The amount of evidence on the use of these approaches varies widely. A significant number of randomized controlled trials, including those with sufficient quantity and quality to allow meta-analyses in some areas, were done to assess the efficacy of acupuncture, botanical medicine, nutritional approaches, manual therapies, and mind–body medicine. Research in the other domains is much more limited. Many culturally based practices such as shamanism and curanderismo have virtually no research basis. A growing number of randomized controlled trials are being done in spiritual healing and homeopathy, but these techniques remain controversial based on the lack of understood biophysical mechanisms to justify their efficacy.
Integrative medicine is a distinct entity separate from the practice of CAM. Integrative medicine neither blindly advocates CAM nor rejects conventional medicine. Integrative medicine is healing oriented and patient centered and adopts a whole-person approach to the treatment of disease and the maintenance of health. It draws on the best practices of medicine, regardless of system of origin. Typically, integrative medicine would include, in addition to conventional medicine, CAM techniques that may be of benefit, including nutrition, movement and exercise, mind–body approaches, and spirituality. As the paradigm of conventional medicine broadens to include other therapeutic modalities that previously were considered “alternative,” and the focus of our system becomes more accepting of health optimization and disease management, we will see greater integration of these philosophies, approaches, and providers. The distinction of “complementary and alternative therapies” may ultimately no longer be useful, nor will integrative medicine. This approach, which is inclusive of effective philosophies and approaches that can improve the health and healing of women, will simply become the standard for U.S. health care.
The first national survey assessing the use of CAM in the United States was done in 1990. This study revealed that 34% of the 1,539 individuals who responded to the survey had used CAM in the previous 12 months and that most of these users were women. When extrapolated, these results suggested 425 million visits to alternative care providers occurred that year, which exceeded the number of visits to primary care providers in the same year (388 million visits). An estimated $13.7 million was spent, $10.3 million of which was spent out of pocket. This expenditure is comparable to the $12.8 billion spent out of pocket for all hospitalizations in the United States that same year. Only 28.5% of individuals disclosed this usage to their physician. Of note to conventional health care providers, 71.5% of individuals using these approaches did not inform their physicians of their use (2).