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| | '''Complementary and alternative medicine (CAM)''' is a catch-all phrase used in a variety of ways that can encompass a broad variety of concerns. It might be used, on the one hand, for any set of health, medical or therapeutic practices not blessed by generally accepted conventional [[medicine]] and thus not covered by [[medical insurance]]. It might also refer, used by a different person, to practices believed by medical regulators to be dangerous, deceptive or ineffective. It might even refer to matters on which physicians and biomedical scientists have no opinion, either because no studies have been done or no opinion sought. Public debates include extreme viewpoints in conflicting directions, from, on the one hand, banning anything and everything not blessed by the establishment, and, on the other hand, to providing individual freedom to try a wide variety of therapies as long as they are not actually banned as dangerous or illegal and as long as no patently unprovable claims of efficacy are being made to potential clients. |
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| ''For an overview of an alternate view of the ideas, taken from philosophical and cutural roots rather than from a biomedical perspective, of 'Alternative Medicine' see [[Alternative medicine (theories)]]''
| | The underlying problem is easy to identify: who gets to decide? The U. S. [[Food and Drug Administration]] is supposed to prevent companies or individuals from marketing drugs or food which are not known to be safe, and also to prevent anyone from making claims of efficacy which are not supported by independent studies using accepted scientific methodology. At the national research, the [[National Center for Complementary and Alternative Medicine]] (NCCAM) is part of the U.S. [[National Institutes of Health]]. For a taxonomy of CAM techniques drawn from both NCCAM and the U.K. Parliament committee on CAM, see [[integrative medicine]]. |
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| '''Alternative medicine''' is a set of therapies that are considered '''whole''' systems of healthcare that typically operate outside the realm of mainstream healthcare in the Western world. '''Complementary medicine''' is comprised of those systems, or parts of systems, that have shown some efficacy experimentally and are frequently used in conjunction with the mainstream. Since some techniques may be found both in whole and complementary systems, it is convenient to speak of '''complementary and alternative medicine (CAM)''' as one broad field. Many of these systems predate modern scientific methods and some, particularly the eastern therapies, stem from well before the time of Hippocrates. Some of these practices include [[acupuncture]], [[homeopathy]], [[Plants, medicinal|herbal medicine]], [[faith healing]], [[chiropractic]], and [[prayer]].
| | A common distinction is that while there may be varying levels of efficacy data both for complementary and alternative medicine, complementary disciplines are open to collaboration with mainstream medicine and also other complementary practitioners. Alternative practitioners, however, present themselves as a literal "alternative" to conventional medicine. NCCAM also uses the term "whole system" for alternative paradigms that present themselves as "whole" alternatives to conventional medicine. |
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| Conventional, biologically-based medicine is not inherently critical of CAM, as some alternatives show as much efficacy as conventional methods, certainly for specific indications. Physicians do express concerns over '''whole systems''' whose patients have not first been evaluated by medically trained physicians for fear that this might delay proper treatment for conditions that are not sufficiently assessed. They also suggest that therapists may either not identify dangerous conditions that are treatable by conventional medicine, such that the patient does not have the information to decide to give [[informed consent]] to alternative treatment alone. Another aspect of that concern is that some conditions can respond to mainstream medical treatment early in the process, but delay of diagnosis could put the patient in a situation where the conventional treatment would no longer be effective.
| | But many state agencies also become involved in regulating what is allowed or not allowed. For example, while medical insurance may not recommend or pay for therapeutic massage, chiropractic manipulation, or acupuncture (just for example), many states require practitioners of these arts to be licensed by a state agency intended to guarantee a certain minimum level of competence and training. |
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| '''Integrative medicine''' is a term coming into increased use, which looks at wider and wider partnerships. While many patients today see both conventional and alternative practitioners, there may be no communication among them; the patient keeps them in different compartments. In integrative medicine, there is active consultation among the various practitioners and the patient. Integrative medicine also includes [nursing|nurses]], whose training emphasizes managing chronic diseases (e.g., compliance with monitoring and medicine), encouraging healthy lifestyles, and providing continuity.
| | The history of struggles and disputes over medical and health approaches is better told in articles related to a specific unofficial health approach. It is easy to consult a regulating authority to find out what therapies and approaches are "official" (and by definition, everything else may be considered CAM). But the issue of whether a specific therapy is "complementary", "harmful", "useful", or whatever, is open to much and passionate dispute. For specific cases, see [[Complementary_and_alternative_medicine/Related_Articles]]. |
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| Integrative medicine reduces some of the concerns that physicians have with patients who self-refer to practitioners of what are indeed complementary techniques, but which might interact with other treatments if all the prescribers are not aware of everything being done. Indeed, one of the challenges of many primary care physicians is simply to find out all the drugs their patients are taking, prescribed by different physician specialists who do not share information.
| | ==Notes== |
| | {{Reflist}} |
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| While some conventional physicians will reject any complementary method for which they do not know the exact mode of action, there are many productive, collaborative treatments by teams of mainstream and complementary (but not whole system) practitioners. For example, it is quite common for [[pain medicine]] specialists to use complementary methods.
| | [[Category:Complementary and alternative medicine]] |
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| Complementary techniques may complement one another. For example, one preliminary clinical trial found that aromatherapy alone, while pleasant, did not speed healing, while using the essential oils of aromatherapy as the lubricants in massage therapy caused more of an effect than massage alone.
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| ==Classification of CAM==
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| To begin a discussion, it is necessary to define the scope of the problem. The table below is derived from one created by the U.S. [[National Center for Complementary and Alternative Medicine]].
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| {| class="wikitable"
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| ! Major field and Description
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| ! Subfield
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| ! Subfield
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| | '''Whole Medical Systems''' comprise 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. These are usually alternative rather than complementary.
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| | '''Western''' systems include [[homeopathy]] and [[naturopathy]]
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| | '''Non-western systems''' include classical [[traditional Chinese medicine]]<ref>To be distinguished from the official Chinese "Three Roads" approach corresponds to using TCM in the context of complementary medicine</ref> and [[ayurveda]]
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| | '''Mind-Body Medicine''' uses a variety of techniques designed to enhance the mind's capacity to affect bodily function and symptoms. Some of the "still considered CAM" techniques are more and more accepted.
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| | '''Accepted as mainstream (not strictly CAM)''' include patient support groups and [[cognitive-behavioral therapy]]
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| | '''Still considered CAM''' include [[meditation]], [[visualization]], and [[relaxation (physiology)]] techniques; [[eye motion desensitization reprocessing]]; [[healing prayer]], [[mental healing]], and creative outlets such as [[art therapy]], [[music therapy]] and dance
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| | '''Biologically based practices''' in CAM use substances found in nature, such as [[Plants, medicinal|medicinal herbs]], [[diet therapy]], [[vitamin, pharmacologic dosage|pharmacologic doses of vitamins]], [[essential oil]]s, and [[dietary supplement]]s. An example of an unproven method is using shark cartilage to treat cancer.
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| | '''Manipulative and Body-Based Practices''' involve the controlled use of force against parts of the body, or maneuvers that move body parts out of their usual range of motion. These may be used as whole systems or as complementary methods. They include [[osteopathic manipulation]], [[massage therapy]], [[chiropractic]], and methods involving movement or posture instruction.
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| | '''Energy Medicine''' breaks into therapies that use forces that are, and are not, detectable with conventional scientific instrumentation.
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| | '''Bioelectromagnetic-based therapies''' involve the unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields, or alternating-current or direct-current fields.
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| | '''Biofield therapies''' are intended to affect energy fields that purportedly surround and penetrate the human body. These include [[qi gong]] (part of [[traditional Chinese medicine]]), [[reiki]], and [[therapeutic touch]]
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| |}
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| ==Criticism (old section)==
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| Critics argue that these practices are not scientifically or clinically verified, and can lead patients to harm in delaying treatment, and point to evidence of [[scams]] and [[fraud]] perpetuated by practitioners of alternative medicine.
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| Critics of alternative medicine seek alternative explanations for the claims that advocates of such therapies make, mostly in the use of the [[placebo effect]], a surprisingly powerful psychological effect where a person who thinks that a medical intervention is effective boosts their own health. Along with this, patients of alternative treatments are said to exhibit a self-delusional bias, where they accept successes and disregard failures for their favorite alternative practices while not doing similarly for mainstream medicine ([[confirmation bias]]). While some defend alternative medicine on the basis that it is not harmful, there are problems with this: as alternative treatments are often not rigorously tested, it can be difficult to know the side effects of some alternative treatments, especially as the natural sources used for such treatments do not often allow for strict control of doses. This has been observed with the incompatibility between [[St John's Wort]], a herbal remedy often prescribed by alternative medicine practitioners for [[depression]] and a variety of drugs including [[AIDS]] and [[heart disease]] medications<ref>Stephen Barrett, [http://www.quackwatch.org/01QuackeryRelatedTopics/DSH/stjohn.html St. John's Wort], ''Quackwatch''</ref><ref>National Institute of Mental Health (US), [http://www.nimh.nih.gov/health/publications/depression/complete-publication.shtml Depression]</ref>. Critics of alternative medicine also note that it can be dangerous if patients delay seeking conventional treatment in preference for use of alternative medicine.
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| Some alternative treatments have been tested through scientific means and when found beneficial have been integrated into normal medical practice. An example of this is [[acupuncture]], which many doctors now use as part of pain relief for some ailments because of the release of [[endorphins]]<ref>NHS Direct Health Encyclopedia (UK), [http://www.nhsdirect.nhs.uk/articles/article.aspx?articleid=6 Acupuncture]</ref>. Some scientific studies have shown that it is effective but have not confirmed the metaphysics upon which it is based—that of qi<ref>''qi'' is the correct spelling in pinyin, which is the Romanization scheme approved by the Chinese government and used by (probably) most western scholars today. "Ch'i" (note the apostrophe!) is the correct spelling in the Wade-Giles system, which was widely used before pinyin, survives in many older texts, and is still used by some western scholars today. </ref>, "vital energy" or the existence of "meridians".<ref>Robert Todd Carroll, "[http://skepdic.com/acupunc.html Acupuncture]" in the ''[[Skeptic's Dictionary]]''</ref>.
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| == References ==
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| <references />
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Complementary and alternative medicine (CAM) is a catch-all phrase used in a variety of ways that can encompass a broad variety of concerns. It might be used, on the one hand, for any set of health, medical or therapeutic practices not blessed by generally accepted conventional medicine and thus not covered by medical insurance. It might also refer, used by a different person, to practices believed by medical regulators to be dangerous, deceptive or ineffective. It might even refer to matters on which physicians and biomedical scientists have no opinion, either because no studies have been done or no opinion sought. Public debates include extreme viewpoints in conflicting directions, from, on the one hand, banning anything and everything not blessed by the establishment, and, on the other hand, to providing individual freedom to try a wide variety of therapies as long as they are not actually banned as dangerous or illegal and as long as no patently unprovable claims of efficacy are being made to potential clients.
The underlying problem is easy to identify: who gets to decide? The U. S. Food and Drug Administration is supposed to prevent companies or individuals from marketing drugs or food which are not known to be safe, and also to prevent anyone from making claims of efficacy which are not supported by independent studies using accepted scientific methodology. At the national research, the National Center for Complementary and Alternative Medicine (NCCAM) is part of the U.S. National Institutes of Health. For a taxonomy of CAM techniques drawn from both NCCAM and the U.K. Parliament committee on CAM, see integrative medicine.
A common distinction is that while there may be varying levels of efficacy data both for complementary and alternative medicine, complementary disciplines are open to collaboration with mainstream medicine and also other complementary practitioners. Alternative practitioners, however, present themselves as a literal "alternative" to conventional medicine. NCCAM also uses the term "whole system" for alternative paradigms that present themselves as "whole" alternatives to conventional medicine.
But many state agencies also become involved in regulating what is allowed or not allowed. For example, while medical insurance may not recommend or pay for therapeutic massage, chiropractic manipulation, or acupuncture (just for example), many states require practitioners of these arts to be licensed by a state agency intended to guarantee a certain minimum level of competence and training.
The history of struggles and disputes over medical and health approaches is better told in articles related to a specific unofficial health approach. It is easy to consult a regulating authority to find out what therapies and approaches are "official" (and by definition, everything else may be considered CAM). But the issue of whether a specific therapy is "complementary", "harmful", "useful", or whatever, is open to much and passionate dispute. For specific cases, see Complementary_and_alternative_medicine/Related_Articles.
Notes
