What is CAM?
Complementary and alternative medicine
(CAM) is a term used to describe a diverse group of healing systems that are
not presently 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 some sort of infection, a
conventional doctor would probably prescribe a specific antibiotic to kill the
invading bacteria. CAM practitioners, on the other hand, take a more "holistic"
approach to healthcare. 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
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 (rather than clinical
experience) 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.
does complementary medicine and alternative medicine mean?
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 rather than
taking medications to treat attention deficit/hyperactivity disorder (ADHD) is
an example of alternative medicine.
What is integrative medicine?
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, for
example) to a standard medical treatment. For example, an integrative treatment
for Alzheimer's disease may include a combination of the following: (1)
medications that increase certain brain chemicals, (2) antioxidants (such as
vitamin E and ginkgo biloba) that scavenge free radicals, (3) changes in
lifestyle (such as walking programs and relaxation training) to reduce anxiety
and improve behavior, and (4) 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 healthcare 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 landmark study
published in 1993 found that more than one-third of Americans had sought CAM
therapies, that in 1990 they had made more visits to CAM providers than to
their primary care physicians, and that consumers had spent more than 13
billion dollars out-of-pocket for these CAM visits.
Studies suggest that
demand for CAM services continues to grow at a startling rate. A 2001 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 healthcare. Although herbs and supplements
are not regulated by the U.S. Food and Drug Administration (FDA), pharmacies
across the country are experiencing a tremendous surge in the demand for these
alternative remedies. From 1991 to 1996 alone, the demand for over-the-counter
natural remedies (including herbs and supplements) doubled. In a 1996 survey by
Landmark Healthcare, more than 70% of HMOs reported an increase in requests for
CAM by their members. Most patients (56%) requested acupuncture, followed by
chiropractic (45%), massage (25%), acupressure and biofeedback (21% each),
hypnotherapy (8%), and reflexology (4%).
Studies also suggest that U.S. medical schools may be warming up to CAM. As
of 1998, 75 out of 117 (64%) U.S. medical schools offer at least one course in
CAM. In a 1994 survey, 60 percent of doctors reported recommending CAM to their
patients. Nearly half of the doctors who responded to the survey acknowledged
that they used CAM themselves. 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 number of health plans now cover the Ornish
heart program, which has a basis in yoga and nutrition. All of these changes in
American healthcare point to the careful movement—often with a healthy dose of
skepticism—toward an integrative medicine system that incorporates the most
useful therapies from the world's many healing traditions.
What are the
major types of CAM?
The National Center for Complementary and
Alternative Medicine (NCCAM) classifies CAM therapies into five 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/or 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 dollars 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
In 1998 Congress established the National Center for
Complementary and Alternative Medicine (NCCAM) to supersede the OAM. With an
annual budget of more than 68 million dollars, 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/).
In July of 2000, the White House announced the establishment of a White
House Commission on Alternative Medicine, designating the Chair and the first
10 members. The goal of the commission is to develop a set of legislative and
administrative recommendations to maximize the benefits of CAM for the American
public. Going beyond the research goals of NCCAM, the commission will set the
agenda for the education and training of CAM practitioners as well as provide
policy recommendations for the insurance industry coverage of alternative
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.
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