Complementary and Alternative Medicine
Complementary and alternative medicine (CAM), as defined by the National Center for Complementary and Integrative Health (NCCIH), 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 “complementary” when used in addition to conventional medicine while therapies and diagnostics used in place of conventional medicine are considered “alternative”. Complementary health approaches typically include natural products, mind and body practices, and the practices of traditional healers (e.g., Chinese medicine, homeopathy and naturopathy).
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.
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.)
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)
Food Sensitivity, Food Intolerance and/or Food Allergy IgG and IgG4 Testing* (i.e., Complement Antigen Testing)
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)
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.
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General definitions/descriptions of terms:
Antigen Leukocyte Cellular Antibody Test (ALCAT) - An in vitro test intended for the purpose of diagnosing intolerance to foods and other environmental agents. It is a blood test that assesses the response of leukocytes and platelets to a panel of foods and/or other environmental agents, by measuring the change in size and number of cells following exposure to a specific agent.
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.
Bioidentical Compounded Hormone Therapy - Compounded hormone prescriptions are purportedly customized to an individual’s particular hormonal needs. These compounded preparations are very heavily marketed to be “all-natural”, more effective, and safer than standard drugs for hormone therapy. Compounded preparations are not approved by the FDA and therefore exempt from including contraindications and warnings in package inserts. It introduces the possibility of multiple compounding sources, creating adverse effects and difficulty identifying the responsible active agent. Additional risks are intrinsic to compounding, such as variable bioavailability and bioactivity, creating overdosage and underdosage concerns.
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.
Food Sensitivity, Food Intolerance and/or Food Allergy IgG and IgG4 Testing - This is an invalidated form of testing for food sensitivity, food intolerance or food allergy offered by alternative health providers, as well as distributed through direct-to-consumer marketing by nationwide chains of pharmacies and laboratories. The use of IgG testing for food intolerance has been widely discredited as reliable information, as the likelihood that circulating levels of IgG occur in most in people in health and in disease. Additionally, claims are widely circulated that this lab test is a tool that helps treat conditions such as Multiple Sclerosis, Autism, ADHD, obesity, thyroid disorders, acne, IBS, and arthritis, among others.
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.
GI Effects Composite Stool Profile - This multianalyte assay is alleged to link autoimmune disorders, diabetes, and cardiovascular disease to imbalanced bacteria in the intestinal tract, to differentiate IBS from IBD, and to optimize gut health management. The test quantifies 26 gut microbiotas, and utilizes standard biochemical and culture methods to test levels of other stool components such as lipids and occult blood, and possible pathogens such as ova and parasites, yeast, and opportunistic bacteria.
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, to monitor therapeutic effects of manipulation, massage, and dietary supplements, and to enhance athletic training and performance.
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 infinitessimals - 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.
MTHFR (methylenetetrahydrofolate reductase) Testing - This testing for the following conditions: Homocystinuria, Cardiovascular disease, Cerebrovascular disease, Hypertension, Psychiatric disease, Metabolic disease, or Cancer is not supported by evidence-based studies.
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.
Qi Gong - The Qi Gong Association of America defines Qi Gong as the skill of attracting vital energy. Qi Gong 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 Qi gong 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.
Revici Cancer Therapy - The Revici Life Science Center was established by Emanuel Revici, M.D. The Revici Guided Chemotherapy varies for each individual but can include a chemical formulation consisting of lipid alcohols, caffeine, zinc, and iron, or a formulation consisting of fatty acids, selenium, magnesium and sulfur. Proponents claim they can treat late stage cancers, especially brain, lung, pancreatic, and metastasized breast carcinomas, and also AIDS.
Vampire Facelift - A procedure performed by a provider by injecting a patient’s own plasma into his or her wrinkles, under the premise those growth factors in the plasma will gradually stimulate collagen production.
While scientific evidence exists for 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.Complementary and alternative medicine including, but not limited to, those listed above, do not meet the following Technology Evaluation Center (TEC) criteria:
American Academy of Allergy, Asthma & Immunology. (2014). Food allergy: a practice parameter update – 2014. Retrieved November 10, 2017 from https://www.aaaai.org/practice-resources/Statements-and-Practice-Parameters/Practice-parameters-and-other-guidelines-page.
American Cancer Society. (2017). Complementary and alternative methods and cancer. Retrieved November 13, 2017 from https://www.cancer.org/treatment/treatments-and-side-effects/complementary-and-alternative-medicine/complementary-and-alternative-methods-and-cancer/what-are-cam.html.
American College of Medical Genetics and Genomics (ACMG). (2013, February). ACMG practice guideline: lack of evidence for MTHR polymorphism testing. Retrieved November 9, 2017 from http://www.acmg.net/docs/MTHFR_gim2012165a_Feb2013.pdf.
American College of Obstetricians and Gynecologists. (2007, reaffirmed 2017). Vaginal “rejuvenation” and cosmetic vaginal procedures. ACOG Committee Opinion Number 378. Retrieved November 6, 2017 from https://www.acog.org/-/media/Committee-Opinions/Committee-on-Gynecologic-Practice/co378.pdf?dmc=1&ts=20171106T2012184954.
American College of Obstetrics and Gynecologists. (2012, reaffirmed 2016). Compounded Bioidentical Menopausal Hormone Therapy. Committee Opinion No. 532: Retrieved November 7, 2017 from www.acog.org.
American College of Physicians. (2014). Nonsurgical management of urinary incontinence in women: a clinical practice guideline from the American College of Physicians. Retrieved November 6, 2017 from the National Guideline Clearinghouse (NGC: 010547).
American Society of Plastic Surgeons. (2012). The vampire facelift: not really a face lift and no vampires involved. Retrieved November 6, 2017 from https://www.plasticsurgery.org/news/blog/the-vampire-facelift-not-really-a-facelift-and-no-vampires-involved.
Atalay, N., Sahin, F., Atalay, A., & Akkaya, N. (2013). Comparison of efficacy of neural therapy and physical therapy in chronic low back pain. African Journal of Traditional, Complementary and Alternative Medicines, 10 (3), 431-435. (Level 3 evidence)
BlueCross BlueShield Association. Medical Policy Reference Manual. (7:2017). Miscellaneous genetic and molecular diagnostic tests (2.04.121). Retrieved November 7, 2017 from BlueWeb. (91 articles and/or guidelines reviewed)
BlueCross BlueShield Association. Medical Policy Reference Manual. (12:2015). Neural therapy (2.01.85). Retrieved December 19, 2016 from BlueWeb. (8 guidelines and/or articles reviewed)
BlueCross BlueShield Association. Medical Policy Reference Manual. (10:2017). Antigen leukocyte antibody test (2.01.93). Retrieved November 7, 2017 from BlueWeb. (8 guidelines and/or articles reviewed)
Jiménez, M., & Molina Mora, J. (2017). Effect of heart rate variability biofeedback on sport performance, a systematic review. Applied Psychophysiology and Biofeedback, 2017 June 1, doi: 10.1007/s10484-017-9364-2. [Epub ahead of print]. Abstract retrieved November 7, 2017 from PubMed database.
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 Institutes of Health. National Center for Complementary and Integrative Health. (2017). Health topics A – Z. Retrieved November 10, 2017 from https://nccih.nih.gov.
Seely, D., Szczurko, O., Cooley, K., Fritz, H., Aberdour, S., Herrington, C., Herman, P., et al. (2013). Naturopathic medicine for the prevention of cardiovascular disease: a randomized clinical trial. Canadian Medical Association Journal, 185 (9), E409-E416. (Level 2 evidence)
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 November 7, 2017 from http://www.lexisnexis.com/hottopics/tncode/.
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. (2017). Multiple chemical sensitivities. Retrieved November 16, 2017 from https://www.osha.gov/SLTC/multiplechemicalsensitivities/index.html
Villafaina, S., Collado-Mateo, D., Fuentes, J., Merellano-Navarro, E., & Gusi, N. (2017). Physical exercise improves heart rate variability in patients with type 2 diabetes: a systematic review. Current Diabetes Reports, 17 (11), 110. Abstract retrieved November 7, 2017 from PubMed database.
Winifred S Hayes, Inc. Medical Technology Directory. (2013, June; last update May 2017). Bioidentical Hormone Replacement Therapy for Menopausal Symptoms. Retrieved November 7, 2017 from https://www.hayesinc.com/subscribers. (61 articles and/or guidelines reviewed)
ORIGINAL EFFECTIVE DATE: 2/1/2003
MOST RECENT REVIEW DATE: 12/14/2017
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