What is "Complementary and Alternative Medicine"?

By Michael Edmonds 31/03/2012 17


In Australia, the Friends of Science in Medicine have issued a challenge to Australian tertiary institutions to stop “offering courses in the health care sciences tat are not underpinned by sound scientific evidence“. This challenge, aimed specifically at tertiary organisations teaching what are commonly referred to as complementary and alternative medicine (CAM), has drawn strong reaction from those who support and teach it.

One of the challenges of discussing CAM is that not everyone has the same definition of what it means. Indeed in Darcy’s post earlier in the week on Why Do People Use Alternative Medicine? the fact that several commenters had slightly different definitions on what “alternative medicine” actually means lead to unnecessary disagreements. A good starting point for any intelligent debate is to make sure that you are talking about the same subject so I have had a look around on line.

The free online dictionary describes CAM as:

“a large and diverse set of systems of diagnosis, treatment, and prevention based on philosophies and techniques other than those used in conventional Western medicine, often derived from traditions of medical practice used in other (non-Western) cultures. Such practices may be described as alternative, that is, existing as a body separate from and as a replacement for conventional Western medicine, or complementary, that is, used in addition to conventional Western practice. CAM is characterized by its focus on the whole person as a unique individual, on the energy of the body and its influence on health and disease, on the healing power of nature and the mobilization of the body’s own resources to heal itself, and on the treatment of the underlying causes, rather than symptoms, of disease. Many of the techniques used are the subject of controversy and have not been validated by controlled studies.”

This is quite a broad definition, and as such provides some challenges – with some people potentially agreeing with parts of it and disagreeing with others. Consequently, perhaps in debates about CAM, there will be more value if proponents and opponents of CAM were to discuss specific “therapies” covered by the CAM banner on an individual basis in order to consider each ones merit, based on the available evidence?

For example, I see no merit in tertiary institutions teaching courses involving homeopathy, reiki, dowsing or colour therapy. There is no reliable evidence which supports these therapies (and a reasonable amount of evidence against them).

Herbal medicine, may first appear to have some merit, after all many modern pharmaceuticals are derived or inspired by natural compounds. However, given that the active components in herbal medicines vary from batch to batch, it seems to me this is an unreliable therapy. Also, given that many of the claims for its benefits focus on vitalism, a concept which has no evidence to support, I personally would be wary of it.

Chiropractic manipulation for muscular complaints and acupuncture for back pain, appears to have some evidence to support it, however, the application of these therapies to a wider range of problems (with no reliable evidence to support it), should, in my opinion, be challenged.

Dietary supplements is a quagmire of an issue. There is strong evidence that some supplements can be used to treat specific diseases (e.g. folic acid to reduce neural tube defects in the unborn; iron supplements for anaemia etc). However, for other claims the evidence is less convincing or even no existent.

The same applies to dietary advice. While gluten-free diets are helpful for those suffering coeliac disease, there is no evidence that they have benefits for everyone. Likewise, while fresh fruit and vegetables provide valuable nutrients, this does not necessarily mean that excessive or exclusive consumption of them will enhance ones health.

CAM is used to cover a wide range of therapies and treatments, a few of which are supported by evidence. However, those with no reliable evidence to support their use, need to be either assessed carefully (if this has not been done) or discarded (if there is evidence to show they do not work). Let each therapy stand on its own merit, or fall by the wayside.




17 Responses to “What is "Complementary and Alternative Medicine"?”

  • At a glance the definition seems reasonably straight-forward, provided you read the first portion (“systems of diagnosis, treatment, and prevention based on philosophies and techniques other than those used in conventional Western medicine”) as the definition and the remainder as elaborating on the definition. After all both ‘complementary’ and ‘alternative’ are relative terms, not absolute, and what they are relative to is ‘conventional medicine’.

    To me a deeper issue is that labels like ‘complementary’ and ‘alternative’ are more marketing tools that anything else in many ways and thus a bit besides the point. In a different way ‘conventional’ can have it‘s problems in cases as for some areas it will be a moving target.

    That said the definition touches on ‘philosophies’ and a key is the basis something is accepted for use within conventional medicine or not.

    With that in mind I suspect it‘s more pragmatic to define things in terms of evidential support or not e.g. evidence-based medicine / science-based medicine or not. There‘s a distinction between EBM and SBM for those that want to philosophise 😉

    Finally, there’s no such thing as a perfect industry – there will always be a few cases that don’t fit as well as we’d like in these sort of square holes. Generalisations have there limitations, etc.

  • Michael says,”However, given that the active components in herbal medicines vary from batch to batch, it seems to me this is an unreliable therapy.”

    This show a lack of understanding of herbs… Michael, to start a discussion, what’s the ‘active component’ of St John’s Wort?

    Michael says, “Dietary supplements is a quagmire of an issue. There is strong evidence that some supplements can be used to treat specific diseases (e.g. folic acid to reduce neural tube defects in the unborn; iron supplements for anaemia etc). However, for other claims the evidence is less convincing or even no existent.”

    mmm, let’s see. All of the vitamins and essential minerals have uncontested prevention and treatment attributes and you suggest the evidence is “less convincing or even no existent.” ??

    Do you really believe that?

  • Michael said, “With that in mind I suspect it‘s more pragmatic to define things in terms of evidential support or not e.g. evidence-based medicine / science-based medicine or not. ”

    So where does that place that multi-billion dollar pharmaceutical earner, prozac? What about antibiotics for glue ear? Or paracetamol for ear aches?

  • Ron,

    “This shows a lack of understanding of herbs”

    Would you care to expand on that? Are you claiming that the active components in herbs do not vary depending on the batch used and that the medicinal properties of the drug are not dependent on the active components?

    Hypericin was first believed to be the major active component of St Johns Wort but recent research suggests that hyperforin may be the major active ingredient.
    Furthermore, a large study in 2001 has indicated that St Johns Wort is only effective for mild to moderate depression and not major depression.

    With regards to dietary supplements, all vitamins and essential minerals, of course by definition, are necessary for good health. However, excessive doses have not been shown to have additional health benefits.
    However, what I was referring terms of the evidence being “less convincing or even no(n) existent, are the various dietary supplements such a deer velvet.

  • ““With that in mind I suspect it‘s more pragmatic to define things in terms of evidential support or not e.g. evidence-based medicine / science-based medicine or not. ”

    Ron, I did NOT say this, I suggest you pay more attention to who says what.

    You are quite right, there are some doctors who still prescribe inappropriate treatments, however, there are many doctors who are re-examining their practices to better reflect the scientific evidence.

  • Grant,
    “To me a deeper issue is that labels like ‘complementary’ and ‘alternative’ are more marketing tools that anything else in many ways and thus a bit besides the point.”

    I would suggest that the term “complementary and alternative” are just used to be able to use the term medicine in the title in an attempt to lend legitimacy to the various therapies. It is interesting that some of these therapies are now using the term “integrative medicine”.
    Is this akin to replacing “creationism” with “intelligent design”?

  • Michael said, “However, excessive doses have not been shown to have additional health benefits.”

    Ok, so what is the ideal amount of folic acid intake to maximise health benefits? What about vitamin D?

    Michael said, “However, what I was referring terms of the evidence being “less convincing or even no(n) existent, are the various dietary supplements such a deer velvet.”

    I guess mind reading isn’t something I’m into. Are you suggesting evidence re deer velvet use is non-existent?

    Apologies re mis-identification of quote… you are quite correct.

  • Ron,

    “I guess mind reading isn’t something I’m into.”

    First, knock it off with the snide comments. They add no value to this discussion.

    Second, because mind reading isn’t possible we have to communicate using words, with which the meaning is not always completely clear. That is why in an intelligent discussion one asks questions about what they are not sure about.
    However, while I have been answering your questions, I notice you do not answer mine. I do not consider this either courteous or likely to produce a reasonable discussion. So before I answer any more of your questions could you please answer the following question which I posed earlier

    After you said:

    “This shows a lack of understanding of herbs”

    I asked :

    “Would you care to expand on that? Are you claiming that the active components in herbs do not vary depending on the batch used and that the medicinal properties of the drug are not dependent on the active components?”

    Could you please answer this question so i can get a better idea of where you are coming from?

  • Ron,

    [Written late last night; haven’t edited it for comments posted since.]

    “Michael said,”

    He didn’t write that.

    “So where does that place that multi-billion dollar pharmaceutical earner, prozac? What about antibiotics for glue ear? Or paracetamol for ear aches?”

    There’s nothing for me to reword, etc., – just put treatments in terms of the evidence as I said. Like I wrote, “there will always be a few cases that don’t fit as well as we’d like in these sort of square holes. Generalisations have [their] limitations, etc.”

    Also relevant is my reference to medicine as a moving target – as researchers learn more they improve the use of things or make recommendations of limitations in particular contexts. So, for example, the issues with antibiotics with respect to ear damage are now well-known and have been quite extensively studied for some time now.

    I note none of your remarks detract from the key points being made, that ‘alternative’ and ‘complementary’ treatments are characterised by being outside of the ‘conventional’ medicine and their dominant feature is a lack of evidence backing them.

  • Michael,

    “I would suggest that the term “complementary and alternative” are just used to be able to use the term medicine in the title in an attempt to lend legitimacy to the various therapies. It is interesting that some of these therapies are now using the term “integrative medicine”.
    Is this akin to replacing “creationism” with “intelligent design”?”

    Borrowing the term ‘medicine’ might be one aspect of it for promoters of ‘complementary’ or ‘alternative’ treatments/practices (practices in the sense of clinics) but I can’t help think for these people it’s as more about marketing them and these treatments as ‘not the doctors’.

    I think you’re right that the ‘integrative medicine’ thing could be viewed as an alternative (ha!) branding. To me it underlines that these labels are marketing brands when it comes down to it. ‘Integrative medicine’ is actually borrowing from medicine/science much closer to the way your first part refers to (to my reading) as it tries to make their treatments part of medicine as opposed to complementing or being alternatives to it. More insidious in that way – ?

    Perhaps in a sense there is even a legal parallel to the creationist/ID shift, e.g. w.r.t. measures to have ‘alternative’ and ‘complementary’ treatments brought under the same registration policies as medicines, but I’d have thought if there is it’s unconscious, rather than a ‘planned’ deliberate thing in the way that ID was to try duck around the US law rulings against teaching creationism as science.

  • Ron,

    St Johns Wort has well documented changes in efficacy depending upon where it was grown, the time of year harvested and the method by which the extract was prepared.

    If this isn’t a good example of the “unreliable therapy” described by Michael then I would hate to think what is.

    Whatever the active component of any herbal therapy, I would prefer to take a specified amount of the active component and leave the inactive, possibly even carcinogenic, components behind.

    To give a real, if non-PC, example: tobacco addicts (smokers, chewers) are after the active component nicotine. Tobacco also contains many other components and the net effect is carcinogenesis – lung, mouth, throat, bladder cancers are all caused by the “inactive” components of the tobacco plant.

    If medically needed, for things such as tobacco withdrawal, there are pure preparations of nicotine available which are much safer than the tobacco plant.

  • FWIW, the term ‘alternative’ emerge in the mid 1800’s when the medical profession attained legal monopoly through legislation… it was legal medicine… the other were the ‘alternative.’ Naturally some said it wasn’t either/or, but both/and and said their’s was complementary… hence the two terms being combined as a blanket cover…

  • A few posts up, Ron said:
    Michael says, “Dietary supplements is a quagmire of an issue. There is strong evidence that some supplements can be used to treat specific diseases (e.g. folic acid to reduce neural tube defects in the unborn; iron supplements for anaemia etc). However, for other claims the evidence is less convincing or even no existent.”
    mmm, let’s see. All of the vitamins and essential minerals have uncontested prevention and treatment attributes and you suggest the evidence is “less convincing or even no existent.” ??

    Yet it’s already been pointed out to you (on another thread, by me) that folic acid, vit.D etc are part of the modern medical pharmacopeia – as are all vitamins & essential minerals. Michael’s point was that other supplements have far less evidence supporting the claims made for them. Kitty litter (zeolite), for example (a search of SB will find my posts on that one).

  • I like Tim Minchin’s take on it : “By definition, Alternative Medicine has either not been proved to work, or been proved not to work. Do you know what they call Alternative Medicine that’s been proved to work ? Medicine.”

  • CAM is used to cover a wide range of therapies and treatments, a few of which are supported by evidence. However, those with no reliable evidence to support their use, need to be either assessed carefully (if this has not been done) or discarded (if there is evidence to show they do not work). Let each therapy stand on its own merit, or fall by the wayside.