special subjects
Overview of Integrative, Complementary, and Alternative Medicine
Introduction
Integrative medicine and health (IMH) and complementary and alternative medicine (CAM) include healing approaches and therapies that historically have not been included in conventional, mainstream Western medicine. CAM is often thought of as medicine that is not based on the principles of mainstream Western medicine. However, this characterization is not strictly accurate. One key difference between CAM and mainstream medicine is the strength of evidence supporting best practices. Mainstream medicine, when possible, bases its practices only on the most conclusive scientific evidence. In contrast, CAM bases its practices on evidence-informed practices—practices based on the best evidence available, even when such evidence does not meet the highest, strictest criteria for efficacy and safety. However, some CAM practices, including use of some Overview of Dietary Supplements , have been validated by traditional scientific criteria. Complementary, alternative, and integrative medicine are terms often used interchangeably, but their meanings are different. Complementary medicinerefers to non-mainstream practices usedtogether withconventional medicine. Alternative medicinerefers to non-mainstream practices usedinstead ofconventional medicine. Integrative medicineis health care that uses all appropriate therapeutic approaches—conventional and non-mainstream—within a framework that focuses on health, the therapeutic relationship, and the whole person. IMH aims to combine CAM with mainstream medicine when appropriate. Some CAM therapies are now offered in hospitals and are sometimes reimbursed by insurance companies. Some traditional medical schools, including 74 North American medical institutions in the Academic Consortium for Integrative Medicine and Health, provide education about integrative medicine and therapies. According to the most recent National Health and Nutrition Examination Survey (NHANES) data, as many as 38% of adults and 12% of children have used CAM at some point, depending on how broadly CAM is defined. ANational Health Interview survey (2012)indicates that commonly used CAM therapies include Mind-body therapy (12.5%) Chiropractic or osteopathic manipulation (9.1%) Massage (8.8%) Movement therapy (6.6%) Use of other CAM therapies and approaches remains variable and sometimes difficult to quantify: for example, approximately 2.2% for homeopathy, 1.6% for acupuncture, and 0.7% for naturopathy. In the United States, more than 50% of adults used at least one dietary supplement in the past 30 days and such use has increased over the past 20 years ( References ). Patients do not always volunteer information about their use of these therapies to health care professionals. Therefore, it is very important for health care professionals to ask their patients specifically about their use of these therapies (including Overview of Dietary Supplements ) in an open, nonjudgmental way. Learning about patients’ use of CAM can do the following: Strengthen rapport and build trust Provide an opportunity to discuss evidence for CAM and its plausibility and risks Sometimes help physicians and other health care professionals (including pharmacists) identify and avoid potentially harmful interactions between medications and CAM therapies or nutritional supplements Monitor patient progress Help patients determine whether they should use specific certified or licensed CAM practitioners Learn from patients’ experiences with CAM 