CH 188 Complementary & Integrative Medicine

Transcription

1 CH 188 Complementary & Integrative Medicine Spring 2014 Syllabus Professor: Meeting Time: Office Hours: Richard Glickman-Simon, MD Department of Public Health & Community Medicine Tufts University School of Medicine Wed, 1:20 4:20 pm Wed, 10 1 pm by appointment Contemporary biomedicine finds itself in a curious situation. Despite almost a century of impressive achievements, one after the next, the American public s enthusiasm for alternatives to allopathic medicine remains high. Why is that? What makes complementary and integrative medicine (CIM) so appealing? How precisely does it differ from the kind of conventional medical care we re so accustomed to? Is its popularity well deserved or does it only offer additional services without additional benefit? In this course, we will take a critical look at CIM from various perspectives: historical, philosophical, scientific, and clinical. Our main objectives will be to (1) explore CIM in the context of an allopathic medical system under increasing economic and social pressure, (2) evaluate the clinical effectiveness of some of the most popular CIM therapies and explore plausible mechanisms to explain their observed health effects, (3) consider to what extent individuals and the public would benefit from a truly integrated model of health care, and (4) observe how actual healers practice their professions. Learning Objectives By the end of this course, you will be able to: Characterize the utilization patterns of Americans seeking non-allopathic services and suggest possible motivations for their health care decisions Distinguish between allopathic and non-allopathic approaches to health, disease and illness; and explain under what circumstance a useful distinction can and cannot be drawn Describe theoretical mechanisms biomedical researchers use to explain the observed health effects of selected CIM interventions

2 2 Explain the standards of evidence allopathic clinicians and researchers use to evaluate the effectiveness of clinical interventions and apply these standards to selected CAM therapies Identify the challenges and prospects of creating an integrative clinical model, in which the best of allopathic and complementary medicine are seamlessly combined Compare the relative risks and benefits of allopathic and non-allopathic interventions, in terms of their effectiveness, safety and costs Describe the (1) healing philosophy, (2) evidence of effectiveness, (3) mechanisms of action, (4) common clinical applications, (5) safety and cost, and (6) practice parameters for selected complementary therapies Recommend an evidence-based, integrated approach to the treatment of a chronic health condition for which allopathic medicine often produces less than optimal results Online Readings Student Responsibilities There is no paper text for this course. Readings are from 3 books (available for purchase online) and free full-text articles from medical journals (available via the Trunk course site). Books to purchase from Kindle (or another ebook seller): A Weil, Spontaneous Healing (1995) P Offit, Do You Believe in Magic? (2013) E Ernst, Healing, Hype or Harm? (2008) Class Participation Your active and enthusiastic participation is essential for this small seminar to work. Be sure come prepared by doing the assigned reading and completing any other assignments (see below) prior to each session. Reading Reflections You will find 8-10 reflection questions related to the reading assignments for Session 2, 3, and 4. I will ask you choose any 5 of those questions and post your one paragraph ( words) response to each on Trunk prior to the relevant session. You will find the questions under Assignments. Since these reflections are designed to help you prepare for these sessions, no extensions are permitted.

3 3 Complementary Modality Project This project consists of 2 components: a written paper and an oral presentation. During Session 2, you will choose a non-allopathic treatment modality that most interest you from the following list: Acupuncture Aromatherapy Balneotherapy Biofeedback Chiropractic Detoxification therapy Guided imagery Herbal medicine Homeopathy Hypnotherapy Macrobiotics Magnet therapy Massage therapy Music therapy Orthomolecular medicine Osteopathic manipulative therapy Reflexology Reiki Therapeutic touch Tai Chi Since there can be no duplications, come prepared with one or two alternatives. Your first task is to research and write a paper incorporating the following 5 sections: Origins and Historical Use. Describe where and when the practice originated and what sorts of conditions original practitioners treated. Healing Philosophy or Mechanism. Describe how a traditional practitioner conceptualizes health and illness, and how he or she would say the therapy works. Biomedical Interpretations. Describe how a biomedical scientist would explain the observed benefits of the therapy. (In some cases, this may not differ substantially from a traditional practitioners explanation. If so, briefly explain why.) Common indications. Identify the medical diagnoses that practitioners are most likely to encounter at present. Comment on whether or not these conditions seem reasonable given the traditional (non-allopathic) and biomedical explanations previously discussed. Associated Risks and Costs. Describe the potential and actual risks associated with the therapy and what steps are (or should be) taken to keep patients safe. Also, briefly describe the costs associated with a typical trial of treatment (including out of pocket expenses for products and services). Papers should be 3-4 single-spaced pages in length ( 12-point font, please) excluding cited references. PowerPoint presentations are scheduled for Sessions 6 and 7. They should be minutes in length (corresponding to about total slides) and cover the same 5 sections. Be prepared for 5-10 minutes of questions and discussion afterwards.

4 4 Submit both your paper and presentation slides on Trunk (Assignments > Session 6) by 1:00 pm on March 26, irrespective of when you re scheduled to present. Don t forget to bring your presentation with you on a USB flash drive and be sure to it to yourself as a back up. (See tips on preparing PowerPoint presentations below.) Evidence-Based Integration (EBI) Project For this project, you will take on the role of an allopathic physician treating a patient with a chronic condition. Your patient is not completely satisfied with the treatments you ve tried and asks about a specific non-allopathic alternative. Unfamiliar with these sorts of therapies, you decide to do some research before making a recommendation. In this case, you get to decide what condition your patient has and which non-allopathic intervention he or she is interested in trying. Your objective is to determine whether or not you would recommend this treatment either alone or in combination with allopathic medicine. Assume your patient is covered by a typical health insurance plan that imposes significant limitations on non-allopathic therapies. This project also consists of 2 components: a written paper and an oral presentation. During Session 4, you will choose a medical diagnosis and nonallopathic modality other than the one you chose previously. Since there can be no duplications, come prepared with one or two alternatives. Your first task is to research and write a paper incorporating the following 5 sections: Case Overview. Briefly describe your patient s case including his or her risk factors (e.g., past medical history, social and family history), clinical presentation (i.e., presenting signs and symptoms), how the condition was diagnosed and treated, and the course of the illness to date. Give a reasonable explanation for why your patient is dissatisfied with his or her treatment (e.g., insufficiently effective, unacceptable adverse effects, unaffordable). Effectiveness of Allopathic Therapy. Provide evidence for why the allopathic treatment(s) your patient has tried thus far are considered the standard of care. Be sure to cite actual clinical trials and/or systematic reviews of clinical trials (if they exist), though you do not need to analyze them. If multiple interventions are commonly used for this condition (often the case), you may restrict yourself to the 2 or 3 most commonly used. Non-Allopathic Therapy. Succinctly describe the non-allopathic therapy your patient is interested in pursuing, including brief accounts of its traditional healing philosophy, how it is administered, and its associated risks and costs. Restrict yourself to one therapy only. Effectiveness of Non-Allopathic Therapy. Analyze the evidence, supportive and unsupportive, for the effectiveness of this treatment modality for the condition in question. Using the best available evidence (ideally systematic reviews and/or large, well-designed RCT s), thoroughly justify your own (as opposed to the study authors ) conclusion regarding its

5 5 effectiveness. This will require analyzing the quality of the studies you cite and how well their results apply to your patient s situation. Final Recommendation. Taking into account only those interventions you investigated, recommend a course of action suitable for your patient s circumstances. Your recommendation may be totally allopathic, totally non-allopathic or some combination of both. Be sure your recommendation is evidence-based and takes into account the effectiveness, safety, cost and any other factors relevant to your patient s case (e.g., lifestyle, occupation, insurance coverage, etc.). Your paper should be 4-5 single-spaced pages in length ( 12-point font, please) excluding cited references. PowerPoint presentations are scheduled for Sessions 9 and 10. They should be minutes in length (corresponding to about total slides) and cover the same 5 sections. Be prepared for minutes of questions and discussion afterwards. Submit your paper and presentation slides on Trunk (Assignments > Session 9) by 1:00 pm on April 16, irrespective of when you re scheduled to present. Don t forget to bring your presentation with you on a USB flash drive and be sure to it to yourself as a back up. (See tips on preparing PowerPoint presentations below.) Notes on Projects Sources and Citations. The reliability (accuracy and timeliness) of information available on the internet varies considerably. You should therefore rely only on peered-reviewed sources, such as textbooks and journal articles for your projects. Any sources available directly via the Hirsh Health Sciences Library website ( should be reliable. Avoid citing websites ending in dot-com (though it may be useful to begin your research with these sites). Numbered citations, imbedded in the text, are essential (including the actual references for published studies). Footnotes on every page are optional, but all numbered citations should appear on a bibliographic page (not included in the page limit). Citations should appear on the bottom of each relevant slide and on 1 or 2 references slides at the end of your presentations. Authorship. It is always best to avoid cutting and pasting content from any other source directly into your paper or presentation. However, if you choose to do so, it is essential that you provide proper attribution, including quotation marks and accurate, detailed citations. Failure to do so may constitute plagiarism, in which case you will receive an automatic score of zero on the paper or presentation and will jeopardize a passing grade for the course. Evaluation. Projects will be evaluated using the following criteria:

6 6 Content accuracy and completeness 60% Writing quality and efficiency 20% Slide clarity, organization and visual appeal 10% Oral communications skills 10% Be sure to remove all grammatical and typographical errors before submitting your papers. Extensions. You may have a 48-hour extension on papers without a score deduction as long as I approve your extension request prior to the due date/time. Without prior approval, or after 48 hours with approval, 1 point will be deducted for each additional day (including weekends) your paper is late. No extensions are permitted on presentations. Tips for Effective Presenting Never, ever read your slides; consider them as merely tools to organize your talk and illustrate key points Make frequent eye contact with each individual in the room Stand up straight and squarely face the audience Make sure the font on each slide is no smaller than 20 points (ideally 24-28) and that letters and graphics sharply contrast with the background Limit the amount of text on each slide to no more than 3-5 bullet points and one graphic Avoid any grammatical or typographical errors Suppress your urge to overuse slick animation Don t skip over any content in your slides and be sure your audience has plenty of time to absorb it all before moving on Look the part by dressing professionally (or at least presentably) Final Exam There will be an open-book, open-note, open-everything final exam on Trunk that you may take at any time on May 2. You will have 2 contiguous hours to answer 4 essay questions covering material from the entire course.

7 7 Grading Policy Your final grade for the course will be calculated according to the following point distribution: Class Participation Reflection Questions (x3) Modalities Project EBI Project Final Exam Total 15 pts 15 pts 20 pts 30 pts 20 pts 100 pts

8 Course Schedule Session Date Topic Assignment/Notes* 1 Jan 15 Course Introduction Readings: Ernst. Healing, Hype Or Harm? What is CAM, p Why is CAM So Popular, p Jan 22 No class Monday s schedule 2 Jan 29 Pro-CAM perspective Reading: A Weil, Spontaneous Healing Session 2 reflection due Choose Modalities Project topics Feb 5 Modality Project Meetings B & B over coffee 3 Feb 12 Anti-CAM perspective Reading: P Offit, Do you Believe in Magic? Session 3 reflection due Feb 19 No class

9 9 4 Feb 26 The Nature of Evidence Placebo Medicine Readings: Ernst. Healing, Hype Or Harm? Evidence in Healthcare, p Research in CAM, p Placebo and Other Non-specific Effects, p Caspi O. Evidence-Based Medicine and Clinical Decision Making. Rakel: Integrative Medicine (2007); pp Bensing J. The silent healer: the role of communication in placebo effects. Pat Educ Counsel (2010); 80: Kaptchuk TJ. Placebo studies and ritual theory: a comparative analysis of Navajo, acupuncture and biomedical healing. Phil. Trans. R. Soc. B (2011); 366: Session 4 reflection due Choose EBI Project topics Mar 5 EBI Project meetings B & B over coffee 5 Mar 12 Herbs & Dietary Supplements Readings: NCCAM Herbal Fact Sheets: Ten popular herbs Bent S. Herbal medicine in the United States: review of efficacy, safety, and regulation. Jrl Gen Int Med. 23(6):854-9, 2008 Jun. Gardiner P, Low Dog T. Prescribing Botanicals. Rakel: Integrative Medicine (2007); pp Mar 19 No class Spring break 6 Mar 26 Modality Projects Presentations I Finalize Modality Project papers and presentation 7 Apr 2 Modality Project Presentations II 8 Apr 9 Practitioner Day 9 Apr 16 EBI Project Presentations I Finalize EBI Project papers and presentation 10 Apr 23 EBI Projects Presentations II Final Integration

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