The White House Commission on Complementary and Alternative Medicine
Policy: Definition of CAM
As we explore this concept of "Integrative Medicine", we
need to better understand "who" and "what" are being integrated. While
conventional medicine is pretty well understood, complementary and alternative
medicine (CAM) is not. The WHCCAMP was created in 2000 by Congress and members appointed
by the President to help address this question. Specifically, our mandate was
to make recommendations on:
- Coordination
of research to increase knowledge about CAM products,
- Education
and training of health care practitioners in CAM,
- Provision
of reliable and useful information about CAM practices and products to
health care professionals, and
- Guidance
regarding appropriate access to and delivery of CAM.
The Commission was composed of 2 conventional medical
doctors, 6 "holistic" medical doctors, 5 CAM professionals, 2 natural products
industry representatives and 5 members of the public.
One of the most significant challenges the Commission faced
was defining CAM. We soon came to realize that no single definition would work
as CAM was being defined more by what it was not rather than what it was - a
diagnosis of exclusion. Of great assistance in our deliberations was coming to
the realization that CAM is not monolithic—the term was being used as an
umbrella for extremely diverse groups and individuals. After considerable
deliberation, we differentiated CAM into six categories:
1.
Professional CAM practitioners - Healthcare professionals with
defined practice standards, accredited education, state licensing or
registration and peer review. This includes such groups as naturopathic
physicians, chiropractic doctors, and acupuncturists.
2.
"Holistic" medical doctors - Conventionally-trained medical
doctors who utilize some therapies and philosophies that, at least in the past,
have been primarily the province of the "natural" healthcare professions. With
limited formal training programs and no widely established practice standards,
these practitioners have varying competency in these therapeutic modalities.
3.
Traditional healers - Healers who follow centuries-old
traditions and are fully integrated into their community which also provides
oversight. Examples include Native American healers and curanderos.
4.
Emerging professions - Groups of lay practitioners who practice
a known body of knowledge but have not moved to the professional stage. They
are currently debating or working to establish education, practice and
regulatory standards. Examples include lay homeopaths and herbalists.
5.
The self-proclaimed or minimally educated - These individuals
have no apparent body of knowledge, education or practice standards nor are
they subject to oversight. They may assert titles or credentials that they have
not earned and are typically not recognized by states with regulatory
standards.
6.
Medical mavericks - These are conventionally trained medical
doctors who choose to utilize therapies and practices that are highly
controversial, atypical of natural medicine and excluded from conventional standards
of care.
The last two groups were of significant concern to the
Commission because of the potential for serious public harm.
This differentiation of CAM proved critical in our
discussions as we worked to ensure that our recommendations appropriately
accounted for the various categories of practitioners.