2. CHAPTER © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44 Complementary and Alternative Medicine

3. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-2 Learning Outcomes 44.1Explain CAM. 44.2Distinguish between complementary and alternative medicine and conventional medicine. 44.3Summarize how CAM and conventional medicine are used together. 44.4Identify various types of complementary and alternative medicine.

4. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-3 Learning Outcomes (cont.) 44.5Describe how a medical assistant may use his or her knowledge of CAM. 44.6Explain why patients and health-care practitioners are turning to complementary treatments. 44.7Compare insurance and payment for CAM treatments. 44.8Explain how CAM is regulated. 44.9Describe health fraud.

5. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-4 Introduction More than 30% of adults use complementary and alternative therapies –Relieve problems –Promote wellness –No relief from traditional treatments Some physicians use a combination of CAM and traditional therapies

6. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-5 What Is CAM? A group of practices and products that are not part of conventional medicine Allopathy – conventional medicine or common and usual practice Complementary medicine – used with conventional medicine Alternative medicine – used instead of conventional medicine

7. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-6 What Is CAM? (cont.) Scientific evidence concerning safety and effectiveness –Available for some CAM therapies –Research continues, so information changes Integrative medicine –Evolves as CAM therapies are adopted by conventional medicine –Combination of both

8. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-7 Apply Your Knowledge Define CAM and state why these therapies are not in wide use by practitioners of conventional medicine. ANSWER: CAM is a group of practices and products not considered part of conventional medicine. They are not widely used by physicians because there is not a lot of scientific evidence of their safety and effectiveness.

9. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-8 Types of CAM Shared similarities –Individualized treatments, good nutrition, and preventive health practices –Holistic –Promote self-care and self-healing –Recognition of one’s spiritual nature Categories –Alternative medical systems –Mind-body interventions –Biologically-based therapies –Manipulative and body-based methods –Energy therapies

10. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-9 Alternative Medical Systems Evolved apart from conventional medicine Homeopathic medicine –Treating syndromes and conditions with remedies that produce similar syndromes and conditions in healthy people –Remedy Produces the symptoms it is given to treat in order to stimulate the body’s natural defenses to heal itself Must meet FDA standards

11. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-10 Alternative Medical Systems (cont.) Homeopathic medicine –Looks at individuals, not diseases Initial in-depth assessment Follow-up – how they are responding –Medical assistant role Similar to other medical offices Have knowledge of common remedies

12. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-11 Alternative Medical Systems (cont.) Naturopathic medicine –Relies on the healing power of the body to establish, maintain, and restore health –Primary health care Nutritional/lifestyle counseling Dietary supplements/medicinal plants Exercise Homeopathy/traditional Chinese medicine

13. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-12 Alternative Medical Systems (cont.) Naturopathic medicine –Medical assistant – understanding of treatments –Traditional Chinese medicine Balanced qi (vital energy) Flow of qi along meridians (energetic pathways) Acupuncture – insertion of hollow needles along meridians –Ayurveda – provides guidance regarding food and lifestyle; India

14. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-13 Mind-Body Interventions Enhance the mind’s capacity to affect bodily function and symptoms Support groups and cognitive-behavioral therapy now part of traditional medicine Scientific support –Placebo effect – WW II –35% of therapeutic response is due to belief

15. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-14 Mind-Body Interventions (cont.) Most commonly used forms of CAM Types –Prayer –Yoga –Meditation –Hypnosis –Biofeedback

16. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-15 Biologically Based Therapies Use substances found in nature –Dietary supplements –Herbal products –Foods Medical assistant –Keep up-to-date about dietary and herbal products –Be able to provide reliable resources for patients

17. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-16 Biologically Based Therapies (cont.) Dietary supplements –Manufacturers – no evidence of effectiveness or safety –No standardization to ensure consistency and quality –Types Vitamins Minerals Herbals – no established recommended daily amount Recommended daily amount established by the FDA

18. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-17 Biologically Based Therapies (cont.) Patient education for using supplements –Report all supplements as they would prescription medications –Take supplement bottles to appointments Document patient’s use of supplements in the medical record

19. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-18 Manipulative and Body-Based Methods Based on the manipulation and/or movement of one or more parts of the body Types –Massage therapy –Chiropractic manipulation –Reflexology –Alexander technique –Bowen technique –Craniosacral therapy –Feldenkrais method –Rolfing –Trager bodywork –Tui Na

20. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-19 Manipulative and Body-Based Methods (cont.) Massage –Pressure, kneading, stroking, vibration, and tapping to positively affect health –Effects Relaxation Counteracts effects of stress Lowers heart rate and blood pressure Reduces pain/relaxes muscle spasms Improves concentration Promotes restful sleep Helps the mind relax

21. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-20 Manipulative and Body-Based Methods (cont.) Swedish massage –Stimulates circulation and lymph flow –5 basic strokes Neuromuscular massage –Releases tension, relieves pain and pressure on nerves, and increases blood flow –Trigger point therapy Seated massage –Focuses on back and neck

22. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-21 Manipulative and Body-Based Methods (cont.) Chiropractic medicine –Adjustments Manual treatments to re-align the vertebra and restore function of spinal nerves Chiropractor –Performs an exam and takes a history –Tests X-rays Muscle testing Analyzes posture

23. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-22 Energy Therapies Bioelectromagnetic-based therapies –Balances the electromagnetic fields of the body –No scientific evidence of efficacy –Magnetic therapy Most common type Magnets are used to correct disturbances of electromagnetic fields and restore health FDA – no medical value but relatively harmless Avoid for patients with pacemaker or defibrillator

24. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-23 Energy Therapies (cont.) Biofield therapies Manipulate energy field surrounding the body Reiki –Based on qi –Visualization and touch balance energy flow to bring healing energy to organs and glands Therapeutic touch –“Laying-on of hands” –Hands direct human energies to help or heal –No scientific evidence of efficacy

25. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-24 Apply Your Knowledge Match to types of CAM: ___ Therapeutic touchA.Energy therapies ___ Chiropractic medicineB.Mind-body therapies ___ Dietary supplementsC.Body-based therapies ___ Yoga and meditationD.Biologically-based therapies ___ TCME.Alternative medical systems ___ Herbal supplements ___ Homeopathy/naturopathy ___ Magnetic therapy ___ Hypnosis ___ Massage E E D D ANSWER: A C C B B A

26. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-25 Patients Seeking CAM Therapy Use is increasing –Less expensive –Have fewer side effects –More accessible –Increase in spirituality –Personal growth –Environmentalism –Preventive health care Reasons for seeking CAM therapy –Failure of traditional medical interventions –Treat side effects of conventional medicine’s treatments

27. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-26 Patients Seeking CAM Therapy (cont.) Patients with chronic debilitating conditions –Improve quality of life –Improve ability to cope with stress and illness Cultural differences in CAM use –Hispanics –Native Americans Accept patient’s right to choose CAM therapy

28. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-27 Patients Seeking CAM Therapy (cont.) Use of CAM in children on the increase –Safety – children respond differently –Efficacy in children not established –Identify and document if CAM is used

29. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-28 Apply Your Knowledge Mr. State is complaining about chronic back pain. He says that the medication only helps a little and asks you if there is anything else you could recommend that will help him. What should you tell him? ANSWER: If your employer is not averse to CAM therapies, you can tell him that there are CAM therapies that may help with the pain or at least help him cope better with it. He could try mind- body techniques, acupuncture, manipulative and body-based techniques, or energy therapies.

30. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-29 Insurance and CAM Coverage varies –Lack of research and documentation of efficacy –Emphasis on physiological or biochemical response to therapies Alternative health insurance companies emerging in response to need

31. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-30 Insurance and CAM (cont.) Medical assistant –Know whether or not CAM treatments are covered by insurance –Resources Insurance companies State agency that regulates the insurance industry

32. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-31 Regulation of CAM Therapies National Center for Complementary and Alternative Medicine (NCCAM) –Research –Training and career development –Conferences and educational programs –Integration of scientifically proven CAM therapies into conventional medicine

33. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-32 Regulation of CAM Therapies (cont.) White House Commission on Complementary and Alternative Medicine Policy (WHCCAMP) –Funding for research –Communication between CAM and conventional practitioners –Availability of CAM practitioners –State review and evaluation of CAM practitioners –Insurance coverage options

34. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-33 Apply Your Knowledge 1. Why do insurance companies not reimburse for most CAM therapies? ANSWER: Insurance companies do not reimburse for CAM therapies because of the lack of research and documentation of effectiveness of these therapies. 2. What are the federal agencies tasked with regulation of CAM therapies? ANSWER: They are the NCCAM and WHCCAMP. Yippee! 2 for 2!

35. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-34 Health Fraud Articles of unproven effectiveness promoted to improve health, well-being, or appearance –Deception or trickery for profit –Plays on emotions and desperation Regulation –FDA – safety, manufacturing, and labeling –FTC – advertising

36. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-35 Health Fraud (cont.) Health claims –Unproven claims must include a disclaimer –FDA-approved claims for food and supplements Based on scientific evidence Only reduces risk/does not treat or cure

37. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-36 Health Fraud (cont.) FDA-Approved Health Claim Supplement/Food Reduce risk of some cancers Low-fat diets Fruits, vegetables, fiber-containing grain products Whole grains Reduce risk for hypertension Low-sodium diets Potassium Reduce risk for osteoporosis Calcium

38. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-37 Health Fraud (cont.) FDA-Approved Health Claim Supplement/Food Reduce risk of heart disease Low-sodium diets Decreased saturated fat and cholesterol Soluble fiber and whole grains Soy protein/plant sterols/stanol esters Reduce risk for neural tube defects Adequate folate Reduce tooth decay Decreasing between-meal consumption of foods high in sugars and starches

39. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-38 Health Fraud (cont.) Recognizing health fraud –Check with the BBB or attorney general’s office –Check with appropriate health-care group –Contact the FDA –If it sounds to good to be true, it probably is not true –If unproven, get a second opinion –Beware of “secret cures”

40. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-39 Apply Your Knowledge Why do people fall victim to fraudulent health claims? ANSWER: These claims target people who are emotional and desperate. They are hoping to find a cure, improve their health, or just look better. Bravo!

41. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-40 In Summary 44.1Complementary and alternative medicines are practices and products outside the scope of traditional or conventional medicine. 44.2Complementary medicine is used in conjunction with conventional medicine. Alternative medicine is typically used as a replacement for conventional medicine.

42. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-41 In Summary (cont.) 44.3A new type of medicine called integrative medicine has emerged, in which conventional medicine and scientifically proven CAM therapies are used together. 44.4There are five classifications for CAM. They include alternative medical systems, mind-body interventions, biologically-based therapies, manipulative and body- based methods, and energy. Each of these classifications has various types of products and therapies associated with it.

43. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-42 In Summary (cont.) 44.5As a medical assistant, it is your responsibility to have basic knowledge of CAM therapies. If you work with a practitioner that provides CAM therapies, you will be responsible to assist in many cases. Additionally, understanding insurance reimbursement for CAM and health fraud are important aspects of the medical assistant’s role.

44. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-43 In Summary (cont.) 44.6In many cases, patients are looking for low-cost products and services that help to maintain health and prevent disease, so they turn to CAM. Other patients that are offered no effective treatment or cure from conventional medicine are turning to CAM for additional options. Health-care practitioners are using many types of complementary therapy as they become accepted and, in many cases, scientifically proven.

45. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-44 In Summary (cont.) 44.7In general, the insurance industry provides little or no coverage for CAM therapies. To find out if coverage is provided, you can contact the insurance company directly, obtain information from the association’s web site for the type of therapy provided, or contact the state insurance commissioner.

46. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-45 In Summary (cont.) 44.8The NCCAM conducts and supports CAM research and provides CAM information to health-care providers and the public. Some state and federal laws have been enacted to help regulate CAM, and more laws and regulations are expected as research is conducted. 44.9Health fraud as defined by the FDA as “articles of unproven effectiveness that are promoted to improve health, well being, or appearance.” Health fraud is monitored by the FDA and the FTC.

47. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 44-46 There is a magnet in your heart that will attract true friends. That magnet is unselfishness, thinking of others first; when you learn to live for others, they will live for you. ~ Paramahansa Yogananda End of Chapter 44