Complementary and alternative medicine

The emphasis on this page is on the scientific, legal and practitioner issues. For an overview of the philosophical and cultural dimensions, see also Alternative medicine (theories).

Alternative medicine is a set of therapies that are considered whole systems of healthcare that operate outside the realm of mainstream healthcare in the Western world — literally, they consider themselves alternatives to mainstream medicine. Complementary medicine is comprised of those systems, or parts of systems, that are used in conjunction with the mainstream. Since some techniques may be found both in whole and complementary systems, it is convenient to speak of complementary and alternative medicine (CAM) as one broad field. Many of these systems predate modern scientific methods and some, particularly the eastern therapies, stem from well before the time of Hippocrates. Some of these practices include acupuncture, homeopathy, herbal medicine, spiritual therapies, chiropractic, and prayer. Integrative medicine deals with the optimal combination of mainstream and complementary medicine.

Conventional, biologically-based medicine is not inherently critical of CAM, as some alternatives show as much efficacy as conventional methods, certainly for specific indications. Physicians do express concerns over whole systems whose patients have not first been evaluated by medically trained physicians for fear that this might delay proper treatment for conditions that are not sufficiently assessed. They also suggest that therapists may either not identify dangerous conditions that are treatable by conventional medicine, such that the patient does not have the information to decide to give informed consent to alternative treatment alone. Another aspect of that concern is that some conditions can respond to mainstream medical treatment early in the process, but delay of diagnosis could put the patient in a situation where the conventional treatment would no longer be effective.

As the term integrative medicine comes into wider use, its advocates consider it

the very best of conventional medicine and cutting-edge diagnosis and treatment, with appropriate complementary therapies. Whenever possible, it favors the use of low-tech, low-cost interventions. All factors that affect health, wellness, and disease are considered, including the psychosocial and spiritual dimensions of a person's life. It brings patients and caregivers into a partnership to achieve the patient's optimal health and healing."

Integrative medicine does assume that all techniques used, mainstream or complementary, will be evidence-based, and with full information sharing to avoid dangerous interactions or missed diagnoses. As in the Johns Hopkins example, the terminology can get confusing, when an integrative center speaks of "alternative programs", which are not synonymous with "alternative medicine".

Lack of integration

All too often,patients today see both conventional and CAM practitioners, with the patient perhaps not mentioning one type of therapist to the other. In integrative medicine, there is active consultation among the various practitioners and the patient. Integrative medicine also includes nurses, whose training emphasizes managing chronic diseases (e.g., compliance with monitoring and medicine), encouraging healthy lifestyles, and providing continuity.

Integrative medicine reduces some of the concerns that physicians have with patients who self-refer to practitioners of what are indeed complementary techniques, but which might interact with other treatments if all the prescribers are not aware of everything being done. Indeed, one of the challenges of many primary care physicians is simply to find out all the drugs their patients are taking, prescribed by different physician specialists who do not share information.

While some conventional physicians will reject any complementary method for which they do not know the exact mode of action, integrative medicine assumes teams of mainstream and complementary (but not whole system) practitioners. For example, it is quite common for pain medicine specialists to use complementary methods.

Simply to serve as an example that evidence-based methods can deal with complementary techniques, a 1997 NIH Consensus Conference on Acupuncture found evidence for its use for the nausea of cancer chemotherapy, NIH does put a caveat on all of its consensus statements that are more than five years old:

This statement is more than five years old and is provided solely for historical purposes. Due to the cumulative nature of medical research, new knowledge has inevitably accumulated in this subject area in the time since the statement was initially prepared. Thus some of the material is likely to be out of date, and at worst simply wrong.

Classification of CAM

To begin a discussion, it is necessary to define the scope of the problem. The table below is derived from one created by the U.S. National Center for Complementary and Alternative Medicine.

Major field and Description	Subfield	Subfield
Whole Medical Systems comprise 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. These are usually alternative rather than complementary.	Western systems include homeopathy and naturopathy	Non-western systems include classical traditional Chinese medicine and ayurveda
Mind-Body Medicine uses a variety of techniques designed to enhance the mind's capacity to affect bodily function and symptoms. Some of the "still considered CAM" techniques are more and more accepted.	Accepted as mainstream (not strictly CAM) include patient support groups and cognitive-behavioral therapy	Still considered CAM include meditation, visualization, and relaxation (physiology) techniques; eye motion desensitization reprocessing; spiritual therapies, mental healing, and creative outlets such as art therapy, music therapy and dance
Biologically based practices in CAM use substances found in nature, such as medicinal herbs (i.e., phytotherapy), diet therapy, pharmacologic doses of vitamins, essential oils, and dietary supplements. An example of an unproven method is using shark cartilage to treat cancer.
Manipulative and Body-Based Practices involve the controlled use of force against parts of the body, or maneuvers that move body parts out of their usual range of motion. These may be used as whole systems or as complementary methods. They include osteopathic manipulation, massage therapy, chiropractic, reflexology, and methods involving movement or posture instruction.
Energy Medicine breaks into therapies that use forces that are, and are not, detectable with conventional scientific instrumentation.	Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields, or alternating-current or direct-current fields.	Biofield therapies are intended to affect energy fields that purportedly surround and penetrate the human body. These include qi gong (part of traditional Chinese medicine), reiki, and therapeutic touch