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It has been suggested that complementary medicine be merged into this article or section. (Discuss) |
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The neutrality and factual accuracy of this article are disputed. Please see the relevant discussion on the talk page. (December 2007) |
| Complementary and Alternative Medicine | |
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| This article is part of the CAM series of articles. | |
| CAM Article Index | |
| Alternative medical systems - edit |
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| NCCAM classifications |
| See also |
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Complementary and alternative medicine (CAM) is an umbrella term for complementary medicine and alternative medicine, and incorporates integrative medicine and various subjects such as herbalism, meditation, chiropractic, yoga, body work and diet-based therapies.
The peceived boundaries within CAM and between the CAM and the dominant system vary with culture, time and can change with scientfic evidence. In many countries, long established traditional medicines viewed as CAM in US and the West with caution or even scorn, have to various degrees re-emerged, been officially recognized, regulated and standardized,K Terasawa, Evidence-based Reconstruction of Kampo Medicine: Part I—Is Kampo CAM?, eCAM 2004 1(1):11-16 and/or begun a process of scientific rationalization with Western medical principles. Testing and rationalizing biologically based traditional medicines, often based on empirical and clinical foundations, may be complicated by being multicomponent mixtures of nutrients and pharmacologically active constituents, patent issues and biopiracy.Nobutaka Suzuki, Complementary and Alternative Medicine: a Japanese Perspective, Evid Based Complement Alternat Med (eCAM), v.1(2); Sep 2004
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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."Board on Health Promotion and Disease Prevention of the Institute of Medicine (2005). Complementary and Alternative Medicine in the United States, p. 17. National Academies Press. Retrieved on 2008-01-08. For the purposes of their report, entitled "Complementary and Alternative Medicine in the United States" (2005),Board on Health Promotion and Disease Prevention of the Institute of Medicine (2005). Complementary and Alternative Medicine in the United States. National Academies Press. Retrieved on 2008-01-08. 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. CAM includes such resources perceived by their users as associated with positive health outcomes. Boundaries within CAM and between the CAM domain and the domain of the dominant system are not always sharp or fixed."Board on Health Promotion and Disease Prevention of the Institute of Medicine (2005). Complementary and Alternative Medicine in the United States, p. 19. National Academies Press. Retrieved on 2008-01-08.
Other groups and individuals have offered various definitions and distinguishing characteristics of CAM. The National Center for Complementary and Alternative Medicine defines CAM as "a group of diverse medical and health care systems, practices, and products, that are not currently part of conventional medicine."What is Complementary and Alternative Medicine (CAM)?. National Center for Complementary and Alternative Medicine at the National Institutes of Health. Retrieved on 2006-07-11. NCCAM has developed what the IOM calls "[o]ne of the most widely used classification structures"Board on Health Promotion and Disease Prevention of the Institute of Medicine (2005). Complementary and Alternative Medicine in the United States, p. 18. National Academies Press. Retrieved on 2008-01-08. 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."Unconventional Medicine in the United States -- Prevalence, Costs, and Patterns of Use. Eisenberg D, et al. N Engl J Med 1993; 328:246-252. Richard Dawkins defines CAM as a "set of practices which cannot be tested, refuse to be tested, or consistently fail tests."Richard Dawkins Dawkins, Richard (2003). A Devil\'s Chaplain. Weidenfeld & Nicolson. 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."Fontanarosa P.B., and Lundberg G.D. Alternative medicine meets science. JAMA. 1998; 280: 1618-1619.
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. 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."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 The combination of orthodox and complementary medicine with an emphasis on prevention and lifestyle changes is known as Integrated health.
The boundary between conventional and alternative medicine can be fluid, depending on the particular therapy as well as the definition used for CAM, as discussed above.
According to the NCCAM, over time, formerly unproven remedies can be incorporated into conventional medicine if they are shown to be safe and effective.CAM Basics: What is Cam?. National Center for Complementary and Alternative Medicine.
According to Angell and Kassirer, what distinguishes alternative medicine from other unproven therapies is the fact that "its advocates largely deny the need for [scientific] 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."Angell M, Kassirer JP (1998). "Alternative medicine--the risks of untested and unregulated remedies". N. Engl. J. Med. 339 (12): 839–41. PMID 9738094. Retrieved on 2007-12-28. 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.The Cochrane Collaboration Complementary Medicine Field, www.compmed.umm.edu/Cochrane/index.html. Retrieved 5 August 2006.The HealthWatch Award 2005: Prof. Edzard Ernst Complementary medicine: the good the bad and the ugly. www.healthwatch-uk.org/awardwinners/edzardernst.html, retrieved 5 August 2006"Complementary medicine is diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy or by diversifying the conceptual frameworks of medicine." Ernst et al British General Practitioner 1995; 45:506
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."Tonelli MR, Callahan TC (2001). "Why alternative medicine cannot be evidence-based". Academic medicine : journal of the Association of American Medical Colleges 76 (12): 1213-20. PMID 11739043.
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.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 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."Simon Crompton, "Back to the future: Complementary therapies get real," Times Online, Times Newspapers Ltd., January 17, 2004. Many CAMs are criticized by the activist non-profit organization Quackwatch. Barrett, Stephen. "Quackwatch", Your Guide to Quackery, Health Fraud, and Intelligent Decisions, Quackwatch. Retrieved on 2008-03-04.
A survey of websites providing information about breast cancer found that about one in twenty such sites contained inaccurate information, and that CAM websites were 15 more likely to contain inaccuracies.http://www.eurekalert.org/pub_releases/2008-02/w-poi020608.phpElmer V. Bernstam, Muhammad F. Walji, Smitha Sagaram, Deepak Sagaram, Craig W. Johnson, Funda Meric-Bernstam (2008). "Commonly cited website quality criteria are not effective at identifying inaccurate online information about breast cancer". Cancer In press. doi:10.1002/cncr.23308. Retrieved on 2008-02-12.
NCCAM classifies CAM therapies into five major groups. The classification are rather loose, and there can be some overlap.What is CAM? NCCAM
Whole medical systems or "alternative medical systems" (such as Traditional Chinese medicine and Ayurveda) cut across more than one of the other groups.Whole Medical Systems: An Overview. NCCAM
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".Mind-Body Medicine: An Overview. NCCAM
Biologically based practices use substances found in nature such as herbs, foods, vitamins, and other natural substances.Biologically Based Practices: An Overview. NCCAM
Manipulative and body-based practices are based on the manipulation or movement of body parts, such as is done in chiropractic and osteopathic manipulation.Manipulative and Body-Based Practices: An Overview. NCCAM
Energy medicine is a domain that deals with putative and veritable energy fields.Energy Medicine: An Overview [NCCAM Backgrounder] -
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)."Ernst E. "Obstacles to research in complementary and alternative medicine." Medical Journal of Australia, 2003; 179 (6): 279-80. PMID 12964907 MJA online 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.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. 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.Reasons people use CAM. NCCAM Another study suggests a similar figure of 40%.Astin JA "Why patients use alternative medicine: results of a national study" JAMA 1998; 279(19): 1548-1553 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.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
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.Eisenberg, DM, Davis RB, Ettner SL "Trends in alternative medicine use in the United States 1990-1997." JAMA, 1998; 280:1569-1575. PMID 9820257 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."House of Lords report on CAM
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."University of Arizona position on Alternative Medicine 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.Wetzel MS, Eisenberg DM, Kaptchuk TJ. "Courses involving complementary and alternative medicine at US medical schools." JAMA 1998; 280 (9):784 -787. PMID 9729989 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 15083987Fenton 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 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."Barberis L, de Toni E, Schiavone M, Zicca A, Ghio R. Unconventional medicine teaching at the Universities of the European Union. J Altern Complement Med. 2001 Aug;7(4):337-43. PMID: 11558776 Abstract But, "only 40% of the responding [European] universities were offering some form of CAM training."Varga O, Márton S, Molnár P. Status of complementary and alternative medicine in European medical schools. Forsch Komplement Med (2006). 2006 Feb;13(1):41-5. Epub 2006 Jan 3. PMID: 16582550 Abstract
In the UK, no medical schools offer courses that teach the clinical practice of alternative medicine.[citation needed]. However, some aspects of alternative medicine are taught in several schools[weasel words] as part of the curriculum.[citation needed]. Teaching is based mostly on theory and understanding alternative medicine, with emphasis on being able to communicate with alternative medicine specialists.[citation needed]. The British Medical Acupuncture Society, which offers medical acupuncture certificates, is one such example, as is the College of Naturopathic Medicine UK and Ireland.
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."Cassileth, Barrie R. (2002). "The Role of Complementary & Alternative Medicine: Accommodating Pluralism.". NEJM 347: 860-861. As of 2005, total visits to CAM providers each year in the United States exceeds those to primary-care physicians.Board on Health Promotion and Disease Prevention of the Institute of Medicine (2005). Complementary and Alternative Medicine in the United States, p. 1. National Academies Press. Retrieved on 2008-01-29.
The NCCAM surveyed the American public on complementary and alternative medicine use in 2002. According to the survey: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.
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