Complementary and Alternative Medicine (CAM)

There are many terms used to describe approaches to health care that are outside the realm of conventional medicine as practiced in the United States. Below are some definitions from the National Center for Complementary and Alternative Medicine (NCCAM), a component of the National Institutes of Health.

What is complementary and alternative medicine?

Complementary and alternative medicine, as defined by NCCAM, is a group of diverse medical and health care systems, practices and products that are not presently considered to be part of conventional medicine. While some scientific evidence exists regarding some CAM therapies, for most there are key questions that are yet to be answered through well-designed scientific studies - questions such as whether they are safe and whether they work for the diseases or medical conditions for which they are used. The list of what is considered to be CAM changes continually, as those therapies that are proven to be safe and effective become adopted into conventional health care and as new approaches to health care emerge. (Read more about some specific therapies in "CAM Therapies")

Complementary medicine and alternative medicine are not the same thing. Complementary medicine is used together with conventional medicine. An example of a complementary therapy is using aromatherapy or what is called "healing touch" to help lessen a patient's discomfort following surgery.

Alternative medicine is used in place of conventional medicine. An example of an alternative therapy is using a special diet to treat cancer instead of undergoing surgery, radiation or chemotherapy that has been recommended by a conventional doctor.

There is also what is called is integrative medicine. Integrative medicine, as defined by NCCAM, combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness.

NCCAM classifies CAM therapies into five categories:

• Alternative medical systems - Alternative medical systems are built upon complete systems of theory and practice. Often, these systems have evolved apart from and earlier than the conventional medical approach used in the United States. Examples of alternative medical systems that have developed in Western cultures include homeopathic medicine and naturopathic medicine. Examples of systems that have developed in non-Western cultures include traditional Chinese medicine and Ayurveda.
• Mind-body interventions - Mind-body medicine uses a variety of techniques designed to enhance the mind's capacity to affect bodily function and symptoms. Some techniques that were considered CAM in the past have become mainstream (for example, patient support groups and cognitive-behavioral therapy). Other mind-body techniques are still considered CAM, including meditation, prayer, mental healing and therapies that use creative outlets such as art, music or dance.
• Biologically based therapies - Biologically based therapies in CAM use substances found in nature, such as herbs, foods and vitamins. (Read about "Vitamins & Minerals") Some examples include dietary supplements, herbal products (Read about "Herbal Precautions") and the use of other so-called "natural" but as yet scientifically unproven therapies (for example, using shark cartilage to treat cancer).
• Manipulative and body-based methods - Manipulative and body-based methods in CAM are based on manipulation and/or movement of one or more parts of the body. Some examples include chiropractic or osteopathic manipulation and massage.
• Energy therapies - Energy therapies involve the use of energy fields. They are of two types:
  • Biofield therapies are intended to affect energy fields that purportedly surround and penetrate the human body. The existence of such fields has not yet been scientifically proven. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in, or through, these fields. Examples include qi gong, Reiki, Healing Touch and Therapeutic Touch.
  • Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields or alternating current or direct current fields.

Risks versus benefits

NCCAM says the decision to use complementary and alternative treatments is an important one. The following are things to consider before selecting an alternative therapy:

• the safety and effectiveness of the therapy or treatment
• the expertise and qualifications of the health care practitioner
• the quality of the service delivery

These topics should be considered when selecting any practitioner or therapy.

Generally, safety means that the benefits outweigh the risks of a treatment or therapy. A safe product or practice is one that does no harm when used under defined conditions and as intended.

Effectiveness is the likelihood of benefit from a practice, treatment or technology applied under typical conditions by the average practitioner for the typical patient.

Many people find that specific information about an alternative and complementary therapy's safety and effectiveness may be less readily available than information about conventional medical treatments. Research on these therapies is ongoing and continues to grow.

NCCAM says you may want to ask a health care practitioner, whether a physician or a practitioner of complementary and alternative health care, about the safety and effectiveness of the therapy or treatment he or she uses. Tell the practitioner about any alternative or conventional treatments or therapies you may already be receiving, as this information may be used to consider the safety and effectiveness of the entire treatment plan.

Be an informed health consumer and continue gathering information even after a practitioner has been selected. Ask the practitioner about specific new research that may support or not support the safety and effectiveness of the treatment or therapy. Ask about the advantages and disadvantages, risks, side effects, expected results and length of treatment that you can expect.

Speak with people who have undergone the treatment, preferably both those who were treated recently and those treated in the past. Optimally, find people who have the same health condition as you and who have received the treatment.

NCCAM says to remember that patient testimonials used alone do not adequately assess the safety and effectiveness of an alternative therapy and should not be the exclusive criterion for selecting a therapy. Controlled scientific trials usually provide the best information about a therapy's effectiveness and should be sought whenever possible.

Health consumers should take a close look into the background, qualifications and competence of any potential health care practitioner, whether a physician or a practitioner of alternative and complementary health care.

NCCAM has the following suggestions:

First, contact a State or local regulatory agency with authority over practitioners who practice the therapy or treatment you seek. The practice of CAM usually is not as regulated as the practice of conventional medicine. Licensing, accreditation and regulatory laws, however, are increasingly being implemented. Local and State medical boards, other health regulatory boards or agencies and consumer affairs departments provide information about a specific practitioner's license, education and accreditation and whether there are any complaints lodged against the practitioner. Check to see if the practitioner is licensed to deliver the services the practitioner says he or she delivers.

Appropriate State licensing of education and practice is the only way to ensure that the practitioner is competent and provides quality services. Most types of complementary and alternative practices have national organizations of practitioners that are familiar with legislation, State licensing, certification or registration laws.

Some organizations will direct medical consumers to the appropriate regulatory agencies in their State. These organizations also may provide referrals and information about specific practitioners. The organizations usually do not function as regulatory authorities, but promote the services of their members.

Second, talk with those who have had experience with this practitioner, both health practitioners and other patients. Find out about the confidence and competence of the practitioner in question, and whether there have ever been any complaints from patients.

Third, talk with the practitioner in person. Ask about the practitioner's education, additional training, licenses and certifications, both unconventional and conventional. Ask about the practitioner's approach to treatment and patients. Find out how open the practitioner is to communicating with patients about technical aspects of methods, possible side effects and potential problems.

When selecting a health care practitioner, many medical consumers seek someone knowledgeable in a wide variety of disciplines. Look for a practitioner who is easy to talk to. You should feel comfortable asking questions. After you select a practitioner, the education process and dialogue between you and your practitioner should become an ongoing aspect of complementary health care.

The quality of the service delivery or how the treatment or therapy is given and under what conditions, is an important issue. However, quality of service is not necessarily related to the effectiveness or safety of a treatment or practice.

Visit the practitioner's office, clinic or hospital. Ask the practitioner how many patients he or she typically sees in a day or week and how much time the practitioner spends with the patient. Look at the conditions of the office or clinic.

Many issues surround quality of service delivery and each one individually does not provide conclusive and complete information. For example, are the costs of the service excessive for what is delivered? Can the service be obtained only in one place, requiring travel to that place? These issues may serve as warning signs of poor service.

The primary issue to consider is whether the service delivery adheres to regulated standards for medical safety and care. Contact regulatory boards or agencies described in the previous section to obtain objective information. You also may gather information by talking with people who have used the service and through health care consumer organizations.

Costs are an important factor to consider, as many complementary and alternative treatments are not currently reimbursed by health insurance. (Read about "Insurance Terms Glossary") Many patients pay directly for these services. Ask your practitioner and your health insurer which treatments or therapies are reimbursable.

Find out what several practitioners charge for the same treatment to better assess the appropriateness of costs. Regulatory agencies and professional associations also may provide cost information.

Most importantly, discuss all issues concerning treatments and therapies with your health care provider, whether a physician or practitioner of CAM.

Competent health care management requires knowledge of both conventional and alternative therapies for the practitioner to have a complete picture of your treatment plan.

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