Complementary Medicine in Women’s Health

Women's Health 2012: The 20th Annual Congress March 16, 2012

Josephine P. Briggs, M.D.Director, National Center for Complementary and Alternative MedicineNational Institutes of Health

DISCLOSURE

I HAVE NO FINANCIAL INTERESTS OR CONFLICTS OF INTEREST TO DISCLOSE

A group of diverse medical and health care interventions, practices, products, or disciplines that are not generally considered part of conventional medicine

What is Complementary Medicine?

Boundaries are

Gray

Moving

Cultural

Examples of Mind and Body Interventions

Acupuncture Breath practices Mantra Meditation Mindfulness based

stress reduction Guided imagery Progressive

relaxation Tai chi and Qi gong Yoga Spinal manipulation

Hypnosis Alexander technique Pilates Reiki Healing touch Qi gong Craniosacral therapy Massage therapy

© iStockphoto.com/Hagrit

Categories of CAM Natural Products

Dietary supplements Herbal or botanical

products Traditional medicine

formulations Folk medicines Homeopathic remedies Probiotics Food-based

phytochemicals© Bob Stockfield

Adult Use of Selected CAM Therapies: 2007

0

5

10

15

20

Natur

al p

roduct

s

Deep b

reat

hing

Med

itatio

n

Chiro

prac

tic

Mas

sage

Yoga

Speci

al d

iets

Relax

atio

n

Imag

ery

Acupun

ctur

e

% o

f Adu

lt P

opul

atio

n

38.8 million

16 million

Barnes et al., 2008

Adult Use of CAM for Selected Conditions: 2007

0

5

10

15

20

% o

f th

ose

ad

ults

who

u

sed

CA

M

14.3 million

5 million

1.8 million

Barnes et al., 2008

% o

f Adu

lt P

opul

atio

nAdult Use of Selected CAM Therapies: 2002 vs. 2007

Barnes et al. 2004, 2008

***

0

5

10

meditatio

n

massage

yoga

specia

l diets

imagery

acupunctu

re

tai chi

energy t

herapies

naturopathy

qi gong

biofeedback

hypnosis

Ayurve

da

chelatio

n

2002 2007

0%10%20%30%40%50%60%70%80%90%

100%Other Reasons

Treatment AND Well-ness/Preven-tion

Treatment only

Wellness/Prevent only

Reasons for CAM Use: 2007%

usi

ng t

hera

py f

or g

iven

re

ason

Stussman, 2010

87% Treatment42% Wellness

76% Wellness54% Treatment

NHIS CAM Survey: Use and Costs, 2007

CAM use in U.S.: 40% of adults 12% of children

CAM spending in U.S.: $34 billion out-of-pocket

1% of total health care expenditures 10% of total out-of-pocket costs

Across all demographics Women > men West >Midwest >Northeast >South Greater use in people with higher education levels

Overall Use by GenderWomen Men Average43% 34% 40%

How does it work?

The Range of Research Questions

BasicScience

Can it be studied in people?

Translational Research

What are the specific effects?

Efficacy Studies

How well does it work in real world

settings?

Outcomes and

Effectiveness Research

Hierarchy of Evidence

Basic biological understanding

Rigorous human studies

Systematic reviews

Guidelines

Hodis HN, Mack WJ, Kono N, et al. Isoflavone soy protein supplementation and atherosclerosis progression in healthy postmenopausal women: a randomized controlled trial. Stroke. 2011;42(11):3168–3175.

Research Spotlight

Isoflavone soy protein supplementation and atherosclerosis progression in healthy postmenopausal women: a randomized controlled trial.

Research Spotlight

Naqvi AZ, Harty B, Mukamal KJ, et al. Monounsaturated, Trans, and Saturated Fatty Acids and Cognitive Decline in Women. J of the American Geriatrics Society. 2011;59(5):837-843.

Research Spotlight

Barbosa-Cesnik C, Brown MB, Buxton M, et al. Cranberry juice fails to prevent recurrent urinary tract infection: results from a randomized placebo-controlled trial. Clinical Infectious Diseases. 2011;52(1):23–30.

Research Spotlight

Geller SE, Shulman LP, van Breemen RB, et al. Safety and efficacy of black cohosh and red clover for the management of vasomotor symptoms: a randomized controlled trial. Menopause. 2009;16(6):1156–1166.

Tai Chi for Fibromyalgia

Meditative Exercise Therapies

Beyond Drugs: How alternative treatments can ease pain

March 7, 2011

Journal of Manipulative and Physiological Therapeutics

Menopause Research

In 2002, the Women's Health Initiative raised concerns about

long-term safety of menopausal hormone therapy.

One reason that many women are turning to complementary

therapies.

In 2005, NIH State-of-the-Science conference on the

management of menopause-related symptoms determined that

more research is needed to clearly define the natural history of

menopause, associated symptoms, and effectiveness and safety

of treatments for bothersome symptoms.

NCCAM Menopause Research

NCCAM supports a number of studies on complementary health

practices for menopausal symptoms, such as:

A trans-NIH initiative to improve scientific measures of hot

flashes

Research to identify natural plant-based compounds as

promising alternatives to traditional menopausal hormone

therapy

Safety and efficacy and mechanisms of action of black cohosh,

red clover, soy supplements, and other botanicals

Mind and body therapies like yoga, meditation, hypnotherapy,

and acupuncture for reducing hot flashes.

NCCAM Portal Page on Women’s Health

Cancer

Fertility/pregnancy

Menopause

Osteoporosis

Osteoarthritis

Polycystic Ovary

Syndrome

Urinary Tract

Infection

Links to other

Resources

nccam.nih.gov/health/providers/digest

Acknowledgements

NHIS CAM Survey Richard Nahin, NCCAM Barbara Stussman, NCCAM Patricia Barnes, NCHS/CDC

National Center for Complementary and Alternative Medicine

1-888-644-6226nccam.nih.gov