Overview of CAM in the U.S.
Over the past 30 years, public interest in and use of complementary and alternative medicine (CAM) systems, approaches, and products has risen steadily in the United States. Depending on how CAM is defined, an estimated 6.5 percent to as much as 43 percent of the U.S. population has used some form of CAM.
Until recently, the primary response of federal, state, and local health care regulatory agencies to this phenomenon was to restrict access to and delivery of CAM services to protect the public from unproven and potentially dangerous treatments. Since the early 1990s, however, scientific evidence has begun to emerge suggesting that some CAM approaches and products, when used appropriately, can be beneficial for treating illness and promoting health.
CAM, can be defined as a group of medical, health care, and healing systems other than those included in mainstream health care in the United States. CAM includes the worldviews, theories, modalities, products, and practices associated with these systems and their use to treat illness and promote health and well-being.
Although heterogeneous, the major CAM systems have many common characteristics, including a focus on individualizing treatments, treating the whole person, promoting self-care and self-healing, and recognizing the spiritual nature of each individual. In addition, many CAM systems have characteristics commonly found in mainstream health care, such as a focus on good nutrition and preventive practices. Unlike mainstream medicine, CAM often lacks or has only limited experimental and clinical study; however, scientific investigation of CAM is beginning to address this knowledge gap. Thus, boundaries between CAM and mainstream medicine, as well as among different CAM systems, are often blurred and are constantly changing.
Many of the CAM systems of health care listed below have evolved from the collective clinical experiences of many practitioners over generations of practice, such as in Traditional Chinese Medicine. Others have evolved from the clinical experiences of a single practitioner or small groups of practitioners who have developed a particular intervention.
Despite their diversity, there are some common threads that run among many traditional systems of health care as well as systems that have emerged more recently. These similarities include an emphasis on whole systems, the promotion of self-care and the stimulation of self-healing processes, the integration of mind and body, the spiritual nature of illness and healing, and the prevention of illness by enhancing the vital energy, or subtle forces, in the body.
Convergence of CAM and Mainstream Healthcare
Some of the common threads that run through CAM health care systems also are part of mainstream, or conventional, health care. For example, conventional medicine has a long tradition of being concerned with preventing disease as evidenced by the development of programs for immunizations, healthier mothers and babies, family planning, safer and healthier foods, fluoridation of drinking water, control of infectious diseases, reducing deaths from heart disease and stroke, decreasing the use of tobacco products, and promoting motor vehicle safety and safer workplaces.
Mainstream or conventional health care also has long-recognized that good nutrition and exercise are important components of a healthy lifestyle. There also is a growing recognition within conventional health care that biopsychosocial and spiritual factors may play an important role in promoting health and preventing illness.
The difference between conventional and CAM health care systems in many of these areas, however, is one of emphasis. In part, because of the many technological advances that have occurred in conventional health care over the years (see Recent History of CAM section, below), pharmacological, surgical, and other technological approaches have come to dominate conventional health care. While acknowledged, prevention and wellness promotion have been underemphasized. For example, according to a recent report by the Nutrition Education Consortium, the teaching of nutrition in medical schools and residency programs remains “woefully inadequate,” and a survey by Cooksey et al. found that most medical schools do not have faculty trained specifically in nutrition. As a result of this lack of training in nutrition in medical education, many practicing physicians are not adequately prepared to provide nutrition counseling to their patients. However, registered dieticians and clinical nutritionists are employed by hospitals and clinics. These are the specialists who are trained in this area and are well established in the conventional health care system.
Because many CAM approaches often focus on prevention rather than cure, they have come to be identified with wellness and self-care. This may be a reflection of history, as effective treatments for many of the infections and severe injuries that occurred were lacking. Traditional systems were better able to strengthen the individual and attempt to prevent disease than to treat many of the illnesses that killed millions even one hundred years ago. This is not to imply that CAM systems of health care are more effective than conventional health care in promoting health and preventing illness, as many have not been scientifically shown to prevent disease or promote health.
The perception that conventional health care emphasizes high technology approaches to treating patients, while CAM health care emphasizes low technology approaches to promoting health and preventing disease, has led some to suggest that conventional and CAM health care may eventually converge to form a new health care system that integrates the best of each. However, there are not only scientific, but also educational, regulatory, and political obstacles to integration of the two systems.
