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Various terms have been used to describe a broad range of healing approaches that are not widely taught in medical schools, not generally available in hospitals, and not routinely reimbursed by medical insurance. Many of these approaches have their roots in nonwestern cultures. Others have developed within the west, but outside what is considered conventional medical practice. Complementary and alternative medicine (CAM) is the name chosen by the National Institutes of Health for these healing approaches.

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Classification of CAM Modalities

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The National Institutes of Health National Center for Complementary and Alternative Medicine (NCCAM) classifies CAM modalities under five domains (see Table 30–1).

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Table 30–1. NCCAM classification of CAM.
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The authors gratefully acknowledge Dr. Bernard Lo for his valuable input in the preparation of this manuscript.

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Who Seeks CAM & Why?

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Nearly half the U.S. population turns to complementary and alternative practices to maintain or improve their health. The total number of visits to CAM practitioners actually exceeds the total number of visits to primary care physicians each year. CAM is attractive to many people because it treats the "whole person" (body, mind, and spirit), emphasizes health promotion/prevention, and values the uniqueness of each individual. Independent predictors of CAM use in one survey included higher level of education, poorer health status, and a "holistic" interest in health, personal growth, and spirituality. People with conditions such as anxiety and chronic pain were also more likely to have used CAM in the previous year. Dissatisfaction with conventional medicine is not an independent predictor of greater use, so it appears that patients are more "pulled toward" CAM rather than "pushed away" from conventional medicine.

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Epidemiology of Herbal Medicine Use

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More than 39 million Americans take dietary supplements on a weekly basis. Twenty-five percent of patients who take prescription medicines also take at least one nonvitamin dietary supplement. Many are drawn to herbal products because they appear "safe and natural." Regular users hold strong beliefs about what they take. In one survey, more than 70% reported that they would continue to take their favorite supplement, even if there were government research data that indicated it was not effective!

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In 1994, Congress passed the Dietary Supplement Health and Education Act (DSHEA), which limited regulatory control over botanicals. DSHEA classifies herbs, vitamins, minerals, and amino acids as nutritional or dietary supplements. It allows these products to be ...

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