What Is Complementary and Alternative Medicine

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Various definitions have been used to describe the array of approaches and philosophies commonly referred to as "CAM." As the field has evolved, so has the terminology. Unconventional, unproven, alternative, complementary, holistic, integrative, and integral are some of the most common examples of terms in current use.

Historically, medical pluralism has long existed in the United States (Kaptchuk and Eisenberg, 2001a). Over the past few decades, alternative medicine has become a more recognized entity within conventional medicine. Because of the public's growing use of CAM, the National Institutes of Health (NIH) created an Office of Alternative Medicine (OAM) in 1992, with the intention of bringing its scientific expertise "to more adequately explore unconventional medical practices" (NCCAM, 2000). Because of Americans' ongoing and increasing use of CAM, the OAM was expanded to the National Center for Complementary and Alternative Medicine (NCCAM) in 1998, guided by the following mission statement (2000): "We are dedicated to exploring complementary and alternative healing practices in the context of rigorous science, training researchers, and disseminating authoritative information to the public and professional communities." After a decade of work in the field, NCCAM has become a leading resource for helping the public and health professionals better understand this rapidly growing area of medicine. The center's name has led to the more widespread use and recognition of CAM as the defining term for this field. NCCAM's free website contains a wealth of information, including the following definitions (2000):

Complementary and alternative medicine is a group of diverse medical and health care systems, practices, and products that are not considered part of conventional medicine. Although some scientific evidence exists, the list of what is considered to be CAM changes continually as the therapies that are proved to be safe and effective become adopted into conventional health care and as new approaches to health care emerge.

Alternative medicine is used in place of conventional medicine. Complementary medicine is used together with conventional medicine.

Integrative medicine combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness.

The NCCAM further classifies CAM into five categories, or domains (Figure 11-1). Examples of alternative or whole medical systems include homeopathy, naturopathy, and Ayurveda (eAppendix 11-1 provides a glossary of CAM terms online at www.expertconsult.com). Although there are a variety of approaches to the complex taxonomy of CAM (Kaptchuk and Eisenberg, 2001b), the NIH system is most often used.

Another term, holistic medicine, also describes these practices and philosophy. The American Holistic Medical Association (AHMA), founded in 1978, is a membership organization for physicians and other health professionals seeking to practice a broader form of medicine than that currently taught in allopathic medical schools (Table 11-1). "Holistic medicine is the art and science of healing that addresses care of the

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Complementary Alternative Medicine

Figure 11-1 The National Center for Complementary and Alternative Medicine (NCCAM) groups complementary and alternative medicine (CAM) practices into five domains, recognizing that there can be some overlap among them. Biologically based therapies use substances found in nature, such as herbs, special diets, or vitamins (in doses outside those used in conventional medicine). Energy therapies involve the use of energy fields, such as magnetic fields or biofields (i.e., energy fields that some believe surround and penetrate the human body). Manipulative and body-based methods are based on manipulation or movement of one or more body parts. Mind-body medicine uses a variety of techniques designed to enhance the mind's ability to affect bodily function and symptoms. Alternative or whole medical systems are built on 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.

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Figure 11-1 The National Center for Complementary and Alternative Medicine (NCCAM) groups complementary and alternative medicine (CAM) practices into five domains, recognizing that there can be some overlap among them. Biologically based therapies use substances found in nature, such as herbs, special diets, or vitamins (in doses outside those used in conventional medicine). Energy therapies involve the use of energy fields, such as magnetic fields or biofields (i.e., energy fields that some believe surround and penetrate the human body). Manipulative and body-based methods are based on manipulation or movement of one or more body parts. Mind-body medicine uses a variety of techniques designed to enhance the mind's ability to affect bodily function and symptoms. Alternative or whole medical systems are built on 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.

whole person—body, mind, and spirit. The practice of holistic medicine integrates conventional and complementary therapies to promote optimal health and to prevent and treat disease by addressing contributing factors" (AHMA, 2005).

In 1981, the nursing profession, guided by a group of nurses dedicated to bringing the concepts of holism to every arena of nursing practice, founded the American Holistic Nursing Association (AHNA). "Holistic nursing embraces all nursing that has as its goal enhancement of healing the whole person from birth to death. Holistic nursing recognizes that there are two views regarding holism: that holism involves identifying the interrelationships of the biopsycho-sociospiritual dimensions of the person, recognizing that the whole is greater than the sum of its parts, and that holism involves understanding the individual as a unitary whole in mutual process with the environment" (AHNA, 2005).

Integrative medicine, a term brought into popular use by Andrew Weil, MD, founder and director of the innovative University of Arizona Center for Integrative Medicine, describes how CAM and conventional medicine is practiced together (Rakel and Weil, 2003):

Integrative medicine is healing oriented and emphasizes the centrality of the doctor-patient relationship. It focuses on the least invasive, least toxic, and least costly methods to help facilitate health by integrating allopathic and complementary therapies. These are

Table 11-1 Important Events in Complementary and Integrative Medicine based on an understanding of the physical, emotional, psychologic, and spiritual aspects of the individual.

In general, the terms holistic and integrative seem to best convey the ideal blending of conventional and unconventional medicine "in that both imply a balanced, whole-person-centered approach and involve a synthesis of conventional medicine, CAM modalities, and other traditional medical systems, with the aim of prevention and healing as a basic foundation" (Lee et al., 2004).

The term integral has recently emerged in the literature. First noted several decades ago in the book Mind, Body and Health: Toward an Integral Medicine (Gordon et al., 1984), its original use may be traced to the work of Sri Aurobindo, an Indian mystic and political leader. The term has been popularized by contemporary philosopher and transpersonal psychologist Ken Wilber (2005), as applied in the context of his integral theory. Many thought leaders in the field of health and healing, including the Institute of Noetic Sciences (IONS), support these concepts and encourage further research into what may be considered the beginnings of a paradigm shift in medicine (Schiltz, 2005). The following excerpt captures the essence of the deep change and transformation that integral medicine calls for (Wilber, 2005):

The crucial ingredient in any integral medical practice is not the integral medical bag itself—with all the conventional pills, and the orthodox surgery, and the subtle energy medicine, and the acupuncture needles—but the holder of that bag. Integrally informed health-care practitioners, the doctors, nurses, and therapists, have opened themselves to an entire spectrum of consciousness—matter to body to mind to soul to spirit—and who have thereby acknowledged what seems to be happening in any event. Body and mind and spirit are operating in self and culture and nature, and thus health and healing, sickness and wholeness, are all bound up in a multidimensional tapestry that cannot be cut into without loss.

Family physicians know this to be true. They practice with the intention to care for the whole patient within the context of a continuous healing relationship while honoring the rich complexity and interplay of family, community, and environment. They acknowledge the personal and interpersonal effects of health and illness and are trained to consider the behavioral and social aspects of a person's life as well as the biomedical factors.

Now is the time not only to reclaim its roots, but also to move primary care into expanded dimensions and possibilities of health and healing. Family medicine is the ideal discipline to champion this movement and to actualize changes that will begin to heal the failing U.S. health care system. Whether it is called holistic, integrative, or integral, family physicians are collectively evolving toward a more compassionate and sustainable system of care that may ultimately be called good medicine.

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