1. HS 200
Summary, Assessment, and Reflection of Behavior change Project due today.
Rubric must be attached to the front.
Tues, Dec. 5: Last day to accept the Health-Related Community Activity/Event (for those who did not do the 12-Step assignment)

2. Conventional and Complementary Medicine: Skills for the Health Care Consumer
Chapter 15

3. Self-Assessment: Managing Medical Problems
Effectively managing medical problems.
Self-Assessment.
Observing symptoms.
Medical self-tests.
The average person has about four new medical symptoms each month, yet consults a physician only about four times a year. At least 80% of medical symptoms are self-diagnosed and self-treated. Today, people are becoming more confident of their own ability to solve personal health problems. People who manage their own health care gather information and learn skills from physicians, friends, classes, books, magazines, Web sites, or self-help groups; solicit opinions and advice; make decisions; and take action.
Self-assessment – Self-care begins with careful observation of your own body, scanning for unusual sensations, aches, or pains. The next slide discusses self-assessment in more detail.

4. Decision Making: Knowing when to See a Physician
Evaluating Symptoms
Severe
Unusual
Persistent
Recurrent
Evaluating symptoms – The next slide (4) describes characteristic symptoms in which you should contact a physician.
Getting professional assistance – If you evaluate your symptoms and think that you need professional help, you must decide how urgent the problem is. If it is a true emergency, then you should go (or be taken) to the nearest emergency room (ER). Slide 5 shows characteristic symptoms for going to the emergency room.
If your problem is not an emergency, but still requires medical attention, call you physician’s office. Often you can be given medical advice over the phone without the inconvenience of a visit. You will also be advised if you do need to schedule an appointment. You should also see a health care professional for help with preventive care, including screening tests, lifestyle counseling, and immunizations.

5. When to Get Professional Assistance
Any Medical Emergency such as
Major trauma.
Uncontrollable bleeding.
Intolerable pain.
Severe shortness of breath.
Persistent abdominal pain.
Poisoning or drug overdose.
Loss of Consciousness.
Severe or worsening reaction to an bite, sting or medication.
Go or be taken to the nearest emergency room if you have one of the following:
Major trauma or injury such as head injury, suspected broken bone, deep wound, severe burn, eye injury, or animal bite.
Uncontrollable bleeding or internal bleeding, as indicated by blood in the sputum, vomit, urine, or stool
Intolerable or uncontrollable pain or severe chest pain
Severe shortness of breath
Persistent abdominal pain, especially with nausea and vomiting
Poisoning or drug overdose
Loss of consciousness or seizure
Stupor, drowsiness, or disorientation that can not be explained
Severe or worsening reaction to a sting, bite, or to a medication, especially if breathing is difficult.

6. Self-Treatment: Many options
Watchful waiting.
NonDrug options
Self-medication
OTC
Generic
The home pharmacy
Watchful waiting – In most cases, your body can itself relieve your symptoms and heal the disorder. The prescriptions filled by your body’s internal pharmacy are frequently the safest and most effective treatment. So patience and careful self-observation are often the best choices and self-treatment.
Nondrug options – Nondrug options are often easy, inexpensive, safe, and highly effective. For example, massage, ice packs, and neck exercises may be at times more helpful than drugs in relieving headaches and other pains. Adequate rest, increasing exercise, drinking more water, eating more or less of certain foods, using humidifiers, changes in ergonomics when working at desks, and so on are just some of the hundreds of nondrug options for preventing or relieving many common health problems. For a variety of disorders either caused or aggravated by stress; relaxation, visualization, humor, assertive communication, changing negative thoughts, and other stress management techniques may be the treatment of choice.
Self-medication – Self-treatment with nonprescription medications is an important part of our health care system. Nonprescription or over-the-counter (OTC) medications are medicines that the FDA has determined safe for use without a physician’s prescription. There are about 100,000 OTC drugs on the market; about 60% of all medications are sold over the counter. Within every 2 week period, nearly 70% of Americans use one or more OTC drugs. Many OTC drugs are highly effective in relieving symptoms and sometimes in curing illnesses. In fact, many OTC drugs were formerly prescription drugs. More than 600 products sold over the counter today use ingredients or dosage strengths available only by prescription 20 years ago. However; with this increased choice, comes increased consumer responsibility for using OTC drugs safely. Consumers also need to be aware of the barrage of OTC drug advertising aimed at them. The implication of such advertising is that every symptom can and should be relieved by a drug. Although many OTC products are effective, others are unnecessary or divert attention from better ways of coping. Many ingredients in OTC drugs, about 70%, have not been proven to be effective, a fact the FDA does not dispute. And any drug may have risks and side effects. The next slide (7) provides some simple guidelines for safe self-medication.
The home pharmacy – If you were to survey home medicine cabinets, what would you find? On average, there would be 22 medications, including 17 OTC products. You would probably find an oversupply of expired medications and leftover prescription drugs. At the same time, certain essential medications and equipment would be absent. Only a few supplies are actually essential; additional items depend upon the particular health problems you or your family are likely to have. Because many medication deteriorate, buy small quantities of infrequently used medications, and replace them about every 3 years.

7. P. 372 Text

8. Conventional Medicine
“Standard Western Medicine”
“Bio-medicine”
Based on the findings of a variety of biological sciences.
Conventional medicine (standard Western medicine or biomedicine) is a system of medicine based on the application of the scientific method. It focuses on the external, physical causes of disease; the identification of a set of symptoms for different diseases; the development of public health measures to prevent disease; and uses drugs and surgery to treat them. The use of rational, scientific thinking to understand and explain phenomena and a well established research methodology is used throughout the process.

9. Premises and Assumptions of Conventional (Western) Medicine
Every disease is defined by a certain set of symptoms
Pharmaceuticals
Scientific explanation
Empirical
Rational
Testable
Referring to conventional medicine as “standard Western medicine” draws attention to the fact that it differs from the various medical systems that have developed in China, Japan, India, and other parts of the world. Calling it “biomedicine” reflects the concept that conventional medicine is based on the findings of a variety of biological sciences.
Premises and assumptions of conventional medicine – One of the important characteristics of Western medicine is the belief that disease is caused by identifiable physical factors. This belief can be traced back to Hippocrates, the Greek physician of the fourth century B.C. who is credited with placing the practice of medicine on a scientific footing. Hippocrates attacked the idea that disease was caused by spirits or gods and suggested instead that it could be caused by such internal and external factors as climate and diet. He advocated a reliance on careful observation of symptoms, experimentation, and attention to cause and effect. The form of medicine invented by Hippocrates and other Greek physicians was referred to as “rational medicine” because of its focus on facts and observable phenomena. Explanations of the scientific method are described on the next slide (3).

10. Providers of Conventional Medicine
Medical doctors (M.D.)
Doctors of osteopathic medicine (D.O.)
Podiatrists (D.P.M.)
Optometrists (O.D.)
Dentists (D.D.S.) or (D.M.D.)
Allied health care providers
Registered nurses (R.N.), licensed vocational nurses (L.V.N.), physical therapists, social workers, registered dietitians (R.D.), physician assistants (P.A.), nurse practitioners, and certified nurse midwives
Medical doctors (M.D.) – Doctors of medicine hold a degree from an accredited medical school. In the U.S., an education in medicine has several stages: four years of premedical education in a college or university, with an emphasis on the sciences; four years of medical school, which teaches basic medical skills and awards the M.D degree; graduate medical study, called a residency and last from three to eight years, during which a specialty is chosen and studied and a medical license is obtained; and continuing medical education to keep abreast of advances in medical science. Twenty-three medical specialities are currently approved by the American Board of Medical Specialities, each with its own rule-making and certifying body. The larger specialities are further divided into subspecialities; for example, internal medicine includes such subspecialities as cardiology and gastroenterology
Doctors of osteopathic medicine (D.O.) – D.O.s receive a medical education similar to that of M.D.s, but their training places special emphasis on musculoskeletal problems and manipulative therapy. M.D.s and D.O.s are the two types of “complete” physicians in the U.S., meaning they are fully trained and licensed to perform surgery and prescribe medication. D.O.s emphasize a “whole person” approach to medicine.
Podiatrists (D.P.M.) – These doctors specialize in the medical and surgical care of the feet.
Optometrists (O.D.) – These practitioners are trained to examine the eyes, detect eye disease, and treat vision problems. All states permit optometrists to use drugs for diagnostic purposes, and most permit them to use drugs to treat minor eye problems (Ophthalmologists are M.D. eye specialists who care for all types of eye problems and can perform eye surgery).
Dentists (D.D.S.) or (D.M.D.) – Dentists specialize in the care of the teeth and mouth. They are graduates of four year dental schools and hold degrees. Those who wish to become specialists receive additional education.
Allied health care providers – Many of these professionals are licensed to work independently while others are permitted to work under medical supervision or medical referral. These include: Registered nurses (R.N.), licensed vocational nurses (L.V.N.), physical and occupational therapists (P.T & O.T), social workers, registered dietitians (R.D.), physician assistants (P.A.), nurse practitioners, and certified nurse midwives (CNM).

11. Getting The Most Out Of Your Medical Care
Knowing when to seek professional care.
Good communication
The Physician-Patient Partnership
The Diagnosis Process
Self-care involves more than self-diagnosis and self-treatment. It includes knowing when to seek professional care and how to get the most out of your medical care. The key to making the health care system work for you lies in good communication with your physician and other members of the health care team. Studies show that patients who are more active in interacting with physicians, who ask more questions, enjoy better health outcomes. Unfortunately, many people are intimidated by their physicians and afraid to communicate freely. Medical jargon can be very confusing, yet some patients don’t ask questions because they fear appearing stupid. Others are afraid to ask why a test or treatment is needed for fear of appearing to challenge the authority of the physicians.
The physician-patient partnership – The physician-patient relationship is undergoing an important transformation. The image of the all-knowing physician and the passive patient is slowly fading. What is emerging is more of a physician-patient partnership, in which the physician acts more like a consultant and the patient participates more actively. Your physician should listen to you and be able to clearly explain things to you. You, the patient need to be assertive and express your feelings and concerns, ask questions, and, if necessary, be persistent. If your physician is unable to communicate clearly with you in spite of your best efforts, then you probably need to change physicians.
The diagnostic process – There are several general steps in the diagnostic process. They involve a medical history, a physical exam, and medical tests. Patients should ask questions about medical tests and treatments recommended by their physicians.
Medical and surgical treatments – Many conditions can be treated various ways.

12. Complementary and Alternative Medicine
Complementary and Alternative Medicine Balance is the Expression of Health
Guiding Principles
Treat Whole Person
Do no Harm
Remove Barriers to healing
(recognize the natural tendency of the body to heal itself)
NCCAM groups CAM practices into five domains: Alternative medical systems, mind-body interventions, biological-bases therapies, manipulative and body-based therapies, and energy therapies.
The complete alternative medical systems that are best known in the U.S. are probably TCM and homeopathy.
Traditional Chinese Medicine (TCM) – TCM makes use of many treatment methods including herbal remedies and acupuncture, to restore the free flow of qi or life energy. See the next slide.
Homeopathy – Homeopathy is based on the principles that “like cures like” and that “remedies become more effective with greater dilution.”
Mind-body interventions – These interventions include meditation, yoga, breathwork, group support, hypnosis, and prayer.
Biological-based therapies – These therapies consist of herbal remedies, botanicals, and dietary supplements.
Manipulative and body-based methods – These methods include massage and other physical healing techniques. The most commonly accepted method is chiropractic.
Energy therapies – Energy therapies are designed to influence the flow of energy in and around the body. They include qigong, therapeutic touch therapies, and Reiki.
Evaluating CAM – Because there is less information available about complementary and alternative therapies, as well as less regulation of associated products, it is import for consumers to take an active role when they are thinking about using them.

13. Alternative medical systems
Traditional Chinese medicine (TCM).
Acupuncture
Herbal therapies
Homeopathy
Hypnosis
Biological-based therapies

14. Complementary and Alternative Medicine
Manipulative and Body-Based Methods.
Touch and body manipulation
Massage acupressure
Rolfing
Chiropractic
Energy Therapies
Therapeutic touch
Reiki
Touch and body manipulation are long-standing forms of health care. Manual healing techniques are based on the idea that misalignment or dysfunction in one part of the body can cause pain or dysfunction in another part. Therefore, correcting these misalignments can bring the body back to optimal health.
Chiropractic is a method that focuses on the relationship between structure, primarily of joints and muscles, and function, primarily of the nervous system, to maintain or restore health. An important therapeutic procedure is the manipulation of joints, particularly those of the spinal column. However, chiropractors also use a variety of other techniques, including physical therapy, exercise programs, patient education, lifestyle modification, and orthotics (mechanical supports and braces) to treat patients. They do not use drugs or surgery. Chiropractors (D.C.s) are trained for a minimum of four full-time academic years at accredited chiropractic colleges. Chiropractic is listed by the NCCAM as one of the body-based methods of CAM, but it is accepted by many health care and health insurance providers to a far greater extent than the other types of CAM therapies. A word of caution: Spinal manipulation performed by a person without proper chiropractic training can be extremely dangerous.

15. 5 Domains of CAM Practice P. 380 Text

16. Traditional Chinese Medicine (TCM)-
The top two causes of disease:
1. Emotions
2. Rich Diet
Two primary treatments in TCM
herbal remedies
acupuncture.
Alternative medical systems tend to have concepts in common, perhaps because of contact between the Mediterranean area, the Middle East, India, and China in ancient times. For example, the concept of life force or energy exists in many cultures. In traditional Chinese medicine, the life force contained in all living things is call qi (sometimes spelled chi). Qi resembles the vis vitalis (Latin for “life force) of Greek, Roman, and European medical systems, and prana of Ayurveda, the traditional medical system of India. Most traditional (non-Western) medical or CAM systems think of disease as a disturbance or imbalance not just of physical processes, but also of forces and energies within the body, the mind, and the spirit. Treatment aims at reestablishing equilibrium, balance, and harmony.
Traditional Chinese Medicine – TCM is based on highly abstract concepts; a sophisticated set of techniques and methods; and individualized diagnosis, treatment, and prevention. No identical diseases exist in TCM. Two patients with the same diagnosis in Western medicine will get different diagnoses in TCM and will be given different treatments. In TCM, the free and harmonious flow of qi produces health – a positive feeling of well-being and vitality in body, mind, and spirit. Illness occurs when the flow of qi is blocked or disturbed. TCM works to restore and balance the flow of blocked qi. The goal is not only to treat illnesses, but also to increase energy, prevent disease, and support the immune system. The use of a single medicinal botanical is rare in Chinese herbal medicine; rather, several different plants are combined in very precise proportions, often to make a tea or soup.
Acupuncture works to correct disturbances in the flow of qi through the insertion of long, thin needles at appropriate points in the skin. Qi is believe to flow through the body along several meridians, or pathways, and there are approximately 360 acupuncture points locate along these meridians. The points chosen for acupuncture are highly individualized for each patient, and they change over the course of treatment as the patient’s health status changes.

17. Herbal Remedies ~ yin and yang ~ balanced ~ interconnected.
Acupuncture
Qi:
~ excess or deficiency
~ regulates spiritual, emotional, mental,
~ physical balance
~ keep normal flow of energy unblocked
12 main energy pathways in the body
Meridians in Balance= Expression of Health

18. Homeopathy Based on 2 principles: 1. “like cures like”
2. “remedies become more effective with
greater dilution”
Highly individualized form of therapy.
Treatment is determined by the overall condition of the patient rather than by specific symptoms.
“Like cures like” summarizes the concept that a substance that produces the symptoms of an illness or disease in a healthy person can cure the illness when given in very minute quantities. Remedies containing very small quantities of a particular substance are obtained by repeatedly diluting the original solution. The extent of dilution varies, but the final extract is often so dilute that few, if any, of the original molecules are left in it. According to homeopathic thinking, such highly diluted extracts not only retain some form of biological activity, but actually become more potent. Over 1,000 different substances (plant and animal parts, minerals, and chemicals) can be used to prepare homeopathic remedies, and each of these substances is thought to have different effects at different dilutions. That means a homeopath must not only choose the correct remedy for a particular patient, but must also decide on the specific dilution of that remedy in order to achieve the desired effect.
In a recent study, when the results of 185 homeopathic trials were analyzed, it was concluded that the clinical effects of homeopathy could not be completely explained by the placebo effect. At the same time, homeopathy was not found to be effective for any single clinical condition. Homeopathy remains one of the most controversial forms of CAM. Because of the extremely dilute nature of homeopathic remedies, it is generally assumed that they are safe. To date, the FDA has not found any serious adverse events associated with the use of homeopathy, except for denying standard medical care for certain conditions.

19. Mind-Body Interventions
Integral connection between mind and body
Meditation; yoga; visualization; tai chi; biofeedback; psychotherapy; support groups; prayer; and art, music, and dance therapy.
The placebo effect is one of the most widely known examples of mind-body interdependence.
Hypnosis
As listed above, many stress management techniques are classified as mind-body interventions. Currently, there is no clear line between these forms of CAM and conventional medicine (probably because of the difficulty in generating scientific research).
Hypnosis involves the induction of a state of deep relaxation during which the patient is more suggestible (more easily influenced). While the patient is in such a hypnotic trance, the practitioner tries to help him or her change unwanted behavior or deal with pain and other symptoms. Hypnosis is sometimes used in smoking cessation programs and as a non-drug approach to anxiety disorders, such as phobias and chronic conditions like irritable bowel syndrome. Hypnosis can be used by medical professionals, but is also offered by hypnotherapists. Physicians are certified by their own associations; many states require hypnotherapists to be licensed, but the requirements for licensing vary substantially. There is little regulation of practitioners of other relaxation techniques, but it is very rare that adverse events result from such techniques. Many research studies have shown that support groups, friendships, strong family relationships, and prayer can all have a positive impact on health.

20. Biological Based Therapies
Herbal Remedies, Botanicals, Dietary Supplements
For the vast majority of botanicals, there are almost no reliable research findings on efficacy and safety.
Biological-based therapies consist primarily of herbal therapies or remedies, botanicals, and dietary supplements. Materia medica is a term that can include a much larger variety of compounds than just “herbs” (which are plants that die down at the end of a growing season and do not produce woody tissue). Some herbal remedies are not technically herbs, such as the leaves of the ginkgo biloba tree, and some are not even from plants, such as shark cartilage and bear gallbladder. Other items that constitute materia medica are algae, bacteria, fungi, and minerals. For traditional remedies that are of plant origin, many scientists prefer to use the term “botanicals.” Nonetheless, because even official government definitions use the word “herbs” to designate substances from the categories of herbs, botanicals, and other materia medica, the terms are many times used interchangeably. Much of the pharmacopoeia of modern scientific medicine originated in the folk medicine of native peoples, and many drugs used today are derived from plants.
A majority of botanical products are sold as dietary supplements in the form of tablets, pills, capsules, liquid extracts, or teas. Like foods, dietary supplements must carry ingredient labels (see chapter 9).
Well-designed clinical studies have been conducted on only a small number of botanicals. Among the most thoroughly tested plant extracts are St. John's wort, ginkgo, and the coneflowers (Echinacea). Evidence supporting their use for particular uses has been found with only minor adverse events. However; because there is no reliable research regarding most botanicals, many experts are extremely concerned because of all the CAM approaches, the consumption of botanical supplements has the greatest potential to result in serious and even life-threatening consequences.

21. Manipulative and Body Based Therapies
The most commonly accepted CAM
manual healing method is chiropractic
Chiropractic (spinal manipulation) has been shown to be effective in acute low back pain and has shown promising results neck pain and headaches
Touch and body manipulation are long-standing forms of health care. Manual healing techniques are based on the idea that misalignment or dysfunction in one part of the body can cause pain or dysfunction in another part. Therefore, correcting these misalignments can bring the body back to optimal health.
Chiropractic is a method that focuses on the relationship between structure, primarily of joints and muscles, and function, primarily of the nervous system, to maintain or restore health. An important therapeutic procedure is the manipulation of joints, particularly those of the spinal column. However, chiropractors also use a variety of other techniques, including physical therapy, exercise programs, patient education, lifestyle modification, and orthotics (mechanical supports and braces) to treat patients. They do not use drugs or surgery. Chiropractors (D.C.s) are trained for a minimum of four full-time academic years at accredited chiropractic colleges. Chiropractic is listed by the NCCAM as one of the body-based methods of CAM, but it is accepted by many health care and health insurance providers to a far greater extent than the other types of CAM therapies. A word of caution: Spinal manipulation performed by a person without proper chiropractic training can be extremely dangerous.

22. Energy Therapies Therapeutic touch Reiki Bioelectromagnetics
Energy therapies are forms of treatment that use energy fields originating either within the body (biofields) or from other sources (electromagnetic fields). Biofield therapies are based on the idea that energy field surround and penetrate the body and can be influenced by movement, touch, pressure, or the placement of hands in or through the field.
Qigong is a component of TCM and combines movement, meditation, and regulation of breathing to enhance the flow of qi, improve blood circulation, and enhance immune function.
Therapeutic touch is derived from the ancient technique of “laying-on of hands.” It is based on the premise that healers can identify and correct energy imbalances by passing their hands over the patient’s body.
Reiki is one form of therapeutic touch. It is intended to correct disturbances in the flow of life energy (ki is the Japanese form of the Chinese qi).
Bioelectromagnetics is the study of the interaction between living organisms and electromagnetic fields, both those produced by the organism itself and those produced by outside sources. The recognition that the body produces electromagnetic fields has led to the development of many diagnostic procedures in Western medicine, including electroencephalography (EEG), electrocardiography (ECG), and nuclear magnetic resonance (NMR) scans.
Most scientists believe that consumer products containing small magnets have no significant effect on the human body.

23. National Center for Complementary and Alternative Medicine NCCAM
Health Information
CAM Clinical Trials
Treatment Information
News and Events

24. Integrative Medicine Employs rigors of modern science with
most beneficial CAM procedures
Customized approach
Collaboration of both disciplines
National Center for Complementary Medicine (NCCAM)
Created in 1998 under the auspices of National Institutes of Health Projected 2005 budget exceeds $121. million.

25. Models of Integrative Medicine
University of Arizona’s Medical School
Program in Integrative Medicine established in ‘Prospective’ Health Care Model
‘Health Coach’
Duke University Center for Integrative Medicine
Weill -Cornell Center for Integrative Medicine (NY)
Strang-Cornell Cancer Prevention Center

26. Thank You!