Did you know that one out of every three of your adult patients are using some form of complementary and alternative medicine (CAM)? According to a large, nationwide government survey of 31,044 adults released in May 2004, 36% of U.S. adults aged 18 years and over use some form of CAM.1,2When megavitamin therapy and prayer specifically for health reasons are included in the definition of CAM, that number rises to 62%. Do you know which patients of yours are using CAM in addition to the traditional therapies you are already prescribing for them? Whether you are pleased or disturbed by the increased use of CAM, doesn’t really matter. What does matter is that your patients are using, have used, or will use natural approaches, and thus, those practicing today must include reliable knowledge about CAM.
What is CAM?
Complementary and alternative medicine (CAM) is a group of diverse medical and healthcare systems, practices, and products that are not presently considered to be part of conventional medicine.3 Although the two terms are often grouped together, complementary medicine and alternative medicine are not necessarily the same thing. Complementary treatments are often thought of as treatments used alongside conventional therapies prescribed by the physician, while alternative treatments are those used in place of conventional therapies. Some healthcare providers practice both CAM and conventional medicine, which is referred to as integrative medicine.
The federal government’s lead agency for scientific research on CAM, the National Center for Complementary and Alternative Medicine (NCCAM)3, groups CAM practices into four domains — mind-body, bio-based, manipulation, and energy — while recognizing some overlap exists. In addition, NCCAM studies CAM whole medical systems, which cut across all domains.
Whole Medical Systems
Whole medical systems are built upon complete systems of theory and practice. Often, these systems have evolved apart from and earlier than the conventional medical approach used in the United States. Examples of whole medical systems that have developed in Western cultures include:
• Homeopathic medicine. With origins in Europe, homeopathy seeks to stimulate the body’s ability to heal itself by giving very small doses of highly diluted substances that in larger doses would produce illness or symptoms (an approach called “like cures like”).
• Naturopathic medicine. Also with origins in Europe, naturopathy aims to support the body’s ability to heal itself by dietary and lifestyle changes together with CAM therapies such as herbs, massage, and joint manipulation.
• Chinese medicine. This medical system originated in China and is based on the concept that disease results from disruption in the flow of qi (i.e., the life force) and imbalance in the forces of yin and yang. Practices such as use of herbs, meditation, massage, and acupuncture seek to aid healing by restoring the yin-yang balance and the flow of qi.
• Ayurveda. With origins in India, this medical system aims to integrate the body, mind, and spirit to prevent and treat disease. Therapies used include herbs, massage, and yoga.
Mind-Body Medicine
Mind-body medicine uses a variety of techniques designed to enhance the mind’s capacity to affect bodily function and symptoms. Some techniques, such as patient support groups and cognitive-behavioral therapy were considered CAM in the past, but have since become mainstream. Other mind-body techniques still considered CAM include meditation, focusing attention for a sustained period, maintaining a specific posture, and therapies that use creative outlets such as art, music, or dance.
Biologically Based Practices
Biologically based practices in CAM use substances found in nature, such as herbs, foods, and vitamins. Some examples include dietary supplements, herbal products, and the use of other so-called natural, but as yet scientifically unproven, therapies (for example, using shark cartilage to treat cancer).
Manipulative and Body-Based Practices
Manipulative and body-based practices in CAM are based on manipulation, or the application of controlled force to a joint, moving it beyond the normal range of motion in an effort to aid in restoring health. Manipulation may be performed as a part of other therapies or whole medical systems. Some examples include chiropractic manipulation, osteopathic manipulation, physical therapy, and massage therapy.
Energy Medicine
Energy therapies involve the use of energy fields. They are of two types:
• Biofield therapies. These therapies are intended to affect energy fields, or biofields, that purportedly surround and penetrate the human body. The existence of such fields has not yet been scientifically proven. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in, or through, these fields. Examples include qi gong, Reiki, and therapeutic touch.
• Bioelectromagnetic-based therapies. These therapies involve the unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields, or alternating-current or direct-current fields.
Survey Results: Why People are Using CAM
What leads people to use alternative and complementary medicine? Conventional medicine has tried to answer this question as CAM grows in popularity. The NHIS survey asked people to select from five reasons to describe why they used CAM. (See Figure above.) Results were as follows (people could select more than one):
• CAM would improve health when used in combination with conventional medical treatments: 55%
• CAM would be interesting to try: 50%
• Conventional medical treatments would not help: 28%
• A conventional medical professional suggested trying CAM: 26%
• Conventional medical treatments are too expensive: 13% Also, of interest, the survey found that most people use CAM along with conventional medicine rather than in place of conventional medicine.
Diseases and Conditions for Which CAM Is Most Frequently Used
People use CAM for a wide array of diseases and conditions. According to the NHIS survey, CAM is most often used by adults in the United States for treatment and/or prevention of musculoskeletal conditions or other conditions involving chronic or recurring pain. The survey also demonstrated that U.S. adults are most likely to use CAM modalities for colds, anxiety or depression, gastrointestinal disorders, and sleeping problems.
The field of dermatology has not remained unaffected by this trend. A systematic review done in 2000 summarized all surveys of dermatological patients regarding the usage of CAM and found the lifetime prevalence ranged from 35% to 69% with the most frequently used treatment modalities being homeopathy, herbal products and food supplements.4
Who Uses CAM Most
CAM use spans people of all backgrounds. But, according to the NHIS survey, some people are more likely than others to use CAM. Overall, CAM use is greater by:
• Women than men
• People with higher educational levels
• People who have been hospitalized in the past year
• Former smokers, compared with current smokers or those who have never smoked what Physicians Should Know
While some scientific evidence exists regarding some CAM therapies, for most there are key questions yet to be answered through well-designed scientific studies — questions such as whether these therapies are safe and whether they work for the diseases or medical conditions for which they are used.
The list of what is considered to be CAM changes continually, as those therapies that are proven to be safe and effective become adopted into conventional health care and as new approaches to health care emerge. CAM is becoming more popular across all specialties in medicine, including dermatology.
To provide better care to patients, dermatologists need to be informed about CAM therapies that their patients are already using or maybe interested in using.
In future issues of Skin & Aging I will provide evidence-based reviews of CAM therapies used to treat common dermatological conditions. With this in mind, my aim is to provide you with information for guiding your patients who are interested in using CAM to treat their skin conditions.
Did you know that one out of every three of your adult patients are using some form of complementary and alternative medicine (CAM)? According to a large, nationwide government survey of 31,044 adults released in May 2004, 36% of U.S. adults aged 18 years and over use some form of CAM.1,2When megavitamin therapy and prayer specifically for health reasons are included in the definition of CAM, that number rises to 62%. Do you know which patients of yours are using CAM in addition to the traditional therapies you are already prescribing for them? Whether you are pleased or disturbed by the increased use of CAM, doesn’t really matter. What does matter is that your patients are using, have used, or will use natural approaches, and thus, those practicing today must include reliable knowledge about CAM.
What is CAM?
Complementary and alternative medicine (CAM) is a group of diverse medical and healthcare systems, practices, and products that are not presently considered to be part of conventional medicine.3 Although the two terms are often grouped together, complementary medicine and alternative medicine are not necessarily the same thing. Complementary treatments are often thought of as treatments used alongside conventional therapies prescribed by the physician, while alternative treatments are those used in place of conventional therapies. Some healthcare providers practice both CAM and conventional medicine, which is referred to as integrative medicine.
The federal government’s lead agency for scientific research on CAM, the National Center for Complementary and Alternative Medicine (NCCAM)3, groups CAM practices into four domains — mind-body, bio-based, manipulation, and energy — while recognizing some overlap exists. In addition, NCCAM studies CAM whole medical systems, which cut across all domains.
Whole Medical Systems
Whole medical systems are built upon complete systems of theory and practice. Often, these systems have evolved apart from and earlier than the conventional medical approach used in the United States. Examples of whole medical systems that have developed in Western cultures include:
• Homeopathic medicine. With origins in Europe, homeopathy seeks to stimulate the body’s ability to heal itself by giving very small doses of highly diluted substances that in larger doses would produce illness or symptoms (an approach called “like cures like”).
• Naturopathic medicine. Also with origins in Europe, naturopathy aims to support the body’s ability to heal itself by dietary and lifestyle changes together with CAM therapies such as herbs, massage, and joint manipulation.
• Chinese medicine. This medical system originated in China and is based on the concept that disease results from disruption in the flow of qi (i.e., the life force) and imbalance in the forces of yin and yang. Practices such as use of herbs, meditation, massage, and acupuncture seek to aid healing by restoring the yin-yang balance and the flow of qi.
• Ayurveda. With origins in India, this medical system aims to integrate the body, mind, and spirit to prevent and treat disease. Therapies used include herbs, massage, and yoga.
Mind-Body Medicine
Mind-body medicine uses a variety of techniques designed to enhance the mind’s capacity to affect bodily function and symptoms. Some techniques, such as patient support groups and cognitive-behavioral therapy were considered CAM in the past, but have since become mainstream. Other mind-body techniques still considered CAM include meditation, focusing attention for a sustained period, maintaining a specific posture, and therapies that use creative outlets such as art, music, or dance.
Biologically Based Practices
Biologically based practices in CAM use substances found in nature, such as herbs, foods, and vitamins. Some examples include dietary supplements, herbal products, and the use of other so-called natural, but as yet scientifically unproven, therapies (for example, using shark cartilage to treat cancer).
Manipulative and Body-Based Practices
Manipulative and body-based practices in CAM are based on manipulation, or the application of controlled force to a joint, moving it beyond the normal range of motion in an effort to aid in restoring health. Manipulation may be performed as a part of other therapies or whole medical systems. Some examples include chiropractic manipulation, osteopathic manipulation, physical therapy, and massage therapy.
Energy Medicine
Energy therapies involve the use of energy fields. They are of two types:
• Biofield therapies. These therapies are intended to affect energy fields, or biofields, that purportedly surround and penetrate the human body. The existence of such fields has not yet been scientifically proven. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in, or through, these fields. Examples include qi gong, Reiki, and therapeutic touch.
• Bioelectromagnetic-based therapies. These therapies involve the unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields, or alternating-current or direct-current fields.
Survey Results: Why People are Using CAM
What leads people to use alternative and complementary medicine? Conventional medicine has tried to answer this question as CAM grows in popularity. The NHIS survey asked people to select from five reasons to describe why they used CAM. (See Figure above.) Results were as follows (people could select more than one):
• CAM would improve health when used in combination with conventional medical treatments: 55%
• CAM would be interesting to try: 50%
• Conventional medical treatments would not help: 28%
• A conventional medical professional suggested trying CAM: 26%
• Conventional medical treatments are too expensive: 13% Also, of interest, the survey found that most people use CAM along with conventional medicine rather than in place of conventional medicine.
Diseases and Conditions for Which CAM Is Most Frequently Used
People use CAM for a wide array of diseases and conditions. According to the NHIS survey, CAM is most often used by adults in the United States for treatment and/or prevention of musculoskeletal conditions or other conditions involving chronic or recurring pain. The survey also demonstrated that U.S. adults are most likely to use CAM modalities for colds, anxiety or depression, gastrointestinal disorders, and sleeping problems.
The field of dermatology has not remained unaffected by this trend. A systematic review done in 2000 summarized all surveys of dermatological patients regarding the usage of CAM and found the lifetime prevalence ranged from 35% to 69% with the most frequently used treatment modalities being homeopathy, herbal products and food supplements.4
Who Uses CAM Most
CAM use spans people of all backgrounds. But, according to the NHIS survey, some people are more likely than others to use CAM. Overall, CAM use is greater by:
• Women than men
• People with higher educational levels
• People who have been hospitalized in the past year
• Former smokers, compared with current smokers or those who have never smoked what Physicians Should Know
While some scientific evidence exists regarding some CAM therapies, for most there are key questions yet to be answered through well-designed scientific studies — questions such as whether these therapies are safe and whether they work for the diseases or medical conditions for which they are used.
The list of what is considered to be CAM changes continually, as those therapies that are proven to be safe and effective become adopted into conventional health care and as new approaches to health care emerge. CAM is becoming more popular across all specialties in medicine, including dermatology.
To provide better care to patients, dermatologists need to be informed about CAM therapies that their patients are already using or maybe interested in using.
In future issues of Skin & Aging I will provide evidence-based reviews of CAM therapies used to treat common dermatological conditions. With this in mind, my aim is to provide you with information for guiding your patients who are interested in using CAM to treat their skin conditions.
Did you know that one out of every three of your adult patients are using some form of complementary and alternative medicine (CAM)? According to a large, nationwide government survey of 31,044 adults released in May 2004, 36% of U.S. adults aged 18 years and over use some form of CAM.1,2When megavitamin therapy and prayer specifically for health reasons are included in the definition of CAM, that number rises to 62%. Do you know which patients of yours are using CAM in addition to the traditional therapies you are already prescribing for them? Whether you are pleased or disturbed by the increased use of CAM, doesn’t really matter. What does matter is that your patients are using, have used, or will use natural approaches, and thus, those practicing today must include reliable knowledge about CAM.
What is CAM?
Complementary and alternative medicine (CAM) is a group of diverse medical and healthcare systems, practices, and products that are not presently considered to be part of conventional medicine.3 Although the two terms are often grouped together, complementary medicine and alternative medicine are not necessarily the same thing. Complementary treatments are often thought of as treatments used alongside conventional therapies prescribed by the physician, while alternative treatments are those used in place of conventional therapies. Some healthcare providers practice both CAM and conventional medicine, which is referred to as integrative medicine.
The federal government’s lead agency for scientific research on CAM, the National Center for Complementary and Alternative Medicine (NCCAM)3, groups CAM practices into four domains — mind-body, bio-based, manipulation, and energy — while recognizing some overlap exists. In addition, NCCAM studies CAM whole medical systems, which cut across all domains.
Whole Medical Systems
Whole medical systems are built upon complete systems of theory and practice. Often, these systems have evolved apart from and earlier than the conventional medical approach used in the United States. Examples of whole medical systems that have developed in Western cultures include:
• Homeopathic medicine. With origins in Europe, homeopathy seeks to stimulate the body’s ability to heal itself by giving very small doses of highly diluted substances that in larger doses would produce illness or symptoms (an approach called “like cures like”).
• Naturopathic medicine. Also with origins in Europe, naturopathy aims to support the body’s ability to heal itself by dietary and lifestyle changes together with CAM therapies such as herbs, massage, and joint manipulation.
• Chinese medicine. This medical system originated in China and is based on the concept that disease results from disruption in the flow of qi (i.e., the life force) and imbalance in the forces of yin and yang. Practices such as use of herbs, meditation, massage, and acupuncture seek to aid healing by restoring the yin-yang balance and the flow of qi.
• Ayurveda. With origins in India, this medical system aims to integrate the body, mind, and spirit to prevent and treat disease. Therapies used include herbs, massage, and yoga.
Mind-Body Medicine
Mind-body medicine uses a variety of techniques designed to enhance the mind’s capacity to affect bodily function and symptoms. Some techniques, such as patient support groups and cognitive-behavioral therapy were considered CAM in the past, but have since become mainstream. Other mind-body techniques still considered CAM include meditation, focusing attention for a sustained period, maintaining a specific posture, and therapies that use creative outlets such as art, music, or dance.
Biologically Based Practices
Biologically based practices in CAM use substances found in nature, such as herbs, foods, and vitamins. Some examples include dietary supplements, herbal products, and the use of other so-called natural, but as yet scientifically unproven, therapies (for example, using shark cartilage to treat cancer).
Manipulative and Body-Based Practices
Manipulative and body-based practices in CAM are based on manipulation, or the application of controlled force to a joint, moving it beyond the normal range of motion in an effort to aid in restoring health. Manipulation may be performed as a part of other therapies or whole medical systems. Some examples include chiropractic manipulation, osteopathic manipulation, physical therapy, and massage therapy.
Energy Medicine
Energy therapies involve the use of energy fields. They are of two types:
• Biofield therapies. These therapies are intended to affect energy fields, or biofields, that purportedly surround and penetrate the human body. The existence of such fields has not yet been scientifically proven. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in, or through, these fields. Examples include qi gong, Reiki, and therapeutic touch.
• Bioelectromagnetic-based therapies. These therapies involve the unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields, or alternating-current or direct-current fields.
Survey Results: Why People are Using CAM
What leads people to use alternative and complementary medicine? Conventional medicine has tried to answer this question as CAM grows in popularity. The NHIS survey asked people to select from five reasons to describe why they used CAM. (See Figure above.) Results were as follows (people could select more than one):
• CAM would improve health when used in combination with conventional medical treatments: 55%
• CAM would be interesting to try: 50%
• Conventional medical treatments would not help: 28%
• A conventional medical professional suggested trying CAM: 26%
• Conventional medical treatments are too expensive: 13% Also, of interest, the survey found that most people use CAM along with conventional medicine rather than in place of conventional medicine.
Diseases and Conditions for Which CAM Is Most Frequently Used
People use CAM for a wide array of diseases and conditions. According to the NHIS survey, CAM is most often used by adults in the United States for treatment and/or prevention of musculoskeletal conditions or other conditions involving chronic or recurring pain. The survey also demonstrated that U.S. adults are most likely to use CAM modalities for colds, anxiety or depression, gastrointestinal disorders, and sleeping problems.
The field of dermatology has not remained unaffected by this trend. A systematic review done in 2000 summarized all surveys of dermatological patients regarding the usage of CAM and found the lifetime prevalence ranged from 35% to 69% with the most frequently used treatment modalities being homeopathy, herbal products and food supplements.4
Who Uses CAM Most
CAM use spans people of all backgrounds. But, according to the NHIS survey, some people are more likely than others to use CAM. Overall, CAM use is greater by:
• Women than men
• People with higher educational levels
• People who have been hospitalized in the past year
• Former smokers, compared with current smokers or those who have never smoked what Physicians Should Know
While some scientific evidence exists regarding some CAM therapies, for most there are key questions yet to be answered through well-designed scientific studies — questions such as whether these therapies are safe and whether they work for the diseases or medical conditions for which they are used.
The list of what is considered to be CAM changes continually, as those therapies that are proven to be safe and effective become adopted into conventional health care and as new approaches to health care emerge. CAM is becoming more popular across all specialties in medicine, including dermatology.
To provide better care to patients, dermatologists need to be informed about CAM therapies that their patients are already using or maybe interested in using.
In future issues of Skin & Aging I will provide evidence-based reviews of CAM therapies used to treat common dermatological conditions. With this in mind, my aim is to provide you with information for guiding your patients who are interested in using CAM to treat their skin conditions.
