stephen holt md-integrative medicine definitions and initiatives

8/8/2019 Stephen Holt MD-Integrative Medicine Definitions and Initiatives

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Stephen Holt, MD, LLD (Hon.)Stephen Holt, MD, LLD (Hon.)

INTEGRATIVE MEDICINE:DEFINITIONS AND

INITIATIVES



WHAT IS INTEGRATIVE MEDICINE?

Lost in ³terms´ e.g. integrated, holistic,

eclectic, alternative etc.

Large consumer lobby for alternativemedicine.

Increasing requests by patients for

what they perceive to be simple, gentle

natural options for health.

Conversations in Integrative Medicine



PLURALISTIC MEDICINE CONVENTIONAL MEDICINE

Natural approaches integratedPhysician interventions drugs or surgery

Nutrition of primaryimportance

Nutrition of secondaryimportance

Healing orientated Disease orientated

Body and mind Physical focus

Blends of synthetic andnatural treatments

Synthetic, single drugs

Sympathetic to belief Ignores belief systems

Changing traditions Fixed traditions

All disciplines Exclusive ownership



ALTERNATIVE MEDICINE?

Licensed healthcare givers are

governed by ³scopes of practice.´

Increasing numbers of clinicians

operate in eclectic medical facilities

and ³wellness centers´ or ³spas´. Many alternative medicine

interventions do not require any

licensure or educational standard for their application or ³practice´.

Need for defined standards of

education and agreed curricula.



ALTERNATIVE MEDICINE

Simple definition: non-allopathic andoften not ³usual and customary´.

Attempts to define evidence-based

vs. non-evidence based alternatives. Medicine has been described as

³At The Crossroads´: ³Spaghetti

Junction´ Regulators wrestle with licensure of

several disciplines of alternativemedicine.



COMPLEMENTARY MEDICINE

More than semantics

The use of general principles of

care for disease management,involving positive lifestyle

change, specific nutritional

interventions or the use of dietarysupplements etc.



PODIATRIC POETRY IN POOR TASTE!

³The podiatrist can play all day

In attempts to heal the foot.

Wasting some of their time as they may

Not tending to the underlying disease.How focused and clever we are

Engaged in this activity with ease.

Did it occur to the profession

To extend their scope of practice

And overcome their minor obsession.´

³ A Bad Poet´, Anon.



EMERGING CONCEPTS: 1

Natural medicine cannot integrate

into general medical practice

without a scientific base.

Botanicals or herbs are ³drugs´ andmany drugs are botanicals or herbs,

or synthetic copies.

Dietary supplement manufacturersexhibit widespread ignorance about

pharmaceutical science.



EMERGING CONCEPTS: 2

Some natural clinicians baulk at

attempts to explain the bioactivity of

natural therapies within the

framework of scientific knowledge. While sympathy exists for this

position, our understanding of

pharmacodynamic effects of herbs,botanicals or nutrients must be

based on scientific principles.



HISTORIC PERSPECTIVES

Pharmacognosy: the study of

natural products used in medicine

Ancient discipline of medicalscience

Pharmakon = drug, Gnosis =

knowledge



GENERAL ISSUES

Dietary Supplements are the main stay of alternative and complementary medicine

Growth overall in OTC sales

Contemporary switch to natural remedies

The natural remedy is the ³first lineoption´ as well as the ³last line option´



DRUG OR NUTRACEUTICAL

DISPOSITION If dietary supplements are to be used as

therapeutic agents, there must be somerespect for basic pharmacologic concepts.

The concepts are A, D, M and E

One may look critically at some dietarysupplements by simply consideringfactors that influence absorption,

distribution, metabolism and excretion of chemical compounds [drugs or nutraceuticals] e.g. fish oil



DIETARY SUPPLEMENT

DISPENSATION

Declining revenue for cognitiveactivity in clinical practice

Dietary supplement dispensaries are

incorporated increasingly intopractice

Supplement dispensation improvescontinuity and quality of care

Supporting literature savesconsultation time



CHANGE IN HEALTHCARE

PARADIGMS

Lifestyle medicine combined with

nutritional interventions have

overshadowed allopathic approaches for

many public health problems First line options for disease prevention

are not rooted in drugs or surgery

Many factors have moved consumers of

health care to the new paradigm of

simple, gentle and more ³natural´

interventions



KEY PUBLIC HEALTH

INITIATIVES Adult obesity

Childhood obesity

Cardiovascular health Cancer

Arthritis

Osteoporosis Metabolic Syndrome X/ Diabetes

THERE MUST BE A CONDITION SPECIFIC APPROACH



THE KEY PUBLIC HEALTH

INITIATIVE The metabolic syndrome

(SYNDROME X)

A complex disorder caused bygenetics, adverse lifestyle,environmental influence and poor

nutritional practices

Defining Syndrome X



THE PUBLIC HEALTH RISK

Syndrome X increases risk for :

Maturity Onset Diabetes Mellitus

Cardiovascular Disease

Cardiovascular Deaths

Deaths from ALL CAUSES

Am.J.Epidemiol, 148, 958, 1998.

UNDERLIES THE CONCEPT OF SYNDROME X,Y,Z«



SYNDROME X : THERAPEUTICS

Positive lifestyle change Soluble fiber e.g. oat beta glucan hydrocolloid

Soy Protein 25 g/day

Omega 3 fatty acids (EPA)

Chromium Alpha lipoic acid

Vanadium

Antioxidants e.g. ellagic acid, bioflavonoids

Starch blockers

Cinnamon Maitake

Green coffee bean extract

Hoodia gordonii/ Caralluma/ Fucoxanthin



WEIGHT MANAGEMENT

A holistic management approach that isaddressed by integrative medicine

Multifactorial causes requiring

multipronged approaches Weight loss must not be the sole target.

The real issue is obesity related disease,disability and death



CONCLUSION

The interface between alternativemedicine and allopathic medicine is

increasingly indistinct (INTEGRATIVE)

At least three quarters of all patientsin an out-patient, hospital, clinic are

taking supplements

Healthcare professionals should be

highly educated in dietary supplement

counseling and lifestyle medicine

³Edutherapies´ will improve health

stephen holt md-integrative medicine definitions and initiatives

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