Complementary and alternative medicine

Alternative medicine is a catch-all phrase used in a variety of ways that can encompass a broad variety of concerns. It might be used, on the one hand, for any set of health, medical or therapeutic practices not blessed by the medical establishment and thus not covered by medical insurance. It might also refer, used by a different person, to practices believed by the established medical authority to be dangerous, deceptive or ineffective. It might even refer to matters on which the established medical authority has no opinion, either because no studies have been done or no opinion sought. Public debates include extreme viewpoints in conflicting directions, from on the one hand, banning anything and everything not blessed by the establishment, and on the other hand, to providing individual freedom to try a wide variety of therapies as long as they are not actually banned as dangerous or illegal and as long as no patently unprovable claims of efficacy are being made to potential clients.

This begs the question: who gets to decide? In the United State, the American Medical Association is the entity that is legally empowered to endorse or ban medical practices, and at least in theory, medical insurance is expected to cover therapies and approaches endorsed by the AMA. The U. S. Food and Drug Administration is supposed to prevent companies or individuals from marketing drugs or food which are not known to be safe, and also to prevent anyone from making claims of efficacy which are not supported by independent studies using accepted scientific methodology.

But many state agencies also become involved in regulating what is allowed or not allowed. For example, while medical insurance may not recommend or pay for therapeutic massage, chiropractic manipulation, or acupuncture (just for example), many states require practitioners of these arts to be licensed by a state agency intended to guarantee a certain minimum level of competence and training.

The history of struggles and disputes over medical and health approaches is better told in articles related to a specific unofficial health approach. It is easy to consult a regulating authority to find out what therapies and approaches are "official" (and by definition, everything else may be considered "alternative"). But the issue of whether a specific therapy is "complementary", "harmful", "useful", or whatever, is open to much and passionate dispute. For specific cases, see Complementary_and_alternative_medicine/Related_Articles.

First, the American Medical Association doesn't regulate or authorize anything in the U.S., although it may issue position papers. While the majority of physicians once belonged, I think membership is in the 30 percent range.

At the national level in the U.S., there is a National Board of Medical Examiners that supervises examinations after years 2 and 4 of medical school, and first year graduate medical training. Beyond that, there are specialty boards. To prescribe certain drugs, you must be licensed by the Drug Enforcement Administration; to use radioisotopes in diagnosis and therapy, you need a Department of Energy license whether or not you are board-certified in nuclear medicine.

Some states tightly regulate who can perform what, and others are permissive. Insurance reimbursement is yet another issue.

Acupuncture and herbal medicine are often regulated differently, but the scope of recognized traditional Chinese medicine (often an OMD degree) includes both, as well as some other techniques. I have had two mentors in acupuncture and some related areas; one was a graduate of a U.S. school (Florida) of Oriental medicine, and her scope of practice was quite limited. The other was a board-certified OB/GYN, and, in fact a Washington DC and national authority on gynecological ultrasonography -- but also had acupuncture training from his native Vietnam. He still needed a Virginia acupuncture license on top of his MD and FACOG (OB/GYN board). I vaguely remember that he had to retake a short acupuncture program to have the credential, since the school in Vietnam no longer existed to send a certificate. Howard C. Berkowitz 02:32, 27 December 2008 (UTC)

The safety and efficacy of a treatment method is open to dispute, but that doesn't depend on whether it's mainstream or CAM. CM and AM are different by the NCCAM definition. What would you call, for example, chiropractic, in a state where one is licensed and authorized to practice independently? It's not "medicine". It could be either complementary or alternative, depending on whether it is offered as a "whole system". Even the whole system idea isn't always clean; some practitioners are perfectly willing for a surgeon to take over for trauma, but they might go back to herbalism or naturopathy for cancer. The World Health Organization recognizes culturally specific traditional forms of treatment.

Culturally specific may involve multiple modalities; China has what it calls the "Three Roads" method that includes both traditional Chinese medicine and conventional techniques. Howard C. Berkowitz 02:32, 27 December 2008 (UTC)