A wealth of information on the many types of Complementary and Alternative Medicine (CAM) is offered in the United States. Find out what is hype, which types are based on sciences, how to find an appropriately credentialed CAM provider and what to expect. Look into the evolving world of Integrative Medicine using the best of all practices based on scientific evidence.

Learn why people seek out alternative medicine practitioners, spending three times as much in out of pocket expenses on CAM ($10.3 billion) as on traditional Western medicine ($3.5 billion) and have more visits to alternative medicine practitioners than primary care physicians.

Introduction

"Complementary", "alternative", "traditional", and "integrative" medicine are frequently used terms to describe a variety of healthcare treatments. There are no universally accepted definitions for these terms. Medical practice that is considered "alternative" in one country may be "traditional" in another country. Definitions below will be used in this article.

Non-traditional forms of Western medicine have always been practiced in the United States. These practices of medicine were rarely discussed in traditional physicians' offices, either by the doctor or the patient. A landmark article in the New England Journal of Medicine by Harvard University's Dr. David Eisenberg in January 1993 brought the debate about the use of "non-traditional" medical treatments to the forefront of medical literature. Dr. David Eisenberg is Director of the Centre for Alternative Medicine and Research, Beth Israel Deaconess Medical Centre associated with Harvard University.

In his article, Dr. Eisenberg and his researchers estimated that one-third of the US population used alternative healthcare practices and physicians in 1990. Approximately 10% more Americans sought treatment with alternative medicine practitioners than sought care with conventional primary care physicians. These consumers spent over 10 billion dollars in alternative healthcare treatments compared with the approximately three billion dollars out-of-pocket expenses with traditional Western medical doctors.

In his follow-up article in the Nov. 11, 1998 issue of The Journal of the American Medical Association (dedicated solely to complementary and alternative medicine), Dr. Eisenberg notes that, as of 1997, that over 42% of American survey responders indicated that they had tried alternative medical treatment in the previous year. Nearly all of these had also seen a physician practicing traditional medicine during the same period of time. However, very few of these individuals report their alternative medicine treatment to their physician and nearly 20% of those taking prescription medicine also used herbal products and nutritional supplements during the same period of time.

The debate regarding the role of each of these types of medicine is very active. Although many practitioners of a specific type of medical system are convinced they have the only answer, a growing number of both conventional and alternative medicine practitioners are attempting to integrate the best components of several types of medical practice into their healthcare delivery system.

A 1997 issue of The American Journal of Health Promotion lists reasons given by American consumers of healthcare for seeking alternative medicine treatments. These reasons include dissatisfaction with conventional medicine capabilities and delivery systems, cost of traditional medicine and the numerous medications used and side effects. From a Western medicine perspective, more disturbing reasons include traditional physicians' tendency to treat disease rather than emphasize wellness and preventive healthcare, depersonalization of the treatment of patients and a lack of knowledge regarding the increasingly apparent role of lifestyle decisions, emotional issues and nutritional factors in disease. A study from Stanford University found that may users of alternative medicine are not necessarily dissatisfied with traditional medicine practices, but find alternative medicine fits well with their lifestyle and philosophy about health.

Finally, the American consumer has more access to information and increased awareness of potentially successful alternative medical practices which are being acknowledged by practicing Western medicine physicians and institutions. Examples include the establishment of the National Institutes of Health Office of Alternative Medicine in 1992 (now called the National Center for Complementary and Alternative Medicine), the increased course offerings in alternative medical practices in American medical schools, certification and credentialling by government bodies of alternative medicine practitioners and emerging studies by Western researchers on the effectiveness of alternative medical treatments.

Many traditional Western medical practitioners are cautious about accepting CAM practices because of the scant amount of rigorous research studies published in scientific literature. This view is clearly articulated by the editors of the New England Journal of Medicine in 1998. Proponents of CAM argue that scant funding is available for research, there are no financial incentives for investigating treatments that can not be published and traditional medicine journals are reluctant to publish CAM studies. They also argue that there is greater harm in not using many of the therapies used over the centuries without extensive study.

The harm, counters traditional medicine advocates, is twofold. First, some patients avoid using effective medical treatments while searching for alternative medicine answers and allowing the disease to progress. Secondly, some treatments may actually be harmful. Although there is no single answer for this concern, certainly each side is correct in its view when the great number of CAM therapies is considered.

Another issue with traditional physicians is malpractice liability for referrals to CAM practitioners. For two excellent articles on the subject, the the November 11, 1998 issue of JAMA on Medical Malpractice Implications of Alternative Medicine and the Integrative Medicine Consult article on Liability for Referral to Complementary and Alternative Providers by attorney Michael Cohen.

For additional information on the debate from a western medicine perspective, see an editorial from American Family Physician January 1, 2003,"Complementary and Alternative Medicine: Examining the Evidence,"

Definitions

Traditional Medicine

Traditional medicine in this article is defined as those practices generally taught in American medical schools and schools of osteopathy. Practitioners of this type of medicine are usually designated as M.D. or D.O. Most hospitals and insurance companies in the United States use traditional medicine as the allowable and reimbursable form of healthcare. Practitioners in Eastern countries such as India and China would not consider this practice of medicine "traditional." Much of the scientific literature available to English readers is based on research on this type of medicine and using drugs manufactured by pharmaceutical companies to provide this type of treatment.

Traditional Western medicine is designed to suppress symptoms, surgically correct injuries, remove diseased organs or tissue and eliminate disease-causing organisms. Recent interest in preventive medicine has increased use of wellness practices emphasized long ago by alternative medical systems. Osteopathic medicine incorporates all of these treatment techniques and adds manipulation of the joints and assessment of each individual's health status.

Interestingly, two thirds of US allopathic medical schools now offer classes in alternative medicine subjects. One third of the courses offered are required courses. Obviously, there is considerable overlap between all of the medical systems and approaches. Many types of traditional Western medicine incorporate elements from other medical systems. This is particularly true with primary care specialists, rehabilitation medicine and with preventive medicine physicians.

Many traditional Western medicine practitioners are reluctant to prescribe alternative treatments, not only because of a lack of knowledge and understanding, but also for a fear of malpractice liability. Credentialling and licensure of alternative medical practitioners varies widely across the nation and medical practice types. In general, malpractice claims against alternative medicine providers are less frequent and less severe than those against traditional practitioners, according to a recent article in JAMA. Traditional physicians do have responsibilities and liabilities in referring patients to alternative practitioners.

Alternative medical practitioners are frequently limited in access to diagnostic testing equipment and their ability to write for prescription medication. For many of the CAM systems, diagnosis of illness or disease is not based on traditional laboratory testing nor is treatment dependent upon prescription medication. In fact, in many of the CAM systems, use of invasive testing and medications with potential side effects is contrary to that systems' philosophy. The overlapping areas of nutrition, physical manipulation, pain relief techniques, psychological support, avoidance of environmental toxins and personal lifestyle decisions cross into both traditional and CAM healthcare delivery philosophies.

Alternative Medicine

Alternative medicine practices incorporate a wide variety of healthcare methods. These methods generally use "natural" techniques and healing powers of the body to return to a state of health. The term "alternative medicine" is frequently used to describe techniques not generally practiced by traditionally trained Western physicians. Many people use this term when an individual participates in non-traditional medical practices without the knowledge of their traditional medicine physician. Traditionally trained Western physicians generally do not practice these techniques. A brief overview of many of the types of alternative medicine is found below.

Complementary Medicine

Complementary medicine combines the practices of both alternative medicine and traditional medical practices and looks at the spectrum of medical treatment options available for any particular condition. Complementary medicine uses basic principles of traditional Western medicine with treatments for some conditions being "complemented" by "alternative system." Medical practitioners tend to use the synergistic effect of two separate healthcare systems to the good of the patient. To a limited extent, nearly every person in the US has participated in some form of complementary medicine. For example, many people modify their diet to reduce the risk of particular diseases, ice or massaged an injury, take a vitamin or allocate time for spiritual contemplation. Often, individuals are practicing complementary medicine without notifying their traditional physician of their use of other therapies. This reluctance to mention it may be based on the patient's embarrassment to admit such use or the physician's lack of knowledge and acceptance alternative medicine practices.

Integrative Medicine

Integrative medicine, as we define it, is a scientific assessment of all reviews of medical practice used individually or in combination. The goal of integrative medicine is to use evidenced-based healthcare practices from all types of medicine to provide the optimum healthcare outcome to an individual. All types of medical practices are options for treating any particular condition. "Integrative medicine operates on the premise that prevention is the primary responsibility of the practitioner and appreciates the influences of nutrition and lifestyle on health and illness", according to Drs. Caspi, Lutz and Greenfield of the University of Arizona Health Science Centre. They go on to state "The concept of integrative medicine represents universal values of health care. Integrative medicine shifts the orientation from curing disease to healing illness. It is based on a partnership between patient and practitioner that addresses well-being as well as seeking remedies….. It teaches health care providers to honour the subtle, yet complex, interactions of mind, body, spirit, community, and environment. Integrative medicine is the foundation of the practice of good medicine, whether its origins are conventional or alternative, and good medicine is based on open-minded, inquiry-driven good science."

Many "wellness clinics" are practicing integrative medicine. As research in the "alternative" medical fields evolves, more evidence supporting the effectiveness of these treatment styles will grow. Integrative practitioners will use the technique or combination of techniques which provide the best results based on research. For an excellent discussion of the validity of difference types of scientific study and the degree of necessity of scientific proof. The JAMA editorial, "Alternative Medicine Meets Science", argues that there should be no distinction between types of medicine, just effective medical practices proven by scientific study. This is the premise of integrative medicine or evidence-based medical practice. As both interest and funding grow in "alternative" medical practices, some therapies will move to the mainstream of medical practice, while others will be eliminated if shown to be ineffective or even harmful.

Throughout the remainder of this article, the term "CAM (Complementary and Alternative Medicine)" will be used to describe medical practices not routinely taught in American medical schools or schools of osteopathy. We recognize that there is considerable overlap in all of these techniques. What is at one time considered alternative or complementary, may progress into an integrative system or even be accepted as "traditional" at sometime in the future. The examples include the use of vitamins and minerals to prevent diseases such as osteoporosis, birth defects, cancers and cardiovascular disease. Other examples include use of acupuncture for pain relief and biofeedback for anxiety control.

Alternative Medical Systems

Complementary and alternative medicines can be divided into several areas. Alternative medical systems include a comprehensive philosophy of wellness, treatment of illness and attempts to cure disease. Physical Medicine uses actual physical hands-on contact by the provider with the patient as part of the treatment program. Mind Body Medicine instructs the patient on techniques to use their own mental powers to relieve physical conditions. Nutritional Medicine Systems use vitamins, minerals, herbs and other botanical (plant) products to restore health or optimize wellness. Energy Medicine uses light, sound, electromagnetic fields or other forms of energy to treat conditions. Environmental medicine seeks avoidance of toxins the patient is exposed to avoid disease or combat illness. A host of other symptoms are also briefly described.

The alternative medical systems include Traditional Chinese Medicine (TCM), Ayurveda, naturopathy and homeopathy. Although some people consider osteopathy a form of an alternative medicine system, most of its practitioners have very similar training and identical privileges and credentialling to conventional Western allopathic medical doctors. The alternative medical systems of Traditional Chinese Medicine and Ayurveda involve elements of many of the other subsets of "alternative" medical systems.

Alternative Medical Systems- Traditional Chinese Medicine

Traditional Chinese Medicine (TCM) is a comprehensive health philosophy based on physical, emotional and spiritual healing. The essential belief in Chinese medicine is that the "qi" is the vital energy or life force in all living objects. This qi can be transferred between living beings. Also essential is the concept that "tao" or "way of life" is the ideal way to conduct one's life. People who live according to the tao enjoy good health, where disease results from a lack of balance in the tao. This balance in all aspects of life is described as opposite forces, called "yin" and "yang." The diagnosis of disease of these conditions involves an assessment of the balancing forces acting on qi. Some disease states, often evaluated by the appearance of the tongue, can be corrected by avoiding or using specific foods. A disease that is characterized as "hot" may include treatment with the use of more "cold" foods or the avoidance of other foods that will produce heat in the body. The TCM treatments for most conditions involve the use of five principle modalities: Chinese herbal medicines, acupuncture, dietary changes, massage, exercise and stress reduction.

Chinese Herbal Medicine

Although Chinese medicines are called herbs, they may be derived from plants, animals or minerals. Herbs are often given in complex formulations based on an assessment of the organ system that is out of balance. Using the philosophy of yin and yang, the herbs attempt to restore balance and, therefore, health to the organ system. The oldest medical textbook known to man, Nei Jing (The Yellow Emperor’s Classic of Internal Medicine) discusses many of he TCM herbs as well as the philosophy of wellness.

Acupuncture

Acupuncture is the art of restoring qi, the vital force, by the insertion of very thin needles into certain points in the body. These points are mapped along fourteen meridians that control the qi. Sometimes, acupuncturists will warm the needles with a burning herb, called moxibustion. At other times, key points along the meridian may be stimulated to restore qi by pressure with the fingertips, called acupressure or shiatsu. See Acupuncture Helps in Treating Medical Problems in Flight Safety Foundation's Human Factors & Aviation Medicine Sep-Oct 02.

Qi gong and T’ai Chi

Exercise and stress reduction often combined in TCM in a manner similar to physical therapy and medication in the West. "Qi gong" incorporates movement, with focus on breathing to restore qi and cleanse the body. "T'ai chi" is practiced more and more in the US. It involves slow, deliberate movements performed with a certain rhythm and is designed to a certain rhythm with meditation and is designed to restore qi to the body.

Diet and Nutrition

A TCM practitioner will evaluate a person’s pulse in a completely different way than Western physicians do. In TCM, the pulse gives an indication of the balance of Qi. Some conditions are associated with "Hot" and other are considered "Cold". Specific foods also have Hot and Cold properties and can be effective in restoring the Qi. Ironically, Western medicine also uses certain foods to prevent or treat conditions, such as red meats and green vegetables for iron deficiency anemia and dairy products to prevent bone loss. Many other examples exist.

Massage

The use of massage techniques (An-mo and Tui Na) releases toxins from the body while relaxing and healing the individual. As with other therapies, TCM practitioners use massage for inner peace and to restore the balance of Qi.

Accrediting bodies in traditional Chinese medicine include the National Certification Commission for Acupuncture and Oriental Medicine, which conducts national board examinations for acupuncture, oriental bodywork and Chinese herbology. Acupuncturists are licensed in 29 states in the US. Another source is the American Association of Oriental Medicine.

Alternative Medical Systems- Ayurvedic Medicine (India)

Prana, Dosha and Prakiti

Ayurveda is the practice of traditional medicine in the country of India and is over 5,000 years old. It emphasizes that true health results from a balance between body, mind and spirit and the interrelationship of each. Like the Chinese qi, the life spirit in Ayurveda is called Prana. Srotas or channels (similar to Chinese meridians) help balance the five forces of life and the five organ systems called Vayus. The principles of Ayurveda state that we are each born with a unique personal physical and mental constitution , known as Prakruti. Throughout life, illness results from a deviation form this constitution. This state of imbalance is termed vikruti.

All living organisms have a constitutional makeup or personality called Dosha. There are three dosha types, Vada, Pitta and Kapha. The Vada type is an energetic and enthusiastic, though somewhat restless type. The Pitta dosha is very intense, inpatient and regimented. This resembles the type A personality in Western medicine. Kapha doshas are more relaxed, tranquil and easygoing. Each of the doshas is associated with certain body type, specific health concerns and mental functions. All people have elements of each dosha, although one tends to be dominant. Their unique combination given to them at birth is their Prakruti. By understanding the Prakruti, one can select a diet and lifestyle that will support health and optimal functioning of the mind, body and spirit.

Ayurvedic Schools of Practice

Ayurvedic medicine has two main schools of practice. 1) Maharishi Mahesh Yogi founded one school that emphasizes transcendental meditation. The Beatles made this form of Ayurveda famous in the 1970's. It is still taught and practiced throughout the world. 2) Deepak Chopra, M.D., who is also a famous motivational speaker throughout the US, incorporates the second branch. He is also the author of the best selling books, "Perfect Health: Complete Mind/Body Guide" and "Ageless Mind, Timeless Body". It incorporates meditation, but also uses other therapies, which are described below.

Ayurvedic Healing Methods

Ayurvedic therapeutics focuses on personal diet and lifestyle regimes that work with the individual constitution to prevent illness and promote health. Ayurveda is becoming recognized today through the related practice of Yoga. Yoga is a set of exercises and postures combined with meditation to reunify mind and body. Yoga postures are called Asanas and breathing practices are known as Pranayama. Yoga is becoming popular for its proven ability to relieve stress, promote fitness and aid a variety of disorders.

Other healing methods include herbal therapy, a form of acupressure known as Marma Chikitsa, and rejuvenative medicines known as Rasayana and Panchakarma. The latter of these is a cleansing program that utilizes Abhyanga (oil massage), a specialized diet, Nasya (the administration of oils to the nostrils), Shirodhara (a warm stream of oil poured on the forehead), herbal therapy, yoga and other methods to gently balance the dosha and aid the body in returning to the prakruti.

Ayurvedic Research

Research in Ayurveda is only just beginning in the Western world. Meditation and the integration of mind, body and spirit certainly are gaining respect in Western medicine, however. The NIH Office of Alternative Medicine and the National Cancer Institute are currently studying several Ayurvedic techniques for potential benefits. See the American Cancer Society' detailed description of Ayurveda and its potential benefits. The Health Education Alliance for Life and Longevity also has extensive information on Ayurveda. Currently, there is little regulated standard for Ayurvedic education in the United States and no licensing process for Ayurvedic practitioners.

Alternative Medical Systems- Naturopathy

Naturopathy or naturopathic medicine emphasizes Vis medicatrix nataurae (the healing power of nature). Benedict Lust formed the first American School of Naturopathy in 1902. This type of medicine is increasingly popular in the US, and in particular, the Pacific Northwest. Its' practitioners are primary care providers who have gone through four years of college and a four year graduate school in naturopathy. The most prominent school is Baystyr University and the National College of Naturopathic Medicine. Baystyr University is one of the National Institutes of Health Office of Alternative Medicine's eleven research centres.

Graduates from naturopathic schools have the initials "N.D." after their names and are called doctors of naturopathic medicine. There are tremendous similarities between traditional teaching of M.D.’s D.O.'s and N.D.'s. Naturopaths study the biological and physical origins of disease. Evaluations include diagnostic studies using laboratory work, physical examination and pathology in the same way that Western physicians and osteopaths do. The major distinction is that, rather than using artificially produced pharmaceutical medications and surgery, N.D.'s use natural sources for healing properties, including dietary, herbal and environmental interventions.

Guiding Principles of Naturopathy

There are six guiding principles in naturopathy:

1. Primum non nocere ("First, do no harm"). Practitioners of conventional Western medicine share this philosophy, which is included in the Hippocratic Oath.

2. Tolle causam ("Find the cause"). N.D.'s seek not to eliminate symptoms of disease, but to treat the underlying cause, which they believe is based on environmental, dietary or lifestyle issues. Correcting the cause of disease is the key, not treating the symptoms.

3. Vis medicatrix naturae ("the healing power of nature"). This recognizes the body's ability to heal itself by using its own powers and natural resources of the environment and diet.

4. Holism. Treat the whole person, not just the diseased organ. This is often called holistic approach. Examples of this approach in Western medicine are to combine traditional, surgical and pharmacological treatments for heart disease with dietary recommendations, exercise, prescriptions and lifestyle modifications.

5. All doctors should be teachers. Any patients seeking the assistance of an N.D. should expect to have a careful explanation of the diagnosis and treatment and to incorporate the patient into the recovery plan. A frequent criticism of the Western healthcare systems is that treating physicians do not spend enough time explaining conditions and treatments to their patients.

6. The sixth principle is that prevention is the best medicine. Healthy lifestyle habits do far more to prevent disease than medicine can do to treat it.

Naturopaths are trained in clinical, physical and laboratory sciences in a similar fashion to M.D.'s. While lacking in surgical training, N.D.'s often have a strong background in clinical nutrition, herbal medication and other forms of alternative medicine. N.D.'s should be a graduate of one of these institutions and be listed by the American Association of Naturopathic Physicians. Just as many M.D.'s are not qualified to practice all elements of naturopathic medicine, N.D.'s are trained in many, but not, all elements of allopathic medicine.

Alternative Medical Systems- Homeopathy

Homeopathy is based on the philosophy of Samuel Hahnemann, a German physician who espoused the philosophy that "like cures like" or the law of similars. The law of infinitesimals states that small amounts of a compound or dilutions of a compound are much more powerful than larger amounts in curing disease. Hahnemann's law of chronic disease states that any treatment for a disease will worsen it unless it's taken in increasingly dilute amounts.

Homeopathy is relatively well accepted in Europe, but generally dismissed as non-scientific in the US. Many of the homeopathic "cures" are thought to be to the placebo effect or the power of suggestion. Only Connecticut and Arizona license M.D.'s and D.O.'s to practice homeopathic medication. The National Center for Homeopathy in Virginia provides additional training to physicians interested in this medical art. Homeopathy is generally safe. The major danger exists if a full evaluation of serious medical conditions and definitive treatment is delayed while awaiting the benefits of homeopathic medication. Recent articles in The Lancet (9-20-97,pg. 134) indicates there may be some benefits beyond the placebo affect for homeopathic medicine.

Physical Medical Systems- Chiropractic Care

Chiropractic medicine is the most widely practiced form of "alternative" medicine in the US. Nearly 15% of the US population has been treated by a chiropractor within the last year. Chiropractic medicine focuses on the effect of misalignment of the bones of the spine that affects the nerves arising from the spine. These affected nerves then produce illness or discomfort in various body tissues and organs. By properly aligning the bones of the spine (vertebrae) the proper relationship between the spine and nervous system can be restored an illness treated.

Diagnosis of disease is made by obtaining a careful history of the patient's illness, evaluating the posture, reflexes and alignment of the vertebrae to determine possible treatments. Often the evaluation included a series of x-rays. Spinal manipulation is then used to correct the alignment and treat the condition. In some cases, other joints and bones are manipulated to relieve disease. Rarely, spine or joint manipulation may cause further problems. Traditional medicine uses some chiropractic techniques, usually administered by a physical therapist, who work under the direction of a physician. The National Association for Chiropractic Medicine is an organization dedicated to moving legitimately trained and properly licensed chiropractors in to mainstream medical care.

Chiropractic training involves five years of study and clinical experience at one of the 17 accredited chiropractic schools in the US. The Council of Chiropractic Education accredits one of the 17 chiropractic colleges in the US. Chiropractors are licensed in all 50 states. The American Chiropractic Association provides a listing of the licensed chiropractors in the United States. Although some work through a regular relationship with a traditional physician, many chiropractors work independently. Insurance coverage for chiropractic care is slowly becoming available.

Physical Medical Systems- Massage and Bodywork

There are many types of massage therapy available. Different techniques have evolved from European traditions, Asian techniques and contemporary Western massage. Massage is essentially manipulation of the soft tissues of the body, including muscle, fascia or connective tissue. Massage is widely used in sports medicine by many world-class athletes. Several studies have shown that simple physical contact may have beneficial effects in healing of the body.

European Bodywork

European massage techniques include the gentle Swedish massage of the superficial layers of the muscle and lymphatic massage to improve lymph flow through the body. Deeper forms of massage include deep tissue massage which focuses on a specific injured area, neuromuscular or trigger point massage that focuses on points on the body that trigger pain and Rolfing which involves manipulation of the fascia or (tissue that covers the muscle).

Asian Bodywork

Asian bodywork incorporates several basic techniques with numerous variations. Often included in traditional Chinese medicine, acupressure treats medical conditions using the same principles as acupuncture, but uses pressure applied with the fingers, rather than needles to stimulate the flow of qi through the meridians of the body. The Japanese equivalent of acupressure is shiatsu and may involve pressure applied not only with the fingers, but also with the elbows, knees, feet and hands. Other variations that include a combination of acupressure and massage include Tui Na, An-Mo, Jin shindo and Jin shin jutsu. Self-application of acupressure includes Acu-yoga and Do-In. There are many forms of Oriental and Ayurvedic massage also. As mentioned above, one form of Ayurvedic massage is also called Marma therapy, which involves rubbing specific areas of the body. Another form called Abhyanga involves rubbing the skin with sesame oil to aid in removal of toxins.

Western Bodywork

Western bodywork also includes a variety of techniques. These techniques tend to combine massage movement and posture exercises designed to improve mental relaxation, relieve physical discomfort and improve movement and balance. These types of bodywork include the Alexander technique, the Feldencrais method, the Trager method, the Pilates/Physical Mind method, Hellerwork and Rolfing.

Physical Medical Systems- Therapeutic Touch

The technique developed by a professor of nursing in New York involves passing the hands of the practitioner near the patient for the purpose of changing a patient's "energy field" without any true physical contact. A study in The Journal of the American Medical Association called in to question the value of this technique, although some patients report dramatic results. Very similar techniques include polarity therapy and the Japanese Reiki.

Although most forms of bodywork are generally safe, there are numerous "practitioners" without formal training. The National Certification Board for Therapeutic Massage and Bodywork gives a list of therapists who have passed a national certifying exam, have met requirements for ongoing education and have been certified by their state if required. The term "LMT" or licensed massage therapist does not imply specific training or certification.

Mind/Body Medicine

In general, the goal of mind/bodywork is to create a state of relaxation or focused concentration to use the healing abilities of one's own mind to address physical conditions. Although it may be very difficult to see a direct relationship between the mind and physical illness, a growing field of study called psychoneuroimmunology is evaluating the relationship between the mind, the nervous system and the immune system. Not fully accepted by many medical practitioners and patients because of a lack of concrete scientific studies, many people intuitively accept the concept that stress, anxiety and other negative mental states may have an adverse effect on health. The relationship of a Type A personality with coronary artery disease, stress with ulcers, improved cancer outcomes with positive mental attitudes and avoidance of colds with rest and relaxation are commonly talked about in a casual manner among traditional Western physicians. Increasing numbers of scientific studies are demonstrating a direct relationship between mental states and the immune system of the body, which fights a variety of diseases and infections. In some cases, direct, measurable physical responses show an improvement with some forms of mind/body medicine. Many types of mind/body medicine exist. They include the Relaxation Response, meditation types, yoga, hypnosis, guided imagery and biofeedback.

Mind/Body Medicine- The Relaxation Response

Dr. Herbert Benson of Harvard University's Mind/Body Medical Institute developed the theory of the relaxation response in the early 1970's. The goal is to provide people with a self-taught method of finding a peaceful mental state to improve conditions that may be aggravated by stress. This is achieved in a relatively brief period of time using relaxed breathing, visual imaging and repeating a work or phrase that allows the individual to block out stressful inputs. The repeating of a word or "mantra" is similar to techniques used in Eastern healing systems.

Mind/Body Medicine- Meditation

Several forms of meditation or relaxation techniques are also used. They include autogenic training with visual imagery, all focusing on particular parts of the body. Progressive muscle relaxation involves systematically contracting a muscle and slowly relaxing it and then moving to another muscle. Other techniques include mindfulness (vipassana) and body scanning.

Two forms of meditation adopted from Eastern Medical Systems and religions are commonly practiced. Like vipassana, which also comes from Buddhism, Zen involves focusing on breathing and reading the mind of any intrusive thoughts to induce a state or relaxation. Zen is an essential part of the Buddhist religion where an individual seeks enlightenment through meditation.

Transcendental medication is the Indian equivalent practice to Zen in Ayurvedic medicine. Very similar to the relaxation response, this technique uses the repetition of a simple mantra to allow the mind to easily wonder to a state of increased consciousness and awareness.

Mind/Body Medicine- Yoga

Also from Ayurvedic medicine comes the technique of yoga which involves particular postures with focused breathing. There are numerous types of yoga practiced. Classes in each type, as with many of the mind/body techniques, are found throughout the US.

Mind/Body Medicine- Spiritual Medicine

Prayer is another form of medication producing mental relaxation. Some Western religions report that faith healing through individual prayer or the collective power of prayer focused through a spiritual healer as having cured some medical conditions. The Bible contains many examples of spiritual healing and miraculous recoveries from disease have been reported many times over the century.

There is little, if any, concrete evidence at this time that any of the mind/body techniques will actually cure an illness. However, the field of psychoneuroimmunology raises the possibility that many conditions may have a more favourable response when combined with a positive mental attitude. The cancer treatment centres of America certainly use this relationship between the mind and the immune system as a key component in their comprehensive program to address patients with cancer.

Other mind/body techniques that have more Western scientific research behind them include biofeedback, hypnosis and guided imagery.

Mind/Body Medicine- Hypnosis

Although hypnosis has been used since ancient Greece, Franz Anton Mesmer formalized the term in the later 1700's. The word "mesmerized" is derived from his name and technique. Hypnosis can be used with the assistance of a person trained in hypnotism or can be self-induced.

A common misconception is that hypnotized individuals can be induced to do a task against their will. In contrast, hypnosis requires a willing subject and hypnotic suggestions are only carried out if the individual is willing to do so. Not all individuals are susceptible to hypnosis. Those who tend to be more creative seem to be better candidates.

Hypnosis has been accepted as a legitimate medical therapy in Western medicine since the 1950's. Many anaesthesiologists, dentists and psychologists use hypnosis as an essential part of their treatment. Hypnosis is particularly useful in behaviour modification and pain control. Examples include dental work, weight reduction, smoking cessation, addictive behaviours, anxiety conditions and social phobias.

Some individuals who have a fear of flying have also used hypnosis successfully to overcome this incapacitating phobia. Many people have learned the art of self-hypnosis with the assistance of a trained hypnotherapist. Hypnosis is generally safe, with the possible exception of individuals with severe psychiatric conditions practicing self-hypnosis. The American Board of Hypnosis or the American Council of Hypnotists Examiners certifies hypnotherapists. Many physicians are also licensed hypnotherapists.

Mind/Body Medicine- Guided Imagery

Guided imagery involves the concept of imagining yourself performing in a certain way to achieve desired results. Guided imagery may also be looked at in terms of positive visualization through the use of imagination. Many collegiate and professional athletes use guided imagery, with the help of sports psychologists, to improve their performance. Baseball, for example, baseball players visualized the ball prior to hitting their bat and following the ball over the fence, while gymnasts and divers mentally rehearse their performance prior to execution. Sports enthusiasts have seen golfers, downhill skiers, figure skaters and many other athletes "walking through" their events prior to starting.

The physical responses to guided images were well demonstrated by Pavlov who repeatedly rang bells prior to presenting dogs with food. Soon the sound of the bell triggered images of food and elicited a response of anticipation and salivation in the dogs even when not presented with food. Humans are very familiar with the response to guided imagery when discussing a good meal when hungry or a cold beverage when thirsty, although the direct connection with healing properties is not established. Certainly, the ability of the mind to trigger specific physical responses is well accepted.

Mind/Body Medicine- Biofeedback

Perhaps the best scientifically studied example of the ability of the mind to affect the body is biofeedback. Certain body functions that are termed "autonomic" or beyond conscious control, such as pulse, blood pressure and body temperature have been conclusively shown to be affected by the mind through biofeedback. Even brain activity measured by an electroencephalogram can be changed through biofeedback.

The principle of this therapy involves monitoring the desired physiologic outcome, such as pulse, blood pressure or temperature, in a direct way while the individual mentally attempts to change that body function. Feedback is provided through sound, gauges, graphs or lights, for example, when the physical function moves in the desired direction. The individual soon learns what mental states will cause movement in the appropriate direction and soon learns to be able to cause these movements without any direct feedback.

The phenomenon known as "white coat hypertension" where an individual, such as a pilot, notes an increase in the blood pressure when visiting a physician for a medical examination. This unconscious physical response may be easily controlled through biofeedback techniques. Other conditions that have shown positive responses to biofeedback include anxiety, irregular heartbeats, migraine headaches, asthma, excessive sweating, insomnia, and cravings for addictive substances, including tobacco and food hunger. Many of these conditions may be treated with traditional prescription medications to control the autonomic nervous system. The effectiveness of biofeedback clearly demonstrates in a scientifically proven manner, the ability of the mind to produce physical results comparable to those of medications.

Mind/Body Medicine- Social Support and Positive Mental Attitude

Many studies have shown improved life span and quality of life in individuals who have a system of social support, loving relationships and a positive mental attitude. Elderly, married individuals tend to live longer than their single counterparts. Nursing homes and hospitals have even found that the presence of a pet may improve quality of live and medical conditions. Many organizations for specific diseases effectively use support groups to improve not only education about the disease, but attitudes and outcomes of those afflicted.

One well-known business productivity speaker, Peter McLaughlin, addresses the positive effects on productivity and performance in his book Catch Fire. In addition to excellent descriptions of the benefits of nutrition, exercise and rest, he points out that a sense of personal control through a positive attitude, favorable environment in stress reduction is key to improved performance. He points out that the Chinese art of placement and design "Feng Shui" has long been used as a way to improve peoples' health and vitality. This is closely related to medical theories of psychoneurobiology associated with a positive response and a sense of control.

Those individuals who can avoid the "victim" mentality or have the survivor personality do well, not only in business, but also in survival situations and in conditions of chronic and progressive disease. The direct scientific relationship is not yet defined, but common sense and an infinite number of examples demonstrate a definite relationship between positive mental images, personal performance and health.

Energy Medicine- Introduction

The term energy medicine is used to describe therapeutic techniques using electromagnetic (including light) and sound energy to promote healing. Many of the techniques used in energy medicine are considered standard in traditional Western medical systems. Western Medical Systems also make extensive use of energy systems in diagnostic therapy, such as EKG's, electroencephalograms (EEG's), CAT scans, MRI's, x-rays and ultrasound procedures. The body cells all have electrical charges and many cells function by a change in the electrical charge. Muscles contract with an influx of positively charged anions, such as calcium. The heart’s rate and rhythm are determined by changes in electrical activity. The conduction of impulses to nerves and muscles is controlled both by electrical and chemical changes. These inter-relationships of energy forces and health are the rationale behind Energy Medicine.

Energy Medicine- Electric Energy

Electricity is used in several therapeutic methods. Severe psychiatric disorders were treated with electroconvulsive therapy (ECT) fairly routinely in the past. This therapy is still used, though less frequently now, to treat disease that does not respond to medication. This therapy probably worked by changing the chemical transmitters in the brain or electrical activity in certain areas of the brain. ECT is generally considered part of traditional Western medicine, rather than being used in any Alternative Medicine System.

Another use of electricity that is common in traditional Western medicine is Transcutaneous Electrical Nerve Stimulation (TENS). TENS units supply electrical stimulus to certain nerves to prevent them from conducting pain signals to the brain. Chronic pain syndromes are treated with TENS units routinely in Western medicine. Frequently, physical therapists, orthopedic surgeons, anesthesiologists or rehabilitation medicine physicians use them.

One form of alternative medicine uses electroacupuncture biofeedback, which measures the electrical energy at certain biofeedback points in the body. The energy at certain points is monitored and the individual with a medical condition attempts to alter the energy to improve the condition, a technique very similar to biofeedback.

Energy Medicine- Electromagnetic Energy

The other part of electromagnetic energy is the use of magnetic fields to treat disease. Although orthopaedic surgeons have long used electromagnets to help bones heal faster and straighter, some alternative medicine practitioners advocate the use of small, low intensity magnets to relieve chronic nerve pain. Although not proven to be effective, the magnets are relatively harmless unless placed near a pacemaker. Western medicine relies heavily on magnetic energy for diagnostic purposes through he use of the MRI or Magnetic Resonance Imagery.

Energy Medicine- Light Energy

A difference range of the electromagnetic spectrum is that of light energy. Treatment with various spectrums of light is termed phototherapy. Again, some forms of phototherapy are routinely accepted in traditional Western medicine. One common use of bright light therapy is for a condition called seasonal affective disorder or SAD. In this condition, people who live in northern latitudes experience prolonged periods of darkness during the winter months. Because of a relationship with the pineal gland located in the brain, which is sensitive to the light, this reduced exposure to bright light during the daylight hours seems to affect eating, sleeping, energy levels and moods of affected people. Regular exposure to the light is effective in improving mood and other disturbances in many people affected by SAD.

Bright light therapy is also used in some instances to adjust to jet lag conditions or night shift work. NASA used bright light therapy in astronauts prior to launches, which would occur during low periods of circadian rhythm (2:00 A.M. - 6:00 A.M. body clock time).

Practitioners of traditional medicine in treating various skin conditions effectively use ultraviolet light therapy using the UV-A spectrum. At times, combining photo UV-A (PUVA) light therapy with coal tar applications results in dramatic improvements in the skin changes of psoriasis. Ultraviolet light in the UV-B spectrum tends to be the dangerous form that can cause sunburn skin cancers and premature skin aging.

Alternative medicine practitioners will recommend full spectrum light therapy to correct a variety of conditions. Full spectrum light therapy included the entire range of visible light, plus infrared and ultraviolet light. Conditions treated include depression, insomnia, headaches, menstrual disorders and other conditions.

Energy Medicine- Lasers

Lasers use a very narrow wavelength of light with all waves oriented in a single direction. Traditional medicine physicians have used lasers very effectively for treating bleeding spots on the retina of the eye in diabetics, changing the shape of the cornea to improve vision in procedures known as PRK and LASIK, treating skin conditions and in doing surgery. Cold laser therapy has been used in alternative medicine by acupuncturists who use lasers instead of needles. Like acupuncture, another use has included control of pain.

Energy Medicine- Colour Therapy

Another alternative medicine practice is to use colour therapy. There are many types of colour therapy. One type which involved surrounding yourself with painted walls, pictures or lights of a particular colour that is pleasing to you is closely related to the Chinese Feng Shui which arranges a person's environment to improve mood and health.

Energy Medicine- Sound and Music Therapy

Though not in the electromagnetic spectrum, the pressure waves generated by sound are also used for healing. Many of the Eastern medical systems will use sound and vibration to correct imbalances in the body and improve a host of medical conditions. Though not considered strict medical treatment, music has been shown to relieve stress in many individuals. The soothing psychological effect of pleasing music is relatively well known, with the use of music to treat chronic degenerative diseases, neurologic conditions and some mental disabilities is also used.

A recent study from 5 universities evaluating the effect of music therapy in the form of keyboard lessons for seniors. The 20 week case control study found lower levels of stress, depression and anxiety in the group participating in music therapy with no change in the non-participating group.

Traditional Western medicine uses ultrasound to diagnose many conditions in a non-invasive fashion. Traditional Western medicine physicians and physical therapists also use ultrasound to treat muscular injuries.

Nutritional Medicine- Introduction

The idea that nutrition to be used to treat disease through vitamins, minerals and herbal supplements is common to all forms of Western medicine and alternative medical practices. Naturopathy, as discussed above, uses nutrition as the prime means of treating a whole host of diseases. The American Heart Association and American Cancer Society have very specific nutritional recommendations to control and minimize the risk of a host of diseases. At least one quarter of the medicines commonly used by Western physicians and osteopaths are derived from plants and herbs. Prevention of specific diseases, such as scurvy, beriberi, rickets, osteoporosis and some birth defects have been conclusively shown to be prevented by adequate intake of vitamins and minerals.

The question is not can nutrition help to prevent disease and increase health, but how much of certain products are required and to what extent are various medical conditions prevented or treated through adequate nutrition.

A second question revolves around the concept of adequacy. When the recommended daily allowances for certain vitamins and minerals were created for American consumers in the 1940's and 1950's, these levels were designed as the minimum amount to prevent overt disease. A growing body of thought in Western medicine (already commonly accepted in most alternative medical systems) is the increased amounts of nutrients may optimize health and reduce the risk of certain chronic diseases, infections, cancer and mental disorders.

Approximately two-thirds of over 700 cardiologists indicate that they take dietary supplements of antioxidants to lower their risk of heart disease. A slightly lower percentage of family physicians have used or recommended nutritional supplements for themselves or their patients.

Nearly all practitioners are in agreement that nutrition is ideally obtained from natural food products. Unfortunately, several factors have led to current diets not providing adequate nutrition without supplementation. Our fast paced lifestyle frequently does not allow enough time for preparation and eating of a nutritionally balanced diet. The advent of numerous processed foods of questionable nutrient value and possible harm has diminished the nutrition we receive from our diet. Depletion of essential nutrients from the soil has led to lower amounts of the same nutrients in the fruits, vegetables, grains and meats we consume. The decreased amount of physical activity have our current society compared to that of a century ago leads to a reduced need for calories to maintain weight. Some nutrients would be available in adequate amounts only by the daily consumption of tremendous amounts of calories that would cause a rapid weight gain.

For these reasons, many alternative medicine practitioners and some traditional Western practitioners feel that nutritional supplementation is necessary for optimum health. Taking this concept one step further, many alternative medicine advocates seek to treat specific medical conditions with specific plant products and herbs. This type of treatment has been routine in traditional Chinese medicine and Ayurvedic medicine.

From a Western medicine perspective, the dangers of this philosophy lie in two areas. First, herbs are potentially very powerful substances that could have serious interactions with traditional Western medications, particularly if used simultaneously without the knowledge of the treating physician. Secondly, many traditional Western medicine physicians feel that the use of herbs with self-diagnosis and treatment delays the diagnosis and treatment of potentially serious medical conditions. Alternative medicine practitioners would counter that many of traditional Western medications have significant side effects and toxicity and may be less effective than their treatments. As mentioned in the beginning of this article, integrative medicine practitioners seek to find the best evidenced-based treatment or prevention for any condition, regardless of the medical system from which it is derived. For a full discussion of vitamins and minerals, herbs and other nutritional supplements, please see the VFS articles on these specific subjects.

Nutritional Medicine- Orthomolecular Medicine

Orthomolecular medicine advocates that megadoses of certain nutrients will protect against a variety of disease states. Its most famous proponent and originator, Linus Pauling, Ph.D., gained attention by recommending huge doses of vitamin C to prevent and treat the common cold. Most Western physicians do not accept this theory as valid. Other nutrients recommended in high amounts include vitamins D and E, beta-carotene, niacin, calcium, magnesium and folate. Some studies indicate potential benefits from large doses of some of these nutrients. See the VFS article on Vitamins and Minerals for information on possible benefits and observed toxic levels of many vitamins and minerals.

Other Alternative Medical Treatments- Introduction

There are numerous other alternative medicine therapies of using a host of techniques and philosophies. VFS has not attempted to provide a comprehensive list. We have briefly discussed several of the current popular therapies below.

Other Alternative Medical Treatments- Reflexology

Reflexologists use pressure on certain mapped portions of the foot to balance energy in certain organ systems. They may also use massage points on the palms to seek desired effects. Although similar to acupressure, but confined to the palms and soles, its roots are Western. There is little danger in reflexology, but studies have yet to substantiate any claims.

Other Alternative Medical Treatments- Aroma Therapy

In this form of alternative therapy, the scent of oils is used to heal. Certain scents may trigger strong emotions, reactions or memories, but whether they can heal is yet to be shown. Aroma therapy is popular in many health spas.

Other Alternative Medical Treatments- Chelation Therapy

Chelation is the chemical binding and elimination of minerals from the body. Western physicians occasionally use chelation to treat overdoses of certain heavy metals, such as iron or lead. Most forms of chelation use the chemical EDTA to bind minerals. Advocates suggest chelation is useful in reversing cardiovascular disease by binding calcium in plaque in the arteries. Evidence to support this is lacking. The treatment is prolonged, expensive and possibly harmful, but is not as invasive as some other interventions for heart disease.
Other Alternative Medical Treatments- Oxygen-Ozone Therapies

Most people naturally think oxygen is good for them. Certainly we need it for cellular respiration. Unfortunately, the natural form of oxygen with two attached molecules (O2) and its triplet form (O3) called ozone, are potentially harmful to the body. Oxygen in increased amounts helps heal conditions in which there is not enough blood flow to an area, such as gangrene, decompression sickness and respiratory conditions. Too much oxygen can be toxic however. Both oxygen and ozone increase oxidation in the body releasing damaging free radicals. Proponents feel it can improve AIDS, arthritis, cancer, hepatitis and cardiovascular disease. Studies to support these claims are lacking.

Other Alternative Medical Treatments- Summary

The field of complementary and alternative medicine practices is receiving significant consumer use and increasing scientific attention in the West. The strengths of CAM lie in the primary care arena focusing on the patient as a whole individual and in preventing and treating chronic disease states. Traditional medicine strengths include well-funded scientific studies of treatments and superiority in interventional medicine, critical care and emergency situations, technologic advances in medical devices and uniform certification and training of providers. Several limitations on large scale, robust scientific studies of CAM practices lead to reluctance to incorporate them into widespread traditional western medicine. Many CAM therapies have been used for centuries in other cultures, with mixed results. A closer look at Western medicine reveals elements of CAM in many therapies considered "traditional". Certification and credentialling of CAM providers is not uniform and the consumer needs to exercise caution in using these forms of medical treatment. Consumers of both traditional and CAM need to inform all of their providers about other forms of practice to avoid dangers of adverse therapeutic interactions. A prudent approach for medical consumers is to use the best evidence based medical therapies available provided by certified and reputable practitioners. Prudent traditional Western physicians and osteopaths should become familiar with available CAM therapies and science in their field and develop a network of reliable CAM providers for coordinated medical therapy for the benefit of their shared patients.

FAA Standards and Reporting

While use of nutritional supplements is not specifically regulated by the FAA, the underlying condition can often be of aeromedical significance. It is also often difficult to determine whether a particular complementary or alternative medical treatment would be considered a visit to "healthcare professional" and therefore reportable on a FAA medical application.