A lack of consistency in the definition of what is included in CAM is found throughout the literature. The National Center for Complementary and Alternative Medicine (NCCAM) of NIH defines CAM as “a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine” (NCCAM, 2002). However, many would argue that a therapy does not cease to be a CAM therapy because it has been proven to be safe and effective and is used in conventional practice. “Simply because an herbal remedy comes to be used by physicians does not mean that herbalists cease to practice, or that the practice of the one becomes like that of the other” (Hufford, 2002:29).

Descriptive definitions of CAM include one by Ernst et al. (1995), who write that CAM is a “diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, satisfying a demand not met by orthodox, or diversifying the conceptual framework of medicine.” Gevitz (1988) proposes that CAM includes “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.” In 1993, Eisenberg et al. defined CAM as “interventions neither taught widely in medical schools nor generally available in hospitals.”

Kopelman (2002) argues that descriptive definitions such as those offered by Ernst et al. and Gevitz do not adequately answer the question, What is CAM? Definitions that place CAM outside the politically dominant health care system fail “to offer a standard for differentiating conventional interventions and CAM other than by appealing to what is or is not intrinsic to the practices of the dominant culture. This assumes there is a reliable and useful way to count cultures or subcultures and sort them into those that are dominant and those that are not” (Kopelman, 2002). Other descriptive definitions fail because conditions change, and therefore, descriptions of the conditions are no longer accurate. For example, look at the definition of Eisenberg and colleagues (1993), which states that CAM comprises inteventions that are neither taught widely in medical schools nor generally available in hospitals; however, more than half of all U.S. medical schools provide education about CAM, health care institutions are offering CAM services, and the numbers of insurers offering reimbursement for CAM therapies is growing (see Chapters 7 and 8).

According to Kopelman, normative definitions (e.g., untested or unscientific) also fail to distinguish CAM from conventional medicine. For example, Angell and Kassier (1998) write “there is only medicine that has been adequately tested and medicine that has not.” However such a definition does not distinguish between conventional medicine and CAM because many conventional treatments have not been supported by rigorous testing. For example, a review of 160 Cochrane systematic reviews of the effectiveness of conventional biomedical procedures found that 20 percent showed



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