Advances in medical research, the consumer empowerment, and rising cost of health care have demonstrated the need to treatment models that are holistic and client driven. Complementary and alternative medicine (CAM) offers consumers choices. It includes traditional healing practices, medical systems that are thousands of years old and new or innovative treatments that may be consider unconventional. Well known examples of CAM include herbal remedies, mindfulness, meditation, manipulative/movement therapies, and Chinese Medicine. Knowledge of CAM offers social workers in all settings the opportunity to provide education and advocacy in seeking client centered and culturally competent treatment options.

Tuesday, May 3, 2011

Is CAM Evidence-Based Medicine?

Is complementary and alternative medicine (CAM) evidence-based medicine?  CAM has been defined as a group of diverse medical and health systems, practices and products that are not presently considered part of conventional medicine (NCCAM, 2009).  CAM includes but is not limited to Chinese Medicine, Ayuverdic Medicine, homeopathy, spinal-manipulative medical practices as well as mind/body Practices.  Evidence-based medicine consists of an approach and/or attempt by professionals (social workers, therapists, health providers) to integrate clinical expertise with the best available external clinical evidence from systematic research (Sackett, et al, 1996).  The level of clinical expertise for CAM interventions varies depending on discipline, licensure and regulatory bodies.  CAM practices are evaluated in the same way that other interventions in the field of psychology, social work and medicine are evaluated.  In evidence-based medicine, there is a standard and hierarchy.  The gold standard for scientific evidence is the systematic review of several double-blind, randomized controlled trials (RCT).   The next level of scientific evidence consists of quasi-experimental studies, open clinical trials, systematic observations, and unsystematic observations.  It is also important to take into account number of studies, treatment effects, the importance of outcomes, the generalizability of studies, and other factors (Drake et al, 2003, p. 812).  Problems inherent in conducting gold standard CAM interventions include the consideration of individualized treatment plans, difficulty associated with the creation of control groups, and blinding or double blinding researchers and participants (Satterfield et al & Baranowsky, 2009).  Verhoef, Casebeer and Hilsden (2002) argue that an effective evaluation of CAM interventions need to include qualitative research designs that assess the understanding, significance and beliefs patients hold about the treatment and expectations of the outcome.  Despite these difficulties thousands of RCT evaluating the effectiveness of CAM treatments in general and for specific diseases have been conducted (NCCAM, 2009). 

Drake, R.E., Latimer, E.A., Leff, H.S., McHugo, G.J., & Burns, B.J. (2004). What is evidence? Child and Adolescent Psychiatric Clinics of North America, 13(4), 717-728. doi: 10.1016/j.chc.2004.05.005.
NCCAM (2009). What is complementary and alternative Medicine? (March 12, 2011)
Sackett, D., Rosenberg, W., Muir Gray, J., Haynes, R. Richardson, W.  (1996). Evidence-based medicine: what it is and what it isn't.  British Medical Journal, 312, 71-72.  
Satterfield, , J. M., Spring, B., Brownson, R. C., Mullen, E. J., Newhouse, R. P., Walker, B. B., & Whitlock, E. P. (2009). Toward a Transdisciplinary Model of Evidence-Based Practice. Milbank Quarterly, 87(2), 368-390. doi:10.1111/j.1468-0009.2009.00561.x
Verhoef, M. J., Casebeer, A. L., & Hilsden, R. J. (2002). Assessing Efficacy of Complementary Medicine: Adding Qualitative Research Methods to the "Gold Standard". Journal of Alternative & Complementary Medicine, 8(3), 275-281. doi:10.1089/10755530260127961


  1. CAM otherwise known as Complementary and Alternative Medicine covers a broad range of different therapy types, systems of delivery and techniques that fall “outside” typical Western practice. For many, CAM has become an integrated part of their daily living (Mamtani and Cimino, 2002, p.367-368).

    Such practices as massage and chiropractic care are examples of manipulative and body based therapy. Acupuncture, homeopathy and traditional Chinese medicine are part of what is loosely considered as part of the alternative medical systems. Biologically based therapies include the use of certain herbs, vitamins and food supplements or diets. The focus of mind/body interventions is mainly through the use of such tools as meditation, music, dance, relaxation techniques, prayer and biofeedback. Finally, such therapies as Reiki and therapeutic touch can be loosely connected to energy therapies (Mamtani and Cimino, 2002, p.370-371).

    Each of the above has been widely practiced in many parts of the world for many years, the success of such treatment has not been widely researched however. The immediate benefits and the widespread use of them indicate at least a “popular” approach to success, and as more studies are conducted to measure efficacy it seems these results may be validated (Mamtani and Cimino, 2002, p.379).

    Traditional Western healthcare providers are finding that their patients are more receptive and may even be more knowledgeable about such alternatives. There is an increasing demand for such treatments and as such the need for providers to develop a stronger knowledge base (Mamtani and Cimino, 2002, p.377-379).

    In discussing any of these “alternate” therapies with a client I would first want to gauge their knowledge, experience and perspective (receptivity) to such treatments. Some evidence-based research has been conducted to “prove” efficacy, this may become part of our conversation. Also, individual cultures present a wide array of “remedies” that should be included in our communication. It is extremely important to present to the client any “toxicity” issues that may arise (more often with vitamin, herbal and dietary type treatments than others). Basically I would encourage clients to use and adopt any technique that they find that provides alleviation from their negative symptoms.

  2. Beautifully written Megan! The use of Complementary and Alternative Medicine (CAM) has been increasing in popularity although the medical field has not yet fully recognized alternative medicine as a means to obtaining optimum health. I agree with Mamtani and Cimino (2002) when they stated, “Physicians must become informed practitioners so that they can provide appropriate and meaningful advice to patients concerning benefits and limitations of CAM.” (pp.367-368) With more and more of the population turning to alternative methods to assist them with their health challenges, the physicians that care for those patients should be informed. Not only should they be informed to provide advice to patients concerning the benefits and limitations to CAM, but also to ensure that the physician’s use of conventional medicine won’t conflict or be conflicted with CAM methods. For example, Memtani and Cimino (2002) discussed how large doses of vitamins or herbal supplements may interact with conventional medications. I have had several experiences when I was prescribed a medication and never told the possible herbal or vitamin interactions that the medication may have, I was only made aware of the interactions after reading the tiny print drug information sheet.
    Upon reading this article I was excited to hear that studies have now been occurring to show the efficiency of the use of CAM. As social workers, we take into account the mind-body connection and should be knowledgeable about alternative methods that may be more appealing to clients that are turned away from conventional medicine. If the client has received a conventional diagnosis and is seeking non-conventional methods, the social worker would need to be well informed of CAM benefits and limitations prior to referring a client in that direction. Even if the social worker points the client towards CAM it is important to discuss the need for ongoing conventional evaluation with the client. Ways to approach the need for ongoing conventional evaluation could be approached to the client in a variety of ways by the social worker. After the objectives or CAM method is selected I would discuss the limitations or risks of that method in further detail to assist the client with understanding the need for conventional monitoring. It is important not to discount alternate methods discovered (or re-discovered) if there is evidence that the method may help the client, the client is seeking alternative methods, and the client is made fully aware of the potential risks and/or potential side effects of CAM.

  3. Complementary and Alternative Medicine (CAM) encompasses a broad range of alternative therapies including: homeopathy, ayurveda, herbal products, hypnosis, and massage therapy.
    There are many pro’s to CAM; the most prominent being that they are a wide selection of treatments. For example individuals suffering from anxiety can seek relief through acupuncture, hypnosis, or massage therapy; the fact that CAM allows for such variety accommodates more clients. In the example given some clients might be afraid of needles so acupuncture would not be best option for them; whereas, another client might have religious beliefs that frown upon hypnosis. Unlike typical therapy had the client not agreed with the method of the therapy the options would be limited. In addition to providing clients with options, CAM also provides a culture avenue to selecting a course of treatment. This provides clinicians the opportunity to explore their client’s cultural backgrounds and to explore treatments accordingly.
    There are also con’s to CAM. Although CAM is starting to be accepted by some practitioners it is still not accepted by the mental health world as a whole; which could lead to stigma attached to CAM treatments and reluctance of some practitioners to prescribe such treatments. Another con to CAM is there has not been enough research done on it to understand the effectiveness and long term implications of it.
    As a social worker I would explain CAM as an option to my clients. I would explain that although there is not a great deal of research done on CAM there is evidence that CAM is effective. I would also explain that they are a wide variety of treatments available with CAM and explain each of those options according to what is appropriate for their diagnosis. We would then discuss any concerns or questions that the client might have.

  4. CAM promotes a holistic approach to health which is in-line with client-centered social work values.

  5. CAM is something that I have grown up with in my culture and my upbringing. In the Chinese culture we look at the human body with a holistic approach and treat a person’s illness with holistic interventions such as mentioned in the article. Acupuncture being the most famous of the techniques mainly for pain management.
    One benefit from these techniques is the less dangerous side effects that western medication has. The crux and center of these techniques is the idea that the human body will eventually heal itself. The massages, the acupuncture, the relaxation techniques, and the chiropractic treatments are there to help a person’s body heal correctly and give your immune system a little push in the right direction. Another advantage is that a person can easily access most of these techniques within their own home, after the guidance of a physician or expert. It changes more than the client’s illness; it creates a healthier lifestyle for the client, and one that the client can follow at their own pace.
    However there are also many disadvantages about CAM techniques and one main disadvantage is time. Many techniques require a number of visits to professionals or a time commitment in eating right and taking care of one’s own body. It is a lifestyle and many people want immediate relief, which is understandable. Also there have not been a lot of research done and proof that the herbs and the techniques work and because of how long these techniques take, a person cannot determine whether it was the technique or the time that healed them.
    When talking to a client about CAM I would approach them with an open conversation and help them understand some of the benefits that CAM can provide. Along with cautions that the techniques encompasses, much like presenting a western medication. I think that talking about the advantages first will be more effective, but it depends on the client and how receptive they are to new techniques.

  6. Complimentary and Alternative Medicine (CAM) approaches have been proven to be both effective as well limited in the efficacy thereof. There has been evidence of CAM’s effectiveness when dealing with such symptoms of depression, anxiety, insomnia, and chronic pain through methods such as massage therapy, meditation, music therapy, and mind-body interventions. The benefit of CAM is that this type of treatment has a focus on psychological health, and includes the individual in the process of healing. In CAM approaches, the individual plays a role in the treatment and is given an opportunity for empowerment as a result. There is also a focus on self-care that is emphasized through these methodologies because these types of therapies necessitate one to seek within themselves a sense of pacification. The source for the treatment in effect becomes within a person, formulating reason for one to maintain his or her wellbeing. CAM also has values in religion or spirituality and also encourages positive relationships with others.

    On the other hand, CAM also exhibits limitations in the fact that alternative medicine like herbal supplements and vitamins has the potential to interfere with body chemistry if the participant is taking other medications. There are also potential side effects to these supplements, such as fatigue, confusion, GI issues, and headaches. Health care professionals often lack education in providing such integrative types of treatment and utilizing forms of CAM must be done with prudence and proper training. The efficacy of CAM is also not as scientifically and empirically proven as is modern types of medicine. There is evidence that CAM is not a curative approach and is limited in the idea that it only works to assist with symptoms.

    As someone who works often in palliative care environments, I often use CAM methods with my clients. I would always discuss CAM as explorative ideas, not suggested practice. I would allow the client, if they are capable (many of my clients with a dementia dx are not), an opportunity for empowerment in exploring what approaches they feel connected to, may have worked for them in the past, or are open to trying. Music, art, reminiscent and dance therapies are things I commonly use, and my clients often respond well to these types of stimulation. It is important, I believe, to consider what the goal is within the social worker’s scope with the client to understand what is applicable and appropriate in terms of treatment.

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  8. I believe a huge Pro in complementary and Alternative Medicine is it’s variety of treatments and accommodations to individual clients. It seems that CAM could tailor to the preferences of the clients and their unique needs and levels of comfort. It also seems attainable for almost everyone getting the treatment desired. According to Cochran CAM is a broad domain of healing health resources that encompasses all health systems, modalities and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant healthy system of a particular society or culture in a given historical period. It includes many types of alternative therapy such as homeopathy, Ayurveda mediation, hypnosis, herbal remedies, massage and energy therapies.
    A Con of CAM would be it’s research data being insufficient to prove their absolute effectiveness. This may leave doubt in peoples mind going into seeking this type of treatment. Something else that stood out to me as a Con when it came to herbal remedies that could have “detrimental” side effects and can result in serious interactions with commonly used medications. I also think of it’s commitment level and that it’s not a “one-stop” remedy or fix, it would have to be a form of change of lifestyle and continuance in one’s life. I don’t know that many people can commit to that if needed. With that said, I believe con would be that it does promote healthy habits of lifestyle.
    When working with my client I would definitely give CAM as an option for healing to my clients. I would go into detail and tell them about certain methods that may be best for them according to their history background and culture. I would also explain the limitations in research and data when it comes to CAM as well. I would leave it as “food for thought” and let them explore if it is something that they can believe in and connect with and assist in thier well being.

  9. There are many pro’s associated with the use of complementary and alternative medicine (CAM). CAM therapies are widely used around the world and research has confirmed that patient satisfaction with CAM is very high. The use of herbal supplements, acupuncture, and mind-body techniques such as the use of biofeedback, and meditation are relatively common among individuals diagnosed with psychiatric disorders. Research has also shown that cancer patients who have used CAM reports psychological benefits such as gaining hope and optimism. Physicians who practice CAM also reports getting benefits both for their patients and themselves. Sufficient data supports the complementary use of acupuncture for the treatment of addiction, fibromyalgia, and low back pain while other studies favors acupuncture treatment for headaches, musculoskeletal, and neck pain. Acupuncture is also an option for patients who are at risk for side effects associated with pain medication use.

    Homeopathy is considered to be a safe treatment that lacks the potential for life threatening side effects. Homeopathy can be used by pregnant women, the elderly and children without causing any harm. Many patients with anxiety and depression also use homeopathy. Studies have proven that Ayurvedic treatments including mind body interventions such as meditation and various forms of yoga to have physiological functions. Yoga has shown to have affected on fitness measures, and improvement in patients with chronic diseases such as psoriasis, hypertension, and headaches. There is also some evidence that supports vitamin B6 supplements to help people with autism and premenstrual syndrome. Many nutritional and dietary approaches are claimed to be beneficial for mental health and related problems. Relaxation techniques have been found to be effective for insomnia, chronic pain and anxiety associated with stress situations such as receiving chemotherapy. Evidence shows that both relaxation techniques and hypnosis can effectively reduce anxiety, and help patients with chronic pain, insomnia, and panic disorders. In addition, hypnosis can successfully complement the effects of cognitive behavioral therapy for treatment of phobia and obesity.

    There are also some con’s associated with CAM therapies. Although there are many CAM therapies, some have very little to offer or might even be harmful to patients. Excessive doses of vitamins, certain herbal supplements and their interaction with conventional medications can produce serious side effects. Evidence is still lacking for some complementary and alternative medicine in the treatment of major psychiatric disorders. Manufacturing standards regulating the quality and production of herbal remedies do not exist. Therefore, adverse reactions to herbal supplements are becoming more noticeable. In order to provide appropriate guidance to patients, physicians must become more knowledgeable about the commonly used herbal products, their benefits and limitations. Many health care providers including physicians still remain unfamiliar or skeptical about the usefulness and limitations of CAM despite the research findings. They must become informed practitioners so that they can provide appropriate and meaningful advice to patients concerning benefits and limitations.

    When discussing the option of complementary and alternative medicine treatments with clients, I would use evidenced-based practice. First of all, it is imperative to discuss the positive and negative aspects of CAM therapies. Although it is obvious that the research data on CAM is insufficient to prove their absolute effectiveness, I will explain the available findings of randomized clinical trials to prove its value. Since knowledge is power, I will educate my clients on the usefulness of CAM therapies, and provide informational resources for them to act upon the available evidence.

  10. ***Reposting because it seemed to disappear. First posting was at 9:30pm.

    Complimentary and Alternative Medicine (CAM) is a holistic approach to different methods of treatment that a client can choose. There are five major domains of CAM: alternative medical systems, mind-body interventions, biologically-based therapies, manipulative and body-based therapies, and energy therapies. These five domains allow clients to try an untraditional approach to their illness.

    A pro of CAM is it seems to be very empowering and beneficial for a client to be able to choose a form of treatment. The options they choose may cause some relief for them, and may help the traditional form of medication they may be on. Whether the CAM includes a more religious or cultural value to the client, the client can own the intervention and make it much more meaningful for their self. I have a client suffering from depression and back pain and I know she has tried acupuncture, meditation, and even changed her diet because of other health issues. She explained to me that the reason why she tries alternative medicine is because she wants to “help” the medication she is on since it is helping her. She likes to meditate and believes that she is doing her very best to have better outcomes for her physical and mental health. She said doing these things help her feel better, and help her medication work.

    There are cons to CAM because not much research has been done on it and the research that has been done has not provided conclusive evidence. CAM is another option it seems that physicians should present to clients. Clients should hear all the options with the side effects or test results and be able to make a decision on what they think is best for their health. CAM does have limitations and is different case by case, but if appropriately used can provide symptomatic assistance to patients.

    When working with clients I would discuss CAM as an option alongside other traditional treatment. I would discuss the limitations, side effects, risks, and benefits. I would want the client to know that it is complimentary and things such as art, meditation, and dancing could accompany their medicine to help with their mental and physical health. Clients may be open to CAM therapies, but some may not and that is respected because it is their decision and their health.

  11. (by Tiffany Smith (CSU EAST BAY, MSW Program)
    Complementary and alternative medicines (CAM) have shown some evidence of relieving some of the symptoms of mental disorders as well as some physical problems. Those in favor of CAM can argue that it offers a more natural management of symptoms without the use of drugs created in a lab. This form of treatment can include herbal remedies as well as human touch and mindfulness. Using these approaches may provide less unwanted side effects than certain psychiatric medications and can be used on children and pregnant women. Those who oppose CAM can argue that not all of these remedies and procedures have been proven to be helpful with certain conditions. Administering medical interventions that have not shown evidence of being effective may be considered unethical practice and may actually put a patient’s health at risk.
    If I were to discuss CAM with my client, I would provide as much educational information as possible about the practice. I would inform them of the risks and possible benefits of using CAM. I would also give them information about its effectiveness and let them know that it is not necessarily a cure but a means of easing symptoms. I would let them know if there could be any conflicts with their traditional medical treatment (for example: certain herbs negating the effects of another drug). I would also try to reinforce the fact that using this type of medicine is a personal choice and that they should take some time to study and think about whether this type of treatment is best for them. Lastly, I think educating the client’s family, when necessary, is important to the success of the treatment. Giving them information may help ease the resistance of family members who oppose the wishes of clients want to seek out alternative and complementary methods of mental healthcare.

  12. In the evolving world of medicine and disease, Complementary and Alternative Medicines (CAM) have been used widely throughout the world for preventative medicine as well as a form of treatment. Chiropractic, acupuncture, homeopathy, biofeedback and relaxation therapies are just a few of the CAM treatments available.

    There are many positive and some negative attributes in the usage of CAM, it is in the health care providers and patients best interest to be fully aware of their options when it comes to health care. The encouraging and positive uses of CAM are numerous, with many options to pick from. CAM is comparatively safe and less invasive than western medicine as it serves to heal people on a more natural and safe level. People of all ages and conditions are able to use CAM and able to work with a practitioner to formulate an individualized treatment plan that works for them.

    Negatives aspects of using CAM in the treatment of disease and is frowned upon in the medical field as conventional medicine is pushed heavily. There is not enough sufficient data of all alternative based medicines to be fully accepted by conventional medicine. There is a need for medical practitioners to become more aware and educated on the types and uses of alternative based treatments. It has been found that the implementation of CAM in conjunction with conventional medicine such as MAO inhibitors and SSRI’s in the treatment of mental health patients has caused undesirable side effects such as GI upset and confusion/sedation.

    As a future social worker it is important to be fully competent in forms of available treatment and to also be aware that there may be restrictions that will need to be accommodated for clients due to cultural and ethnic reasoning’s. It would be important to discuss the many forms of CAM and its use as a less invasive option of treatment focusing more on the mind and body to heal itself. It is important that patients and health care providers become more aware of different treatments and what would work best in a treatment or prevention plan. I would also suggest that my client/patient seek primary care doctors that are willing to be fully competent in the usefulness and practicality of both conventional medicine and CAM in order to give the best advice and treatment to their patients.

  13. As social workers it is important to stay informed regarding the latest research and information that affect the choices that our clients make. Given the current status of our health system, it is important to have as many choices as possible.

  14. While reading the article on Complimentary and Alternative Medicine (CAM) it
    appeared that there were more pros than cons. The article was able to provide a
    list of the complimentary medicines and their benefits. One of the main benefits
    that I saw from CAM is that it is considered a “complimentary conventional care”
    meaning it works along side traditional medicine, so it can be considered
    comprehensive. CAM also encompasses “all health systems, modalities and
    practices and their accompanying theories and beliefs, other than those
    intrinsic to the politically dominant health system of a particular society or
    culture in a given historical period” (p. 370).

    Another benefit of CAM approaches is that they are very diverse and abundant.
    Homeopathy treatments are patient specific and individualized. Mind body
    interventions are very beneficial in treating chronic pain and insomnia.

    In looking at the cons of CAM approaches it was noted that herbal remedies can
    have harmful side effects and “manufacturing standards regulating the quality
    and production of herbal remedies do not exist. As a result of all these factors
    adverse reactions to herbal supplements are becoming noticeable” (p. 373).

    Another negative aspect of CAM approaches was in regards to evidence and
    testing. For example, in homeopathy, there is still a lack of evidence regarding
    treatment in psychotic disorders.

    When working with client’s who felt that their current medication was not
    assisting them with their disorder I would ask my client if they would be
    interested in trying other alternative methods. I would first start off by
    introducing CAM approaches to the client and assist them in getting familiar
    with the different types. If the client was interested in learning more about
    CAM I would even consider providing this article to the client. We could then
    talk about the pros and cons and go more into detail about specific CAM

    Overall, it appears that CAM Is becoming more and more popular and more doctors
    are being encouraged to learn about these diverse methods to be able to provide
    their clients with other alternative methods. As the article mentioned, many
    patients might be getting frustrated with their current treatment and might be
    looking to find an alternative source.