Complementary and Alternative Health Practices

August 11, 2011

Complementary and alternative medicine (CAM) is a group of health-related practices that are generally viewed as falling outside of mainstream medicine. Complementary and alternative medicine is the term currently utilized by the National Institutes of Health. However, semantics used to describe this area of medicine can often be confusing. The term that people are most familiar with in the United States is “alternative” medicine. However, this term is not favored by some, as it seems to imply abandoning conventional care in favor of a nonconventional or alternative approach. “Complementary” medicine is the term most frequently used in England. It implies that the nonconventional therapies will be used to complement the conventional care that a person is receiving. A more current term is “integrative” medicine. Integrative medicine is considered by most to describe an approach to health that incorporates considerations of mind, body, and spirit with an openness to look beyond mainstream medicine. The National Institutes of Health has categorized CAM into five main areas. They include alternative medical systems, mind-body interventions, biologically based therapies, manipulation and body-based methods, and energy therapies.

Alternative medical systems are complete systems of medicine which differ from the dominant medical system in the United States, frequently referred to as Western medicine or biomedicine. These systems, such as traditional Chinese medicine and Ayurvedic medicine from India, have their own unique way of viewing health, disease, and treatment. However, in any culture, there is always a dominant medical system and multiple alternative or nondominant systems. All of these systems have various strengths and weaknesses, as well as similarities and differences.

Mind-body interventions are a category of treatments that recognize and utilize the connection between the mind and the body. They include such modalities as hypnotherapy, biofeedback, guided visualization, and progressive relaxation, to name a few. Recognizing the connection between physical health and emotional or mental state can often lead to significant improvement in symptoms or even cure of various conditions.

Biologically based therapies such as dietary supplements, including vitamins, minerals, and herbs, as well as the use of foods to treat or prevent disease, are popular as they are usually readily accessible by the general population. Many of these therapies are effective; however, some may interact with medications or be otherwise potentially harmful. It is important to review potential dietary supplement-drug, dietary supplementdietary supplement, or even food-drug interactions when considering biologically based therapies. A complete list of one’s dietary supplements should be included when disclosing medication use.

Manipulation and body-based methods include therapeutic massage, of which there are over 80 techniques, chiropractic manipulation, and osteopathic manual therapy. These methods in general can be particularly effective for musculoskeletal-related disorders, including relief of pain, spasm, and stiffness. Although additional non-musculoskeletal-related conditions may respond to manipulation or body-based therapies, further research is needed to clarify the most appropriate indications.

Energy therapies utilize an individual’s or nature’s healing energy to bring about relief of symptoms or treat disease. These therapies include such modalities as therapeutic touch, healing touch, Reiki, Chi Gong, and polarity. Electromagnetic or magnet therapy is also included in this category. Again an area with great potential, energy medicine is gaining recognition, and some have suggested is the next great frontier for medicine.

In 1993, David Eisenberg published the results of a research survey which showed that approximately 38% of the U.S. population had used some form of CAM during the previous 12 months. This realization stunned many and led to an increased interest in CAM on the part of not only consumers, but health care providers, health care systems, insurers, and developers of healthrelated products. When Eisenberg repeated his study in 1997, he found that use of complementary medicine had increased to 42% of the population. Total number of visits to Complementary and alternative medicine providers had gone from 427 to 629 million visits, a number larger than all visits to U.S. primary care physicians during the same year. It was also reported that people were spending an estimated $27 billion out of pocket on CAM-related services and products.

It is important to point out that another discovery of the Eisenberg surveys was that less than half of consumers were telling their physician about their use of CAM. This is particularly concerning given the recognition that while many CAM treatments are likely effective, many also have the potential to interact with conventional medical therapies.

The growing interest in CAM has clearly been consumer driven. Researchers such as John Astin have investigated the reasons that people seek CAM therapies. What Astin and others have discovered is that the vast majority of individuals do not abandon conventional care but use CAM as an adjunct to the conventional care they are receiving. Most people who use both conventional and nonconventional therapies do so because they believe the combination to be superior to either alone. Many people pursue CAM therapies because they are looking for a more holistic orientation to health. Some have suggested that in this era of “high tech,” many also desire the “high touch” frequently offered by CAM providers.

Investigators have also looked at CAM use within specific populations. Multiple studies have confirmed that patients with cancer, rheumatologic, and other chronic conditions utilize CAM at an even higher rate than the general population. In a paper written by DiGianni, it was reported that 63-83% of women with breast cancer used at least one type of CAM. The reasons for CAM use among these populations vary but include not only the hope that the CAM modality will help treat a medical condition, but also the desire for an increased sense of control that often comes from the ability to incorporate CAM into one’s plan of care.

It is perhaps not surprising that more women than men utilize Complementary and alternative medicine. Women are typically the primary health care decision-makers within a family. As one begins to seek information about health, it is hard not to come across various recommendations on CAM either from friends, health professionals, literature, or the Internet. However, one must look at all sources of information with a critical eye in order to make a truly informed decision. Much of the information available on CAM has been supplied by companies that provide the service or product. This information is often presented in such a way as to make the potential product appear supported by scientific studies, when in fact it is often not the case. For that reason, it is advisable that women discuss their use of Complementary and alternative medicine with their physician or other health care providers.

In the past, many people had the correct perception that most health care providers were not open to a discussion on CAM. However, that has changed. The conventional medical community now clearly recognizes that the general public desire access and increased information on CAM modalities. Many medical, nursing, and allied health schools have responded by adding some training on CAM into their curriculum. This is leading to a generation of health care providers with a more open attitude toward CAM. The federal government has also recognized the increased utilization of CAM and, in response, has established the National Center for Complementary and Alternative Medicine (NCCAM) under the NIH. With a budget of $113 million in 2003, NCCAM, as well as other institutes at the NIH, is funding significant research in the area of CAM. As more of this research becomes available, health care providers, and in turn the general public, will be better able to make evidence-based decisions regarding the use of CAM.

It has become increasingly apparent that CAM is, and will continue to be, an important component of our health care system. For women concerned with their own health or the health of loved ones, consideration of select CAM modalities in conjunction with conventional care is essential when considering a comprehensive plan of care. Multiple resources should be consulted when determining which CAM modalities to incorporate and discussion with one’s health care provider is strongly recommended.

SEE ALSO: Chiropractic care, Energy healing, Massage, Meditation, Yoga

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