Complementary and Alternative Medicine (CAM): What Is It? Why Do We Care?
One hot topic in the treatment of children with developmental delays and disabilities is the use of complementary and alternative medicine (CAM), a collection of practices described as ‘outside’ the scope of conventional medical practice. Because the boundaries between medicine, alternative practice, and what is considered ‘mainstream’ treatment can be confusing, we’re providing a short primer on what exactly these different terms mean.
What is Complementary and Alternative Medicine (CAM)?
First and foremost, it’s important to remember that CAM is positioned in opposition to what people typically consider to be ‘traditional’ Western medicine. Conventional medicine is what most practitioners with MD or DO degrees practice – the focus is often on treating existing ailments within the context of very specific scientific frameworks. Treatments fall under the purview of ‘evidence-based medicine (EBM)’, which tests different treatments to confirm that they are effective and safe. These treatments are tested in a hierarchy, with only rigorously-tested procedures or treatments passing into the realm of ‘clinical practice guidelines.’
On the other hand, CAM practices sit outside ‘mainstream’ medicine, as they have either not been studied, not been proven to be effective, or lack scientific underpinnings to justify their inclusion in the scientific canon. It is important to note, however, that there are differences between complementary and alternative therapies:
- Complementary medicine is used in conjunction with or as a supplement to mainstream medicine.
- Alternative therapies are used to replace mainstream medical solutions, and thus may often carry with them correspondingly greater risks.
It is also very important to note that what is considered CAM can sometimes be a moving target because sometimes CAM therapies do get rigorously tested and adopted into ‘regular’ medicine. Some doctors, due to very high demand, even combine CAM practices with mainstream medicine in a hybrid called integrative medicine. One common rebuttal to CAM is, “If it were proven to work, it wouldn’t be an ‘alternative treatment’ – we’d all be using them.”
According to the National Center for Complementary and Integrative Health (NCCIH, formerly NCCAM), these therapies can be divided into five different categories:
- Alternative medical systems (medical treatments that center on specific philosophy, such as Ayurveda, first Nations traditional healing, traditional Chinese medicine, homeopathy and naturopathy)
- Mind-body interventions (treatments that involve fostering the mind-body connection, such as meditation, prayer, relaxation, and art therapy)
- Biologically based therapies (such as dietary supplements and herbal remedies)
- Manipulative and body-based methods (such as chiropractic and osteopathic manipulation and massage)
- Energy therapies (such as biofield therapies – including Qi Gong, therapeutic touch, and reiki – and bioelectromagnetic-based therapies such as magnet therapy or alternating-current or direct-current field therapy)
In many cases, however, there is a great deal of overlap, and the division between many of these therapies is not clear-cut. Many of these therapies claim to focus on the individual ‘holistically,’ looking to improve physical, emotional, mental and spiritual health.
Some medical practitioners can be cautious regarding recommending CAM therapies because many (if not most) have not undergone rigorous testing to confirm their safety. Some CAM therapies (such as dietary supplementation for cancer treatment) have been found not only ineffective, but actively harmful.
Is CAM Effective?
It is not possible to say that CAM therapies as a whole are ineffective, however, as many have not been tested for efficacy. Very controlled trials are expensive, which can make CAM efficacy testing difficult. Conventional medicine research is often supported by private firms, so clinical trials are feasible for them. CAM generally doesn’t have the same kind of backing, so clinical trials are more difficult to carry out. It is important to note, however, that without rigorous tests, it is very difficult to know what the possible risks and benefits of a CAM therapy could be. While some clinical trials for CAMs demonstrate some benefits, the benefits do not pass the standards for controlled clinical trials. Because of this, parents should exercise caution and talk to a medical professional to help make informed decisions if you are considering CAM therapies.
How CAM Therapies Are Tested for Efficacy
To demonstrate that CAM therapies are effective, there are three ‘tiers’ of support for their use. The most rigorous is a demonstration of clinical outcomes through controlled clinical trials. Less rigorous is a demonstration of established physiological mechanisms of action (ie, demonstrating that a treatment has an effect on some specific process that occurs in the body). The least persuasive is historical use, though this is generally considered anecdotal and unreliable evidence. In many cases, CAM is not practiced in a culture of evidence-based medicine, however, so disproving efficacy is not always enough to discourage the use of ineffective therapies.
Before Trying a Complementary or Alternative Therapy
Before trying an alternative therapy, remember that doctors are trained and licensed. CAM practitioners often don’t have to be, and many are not. Many health professionals recommend asking a healthcare provider such as a primary care physician for a referral if you are interested in CAM services, gathering information about the practitioner, and asking about the pros and cons of treatment – just like you would with any other medical care provider.
Examples of Complementary and Alternative Therapy
What are examples of Complementary and Alternative Medicine (CAM)?
- Alexander technique
- Chiropractic medicine
- Diet therapy
- Holistic nursing
- Massage therapy
- Nutritional therapy
- Osteopathic manipulative therapy (OMT)
- Qi gong (internal and external Qigong)
- Spiritual healing
- Tai Chi
- Traditional Chinese Medicine (TCM)
- National Center for Complementary and Alternative Medicine Website
- Mayo Clinic: What is Alternative Medicine?
- National Center for Complementary and Integrative Health: Complementary, Alternative, or Integrative Health: What’s In a Name?
- MedlinePlus: Learning about CAM? Start Here!
- CAM Overview
- Ethical problems arising in evidence-based complementary and alternative medicine
- Complementary and Alternative Healthcare: Is it Evidence-based?
- CAM-related Journals: Alternative and Complementary Therapies, Journal of Evidence-Based Complementary & Alternative Medicine, Evidence-Based Complementary and Alternative Medicine, Evidence -Based CAM
- CAM Organizations: Academy of Integrative Health and Medicine, American Chiropractic Association, American Holistic Health Association