What is CAM and Who is Using it?

Complementary and Alternative Medicine (“CAM”), also known as Integrative Medicine, is a diverse field covering a variety of treatments that are provided by practitioners with varying degrees of training. CAM can be classified into five areas1 that include:

1)    alternative medical systems
2)    biologic-based therapies
3)    energy therapies
4)    manipulative and body-based systems
5)    mind-body interventions

Of the examples of the different therapies shown in the table below, massage and chiropractic care tend to be the most popular.

Why CAM?

With the health care system under strain from reduced funding and increasing costs, patients with asthma and allergies often turn to CAM practitioners to obtain relief from symptoms and in the hope of a cure. But they are not the only ones to do so. Patients feels that CAM is

  • patient-centered
  • holistic
  • concerned with the patient-provider relationship
  • uses therapeutic approaches
  • accessible
  • empowering
  • legitimate
  • more in keeping with their beliefs
  • offers more personal autonomy

Users of CAM often cite an unmet medical need or because there was a delay in getting medical care. It may also be the result of barriers to obtaining medication or concerns about medication. They often see CAM as being more affordable too.2 They also agree with the World Health Organization’s definition of health as a state of social, mental and physical well-being and not merely the absence of disease.

Where do users of CAM find information about CAM? According to a study done in Canada3 most users get their information from

  • family or friends (65%)
  • books (40%)
  • health food stores (37%)
  • pharmacies (35%)
  • the internet (29%)
  • CAM health providers (28%)
  • hospital clinic (27%)
  • allopathic health providers (26%)

Clearly users have more than one source of information.

Who uses CAM?

In any given year, two out of every five Americans will consult a CAM practitioner. Often CAM is used in addition to or instead of conventional allopathic medicine.

A recent study in the Journal of Health Care for the Poor and Underserved4 shows that more and more Americans are seeking help from CAM, and that the demand for CAM is growing. In 1990 about a third of all Americans used some form of CAM. By 2002 the number of CAM users had doubled to 42% and in the last five years CAM usage has increased by 14%. Caucasians are twice as likely as African-Americans or Hispanics to use CAM. Asians are slightly less likely than Caucasians to use CAM. However the gap between CAM use by non-Hispanic whites and African-Americans and Hispanic populations is growing.

Patients, whether adults or children, who have a chronic discase such as asthma are more likely to use CAM than those who do not have a chronic illness.5 Asthmatic adults, particularly women with a college education, tend to be users of CAM.6,7 CAM use is also inversely linked to income. The use of CAM in patients with asthma ranges from 51% to 89%.8 The severity of asthma has also been linked to the use of CAM.9

CAM is popular with allergy and asthma sufferers since conventional allopathic medicine does not provide a cure and these conditions may be life-threatening. Allergy and asthma have a major impact on the individual’s quality of life and require

  • control of the environment
  • avoidance of triggers
  • adherence to a prescribed and often daily regimen

A study in California involving 300 patients with asthma or rhinosinusitis found that:10

  • 1 in 4 did not currently use prescribed medication
  • 1 in 4 used herbal remedies
  • 18% used caffeine treatment
  • 22% used alternate therapies

Other surveys of CAM usage in asthma showed a high level, with 78% of children and 79% of adults using a variety of treatments.11 30% of those surveyed reported using some form of breathing techniques.12 The most frequently used CAM therapies for respiratory problems, asthma and allergies include aromatherapy, Bowen technique, homeopathy, magnetic therapy, massage and reflexology.13

Problems with CAM

The medical community has not totally embraced CAM for the simple reason that reports on its effectiveness tend to be descriptive and anecdotal rather than scientific and evidence-based. There are few randomized control trials, program evaluations and cost-effectiveness studies. While this is a growing field, there is a lack of consensus of both definition and taxonomy (the practice and science of classification) that makes it very difficult to evaluate the benefits and effectiveness of CAM.

However, there is a growing trend to integrate CAM into mainstream health-care in the US. A survey of physician referrals showed that allopathic practitioners were comfortable referring patients for acupuncture, chiropractic and massage.14 Varying numbers of those surveyed indicated their belief in the efficacy of CAM modalities such as: chiropractic – 53% massage – 48% homeopathy – 26% herbal medicine – 13%

Fewer than half the number of patients who use CAM disclose this fact to their health care provider,15 with disclosure being especially low among both racial and ethnic minorities. Among the latter, having a regular provider together with a quality patient-provider relationship can overcame the differences in CAM disclosure.

The asthma educator is required to ask patients about their use of CAM and to warn patients that any CAM modality that requires the patient to discontinue all asthma medication may be harmful to health. CAM practitioners can work in conjunction with allopathic medicine for the betterment of patients and as such, the asthma educator should have some knowledge about the variety of CAM modalities and the patient’s degree of involvement.

References

  1. Straud R.  Effectiveness of CAM therapy: Understanding the evidence. Rheum Dis Clin North Am. 2011;37(1):9-17. Epub 2010 Dec 3. Abstract.
  2. Maizes V, Rakel D, Niemiec C. Integrative medicine and patient-centered care. Explore (NY). 2009; 5(5): 277-89.
  3. Richmond E, Adams D et al.  Complementary and alternative medicine: A survey of its use in children with chronic respiratory illness. Can J Respir Ther. 2014 Spring;50(1):27-32.
  4. Su D, Li L. Trends in the use of complementary and alternative medicine in the United States: 2002-2007. J Health Care Poor Underserved. 2011;22(1):296-310.
  5. Jean D, Cyr C. Use of complementary and alternative medicine in a general pediatric clinic. Pediatrics. 2007;120:e138–41
  6. Slader CA, Reddel HK, et al. Complementary and alternative medicine use in asthma: Who is using what? Respirology. 2006;11:373–87.
  7. Ward CD, Baptist AP. Characteristics of complementary and alternative medicine use among older adults with asthma. J Asthma. 2016; 53(5): 546-552. doi: 10.3109/02770903.2015.1116090.
  8. Morgan W, Center H et al. Complementary and alternative medicine use and asthma: relation to asthma severity and comorbid chronic disease. J Asthma 2014; 51(3):333-338. doi: 10.3109/02770903.2013.871559.
  9. Mark JD, Chung y. Complementary and alternative medicine in pulmonology. Curr Opin Pediatr. 2015; 27(3):334-340. doi: 10.1097/MOP.0000000000000217.
  10. Blanc PD, Trupin L, et al. Alternate therapies among adults with a reported diagnosis of asthma or rhinosinusitis. Chest 2001; 120:1461-67
  11. Slader CA, Reddel HK, et al. Double blind randomised controlled trial of two different breathing techniques in the management of asthma. Thorax 2006; 61:651–656.
  12. Ernst E. Breathing techniques: adjunctive treatment modalities for asthma? A systematic review. Eur Respir J 2000; 15:969–972.
  13. Long L, Huntley A, Ernst E. Which complementary and alternate therapies benefit which conditions? A survey of opinions of 223 professional organizations. Comp Therapies Med 2001; 9:178-85
  14. Astin JA, Marie A, et al. A review of the incorporation of complementary and alternate medicine by mainstream physicians. Arch Intern Med 1998; 158:2303-10
  15. Chao MT, Wade C, Kronenberg F. Disclosure of complementary and alternative medicine to conventional medical providers: variation by race/ethnicity and type of CAM. J Natl Med Assoc. 2008;100(11):1341-9.