Complementary and Alternative Medicine - CAM

“I had high blood pressure…I used to work part time for a doctor. The nurse there told me she had been to (a university medical center) and somebody had advised her to mix honey and vinegar for blood pressure. So for years I took honey and vinegar.”
From: Arcury, TA, Bell RA, Vitolins MA, Quandt SA. Rural older adults beliefs and behavior related to complementary and alterantive medicine use. Complementary Health Practice Review. 2005, 10(1). 33-44.

Issues Related to Older Adults and CAM

Older adults are active users of the full range of complementary and alternative medicine (CAM). They seek advice from CAM practitioners and from the Internet, and develop self-directed care plans that incorporate specific therapies pertinent to their concerns and goals.

Interest in CAM may stem from cultural familiarity, a desire for more holistic or preventive care, or from the limitations of conventional medicine to adequately address specific problems or conditions such as osteoarthritis. Older adults need to be able to obtain reliable information about the safety and efficacy of various interventions, and they need good communication with health care practitioners so that their care regimens can be integrated for maximum benefit and minimum risk.

In June 1997, the American Medical Association adopted a resolution to promote awareness among medical students and physicians of the wide use of complementary and alternative medicine. The AMA charges that ”physicians should routinely inquire about the use of alternative or unconventional therapy by their patients, and educate themselves and their patients about the state of scientific knowledge with regard to alternative therapy that may be used or contemplated.” (Report 12 of the Council on Scientific Affairs, A-97, June 1997).)

Health care practitioners who work with older adults should ask their patients about the use of CAM and educate themselves about the various modalities, their applications and outcomes. This unit is intended to provide a basic overview of CAM to inform practitioners and better enable them to communicate effectively with their patients.

What is CAM?

Complementary and Alternative Medicine is described by the National Institutes of Health's National Center for Complementary and Alternative Medicine (NCCAM) as "A group of diverse medical and health-care systems, practices, and products that are not presently considered to be part of conventional medicine."

• Complementary medicine is used in addition to conventional medicine.
• Alternative medicine is used instead of conventional medicine.
• Integrative medicine involves bringing together the best of CAM and conventional care for the benefit of the patient.

These therapies include highly specialized methods such as biofeedback, millennia-old practices such as meditation, and comprehensive traditional healing systems such as Traditional Chinese Medicine, encompassing a wide variety of skills and training, with widely varying certification and licensure requirements.

The following are excerpts from the NCCAM definitions of the five major types of CAM modalities. For the complete definitions, go to: http://nccam.nih.gov/health/whatiscam/

Whole medical systems are built upon complete systems of theory and practice, such as homeopathic medicine, which seeks to stimulate the body's ability to heal itself. Naturopathy aims to support the body's ability to heal itself through the use of dietary and lifestyle changes together with CAM therapies such as herbs, massage, and joint manipulation. Systems developed in non-Western cultures include traditional Chinese medicine, based on the concept that disease results from disruption in the flow of qi (energy) and imbalance in the forces of yin and yang. Ayurveda, which originated in India, works integrate the body, mind, and spirit to prevent and treat disease. Therapies used include herbs, massage, and yoga.

Mind-Body Medicine modalities are designed to enhance the mind's capacity to affect bodily function and symptoms. Examples include meditation - a conscious mental process using techniques such as focusing attention or maintaining a specific posture -- to suspend the stream of thoughts and relax the body and mind. Prayer, visualization and guided imagery, and therapies that use creative outlets such as art, music, or dance are also being used.

Biologically Based Practices in CAM use substances found in nature, such as herbs, foods, and vitamins, such as dietary supplements and herbal products.

Manipulative and Body-Based Practices in CAM are based on the application of controlled force to a joint, moving it beyond the normal range of motion in an effort to aid in restoring health. Manipulation may be performed as a part of other therapies or whole medical systems, including chiropractic medicine, massage, and naturopathy. Examples include chiropractic or osteopathic treatments.

Energy Medicine involves the use of energy fields. They are of two types:
Biofield therapies are intended to affect energy fields that are believed to surround and penetrate the body. Examples include qi gong, a component of traditional Chinese medicine that combines movement, meditation, and controlled breathing. Reiki practitioners seek to transmit energy to a person, either from a distance or by placing their hands on or near that person with the intention of healing the spirit and thus the body. In Therapeutic Touch, practitioners pass their hands over another person's body with the intent to use their own perceived healing energy to identify energy imbalances and promote health.

Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields, or alternating-current or direct-current fields.