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The ] defines CAM as "a group of diverse medical and health care systems, practices, and products, that are not currently part of ] medicine."<ref name=NCCAM_CAM/> Alternately, CAM can be defined as as "medical interventions not taught widely at U.S. medical schools or generally available at U.S. hospitals",<ref name="Eisenberg"> Eisenberg D, et al. ''N Engl J Med'' 1993; 328:246-252.</ref> or as "set of practices which cannot be tested, refuse to be tested, or consistently fail tests"<ref>{{cite book | last = Dawkins | first = Richard | author = Richard Dawkins | year = 2003 | title = A Devil's Chaplain | publisher = Weidenfeld & Nicolson}}</ref> or whose advocates "deny the need for testing".<ref name="Angell"/> Others go further, denying that such a thing as "alternative medicine" exists, but rather that there is only "evidence-based medicine supported by solid data or unproven medicine".<ref name="Fontanarosa"/> The ] defines CAM as "a group of diverse medical and health care systems, practices, and products, that are not currently part of ] medicine."<ref name=NCCAM_CAM/> Alternately, CAM can be defined as as "medical interventions not taught widely at U.S. medical schools or generally available at U.S. hospitals",<ref name="Eisenberg"> Eisenberg D, et al. ''N Engl J Med'' 1993; 328:246-252.</ref> or as "set of practices which cannot be tested, refuse to be tested, or consistently fail tests"<ref>{{cite book | last = Dawkins | first = Richard | author = Richard Dawkins | year = 2003 | title = A Devil's Chaplain | publisher = Weidenfeld & Nicolson}}</ref> or whose advocates "deny the need for testing".<ref name="Angell"/> Others go further, denying that such a thing as "alternative medicine" exists, but rather that there is only "evidence-based medicine supported by solid data or unproven medicine".<ref name="Fontanarosa"/>


The term "alternative medicine" is used to describe "every available approach to healing that does not fall within the realm of conventional medicine".<ref name="bratman7"">{{cite book |title=The Alternative Medicine Sourcebook |last=Bratman, MD |first=Steven |year=1997 |publisher=Lowell House |pages=p 7|isbn=1565656261}}</ref> 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.<ref name=NCCAM_CAM/> NCCAM has developed a classification system for the branches of complementary and alternative medicine.<ref name=NCCAM_CAM/> 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.<ref name=NCCAM_CAM/> NCCAM has developed a classification system for the branches of complementary and alternative medicine.<ref name=NCCAM_CAM/>


<!-- YOU CAN'T USE PROJECTIONS SEVERAL YEARS AFTER THE FACT; ALSO, THE EXTIMATE IS UNCITED In 2002, the growth estimate during the years 1995 to 2005 in the USA and other developed countries for the number of chiropractors, acupuncturists, naturopaths, and other nonphysician clinicians was double that of physicians.<ref name=Cassileth>{{cite journal | author = Cassileth, Barrie R. | title = The Role of Complementary & Alternative Medicine: Accommodating Pluralism. | journal = NEJM | volume = 347 | pages = 860-861 | year = 2002}}</ref>--> <!-- YOU CAN'T USE PROJECTIONS SEVERAL YEARS AFTER THE FACT; ALSO, THE EXTIMATE IS UNCITED In 2002, the growth estimate during the years 1995 to 2005 in the USA and other developed countries for the number of chiropractors, acupuncturists, naturopaths, and other nonphysician clinicians was double that of physicians.<ref name=Cassileth>{{cite journal | author = Cassileth, Barrie R. | title = The Role of Complementary & Alternative Medicine: Accommodating Pluralism. | journal = NEJM | volume = 347 | pages = 860-861 | year = 2002}}</ref>-->


⚫ ] and ] 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".<ref name=Snyderman>{{cite paper | author = Snyderman, R.; Weil, A. T.| url = http://www.bravewell.org/news_resources/bravewell_news/bringing_medicine_back_to_its_roots/| title = Integrative Medicine: Bringing Medicine Back To Its Roots| publisher = Archives of Internal Medicine| date= 2002-02-25| accessdate = 2006-07-11}} </ref>
== Definitions and descriptions ==

The 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 " mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness".<ref name=NCCAM_CAM>{{cite web| url = http://nccam.nih.gov/health/whatiscam/| title = What is Complementary and Alternative Medicine (CAM)?| accessdate = 2006-07-11|publisher=] at the ]}}</ref>

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."<ref name=Kamerow>{{cite journal | author = Kamerow D. | title = Wham, bam, thank you CAM. | journal = Brit Med J | volume = 335 | pages = 647 | year = 2007}}</ref>

⚫ ] and ] 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".<ref name=Snyderman>{{cite paper | author = Snyderman, R.; Weil, A. T.| url = http://www.bravewell.org/news_resources/bravewell_news/bringing_medicine_back_to_its_roots/| title = Integrative Medicine: Bringing Medicine Back To Its Roots| publisher = Archives of Internal Medicine| date= 2002-02-25| accessdate = 2006-07-11}} </ref>


== Relationship between alternative and conventional medicine == == Relationship between alternative and conventional medicine ==
⚫ The boundary between conventional and alternative medicine can be fluid. Over time, unproven remedies can be incorporated into conventional medicine if they are shown to be safe and effective.<ref>. ].</ref> "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."<ref name="Angell"> ], Kassirer JP. ''N Engl J Med'' 1998;339:839.</ref><ref name="Fontanarosa"> Fontanarosa P.B., and Lundberg G.D. ''JAMA''. 1998; 280: 1618-1619.</ref> Disproven practices remain in the realm of CAM.<ref name = Dawkins/>

⚫ What is considered alternative 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".<ref>NCCAM -- CAM Basics: What is Cam? </ref> 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.<ref>, WebMD, Inc., 2007</ref> "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."<ref name="Angell"> ], Kassirer JP. ''N Engl J Med'' 1998;339:839.</ref><ref name="Fontanarosa"> Fontanarosa P.B., and Lundberg G.D. ''JAMA''. 1998; 280: 1618-1619.</ref>


Fontanarosa and Lundberg denied that there is such a thing as alternative medicine, but rather, "here is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking".<ref name="Fontanarosa"/> According to Angell and Kassirier, what distinguishes alternative medicine from other unproven therapies is the fact that "its advocates largely deny the need for testing".<ref name="Angell"/> Fontanarosa and Lundberg denied that there is such a thing as alternative medicine, but rather, "here is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking".<ref name="Fontanarosa"/> According to Angell and Kassirier, what distinguishes alternative medicine from other unproven therapies is the fact that "its advocates largely deny the need for testing".<ref name="Angell"/>
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==NCCAM Classifications of CAM== ==NCCAM Classifications of CAM==
NCCAM classifies CAM therapies into five major groups. The classification are rather loose, and there can be some overlap.<ref>http://nccam.nih.gov/health/whatiscam/</ref> NCCAM classifies CAM therapies into four domains, and also recognises "whole medical systems" (such as traditional ] or ] as cutting across domains.<ref name=NCCAM_CAM/>

===Alternative Medical Systems===
Alternative or whole medical systems" (such as traditional ] or ] cut across more than one of the other groups. These are the classical branches of CAM with a long enough history to have historically competed with medicine as a replacement.<ref name=NCCAM_CAM/>


===Mind-body medicine=== ===Mind-body medicine===
This group is about the mind-body connection. These therapies 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".<ref name=NCCAM_CAM/> This works under the premise that the mind can affect "bodily functions and symptoms".<ref name=NCCAM_CAM/>


===Biologically based practices=== ===Biologically based practices===

Revision as of 17:03, 25 December 2007

This article may be unbalanced toward certain viewpoints. Please improve the article by adding information on neglected viewpoints, or discuss the issue on the talk page.

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




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

Complementary and alternative medicine (CAM) is an umbrella term for alternative medicine, complementary medicine, and integrative medicine. They include, herbalism, meditation, chiropractic, yoga, body work and diet-based therapies.

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." Alternately, CAM can be defined as as "medical interventions not taught widely at U.S. medical schools or generally available at U.S. hospitals", or as "set of practices which cannot be tested, refuse to be tested, or consistently fail tests" or whose advocates "deny the need for testing". Others go further, denying that such a thing as "alternative medicine" exists, but rather that 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. NCCAM has developed a classification system for the branches of complementary and alternative 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".

Relationship between alternative and conventional medicine

The boundary between conventional and alternative medicine can be fluid. Over time, unproven remedies can be incorporated into conventional medicine if they are shown to be safe and effective. "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." Disproven practices remain in the realm of CAM.

Fontanarosa and Lundberg denied that there is such a thing as alternative medicine, but rather, "here is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking". According to Angell and Kassirier, what distinguishes alternative medicine from other unproven therapies is the fact that "its advocates largely deny the need for testing".

A review of Michael L. Millenson's book 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 that "only 10 per cent of what doctors do in primary care is evidence-based."

NCCAM Classifications of CAM

NCCAM classifies CAM therapies into four domains, and also recognises "whole medical systems" (such as traditional traditional Chinese medicine or Ayurveda as cutting across domains.

Mind-body medicine

This works under the premise that the mind can affect "bodily functions and symptoms".

Biologically based practices

This uses herbs, foods and vitamins.

Manipulative and body-based practices

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

Energy therapies

These practices are supposed to manipulate "energy fields". There are two groups of energy therapies - biofield therapies and bioelectromagnetic-based therapies.

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.

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.

Public use in the US

Growth estimates from 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%)

Further reading

References

  1. ^ Cite error: The named reference NCCAM_CAM was invoked but never defined (see the help page).
  2. Unconventional Medicine in the United States -- Prevalence, Costs, and Patterns of Use. Eisenberg D, et al. N Engl J Med 1993; 328:246-252.
  3. Dawkins, Richard (2003). A Devil's Chaplain. Weidenfeld & Nicolson. {{cite book}}: More than one of |author= and |last= specified (help)
  4. ^ Alternative medicine--the risks of untested and unregulated remedies. Angell M, Kassirer JP. N Engl J Med 1998;339:839.
  5. ^ Alternative medicine meets science. Fontanarosa P.B., and Lundberg G.D. JAMA. 1998; 280: 1618-1619.
  6. Snyderman, R.; Weil, A. T. (2002-02-25). "Integrative Medicine: Bringing Medicine Back To Its Roots". Archives of Internal Medicine. Retrieved 2006-07-11. {{cite journal}}: Cite journal requires |journal= (help)CS1 maint: multiple names: authors list (link) PMID 11863470
  7. CAM Basics: What is Cam?. National Center for Complementary and Alternative Medicine.
  8. Cite error: The named reference Dawkins was invoked but never defined (see the help page).
  9. 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
  10. Simon Crompton, "Back to the future: Complementary therapies get real," Times Online, Times Newspapers Ltd., January 17, 2004.
  11. Ernst E. "Obstacles to research in complementary and alternative medicine." Medical Journal of Australia, 2003; 179 (6): 279-80. PMID 12964907 MJA online
  12. ^ Barnes, P. M.; Powell-Griner, E.; McFann, K.; Nahin, R. L. (2004). "Complementary and Alternative Medicine Use Among Adults: United States, 2002" (PDF). National Center for Health Statistics. {{cite journal}}: Cite journal requires |journal= (help)CS1 maint: multiple names: authors list (link) Cite error: The named reference "Barnes" was defined multiple times with different content (see the help page).
  13. Reasons people use CAM. NCCAM
  14. Astin JA "Why patients use alternative medicine: results of a national study" JAMA 1998; 279(19): 1548-1553
  15. 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
  16. Eisenberg, DM, Davis RB, Ettner SL "Trends in alternative medicine use in the United States 1990-1997." JAMA, 1998; 280:1569-1575. PMID 9820257
  17. House of Lords report on CAM
  18. University of Arizona position on Alternative Medicine
  19. Wetzel MS, Eisenberg DM, Kaptchuk TJ. "Courses involving complementary and alternative medicine at US medical schools." JAMA 1998; 280 (9):784 -787. PMID 9729989
  20. 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
  21. 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
  22. Cassileth, Barrie R. (2002). "The Role of Complementary & Alternative Medicine: Accommodating Pluralism". NEJM. 347: 860–861.
  23. CAM Use by U.S. Adults. NCCAM

  • 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

External links

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