Integrative Drug

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Homeopathy, Naturopathy. Elective. Medicinal. Frameworks. 5 Domains of CAM. As Defined by NCCAM ... Homeopathy, Naturopathy. Elective. Restorative. Frameworks. 5 Domains of CAM ...

Presentation Transcript

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Integrative Medicine Aaron J. Michelfelder, M.D., FAAFP, FAAMA Vice-Chair and Predoctoral Director, Family Medicine Associate Professor of Family Medicine, and Bioethics & Health Policy Board Certified Medical Acupuncturist

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Objectives By the end of this presentation, you ought to have the capacity to... Characterize "Integrative Medicine" Understand how Integrative Medicine identifies with Modern Medicine Prepare to rehearse Integrative Medicine later on

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Presentation Outline Definitions Why Should We Care About CAM? What Do Patients Want? What Can We Provide to Meet the Demand?

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Real Patient 54 year-old female presents with fringe neuropathy, bear tendonitis, and carpal passage disorder around 15 months subsequent to finishing chemotherapy for bosom tumor. She is accepted to be in total abatement as of now. She expresses that she is working out, doing exercise based recuperation, taking a multi-vitamin and taking after the majority of the proposals of her doctors, yet feels like she could help out her issues. What more would you like to know? What alternatives would ring a bell for you? How might you discover data about those alternatives?

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"Envision a world - situated toward recuperating instead of ailment, where doctors had faith in the common mending limit of individuals, and accentuated counteractive action above treatment. In such a world, specialists and patients would be accomplices moving in the direction of similar closures."

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Definitions "Reciprocal and Alternative Medicine is a Group of Diverse Medical and Health Care Systems, Practices, and Products That are Not Presently Considered Part of Conventional Medicine" National Center for Complementary and Alternative Medicine

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Definitions "Corresponding Medicine is Used Together With Conventional Medicine." "Elective Medicine is Used in Place of Conventional Medicine."

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Definitions "Integrative Medicine Combines Mainstream Medical Therapies and CAM Therapies for Which There is Some High-Quality Scientific Evidence of Safety and Effectiveness." NCCAM

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5 Domains of CAM As Defined by NCCAM

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Why Should We Care? 30,000 herbs available right now Estimates of $30-40 billion dollars spent yearly Eisenberg D. et al, JAMA, Nov 11, 1998(18) 1569-1575 Estimates of 42% of populace utilize CAM at present Eisenberg D. et al, JAMA, Nov 11, 1998(18) 1569-1575 Sales of Metabolite 356 drew closer $1billion in 1999 Alternative Medicine Alert, January 2000 Relacor $23 Million; 900,000 jugs by July 06

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Overall Supplement Use

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Why Should We Care? 600 Million Visits a Year to CAM Providers – More Than to Primary Care Providers Why? What is Mainstream Medicine Not Offering to Our Patients? Eisenberg D. et al, JAMA, Nov 11, 1998(18) 1569-1575

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Have We Missed the Boat? Disappointment with social insurance suppliers and medicinal results Side impacts of medications and medicines High wellbeing costs Technology Lack of control in their own particular human services rehearses Time went through with specialist Stephen Strauss, M.D., NCCAM Director

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Have We Missed the Boat? Searching for "cures" Want to utilize "common" items Patient feels engaged Focus on most profound sense of being and enthusiastic prosperity Health Care Provider gives the 3 T's: touch, talk, time Stephen Strauss, M.D., NCCAM Director

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What about correspondence? Somewhere around 40 and 70% of CAM clients don't unveil their utilization to their doctor. WHY? Eisenberg 2001

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Why do patients not educate their doctor regarding their CAM utilize? 60% - "My specialist never inquired." 60% - "It wasn't essential for my specialist to know." 20% - "My specialist wouldn't get it." 14% - "My specialist would dislike." 70% of patients see their Physician before or simultaneous with their visits to a CAM supplier Eisenberg DM. Ann Int Med 2001;135(5):344-51

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Why might patients not believe us? Avandia Kills – FDA Black Box Warning Ketek Kills – removed the market Rezulin Kills – removed the market Trovan Kills - removed the market Vioxx Kills – removed the market

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PRESS RELEASE: Medication mistakes are among the most widely recognized therapeutic blunders, hurting no less than 1.5 million individuals consistently, says another report from the Institute of Medicine of the National Academies.  The additional restorative expenses of treating medication related wounds happening in doctor's facilities alone conservatively add up to $3.5 billion a year, and this gauge does not consider lost wages and  profitability or extra social insurance costs, the report says. - IOM July 2006

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Why Would We Not Trust CAM? "Specialists concerned on the grounds that few cases reported of liver disappointment with Kava, a broadly utilized normal solution for nervousness"

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Government Not Helping Us? DSHEA 1994 www.consumerlabs.com New FDA Regulations 8-24-07 – Interim Final Rule Identity, Purity, Strength, and Free from Harmful Contaminants Food, Drug and Cosmetic Act

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Are Our Patients Reading This?

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Or This?

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Evidence Based Medicine Difficulties With CAM Research Sham Acupuncture Non Standardized Herbal Formulations Difficult to Blind Patients and Practitioners Treatments Very Individualized – Difficult to Formulate Protocols

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RCCT Gleevec Albuterol Acupuncture Chinese Herbal Therapies How Can This Stand the Test of Time?

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Comparison Mainstream Medicine Large Double Blind Placebo Controlled Trials Many Exclusions Such As Multiple Medicines, Other Illnesses, Female, Pregnant, Children, Race "Misleading Effect" Discounted Apply These Narrow Results to The Individual Integrative Medicine Very Individualized "Misleading Effect" Not Discounted

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Licensing Issues

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Patients are picking integrative and elective solution, however shouldn't something be said about doctors?

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Clinical Fellowships: University of Arizona (Founding Program) University of Michigan University of Maryland University of Wisconsin Maine Medical Center Cooper Health System (NJ) Lawrence MA Beth Israel Medical Center UCLA Academic Fellowships (Research) Harvard University Tufts Boston University Stanford Duke Residencies in Integrative Medicine Oregon Health Sciences University Montefiore Medical Center (NY) Where Are We Today?

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Where Are We Today?

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Albert Einstein/Beth Israel Columbia University Duke University George Washington Georgetown Harvard Laval University Mayo Clinic OHSU Stanford University Yale University Wake Forest University of Alberta University of CA/Irvine Thomas Jefferson UMDNJ University of Arizona University of Calgary University of Hawaii University of Washington University of California/LA University of California/SF University of Colorado University of Connecticut University of Kansas University of Maryland University of Massachusetts University of New Jersey University of New Mexico University of North Carolina-Chapel Hill University of Michigan University of Minnesota University of Pennsylvania University of Pittsburgh University of Texas-Galveston University of Vermont University of Wisconsin CAHCIM Members

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Loyola Integrative Medicine Physician Faculty Mariadas Chinthagada, M.D. , Anesthesiology, Acupuncture Youngran Chung, M.D. , Peds Pulmonology, Acupuncture, Hypnosis Chuck Dumont, M.D. , Peds GI, Acupuncture, Herbal Therapies, Homeopathy, Hypnosis Marypat Fitzgerald, M.D. , Urogynecology, Acupuncture Aaron Michelfelder, M.D., Fam Med, Acupuncture, Herbal Therapies, Hypnosis Kit Lee, M.D., Fam Med, Acupuncture Bo Rana, M.D., Anesthesiology, Acupuncture Nila Vora, M.D. , IM, Ayurvedic Medicine

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Loyola CAM Providers Amy Wu, L.Ac., Acupuncture, Chinese Herbal Therapies Karen Wagner, RD, LD, Nutritionist Linda Moore, MT, Visceral, Pregnancy, Deep Tissue, Muscular Massage Eva McCormick, PT, Biofeedback Marilyn Moore, Guided Imagery Thomas J. Rostafinski, Ph.D., Hypnosis

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Medical Students Integrative Medicine Curriculum Demanded by Students Integrative Medicine Interest Group "Incorporate Chicago" http://www.integratechicago.com/index.html

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The Future of Integrative Medicine Definition of Integrative Medicine From the CAHCIM "Integrative pharmaceutical is the act of solution that reaffirms the significance of the relationship amongst specialist and patient, concentrates all in all individual, is educated by confirmation, and makes utilization of all proper helpful ways to deal with accomplish ideal wellbeing and recuperating."

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The Future of Integrative Medicine The Term "Integrative Medicine" Will Die Our Patients Will Demand Integrative Medicine From All of Us Training Will Be Demanded by Medical Students Training Will Be Demanded by Residents

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The Future of Integrative Medicine Integrative Medicine Will Be A Skill Set Added on Just Like: Electronic Health Records New Medications New Procedures

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The Future of Integrative Medicine What Cannot Be Added On is Empathy and Open-mindedness 600 Million Visits a Year to Alternative Practitioners

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The Future of Integrative Medicine The Future Is Sometimes Curing, But Always Caring

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Real Patient 54 year-old female presents with fringe neuropathy, bear tendonitis, and carpal passage disorder around 15 months in the wake of finishing chemotherapy for bosom growth. She is accepted to be in total abatement right now. She expresses that she is working out, doing active recuperation, taking a multi-vitamin and taking after the majority of the proposals of her doctors, however feels like she could help out her issues. What more would you like to know? What alternatives would ring a bell for you? How might you discover data about those choices?

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Integrative Medicine requires a worldview

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