Lecture Notes: Grand Rounds with Dr. Matt Brunner

Introduction

• Last Grand Rounds of the Year
  • Next one in the auditorium after Labor Day.
  • Upcoming Research Day Grand Rounds in HSLC.
• Presenter: Dr. Matt Brunner, Bridges Family Endowed Chief Resident.
  • Education: University of Michigan, Tulane University.
  • Achievements: Gold Humanism Honor Society, Best Mentor Award, Resident Excellence in Teaching.
  • Future plans: Fellowship in Hematology Oncology.

Presentation Topic: Complementary and Alternative Medicine (CAM) in Modern Healthcare

Audience Engagement

• Initial questions to gauge audience perception of CAM.
  • Mixed feelings among conventional practitioners.

Personal Story

• Patient with GI cancer refusing chemotherapy, opting for CAM.
  • Result: Worsened condition with unconventional treatments (mistletoe injections).

Objectives

1. Describe epistemologic differences between conventional and CAM.
2. Understand patient motivations for using CAM.
3. Discuss barriers to integrative health.

Understanding Conventional Medicine

• Science and its evolution: From Renaissance to modern era.
  • Mechanistic understanding improved medicine.
• Issues with Science:
  • Pseudoscience vs real science.
  • Example: Tobacco industry and smoking data.

The Role of Evidence-Based Medicine (EBM)

• Process: Bench to bedside; randomized trials; systematic reviews.
• Case Study: Oseltamivir and data transparency issues.
  • Problem with unpublished data and selective reporting.

Complementary and Alternative Medicine (CAM)

• Definitions: Health practices outside convention.
  • Complementary: in addition to.
  • Alternative: instead of.
• Usage Statistics: 35% of U.S. adults use CAM.
  • Higher use in chronic pain and cancer patients.

Reasons for CAM Usage

• Study (ASTIN 98): Worldview predicts CAM usage rather than distrust or desire for control.

Challenges with CAM Evidence

• Lack of Funding: No natural funding source for CAM research.
• Trial Issues: Blinding, placebo, and complex treatments.

Integrative Health

• NIH's National Center for Complementary and Integrative Health (NCCIH).
• Controversy: Mixed opinions about integrating CAM into mainstream.

CAM Modality Examples

• Homeopathy: Highly diluted substances, criticized as pseudoscience.

  • Issues with evidence quality and plausibility.

• Naturopathy: Focus on 'ancient wisdom'.

  • Differences in epistemology lead to different clinical practices.

Critique of Integrative Health

• Concerns: Testing non-scientific modalities and practitioner involvement.
  • Example: TACT Trial for chelation therapy.
  • Reliability of data questioned due to CAM practitioners' involvement.

Conclusion and Recommendations

• Skepticism of Integrative Health: Need for strong justifications and responsible partnerships.
• Role of Conventional Medicine: Uphold science and evidence-based practices.

Closing Remarks

• Importance of understanding worldviews in patient care.
• Acknowledgements: Family, mentors, and colleagues.

Questions from Audience

• Patient Satisfaction with CAM: May be higher due to longer consultations and placebo effect.
• Discussion on CAM in Allergology: Concerns about misinterpretation of diagnostic tests.
• Counseling CAM-Interested Patients: Emphasize relationship-building and understanding patient perspectives.