What is CAM? The US National Center for Complementary and Alternative Medicine defines it as "medical practices that are not commonly used, accepted, or available in conventional medicine." At present, this umbrella term includes many therapies. Among these are herbal medicine, homeopathy, hypnosis, ayurvedic medicine from India, traditional Chinese medicine, chiropractic, faith healing, and others. Currently, medical science is trying to distinguish among those therapies that are safe and effective, those that are effective but may carry health risks, those that are ineffective, and those that are both ineffective and unsafe.
In recent years, the popularity of alternative and complementary therapies has increased dramatically. Studies published by Eisenberg and colleagues at Harvard Medical School documented that 42 percent of adults in the United States (82 million people) routinely use complementary medical therapies to treat their most common medical conditions. In 1997, Americans made an estimated 629 million office visits to complementary therapy providers and spent an estimated $27 billion out-of-pocket on complementary care. Harvard researchers have also documented that most Americans use complementary and alternative therapies as adjuncts to – rather than as replacement for – conventional medical care.
Despite the growing popularity of such approaches, many people do not seek out alternatives to conventional medical care. In a survey in 2000 of its readers, Consumer Reports found that 65percent of the 46,000 respondents did not use alternative therapies, saying they were satisfied with standard medical treatment. This survey was not a scientific sampling of the population at large. But it did reveal an interesting, positive result: a majority of respondents said they tell their doctors about their use of alternative therapies – 60 percent according to the survey.
That’s good news because, as late as 1998, a national survey published in the Journal of the American Medical Association, reported that many patients were reluctant to discuss complementary therapies with their doctors as many physicians were unsympathetic toward – or just plain uninformed about – complementary therapies. But that is changing. Most doctors now acknowledge the widespread use of complementary medicine. And it is important for patients to keep their doctors informed so that they can stay alert for possible drug-herb interactions and even learn from patients who have found a beneficial therapy.
What else is happening? Employers are jumping on the bandwagon, although not in the numbers expected. A survey in 2000 of 30 large US national employers revealed that 76 percent offer insurance coverage for at least one form of complementary therapy. But 75 percent of employers said that the main obstacle to adding or expanding such coverage was the lack of evidence-based clinical research into the effectiveness of complementary therapies.
That criticism is right on the mark. It’s true that in many cases, there is not enough research concerning either the effectiveness or safety of CAM therapies. But that is changing. The US government agencies and major medical institutions are beginning to fund education and long-overdue research.By 1998, 64 percent of US mainstream medical schools were offering elective or required courses in alternative medicine.
Over the past 25 years, attitudes have changed as more and more people have turned to nontraditional healers. Particularly when a health problem is hard to treat – as is the case for chronic pain or osteoarthritis – and when conventional medicine doesn’t seem to work, many have looked for help elsewhere. But before you try an alternative medicine – or any medicine, for that matter – there are two basic questions you should ask: Is it safe? And does it work? IS IT SAFE ?
Safety should be the first consideration when contemplating medical treatment. Particularly if you are considering taking something orally – an herbal supplement, for example. In order to be effective, herbal preparations or other supplements must be biologically active, that is, they must contain substances that have an effect on the body. Even though they are often touted as safer and more natural than conventional drugs, it only stands to reason that herbal and other alternative medicines could interact with drugs – as well as with other alternative remedies.
St. John’s Wort is a good example; it affects the action of drugs as varied as warfarin (Coumadin), the anti-clotting drug, and indinavir (Crixivan), an AIDS drug. Likewise there have been reports that the popular herbs gingko biloba and ginseng interact with warfarin, and that kava does so with sedatives and other agents. Because of such potentially dangerous interactions, be sure to tell your doctor if you’re taking an alternative medicine. Remember, products that are "all natural" or "organic" are not necessarily safe.
DOES IT WORK?
When friends and relatives tell you that an alternative medicine, supplement, or treatment has done wonders for them, should you believe them? Such anecdotes are certainly a form of evidence, and people often make decisions based on the advice of someone they know. But when it comes to evaluating the efficacy of a medical treatment, such anecdotes are fraught with shortcomings and potential for bias. The best way to evaluate the worth of any medical treatment is through well-designed scientific studies.
These days, there is a growing number of such studies on alternative and complementary treatments, some with positive results. For example, researchers at Boston University published a meta-analysis, a study that combines smaller studies, in the Journal of the American Medical Association, showing that glucosamine and chondroitin preparations have "some degree of efficacy" in the treatment of osteoarthritis. Comb the medical literature and you’ll find positive results for a wide variety of herbal remedies, including, among others, gingko biloba, St. John’s Wort, and echinacea. But keep in mind that a published article isn’t the same as proof. The quality of published research varies tremendously.
Even on the Internet, you won’t find one reliable source of an alternative medicine that has consulted all the research and spells out what has been proven and what hasn’t. But medical research is a diffuse process in which the "truth" often emerges by fits and starts. Don’t expect pat answers though, even if your Uncle Pat swears it works for him.
Read up. Read the label, do some research, and ask your doctor or pharmacist about the ingredients before you take it.
Combine complementary and conventional therapies. If you decide to try an alternative approach, be sure that you also continue your conventional treatment. This is particularly true in cases of serious or life-threatening illnesses, such as cancer.
Tell your doctor. Inform your physician if you are taking any herbal remedy or visiting an alternative or complementary therapist. Such information can help your doctor keep an eye out for possible signs of drug interactions or other adverse effects.
Be skeptical. Be alert to promises and claims that sound too good to be true – they probably are!