Complementary and alternative medicine

Complementary and alternative medicine include a variety of healing approaches and therapies that come from around the world and that are not based on the methods of conventional Western medicine. These therapies are called alternative medicine when used alone and complementary medicine when used in conjunction with conventional medicine. Integrative medicine refers to the use of all appropriate therapeutic approaches (conventional and alternative) within a framework that focuses on the whole person and strengthens the relationship between the health care practitioner and the patient. For ease of understanding, the term alternative medicine is used throughout the remainder of this chapter.

Alternative medicine includes therapies and health practices not widely taught in most medical schools; however, many such practices are popular, and some are used in hospitals and are reimbursed by insurance companies for failures. An increasing number of patients in Western countries are willing to try alternative medicine. In the United States in 2002, 36% of people over the age of 18 used some form of alternative medicine; when prayer for health is included as a component of alternative medicine, this percentage increases to 62%.

Although the distinction between conventional and alternative medicine is not always easy to define, there is a basic philosophical difference between the two. Conventional medicine typically defines health as the absence of disease; illness is thought to result from isolated factors (e.g., pathogens, biochemical imbalances), and treatment often involves drugs or surgery. Alternative medicine often defines health as a balance of the body's systems—physical, emotional, and spiritual—that encompasses the entire patient; it is more holistic. Disease is thought to result from disharmony and imbalances between the body's systems. Such theories are based more on concepts of energy and function than on concepts of anatomy and structural organization. Treatment often involves strengthening the body's own vitality and restoring these balances and energy flows.

Patients most likely to seek alternative medicine include those diagnosed with chronic back pain, nervous stress, headaches, migraines, menopausal symptoms, cancer, and arthritis. Some patients seek alternative medicine when conventional medicine fails to offer hope, especially at the end of life.

In 1992, the Office of Alternative Medicine was formed within the National Institutes of Health (NIH) to research the effectiveness and safety of alternative therapies. In 1999, this office became the National Center for Complementary and Alternative Medicine (NCCAM; see www.nccam.nih.gov ).

Some alternative therapies have been shown to be effective for treating certain health conditions. However, these therapies are often used more widely and without evidence of their effectiveness. Some alternative therapies have been found to be ineffective and cannot be approved for use. Others cannot be explained by current scientific principles. Most forms of alternative medicine have not been adequately studied; however, lack of evidence does not constitute evidence of ineffectiveness.

The number of documented positive cases of many complementary therapies is high. However, some alternative therapies have negative potential. Using an alternative approach instead of a proven conventional approach carries enormous risks, but this rarely happens.

Because the FDA regulates herbs and drugs differently, herbal medicine manufacturers do not have to prove their safety, despite the fact that many herbs contain substances with significant pharmacological activity. Alternative therapies that use body manipulation or other non-chemical interventions may also cause harm. For most types of alternative medicine, potential harm has not been established, nor has it been ruled out; however, in some cases potential harm has been proven but widely criticized by proponents of the approach.

Alternative medicine can be classified in many ways; each relies on underlying theories about the origins of disease or the factors that contribute to disease. There are five generally recognized categories of alternative medicine: alternative medical systems, mind-body therapies, biologically based therapies, manipulative and body-based therapies, and energy therapies. The names of many therapies only partially describe their components.

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