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 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 (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.
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
rather than taking medications to treat attention deficit/hyperactivity disorder
(ADHD) 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, 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
- The focus is on the whole person -- physical, emotional, social, and
- Prevention of illness is a primary concern.
- Treatments are highly individualized.
- Treatments are aimed at the causes of illness rather than at its
- Treatments are designed to support the natural healing processes of
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 general
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
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.
The following web sites are all available free of charge, without
FDA Center for Food Safety and Applied Nutrition: Dietary Supplements
National Cancer Institute: Office of Cancer Complementary and Alternative
National Center for Complementary and Alternative Medicine (NCCAM)
NIH Office of Dietary Supplements (ODS)
University of Wisconsin HealthWeb—Alternative /
NOAH (New York Online Access to Health): Alternative Medicine Resources
Rosenthal Center: Information Resources
University of Pittsburgh: Alternative Medicine Homepage
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