With Apologies for Cross Posting

Dear Members:

First, Thank so much for the "avalanche" of answers to issue.

I´ll try to do a summary of your answers.

1.- Jérôme Dumoulin wrote "A simple definition of alternative medicine is
medicine tools and technologies of which are not "evidence based" according
present rules of scientific evidence. This definition is broad, may be too
much, but simple to use. I used it successfully to analyse drug expendures
in France." [log in to unmask] 

2.- Reinhard Wentz wrote "I doubt whether there is an 'official' or
'authoritative' definition of complementary or alternative medicine (?by
definition, there can't be??), but the MeSH definition may be a reasonable
start"[log in to unmask]

3.- William D. Grant wrote "try the following it is the site of the US
National Insitutute of Medicine Complementary and Alternative Medicine
Institute 
http://nccam.nih.gov/" [log in to unmask]

4.- Judith Deutsch ([log in to unmask]) wrote "There are several definitions
of alternative and complementary therapies I have listed a few below). You
may want to visit the NCCAM web page as a starting point.
http://altmed.od.nih.gov/nccam/ 
I like the WHO definition: 

Complementary and alternative medicine (CAM) covers a broad range of healing
philosophies, approaches, and therapies. It generally is defined as those
treatments and health care practices not taught widely in medical schools,
not generally used in hospitals, and not usually reimbursed by medical
insurance companies.” (NCCAM, 1999)
underlying model of action is different from standard Western Scientific
understanding (Shifflet, 1998)
usually lies outside the official health sector (WHO)
neither taught widely in US medical schools nor generally available in US
hospitals (Eisenberg, NEJM, 1993)
practices of unregistered (non-licensed) practitioners (GMC)

5.- Stephen M. Perle ([log in to unmask])

" The NIH Center for Complementary and Alternative Medicine describes CAM
as: Complementary and alternative medicine (CAM) covers a broad range of
healing philosophies, approaches, and therapies. Generally , it is
defined as those treatments and healthcare practices not taught widely
in medical schools, not generally used in hospitals, and not usually
reimbursed by medical insurance companies.  

Many therapies are termed "holistic," which generally means that the
healthcare practitioner considers the whole person, including physical,
mental, emotional, and spiritual aspects. Many therapies are also known
as "preventive," which means that the practitioner educates and treats
the person to prevent health problems from arising, rather than treating
symptoms after problems have occurred. 

People use these treatments and therapies in a variety of ways.
Therapies are used alone (often referred to as alternative), in
combination with other alternative therapies, or in addition to
conventional therapies (sometimes referred to as complementary).  

Some approaches are consistent with physiological principles of Western
medicine, while others constitute healing systems with a different
origin. While some therapies are far outside the realm of accepted
Western medical theory and practice, others are becoming established in
mainstream medicine. 
http://nccam.nih.gov/nccam/fcp/faq/#what-is

6.- Preston  H. Long ([log in to unmask])
"My 17 years in the CAM field has shown me that all CAM's are difficult to
define thus impossible to prove one way or the other."

7.- Norman Vetter ([log in to unmask])
" Forgive me being obvious but I have never seen the point of these phrases
'alternative',  'complimentary' etc. Archie Cochrane said 'Use anything that
works'. Medicine it seems to me should include anything that works and
exclude anything that doesn't.

The tricky bit is when we have things that don't seem to do much good or
much obvious harm, or approaches which have not yet been properly
researched, when traditional medicine has the benefit of being vaguely
understood by the establishment practitioners but non traditional does not
have that benefit. The non-traditional then has to jump through the evidence
hoops before becoming part of the establishment, whereas traditional just
sticks there 'till someone blows it out of the water.

It's tough, but I see no easy way around it. We are gradually getting to the
sacred cows of traditional medicine (mixed metaphor heaven).

8.- Peter Ellis ([log in to unmask])

"I think that Norman Vetter's comments raise some interesting questions whan
defining 'what works'.

The difficulty here is defining the outcome of interest. In oncology the
use of
complementary therapies is high. Trials of 'traditional medicines' have
focused
on 'hard' outcomes such as survival or more recently time to disease
progression. However there may be other outcomes which are important to
individual patients.
I think that you are correct that complentary medicines are often frowned upon
for a variety of reasons. There is a lack of high quality evidence regarding
their usage, which adds uncertainty to the question of benefit. However, many
patients choose to take such therapies. In my anecdotal experience, this
decision is not influenced greatly by an explicit discussion of the
uncertainty
of the benefits and harms of complementary therapies.
We need better evidence regarding what 'works'. However I feel that patient
focused outcomes need to be considered so that we ask the right questions.

9.- Andrews Vickers ([log in to unmask])
"The key think from the point of view of a survey is not the definition
(there 
really isn't any good definition of complementary medicine) but the 
questionnaire you use. I am cc'ing this message to Rebecca Rees, a colleague 
with experience who may be able to refer you to a published version of a good 
quality survey instrument for complementary medicine use. In short, you
need to 
ask about each complementary medicine practice separately than combine these 
data into a single prevalence score.
http://www.bmj.com/cgi/collection/complementary_medicine

10.- Roy M. Poses ([log in to unmask])
Did anyone else find this "official" definition extremely vague?  I don't know
how one would operationalize it into a study.

First of all, it is easy to think of "conventional" treatments that fit most
of this definition.  For example, influenza vaccine receives little attention
in most medical schools, is not used often in hospitals, and at least up to
the last few years, was not always reimbursed by insurance in the US.
Furthermore, it is preventative, and can be used alone or in conjunction with
other interventions.

The definition of "holistic" seems to be a non-sequitur in a definition of
"alternative or complementary" treatments, because it seems to refer to the
thought processes of the practioner rather than the therapy he/she employs.

11.- As answer to Dr. Poses, Stephen M. Perle ([log in to unmask])wrote:
" Dr. Poses is correct that NCCAM's definition of CAM is vague. One could
never operationalize it and one must question its validity. The largest
CAM profession is the chiropractic profession.  While it is true that
chiropractic is not taught "widely" in medical schools, nor is it
"generally" used in hospitals (even though more hospitals are granting
staff privileges to chiropractors) chiropractic IS usually reimbursed by
medical insurance companies.  Further, as a result of the awareness of
the public's interest in CAM more medical schools are teaching CAM
procedures (for a listing of such courses see:
http://cpmcnet.columbia.edu/dept/rosenthal/Med_Courses.html )

12.- Like answer to P.Ellis, Roy Poses wrote:  
"It seems there are several issues here.  First, it is certainly true that
many
RCT's of "conventional" therapy did not report a variety of outcomes that may
be important to patients, e.g., health status, quality of life, symptoms, etc.
etc.  Further,although the technology is imperfect, there are methods
available
to measure such outcomes, from generic scales like the SF-36 through disease
specific methods, to patient specific methods like utility assessment. So
ideally, before doing a RCT of "conventional" therapy, one should consider
all the possible outcomes of that therapy, good and bad, that might matter to
patients, and try to assess these outcomes.

Having said this, at least in oncology (and other fields) many trials have
been done which at least show the effects of the treatments on some outcomes.
Of course, it does not make sense to say a treatment probably improves
quality of life merely because it improves quantity of life.  On the other
hand, most "complementary" therapies have never been subject to any sort of
trial.  It makes less sense to say a treatment probably improves quality of
life in the absence of any good evidence about its effects on any outcomes.
But for some reason, there seems to be some sort of double standard for
complementary therapy that allows claims about improvement in quality of
life to be taken more seriously by some people than such claims about
conventional therapy.  Perhaps this involves what psychologists call magical
thinking, but magical thinking rarely leads to good decisions.

13.- Dr. Reggie from WHO sent me a fax with educational material about this
issue, it is write in spanish and it´s very good. Unfortunately, Dr. Reggie
did not send his e-mail to ask him about more about that publication.

It is necessary to know some definition because it is the start point (What
is...? The CAM is a reality all over the world, I am againt to it, because
CAM lack of cientific bases. But, the people use CAM, then let go, the CAM
must be studied. The CAM is related with Pharmacoepi, isn`t it ?

Once again, thank so much, a warm handshake from Valencia, Venezuela

Arturo Martí-Carvajal
[log in to unmask]








%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%