Complementary and alternative medicine

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Complementary and Alternative Medicine
This article is part of the CAM series of articles.
CAM Article Index
Alternative medical systems - edit
NCCAM classifications
  1. Alternative Medical Systems
  2. Mind-Body Intervention
  3. Biologically Based Therapy
  4. Manipulative and body-based methods
  5. Energy Therapy
See also

The term complementary and alternative medicine (CAM) is an umbrella term for alternative medicine, complementary medicine, and integrative medicine.

"Alternative medicine" describes practices used in place of conventional medical treatments. When some of those practices are used in conjunction and cooperation with conventional medicine they are termed "complementary medicine". "Integrative medicine" is viewed by its advocates as the best of complementary medicine.

The list of therapies included under CAM changes over time. If and when an approach, initially regarded as "unproven", is proven to be safe and effective, it will be adopted into conventional health care and over time may cease to be considered "alternative".

Contents

"Complementary and alternative medicine (CAM) is 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. CAM includes all such practices and ideas self-defined by their users as preventing or treating illness or promoting health and well-being. Boundaries within CAM and between the CAM domain and the domain of the dominant system are not always sharp or fixed." [1]

The National Center for Complementary and Alternative Medicine (NCCAM) defines complementary and alternative medicine as "a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine". It also defines integrative medicine as "[combining] mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness".[2]

CAM has been described as comprising "a diverse group of treatments, ranging from symptomatic interventions to be used in conjunction with traditional therapies—therapeutic touch or meditation—to unique treatments meant to replace conventional chemotherapy or surgery. CAM includes complex and longstanding fields of study, such as acupuncture, ayurvedic medicine, and homoeopathy, but can also be as straightforward as taking a specific dietary supplement to lower blood pressure or blood lipid concentrations."[3]

Ralph Snyderman and Andrew Weil state "integrative medicine is not synonymous with complementary and alternative medicine (CAM). It has a far larger meaning and mission in that it calls for restoration of the focus of medicine on health and healing and emphasizes the centrality of the patient-physician relationship".[4]

In a frequently-cited review, David M. Eisenberg[5] used the term "unconventional medicine" to signify "medical interventions not taught widely at U.S. medical schools or generally available at U.S. hospitals."[6]

NCCAM classifies CAM therapies into five categories, or domains.[2]

Alternative medical systems are built upon complete systems of theory and practice. Often, these systems have evolved apart from and earlier than the conventional medical approach used in the United States. Examples of alternative medical systems that have developed in Western cultures include homeopathic medicine and naturopathic medicine. Examples of systems that have developed in non-Western cultures include traditional Chinese medicine and Ayurveda.

Mind-body medicine uses a variety of techniques designed to enhance the mind's capacity to affect bodily function and symptoms. Some techniques that were considered CAM in the past have become mainstream (for example, patient support groups and cognitive behavioral therapy). Other mind-body techniques are still considered CAM, including meditation, prayer, mental healing, and therapies that use creative outlets such as art, music, or dance.

Biologically based therapies in CAM use substances found in nature, such as herbs, foods, and vitamins. Some examples include dietary supplements,3 herbal products, and the use of other so-called natural but as yet scientifically unproven therapies (for example, using shark cartilage to treat cancer).

Manipulative and body-based methods in CAM are based on manipulation and/or movement of one or more parts of the body. Some examples include chiropractic, osteopathy and massage.

Energy therapies involve the use of energy fields. They are of two types:

Biofield therapies are intended to affect energy fields that purportedly surround and penetrate the human body. The existence of such fields has not yet been scientifically proven. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in, or through, these fields. Examples include qi gong, Reiki, and therapeutic touch.

Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields, or alternating-current or direct-current fields.

Many people utilize mainstream medicine for diagnosis and basic information, while turning to alternatives for what they believe to be health-enhancing measures. However, studies indicate that the majority of people use alternative approaches in conjunction with conventional medicine.

Edzard Ernst wrote in the Medical Journal of Australia that "about half the general population in developed countries use complementary and alternative medicine (CAM)."[7] A survey released in May 2004 by the National Center for Complementary and Alternative Medicine, part of the National Institutes of Health in the United States, found that in 2002, 36% of Americans used some form of alternative therapy in the past 12 months, 50% in a lifetime — a category that included yoga, meditation, herbal treatments and the Atkins diet.[8] If prayer was counted as an alternative therapy, the figure rose to 62.1%. 25% of people who use CAM do so because medical professional suggested it.[9] Another study suggests a similar figure of 40%.[10] A British telephone survey by the BBC of 1209 adults in 1998 shows that around 20% of adults in Britain had used alternative medicine in the past 12 months.[11]

The use of alternative medicine appears to be increasing, as a 1998 study showed that the use of alternative medicine had risen from 33.8% in 1990 to 42.1% in 1997.[12] In the United Kingdom, a 2000 report ordered by the House of Lords suggested that "...limited data seem to support the idea that CAM use in the United Kingdom is high and is increasing."[13]

Increasing numbers of medical colleges have begun offering courses in alternative medicine. For example, the University of Arizona College of Medicine offers a program in Integrative Medicine under the leadership of Dr. Andrew Weil which trains physicians in various branches of alternative medicine which "...neither rejects conventional medicine, nor embraces alternative practices uncritically."[14] In three separate research surveys that surveyed 729 schools in the United States (125 medical schools offering an MD degree, 19 medical schools offering a Doctor of Osteopathy degree, and 585 schools offering a nursing degree), 60% of the standard medical schools, 95% of osteopathic medical schools and 84.8% of the nursing schools teach some form of CAM.[15][16][17] Accredited Naturopathic colleges and universities are increasing in number and popularity in the U.S.A. See Naturopathic medicine.

In the UK, no medical schools offer courses that teach the clinical practice of alternative medicine. However, alternative medicine is taught in several schools as part of the curriculum. Teaching is based mostly on theory and understanding alternative medicine, with emphasis on being able to communicate with alternative medicine specialists. To obtain competence in practicing clinical alternative medicine, qualifications must be obtained from individual medical societies. The student must have graduated and be a qualified doctor. The British Medical Acupuncture Society, which offers medical acupuncture certificates to doctors, is one such example, as is the College of Naturopathic Medicine UK and Ireland.

The NCCAM surveyed the American public on complementary and alternative medicine use in 2002. According to the survey:[8]

  • 50 percent of U.S. adults age 18 years and over used some form of complementary and alternative medicine (CAM).[18]
  • When prayer specifically for health reasons is included in the definition of CAM, the number of adults using some form of CAM in 2002 rose to 62 percent.
  • The majority of individuals (54.9%) used CAM in conjunction with conventional medicine.
  • Most people use CAM to treat and/or prevent musculoskeletal conditions or other conditions associated with chronic or recurring pain.
  • "The fact that only 14.8% of adults sought care from a licensed or certified CAM practitioner suggests that most individuals who use CAM prefer to treat themselves."
  • "Women were more likely than men to use CAM. The largest sex differential is seen in the use of mind-body therapies including prayer specifically for health reasons".
  • "Except for the groups of therapies that included prayer specifically for health reasons, use of CAM increased as education levels increased".
  • The most common CAM therapies used in the USA in 2002 were prayer (45.2%), herbalism (18.9%), breathing meditation (11.6%), meditation (7.6%), chiropractic medicine (7.5%), yoga (5.1%), body work (5.0%), diet-based therapy (3.5%), progressive relaxation (3.0%), mega-vitamin therapy (2.8%) and Visualization (2.1%)

  1. ^ O’Connor BB, Calabrese C, Cardeña E, Eisenberg D, Fincher J, Hufford DJ, Jonas WB, Kaptchuk T, Martin SC, Scott AW, Zhang X (Panel on Definition and Description, CAM Research Methodology Conference, April 1995). (1997). "Defining and describing complementary and alternative medicine.". Alternative Therapies 3 (2): 49-57. 
  2. ^ a b What is Complementary and Alternative Medicine (CAM)?. Retrieved on 2006-07-11. NCCAM
  3. ^ Kamerow D. (2007). "Wham, bam, thank you CAM.". Brit Med J 335: 647. 
  4. ^ Snyderman, R.; Weil, A. T. (2002-02-25). "Integrative Medicine: Bringing Medicine Back To Its Roots". Archives of Internal Medicine. Retrieved on 2006-07-11. PMID 11863470
  5. ^ David M. Eisenberg
  6. ^ Unconventional Medicine in the United States -- Prevalence, Costs, and Patterns of Use. Eisenberg D, et al. N Engl J Med 1993; 328:246-252.
  7. ^ Ernst E. "Obstacles to research in complementary and alternative medicine." Medical Journal of Australia, 2003; 179 (6): 279-80. PMID 12964907 MJA online
  8. ^ a b Barnes, P. M.; Powell-Griner, E.; McFann, K.; Nahin, R. L. (2004). "Complementary and Alternative Medicine Use Among Adults: United States, 2002". National Center for Health Statistics.
  9. ^ Reasons people use CAM. NCCAM
  10. ^ Astin JA "Why patients use alternative medicine: results of a national study" JAMA 1998; 279(19): 1548-1553
  11. ^ Thomas KJ, Nicholl JP, Coleman P. Use and expenditure on complementary medicine in England: a population based survey. Complement Ther Med. 2001 Mar;9(1):2-11. PMID: 11264963
  12. ^ Eisenberg, DM, Davis RB, Ettner SL "Trends in alternative medicine use in the United States 1990-1997." JAMA, 1998; 280:1569-1575. PMID 9820257
  13. ^ House of Lords report on CAM
  14. ^ University of Arizona position on Alternative Medicine
  15. ^ Wetzel MS, Eisenberg DM, Kaptchuk TJ. "Courses involving complementary and alternative medicine at US medical schools." JAMA 1998; 280 (9):784 -787. PMID 9729989
  16. ^ Saxon DW, Tunnicliff G, Brokaw JJ, Raess BU. "Status of complementary and alternative medicine in the osteopathic medical school curriculum." J Am Osteopath Assoc 2004; 104 (3):121-6. PMID 15083987
  17. ^ Fenton MV, Morris DL. "The integration of holistic nursing practices and complementary and alternative modalities into curricula of schools of nursing." Altern Ther Health Med, 2003; 9 (4):62-7. PMID 12868254
  18. ^ CAM Use by U.S. Adults. NCCAM

  1. Barnes P, Powell-Griner E, McFann K, Nahin R. "Complementary and Alternative Medicine Use Among Adults: United States, 2002." Advanced data from vital health and statistics 2004; Hyattsville, Maryland:NCHS Online
  2. Benedetti F, Maggi G, Lopiano L. "Open Versus Hidden Medical Treatments: The Patient's Knowledge About a Therapy Affects the Therapy Outcome." Prevention & Treatment, 2003; 6(1), APA online
  3. Downing AM, Hunter DG. "Validating clinical reasoning: a question of perspective, but whose perspective?" Man Ther, 2003; 8(2): 117-9. PMID 12890440 Manual Therapy Online
  4. Eisenberg DM. "Advising patients who seek alternative medical therapies." Ann Intern Med 1997; 127:61-69. PMID 9214254
  5. Gunn IP. "A critique of Michael L. Millenson's book, Demanding medical excellence: doctors and accountability in the information age, and its relevance to CRNAs and nursing." AANA J, 1998 66(6):575-82. Review. PMID 10488264
  6. Tonelli MR. "The limits of evidence-based medicine." Respir Care, 2001; 46(12): 1435-40; discussion 1440-1. Review. PMID 11728302 PMID: 11863470
  7. Zalewski Z. "Importance of Philosophy of Science to the History of Medical Thinking." CMJ 1999; 40: 8-13. CMJ online

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