What is CAM?
Understanding This Major Trend
By Mark L. Hoch, MD, DABFP

Each year we hear and read more about complementary and alternative medicine (CAM). Included under that umbrella term are nutritional and herbal supplements and treatments, homeopathic and mind-body medicine, chiropractic, naturopathy, acupuncture, traditional medical practices and others. Each year Americans make hundreds of millions of visits to nonconventional health care practitioners and spend tens of billions of dollars on CAM. What’s all the excitement about, and why is it important?

This article defines several defines several CAM terms and explains why it is important for health care professionals, business people and educators to understand CAM and the meaning behind the movement.

CAM terminology

• Allopathic medicine – from allo (other or opposite) and pathos (suffering), the conventional medicine of 20th-century and early 21st-century America. Allopathy focuses on disease and symptom management by directly counteracting problems by external means, such as the use of drugs and surgery. The names of treatments reflect this philosophy. Common treatments include antibiotics, antiinflammatories, antidepressants, antihistamines, beta blockers, alpha blockers, ACE inhibitors, serotonin reuptake inhibitors, operations to remove or replace diseases or malfunctioning organs, and the use of stents to
• Conventional medicine – theories and practices that are part of the allopathic medical system of the United States and are taught at mainstream institutions such as medical schools and teaching hospitals.
• Alternative medicine – treatments or systems generally not taught in mainstream institutions or used in hospitals. This term usually carries the connotation of going outside of the system to see non-allopathic practitioners or using supplements from health food stores.
• Complementary medicine – non-allopathic medicine that may be used with allopathic treatment, usually after a conventional assessment and diagnosis have been made.
• Holistic medicine – a philosophy and way of being that recognizes and addresses all aspects of health, including physical and environmental, emotional, mental, social, and spiritual health. Holism emphasizes promoting optimal health and evoking healing rather than countering disease. It embraces the use of all effective, safe means of diagnosis and treatment. The unit of care for a holistic practitioner is the person or the system that person lives in, not a symptom or an organ system.
• Integrative medicine – using various approaches, usually from an allopathic perspective, interchangeably or together to improve results.
• Traditional medicine – the medical system of a culture. The current medical system in the United States has been the dominant system for less than 100 years. In other cultures, such as India and China, traditional medicine has documented texts dating back 3,000 years and evidence of use form as long as 5,000 years ago.

Opting for change
As readers may be aware, in 1990 and 1997, David Eisenberg, M.D. and colleagues conducted two studies on the use of alternative medicine. The studies were published in the New England Journal of Medicine (1993) and the Journal of the American Medical Association (1998), respectively. The latter study showed that Americans paid and estimated 629 million visits to CAM providers in 1997, compared with only 386 million visits to primary care doctors. That study also conservatively estimated that Americans spent more than $21 billion on professional services and several billion dollars more on CAM products and classes in 1997. Those figures represent increases of 45% over the 1990 data and indicate that approximately 42% of adult Americans used CAM services in 1997. Eisenberg’s and several other studies have shown that the more educated and the more affluent a person is, the more likely she or he is to use non-allopathic therapies. CAM is not a passing fad, but a large and growing consumer movement.

With conventional medicine making significant advances in diagnosing, treating and curing many diseases and people, why are so many seeking care outside of the conventional medical system? Why are they willing to spend billions of dollars – most of it out of pocket – annually on CAM practitioners and treatments? The reasons are many, but simply put, people are getting tired of a system that doesn’t meet many of their needs. Some haven’t had good results with allopathic medicine, especially in treating so-called chronic diseases, because the treatments don’t get at the cause of the problems. Others fear, or have experienced, the well documented, undesirable side effects that allopathic treatments can cause. Many others know that they cannot express – and a doctor cannot address – all of their concerns during a six minute office visit. People want time with their doctors to understand why therapies are prescribed, what their options are and what potential side effects they may experience.

People are puzzled by the ’90’s idea of “patient-centered care.” Many wonder who or what was at the center of care before that and whether or not they truly are the center of care now. They know that there is evidence that other types of treatments work. They read books and magazines, search the Internet and speak with friends and family members. Many have found that they know more about certain treatment modalities than their doctors do, and that their doctors are uncomfortable even broaching the subject of alternative treatments. Several studies, including Eisenberg’s, have shown that 40 percent to 70 percent of patients don’t even tell their doctors when they use CAM treatment out of fear of being belittled or misunderstood. From a quality of care standpoint, those are big issues.

It is no longer tenable to simply dismiss CAM and holism by saying there is no data available because one is unaware of or does not want to know about documented evidence of the effectiveness of alternative therapies and treatments. A large database of evidenced based medicine as it relates to CAM exists. Robert Anderson, M.D., has compiled, organized, and indexed more that 4,000 abstracts from various CAM studies in the United States and around the world. The NIH has a similar, larger database and has published a consensus statement on the documented effects of acupuncture.

Many people who have sought alternative health care practitioners have found more effective or safer therapies for their problems. Many are glad to find a holistic practitioner who focuses on the body’s ability to heal itself and on health and prevention. The vast majority are grateful for someone who spends time with them and listens to their concerns during an office visit and tries to address those concerns in some way.

The number of people who are opting for change with their consciences, their educated opinions and their pocketbooks has steadily and dramatically increased over the past 12 years. Payers, policymakers and providers need to understand those shifts and explore ways to improve the health of the work force and society while keeping costs down.

Needed: a broader perspective
Conventional Western medicine has had many triumphs and saves many lives every day. However, in order to survive in the 21st century, all of the parties involved in health care will need to be open-minded enough to practice the best medicine available, whether conventional or no conventional. Adherence to traditional ways out of convenience or simply because that is the way something ahs always been done cannot continue.

We need to take a broader look at a system that is full of dissatisfied physicians, struggling hospitals, frustrated employers and angry patients. Policy makers, doctors and health systems need to embrace therapies that have been proven effective and safe – and, in the process, meet the public’s demand for more holistic and better care.

Mark L. Hoch, M.D., D.A.B.F.P. is president of the American Holistic Medical Association, founded by physicians in 1978. He has a holistic medicine practice in Minneapolis and when this article was written worked in the Abbott Northwestern Hospital Chronic Pain Center.