Blending the boundaries: steps toward an integration of complementary and alternative medicine into mainstream practice.

Complementary and alternative medicine (CAM) is growing in popularity among patients traditionally seen in an allopathic setting. A literature review and information search was conducted to determine the trend in demand for and the availability of CAM in the United States. The results of major surveys show that there is an increase in the use of CAM in the United States. The best predictor of CAM use is higher level of education. In addition, findings reveal that the field of CAM is poorly researched. Many studies in CAM therapies have flaws, such as insufficient statistical power, poor controls, inconsistent treatment, and lack of comparisons. The National Center for Complementary and Alternative Medicine of the National Institutes of Health, has declared their top strategic priority to be investing in research. Currently, more than 70 medical schools offer some type of training in alternative medicine, although there are few guidelines for curriculum and there is considerable heterogeneity in content, format, and requirements among CAM courses. As patients have greater access to information, their needs and values change. They become more involved in their overall health care and are taking a more natural and holistic approach to achieving well-being. Health care practitioners, both allopathic and alternative, must be well informed. There is an imperative to make CAM research a high priority. Valid and reliable empirical data must document the clinical efficacy and safety of CAM practices. In order to integrate CAM into the mainstream, there must be a coordinated effort among all the entities involved. Physicians need to be familiar with proven CAM therapies in order to advise patients about these modalities and the potential benefits and limitations. CAM practitioners should be licensed and regulated in scope of practice to provide a high standard of care, and be sufficiently educated in conventional medical science(s) in order to recognize how, where, and why their respective complementary practice is most effective for integration.