Abstract
Complementary and alternative medicine (CAM) is an area of great public interest and activity, both nationally and worldwide. Many alternative medical practices have existed for hundreds, even thousands of years. Patients and professionals are turning to CAM for a variety of reasons. Most have tried conventional medicine for a particular (usually chronic) medical condition and have found the results inadequate. Some are concerned over the side effects of conventional therapies. Some are seeking out a more “holistic” orientation in health care where they can address body, mind, and spirit. A continuing challenge will be how to address CAM services that are based on time, practitioner–patient interactions, and self-care, using modern standards of evidence, education, licensing, and reimbursement. For most CAM therapies, there is insufficient research to say definitively that it works and CAM research is especially limited in the area of cancer. Given that situation, the questions (but not answers) facing the medical practitioner are clear-cut. Should the practitioner await the definitive results of formal Phase III randomized clinical trials, or should the practitioner rely on limited data, seeking out evidence that makes physiological sense and small trials that seem to offer some benefit to the patient? When and at what point do you discourage, permit, or recommend an available alternative therapy? The answers are not simple. There may be differences of opinion and values among the patient, the practitioner, and the organizations that pay for a therapy. CAM areas should be approached with every patient who enters the office recognizing that there are precautions to consider when patients are using, or plan to use, such therapies. This paper presents a broad survey of what complementary and alternative medicine is from the perspectives of both the public as user and the conventional medical practitioner, as well as provides examples of issues pertinent to understanding and evaluating research in CAM. The past is back and the future will involve integration of modern and ancient ways.
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REFERENCES
Anderson, W. H. (1993). Patient use and assessment of conventional and alternative therapies for HIV infection and AIDS. AIDS, 74, 561-564.
Armanini, D., Bonanni, G., & Palermo, M. (1999). Reduction of serum testosterone in men by licorice. New England Journal of Medicine, 341, 1158.
Astin, J. A. (1998). Why patients use alternative medicine: Results of a national study. Journal of the American Medical Association, 279, 1548-1553.
Astin, J. A., Marie, A. M., Pelletier, K. R., Hansen, E., & Haskell, W. L. (1998). A review of the incorporation of complementary and alternative medicine by mainstream physicians. Archives of Internal Medicine, 158, 2303-2310.
Blumberg, D. L., Grant, W. D., Hendricks, S. R., Kamps, C. A., & Dewan, M. J. (1995). The physician and unconventional medicine. Alternative Therapies in Health and Medicine, 1, 31-35.
Cassileth, B. R., & Chapman, C. C. (1996). Alternative cancer medicine: A ten-year update. Cancer Investigation, 14, 396-404.
De Smet, P. A. G. M., Keller, K., Hänsel, R., & Chandler, R. F. (1997). Adverse effects of herbal drugs. Heidelberg: Springer-Verlag.
Eisenberg, D. M., Davis, R. B., Ettner, S., Appel, S., Wilkey, S., Van Rompay, M., & Kessler, R. C. (1998). Trends in alternative medicine use in the United States 1990-1997: Results of a follow-up national survey. Journal of the American Medical Association, 280, 1569-1575.
Eisenberg, D. M., Kessler, R. C., Foster, C., Norlock, F. E., Calkins, D. R., & Delbanco, T. L. (1993). Unconventional medicine in the United States-Prevalence, costs, and patterns of use. New England Journal of Medicine, 328, 246-252.
Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196, 129-136.
Ernst, E. (1999). Second thoughts about safety of St. John's wort. Lancet, 354, 2014-2016.
Ernst, E., Resch, K. L., & Hill, S. (1997). Do complementary practitioners have a better bedside manner than physicians? [letter]. Journal of the Royal Society of Medicine, 90, 118-119.
Ezzo, J., Berman, B., Vickers, A., & Linde, K. (1998). Complementary medicine and the cochrane collaboration. Journal of the American Medical Association, 280, 1628-1630.
Fabbender, H. (1994). Glucosamine sulfate compared to ibuprofen in osteoarthritis of the knee. Osteoarthritis and Cartilage, 2, 61-69.
Fawzy, F., Fawzy, N., Hyun, C., Elashoff, R., Guthrie, D., Fahey, F., & Morton, D. (1993). Malignant melanoma: Effects of an early structured psychiatric intervention, coping, and affective state on recurrence and survival 6 years later. Archives of General Psychiatry, 50, 681-689.
Furnham, A., & Forey, J. (1994). The attitudes, behaviors and beliefs of patients of conventional vs. complementary (alternative) medicine. Journal of Clinical Psychology, 50, 458-469.
Furnham, A., & Kirkcaldy, B. (1996). The health beliefs and behaviours of orthodox and complementary medicine clients. British Journal of Clinical Psychology, 35, 49-61.
Hammerschlag, R., & Morris, M. M. (1997). Clinical trials comparing acupuncture with biomedical standard care: A criteria-based evaluation of research design and reporting. Complementary Therapies in Medicine, 5, 133-140.
Jonas, W. B. (1998). Alternative medicine-Learning from the past, examining the present, advancing the future. Journal of the American Medical Association, 280, 1616-1618.
Jonas, W. B. (1996). Safety in complementary medicine. In E. Ernst (Ed.), Complementary medicine-An objective appraisal (pp. 126-149). Oxford: Butterworth-Heinemann.
Jonas, W. B. (1997a). Alternative medicine. Journal of Family Practice, 45, 34-37.
Jonas, W. B. (1997b). Clinical trials for chronic disease: Randomized, controlled clinical trials are essential. Journal of NIH Research, 9, 33-39.
Jonas, W. B., Linde, K., & Walach, H. (1999). How to practice evidence-based complementary and alternative medicine. In W. B. Jonas & J. S. Levin (Eds.), Essentials of complementary and alternative medicine (pp. 72-87). Philadelphia: Lippincott Williams & Wilkins.
Kelner, M., & Wellman, B. (2000). The social science of complementary and alternative medicine. New York: Gordon & Breach.
Klaus, M. K. (1992). Maternal assistance and support in labor: Father, nurse, midwife, or doula? Clinical Consultations in Obstetrics and Gynecology, 4, 211-217.
Linde, K., Ramirez, G., Mulrow, C. D., Pauls, A., Weidenhammer, W., & Melchart, D. (1996). St John's wort for depression-an overview and meta-analysis of randomised clinical trials [see comments]. British Medical Journal, 313, 253-258.
Moerman, D., & Jonas, W. B. (2000). Toward a research agenda on placebo. Advances, 16, 33-46.
Pelletier, K. R., Marie, A., Krasner, M., & Haskell, W. L. (1997). Current trends in the integration and reimbursement of complementary and alternative medicine by managed care, insurance carriers, and hospital providers. American Journal of Health Promotion, 12, 112-123.
Piscitelli, S., Burstein, A., & Chaitt, D. (2000). Indinavir concentrations and St. John'swort. Lancet, 355, 547-548.
Redelheimer, D., Molin, J., & Tibshirani, R. (1995). A randomized trial of compassionate care for the homeless in an emergency department. Lancet, 346, 1131-1134.
Reuter, H. (1995). Ginkgo Bilboa-Botany, constituents, pharmacology, and clinical trials. British Journal of Phytotherapy, 4, 3-20.
Ruschitzka, F., Meier, P., & Turina, M. (2000). Acute heart transplant rejection due to St. John's Wort. Lancet, 355, 548-549.
Sobel, D. S. (1995). Rethinking medicine: Improving health outcomes with cost-effective psychosocial interventions. Psychosomatic Medicine, 57, 234-244.
Spiegel, D., Kraemer, H. C., Bloom, J. R., & Gottheil, E. (1989). Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet, 2(8668), 888-891.
Vickers, A. J. (1996). Can acupuncture have specific effects on health? A systematic review of acupuncture antiemesis trials. Journal of the Royal Society of Medicine, 89, 303-311.
White, A., Resch, K., & Ernst, E. (1997). Smoking cessation with acupuncture? A best evidence synthesis. Forsch Komplementarmedicine, 4, 102-105.
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Jonas, W.B. Advising Patients on the Use of Complementary and Alternative Medicine. Appl Psychophysiol Biofeedback 26, 205–214 (2001). https://doi.org/10.1023/A:1011398120476
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DOI: https://doi.org/10.1023/A:1011398120476