Frequently Asked Questions
Complementary and alternative medicine (CAM) is a term used to encompass a wide variety of diverse treatment and diagnostic techniques that are currently outside of the mainstream of medicine in this country. The treatments may be used in conjunction with conventional medicine (complementary) or they may be complete (alternative) systems in their own right, such as traditional Chinese medicine.
Many of these systems have deep historical and intellectual roots in the cultures of other countries and have been around for hundreds if not thousands of years. In fact, for over 70 percent of the world’s population they are not "alternative" but in fact the primary source of health care.
The National Institutes of Health (NIH), National Center for Complementary and Alternative Medicine has defined CAM as: "those healthcare and medical practices that are currently not part of conventional medicine." Classification of a practice as CAM may change, depending upon changing attitudes, scientific data, and experience. They have grouped CAM practices into five major domains:
Alternative Medical Practices – which includes complete systems of theory and practice originating in other cultures, such as traditional Chinese medicine, Ayurveda, and Native American medicine, or in Western traditions, such as homeopathy and naturopathy.
Mind-Body Interventions – various techniques designed to facilitate the mind’s capacity to affect bodily functions and symptoms. Some such techniques are already part of mainstream medicine but others such as meditation, certain uses of hypnosis, dance or art therapy, and prayer are categorized as CAM.
Biological-based therapies – natural and biologically based practices and products, such as herbs, special diets, food supplements, or, among others, bee pollen and enzyme therapy.
Manipulative and Body-Based Systems – which includes chiropractic, massage, body work such as rolfing and reflexology.
Energy Therapies – focusing on energy fields originating within the body (biofields), for example Qi Gong, Reiki, or therapeutic touch, or external sources (electromagnetic fields), for example magnets.
Integrative medicine incorporates elements of complementary and alternative medicine alongside conventional, mainstream methods of treatment and diagnosis. At its heart, however, it aims to do more than just add new tools to the medicine bag. Integrative medicine aims to enhance current medical practice and, although perceived as a "new movement", it in fact re-focuses medicine on its ancient roots and values. These values include:
Whole person care – attending not only to the physical but also to the psychological, emotional, social, spiritual and cultural dimensions of each person
Relationship and patient-centered care – which recognizes the fundamental importance of the relationship between the patient and the health care provider, is deeply respectful of the wishes and experience of the individual patient, and values the patient as an active partner in their own care
Self-care – believing that health care providers should be teachers, facilitating patients in caring for themselves in order to both prevent and alleviate illness. At the same time, providers should themselves embody a philosophy of self-care and, in being truly attentive of their own health and well-being, better serve the needs of others
Evidence-based – supporting informed decision-making based on the best available evidence on the safety and effectiveness of all treatment options
There is an abundance of websites, magazines, books and other information on complementary and alternative medicine, but how do you know which information sources to trust? One of the first cautions is to beware of any claims of cures, often these are far-fetched and you need to know a whole lot more about the evidence. Also, even if a product or treatment is touted as "natural" be aware that this does not necessarily mean it is safe. Herbs, for instance, although natural, can be very potent and you need to be concerned about the fact that even if okay by themselves, they may be very dangerous if you are on medication or taking a different herb.
So where do you begin to look for good quality information? You may want to start with our resources page. We have put together a variety of sources of information that meet certain standards of credibility. We do not have control over the contents of these sources, however, and cannot guarantee the quality of the information. Nevertheless, we do suggest how you might be able to judge for yourself how reliable these sites are and whether their information is based on solid scientific evidence. Some questions to bear in mind as you read or as you question professionals or other experts:
Credentials/authorship: authors and contributors of books, magazines and other publications: Do they give their affiliations and relevant credentials? Similarly, with CAM practitioners: Are they members of a professional organization? Do they have licensing or credentials in their field (where these exist)?
Attribution: references and sources for all content should be listed clearly, and all relevant copyright information noted. Are claims backed up by studies published in peer-reviewed journals? Do they give these references?
Disclosure: Web site "ownership" should be prominently and fully disclosed, as should any sponsorship, advertising, underwriting, commercial funding arrangements or support, or potential conflicts of interest. This includes arrangements in which links to other sites are posted as a result of financial considerations. Similar standards should hold in discussion forums. This will give you an idea of whether the site is truly independent and unbiased, or whether there is an economic interest driving it.
Currency: Dates that content was posted and updated should be indicated. New evidence is constantly being generated and should be taken into account.
The CAM field is often criticized for not having a great deal of solid scientific evidence on safety and effectiveness. Some of the reason for this lack is that the field as a whole has not had the same infrastructure or resources as mainstream medicine - meaning that there has not been the money, the research expertise, nor the large institutional support to facilitate extensive, high-quality studies and investigation. This is now changing, however, as the federal government is supporting the National Institutes of Health in funding this field (through the National Center for Complementary and Alternative Medicine, NCCAM and other Institutes. Also, many programs in CAM, such as ours at the University of Maryland, are now being developed at academic medical centers around the country with support from NCCAM, the NIH and other private sources and are pushing forward the work in this field.
Significant progress is now being made in collecting and evaluating all the existing scientific literature in CAM. Some areas, such as acupuncture for pain relief or mind/body therapies for pain and for insomnia, have a fair amount of evidence and have even been the subjects of National Institutes of Health Consensus Development conferences, which have put out recommendations for their use. Other areas do not have a great deal of evidence yet. However, the same can actually be said of many areas of conventional medicine. An excellent source of information on all areas of medicine is the Cochrane Collaboration which collects and reviews the literature in all areas of health care. You can also look at our research page for the latest findings coming out of our center. In any treatment you seek, you should, of course, consider the evidence, but even if there is little evidence, there are some basic questions you should ask.
These are suggestions for some of the questions you might consider:
How invasive is this treatment and how likely to cause harm?
Is there an existing treatment for my condition that has a lot of evidence for its effectiveness and safety?
Will this treatment interact negatively with something I am already taking or doing?
Is the practitioner licensed and/or a member of a professional body?
How much training/how many years of experience does the practitioner have?
Is the practitioner willing to communicate with other practitioners/physicians I am seeing for my care?
What is a likely course of treatment for me to see changes in my condition?
Is this treatment likely to enhance my quality of life even if it does not cure my problem?
No. In fact, you should always keep your doctor informed of other therapies and approaches you are using. If you visit our clinic we will work with your current health care providers and encourage you to keep in contact with them. We will also help coordinate your care as we work with you to set up the best treatment program to meet your individual needs.
Yes, we can act as your primary care provider. Please call our clinic at 410-448-6361 for more information.
Also, our doctors and practitioners will work in consultation with your primary care provider if you already have one. We will also work with you to coordinate an individual program of care that may involve treatment by various members of our team.
Acupuncture is a form of treatment that is a part of traditional Chinese medicine. It involves the insertion of very fine needles into the skin at specific locations, "acupuncture points", on the body. The number of needles used and their placement will vary according to the health problem of the individual person. The needles we use in our clinic are disposable, i.e. they are new and fully sterilized and, once used, are discarded in sealed containers. The needles are extremely fine, much finer than the ones you are familiar with from hypodermic syringes or even a pin. Most patients report feeling little more than a slight, quick, pricking sensation when the needle is inserted and become extremely relaxed during the 20-30 minutes that the needles are left in for treatment. During the treatment the acupuncturist may "stimulate" the acupuncture point through a gentle low voltage electrical current conducted through the needle (electro-acupuncture) or through gentle movement of the needle. At this time you may experience a tingling sensation at the acupuncture point. In Chinese medicine this is called "De Qi" and is considered a desirable effect and proof that the energy or "Qi" is moving freely.
This is a general classification for a wide spectrum of interventions from many different medical paradigms; in both traditional and modern practice, mind/body therapies are often used as adjunctive or preventative therapies. They include more conventional western therapies such as psychotherapy, cognitive-behavioral therapy, and hypnosis as well as techniques native to Asian medical systems and cultures such as yoga, qi gong, and meditation. In addition, mind/body therapies include techniques such as relaxation response, guided imagery, and biofeedback as well as more controversial therapies such as art, music, and dance therapies, prayer, and distant healing.
The term neutraceuticals is a general classification that refers to the wide array of biologically-based products available to health practitioners and consumers; they include vitamins, minerals, neurotransmitters, hormones, animal products such as shark cartilage and glandulars, and other naturally occurring substances such as glucosamine and SAM-e. The efficacy and safety of most of these therapies have not been thoroughly investigated. However, there are a few neutraceuticals that are beginning to build a substantial evidence base for the treatment of rheumatic and musculoskeletal diseases, most notably glucosamine and chondroitin, SAM-e, and essential fatty acids.
Homeopathy was developed by Samuel Hahnemann, a Germany physician, some 200 years ago. It involves the prescription of often very dilute, indeed in some cases ultramolecular, doses of usually herbal products that have been shaken and serially diluted. The first principle of homeopathy is that of similars or "like cures like": this states that patients who present with particular signs and symptoms can be cured if they are given a homeopathic medication that produces the same signs and symptoms in a healthy individual. A homeopath will thus look at the total picture of the individual patient's symptoms and match this with the picture described for a particular homeopathic remedy. The second, and probably the most confusing principle to western physicians, is that of serial dilution of a medication. Often the medication is diluted to the point where it has no molecules of the original product left. In homeopathy these remedies are considered to be the most powerful. The interesting challenge to science and modern medicine is that systematic reviews of the literature have concluded that, although there is insufficient proof that homeopathy is effective for specific conditions, there is proof that homeopathy has an effect beyond placebo.
Qigong is a self-healing art that combines movement and meditation. "Qi" is a Chinese word that means vital energy or life force. In different cultures it has different names such as "prana". The concept of Qi is an important part of Chinese culture and underlies much of traditional Chinese medicine which believes in balancing or unblocking Qi in order to create or maintain good health. "Gong" is the physical manifestation of Qi through special movements. There are many types and practices of Qi Gong.