How does one classify complementary and alternative medicine (CAM)? It's a simple question, but the answer you get may well depend on who you ask. Medical doctors, for instance, may classify CAM as anything that hasn't been scientifically proven by clinical trials. Legislators, meanwhile, may define CAM as any type of care not related to the practice of allopathic medicine. Insurance providers and managed care organizations may have their own unique definitions for what CAM entails, further clouding the waters of a field of care that already includes several separate and distinct therapies.
Perhaps the most important opinion as to what CAM is and does is that of the average consumer. The results of a recent study published in Complementary Therapies in Medicine suggest that lay people know exactly what complementary and alternative medicine is and believe they know how those therapies work, and that for the most part, they find CAM to be safe and effective.
In the study, nearly 600 participants (192 men, 387 women) from Great Britain completed a questionnaire that listed 39 different CAM therapies. Participants were asked to answer four questions related to each therapy:
- Had they ever heard of the therapy?
- Did they think they knew how it worked?
- Had they ever tried the therapy themselves?
- On a scale of 1-10 (10 being "very effective"), how effective did they believe the therapy to be?
In addition to answering those questions, participants provided details about their age, sex, marital status, and level of education.
Mixed Results for Acupuncture
On the positive side, acupuncture ranked as the most well-known of any therapy on the list; 97.2% of those surveyed said they had heard of it, followed by aromatherapy (95.5%) and herbal medicine (95.4%). Traditional Chinese medicine ranked 12th on the list, with 82.6% of respondents saying they had heard of it before.
Among those therapies that participants said they thought they knew how it worked, acupuncture finished second at 83.7%, less than half a percent behind massage. Herbal medicine ranked fifth at 74.3%.
Although acupuncture ranked at or near the top in terms of familiarity and the belief that people know how it works, a surprisingly low number of participants said they had actually tried it. Only 53 people - just over nine percent of those surveyed - wrote that they had tried acupuncture in the past. Similarly, only 62 people (10.5%) said they had tried traditional Chinese medicine. Nearly twice as many people (211) reported using herbal medicine as those who had tried acupuncture and TCM combined.
Those people who had tried acupuncture, however, considered it an effective form of care. It ranked fourth on a 10-point efficacy scale with a rating of 6.30, just behind massage, relaxation and counseling. Herbal medicine was ranked ninth (5.76), while traditional Chinese medicine finished 13th (5.24).
| Table I: CAM therapy ratings. |
| Therapy | Heard of (Yes/No) | Works (Yes/No) | Tried (Yes/No) | Effectiveness(1-10, 10 being "very effective") |
| Acupuncture | 513/11 | 493/57 | 53/516 | 6.30 |
| Acupressure | 326/255 | 262/197 | 45/455 | 5.00 |
Alexander technique
| 252/332 | 190/264 | 43/450 | 4.91 |
| Aromatherapy | 563/19 | 443/108 | 292/271 | 5.71 |
| Art therapy | 223/360 | 159/282 | 36/441 | 4.27 |
| Autogenic training | 29/551 | 23/260 | 4/426 | 2.87 |
| Ayurveda | 63/520 | 45/343 | 19/417 | 3.20 |
| Bach flower remedies | 191/391 | 119/302 | 81/382 | 3.91 |
| Biochemical tissue salts | 23/509 | 53/329 | 19/410 | 3.45 |
| Biorhythms | 285/296 | 137/311 | 30/451 | 3.54 |
| Chiropractic | 431/150 | 313/182 | 87/440 | 5.83 |
| Chelation and cell therapy | 64/517 | 41/340 | 2/435 | 3.18 |
| Colonic irrigation | 428/158 | 276/219 | 19/513 | 4.42 |
| Color therapy | 254/327 | 152/280 | 34/437 | 3.60 |
| Crystal and gem therapy | 269/312 | 116/332 | 32/447 | 2.95 |
| Dance movement therapy | 266/320 | 194/249 | 44/440 | 4.40 |
| Healing | 465/105 | 276/219 | 87/432 | 4.86 |
| Herbal medicine | 562/22 | 438/109 | 211/346 | 5.76 |
| Homeopathy | 506/74 | 71/162 | 164/392 | 5.64 |
| Hypnosis | 559/21 | 418/126 | 103/461 | 5.71 |
| Magnetic therapy | 165/419 | 80/337 | 18/447 | 3.57 |
| Massage | 552/33 | 495/46 | 360/195 | 7.04 |
| Meditation | 545/40 | 429/100 | 193/357 | 6.05 |
| Music therapy | 324/460 | 241/224 | 76/422 | 5.07 |
| Naturopathy | 100/484 | 61/245 | 19/427 | 3.46 |
| Nutritional therapy | 252/233 | 205/236 | 54/418 | 5.10 |
| Osteopathy | 423/161 | 309/180 | 86/419 | 5.83 |
| Ozone therapy | 43/539 | 24/362 | 7/426 | 2.82 |
| Reiki | 100/482 | 60/335 | 25/411 | 3.26 |
| Reflexology | 512/73 | 360/167 | 137/408 | 5.59 |
| Relaxation | 540/39 | 460/78 | 297/249 | 6.42 |
| Shiatsu | 325/255 | 183/255 | 49/247 | 4.62 |
| Spiritual healing | 450/105 | 228/263 | 67/446 | 4.45 |
| Talk therapies and counseling | 195/88 | 416/114 | 162/378 | 6.31 |
| Traditional Chinese medicine | 487/96 | 289/217 | 62/472 | 5.24 |
| Therapeutic touch | 200/383 | 108/313 | 18/440 | 3.69 |
| Visualization | 184/400 | 122/298 | 55/405 | 3.99 |
| Voice and sound therapy | 150/432 | 82/332 | 19/430 | 3.62 |
| Yoga | 559/23 | 430/113 | 183/381 | 6.17 |
Two clear findings were noted in the study. The first showed that while each of the therapies was rated on four different scales, there tended to be a high intercorrelation between each rating. The more people had heard of a therapy, for instance, the more likely they were to have tried it. In fact, of the ten therapies people had heard of most, nine of them also ranked in the top ten in terms of being tried.
"It seems quite clear that these different ratings are related," wrote Professor Adrian Furhnam, the study's author. "People are most likely to try those therapies they have heard of that they believe work."
The major exception to this rule, surprisingly, was acupuncture. Only 9.2% of those surveyed had ever tried it, ranking below such arcane forms of care as visualization (12%) and Bach flower remedies (17.5%).
Why the disparity between acupuncture and other forms of care? Although the paper didn't discuss the reasons behind such low use, geography may have played a factor (the population base hailed from the southeast of England, an area which may suffer from a lack of qualified acupuncture practitioners). Gender and education may also have played a role (more than twice as many women as men took the survey, and a third of the survey participants had no formal education beyond a school-leaving certificate).
Despite these factors, the survey produced another important finding: a pattern that provided some information about the average person's thoughts toward complementary therapies.
"It seems as if lay peoples' perception of CAM therapies is as much a function of knowledge based on media interest as their understanding of the philosophy or method underlying these therapies," wrote Furnham. "Experts tend to classify CAM therapies into structural, biomechanical or 'psychological' while lay people seem equally happy to classify them in terms primarily of familiarity and perceived effectiveness.
"Clearly, these results have implications for the education of lay people about CAM therapies," Furnham concluded. They also suggested that further studies be conducted, and that "more qualitative methods may be used to get a better insight into lay peoples' understanding of the nature of these therapies and the mechanisms and processes underlying them."
Reference
- Furnham A. How the public classify complementary medicine: a factor analytic study. Complementary Therapies in Medicine 2000(8):82-87.
