Dr. Ejaz Naqvi: Complimentary Medicine & Alternative Medicine
Today, our guest’s post is by Dr. Ejaz Naqvi, the Chief of Chronic Pain Program and a specialist in Complementary and Alternative Therapy in Kaiser Permanente Walnut Creek. I asked Dr. Naqvi to offer some insight on how research is embracing alternative methods of healing besides western medicine and what are its pros and cons. This is what he had to say:
The terms Complimentary and Alternative Therapy (CAM) are often used interchangeably. Strictly speaking, they are not the same. Another term used in this context is “Integrative Medicine”. So what about the “traditional medicine” or conventional medicine?
In order to fully understand the “alternative”, we need to understand what the traditional or mainstream medicine means. Simply put, your medical doctor, with an M.D. (Doctor of Medicine) degree is trained in “western medicine” or allopathic medicine. This typically entails a study of pathophysiology of a disorder, set of diagnostic tests and a therapeutic model that consists of prescribing (yes, you guessed it) western medications, physical therapy and the likes. A typical scenario consists of seeing a doctor for something like abdominal pain. Your doctor will then go through history and physical exam to arrive at a diagnosis, aided by tests such as some blood tests, perhaps a CT scan of your abdomen, and endoscopy to find out that you have stomach ulcer. He/she will then treat with medications to reduce stomach acid, such as a medication called Prilosec. That is traditional/western medicine at a glance.
Complimentary or Alternative medicine is any medical modality that is not traditional/western medicine. So what’s the difference between Western medicine and Complimentary medicine or Alternative medicine? Well, alternative medicine means that the modality is used instead of traditional medicine. The complimentary medicine means that these modalities are used in addition to the traditional medicine. Integrative approach means the non-traditional and traditional modalities are used in a systematic fashion to best suit the needs of a given patient. From now on, I would use the term ‘CAM’ to refer to these modalities.
Categories of CAM: Most CAM modalities fall into two broad categories.
A. Products, such as herbs and botanicals, including probiotics.
B. Mind/Body modalities, such as Yoga and meditation.
There are a number of CAM modalities out there. Some have shown to provide benefit based on western research. Others are not as well studied, according to the western standards; therefore we need to be very cautious in evaluating the beneficial claims of the manufacturers.
Types of CAM modalities: According to a 2012 National Health Interview survey conducted by NIH, close to 18% of the Americans consumed a dietary supplement (other than the vitamins and minerals formula). Following list completes the top 10 most-used modalities by Americans.
Deep breathing: 10.9 percent
Yoga, Tai Chi, or Qi Gong: 10.1 percent
Chiropractic or osteopathic manipulation: 8.4 percent
Meditation: 8.0 percent
Massage: 6.9 percent
Special diets: 3.0 percent
Homeopathy: 2.2 percent
Progressive relaxation: 2.1 percent
Guided imagery: 1.7 percent
These are botanicals that are plants or part of a plant that are used as a dietary supplement, alone or in combination with other herbs. A common myth is that because they are natural, they are safe. That is not necessarily true. Another fact to keep in mind is that these herbs often do not go through the rigorous research process that a new drug does, though some have been studied a little better than others. Also remember that that the FDA approves all prescription and OTC drugs as safe and effective. The herbs are defined as herbs and FDA categorizes them as food, therefore the FDA does not require their safety or effectiveness. Having said that if a given herb has clearly shown/reported to have serious health hazards, the FDA WILL remove them from the market.
Among the most common in the market today include gingko balboa (for memory), saw palmetto (for prostate symptoms in males), ginseng (multiple uses- fatigue, memory issues, menopausal symptoms), Echinacea (common cold and as an immune booster), valerian (anxiety/insomnia), St John’s wort (depression) chamomile (anxiety, insomnia and dyspepsia) and turmeric (as an anti-inflammatory/pain killer).
Cautionary note about the herbals:
The effectiveness of the herbs is often not well established. The herbs do have side effects. Another important thing to remember is that they do interact with drugs and have herb-herb interaction, so make sure you tell your doctor you are taking herbs and research for their safety profile and effectiveness before using them. Some of the herbs have anti platelet effects like Aspirin does and you may have to stop them before surgery. Another pitfall is relying heavily on the herbal products, thereby delaying seeking medical advice for your ailment.
The good thing about these modalities is that most of them are generally considered safe, even though their effectiveness may be questionable. Many modalities are used to treat chronic pain, anxiety, stress and depression such as meditation, guided imagery and “movement therapies” such as tai-chi, yoga and qi-gong.
Even though these are considered “products”, perhaps the best thing about homeopathy is that these products don’t tend to have side effects, at least the more serious types. The modality is German in origin, pioneered by Samuel Hahnemann. They work on the principle that the “like cures the like”, whereby minute doses of a product is used to produce the same symptoms they are intended to cure. They are widely used to treat allergies, cold and skin conditions. Two of the most common prescribed agents are Arnica Montana (for bruising post trauma and to reduce post trauma swelling) and Arsenic album (to treat allergic conditions such as hay fever and asthma).
What about acupuncture?
Acupuncture is an ancient Chinese method of using fine needles strategically placed over the body to restore the energy balance. That flows throughout the body. It is generally safe and has been widely used to treat chronic pain, nausea and vomiting, smoking cessation and addictive disorders. It has been used so widely that it is almost considered mainstream now. Make sure the provider you see is a licensed acupuncturist (Lac) or is a medical doctor who has acquired additional training on acupuncture, usually through institutes that offer acupuncture and traditional Chinese medicine, or TCM.
Here are some useful and reliable sources for the effectiveness and safety on the herbs and other forms of CAM.
National center for Integrative and complimentary Health- a branch of NIH
FDA’s resource on dietary supplements
6 things to consider when selecting an alternative care practitioner