Use of Cams in Pediatrics

CAMS Notes:

CAMS Use in Children (why the sudden popularity?):

[pic 1]

Readings:

Use of CAMS in Pediatrics:

NIH defines complementary and alternative medicine (CAM) as a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional Western medicine. Also called holistic or integrative medicine.

Complementary: use in conjunction with other treatment; Alternate: use instead of other treatment

 In the US, more than a third of adults use CAM. Visits have increased by 47.3% (420 in 1990 to 629M in 97). Yet pediatric CAM research is 7%

Use of CAMs higher in special needs, homeless, chronic or terminal patients (children).eg-asthma, add, cancer, cerebral palsy, etc

66% did not inform their child’s doctor of CAM usage; Methods are more congruent with patients philosophical, beliefs, values towards health and life, versus plain efficacy over conventional meds.

Reasons cited: WOM, ineffective treatment, fear of side or adverse effects of drugs, more personal attention.

Most common CAM modality covered by insurance in 98 was chiropractic care. CPT (Current Procedural Terminology) codes are not available for every CAM modality, some practitioners instead use ABC codes.

DSHEA- Act relating to regulation of dietary and health supplements- manufacturers bare the burden of proof of ingredient safety. For new ingredients, a manufacturer must only provide evidence to prove the product is ‘reasonably expected to be safe’. FDA must prove its unsafety before restricting its use, it depends on Medi-watch for this data. Claims to heal must be checked by the FDA.

Kemper Model of Holistic Care; Biochemical: herbs, supplements; Lifestyle: Meditation, biofeedback; Biomechanical: massage, chiropractic; Bioenergetic: Acupuncture, homeopathy, reiki

NCCAM identification:

Mind body medicine- Yoga, Deep breathing, guided imagery, hypnosis, meditation, biofeedback

Biologically Based Practices- Herbs and supplements, Special diets, psychedelics, thc

Manipulative and Body Based Techniques- Exercise, Massage, Chiropractic, Dance

Energy Medicine- Reiki, Tai Chi, Chakra therapy, Spirituality, Therapeutic Touch

Whole Health Systems- Ayurveda, TCM, Homeopathy, Naturopathy, Native American Medicine

Quality and similarity of research products in a main obstacle.

Homeopathy: Samuel Hahnemann ‘like cures like’. Substances given in high doses cause symptoms of diseases, these same substances given in small doses act as cures. Greater dilution=greater potency

Largest Users of Cams: 18-29 Adolescents,50-59, Children with chronic illness or disability, ethno cultural groups,

• Klassen et. All (2005). For randomized controlled trials, the quality of reports of complementary and alternative medicine was as good as reports of conventional medicine. Journal of Clinical Epidemiology, 58(8), 763-768.

Read: Legal, Research, Conclusion

Principles of Integrative Medicine- Optimal Emotional and Physical Health, Attention to the whole person, Acceptance and Care, Scientific Approach, Prevention, Identify Self-Healing Ability, Integrative Approach, Individual Patient Centered Care, Relationship Centered Care, Teaching by Example, Recognize Growth, Shared Responsibility within Health providers

History of Medicine Part 1 and 2:

Natural vs pseudo-natural (artificial) medicines

Traditional Evidence: Procedure based, provings, case studies, systematic observation, inductive (bottom up logic)

Complementary Medicine: Complements an existing option

Natural medicine: Existing or derived from nature; not made or caused by humankind

Traditional Medicine: Handed down, folk, oral instruction for medicine used in accordance to tradition.

Alternative Medicine: Relating to activities that depart from or challenge tradition. (integrative and Integrated Medicine)

• What is Health?

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” – World Health Organisation

• What is Disease?

• Disturbance of vitality

• What is the Cause?

• Imbalance of energies

• What are Symptoms … really?

• Warning signs
• Representation of underlying conditions
• Symptoms are not the disease

Roots of natural medicine: Aegean Civilisation-The Minoans

Ancient Greek medicine: transition from supernatural ideas of disease to empirical ideas, to philosophical and finally scientific ideas.

Balneotherapy-healing through baths( thermal springs)

Paracelsus-Auroleus Phillipus Theostratus Bombastus von Hohenheim (Dutch army surgeon): Father of toxicology “dose makes the poison”

New crops: Tomatos, potatos, capsicum and grains become staples

Timeline of introduction of natural products to the west: Quinine, tobacco, chocolate, coffee, tea

War advanced surgery and medicine -leaches, cauterizing, lime juice, trepanation, battle wounds

Industrialization, urbanization leads to issues of public health-cholera

Edward Anthony Jenner: Father of Immunology: smallpox vaccine

Joseph Lister: pioneer of antiseptic surgery; carbolic acid to sterilize instruments and clean wounds

Constructionism and Holism: connection of mind and body

Naturopathy is a holistic approach to ‘wellness’, disease prevention and integrated health care.  The concept of ‘nature cures’ dates back to Hippocrates.  Hippocrates embraced ‘holistic’ and ‘vitalistic’ principles.  

Principles of naturopathy:

1. The healing power of nature
2. First do no harm
3. Identify and treat the cause
4. Treat the whole person
5. Prevention
6. Doctor as teacher

Therapies-Diagnostics-Herbalism

Nutritional medicine: study of food as medicine

Ayurveda: regulate doshas using psycho somatic approach

TCM: disease is physical expression of unbalance. Yin- dark, Yang-Light

Manual  Therapy: Massage, touch: manipulation of the body soft tissue to promote health

...