What are complementary and alternative therapies?


Differences between complementary and alternative medicine: Complementary medicine is used along with conventional medicine. Practitioners of conventional medicine include allopathic (medical doctor, MD) and osteopathic (doctor of osteopathy, DO) physicians. Allied conventional health professionals include nurses, respiratory therapists, and psychologists. Examples of complementary therapies include using aromatherapy or massage to lessen discomfort following surgery or chemotherapy.

Alternative medicine is used instead of conventional medicine. Treating cancer with the compound containing amygdalin (trademark Laetrile) in place of undergoing surgery, radiation, or chemotherapy is an example of an alternative therapy. Little reliable evidence exists for Laetrile’s efficacy as a cancer drug, and the US Food and Drug Administration has not approved the use of this compound for cancer treatment.

The NCCAM, part of the National Institutes of Health (NIH), defines integrative medicine as a combination of mainstream medicine and those parts of complementary and alternative medicine that have high-quality scientific evidence of safety and effectiveness.

The NIH has placed complementary and alternative medicine modalities into five major categories: alternative medical systems, biologically based therapies, manipulative and body-based methods, mind-body interventions, and energy therapies. These provide a useful framework for understanding many different therapeutic approaches to health care.

Alternative medical systems: Alternative medical systems are complete care systems, much as conventional medicine is a complete system of theory and practice. These complete systems have central philosophies, such as the healing power of nature, and use therapies in line with these philosophies. These systems include traditional Chinese medicine and other medical systems formulated outside of Western culture, such as American Indian, Tibetan, and Indian (Ayurvedic) systems, as well as homeopathic and naturopathic medicine, formulated within Western culture.

Although considered alternative medicine in the United States, traditional Chinese medicine and Ayurveda are part of the culture and heritage of China and India, respectively, and in these countries they have been practiced for millennia and coexist with conventional medicine. According to the NIH, scientific evidence supports the use of acupuncture, a technique from traditional Chinese medicine, to treat postoperative and chemotherapy-associated nausea and vomiting. Acupuncture may be useful as an adjunct for treating pain-related conditions and other maladies.

Naturopathy is a healing system initiated in Europe. It views disease as alterations in the body’s natural healing processes. Naturopaths believe that the body can heal itself if it is in a healthy environment. They take a holistic approach to the body, looking at the patient’s mind, body, and spirit, and use therapies such as nutrition and herbal medicine, physical medicine, hot/cold compresses, massage, lifestyle and psychological counseling, and detoxification. Scientific evidence does not support naturopathy’s claims.

Homeopathy was developed by Samuel Hahnemann (1755–1843) in Germany during the late 1700s and early 1800s. Hahnemann believed that effective remedies must contain substances that produce effects similar to those produced by the diseases they cured, and he called this the principle of similars. Conventional medicine uses a thought process not unlike this principle in vaccine development. Homeopathy emphasizes the careful examination of all aspects of an individual’s health, including mental and emotional states, as well as distinctive physical and personality characteristics.

Homeopathy employs liquids or pills that have been diluted from the original substance to the point that sometimes no detectable trace of the original molecule may be found. The manufacturing process involves vigorous shaking between dilution steps, purportedly producing the vital essence of the substance. Homeopathy contends that the memory of the original molecule is retained after the homeopathic dilution process and that the end product is therapeutic even when the original molecule is thinned out of measurable existence. Scientific and clinical evidence of the efficacy of homeopathy is lacking.

Biologically based therapies: Biologically based therapies use natural substances such as herbs, vitamins, foods, and other dietary supplements. These substances are formulated in many ways, including tablets, capsules, gel caps, powders, teas, oils, and syrups. Although the idea of a natural substance is very attractive to many consumers, natural products can have serious side effects. Some biologically based therapies, such as the use of shark cartilage or Laetrile (a compound containing amygdalin) to treat cancer, lack scientific support, while others have some scientific studies that show their efficacy.

Amygdalin is a chemical found in the pits of many fruits. In the presence of certain enzymes, Laetrile breaks down and produces cyanide, a known poison. In addition to lacking effectiveness, Laetrile creates many side effects, mostly related to cyanide poisoning, including cyanosis (bluish skin secondary to oxygen deprivation), uncoordinated walking, liver damage, low blood pressure, and droopy upper eyelids.

The essential oils used in aromatherapy are extracted from fragrant plants such as chamomile, lavender, lemon, and cedarwood. These oils are inhaled or applied to the skin. Although aromatherapy does not cure cancer, it can help patients with quality-of-life issues. Studies have shown that odors can improve mood, enhance perceptions of health, and reduce anxiety. Allergic reactions and dermatitis have been reported as side effects of aromatherapy.

The seeds of milk thistle, a plant native to Europe but also found in North and South America, have been harvested for more than two thousand years for use primarily as a treatment for liver disease. Silymarin, the chemical compound identified as the active ingredient in milk thistle seeds, is a potent antioxidant. It has been shown to help in cases of chronic hepatitis and cirrhosis, and some laboratory studies have indicated that it may increase the ability of some chemotherapeutic agents to treat cancer and decrease the drugs’ toxicity. More research must be done before its true efficacy is known. Few side effects are reported regarding milk thistle.

Dietary supplements include vitamins, minerals, herbs, amino acids, enzymes, and organ tissues. Although many people take these types of compounds for health reasons, these supplements are not regulated the same way as are over-the-counter and prescription medications. Prescription medications, in particular, must go through extensive testing and clinical trials and have proven efficacy before they are allowed on the market. Dietary supplements are regulated in a manner closer to the production of salt and pepper than that of prescription medication.

Manufacturers of herbs, vitamins, minerals, and other biologically based dietary supplements follow manufacturing guidelines for the production of food. Medications require Food and Drug Administration approval before they can be placed on the market, whereas individual manufacturers of dietary supplements are responsible for the safe production of their products. The Federal Trade Commission monitors dietary supplements for accuracy in advertisement, whereas the Food and Drug Administration regulates the production of prescription medications. These differences in oversight are not usually evident to the consumer, but consumers should be aware that supplements are much different from medications.

Manipulative and body-based methods: Body-based therapies are based on movement or manipulation of body parts. Chiropractic or osteopathic manipulation and massage therapy are examples of manipulative and body-based therapies. Rolfing, reflexology, Trager bodywork, Alexander and Bowen techniques, the Feldenkrais method, and many other techniques and therapies are included in this category. The NCCAM reports that appointments with chiropractors and massage therapists represent 50 percent of all visits to complementary and alternative health practitioners.

These practices focus on the body’s structural elements, such as bones and joints. Circulatory and lymphatic systems are often emphasized in manipulative and body-based practices. Some of these techniques were developed over the past two thousand years in traditional systems from China and India, whereas others, such as chiropractic and osteopathic manipulations, arose in the last 150 years. Although many practitioners are formally trained in anatomy and physiology, considerable variability exists in the education and approaches of these providers.

For example, osteopaths and chiropractors use manipulations involving rapid movements, whereas massage therapists use techniques involving slower force applications. Manipulative and body-based modalities share some principles, including the body’s ability to heal itself, self-regulation by the human body, and the interdependence of parts of the human body. These characteristics, along with the laying on of hands, are attractive to some health care consumers seeking relief from various ailments. Studies have shown massage to be useful in the short-term relief of pain, anxiety, depression, fatigue, and stress in cancer patients, but there is no scientific support for claims that massage slows the growth or spread of cancer.

Mind-body interventions: Mental, emotional, spiritual, and behavioral factors affect an individual’s health. Mind-body therapies focus on these powerful factors and on the interaction between mind, brain, body, and behavior. The therapies are generally based on respecting and enhancing the human capacity for self-care and individual knowledge. Techniques included in this category include hypnosis, meditation, visual imagery, biofeedback, yoga, tai chi, spirituality, support groups, and therapies tapping creative channels such as music, writing, art, or dance. Some of these therapies, such as patient support groups, have become part of integrated or even conventional medicine.

Evidence exists that a number of the mind-body therapies have been shown to help strengthen the immune system and reduce pain, anxiety, stress, and depression, thus improving the quality of life for cancer patients.

Energy therapies: Energy therapies use two major types of energy fields, biofield and bioelectromagnetic. Biofield therapies claim to manipulate energy fields surrounding and penetrating the body. These energy fields have not been adequately measured or scientifically proven. Some energy therapy techniques try to change biofields by manipulating the body or applying pressure in, on, or through these biofields. Examples include Reiki and Therapeutic Touch. Bioelectromagnetic-based techniques involve using electromagnetic fields, including pulsed, magnetic, alternating-current, or direct-current fields in unconventional manners. Their efficacy for cancer has not been proven.

Perspective and prospects: Conventional health care is disease oriented, tends toward specialty-based care, and is often used after an acute event (a major accident or illness). Allopathic and osteopathic (conventional) medicine becomes more specialty oriented as more scientific mechanisms for disease are discovered. Many people using complementary and alternative therapies are more concerned with maintaining health and optimizing defenses against disease. These people do not reject conventional health care but see conventional health care as an important part of their overall care plan, particularly for acute disease. Those who turn to complementary and alternative therapies after becoming ill typically want to optimize their chances for becoming well.

Many therapies previously considered a part of complementary or alternative medicine such as support groups for cancer patients, hypnosis for smoking cessation, aspirin for reducing inflammation, or digitalis for heart conditions have become part of mainstream or integrative medicine. Science does not support all modalities of complementary and alternative medicine, but it supports some aspects. The NCCAM, part of the US Department of Health and Human Services and National Institutes of Health, conducts and funds scientific research into nonconventional medicine in an attempt to help medical professionals and the public understand which therapies have been shown to be safe and effective.


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