Complementary and alternative medicine: Many use CAM–but what is it? A family doctor’s opinion.

by James Hubbard, M.D., M.P.H.

A government survey recently revealed that 38 percent of adults and 12 percent of children used complementary or alternative medicine (CAM) in the U.S. in 2007.  But how did they define CAM? What is conventional medicine?  And why do people use CAM, anyway?

These and more answered by your favorite family doctor :).  OK, second best, I’ll give you my opinions.


What is “complementary and alternative medicine”?

According to the National Center for Complementary and Alternative Medicine:

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.

CAM can become conventional once enough quality studies back up their effectiveness and safety.


What’s the difference between “complementary” and “alternative”?

  • Complementary medicine: When you use alternative medicine in addition to conventional medicine.
  • Alternative medicine: When you use it instead of the conventional treatment.

“Integrative medicine combines treatments from conventional medicine and CAM for which there is some high-quality evidence of safety and effectiveness,” says the NCCAM.

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What did the CAM survey find?

In a National Health Statitistics Report breakdown, the 10-most used types of CAM, along with percentage of U.S. adults using them, were:

  1. Non-vitamin, non-mineral, natural products (17.7 percent)
    Most common were fish oil/omega 3/DHA, glucosamine, echinacea, flaxoil seed or pills, ginseng
  2. Deep-breathing exercises (12.7 percent)
  3. Meditation (9.4 percent)
  4. Chiropractic or osteopathic manipulation (8.6 percent)
  5. Massage (8.3 percent)
  6. Yoga (6.1 percent)
  7. Diet-based therapies (3.6 percent)
  8. Progressive relaxation (2.9 percent)
  9. Guided imagery (2.2 percent)
  10. Homeopathic therapy (1.8 percent)

Women, people with more education and those with higher incomes used them more. Most people combined them with conventional medicine.

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Why do people use CAM?

I can think of a few reasons.  Please help me out with your own thoughts.

  • People need to feel more in control of their health.
  • CAM practitioners spend more time, and are more hands-on with them.
  • People are always looking for that magic cure.
  • People think it’s more natural.
  • There is no good conventional treatment for the ailment, or it isn’t working well.

Of course, the obvious one is that the CAM therapy may work better.  But how can we know that?  You have do to good objective, statistically relevant, peer-reviewed studies, and they are few and far between in CAM.  Conventional and CAM docs must put aside bias and test these things out, then go with the results.  Supplements must be regulated, false claims prosecuted.  With health-care costs soaring, we cannot continue to use treatments that don’t work, nor afford not to use those that do.

If anyone has any alternative ideas, I would love to hear them.

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14 Responses to “Complementary and alternative medicine: Many use CAM–but what is it? A family doctor’s opinion.”

  1. cathy Says:

    Very interesting. I’m more of a conventional medicine kind of gal, but I’ll admit to being intrigued by complementary medicine. Acupuncture is big around here, and I know several people (including nurses very involved in conventional medicine) that swear by it. I’d love to see real studies done on complementary medicine too.

    cathys last blog post..My comments on new HFCS research

  2. James Hubbard, M.D., M.P.H. Says:

    Cathy, the report found 40 studies from 2002 through 2007 involving acupuncture, massage therapy, naturopathy or yoga. 10 showed evidence that CAM was effective for treatment studied:
    Acupuncture, yoga and limited massage therapy for back pain.
    Acupuncture for knee pain, insomnia, and nausea and vomiting.

    thanks

  3. physyko Says:

    The most interesting comment is:

    “Women, people with more education and those with higher incomes used them more.”

    Several months ago I watched a federal Senate presentation that included among others the idea that medicine is migrating from a mass formula for all to a more individualized medicine format. Think anti-retroviral treatments for AIDS. Each individual actually needs a slightly different mix to really maximize results. If you note that it is the most informed and higher incomes that are mixing and matching conventional and alternative care to arrive at the best solution for each person individually it all makes sense. No you can’t run a mass trial and obtain the results that support this type of care; but if we are willing to understand and support individualized treatment plans for AIDS why not for everything else?

    physykos last blog post..More on the right to die and the false hopes of treatments that either don’t work or are basically experimental!

  4. Sagan Says:

    Very interesting!

    My mum is a vet who practiced regular medicine for about 25 years before she decided to focus only on Chinese medicine. Basically, she sees all the animals that have not been able to be treated with Western medicine. She also sees patients that don’t want to have to go through surgery or take steroids etc. Often her job is to relieve pain for animals that are going to die anyways, and she can extend their lifetime and QUALITY of life in ways that Western medicine can’t do.

    I think that both Western and Chinese medicine have their merits, and, as she says, they work best when both are used at the same time. Pretty much all of the patients she sees have a regular vet as well, so they are getting both kinds of treatment to really get the best results possible. It’s amazing how much chiropractic and acupuncture can do- and it’s all science, which I think a lot of people don’t really recognize.

  5. Steve Parker, M.D. Says:

    Dr Hubbard, your list of reasons why people use CAM is pretty complete. The only other one I can think of would be a predisposition based on ethnic/cultural background. For example, someone from an Eastern culture may be more likely than others investigate yoga or accupuncture.

    As I read “chiropractic” on your list, it struck me that chiropractors are so common, and for years, that I had forgotten they are CAM.

    -Steve

  6. James Hubbard, M.D., M.P.H. Says:

    physyko, I agree with individualizing treatment as best we can, but we really need some sort of objective proof that a treatment works.

    Thanks

  7. James Hubbard, M.D., M.P.H. Says:

    Sagan, your mother does not have to worry much about placebo effect on her patients :) Interesting insight.

  8. James Hubbard, M.D., M.P.H. Says:

    Steve,
    The report listed chiropractors under CAM. I think many may think of them as conventional in the musculoskeletal area. I agree with the ethnic background. In fact, the report said about half of Native Americans use CAM.
    Ethnic/cultural ideas about medicine is a very interesting topic in itself.
    thanks

  9. Steve Parker, M.D. Says:

    I forgot to mention a website I consult when I want an evidence-based assessment of a controversial or unconventional treatment: Stephne Barrett’s Quackwatch.com (http://quackwatch.com)

    [And I mean "evidence-based" in the best possible way.]

    -Steve

  10. James Hubbard, M.D., M.P.H. Says:

    I know the site and agree. In fact, we interviewed him for our Nov/Dec 2008 print magazine about interpreting media medical stories.

  11. LizS Says:

    Interesting article. I believe that many Western practitioners are naturally biased against alternative therapies without necessarily understanding them. I care to differ when it comes to evidence based research; indeed, there are some very reputable journals, The Menopause or Maturitas, that regularly publish peer reviewed data on alternative therapies. I suspect that consumers are tired of “a pill for all that ails,” and as they become more interested in their health, their mind opens to other modalities that might help without supporting big pharma or the FDA. I disagree that the FDA should regulate supplements but I do think that there should be laws about standardizing manufacturing practices to ensure safety. Fascinating…would love to read more. Thanks.

  12. James Hubbard, M.D., M.P.H. Says:

    Thanks LizS:
    I am not familiar with those journals. Will have to look them up.

  13. Dr. J Says:

    Thanks so much for this comprehensive discussion on CAM!!

    Dr. Js last blog post..Dr. J on doctors and angry patients

  14. James Hubbard, M.D., M.P.H. Says:

    You are welcome, Dr. J.

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