Friday, June 29, 2007

Complementary and Alternative Medicine 101

More and more Americans begin seeking complementary and alternative medicine (CAM) to solve health problems. According to a survey conducted by The National Center for Complementary and Alternative Medicine (NCCAM) in 2002, 50 percent of U.S. adults age 18 years and older have used some type of CAM. Due to the heterogeneity of CAM, some people may hold misconceptions about the practices of CAM. The following sections are provided to highlight the basics of CAM.

What is the definition of CAM?

The NCCAM defines CAM as “a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine.” David Eisenberg, M.D., Director of the Division for Research and Education in Complementary and Integrative Medical Therapies of the Osher Institute at Harvard Medical School, describes CAM as “practices explicitly used for medical intervention, health promotion, or disease prevention which are not routinely taught at United States medical schools, nor routinely underwritten by third party payers within the existing United States health care system.” Alternative medicine, complementary medicine, integrative medicine, holistic medicine, and natural medicine are other terms for CAM.

What are the common practices of CAM?

1. Energy Medicine
Energy medicine deals with the application of energy fields (such as magnetic field and bio-field) under the concept that the human body holds energy and people interact with each other through energy exchange. Energy is considered as the vital life force under different names in different cultures. Qi is known as energy in traditional Chinese medicine, Ki in the Japanese Kampo system, and Doshas in Ayurvedic medicine. Illnesses arise when there is an imbalance of energy in the human body. Restoring the normal flow of the energy helps improve one’s health. Qi Gong from China, Reiki and Johrei from Japan, healing touch, and intercessory prayer are examples of energy medicine practices.

There is an increasing demand for energy medicine in America in recent years. Some academic medical centers began investigation projects on the subject. However, energy medicine remains very controversial in the mainstream medical field, because the existing scientific technology cannot demonstrate the biophysical means of human energy field, external energy field, and their therapeutic effects. Dr. Mehmet C. Oz, Professor and Vice Chairman of Surgery at Columbia University in New York City, Director of the Cardiovascular Institute, and Founder and Director for the Complementary Medicine Program at New York Presbyterian Hospital, says "As we get better at understanding how little we know about the body, we begin to realize that the next big frontier … in medicine is energy medicine.”

2. Mind-body Medicine
Hippocrates (ca. 460BC-ca. 370BC) recognized the moral and spiritual aspects of healing. He believed that treatments could occur only with consideration of patient’s attitude, environmental impacts, and natural remedies. Traditional Chinese and Ayurvedic medicines integrated the mind healing into their medical philosophies, dating back more than 2,000 years. Scientific developments in the West around the 16th and 17th centuries led to a separation of the spiritual or emotional stage from the physical body.

In the modern world, mind-body medicine focuses on the interactions among the mind, the body, the effects of emotional, mental, social, and spiritual behaviors on a person’s health, and the empowerment of one’s capacity for self-care. Among a variety of mind-body intervention techniques, relaxation, hypnosis, visual imagery, meditation, yoga, biofeedback, tai chi, qi gong, cognitive-behavioral therapies, group support, and autogenic training are commonly practiced in the United States.

3. Manipulative and Body-based Practice
Manipulative and body-based practices treat the structures and systems of the body, including bones and joints, soft tissues, and circulatory and lymphatic systems. Chiropractic and osteopathic manipulation, Massage therapy, Tui na (Traditional Chinese Medicine Massage Technique), Reflexology, Rolfing, Bowen technique, Trager bodywork, Alexander technique, and Feldenkrais method are under the umbrella of Manipulative and Body-based Practice.

In the United States, manipulative and body-based therapies are primarily practiced by doctors of chiropractic, osteopathic physicians, physical therapists, and physiatrists. The majority of the research on the cost and utilization of spinal manipulation have focused on chiropractic, which covers 90% of manipulative practice. Similar to spinal manipulation, massage is commonly used for musculoskeletal dysfunctions. However, a significant fraction of people seek massage care for relaxation and stress relief.

4. Biologically Based Practice
Biologically based practice includes vitamins, minerals, fatty acids, amino acids, proteins, botanicals, animal-derived extracts, prebiotics and probiotics, whole diets, and functional foods. Increasing use of dietary supplements in the past two decades indicates that there is a strong desire for consumers to promote overall health and wellbeing. Clinical studies find some evidence for the effectiveness of dietary supplements in improving energy level and promoting health.

In addition to dietary supplements, herbal supplements also became popular in recent years. Like over-ther-counter and prescription drugs, they have active ingredients that affect one’s physical environment. If herbal supplements are applied properly, they can work wonders. However, the correct application of herbal supplements depends on herbs’ properties and individuals’ body constitutions. Self-prescription is not recommended and may cause adverse effects.

What are the conceptual foundations for CAM?

Generally, CAM follows these basic concepts:
  • Body has the ability to heal itself.
  • Take a proactive role in disease prevention to achieve balanced health.
  • Target at the root cause of an illness instead of focusing on the symptoms of the illness.
  • Holistic treatments address all aspects of one’s life. Body, mind and spirit cannot be treated separately. The abnormal condition of one directly affects the wellbeing of others.
  • Try natural methods first, and avoid invasive procedures that may cause other problems later on. However, seek these procedures when necessary, and integrate CAM into treatment plans.
How prevalent is CAM in the United States?

The NCCAM survey conducted in 2002 finds that 50 percent of U.S. adults age 18 years and older have used some form of CAM. There is a significant increase in the use of herbal supplements, growing from 12.1 percent of adults reporting the usage in 1997 to 18.6 percent in 2002. Yoga practice has increased 40 percent during the same period, from 3.7 percent to 5.1 percent. If prayer specifically for health reasons is considered as a form of CAM, the number of adults using this healing method rose to 62 percent in 2002. The 2002 National Health Interview Survey showed that 4.1% of the respondents reported lifetime use of acupuncture, and 1.1% (representing 2.13 million Americans) reported recent use of acupuncture.

Why do Americans seek CAM?

When suffering from chronic ailments that have not been successfully treated by conventional medicine, many Americans turn to CAM for help. CAM works particularly well with chronic disease management and health maintenance through proper diet, exercise, stress management and emotional healing. Disease prevention is the goal of some CAM users. While some people seek CAM based on friends’ or physicians’ recommendation, others try CAM out of curiosity. Of course, the economic burden of conventional medical treatments urges people to look for alternative healthcare solutions.
Americans use CAM for different types of diseases and conditions. It is commonly seen that people use CAM for pain management of neck, back, and joints, psychological disorders such as anxiety or depression, gastrointestinal disorders, and sleeping problems. Women are more likely than men to experience mind-body therapies, while men often seek CAM for musculoskeletal conditions or chronic and recurring pain. Higher socio-economic status increases the likelihood of CAM utilization.

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