CAM

CAM Impact on Public Health



CAM Impact on Public Health

Introduction

Complementary and alternative medicine (CAM) can be defined as 'a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine ' (NCCAM, 2008). Complementary medicine is typically used together with conventional medicine, whereas alternative medicine is used in place of conventional medicine. CAM practices are not part of conventional medicine because there is insufficient proof that they are safe and effective.

The CAM therapies are classified into five categories: whole medical systems, mind-body medicine, biologically-based therapies, manipulative and body-based methods, and energy therapies (NCCAM, 2008).

Longstanding models of health self-management and recent conceptualizations of CAM suggest that individuals' use of CAM can serve at least two basic functions: to treat existing disease, and to prevent illness and maintain health (Grzywacz et al., 2005). However, while studies, reviews and even meta-analyses on the effectiveness and safety of CAM modalities in the treatment of diseases are increasingly presented, prevention aspects are rarely addressed. The aim of this non-systematic review is to evaluate CAM therapies in the context of prevention of illness and maintenance of health. It addresses the prevalence of CAM use for prevention, reasons for popularity of CAM, cost implications, CAM treatments with more or less proven effectiveness in common conditions and risks associated with CAM use in prevention. MEDLINE was searched for publications until December 2008 using combinations of the keywords CAM, prevention and cost. More recent and larger studies, and, if available, reviews were preferred.

Prevalence of CAM use for prevention

Studies on the use of CAM for prevention are rather rare. In 1990, 33.8% of Americans used at least one form of CAM past the last 12 months. In 1997, this trend had increased to 44%. About one third of respondents in 1990 did not use CAM for a primary medical problem, in 1997 already 58% started to use CAM to 'prevent future illness from occurring or to maintain health and vitality' ([Eisenberg et al., 1993], [Eisenberg et al., 1998] and [Wolsko et al., 2002]). In a survey on enrollees in a Medicare supplement plan offering selected CAM benefits, 42% of the participants used CAM therapies for 'general health improvement' (Astin et al., 2000). In the 2002 United States National Health Interview Survey (NHIS) 36.0% had used CAM past the last 12 months.

CAM use was more prevalent among women, among adults who had higher educational attainment or who engaged in leisure-time physical activity, as well as among adults who had one or more existing health conditions or who made frequent medical visits in the prior year (Barnes et al., 2004). Also ethnic aspects are relevant: in the 2002 NHIS black non-Hispanics and other non-Hispanics use biologically-based modalities (herbals, special diets, and megavitamins) mainly for prevention (50.9%; 60.1%), whereas Hispanics and white non-Hispanics use them mainly for treatment (52.9%; 50.0%). Mind-body interventions were used more often for prevention (at least 64.2%) in all ethnic groups (Grzywacz et ...