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The Impact of Individualized Complementary and Integrative
Health Interventions Provided in Clinical Settings on Quality
of Life: A Systematic Review of Practice-Based Research
J Integr Complement Med 2022 (Aug); 28 (8): 618–640 ~ FULL TEXT
The literature search yielded 3,316 records with 264 assessed for full-text review. Of these, 19 studies (including ~14,002 patients) were specific to quality of life (or well-being) as a main outcome. Most studies included were multidisciplinary studies (n = 12), followed by acupuncture (n = 4), chiropractic (n = 3), and massage or reflexology (n = 1). The short-form group of questionnaires (SF-12, SF-36, SF-8) were the most used quality-of-life/well-being questionnaire, comprising 37% of studies (n = 7), and the Patient Reported Outcomes Measurement Information System (PROMIS) measures comprised 21% (n = 4). Both questionnaires are normed to U.S. population, allowing for comparison. The average improvement across the comparable SF and PROMIS measures for Physical Health was 6% (range 2%-20%) and for Mental Health was 5% (range 1%-11%), demonstrating clinical significance. Improvements in the observational studies are comparable to improvements reported from randomized controlled trials.
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U.S. Physician Recommendations to Their Patients About
the Use of Complementary Health Approaches
J Altern Complement Med 2020 (Jan); 26 (1): 25-33 ~ FULL TEXT
This study analyses show that physicians often recommend CHAs, with 53.1% of office-based U.S. physicians recommending at least one to their patients in the past 12 months. Recommendation rates were higher among female physicians than among male physicians and varied by medical specialty. General/family practitioners and internists recommended CHAs at higher rates than pediatricians, and more than half of psychiatrists recommended mind–body therapies, compared with <30% of physicians from other specialties. Understanding practice patterns of U.S. physicians related to recommendations for CHAs, and their differences across medical specialties and physician sex, could inform consumers, physicians, and medical schools.
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The Use of Complementary and Integrative Health Approaches
for Chronic Musculoskeletal Pain in Younger US Veterans:
An Economic Evaluation
PLoS One. 2019 (Jun 5); 14 (6): e0217831 ~ FULL TEXT
According to our propensity score-weighted HLM analysis, in a cohort of younger Veterans with chronic MSD pain during 2010 through 2013, any use of complementary and integrative health (CIH) was not only cost-effective, it was cost saving. Any use of CIH was associated with an average reduction in healthcare costs of $637, a 0.34-point reduction in pain intensity on a 0–10 pain scale, and a less than one percentage point increase in opioid use during the year after CIH start. Given the VA's growing interest in the use of CIH, further, more detailed analyses of its impacts are warranted.
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Researching the Appropriateness of Care in the Complementary and Integrative Health Professions
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Part 1: Introduction
J Manipulative Physiol Ther. 2018 (Nov); 41 (9): 800–806 ~ FULL TEXT
Although there is general agreement that all patients should receive health care that is appropriate to their health problem and that inappropriate care is costly, [1] the challenge comes in determining what is appropriate care. [2] In general, appropriateness comprises the right therapy, for the right problem, and for the right patient. In the current health care system, one answer to the question of appropriateness is that evidence-based care is appropriate care. However, this answer only shifts the problem from deciding what is appropriate to deciding what is evidence-based. Further, there is considerable debate about what percentage of treatments can claim to be evidence based.
Some estimate that as little as 15% to 20% of all medical practice can truly claim to be evidence based. [3–6]
Hicks notes, “It is generally accepted that between 20% and 60% of patients either receive inappropriate care or are not offered appropriate care.” [6] For large areas of health care, including complementary and integrative health (CIH; previously known as complementary and alternative medicine [CAM]), [7, 8] we have very little data on how much care is appropriate or evidence based.
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Part 2: What Every Researcher and Practitioner Should Know
About the Health Insurance Portability and Accountability
Act and Practice-based Research in the United States.
J Manipulative Physiol Ther. 2018 (Nov); 41 (9): 807–813 ~ FULL TEXT
For this study, we provided clinics with information about what the rules are under HIPAA, demonstrated how the study complied with those rules, explained the logic behind the necessity for collecting files from both the prospective and retrospective samples, and if requested, provided clinics with a confidentiality agreement signed by the study principal investigator and an organizational contracts representative. We hope that the process we developed will assist other CIH researchers and practitioners in future studies.
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Part 3: Designing Instruments With Patient Input
J Manipulative Physiol Ther. 2019 (Jun); 42 (5): 307–318 ~ FULL TEXT
It is important to collect valid data about patients’ experiences and beliefs for research and clinical care. In many instances, as with our study, the best approach may be to use existing measures for some constructs, to modify existing measures for other constructs, and to create entirely new measures for constructs where the existing measures are insufficient. In this article, we have described how we used multiple qualitative methods and a review of the literature to identify constructs and then design questionnaires that were successfully administered as part of a national survey of chiropractic patients with chronic low back and neck pain. We have presented preliminary reliability and validity data for one of our novel measures, which addresses coping behaviors. We have also outlined suggestions for CIH researchers and providers who want to collect this sort of information from patients.
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Part 4: Putting Practice Back Into Evidence-based Practice
by Recruiting Clinics and Patients
J Manipulative Physiol Ther. 2019 (Jun); 42 (5): 319–326 ~ FULL TEXT
In this paper, we have outlined the way in which we can make the evidence practiced based in a way that ensures rigorous methods are applied and valid and reliable data are collected. Through this process, we learned that clinic staff is essential. The study demonstrated that at least in chiropractic, and we think CIH generally, there is a strong desire among practitioners to be involved in research and therefore a good basis to move the “P” into EBP. If the chiropractor supported the study, so did the staff, and if the staff and chiropractor supported the study, so did the patients. Another lesson from this study was the amount of effort needed to obtain a substantial and empowered sample. The RAND Corp was helped by its earlier studies in chiropractic and its positive reputation in the chiropractic community, but it was also helped by the responsiveness of the profession in engaging in research.
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Part 5: Using Patient Records: Selection, Protection,
and Abstraction
J Manipulative Physiol Ther. 2019 (Jun); 42 (5): 327–334 ~ FULL TEXT
The chiropractic record data collection for this project focused on evaluating the appropriateness of mobilization and manipulation for chronic low back pain (CLBP) and chronic cervical pain (CCP). Additional data were collected to summarize the duration of care, frequency of visits, and nature of treatments provided. For this study, the chiropractic record provided the most comprehensive data to assess appropriateness of chiropractic care. Records of care were successfully obtained from most study sites.
This paper set out to provide an overview of the 4–step process (consent, selection, protection, and abstraction) of acquiring a large sample of chiropractic patient records from multiple practices and subsequent data abstraction. As we noted, each step poses challenges, and in each step, we documented the solutions we implemented. For future research based on chiropractic clinics, it is clear that improved record keeping and easier access to files would greatly simplify the task of abstracting data from a patient file.
Use of an EHR may improve clinical content, but even paper-based records could benefit from improved and better use of templates to document patient history, examinations, treatment, and outcome measurements. Consistent documentation would ease ongoing research efforts and support providers in case of legal questions or a reimbursement audit. As chiropractic care becomes more accepted in medical settings that may require more provider collaboration, maintenance of complete treatment documentation will become even more important.
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Complementary and Alternative Medicine Services in
the Military Health System
J Altern Complement Med. 2017 (Nov); 23 (11): 837–843 ~ FULL TEXT
Three-fourths of military treatment facilities (MTFs) offering CAM provide stress management/relaxation therapy, two-thirds provide acupuncture, and at least half provide progressive muscle relaxation, guided imagery, chiropractic, and mindfulness meditation. MTFs most commonly report CAM use for pain and mental health conditions. Acupuncture and chiropractic are most commonly used for pain, and stress management/relaxation therapy and mind-body medicine combinations are most often used for mental health-related conditions. We estimate 76,000 CAM patient encounters per month across the MHS.
This article derives from a much larger (95-page) document, prepared for the Office of the Secretary of Defense
by the same authors and the RAND Corporation, under the title:
Complementary and Alternative Medicine in the Military Health System
along with a 67-page Addendum document, under the same title:
Complementary and Alternative Medicine in
the Military Health System Appendixes
RAND Corporation, Santa Monica, Calif. (2017)
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Alternative Medicine, Worker Health, and Absenteeism
in the United States
Complement Ther Med. 2017 (Jun); 32: 116–128 ~ FULL TEXT
In a sample of 8,820 workers, the average annual number of workdays lost due to illness is 3.69. Visiting an acupuncturist correlates with lower absenteeism among men (1.182 fewer workdays missed, p<0.05), whereas visiting a naturopathic doctor correlates with 2.359 and 2.521 fewer workdays missed for women and men, respectively (both p<0.001). Active mind-body practices, massage, chiropractic and acupuncture treatments are all significantly associated with improved health.
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Complementary and Alternative Medicine Use by Children
with Pain in the United States
Acad Pediatr. 2017 (Feb 20). pii: S1876-2859(17)30063-3
Parents reported that 26.6% of children had pain conditions (e.g. headache, abdominal, musculoskeletal pain) in the past year; of these children, 21.3% used CAM. In contrast only 8.1% of children without pain conditions used CAM (χ2: p<.001). CAM use among children with pain was associated with female sex (adjusted odds ratio (aOR)=1.49, p=0.005), higher income (aOR=1.61, p=0.027), and presence of 4+ comorbidities (aOR=2.01, p=0.013). Among children with pain who used CAM the 2 most commonly used CAM modalities were biologically-based therapies (47.3%) (e.g., special diets and herbal supplements) and manipulative or body-based therapies (46.3%) (e.g., chiropractic and massage). CONCLUSIONS: CAM is frequently used by children with pain in the USA and many parents report benefits for their child's symptoms.
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Evidence-Based Evaluation of Complementary Health Approaches
for Pain Management in the United States
Mayo Clin Proc. 2016 (Sep); 91 (9): 1292–1306 ~ FULL TEXT
Although most pain is acute and resolves within a few days or weeks, millions of Americans have persistent or recurring pain that may become chronic and debilitating. Medications may provide only partial relief from this chronic pain and can be associated with unwanted effects. As a result, many individuals turn to complementary health approaches as part of their pain management strategy. This article examines the clinical trial evidence for the efficacy and safety of several specific approaches-acupuncture, manipulation, massage therapy, relaxation techniques including meditation, selected natural product supplements (chondroitin, glucosamine, methylsulfonylmethane, S-adenosylmethionine), tai chi, and yoga-as used to manage chronic pain and related disability associated with back pain, fibromyalgia, osteoarthritis, neck pain, and severe headaches or migraines.
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Mapping the Health Care Policy Landscape for Complementary
and Alternative Medicine Professions Using Expert
Panels and Literature Analysis
J Manipulative Physiol Ther. 2016 (Sep); 39 (7); 500–509 ~ FULL TEXT
One generally recognized characteristic of complementary and alternative medicine (CAM) is holism, which is a focus on treating the whole person. [1, 2] Complementary and alternative medicine practitioners use a wide range of techniques embedded within various broad healing paradigms to provide treatment. However, despite this broad approach and holistic goal, CAM is often addressed in policy and research as individual procedures (ie, modalities or treatments). In sociology, this dichotomy is one of CAM practitioners as members of professions vs members of skilled occupations, with professions having broader authority and autonomy because of a systematic body of theory that goes beyond skills. [3]
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Use of Complementary Health Approaches at Military
Treatment Facilities, Active Component, U.S.
Armed Forces, 2010-2015
Medical Surveillance Monthly Report (MSMR) 2016 (Jul); 23 (7): 9–22 ~ FULL TEXT
The majority of the 240 military installations in this analysis provided chiropractic/osteopathic manipulation; more than three-quarters provided acupuncture; and approximately one-third provided biofeedback procedures. "Other and unspecified disorders of the back" was the most frequent condition for which chiropractic/osteopathic manipulation and acupuncture were used. "Non-allopathic lesions not elsewhere classified" was the second most frequent diagnosis during chiropractic/osteopathic manipulation-related visits. The second and third most frequent diagnoses during acupuncture-related visits were "acute and chronic pain" and "adjustment reaction," respectively. "Adjustment reaction" was the second most frequent diagnosis associated with biofeedback. Continued research is needed to gain a better understanding of why military personnel are using CAM and the role these procedures play in their health care.
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Complementary and Alternative Medicine: Professions
or Modalities? Policy Implications for Coverage,
Licensure, Scope of Practice, Institutional
Privileges, and Research
(PDF)
RAND Corporation, Santa Monica, CA; 2015 ~ FULL TEXT
The purpose of this project is to produce a RAND report/white paper on a problem that
confronts the complementary and alternative medicine (CAM) professions whereby a profession
is defined politically not by its full professional scope but by its treatment modalities. Even when
CAM disciplines are defined by legal statutes as broad-based professions, this designation is not
honored by such codes as the policies of insurance coverage. This project consisted of three
parts: development of a background paper on the policy issues associated with the scope of
practice and utilization of CAM practitioners in the health care system, input from a panel of
CAM experts, and input from a panel of health care policy decisionmakers.
You may also want to read this companion piece, titled:
Advancing Complementary and Alternative Medicine Professions
You will also enjoy the following review, titled:
Chiropractic: Profession or Modality?
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Chiropractic: Profession or Modality?
HuffPost (11-19-2015) and Dynamic Chiropractic (12-15-2015)~ FULL TEXT
Is chiropractic a profession or a modality? That's the thought-provoking question explored in a new RAND report funded by the NCMIC Foundation. “Complementary and Alternative Medicine: Professions or Modalities?“
focuses on “a problem that confronts the complementary and alternative medicine (CAM) professions whereby a profession is defined politically not by its full professional scope but by its treatment modalities.”
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Public Perceptions of Doctors of Chiropractic:
Results of a National Survey and Examination
of Variation According to Respondents'
Likelihood to Use Chiropractic, Experience
With Chiropractic, and Chiropractic Supply
in Local Health Care Markets
J Manipulative Physiol Ther. 2015 (Oct); 38 (8): 533–544 ~ FULL TEXT
Most (61.4%) respondents believed that chiropractic care was effective at treating neck and back pain, 52.6% thought DCs were trustworthy, and 24.2% thought chiropractic care was dangerous; however, as respondents' likelihood to use a DC increased, perceptions of effectiveness and trustworthiness increased, and perceptions of danger decreased. Of all 5422 survey respondents, 744 or 13.7% indicated that they had seen a DC within the last 12 months.
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Use of Complementary Health Approaches Among Children
Aged 4–17 Years in the United States: National
Health Interview Survey, 2007–2012
National Health Statistics Report 2015 (Feb 10); (78): 1–19 ~ FULL TEXT
This report presents national estimates of the use of complementary health approaches among children aged 4–17 years in the United States. Selected modalities are compared for 2007 and 2012 to examine changes over time. The combined sample included 17,321 interviews with knowledgeable adults about children aged 4–17 years.
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Trends in the Use of Complementary Health Approaches
Among Adults: United States, 2002-2012
National Health Statistics Report 2015 (Feb 10); (78): 1–16 ~ FULL TEXT
In 2002, 2007, and 2012, the ALT supplement was administered to the sample adult respondent. Sponsored by the National Center for Complementary and Integrative Health [(NCCIH) formerly the National Center for Complementary and Alternative Medicine], part of the National Institutes of Health (NIH), the ALT supplement was implemented in order to provide a national data source on complementary medicine use. Since its inception in 2002, much of the content of the ALT supplement has remained constant, but modifications have been made in order to accommodate emerging scientific information, expert panel input, and societal shifts. Although the approaches included have varied slightly across survey years, the following were included in all three questionnaires: acupuncture; Ayurveda; biofeedback; chelation therapy; chiropractic care; energy healing therapy; hypnosis; massage; naturopathy; nonvitamin, nonmineral dietary supplements; homeopathic treatment; diet-based therapies; yoga; tai chi; qi gong; and meditation and other relaxation techniques.
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A Qualitative Study of Changes in Expectations Over Time
Among Patients with Chronic Low Back Pain Seeking
Four CAM Therapies
BMC Complement Altern Med. 2015 (Feb 5); 15: 12 ~ FULL TEXT
These findings suggest the value of further research into the potential of the CAM therapeutic process to assist patients in taking control of their health management and wellness. Sointu [58] argues that CAM use is becoming increasingly common because the “discourse of well-being” (9) embedded in CAM interactions (see also [24, 25]) resonates with how people understand their bodies and selves. Our data support the finding that CAM participants report greater awareness of the need for ongoing engagement in their own care, an increased sense of control or empowerment, and motivation to seek effective coping strategies. [ Editorial Comment: These are all things that conventional medicine struggles with.]
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Wellness-related Use of Common Complementary Health
Approaches Among Adults: United States, 2012
National Health Statistics Report 2015 (Nov 4); (85): 1–12 ~ FULL TEXT
This 12 page National Institutes of Health report presents national estimates of selected wellness-related reasons for the use of natural product supplements, yoga, and spinal manipulation among U.S. adults in 2012. Self-reported perceived health outcomes were also examined.
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A Culture of Collaboration at an Integrative Health Center
An Interview with David Fogel, MD -
Interviewed by Daniel Redwood, DC
Topics in Integrative Health Care 2014, 5 (3)
David Fogel, MD, is the cofounder (with his wife, Ilana Bar-Levav, MD), of the Casey Health Institute (CHI) in Gaithersburg, Maryland, a nonprofit integrative primary care practice that includes Internal Medicine, Family Practice, Chiropractic, Acupuncture, Massage Therapy, Yoga Therapy, Naturopathic Medicine and more. He is board certified in Internal Medicine with additional specialty training in mind/body focused individual and group psychotherapy.
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The Association of Complementary and Alternative Medicine
Use and Health Care Expenditures for
Back and Neck Problems
Medical Care 2012 (Dec); 50 (12): 1029–1036 ~ FULL TEXT
Complementary and alternative medicine (CAM) includes professional services provided by chiropractic, homeopathic and naturopathic physicians, herbalists, acupuncturists and massage therapists.(Kaptchuk and Eisenberg 2001) As insurance coverage has become more widespread, CAM use among patients with spine problems has increased.(Eisenberg 1998; Pelletier 2002; Nahin 2009) For example, the number of adults in the United States who sought chiropractic care, the most common type of CAM used by people with spine problems, increased 57% from 1997 to 2006.(Davis 2010)
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Complementary and Alternative Medicine Use by
Pediatric Specialty Outpatients
Pediatrics. 2013 (Feb); 131 (2): 225–232
Complementary and alternative medicine (CAM) use is high among children and youth with chronic illnesses. The most common CAM practices currently used were massage, chiropractic, relaxation, and aromatherapy. Results of this study indicate that CAM use is high among pediatric specialty clinic outpatients and is much greater in the western than in the central hospital. Most respondents felt that their CAM use was helpful with few or no harms associated. Many patients, using CAM alongside their conventional medicines, are still not discussing their CAM use with their physicians and are increasing the likelihood for potential interactions and preventable harms.
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US Spending on Complementary and Alternative Medicine During
2002-08 Plateaued, Suggesting Role in Reformed Health System
Health Affairs 2013 (Jan); 32 (1): 45–52
Complementary and alternative medicine services in the United States are an approximately $9 billion market each year, equal to 3 percent of national ambulatory health care expenditures. Unlike conventional allopathic health care, complementary and alternative medicine is primarily paid for out of pocket, although some services are covered by most health insurance. Examining trends in demand for complementary and alternative medicine services in the United States reported in the Medical Expenditure Panel Survey during 2002–08, we found that use of and spending on these services, previously on the rise, have largely plateaued. The higher proportion of out-of-pocket responsibility for payment for services may explain the lack of growth. Our findings suggest that any attempt to reduce national health care spending by eliminating coverage for complementary and alternative medicine would have little impact at best. Should some forms of complementary and alternative medicine-for example, chiropractic care for back pain-be proven more efficient than allopathic and specialty medicine, the inclusion of complementary and alternative medicine providers in new delivery systems such as accountable care organizations could help slow growth in national health care spending.
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A Systematic Review and Meta-analysis of Efficacy,
Cost-effectiveness, and Safety of Selected
Complementary and Alternative Medicine
for Neck and Low-back Pain
Evid Based Complement Alternat Med. 2012 (Nov 24); 2012: 953139 ~ FULL TEXT
Reports of 147 randomized trials and 5 non-randomized studies were included. CAM treatments were more effective in reducing pain and disability compared to no treatment, physical therapy (exercise and/or electrotherapy) or usual care immediately or at short-term follow-up. Trials that applied sham-acupuncture tended towards statistically non-significant results. In several studies, acupuncture caused bleeding on the site of application, and manipulation and massage caused pain episodes of mild and transient nature.
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A Randomized Controlled Trial of a Multifaceted Integrated
Complementary-alternative Therapy for Chronic
Herpes Zoster-related Pain
Alternative Medicine Review 2012 (Mar); 17 (1): 57–68
Participants had a mean age of 69.8 years (SD=11.1) and had had herpes zoster-related pain for a median of 4.8 months (range: 1 month to 15 years). The immediate treatment and control groups had similar pain levels at baseline (treatment = 7.5; control = 7.8; p=0.5; scores based on the 10-point Likert pain scale). At three weeks post-randomization (i.e., after the immediate treatment group completed treatment) pain scores differed significantly (treatment = 2.3; control = 7.2; p<0.001). The observed reduction in pain in the immediate treatment group was maintained at nine weeks and at long-term follow-up (one to two years later).
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Complementary and Alternative Medicine in a Military
Primary Care Clinic:
A 5-year Cohort Study
Military Medicine 2011 (Jun); 176 (6): 685–688 ~ FULL TEXT
Previous studies have found that complementary and alternative medication (CAM) use is common. We enrolled 500 adults presenting to a primary care military clinic. Subjects completed surveys before the visit, immediately afterwards, at 2 weeks, 3 months, and 5 years. Over 5 years, 25% used CAM for their presenting symptom. Most (72%) reported that CAM helped their symptom. Independent predictors of CAM use included female sex (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.1-3.7), college educated (OR, 3.4; 95% CI, 1.8-6.3), more severe symptoms (OR, 1.14; 95% CI, 1.01-1.28), and persistence of symptom beyond 3 months (OR, 3.9; 95% CI, 2.0-7.5). We concluded that a quarter of military primary care patients use CAM over 5 years of follow-up and most find it helpful. CAM users tend to be female and better educated. Patients with more severe symptoms or symptoms that persist beyond 3 months are also more likely to turn to CAM.
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Neuromusculoskeletal Disorders Following SARS:
A Case Series
J Can Chiropr Assoc. 2011 (Mar); 55 (1): 32–39 ~ FULL TEXT
In this case series, three patients with varied neuromuscular complaints reported short-term subjective improvements in their pain experience and quality of life, and two were able to return to work. Future research should investigate the role of conservative care and manual therapies for this type of patient population using subjective outcome measures.
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Alternative Headache Treatments:
Nutraceuticals, Behavioral and Physical Treatments
Headache. 2011 (Mar); 51 (3): 469–483
There is a growing body of evidence supporting the efficacy of various complementary and alternative medicine approaches in the management of headache disorders. These treatment modalities include nutraceutical, physical and behavioral therapies. Nutraceutical options comprise vitamins and supplements (magnesium, riboflavin, coenzyme Q(10), and alpha lipoic acid) and herbal preparations (feverfew, and butterbur).
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Agents of Change: How Do Complementary and Alternative
Medicine Providers Play a Role in Health Behavior Change?
Altern Ther Health Med. 2011 (Jan); 17 (1): 22–30 ~ FULL TEXT
Consumers reported encouragement from providers and improved energy resulting from treatments as reasons for making health behavior changes. Multivariate analysis showed that increased odds of self-reported dietary change were significantly associated with increasing body awareness as a result of therapy, endorsing the statement that sustained improvement for their health conditions required self-care, using an acupuncturist, and being 44 years or younger. Comparable results were found for exercise change, except using an acupuncturist was a significant negative predictor and age was not significant. Focus group findings echoed these themes.
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Inclusion of a CAM Therapy (Chiropractic Care) for the Management
of Musculoskeletal Pain in an Integrative, Inner City,
Hospital-based Primary Care Setting
J Alternative Medicine Research 2010 (Dec); 2 (1) 61–74 ~ FULL TEXT
We have reported on an innovative program to integrate a CAM treatment service, chiropractic, into the primary care musculoskeletal services provided by a Canadian hospital to its inner city population. The success of this program has been confirmed through a mixed-methods evaluative process. Programmatic success was achieved by the concerted efforts of all stakeholders, especially when led by an institutional champion. High satisfaction with the program was reported by administrators, practitioners and patients. Clinical outcomes were evaluated by a standardized outcomes protocol. Our findings demonstrate that the majority of patients with MSK complaints obtained clinically important improvements when able to access chiropractic care. This is especially important given the frequency of chronic, complex complaints with numerous co-morbidities in our study population and the significant barriers these people face in accessing traditional hospital services. Our team found that CAM therapies may be useful adjuncts in the management of MSK pain conditions, even in highly systematized settings of primary care hospital clinics and for clinically complex and marginalized populations.
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Complementary and Alternative Medicine Use Among
Military Family Medicine Patients in Hawaii
Military Medicine 2010 (Jul); 175 (7): 534–538 ~ FULL TEXT
Complementary and alternative medicine (CAM) is a growing component of medicine within the U.S. civilian and military populations. Tripler Army Medical Center (TAMC) Family Medicine Clinic represents an overseas medical facility stationed among a diverse ethnic population. The impact that local cultures have on CAM utilization in the military population in overseas medical facilities is unknown.
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Perceived Benefit of Complementary and Alternative
Medicine (CAM) for Back Pain:
A National Survey
J American Board of Family Medicine 2010 (May); 23 (3): 354–362 ~ FULL TEXT
This new reports on interviews with 31,044 individuals who used CAM for low back pain.
The results are quite fascinating:
The top 6 CAM therapies for LBP, starting with the most-used, are chiropractic, massage, herbal therapy, acupuncture, yoga/tai chi/qi gong, and relaxation techniques.
Chiropractic use (76% of respondents) was greater than all the other 5 therapies combined
(see Figure 1)
Chiropractic users scored their satisfaction (and benefits) the highest of all 6 approaches used. (see Table 2). This reconfirms earlier findings from the Archives of Physical Medicine & Rehabilitation 2005, which reported that SMT provided the greatest pain relief (7.33), scoring higher than nerve blocks (6.75), Opioid analgesics (6.37), muscle relaxants (5.78), Acupuncture (5.29), or NSAIDs (5.22).
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Unanticipated Benefits of CAM Therapies for Back Pain:
An Exploration of Patient Experiences
J Alternative and Complementary Medicine 2010 (Feb); 16 (2): 157–163 ~ FULL TEXT
Our analysis identified a range of positive outcomes that participants in CAM trials considered important but were not captured by standard quantitative outcome measures. Positive outcome themes included increased options and hope, increased ability to relax, positive changes in emotional states, increased body awareness, changes in thinking that increased the ability to cope with back pain, increased sense of well-being, improvement in physical conditions unrelated to back pain, increased energy, increased patient activation, and dramatic improvements in health or well-being. The first five of these themes were mentioned for all of the CAM treatments, while others tended to be more treatment specific. A small fraction of these effects were considered life transforming. Our findings suggest that standard measures used to assess the outcomes of CAM treatments fail to capture the full range of outcomes that are important to patients. In order to capture the full impact of CAM therapies, future trials should include a broader range of outcomes measures.
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Intractable Migraine Headaches During Pregnancy
Under Chiropractic Care
Complementary Therapies in Clinical Practice 2009 (Nov); 15 (4): 192–197
The absence of hormone fluctuations and/or the analgesic effects of increased beta-endorphins are thought to confer improvements in headache symptoms during pregnancy. However, for a number of pregnant patients, they continue to suffer or have worsening headache symptoms. The use of pharmacotherapy for palliative care is a concern for both the mother and the developing fetus and alternative/complementary care options are sought. We present a 24-year-old gravid female with chronic migraine headaches since age 12years. Previous unsuccessful care included osteopathy, physical therapy, massage and medication. Non-steroidal anti-inflammatory medication with codeine provided minor and temporary relief. Chiropractic care involving spinal manipulative therapy (SMT) and adjunctive therapies resulted in symptom improvement and independence from medication. This document provides supporting evidence on the safety and possible effectiveness of chiropractic care for patients with headaches during pregnancy.
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Costs of Complementary and Alternative Medicine (CAM)
and Frequency of Visits to CAM Practitioners:
United States, 2007
National Health Statistics Reports 2009 (Jul 30); (18): 1–14
In 2007, adults in the United States spent $33.9 billion out of pocket on visits to CAM practitioners and purchases of CAM products, classes, and materials. Nearly two-thirds of the total out-of-pocket costs that adults spent on CAM were for self-care purchases of CAM products, classes, and materials during the past 12 months ($22.0 billion), compared with about one-third spent on practitioner visits ($11.9 billion). Despite this emphasis on self-care therapies, 38.1 million adults made an estimated 354.2 million visits to practitioners of CAM. About three-quarters of both visits to CAM practitioners and total out-of-pocket costs spent on CAM practitioners were associated with manipulative and body-based therapies. A total of 44% of all out-of-pocket costs for CAM, or about $14.8 billion, was spent on the purchase of nonvitamin, nonmineral, natural products.
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Chiropractic Care Amongst People With Multiple Sclerosis:
A Survey of MS Therapy Centres in the UK
Clinical Chiropractic 2009 (Mar); 12 (1): 23–27 ~ FULL TEXT
Many of the musculoskeletal symptoms associated with multiple sclerosis (MS) can be managed with physical therapy. Chiropractors are well placed to deliver this, but the extent of their involvement in the team management of multiple sclerosis in the UK is unknown. The present study investigates the level of awareness and use of chiropractic by people with MS in the UK.
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Factors Influencing Parents Decisions To Choose Chiropractic
Care For Their Children in the UK
Clinical Chiropractic 2009 (Mar); 12 (1): 11–22 ~ FULL TEXT
The results indicate that mothers are the main decision-makers when chiropractic care is chosen for a child and they are mostly influenced by the family physician and friends. This information could help inform campaigns aimed at dissemination of information about the practice and scope of paediatric chiropractic care.
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Complementary and Alternative Medicine:
Attitudes and Patterns of Use by
German Physicians in a National Survey
J Altern Complement Med 2008 (Dec); 14 (10): 1255–1261 ~ FULL TEXT
In our sample, 51% were in favor of CAM use (26% were very much in favor, 25% were in favor). Three single CAM techniques and three CAM treatment systems (integrating several techniques and/or covering a wide range of indications) were to be scored on their seriousness,with 4 answers possible: rather credible, rather questionable, undecided, don’t know. Acupuncture was judged rather credible by 394 (76.4%), chiropractic by 373 (73.3%), homeopathy by 257 (49.8%), anthroposophical medicine by 101 (19.6%), electroacupuncture by 183 (35.5%),and autologous blood therapy by 144 (27.9%). The two latter techniques were chosen because of their widespread use in Germany in spite of explicit nonrecommendations given by the Federal Joint Committee, a national board of physicians and insurance providers.
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Do Chiropractors Identify with Complementary and
Alternative Medicine? Results of a Survey
J Altern Complement Med 2008 (May); 14 (4): 361–368
Of the total sample of 132, 69% did not agree that chiropractic should be categorized as CAM. Twenty-seven percent (27%) of 132 thought that chiropractors should be classified as IM; 20% of practitioners and 6% of faculty considered chiropractic mainstream medicine. The majority (69%) of the chiropractors in this sample rejected being characterized as CAM practitioners, showing some preference for the term IM (27%).
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Efficacy of Selected Complementary and Alternative
Medicine Interventions For Chronic Pain
J Rehabil Res Dev. 2007; 44 (2): 195–222 ~ FULL TEXT
Complementary and alternative medicine (CAM) is a group of diverse medical and healthcare systems, therapies, and products that are not presently considered part of conventional medicine. This article provides an up-to-date review of the efficacy of selected CAM modalities in the management of chronic pain. Findings are presented according to the classification system developed by the National Institutes of Health National Center for Complementary and Alternative Medicine (formerly Office of Alternative Medicine) and are grouped into four domains: biologically based medicine, energy medicine, manipulative and body-based medicine, and mind-body medicine.
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Use of Complementary and Alternative Therapies in
Community-dwelling Older Adults
J Altern Complement Med 2007 (Nov); 13 (9): 997–1006
Overall, 62.9% (N = 445) of the respondents reported use of one or more complementary and alternative medicine modalities with an average of three modalities (SD +/- 1.9, range 1–11). The top five CAM modalities used were nutritional supplements (44.3%), spiritual healing/prayer (29.7%), megavitamins (28.3%), herbal supplements (20.7%), and chiropractic (17.8%). Maintaining health and treating a health condition were the primary reasons for CAM use. The most common conditions treated were arthritis (44.4%) and chronic pain (23.3%).
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Pattern and Frequency of Use of Complementary and Alternative
Medicine Among Patients with Epilepsy in
the Midwestern United States
Epilepsy & Behavior 2007 (Jun); 10 (4): 576–582
Thirty-nine percent (of those interviewed) reported using CAM; 23% reported using CAM specifically for their epilepsy. Prayer/spirituality was the most commonly used form of CAM (46%), followed by "mega" vitamins (23%), chiropractic care (24%), and stress management (16%). CAM use is common among midwestern patients with epilepsy, although the pattern of use may be slightly different than in other regions of the United States and elsewhere.
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Complementary and Alternative Medicine Use Among US Navy
and Marine Corps Personnel
BMC Complement Altern Med. 2007 (May 16); 7: 16
Of 3,683 service members contacted, 1,446 (39.3%) returned a questionnaire and 1,305 gave complete demographic and survey data suitable for study. Among respondents, more than 37% reported using at least one CAM therapy during the past year. Herbal therapies were among the most commonly reported (15.9%). Most respondents (69.8%) reported their health as being very good or excellent. Modeling revealed that CAM use was most common among personnel who were women, white, and officers. Higher levels of recent physical pain and lower levels of satisfaction with conventional medical care were significantly associated with increased odds of reporting CAM use.
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A Large-sample Survey of First- and Second-year Medical Student
Attitudes Toward Complementary and Alternative Medicine
in the Curriculum and in Practice
Altern Ther Health Med 2007 (Jan); 13 (1): 30–35
Nearly all (91%) students agreed that "CAM includes ideas and methods from which Western medicine could benefit"; more than 83% agreed that "knowledge about CAM is important to me as a student/future practicing health professional"; and more than 73% felt that CAM should be included in the curriculum. Among all students, the most frequently indicated level of desired training was "sufficient to advise patients about use," for 11 of the 15 modalities. The greatest level of training was wanted for acupuncture, chiropractic, herbal medicine, and nutritional supplements. The descriptions of CAM in future clinical practice that occurred most frequently were endorsement, referral, or provision of acupuncture, biofeedback, chiropractic, herbal medicine, massage, nutritional supplements, prayer, and meditation.
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Chiropractic and CAM Utilization:
A Descriptive Review
Chiropractic & Osteopathy 2007 (Jan 22); 15: 2 ~ FULL TEXT
Studies looking at chiropractic utilization demonstrate that the rates vary, but generally fall into a range from around 6% to 12% of the population, most of whom seek chiropractic care for low back pain and not for organic disease or visceral dysfunction. CAM and chiropractic often offer lower costs for comparable results compared to conventional medicine.
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How Far Can Complementary and Alternative Medicine Go?
The Case of Chiropractic and Homeopathy
Soc Sci Med. 2006 (Nov); 63 (10): 2617–2627
The data revealed four main strategies: (1) improving the quality of educational programs, (2) elevating standards of practice, (3) developing more peer reviewed research, and (4) increasing group cohesion. Although both groups identified similar strategies, the chiropractors were bolstered by more resources as well as state sanctioned regulation. The efforts of the homeopaths were constrained by scarce resources and the absence of self-regulation.
In both cases the lack of strong structural support from government and the established health professions played an important role in limiting what was possible. In the future, it may be to the state's advantage to modify the overall shape of health care to include alternative paradigms of healing along with conventional medical care.
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Use of Selected Complementary and Alternative Medicine (CAM)
Treatments in Veterans with Cancer or Chronic Pain:
A Cross-sectional Survey
BMC Complement Altern Med 2006 (Oct 6); 6: 34 ~ FULL TEXT
One of the largest groups to utilize alternative therapies is veterans. A recent mail survey evaluated selected alternative medicine use among 264 veterans. The survey included questions on demographics, health beliefs, medical problems and use of six common alternative therapies (chiropractic, herbs, dietary supplements, massage therapy, acupuncture and homeopathy). Seventy-two patients (27.3%) reported alternative therapy use within the past 12 months. COLOR="#8B0000">One-fourth of patients (26%) used chiropractic care to alleviate their pain. Back pain was the most frequently reported medical problem (62.3%). While most veterans (76.9%) had used prescription pills to treat their medical problems, 67% of veterans who had not used alternative therapies reported that they would use it if offered by the Veterans Administration (VA).
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U.S. and Canadian Pharmacists' Attitudes, Knowledge, and
Professional Practice Behaviors Toward Dietary Supplements:
A Systematic Review
BMC Complement Altern Med 2006 (Sep 19); 6 (1): 31 ~ FULL TEXT
There is strong agreement among pharmacists for the need to have additional training on Dietary Supplements (DS), increased regulation of DS, and quality information on DS. In addition, survey data indicate that pharmacists do not perceive their knowledge of DS to be adequate and that pharmacists do not routinely document, monitor, or inquire about patients' use of DS. Despite this, a large proportion of pharmacists reported receiving questions about DS from patients and other health care practitioners.
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Insurance Coverage and Subsequent Utilization of
Complementary and Alternative Medicine Providers
Am J Manag Care 2006 (Jul); 12 (7): 397–404
Among more than 600,000 enrollees, 13.7% made CAM claims. This included 1.3% of enrollees with claims for acupuncture, 1.6% for naturopathy, 2.4% for massage, and 10.9% for chiropractic. Patients enrolled in preferred provider organizations and point-of-service products were notably more likely to use CAM than those with health maintenance organization coverage. The use of CAM was greater among women and among persons 31 to 50 years of age. The use of chiropractic was more frequent in less populous counties. The CAM provider visits usually focused on musculoskeletal complaints except for naturopathic physicians, who treated a broader array of problems. The median per-visit expenditures were $39.00 for CAM care and $74.40 for conventional outpatient care. The number of people using CAM insurance benefits was substantial; the effect on insurance expenditures was modest.
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The Role of Evidence in Alternative Medicine:
Contrasting Biomedical and Anthropological Approaches ~ FULL TEXT
Soc Sci Med. 2006 (Jun); 62 (11): 2646–2657
In this paper, the supposed objectivity of scientific, biomedical forms of evidence is questioned through an illumination of the multiple rhetorics embedded in the evidence-based medicine phenomenon, both within biomedicine itself and in calls for its use to evaluate alternative therapeutic systems. Anthropological notions of evidence are constructed very differently from those of biomedical science, and offer a closer resonance with the philosophy of alternative medicine. Examples are given of the kinds of evidence produced by anthropologists researching alternative medicine.
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Complementary Healthcare:
A Guide for Patients (PDF)
Prince of Wales’s Foundation for Integrated Health ~ 2005
This report, prepared by the The Prince's Foundation for Integrated Health advises British citizens about the regulated professions of chiropractic and osteopathy, the soon-to-be regulated field of acupuncture, and 12 other unregulated techniques, ranging from Aromatherapy to Yoga.
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An Analysis of Sickness Absence in Chronically Ill Patients
Receiving Complementary and Alternative Medicine:
A Longterm Prospective Intermittent Study
BMC Public Health 2006 (Feb 12); 6 (1): 28
Results of this longterm observational study show a reduction of sick leave in chronically ill patients after a complex multimodal CAM intervention. However, as this is an uncontrolled observational study efficacy of any specific CAM treatment can not be proven. The results might indicate an general effectiveness of CAM in primary care, worthwhile further investigations. Future studies should identify the most suitable patients for CAM practices, the most appropriate and safe treatments, provide information on the magnitude of the effects to facilitate subsequent definitive randomised controlled studies that will help to position complementary and alternative medicine in health care.
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Homeopathic Care for the Prevention of Upper Respiratory Tract
Infections in Children: A Pragmatic, Randomised, Controlled
Trial Comparing Individualised Homeopathic Care and
Waiting-list Controls
Complementary Therapies in Medicine 2005 (Dec); 13 (4): 231–238
There was a significant difference in median total symptom score in favour of homeopathic care (24 points) compared to the control group (44 points) (p = 0.026). The difference in the median number of days with URTI symptoms was statistically significant with 8 days in the homeopathic group and 13 days in the control group (p = 0.006). There was no statistical difference in the use of conventional medication or care between the two groups.
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Is Complementary and Alternative Medicine (CAM)
Cost-effective? A Systematic Review
BMC Complementary and Alternative Medicine 2005 (Jun 2); 5: 11 ~ FULL TEXT
These exemplary studies indicate CAM therapies that may be considered cost-effective compared to usual care for various conditions: acupuncture for migraine, manual therapy for neck pain, spa therapy for Parkinson's, self-administered stress management for cancer patients undergoing chemotherapy, pre- and post-operative oral nutritional supplementation for lower gastrointestinal tract surgery.
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Interprofessional Referral Patterns in
an Integrated Medical System
J Manipulative Physiol Ther 2005 (Mar); 28 (3): 170–174 ~ FULL TEXT
The data resemble a good news/bad news scenario. For the good news, in this network, of the 42 PCP providers, only 3 are not linked through referrals to at least one CAM provider in the period studied. But the bad news, however, is that for most of the PCPs, the number of referrals is quite low. Any CAM provider relying solely on the referrals to generate a patient flow would not do very well in this network. This finding might reflect either the nature of the patient population, one which does not necessitate referral, or may reflect reluctance or inexperience on the part of the PCPs with the type of CAM therapy offered by DOMs or DCs.
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Consumer Reports’ Survey of 34,000 Readers Finds
Hands-on Treatments Most Successful
A press release from Consumer Reports (July 2005)
Readers gave the highest marks to hands-on treatments, which worked better than conventional treatments for conditions such as back pain and arthritis. Chiropractic was ranked ahead of all conventional treatments, including prescription drugs, by readers with back pain.
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Perceptions of Complementary and Alternative Medicine
Amongst Medical Students in Singapore - A Survey
Acupuncture in Medicine 2005 (Mar); 23 (1): 19–26
Acupuncture was the best known therapy, with 57% claiming to know at least something about it. No students claimed they knew a lot about chiropractic, osteopathy, Ayuverdic medicine, homeopathy and naturopathy, and many had not ever heard of these therapies. Knowledge of commonly held beliefs about the 16 CAM modalities was generally poor, even for modalities which students claimed to know most about. A significant number of students had knowledge about CAM that was erroneous.
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Complementary and Alternative Medicine
in the United States PDF
Institute of Medicine and the Committee on the Use of Complementary
and Alternative Medicine by the American Public Board on
Health Promotion and Disease Prevention (2005)
This 360 page report states: In determining what CAM care to provide, the goal should be comprehensive care that uses the best scientific evidence available regarding benefits and harm, encourages a focus on healing, recognizes the importance of compassion and caring, emphasizes the centrality of relationship-based care, encourages patients to share in decision making about therapeutic options, and promotes choices in care that can include complementary therapies where appropriate.
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What is the Best and Most Ethical Model for the Relationship
Between Mainstream and Alternative Medicine:
Opposition, Integration, or Pluralism?
Acad Med 2005 (Mar); 80 (3): 286–290
Pluralism, which has been relatively ignored, calls for cooperation between the different medical systems rather than their integration. As an ethical model, pluralism realizes that physicians must be prepared to disagree with patient choices to pursue alternative therapies, and urge patients not to forgo medically indicated treatment. Pluralism encourages cooperation, research, and open communication and respect between practitioners despite the possible existence of honest disagreement, and preserves the integrity of each of the treatment systems involved.
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Policies Pertaining to Complementary and Alternative Medical
Therapies in a Random Sample of 39 Academic Health Centers
Altern Ther Health Med 2005 (Jan); 11 (1): 36–40
This research documents policies in 39 randomly selected academic medical centers integrating complementary and alternative medical (CAM) services into conventional care. Twenty-three offered CAM services-most commonly, acupuncture, massage, dietary supplements, mind-body therapies, and music therapy. None had written policies concerning credentialing practices or malpractice liability. Only 10 reported a written policy governing use of dietary supplements, although three sold supplements in inpatient formularies.
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Boundary at Work:
Alternative Medicine in Biomedical Settings
Sociol Health Illn. 2005 (Jan); 27 (1): 20–43
The study uses qualitative methods to examine the nature of this collaboration by calling attention to the ways in which the biomedical profession manages to secure its boundaries and to protect its hard-core professional knowledge. It identifies the processes of exclusion and marginalization as the main mechanisms by which symbolic boundaries are marked daily in the professional field. These processes enable the biomedical profession to contain its competitors and at the same time to avoid overt confrontations and mitigate potential tensions between the two medical systems.
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Complementary and Alternative Medical Therapies for
Chronic Low Back Pain: What Treatments Are
Patients Willing To Try?
BMC Complement Altern Med. 2004 (Jul 19); 4: 9 ~ FULL TEXT
Most patients with chronic back pain in our sample were interested in trying therapeutic options that lie outside the conventional medical spectrum. This highlights the need for additional studies evaluating their effectiveness and suggests that researchers conducting clinical trials of these therapies may not have difficulties recruiting patients.
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Complementary and Alternative Medicine Use
Among Adults: United States, 2002 (PDF)
Centers for Disease Control and Prevention (CDC) ~ May 27, 2004
Complementary and alternative medicine (CAM) is a group of diverse medical and health care systems, therapies, and products that are not presently considered to be part of conventional medicine. The U.S.
public’s use of CAM increased substantially during the 1990s (1–11). This high rate of use translates into
large out-of-pocket expenditures on CAM. It has been estimated that the U.S. public spent between $36 billion and $47 billion on CAM therapies in 1997 (5). Of this amount, between $12.2 billion and $19.6 billion was paid out-of-pocket for the services of professional CAM health care providers such as chiropractors, acupuncturists, and massage therapists. These fees are more than the U.S. public paid out-of pocket for all hospitalizations in 1997 and about half that paid for all out-of pocket physician services (12). Explanations for this growth in CAM use have been proposed, including marketing forces, availability of information on the Internet, the desire of patients to be actively involved with medical decision making, and dissatisfaction with conventional (western) medicine (13). This FULL TEXT Adobe Acrobat article (617 KB) is one of the most comprehensive to date, with a subject interview base of more than 31,000 U.S. adults.
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The Use of Complementary and Alternative Medical Providers
by Insured Cancer Patients in Washington State
Cancer 2004 (Apr 1); 100 (7): 1522–1530
A substantial number of insured cancer patients will use alternative providers if they are given the choice. The cost of this treatment is modest compared with conventional care charges. For individuals with cancer, CAM providers do not appear to be replacing conventional providers but instead are integrated into overall care.
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Student Nurses' Perceptions of Alternative
and Allopathic Medicine
West J Nurs Res 2004 (Apr); 26 (3): 356–366
Three themes were identified: (a) "They are not at all alike," (b) "The two can or should be used together," and (c) "Those who practice alternative medicine and those who practice allopathic do not get along very well." The discussion suggests some reasons for these perceptions and considers some implications for future health care.
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Complementary and Alternative Medicine:
Personal Preference or Low Cost Option?
LDI Issue Brief 2004 (Feb); 10 (4): 1–4
The reasons that people give for using CAM are as diverse as the CAM therapies themselves: some perceive that conventional health care is ineffective, while others consider CAM to be more consistent with their own values and beliefs about health. As conventional health care costs rise, it is also possible that some people turn to CAM as a low cost alternative. This Issue Brief summarizes research that evaluates the relationship between CAM use and perceived access to conventional health care.
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Alternative Therapies in the Management
of Headache and Facial Pain
Otolaryngol Clin North Am 2003 (Dec); 36 (6): 1221–1230
Complementary therapies are now becoming the rule rather than the exception in the management of headache and facial pain. It is incumbent on physicians to be aware of and to have a working knowledge of these increasingly popular modalities.
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Obstacles to Research in Complementary and Alternative Medicine
Medical Journal of Australia 2003 (Sep 15); 179 (6): 279–280
About half the general population in developed countries uses complementary and alternative medicine (CAM). Yet many conventional healthcare professionals refuse to take CAM seriously — one often-voiced argument is “there is no research in CAM” Certainly, for some modalities there is no compelling evidence base, and some of the research into CAM has methodological flaws and biases. On the other hand, many doctors and medical educators are uninformed about the quality evidence that does exist. In this article, I discuss some of the obstacles to developing an evidence base for CAM.
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RESPONSE TO: Obstacles to Research in Complementary and Alternative Medicine
Medical Journal of Australia 2004; 180 (2): 95–96
With respect to spinal manipulation therapy as an alternative medical approach to constitutional ailments, such as migraine, the key evidence is the recovery of vision, which occurs with spinal manipulation in appropriately ill patients. In my personal experience, the main obstacle to research of complementary medicine precepts has been the censorship of dissenting data from orthodox medical literature. The most blatant example of this is the studied neglect of the “tunnel vision information”: the knowledge that vision improves in appropriately ill patients when the spine is manipulated.
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Alternative Medicine and Leo Galland, M.D.
Two decades ago Leo Galland, M.D., an honors graduate of Harvard University Medical School, left academic medicine to establish a private practice in a small Connecticut town. "As soon as I stopped working with critically ill patients in the intensive care unit and started seeing people who were chronically ill, it became apparent that what worked for emergency situations was not very useful for restoring health. That was 25 years ago, and there wasn't much "alternative" out there. But I found a tremendous amount of scientific research about nutritional and psychological influences on illness and recovery, and about the role of exercise in health. I've always felt most comfortable working from a platform of what's scientific and rational."
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A Dose of Our Own Medicine: Alternative Medicine,
Conventional Medicine, and the Standards of Science
J Law Med Ethics 2003 (Summer); 31 (2): 222–235
Commentators often argue that complementary and alternative medicine (CAM) should be held to the same scientific standards as conventional medicine. This article argues that medicine is not always as scientific as assumed; reciprocally, it can cause harms and waste money. Although medicine has had remarkable success, its problems and limits justify a relatively tolerant approach toward CAM.
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Assessing Alternative Medicine:
Methodological and Research Policy Concerns
Int J Technol Assess Health Care 2003 (Summer); 19 (3): 435–445
Setting funding priorities among research projects for complementary and alternative therapies is especially vulnerable to arbitrary, partisan criteria and opportunistic readings of controversial evidence. Relying on an open, formal procedure for comparing unconventional therapies offers protection against prejudgment in setting funding priorities, especially when weak clinical evidence relates more to a low investment in research than lack of efficacy.
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Complementary and Alternative Medicine:
Use in an Older Population
Journal of Gerontological Nursing 2003 (May): 29 (5): 20–28
Seventy-three percent of the participants reported using some form of CAM. Chiropractic was the most commonly used therapy among elderly patients (61.9 percent), followed by herbal medicine (54.8 percent), massage therapy (35.7 percent) and acupuncture (33.3 percent). Among the reasons for using CAM therapies, 54.8 percent used CAM for pain relief; 45.2 percent used CAM to improve quality of life; and 40.5 percent used CAM to maintain health and fitness.
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Chiropractors as Wellness Practitioners:
An Idea Whose Time Has Come
Dynamic Chiropractic (December 16, 2002)
In a recent article authored by chiropractors in the Annals of Internal Medicine (perhaps another first for the profession), chiropractic was called a profession at the crossroads of mainstream and alternative care. There are several views among DCs on which path to follow at the crossroads. Some would have us be musculoskeletal or back specialists, dealing exclusively with pain management; others would have us be subluxation specialists, limiting our concern to the articulations of the spine – an extreme of reductionism, though perhaps a viable one for many; and yet others would like to see us as primary care providers, differing from medical physicians in our focus on health, rather than disease, and on assisting the body through noninvasive means to restore balance and achieve optimal function.
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Willingness of Emergency Department Patients with
Musculoskeletal Complaints to Participate in
Complementary and Alternative Medicine Research
CJEM 2002 (Nov); 4 (6): 401–407
Of 107 eligible patients, 93 participated (87%). Most symptoms began on the day of presentation (44%) or in the previous week (41%). Seventy-six percent of patients had utilized CAM previously during their lives, and 13% were currently using CAM for their presenting problem. The majority of patients stated an informed hypothetical willingness to enroll in a CAM study of the following therapies: traditional Chinese medicine 74%; chiropractic 70%; and other CAM therapies 92%. Of patients asked, 99% stated they would comply with 4 to 6 weeks of outpatient follow-up, and 70% stated they would participate in a placebo-controlled study.
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Chiropractic: A Profession at the Crossroads
of Mainstream and Alternative Medicine
Annals of Internal Medicine 2002 (Feb 5); 136 (3) Feb 5: 216–227 ~ FULL TEXT
Chiropractic is a large and well-established health care profession in the United States. In this overview, we briefly examine the development of chiropractic from humble and contentious beginnings to its current state at the crossroads of alternative and mainstream medicine.
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US Military Veterans' Perceptions of the Conventional Medical Care
System and Their Use of Complementary and Alternative Medicine
Family Practice 2002 (Feb); 19 (1): 57–64 ~ FULL TEXT
Although participants were satisfied in general terms with their conventional care, there were particular aspects of the conventional care system that they criticized. Dissatisfaction with aspects of conventional care, particularly its reliance on prescription medications, was an important component in their motivation to use CAM. Results also suggest that the conventional medical system's lack of holism (inadequate information regarding diet, nutrition and exercise, and ignorance of social and spiritual dimensions) is also an important motivation for turning to CAM in this particular population.
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Use of Alternative Therapies by Older Adults with Osteoarthritis
Arthritis Rheum 2001 (Jun); 45 (3): 222–227
More than 47% of participants reported using at least one type of alternative care during the 20–week intervention period. Among alternative care consumers, the most commonly used treatments were massage therapy (57%), chiropractic services (20.7%), and nonprescribed alternative medications (17.2%). Four percent of subjects reported using only alternative care during the study period.
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Integrated Health Care:
Applying Best Practices From Two Medical Models
Nutrition Science News (May 2001)
Allopathic medical practitioners have been ill-prepared to deal with the rapid proliferation of alternative medical therapies and natural supplements, many of which are being used by their patients in conjunction with traditional treatments. While practitioners are justifiably hesitant to begin an integrated practice, there are valid reasons for becoming more knowledgeable about alternative approaches to health care, and more willing to start adding select remedies to their practices.
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Legal Status of Traditional Medicine and
Complementary/Alternative Medicine:
A Worldwide Review
World Health Organization 2001 (199 pages)
National policies are the basis for defining the role of traditional and complementary/alternative medicine in national health care programmes, ensuring that the necessary regulatory and legal mechanisms are created for promoting and maintaining good practice; assuring authenticity, safety and efficacy of traditional and complementary/alternative therapies; and providing equitable access to health care resources and information about those resources.
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Visit Our Older Alt-Med Articles
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Complementary Medicine and the General Practitioner
British Medical Journal 1986 (Jun 7); 292 (6534): 1498–1500 ~ FULL TEXT
The attitudes to complementary medicine of a random sample of general practitioners in Avon were assessed. A questionnaire was sent to 200 general practitioners, of whom 145 responded. The treatments studied were acupuncture, homoeopathy, herbal medicine, spinal manipulation, faith healing, and hypnosis. Of the 145 general practitioners, 55 (38%) had received some training in complementary medicine and 22 (13%) wished to arrange training.
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Complementary Medicine in Europe
British Medical Journal 1994 (Jul 9); 309 (6947): 107–111 ~ FULL TEXT
Complementary or unconventional treatments are used by many doctors and other therapists throughout Europe. The major forms are acupuncture, homoeopathy, manual therapy or manipulation, and phytotherapy or herbal medicine. The relative popularity of therapies differs between countries, but public demand is strong and growing. Regulation of practitioners varies widely: in most countries only registered health professionals may practice, but in the United Kingdom practice is virtually unregulated. Germany and some Scandinavian countries have intermediate systems.
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Double Standards Exist in Judging Traditional and Alternative Medicine
British Medical Journal 1998 (Jun 6); 313: 1694 ~ FULL TEXT
The double standards that exist in judging orthodox and alternative medicine should be challenged, and reliable tools that can validate both approaches need to be found. The call came last week in London at a conference on integrated medicine which was organised by the Prince of Wales.
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Complementary Medicine and the Doctor
British Medical Journal 1999 (Sep 11); 319: 693–696 ~ FULL TEXT
Doctors deal with complementary medicine in a variety of professional situations. Patients may ask for advice about whether to pursue complementary therapies or which therapist to consult; they may request referral or delegation, either privately or on the NHS; or they may want to discuss treatment or advice given by complementary practitioners. Doctors prescribing drugs to patients taking complementary treatments may have concerns about possible interactions. Doctors should therefore consider strategies for minimising risk and facilitating sensible and appropriate discussions with patients and complementary practitioners.
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Users and Practitioners of Complementary Medicine
British Medical Journal 1999 (Sep 25); 319: 836–838 ~ FULL TEXT
Complementary medicine seems to be becoming more popular in Britain. Media coverage, specialist publications, and numbers of complementary therapists have all increased dramatically in the past 20 years. In this chapter we analyse this phenomenon and review available evidence about the use of complementary medicine.
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Complementary Medicine in Conventional Practice
British Medical Journal 1999 (Oct 2); 319: 901–904 ~ FULL TEXT
The past 10 years has seen a significant increase in the amount of complementary medicine being accessed through the NHS. These services are not evenly distributed, and many different delivery mechanisms are used, some of which (such as homoeopathic hospitals) predate the inception of the NHS. Others depend on more recent NHS reorganisations, like general practice fundholding and health commission contracting, or have been set up as evaluated pilot projects.
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Acupuncture
British Medical Journal 1999 (Oct 9); 319 : 973–976 ~ FULL TEXT
Acupuncture is the stimulation of special points on the body, usually by the insertion of fine needles. Originating in the Far East about 2000 years ago, it has made various appearances in the history of European and north American medicine. William Osler, for example, used acupuncture therapeutically in the 19th century. Acupuncture's recent popularity in the West dates from the 1970s, when President Nixon visited China.
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Herbal Medicine
British Medical Journal 1999 (Oct 16); 319 : 1050–1053 ~ FULL TEXT
The use of plants for healing purposes predates human history and forms the origin of much modern medicine. Many conventional drugs originate from plant sources: a century ago, most of the few effective drugs were plant based. Examples include aspirin (from willow bark), digoxin (from foxglove), quinine (from cinchona bark), and morphine (from the opium poppy). The development of drugs from plants continues, with drug companies engaged in large scale pharmacological screening of herbs.
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Homoeopathy
British Medical Journal 1999 (Oct 23); 319 : 1115–1118 ~ FULL TEXT
Homoeopaths treat disease using very low dose preparations administered according to the principle that "like should be cured with like." Practitioners select a drug that would, if given to a healthy volunteer, cause the presenting symptoms of the patient. For example, the homoeopathic remedy Allium cepa is derived from the common onion. Contact with raw onions typically causes lacrimation, stinging and irritation around the eyes and nose, and clear nasal discharge. Allium cepa might be prescribed to patients with hay fever, especially if both nose and eyes are affected.
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The Manipulative Therapies: Osteopathy and Chiropractic
British Medical Journal 1999 (Oct 30); 319: 1176–1179 ~ FULL TEXT
Osteopathy and chiropractic share a common origin. Their roots can be found in folk traditions of "bone setting," and both were systematised in the late 19th century in the United States: Daniel D Palmer, the founder of chiropractic, is said to have met with Andrew Taylor Still, the founder of osteopathy, before setting up his own school. The therapies remain relatively similar, and many textbooks and journals are relevant to both. The term "manipulative therapy" refers to both osteopathy and chiropractic.
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Unconventional Approaches to Nutritional Medicine
British Medical Journal 1999 (Nov 27); 319: 1419–1422 ~ FULL TEXT
Although nutrition, as a science, has always been part of conventional medicine, doctors are not taught, and therefore do not practise, much in the way of nutritional therapeutics. Dieticians in conventional settings tend to work mainly with particular patient groups---such as those with diabetes, obesity, digestive or swallowing problems, or cardiovascular risk factors. Apart from the treatment of gross nutritional deficiencies and rare metabolic disorders, other nutritional interventions generally fall outside the mainstream and can therefore be described as complementary medicine.
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Complementary Medicine and the Patient
British Medical Journal 1999 (Dec 4); 319: 1558–1561 ~ FULL TEXT
In surveys of users of complementary medicine, about 80% are satisfied with the treatment they received. Interestingly, this is not always dependent on an improvement in their presenting complaint. For example, in one UK survey of cancer patients, changes attributed to complementary medicine included being emotionally stronger, less anxious, and more hopeful about the future even if the cancer remained unchanged.
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What is Complementary Medicine?
British Medical Journal 1999 (Dec 11); 319: 1558–1561 ~ FULL TEXT
Complementary medicine refers to a group of therapeutic and diagnostic disciplines that exist largely outside the institutions where conventional health care is taught and provided. Complementary medicine is an increasing feature of healthcare practice, but considerable confusion remains about what exactly it is and what position the disciplines included under this term should hold in relation to conventional medicine
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Complementary Medicine and Medical Education
British Medical Journal 2001 (Jan 20); 322 : 121–122 ~ FULL TEXT
Complementary and alternative medicine is no longer an obscure issue in medicine. Our patients are using alternative therapies in addition to conventional care (1, 2) and sometimes do not share this information with us. But even if they did would we know how best to advise them about safety issues or about the effectiveness of a particular therapy for their problem? Surveys indicate that doctors and medical students are increasingly interested in complementary and alternative therapy,3–5 yet lack of knowledge is one of the greatest barriers to its appropriate use.
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Integrative Medicine
British Medical Journal 2001 (Jan 20); 322: 119–120 ~ FULL TEXT
Integrated medicine (or integrative medicine as it is referred to in the United States) is practising medicine in a way that selectively incorporates elements of complementary and alternative medicine into comprehensive treatment plans alongside solidly orthodox methods of diagnosis and treatment. The concept is better recognised in the US than in the United Kingdom, but a conference in London next week, organised by the Royal College of Physicians and the US National Center for Complementary and Alternative Medicine, may help to raise its profile in the UK.
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Research into Complementary and Alternative Medicine:
Problems and Potential
British Medical Journal 2001 (Jan 20); 322: 161–164 ~ FULL TEXT
The growing use of unsubstantiated complementary and alternative medicine therapies by people in the United States1 along with its increasing coverage by third party payers (2) encouraged Congress to create the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health. The centre's mission is "to explore complementary and alternative healing practices in the context of rigorous science; to educate and training CAM researchers; and to disseminate authoritative information to the public and professionals." (3)
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Dealing With Pain:
Time For a Fresh Look at Complementary Medicine
British Medical Journal 2003 (Jun 14); 326 : 1322 ~ FULL TEXT
Lord Baldwin—who chaired the British Acupuncture Accreditation Board 1990-9, was joint chairman of the Parliamentary Group for Alternative and Complementary Medicine 1992–2002, and served on the House of Lords Science and Technology Select Committee inquiry into complementary and alternative medicine in 2000—asks that both complementary and conventional practitioners keep an open mind
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