COMPLEMENTARY
ALTERNATIVE MEDICINE
(CAM)
Here and in the world
SUMMARY
Complementary and Alternative Medicine .................................................................................................. 3
CAM Costs Overall ................................................................................................................................. 3
Figure 1 and Figure 2 Combined Combined Total Health Care Spending and Out-of-Pocket
Spending Graphic.......................................................................................................................................... 4
CAM's Part of Total Health Care Costs.............................................................................................................. 4
Figure 3 CAM Out-of-Pocket Spending: Self-Care* vs. Practitioner Costs ................................................... 5
CAM Use by U.S. Adults and Children............................................................................................................... 6
Complementary and Alternative Medicine: What People Aged 50 and Older Discuss With Their Health Care
Providers ............................................................................................................................................................... 6
Introduction .......................................................................................................................................................... 6
Methodology ........................................................................................................................................................ 7
CAM Use ........................................................................................................................................................... 7
Figure 1. Type of CAM Used in the Past 12 Months ..................................................................................... 8
Figure 2. Education Level and Type of CAM Used in the Past 12 Months.................................................... 9
The National Health Interview Survey and CAM Use Among People 50+ ........................................................ 9
Figure 3. CAM Use in the Past 12 Months Among U.S. Adults, by Age Category4 ..................................... 10
Reasons for CAM Use ..................................................................................................................................... 10
Figure 4. Reasons for CAM Use .................................................................................................................. 11
Specific Information Discussed ....................................................................................................................... 11
Figure 8. Topics Discussed by Health Care Provider ................................................................................... 12
Primary Sources of Information About CAM Treatments .............................................................................. 12
Figure 10. Primary Source of CAM Information ......................................................................................... 13
Use of Prescription Medications..................................................................................................................... 13
Figure 11. Number of Prescription Medications Currently Taken.............................................................. 14
Figure 12. Number of Prescription Medications Currently Taken by CAM Users ...................................... 14
Who Uses CAM Most ...................................................................................................................................... 15
CAM Therapies Used the Most ....................................................................................................................... 16
CAM Use Among Children .......................................................................................................................... 16
Review of Research Shows, Overall, Acupuncture Did Not Increase Pregnancy Rates with IVF ........................ 17
Natural Medicine: The Future of Careers in Global Health......................................................................... 18
Over 50% of European adults and children use CAM.................................................................................. 24
2
The use of complementary and alternative
medicine in the United States
Complementary and Alternative Medicine
Also called: CAM
Complementary and alternative medicine (CAM) is the term for medical products and practices
that are not part of standard care. Standard care is what medical doctors, doctors of osteopathy,
and allied health professionals, such as nurses and physical therapists, practice.
Complementary medicine is used together with standard medical care. An example is using
acupuncture to help with side effects of cancer treatment.
Alternative medicine is used in place of standard medical care. An example is treating heart
disease with chelation therapy (which seeks to remove excess metals from the blood) instead of
using a standard approach.
The claims that CAM treatment providers make can sound promising. However, researchers do
not know how safe many CAM treatments are or how well they work. Studies are underway to
determine the safety and usefulness of many CAM practices.
CAM Costs Overall
According to the NHIS survey, 83 million U.S. adults spent $33.9 billion out-of-pocket on visits
to CAM practitioners and on purchases of CAM products, classes, and materials. In total, there
were approximately 354 million visits to CAM practitioners and approximately 835
million purchases.
3
Figure 1 and Figure 2 Combined
Combined Total Health Care Spending and Out-of-Pocket Spending Graphic
CAM's Part of Total Health Care Costs
At $33.9 billion, CAM accounts for approximately 1.5 percent of total health care expenditures
and 11.2 percent of total out-of-pocket expenditures on health care in the United States. See
Figure 1 above.
4
The $14.8 billion spent on nonvitamin, nonmineral, naturalproducts is equivalent to
approximately one-third of totalout-of-pocket spending on prescription drugs ($47.6 billion), and
the $11.9 billion spent on CAM practitioner visits is equivalentto approximately one-quarter of
total out-of-pocket spendingon physician visits ($49.6 billion)
Figure 3 CAM Out-of-Pocket Spending: Self-Care* vs. Practitioner Costs
5
* Totals for nonvitamin, nonmineral, natural products and homeopathy include both CAM
practitioner costs and costs of purchasing CAM products. Totals for massage and chiropractic
and osteopathic manipulation are only CAM practitioner costs. Totals for yoga, tai chi, and qi
gong classes are only the cost of purchasing CAM products.
CAM Use by U.S. Adults and Children
Percentage of U.S. adults in 2002 vs. 2007 and children in 2007 who used complementary and
alternative medicine (CAM) in the past 12 months. The figures show that CAM use among
adults has remained relatively steady from 2002 to 2007.
Complementary and
Alternative Medicine: What People Aged 50
and Older Discuss With Their Health Care
Providers
Introduction
Do Americans aged 50 and older discuss the use of complementary and alternative medicine
(CAM) with their health care providers? What do they talk about—or why don't they? To help
answer these questions, in October 2010 AARP and the National Center for Complementary and
Alternative Medicine (NCCAM) at the National Institutes of Health partnered on a telephone
survey. The survey builds on a similar study conducted in 2006.
Use of CAM is widespread. The 2007 National Health Interview Survey, a nationwide
Government survey, found that 38 percent of U.S. adults reported using CAM in the previous
6
12 months, with the highest rates among people aged 50–59 (44 percent)1. The NHIS data also
revealed that approximately 42 percent of adults who used CAM in the past 12 months disclosed
their use of CAM to a physician (M.D.) or osteopathic physician (D.O.)2. Because many adults
also use over-the-counter medications, prescription drugs, or other conventional medical
approaches to manage their health, communication between patients and health care providers
about CAM and conventional therapies is vital to ensuring safe, integrated use of all health
care approaches.
CAM is defined as a group of diverse medical and health care systems, practices, and products
that are not generally considered part of conventional medicine. CAM includes such products
and practices as herbal or dietary supplements, meditation, chiropractic care, and acupuncture.
Methodology
AARP commissioned SSRS, an independent research company, to conduct a telephone survey to
assess the use of CAM among people 50 and older and the circumstances under which they
discuss such use with their health care providers. Questions covered the following topics:

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Whether respondents had used various types of CAM in the past 12 months or ever, and for
what purposes
Whether they had discussed CAM with their health care providers
What they discussed or why they had not had a discussion
Who initiated the discussion
Their primary source of information about CAM
Their current use of prescription medications.
Interviews were conducted October 13–26, 2010, with a random sample of 1,013 people aged 50
and older. Responses were weighted to reflect the U.S. population of that age. The survey’s
overall margin of error is plus or minus 3.1 percentage points at the 95 percent confidence level.
The response rate for the survey was 11 percent. Where possible, comparisons were made with a
similar study conducted in 2006 with 1,559 respondents aged 50 and older and a margin of error
of plus or minus 2.48 percentage points at the 95 percent confidence level
CAM Use
In the AARP/NCCAM survey, just over half (53 percent) of people 50 and older reported using
CAM at some point in their lives, and nearly as many (47 percent) reported using it in the past 12
months. Herbal products or dietary supplements were the type of CAM most commonly used,
with just over a third (37 percent) of respondents reporting their use, followed by massage
therapy, chiropractic manipulation, and other bodywork, used by around a fifth (22 percent) of
respondents (Figure 1).
7
Figure 1. Type of CAM Used in the Past 12 Months
*Base: All respondents (n=1,013); sampling error = ±3.1 percentage points; respondents could
choose more than one answer.
Source: AARP/NCCAM Survey of U.S. Adults 50+, 2010
Some demographic groups were more likely to use CAM than others:
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Women were more likely than men to report using any form of CAM in the past 12 months (51
vs. 43 percent) as well as two particular types: herbal products or dietary supplements (41 vs.
33 percent) and massage therapy, chiropractic manipulation, or other bodywork (27
vs. 16 percent).
In most cases, the use of CAM increased with education. As Figure 2 illustrates, those who had
attended or graduated from college were significantly more likely than those who had a high
school education or less to use every form of CAM with one exception: Those who graduated
from college were not significantly more likely than those with a high school education or less to
use naturopathy, acupuncture, or homeopathy.
8
Figure 2. Education Level and Type of CAM Used in the Past 12 Months
*Base: All respondents (n=1,013); sampling error = ±3.1 percentage points; respondents could
choose more than one answer.
Source: AARP/NCCAM Survey of U.S. Adults 50+, 2010

Though relatively few respondents used mind/body practices or alternative medical systems,
about twice as many in the younger age group did so.
o Eleven percent of people aged 50-64 reported using mind/body practices including
hypnosis and meditation, compared with 5 percent of those 65 and older.
o About 7 percent of those aged 50-64 reported using naturopathy, acupuncture, or
homeopathy, compared with 3 percent of those aged 65 and older.
The National Health Interview Survey and CAM Use Among People 50+
The National Health Interview Survey (NHIS) provides the official Government estimates of
CAM use. NHIS is a nationally representative survey of the civilian noninstitutionalized
household population of the United States. The survey, conducted by the Centers for Disease
Control and Prevention's National Center for Health Statistics, is done through in-person
interviews. Questions about CAM usage were included in NHIS in 2007. Over 23,000 adults
were asked these questions. Overall, 38 percent of U.S. adults reported using CAM in the
previous 12 months, with the highest rates among people aged 50-59 (44 percent).
As Figure 3 illustrates, CAM usage peaks from 50-59 and then begins to decline with age.
Among all NHIS respondents aged 50 and over, approximately 39 percent3 reported using CAM
in the past 12 months.
9
Figure 3. CAM Use in the Past 12 Months Among U.S. Adults, by Age Category4
*Base: All adult respondents 18+ (n=23,393)
Reasons for CAM Use
When those who used CAM were asked why they used these approaches, the most common
reasons were to prevent illness or for overall wellness (77 percent) or to reduce pain or treat
painful conditions (73 percent) (Figure 4). Other popular uses were to treat a specific health
condition (59 percent) or to supplement conventional medicine (53 percent).
10
Figure 4. Reasons for CAM Use
*Base: Respondents who used CAM in past 12 months or ever (n=539); sampling error = ±4.2
percentage points; respondents could choose more than one answer.
Specific Information Discussed
As shown in Figure 8, respondents said their health care providers most often discussed:
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the potential of interactions between CAM and other medications or treatments (44 percent)
advice on whether to pursue CAM treatments (41 percent)
the effectiveness of CAM therapies (41 percent), what type of CAM to use (40 percent)
the safety of CAM therapies (38 percent).
11
Figure 8. Topics Discussed by Health Care Provider
*Base: Respondents who have discussed CAM with a health care provider (n=345); sampling
error = ±5.3 percentage points; respondents could choose more than one answer.
Source: AARP/NCCAM Survey of U.S. Adults 50+, 2010
Those with a high school education or less were more likely than college graduates to report that
their health care provider had discussed how the CAM therapy might interact with other
medications or treatments (50 vs. 35 percent). No other demographic differences were noted
Primary Sources of Information About CAM Treatments
People aged 50 and older who use CAM get their information about it from a variety of sources,
as Figure 10 shows. They are most likely to learn about CAM from family or friends
(26 percent), followed by the Internet (14 percent), their physician (13 percent; 21 percent for all
health care providers), publications including magazines, newspapers, and books (13 percent),
and radio or television (7 percent). College graduates are less likely to report getting information
from radio and television (1 vs. 9 percent of those who attended college or have less education);
no other demographic differences were found. Only one significant difference exists in the
sources they consulted in 2010, compared with 4 years earlier: they are more likely to turn to the
Internet in 2010 than in 2006 (14 vs. 10 percent).
12
Figure 10. Primary Source of CAM Information
*Base: Respondents who used CAM in past 12 months or ever; 2010: n=539, sampling error =
±4.2 percentage points; 2006: n=1005, sampling error= ±3.1 percentage points
Use of Prescription Medications
Overall, four out of five respondents (78 percent) reported taking one or more prescription
medications (Figure 11). Younger respondents were less likely to take prescription medications:
Of those aged 50–64, 1 in 4 (28 percent) reported taking no prescription medications, compared
with 1 in 10 (10 percent) of those aged 65 and older. In addition to any CAM therapies they take,
77 percent of people who have used CAM in the past 12 months reported taking one or more
prescription medications (Figure 12).
13
Figure 11. Number of Prescription Medications Currently Taken
Source: AARP/NCCAM Survey of U.S. Adults 50+, 2010
Figure 12. Number of Prescription Medications Currently Taken by CAM Users
Source: AARP/NCCAM Survey of U.S. Adults 50+, 2010
CAM users who also take prescription medications were more likely to report that they had
discussed CAM with a health care provider. Sixty-four percent of those who have used CAM in
the past 12 months and reported currently taking prescription medicines said they have discussed
CAM with a health care provider; among those who used CAM in the past 12 months but said
they take no prescription medicines, 51 percent reported discussing CAM with a health
care provider.
14
Who Uses CAM Most
People of all backgrounds use CAM. However, CAM use among adults is greater among women
and those with higher levels of education and higher incomes. Figure 2 shows the percentage of
people using CAM by age.
15
CAM Therapies Used the Most
Nonvitamin, nonmineral natural products are the most commonly used CAM therapy among
adults. Use has increased for several therapies, including deep breathing exercises, meditation,
massage therapy, and yoga.
CAM Use Among Children
The 2007 NHIS asked selected adult respondents about CAM use by children in their
households. Overall, approximately 12 percent of children use some form of CAM. Use is
greater among:
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Children whose parents used CAM (23.9%)
Adolescents aged 12-17 (16.4%), compared to younger children
White children (12.8%), compared to Hispanic children (7.9%) and black children (5.9%)
Children whose parents had higher education levels (more than high school: 14.7%)
Children with six or more health conditions (23.8%)
Children whose families delayed conventional care because of cost (16.9%)
16
Review of Research Shows, Overall,
Acupuncture Did Not Increase Pregnancy
Rates with IVF
An analysis of research conducted on acupuncture as an adjuvant (booster) treatment to in vitro
fertilization (IVF) found that, overall, acupuncture did not increase pregnancy rates. However,
acupuncture did seem to increase pregnancy success rates at IVF clinics with baseline pregnancy
17
rates that were lower than 32 percent. This review, funded in part by NCCAM, was published
online in the journal Human Reproduction Update.
The review analyzed 16 randomized controlled clinical studies (4,038 participants) from around
the world since 2002 that compared actual acupuncture with simulated (sham) acupuncture or no
additional treatment. Actual acupuncture consisted of one to three treatment sessions of needling
at traditional points (and, in some trials, at tender points). In all trials acupuncture was given
within one day of the IVF procedure. The primary outcome was clinical pregnancy rates.
When all the trials were combined, the reviewers found no statistically significant improvement
in the rates of clinical pregnancies, ongoing pregnancies (pregnancies beyond 12 weeks of
gestation), or live births between women receiving actual acupuncture and the control groups.
The reviewers observed heterogeneity (i.e., variability) between studies in the effects of actual
acupuncture, with noticeably larger effects on clinical pregnancy rates in one subgroup: IVF
clinics that had lower pregnancy rates. For example, one potential factor for this may be related
to the number of embryos transplanted per cycle—fewer typically are transferred per cycle in
European countries compared to IVF practices in the United States. However, the authors noted
that this finding could have various explanations and needs further study. They also suggested
that acupuncture could benefit IVF patients beyond potentially improving rates of IVF pregnancy
success, noting that it is relatively safe and inexpensive and may aid these patients in coping with
the emotional and psychological challenges related to IVF and fertility.
Natural Medicine: The Future of Careers in Global Health
Health care practitioners are laboring hard to manage the symptoms of today's ailing global health care
system. As medical costs and the prevalence of chronic illness continue to rise internationally, a growing
number of experts recognize that a more preventative, integrative model of health care may be the
solution.
In 2006, US$2.1 trillion was spent on medical care in the United States. At least 75 percent of this went
toward treating chronic diseases, such as heart disease and diabetes, which are preventable or even
reversible through diet and lifestyle changes.
The current model of allopathic medicine widely practiced in North America today is based upon
managing symptoms. This approach to medicine certainly has its place in the healthcare arena and an
incredible number of scientific breakthroughs have taken place through this model of care. However, topnotch medical research and leading-edge surgical techniques alone are not effective when millions
continue to suffer from debilitating chronic disease.
Natural approaches to health care, such as naturopathic medicine, nutritional counseling, acupuncture and
Oriental Medicine, and psychological counseling are both medically effective and cost-effective. These
modalities emphasize patient-focused care and provide the opportunity to make affordable, quality health
care available to those who most need it.
18
In fact, studies show that an approach to health care that integrates natural, minimally invasive methods
such as plant-based diets, yoga, meditation, acupuncture and psychosocial support, may stop or even
reverse the progression of many chronic conditions. It is proven to prevent and provide relief from many
conditions, including allergies, asthma, diabetes, heart disease, chronic pain and fatigue, depression, and
digestive disorders, as well as help patients manage illnesses such as cancer and HIV/AIDS.
Growing in popularity throughout North America, different forms of Complementary and Alternative
Medicine (CAM) are commonly used in conjunction with allopathic medical techniques. According to a
2007 survey conducted by the National Institutes of Health (NIH), approximately 38 percent of adults and
approximately 12 percent of children are using some form of CAM therapy in America. A 2002 study
published in the American Journal of Public Health found a similar trend in CAM usage among
Canadians and Americans.
Pursuing an education in natural medicine is a great way to personally effect a positive change in the
health of communities around the world. Enrolling in a comprehensive natural health sciences program
that combines the best of eastern and western medicine will prepare future practitioners to bring their
patients healthcare that changes their lives and has the power to shift the global health paradigm.
An important tool in reversing the chronic disease epidemic, CAM is poised to play a major role in the
future of medicine. An education in this field prepares students to become naturopathic doctors,
nutritionists, psychologists, midwives, herbalists or exercise physiologists. When training to become a
natural health care provider, students learn how to look for and find the cause of an illness rather than just
treat the symptoms. They are taught to explore a patient's entire health care picture, including issues
related to lifestyle, history and diet, from a holistic perspective that recognizes the body's innate ability to
heal itself.
Alternative medicine in Europe ( OVERVIEW )
Despite the advances in Western medicine, up to one in three people in populations served by
this medical system are seeking some form of unorthodox care each year, and Europe is no
exception. Patients have driven this change, to the point where complementary and alternative
medicine (CAM) is the second biggest growth industry in Europe. Often patients have to rely on
the growing numbers of CAM practitioners with a variable standard of care that ranges from
excellent to dangerous. Many practitioners work without regulation or even work illegally. Many
orthodox health care professionals have shared their patients' concerns. Over the last 15 years,
these practitioners have moved from silent interest to open enquiry and growing use. For
example, approximately one in five of Scotland's general practitioners have received basic
training in integrating homeopathy with orthodox practice. The demand for CAM is in part a
search for a broader range of therapies, but is also a call for a different approach to care, with
less emphasis on drugs, and a more whole-person approach. Mostly, people look to CAM when
orthodoxy has failed. But CAM is also increasingly becoming a first-line intervention for some,
because of the worry about the side effects of conventional treatments and a perception that
orthodoxy has become dehumanized. With some exceptions, research is still in its early stages
and lacks infrastructure. Patient satisfaction, empirical clinical outcome, and cost are beginning
to be emphasized over mechanism of action or explanatory models. Recent official reports are
calling for national and European-level enquiry and response. Future development is likely to
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emphasize integrative care. The challenge is to create better medical systems, with a wholeperson emphasis, calling on a broader range of approaches than is currently orthodox. We seem
to need a reunion of the art and science of medicine.
CAM in Europe
Few European countries have national policies for CAM. Other than for herbal and
homeopathic medicines there are no EU regulations governing CAM. Variations in definitions
and categorizations of CAM therapies render regulation a challenge as does insufficient
knowledge among policy makers of the potential contribution of CAM to healthcare.
There are substantial differences in the way that CAM is recognised, practised and regulated
across EU member states, with differences again between the CAM therapies. Some form of
regulation exists in 18 out the 29 EU and EEA countries, although there is considerable
variation. EUROCAM and especially the CAM doctors association CAMDOC as well as the
practitioners organization EFCAM are working to promote the need for a statutory regulation of
all those working in the CAM field as well as for the availability of all CAM medicinal products.
CAM has begun to receive greater attention from the European Commission in recent years, with
funding being allocated to research and more activity within the institutions including an
informal CAM Interest Group within the European Parliament. The European Commission has
started a regular dialogue with CAM stakeholders and some CAM products are covered by
existing legislation both in the medicines and in the food field. The European Medicines Agency
(EMA) is also undertaking activities in the field of CAM.
Statistics about CAM in Europe
Summary
The most commonly used CAM therapies in Europe that are practised by medical doctors
are acupuncture, homeopathy, phytotherapy, anthroposophic medicine, naturopathy,
Traditional Chinese Medicine, osteopathy and chiropractic.
Due to a great variety of medical cultures and traditions in different parts of Europe, CAM
looks back on a well-established tradition in some countries or is hardly recognized and
available in others.
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The regulatory status of CAM is complicated by the different models applied in the EU
Member States to provide medical services in their respective countries. CAM is primarily
provided by physicians in Middle and Southern Europe, whilst the practice of CAM outside
of regulated health care is illegal and violations are considered an offence. By contrast, in
Northern Europe the practice of CAM by non-medically qualified practitioners is allowed
which has led to a situation where treatment providers outside of the established health
service constitute the core CAM providers.
The extent to which countries have established a statutory regulation of CAM and how such
regulation is performed varies widely. Some countries have government-administered
regulations or laws about the practice of CAM in general, some regulate specific CAM
therapies, while still others have no CAM regulation at all.
In 18 of 29 EU and EEA countries specific CAM therapies are statutorily regulated although
wide variations exist throughout Europe regarding the types of CAM that are regulated. In
some countries some CAM therapies are recognised as specific medical qualifications.
In a few countries diplomas for doctors who have taken a full course of a particular CAM
modality are issued and recognised by the national medical
associations/chambers/councils. However, there is no mutual recognition of diplomas
among the various Member States, which impedes the free movement of CAM doctors.
Approximately 180,000 medical doctors in the European Union have taken training and
education in one or more CAM modalities.
Familiarisation courses about CAM therapies are provided in the medical undergraduate
curriculum as a part of a course on Complementary and Alternative Medicine in several
countries. These courses are optional in most countries, obligatory in some.
Postgraduate training courses in specific CAM therapies are provided to doctors at several
universities in the majority of EU Member States, in other countries at private teaching
centres only.
Professorial chairs of CAM exist in at least 9 EU Member States, in some Member States also
chairs in a specific CAM therapy.
Introduction
Complementary and alternative medicine (CAM) is becoming increasingly popular in
Europe with up to 65% of the population reporting that they have used this form of
medicine. Approximately 30-50% of the European population use CAM as self-support and
10-20% of the European population has seen a CAM physician/practitioner within the
previous year.
The most commonly used CAM therapies in Europe that are practised by medical doctors
are acupuncture, homeopathy, phytotherapy, anthroposophic medicine, naturopathy,
Traditional Chinese Medicine, osteopathy and chiropractic. The popularity of the individual
therapies, however, differs widely between countries. This diversity is both a challenge for
examining the state of CAM in Europe and an opportunity since its inherent plurality gives
Europe a unique richness and leading position in the world in terms of the variety of
approaches, high quality, integrated, holistic and patient oriented healthcare.
The regulatory status of CAM in Europe reflects the diversity of acceptance, use and
availability of these treatment approaches in the EU Member States. Due to a great variety of
medical cultures and traditions in different parts of Europe, CAM looks back on a well
established tradition in some countries or is hardly recognized and available in others.
21
Models of statutory regulation
There are three main models used to regulate the practice of medicine, namely direct
government-administered regulation, government-sanctioned self-regulation and
independent self-regulation1. These models differ in the depth of direct government
involvement and are often used in tandem with other acts, which may regulate certain
aspects of the health service and medical practice.
1. Direct government-administered regulation
In most European countries the government authorises, registers and supervises the health
professionals. The authorities can withdraw the authorisation of health professionals if the
law is violated. This implies that the government, through the appropriate authorities,
decides to what extent the use of CAM by regulated health professionals can be designated
as “responsible professional conduct”.
2. Government-sanctioned self-regulation
In some countries the law delegates the tasks of authorisation, registration and supervision
of health professionals to the national medical associations. This implies that the national
medical associations decide to what extent the use of CAM by authorised health
professionals can be designated as “responsible professional conduct”.
3. Independent self-regulation
Some federations of CAM providers are developing what they call “self-regulation”.
“Self-regulation” is a process in which associations of individual therapies develop their own
statistics, educational programmes, code of ethics, research programmes and standards of
competence. In some countries, self-regulation is required for an association to be approved
by the government. A “registered” CAM provider must have a membership in a
government-approved providers’ federation.
Different models of providing medical services in Europe
According to the Declaration on Professional Autonomy and Clinical Independence of the
World Medical Association (2008) individual physicians ‘have the freedom to exercise their
professional judgment in the care and treatment of their patients without undue influence by
outside parties or individuals’. However, CAM therapies usually do not have the same
regulatory status as conventional medicine. They exist largely outside the institutions where
conventional health care is taught and provided and in some countries the medical
associations have even enforced strict regulations that thwart the practice of CAM by
medical doctors, eg in Sweden and Slovenia.
CAM is primarily provided by physicians in Middle and Southern Europe, the practice of
CAM outside of regulated health care is illegal and violations are considered an offence. In
Northern Europe anybody may provide CAM whilst only specific medical acts (e.g. treating
people for infectious diseases, performing surgery, administering anaesthetics, prescribing
drugs that require a prescription, giving injections, using X-ray) are restricted to medical
doctors with a university degree, although the range of these medical acts may differ from
country to country. This implies that the practice of CAM by non-medically qualified
practitioners is allowed which has led to a situation where treatment providers outside of the
established health service constitute the core CAM providers.
In Hungary and Slovenia the law allows some CAM modalities to be practiced by nonmedically
22
qualified practitioners; some only by medical doctors. In Slovenia homeopathy,
acupuncture and chiropractic/osteopathy are only permitted to medical doctors, in Hungary
homeopathy, anthroposophic medicine, traditional Chinese medicine and acupuncture,
chiropractic/osteopathy, ayurvedic medicine and traditional Tibetan medicine.
Findings (Reliability)- Statistics
There is a lack of reliable data on the prevalence of CAM.However, use of herbal medicine was
the most frequently reported use of CAM. Musculoskeletal problems were the most reported
condition.
While there are a few rigorous prevalence studies that are based on nationally representative
samples, the vast majority are small and of poor quality. Most EU countries do not have any data
at all. Reported prevalence rates of CAM use were between 0.3% and 86%. We were unable to
calculate the overall
prevalence rate for herbal medicine, homoeopathy, chiropractic, acupuncture or reflexology by
either country or across the EU or to differentiate between practitioner (doctor) based
prescriptions and over the counter purchases of homeopathic and herbal medicines.
Prevalence rates of the main therapies in use were reported as follows:
• Herbal medicine (31 studies): prevalence rates varied from 5.9 – 48.3% of the population
studies. However herbal medicine was not well defined (it may be included in naturopathy, folk
medicine or traditional Chinese medicine) and variously categorized as medical herbalism,
herbal remedies, herbal teas, phytotherapy. Some specific herbs were reported by name such as
St John’s Wort.
23
• Homeopathy (25 studies): prevalence rates varied from 2 – 27% of the populations studied.
• Chiropractic (17 studies): sometimes reported as “Chiropractic or osteopathy” (1 study), as one
of a group of CAMs (4 studies) and as “manual or manipulative treatments” (2 studies).
Prevalence rates were 0.4 – 20.8% of the populations studied.
• Acupuncture (14 studies): was poorly defined. Prevalence rates were 0.44 – 23% of the
populations studied. Eight further studies reported acupuncture as part of groups of CAMs.
• Reflexology (11 studies): and in a group of CAMs in one other study. Prevalence rates varied
from
0.4 – 21% of the populations studied.
• Dietary supplements: calcium supplement use was reported in 9 studies. Use of all other dietary
supplements, vitamins, minerals, fish oils, glucosamine and other products was reported
heterogeneously in groups, singly or combinations of supplements in 28 papers. It was not
possible to distinguish whether
the dietary supplements were bought over the counter or prescribed at consultations.
CAM provision in Europe comprises health care practitioners and physicians with different
healing attitudes, medical background, training, certification, and practice. Data are only
available if they are registered in any specific body open to the public, and are therefore scarce,
scientific publications are almost lacking completely. Both medical and non-medical
practitioners play an important role in the provision of CAM within the healthcare system in
Europe. CAM provision in the EU27+12 is maintained by more than 150,000 registered medical
doctors (MDs) with additional CAM certification and more than 180,000 registered and certified
non-medical CAM practitioners. This suggests up to 65 CAM providers (35 non-medical
practitioners and 30 physicians) per 100,000 inhabitants, compared to the EU figures of 95
general medical practitioners per 100,000 inhabitants. Acupuncture is the most frequently
provided method (53% of all practitioners) with 80,000 physicians and 16,000 non-medical
practitioners trained in the therapy, followed by homeopathy (27% – 45,000 and 4,500,
respectively). These two disciplines
are both dominated by physicians. Herbal medicine and manual therapies are almost exclusively
provided by non-medical practitioners.Naturopathy, on the other hand, is dominated by 15,000
(mostly German) physicians, as is anthroposophic medicine (4,500) and neural therapy (1,500).
CAM provision in Europe has not yet gained governmental interest at large; state funded
research based knowledge is mainly
available for Denmark, Germany, Norway, Switzerland, and the UK. This calls for more research
in this field throughout the EU and associated countries.
Over 50% of European adults and children use CAM
A recent European review, performed by combining data from published surveys with expert
perspectives, indicates that CAM appears to be popular not only among adults in Europe, but
also for children.
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CAM statistics
All European countries with a minimum of 5 million habitants were initially included for which
any data about CAM use in children were published in the last 10 years (29 countries), then
expanded to include 2 smaller countries. Corresponding authors from these publications were
contacted in each country, and they were asked to provide information about paediatric CAM use
in their countries.
Limitations created by a lack of representative studies, varying definitions of CAM use, and what
qualifies as CAM in different countries was partially overcome by integrating local experts to
summarise information available only in the national language and provide their perspectives
about CAM availability, quality, use and popularity in their countries using a semi-structured
questionnaire. Local and international published surveys were summarised, and the prevalence of
CAM use was extrapolated.
Data from 20 European countries were available, representing 69% of the European population.
Some data about CAM use by the general population were available for 90% of the examined
countries, whereas peer-reviewed published surveys were available for only 60%. The authors
extrapolated that 56% (range: 10—90%, adjusted for population size) of the European
population in general had used CAM at least once in the past year. Surveys in CAM use by
children were available for 55% of the investigated countries. The extrapolated prevalence of
CAM use by children in Europe was 52% (range: 5—90%, adjusted for population size).
Paediatric CAM experts reported an increasing awareness for and use of CAM in healthcare
institutions.
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Complementary and Alternative Medicine Practitioners in Europe.
Prevalence, Right to Practice, Use and Research.
Complementary and Alternative Medicine, CAM, is the most common term used in Europe to
describe a large number of health practices (over 80) based on a holistic view of the person.
While there is no universally accepted definition, the following includes key characteristics of
CAM practice: CAM utilized by European citizens represents a variety of different healthcare
systems and disciplines based on the knowledge, skills, practices derived from philosophies,
theories, beliefs and experiences used to maintain health, as well as to prevent, diagnose,
improve or treat the health needs of the whole person. CAM disciplines/modalities are mainly
used outside conventional medical care, but in many countries some disciplines are increasingly
used in conventional medical settings.
Legal and Practice Context
In Europe close to 50 CAM modalities are practiced by non-medically trained practitioners that
are organised in well established professional associations on the national and European level.
There are several more modalities which, to the best of our knowledge at this time, do not have
strong professional organisation. Less than 10 CAM modalities are practiced by medical
practitioners who have an additional training in the CAM modality.
By and large in Europe there is no positive legal right to practice CAM, but there are a small
number of exceptions particularly in common law countries. There is an absence of State
education and regulatory procedures for professional recognition, again with a small number of
exceptions. Practice is often legally “grey”, disguised or hidden, and tolerated or ignored by the
authorities. In some countries practice by non-medically trained people is forbidden and hardly
exists at all. There is no EU level harmonisation, but there is some restrictive EU regulation of
CAM medicines and products.
These conditions put a brake on professional development and access to the therapies medicines
and products. Practice is almost exclusively private and fee paying, and available only to those
with the means to pay. Nevertheless there are millions of users of CAM practitioner services.
Where it is legally open to practice, practitioner numbers have grown in response to citizen
demand. Where the political and legal climate is less open there is also much “unofficial”
successful and effective practice. There is a significant amount of practice in the non regularised
part of the market.
There is also medical opposition, hostility, negative media comment and an absence of accurate
information for potential users. CAM’s safety record is good. But there is insufficient
appropriate research and research design leaving CAM vulnerable to often unjustified criticism.
Nevertheless, several of the modalities professionally organised are seeking appropriate State
regulation. Some have been more successful at negotiation of this than others, so they are more
publicly visible.
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Practitioner Numbers
No European country has established a comprehensive and reliable system to enumerate
practitioners. A number of modalities have established national and European professional
organisations with practitioner registers
based on effective accreditation
procedures. However, the true spread and
number of practitioners is difficult to
determine at this time. A dedicated study
designed to take into account the legally
grey conditions of practice described
above is urgently needed. In it’s absence
the European Federation for
Complementary and Alternative
Medicine, EFCAM, carried out it’s own
survey among modalities with a
professional organisation. These
numbers are taken from professional
registers and can be relied upon.
However, no modality organisation in
any country in Europe contains all that
that modality’s practitioners so the
numbers here are less than the total
numbers for those modalities. Estimates
for all the other modalities are based on
general knowledge of the practice of those modalities.
EFCAM’s best estimate, therefore, for a total number of CAM
practitioners (non-medical) in Europe is: 270,000.
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Commentary
The existence of 180,000 non-medically trained practitioners is verifiable from professional
association registers and the associations’ accreditation procedures. Another 90,000, approx, are
known to exist practising the following modalities not listed above: Alexander technique, Anma,
Aromatherapy, Ayuerveda, Bach Flowers, Balneotherapy, Bio-energy, Chi Gung, Colonic
Irrigation, Massage (various kinds), Music Therapy, NLP, Nutritional Therapy, Pilates, Reiki,
Rolfing, Scenar, Spiritual Healing, Trager, T’ai Chi, Thai Massage, Tuina, Yoga, Watsu and
others.
Our estimated total is therefore 270,000 plus a further number undetermined right now.
No study of the economic value of CAM practice in Europe exists. The following is a projected
spend calculation on treatments from known practitioners:
270,000 X 46 weeks X 10 clients/week X 35euro fee = 4.35 billion per annum.
This is a projection only as no proper data is currently available.
Reasons for use of CAM Practitioners
The following are commonly stated reasons for attending CAM practitioners
and many others
s, health education and health literacy
-responsibility for health and self empowerment (user profile early middle
aged and up mostly)
whole individual, for being heard, for non-invasive
treatment, for safety, for general wellbeing effects alongside effectiveness for specific conditions
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