Medicine, once the domain of solitary generalists and their nurse assistants, now engages scores of specialists and allied professionals—radiation physicists, cytologists, nurse practitioners, psychiatric social workers, dental hygienists, and many more—who wield tools of unprecedented ability to extend life and sustain its quality. This evolution of the health care system has been achieved in part by a formidable enterprise of critical observation and formal investigation that disproves some accepted practices and stimulates the emergence of new approaches. One need only peruse the serial editions of this textbook to comprehend the scope of these changes.
Other factors also have affected evolutionary changes in medicine. The U.S. health care system has always been pluralistic, including many practices that are outside mainstream medicine. The public's expectations of health and the nature of the health care system have been altered by unprecedented access to sources of information, goods, and services; the disposable income to afford them; and a patchwork quilt of regulations and laws that constrain medical practice on the one hand and facilitate increased choice in health care on the other. Immigration and related demographic changes have created diverse communities that value their own health traditions. The emergence of complementary and alternative health practices and the approach called integrative medicine are manifestations of these changes in health care.
Complementary and alternative medicine (CAM) refers to a group of diverse medical and health care systems, practices, and products that are not considered part of conventional or allopathic medicine or that have historic origins outside mainstream medicine. Most of these practices are used together with conventional therapies and therefore have been called complementary to distinguish them from alternative practices, which are those used instead of standard care. Use of dietary supplements, mind-body practices such as hypnosis, and care from a traditional healer all fall under the umbrella of CAM. Although some CAM practices are directed by an alternative health care provider such as a chiropractor, acupuncturist, or naturopathic practitioner, much of CAM is undertaken as "self-care" and paid for out of pocket. CAM does not encompass practices that have not been translated fully from the laboratory to the clinic or practices that have been well studied and disproved but still have some public appeal. Rather, CAM entails approaches with surprising pervasiveness, many of which can claim at least some evidentiary support. Until a few years ago, CAM also could be defined as practices that are neither widely taught in medical schools nor reimbursed, but this definition is no longer useful, since medical students increasingly seek and receive some instruction about CAM and some CAM practices are reimbursed by third-party payers. Definitions of common CAM practices are provided in Table e2-1.
Table e2-1 Terminology of Complementary and Alternative Medical Practices
| Save Table
Table e2-1 Terminology of Complementary and Alternative Medical Practices
|Mind-Body and Manipulative Practices|
|Acupuncture and acupressure||A family of procedures involving stimulation of defined anatomic points, a component of the major Asian medical traditions. Most common application involves the insertion and manipulation of thin metallic needles|
|Alexander technique||A movement therapy that uses guidance and education to improve posture, movement, and efficient use of muscles for improvement of overall body functioning|
|Guided imagery||The use of relaxation techniques followed by the visualization of images, usually calm and peaceful in nature, to invoke specific images to alter neurologic function or physiologic states|
|Hypnosis||The induction of an altered state of consciousness characterized by increased responsiveness to suggestion|
|Massage||Manual therapies that manipulate muscle and connective tissues to promote muscle relaxation, healing, and sense of well-being|
|Meditation||A group of practices, largely based in Eastern spiritual traditions, intended to focus or control attention and obtain greater awareness of the present moment, or mindfulness|
|Reflexology||Manual stimulation of points on hands or feet that are believed to affect organ function|
|Rolfing/structural integration||A manual therapy that attempts to realign the body by deep tissue manipulation of fascia|
|Spinal manipulation||A range of manual techniques, employed by chiropractors and osteopaths, for adjustments of the spine to affect neuromuscular function and other health outcomes|
|Tai chi||A mind-body practice originating in China that involves slow, gentle movements and sometimes is described as "moving meditation"|
|Therapeutic touch||Secular version of the laying on of hands, described as "healing meditation"|
|Yoga||An exercise practice, originally east Indian, that combines breathing exercises, physical postures, and meditation|
|Traditional Medical Systems|
|Ayurvedic medicine||The major East Indian traditional medicine system. Treatment includes meditation, diet, exercise, herbs, and elimination regimens (using emetics and diarrheals)|
|Curanderismo||A spiritual healing tradition common in Latin American communities that uses ritual cleansing, herbs, and incantations|
|Native American medicine||Diverse traditional systems that incorporate chanting, shaman healing ceremonies, herbs, laying on of hands, and smudging (ritual cleansing with smoke from sacred plants)|
|Siddha medicine||An East Indian medical system (prevalent among Tamil-speaking people)|
|Tibetan medicine||A medical system that uses diagnosis by pulse and urine examination; therapies include herbs, diet, and massage|
|Traditional Chinese medicine||A medical system that uses acupuncture, herbal mixtures, massage, exercise, and diet|
|Unani medicine||An East Indian medical system, derived from Persian medicine, practiced primarily in the Muslim community; also called "hikmat"|
|"Modern" Medical Systems|
|Anthroposophic medicine||A spiritually based system of medicine that incorporates herbs, homeopathy, diet, and a movement therapy called eurythmy|
|Chiropractic||Chiropractic care involves the adjustment of the spine and joints to alleviate pain and improve general health; primarily used to treat back problems, musculoskeletal complaints, and headaches|
|Homeopathy||A medical system with origins in Germany that is based on a core belief in the theory of "like cures like"—compounds that produce certain syndromes, if administered in very diluted solutions, will be curative|
|Naturopathy||A clinical discipline that emphasizes a holistic approach to the patient, herbal medications, diet, and exercise. Practitioners have degrees as doctors of naturopathy|
|Osteopathy||A clinical discipline, now incorporated into mainstream ...|
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