Mosby's Complementary Alternative Medicine: A Research-Based Approach

By Lyn W. Freeman; G. Frank Lawlis | Go to book overview

Foreword

Education in Alternative Medicine
and the Fall of the Bamboo Curtain
In late November 1997, a reporter from USA Today interviewed George Lundberg, MD, who was then editor of the Journal of the American Medical Association (JAMA). He was asked to comment on the burgeoning consumer use of complementary and alternative medicines (CAM).The interview took place only weeks before Lundberg's watershed, December 17, 1997, article in JAMA that announced within the year an entire volume of the American Medical Association's (AMA's) flagship journal, together with the AMA's extended family of peer-reviewed publications, would be devoted to scientific studies and editorial content on CAM. Henceforward, the AMA journals would be more open to CAM articles.The AMA's historic announcement was evidence-based. Consecutive year surveys of editors and advisors to AMA publications discovered a remarkable transformation in attitudes. In a period of only 12 months, the relative rating of CAM as a subject matter for publication in the journals rose from an obscure, bit player (68 of 73 topics) to star billing (in the top 3 among 86 topics).Lundberg, who would have known these as yet unannounced outcomes and of JAMA's editorial shift at the time of his USA Today interview, summed up the moment with a telling metaphor. He spoke of a "bamboo curtain" between alternative and conventional medicine, which he said was "beginning to splinter."The cold war image is rich in evoking the historic debate over the role of CAM in medicine in the United States. The phrase conjures restrictions on speech, barriers to the free flow of ideas, and fears of reprisal. Consider the need of mainstream providers with a personal interest in or use of CAM keeping this information to themselves or covertly delivering services.We know that behind such barriers—whether between couples, nations, or health care approaches—ignorance quickly fills with polarizing stories. Each party justifies his or her own place by building up one's positive characteristics and downplaying negative attributes. The party on the other side of the barrier receives the opposite treatment. In a polarized alternative versus conventional medical context, CAM providers are likely to focus on the adverse effects of pharmaceuticals and the over-performance of surgeries. They are less likely to honor the lifesaving qualities of these agents and procedures when appropriately applied. From conventional medicine's perspective, CAM is likely to be painted as "unscientific" without any reference to the limited evidence-based support for many mainstream practices.The "bamboo curtain" is indeed splintering.
Numerous studies of physicians find a majority supports the use of one or more CAM treatments.
Ten years ago, no more than a handful of medical schools offered any education in CAM; by 1997, 75 were doing so.
Currently, approximately two thirds of health maintenance organizations (HMOs) offer their membership some CAM.
Of employers offering nonchiropractic CAM in 1999, 50% began doing so in 1995.
In August 1999 the editorial board of a leading employee benefits periodical published its opinion that employers should "expect to see huge increases in both the credibility and the use of alternative medicine."
In August 1999 the American Hospital Association (AHA) kicked off a program to help educate the organization's member institutions on how to better offer CAM to AHA members.
Integrative clinics, in which CAM and conventional providers work side by side, are springing up inside health care systems across the United States.
At the federal level, direct research into CAM through the National Institutes of Health Center for Complementary and Alternative Medicine swelled to $50 million annually in 1999.

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