13.6: Alternative Medical Practices

Complementary and alternative medicine (CAM) is the term for medical products and practices that are not part of standard care. Standard care is what medical doctors, doctors of osteopathy and allied health professionals, such as registered nurses and physical therapists, practice. Alternative medicine means treatments that you use instead of standard ones. Complementary medicine means nonstandard treatments that you use along with standard ones. Examples of CAM therapies are acupuncture, chiropractic and herbal medicines.

The claims that CAM treatment providers make about their benefits can sound promising. However, researchers do not know how safe many CAM treatments are or how well they work. Studies are underway to determine the safety and usefulness of many CAM practices.

What Is Complementary and Alternative Medicine?

Many Americans use complementary and alternative medicine (CAM) in pursuit of health and well-being. The 2007 National Health Interview Survey (NHIS), which included a comprehensive survey of CAM use by Americans, showed that approximately 38 percent of adults use CAM.

Defining CAM

Defining CAM is difficult, because the field is very broad and constantly changing. NCCAM defines CAM as a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. Conventional medicine (also called Western or allopathic medicine) is medicine as practiced by holders of M.D. (medical doctor) and D.O. (doctor of osteopathic medicine) degrees and by allied health professionals, such as physical therapists, psychologists, and registered nurses. The boundaries between CAM and conventional medicine are not absolute, and specific CAM practices may, over time, become widely accepted.

"Complementary medicine" refers to use of CAM together with conventional medicine, such as using acupuncture in addition to usual care to help lessen pain. Most use of CAM by Americans is complementary. "Alternative medicine" refers to use of CAM in place of conventional medicine. "Integrative medicine" combines treatments from conventional medicine and CAM for which there is some high-quality evidence of safety and effectiveness. It is also called integrated medicine.

Types of CAM

CAM practices are often grouped into broad categories, such as natural products, mind and body medicine, and manipulative and body-based practices. Although these categories are not formally defined, they are useful for discussing CAM practices. Some CAM practices may fit into more than one category.

Natural Products

This area of CAM includes use of a variety of herbal medicines (also known as botanicals), vitamins, minerals, and other "natural products." Many are sold over the counter as dietary supplements. (Some uses of dietary supplements—e.g., taking a multivitamin to meet minimum daily nutritional requirements or taking calcium to promote bone health—are not thought of as CAM.)

CAM "natural products" also include probiotics—live microorganisms (usually bacteria) that are similar to microorganisms normally found in the human digestive tract and that may have beneficial effects. Probiotics are available in foods (e.g., yogurts) or as dietary supplements. They are not the same thing as prebiotics — nondigestible food ingredients that selectively stimulate the growth and/or activity of microorganisms already present in the body.

Interest in and use of CAM natural products have grown considerably in the past few decades. The 2007 NHIS found that 17.7 percent of American adults had used a nonvitamin/nonmineral natural product. These products were the most popular form of CAM among both adults and children. The most commonly used product among adults was fish oil/omega 3s (reported by 37.4 percent of all adults who said they used natural products); popular products for children included echinacea (37.2 percent) and fish oil/omega 3s (30.5 percent).

Figure \(\PageIndex{1}\). NIH

Mind and Body Medicine

Mind and body practices focus on the interactions among the brain, mind, body, and behavior, with the intent to use the mind to affect physical functioning and promote health. Many CAM practices embody this concept—in different ways.

• Meditation techniques include specific postures, focused attention, or an open attitude toward distractions. People use meditation to increase calmness and relaxation, improve psychological balance, cope with illness, or enhance overall health and well-being.
• The various styles of yoga used for health purposes typically combine physical postures, breathing techniques, and meditation or relaxation. People use yoga as part of a general health regimen, and also for a variety of health conditions.
• Acupuncture is a family of procedures involving the stimulation of specific points on the body using a variety of techniques, such as penetrating the skin with needles that are then manipulated by hand or by electrical stimulation. It is one of the key components of traditional Chinese medicine, and is among the oldest healing practices in the world.

Other examples of mind and body practices include deep-breathing exercises, guided imagery, hypnotherapy, progressive relaxation, qi gong, and tai chi.

Historical note: The concept that the mind is important in the treatment of illness is integral to the healing approaches of traditional Chinese medicine and Ayurvedic medicine, dating back more than 2,000 years. Hippocrates also noted the moral and spiritual aspects of healing and believed that treatment could occur only with consideration of attitude, environmental influences, and natural remedies.

Current use: Several mind and body approaches ranked among the top 10 CAM practices reported by adults in the 2007 NHIS. For example, the survey found that 12.7 percent of adults had used deep-breathing exercises, 9.4 percent had practiced meditation, and 6.1 percent had practiced yoga; use of these three CAM practices had increased significantly since the previous (2002) NHIS. Progressive relaxation and guided imagery were also among the top 10 CAM therapies for adults; deep breathing and yoga ranked high among children. Acupuncture had been used by 1.4 percent of adults and 0.2 percent of children. Acupuncture is considered to be a part of mind and body medicine, but it is also a component of energy medicine, manipulative and body-based practices, and traditional Chinese medicine.

Manipulative and Body-Based Practices

Manipulative and body-based practices focus primarily on the structures and systems of the body, including the bones and joints, soft tissues, and circulatory and lymphatic systems. Two commonly used therapies fall within this category:

• Spinal manipulation is performed by chiropractors and by other health care professionals such as physical therapists, osteopathic physicians, and some conventional medical doctors. Practitioners use their hands or a device to apply a controlled force to a joint of the spine, moving it beyond its passive range of motion; the amount of force applied depends on the form of manipulation used. Spinal manipulation is among the treatment options used by people with low-back pain - a very common condition that can be difficult to treat.
• The term massage therapy encompasses many different techniques. In general, therapists press, rub, and otherwise manipulate the muscles and other soft tissues of the body. People use massage for a variety of health-related purposes, including to relieve pain, rehabilitate sports injuries, reduce stress, increase relaxation, address anxiety and depression, and aid general well-being.

Other CAM Practices

CAM also encompasses movement therapies—a broad range of Eastern and Western movement-based approaches used to promote physical, mental, emotional, and spiritual well-being. Examples include Feldenkrais method, Alexander technique, Pilates, Rolfing Structural Integration, and Trager psychophysical integration. According to the 2007 NHIS, 1.5 percent of adults and 0.4 percent of children used movement therapies.

Practices of traditional healers can also be considered a form of CAM. Traditional healers use methods based on indigenous theories, beliefs, and experiences handed down from generation to generation. A familiar example in the United States is the Native American healer/medicine man. The 2007 NHIS found that 0.4 percent of adults and 1.1 percent of children had used a traditional healer (usage varied for the seven specific types of healers identified in the survey).

Some CAM practices involve manipulation of various energy fields to affect health. Such fields may be characterized as veritable (measurable) or putative (yet to be measured). Practices based on veritable forms of energy include those involving electromagnetic fields (e.g., magnet therapy and light therapy). Practices based on putative energy fields (also called biofields) generally reflect the concept that human beings are infused with subtle forms of energy; qi gong, Reiki, and healing touch are examples of such practices. The 2007 NHIS found relatively low use of putative energy therapies. Only 0.5 percent of adults and 0.2 percent of children had used energy healing/Reiki (the survey defined energy healing as the channeling of healing energy through the hands of a practitioner into the client's body).

Finally, whole medical systems, which are complete systems of theory and practice that have evolved over time in different cultures and apart from conventional or Western medicine, may be considered CAM. Examples of ancient whole medical systems include Ayurvedic medicine and traditional Chinese medicine. More modern systems that have developed in the past few centuries include homeopathy and naturopathy. The 2007 NHIS asked about the use of Ayurveda, homeopathy, and naturopathy. Although relatively few respondents said they had used Ayurveda or naturopathy, homeopathy ranked 10th in usage among adults (1.8 percent) and 5th among children (1.3 percent).

Health Fraud

You have probably seen ads for miracle cures - a supplement to cure cancer, a diet to cure diabetes. But remember - if it sounds too good to be true, then it probably is. Health fraud involves selling drugs, devices, foods or cosmetics that have not been proven effective. At best, these scams don't work. At worst, they're dangerous. They also waste money, and they might keep you from getting the treatment you really need. Health scams often target older people. Most victims in the United States are older than 65.

To protect yourself

• Question claims of miracle cures or breakthroughs
• Know that newspapers, magazines, and radio and TV stations do not have to make sure that the ads they run are true
• Find out about products before you buy them
• Don't let salespeople force you into making snap decisions
• Check with your doctor before taking products

Beware of Health Scams

You see the ads everywhere these days — “Smart Drugs” for long life or “Arthritis Aches and Pains Disappear Like Magic!” or even statements claiming, “This treatment cured my cancer in 1 week.” It’s easy to understand the appeal of these promises. But there is still plenty of truth to the old saying, “If it sounds too good to be true, it probably is!”

Health scams and the marketing of unproven cures have been around for many years. Today, there are more ways than ever to sell these untested products. In addition to TV, radio, magazines, newspapers, infomercials, mail, telemarketing, and even word-of-mouth, these products are now offered over the Internet—with websites describing miracle cures and emails telling stories of overnight magic. Sadly, older people are often the target of such scams.

The problem is serious. Untested remedies may be harmful. They may get in the way of medicines prescribed by your doctor. They may also waste money. And, sometimes, using these products keeps people from getting the medical treatment they need.

False Hopes

Why do people fall for these sales pitches? Unproven remedies promise false hope. They offer cures that appear to be painless or quick. At best, these treatments are worthless. At worst, they are dangerous. Health scams prey on people who are frightened or in pain. Living with a chronic health problem is hard. It’s easy to see why people might fall for a false promise of a quick and painless cure. The best way for scientists to find out if a treatment works is through a clinical trial.

These scams usually target diseases that have no cures, like diabetes, arthritis, and Alzheimer’s disease.

How Can You Protect Yourself From Health Scams?

Be wary. Question what you see or hear in ads or on the Internet. Newspapers, magazines, radio, and TV stations do not always check to make sure the claims in their ads are true. Find out about a product before you buy. Don’t let a salesperson talk you into making a snap decision. Check with your healthcare provider first.

• Promise a quick or painless cure
• Claim the product is made from a special, secret, or ancient formula
• Offer products and services only by mail or from one company
• Use statements or unproven case histories from so-called satisfied patients
• Claim to be a cure for a wide range of ailments
• Claim to cure a disease (such as arthritis or Alzheimer’s disease) that hasn’t been cured by medical science
• Promise a no-risk, money-back guarantee
• Offer an additional “free” gift or a larger amount of the product as a “special promotion”
• Require advance payment and claim there is a limited supply of the product