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Fundamentals Of Complementary And Alternative Medicine Pdf

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Fundamentals of Complementary and Alternative Medicine. (Marc S. Micozzi, Ed. ) (). ISBN Available from Churchill Livingstone, Fundamentals of Complementary and Alternative Medicine is appropriate for Download the PDF to view the article, as well as its associated figures and tables . The personal training industry is positioned for tremendous growth. success of any Personal ACSM's Resources for the P.

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Public law Food and Drug Administration. MedWatch: Safety Information. Touger-Decker R, Mobley C. Oral health and nutrition: position of ADA. J Am Diet Assoc ; — Healthy People Understanding and Improving Health. Washington, DC: U. Government Printing Office, Google Scholar Jacobs J, Moskowitz H. In Micozzi MS, ed. Fundamentals of Complementary and Alternative Medicine.

Lange A. Textbook of Natural Medicine. Reilly D. The puzzle of homeopathy. Vickers A, Zollman C. Br Med J ; — Are the clinical effects of homeopathy placebo effects? A metaanalysis of placebo-controlled trials. Lancet ; — Brunette DM. Alternative therapies: abuses of scientific method and challenges to dental research.

J Prosthet Dent ; — Unconventional Dentistry.

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Bradley RS. Philosophy of naturopathic medicine. Pizzorno JE. Naturopathic Medicine. Med Clin North Am ; — Ergil KV. Fugh-Berman A. Alternative Medicine: What Works. Tucson, AZ: Odonian Press, Acupuncture Information and Resources. Accessed June 30, Berman BM.

Clinical applications of acupuncture: an overview of the evidence. Rosted P. The use of acupuncture in dentistry: a review of the scientific validity of published papers. Oral Dis ; — Rydholm M, Strang P. Acupuncture for patients in hospital-based home care suffering from xerostomia. J Palliat Care ; 15 4 — Acupuncture for xerostomia: clinical update. Cancer ; — Blom M, Lundeberg T.

Long-term follow-up of patients treated with acupuncture for xerostomia and the influence of additional treatment. Benson H. The Relaxation Response. New York: Outlet Books, Jacobs GD. Clinical applications of the relaxation response and mind-body interventions. The physiology of mind-body interactions: the stress response and the relaxation response. The psychosomatic network: foundations of mind-body medicine. Altern Ther Health Med ; — Kerkvliet GJ.

Music therapy may help control cancer pain. J Natl Cancer Inst ; — Long-term efficacy of biobehavioral treatment of temporomandibular disorders. J Behav Med ; — The use of hypnosis in dentistry: a review. Dent Update ; — Whereas the ancient Greeks postulated that health requires a balance of vital humors, Asian cultures considered that health depends on the balance and flow of vital energies through the body.

This latter theory underlies the practice of acupuncture, for example, which asserts that vital energy flow can be restored by placing needles at critical body points.

Energy medicine. This approach uses therapies that involve the use of energy—either biofield- or bioelectromagnetic-based interventions. An example of the former is Reiki therapy, which aims to realign and strengthen healthful energies through the intervention of energies radiating from the hands of a master healer.

For example, traditional Chinese medicine incorporates acupuncture, herbal medicines, special diets, and meditative exercises such as tai chi. Ayurveda in India similarly uses the meditative exercises of yoga, purifying diets, and natural products.

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In the West, homeopathic medicine and naturopathic medicine each arose in the late 19th century as reactions to the largely ineffectual and toxic conventional approaches of the day: purging, bleeding, and treatments with heavy metals such as mercury and arsenicals.

In developing nations, TM is the sole source of health care for all but the privileged few.

By contrast, in affluent countries individuals select CAM approaches according to their specific beliefs. For example, as many as 60 percent of those living in France, Germany, and the United Kingdom consume homeopathic or herbal products. Only 1 to 2 percent of Americans use homeopathy, but 10 percent of adults use herbal medicines, 8 percent visit chiropractors, and 1 to 2 percent undergo acupuncture every year Ni, Simile, and Hardy Table There is remarkably little correlation between the use of CAM and TM approaches and scientific evidence that they are safe or effective.

For many CAM and TM practices, the only evidence of their safety and efficacy is embodied in folklore. Beginning more than 1, years ago, data on the use of thousands of natural products were assembled into impressive monographs in China, India, and Korea, but these compendiums—and similar texts from Arabic, Egyptian, Greek, and Persian sources and their major European derivatives—are merely catalogs of products and their use rather than formal analyses of safety and efficacy.

Many people who today choose herbal products in lieu of prescription medications assume that because these products are natural, they must be safe, even when the evidence for this assertion is essentially anecdotal.

Recent studies have shown that herbals are highly variable in quality and composition, with many marketed products containing little of the intended ingredients and containing unintended contaminants, such as heavy metals and prescription drugs. A few herbals are banned outright in several countries. Comfrey and kava have been associated with liver failure, aristolochia with genitourinary cancer De Smet , and ephedra with heart attacks and strokes Shekelle and others More important, herbals contain ingredients that can accelerate or inhibit the metabolism of prescription drugs table The most notorious of these is St.

John's wort, which affects the metabolism of nearly 50 percent of all prescription drugs Markowitz and others The cumulative data on the pharmacological and potential adverse effects of herbal supplements now dictate that patients discuss their use of supplements with knowledgeable practitioners before initiating treatment. As to evidence of the efficacy of CAM and TM approaches, thousands of small studies and case series have been reported over the past 50 years.

Few were rigorous enough to be at all compelling, but they are sufficient to generate hypotheses that are now being tested in robust clinical trials. The existing body of data already shows that some approaches are useless, that for many the evidence is positive but weak, and that a few are highly encouraging table Economics of Complementary and Alternative Medicine and Traditional Medicine Although social, medical, and cultural reasons may account for why people in a given country prefer CAM and TM to conventional Western medicine, economic forces are also at play.

Fundamentals of complementary and alternative medicine

This section describes the socioeconomic determinants of seeking treatment from traditional healers and providers of CAM; reviews the evidence on the cost-effectiveness of CAM and TM; and discusses cost-effective approaches to regulating, improving, and expanding the use of CAM and TM. Much of this evidence is from industrial countries; few studies have been conducted in or are applicable to low- and middle-income countries.

This caveat is important for two reasons. First, the CAM and TM modalities discussed in this section may not be used in many developing countries. Second, the limited data on cost-effectiveness may not be applicable in the case of those countries.

Nevertheless, the data give a rough picture of the relative cost-effectiveness of a number of CAM and TM practices. Although economic factors play a role in this choice, the underlying incentives are not always predictable. For instance, a common misconception is that patients opt for CAM and TM services because they are cheaper alternatives to conventional medical care.

Even though there are certainly instances when the cost of treatment using CAM or TM is much cheaper than the cost of accessing a conventional medical service, several studies have found that CAM and TM cost the same or more than conventional treatments for the same conditions see, for example, Muela, Mushi, and Ribera At least one study has shown that financial considerations are rarely the primary factor in choosing a traditional healer, ranking behind such reasons as confidence in the treatment, ease of access, and convenience Winston and Patel The high cost of using a healer was cited as the most common barrier to seeking care from this source.

The same survey found that outcomes tended to be better when patients went to government clinics TM is not always more expensive than conventional medicine, however. Another common misconception is that the poor are more likely to use TM.

At least one study shows that this may not be true. Although some traditional healers charge more than conventional practitioners, their fees may be negotiable, the method of payment may be flexible often on credit or in exchange for labor , and payment may be contingent on outcome. The availability of an outcome-contingent contract favors TM over Western medicine when the disease condition requires providers to both exert effort in curing patients and induce patients to comply with their recommendations.

Nonetheless, this strategy may be difficult to apply to the larger health care system.

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Furthermore, patients tend to seek care from traditional healers for conditions such as mental illness, impotence, and chronic disorders, which they perceive as requiring greater involvement by the extended family and kinship group. Accordingly, the availability of financial support for seeking treatments for these disorders is greater than it is for illnesses such as malaria or diarrhea, for which patients more often seek conventional treatment. Few published data are available on the financial costs of TM in low- and middle-income countries.

The data presented here on the use of traditional healers are extracted from the World Bank's living standards surveys in Vietnam to provide one nationally representative snapshot of the situation.

Of 28, individuals in the sample, 10, had consulted a health care provider in the four weeks preceding the survey. These consultations included both home visits and visits to a provider. Of the 10,, 1, had been to a public provider, 1, to a private provider, 7, to a pharmacy, and to a traditional healer.

The per visit drug cost for consulting a traditional healer was D 46, and the total cost per visit was D 51, compared with drug costs of D 38 and total costs of D 41 for going to a private clinic. One commonly cited motivation for using CAM and TM is that their use might lower the incidence and costs of side effects associated with conventional treatments, but the published evidence on this point remains mixed.

There is some evidence that CAM is used in addition to conventional treatments Thomas and others , but CAM may also have the effect of displacing conventional treatments.

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An outpatient survey found that, of patients who had been receiving conventional treatment from the Royal London Homeopathic Hospital since the onset of care, a third had halted their conventional treatment and another third had reduced their intake of conventional medication van Haselen The use of homeopathic treatment often replaced conventional treatments in patients with skin and respiratory infections; in patients with cancer, its use was purely complementary and therefore added to overall health care costs.

Thomas and others observe that patients who use CAM and TM also commonly access conventional medical care. In industrial countries, most CAM usage complements conventional care, but this is also common in developing nations. For instance, Mwabu provides evidence from Kenya that patients are likely to use more than one type of provider from the range of those available, such as government facilities, mission clinics, private clinics, pharmacies, and traditional healers.

Furthermore, the choice of provider depends on patients' illness, condition, socioeconomic status, and education. If an initial visit to one kind of provider did not resolve the disease satisfactorily, a follow-up visit was made to a different kind of provider.

Finally, the quality of care—including efficiency of service and waiting time at government and private clinics—is an important determinant of whether patients choose to go to traditional healers.

Most traditional healers surveyed in a second study referred patients to Western practices for treatment when necessary Mwabu, Ainsworth, and Nyamete Economic Evidence Although most studies tend to focus on a specific CAM or TM practice, Sommer, Burgi, and Theiss looked more broadly at whether the provision of CAM and TM services through prepaid health plans or government insurance reduces the overall costs of health care and found that it does not.

A possible reason is that few individuals who are offered access to CAM use them, and those who do might access those services in addition to, not in place of, more conventional health services. Studies that compare the cost-effectiveness of different CAM and TM approaches using the same analytical framework are rare. Complementary medical practices evaluated included acupuncture, homeopathy, tai chi, meditation, reflexology, hydrotherapy, naturopathy, and massage.

Patients were enrolled in either the Western medicine group or the CAM group. Patients were not randomized between the two treatment groups, but they were matched by disease pathology and severity, age, and sex.

Furthermore, selected patients had completed at least one year in the health system, as the investigators reasoned that this would enable them to evaluate their follow-up.

Overall, the investigators found that complementary medicine was between 53 and 63 percent less expensive than conventional medicine for achieving equivalent levels of effectiveness. Complementary medicine was especially cost-effective for osteoarthritis, hypertension , facial paralysis, and peptic ulcers. However, this study was not randomized, and patients had to have failed first-line drug treatment before being offered the choice of second line-treatment, either with acupuncture or with Western medicine.

Homeopathy Evidence indicates that the cost of homeopathic medication is lower than the average cost of allopathic products, which would be an economic factor in favor of its use if homeopathy were proven to be effective. A study by the National Health Service in the United Kingdom found that the drug costs associated with homeopathy were lower than those of allopathic practitioners Swayne However, the study was not randomized and failed to control for the inclination of only a subset of people to accept and remain compliant with ayurvedic approaches.

Chiropractic Some studies found that spinal manipulation is less expensive than conventional treatments for episodes of back pain. Moreover, 15 percent of patients in the chiropractic group were able to return to work, compared with none in the control group. However, other larger and better-controlled studies failed to find a difference between chiropractic and physical therapy in terms of either outcomes or costs Cherkin and others ; Skargren and others ; Skargren, Carlsson, and Oberg A study of adults with low back pain who were randomly assigned to physical therapy or chiropractic manipulation or were just given an educational booklet found no significant differences in either the mean costs of care or the outcomes between the physical therapy and chiropractic groups Cherkin and others Mind-Body Treatments Little evidence is available on the cost-effectiveness of practices such as meditation and yoga, but the cost of acquiring the skills required for these practices, as well as the time costs of practicing them, are so low relative to conventional medicine that evidence of their clinical effectiveness might suffice to justify their use on economic grounds.

Available evidence from clinical studies suggests that mind-body treatments can be cost-effective Caudill and others ; Friedman and others ; Hellman and others ; Sobel Translation from Conventional Medicine 3.

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