Complementary and Alternative Medicine

What is Complementary and Alternative Medicine (CAM)?^

According to the National Center for Complementary and Alternative Medicine (NCCAM), complementary and alternative medicine (CAM) “is a 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. For example, a patient suffering from a cold might take both vitamin C and an over-the-counter decongestant, or a patient who has just had surgery and has limited motility might add massage to his recovery regiment, in addition to conventional physical therapy. Alternative medicine, on the other hand, is used instead of conventional practices, such as when a person with cancer refuses chemotherapy or surgery and instead chooses to take injections of shark cartilage.

Many people pick and choose from a variety of conventional and CAM therapies, seeking the opinions of medical doctors (MDs) or CAM practitioners, depending on their needs. Some patients turn to CAM because they believe these treatments are safer or more effective than conventional treatments. Others choose CAM by default because there are no conventional treatments for their illnesses.

For further reading:^

• National Center for Complementary and Alternative Medicine. Online.
  This page contains a lot of information about alternative medicine, including a description of different CAM treatments, CAM-related press releases, and a list of CAM clinical trials.

What Types of CAM Therapies are Available?^

Several different CAM therapies are currently available in the United States, although most of these treatments are not covered by insurance and many do not have scientific verification. Each alternative medicine system has a different theory about how the human body functions in health and illness. As a result, each system promotes its own array of remedies and preventative measures.

One alternative medical system is homeopathy. The central belief of homeopathy is that “like cures like.” In this system, extremely dilute amounts of substances that can cause a patient’s symptoms (when given in much higher doses) are given to the patient to treat his or her symptoms. As the National Center for Homeopathy explains, “Instead of looking upon the symptoms as something wrong which must be set right, we see them as signs of the way the body is attempting to help itself. Instead of trying to stop the cough with suppressants, as conventional medicine does, a homeopath will give a remedy that will cause a cough in a healthy person, and thus stimulate the ill body to restore itself.” However, a recent study found little evidence for the effectiveness of homeopathic remedies and urged patients not to substitute homeopathy for proven conventional treatments. Thus, patients interested in pursuing homeopathic remedies should consult their physicians for advice.

Ayurveda and traditional Chinese medicine (TCM) are two alternative medical systems that were developed in Asia and have gained greater recognition in the US over the last several years. Ayurveda, a system that relies on herbal and dietary remedies and focuses on the use of mind, body, and spirit in disease prevention and treatment, has been practiced in India for thousands of years. According to Ayurveda, each human being is made up of a unique combination of the five elements: fire, water, earth, air, and ether. These elements combine to determine the balance of doshas, energetic and physiological qualities that are similar to the humoral system of the Ancient Greeks. Practitioners of Ayurveda believe that illness occurs when the body’s physical state is unbalanced. Although some current research on Ayurvedic techniques appears promising, the English-language literature has virtually no large-scale, controlled clinical studies evaluating the effectiveness of this system.

The theory behind traditional Chinese medicine is that the human body “is subject to constant battling between opposing forces such as heat and cold, male and female, [and] joy and sadness, which manifest themselves … as too much or too little activity in particular organs. An imbalance between any of these forces can cause a blockage in the flow of qi [pronounce “chee”], or vital energy, traveling through the body along invisible pathways known as meridians.” Practitioners have many techniques to unblock the flow of qi, including medication, herbs, acupuncture, massage, and exercises. Certain TCM treatments have been proven effective in treating a variety of medical conditions, while other treatments appear to be ineffective or even toxic.

For further reading:^

• National Center for Homeopathy. Online.
  This page describes the difference between homeopathy and conventional medicine, gives an overview of homeopathic drug products and prescription practices, and explains the history of homeopathy.
• Jonas WB, Kaptchuk TJ, Linde K. A critical overview of homeopathy. Annals of Internal Medicine 2003; 138(5): 393-399.
  A fairly easy to read paper that describes homeopathy and discusses some placebo-controlled studies of the system.
• A Healthy Me – Traditional Chinese Medicine. Online.
  This page describes the theory behind TCM treatments and provides information on how to find a practitioner.

Are CAM Treatments Safe and Effective?^

As explained in the previous section, a number of different CAM treatments are available in the US, but most of them have never undergone clinical trials (i.e., been tested on humans in a controlled, systematic way). Of the treatments that have been tested, some have been shown to be effective, while others have been shown to be useless or even dangerous. However, virtually all CAM treatments, even those that have been found to be completely ineffective, have some enthusiastic supporters. How can people claim that a treatment works when clinical studies have clearly shown that it does not? In these cases, it is likely that patients who say that the treatment was successful have actually experienced the placebo effect, which is when an inert substance (i.e., a substance that does not affect the body) leads to improvement in a person’s medical condition. Psychologists have proposed that this phenomenon is a result of the patient’s belief that the treatment will succeed. In other words, some patients get better simply because they believe that whatever they are doing will help them get better, not because they are using treatments with actual physiological effects. In most clinical studies, a group of patients that receives a treatment is compared to a group of patients that receives a placebo, and neither group knows which treatment they are receiving. This study design allows researchers to determine whether the treatment in question is more effective than the placebo.

Since some CAM treatments can be harmful, and many of them can be expensive, it is important for patients to make thoughtful and informed decisions about which ones, if any, to include in their treatment regimens.

For further reading:^

• Beecher H.K. The powerful placebo. JAMA 1955; 159(17): 1602-1606.
  An easy-to-read paper that describes the effects of placebos and explains the reasons for their use.

Potential CAM Treatments for Huntington’s Disease^

Currently, there is no cure for Huntington’s disease. However, just as some medications can alleviate symptoms, some complementary and alternative medicine (abbreviated “CAM”) treatments can help patients function better and even slow the course of the disease. HOPES offers this information only for educational purposes. We are not medical professionals, and we do not recommend any particular treatments. We advise readers to consult their physicians about all CAM techniques.

While some CAM techniques can be very bizarre, others are simply everyday practices of good physical and mental health, such as exercise and environmental stimulation.

A very common CAM practice is taking dietary supplements, a topic that is further discussed below.

What Are Dietary Supplements?^

The Office of Dietary Supplements at the National Institutes of Health in the U.S. defines a dietary supplement as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.”

Consumers can purchase dietary supplements at many supermarkets, health food stores, and online retailers. Due to licensing requirements, many CAM treatments are sold as dietary supplements.

How Are Dietary Supplements Different from Medications?^

One of the most important differences between dietary supplements and over-the-counter medications is the way in which the US government regulates them. In order for a medication to be approved, it must pass through several clinical trials (i.e., the medication must be pre-tested on humans). Afterward, the Food and Drug Administration’s (FDA) Center for Drug Evaluation and Research examines the data from the clinical trials and evaluates the risks and benefits of the drug. In contrast, the FDA regulates dietary supplements as foods, not as drugs, which means that dietary supplements can be sold in the US without FDA approval. Manufacturers do not have to test the supplements’ safety or effectiveness. Additionally, the FDA does not regulate the content of supplements. In other words, a supplement might contain higher or lower amounts of the active ingredient than it lists the label, it might be contaminated, or it might not even contain the active ingredient at all.

For further reading:^

1. Office of Dietary Supplements. Online.
   This is a very informative page that provides fact sheets on dietary supplements and lots of related research articles and news bulletins.
2. The CDER Handbook. Online.
   This page provides information about drug development, review, and approval.
3. What’s in a Bottle? Introduction to Dietary Supplements. Online.
   This easy-to-read page provides a good overview of dietary supplements.