREATMENTS

55. TAKE HOME MESSAGES
1.Be non-judgmental despite personal opinions
2. Build rapport by showing patient respect – if not, he may be afraid
to tell about CAM use
3. Understand that C.A.M. can be beneficial, when used correctly
4. Be aware that C.A.M. can be dangerous if it interacts or interferes
with conventional treatment
5. Be willing to teach the public about the positive and negative
information regarding C.A.M.
6. Be aware that use of C.A.M. is popular and increasing and must be
included in the history & physical
7. Know that Herbals, in particular, can have significant effect on
prescription drugs and body function

56. THANK YOUTHANK YOU