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Complementary and alternative medicine (CAM) encompasses a large range
of therapies outside the domain of mainstream conventional or Western
medicine that are used for the purpose of medical intervention, health
promotion, or disease prevention. A distinct trend toward the integration
of CAM therapies with the practice of conventional medicine is occurring.
Hospitals are offering CAM therapies, health maintenance organizations
(HMOs) are covering such therapies, a growing number of physicians
are using CAM therapies in their practices, and insurance coverage
for CAM therapies is increasing. Integrative medicine centers and
clinics are being established, many with close ties to medical schools
and teaching hospitals. As a result of increasing interest in CAM
and the realization of our limited understanding of these modalities,
the National Center for Complementary and Alternative Medicine (NCCAM)
was established by a mandate in 1998 to facilitate and conduct research
and education on CAM.
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The NCCAM at the National Institutes of Health defines CAM as “a
group of diverse medical and health care systems, practices, and
products that are not presently considered to be part of conventional
medicine,”1 Many terms are used to describe
CAM. Complementary medicine describes CAM when
it is used in conjunction with conventional medicine. Alternative
medicine is used in place of conventional medical care. Integrative
medicine is becoming more popular and is the preferred term
because it incorporates all appropriate approaches, both conventional
medicine and CAM therapies, to achieve optimal health and healing.
The Consortium of Academic Health Centers for Integrative Medicine,
which consists of 36 prominent medical schools, further defines
integrative medicine as “the practice of medicine that
reaffirms the importance of the relationship between practitioner
and patient, focuses on the whole person, is informed by evidence,
and makes use of all appropriate therapeutic approaches, health
care professionals, and disciplines to achieve optimal health and
healing.”2
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CAM therapies include alternative/whole medical systems
(homeopathy, naturopathy, ayurveda, and traditional oriental medicine), mind-body
interventions (meditation, prayer for healing, biofeedback, yoga,
and art and music therapy), biologically based therapies (megavitamins,
nutritional supplements, and herbs), manipulative and body-based
methods (chiropractic manipulations, osteopathy, massage), and energy
therapies (Reiki and therapeutic touch).1
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The use of CAM is prevalent among adults in the United States.3 Eisenberg
and colleagues showed that use of alternative therapies increased
from 34% to 42% among adults in the United States
from 1990 to 1997.3 In 2002, the National
Center for Health Statistics (part of the Centers for Disease Control
and Prevention) conducted the National Health Interview Survey of
31,044 adults and found that 62% used some form of CAM
in the past 12 months when prayer for health reasons was included.4 Total
visits to CAM providers exceeded total visits to all primary care
physicians. Out-of-pocket expenditures for CAM are greater than
for hospitalization.3
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CAM use among parents is the number-one predictor of CAM use
among children, which is increasing.5 Studies of
CAM use in ...