![Page 1: Alternative Medicine November 29 th 2002 Gil C. Grimes, MD](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649e385503460f94b29188/html5/thumbnails/1.jpg)
Alternative Medicine
November 29th 2002
Gil C. Grimes, MD
![Page 2: Alternative Medicine November 29 th 2002 Gil C. Grimes, MD](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649e385503460f94b29188/html5/thumbnails/2.jpg)
General Data
The Diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, satisfying a demand not met by orthodoxy, or diversifying the conceptual frameworks of medicine
Ernst E et al. Complementary medicine- a definition. BJ Gen Prac 1995, 45:506
![Page 3: Alternative Medicine November 29 th 2002 Gil C. Grimes, MD](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649e385503460f94b29188/html5/thumbnails/3.jpg)
General Data
Landmark Report 1998 random sample adults USA42% used CAM in last year17% herbal therapy16% chiropractic14% massage
![Page 4: Alternative Medicine November 29 th 2002 Gil C. Grimes, MD](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649e385503460f94b29188/html5/thumbnails/4.jpg)
General Data
Austin 1998Random sample 1500 adults (80% white,
51% female 30% high school ed or less)Have you used CAM in last year
40% Yes16% chiropractic8% lifestyle diet7% exercise7% relaxation
![Page 5: Alternative Medicine November 29 th 2002 Gil C. Grimes, MD](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649e385503460f94b29188/html5/thumbnails/5.jpg)
General Data
Who is using?People with chronic health problemsMore common caucasianMore common womenMore educated
![Page 6: Alternative Medicine November 29 th 2002 Gil C. Grimes, MD](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649e385503460f94b29188/html5/thumbnails/6.jpg)
General Data
$13.7 billion unconventional therapy
$10.3 billion (75%) out of pocket
$12.8 billion out of pocket for all hospitalizations in the United States
1990 data
Eisenberg DM et al, N Engl J Med 1993 Jan 28;328(4):246-52
![Page 7: Alternative Medicine November 29 th 2002 Gil C. Grimes, MD](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649e385503460f94b29188/html5/thumbnails/7.jpg)
General Data
Increase 45.2% between 1990 and 1997
estimated at $21.2 billion 1997
$12.2 billion paid out of pocket
Eisenberg DM et al, JAMA 1998; 280:1569-1575
![Page 8: Alternative Medicine November 29 th 2002 Gil C. Grimes, MD](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649e385503460f94b29188/html5/thumbnails/8.jpg)
Getting the Truth
InforetrieverCochrane reviewNational Center for Complementary and Alternative MedicineAlternative Medicine Homepage University of PittsburghBritish Homeopathic LibraryNatural Medicine Database
![Page 9: Alternative Medicine November 29 th 2002 Gil C. Grimes, MD](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649e385503460f94b29188/html5/thumbnails/9.jpg)
Type of CAM
Herbal Medicine
Acupuncture
Nutrition
Exercise
Homeopathy
Manipulation
Massage
Meditation
![Page 10: Alternative Medicine November 29 th 2002 Gil C. Grimes, MD](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649e385503460f94b29188/html5/thumbnails/10.jpg)
Herbal Medicine
Various Forms Crude plant preparations Dried specimen Aqueous extract Tinctures Active ingredients
![Page 11: Alternative Medicine November 29 th 2002 Gil C. Grimes, MD](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649e385503460f94b29188/html5/thumbnails/11.jpg)
Herbal Medicine
Choosing the product Degree of purity Variation in potency
Look for the following Lot number Expiration date Analysis of ingredients
![Page 12: Alternative Medicine November 29 th 2002 Gil C. Grimes, MD](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649e385503460f94b29188/html5/thumbnails/12.jpg)
Acupuncture
2000 year tradition
Osler was aware of acupuncture
Alters conduction of electromagnetic signals
Alters neurotransmitters in brain
TCM relates this to a release of the Qi that is blocked
![Page 13: Alternative Medicine November 29 th 2002 Gil C. Grimes, MD](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649e385503460f94b29188/html5/thumbnails/13.jpg)
Acupuncture
EfficacyAdult postoperative N/V (1b) JAMA 1998;280:1518-24 Chemotherapy N/V (1b) JAMA 2000;284:2755-61Chronic neck pain (1b)BMJ 2001;322:1574Headache (cochrane)Menstrual cramps (cochrane)Tennis elbow, myofascial pain, carpal tunnel syndrome
National Center for Complimentary and Alternative Medicine
![Page 14: Alternative Medicine November 29 th 2002 Gil C. Grimes, MD](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649e385503460f94b29188/html5/thumbnails/14.jpg)
Acupuncture
Trouble with blinding
Sham Needles
Blinding Evaluators
![Page 15: Alternative Medicine November 29 th 2002 Gil C. Grimes, MD](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649e385503460f94b29188/html5/thumbnails/15.jpg)
Exercise
Benefits Improved respiratoryLower BPMore efficient CO Increases insulin sensitivity Improves utilization of FFA from adipose
![Page 16: Alternative Medicine November 29 th 2002 Gil C. Grimes, MD](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649e385503460f94b29188/html5/thumbnails/16.jpg)
Exercise
Physician advice Meta-analysis DARE abstract 971480
demonstrate efficacy of counseling
Exercise Rx Type of activity (aerobic etc) Intensity (60-90% Max Heart rate)
(220-Age) x 0.60 or 0.90 gives low and high end of target heart rate
Work longer low end and short bursts in high end
![Page 17: Alternative Medicine November 29 th 2002 Gil C. Grimes, MD](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649e385503460f94b29188/html5/thumbnails/17.jpg)
Exercise
Exercise RxDuration
Inversely proportional to the intensityRate fatigue one hour after exercise to judge
Frequency3-5 sessions per weekNo greater than 48 hours off
![Page 18: Alternative Medicine November 29 th 2002 Gil C. Grimes, MD](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649e385503460f94b29188/html5/thumbnails/18.jpg)
Exercise
Three phases of exerciseWarm upConditioningCool downStretch some before and always after
![Page 19: Alternative Medicine November 29 th 2002 Gil C. Grimes, MD](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649e385503460f94b29188/html5/thumbnails/19.jpg)
Homeopathy
Treats illness with progressively dilute substances that produce similar pattern of injury
Treating like with like
Therapy is individualized to the patient
Meta-analysis of homeopathy trials Lancet 1997;350:834-43
![Page 20: Alternative Medicine November 29 th 2002 Gil C. Grimes, MD](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649e385503460f94b29188/html5/thumbnails/20.jpg)
Cystitis
CranberryRandomised trial of cranberry-ligonberry
juice and Lactobacillus GG drink for the prevention of UTI in women. BMJ2001;322:1-5 (LOE 1c)
Glass of unsweetened cranberry juice a day
NNT=5 at 12 months to reduce frequnecy of UTI from 36% to 16%
![Page 21: Alternative Medicine November 29 th 2002 Gil C. Grimes, MD](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649e385503460f94b29188/html5/thumbnails/21.jpg)
Migraine
Riboflavin 400 mg Riboflavin daily (LOA 1b) NNT= 2.8 to reduce frequency of attacks per
month (56% to 19%) NNT= 2.3 reduce headache days (59% to 15%) Effectiveness of high-dose riboflavin in migraine
prophyloaxis: a randomized controlled trial.
Neurology 1988; 50:466-70
![Page 22: Alternative Medicine November 29 th 2002 Gil C. Grimes, MD](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649e385503460f94b29188/html5/thumbnails/22.jpg)
Morning Sickness
Ginger root (LOE 1b)250 mg powdered ginger root before meals
and bedtime (1 gm per day)Small double blinded placebo controlled
randomized trialDecreased vomiting
Obstet Gynecol 2001; 97:577-82
![Page 23: Alternative Medicine November 29 th 2002 Gil C. Grimes, MD](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649e385503460f94b29188/html5/thumbnails/23.jpg)
Morning Sickness
Vitamin B625- 50 mg 2-3 times daily
Acupressure Wrist band on P6 point
Reduced severity of nausea
Cochrane Library, Issue 2, 2002
![Page 24: Alternative Medicine November 29 th 2002 Gil C. Grimes, MD](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649e385503460f94b29188/html5/thumbnails/24.jpg)
Osteoporosis
Calcium and Vitamin D500mg Ca++ and 700 IU Vit D (LOE 1b)Better bone densityFewer fractures over 3 years (5.9% vs
12.9%)
Effect of calcium and vitamin D supplementation on bone mineral density in men and women 65 years of age or older. NEJM 1997; 337: 670-6
![Page 25: Alternative Medicine November 29 th 2002 Gil C. Grimes, MD](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649e385503460f94b29188/html5/thumbnails/25.jpg)
Menopause
Soy supplementation
60 gm soy protein daily (LOE 1b)Decreased frequency and severity of hot
flushes
The effect of dietary soy supplementation on hot flushes Ob Gyn 1998;91:6-11
![Page 26: Alternative Medicine November 29 th 2002 Gil C. Grimes, MD](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649e385503460f94b29188/html5/thumbnails/26.jpg)
Warts
PodophyllumThe rhizomes are used as a catharticResin extracted used as an irritant
![Page 27: Alternative Medicine November 29 th 2002 Gil C. Grimes, MD](https://reader036.vdocuments.us/reader036/viewer/2022062407/56649e385503460f94b29188/html5/thumbnails/27.jpg)
Closing
Ask your patients
Ask more than once
Ask about vitamins or supplements