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Complementary and alternative medicine (CAM) modalities constitute a diverse group of consumer-driven medical and health care practices outside the realm of conventional medicine, which are yet to be validated using scientific methods. Considered as such, CAM practices are ever changing. Most CAM use is complementary, that is, as an adjunct to conventional practices, and only a minority is used as an alternative to mainstream medical care. A main tenet of CAM therapy is that it stimulates and strengthens the body's own natural defense systems to prevent and treat diseases. Thus, elderly as well as nonelderly individuals use CAM practices with the hope of improving wellness and for relief of symptoms attributable to chronic, “stressful,” degenerative, or fatal conditions.

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From a conceptual perspective, the panoply of CAM modalities can be divided into five major groupings: alternative medical systems, mind–body interventions, manipulative and body-based methods, energy therapies, and biologically based treatments (including dietary supplements) (Table 25-1). A dietary supplement is defined as: (1) a product that contains one or more of the following ingredients: vitamin, mineral, herb, botanical, amino acid, or a substance to increase total daily intake; (2) ingested orally; (3) not a conventional food or sold as a meal or diet, and (4) labeled as a dietary supplement (Food and Drug Administration (FDA) Web site).

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Table 25-1 CAM Domains
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In the United States, CAM practices are widely available (Table 25-2), but are largely unregulated. Among CAM practices, only five (acupuncture, chiropractic, massage, naturopathy, and homeopathy) are licensed in multiple states, whereas several others (art therapy, traditional Chinese medicine, reflexology) are licensed in only a few states, and still others (biofeedback, hypnosis) require only certification. Moreover, the scope of practice may vary from state to state (e.g., acupuncture). The American public spends more out-of-pocket for CAM practices than for all other health care needs. Most consumers believe that their health plans should pay for CAM treatments, and an increasing number of insurers and Health Maintenance Organizations are now doing so.

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Table 25-2 CAM Practitioners and Their Utilization

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