HEALTHY WOMAN
News from the Office of Women’s Health
Summer 2000

What is Complementary and Alternative Medicine?

Complementary and alternative medicine (CAM)—also referred to as integrative medicine—includes a broad range of healing philosophies, approaches, and therapies. A therapy is generally called complementary when it is used in addition to conventional treatments; it is often called alternative when it is used instead of conventional treatment. (Conventional treatments are those that are widely accepted and practiced by the mainstream medical community.) Depending on how they are used, some therapies can be considered either complementary or alternative. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization or relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.

Scientific evaluation is important in understanding if and when complementary and alternative therapies work. A number of medical centers are evaluating complementary and alternative therapies by developing scientific studies to test them. Conventional therapies have generally been studied for safety and effectiveness through a rigorous scientific process, including clinical trials with large numbers of patients. Often, less is known about the safety and effectiveness of complementary and alternative methods and some have not undergone rigorous evaluation. Others, once considered unorthodox, are finding a place in medicine—not as cures, but as complementary therapies that may help patients feel better and recover faster. Some approaches have been studied and found ineffective or potentially harmful.

Patients considering complementary and alternative medicine should discuss this decision with their health care provider, as they would any therapeutic approach, because some complementary and alternative therapies may interfere with their standard treatment or may be harmful when used with conventional treatment. Always be sure to notify your health care provider of any complementary or alternative therapies you have taken or are taking.

When considering complementary and alternative therapies, patients should ask their health care providers the following questions:

• What benefits can be expected from this therapy?
• What are the risks associated with this therapy?
• Do the known benefits outweigh the risks?
• What side effects can be expected?
• Will the therapy interfere with conventional treatment?
• Will the therapy be covered by health insurance?

Classification of Alternative Medicine Practices

This classification system was designed by the National Center for Complementary and Alternative Medicine at the National Institutes of Health (NIH) to assist in prioritizing applications for research grants in complementary and alternative medicine (CAM). Following is a list of seven categories recognized by NIH, along with some examples of the more well-known practices within each category.

Mind-Body Medicine

Mind-body medicine involves behavioral, psychological, social, and spiritual approaches to health. Examples include yoga, tai chi, biofeedback, hypnosis, meditation, spiritual healing and art therapy.

Alternative Medical Systems

This category involves complete systems of theory and practice that have been developed outside of the Western biomedical approach. Examples include acupuncture, homeopathy, herbal medicine, Auyervedic medicine, naturopathy and Chinese medicine.

Lifestyle and Disease Prevention

This category involves theories and practices designed to prevent the development of illness, identify and treat risk factors, or support the healing and recovery process. Lifestyle and disease prevention is concerned with integrated approaches for the prevention and management of chronic disease in general or the common determinants of chronic disease. To be classified as CAM, the changes in lifestyle must be based on a nonorthodox system of medicine, be applied in unconventional ways, or be applied across non-Western diagnostic approaches.

Biologically-Based Therapies
This category includes natural and biologically-based practices, interventions, and products. Many overlap with conventional medicine’s use of dietary supplements. Examples include phytotherapy and herbalism (ginko biloba, echinacea, green tea); special diet therapies (Pritikin, macrobiotic); and nutritional and food supplements used for preventive or therapeutic purposes (melatonin, co-enzyme Q10, niacinamide).

Manipulative and Body-Based Systems
This category refers to systems that are based on manipulation and/or movement of the body. Examples include chiropractic medicine, massage therapy, acupressure, reflexology, colonics, hydrotherapy.

Biofield
Biofield medicine involves systems that use subtle energy fields in and around the body for medical purposes. Examples include Reiki, therapeutic touch.

Bioelectromagnetics
Bioelectromagnetics refers to the unconventional use of electromagnetic fields for medical purposes.

National Center for Complementary and Alternative Medicine

Alternative Medicine-- What Consumers Should Know

Public interest in alternative medicine has given new life to a number of healing approaches and has created quite a stir among many conventional health practitioners. Research on the effectiveness of alternative therapies has grown, as has the number of practitioners of "unconventional" medicine. Highly esteemed academic and research institutions, such as Harvard University and the National Institutes of Health, are studying the effects that alternative treatments have on healing. And procedures such as chiropractic increasingly are finding their way onto lists of health services that insurance companies will pay for.

Alternative medicine - sometimes also referred to as holistic medicine, complementary or integrative medicine, mind-body medicine, or unconventional medicine - takes many forms. Some of the more well-known alternative therapies include acupuncture, aromatherapy, biofeedback, chiropractic, homeopathy, massage therapy, and naturopathy.

As more health care consumers choose alternative practices to complement or replace their existing medical care, it is critical that they become educated and discriminating about their options. Here are some things to keep in mind when considering alternative medical treatment:

• Learn your options, keeping in mind that alternative health healing covers everything from fads to promising and proven therapies.
• Seek referrals from family members, friends and other health care providers. Consider interviewing more than one provider.
• Seek the advice of your physician or other qualified health provider before starting any new treatment or procedure involving your health.
• Don't delay seeking medical care - or disregard taking medical advice - because of something you may read or hear about alternative medicine.
• Understand that indiscriminate use of some of the alternative therapies and procedures could be harmful to your health.
• Consider the source of information you review. Many Web sites are maintained by adherents of particular alternative approaches. They are going to be very enthusiastic about their methods. Conduct a reality check. Seek information with balanced views.
• Consider alternative medicine a supplement to - not a replacement for - conventional medicine.

Alternative and Complementary Medicine Web Sites

These links are provided as an educational resource and are not intended to take the place of the advice of a physician or health care provider nor does their inclusion here constitute any endorsement by the Illinois Department of Public Health. Do not seek any alternative therapy without first consulting your physician or health care provider.=

The National Center for Complementary and Alternative Medicine
1-888-664-6226
www.dpr.state.il.us

http://www.nlm.nih.gov/medlineplus/alternativemedicine.html
MedlinePlus Alternative Medicine

www.4woman.gov 
National Women's Health Information Center
1-800-994-9666

http://www.altmedicine.com/app/registeruser.cfm  
Healthfinder Alternative Medicine topics

http://www.fda.gov
U.S. Food and Drug Administration

http://ehis.niehs.nih.gov/topic/herbmedicine.html  
National Institutes of Health Environmental Health Information Service
919-541-3841

www.herbalgram.org 
The American Botanical Council

www.altmedicine.com
Alternative Medicine News

Editor’s note: In Illinois ,the Department of Professional Regulation licenses chiropractors and acupuncturists. For information, contact that agency at:

320 W. Washington St.
Springfield, IL 62786
Phone 217-785-0800
TTY (hearing impaired use only) 217-524-6735
www.dpr.state.il.us

Guide to Dietary Supplements

A local health food store offers yet another brand of edible items: bottled herbs like cat's claw, dandelion root and blessed thistle. Vitamins and minerals in varying doses. Herbal and nutrient concoctions whose labels carry claims about relieving pain, "energizing" and "detoxifying" the body, or providing "guaranteed results."

This store sells dietary supplements, some of the hottest selling items on the market today. Surveys show that more than half of the U.S. adult population uses these products. In 1996 alone, consumers spent more than $6.5 billion on dietary supplements, according to Packaged Facts Inc., a market research firm in New York City. But even with all the business they generate, consumers still ask questions about dietary supplements: Can their claims be trusted? Are they safe? Does the Food and Drug Administration approve them? Many of these questions come in the wake of the 1994 Dietary Supplement Health and Education Act, or DSHEA, which set up a new framework for FDA regulation of dietary supplements. It also created an office in the National Institutes of Health to coordinate research on dietary supplements, and it called on President Bill Clinton to set up an independent dietary supplement commission to report on the use of claims in dietary supplement labeling.

What Is a Dietary Supplement?

Traditionally, dietary supplements referred to products made of one or more of the essential nutrients, such as vitamins, minerals, and protein. But DSHEA broadens the definition to include, with some exceptions, any product intended for ingestion as a supplement to the diet. This includes vitamins; minerals; herbs, botanicals and other plant-derived substances; and amino acids and concentrates, metabolites, constituents and extracts of these substances. It's easy to spot a supplement because DSHEA requires manufacturers to include the words "dietary supplement" on product labels.

Dietary supplements come in many forms, including tablets, capsules, powders, softgels, gelcaps, and liquids. Though commonly associated with health food stores, dietary supplements also are sold in grocery, drug and national discount chain stores, as well as through mail-order catalogs, TV programs, the Internet, and direct sales. One thing dietary supplements are not is drugs. A drug, which sometimes can be derived from plants used as traditional medicines, is intended to diagnose, cure, mitigate, treat, or prevent diseases. Before marketing, drugs must undergo clinical studies to determine their effectiveness, safety, possible interactions with other substances, and appropriate dosages, and the FDA must review these data and authorize the drugs' use before they are marketed. FDA does not authorize or test dietary supplements. A product sold as a dietary supplement and touted in its labeling as a new treatment or cure for a specific disease or condition would be considered an unauthorized--and thus illegal--drug. Another thing dietary supplements are not are replacements for conventional diets, nutritionists say. Supplements do not provide all the known--and perhaps unknown--nutritional benefits of conventional food.

Before starting a dietary supplement, it's always wise to check with a medical doctor. It is especially important for people who are:

• pregnant or breastfeeding
• chronically ill
• elderly
• under 18
• taking prescription or over-the-counter medicines. Certain supplements can boost blood levels of certain drugs to dangerous levels.

 Are you considering alternative therapies?

The decision to use complementary and alternative treatments is an important one. Following are topics to consider before selecting an alternative therapy.

Assess the Safety and Effectiveness of the Therapy

Generally, safety means that the benefits outweigh the risks of a treatment or therapy. A safe product or practice is one that does no harm when used under defined conditions and as intended. Effectiveness is the likelihood of benefit from a practice, treatment, or technology applied under typical conditions by the average practitioner for the typical patient. You may want to ask the health care practitioner about the safety and effectiveness of the therapy or treatment he or she uses. Tell the practitioner about any alternative or conventional treatments or therapies you may already be receiving, as this information may be used to consider the safety and effectiveness of the entire treatment plan.

For general, nonscientific information, thousands of articles on health issues and complementary and alternative medicine are published in books, journals, and magazines every year. Ask the practitioner about specific new research that may support or not support the safety and effectiveness of the treatment or therapy. Ask about the advantages and disadvantages, risks, side effects, expected results, and length of treatment that you can expect. Speak with people who have undergone the treatment. Controlled scientific trials usually provide the best information about a therapy’s effectiveness and should be sought whenever possible.

Examine the Practitioner's Expertise

Health consumers may want to take a close look into the background, qualifications, and competence of any potential health care practitioner, whether a physician or a practitioner of alternative and complementary healthcare. First, contact a state or local regulatory agency with authority over practitioners who practice the therapy or treatment you seek. Appropriate state licensing is the only way to ensure that the practitioner is competent and provides quality services. Second, talk with those who have had experience with this practitioner or a local consumer affairs department. Find out about the confidence in and competence of the practitioner in question, and whether there have ever been any complaints from patients. Third, talk with the practitioner in person. Ask about the practitioner’s approach to treatment and patients. Find out how open the practitioner is to communicating with patients about technical issues, possible side effects, and potential problems. Look for a practitioner who is easy to talk to. You should feel comfortable asking questions.

Consider the Service Delivery

The quality of the service delivery, or how the treatment or therapy is given and under what conditions, is an important issue. Visit the practitioner’s office, clinic, or hospital. Ask the practitioner how many patients he or she typically sees in a day or week, and how much time the practitioner spends with the patient. Look at the conditions of the office or clinic. Can the service be obtained only in one place, requiring travel to that place? These issues may serve as warning signs of poor service.

Consider the Costs

Costs are an important factor to consider as many complementary and alternative treatments are not currently reimbursed by health insurance. Many patients pay directly for these services. Ask your practitioner and your health insurer which treatments or therapies are reimbursable. Find out what several practitioners charge for the same treatment to better assess the appropriateness of costs. Regulatory agencies and professional associations also may provide cost information.

Consult Your Healthcare Provider

Most importantly, discuss all issues concerning treatments and therapies with your health care provider whether a physician or practitioner of complementary and alternative medicine. Competent health care management requires knowledge of both conventional and alternative therapies for the practitioner to have a complete picture of your treatment plan.

New Faces

In the last few months, there have been some changes in the Office of Women’s Health.

In November 1999, Conny Mueller Moody joined the office as chief of the Division of Women’s Health Services. She administers the Illinois Breast and Cervical Cancer Program and does legislative analysis for the office. Conny was formerly a senior health policy analyst for the Department’s Office of Health Protection where she developed policy papers on topics such as managed care, infectious diseases and food safety.

In March, Lois Vogel became chief of the Division of Technical Support. Her responsibilities include the office’s promotion plan and outreach efforts, including teleconferences, seminars and workshops. Lois also oversees the Women’s Health Initiative Grant process. She came to the Office of Women’s Health from the IDPH Training and Resource Center where she developed and led training sessions on a variety of human resources topics.

We have a new look and a new name. Formerly Friend-to-friend, Women’s Health Beat newsletter is published quarterly by the ILLINOIS DEPARTMENT OF PUBLIC HEALTH.