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Complementary and alternative medicine

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. Biologically Based Therapy
  3. Manipulative and body-based methods
  4. Energy Therapy
See also

Complementary and alternative medicine (CAM) is an umbrella term for complementary medicine and alternative medicine, and incorporates integrative medicine and various subjects such as herbalism, meditation, chiropractic, yoga, body work and diet-based therapies.

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 states 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 go even further, denying that such a thing as "alternative medicine" exists, but rather that 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]


Relationship between alternative and conventional medicine

The boundary between conventional and alternative medicine can be fluid. Over time, formerly unproven remedies can be incorporated into conventional medicine if they are shown to be safe and effective.[11] "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][9] Disproven practices remain in the realm of CAM.[7]

Fontanarosa and Lundberg denied that there is such a thing as alternative medicine, but rather, "[t]here is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking".[9] According to Angell and Kassirier, 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."[8]

Well-known 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.[12][13][14]

A review of Michael L. Millenson's book 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.[15] 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."[16]

NCCAM classifications of CAM

NCCAM classifies CAM therapies into five major groups. The classification are rather loose, and there can be some overlap.[17]

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.[18]

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".[19]

Biologically based practices

Biologically based practices use substances found in nature such as herbs, foods, vitamins, and other natural substances.[20]

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.[21]

Energy medicine

Energy medicine is a domain that deals with putative and veritable energy fields.[22] -

  • 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. [23]

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)."[24] 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.[25] 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.[26] Another study suggests a similar figure of 40%.[27] 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.[28]

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.[29] In the United Kingdom, a 2000 report ordered by the House of Lords suggested that " data seem to support the idea that CAM use in the United Kingdom is high and is increasing."[30]

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."[31] 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.[32][33][34] 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."[35] But, "only 40% of the responding [European] universities were offering some form of CAM training."[36]

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."[37]

The NCCAM surveyed the American public on complementary and alternative medicine use in 2002. According to the survey:[25]

  • 50 percent of U.S. adults age 18 years and over used some form of complementary and alternative medicine (CAM).[38]
  • 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%)

See also

Further reading

  • BMC complementary and alternative medicine. London : BioMed Central, 2001- NLM ID: 101088661
  • Evidence based complementary and alternative medicine
  • Evidence Based journal of Integrative medicine
  • Journal of Integrative medicine.
  • Journal for Alternative and Complementary Medicine: research on paradigm, practice, and policy. New York, NY : Mary Ann Liebert, Inc., c1995-]
  • Bausell, R. Barker (2007), , Oxford University Press, ISBN 978-0-19-531368-0


  • 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


  1. ^
  2. ^
  3. ^
  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. ^
  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. PMID 9738094. Retrieved on 2007-12-28.
  9. ^ a b c 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, Retrieved 5 August 2006.
  13. ^ The HealthWatch Award 2005: Prof. Edzard Ernst Complementary medicine: the good the bad and the ugly., 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. ^ 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
  16. ^ Simon Crompton, "Back to the future: Complementary therapies get real," Times Online, Times Newspapers Ltd., January 17, 2004.
  17. ^ What is CAM? NCCAM
  18. ^ Whole Medical Systems: An Overview. NCCAM
  19. ^ Mind-Body Medicine: An Overview. NCCAM
  20. ^ Biologically Based Practices: An Overview. NCCAM
  21. ^ Manipulative and Body-Based Practices: An Overview. NCCAM
  22. ^
  23. ^ Energy Medicine
  24. ^ Ernst E. "Obstacles to research in complementary and alternative medicine." Medical Journal of Australia, 2003; 179 (6): 279-80. PMID 12964907 MJA online
  25. ^ a b 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.
  26. ^ Reasons people use CAM. NCCAM
  27. ^ Astin JA "Why patients use alternative medicine: results of a national study" JAMA 1998; 279(19): 1548-1553
  28. ^ 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
  29. ^ House of Lords report on CAM
  30. ^ University of Arizona position on Alternative Medicine
  31. ^ Wetzel MS, Eisenberg DM, Kaptchuk TJ. "Courses involving complementary and alternative medicine at US medical schools." JAMA 1998; 280 (9):784 -787. PMID 9729989
  32. ^ 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
  33. ^ 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
  34. ^ 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
  35. ^ 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
  36. ^ Cassileth, Barrie R. (2002). "The Role of Complementary & Alternative Medicine: Accommodating Pluralism.". NEJM 347: 860-861.
  37. ^ CAM Use by U.S. Adults. NCCAM
This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Complementary_and_alternative_medicine". A list of authors is available in Wikipedia.
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