Wednesday, October 21, 2009

Complimentary and Alternative Medicine

Introduction

There are many terms used to describe approaches to health care that are outside the realm of conventional medicineMedicine 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. as practiced in the United States. 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)A group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Complementary medicine is used together with conventional medicine, and alternative medicine is used in place of conventional medicine.. Terms that are underlined in the text are defined at the end of this fact sheet.

What is CAM?

CAM is a group of diverse medical and health care systems, practices, and products that are not generally considered to be part of conventional medicine. While 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 purposes for which they are used.


Are complementary medicine and alternative medicine different from each other?

Yes, they are different.

What is integrative medicine?

Integrative medicine combines treatments from conventional medicine and CAM for which there is evidence of safety and effectiveness. It is also called integrated medicineAn approach to medicine that combines treatments from conventional medicine and CAM for which there is some high-quality scientific evidence of safety and effectiveness..


What are the major types of complementary and alternative medicine?

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 medicineA whole medical system that originated in Europe. Homeopathy seeks to stimulate the body's ability to heal itself by giving very small doses of highly diluted substances that in larger doses would produce illness or symptoms (an approach called "like cures like"). and naturopathic medicineA whole medical system that originated in Europe. Naturopathy aims to support the body's ability to heal itself through the use of dietary and lifestyle changes together with CAM therapies such as herbs, massage, and joint manipulation.. Examples of systems that have developed in non-Western cultures include traditional traditional Chinese medicineA whole medical system that originated in China. It is based on the concept that disease results from disruption in the flow of qi and imbalance in the forces of yin and yang. Practices such as herbs, meditation, massage, and acupuncture seek to aid healing by restoring the yin-yang balance and the flow of qi. and AyurvedaA whole medical system that originated in India. It aims to integrate the body, mind, and spirit to prevent and treat disease. Therapies used include herbs, massage, and yoga..

Mind-Body Medicine

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 meditationA conscious mental process using certain techniques—such as focusing attention or maintaining a specific posture—to suspend the stream of thoughts and relax the body and mind., 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 manipulationThe 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 manipulationA type of manipulation practiced by osteopathic physicians. It is combined with physical therapy and instruction in proper posture., and massagePressing, rubbing, and moving muscles and other soft tissues of the body, primarily by using the hands and fingers. The aim is to increase the flow of blood and oxygen to the massaged area..

Energy Medicine

Energy therapies involve the use of energy fields. They are of two types:

What is NCCAM's role in the field of CAM?

NCCAM is the Federal Government's lead agency for scientific research on CAM. . NCCAM's mission is to explore complementary and alternative healing practices in the context of rigorous science, train CAM researchers, and disseminate authoritative information to the public and professionals.

For More Information

Sources of NCCAM Information

NCCAM Clearinghouse

The NCCAM Clearinghouse provides information on CAM and NCCAM, including publications and searches of Federal databases of scientific and medical literature. Examples of publications include "Selecting a CAM Practitioner" and "Are You Considering Using CAM?" The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.


A wide range of complementary and alternative medicine (CAM) therapies are used in children, including herbs and dietary supplements, massagePressing, rubbing, and moving muscles and other soft tissues of the body, primarily by using the hands and fingers. The aim is to increase the flow of blood and oxygen to the massaged area., acupunctureA family of procedures that originated in traditional Chinese medicine. Acupuncture is the stimulation of specific points on the body by a variety of techniques, including the insertion of thin metal needles though the skin. It is intended to remove blockages in the flow of qi and restore and maintain health., chiropractic care, naturopathyA whole medical system that originated in Europe. Naturopathy aims to support the body's ability to heal itself through the use of dietary and lifestyle changes together with CAM therapies such as herbs, massage, and joint manipulation., and homeopathyA whole medical system that originated in Europe. Homeopathy seeks to stimulate the body's ability to heal itself by giving very small doses of highly diluted substances that in larger doses would produce illness or symptoms (an approach called "like cures like").. This fact sheet from the National Center for Complementary and Alternative Medicine (NCCAM) offers information for parents who are thinking about using a CAM therapy for their child.


Key Points

  • CAM is used by American children, including adolescents.
  • Children are not small adults. Their bodies can react differently from adults' bodies to medical therapies, including CAM.
  • In general, CAM therapies have not been well studied in children.
  • Tell your child's health care providers about any CAM therapy you are considering or using for your child. This helps to ensure coordinated and safe care.

Patterns of CAM Use in Children

The 2007 National Health Interview Survey gathered information on CAM use among more than 9,000 children aged 17 and under. Nearly 12 percent of the children had used some form of CAM during the past 12 months. CAM use was much more likely among children whose parents also used CAM. Adolescents aged 12–17, children with multiple health conditions, and those whose families delayed or did not use conventional medical care because of cost were also more likely to use CAM. The accompanying figures show survey findings on CAM use by children, including top therapies and diseases/conditions.

In addition, a 2001 survey of 745 members of the American Academy of Pediatrics found that 87 percent of pediatricians had been asked about CAM therapies by a patient or a parent in the 3 months prior to the survey. The pediatricians were asked most often about herbs and dietary supplements.

10 Most Common Therapies Among Children-2007: follow link for full description

Diseases/Conditions for Which CAM Is Most Frequently Used Among Children-2007: follow link for full description


Safety of Childhood CAM Use

Few high-quality studies have examined how CAM therapies may affect young people, and results from studies in adults do not necessarily apply to children. Children are not small adults. Their immune and central nervous systems are not fully developed, which can make them respond to treatments differently from adults. This is especially true for infants and young children.

Herbs and other dietary supplements may interact with medicines or other supplements, or they may cause problems during surgery, such as bleeding-related complications. In addition, "natural" does not necessarily mean "safe." CAM therapies can have side effects, and these may be different in children than in adults.

Parents should seek information from scientific studies about how safe and effective a specific CAM therapy is in children. However, since few, if any, rigorous studies in young people exist, additional scientific studies are needed. Anecdotes and testimonials (personal stories) about CAM therapies are common and can be compelling, but they are not evidence.

Discussing CAM With Your Pediatrician

Parents often do not tell pediatricians or other health care providers that their child is receiving CAM. It is important, however, that families speak with their child's health care provider about any CAM therapy being used or considered. Providing a full picture of what is being done to manage your child's health will help ensure coordinated and safe care.

For tips about talking with your health care provider about CAM, see NCCAM's Time to Talk campaign at nccam.nih.gov/timetotalk.

When seeking care from a CAM practitioner, it is important to ask about the practitioner's:

  • Education and training
  • Experience in delivering care to children
  • Experience working with other providers, including physicians, to ensure coordinated care
  • Licensing (some states have licensing requirements for certain CAM practitioners, such as chiropractors, naturopathic doctors, massage therapists, and acupuncturists).

Additional Points To Consider

In addition to asking your child's physician what is known about whether a therapy works and is safe for children, consider these points when making decisions about using CAM in children:

  • Ensure that your child has received an accurate diagnosis from a licensed health care provider and that CAM use does not replace or delay conventional medical care.
  • If you decide to use CAM for your child, do not increase the dose or length of treatment beyond what is recommended. More is not necessarily better.
  • If your child experiences an effect from a CAM therapy that concerns you, contact your child's health care provider.
  • Store herbal and other dietary supplements out of the sight and reach of children.
  • If you are a woman who is pregnant or breastfeeding, remember that some CAM therapies may affect your fetus or nursing infant.

For More Information

NCCAM Clearinghouse

The NCCAM Clearinghouse provides information on CAM and NCCAM, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

Toll-free in the U.S.: 1-888-644-6226
TTY (for deaf and hard-of-hearing callers): 1-866-464-3615
Web site: nccam.nih.gov
E-mail: info@nccam.nih.gov

PubMed®

A service of the National Library of Medicine (NLM), PubMed contains publication information and (in most cases) brief summaries of articles from scientific and medical journals. CAM on PubMed, developed jointly by NCCAM and NLM, is a subset of the PubMed system and focuses on the topic of CAM.

Web site: www.ncbi.nlm.nih.gov/sites/entrez
CAM on PubMed: nccam.nih.gov/research/camonpubmed/

References

References are primarily recent reviews on the topic of children and adolescents and CAM in the peer-reviewed medical and scientific literature in English in the PubMed database or from Federal Government text.

  • Ang-Lee MK, Moss J, Yuan CS. Herbal medicines and perioperative care. Journal of the American Medical Association. 2001;286(2):208–216.
  • Breuner CC. Complementary medicine in pediatrics: a review of acupuncture, homeopathy, massage, and chiropractic therapies. Current Problems in Pediatric and Adolescent Health Care. 2002;32(10):353–384.
  • Committee on Children with Disabilities, American Academy of Pediatrics. Counseling families who choose complementary and alternative medicine for their child with chronic illness or disability. Pediatrics. 2001;107(3):598–601.
  • Davis MP, Darden PM. Use of complementary and alternative medicine by children in the United States. Archives of Pediatrics and Adolescent Medicine. 2003;157(4):393–396.
  • Ernst E. Serious adverse effects of unconventional therapies for children and adolescents: a systematic review of recent evidence. European Journal of Pediatrics. 2003;162(2):72–80.
  • Gardiner P, Dvorkin L, Kemper KJ. Supplement use growing among children and adolescents. Pediatric Annals. 2004;33(4):227–232.
  • Kemper KJ, Cassileth B, Ferris T. Holistic pediatrics: a research agenda. Pediatrics. 1999;103(4 Pt 2):902-909.
  • Kemper KJ, O'Connor KG. Pediatricians' recommendations for complementary and alternative medical (CAM) therapies. Ambulatory Pediatrics. 2004;4(6):482–487.
  • Sawni-Sikand A, Schubiner H, Thomas RL. Use of complementary/alternative remedies among children in primary care pediatrics. Ambulatory Pediatrics. 2002;2(2):99–103.
  • Sibinga EM, Ottolini MC, Duggan AK, et al. Parent-pediatrician communication about complementary and alternative medicine use for children. Clinical Pediatrics. 2004;43(4):367–373.
  • Wilson KM, Klein JD, Sesselberg TS, et al. Use of complementary medicine and dietary supplements among U.S. adolescents. Journal of Adolescent Health. 2006;38(4):385–394.
  • Woolf AD. Herbal remedies and children: do they work? Are they harmful? Pediatrics. 2003;112(1 Pt 2):240–246.
  • Yussman SM, Ryan SA, Auinger P, et al. Visits to complementary and alternative medicine providers by children and adolescents in the United States. Ambulatory Pediatrics. 2004;4(5):429–435.

This publication is not copyrighted and is in the public domain. Duplication is encouraged.

NCCAM has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your primary health care provider. We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by NCCAM.

NCCAM Publication No. D383
Created May 2007
Updated February 2009


How To Find a Good Alternative Medicine

By Katy Koontz
From Health magazine

Whether you’re getting a deep-tissue massage or trying acupuncture for the first time, picking the right alternative medicine professional is important to your health. Here’s how to pick the right one for you.

  • Ask for referrals from your doctor, local hospital, or medical school.
  • Get a recommendation from a professional organization for the type of practitioner you are looking for. The National Institutes of Health’s Directory of Health Organizations is a good place to start.
  • Call your local health department to find out if your state has a regulatory agency or licensing board for the therapy you’re interested in, and then contact that office for referrals.
  • Check on the training, certification, or other qualifications of your practitioner. See if he or she will speak with you briefly on the phone for this purpose before you make an appointment.
  • Find out how much experience the practitioner has with your health concern and how effective he or she believes this therapy may be for your condition. (Be sure to ask about scientific research, as well.)

Four Things You Didn't Know About Natural Medicine

If natural medicine still sounds too alternative for you, here are four things that may help mainstream the concept for you.

It’s not so “out there”
In addition to the 38 percent of all adults in the United States who have tried natural medicine, nearly 12 percent of children have used complementary and alternative (CAM) therapies. Veterinarians use it on pets, too. “It’s not just the fringe anymore,” says Donald B. Levy, MD, medical director of the Osher Clinical Center for Complementary and Integrative Medical Therapies at Brigham and Women’s Hospital in Boston.

“It’s more widespread.” In fact, CAM is considered standard treatment in many European countries (including Germany, which regulates herbs, and France, where hospitals widely use acupuncture), so sometimes alternative treatments new to the States have already been researched and used for years abroad.

It’s a spa thing
Our strong desire to “heal” ourselves with natural medicine has made alternative therapies hot items at spas and resorts. Some treatments may sound like a wacky mix of the scientific and the spiritual—Crystal Bowl Sound Healing (at Rancho La Puerta Fitness Resort and Spa in Baja California) claims to activate alpha waves in the brain; Spirit Flight treatment (at Miraval in Tucson, Arizona) is touted as a blend of energy medicine, full-body massage, acupuncture, craniosacral therapy, and spinal alignment, along with indigenous ceremonial rituals.

But treatments like these are very popular, and an arm of the National Institutes of Health called the National Center for Complementary and Alternative Medicine (NCCAM) is researching their validity. In fact, you may be able to take part in a clinical trial for an alt med therapy being studied at a university near you. For information, visit the NCCAM’s Web site.

Lots of MDs use it
More than half of U.S. medical schools now include at least some courses in alternative medicine. And the government is pumping more money than ever into research. The current budget for the NCCAM is $121.5 million—that’s 61 times as much as it was in 1992, the year the department was founded.

Many people turn to alt med when conventional therapy doesn’t do the trick, says Richard Nahin, PhD, senior advisor for scientific coordination and outreach at the NCCAM. The number-one concern: relief for chronic pain (in areas like the neck, joints, and lower back).

But adding complementary therapies like supplements (specifically, omega-3 fatty acids found in fish oils), Tai Chi or yoga, mind-body therapies (such as biofeedback), and even spiritual practices (including forgiveness), to conventional medications for heart disease is getting a lot of attention and can lower risk, says Victor Sierpina, MD, chairman of the Consortium of Academic Health Centers for Integrative Medicine.

Some docs use natural products along with prescription medication, Dr. Levy says. For instance, he may suggest that his patients who can’t tolerate migraine medication try Petasites hybridus (butterbur) root to ease the side effects. “It’s the perfect marriage with modern medicine,” he adds.

Insurance may pay for it
Just over 80 percent of employers’ health insurance plans cover chiropractic care, and more than 33 percent cover acupuncture or acupressure. At least 13 percent will pay for massage and nutrition therapy, and 9 percent cover biofeedback.

Contact your state’s insurance department to find out which companies in your area are most alternative-friendly. You may also be able to deduct some alt med treatments as medical expenses on your tax return if you itemize or as eligible expenses for most flexible-spending and health-savings accounts.




Regards,

Samuel Gultom
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