© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Complementary and Complementary and Alternative MedicineAlternative Medicine

PowerPoint® presentation to accompany:

Medical AssistingThird Edition

Booth, Whicker, Wyman, Pugh, Thompson

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© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Learning Outcomes

44-1 Define CAM.

44-2 Compare complementary and alternative medicine to conventional medicine.

44-3 Discuss how CAM and conventional medicine are used together.

44-4 Identify various types of complementary and alternative medicine.

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Learning Outcomes (cont.)

44-5 Describe how a medical assistant may use his or her knowledge of CAM.

44-6 Explain why patients and health-care practitioners are turning to complementary treatments.

44-7 Discuss insurance and payment for CAM treatments.

44-8 Explain how CAM is regulated.

44-9 Describe health fraud.

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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

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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

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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

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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.

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Types of CAM

Shared similarities Individualized

treatments, good nutrition, and preventative 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

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Types of CAM: 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

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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

Types of CAM: Alternative Medical Systems (cont.)

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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

Types of CAM: Alternative Medical Systems (cont.)

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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

Types of CAM: Alternative Medical Systems (cont.)

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Types of CAM: 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

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Most commonly used forms of CAM

Types Prayer Yoga Meditation Hypnosis Biofeedback

Types of CAM: Mind-Body Interventions (cont.)

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Types of CAM: 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

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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

Types of CAM: Biologically-Based Therapies (cont.)

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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

Types of CAM: Biologically-Based Therapies (cont.)

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Types of CAM: 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

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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

Types of CAM: Manipulative and Body-Based Methods (cont.)

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Swedish massage Stimulates circulation and

lymph flow 5 basic strokes

Neuromuscular massage Release tension, relieves

pain and pressure on nerves, and increases blood flow

Trigger point therapy

Seated massage Focuses on back and

neck

Types of CAM: Manipulative and Body-Based Methods (cont.)

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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

Types of CAM: Manipulative and Body-Based Methods (cont.)

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Types of CAM: Energy Therapies

Bioeletromagnetic-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

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Biofield therapies Manipulate energy field surrounding the body Reiki

Based on qi Visualization and touch

balance energy flow to bring healing energyto organs and glands

Therapeutic touch “Laying-on of hands” Hands direct human

energies to help or heal No scientific evidence

of efficacy

Types of CAM: Energy Therapies

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Apply Your Knowledge Match to types of CAM:

___ Therapeutic touch A. Energy therapies

___ Chiropractic medicine B. Mind-body therapies

___ Dietary supplements C. Body-based therapies

___ Yoga and meditation D. Biologically-based therapies

___ TCM E. Alternative medical systems

___ Herbal supplements

___ Homeopathy / naturopathy

___ Magnetic therapy

___ Hypnosis

___ Massage

E

E

D

D

ANSWER:

A

C

C

B

B

A

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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

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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

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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.

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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

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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

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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

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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

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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!

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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

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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

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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

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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

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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 Be aware of “secret cures”

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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!

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In Summary

CAM is therapy outside conventional medicine Complementary

medicine is used with conventional medicine

Alternative medicine is used in place of conventional medicine

5 classifications

Medical assistant must understand CAM therapies

Insurance reimbursement

Health fraud

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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