Essentials of. Complementary and. Alternative. Medicine eBook-een

mainstream medicine. Over seventy-five medical schools have courses on CAM ( 3), hospitals are 

developing complementary and integrated medicine programs, health insurers are offering “expanded” 

benefits packages that include alternative medicine serv ices (4), and biomedical research organizations 

are investing more into the investigation of these practices (5). The American Medical Association recently 

devoted an entire issue of each of their journals to CAM. 

This rising interest in CAM reflects not only changing behaviors, but also changing needs and values in 

modern society. This includes changes in the psychosocial determinants of CAM use; the “normalization” 

of users over time; concepts of the body; the relationship among the growing “fitness ” movement, aging 

“baby boomers,” and CAM; and the nature of both the therapeutic relationship and the health care 

preferences. Many complementary health care practices diffuse throughout society through health 

“networks” that increasingly determine therapeutic choices (5a). 

Of note is that CAM practices, like most conventional practices, are adopted and normalized long before 

scientific evidence has established their safety and efficacy. A key difference in how this occurs, however, 

is that in conventional practice, procedures are usually introduced by professionalized bodies or industries 

rather than by the public (6). Adoption in complementary medicine has occurred in the opposite direction: 

the public adopts and seeks out these practices first, and health care professions and industries follow. 

This says something about the changing nature of public preferences and professional responsiveness to 

those preferences. It also predicts that new “unconventional” practices will arise in the future as current 

CAM groups become more “professionalized” themselves and are adopted into the mainstream. Thus, we 

will always need ways of addressing alternative practices responsibly. 

 

 

Responding to CAM 

The prominence and definition of unorthodox practices varies from generation to generation. With the 

development of scientific medicine and advances in treatment of acute and infectious disease in this 

century, interest in alternatives largely subsided. As the limitations of conventional medicine have become 

more obvious, interest in alternatives has risen. The medical and scientific response to claims of efficacy 

outside official medicine has a distinct pattern (7). Initially, orthodox groups either ignore these practices 

or attempt to undermine and suppress them by making them hard to access, by labeling them as quackery 

or pseudo-scientific, and by disciplining those that use them (8, 9 and 10). Later, if the influence of these 

practices grows, the mainstream community begins to examine them, find similarities with what they 

already do, and selectively adopt practices into conventional medicine that easily fit (8, 9) (see also 

Chapter 1). Once these concepts are “integrated,” the groups that originally held them are then considered 

mainstream, and those left on the fringes are again ignored and persecuted until their influence rises. This 

pattern of wholesale marginalization, followed by rapid but selective adoption, results in almost continual 

conflict between differing “camps ” and wide fluctuations in resources and attention devoted to these 

areas–producing what Thomas Kuhn called “revolutions” in science and medicine (10). 

How can the mainstream scientific and medical  community responsibly address the “unofficial,” 

“unorthodox,” “fringe,” and “alternative” on a less erratic, more regular, and more rational basis? Any 

approach must not completely ignore or attempt to elim inate important values, concepts, and activities that 

alternatives have to offer. At the same time it must  not throw open medicine to dangerous practices that 

compromise the desirable quality and ethical and scientific standards in the conventional world. Any such 

process must create a space and provide resources whereby unconventional concepts and claims can 

officially be explored, developed, and accommodated. Given the diversity of concepts, languages, and 

perceptions about reality that these various systems hold, this process must intentionally incorporate 

methods for conflict resolution, knowledge management, and transparency (11, 12). Such a process must 

first systematically explore the reasons for alternative practices. It must then seek out the common, 

underlying concepts upon which change in both alternative and conventional practices can be based. 

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WHY IS THERE INCREASING INTEREST IN CAM? 

The Potential Benefits of CAM 

Many CAM practices have value for the way their practitioners manage health and disease. However, most 

of what is known about these practices comes from small clinical trials. For example, there is research 

showing the benefit of herbal products such as ginkgo biloba for improving dementia due to circulation 

problems (13) and possibly Alzheimer's (14); saw palmetto and other herbal preparations for treating 

benign prostatic hypertrophy (15, 16); and garlic for preventing heart disease (17). Over 24 placebo-

controlled trials have been done with hypericum (St. John's wort) and have shown that it effectively treats 

depression. For mild to moderate depression, hypericum appears to be equally effective as conventional 

antidepressants, yet produces fewer side effects and costs less (18). The scientific quality of many trials, 

however, is poor. 

As credible research continues on CAM, expanded options for managing clinical conditions will arise. In 

arthritis, for example, there are  controlled trials reporting improvement with homeopathy (19), acupuncture 

(20), vitamin and nutritional supplements ( 21), botanical products ( 22, 23), diet therapies (24), mind–body 

approaches (25), and manipulation (26). Collections of (mostly small)  studies exist for many other 

conditions, such as heart disease, depression, asthma, and addictions. The Cochrane Collaboration (with 

assistance from the 

 

 

Research Council for Complementary Medicine in the United Kingdom) provides a continually updated list 

of randomized controlled trials in CAM. A summary of the number of controlled trials currently in that 

database by condition and modality is in Appendix (B) of this book. The database in available online 

through the NCCAM webpage and through the Cochrane Collaboration (see Chapter 5). With increasingly 

better research, more options and more rational and optimal CAM treatments can be developed. A 

diversity of credible approaches to disease is something that the public increasingly seeks (5a, 7). 

The Potential Risks of CAM 

Safety concerns of unregulated products and practices are also an important area for concern. Despite the 

presence of potential benefits, the amount of research on CAM systems and practices is nonetheless quite 

small when compared with conventional medicine. For example, there are more than 20,000 randomized 

controlled trials cited in the National Library of  Medicine's bibliographic database, MEDLINE, on 

conventional cancer treatments, but only about 50 on alternative cancer treatments. As public use of CAM 

increases, limited information on the safety and efficacy of most CAM treatments creates a potentially 

dangerous situation. Although practices such as acupuncture, homeopathy, and meditation are low-risk, 

they must be used by fully competent and licensed practitioners to avoid inappropriate application (27). 

Herbs, however, can contain powerful pharmacological substances that can be toxic and produce herb–

drug interactions (28). Some of these products may be contaminated and made with poor quality control, 

especially if shipped from Asia and India (29). 

Reasons for Supplementary Role of CAM 

Patients use CAM practices for a variety of reasons. For example, use of alternative therapies may be 

normative behavior in their social networks; they may be dissatisfied with conventional care; and they may 

be attracted to CAM philosophies and health beliefs (5a, 30, 31). The overwhelming majority of those who 

use unconventional practices do so along with conventional medicine (32), thus corresponding to the 

implicit ideal of the phrase “complementary medicine.” CAM is truly “alternative”–that is, used exclusively–

for less than 5% of the population (31). Further, contrary to some opinions within conventional medicine, 

studies have found that patients who use CAM do not generally do so because of antiscience or 

anticonventional-medicine sentiment, nor because they are disproportionately uneducated, poor, seriously 

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