Is CAM a sham? – Learn About Complementary and Alternative Medicine!

Without a doubt, the progress of modern medicine could be deemed miraculous, but current treatments cannot cure every ailment or disorder. In the face of many problems, ranging from routine to terminal illness, CAM is a very real option. Complementary and alternative medicine has been defined as “diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy or by diversifying the conceptual frame works of medicine.” This term covers a tremendous umbrella for various treatments and methods, running the gambit from using bee pollen to help with allergies, to entirely different medical systems like those of traditional Chinese or Ayurvedic medicine.

Think everyone believes CAM is completely unreliable? Data obtained from the 2007 adult CAM supplement and components of the National Health Interview Survey (NHIS), with a sample of 20,710 people, illustrated results on CAM usage from adults both with and without functional limitations, which are indicative of a range of disabilities. Adults with functional limitations utilized CAM more frequently, with 48.7% against 35.4% of those without. Though those without functional limitations tended to use CAM less, the percentage of those that utilize CAM is still a considerable amount.

It’s not difficult to see why these methods might be preferred. One is not simply limited to what some would deem a reductive medical system, health care aside, but can explore healing in difference aspects. CAM may be better for patients psychologically and provide a preferred patient-provider relationship. Unfortunately, the main issues with CAM involve the lack of concrete research involved with the efficacy of many of its techniques, as well as other problems such as misdiagnosing and believing that since a treatment may be “all natural,” there exist no harmful side effects.

 It’s already more appealing.

What do physicians think about CAM? On one side a recent report showed 72% of those seeing alternative practitioners did not inform their physician they were doing so. However, in a survey of 594 U.S. family physicians, 44% believed faith healers and physicians could work together to cure some patients, while 23% believed that faith healers heal some patients whom physicians are unable to help. Dr. Arlan Cohn points out about the subject, “Alternative therapists are absolutely sure of their methods, where a doctor has a talmudic skepticism about his or her methods.”

In regards to physician sensitivity and awareness of CAM, the teaching of these methods has increased in medical schools over the years. From data collected from questionnaires in 2002 mailed to 74 U.S. medical schools, the topics most often taught are acupuncture (76.7%), herbs and botanicals (69.9%), meditation and relaxation (65.8%), spirituality/faith/prayer (64.4%), chiropractic (60.3%), homeopathy (57.5%), and nutrition and diets (50.7%). Typically, these courses were taught as electives, most likely in the first or fourth year of schooling. As one might expect, in the year 2004, 18 out of 19 osteopathic medical schools taught CAM, with similar teachings as those reported in allopathic schools.

Despite the perceived limitations of CAM, many have been using its methods in some fashion to supplement their health and ultimately, it will only gain in popularity. CAM as a major component of the U.S.’s health was recognized by NIH in 1991 when the National Center for Complementary and Alternative Medicine (NCCAM) was established, initially as the Office of Alternative Medicine, to “build the evidence base used to make decisions about whether Cam treatments are safe and effective.” According to the 2007 NHIS, adults in the U.S. spent an estimated $33.9 billion out-of-pocket on CAM treatments during the past year, with $22.0 billion on self-care costs and the remaining $11.9 billion on visits to practitioners. Some health care companies do recognize the use of CAM, accounting for approximately 1.5% of health care expenditures. If coverage is provided, typically it has been for chiropractic care, acupuncture, and massage. What is of utmost importance is collecting viable data on CAM and to ensure that those who utilize it are informed of the possible detriments of whichever method they are using. In the end, as with any kind of treatment, it’s up to the patient to make those choices.

Sources

1. Okoro, C et al. Use of complementary and alternative medicine among US adults with and without functional limitations. Jan 2012. Disability and Rehabilitation. Vol 34 (2): 128-135. DOI: http://dx.doi.org/10.3109/09638288.2011.591887
2. Ernst, E. The Role of Complementary and Alternative Medicine. Nov 2000. BMJ: British Medical Journal. Vol 321 (7269): 1133-1135. http://www.jstor.org/stable/25226100
3. Ernst, E. and Fugh-Berman, A. Education: Complementary and Alternative Medicine: What is it All About? Feb 2002. Occupational and Environmental Medicine, Vol. 5 (2): 140-144. http://www.jstor.org/stable/27731640
4. Paying for CAM Treatment. NCCAM of the NIH. Last Updated July 2011. http://nccam.nih.gov/health/financial
5. Brokaw, JJ et al. The teaching of complementary and alternative medicine in U.S. medical schools: a survey of course directors. Sep 2002. Acad. Med. 77 (9): 876-81.
6. Saxon, DW et al. Status of complementary and alternative medicine in the osteopathic medical school curriculum. Mar 2004. J Am Osteopath Assoc. 104 (3): 121-6.
7. Wall, Alexandra. “World’s Best Doctor’ essayist excises humor from pain.” July 2001. jweekly.com. 12 July 2013.

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Personally, I love learning about this topic, especially as someone hoping to become a physician, specifically a Doctor of Osteopathic Medicine (D.O.), someday. Which reminds me…I’m not sure why I haven’t written an article on what a D.O. is, since 99% of the people I talk to I have to explain what the difference is with a traditional M.D. This observation may vary for you depending on where you live.

If Music Be the Food of Health, Play On

Actually, Shakespeare was talking about love, but maybe music is just as beneficial. Everyone knows that listening to your favorite melodies can uplift your spirits as much as it can enrage or depress you, exhibiting such an internal grip on your emotions. Now, several new fascinating studies are shedding light on the far more specific, physiological consequences of having that little ditty stuck in your head, as well as providing insight on its continuing healing potential beyond simple stress therapy.

In a 2009 experiment, 24 volunteers, half of which were practiced singers while the other half had no musical training, listened to selections of Classical music. Researchers found that their cardio and respiratory systems mirrored the musical selection’s tempo. During crescendos, subjects experienced a proportional constriction of blood vessels and an increase in blood pressure, while with decrescendos and silent periods, the opposite occurred. Heart rate would synchronize with “rich” music phases of short, famous expressive arias. Researchers suggested perhaps these responses influenced our emotions, not vice versa. Previous studies were mentioned alluding to how music even affects the respiratory systems of semi-vegetative patients subconsciously.

With the beginning of the aria, the agreement between music envelope (distinctive patterns in tone) and diastolic blood pressure (resting blood vessel pressure between heart beats) increased and remained high until after the end of the aria. The subjects synchronized their Mayer waves (waves in arterial blood pressure) with the rhythm of the music. Sorry, this isn’t as funny as it is interesting.

Music also has been proven to positively influence metabolic activity in humans. Gastrointestinal disease patients who listened to enjoyable music showed increased gastric motility and stimulated gastric emptying, implying music’s ability to facilitate normalizing intestinal movement. Exercise and post-exercise activities can also benefit through increased lipid breakdown and lactic acid clearance, which have been found to be stimulated by listening to music.  Additionally, music aids with the progression of general anabolic responses which come with recovering from injuries and stress.

Lastly, the connection between the rhythmic nature of music and its resemblance with that of the timed, systematic processing of the brain has been explored, especially the mechanisms that control sequencing and coordination of movement.  Years of experimentation has revealed that music’s rhythmic quality has the ability to synchronize with motor function to help patients improve from stroke, Parkinson’s disease, cerebral palsy, or traumatic brain injury. It has been found that “sound can arouse and excite the spinal motor neurons mediated by auditory-motor connections at the brain stem and spinal cord level.” Without this stimulus, the similar procedural and rhythmic processing that occurs in the brain could not prepare itself to execute the movements associated with the excitation from music. Music also provides an outstanding memory template for procedural learning. Musical information in patients with memory disorders, such as Alzheimer’s disease, has been found to be preserved longer and more proportionally so than with their existing state of memory loss. Researchers concluded that music creates more deeply imbued and resistant connections in the brain.

Studies involving more in-depth experimentation regarding the physiological influence of music and its possible benefits have a long way to go. However, music’s varying effect on us is undeniable. At times we have the pleasure to experience songs that move us, but now it seems music can improve lives on a level never before seen.

Sources:

1. Bernardi, L. et al. Dynamic Interactions Between Musical, Cardiovascular, and Cerebral Rhythms in Humans. Circulation, 2009; 119: 3171- 3180. DOI: 10.1161
2. Thaut, M. The Future of Music in Therapy and Medicine. 2006 DOI: 10.1196/annals.1360.023
3. Yamasaki, A., et al. The impact of music on metabolism. Nutrition – 06 August 2012 DOI: 10.1016/j.nut.2012.01.020

Love, Medicine, and Miracles

I could write more in-depth on this topic and I probably will later, but it’s a lazy kind of Saturday. I learned about Dr. Siegel by reading his book mentioned in the title of this post. It’s an endearing and fascinating read if you’ve got the time.

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During his practice, Dr. Bernie Siegel would ask his cancer patients to depict what they believed their diseases looked like, including drawings of themselves and how treatments would effect them. He utilized this method to give not only himself, but also the patient, a greater understanding of how to confront their circumstances. As someone who loves studying art history, I was amazed to learn about this kind of therapy, where Dr. Siegel was so versed and experienced in its effectiveness, that he actually developed a sort of lexicon for what different colors and figures could mean. Regardless if you think what was drawn was *true* or not in its alleged meaning, the entirety of the response and discourse that followed en route to a healthier outcome is something that is absolutely valuable.

Practice Makes…Preventive Hearing Loss

April 2012

Remember when your parents yelled at you to “cut out all that racket” while you were practicing in the garage? Yeah, me neither, but those of you who do may have more advantages than the rest of us in the future. Well, as long as you’ve been keeping it up and continue to do so for many years.

A study in 2011 focused on investigating the effects of long-term musical practice on auditory memory and the ability to discern speech in noisy environments in adults ranging from 45 to 65 years. As many know, it is typical for people to experience hearing loss, especially around this age range.

“Sorry, I can’t hear you over the applause for all of my success.”

Nina Kraus, director of the Auditory Neuroscience Laboratory at Northwestern University explains that even among older adults with similar age-related hearing loss, “it’s well known that adults with virtually the same hearing profile can differ dramatically in their ability to hear speech in noise.”

It’s not only a disadvantage in the physiological sense, but can also contribute to social isolation and depression. Communication is one of the most important aspects of life. When this essential skill becomes more of a problem for people, it is easy to understand the significance of finding ways to prevent this issue.

The results revealed musicians, who have been playing an instrument from age 9 or earlier and have continued to do so, scored much better with neurological tests involving hearing speech among noise, auditory working memory, and auditory temporal processing than their non-musician counterparts. All 18 musicians and 19 non-musicians were also subjected to visual working memory tests but had no significant differences between them.

Researchers found that auditory skills are sharpened over time as musicians must not only simply remember pieces of music, but must also be able to differentiate distinct sounds among others in a song. This allows them to be apt at extracting “relevant patterns, including the sound of their own instrument, harmonies and rhythms,” says Kraus.

So do yourself a favor and start the habit now. There are no guarantees and it can definitely be hard work, but it can also be fun and rewarding, which are much better alternatives than having to deal with the possible stress later on. One must keep in mind that it’s the practice and skills gained that help you, not turning the volume all the way up until your ears go numb. Now you’re just being counterproductive.

Sources

1. Northwestern University (2011, May 11). Musical experience offsets some aging effects: Older musicians excel in memory and hearing speech in noise compared to non-musicians.ScienceDaily. Retrieved March 16, 2012, from http://www.sciencedaily.com­/releases/2011/05/110511170931.htm
2. Alexandra Parbery-Clark, Dana L. Strait, Samira Anderson, Emily Hittner, Nina Kraus. Musical Experience and the Aging Auditory System: Implications for Cognitive Abilities and Hearing Speech in Noise. PLoS ONE, 2011; 6 (5): e18082 DOI: 10.1371/journal.pone.0018082

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Also included in this issue was a graphic I made for Women’s History Month, which is actually March, or when I originally made it, but it had to be put in the April issue due to timing and other excuses. It’s not that great since I did it in a hurry, but it does have some interesting information.

Sources

1. Britannica Editors. “10 Women Scientists Who Should Be Famous (or More Famous). Encyclopedia Britannica. March 10, 2011. Site visited March 17, 2012. http://www.britannica.com/blogs/2011/03/10-women-scientists-famous-famous/
2. Svitil, Kathy. “The 50 Most Important Women in Science.” Discover Magazine. November 1, 2002. Site visited March 17, 2012. http://discovermagazine.com/2002/nov/feat50

An Artistic Diagnosis

March 2012

One of the treasures of the frequent art observer is to, over time, be able to recognize certain symbols that signify to the viewer a nod to the various rich traditions of art. Those who have contributed to the visual arts have utilized this technique in many ways, including the storytelling of religions and cultures and sometimes, it’s simply used for more personal reasons. Either way, if the observer is experienced enough in whatever category of art the piece falls under, they will have a much deeper understanding of what is being conveyed. This kind of pattern recognition plays a significant role for the analysis of art throughout history and as it turns out is also vital in the world of medicine.

Recently, medical universities around the country have been implementing several humanities programs to aid their medical training in new and impactful ways. One of these includes the opportunity to fine-tune observation skills by examining works of art.

At Yale Medical School, students must visit and survey paintings at the Yale Center for British Art. An example viewing includes initial scrutiny, followed by the professor guiding them through descriptions of what details may hold more importance over others. The paintings shown were made with distinct purpose so that there exists a proper “diagnosis,” and the goal of students is to discover this deliberate intent.

Definitely not lupus.

Jefferson Medical College and the Pennsylvania Academy of the Fine Arts have also been working together in a similar program. Aspiring doctors must take a “visual inventory” of works. In addition to seeing the finer details, they must also attempt to relate those to the broader scope of the piece. Courses included within this program include a Visual Perception workshop, Accuracy and Perception, Hand-Eye Coordination, Art in Healing, and Sculpture and Surgery, all of which teach through a collaborate effort of demonstration, traditional lecture, and hands-on experience.

Around a decade ago when Yale Medical School first began taking students to view art in order to supplement their course work, a 2001 study in the Journal of  the American Medical Association determined students significantly improved in their ability to scrutinize and observe against their peers who had not participated in the program. A study entitled “Format Art Observation Training Improves Medical Students’ Visual Diagnostic Skills” published in 2008 explored the results of teaching “visual literacy,” or the ability to assess physiology and pathophysiology from close observation. At the end of experimentation it was found that after the course, students increased their average number of observations and additionally improved in the level of detail given in descriptions of artistic and clinical images.

According to the Association of Medical Colleges in 2007, 89 of the country’s 125 medical schools have implemented humanities classes in required coursework and 66 have them as electives to further aid in medical training.  Such programs were implemented because of the recent concern with the overbearing reliance on medical technology. Undoubtedly machines such as magnetic resonance imaging (MRI) and computed tomography (CAT) scans have revolutionized and improved the world of medicine greatly, but that does not mean doctors do not have to be sensitive to the patient’s condition with their own eyes, a skill that has become increasingly overlooked.

Irwin Braverman, professor emeritus and senior research scientist in dermatology at Yale Medical School mentioned in an e-mail to LiveScience,“Medical schools teach future doctors to memorize patterns in order to recognize syndromes, which are collections of different signs and symptoms. With a rash, for example, students learn to look for two components: first, the distribution of the rash, and second, the morphology of the individual lesions in the rash. Those two characteristics together allow a doctor to make a diagnosis. However, visual analysis, like that honed by describing the paintings, becomes important when a rash doesn’t fit a pattern the doctor recognizes.”

Though novel technology is both necessary and effective, this additional training enables doctors to get more out of their typically brief patient interaction, possibly even making up for less time spent by being more efficient in diagnosing.

1. Naghshineh, S. et al. (2008) Formal Art Observation Training Improves Medical Students’ Visual Diagnostic Skills. J Gen Intern Med. 2008 July; 23(7): 991–997. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2517949/
2. Parry, Wynne. (2010, November). Art of Medicine: Paintings Sharped Med Students’ Skills. LiveScience. Retrieved from http://www.msnbc.msn.com/id/40156796/ns/technology_and_science-science/t/art-medicine-paintings-sharpen-med-students-skills/
3. Rourke, Matt.  (2007, March). Art Classes Hone Med Students’ Visual Skills. Associated Press. Retrieved from http://www.msnbc.msn.com/id/17707457/ns/health-health_care/t/art-classes-hone-med-students-visual-skills/