MEDICAL
INFORMATION |
Complementary
& Alternative Medicine Karen Swedersky |
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Within the
Tracker: Journal of the
American Medical Association (JAMA) National
Center for Complementary and Alternative Medicine (NCCAM) |
With the popularity of Complementary and Alternative Medicine (CAM) growing by an estimated 47% since 1990, this fringe movement is quickly coming to the forefront of the American medical system. Recognized by a variety of names—integrative, complementary, or alternative medicine—CAM covers a broad variety of practices and disciplines that span hundreds of modalities, belief systems, and medical practices. While definitions vary, CAM generally refers to "a group of therapeutic and diagnostic disciplines that exist largely outside the institutions where conventional health care is taught and provided…by a particular society or culture in a given historical period." CAM includes all such practices and ideas self-defined by their users as preventing or treating illness or promoting health and well-being. Boundaries within CAM and between the CAM domain and that of the dominant system are not always sharp or fixed."1 It is also important to point out that what is considered "conventional" not only varies among countries and cultures, but also changes over time. The line between "complementary and conventional medicine is therefore blurred and constantly shifting."2 Harvard Medical School researchers published their findings last year in the November issue of Journal of the American Medical Association (JAMA). They estimated in 1997 U.S. consumers spent more than $27 billion in out-of-pocket expenses on CAM and made more than 629 million visits to alternative providers, almost double the 386 million visits to primary care physicians during the same period.3 Given the number of consumers seeking non-traditional care, patients are clearly driving this paradigm shift and bringing Western medicine to the crossroads of numerous other medical systems and treatment approaches. CAM’s popularity with patients is certainly impacting the current health care system: traditional providers are scrambling to understand which modalities are most effective and how to integrate them into mainstream medicine. As the struggle continues within the medical community about how or whether to integrate some or all complementary and alternative therapies, Congress appropriated $50 million in 1999 to establish the National Center For Complementary and Alternative Medicine (NCCAM), an outgrowth of the Office of Alternative Medicine at the National Institutes of Health. And while most alternative care is not covered by health plans, that may soon change. A study by Landmark Healthcare found that two-thirds of the respondents felt that the availability of alternative care was important in choosing a health plan. Currently, more than 40 states mandate that group health plans provide at least some coverage of chiropractic care; six mandate some coverage for acupuncture; and three mandate some coverage for naturopathy. Washington State probably leads the nation with a 1995 mandate that requires health plans to include every type of licensed alternative medicine practitioner in their provider networks.4 Workers’ compensation coverage is following suit with chiropractic, massage therapy, and acupuncture leading the list of alternative therapies with fee codes approved for reimbursement in many states. While the typical occupational practice generally does not incorporate many of these therapies into its practice or continuum of services, that will probably be changing as employers increasingly seek out ways to return workers safely and promptly to work. The Typical Consumer Who uses CAM, and why? The modalities that have gained the most popularity in the U.S. since 1990 are: herbal remedies, massage, mega-vitamins, self-help groups, folk remedies, energy healing, and homeopathy. A recent study published by JAMA found that patients who utilized unconventional therapies often used them to supplement their existing medical care. These consumers were more likely to use healthcare services in general and to take responsibility for monitoring their health status by using prevention or screening modalities, such as having their blood pressure routinely checked, getting a yearly flu shot, or getting routine breast or prostate checks.5 Prior studies also revealed that patients who choose unconventional care are typically between 30-50 years old, are well-educated, have higher income levels, are usually Caucasian, and are often chronically ill. Relatively few patients utilize alternative practitioners as their sole source of healthcare. Most patients seek out complementary medicine as an avenue to increase their health and augment their traditional medical treatment, although fewer than 20% reported informing their treating physician of their decision and alternative practices.6 While the typical CAM consumer may not be the typical patient in an occupational practice, they may soon represent the typical decision-maker at many companies. As employers gain more exposure to alternative medicine and CAM gains in general popularity, employers and case managers will likely seek out alternative practitioners for their injured workers, particularly those with chronic conditions such as fibromyalgia, repetitive syndrome injuries, and chronic pain. By offering proven, appropriate CAM modalities, some occupational practices may be able to distinguish themselves in highly competitive markets. To assist occupational providers in their understanding of CAM, we turned to the National Center for Complementary and Alternative Medicine (NCCAM), which has developed a classification system to facilitate the understanding and study of the hundreds of disciplines that comprise one or more branches of the CAM family tree.7 Medical practices that are not commonly used, accepted, or available within the conventional medical community are labeled as CAM and are divided into seven major categories. Practices that are generally considered within the umbrella of traditional medicine are designated as Behavioral Medicine. Practices that could be classified under either label are classified as "Overlapping." The examples provided within each category are examples only and do not necessarily constitute a complete or thorough list of all possibilities within a given category. Looking Forward CAM covers a rich, diverse, and, at times, controversial spectrum of modalities, belief systems, and practices. Some practices are centuries old and have assisted the human race since the dawn of time. Other modalities have much more recent origins. Whether old or new, East or West, Complementary and Alternative Medicine has gained the support of the general public and, as with everything else, one only has to "follow the money" to understand that CAM has gained a foothold in the American health delivery system. As the millennium unfolds and the American public becomes more educated about alternative, complementary, and cross-cultural medical therapies, it will become even more important for occupational practitioners to have reliable information about these modalities. Healthcare practitioners need to know what these therapies are, how they are best used, and what research base exists to validate their use. Clearly, conventional Western medicine has successfully treated and saved millions of lives. But patients are obviously "voting with their feet" and saying it is time to examine other medical practices that may heal or improve their conditions and diseases that Western medicine has been unable to cure. By integrating knowledge from many sources, ancient and modern, the entire art and science of medicine will benefit—and so will injured workers and others treated within the new "integrative" delivery systems that are evolving.
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