Complementary & alternative medicine (CAM)
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Complementary and alternative medicine (CAM) is a set of medical practices, services and products that are considered outside of or complementary to standard patient care in doctors' offices and hospitals. As such, CAM does have a tendency to be controversial; it is also a profitable industry where herbal remedies and procedures cost billions of dollars annually. Some of these procedures and supplements are classified as unproven or even dangerous. Information professionals have to be on the watch for patients who need the evidence in CAM to make decisions on self-treatment. According to the Journal of Allergy and Clinical Immunology, CAM is used by "more than 80% of the world's population and ....[increasingly] a component of the US health care system, with more than 70% of the population using CAM at least once and annual spending reaching as much as $34 billion." Consequently, CAM is a part of the work of many reference librarians and library technicians working in health libraries.
CAM is viewed by many physicians in traditional Western medicine as complementary and others view it as foreign and possibly dangerous. Western medicine (allopathic) is typically practiced by those with conventional academic medical training such as physicians, pharmacists, allied health professionals, physical therapists, psychologists and nurses. Many of these professions look to CAM for answers that have not been provided by traditional medicine. In fact, the integrative medical care movement seeks to combine the best evidence in both CAM and Western medicine for the delivery of optimal care. Some health practitioners try to combine elements of CAM into their practice of conventional medicine. While scientific evidence to support the use of CAM is growing, many key questions remain unanswered about its efficacy in treating common ailments and diseases.
To see a list of databases in CAM, see:
Five (5) domains of CAM
According to the National Center for Complementary and Alternative Medicine (NCCAM), CAM is classified into five domains (examples used are NOT exhaustive):
The use of complementary and alternative medicine products and services is well-established in Canada. Natural health products are federally-regulated, and this regulation has tightened up in recent years. Some heavily regulated products are vitamins and minerals, herbal remedies, homeopathic medicines, traditional medicines (e.g. traditional Chinese medicines)and products such as amino acids and essential fatty acids.
Health Canada's Natural and Non-prescription Health Products Directorate (NNHPD) is responsible for ensuring that all natural health products are safe for use, and its role is "...to ensure that Canadians have ready access to natural health products that are safe, effective and of high quality while respecting freedom of choice and philosophical and cultural diversity." The NHP Regulations came into effect in 2004 and covers products and site licensing, manufacturing practices, adverse reaction reporting, clinical trials and labeling.
The Canadian Interdisciplinary Network for CAM Research (IN-CAM) at the University of Toronto was established by Dr. Heather Boon, a pharmacist and medical sociologist with an interest in CAM. Dr. Marja Verhoef, a social scientist and epidemiologist who holds a Canada Research Chair in Complementary Medicine at the University of Calgary's Department of Community Health Sciences, is another scientist working to improve the CAM evidence-base. To address gaps IN-CAM's mission is to "...create a sustainable, well-connected, highly trained Complementary and Alternative Medicine (CAM) research community in Canada that is internationally recognized and known for both its excellence in research and its contributions to understanding CAM and its use."
Other Canadian organizations
These groups work to increase the knowledge base of CAM both in Canada and internationally:
In the regulations, there is a division between federal and provincial levels of government. How these two entities might interact or conflict as time goes on and as CAM (if it continues to grow and/or penetrate allopathic medicine) becomes more entrenched is a good question. InspireHealth is a Vancouver-based non-profit whose mission is to provide integrated cancer care for patients and families. Supported by the British Columbia Ministry of Health and other organizations, it emphasizes informed decision-making and personal involvement in the healing process. Comprised of medical doctors and CAM practitioners, InspireHealth is the first organization of its kind in Canada.
U.S. Regulation of CAM
Since 1994, natural products (or dietary supplements) have been regulated by the Dietary Supplement Health and Education Act. DSHEA creates provisions for: definitions of dietary supplements and ingredients; safety parameters; guidelines for literature (information) displayed where supplements are sold; how claims and statements of efficacy are communicated; labelling practices; and Food and Drug Administration (FDA) authority over Good Manufacturing Practices (GMP's). There are also requirements that a Commission on Dietary Supplement Labels and an Office of Dietary Supplements (ODS) be established within the National Institutes of Health (NIH). In the last few years, the Center for Biologics Evaluation and Research (CBER) issued guidance for industry entitled "Complementary and Alternative Medicine Products and their Regulation by the Food and Drug Administration." According to the FDA, this document will embody the thinking of the FDA on this subject while not limiting its jurisdiction. With uneven regulation of CAM in the U.S., some disciplines licensed and others not, as well as variances in the requirements for same,those that are regulated are controlled at the state level. In California, acupuncture is regulated by the California Acupuncture Board through "licensure, education standards, and enforcement."
CAM education may be viewed as two large divisions: 1) various CAM modalities taught in schools or by organizations that teach CAM specifically (e.g. The Boucher Institute of Naturopathic Medicine in New Westminster, British Columbia or The California College of Ayurveda in Grass Valley, California); 2) the integration of CAM modalities and philosophies into the education of nurses, pharmacists and doctors. Until 2000, medical schools that had CAM components were listed in a periodic update in the Journal of Alternative & Complementary Medicine. This list was migrated to the Rosenthal Center but as an archive by the Columbia University Medical Center in the now apparently defunct Rosenthal Center for Complementary and Alternative Medicine. The note on the page says "At the time we archive[sic] the resource (June 2007) it is rare that any conventional medical school would not have courses in complementary, alternative, or integrative medicine." What was once outside mainstream medical education is now common as to not warrant the efforts of a listing. Canada has its own education initiatives in this area, embodied by the Complementary and Alternative Medicine Issues in Undergraduate Medical Education (CAM in UME) Project. The overarching goal of the project is "...to facilitate high quality and balanced teaching of CAM related issues in undergraduate medical education (UME)."
Medical students received some grounding in CAM principles during the formative years of their education, but there is a lack of consistency and time devoted to CAM in the curriculum - thus this project. Why might a familiarity with CAM be an important aspect of a physician's training? Many people use CAM modalities in Canada (see this PubMed search by way of example) so it is important that physicians be able to talk in an informed manner with their patients. An interesting series of articles on the state of CAM educational initiatives in the United States was published the October 2007 issue of the journal Academic Medicine. The articles focus on the NCCAM Education Grant Program where "...the education program grantees discuss the tools used, challenges faced, and lessons learned in the development of CAM curricula for conventional health care professionals."
See also Evidence-based health care
CAM benefits from a growing research base from which evidence-based decisions can be made. Although in its formative, early stages, the evidence base in complementary and alternative medicine is driven by organizations such as NCCAM in the United States, IN-CAM in Canada and the International Society for Complementary Medicine Research (ISCMR).
Two key sources in the area of evidence-based complementary & alternative medicine are Natural Medicines Comprehensive Database and Natural Standard. NS is an international research collaboration that systematically reviews scientific evidence on complementary and alternative medicine (CAM). With the Harvard Medical School, Natural Standard provides consumer information for Harvard Health Publications and Susan Komen for the Cure. Natural Standard provides information on herbal medicine and dietary supplements to MedlinePlus which is produced by the National Library of Medicine (NLM) and the National Institutes of Health.
CAM journals such as Evidence-based Complementary and Alternative Medicine (eCAM) and The Journal of Alternative and Complementary Medicine give researchers peer-reviewed forums to publish their findings. One criticism leveled at CAM is the lack of evidence for its use so building evidence is critical. To that end, remember that locating "evidence-based complementary and alternative medicine" resources may entail searching across numerous open and "closed" information sources.
Key websites & video
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