Complementary and Alternative Medicine and the Role of Health Education: A Reaction to Johnson et Al, and Nowak and Dorman

Johnson et al. (1) and Nowak and Dorman (2) make a significant contribution to the complementary and alternative medicine (CAM) literature. As noted in both papers, there is little published on the subject in relationship to the role of health education. This brief discusses the three findings common to both papers, including the definition of and attitudes regarding CAM, the type of individuals in the U.S. who engage in CAM treatments or therapies, and the role of health education related to CAM. It also suggests some future roles for health educators. First, a history of the term CAM is in order. Prior to 1998, terms such as "folk medicine," "home remedies," and "traditional medicine" were used. The first federal funding for CAM was approved in October 1991. Public Law 102-170 provided $2 million to the National Institutes of Health (NIH) to establish an office and advisory panel to research programs that would investigate promising but unconventional medical practices. This action was followed by Public Law 103-43, the National Institutes of Health Revitalization Act of 1993, which established the Office of Alternative Medicine (OAM) within the Office of the Director of NIH. Its purpose was to facilitate the evaluation of alternative medicine treatment and to disseminate information to the public through an information clearinghouse. And in October 1998, the Omnibus Consolidated and Emergency Supplemental Appropriations Act (Public Law 105-277) elevated the status of the OAM by authorizing the establishment of the National Commission of Complementary and Alternative Medicine (NCCAM) under the NIH. The term CAM was thereby recognized. (3) Nowak and Dorman reported from the student respondents' perspective that CAM is generally misunderstood and used primarily as a way to enhance personal appearance and/or performance. The students preferred self-directed CAM approaches, such as exercise, dietary supplements, or vitamins. A similar 2002 NCCAM survey of Americans revealed that only 14.8% of adults sought care from licensed or certified CAM practitioners; most individuals using CAM preferred to treat themselves. (2) When added to the analysis, prayer was the most popular CAM strategy for both students and national survey respondents. Even though the NCCAM list of common therapies does not include prayer, there remains confusion as to whether prayer should be included in CAM survey choices. The respondents had misunderstandings about CAM. Although CAM is no longer labeled quackery, Nowak and Dorman (2(p.83)) reported the continued use of the word: "thirty-one percent of respondents believed alternative therapists are quacks, while over a quarter believed most alternative therapies do not work" Although Johnson et al. (1(p.75)) did not report any use of the word quackery, they confirmed CAM misunderstandings--health educators were familiar "with the common CAM therapies, such as massage therapy, chiropractic, and dietary supplements, but were unfamiliar with the less widely used therapies, including Ayurveda, osteopathy, Qi Gong, and Reiki." These findings confirm the relationship between lack of CAM knowledge and misconceptions. Second, from a global perspective and regardless of the term used, CAM has been practiced for centuries by individuals seeking ways to ease their undesirable health symptoms. In addition, many individuals have used folk medicine due to lack of income or lack of access to medical care; but in the U.S., the use of CAM increases as educational attainment increases. Most such individuals use CAM to treat musculoskeletal conditions associated with chronic or recurring pain. (4) Although Johnson et al. (1) did not seek respondents' personal experience with CAM, findings revealed that CAM knowledge was influenced by gender, education level, ethnicity, and employment setting. Nowak and Dorman (2) reported that the majority of students responding were white and female. The national NCCAM survey reported that women were more likely than men to use CAM, (4) which may be the reason why women were more interested in completing the student survey. …