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Complementary and Alternative Medicine
This article is part of the CAM series of articles.
CAM Article Index
See also: Alternative medicine

Complementary and alternative medicine (CAM) refers to alternative medicine when it is used in conjunction with conventional evidence-based medicine. CAM incorporates modalities including integrative medicine, herbalism, meditation, chiropractic, yoga, body work and diet-based therapies.

The National Center for Complementary and Alternative Medicine (NCCAM) defines CAM as "a group of diverse medical and health care systems, practices, and products, that are not currently part of conventional medicine." NCCAM has developed what the Institute of Medicine (IOM) calls "one of the most widely used classification structures" for the branches of complementary and alternative medicine. David M. Eisenberg defines CAM as "medical interventions not taught widely at U.S. medical schools or generally available at U.S. hospitals." Richard Dawkins defines CAM as a "set of practices which cannot be tested, refuse to be tested, or consistently fail tests." Marcia Angell and J. P. Kassirer state that "There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work." Fontanarosa and Lundberg also deny that such a thing as "alternative medicine" exists, saying there is only "evidence-based medicine supported by solid data or unproven medicine."

The term "alternative medicine" is used to describe these practices when they are used in place of conventional medicine. Used in conjunction and cooperation with conventional medicine they are termed "complementary medicine". "Integrative" or "integrated medicine" combines conventional medical treatments with CAM treatments which have some high-quality scientific evidence. It is viewed by its advocates as the best of complementary medicine.

Part of a series on
Alternative medicine
General information
Fringe medicine and science
Controversies
Classifications
Traditional medicine
Alternative diagnoses

Relationship between alternative and conventional medicine

The boundary between conventional and alternative medicine can be fluid. According to the Institute of Medicine (IOM), "A lack of consistency in the definition of what is included in CAM is found throughout the literature." For the purposes of their report, entitled "Complementary and Alternative Medicine in the United States" (2005), the IOM adopted this definition: "Complementary and alternative medicine (CAM) is a broad domain of resources that encompasses health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the dominant health system of a particular society or culture in a given historical period."

According to the NCCAM, over time, formerly unproven remedies can be incorporated into conventional medicine if they are shown to be safe and effective.

According to Angell and Kassirer, what distinguishes alternative medicine from other unproven therapies is the fact that "its advocates largely deny the need for testing" and that "many treatments used in conventional medicine have not been rigorously tested, either, but the scientific community generally acknowledges that this is a failing that needs to be remedied." They state: "Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted."According to Dawkins, disproven practices remain in the realm of CAM.

Other proponents of evidence-based medicine who study CAM, such as the Cochrane Collaboration and Edzard Ernst, Professor of Complementary Medicine at the University of Exeter, believe that CAM can and should be subjected to scientific testing. In their view, there can be "good CAM" or "bad CAM" based on evidentiary support.

M.R. Tonelli argues that CAM cannot be evidence-based unless the definition of evidence is changed. He states that "the methods of developing knowledge within CAM currently have limitations and are subject to bias and varied interpretation. CAM must develop and defend a rational and coherent method for assessing causality and efficacy, though not necessarily one based on the results of controlled clinical trials."

A review of Michael L. Millenson's book Demanding Medical Excellence: Doctors and Accountability in the Information Age described it as "a wake up call to both medicine and nursing" due to what Millenson calls a "lack of scientific-based medical practice". According to the review, the book states that "85% of current practice has not been scientifically validated" and that it suggests that users of the research presented by Medline should question research articles rather than assuming they are accurate simply because the are published. The review states that Millenson's thesis and conclusion call for all health researchers and policy makers do a better job in assuring valid methodology and avoidance of bias in published research. Michael Dixon, the Director of the NHS Alliance stated that “People argue against complementary therapies on the basis of a lack of evidence. But I’d say only 10 per cent of what doctors do in primary care is evidence-based."

Complementary medicine

The term Complementary medicine refers to alternative medicine treatments used in addition (complementary) to conventional medicine prescribed by a physician.

The expressions complementary medicine and alternative medicine are not used to describe different methods, only to describe the different settings in which the same alternative methods are often used. The term complementary medicine was widely adopted to describe systems of health care and individual therapies that people used as adjuncts to their conventional health care. "The term 'complementary' has come into regular usage in the last 15 years, commonly understood as complementing conventional medicine. Practitioners often label complementary medicine as such because they believe that it complements more of the needs of the patient than conventional medicine.

Definitions and descriptions

Complementary medicine does not use alternative medicine as a replacement for conventional care.

The National Center for Complementary and Alternative Medicine (NCCAM) says that "complementary medicine is used together with conventional medicine. An example of a complementary therapy is using aromatherapy therapy in which the scent of essential oils from flowers, herbs, and trees is inhaled in an attempt to promote health and well-being and to help lessen a patient's discomfort following surgery. "

"The term 'complementary' seems to be most often used to refer to the whole range of therapies that are not Western biomedicine, but it is sometimes also used to refer to a subset of these therapies. When used in this more specific form, 'complementary' is sometimes used solely to refer to therapies that can be used to supplement Western biomedical treatment, such as aromatherapy and hypnotherapy."

"'Both alternative and complementary types of medicine are described by the term "non-conventional". This is not an exclusionary term and illustrates the level of acceptance of these methods by the medical community. Complementary medicine is defined as those techniques which are used while the patient is using conventional ones. These include methods such as chiropractic and osteopathy. Alternative medicine includes techniques which are used to the exclusion of conventional medicine. These methods have been specified as incompatible with conventional practice (i.e. certain types of herbal remedies)."

The Compact Oxford English Dictionary defines complementary medicine as "medical therapy that falls beyond the scope of scientific medicine but may be used alongside it, e.g. acupuncture and osteopathy.

The Cochrane Complementary Medicine Field says "what are considered complementary or alternative practices in one country may be considered conventional medical practices in another. Therefore, our definition is broad and general: complementary medicine includes all such practices and ideas which are outside the domain of conventional medicine in several countries and defined by its users as preventing or treating illness, or promoting health and well being (1). These practices complement mainstream medicine by 1) contributing to a common whole, 2) satisfying a demand not met by conventional practices, and 3) diversifying the conceptual framework of medicine."

In defining complementary medicine in the UK, the House of Lords Select Committee determined that the following therapies were the most often used to complement conventional medicine: Alexander technique, Aromatherapy, Bach and other flower remedies, Body work therapies including massage, Counselling stress therapies, hypnotherapy, Meditation, Reflexology, Shiatsu, Maharishi Ayurvedic medicine, Nutritional medicine, and Yoga.

Ralph Snyderman and Andrew Weil considered "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."

As a form of mind-body interventions

The non-pharmacologic interventions of complementary medicine can employ mind-body interventions designed to "reduce pain and concomitant mood disturbance and increase quality of life." Physicians who practice complementary medicine usually discuss and advise patients as to available complementary therapies. Patients often express interest in mind-body complementary therapies because they offer a non-drug approach to treating some health conditions. Some mind-body techniques, such as cognitive-behavioral therapy, were once considered complementary medicine, but are now a part of conventional medicine in the United States.

Used in palliative care

Complementary therapies are often used in palliative care or by practitioners attempting to manage chronic pain in patients. Complementary medicine is considered more acceptable in the interdisciplinary approach used in palliative care than in other areas of medicine. "From its early experiences of care for the dying, palliative care took for granted the necessity of placing patient values and lifestyle habits at the core of any design and delivery of quality care at the end of life. If the patient desired complementary therapies, and as long as such treatments provided additional support and did not endanger the patient, they were considered acceptable."

"Complementary medicine treatments used for pain include: acupuncture, low-level laser therapy, meditation, aroma therapy, Chinese medicine, dance therapy, music therapy, massage, herbalism, therapeutic touch, yoga, osteopathy, chiropractic treatments, naturopathy, and homeopathy."

Used alongside conventional treatment

A 1997 survey found that 13.7% of respondents in the United States had sought the services of both a medical doctor and an alternative medicine practitioner. The same survey found that 96% of respondents who sought the services of an alternative medicine practitioner also sought the services of a medical doctor in the past 12 months. Medical doctors are often not aware of their patient's complementary treatment as 38.5% of the patients alternative therapies were discussed with their medical doctor. This survey illustrates that the majority of alternative medicine use takes place alongside conventional practice and may thus be considered complementary. Physicians may be partially protected from disciplinary action for prescribing complementary medicine in some jurisdictions for unprofessional conduct or failure to practice medicine in an acceptable manner if board specific practice requirements are satisfied and the therapies utilized do not present "a safety risk for the patient that is unreasonably greater that the conventional treatment for the patient's medical condition." (See the state of Texas, as an example.)

NCCAM classifications of CAM

NCCAM classifies CAM therapies into five major groups. The classification are rather loose, and there can be some overlap.

Whole medical systems

Whole medical systems or "alternative medical systems" (such as Traditional Chinese medicine and Ayurveda) cut across more than one of the other groups.

Mind-body medicine

Mind-body medicine take an holistic approach to health that explores the interconnection between the mind, body, and spirit. They work under the premise that the mind can affect "bodily functions and symptoms".

Biologically based practices

Biologically based practices use substances found in nature such as herbs, foods, vitamins, and other natural substances.

Manipulative and body-based practices

Manipulative and body-based practices are based on the manipulation or movement of body parts, such as is done in chiropractic and osteopathic manipulation.

Energy medicine

Energy medicine is a domain that deals with putative and veritable energy fields. -

  • Biofield therapies are intended to influence energy fields that purportedly surround and penetrate the body. No empirical evidence has been found to support the existence of such fields.
  • Bioelectromagnetic-based therapies use electromagnetic fields, such as pulsed fields, alternating-current or direct-current fields in an unconventional manner.

Contemporary use of CAM

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)." 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. 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. Another study suggests a similar figure of 40%. 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.

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. 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."

Medical education

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." 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. Accredited Naturopathic colleges and universities are increasing in number and popularity in the U.S.A. See Naturopathic medicine.

Similarly "unconventional medicine courses are widely represented at European universities. They cover a wide range of therapies. Many of them are used clinically. Research work is underway at several faculties." But, "only 40% of the responding universities were offering some form of CAM training."

In the UK, no medical schools offer courses that teach the clinical practice of alternative medicine. . However, some aspects of alternative medicine are 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. . The British Medical Acupuncture Society, which offers medical acupuncture certificates, is one such example, as is the College of Naturopathic Medicine UK and Ireland.

Public use in the US

2002 growth estimates for 1995 to 2005, in the number of chiropractors, acupuncturists, naturopaths, optometrists, podiatrists and other nonphysician clinicians is double that of physicians. This situation is replicated in most developed countries."

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

  • 50 percent of U.S. adults age 18 years and over used some form of complementary and alternative medicine (CAM).
  • 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%)

See also

Further reading

Notes

  • 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
  • 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
  • Eisenberg DM. "Advising patients who seek alternative medical therapies." Ann Intern Med 1997; 127:61-69. PMID 9214254
  • Tonelli MR. "The limits of evidence-based medicine." Respir Care, 2001; 46(12): 1435-40; discussion 1440-1. Review. PMID 11728302 PMID: 11863470
  • Zalewski Z. "Importance of Philosophy of Science to the History of Medical Thinking." CMJ 1999; 40: 8-13. CMJ online

References

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