Statement of Purpose
Social Science Studies of CAM and IM
The Complementary and Alternative Medicine (CAM) and Integrative Medicine (IM) special interest group of the Society for Medical Anthropology (SMA) was organized to encourage the anthropological study of CAM and IM as emergent socio-medical phenomena having global ramifications in the 21st century. Members of this special interest group recognize that CAM/IM is a contemporary example of medical pluralism, influenced by processes of globalization and hybridization, scientization and commodification. CAM/IM is a global phenomenon and needs to be studied as such.
CAM and IM are forms of “Cosmopolitan Medicine” (Leslie 1976, 1980) that demand examination in relation to social, cultural, political economic and biotechnological forces as well as intensified flows of people, information and products that characterize globalization. In addressing this special interest groups’ scope of interest, it is useful to contextualize the study of CAM and IM within more general ethnomedical inquiry.
Ethnomedicine broadly encompasses the study of medical pluralism and healing traditions (“systems”) as conceptualized and practiced at distinct points in history and in particular geographical, social, cultural, and political economic contexts (Nichter 1992). The broad study of ethnomedicine encompasses the study of comparative medical systems, popular health culture, and folk illnesses (and so on) and is of longstanding interest to medical anthropologists, and the focus of such professional working groups as Curae and IASTAM.
The frequent focal point of studies of CAM and IM is its development as an area of clinical practice in conjunction with biomedicine. Social science studies of CAM and IM capitalize on aspects of complex medical systems in the U.S. and elsewhere, namely that we have within one cosmopolitan culture, the opportunity to comparatively study competing “systems” of medicine treating the same populations and thus learn more about how healing works, and how medical systems work in general.
Examples of subjects relevant to our special interest group include:
- Discourse about what defines CAM and Integrated Medicine; when and how the terms are used and by whom; who gets to determine the authenticity and legitimacy of CAM practices
- How CAM efficacy and effectiveness is evaluated, by what parameters, and for what purposes
- What factors have contributed to the emergence and evolution of CAM/IM practice in various social and cultural contexts.1
- How have practitioners of indigenous medical systems responded to the appropriation and hybridization of healing resources (bio-prospecting) by CAM/IM practitioners
- How and why different populations use CAM modalities alone and in combination with biomedicine for both health promotion and curative purposes;
- How knowledge about CAM is acquired and distributed
- How patients respond to CAM options when they are offered to them by IM practitioners
- How the increasing popularity of CAM and IM has influenced popular perceptions of health and illness.
- What are the most appropriate methods and research designs for studying CAM/IM related issues ranging from CAM/IM practices to policy, the production and marketing of products as CAM (such as dietary supplements) to the study of CAM effectiveness.
Definitions found in the literature on CAM and IM
Eisenberg, D. 2003. “Complementary and Integrative Medical Therapies: Current Status and Future Trends”. In Exploring Complementary and Alternative Medicine, pp 1-15. National Academies Press.
“Complementary”, “Alternative”, and “Integrative” Medical Approaches
Complementary and alternative medical (CAM) therapies encompass a broad spectrum of practices and beliefs (1). From an historical standpoint, they may be defined “… as practices that are not accepted as correct, proper, or appropriate or are not in conformity with the beliefs or standards of the dominant group of medical practitioners in a society” (2). From a functional standpoint, complementary (a.k.a.”alternative”) therapies may be defined as interventions neither taught widely in medical schools nor generally available in hospitals (3). Ernst et al. contend that “complementary” medical techniques “[complement] mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy or by diversifying the conceptual frameworks of medicine” (4). The terminology currently in use to describe these practices remains controversial. Many commonly used labels (e.g., “alternative,” “unconventional,” “unproven”) are judgmental and may inhibit the collaborative inquiry and discourse necessary to distinguish useful from useless techniques (5). “Complementary and Alternative Medicine” (CAM) is the language currently used by the NIH and U.S. federal agencies to describe this field of inquiry. The NIH National Center for Complementary and Integrative Health (NCCIH) defines CAM as, “Healthcare practices outside the realm of conventional medicine, which are yet to be validated using scientific methods.” Two articles by Kaptchuk et al, explore the taxonomy of CAM therapies in the context of medical pluralism (6;7).
refers to ongoing efforts to combine the best of conventional and evidence-based complementary therapies while emphasizing the primacy of the patient-provider relationship and the importance of patient participation in health promotion, disease prevention and medical management. “It (integrative medicine) views patients as whole people with minds and spirits as well as bodies and includes these dimensions into diagnosis and treatment” (8). In the January 2001 British Medical Journal edition devoted entirely to Integrated Medicine, the Journal’s editor, Richard Smith, wrote: “It mightn’t be too pretentious (although it might) to say that such a growth (of integrative medicine) might restore the soul to medicine – the soul being that part of us that is the most important but the least easy to delineate” (9). A variety of articles and editorials have wrestled with the challenges of properly labeling and describing this field of inquiry (8;10-22).
(1) Murray RH, Rubel AJ. Physicians and healers–unwitting partners in health care [see comments]. N Engl J Med. 1992;326:61-64.
(2) Gevitz N. Other Healers: Unorthodox Medicine in America. Baltimore: Johns Hopkins University Press; 1988.
(3) Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States. Prevalence, costs, and patterns of use. N Engl J Med. 1993;328:246-52.
(4) Ernst E, Resch KL, Mills S, et al. Complementary medicine – a definition. Br J Gen Pract. 1995;45:506.
(5) Eisenberg DM, Delbanco TL, Kessler RC. Letter to the editor. N Engl J Med. 1993;329:1203.
(6) Kaptchuk, TJ and Eisenberg, DM. Varieties of healing: 1. Medical pluralism in the United States. Ann Intern Med 135(3), 189-195. 2001.
Ref Type: Journal (Full)
(7) Kaptchuk, TJ and Eisenberg DM. Varieties of healing: 2: A taxonomy of unconventional healing practices. Ann Intern Med 135(3), 196-204. 2001.
Ref Type: Journal (Full)
(8) Weil A, et al. Integrated medicine. BMJ. 2001;322:119-20.
(9) Smith R. Editor’s choice: Restoring the soul of medicine. BMJ. 2001;322:117.
(10) Kaptchuk TJ, Eisenberg DM. The persuasive appeal of alternative medicine. Ann Intern Med. 1998;129:1061-65.
(11) Complementary medicine: time for critical engagement. Lancet. 2000;356:2023.
(12) Fontanarosa PB, Lundberg GD. Alternative medicine meets science. JAMA. 1998;280:1618-19.
(13) Jonas WB. Alternative medicine–learning from the past, examining the present, advancing to the future [editorial] [In Process Citation]. JAMA. 1998;280:1616-18.
(14) Angell M, Kassirer JP. Alternative medicine–the risks of untested and unregulated remedies [editorial; comment]. N Engl J Med. 1998;339:839-41.
(15) Davidoff F. Weighing the alternatives: lessons from the paradoxes of alternative medicine. Ann Intern Med. 1998;129:1068-70.
(16) Dalen JE. “Conventional” and “unconventional” medicine. Can they be integrated? Arch Intern Med. 1998;158:2179-81.
(17) Maizes V, Schneider C, Bell I, Weil A. Integrative Medical Education: Development and Implementation of a Comprehensive Curriculum at the University of Arizona. Academic Medicine. 2002;77:851-60.
(18) Gaudet TW, Snyderman R. Integrative Medicine and the Search for the Best Practice of Medicine. Academic Medicine. 2002;77:861-63.
(19) Astin J. Complementary and Alternative Medicine and the Need for Evidence-based Criticism. Academic Medicine. 2002;77:864-68.
(20) Brokaw JJ, Tunnicliff G, Raess BU, Saxon DW. The Teaching of Complementary and Alternative Medicine in U.S. Medical Schools: A Survey of Course Directors. Academic Medicine. 2002;77:876-81.
(21) Kemper KJ, Amata-Kynvi A, Sanghavi D, Whelan JS, Dvorkin L, Woolf A et al. Randomized Trial of an Internet Curriculum on Herbs and Other Dietary Supplements for Health Care Professionals. Academic Medicine. 2002;77:882-89.
(22) Konefal J. The Challenge of Educating Physicians about Complementary and Alternative Medicine. Academic Medicine. 2002;77:847-50.
For a definition of CAM which adopts the vantage point of the patient see:
Opher Caspi, Lee Sechrest, Iris Bell, Carter Marshall, Howard Pitluk, and Mark Nichter On The Definition of Complementary, Alternative, and Integrative Medicine: Societal Mega-Stereotypes vs. The Patients’ Perspectives” Alternative Therapies in Health and Medicine 9(6):58–62. 2003.