Complementary, Alternative Methods and Supplementary Medicine

Giovanni Vincent Belcaro

• Publisher: WSPC (EUROPE)
• Year: 2018
• eBook ISBN:
  9781786345684
• Topic: Medicine
• Subtopic: Alternative & Complementary Medicine

This volume contains an accessible, yet critical, discussion of the most complementary-alternative treatments based on medical evidence.

Providing readers at any level an introduction to alternative and supplementary medicines, the book is a simplified, complete text including management and medical information. It is arranged in a direct manual style, with select information explaining some of the most important concepts of complementary and alternative medicine and circulation sciences.

Contents:

• Complementary and Alternative Medicine:
  • Introduction
  • Alternative Whole Medical Systems
  • Mind–Body Medicine
  • Biologically Based Practices
  • Manipulative Body-Based Practice
  • Energy Medicine
  • Conclusion
• Pharma-Standard Supplements:
  • Introduction
  • Common PS Supplements
  • PS Supplements in Different Clinical Conditions
  • Testing PS Supplements: Organization of Supplement Studies
  • Conclusion
• Final Comments:
  • Concluding Comments

Readership: Advanced general public, graduates, healthcare managers.
Key Features:

• No competing titles
• The group producing this book has a large critical experience in the field of 'non-mainstream medicine'

Part 1

Complementary and Alternative Medicine

1

Introduction

Complementary and alternative medicine (CAM) is a commonly accepted term that is not completely correct from many points of view. It is probably better to indicate these nonstandard medical methods as “supportive medicine” instead of CAM. Some concepts like “well-being” — very often mentioned and an easy target for CAM — are not logical, scientific, physiological concepts. Well-being is very individual and it is not a treatable disease. Management of aging is another popular target with minimal or no scientific or clinical credibility. The transformation of doctors and qualified practitioners into undefined “healers” is always suspicious and it does not add credibility to the methods.

New Age Hippies have spread a sort of religion assisted by useless zeal. The fantastic images of Edward Hicks (The Peaceful Kingdom in all its approximately 80 versions) in which leopards and lambs, children and lions or wolves, colonist and natives live in peace and harmony have been virtually extended to viruses, bacteria and tumor cells in a kind of “all friends together” mentality, which leads the ignorant and uninformed to some dangerous conclusions.

Some spiritual concepts have been wildly incorporated by the post-Hippy, postindustrial, postreligious, metropolitan Indians, friend of the viruses, pseudo-Zen and followers of modified oriental-style doctrines. Wild notions have been wildly incorporated into “traditional” or “mainstream medicine”. “Spiritual” concepts do not need any clinical or scientific validation or even basic physiological explanation. Yet, in medicine, “traditional” does not mean bad and it does not mean good either. It must be evaluated according to some logic. “Older” does not mean better. The context is of the essence. What was valid in a small rural village in China in a period of very limited options is quite possibly not the best option now.

Complementary medicine and alternative medicine are still fairly misleading terms, and differently accepted concepts and terms (according to cultures and social interactions), and are still not clear to many patients. Medicine is either yes or no, in or out. There is no alternative. Some alternative–complementary healing methods are used often without a specific diagnostic process and for conditions that are not diseases. The concept of accurate dosage appears to be alien to most of these systems. Also, medicine (mainstream or standard medicine, MSM) by law should be practiced only by qualified and certified professionals. However, most unconventional alternative methods are used in many situations by unqualified “healers”. In some cases, professionals are not available, and so alternative or traditional local methods are used for cultural reasons as a result of a lack of mainstream standard medical facilities or for many other reasons including ideology and ignorance when there is no doctor.

According to the Merck Manual, medicine is defined as alternative when use is made of unconventional practices which have not been validated by mainstream medicine or, which do not have a defined, logical, scientific background. Complementary medicine may indicate a set of unconventional peri medical practices and systems using untested healing practices and methods that can be used in association with mainstream medicine. Integrative medicine uses all defined approaches of medicine including alternative practices in a framework that focuses on the whole person. This definition is actually quite meaningless, as good “standard” medicine — when properly applied — is already focused on the entire patient. The fact that complementary and alternative medicine are widely used is not a certification. Also, the cost to the customer of some complementary and alternative therapies may imply that these methods have a more significant value for some patients. Often patients do not tell their physicians about alternative–complementary or integrative methods and the products they use. But physicians need to evaluate potential dangers or identify possible interactions.

The use of CAM in its unidentified galaxy of practices varies from country to country; these methods may help some patients or give them consolation and the impression that some action is in progress when other methods fail, have failed or are not convincing. For these subjects, CAM is a strong temptation and often they see these practices as their only remaining solution and hope. Some points may support the use of specific CAMs (i.e., acupuncture):

•Some healing methods have been used for ages with anecdotal reports of success.

•Some physiological methods or evaluation systems have shown an activity of the healing methods.

•Some clinical studies or GCP trials have shown real efficacy.

The fact that there is no evidence or limited evidence for a specific practice is also misleading. Evidence is searched with resources and persistence (clinical trials) when there is a significant profit to be made or a patent to defend. Most methods and products in CAM are not patentable and therefore do not constitute a significant market to exploit. No profit, no evidence: simple.

Most healing methods are difficult to test and there is no incentive in showing efficacy, because somebody somewhere will always “believe” in them, proof or no proof. Most methods appear to be based on the efficacy of the healer: what he can do cannot be reproduced by others. This concept implies something like sanctity which does not belong to mainstream medicine.

Supplementary medicine (using supplements in pharmaceutical standards) is a different story. Modern products (generally of natural origin) — available in raw form for many years — can now be produced and used according to state of the art pharmaceutical standards. These may be defined as pharma-standard (PS) supplements. An original natural product (e.g., curcumin) with new methods of extraction and purification (i.e., not involving chemicals) is refined, standardized, minimized: new procedures ensure that there are no contaminants (heavy metals, pesticides) even in minimal quantities; the absorption is stable and consistent. With new procedures, its supplementary value becomes quite different from the effects derived from the use of “raw, natural” material.

Most PS supplements are “recognized as safe” (RAS) and have a safety factor much higher than many drugs that have been tested in a relatively small number of patients for a relatively small period of time. These supplements have been tested for centuries in millions of subjects and in some populations, a specific culture has grown around their use, activities, applications and anecdotes about potential dangers or interactions. Most supplementary products in the format of PS supplements can now be tested almost as drugs in specific conditions — and their results can be standardized.

Studies on interactions between PS supplements and drugs are in progress. Any contamination from poisonous substances is now out of question in high-quality PS supplements while this is not possible with “herbal” preparations or nonstandardized products. Interaction between “natural”, nonstandardized products may cause important alterations in the efficacy of many therapies. All CAM therapies must be considered within context because even apparently simple methods, such as physical manipulations or acupuncture (i.e., in subjects using anticoagulants), may result in complications such as bleeding problems and hematomas. Any CAM procedure or healing proposal should be always discussed with a physician and formally approved. The Merck Manual has the best definitions and classifications for these procedures. The manual recognizes five types of “alternative” or peri medical methods are as follows:

•alternative “medical” systems,

•mind–body medical methods,

•biological practices,

•manipulative and body-based practices,

•energy medical methods.

2

Alternative Whole Medical Systems

Ayurveda

Ayurveda is a traditional “medical” complex and system of rules used in India for more than 4,000 years. According to this “traditional system”, diseases are caused by imbalance of prana (a Sanskrit word for “life force” or “vital principle”, the body life force). The balance of prana is determined by the three bodily quantities (doshas), viz Vata, Pitta, Kapha. The balance appears to be specific to each subject; each individual has a dominant dosha. After studying the balance of the doshas in a subject, a specific treatmentmanagement regime is suggested and used for each patient.

Diet, herbs, massages, yoga, detoxification practices (known as “panchakarma”), oil massages, nasal lavages are all used to restore the correct balance between the body and nature. Some scientific, clinical studies have been conducted with controversial results. Some herbal combinations may include important contaminants or be poisoned by heavy metals (lead, mercury, arsenic) as they are actually considered therapeutic instruments.

Heavy-metal toxicity has been reported in a number of patients but often these practices are not officially recorded and it is difficult to find concrete data.

This “perimedical” practice or system — that requires some spiritual help — may have a questionable role when no other medicine is available or in specific contexts. It is really difficult to define its utility or efficacy in the western world and its possible connections with mainstream medicine.

Homeopathy

Homeopathy is a considered a controversial medical system, but it is an important pharmaceutical market. It is based on the principle that like cures like. A product, a molecule that may cause signs/symptoms of a disease at some dosages, may be effective in curing the same symptoms when administered in microscopic doses. This microscopic dose may stimulate the spontaneous healing mechanisms within the body. In theory, all homeopathy treatments are also based on the individual characteristics of the patient (considering symptoms, personality, lifestyle, health pattern).

Homeopathic remedies are obtained from some natural sources or minerals; they are given in microscopic concentrations (with the more diluted concentrations being, apparently, more effective). The dilution is so high that no molecules of the “active” product are actually found in most solutions. The bottles, basically, include water with very little evidence of any other substance. No scientific explanation has been given for this effect. No significant study has clearly shown any effect amongst several disorders.

The method moves a lot of money, has its “priests” and it has spread like a religious and philosophical belief rather than an actual proven medical technique. It is even used in some health systems — with very limited applications — without clear evidence of benefits. The producers of homeopathic remedies must specify the classification as “homeopathic”, must indicate the substance included as well as its dilution. Producers must also include at least one clinical indication and instructions for safe use. It is therefore not assumed that homeopathic preparations are always biologically inactive. The FDA allows some herbal medications to be registered and labeled as homeopathic if they are prepared in specific conditions. Therefore, the original definition of homeopathic has been extended.

Actually, there is no real connection between homeopathic and herbal products. The confusion between homeopathic and herbal is often manipulated to promote questionable products. Homeopathy is used to “treat” several disorders (allergies, digestive problems, different types of pain, etc). Controversial nonconditions and disorders (like fibromyalgia) are natural targets for homeopathy. Side effects and interactions with drugs are, of course, minimal but by using homoeopathy, some patients may delay or avoid actual medicine, sometimes with severe consequences (including death). Allergic or toxic reactions have been reported, and this remains a concern.

New Age people tend to have a strong “ideological” belief in homeopathy which often appears to be the result of resistance to or a lack of belief in the benefit gained from mainstream medicine. Some homeopathy users become “believers” in the method/system and appear to be interested more in the ideological aspects than in the technical aspects aimed at controlling medical problems. The cultural and marketing pressure behind homeopathy should not be underestimated. It is an important business and industry. It could be a criminal offence to use homeopathy in children.

Traditional Chinese medicine

According to concepts used for millennia (this is not an assurance of validity), most diseases are caused by an improper flow of the life force (qi). The motion of qi may be restored to its original patterns by balancing the opposite forces of yin and yang which manifest in the body as heat and cold, external and internal, deficiency and excess. Traditional Chinese procedures like acupuncture, massage, diet, medicinal herbs, meditation (qi gong) are used to preserve and restore qi and therefore health.

There is a vague recognition of diseases the way we see them in mainstream medicine. Chinese medicine uses traditional formulas including mixtures of herbs or herbal products to treat different disorders. Some of these traditional combinations have been studied and tested in clinical conditions. It is possible that herbal products used together may work much better than single herbal products which may be not very effective and may cause significant side effects.

At the moment, most studies are focused on single herbal products (that usually are already a mixture of several products, e.g., curcumin). Some “herbal” or natural products may be effective in treating inflammatory conditions; others are used in subjects with more serious illnesses, e.g., lung cancer (Astrafalus). Several Chinese herbal or natural products have been studied for hepatitis, cirrhosis and other common disorders. However, in this field, research is still limited. This is a result of having few sponsors. Clinical studies — if available — do not easily show the efficacy of herbal products, do not produce patents and therefore the possibility of commercially exploiting products exists.

Chinese lion.

The Chinese herbarium is very large and many products may be very active and clinically effective. These products should be recommended for proper clinical studies and (eventually) proposed in a modern pharmaceutical standard, without contaminants. With a standard dosage and with studies on absorption and metabolism, the Chinese herbarium may become a gold mine in the search for new effective products.

Without standardization, dosage and quality control, some herbal products may even kill. Also, many products may be heavily contaminated by polluted water. Some expensive products may be adulterated with cheaper, toxic substances and colorants. Some may include corticosteroids, antibiotics or ...

Table of contents

• Cover
• Halftitle
• Series Editors
• Title
• Copyright
• Dedication
• Contents
• Foreword
• About the Author
• Part 1 Complementary and Alternative Medicine
• Part 2 Pharma-Standard Supplements
• Part 3 Final Comments
• Index