Complementary and alternative medicines: general considerations

Complementary and alternative medicines: general considerations

Introduction

A complementary therapy is used along with conventional medicine, whereas an alternative therapy is used instead of conventional medicine. However, they are often referred to collectively as ‘complementary and alternative medicines’ (CAM).

The use of CAM is common:

49% of Australians use CAM

20% will visit an alternative medicine practitioner

over $2.3 billion is spent in Australia each year on CAM

those most likely to use CAM are females, 40 to 60 years old, better educated, employed, and with a higher income.

Reasons that people give for using CAM include:

• to provide a sense of self-control and self-determination in treatment

• they feel that orthodox/western medicine has failed them

• they obtain comfort and symptom control

• they believe it improves their general wellbeing

• they believe they are ‘natural’ and will therefore be safe, and free of adverse effects

• they believe it increases resistance to disease

• they believe that CAM practitioners provide a listening ear and hope (not found elsewhere).

Some therapies (eg hypnotherapy and meditation) are considered helpful from a psychological perspective and some general practitioners use, or refer patients for, CAM such as acupuncture, meditation, hypnosis and chiropractic therapy.

The evidence (of the type required for conventional drugs) for efficacy of CAM is largely lacking. A small number of therapies have been shown to provide some benefit; some have been shown to provide no benefit; but for the majority there is no evidence either for or against benefit.

Many patients do not spontaneously disclose their use of CAM, and medical practitioners should routinely enquire about such use. Obtain a thorough history of therapy use, including CAM and over-the-counter and prescription medicines. Discuss considered or planned therapies. Question sensitively, as a dismissive attitude is less likely to discourage patients from using potentially harmful CAM than more sympathetic and considered discussions.

Categories of complementary and alternative medicines

The US National Center for Complementary and Alternative Medicine [URL] classifies complementary and alternative medicine therapies into five categories:

Alternative medical systems arise from complete systems of theory and practice, such as homeopathic medicine in western cultures and traditional Chinese medicine in non-western cultures. 

 

Mind-body interventions use various techniques to enhance the mind’s capacity to affect the body. There is some fluidity in this classification, as some techniques that were once considered CAM have now become mainstream (eg patient support groups, cognitive behavioural therapy). Other techniques still considered CAM include meditation, prayer, mental healing, and creative therapies that use art or music.

 

Biologically based therapies use substances found in nature (eg herbs, foods, vitamins) and include as yet scientifically unproven therapies (eg shark cartilage). Nutritional agents used in therapies include acidophilus, mushrooms, coffee enemas, noni juice, wheatgrass, soybeans, garlic, mega-dose vitamin C, and supplementary mineral and trace elements. Laetrile (vitamin B17) is also still popular, despite significant toxicity and no proof of efficacy. Specific diets include vegetarian diets, Gerson therapy, fasting, grape diet, Willard water and macrobiotic diets. Ozone is also used.

 

Manipulative and body-based methods are based on manipulation and/or movement of one or more parts of the body; they include massage, and chiropractic manipulation.

 

Energy therapies involve the use of energy fields; the two types are 

biofield therapies, which are intended to affect energy fields that purportedly surround and penetrate the human body. These therapies remain scientifically unproven and include qi gong, reiki, and therapeutic touch

bioelectromagnetic-based therapies, which involve the unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields, or alternating-current or direct-current fields.