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Medicine, once the domain of solitary generalists and their nurse assistants, now engages scores of specialists and allied professionals—radiation physicists, cytologists, nurse practitioners, psychiatric social workers, dental hygienists, and many more—who wield tools of unprecedented ability to extend life and sustain its quality. This evolution of the health care system has been achieved in part by a formidable enterprise of critical observation and formal investigation that disproves some accepted practices and stimulates the emergence of new approaches. One need only peruse the serial editions of this textbook to comprehend the scope of these changes.

Other factors also have affected evolutionary changes in medicine. The U.S. health care system has always been pluralistic, including many practices that are outside mainstream medicine. The public's expectations of health and the nature of the health care system have been altered by unprecedented access to sources of information, goods, and services; the disposable income to afford them; and a patchwork quilt of regulations and laws that constrain medical practice on the one hand and facilitate increased choice in health care on the other. Immigration and related demographic changes have created diverse communities that value their own health traditions. The emergence of complementary and alternative health practices and the approach called integrative medicine are manifestations of these changes in health care.

Complementary and alternative medicine (CAM) refers to a group of diverse medical and health care systems, practices, and products that are not considered part of conventional or allopathic medicine or that have historic origins outside mainstream medicine. Most of these practices are used together with conventional therapies and therefore have been called complementary to distinguish them from alternative practices, which are those used instead of standard care. Use of dietary supplements, mind-body practices such as hypnosis, and care from a traditional healer all fall under the umbrella of CAM. Although some CAM practices are directed by an alternative health care provider such as a chiropractor, acupuncturist, or naturopathic practitioner, much of CAM is undertaken as "self-care" and paid for out of pocket. CAM does not encompass practices that have not been translated fully from the laboratory to the clinic or practices that have been well studied and disproved but still have some public appeal. Rather, CAM entails approaches with surprising pervasiveness, many of which can claim at least some evidentiary support. Until a few years ago, CAM also could be defined as practices that are neither widely taught in medical schools nor reimbursed, but this definition is no longer useful, since medical students increasingly seek and receive some instruction about CAM and some CAM practices are reimbursed by third-party payers. Definitions of common CAM practices are provided in Table e2-1.

Table e2-1 Terminology of Complementary and Alternative Medical Practices

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