What is CAM?

Complementary and alternative medicine (CAM) is a term used to describe a wide range of healing systems that are not typically considered part of mainstream or conventional Western medicine. The goal of conventional medicine is to find the physical source of a particular disease and treat it. For example, if a person has an infection, a conventional doctor may prescribe an antibiotic to kill the invading bacteria. CAM practitioners, on the other hand, take a more "holistic" approach to health care. 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 promote good health, CAM practitioners treat the whole person.

In the United States, this holistic approach to health has been labeled "alternative" for a variety of reasons. Sometimes it is difficult to scientifically test alternative therapies in the same way that prescription drugs are tested. The conventional medical community relies on scientific evidence when evaluating the safety and effectiveness of a particular therapy. And while researchers are now beginning to test CAM therapies, scientific studies have long been focused on conventional treatments, meaning there is more evidence as to whether they work or not. In addition, many non-Western healing practices are not taught in U.S. medical schools, available to patients in U.S. hospitals, or covered by health insurance.

What does complementary medicine and alternative medicine mean?

The terms "complementary medicine" and "alternative medicine" sometimes mean the same thing. But they have different implications. Complementary medicine refers to therapies used in combination with conventional medicine, while alternative medicine is used in place of conventional medicine. An example of complementary medicine is using hypnotherapy (hypnosis) with pain medications to reduce anxiety and enhance relaxation in people recovering from severe burns. An example of alternative medicine would be following a special diet and taking herbs or vitamins rather than medications to treat attention deficit hyperactivity disorder (ADHD).

What is integrative medicine?

The term "integrative medicine" is often used interchangeably with CAM. But it has a different meaning. Health care professionals who practice integrative medicine blend CAM therapies with mainstream medicine, rather than simply adding one complementary therapy (such as herbs) to a standard medical treatment. The foundations of integrative medicine are health-promoting practices, including optimal nutrition, dietary supplements to avoid deficiencies, physical activity, and other health-promoting pursuits. The goal is to facilitate healing by using the least invasive, least toxic, and least costly methods. For example, an integrative treatment for Alzheimer disease may include a combination of the following:

• Prescription medications that increase certain brain chemicals
• Antioxidants
• Changes in lifestyle (such as walking programs and relaxation training) to reduce anxiety and improve behavior
• Music therapy

More and more Americans are becoming familiar with integrative medicine. Studies have found that this blended approach to health care is safe and effective for several 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, the physical, emotional, social, and spiritual.
• Prevention of illness is a primary goal.
• 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 healing practices are increasingly being tested for effectiveness and safety in well-designed research studies. Exotic healing practices are becoming more common, and more Americans are turning to integrative medical care than ever before.

The movement toward integrative medicine in the U.S. has been prompted by a growing consumer demand for CAM services. In a survey given of more than 31,000 U.S. adults, nearly 70% reported using at least one form of CAM therapy in their lifetime, making this "unconventional" medical approach one of the fastest growing sectors of American health care. The survey also found that CAM approaches are most often used to treat:

• Back pain and problems
• Colds
• Neck pain or problems
• Joint pain or stiffness
• Anxiety or depression

However, only about 12% of adults sought care from a licensed CAM practitioner, suggesting that most people who use CAM do so on their own. According to the survey, the 10 most commonly used CAM therapies were:

• Prayer for own health
• Prayer by others for the respondent's health
• Participation in prayer group for own health
• Natural products (such as herbs, other botanicals, and enzymes)
• Deep breathing exercises
• Meditation
• Chiropractic care
• Yoga
• Massage
• Diet based therapies (such as Atkins, Pritikin, Ornish, and Zone diets)

The survey also found information about why people use CAM:

• They believed that it would help them when combined with conventional medical treatments.
• They thought CAM would be interesting to try.
• A conventional medical professional suggested they try CAM.
• They felt that conventional medicine was too expensive.

People who have chronic conditions that are difficult to treat effectively may be more likely to pursue CAM methods. Examples include people with irritable bowel syndrome (IBS), rheumatoid arthritis, autism spectrum disorder, attention deficit hyperactivity disorder (ADHD), fibromyalgia, chronic fatigue, and cancer. In one study, published in the Journal of Alternative and Complementary Medicine, people with cancer who received a poor prognosis reported using CAM more often than the better prognosis group. Other studies show that cancer patients experience positive changes and increased spiritual importance as a result of CAM.

Although herbs and supplements are not regulated by the U.S. Food and Drug Administration (FDA), pharmacies across the country are seeing a surge in the demand for these alternative remedies. Pharmacists are being trained to counsel people on the safe and efficient use of CAM therapies. Now, most U.S. medical schools also provide instruction about CAM. More and more health insurance plans are also covering CAM, particularly treatments such as acupuncture and chiropractic care, whose safety and effectiveness for treating certain health problems has been well researched.

What are the major types of CAM?

The National Center for Complementary and Alternative Medicine (NCCAM) classifies CAM therapies into 5 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. The use of substances found in nature, such as herbs, foods, and vitamins to promote health and healing.
• Energy medicine. Involves the use of energy fields to promote health and healing. Some kinds of energy medicine (known as biofield therapies) aim to influence energy fields believed to surround and penetrate the human body. Examples include qi gong, Reiki, and Therapeutic Touch. Other forms of energy medicine (known as bioelectromagnetic based medicine) use electromagnetic fields, such as electroacupuncture.
• Manual medicine. Based on manipulation and movement of one or more parts of the body. Examples include osteopathy, physical therapy, massage, chiropractic, Feldenkrais, and reflexology.
• Mind/body medicine. Uses a range of techniques to help boost the mind's ability to influence bodily functions. Examples include biofeedback, deep relaxation, guided imagery, hypnotherapy, meditation, prayer, support groups, and yoga.

What types of policy changes 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). The OAM was tasked with evaluating CAM practices, supporting CAM research and training, and establishing a CAM information clearinghouse for the public.

In 1998 Congress established the National Center for Complementary and Alternative Medicine (NCCAM) to take the place of the OAM. NCCAM's mission is to support CAM research and provide information to health care providers, as well as the public. Among other efforts, NCCAM focuses on research that looks at the safety and effectiveness of herbs and nutritional supplements, and how they might interact with medications. It also evaluates other CAM treatments, such as acupuncture and chiropractic care. NCCAM funds several research centers outside of the NIH. To learn more about the centers and their research agendas, visit the NCCAM web site at nccam.nih.gov/research.

What is the future of CAM?

There are signs that CAM is becoming accepted into mainstream medicine. For example, breakthroughs in CAM research are now 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 truly integrated medicine. Some of these obstacles include cultural issues, lack of scientific studies, and administrative problems. However, because conventional doctors and CAM practitioners both want to create safe, effective, and affordable treatments, the integration of the best CAM into conventional medicine is already occurring at medical facilities across the country.

• FDA: Dietary Supplements -- www.fda.gov/food/dietarysupplements/default.htm
• National Cancer Institute: Office of Cancer Complementary and Alternative Medicine (OCCAM) -- www.cancer.gov/about-cancer/treatment/cam
• National Center for Complementary and Alternative Medicine (NCCAM) -- nccam.nih.gov
• National Institutes of Health: Office of Dietary Supplements -- ods.od.nih.gov

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