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Alternative Medicine and Complementary Therapies 

About 34% who use complementary therapies, and three out of four patients donít tell their doctors. The number of visits to providers of complementary medicine in 1990 was 425 million, 388 million the same year was to primary care, so you are the alternative rather than the primary course; 13.7 billion spent annually with 75% out of pocket. It is primarily Caucasian, educated, upper income and baby-boomer type population. Thatís the people who are doing it. So there is actually a National Institute of Health office of Alternative Medicine and a budget of 2 million dollars in fiscal year 1992, and now itís up to 20 million dollars. These are the universities that are actually doing research and this type of research is pain management, stroke, womenís health, cancer, general medicine, addictions, AIDS, pain, asthma, aging. They are trying to do research projects to take a look at it. What we want to do is take a look at some of the places where NIH has approved; acupuncture for substance abuse and peripheral neuropathy, Tai Chi for movement disorders in the elderly - like Parkinsonism - biofeedback, hypnosis and Navajo spirituality and mental health, transcendental meditation and control of hypertension alternative medicine, complementary therapies, alternitive medicine

Complementary and alternative medicine was probably ridiculed, and it may now be into the violently opposed - depending upon what part of the country you are in - but certainly contains these six things: herbal medicine - you hear a lot of that. St. Johnís Wort, Remifemin for menopause, which is black cohosh root. The reason it works is

You have alternative systems. So you have Naturopathic and Ayurvedic. Whoís the most famous Ayurvedic practitioner? This is also people who talked about moving energy fields, the therapeutic touch person who thinks they are moving the energy field when they are over people, and then whether that is true or not. Then pharmacologic and biological treatment of all types. So 

Other things that have moved from here are biofeedback, visual imagery, hypnosis, massage therapy. Thatís moving in that direction. Tons of self-care out there that has moved over into - and it may not be proven, but people are sure beginning to think of that. Because how many go to the GNC and are taking so many herbs? And ortho-molecular multivitamin therapies. They 

What do people commonly use complementary/alternative medicine for? These are the list of things that people use it for. In the past 12 months, this is the percent of the people who have used it? How many saw a provider? Of course, chiropractic would have a high touch factor as would acupuncture. And mean visits over the 12 months and you can see the wide range there. So thatís just a breakdown of people who practice it. What do they practice it for? Practice it a lot for back problems, allergies, arthritis, insomnia, sprains or strains, headaches, high blood pressure, digestive problems, anxiety. In my clinic out at Lakeside we have a lot of people with, maybe 20-25 people with menopause symptoms. I have several people with whatever you call it, chronic fatigue syndrome, myofascial difficulties, fibromyalgia. And those people need a lot of TLC. You really canít find

Therapies are unique to the individual. We like to think itís the same pill for all of you, whereas they are saying that itís a different approach to each person. How do you close out for the placebo effect? Well, you donít. Therapies cannot be measured. Thatís true. Outcomes are not fixed. Very hard to find something that you are measuring. Each practitioner has a unique therapy.

Just a moment on the placebo effect. Actually you can find some articles that talk about the placebo effect that is as high as 30% to 50%. People who are trusting, dependent, have chronic anxiety, who like authority and enthusiastic healers, and like plausibility of a overall mechanism that actually explains everything for them, they will more likely have a placebo effect. Usually the response is in six weeks to six months and it doesnít happen again when you repeat the therapy. Tough to control for, but if your therapy gets this and you have six months of feeling great, thatís pretty nice as long as it doesnít cost you an arm and a leg. This is very hard to control for in doing studies on complementary and alternative medicine. This is just an example to tell you how people think about things and how many years this has been out there. These are called Shakraís and they have colors and 

Now, for insurance companies are beginning to pay for complementary/alternative medicine. They are beginning to say that maybe these things have some benefit, and these might. You know, chiropractic - I have to admit that my wife goes to see a chiropractor - she fell out of the kitchen. Opened the door, tripped and fell into the garage and jammed her head into the front end of the car and I guess jammed her head back. She was always complaining about her neck hurting. Nothing is wrong by x-ray, she feels great for a week or two, and then her neck hurts. She goes and he crunches her. Heís a nice guy. He goes to our church. So maybe thereís something. Acupuncture: we have several people in town who are certified. Massage, stress management, body work, fitness. See most of these that they are paying for are not really way out in left field. And they are beginning to use these to have people have some synergy. Oxford pays for chiropractors, Naturopathic physicians, yoga instructors, acupuncturists, massage therapists, nutritionists.

Tell you a story about a guy who had a melanoma on his forearm. It was a level IV, Clarks level IV melanoma. Wide local resection with skin graft. Three years later he presented with right upper quadrant pain diagnosed in the emergency room as cholecystitis. Went to surgery and his gall bladder was full of melanoma, however the liver was clean. Multiple biopsies showed no melanoma in the liver. CAT scans were normal, CEA, blood work etc. was normal. Comes to the office and says, "Iíve had this skin lesion and now Iíve had it come back, what are you going to do for me?" Being an oncologist I could have given him adjuvant chemotherapy. It doesnít work for melanoma. I donít know of anything that works well for melanoma. I said, "I don't think I have anything because I would prefer having a measurable lesion to see whether the chemotherapy has any effect, if I were going to treat you at all." So he said, "Well, I want to be cured of this thing. Iím tired of having this fear." So we went to Athens, Greece and he arrived at this guyís place there and the guy did a blood test on him and the blood test had nine possible numbers. The first number was, "You are totally well" and the ninth number says, "you are almost dead." Now, remember this guy had normal CAT scan, ultrasound and all that. What was his number? Nine. Nine meant he had to stay there nine weeks and where did he stay the nine weeks? He stayed at the guyís hotel, ate the guyís food and got a shot each Monday. Donít know what the shot was, but he got a shot. At the end of the nine weeks he had a blood test. What was the number? One. And the guy said to him, "You are now cured of your cancer. And as long as you stay in balance and the vital forces are not disrupted, the cancer will not grow. And this is how you do that." What was on the list of to doís? No, didnít want him to come back. What he did was he said, "Donít eat salt, donít eat sugar, donít go out at night and donít have any blood work or x-rays." Because that would upset the vital forces, puncturing the skin, sending x-rays through the body, getting night humors. So this guy comes back and he is interviewed by the paper about how he is cured and he wants everybody to go back because he feels so good. He just has to follow this little set of rules. Four years later he has metastatic melanoma and dies. Now while we were caring for him for his hospice time, heís very sad and depressed, he admits that sometime in there he cheated and had sugar. So he dies believing he was cured by this doctor in Greece and that he screwed it up. So some of these people can be very very evil. They make people guilty, they make them feel bad and they put a terrible burden on the family. So if you find somebody like that go after them because that is not user friendly.