In recent years, complementary and alternative medicine (CAM), a collection of unconventional therapies, has come to play an important role in the prevention and treatment of diseases in the United States. As more and more Americans turn to CAM, graduates of conventional Western medical schools often find that their patients expect them to have some understanding of herbal medicine and acupuncture [1]. As increasing numbers of journals, databases, organizations, clinics, and companies are making English-language CAM-related materials available online, the need for a reliable clearinghouse for such materials has become evident [2]. For this reason, the National Center for Complementary and Alternative Medicine (NCCAM), one of the centers of the US National Institutes of Health (NIH), was established by an act of Congress in 1998. NCCAM plays a crucial, unique role in encouraging basic scientific and clinical research in CAM. Among NCCAM's duties is disseminating authoritative information on CAM to the public and medical professionals. NCCAM's official Website has been designed to make this information widely available.
Classification
NCCAM defines CAM as a group of diverse medical and health care systems, practices, and products not presently considered to be part of conventional medicine. CAM subjects change continually, as those therapies that are proved to be safe and effective become adopted into conventional health care and new approaches to health care emerge. Relevant therapies are divided into five categories: alternative medical systems, mind-body interventions, biologically based therapies, manipulative and body-based methods, and energy therapies. But, as the NCCAM Website shows, placing a medical system into a single category is not so easy. For instance, the Website places all of traditional Chinese medicine (TCM) in the first category, alternative medical systems. But, due to the sheer volume of Chinese medical practices, inevitably some of its therapies could accurately be classified as mind-body interventions (for example, tai qi and qi gong) and some as biologically based therapies (those relying on substances found in nature, such as herbs, foods, and vitamins). Chinese medicine is a very complicated system, incorporating a range of distinct theories, such as yin-yang and five phases, and many therapies, such as herbal medicine and acupuncture.
A look at how the NCCAM Website treats this complex body of knowledge shows definitions of the following terms: acupuncture, aromatherapy, Ayurveda (Indian medicine), chiropractic, dietary supplements, electromagnetic fields, homeopathic medicine, massage, naturopathic medicine, osteopathic medicine, qi gong, reiki, therapeutic touch, and TCM. The site also explains that components of TCM are herbal and nutritional therapy, restorative physical exercises, meditation, acupuncture, and remedial massage, but this catalog is unintentionally confusing. First, while acupuncture and qi gong are official categories in TCM, they also turn up in other parts of the site. Second, therapeutic massage is among the practices TCM practitioners use, but the definition of massage on the Website does not mention this. Third, quite confusingly, in a survey carried out by the NCCAM posted on the Website (Complementary and Alternative Medicine Use among Adults [3]), acupuncture is classified as an alternative medical system but TCM is not. In short, Chinese medicine is treated in an overlapping and inconsistent fashion, suggesting that the tyro who relies on the NCCAM Website for an introduction to CAM may come away confused.
Evaluating complementary and alternative medicine (CAM) Websites
Searching online has replaced library research as the most common way for people to seek information. How can searchers evaluate the online information about CAM? NCCAM proposes a list of ten criteria, including who the authors and sponsors of a site are, what a site sets out to do, what the nature of the information is, and how the site manages interactions with visitors. While the criteria are very useful for seeking and evaluating medical Websites, a range of problems makes applying them difficult. First of all, most people are unfamiliar with the terms, concepts, and therapies used in CAM. Do most English-speaking laypersons know the meaning of such Ayurvedic terms as “kapha,” “vata,” and “pitta?” Second, every Website that makes any claim of providing information about CAM drapes itself in scientific garb, making it difficult to tell the half-baked from the highly professional.
NCCAM addresses this problem by providing extensive links to CAM information on authoritative Websites, many of which have been created by NCCAM. External Websites linked are primarily from NIH. The Web pages are categorized by Treatments and Therapies, Diseases and Conditions, and Dietary and Herbal Supplements.
Another useful source of information is the NCCAM Clearinghouse. Through this service, health practitioners and patients can request documents and information on CAM topics produced by US federal government agencies.
Selecting a CAM practitioner
Selecting a CAM practitioner is an important decision. National institutes do not provide referrals but do provide some guides. NCCAM has developed a set of questions to help select a reliable practitioner. The site recommends five key points and a set of questions, from how to identify the right practitioner in an area, to which questions to ask during a first visit, to how to protect consumer rights. The site also identifies the medical circumstances when complementary and alternative therapies are appropriate, explains how to find out what scientific studies have been done on the safety and effectiveness of specific treatments, and offers guidelines on evaluating statements made about the effectiveness of a given therapy. The reviewer strongly urges all those who are considering using CAM or who have taken a further step and are looking for a practitioner to read the information on the NCCAM Website and study the detailed and useful checklist carefully.
CAM on PubMed
NCCAM has collaborated with the NIH National Library of Medicine (NLM) to develop a “complementary medicine” filter for PubMed. A link to this filter from the NCCAM Website allows easy searching of MEDLINE for CAM literature, with free citations and abstracts and links to full-text articles. The purpose of CAM on PubMed is to provide access to reliable scientific studies that have been reviewed by other scientists in the field. Users of the site can assess information about the safety and effectiveness of specific treatments and learn more about the treatment's risks and potential benefits. Nevertheless, the reviewer suspects that consumers and patients will find wading through scientific studies conducted by professional researchers daunting. NCCAM should work with NLM to make the highly technical information it has provided more easily digested by laypersons, as has been done for PubMed links in MedlinePlus.
Research
By funding, conducting, and publishing original research, NCCAM enhances and expands the knowledgebase in the CAM field. NCCAM conducts numerous clinical trials and makes information about them freely available through ClinicalTrials.gov.
As alternative medical practices become integrated into mainstream Western medical practice, the number of potential patients dramatically increases, making research into diseases responsible for huge suffering around the world all the more critical. NCCAM provides grants for scientific research, training and career development, and clinical care. The Website has very detailed information on availability and application processes. This information is particularly important in the study of CAM, because many researchers are not as familiar with federal grant-funding processes. Research grants and fellowships are also available for training and career development.
In May 2004, NCCAM and the National Center for Health Statistics completed a survey, The Use of Complementary and Alternative Medicine in the United States, 2002. The authors compiled comprehensive and reliable data on such topics as “How many people use CAM,” “Who uses CAM most,” “Which CAM therapies are used the most,” “What diseases and conditions do people use CAM for,” “Reasons for using CAM,” “Spending on CAM,” and “The sex, race, and geographic distribution of the use of CAM.” The survey is lucid, comprehensive, and a fine introduction to Western reliance on complementary and alternative medicine.
Conclusion
The NCCAM Website is very useful for people looking for scientific and clinical CAM information. Everyone interested in alternative therapies should become familiar with this indispensable asset.
References
- Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, and Kessler RC. Trends in alternative medicine use in the United States, 1990–1997. JAMA. 1998 Nov 11; 280(18):1569–75. [DOI] [PubMed] [Google Scholar]
- Stirling D.. Complementary and alternative medicine: a checklist of online resources. Online Inform Rev. 2004;28(1):43–52. [Google Scholar]
- Barnes P, Powell-Griner E, McFann K, and Nahin R. Complementary and alternative medicine use among adults: United States, 2002. [Web document]. National Center for Complementary and Alternative Medicine. [cited 24 Mar 2005]. <http://nccam.nih.gov/news/camsurvey.htm>. [Google Scholar]