Complementary and Alternative Medicine - Growing Popularity Of Cam, Types Of Cam, Alternative Medicine Systems, Mind-body Interventions

The National Center for Complementary and Alternative Medicine (NCCAM; formerly the Office of Alternative Medicine, established in 1992) is an institute of the National Institutes of Health (NIH). The center was created because consumers of complementary and alternative medicine (CAM) and health care practitioners wanted to know whether available alternative medical options were safe and effective. NCCAM is "committed to the clinical study of promising CAM substances and modalities before knowledge becomes available about their active ingredients, mechanisms of action, stability, and bioavailability," and the organization uses a hierarchy of evidence to determine a method or product's effectiveness and safety. Studies indicate that data on the efficacy and safety of CAM therapies span a continuum ranging from anecdotes and case studies through encouraging information obtained from large, well-developed clinical trials. (See Table 9.1.)

NCCAM defines alternative medicine as "a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine." Although there is some overlap between them, the NCCAM further distinguishes between "complementary," "alternative," and "integrative" medicine in the following manner:

• Alternative medicine is therapy or treatment that is used instead of conventional medical treatment. One example of alternative medicine is the treatment of depression with St. John's wort (hypericum), a botanical, herbal medicine, rather than with conventional antidepressant drugs such as Prozac.
• Complementary medicine is alternative therapy or treatment that is used along with conventional medicine, not in place of it. An example of complementary medicine is the addition of relaxation techniques or movement awareness therapies (such as the Alexander Technique, Pilates, and the Feldenkrais Method) to the traditional approaches of physical and occupational therapy used to rehabilitate people who have had a stroke. Complementary medicine appears to offer health benefits, but there is generally no scientific evidence to support its utility.
• Integrative medicine is the combination of conventional medical treatment and CAM therapies that have been scientifically researched and have demonstrated that they are both safe and effective. An example of integrative medicine is teaching stress management and relaxation techniques to people with high blood pressure and heart disease along with the use of traditional approaches such as weight management, exercise, and prescription drugs to reduce the risks and complications of heart disease.

Despite the classification system outlined by the NCCAM, CAM continues to be known by a variety of names—nontraditional medicine, unorthodox medical practices, and holistic health care—and reflects a wide range of philosophies, including the need for or reliance on scientific evidence of effectiveness. Generally, alternative therapies tend to be untested and unproven, whereas complementary and integrative practices that are used in conjunction with mainstream medicine are often those with a substantial scientific basis of demonstrated safety and efficacy.