Complementary and alternative medicine
From Wikipedia, the free encyclopedia
Complementary and alternative medicine (CAM) is an umbrella term for complementary medicine and alternative medicine. The term also incorporates integrative medicine.
Typical examples of CAM approaches are herbalism, meditation, chiropractic, yoga, body work and diet-based therapies.
The perceived 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,[1] 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.[2]
Definitions
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."[3] For the purposes of their report, entitled "Complementary and Alternative Medicine in the United States" (2005),[4] 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."[5]
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."[6] NCCAM has developed what the IOM calls "[o]ne of the most widely used classification structures"[7] for the branches of complementary and alternative medicine.[6]
David M. Eisenberg defines CAM as "medical interventions not taught widely at U.S. medical schools or generally available at U.S. hospitals."[8]
Richard Dawkins defines CAM as a "set of practices which cannot be tested, refuse to be tested, or consistently fail tests."[9] 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."[10]
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."[11]
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.[6] 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."[12] The combination of orthodox and complementary medicine with an emphasis on prevention and lifestyle changes is known as Integrated health.
Relationship between alternative and conventional medicine
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.[5]
According to the NCCAM, over time, formerly unproven remedies can be incorporated into conventional medicine if they are shown to be safe and effective.[13]
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."[10] 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."[10]According to Dawkins, disproven practices remain in the realm of CAM.[9]
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.[14][15][16]
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."[17]
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.[18] 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."[19] Many CAMs are criticized by the activist non-profit organization Quackwatch.[20]
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.[21][22]
NCCAM classifications of CAM
NCCAM classifies CAM therapies into five major groups. The classification are rather loose, and there can be some overlap.[23]
Whole medical systems
Whole medical systems or "alternative medical systems" (such as Traditional Chinese medicine and Ayurveda) cut across more than one of the other groups.[24]
Mind-body medicine
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".[25]
Biologically based practices
Biologically based practices use substances found in nature such as herbs, foods, vitamins, and other natural substances.[26]
Manipulative and body-based practices
Manipulative and body-based practices are based on the manipulation or movement of body parts, such as is done in chiropractic and osteopathic manipulation.[27]
Energy medicine
Energy medicine is a domain that deals with putative and veritable energy fields.[28] -
- Biofield therapies are intended to influence energy fields that purportedly surround and penetrate the body. No empirical evidence has been found to support the existence of such fields.
- Bioelectromagnetic-based therapies use electromagnetic fields, such as pulsed fields, alternating-current or direct-current fields in an unconventional manner. [29]
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)."[30] 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.[31] 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.[32] Another study suggests a similar figure of 40%.[33] 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.[34]
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.[35] 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."[36]
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."[37] 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.[38][39][40] 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."[41] But, only 40% of the responding [European] universities were offering some form of CAM training."[42]
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.
Public use in the US
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."[43] As of 2005, total visits to CAM providers each year in the United States exceeds those to primary-care physicians.[44]
The NCCAM surveyed the American public on complementary and alternative medicine use in 2002. According to the survey:[31]
- 50 percent of U.S. adults age 18 years and over used some form of complementary and alternative medicine (CAM).[45]
- 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%)
[edit] See also
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