Tuesday, February 24, 2009

CAM Paper Part I: Introduction

Complementary and alternative medicine (CAM) can be defined as a diverse group of therapies and products that are not considered to be part of conventional medicine. Patients may use CAM to treat a wide variety of conditions, including back problems, colds, neck problems, joint pain, anxiety, depression, rheumatologic problems, digestive problems, chronic pain, insomnia, and other chronic conditions.(1)

Currently, CAM is very popular with patients. A national health interview survey found that in 2002, 36% of American adults had used some form of CAM within the previous 12 months, not including prayer. According to the survey, the most common non-prayer CAM modalities used by patients included natural products, deep breathing exercises, meditation, chiropractic, yoga, massage, and nutritional therapies. Interestingly, prayer for improved health, performed either by the patient or by others on behalf of the patient, was by far the most commonly used form of CAM. Inclusion of prayer as a CAM modality increased the percentage of adults using CAM in the past 12 months to 62%, and the percentage using CAM at any point in their lives to 75%. The popularity of CAM may stem at least in part from patient dissatisfaction with conventional treatments for chronic conditions such as pain.(1)

Multiple surveys suggest that physicians, medical students, and other healthcare providers have limited knowledge about CAM, although some studies have found that physicians would like to learn more about CAM.(2-4) In addition, physicians tend to have more negative attitudes about CAM compared with other healthcare providers like nurses and pharmacists.(3) There is some evidence that the attitudes of medical students toward CAM tend to become less positive as they get further along in medical school and become more entrenched in the conventional medicine model.(5) This may help explain why only about one quarter of surveyed patients reported that they had tried CAM because their physician had suggested that they try it.(1)

Unfortunately, patients themselves are often misinformed about CAM.(1) The rise of the internet has generated a confusing information overload, much of which can mislead patients and possibly even harm their health.(2) Patients commonly self-medicate with CAM and often do not tell their doctors or pharmacists about the nutritional supplements and herbal remedies they are taking.(1-3) Furthermore, physicians opposed to CAM may overstate the case that all CAM is useless, while practitioners of CAM may overstate the curative powers of CAM or claim that the medical establishment wants to suppress CAM.(2)

As a result of the proliferation of misinformation and lack of reliable information about CAM, patients often hold misguided beliefs about CAM therapies.(2) For example, many patients believe that “natural” equates with “safe.” However, herbal remedies and other natural products may interact with prescription drugs, as well as have toxic effects of their own.(2,3) In addition, many patients believe that using CAM therapies will save money. However, the few studies done on this subject suggest the opposite, namely that use of CAM increases costs for healthcare compared to conventional healthcare alone.(2)

This paper will review some of the more popular forms of CAM, including both the theory and practice of these therapies. It will not be possible to cover every form of CAM that patients might discuss with their physicians. However, my hope is that this paper will be a good starting point to help educate current and future healthcare providers about CAM. Although prayer for improved health is the most common form of CAM, it will not be covered here in order to focus in greater detail on several of the physical and chemical CAM modalities that are popular among patients.

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