Advising patients on the use of complementary and alternative medicine

Complementary and alternative medicine (CAM) is an area of great public int erest and activity, both nationally, and worldwide. Many, alternative medic al practices have existed for hundreds, even thousands of years. Patients a nd professionals are turning to CAM for a variety, of reasons. Most have tr ied conventional medicine fora particular (usually, chronic) medical condit ion and have found the results inadequate. Some are concerned over the side effects of conventional therapies. Some are seeking out a more "holistic" orientation in health care where they, can address body,, mind, and spirit. A continuing challenge will be how to address CAM services that are based on time, practitioner-patient interactions, and self-care, using modern sta ndards of evidence, education, licensing, and reimbursement. For most CAM t herapies, there is insufficient research to say, definitively, that it work s and CAM research is especially limited in the area of cancer Given that s ituation, the questions (but not answers) facing the medical practitioner a re clear-cut. Should the practitioner await the definitive results of forma l Phase III randomized clinical trials, or should the practitioner rely, on limited data, seeking out evidence that makes physiological sense and smal l trials that seem to offer some benefit to the patient? When and at what p oint do you discourage, permit, or recommend an available alternative thera py? The answers are not simple. There may, be differences of opinion and va lues among the patient, the practitioner and the organizations that pay, fo r a therapy. CAM areas should be approached with every, patient who enters the office recognizing that there are precautions to consider when patients are using, or plan to use, such therapies. This paper presents a broad sur vey of what complementary and alternative medicine is from the perspectives of both the public as user and the conventional medical practitioner as we ll as provides examples of issues pertinent to understanding and evaluating research in CAM. The past is back and the future will involve integration of modern and ancient ways.