General Considerations

The Lost Book Of Remedies

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Studies have shown that the frequency of use of complementary or alternative medical therapy in the United States is far greater than previously reported. These therapies include relaxation techniques, imagery, chiropractic, massage, spiritual healing, herbal medicine, acupuncture, homeopathy, folk remedies, and prayer, to name a few. It has been estimated that 42% of the American population uses at least one of these and other alternative healing methods to satisfy their medical needs. The most common users of complementary and alternative therapy are the more affluent people, women, those better educated, individuals born after 1950, and those who are concerned about emotional stress and the environment. The most common therapies were relaxation techniques (18%), massage (12%), herbal medicine (10%), and megavitamin therapy (9%). The perceived efficacy of these therapies ranged from 76% (hypnosis) to 98% (energy healing). The number of visits to providers of this health care is greater than the number of visits to all primary care medical doctors nationwide. More than 70% of these patients never mention using alternative therapy to their clinicians. Out-of-pocket expenditures of more than $34 billion per year in the United States are an apparent testament to a widely held belief that complementary and alternative medicine therapies have benefits that outweigh their costs. This figure is in contrast to the $12.8 billion spent out of pocket annually for all hospitalizations in the United States.

One of the reasons why patients seek complementary and alternative therapies may be a failure in the doctor-patient relationship. Health-care providers often fail to discuss the use of these therapies because they lack adequate knowledge in this area and have poor insight into the cultures and beliefs of those who practice complementary and alternative medicine (CAM). To many health-care providers, ''alternative medicine'' entails the threat of displacing conventional medicine for the sake of unproven therapies. It may lack organization and the rigorous, scientific standards of Western, evidence-based medicine. The response of the health-care providers ranges from outright dismissal of the practices to a gradual recognition that their extensive use can no longer be ignored. A lack of communication and knowledge in this area may also prove to be detrimental to the patient because the use of some forms of these therapies, if unsupervised, may be dangerous.

There has been an increasing interest throughout the world in the use of natural ingredients for health, especially tea. Tea is the world's second most popular beverage after water. Green tea accounts for approximately 20% of all tea consumed. It has been claimed that overall health of the body, especially the oral cavity, can be maintained by the consumption of green tea. Green tea is not fermented;therefore, it contains polyphenols that are inactivated in the fermentation process of black tea production. Green tea has been consumed in East Asia, where its benefits have been claimed for centuries. Green tea polyphenols possess antioxidant and antiviral properties that account for its benefits; these benefits have been touted to include lowering blood pressure, lowering cholesterol, stabilizing blood glucose, inhibiting bacterial growth, and blocking many carcinogenic agents. Polyphenols have been shown to inhibit the growth of Streptococcus mutans, the major etiologic bacterium associated with dental caries, and Porphyromonas gingivalis, the bacterium associated with periodontal disease.

In April 1995, the National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (NIH) defined CAM as ''a broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period.'' This group of diverse medical and health-care systems, practices, and products is not currently part of conventional (i.e., allopathic) medicine, although some conventional medical practitioners (those with an MD, DO, or other health-related degrees) are also practitioners of CAM. The CAM marketplace is currently valued at $24 billion or more, and the growth rate is close to 15% per year. Since the inception of the NCCAM, Congress has provided almost $550 million to promote CAM and CAM research. In fiscal year 2004, the funding for NCCAM was $117.7 million.

In December 1995, the American Medical Association (AMA) passed the resolution ''Unconventional Medical Care in the United States.'' The AMA encourages NCCAM to determine by objective scientific evaluation the efficacy and safety of practices and procedures of unconventional medicine and encourages its members to become better informed regarding the practices and techniques of alternative or unconventional medicine.*

What is CAM? Complementary medicine, such as aromatherapy, is used in conjunction with conventional medicine: for example, to lessen a patient's postoperative discomfort. Alternative medicine, such as some herbal medicines, is used instead of conventional medicine to treat cancer. Alternative therapies include, but are not limited to, the following disciplines: folk medicine, herbal medicine, diet fads, homeopathy, faith healing, new age healing, chiropractic, acupuncture, naturopathy, reflexology, massage, and music therapy. Integrative medicine combines conventional medical and CAM therapies for which there is some scientific evidence of safety and effectiveness, regardless of their origin.

The purpose of this chapter is to educate the reader about CAM. Medical schools in the United States are now including courses in which CAM is taught, but 80% of medical students polled have indicated that they would like more information. Because 29 health-care insurance companies in the United States now cover CAM therapies and 67% of health maintenance organizations now offer at least one form of CAM, it is crucial for health-care providers to become more cognizant about these therapies. In the future, there will be more well-designed, randomized, controlled studies that will provide answers to many of today's questions regarding CAM.

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