What is CAM and what does it mean for my child?
CAM is an acronym for complimentary alternative medicine. The arm of the National Institute of Health (NIH) dedicated to providing information on CAM therapeutic options, and evidence for efficacy defines CAM as a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. Conventional medicine is medicine as practiced by holders of M.D., D.O. degrees and by other allied health professionals, such as physical therapists, physician assistants, registered dieticians, psychologists, and registered nurses.
As the US health system migrates from an episodic care based model to a patient centered continuous care model among other changes in the offing, this crisp distinction between CAM and conventional medicine is certain to evolve.The 2007 National Health Interview Survey (NHIS), which included a comprehensive survey of CAM use by Americans, showed that approximately 38 percent of adults use CAM. As a practicing fellow of the American Academy of Pediatrics, this means at least 1:3 of the patients in my care may be using forms of CAM alongside conventional therapies with their parents or may elect to adopt it wholly (Alternative medicine) now or later.
Is CAM bad for my child?
Frankly any judgment on CAM is outside the realm of expertise of graduates of allopathic or osteopathic schools of medicine. The emphasis rather should be to equip the population with adequate information for informed decision-making. All care providers owe it to their patients to use the best of scientific evidence based health care practices whenever appropriate and to provide compassion and sensitivity to the patient's cultural, spiritual and emotional needs. Numerous CAM therapies are widely available to the public. Some of these CAM therapies maybe effective, there isn’t enough body of evidence in the medical literature to support efficacy of all CAM therapeutic options and more research is needed. This is where the quasi- caveat emptor and caveat venditor principle applies. There have been concerns about the safety of some CAM therapies, as reported in a small study from Australia in 2010 published in the Archives of Diseases in Children and Adolescents though the pedigree of controlled clinical trials required to evaluate the safety profiles of these CAM therapies are lacking in this study and the vast majority of others published to date.
CAM therapies have been broadly classified into (1) mind-body medicine, (2) biologically based therapies, (3) manipulative and body-based methods, (4) alternative medical systems, and (5) energy therapies. Biofeedback, Acupuncture, Music therapy, Animal therapy, and guided imagery are some of the popular CAM options commonly seen in pediatric centers and hospitals today.
Biologically based CAM therapies especially herbal therapies are especially common in my experience. They are classified as dietary supplements and outside the jurisdiction of the FDA sparing them the scrutiny of documented safety, efficacy and a profile of adverse effects before being made available for public consumption unlike conventional medications. This lack of regulation, purification and standardization presents unique challenges for the practicing pediatrician, since similarly labeled products from different manufactures may differ significantly in ingredient content and potency. This is especially concerning when pharmaceutically active ingredients like St John’s wort, melatonin etc. are involved. Heavy metal poisoning with lead after ingesting “tea” brewed specially at home for asthma in pottery imported from northern Africa led to significantly higher levels of lead in a patient in my care some years ago. Exposure to heavy metals like lead and arsenic is a key concern with use of some biologically based CAM therapies imported from Asia. Certain cosmetic products while not strictly form of CAM but when imported from exotic places may pose similar risks from absorption of heavy metals through the skin with attendant health effects.
Credible sources as the National Center for Complementary and Alternative Medicine (www.nccam.nih.gov), the natural standard (www.naturalstandard.com) and discussing all treatment options being considered with your physician go a long way in safe guarding desired healthy outcomes. Our goal as aptly stated by Dr. Edward Trudeau in the 1800’s remains, “To cure sometimes, to relieve often, to comfort always”.