Complementary, Alternative, and Integrative Medicine

Definition and Epidemiology

Complementary and alternative medicine (CAM) is a group of medical practices and products neither taught widely in medical schools nor generally available in USA hospitals. Complementary medicine is used together with traditional medicine, alternative medicine is used in lieu of conventional medicine, and integrative medicine combines both standard medical practices with CAM modalities. The prevalence of CAM therapies has increased at an exponential rate both in national and international medical communities. In the 2012 National Health Interview Survey of a sample of 13,505 respondents, 42% of individuals detailed that they had used a CAM therapy within the past year. Estimated annual expenditures for CAM therapies are in excess of $30.2 billion.

The prevalence of use of CAM therapies in gastroenterology outpatients in both a community and a university setting has been reported at 44% to 50%. ^, The 2012 National Health Interview Survey reported that at least 3% of those who had used CAM in the past year used at least one CAM modality to address a GI condition, and over 80% of those people perceived it to be useful. Given the widespread use of these modalities and the continuing trend of their increased utilization, an understanding of CAM therapies, including their potential risks and benefits, is necessary for the practicing gastroenterologist. A thorough knowledge of these practices will allow physicians to provide more comprehensive medical care and can help further therapeutic rapport between physicians and their patients.

Types of Therapies

There are a wide variety of CAM therapies, and those most commonly used for GI and hepatic disease are defined in Box 131.1 . Regardless of which therapy is used, the overall philosophy of CAM takes the uniform holistic approach that all disease results from disturbances at a combination of physical, psychological, social, and spiritual levels. Thus, a CAM modality is used to restore balance and to facilitate the body’s own healing responses, thereby ameliorating troublesome symptoms.

The National Center for Complementary and Integrative Health divides CAM therapies into 2 major subgroups. The first category is natural products, which constitute substances within our environment that are used to strengthen and heal the human body such as herbs, vitamins, minerals, and probiotics. The second category is mind-body medicine, which includes hypnosis, meditation, biofeedback, and relaxation practices. Manipulative and body-based practices also fall under this domain and involve manipulation and movement of one or more parts of the body as a means of achieving healing; examples include chiropractic manipulation, acupuncture, Tai Chi, Yoga, Qi Gong, and Pilates.

Additional complementary health approaches that do not traditionally fall into either of these subgroups, namely Reiki, Ayurveda, traditional Chinese medicine, homeopathy, and naturopathy, are also widely practiced. Reiki uses the power of touch to channel energy into a patient to activate natural healing processes and restore physical well-being. Ayurvedic medicine is a traditional Indian practice, also based on the premise of balance; it is a comprehensive medical discipline aimed at integrating mind, body, and spirit to achieve contentment, prevention of disease, and good health. Practitioners use naturally occurring substances such as oils and herbs, as well as various treatments including fasting, yoga, and meditation, to achieve harmony in an individual patient. Traditional Chinese medicine has a heritage some 2000 years old and concerns itself with bringing a patient into balance through practices that affect the opposing forces of yin and yang. Homeopathy treats disease by administering a small dose of a diluted substance that when otherwise administered in undiluted forms would cause symptoms of the disease. Naturopathy emphasizes prevention and treatment of disease through methods that promote self-healing including, but not limited to, dietary modification, exercise, stress reduction, and practitioner-guided detoxification.

Demography of Complementary and Alternative Medicine Users

Certain patients are more likely to use CAM therapies than are others. Women and Caucasians tend to use CAM more often than do men and African Americans, respectively. Patients with higher levels of education, higher annual incomes, and comorbid medical conditions are also more likely to resort to CAM therapies. ^, Although knowledge of these demographics assists the gastroenterologist in determining which patients are likely to be using CAM therapies, it is also important to understand each patient’s rationale and motivation for choosing a particular therapeutic modality.

Rationale for use

The attraction of CAM therapies is multifaceted. First, they provide patients who might not have a medical background with a sense of control over their own bodies and health. Second, they provide patients with therapeutic alternatives when conventional medical therapies have failed to alleviate their symptoms or cure diseases such as terminal cancer. Last, CAM therapies are attractive to patients who feel dissatisfied with the ways their physicians demonstrate understanding of their illnesses or handle their complaints.