Complementary and Alternative Medicine

Complementary and alternative medicine, commonly referred to as CAM, is a group of unconventional [Page 112]medical systems, practices, and products not currently considered to be part of the conventional biomedical care provided by medical doctors and other conventional health professionals. A nationwide government health survey released in May 2004 indicated that 36% of U.S. adults used some form of CAM, as noted by Patricia M. Barnes and colleagues in 2004. When prayer for health reasons specifically was included, the number of U.S. adults using CAM in the past year rose to 62%. Back pain topped the list of conditions for which CAM was used, confirming prior studies finding musculoskeletal pain linked to CAM use.

The survey found that if the use of prayer for health reasons is included, CAM use is more likely among older adults than among younger adults. In contrast, excluding prayer for health reasons yields a U-shaped relationship between CAM use and age, with the youngest and oldest groups of adults reporting the least use of CAM. Other predictors of CAM use include female gender, education, hospitalization during the past year, and having been a smoker in the past but not currently. Earlier surveys, including one by David M. Eisenberg and colleagues in 1998, found that most CAM users also see medical doctors for conventional medical care but usually do not disclose CAM use to their medical doctors. The same study found that consumers spent an estimated $27 billion out of pocket on CAM in 1997.

Despite their popularity, for most CAM therapies there are unanswered key questions regarding safety, cost-effectiveness, efficacy, and mechanisms. Facilitating the scientific evaluation of CAM is a key objective of the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH). NCCAM's predecessor, the Office of Alternative Medicine (OAM), opened at the NIH in 1992 in the Office of the Director with the mission of providing the American public with reliable information about the safety and effectiveness of CAM practices. A 1998 congressional mandate expanded the OAM into NCCAM. The OAM's 1993 budget of $2 million grew to NCCAM's 2005 budget of more than $123 million. NCCAM's programs include funding research, developing scientific databases, providing a public information clearinghouse, and facilitating national and international cooperative efforts in CAM research and education. (Additional information may be found at http://nccam.nih.gov.)

The National Cancer Institute (NCI) established the Office of Cancer Complementary and Alternative Medicine (OCCAM) in 1998 to coordinate and enhance the activities of the NCI in the CAM arena. Several surveys have indicated that many, if not most, cancer patients use complementary therapies during or after treatment for cancer. Patients' motivations for using CAM include improving quality of life, boosting immunity, prolonging life, and curing disease. Few patients reject conventional treatment entirely and use only alternative therapies. (Additional information may be found at http://www3.cancer.gov/occam.)

At the request of the NIH and the Agency for Healthcare Research and Quality, the Institute of Medicine (IOM) produced a comprehensive report on CAM in 2005 to discuss what is known about Americans' reliance on CAM and to help set guidelines for research. The IOM concluded that CAM is being integrated into medical practice in hospitals and physicians' offices, some health maintenance organizations (HMOs) are covering selected CAM therapies, and insurance coverage for CAM is increasing, and it suggested that health care should strive to be comprehensive and evidence based, with conventional medical treatments and CAM held to the same standards for demonstrating clinical effectiveness. (The full report is available at http://www.iom.edu.)

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