Introduction to Complementary and Alternative Medicines (CAM)

What is Complementary and Alternative Medicine (CA

  • Over 700 treatments/diagnostic methods
  • Name implies it can be used with or in place of orthodox medicine
  • Medicine/therapy
  • All involve stimulating the body to heal itself
  • Holistic - treats whole person rather than a condition or symptom in isolation
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House of Lords Select Committee on Science and Tec

Divided CAM into three groups:

  • Group 1: individual diagnostic approach, well developed self-regulation, effectiveness established through research
  • Group 2: don't include diagnostic skills, not well regulated
  • Group 3: long-established but indifferent to conventional scientific principles (3A), lack any credible evidence base (3B)
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Classification of CAM

Group 1 Examples:

  • Acupuncture
  • Chiropractic
  • Herbal Medicine
  • Homeopathy
  • Osteopathy
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Classification of CAM

Group 2 Examples:

  • Alexander technique
  • Aromatherapy
  • Flower remedies
  • Hypnotherapy
  • Massage 
  • Meditation
  • Nutritional medicine
  • Reflexology
  • Shiatsu
  • Spiritual healing
  • Yoga
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Classification of CAM

Group 3A Examples:

  • Anthroposophical medicine
  • Ayurvedic medicine
  • Chinese herbal medicine
  • Eastern medicine
  • Naturopathy
  • Traditional Chinise Medicine (TCM)

 

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Classification of CAM

Group 3B Examples:

  • Crystal therapy
  • Dowsing
  • Iridology
  • Kinesiology
  • Radionics
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Who uses CAM?

Approximately 1/4 of the UK population use CAM annually and over 40% in a lifetime.

CAM use is associated with:

  • Gender - women more likely
  • Increased education and income
  • Poor health status/chronic illness
  • Belief in importance of mind, body & spirit in health
  • Values of: environmentalism/feminism/personal growth psychology & spirituality/love of foreign & exotic
  • Main conditions: anxiety, musculoskeletal problems (back/chronic pain), urinary tract problems
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Why do people use CAM?

  • Holistic approach
  • Disillusioned with orthodox medicines/consultations
  • Perceived effectiveness/safety
  • 'Green'/'natural'
  • Increased awareness (media, role models)
  • Cultural reasons
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Homeopathy: History and Principles

  • Samual Hahnemann, 18th Century
  • Three principles:
  • 'like cures like'
  • minimal dose
  • single remedy
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Homeopathy: Manufacture

  • Plant, animal/insect, biological, chemical, miscellaneous
  • Extraction to obtain mother tincture
  • Potentisation process
  • Formulation of dosage form - tablets, granules, powders, mother tinctures, lotions, creams, ointments
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Homeopathy: Examples of illness

Osteoarthritis

  • Rhus tox: for pain relieved by heat, worse for cold and damp, wears off with continued movement, worse in the morning
  • Bryonia: for severe pain worse for heat and movement, relieved by cold applications
  • Pulsatilla: for when heat and warm rooms make pain worse, feeling weepy
  • Calcarea phos: for when joints feel cold and numb, worse when weather changes, weakness climbing stairs
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Homeopathy: Examples of remedy

Arnica

  • From Arnica Montana (mountain daisy)
  • Used for: injury - bruising, sprains; insomnia; gout
  • Remedy picture:
    • symptoms better for: lying down, rest, head low
    • worse for: cold, damp, touch, movement
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Homeopathy: Evidence

  • Controversial - both those for and against will present literature to support their view
  • Lots of anecdotal evidence for
  • Meta-analyses:
    • Linde et al (1997) - more than placebo but no indications identified where superior to placebo
    • Shang et al (2005) - weak evidence for effect seen but compatible with placebo effect
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Homeopathy: Evidence

  • National Health and Medical Research Council (Australia) 2015: 'There was no reliable evidence from research in humans that homeopathy was effective for treating the range of health conditions considered: no good-quality, well-designed studies with enough participants for a meaningful result reported either that homeopathy caused greater health improvements than placebo, or caused health improvements equal to those of another treatment'.
  • Safety (apart from missed diagnoses) generally not an issue.
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Homeopathy: Evidence

  • Science and Technology Committee Report 2010 recommended:
    • No efficacy beyong placebo - manufacturers shouldn't make medical claims
    • MHRA (Medicines and Healthcare Products Regulatory Agency) should not licence as medicines
    • NHS should not fund
  • Overall, no evidence to prove efficacy
  • NHS England guidance 2017 includes homeopathy on list of items which not be prescribed on NHS
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Medical Herbalism: History and Action

  • In use for thousands of years (humans and animals)
  • Whole plants/parts of plants/extracts
  • Pharmacologically active constituents
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Medical Herbalism: Example 1

St. John's Wort (hypericum perforatum)

  • Aerial parts used for wound healing, diuretic, depression, pain relief etc.
  • Treatment of mild-moderate depression
  • Side effects (gastro-intestinal) and quality issues
  • Interactions, e.g. reduced effect of antidepressants, anti-epileptics, oral contraceptived
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Medical Herbalism: Example 2

Echinacea spp

  • Traditionally used by Native Americans
  • Used for wound healing, treatment and prevention of infection, fever, toothache, eczema etc.
  • Anti-inflammatory, immune-stimulant, local anaesthetic 
  • Commonly used to boost immune system to 'ward off' colds
  • Trials show little evidence to efficacy
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Medical Herbalism: Safety Issues

  • Adulteration with other ingredients (other plant species, chemical products etc.)
  • Nephritis in 70 Belgians taking slimming preparation. Stephania tetrandra (Fangji) substituted with nephrotoxic Aristolochia fangchi (Guang fangji)
  • Intrinsic toxicity, e.g.:
    • Comfrey can cause hepatotoxicity
    • Kelp can cause hyperthyroidism
    • Celery can cause phototoxicity
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Medical Herbalism: Regulation

  • Since 30 April 2011 all herbal medicines placed on the UK market need a THR (Traditional Herbal Registration) or product licence.
  • Registered traditional herbal medicines
    • Products required to meet specific standards of safety and quality and be accompanied by agreed indications, based on traditional usage, and information for the patients on the safe use of the product.
  • Licensed herbal medicines
    • Herbal medicines which hold a product licence or marketing authorisation are required to demonstrate safety, quality and be accompanied by the necessary information for safe usage. Have product licence number.
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Medical Herbalism: Regulation

  • Unlicensed herbal medicines
    • Practitioners are allowed to make up and supply unlicensed medicines to meet the needs of an individual patient following a consultation. Medicines made up by practitioners are not subject to specific safety or quality requirements and do not offer adequate public health protection.

 

  • Herbal medicines also on list of items not to be prescribed on NHS
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Acupuncture: History and Principles

  • Probably 4-5000 years old
  • Insertion of fine needles at various points (acupoints in Traditional Chinese Medicine, trigger points in Western acupuncture)
  • 365 acupoints along meridians plus 1000 others
  • Affects flow of blood and qi along meridian?
  • Release of neurotransmitters?
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Acupuncture: Evidence - trials to date

  • More effective than placebo for: dental pain, nausea, osteoarthritis
  • Mixed/inconclusive: asthma, back and neck pain, migraine, rheumatic disease, tension headache, drug dependency
  • Ineffective in: smoking, weight loss
  • Trials problematic due to difficulty in blinding
  • Safety - local reactions/sterility of needles

Currently appears in NICE guidelines for prophylaxis

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