Complementary and alternative medicine

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Complementary and Alternative Medicine
This article is part of the CAM series of articles.
CAM Article Index
Alternative medical systems - edit
NCCAM classifications
  1. Alternative Medical Systems
  2. Mind-Body Intervention
  3. Biologically Based Therapy
  4. Manipulative and body-based methods
  5. Energy Therapy
See also

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. Definitions of CAM vary with culture and time and can change with scientific evidence. CAM therapies have been criticized by scientific researchers.

Contents

[edit] 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."[1] For the purposes of their report, entitled "Complementary and Alternative Medicine in the United States" (2005),[2] 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."[3]

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."[4] NCCAM has developed what the IOM calls "[o]ne of the most widely used classification structures"[5] for the branches of complementary and alternative medicine.[4] David M. Eisenberg defines CAM as "medical interventions not taught widely at U.S. medical schools or generally available at U.S. hospitals."[6] Richard Dawkins defines CAM as a "set of practices which cannot be tested, refuse to be tested, or consistently fail tests."[7] 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."[8] 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."[9]

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.[4] 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."[10] The combination of orthodox and complementary medicine with an emphasis on prevention and lifestyle changes is known as Integrated health.

[edit] Relationship between conventional medicine and CAM

According to the NCCAM formerly unproven remedies may be incorporated into conventional medicine if they are shown to be safe and effective.[11]

According to Angell and Kassirer, "What most sets alternative medicine apart, in our view, is that it has not been scientifically tested and its advocates largely deny the need for such testing." They also state "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."[8] 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."[8]According to Dawkins, disproven practices remain in the realm of CAM.[7]

Edzard Ernst, Professor of Complementary Medicine at the University of Exeter, believes that CAM can and should be subjected to scientific testing. In his view, there can be "good CAM" or "bad CAM" based on evidentiary support.[12][13][14]

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."[15]

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.[16] 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."[17] Many CAMs are criticized by the activist non-profit organization Quackwatch.[18]

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.[19][20]

[edit] NCCAM classifications of CAM

NCCAM classifies CAM therapies into five major groups. The classification are rather loose, and there can be some overlap.[21]

[edit] 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.[22]

[edit] Mind-body medicine

Mind-body medicine take an holistic approach to health that explores the interconnection between the mind, body, and spirit. It works under the premise that the mind can affect "bodily functions and symptoms".[23]

[edit] Biologically based practices

Biologically based practices use substances found in nature such as herbs, foods, vitamins, and other natural substances.[24]

[edit] 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.[25]

[edit] Energy medicine

Energy medicine is a domain that deals with putative and veritable energy fields.[26] -

  • 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 the "putative" energy fields on which these therapies are predicated.
  • Bioelectromagnetic-based therapies use electromagnetic fields, such as pulsed fields, alternating-current or direct-current fields in an unconventional manner. [27]

[edit] Contemporary use of CAM

Edzard Ernst wrote in the Medical Journal of Australia that "about half the general population in developed countries use complementary and alternative medicine (CAM)."[28] 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.[29] 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.[30] Another study suggests a similar figure of 40%.[31] 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.[32]

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.[33] 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."[34]

In April 2008 The Times published a letter from Edzard Ernst, Professor of Complementary Medicine asking Prince Charles and his Foundation for Integrated Health to recall two guides that promote "alternative medicine." The letter said "The majority of alternative therapies appear to be clinically ineffective, and many are downright dangerous."[1]

[edit] 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."[35] 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.[36][37][38] 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."[39] But, "only 40% of the responding [European] universities were offering some form of CAM training."[40]

In the UK, no medical schools offer courses that teach the clinical practice of alternative medicine.[citation needed].

[edit] See also

[edit] Further reading

[edit] Notes

  • 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

[edit] References

  1. ^ Board on Health Promotion and Disease Prevention of the Institute of Medicine (2005). Complementary and Alternative Medicine in the United States, p. 17. National Academies Press. Retrieved on 2008-01-08.
  2. ^ Board on Health Promotion and Disease Prevention of the Institute of Medicine (2005). Complementary and Alternative Medicine in the United States. National Academies Press. Retrieved on 2008-01-08.
  3. ^ Board on Health Promotion and Disease Prevention of the Institute of Medicine (2005). Complementary and Alternative Medicine in the United States, p. 19. National Academies Press. Retrieved on 2008-01-08.
  4. ^ a b c What is Complementary and Alternative Medicine (CAM)?. National Center for Complementary and Alternative Medicine at the National Institutes of Health. Retrieved on 2006-07-11.
  5. ^ Board on Health Promotion and Disease Prevention of the Institute of Medicine (2005). Complementary and Alternative Medicine in the United States, p. 18. National Academies Press. Retrieved on 2008-01-08.
  6. ^ Unconventional Medicine in the United States -- Prevalence, Costs, and Patterns of Use. Eisenberg D, et al. N Engl J Med 1993; 328:246-252.
  7. ^ a b Richard Dawkins Dawkins, Richard (2003). A Devil's Chaplain. Weidenfeld & Nicolson. 
  8. ^ a b c Angell M, Kassirer JP (1998). "Alternative medicine--the risks of untested and unregulated remedies". N. Engl. J. Med. 339 (12): 839–41. doi:10.1056/NEJM199809173391210. PMID 9738094. 
  9. ^ Fontanarosa P.B., and Lundberg G.D. Alternative medicine meets science. JAMA. 1998; 280: 1618-1619.
  10. ^ Snyderman, R.; Weil, A. T. (2002-02-25). "Integrative Medicine: Bringing Medicine Back To Its Roots". . Archives of Internal Medicine Retrieved on 2006-07-11. PMID 11863470
  11. ^ CAM Basics: What is Cam?. National Center for Complementary and Alternative Medicine.
  12. ^ The Cochrane Collaboration Complementary Medicine Field, www.compmed.umm.edu/Cochrane/index.html. Retrieved 5 August 2006.
  13. ^ The HealthWatch Award 2005: Prof. Edzard Ernst Complementary medicine: the good the bad and the ugly. www.healthwatch-uk.org/awardwinners/edzardernst.html, retrieved 5 August 2006
  14. ^ "Complementary medicine is diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy or by diversifying the conceptual frameworks of medicine." Ernst et al British General Practitioner 1995; 45:506
  15. ^ Tonelli MR, Callahan TC (2001). "Why alternative medicine cannot be evidence-based". Academic medicine : journal of the Association of American Medical Colleges 76 (12): 1213-20. PMID 11739043. 
  16. ^ 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
  17. ^ Simon Crompton, "Back to the future: Complementary therapies get real," Times Online, Times Newspapers Ltd., January 17, 2004.
  18. ^ Barrett, Stephen. "Quackwatch", Your Guide to Quackery, Health Fraud, and Intelligent Decisions, Quackwatch. Retrieved on 2008-03-04. 
  19. ^ Predictors of inaccurate online breast cancer information
  20. ^ Elmer V. Bernstam, Muhammad F. Walji, Smitha Sagaram, Deepak Sagaram, Craig W. Johnson, Funda Meric-Bernstam (2008). "Commonly cited website quality criteria are not effective at identifying inaccurate online information about breast cancer". Cancer In press: 1206. doi:10.1002/cncr.23308. 
  21. ^ What is CAM? NCCAM
  22. ^ Whole Medical Systems: An Overview. NCCAM
  23. ^ Mind-Body Medicine: An Overview. NCCAM
  24. ^ Biologically Based Practices: An Overview. NCCAM
  25. ^ Manipulative and Body-Based Practices: An Overview. NCCAM
  26. ^ Energy Medicine: An Overview [NCCAM Backgrounder]
  27. ^ Energy Medicine
  28. ^ Ernst E. "Obstacles to research in complementary and alternative medicine." Medical Journal of Australia, 2003; 179 (6): 279-80. PMID 12964907 MJA online
  29. ^ Barnes, P. M.; Powell-Griner, E.; McFann, K.; Nahin, R. L. (2004). "Complementary and Alternative Medicine Use Among Adults: United States, 2002". . National Center for Health Statistics
  30. ^ Reasons people use CAM. NCCAM
  31. ^ Astin JA "Why patients use alternative medicine: results of a national study" JAMA 1998; 279(19): 1548-1553
  32. ^ 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
  33. ^ House of Lords report on CAM
  34. ^ University of Arizona position on Alternative Medicine
  35. ^ Wetzel MS, Eisenberg DM, Kaptchuk TJ. "Courses involving complementary and alternative medicine at US medical schools." JAMA 1998; 280 (9):784 -787. PMID 9729989
  36. ^ 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
  37. ^ 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
  38. ^ Barberis L, de Toni E, Schiavone M, Zicca A, Ghio R. Unconventional medicine teaching at the Universities of the European Union. J Altern Complement Med. 2001 Aug;7(4):337-43. PMID: 11558776 Abstract
  39. ^ Varga O, Márton S, Molnár P. Status of complementary and alternative medicine in European medical schools. Forsch Komplement Med (2006). 2006 Feb;13(1):41-5. Epub 2006 Jan 3. PMID: 16582550 Abstract

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