The National Center for Complementary and Alternative Medicine (N C C A M): Part of the National Institutes of Health

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What Is Complementary and Alternative Medicine?

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Introduction

Many Americans use complementary and alternative medicineA group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Complementary medicine is used together with conventional medicine, and alternative medicine is used in place of conventional medicine. (CAM) in pursuit of health and well-being. The 2007 National Health Interview Survey (NHIS), which included a comprehensive survey of CAM use by Americans, showed that approximately 38 percent of adults use CAM. This fact sheet presents an overview of CAM, types of CAM, summary information on safety and regulation, the mission of the National Center for Complementary and Alternative Medicine (NCCAM), and additional resources.

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Defining CAM

Defining CAM is difficult, because the field is very broad and constantly changing. NCCAM defines CAM as a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicineMedicine as practiced by holders of M.D. (medical doctor) or D.O. (Doctor of Osteopathic Medicine) degrees and by their allied health professionals such as physical therapists, psychologists, and registered nurses.. Conventional medicine (also called Western or allopathic medicine) is medicine as practiced by holders of M.D. (medical doctor) and D.O. (doctor of osteopathic medicineDoctors of Osteopathic Medicine (DOs) are fully licensed physicians. They provide a full range of services, from prescribing drugs to performing surgery, and employ a "whole person" approach to health care. DOs focus special attention on the musculoskeletal system, a system of bones and muscles that makes up about two-thirds of the body's mass. They may use osteopathic manipulative treatment, a system of manual therapy, to treat mechanical strains affecting all aspects of the anatomy, relieve pain, and improve physiologic function.) degrees and by allied health professionals, such as physical therapists, psychologists, and registered nurses. The boundaries between CAM and conventional medicine are not absolute, and specific CAM practices may, over time, become widely accepted.

"Complementary medicine" refers to use of CAM together with conventional medicine, such as using acupunctureA family of procedures that originated in traditional Chinese medicine. Acupuncture is the stimulation of specific points on the body by a variety of techniques, including the insertion of thin metal needles though the skin. It is intended to remove blockages in the flow of qi and restore and maintain health. in addition to usual care to help lessen pain. Most use of CAM by Americans is complementary. "Alternative medicine" refers to use of CAM in place of conventional medicine. "Integrative medicine" combines treatments from conventional medicine and CAM for which there is some high-quality evidence of safety and effectiveness. It is also called integrated medicine.

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Types of CAM

CAM practices are often grouped into broad categories, such as natural products, mind and body medicinePractices that focus on the interactions among the brain, mind, body, and behavior, with the intent to use the mind to affect physical functioning and promote health. Examples include meditation and yoga., and manipulative and body-based practices. Although these categories are not formally defined, they are useful for discussing CAM practices. Some CAM practices may fit into more than one category.

Natural Products

This area of CAM includes use of a variety of herbal medicines (also known as botanicals), vitamins, minerals, and other "natural products." Many are sold over the counter as dietary supplements. (Some uses of dietary supplements—e.g., taking a multivitamin to meet minimum daily nutritional requirements or taking calcium to promote bone health—are not thought of as CAM.)

CAM "natural products" also include probioticsLive bacteria (and sometimes yeasts) found in foods such as yogurt or in dietary supplements.—live microorganisms (usually bacteria) that are similar to microorganisms normally found in the human digestive tract and that may have beneficial effects. Probiotics are available in foods (e.g., yogurts) or as dietary supplements. They are not the same thing as prebiotics—nondigestible food ingredients that selectively stimulate the growth and/or activity of microorganisms already present in the body.

Historical note: Herbal or botanicalA plant or part of a plant used for its flavor, scent, or potential therapeutic properties. Includes flowers, leaves, bark, fruit, seeds, stems, and roots. medicines reflect some of the first attempts to improve the human condition. The personal effects of the mummified prehistoric "ice man" found in the Italian Alps in 1991 included medicinal herbs. By the Middle Ages, thousands of botanical products had been inventoried for their medicinal effects.

Current use: Interest in and use of CAM natural products have grown considerably in the past few decades. The 2007 NHIS found that 17.7 percent of American adults had used a nonvitamin/nonmineral natural product. These products were the most popular form of CAM among both adults and children. The most commonly used product among adults was fish oil/omega 3s (reported by 37.4 percent of all adults who said they used natural products); popular products for children included echinacea (37.2 percent) and fish oil/omega 3s (30.5 percent).

Mind and Body Medicine

Mind and body practices focus on the interactions among the brain, mind, body, and behavior, with the intent to use the mind to affect physical functioning and promote health. Many CAM practices embody this concept—in different ways.

Other examples of mind and body practices include deep-breathing exercises, guided imageryAny of various techniques (such as a series of verbal suggestions) used to guide another person or oneself in imagining sensations—especially in visualizing an image in the mind—to bring about a desired physical response (such as stress reduction)., hypnotherapy, progressive relaxation, qi gongA component of traditional Chinese medicine that combines movement, meditation, and controlled breathing. The intent is to improve blood flow and the flow of qi., and tai chi.

Historical note: The concept that the mind is important in the treatment of illness is integral to the healing approaches of traditional Chinese medicine and Ayurvedic medicineA whole medical system that originated in India. It aims to integrate the body, mind, and spirit to prevent and treat disease. Therapies used include herbs, massage, and yoga., dating back more than 2,000 years. Hippocrates also noted the moral and spiritual aspects of healing and believed that treatment could occur only with consideration of attitude, environmental influences, and natural remedies.

Current use: Several mind and body approaches ranked among the top 10 CAM practices reported by adults in the 2007 NHIS. For example, the survey found that 12.7 percent of adults had used deep-breathing exercises, 9.4 percent had practiced meditation, and 6.1 percent had practiced yoga; use of these three CAM practices had increased significantly since the previous (2002) NHIS. Progressive relaxation and guided imagery were also among the top 10 CAM therapies for adults; deep breathing and yoga ranked high among children. Acupuncture had been used by 1.4 percent of adults and 0.2 percent of children.

1 Acupuncture is considered to be a part of mind and body medicine, but it is also a component of energy medicine, manipulative and body-based practices, and traditional Chinese medicine.

Manipulative and Body-Based Practices

Manipulative and body-based practices focus primarily on the structures and systems of the body, including the bones and joints, soft tissues, and circulatory and lymphatic systems. Two commonly used therapies fall within this category:

Historical note: Spinal manipulation has been used since the time of the ancient Greeks and was incorporated into chiropractic and osteopathic medicine in the late 19th century. Massage therapy dates back thousands of years. References to massage appear in writings from ancient China, Japan, India, Arabic nations, Egypt, Greece (Hippocrates defined medicine as "the art of rubbing"), and Rome.

Current use: According to the 2007 NHIS, chiropractic/osteopathic manipulationA type of manipulation practiced by osteopathic physicians. It is combined with physical therapy and instruction in proper posture. and massage ranked in the top 10 CAM therapies among both adults and children. The survey found that 8.6 percent of adults and 2.8 percent of children had used chiropractic or osteopathic manipulation, and 8.3 percent of adults and 1 percent of children had used massage.

Other CAM Practices

CAM also encompasses movement therapies—a broad range of Eastern and Western movement-based approaches used to promote physical, mental, emotional, and spiritual well-being. Examples include Feldenkrais method, Alexander technique, Pilates, Rolfing Structural IntegrationRolfing Structural Integration is a body-based practice that uses deep tissue fascial manipulation and movement education. The goal is to encourage health and relieve stress by bringing the body into proper alignment with gravity., and Trager psychophysical integration. According to the 2007 NHIS, 1.5 percent of adults and 0.4 percent of children used movement therapies.

Practices of traditional healers can also be considered a form of CAM. Traditional healers use methods based on indigenous theories, beliefs, and experiences handed down from generation to generation. A familiar example in the United States is the Native American healer/medicine man. The 2007 NHIS found that 0.4 percent of adults and 1.1 percent of children had used a traditional healer (usage varied for the seven specific types of healers identified in the survey).

Some CAM practices involve manipulation of various energy fields to affect health. Such fields may be characterized as veritable (measurable) or putative (yet to be measured). Practices based on veritable forms of energy include those involving electromagnetic fields (e.g., magnet therapy and light therapy). Practices based on putative energy fields (also called biofields) generally reflect the concept that human beings are infused with subtle forms of energy; qi gong, ReikiA therapy in which practitioners seek to transmit a universal energy to a person, either from a distance or by placing their hands on or near that person. The intent is to heal the spirit and thus the body., and healing touch are examples of such practices. The 2007 NHIS found relatively low use of putative energy therapies. Only 0.5 percent of adults and 0.2 percent of children had used energy healing/Reiki (the survey defined energy healing as the channeling of healing energy through the hands of a practitioner into the client's body).

Finally, whole medical systems, which are complete systems of theory and practice that have evolved over time in different cultures and apart from conventional or Western medicineMedicine as practiced by holders of M.D. (medical doctor) or D.O. (Doctor of Osteopathic Medicine) degrees and by their allied health professionals such as physical therapists, psychologists, and registered nurses., may be considered CAM. Examples of ancient whole medical systems include Ayurvedic medicine and traditional Chinese medicine. More modern systems that have developed in the past few centuries include homeopathyA whole medical system that originated in Europe. Homeopathy seeks to stimulate the body's ability to heal itself by giving very small doses of highly diluted substances that in larger doses would produce illness or symptoms (an approach called "like cures like"). and naturopathyA whole medical system that originated in Europe. Naturopathy aims to support the body's ability to heal itself through the use of dietary and lifestyle changes together with CAM therapies such as herbs, massage, and joint manipulation.. The 2007 NHIS asked about the use of AyurvedaA whole medical system that originated in India. It aims to integrate the body, mind, and spirit to prevent and treat disease. Therapies used include herbs, massage, and yoga., homeopathy, and naturopathy. Although relatively few respondents said they had used Ayurveda or naturopathy, homeopathy ranked 10th in usage among adults (1.8 percent) and 5th among children (1.3 percent).

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A Note About Safety and Effectiveness

Rigorous, well-designed clinical trials for many CAM therapies are often lacking; therefore, the safety and effectiveness of many CAM therapies are uncertain. NCCAM is sponsoring research designed to fill this knowledge gap by building a scientific evidence base about CAM therapies—whether they are safe; and whether they work for the conditions for which people use them and, if so, how they work.

As with any medical treatment, there can be risks with CAM therapies. These general precautions can help to minimize risks:

  • Select CAM practitioners with care. Find out about the practitioner's training and experience.
  • Be aware that some dietary supplements may interact with medications or other supplements, may have side effects of their own, or may contain potentially harmful ingredients not listed on the label. Also keep in mind that most supplements have not been tested in pregnant women, nursing mothers, or children.
  • Tell all your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care. For tips about talking with your health care providers about CAM, see NCCAM's Time to Talk campaign.

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NCCAM's Role

NCCAM's mission is to define, through rigorous scientific investigation, the usefulness and safety of complementary and alternative medicine interventions and their roles in improving health and health care. NCCAM achieves its mission through basic, translational ("bench-to-bedside"), and clinical research; research capacity building and training; and education and outreach programs.

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Be an Informed Consumer: Information Resources From NCCAM

The Health Information page of the NCCAM Web site provides access to a variety of information on CAM, as well as links to other National Institutes of Health (NIH) resources. Materials include:

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A Note About Government Regulation

Dietary Supplements

The Federal Government regulates dietary supplementsA product that contains vitamins, minerals, herbs or other botanicals, amino acids, enzymes, and/or other ingredients intended to supplement the diet. The U.S. Food and Drug Administration has special labeling requirements for dietary supplements and treats them as foods, not drugs. primarily through the U.S. Food and Drug Administration (FDA). The regulations for dietary supplements are not the same as those for prescription or over-the-counter drugs. In general, the regulations for dietary supplements are less strict; for example, a manufacturer does not have to prove the safety and effectiveness of a dietary supplement before it is marketed. Once a dietary supplement is on the market, the FDA monitors safety and product information (label claims and package inserts), and the Federal Trade Commission (FTC) monitors advertising.

Practitioner-Based Therapies

There is no standardized, national system for credentialing CAM practitioners. The extent and type of credentialing vary widely from state to state and from one CAM profession to another. For example, some CAM professions (e.g., chiropractic) are licensed in all or most states, although specific requirements for training, testing, and continuing education vary; other CAM professions are licensed in only a few states or not at all.

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For More Information

NCCAM Clearinghouse

The NCCAM Clearinghouse provides information on NCCAM and complementary health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

Toll-free in the U.S.: 
1-888-644-6226
TTY (for deaf and hard-of-hearing callers): 
1-866-464-3615

Office of Dietary Supplements (ODS), National Institutes of Health (NIH)

ODS seeks to strengthen knowledge and understanding of dietary supplements by evaluating scientific information, supporting research, sharing research results, and educating the public. Its resources include publications (such as Dietary Supplements: What You Need to Know), fact sheets on a variety of specific supplement ingredients and products (such as vitamin D and multivitamin/mineral supplements), and the PubMed Dietary Supplement Subset.

PubMed Dietary Supplement Subset: ods.od.nih.gov/Research/PubMed_Dietary_Supplement_Subset.aspx

E-mail: 

U.S. Food and Drug Administration (FDA)

The FDA oversees the safety of many products, such as foods, medicines, dietary supplements, medical devices, and cosmetics. Its series of consumer updates includes the publication FDA 101: Dietary Supplements.

Toll-free in the U.S.: 
1-888-463-6332

Center for Food Safety and Applied Nutrition (CFSAN)

Part of the FDA, CFSAN oversees the safety and labeling of supplements, foods, and cosmetics. It provides information on dietary supplements. Online resources for consumers include Tips for Dietary Supplement Users: Making Informed Decisions and Evaluating Information.

Toll-free in the U.S.: 
1-888-723-3366

PubMed®

A service of the National Library of Medicine (NLM), PubMed® contains publication information and (in most cases) brief summaries of articles from scientific and medical journals.

NIH National Library of Medicine's MedlinePlus

To provide resources that help answer health questions, MedlinePlus brings together authoritative information from the National Institutes of Health as well as other Government agencies and health-related organizations.

Web site: www.medlineplus.gov

This publication is not copyrighted and is in the public domain. Duplication is encouraged.

NCCAM has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your primary health care provider. We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by NCCAM.

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NCCAM Pub No.: 
D347
Date Created: 
October 2008
Last Updated: 
May 2012