CHAPTER 8 Global Use of Complementary and Alternative Medicine (CAM) and Treatments

CAM Defined: Complementary and Alternative or Traditional? Refers to a set of medical and healthcare systems, practices, and products that are not part of that country’s tradition and are not integrated into the dominant healthcare system

CAM Defined: Complementary and Alternative or Traditional? WHO defines traditional medicine as the “knowledge skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness”

Alternative Medicine Complementary Medicine Traditional Medicine CAM in the United States Allopathic Medicine 2005 Institute of Medicine’s Report on Complementary and Alternative Medicine in the United States

CAM use by category, in order of prevalence: Biologically based (19.9%). Mind–body (19.2%). Manipulative and body-based therapies (15.2%). Alternative medical systems: Acupuncture, Ayurveda, homeopathic treatment, naturopathy, and traditional healers (3.4%). Energy healing therapies (0.5%). (Barnes, Bloom, & Nahin, 2008)

People who are more likely to use CAM: Women People with higher household income Older adults Ethnic minorities & low-income individuals People with lower emotional role functioning and perceived general health People who had been hospitalized in the last year People with a holistic orientation to health People with certain health problems

Reasons that people were most likely to use CAM They believe CAM therapies integrated with conventional therapies yield better results They thought trying CAM therapies would be interesting They were recommended by a medical professional

Reasons that people were most likely to use CAM They felt allopathic therapies were not effective They felt CAM therapies would be more cost- effective They believe CAM therapies can boost the immune system, treat cancer, and help them live longer

Mind-Body therapies, including prayer Megavitamin Therapy Biologically based therapies Manipulative Therapies Alternative Medical Systems Energy Therapies

Nonvitamin, Nonmineral, Natural products Deep Breathing Exercises Participating in prayer Meditation Chiropractic care Yoga Massage Diet-based therapies

CAM IN THE WORLD Global Use of CAM China Ghana, Mali, Nigeria and Zambia African countries Europe North America Canada Germany United Kingdom

MAJOR FORMS OF CAM Alternative Medical Systems Ayurvedic Medicine Homeopathic Medicine Naturopathic Medicine Traditional Chinese Medicine

MAJOR FORMS OF CAM designated by NCCAM Natural products Mind-Body Medicine Meditation Yoga Manipulative and Body-Based Methods Chiropractic Medicine & Massage Therapy Energy Fields Reiki, Therapeutic Touch, Qi Gong

RESEARCH AND TECHNOLOGY Research Areas of Special Interest Anxiety and depression Cardiovascular diseases Ethnomedicine Immune modulation or enhancement Inflammatory bowel disease Irritable bowel syndrome Insomnia Liver Obesity and metabolic syndrome Respiratory diseases

Scientific evidence from randomized clinical trials is strong for: many uses of acupuncture some herbal medicines some of the manipulative therapies (such as chiropractic and massage therapy) Robinson & Zhang, 2011

NCCAM future research priorities in CAM (NCCAM, 2011b): Advance research on mind and body interventions, practices, and disciplines Advance research on CAM natural products Increase understanding of “real-world” patterns and outcomes of CAM use and its integration into health care and health promotion Improve the capacity of the field to carry out rigorous research Develop and disseminate objective, evidence-based information on CAM interventions

LEGAL AND ETHICAL ISSUES Development and implementation of regulations for: Traditional medicine Complementary medicine Alternative medicine Herbal medicine

LEGAL AND ETHICAL ISSUES These challenges are related to the: Regulatory status Assessment of safety and efficacy Quality control Safety monitoring Lack of knowledge by national drug regulatory authorities

Dietary Supplement Health and Education Act of 1994 (DSHEA) FDA does require homeopathic remedies to meet certain legal standard for: Strength Quality Purity Packaging Dietary Supplement Health and Education Act of 1994 (DSHEA) Ethical Responsibility

Ethical Issues Surrounding CAM Treatment and Research Influences of Politics, Economics, Culture, and Religion Politics – The Role of Government The influence of politics and government is significant in the United States

The use of CAM worldwide makes it important for governments to: Formulate national policy and regulation for the proper use Establish regulatory mechanisms to control the safety and quality of products Create awareness about safe and effective traditional medicine Cultivate and conserve medicinal plants

Economics Culture and Religion Developing and Developed Societies Cultural beliefs significantly predict the use of traditional medicine practices Developing and Developed Societies The industrialized world uses traditional medicine and CAM as a choice Well-educated Well-informed