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

ill, or neurotic (30, 31, 33, 34). Instead, several salient beliefs and attitudes motivating CAM and 

characterizing CAM users can be identified. 

PRAGMATISM 

For the majority of patients, the choice to use unorthodox methods is largely pragmatic. They have a 

chronic disease for which orthodox medicine has been incomplete or unsatisfactory. Thus, we see many 

patients with chronic pain syndromes (low back pain, fibromyalgia, arthritis) or chronic and frequently fatal 

diseases (cancer, AIDS) seeking out CAM for supportive care (2, 30, 30a). An underlying characteristic of 

all of these conditions is that a specific cause of the disease either is unknown or cannot be stopped. 

Medical approaches did not work well with these conditions. Many CAM systems offer supportive care 

under these circumstances rather than addressing specific causes. 

HOLISM 

CAM users are attracted to certain philosophies and health beliefs (31). In medicine, this philosophy is 

reflected in the desire for a “holistic” approach to the patient. In reality, all therapy, whether conventional 

or alternative, is holistic in the sense that the whole person always responds. Any intervention–drugs, 

surgery, psychotherapy, acupuncture, or herbal treatments–affects the entire body and mind. For patients, 

holism often means attending to the psychosocial aspects of illness. CAM practitioners spend more time 

addressing psychosocial issues, leaving patients more satisfied than with their visits 

 

 

to conventional practitioners (35). This perspective also emphasizes using health enhancement in the 

treatment of the disease, and being proactive in addressing early warning and life style factors that put 

patients at risk (36, 36a). 

LIFE STYLE 

The emphasis on health promotion as an integral part of disease treatment is part of almost all CAM 

systems. Most of these systems use similar health enhancement approaches that cover five basic areas. 

These five areas are: a) stress  management; b) spirituality and meaning issues (37); c) dietary and 

nutritional counseling; d) exercise and fitness; and e) addiction or habit management (especially tobacco 

and alcohol use) (38, 38a). All major CAM systems (and increasingly conventional approaches) make 

these areas primary in disease treatment (see chapters in PART III). Many patients find that the more they 

incorporate these activities into their lives, the less difficulty they have in managing chronic disease no 

matter what the cultural orientation (38, 38a and 39). 

SPIRITUALITY 

There is a surge of interest in the role of religion and spirituality in medical practice, research, and 

education (39a). The concept of “holism” often takes on the language of spirituality, in which patients seek 

a greater meaning in their suffering than is offered in conventional medicine (39b). Most CAM systems 

address spirituality and the meaning of suffering directly. Often they have their own special concepts and 

terms for how healing relates to the inner and outer forces of the spirit. Tibetan medicine (Chapter 14) and 

Native American medicine (Chapter 13) illustrate this most clearly. In anthroposophically-extended 

medicine, physicians receive conventional training and then get special instruction aimed at developing 

intuitive and spiritual sensitivity. 

HEALING 

When a specific cause is the dominant factor in an illness, it makes sense to direct a therapy toward that 

factor and then attempt to minimize the side effects of therapy. If a patient has an upper respiratory tract 

infection (URI) that develops into bacterial meningitis, for example, the healing action of the body has 

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been overwhelmed by the cause, and the only hope of recovery is to eliminate the bacteria with high-dose 

antibiotics. However, if the URI becomes a chronic sinus problem, in which the efforts of the body are the 

dominant factor in the illness complex, a drug must  act on the person to enhance (by stimulation or 

support) those self-healing efforts. Approaches for st imulating the immune system (e.g., acupuncture or 

herbs) or supporting auto-regulatory mechanisms (e.g., rest, fluids, dietary changes, relaxation and 

imagery) may be preferred. Most CAM systems aim to enhance the body's healing efforts but may not 

address a known cause. This characteristic of CAM is attractive to patients (40). 

ADVERSE EFFECTS OF CONVENTIONAL THERAPIES 

Patients are also concerned about the side effects of conventional medicine. Approximately 10% of 

hospitalizations are due to iatrogenic factors (41), and properly delivered conventional treatments are the 

sixth leading cause of death in the West (42). There is a perception among patients that orthodox 

treatments are too harsh, especially when used over long periods for chronic disease (43) and that CAM 

treatments are safer. Some interest in CAM is based on the myth that “natural” is somehow inherently 

safer than conventional medicine–an idea that is certainly not true (44, 45). Another misconception is that 

avoiding “harsh” orthodox treatments will result in better quality of life. This is also not necessarily true. 

For example, Cassileth showed that patients who underwent chemotherapy compared with those who 

underwent a dietary and life style treatment for cancer actually had slightly better quality of life scores 

(46). 

COSTS 

Concern over the escalating costs of conventional health care is another reason for the interest in CAM. 

Control of health care costs by improving efficiency in delivery and management of health care services 

has reached a maximum, and costs are expected to double in the 

 

 

next 10 years (47). Many developing countries are realizing that access to and affordability of conventional 

medicine are impossible for their population and that lower-cost, “traditional” medical approaches need to 

be developed (47a). Approaches that attempt to induce auto-regulation and self-healing and that rely on 

life style and self-care approaches may reduce such costs (39, 48). 

THE DEMOCRATIZATION OF MEDICINE 

Several other social factors also influence the increasing interest in CAM. These include the rising 

prevalence of chronic disease with aging; increased access  to health information in the media and over the 

Internet; and a declining faith that scientific breakthroughs will have relevant benefits for personal health; 

(49). An especially salient factor has been the “democratization” and “consumerization” of medical 

decision making (12, 50). The explosion of readily available information for the consumer and the ability to 

experience diverse cultures around the world have accelerated this process. Increasingly, patients wish to 

be active participants in their health care decisions. This participation includes evaluating information 

about treatment options, accessing products and practices that enable them to explore those options, and 

engaging in activities that may help them remain healthy (5a). 

CAM AND STANDARDS OF EVIDENCE 

New standards may be needed for the examination of both unconventional and conventional medicine (51, 

54). Historically, medical science has benefited from the development of new methodologies, such as 

blinding and randomization which are first applied to unorthodox practices before being adopted as 

standards for all medicine (51, 52 and 53). 

Humans seem to have an infinite capacity to fool themselves and are constantly making spurious claims of 

truth, postulating unfounded explanations, and ignoring or denying the reality of observations they cannot 

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