pm 3.30 briggs
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TRANSCRIPT
Complementary Medicine in Women’s Health
Women's Health 2012: The 20th Annual Congress March 16, 2012
Josephine P. Briggs, M.D.Director, National Center for Complementary and Alternative MedicineNational Institutes of Health
DISCLOSURE
I HAVE NO FINANCIAL INTERESTS OR CONFLICTS OF INTEREST TO DISCLOSE
A group of diverse medical and health care interventions, practices, products, or disciplines that are not generally considered part of conventional medicine
What is Complementary Medicine?
Boundaries are
Gray
Moving
Cultural
Examples of Mind and Body Interventions
Acupuncture Breath practices Mantra Meditation Mindfulness based
stress reduction Guided imagery Progressive
relaxation Tai chi and Qi gong Yoga Spinal manipulation
Hypnosis Alexander technique Pilates Reiki Healing touch Qi gong Craniosacral therapy Massage therapy
© iStockphoto.com/Hagrit
Categories of CAM Natural Products
Dietary supplements Herbal or botanical
products Traditional medicine
formulations Folk medicines Homeopathic remedies Probiotics Food-based
phytochemicals© Bob Stockfield
Adult Use of Selected CAM Therapies: 2007
0
5
10
15
20
Natur
al p
roduct
s
Deep b
reat
hing
Med
itatio
n
Chiro
prac
tic
Mas
sage
Yoga
Speci
al d
iets
Relax
atio
n
Imag
ery
Acupun
ctur
e
% o
f Adu
lt P
opul
atio
n
38.8 million
16 million
Barnes et al., 2008
Adult Use of CAM for Selected Conditions: 2007
0
5
10
15
20
% o
f th
ose
ad
ults
who
u
sed
CA
M
14.3 million
5 million
1.8 million
Barnes et al., 2008
% o
f Adu
lt P
opul
atio
nAdult Use of Selected CAM Therapies: 2002 vs. 2007
Barnes et al. 2004, 2008
***
0
5
10
meditatio
n
massage
yoga
specia
l diets
imagery
acupunctu
re
tai chi
energy t
herapies
naturopathy
qi gong
biofeedback
hypnosis
Ayurve
da
chelatio
n
2002 2007
0%10%20%30%40%50%60%70%80%90%
100%Other Reasons
Treatment AND Well-ness/Preven-tion
Treatment only
Wellness/Prevent only
Reasons for CAM Use: 2007%
usi
ng t
hera
py f
or g
iven
re
ason
Stussman, 2010
87% Treatment42% Wellness
76% Wellness54% Treatment
NHIS CAM Survey: Use and Costs, 2007
CAM use in U.S.: 40% of adults 12% of children
CAM spending in U.S.: $34 billion out-of-pocket
1% of total health care expenditures 10% of total out-of-pocket costs
Across all demographics Women > men West >Midwest >Northeast >South Greater use in people with higher education levels
Overall Use by GenderWomen Men Average43% 34% 40%
How does it work?
The Range of Research Questions
BasicScience
Can it be studied in people?
Translational Research
What are the specific effects?
Efficacy Studies
How well does it work in real world
settings?
Outcomes and
Effectiveness Research
Hierarchy of Evidence
Basic biological understanding
Rigorous human studies
Systematic reviews
Guidelines
Hodis HN, Mack WJ, Kono N, et al. Isoflavone soy protein supplementation and atherosclerosis progression in healthy postmenopausal women: a randomized controlled trial. Stroke. 2011;42(11):3168–3175.
Research Spotlight
Isoflavone soy protein supplementation and atherosclerosis progression in healthy postmenopausal women: a randomized controlled trial.
Research Spotlight
Naqvi AZ, Harty B, Mukamal KJ, et al. Monounsaturated, Trans, and Saturated Fatty Acids and Cognitive Decline in Women. J of the American Geriatrics Society. 2011;59(5):837-843.
Research Spotlight
Barbosa-Cesnik C, Brown MB, Buxton M, et al. Cranberry juice fails to prevent recurrent urinary tract infection: results from a randomized placebo-controlled trial. Clinical Infectious Diseases. 2011;52(1):23–30.
Research Spotlight
Geller SE, Shulman LP, van Breemen RB, et al. Safety and efficacy of black cohosh and red clover for the management of vasomotor symptoms: a randomized controlled trial. Menopause. 2009;16(6):1156–1166.
Tai Chi for Fibromyalgia
Meditative Exercise Therapies
Beyond Drugs: How alternative treatments can ease pain
March 7, 2011
Journal of Manipulative and Physiological Therapeutics
Menopause Research
In 2002, the Women's Health Initiative raised concerns about
long-term safety of menopausal hormone therapy.
One reason that many women are turning to complementary
therapies.
In 2005, NIH State-of-the-Science conference on the
management of menopause-related symptoms determined that
more research is needed to clearly define the natural history of
menopause, associated symptoms, and effectiveness and safety
of treatments for bothersome symptoms.
NCCAM Menopause Research
NCCAM supports a number of studies on complementary health
practices for menopausal symptoms, such as:
A trans-NIH initiative to improve scientific measures of hot
flashes
Research to identify natural plant-based compounds as
promising alternatives to traditional menopausal hormone
therapy
Safety and efficacy and mechanisms of action of black cohosh,
red clover, soy supplements, and other botanicals
Mind and body therapies like yoga, meditation, hypnotherapy,
and acupuncture for reducing hot flashes.
NCCAM Portal Page on Women’s Health
Cancer
Fertility/pregnancy
Menopause
Osteoporosis
Osteoarthritis
Polycystic Ovary
Syndrome
Urinary Tract
Infection
Links to other
Resources
nccam.nih.gov/health/providers/digest
Acknowledgements
NHIS CAM Survey Richard Nahin, NCCAM Barbara Stussman, NCCAM Patricia Barnes, NCHS/CDC
National Center for Complementary and Alternative Medicine
1-888-644-6226nccam.nih.gov