CAM

The terms "complementary medicine" and "alternative medicine" are commonly used and may denote different meaning to each person . While the terms “complementary” and “alternative” are often used interchangeably, differences do exist, although some tend to even use two terms synonymously with traditional medicine. “Complementary” refers to a non-mainstream approach alongside conventional medicine, while “alternative” refers to a non-mainstream approach in place of conventional medicine . Additional terms include “integrative” and “unconventional” medicine . Substantial overlap may exist between conventional medicine and the other forms. Conventional medicine believes that health refers to an absence of disease, which is an alteration in organ or tissue structure, and alternative medicine believes in health resulting from a balance of opposing forces. Accordingly, in lay terms, conventional medicine appears to suppress forces that make one ill while alternative therapy may strengthen health-promoting forces . In this review, the preferred terms used will be "complementary medicine" and "alternative medicine" (CAM).

The broad umbrella of CAM includes herbal therapy (including numerous plant species), dietary supplements, and vitamins, in addition to other approaches. The additional modalities are numerous, including but not limited to: prayer, meditation, yoga, relaxation therapy, massage therapy, acupuncture, homeopathy, light therapy, transcutaneous electrical therapy, and biofeedback, for example. This review will focus on herbs and dietary supplements.

The term “Natural Products” includes herbs (or botanicals), minerals, and vitamins, marketed usually as dietary supplements. A dietary or nutritional supplement is a dietary component that may cause certain manifestations when not consumed in adequate amounts, and broadly includes minerals, vitamins, amino acids, fatty acids, and fiber . Dietary supplements are marketed in liquid, powder, bars, tablet, and capsule forms. Administration of supplements usually does not help make a diagnosis or provide a cure for disease, although such claims may be made in labeling; on the other hand, their excessive use can result in adverse or unwanted effects. Herbal supplement regulation is not under the control of the United States Food and Drug Administration (FDA).

The question often asked, for which a distinct answer is solicited, is: does CAM work? And further, is there evidence that CAM works? While past evidence is weak, it is clearer that in the present era, efforts are directed to verify and evaluate claims regarding benefits of CAM. The use of CAM has been on the rise in the past two decades. From about one-third of the population in the U.S. using CAM in the early 1990’s, the number has risen to about one-half the population . The pattern is quite similar in France, Netherlands, and the United Kingdom, with many general practitioners referring patients for some form of CAM therapy.

Prior to 1994, the regulatory category for dietary supplements included vitamins and minerals. The Dietary Supplement Health and Education Act (DSHEA) introduced in 1994 elaborated the list to include botanicals and other traditional medicinal products, excluding them from regulation by the FDA. But the Act did not subject supplements to the same safety precautions that apply to prescription and over-the-counter medications; it designated that supplements be regulated like foods, exempting manufacturers from conducting premarketing safety and efficacy tests. Consequently, manufacturers are not required to provide premarketing safety or efficacy data. The FDA believes that adverse events are markedly under-reported. Further, there are claims that dietary supplements may be contaminated with harmful ingredients or adulterated, with substantial possibility for harm. Sometimes, claims for benefits during marketing are based on sound data while at other times they may be exaggerated . There is a need for more effective regulation along with consumer and provider education, as physicians are poorly informed about the topic. CAM being a multi-billion dollar industry, a lot is at stake for the industry, provider, and consumer.

More recently, the FDA has observed that dietary supplements may contain ingredients that have the potential for harm. Such a dietary ingredient may be a vitamin, mineral, herb, amino acid, or a metabolite. Recalls of dietary supplements containing inappropriate ingredients have begun increasing, with efforts aimed at protecting the health and safety of the public . Given their widespread use without good evidence, and the potential harm from food supplements, the policy of marketing these products without clinical evidence may require reconsideration .

Over the past decades, there has been a dramatic rise in the use of herbal products around the world, with these products classified and promoted as food rather than as pharmaceuticals . In view of alterations in physiological function with aging, especially relating to renal and hepatic function, in addition to altered water and fat stores, older adults are particularly vulnerable to the effects of herbals . Herbals and supplements are commonly used by the educated and high average income group, but importantly, the patient often does not disclose their use to the primary care providers . However, in the European Union, the manufacturing and trade of herbs and dietary supplements are regulated by pharmaceutical and food laws . In a survey of over 3,000 community individuals, where the majority was on prescription medications, 46% used over-the-counter medications and 52% also used dietary supplements, with the highest prevalence in the oldest age group . Nearly half the patients were on anticoagulants; in these individuals, the potential for drug interactions require emphasis . While claims made on the benefits of herbals and supplements may be assuring, scientific evidence is generally lacking and warrant further research.