Understanding Complementary and Alternative Medicine

General Considerations

Complementary and alternative medicine (CAM) includes a group of diverse medical and health care systems, practices, and products, taken from around the world, that fall outside the realm of conventional medicine. Many aspects of CAM are rooted in ancient systems of healing from China, Tibet, India, Japan, Korea, Mongolia, Africa, and the Americas. Today, CAM alongside conventional medicine is widely used to treat and restore health to the sick and prevention of disease in healthy individuals.

What is CAM? Complementary medicine , such as aromatherapy, is used in conjunction with conventional medicine, for example, to lessen a patient's postoperative discomfort. Alternative medicine , such as some herbal medicines, is used instead of conventional medicine to treat cancer, as an example. Alternative therapies include, but are not limited to, the following disciplines: folk medicine, herbal medicine, diet fads, homeopathy, faith healing, new age healing, chiropractic, acupuncture, naturopathy, reflexology, massage, and music therapy. Integrative medicine combines conventional medical and CAM therapies for which there is some scientific evidence of safety and effectiveness, regardless of their origin.

Studies have shown that the frequency of use of CAM therapy in the United States is far greater than previously reported. It has been estimated that 38.3% of the American population uses at least one of these healing methods to satisfy medical needs. The most common users of CAM therapy are more affluent people, women, those better educated, individuals born after 1950, and those who are concerned about emotional stress and the environment. According to the National Health Interview Survey (NHIS) of the Centers for Disease Control and Prevention, ¹

1 https://www.cdc.gov/nchs/nhis/index.htm Updated December 27, 2018. Assessed January 5, 2019.

the most common therapies are relaxation techniques (18%), massage (12%), herbal medicine (10%), and megavitamin therapy (9%). The perceived efficacy of these therapies ranged from 76% (hypnosis) to 98% (energy healing). The number of visits to providers of this health care is greater than the number of visits to all primary care medical doctors nationwide. More than 70% of these patients never mention using alternative therapy to their clinicians. Out-of-pocket expenditures of more than $34 billion per year in the United States are a testament to a widely held belief that CAM therapies have benefits that outweigh their costs. This figure is in contrast to the $12.8 billion spent out of pocket annually for all hospitalizations in the United States.

One of the reasons patients seek CAM therapies may be a failure in the doctor-patient relationship. Health care providers often fail to discuss the use of these therapies, because they lack adequate knowledge in this area and have poor insight into the cultures and beliefs of those who practice CAM. To many health care providers, “alternative medicine” entails the threat of displacing conventional medicine for the sake of unproven therapies. It may lack organization and the rigorous, scientific standards of Western, evidence-based medicine. The response of the health care providers ranges from outright dismissal of the practices to a gradual recognition that their extensive use can no longer be ignored. A lack of communication and knowledge in this area may also prove to be detrimental to the patient because the use of some forms of these therapies, if unsupervised, may be dangerous.

There has been an increasing interest throughout the world in the use of natural ingredients for health, especially tea. Tea is the world's second most popular beverage after water. Tea originated in the Southwest China provinces, where it is used as a medicinal beverage. Green tea accounts for approximately 20% of all tea consumed. It has been claimed that overall health of the body, especially the oral cavity, can be maintained by the consumption of green tea. Green tea is rich in polyphenols, about 30% by weight, including large amounts of a catechin called epigallocatechin-3-gallate (EGCG). ²

2 Eng QY, Thanikachalam PV, Ramamurthy S: Molecular understanding of epigallocatechin gallate (EGCG) in cardiovascular and metabolic diseases. J Ethnopharmacol 210:296, 2018. doi: 10.1016/j.jep.2017.08.035. Epub 2017 Aug 31.

EGCG is one of the most powerful compounds in green tea. It has been studied to treat various diseases and may be one of the main reasons green tea has such powerful medicinal properties. Catechins are natural antioxidants that help prevent cellular damage. They also reduce the formation of free radicals protecting cells from damage. These antioxidant properties have been touted to include lowering blood pressure, lowering cholesterol, stabilizing blood glucose, inhibiting bacterial growth, and blocking many carcinogenic agents. Green tea is not fermented; therefore, it contains active polyphenols that would be inactivated in the fermentation process of black tea production. Scientists have found that the catechins in green tea extract increases the body's ability to burn fat as fuel, which accounts for improved muscle endurance. These antioxidants might help protect against a large number of cancers, including breast, ³

3 Ogunleye AA, Xue F, Michel KB: Green tea consumption and breast cancer risk or recurrence: a meta-analysis. Breast Cancer Res Treat . 119(2):477, 2010. doi: 10.1007/s10549-009-0415-0. Epub 2009 May 13.

colon, colorectal, ⁴

4 Chen Y, Wu Y, Du M, et al: An inverse association between tea consumption and colorectal cancer risk. Oncotarget . 8(23):37367, 2017. doi: 10.18632/oncotarget.16959.

skin, lung, esophagus, stomach, small intestine, pancreas, liver, ovarian, prostate ⁵

5 Kurahashi N, Sasazuki S, Iwasaki M, et al: Green tea consumption and prostate cancer risk in Japanese men: a prospective study. Am J Epidemiol 167(1):71, 2008. Epub 2007 Sep 29.

and oral cancer. Polyphenols have been shown also to inhibit the growth of Streptococcus mutans , the major etiologic bacterium associated with dental caries, and Porphyromonas gingivalis , the bacterium associated with periodontal disease.

In April 1995, the National Center for Complementary and Alternative Medicine (NCCAM) ⁶

6 In January 2015, NCCAM was renamed the National Center for Complementary and Integrative Health (NCCIH). It is the federal government's lead agency for scientific research on complementary and integrative health approaches. Its mission is to define, through rigorous scientific investigation, the usefulness and safety of complementary and integrative health interventions and their roles in improving health and health care.

of the National Institutes of Health (NIH) defined CAM as “a broad domain of healing resources that encompasses all health systems, modalities, and 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.” This group of therapeutics is not currently part of allopathic medicine, although some conventional medical practitioners (those with an MD, DO, or other health-related degrees) are also practitioners of CAM. The CAM marketplace is currently valued at $24 billion or more, and the growth rate is close to 15% per year. Since 2010, Congress has provided more than $2.3 billion to promote CAM research. In fiscal year 2018, the funding for the National Center for Complementary and Integrative Health (NCCIH) was $142 million. ⁷

7 https://nccih.nih.gov/about/budget/appropriations.htm Assessed January 3, 2019.

The purpose of this chapter is to educate the reader about CAM. Medical schools in the United States are now including courses in which CAM treatments are taught, but 80% of medical students polled have indicated that they would like more information. Because several health care insurance companies in the United States now cover CAM therapies and 67% of health maintenance organizations now offer at least one form of CAM, ⁸

8 Fan AY: “Obamacare” covers fifty-four million Americans for acupuncture as Essential Healthcare Benefit. J Integr Med 12(4):390, 2014.

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9 Clarke TC, Black LI, Stussman BJ, et al: Trends in the use of complementary health approaches among adults: United States, 2002–2012. National Health Statistics Reports, no 79. Hyattsville, MD, 2015, National Center for Health Statistics.

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10 Nahin RL, Barnes PM, Stussman BJ: Insurance coverage for complementary health approaches among adult users: United States, 2002 and 2012 . NCHS data brief, no 235. Hyattsville, MD, 2016, National Center for Health Statistics.

it is crucial for health care providers to become more cognizant about these therapies. In the future, there will be more well-designed, randomized, controlled studies that will provide answers to many of today's questions regarding CAM.

Classifications of Complementary and Alternative Medicine

The NCCIH has classified CAM therapies into five major but overlapping categories:

• 1

  Alternative medical systems

• 2

  Mind–body interventions

• 3

  Biologically based therapies

• 4

  Manipulative and body-based methods

• 5

  Energy therapies