Complementary And

Alternative Therapies

Dwi Nur Rahmantika PS ,S.Kep.,Ners

• Complementary and alternative therapies
(CAM) is a intervention which colaborating
between conventional therapy with
traditional therapy.
• October 1991 — The U.S. Congress to investigate
and evaluate promising unconventional medical
practices.
• June 1993 — The NIH Revitalization Act formally
establishes the OAM within the Office of the
Director, NIH, to facilitate study and evaluation of
complementary and alternative medical practices
and to disseminate the resulting information to the
public.
• October 1998 — NCCAM is established by
Congress under Title VI, Section 601 of the
Omnibus Appropriations Act of 1999 (P.L. 105-
277). This bill amends Title IV of the Public Health
Service Act and elevates the status of the OAM to
an NIH Center.
• February 1999 — The U.S. Secretary of Health and
Human Services (HHS) signs the organizational
change memorandum creating NCCAM and making
it the 25th independent component of NIH.
• MAugust 1999 — The National Advisory Council on
Complementary and Alternative Medicine
(NACCAM) is chartered.
• February 2001 — NCCAM and the National Library
of Medicine launch CAM on PubMed, a
comprehensive Internet source of research-based
information.
 Complementary - together with
conventional medicine

Alternative - in place of conventional

medicine

Some providers practice both

 Topics?
• Why do people use them?
• Who uses them?
• Frequency of use?
• Types?
• Costs?
• Evidence?
• Problems?
Why?
 Why?
• Positive motives
– Perceived – Good patient/therapist
effectiveness or safety relationship
– Spiritual • Fewer time restraints (£)
• On equal terms (£)
– Holism
• Empathy (£)
– All things natural
– Non-invasive
– Active role
– Accessibility (£)
– Control over treatment
– Affluence (£)
– Pleasant therapeutic
experience
 Why?
• Negative motives
– Dissatisfaction with – Reject science and
conventional health technology
care – Reject “the
• Ineffective establishment”
• Adverse effects – Desperation
– Doctor-patient
relationship
• insufficient time
• waiting lists
 Why?
• Other Motives
– Not an alternative
– What is available for their health care
 Who?
• Women>Men • Chronic Ill Health
• Well educated + – Cancer
affluent – AIDS
• Middle aged – Long term conditions

• Ethnic population • Worried well

– Afro- • Myalgic
Caribbean>Asian>Cau Encephalopathy
casian – 33% use CAM
 Frequency?
• 46% UK population will try at some point
• 1999
– 50,000 CAM practitioners (UK)
– 5 million patients consulted a CAM
practitioner in one year
• More uptake in Europe
– France & Germany
• USA
– 629 million visits in one year alone (?%pop)
 Frequency?
• Use of CAM in the United Kingdom 1999 (%)
– Herbal medicine (34)
– Aromatherapy (21)
– Homeopathy (17)
– Acupuncture / acupressure (14)
– Massage (6)
– Reflexology (6)
– Osteopathy (4)
– Chiropractic (3)
Costs?
 Costs?
• Not necessarily actual cost
• Cost effectiveness
• Aromatherapy session
• Acupuncture
• Massage
How Many Types?
 Types?
• Biologically based practices
– supplementing a person's normal diet
• Manipulative and body-based therapies
– focus on the body's various systems and structures
• Mind-body interventions
– use the connection between a person's mind, body,
and spirit to enhance total well being
• Energy therapies
– are meant to restore disturbances in the body's
natural energy
 Types? (Common)
• Acupuncture • Bowen
• Alexander Technique • Biofeedback
• Allergy testing • Chiropractic
• Aromatherapy • Chinese Herbal Medicine
• Art Therapy • Counselling
• Autogenic Training • Craniosacral Therapy
• Auricular Acupuncture • Crystal Therapy
• Ayuveda • Dowsing Flower Therapy
• Bodywork • Healing Herbalism
• Homeopathy
 Types? (Common)
• Hydrotherapy • Physiotherapy
• Hypnotherapy • Radionics
• Indian Head Massage • Reflexology
• Iridology • Reiki
• Kinesiology • Shiatsu
• Music Therapy • Tai Chi
• Naturopathy • TENS therapy
• Nutrition • Traditional Chinese
• Osteopathy Medicine
• Thought Field Therapy
• Yoga Therapy
 Types? (Rarer)
• Auricular Acupuncture • Light Touch Therapy
• Australian Flower Essences Therapy • Magnotherapy
• Bach Flower remedies • Marma Therapy
• Bee Venom Therapy • Meta-Aromatherapy
• Chelation Therapy • Microwave Resonanace Therapy
• Colonic Hydrotherapy • Naturotherapy
• Colour Therapy • Oxygen Therapy
• Dream Therapy • Panchakama Therapy
• Eye Movement Desensitization and • PIP scans
Reprogramming • Raw Vegetable Juice Therapy
• Exercise Healing • Rolfing
• Health Clubs • Spiritual Counselling
• Health Screening • Stress Management
• Juice Therapy • Swimming Therapy
• Light Therapy • Transdecendal Meditation
• Tragerwork
• Vegetable Juice Therapy
 Specific Types?
• Aromatherapy
– Used since Egyptian times
– Distilled plant extracts
• 400 Oils
• Varying quality (RCT)
– Improve well-being
• Peppermint – digestive effects
• Tea Tree Oil – antibacterial
– Massage, Baths, Inhalation
 Specific Types?
• Bee Venom Therapy
– Contain sulphur
– Stimulates cortisol release
– Applied to surface
– Chronic inflammatory conditions
– RA, Myositis
– Applied for 5days with 2-3day interval
– Normally haemorrhagic
 Evidence?
• Circumstantial
• Past attempts at investigations
• Little research
– Difficulty with RCT
– Outcomes dependant on social, cultural and
spiritual beliefs
 Evidence?
• Evidence Based Complementary and Alternative
Medicine (eCAM)
– Yoga
• Improve risk in adults with DM 2
• Prevention and management of cardiovascular complications
• May be useful in the management of stress (post tsunami
victims)
– Massage
• Benefits in chronic pain conditions
– Sanfujiu (herbal ointments into pressure points)
• moderately effective in treating allergic symptoms
 Evidence?
• eCAM
– Green Tea
• Regular intake (>3 cups per day) may reduce the
lung cancer in smokers
– Gentle Touch Therapy
• (strong) circumstantial evidence
• Improved psychological well-being
• Self-reported psychological problems
 Evidence?
• eCAM
– Electro-acupuncture
• Relieving labour pain
• Synergism of the CNS with a direct impact on the uterus
through release of ß-EP and 5-HT into the blood
– Tai Chi
• 15 week course
• effective in reducing headache symptoms and perception of
physical and mental health
– Music Therapy
• Benefited patients in hospice and palliative care
 Evidence?
• (2007) NHS trial in Belfast
– £200,000 for GP to use alternative therapies
– Was it a success?
– Reduced use of conventional therapy
– Effective?
Problems?
 Problems?
• Safety risk
– Especially during pregnancy
– Ayurvedic treatments
• Heavy metals (Lead, Mercury, Arsenic)
– Unknown purities
– Reactions are not routinely monitored
– Dietary supplements can interact with prescribed
medications

• Difficulty establishing reliability/efficacy

 Problems?
• Significant lack of evidence/research
– Speculative
– Small trials
– Often biased

• Financial motivations

• Lack of regulation
– Some with registered Osteopaths (GOsC) and
Chiropractors (GCC)
– Remaining registration is voluntary
Problems?
 Topics?
• Why do people use them?
• Who uses them?
• Frequency of use?
• Types?
• Costs?
• Evidence?
• Problems?
 Useful Links?
• http://www.bcma.co.uk/
• http://www.cancerbackup.org.uk/Treatments/Complementarytherapi
es/Generalinformation/Complementaryalternativetherapies
• http://www.therapiesguide.co.uk/
• http://www.holisticpages.co.uk/
• http://www.dh.gov.uk/en/Publichealth/Healthimprovement/Compleme
ntaryandalternativemedicine/index.htm
• http://www.medicine.ox.ac.uk/bandolier/booth/booths/altmed.html
• http://www.nlm.nih.gov/medlineplus/complementaryandalternativeth
erapies.html
• http://www.cancer.org/docroot/ETO/ETO_5.asp
• http://www.nhsdirectory.org/
• http://nccam.nih.gov/
 Useful Links?
• http://www.library.nhs.uk/cam/
• http://www.internethealthlibrary.com/Prime-pages/A-
ZDirAltTherapies.htm
• http://www.arc.org.uk/arthinfo/patpubs/6007/6007.asp
• http://diabetes.niddk.nih.gov/dm/pubs/alternativetherapies/
• http://www.publications.parliament.uk/pa/ld199900/ldselect/ldsctech/
123/12301.htm
• http://homeopathy4health.wordpress.com/
• http://ecam.oxfordjournals.org/
• http://www.bmj.com/cgi/content/full/319/7211/693
• http://www.cancerhelp.org.uk/help/default.asp?page=216
• http://www.medicalnewstoday.com/sections/complementary_medicin
e/
 The Three Oils
• A = Lavender
– calming effect, aiding relaxation and anxiety
• B = Lemon Grass
– antiseptic, bactericidal, deodorant and
antifungal
• C = Sandalwood
– Stress and anxiety, itching and skin
inflammation, aphrodisiac