By Marlo Sollitto
There are many terms used to describe approaches to health care that are outside the realm of conventional medicine.
What is CAM?
CAM is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Conventional medicine is medicine as practiced by holders of M.D. (medical doctor) or D.O. (doctor of osteopathy) degrees and by their allied health professionals, such as physical therapists, psychologists, and registered nurses. Some health care providers practice both CAM and 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 these therapies 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.
Are Complementary Medicine and Alternative Medicine Different?
Yes, they are different. Complementary medicine is used together with conventional medicine. An example of a complementary therapy is using aromatherapy 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.
What is Integrative Medicine?
Integrative medicine combines treatments from conventional medicine and CAM for which there is some high-quality evidence of safety and effectiveness. It is also called integrated medicine.
What are the Major Complementary and Alternative Medicines?
NCCAM groups CAM practices into four domains, recognizing there can be some overlap. In addition, NCCAM studies CAM whole medical systems, which cut across all domains.
Whole Medical Systems
Whole 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 whole medical systems that have developed in Western cultures include homeopathic medicine and natural medicine.
Examples of systems that have developed in non-Western cultures include traditional traditional Chinese medicine and Ayurveda, a whole medical system that originated in India that aims to integrate the body, mind, and spirit to prevent and treat disease. Therapies used include herbs, massage, and yoga.
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 Practices
Biologically based practices in CAM use substances found in nature, such as herbs, foods, and vitamins. Some examples include dietary supplements, herbal products, 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 Practices
Manipulative and body-based practices in CAM are based on manipulation (The application of controlled force to a joint, moving it beyond the normal range of motion in an effort to aid in restoring health. Manipulation may be performed as a part of other therapies or whole medical systems, including chiropractic medicine, massage, and naturopathy) and/or movement of one or more parts of the body. Some examples include chiropractic or osteopathic manipulation, which is a type of manipulation practiced by osteopathic physicians. It is combined with physical therapy and instruction in proper posture, and massage.
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 (a component of traditional Chinese medicine that combines movement, meditation, and controlled breathing. The intent is to improve blood flow and the flow of qi), Reiki therapy (practitioners seek to transmit a universal energy to a person, either from a distance or by placing their hands on or near that person. The intent is to heal the spirit and thus the body), and Therapeutic Touch (a therapy in which practitioners pass their hands over another person's body with the intent to use their own perceived healing energy to identify energy imbalances and promote health).
- Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields, or alternating-current or direct-current fields.
How Can I Get Reliable Information about a CAM Therapy?
It is important to learn what scientific studies have discovered about the therapy in which you are interested. It is not a good idea to use a CAM therapy simply because of something you have seen in an advertisement or on a Web site or because someone has told you that it worked for them.
Understanding a treatment's risks, potential benefits, and scientific evidence is critical to your health and safety. Scientific research on many CAM therapies is relatively new, so this kind of information may not be available for every therapy. However, many studies on CAM treatments are underway, including those that NCCAM supports, and our knowledge and understanding of CAM is increasing all the time. Here are some ways to find scientifically based information:
- Talk to your healthcare practitioner(s). Tell them about the therapy you are considering and ask any questions you may have about safety, effectiveness, or interactions with medications (prescription or non-prescription). They may know about the therapy and be able to advise you on its safety and use. If your practitioner cannot answer your questions, he may be able to refer you to someone who can. Your practitioner may also be able to help you interpret the results of scientific articles you have found.
- Use the Internet to search medical libraries and databases for information. One database called CAM on PubMed (http://nccam.nih.gov/camonpubmed), developed by NCCAM and the National Library of Medicine, gives citations or abstracts (brief summaries) of the results of scientific studies on CAM. In some cases, it provides links to publishers' Web sites where you may be able to view or obtain the full articles. The articles cited in CAM on PubMed are peer-reviewed-that is, other scientists in the same field have reviewed the article, the data, and the conclusions, and judged them to be accurate and important to the field. Another database, International Bibliographic Information on Dietary Supplements, is useful for searching the scientific literature on dietary supplements.
- Visit your local library or a medical library to see if there are books or publications that contain scientific articles discussing CAM in general or the treatment in which you are interested. Thousands of articles on health issues and CAM are published in books and scientific journals every year. A reference librarian can help you search for those on the therapy that interests you.
Are CAM Therapies Safe?
Each treatment needs to be considered on its own. However, here are some issues to think about when considering a CAM therapy.
Many consumers believe that "natural" means the same thing as safe. This is not necessarily true. For example, think of mushrooms that grow in the wild: some are safe to eat, while others are poisonous.
Individuals respond differently to treatments. How a person might respond to a CAM treatment depends on many things, including the person's state of health, how the treatment is used, or the person's belief in the treatment.
For a CAM product that is sold over the counter (without a prescription), such as a dietary supplement, safety can also depend on a number of things:
- The components or ingredients that make up the product.
- Where the components or ingredients come from.
- The quality of the manufacturing process (for example, how well the manufacturer is able to avoid contamination).
- The manufacturer of a dietary supplement is responsible for ensuring the safety and effectiveness of the product before it is sold. The U.S. Food and Drug Administration (FDA) cannot require testing of dietary supplements prior to marketing. However, while manufacturers are prohibited from selling dangerous products, the FDA can remove a product from the marketplace if the product is dangerous to the health of Americans. Furthermore, if in the labeling or marketing of a dietary supplement a claim is made that the product can diagnose, treat, cure, or prevent disease, such as "cures cancer," the product is said to be an unapproved new drug and is, therefore, being sold illegally. Such claims must have scientific proof.
For CAM therapies that are administered by a practitioner, the training, skill, and experience of the practitioner affect safety. However, in spite of careful and skilled practice, all treatments--whether CAM or conventional--can have risks.
Confirming the Statements Made About the Effectiveness of a CAM Therapy
Statements that manufacturers and providers of CAM therapies may make about the effectiveness of a therapy and its other benefits can sound reasonable and promising. However, they may or may not be backed up by scientific evidence. Before you begin using a CAM treatment, it is a good idea to ask the following questions:
- Is there scientific evidence (not just personal stories) to back up the statements? Ask the manufacturer or the practitioner for scientific articles or the results of studies. They should be willing to share this information, if it exists.
- Does the Federal Government have anything to report about the therapy? Visit the FDA online at www.fda.gov to see if there is any information available about the product or practice. Information specifically about dietary supplements can be found on FDA's Center for Food Safety and Applied Nutrition Web site at www.cfsan.fda.gov. Or visit the FDA's Web page on recalls and safety alerts www.fda.gov/opacom/7alerts.html. Check with the Federal Trade Commission (FTC) at www.ftc.gov to see if there are any fraudulent claims or consumer alerts regarding the therapy. Visit the Diet, Health, and Fitness Consumer Information Web site at http://www.ftc.gov/bcp/menus/resources/guidance/health.shtm. Visit the NCCAM Web site, www.nccam.nih.gov, to see if NCCAM has any information or scientific findings to report about the therapy.
- How does the provider or manufacturer describe the treatment? The FDA advises that certain types of language may sound impressive but actually disguise a lack of science. Be wary of terminology such as "innovation," "quick cure," "miracle cure," "exclusive product," "new discovery," or "magical discovery." Watch out for claims of a "secret formula." If a therapy were a cure for a disease, it would be widely reported and prescribed or recommended. Legitimate scientists want to share their knowledge so that their peers can review their data. Be suspicious of phrases like "suppressed by government" or claims that the medical profession or research scientists have conspired to prevent a therapy from reaching the public. Finally, be wary of claims that something cures a wide range of unrelated diseases (for example, cancer, diabetes, and AIDS). No product can treat every disease and condition.
Are There Any Risks to Using CAM Treatments?
Yes, there can be risks, as with any medical therapy. These risks depend upon the specific CAM treatment. The following are general suggestions to help you learn about or minimize the risks.
Tell your healthcare providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care. For example, herbal products and other dietary supplements may interact with medications (prescription or non-prescription). They may also have negative, even dangerous, effects on their own. Research has shown that the herb St. John's wort, which is used by some people to treat depression, may cause certain drugs to become less effective. And kava, an herb that has been used for insomnia, stress, and anxiety, has been linked to liver damage.
If you have more than one healthcare provider, let all of them know about the CAM and conventional therapies you are using. This will help each provider make sure that all aspects of your health care work together.
Take charge of your health by being an informed consumer. Find out what the scientific evidence is about any treatment's safety and whether it works.
If you decide to use a CAM treatment that would be given by a practitioner, choose the practitioner carefully to help minimize any possible risks.
Are CAM Therapies Tested to See if They Work?
While some scientific evidence exists regarding the effectiveness of some CAM therapies, for most there are key questions that are yet to be answered through well-designed scientific studies-questions such as whether the therapies are safe, how they work, and whether they work for the diseases or medical conditions for which they are used.
NCCAM is the Federal Government's lead agency for scientific research on CAM. NCCAM supports research on CAM therapies to determine if they work, how they work, whether they are effective, and who might benefit most from the use of specific therapies.
I am Interested in a CAM Therapy that Involves Treatment from a Practitioner
Here are a few things to consider when selecting a practitioner:
- Ask your physician, other health professionals, or someone you believe to be knowledgeable regarding CAM whether they have recommendations.
- Contact a nearby hospital or a medical school and ask if they maintain a list of area CAM practitioners or could make a recommendation. Some regional medical centers may have a CAM center or CAM practitioners on staff.
- Contact a professional organization for the type of practitioner you are seeking. Often, professional organizations have standards of practice, provide referrals to practitioners, have publications explaining the therapy (or therapies) that their members provide, and may offer information on the type of training needed and whether practitioners of a therapy must be licensed or certified in your state. Professional organizations can be located by searching the Internet or directories in libraries (ask the librarian). One directory is the Directory of Information Resources Online (DIRLINE) compiled by the National Library of Medicine (dirline.nlm.nih.gov). It contains locations and descriptive information about a variety of health organizations, including CAM associations and organizations.
Many states have regulatory agencies or licensing boards for certain types of practitioners. They may be able to provide you with information regarding practitioners in your area. Your state, county, or city health department may be able to refer you to such agencies or boards. Licensing, accreditation, and regulatory laws for CAM practices are becoming more common to help ensure that practitioners are competent and provide quality services.
This fact sheet explains how the National Center for Complementary and Alternative Medicine (NCCAM), a component of the National Institutes of Health, defines some of the key terms used in the field of Complementary and Alternative Medicine (CAM).