Complementary and alternative medicine was once defined not by what it was but by tive medicine by many complementary and alternative therapies. A theme common …
PA R T O N E
What Is Complementary and Alternative Medicine CAM?
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Defining CAM
have a question for you: how do you eat an elephant? The answer: one bite at a time Now, I am sure you are very pleased that you bought this book, since the author has opened with such an insightful observation In truth, I am quoting a friend who, I believe, borrowed it from an ancient proverb Irrespective of its origins, its message is important for any subject you may be dealing with — you need to start slowly and at the beginning Complementary and alternative medicine is a fascinating subject with many facets and intriguing aspects It is also highly politicized, with many provocative half-truths and suppositions raised by people who lack an understanding of the subject itself The aim of this first chapter is to answer the question, What exactly is complementary medicine?
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CAM: A Definition
Complementary and alternative medicine was once defined not by what it was but by what it was not If it was
not taught in a medical school, published in a medical journal or researched at a university, then it was considered complementary medicine But times are changing and such exclusionary definitions are being replaced by more positive descriptions While many different definitions still exist, the one most widely used now is the one accepted by a scientific research group called the Cochrane Collaboration It defines complementary and alternative medicine, or CAM, as
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a broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period CAM includes all such practices and ideas self defined by their users as preventing or treating illness or promoting health and well being Boundaries within CAM and between the CAM domain and that of the dominant system are not always
sharp or fixed1 From reading this definition, you have probably reached two immediate conclusions: first, that it was almost certainly written by a lawyer; second, that dedicating the first chapter to working out what we are actually talking about is not simply to be pedantic Complementary and alternative medicine is a complicated subject While this definition may seem wordy at first glance, it is the most complete and accurate one prepared so far So, as with eating an elephant, let us begin by breaking it up into bite-sized pieces
A Broad Domain of Healing Resources
The Cochrane Collaboration definition of CAM illustrates a number of important points CAM is not a single treatment or therapy but rather a number of therapies that have been grouped together more for political than for therapeutic reasons After a busy day at the office, the chiropractor, the homeopath and the naturopath do not meet for a beer or herbal tea While they all share common beliefs — such as treating the whole
person — and they often use methods of diagnosis not used in conventional medicine, therapies actually have very little in common In fact, many have as much in common with conventional medicine as with other complementary therapies The definition also allows that the therapies are different from conventional medicine in the way they view health and disease Whether it is the importance of qi in Traditional Chinese Medicine or the importance of vital force in homeopathy, belief systems that differ from that which currently operates in the mainstream or dominant health-care system are allowed for Our definition also hints at the fact that health care is not a level playing field We are always comparing new things to the ones we are familiar with This comparison occurs on all levels when we look at CAM — the way we use it, the laws that apply to it and even the way we research it So, in this case, CAM is measured using the same checks and balances used in conventional medicine Such
methods of comparison between CAM and conventional medicine have made it hard — in fact, practically
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What Is Complementary and Alternative Medicine?
impossible — for CAM to be accepted, since the standards it had to measure up to were often irrelevant to the practice of the therapies in question While times are changing, many complementary therapies can still be legitimately viewed as the underdogs of health care
Preventing Illness and Promoting Health
The Cochrane Collaboration definition identifies the importance placed on preventive medicine by many complementary and alternative therapies A theme common to many forms of CAM is the focus on health promotion rather than disease treatment Now, I can hear many doctors and public health nurses complaining that to say that conventional medicine neglects this aspect of health care is unfair Nevertheless, while it is true that health promotion does play a role in conventional medicine, it does not have the same fundamental
importance as it does in many complementary therapies Traditional Chinese Medicine has been concerned with health promotion for more than 5000 years, and modern conventional medicine can perhaps learn a thing or two from some ancient healing models
Boundaries Are Not Fixed
The definition also addresses the fact that times change The best way to illustrate this is to use an example In 1996, a study showed that extracts of the herbal medicine St Johns wort were as effective as conventional drugs and better than placebos in treating mild to moderate depression2 It is important to note that this study was published in the prestigious British Medical Journal The effect of this publication was dramatic Within 12 months, the market for St Johns wort in the United States increased by over 3000 percent3 This herbal medicine was, and still is, being used by many medical doctors as a possible treatment of choice in cases of mild depression In essence, St Johns wort was no longer considered by
many physicians and pharmacists to be a complementary treatment, but was being treated like a conventional one The role of this herbal medicine changed literally overnight The final sentence of our CAM definition also takes us back to the first sentence, reminding us to think beyond our own culture It is easy to forget that, while we in North America consider conventional medicine to be standard, it is not always the case in other parts of the world The issues here are not simply economic, related to the ability of a developing nation to afford expensive conventional medicine After all, extracts of St Johns wort have been used in countries such as Germany long before use of herbal medicine was accepted in North America
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Whats in a Name?
If you thought that defining CAM was difficult, the issues faced in giving it a name are arguably more pronounced The best way of explaining this is to look at some of the commonly used names4
Alternative Medicine
Alternative medicine
is definitely a name from the past It has fallen out of popularity because it implies that CAM therapies are alternatives to conventional medicine, approaches used instead of effective conventional treatments This is not the case, as very few people abandon conventional medicine and use nothing but these therapies
Complementary Medicine
The term complementary medicine was the one of choice for many years in Europe, and has been becoming more popular in North America recently I prefer this term, as it accurately describes how most people use these therapies — they complement their conventional health care by adding these new therapies to their healthcare program
Complementary and Alternative Medicine CAM
Complementary and alternative medicine CAM is probably the main term used today It combines the familiarity of alternative with the accuracy of complementary In fact, it has become so popular that many people simply use the abbreviation CAM, without actually knowing what it stands
for Youll sometimes see the use of therapies instead of medicine — as you do in the subtitle of this book While I must admit I prefer the use of therapies when the term is used in full, the abbreviation CATs is not as successful as CAM
Traditional Medicine
Many people refer to CAM as Traditional Medicine, but — what is traditional? In Canada, traditional medicine consists of drugs, surgery and other conventional medical treatments; in China, traditional is the Traditional Chinese Medicine that includes acupuncture and patent herbal formulas And not all examples are as clear cut as this — take osteopathy as an example In the United Kingdom, osteopathy is a manipulative therapy that is considered to be CAM In the United States, a qualification in osteopathy is considered almost interchangeable with an MD, and does not limit
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What Is Complementary and Alternative Medicine?
the osteopath to treating primarily musculo-skeletal problems Which form of osteopathy is traditional? Given
the confusion this term causes, it is not a helpful one for our purposes
Integrated Medicine
The term integrated medicine is based more on a future goal than on what actually exists now Integrated or integrative points to the hope that in the future both forms of health care — CAM and conventional — will be used in tandem, with the patient being able to move easily from one to another While an integrated health-care system may be a goal to strive for, it is a long way off Until CAM becomes generally accepted by mainstream medicine and becomes more regulated, this integration cannot fully be achieved To add to the confusion, integrated is a term already used in conventional medicine If you see both a medical doctor and a physiotherapist for a shoulder injury, for example, that is an integrated approach
Unconventional Medicine
If the health care we are most familiar with in the industrialized world ie, pharmaceutical drugs and surgery is conventional, why not term anything else as
unconventional? The use of the term unconventional carries with it the implication that it is unproven and substandard This connotation is not always accurate, and it is not very flattering to the practitioners After all, referring to a naturopath or acupuncturist as an unconventional therapist can give rise to a lot of speculation This term is usually restricted to questions of scientific research rather than practice
Unproven Medicine
While this term is accurate in some cases, it tends to be used more for its impact rather than for any attempt at honesty It is often used to portray practitioners as zealots, more concerned with an evangelical message than any intention to act in a rational way
Allopathic Medicine
If complementary medicine goes by many different names, does the same apply to mainstream medicine like the kind practised in North America? I was recently confronted by a doctor who wanted to know what an allopath was She had heard the term used, but was unsure what it
meant Sheepishly I told her that she was an allopath, and that allopathic medicine was a term used by CAM practitioners to describe the
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form of health care used in countries such as Canada and the United States Allopathy is treatment based on opposing the symptoms; for instance, anti-inflammatory drugs are used to decrease inflammation, and analgesics are used to kill pain However, many conventional medical methods are not allopathic in nature, but are quite holistic and help support the body And ironically a number of CAM treatments, such as herbal painkillers, can legitimately be considered allopathic
The CAM Hierarchy
While it would be wrong to discount any therapy simply on the weight of market forces, a fact of life is that a hierarchy is forming among CAM therapies This pecking order is largely determined by public popularity, the amount of research supporting the use of certain therapies, the amount of legislation controlling the practices and how much they
are accepted by conventional medicine While there are differences depending on geographical location, a number of surveys conducted in both Europe and North America have identified a number of therapies that have become more established and dominant5 In most cases, the top of the list has been held by the manual therapies, most notably chiropractic, therapeutic massage and, in the United Kingdom, osteopathy These are followed by acupuncture, mind/body therapies, herbal medicine, homeopathy and naturopathic medicine, which embraces many of the above therapies
The Growth of CAM in the 1990s
While everybody knew that CAM was becoming more popular in the last decade, nobody realized how truly large the market was until quite recently The watershed came with two surveys conducted by Dr David Eisenberg and his team at Harvard Medical School, one in 1990 and one in 19976 The results of these surveys were so astonishing that many experts in the field now consider CAM to be dated BE before the
Eisenberg survey and AE after the Eisenberg survey The 1997 survey estimated visits to CAM providers in the United States to be 629 million, exceeding the number of visits to all primary-care physicians in the United States for the same time period, and showing an increase of almost 50 percent over the 1990 survey In addition, the total spent out of pocket for this care was almost 22 billion US, greater than the total out-of-pocket expenses for hospital visits for that year The most-used CAM therapies were chiropractic, mind/body, therapeutic massage, acupuncture and herbal medicine Herbal medicine was the star performer, increasing by almost 400 percent between 1990 and 1997 Even when you consider the fact that therapies such as chi-
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What Is Complementary and Alternative Medicine?
ropractic and acupuncture require more practitioner visits than are required by the typical general practitioner, these figures are truly amazing When you consider that these figures do not include
self-prescribing and the market for natural health products, the actual use of CAM therapies is astounding A similar, but larger, Canadian survey conducted in 1997 had very similar findings7 The total Canadian market, including products and practitioner visits, was estimated at approximately 4 billion CDN, with chiropractic and therapeutic massage being the most popular treatments The chiropractic market alone was estimated at over 600 million, and the market for herbs and vitamins reached over 1 billion The survey showed that British Columbians were most likely to have used CAM in their lifetime 84 percent, with people in Quebec the least likely 66 percent
The Typical CAM Patient
It is clear that CAM is gaining rapidly in popularity and usage But who are the typical users of CAM? Considering the high numbers, one can expect a wide diversity of CAM consumers There are, however, some trends that indicate certain people to be more inclined to use CAM than others From the two Harvard
surveys and a third conducted by Stanford,8 we have a fairly accurate picture of the typical user of CAM We can reach some general conclusions about why users of CAM use these therapies, and when they consider them appropriate As with conventional medicine, women are more likely to use CAM than men The female CAM user is typically in her thirties or forties, tends to have a higher than average annual income and typically has at least a college education This profile differs from that of the typical user of conventional health care, where most patients are either very old or very young9 When do people use CAM? While the media tend to focus on the melodramatic events, the use of CAM to treat acute life-threatening conditions, in truth most people turn to CAM to treat common illnesses People are more likely to use CAM as a preventive measure or to treat a chronic condition The top five conditions for which Canadians are most likely to see a CAM provider are neck and back pains, allergies,
arthritis and rheumatism, walking difficulties and headaches This is not to say that people with terminal or life-threatening conditions do not use CAM For example, women with breast cancer10 and people living with HIV/AIDS11 frequently use CAM therapies and natural health products There is a common misconception that most people turn to CAM for negative reasons The feeling is that they are motivated not so much by the beneficial nature of CAM as by the fear of, or dissatisfaction with, conventional medicine Survey results
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show that this is not the case12 CAM users tend to turn to CAM for more positive reasons, including their desire to take control of their health and focus on preventive care, and the fact that CAM is compatible with their existing beliefs, such as a concern with environmental issues Also, people who use CAM frequently cite an event in their life that has had a profound effect on the way they view their health The personal touch is often mentioned
as one of the primary attractions of CAM Even with the best of intentions, the present conventional health-care system does not allow doctors and nurses to spend the time needed to effectively connect with their patients Positive motivations for people using CAM include the facts that CAM providers spend time with their patients, that interventions are frequently low-tech and that frequently the therapies used — massage therapy and aromatherapy, for instance — require some kind of physical contact It is interesting to note that people who use CAM are no less satisfied with conventional medicine than non-CAM users This finding is reflected in the fact that it is estimated that only 6 percent of Canadians and 5 percent of Americans use CAM at the exclusion of conventional medicine The vast majority of CAM users do so along with conventional health care, making their choices according to which they consider to be the most effective in particular circumstances13
IN A NUTSHELL
There are
many myths and misconceptions circulating about complementary and alternative medicine For an informed understanding of CAM, keep these points in mind
While a number of terms are used to describe CAM therapies, the most popular is complementary and alternative medicine CAM Complementary and alternative medicine is a group of diverse therapies, generally practised outside of mainstream or conventional medicine, that were initially grouped together for political reasons Times are changing and so is the definition of CAM CAM therapies are now often grouped by where they come from and how they are practised Definitions change with time and location While a specific therapy may be regarded as CAM in one part of the world, it may be defined as standard in another A therapy considered CAM at one stage may be absorbed into conventional health care after it has been scientifically shown to be effective CAM is used primarily as a preventive measure or to treat chronic conditions, and is
less frequently used for acute or life-threatening conditions
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What Is Complementary and Alternative Medicine?
CAM constitutes one of the fastest growing areas of health care While CAM is used by all parts of the population, it is especially popular among middle-class, educated women People use CAM for positive reasons rather than negative ones You can use CAM in tandem with conventional medicine and, in fact, most people do
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Source:pediatricapta.org
