Complementary and Alternative Medicine

Complementary and alternative medicine, sometimes referred to as CAM, is an umbrella term for a vast array of treatments that fall outside conventional Western approaches. Some have been well-studied and proven to be effective; others have not.

Although labels like "alternative medicine," "naturopathic medicine" and "integrative medicine" are often casually used (and misused), each term refers to something specific and different.

Here are eight common terms used in non-conventional approaches to medicine and what researchers and practitioners say about them.

Alternative Medicine

According to the National Center for Complementary and Integrative Health, actual alternative medicine is very rare. The organization defines alternative medicine as any non-conventional interventions that are used instead of conventional treatments, not in conjunction with them. Interventions like yoga, acupuncture, herbal remedies and massage therapy may be alternative treatments, but are considered alternative medicine only when they're used in place of conventional treatments, explained National Center for Complementary and Integrative Health Deputy Director David Shurtleff.

Complementary Health Care

Complementary health care refers to alternative treatments used in conjunction with mainstream treatment.

Using acupuncture in conjunction with standard pharmacological treatment of osteoarthritis of the knee, for instance, is a form of complementary medicine that has been proven to be more effective than the conventional treatment alone.

Shurtleff noted that some non-conventional practices eventually become accepted as part of standard, conventional care. "As the practice becomes more codified, as people start to request it, as evidence starts to become more solid as far as the efficacy...it can become more mainstream," he said, pointing out how chiropractic care was once considered complementary medicine, but is now part of conventional care for certain people, including veterans.

Integrative Health Care

Integrative health care can be defined in several ways, but "all involve bringing conventional and complementary approaches together in a coordinated way," according to the National Center for Complementary and Integrative Health.

"Integrative [health care] is a philosophy of how we take care of the patient," said Melinda Ring, clinical associate professor of medicine at Northwestern Medicine's Osher Center for Integrative Medicine. "It is an approach that looks holistically at the patient, including all aspects of their lifestyle, their community, their environment, in addition to physical and emotional aspects of their health." The goal is to seek to address the roots of illness, not just the symptoms.

Natural Health Care Products

Natural health care products are nutritional or dietary supplements, including herbs, that are not vitamins or minerals. The NCCIH reports that the most common natural product used by adults in 2012 was fish oil. Other popular natural products include melatonin, echinacea and probiotics.

Many natural products have not yet been sufficiently studied or scrutinized. According to the NCCIH, more research is being done to determine the efficacy of different supplements.

"Some of the earlier studies were not so well designed," Ring said. Researchers may not have used the right parts of certain plants or used incorrect dosages. "It's hard to get conclusive data when these studies are looking at different aspects of things, and not always looking at things the way they've been used traditionally."

Timothy Mitchison, professor of systems biology at Harvard Medical School, said that standardizing herbal medicine so each batch has the same amount of active ingredients is a challenge.

Patients seeking natural products should consult a licensed health-care practitioner before using nutritional or herbal supplements, particularly when using them alongside pharmaceuticals, since interactions can occur.

Mind-Body Approaches

According to the National Institute of Health, mind-body medicine focuses on the way emotional, mental, social, spiritual, experiential and behavioral factors affect physical health.

Mind-body approaches include yoga, tai-chi, chiropractic and osteopathic manipulation, meditation, massage therapy, and relaxation techniques like biofeedback therapy and progressive relaxation..

"In the West, the notion that mind and body were separate began during the Renaissance and Enlightenment eras," the NIH reports. "Increasing numbers of scientific and technological discoveries furthered this split and led to an emphasis on disease-based models, pathological changes and external cures. The role of mind and belief in health and illness began to re-enter Western health care in the 20th century, led by discoveries about pain control via the placebo effect and effects of stress on health."

Today, practitioners of Western medicine are becoming increasingly aware of the connection between mind and body. In a story for The New York Times last year, Dr. Dhruv Khullar, a resident physician at Massachusetts General Hospital and Harvard Medical School, described the risks to physical health associated with social isolation, which might have once been dismissed as an exclusively mental experience.

Studies are now underway to determine whether practices like loving-kindness meditation can effectively train the brain to better cope with stress and emotions.

Acupuncture

Acupuncture, one of the most widely studied non-conventional treatments, involves stimulating various points in the body with needles.

"Clinically, acupuncture is helpful for people who have symptoms and conditions that are made worse by stress, which is most chronic conditions," said Mel Hopper Koppelman, an acupuncturist and the director of Evidence Based Acupuncture, in an email. "This is partly to do with its effect on quickly rebalancing the autonomic nervous system as well as its role on the hypothalamus, the part of the brain that regulates hormones and the stress response."

According to the University of California San Diego Center for Integrative Medicine, clinical studies have shown acupuncture to be effective for over 20 conditions including depression, hypertension and stroke. There is limited, but probable, evidence to support the use of acupuncture for dozens of conditions and diseases from opium and tobacco addiction to Tourette Syndrome.

Helene Langevin, director of the Osher Center for Integrative Medicine at Brigham and Women's Hospital and Harvard Medical School, said that more research is needed to answer other questions about acupuncture, such as whether the location at which needles are placed makes a significant difference. "If we observe different effects of acupuncture when using different combinations of acupuncture points, it is hard to know whether this relate[s] to aspects of Traditional Chinese Medicine theory (like Yin and Yang), or to different nerves being stimulated at the locations that are being compared," she said in an email.

Naturopathic Medicine

According to the American Association of Naturopathic Physicians, naturopathy draws on traditional, scientific and empirical evidence. Jaclyn Chasse, the president of AANP, said naturopathic physicians are different from Naturopaths, Chasse warned. "Naturopath is not a protected term," Chasse said.

Unlike Naturopaths, Naturopathic physicians are licensed as primary care providers in many states and receive four years of training in both Western pharmaceutical medicine and other therapies, including nutrition, herbal medicine, homeopathy, physical medicine like osteopathic manipulation, and counseling.

Chasse said most naturopathic physicians prefer to try non-conventional treatments first because conventional treatments are generally restricted to prescription drugs and surgeries. Naturopathic medicine offers more options, she said. "I think there are a lot more tools in our toolkit." Contrary to popular belief, she added, naturopaths are not against Western medicine.

Traditional Chinese Medicine

Traditional Chinese medicine incorporates a number of treatments, including acupuncture, herbal medicine, cupping, and moxibustion, which involves burning mugwort to improve the flow of energy, or qi. Other techniques often used include tuina, a form of massage, and guasha, in which the practitioner scrapes a part of the body for therapeutic purposes. Practitioners are certified by the National Certification Commission for Acupuncture and Oriental Medicine or the California Acupuncture Board.

"Chinese medicine is essentially a 2,500-year clinical trial," said Dr. David Miller, a Chicago-based doctor who is board-certified in pediatrics and traditional Chinese medicine.

When properly practiced, Chinese medicine is "very systematic in its thinking," Miller explained. Before he began studying Traditional Chinese medicine, Miller said his treatment options for patients were limited to pharmaceuticals, reassurance or referral. "Chinese medicine gave me a whole range of treatments that could be appropriated before moving to more extreme stuff that western medicine has to offer."

Homeopathy

Homeopathy is the practice of treating illnesses based on the "law of similars," which says that substances known to cause certain symptoms can also be used to used to treat those symptoms when used in extremely small doses, said Ronald Whitmont, president of the American Institute of Homeopathy. A 2005 study suggested homeopathy may be beneficial in the long-term care of patients with chronic illnesses.

Homeopaths use "medicine specifically formulated from natural substances that are usually extremely dilute," Whitmont said. Medications are "prescribed on an individual basis on the holistic totality of the patient's personal, physical, and emotional attributes."