This document discusses complementary and alternative medicine (CAM). It defines CAM as healing practices other than those of conventional Western medicine. The document outlines common CAM practices like acupuncture, chiropractic, massage therapy and dietary supplements. It notes that 20% of Canadians visit CAM practitioners and over 70% use natural health products. Regulation of CAM practitioners and products varies between provinces and between practices. The document advises that Echinacea, ginseng, vitamin C and zinc may help treat or prevent colds, but that oil of oregano is not supported by research for cold treatment.

1. Complementary andComplementary and
Alternative Medicine (CAM)Alternative Medicine (CAM)
Heather Boon, BScPhm, PhDHeather Boon, BScPhm, PhD
Professor andProfessor and
Associate Dean for Graduate EducationAssociate Dean for Graduate Education
Leslie Dan Faculty of Pharmacy,Leslie Dan Faculty of Pharmacy,
University of TorontoUniversity of Toronto
(heather.boon@utoronto.ca)(heather.boon@utoronto.ca)
11

2. OutlineOutline
 What is CAM?What is CAM?
 Who uses CAM and why?Who uses CAM and why?
 Regulation of CAM practitionersRegulation of CAM practitioners
 Regulation of natural health productsRegulation of natural health products
(NHPs)(NHPs)
 CAM and pharmacy – do pharmacistsCAM and pharmacy – do pharmacists
have a role to play?have a role to play?
22

3. What is CAMWhat is CAM
 Anything that isn’t conventional medicine?Anything that isn’t conventional medicine?
 “…“…healing resourceshealing resources that encompass all healththat encompass all health
systems, modalities, and practices and theirsystems, modalities, and practices and their
accompanying theories and beliefs,accompanying theories and beliefs, other thanother than
those intrinsic to the politically dominant healththose intrinsic to the politically dominant health
systemsystem of a particular society or culture in aof a particular society or culture in a
given historical period. CAM includes allgiven historical period. CAM includes all suchsuch
practices and ideas self-defined by their userspractices and ideas self-defined by their users
as preventing or treating illness or promotingas preventing or treating illness or promoting
health and well-being… (NIH)health and well-being… (NIH)

4. 44
NIH ClassificationsNIH Classifications
 Alternative medical systemsAlternative medical systems
(e.g., TCM, naturopathy, homeopathy)(e.g., TCM, naturopathy, homeopathy)
 Mind-body interventionsMind-body interventions
(e.g., meditation)(e.g., meditation)
 Biological-based therapiesBiological-based therapies
(e.g., herbs, supplements)(e.g., herbs, supplements)
 Manipulative and body-based methodsManipulative and body-based methods
((e.g., chiropractic, massage)e.g., chiropractic, massage)
 Energy TherapiesEnergy Therapies
((e.g., therapeutic touch, Reiki)e.g., therapeutic touch, Reiki)

5. 55
Who Uses CAM?Who Uses CAM?
 20%20% of Canadiansof Canadians visited a CAM providervisited a CAM provider inin
20032003 (Canadian Community Health Survey)(Canadian Community Health Survey)
 Most common CAM practitioners visited:Most common CAM practitioners visited:
 chiropractic (11%)chiropractic (11%)
 massage therapy (8%)massage therapy (8%)
 acupuncturist (3%)acupuncturist (3%)
 73% of Canadians73% of Canadians have ever used an NHPhave ever used an NHP
(2010)(2010) (http://epe.lac-bac.gc.ca/100/200/301/pwgsc-tpsgc/por-(http://epe.lac-bac.gc.ca/100/200/301/pwgsc-tpsgc/por-
ef/health/2011/135-09/report.pdf)ef/health/2011/135-09/report.pdf)
 32% of Canadians use NHPs on a daily basis32% of Canadians use NHPs on a daily basis
 vitamins and minerals (53%)vitamins and minerals (53%)
 omega 3 fatty acids/fish oils (18%) andomega 3 fatty acids/fish oils (18%) and
 herbal teas (11%)herbal teas (11%)

6. 66
CAM RegulationCAM Regulation
PractitionersPractitioners
 Provincial jurisdictionProvincial jurisdiction
 Many unregulatedMany unregulated
 Wide variation inWide variation in
training andtraining and
credentialscredentials
ProductsProducts
 Federal jurisdictionFederal jurisdiction
 Natural HealthNatural Health
Products (NHPs)Products (NHPs)
 Regulations fullyRegulations fully
implemented in 2010implemented in 2010

7. 77
CAM PractitionersCAM Practitioners
 ChiropractorsChiropractors – regulated in all Canadian– regulated in all Canadian
ProvincesProvinces
 Naturopathic MedicineNaturopathic Medicine – regulated in 6– regulated in 6
Provinces including OntarioProvinces including Ontario
 Traditional Chinese medicine andTraditional Chinese medicine and
acupunctureacupuncture –pending in Ontario; TCM–pending in Ontario; TCM
regulated in BCacupuncture regulated inregulated in BCacupuncture regulated in
some other Provincessome other Provinces
 HomeopathyHomeopathy – pending in Ontario– pending in Ontario
 Registered Massage TherapistsRegistered Massage Therapists --
regulated in Ontario (plus some otherregulated in Ontario (plus some other
Provinces)Provinces)

8. 88
Regulation of Natural HealthRegulation of Natural Health
Products (NHPs)Products (NHPs)
 Regulated by theRegulated by the Natural Health ProductsNatural Health Products
Directorate (Health Canada)Directorate (Health Canada)
since January 1, 2004 (since January 1, 2004 (
http://www.hc-sc.gc.ca/dhp-mps/prodnatur/index-eng.phphttp://www.hc-sc.gc.ca/dhp-mps/prodnatur/index-eng.php))
 natural product number (NPN)natural product number (NPN) or (DIN-HM)or (DIN-HM)
 Quality control and good manufacturing practicesQuality control and good manufacturing practices
 Risk-based review of safety and efficacyRisk-based review of safety and efficacy
 Modern health claims vs. traditional use claimsModern health claims vs. traditional use claims

9. Some Practical AdviceSome Practical Advice
NHPs for ColdsNHPs for Colds
99

10. EchinaceaEchinacea ((Echinacea purpurea; E. angustifolia; E. pallidaEchinacea purpurea; E. angustifolia; E. pallida))
1010
http://www.cobleskill.edu/courses/orht321/Echinacea%20purpurea%200104.jpg

11. GinsengGinseng ((Panax quinquefoliusPanax quinquefolius or North Americanor North American
Ginseng)Ginseng)
1111

12. Oregano (Oregano (Origanum vulgareOriganum vulgare))
1212
http://2.bp.blogspot.com/-hULRiYTbsSc/UEL352AYn_I/AAAAAAAAh9E/
7mFxkQKsABs/s1600/Greek+Oregano55.JPG

13. 1313http://extremelongevity.net/wp-content/uploads/vitamin-c.jpg

14. 1414
http://ods.od.nih.gov/images/content/Zinc-Pills.jpg

15. NHPs for ColdsNHPs for Colds
Might HelpMight Help
 EchinaceaEchinacea (arial parts of(arial parts of
E. Purpurea) forE. Purpurea) for
treatmenttreatment
 GinsengGinseng (North American(North American
ginseng) for preventionginseng) for prevention
 Vitamin CVitamin C – 200mg /day– 200mg /day
for preventionfor prevention
 ZincZinc – lozenges for– lozenges for
treatmenttreatment
Don’t BotherDon’t Bother
 Oil of oreganoOil of oregano (no(no
research)research)
1515