## BACKGROUND

According to the World Health Organization, between 65% and 80% of the world’s health care services are classified as traditional medicine. These practices become relabeled as complementary, alternative, or unconventional medicine when they are used in Western countries. In April 1995, a panel of experts, convened at the National Institutes of Health (NIH), defined complementary and alternative medicine (CAM) as “a broad domain of healing resources that encompasses all health systems, modalities, practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period.” Similar definitions have been used since then by other organizations. Surveys of CAM use by the public and health professionals have defined it as those practices used for the prevention and treatment of disease that are not an integral part of conventional care, and are neither taught widely in medical schools nor generally available in hospitals. Table 50-1 lists the major types and domains of complementary and alternative medicine, while recognizing that there can be some overlap, adapted from the National Center for Complementary and Alternative Medicine (NCCAM) at NIH.

Table 50–1.Complementary and alternative medicine (CAM) systems of healthcare, therapies, or products.

### A. Use of Complementary and Alternative Medicine

Practices that lie outside the mainstream of “official” or current conventional medicine have always been an important part of the public’s management of their personal health. Complementary, alternative, and unconventional medicine has become increasingly popular in the United States. Two identical surveys of unconventional medicine use in the United States, done in 1990 and 1996, showed a 45% increase in use of CAM by the public. Visits to CAM practitioners increased from 400 million to >600 million per year. The amount spent on these practices rose from $14 billion to$27 billion—most of it not reimbursed. Recent data from the National Health Interview Survey (NHIS) have increased this estimate to \$33.9 billion. Professional organizations are now beginning the “integration” of these practices into mainstream medicine. In 2007, the number of those using CAM was similar between 1997 and 2002, ...

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