Complementary and Alternative Medicine
DESCRIPTION
Complementary and alternative medicine (CAM), as defined by the National Center for Complementary and Alternative Medicine (NCCAM), is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Therapies and diagnostics are termed as complementary when used in addition to conventional medicine and as alternative when used instead of conventional medicine.
Integrative Medicine (IM) combines state of the art conventional medicine with alternative modalities to stimulate the body's natural healing potential. IM is based upon a model of health and wellness, as opposed to a model of disease. It seeks to care for the whole person by taking into account the many interrelated physical and nonphysical factors that affect health, wellness, and disease.
Naturopathy is a distinct area of primary care medicine that blends traditional healing methods with current science and research. Naturopathy emphasizes the body’s innate ability to heal itself through the correction of underlying imbalances, and focuses greatly on disease prevention and personal responsibility in the pursuit of optimal health. The predominant research paradigm employed by naturopathy is the whole-system research (WSR) model which evaluates individualized, multifaceted treatment modalities in contrast to randomized clinical trials which attempt to determine the best treatment for large patient populations.
Holistic/naturopathic diagnostics attempt to discover which signs and symptoms of illness are related to human imbalance, or disruption in the homeostasis of the physical, emotional, spiritual, social, and environmental state of the whole being. It is hypothesized that recognition and correction of this imbalance will treat the cause of illness and prevent reoccurrence of symptoms.
In the United States, approximately 38 percent of adults (about 4 in 10) and approximately 12 percent of children (about 1 in 9) are using some form of CAM. Financial analysis reveals that approximately 83 million adults spend $33.9 billion out-of-pocket on CAM which is in excess of 11% of total out-of-pocket health care expenditures.
POLICY
Complementary and alternative medicine including, but not limited to, the modalities listed below for the diagnosis, prevention, and/or treatment of diseases and health related symptoms or conditions are considered investigational. (*See Additional Information below for definition/description.)
Aromatherapy
Chinese herbal medicines (e.g., Dang Shen, Fang Feng, Tian Xian, Yin Chen, Pao Jiang)
Colon therapy (i.e., colonic hydrotherapy, high colonic, detoxification therapy, coffee enemas)
Heart Rate Variability Test* (e.g. Nerve Express, Heart Rhythm Scanner PE, Intelwave, PD2i®)
Herbs (e.g., Black cohosh, Chaparral, Echinacea, FeverFew, Ginkgo biloba, Goldenseal, Green tea, St. John's Wort, Valerian)
Idiopathic Environmental Intolerances or Multiple Chemical Sensitivity* (diagnostic and /or management tests)
Magnet therapy
Therapeutic touch
See also:
Light Box Therapy (Phototherapy) for Seasonal Affective Disorder
Orthoptic Training for the Treatment of Vision or Learning Disabilities
Transcutaneous Electrical Nerve Stimulation (TENS) for the Treatment of Nausea and Vomiting
IMPORTANT REMINDERS
ADDITIONAL INFORMATION
General definitions/descriptions of terms:
Antigen Leukocyte Cellular Antibody Test (ALCAT) - An in vitro screening test for adverse reactions to specific foods, food additives, food colorings, and other chemicals.
Ayurveda - Ayurveda traces its roots to the Vedic period in ancient India. The Ayurvedic medicine program utilizes foods, spices, herbal medicines, colors, metals, gems and sound to allegedly overcome illness and strengthen an individual.
Balneotherapy - This therapy utilizes natural elements, such as hot springs, climatic factors, chronobiological and circadian rhythmic phases and peat substances. The term balneology refers to the study of the art and science of bathing. Balneotherapy is the use of balneology in the treatment of disease.
Di Bella Cancer Therapy - Di Bella therapy consist of a mixture of the drugs somatostatin, bromocriptine, as well as vitamins, melatonin, and sometimes other substances combined in varying amounts depending on the individual under treatment. Proponents claim the drug mixture stimulates the body's self-healing properties and can shrink tumors and even cure cancer.
Gerson Therapy - The practitioners of Gerson therapy allege that the treatment is effective for a wide variety of ailments because it restores the body's ability to heal itself. Practitioners do not claim that this therapy will cure everything or everyone. A number of components are considered important to this therapy. These components include: juicing (as many as 13 glasses of fresh, organic vegetable/fruit juice are recommended per day), diet (three full vegetarian meals from organic sources), detoxification of tissues and blood (accomplished foremost via coffee enemas), and medications (e.g., Lugol's solution, vitamin B-12, injectable crude liver extract, pancreatic enzymes, enemas of coffee and/or chamomile). Certain complementary therapies may also be recommended, such as: polarizing treatment (GKI), ozone therapy by rectal insufflation, hydrotherapy, and acupuncture.
Greek Cancer Cure - This treatment consist of a blood test reportedly used to diagnose cancer, and a secret intravenous therapy believed to consist of, among other things, brown sugar, niacin, vitamin C, and alanine (an amino acid). The blood test is alleged to determine the nature, location and seriousness of an individual's tumor.
Heart Rate Variability - This automated, diagnostic tool is a non-invasive electrophysiologic test to assess the cardiac autonomic nervous system (ANS) and the effect of stress on the heart. Heart rate variations are recorded and are categorized as representing a response of the sympathetic or parasympathetic nervous system. The test is used to assess for cardiac risk, the role of ANS in arrhythmias, heart failure, vertigo, and obesity, and to monitor therapeutic effects of manipulation, massage, and dietary supplements.
Homeopathy - As reported by MayoClinic.com, homeopathy utilizes highly diluted preparations of natural substances, typically plants and minerals to treat symptoms of illness. Homeopathic medicine is based on two beliefs: 1) The law of similars - Sometimes called "like cures like". When given to a healthy person in large quantities, some plant, animal and mineral substances produce symptoms of disease. But when given to a sick person, much smaller doses of the same substances can (theoretically) relieve the same symptoms. 2) The law of infinitesimals - Literally, infinitesimal means too small to be measured. According to this belief, substances treat disease most effectively when they are highly diluted, often in distilled water or alcohol.
Idiopathic Environmental Intolerances (i.e. Multiple chemical sensitivity or injury, clinical ecology, environmental illness) - Idiopathic environmental intolerance is typically characterized by recurrent, nonspecific symptoms that an individual or a clinician believe are the result of low levels of exposure to chemical, biologic, or physical agents. Reported symptoms are wide-ranging, and in the absence of clearly established diagnostic criteria no specific test can confirm the diagnosis. Frequently an extensive battery of tests are simultaneously undertaken as part of the diagnostic odyssey that attempts to confirm this intolerance and may include RNase-L testing, trace minerals in the serum or urine, antibodies for a variety of infectious agents simultaneously, allergy services (including provocation testing), positron emission tomography (PET) scans, neuropsychologic testing and elaborate nutritional assessment, including intracellular micronutrient assays.
Kelly's Nutritional-Metabolic Therapy - William D. Kelley, a dentist, developed this therapy. Dr. Kelley held that the root cause of cancer is an individual's inability to properly metabolize protein. He linked this faulty metabolism to a deficiency of pancreatic enzymes. The three primary elements of Kelly's Nutritional-Metabolic Therapy program are nutrition, detoxification (utilizing coffee enemas) and supplements of pancreatic enzymes.
Livingston-Wheeler Therapy - This therapy includes vaccines, antibiotics, vitamin and mineral supplements, digestive enzymes, cleansing enemas, and a vegetarian diet. Livingston-Wheeler therapy is promoted primarily for use in the treatment of cancer but it is also used to treat lupus, arthritis, and other chronic conditions.
Moxibustion - Reportedly treats and prevents disease by applying heat to points or certain locations on the human body. The material/instrument used to apply the heat is primarily moxa-wool in the shape of a cone or stick. Some proponents suggest that when a disease fails to respond to medication and/or acupuncture, moxibustion should be applied.
Naturopathy - As reported by MayoClinic.com, naturopathic care is one of the least organized of the CAM treatment approaches. Naturopaths emphasize lifestyle - including fresh air, clean water and exercise - as the foundation of health. Naturopaths draw on many of the CAM practices, such as acupuncture, manipulative therapies and herbal medicines, with modern diagnostic sciences and standards of care. Practitioners of naturopathy typically counsel individuals to avoid prescription drugs and surgery.
Neural Therapy - Neural therapy is a method of diagnosing and treating illness and pain caused by electrical disturbances called "interference fields". These disturbances are believed to be manifestations of cell membrane instability and typically trigger abnormal autonomic nervous system responses. If an interference field is found, it is claimed to be easily treated by injecting it with a local anesthetic.
Qigong - The Qigong Association of America defines Qigong as the skill of attracting vital energy. Qigong is alleged to be a self-healing art that combines movement, meditation and visualizations to enhance the mind/body connection and assist healing. The association claims that the regular practice of qigong can prevent and treat illness.
Reiki - According to the International Center for Reiki Training, Reiki is defined as spiritually guided life force energy. Reiki is allegedly a technique for stress reduction and relaxation that allows an individual to tap into an unlimited supply of life force energy for the purpose of improving health and enhancing the quality of life.
While scientific evidence exists regarding some CAM therapies and diagnostics, for most there are key questions that are yet to be answered through well-designed scientific studies.
Systematic reviews of Traditional Chinese Medicine were inconclusive due specifically to poor methodology and heterogeneity of the studies.
Many CAM products are available on the market as dietary supplements and may be contaminated or vary tremendously resulting in inconsistent dosing. The World Health Organization expresses safety concerns over international marketing of herbal products that may be counterfeit, poor quality or adulterated. Legislation is pending to ensure that the Dietary Supplement Health and Education Act of 1994 is fully implemented with FDA oversight of dietary supplements.
Complementary and alternative medicine including, but not limited to, those listed above, do not meet the following Technology Evaluation Center (TEC) criteria:
SOURCES
111th Congress: 2nd Session: S. 3414: (2010, May). Dietary supplement full implementation and enforcement act of 2010. Retrieved September 7, 2010 from http://thomas.loc.gov .
American Cancer Society. (2000). Complementary and Alternative Cancer Methods. Atlanta: The American Cancer Society.
BlueCross BlueShield Association, Medical Policy Reference Manual. (5:2012). Diagnosis and management of idiopathic environmental intolerances (i.e.multiple chemical sensitivities). (2.01.01). Retrieved July 2, 2012 from BlueWeb. (18 guidelines and/or articles reviewed)
BlueCross BlueShield Association, Medical Policy Reference Manual. (12:2011). Neural therapy (2.01.85). Retrieved January 11, 2012. (4 guidelines and/or articles reviewed)
Boulton, A., Vinik, A., Arezzo, J., Bril, V., Freeman,R., Malik, R., et al. (2005). Diabetic neuropathies. Diabetic Care 28 (4), 956-962.
Complete Guide to Medicare Coverage Issues [Computer software]. (2010, April). Biofeedback therapy (NCD 30.1, p. 2-29). Ingenix.
Complete Guide to Medicare Coverage Issues [Computer software]. (2010, April). Biofeedback therapy for the treatment of urinary incontinence (NCD 30.1.1, p. 2-29). Ingenix.
Complete Guide to Medicare Coverage Issues [Computer software]. (2010, April). Thermogenic therapy (NCD 30.2, p. 2-30). Ingenix.
Complete Guide to Medicare Coverage Issues [Computer software]. (2010, April). Acupuncture – Not covered (NCD 30.3, p. 2-30). Ingenix.
Complete Guide to Medicare Coverage Issues [Computer software]. (2010, April). Acupuncture for fibromyalgia (NCD 30.3.1, p. 2-30). Ingenix.
Complete Guide to Medicare Coverage Issues [Computer software]. (2010, April). Acupuncture for osteoarthritis (NCD 30.3.2, p. 2-30). Ingenix.
Complete Guide to Medicare Coverage Issues [Computer software]. (2010, April). Electrosleep therapy – Not covered (NCD 30.4, p. 2-31). Ingenix.
Complete Guide to Medicare Coverage Issues [Computer software]. (2010, April). Transcendental meditation (NCD 30.5, p. 2-31). Ingenix.
Complete Guide to Medicare Coverage Issues [Computer software]. (2010, April). Intravenous histamine therapy (NCD 30.6, p. 2-31). Ingenix.
Complete Guide to Medicare Coverage Issues [Computer software]. (2010, April). Laetrile and related substances (NCD 30.7, p. 2-32). Ingenix.
Complete Guide to Medicare Coverage Issues [Computer software]. (2010, April). Cellular therapy (NCD 30.8, p. 2-32). Ingenix.
Complete Guide to Medicare Coverage Issues [Computer software]. (2010, April). Transillumination light scanning or diaphanography (NCD 30.9, p. 2-32). Ingenix.
Fleming, S., Gutknecht, N. (2010). Naturopathy and the primary care practice. Primary Care, 37(1), 119-136.
Institute of Medicine of the National Academies. (2005). Complementary and Alternative Medicine in the United States. Washington D. C.: The National Academies Press.
Kaul, P. N., & Joshi, B. S. (2001). Alternative medicine: Herbal drugs and their critical appraisal - Part II. Progress in Drug Research, 57, 1-75.
Magill, M. & Suruda, A. (1998). Multiple chemical sensitivity syndrome. American Family Physician, 58 (3), 721-728.
Manheimer, E., Wieland, S., Kimbrough, E., Cheng, K., & Berman, B. (2008) Evidence from the Cochrane collaboration for traditional Chinese medicine therapies. Journal of Alternative and Complementary Medicine, 15 (9), 1001-1014. (Level 1 Evidence - Industry sponsored)
National Cancer Institute. (2008) NCI’s annual report on complementary and alternative medicine. Retrieved September 14, 2010 from http://www.cancer.gov/cam/attachments/fy2008_CAM_annual_report.pdf.
National Institute of Allergy and Infectious Diseases. (2010) Guidelines for the diagnosis and management of food allergy in the United States. Retrieved July 16, 2012 from http://www.niaid.nih.gov/topics/foodAllergy/clinical/Documents/FAGuidelinesExecSummary.pdf.
National Institute of Health, National Center for Complementary and Alternative Medicine (July, 2009). The use of complementary and alternative medicine in the United States. Retrieved September 9, 2010 from: http://nccam.nih.gov/news/camstats/costs/costdatafs.htm.
National Institute of Health, National Center for Complementary and Alternative Medicine (June, 2010). Herbs at a glance. Retrieved September 9, 2010 from: http://nccam.nih.gov/health/NIH_Herbs_at_a_Glance.pdf.
Tennessee Code: Title 63 Professions of the Healing Arts: Chapter 6 Medicine and Surgery: Part 2 General Provisions: 63-6-205. Practice of naturopathy. Retrieved September 7, 2010 from http://www.michie.com/tennessee/lpext.dll?f=templates&fn=main-h.htm&cp=tncode.
Tilburt, J., Curlin, F., Kaptchuk, T., Clarridge, B., Bolcic-Jankovic, D., Emmanuel, E., et al. (2009). Alternative medicine research in clinical practice: a US national survey. Archives of Internal Medicine, 169 (7), 670-677. (Level 5 evidence - Industry sponsored)
Tulppo, M. & Huihuri, H. (2004) Origin and significance of heart rate variability. Journal of the American College of Cardiology, 43 (12) 2278-2279.
U. S. Food and Drug Administration. (2011. April). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K101867. Retrieved July 3, 2012 from http://www.accessdata.fda.gov/cdrh_docs/pdf10/K101867.pdf.
United States Department of Labor. Occupational Safety and Health Administration. (2011). Multiple chemical sensitivities. Retrieved July 3, 2012 from http://www.osha.gov/SLTC/multiplechemicalsensitivities/index.html.
Voelker, R. (2005). IOM points to need for more research, regulation in alternative medicine. JAMA, 293 (10), 1178-1180.
Winifred S Hayes, Inc. Medical Technology Directory. (2008, August, last update July 2010). Melatonin for jet lag and shift work disorder. Retrieved September 8, 2010 from https://www.hayesinc.com/subscribers/subscriberArticlePDF.pdf?articleId=8445. (40 articles and/or guidelines reviewed)
Winifred S Hayes, Inc. Medical Technology Directory. (2008, August, last update July 2010). Melatonin for primary sleep disorder. Retrieved September 8, 2010 from https://www.hayesinc.com/subscribers/subscriberArticlePDF.pdf?articleId=8685. (46 articles and/or guidelines reviewed)
Winifred S Hayes, Inc. Medical Technology Directory. (2008, December, last update January 2010). Valerian for the treatment of insomnia. Retrieved September 8, 2010 from https://www.hayesinc.com/subscribers/subscriberArticlePDF.pdf?articleId=9058. (41 articles and/or guidelines reviewed)
Winifred S Hayes, Inc. Medical Technology Directory. (2008, February, last update search February 2010) Horse chestnut for chronic venous insufficiency. Retrieved September 8, 2010 from https://www.hayesinc.com/subscribers/subscriberArticlePDF.pdf?articleId=7731. (19 articles and/or guidelines reviewed)
Winifred S Hayes, Inc. Medical Technology Directory. (2008, January, last update July 2010). St John’s wort for major depressive disorder. Retrieved September 8, 2010 from https://www.hayesinc.com/subscribers/subscriberArticlePDF.pdf?articleId=7586. (31 articles and/or guidelines reviewed)
Winifred S Hayes, Inc. Medical Technology Directory. (2008, September, last update July 2010). Black cohosh for the treatment of menopausal symptoms. Retrieved September 8, 2010 from https://www.hayesinc.com/subscribers/subscriberArticlePDF.pdf?articleId=8605. (34 articles and/or guidelines reviewed)
Winifred S Hayes, Inc. Medical Technology Directory. (2008, September, last update August 2010). Melatonin for secondary sleep disorder. Retrieved September 8, 2010 from https://www.hayesinc.com/subscribers/subscriberArticlePDF.pdf?articleId=8685. (60 articles and/or guidelines reviewed)
Winifred S Hayes, Inc. Medical Technology Directory. (2009, February, last update February 2010). Echinacea for prevention or treatment of the common cold. Retrieved September 8, 2010 from https://www.hayesinc.com/subscribers/subscriberArticlePDF.pdf?articleId=9336. (38 articles and/or guidelines reviewed)
Winifred S Hayes, Inc. Medical Technology Directory. (2009, March, last update March 2010). Craniosacral therapy. Retrieved September 8, 2010 from https://www.hayesinc.com/subscribers/subscriberArticlePDF.pdf?articleId=9514. (22 articles and/or guidelines reviewed)
Winifred S Hayes, Inc. Medical Technology Directory. (2009, March, last update March 2010). Saw palmetto for benign prostatic hyperplasia. Retrieved September 8, 2010 from https://www.hayesinc.com/subscribers/subscriberArticlePDF.pdf?articleId=9587. (45 articles and/or guidelines reviewed)
Winifred S Hayes, Inc. Medical Technology Directory. (2010, January). Autonomic nervous system monitoring for neuropathy. Retrieved August 8, 2012 from https://www.hayesinc.com/subscribers/subscriberArticlePDF.pdf?articleId=10730 (67 articles and/or guidelines reviewed)
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ORIGINAL EFFECTIVE DATE: 2/1/2003
MOST RECENT REVIEW DATE: 11/10/2012
ID_BT
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