What is CAM?

Complementary and alternative medicine (CAM) is a term used to describe a diverse group of healing systems that are not considered to be part of mainstream medicine. The goal of conventional medicine is to locate the physical source of a particular disease and then remove it. For example, if a patient has an infection, a conventional doctor may prescribe a specific antibiotic to try to kill the invading bacteria. CAM practitioners, on the other hand, take a more "holistic" approach to health care. They believe that health and disease involve a complex interaction of physical, spiritual, mental, emotional, genetic, environmental, and social factors. In order to treat a disease or simply promote good health, CAM practitioners treat the whole body by taking all of these factors into account.

In the United States, this holistic approach to health has been labeled "alternative" for a variety of scientific, cultural, and political reasons. In many cases it is very difficult to scientifically test alternative practices, such as acupuncture, in the same way that certain conventional practices, such as medications, are tested. Although alternative therapies are often based on hundreds -- in some cases thousands -- of years of experience, the conventional medical community relies heavily on scientific evidence when evaluating the safety and effectiveness of a particular therapy. For this reason, many alternative practices that have not been thoroughly tested (or cannot be thoroughly tested) are considered "unscientific" by modern Western standards. In addition, many non-Western healing practices are not taught in United States medical schools, available to patients in U.S. hospitals, or even covered by health insurance in the country.

What does complementary medicine and alternative medicine mean?

The terms "complementary medicine" and "alternative medicine," although often used to mean the same thing, actually have quite different implications. Complementary medicine refers to medical practices used together with conventional medicine, while alternative medicine is used in place of conventional medicine. An example of complementary medicine is the use of hypnotherapy together with pain medications to reduce anxiety and enhance relaxation in people recovering from severe burns. Following a special diet and supplementing with herbs or vitamins rather than taking medications to treat attention-deficit hyperactivity disorder is an example of alternative medicine.

What is integrative medicine?

The term "integrative medicine" is often used interchangeably with CAM, but it has a subtle and very important different meaning. Professionals who practice integrative medicine blend appropriate CAM therapies with mainstream medicine rather than simply adding one complementary therapy (such as herbs) to a standard medical treatment. For example, an integrative treatment for Alzheimer's disease may include a combination of the following:

• Medications that increase certain brain chemicals
• Antioxidants (such as vitamin E and ginkgo biloba ) that scavenge free radicals
• Changes in lifestyle (such as walking programs and relaxation training) to reduce anxiety and improve behavior
• Music therapy to bolster the immune system

More and more Americans are becoming familiar with the term "integrative medicine," and studies have found that this blended approach to health care is safe and effective for a growing number of medical conditions.

What are the basic principles of CAM?

Although CAM therapies vary widely, several themes can be traced through them all:

• The focus is on the whole person -- physical, emotional, social, and spiritual.
• Prevention of illness is a primary concern.
• Treatments are highly individualized.
• Treatments are aimed at the causes of illness rather than at its symptoms.
• Treatments are designed to support the natural healing processes of the body.

Who is using CAM?

The barriers to integrative medicine are beginning to fall -- or, at least are becoming less difficult to overcome. Alternative healing practices are increasingly being tested for effectiveness and safety in well-designed research studies. The intermixing of diverse cultures in the West are bringing once distant healing practices to the forefront, and more Americans are turning to integrative medical care than ever before.

The movement toward integrative medicine in the United States has been prompted by a growing consumer demand for CAM services. A survey was administered to over 31,000 representative U.S. adults and was conducted as part of the Centers for Disease Control and Prevention's (CDC) 2002 National Health Interview Survey (NHIS). The survey found that nearly 70% of Americans have used at least one form of CAM therapy in their lifetime, making this "unconventional" medical approach one of the fastest growing sectors of American health care. In 2004 in the United States, 36% of adults were using some form of CAM. When megavitamin therapy and prayer specifically for health reasons are included in the definition of CAM, that number rose to 62%.

The survey also found that CAM approaches are most often used to treat back pain or problems, colds, neck pain or problems, joint pain or stiffness, and anxiety or depression. However, only about 12% of adults sought care from a licensed CAM practitioner, suggesting that most people who use CAM do so without consulting a practitioner. According to the survey, the 10 most commonly used CAM therapies and the approximate percent of U.S. adults using each therapy were:

• Prayer for own health, 43%
• Prayer by others for the respondent's health, 24%
• Natural products (such as herbs, other botanicals, and enzymes), 19%
• Deep breathing exercises, 12%
• Participation in prayer group for own health, 10%
• Meditation, 8%
• Chiropractic care, 8%
• Yoga, 5%
• Massage, 5%
• Diet-based therapies (such as Atkins, Pritikin, Ornish, and Zone diets), 4%

In addition to gathering data on the use of CAM practices, the survey also found information about why people use CAM. Findings indicate that:

• 55% of adults said they were most likely to use CAM because they believed that it would help them when combined with conventional medical treatments.
• 50% thought CAM would be interesting to try.
• 26% used CAM because a conventional medical professional suggested they try it.
• 13% used CAM because they felt that conventional medicine was too expensive.

Studies also report 41% of individuals using CAM use two or more CAM therapies during the prior year. Factors associated with highest rates of CAM use were ages 40 - 64, female gender, non-black/non-Hispanic race, and annual income of $65,000 or higher.

Although herbs and supplements are not regulated by the U.S. Food and Drug Administration, pharmacies across the country are experiencing a tremendous surge in the demand for these alternative remedies. About 73 - 86% of schools of pharmacy now offer some sort of CAM in the curriculum. Pharmacists are being trained to counsel patients on the safe and efficient use of CAM therapies. Most U.S. medical schools also now include instruction about CAM in their curricula. More and more health insurance plans are also covering CAM, particularly treatments such as acupuncture and chiropractic, whose safety and effectiveness in the treatment of certain health problems has been fairly well researched. A study found that among the 600,000 enrollees in a particular health insurance plan, 13.7% made CAM claims. Of those enrollees, 1.3% made claims for acupuncture, compared with 1.6% for naturopathic medicine, 2.4% for massage, and 10.9% for chiropractic.

What are the major types of CAM?

The National Center for Complementary and Alternative Medicine (NCCAM) classifies CAM therapies into 5 major groups:

• Alternative medical systems: built upon complete systems of theory and practice. Examples include homeopathy, naturopathy, traditional Chinese medicine (TCM), and Ayurveda.
• Biological medicine: use of substances found in nature, such as herbs, foods, and vitamins to promote health.
• Energy medicine: involves the use of energy fields to promote health. Some forms of energy medicine (known as biofield therapies) are designed to influence energy fields that are believed to surround and penetrate the human body. Examples of biofield therapies include qi gong, Reiki, and Therapeutic Touch. Other forms of energy medicine (known as bioelectromagnetic-based medicine) involve the use of electromagnetic fields, such as electroacupuncture.
• Manual medicine: based on manipulation and movement of one or more parts of the body. Examples include osteopathy, physical therapy, massage, chiropractic, Feldeinkrais, and reflexology.
• Mind-body medicine: uses a range of techniques that help boost the mind's ability to influence bodily functions and symptoms. Examples include biofeedback, deep relaxation, guided imagery, hypnotherapy, meditation, prayer, support groups, and yoga.

What types of changes in policy are happening in order to incorporate CAM into the U.S. medical system?

In 1991, under a Congressional mandate, the National Institutes of Health (NIH) established the Office of Alternative Medicine (OAM) with an annual budget of $2 million to coordinate NIH research on nontraditional health practices. Specifically, OAM was to evaluate CAM practices, support CAM research and training, and establish a CAM information clearinghouse for the general public.

In 1998 Congress established the National Center for Complementary and Alternative Medicine (NCCAM) to supersede the OAM. With an annual budget of more than $4 billion, NCCAM's mission is to support basic and applied CAM research and provide information to healthcare providers as well as the public. Among other efforts, NCCAM focuses on research that evaluates the safety and effectiveness of herbs and nutritional supplements and their potential for interaction with medications. It also evaluates other CAM treatments such as acupuncture and chiropractic. NCCAM funds several research centers outside of the NIH. To learn more about the centers and their research agendas, visit NCCAM's web site at http://nccam.nih.gov/research.

What is the Future of CAM?

There are many encouraging signs that CAM is slowly becoming accepted into mainstream medicine. For example, breakthroughs in CAM research are frequently published in prestigious Western peer-reviewed journals such as the Journal of the American Medical Association and the Annals of Internal Medicine. Still, there are real obstacles to the achievement of truly integrated medicine. Some of these obstacles include cultural conflicts, lack of scientific studies, and administrative issues. However, because conventional doctors and CAM practitioners alike seek to create safe, effective, and affordable medical treatment for all patients, the integration of the best CAM into conventional medicine may not be worlds away.

The following web sites are all available free of charge, without subscription.

Government sites:

FDA Center for Food Safety and Applied Nutrition: Dietary Supplements

http://vm.cfsan.fda.gov/~dms/supplmnt.html

National Cancer Institute: Office of Cancer Complementary and Alternative Medicine (OCCAM)

http://occam.nci.nih.gov/

National Center for Complementary and Alternative Medicine (NCCAM)

http://nccam.nih.gov/

NIH Office of Dietary Supplements (ODS)

http://ods.od.nih.gov/

Directories:

NOAH (New York Online Access to Health): Alternative Medicine Resources

www.noah-health.org/en/alternative/index.html

Rosenthal Center: Information Resources

http://cpmcnet.columbia.edu/dept/rosenthal/CAM.html

University of Pittsburgh: Alternative Medicine Homepage

www.pitt.edu/%7Ecbw/altm.html

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