How does one classify complementary and alternative medicine (CAM)? It's a simple question, but the answer you get may well depend on who you ask.

Medical doctors, for instance, may classify CAM as anything that hasn't been scientifically proven by clinical trials. Legislators, meanwhile, may define CAM as any type of care not related to the practice of allopathic medicine. Insurance providers and managed care organizations may have their own unique definitions for what CAM entails, further clouding the waters of a field of care that already includes several separate and distinct therapies.

Perhaps the most important opinion as to what CAM is and does is that of the average consumer. The results of a recent study published in Complementary Therapies in Medicine suggest that lay people know exactly what complementary and alternative medicine is and believe they know how those therapies work, and that for the most part, they find CAM to be safe and effective.

In the study, nearly 600 participants (192 men, 387 women) from Great Britain completed a questionnaire that listed 39 different CAM therapies. Participants were asked to answer four questions related to each therapy:

1. Had they ever heard of the therapy?
2. Did they think they knew how it worked?
3. Had they ever tried the therapy themselves?
4. On a scale of 1-10 (10 being "very effective"), how effective did they believe the therapy to be?

In addition to answering those questions, participants provided details about their age, sex, marital status, and level of education.

Mixed Results for Acupuncture

On the positive side, acupuncture ranked as the most well-known of any therapy on the list; 97.2% of those surveyed said they had heard of it, followed by aromatherapy (95.5%) and herbal medicine (95.4%). Traditional Chinese medicine ranked 12th on the list, with 82.6% of respondents saying they had heard of it before.

Among those therapies that participants said they thought they knew how it worked, acupuncture finished second at 83.7%, less than half a percent behind massage. Herbal medicine ranked fifth at 74.3%.

Although acupuncture ranked at or near the top in terms of familiarity and the belief that people know how it works, a surprisingly low number of participants said they had actually tried it. Only 53 people - just over nine percent of those surveyed - wrote that they had tried acupuncture in the past. Similarly, only 62 people (10.5%) said they had tried traditional Chinese medicine. Nearly twice as many people (211) reported using herbal medicine as those who had tried acupuncture and TCM combined.

Those people who had tried acupuncture, however, considered it an effective form of care. It ranked fourth on a 10-point efficacy scale with a rating of 6.30, just behind massage, relaxation and counseling. Herbal medicine was ranked ninth (5.76), while traditional Chinese medicine finished 13th (5.24).

Table I: CAM therapy ratings.
Therapy	Heard of (Yes/No)	Works (Yes/No)	Tried (Yes/No)	Effectiveness(1-10, 10 being "very effective")
Acupuncture	513/11	493/57	53/516	6.30
Acupressure	326/255	262/197	45/455	5.00
Alexander technique	252/332	190/264	43/450	4.91
Aromatherapy	563/19	443/108	292/271	5.71
Art therapy	223/360	159/282	36/441	4.27
Autogenic training	29/551	23/260	4/426	2.87
Ayurveda	63/520	45/343	19/417	3.20
Bach flower remedies	191/391	119/302	81/382	3.91
Biochemical tissue salts	23/509	53/329	19/410	3.45
Biorhythms	285/296	137/311	30/451	3.54
Chiropractic	431/150	313/182	87/440	5.83
Chelation and cell therapy	64/517	41/340	2/435	3.18
Colonic irrigation	428/158	276/219	19/513	4.42
Color therapy	254/327	152/280	34/437	3.60
Crystal and gem therapy	269/312	116/332	32/447	2.95
Dance movement therapy	266/320	194/249	44/440	4.40
Healing	465/105	276/219	87/432	4.86
Herbal medicine	562/22	438/109	211/346	5.76
Homeopathy	506/74	71/162	164/392	5.64
Hypnosis	559/21	418/126	103/461	5.71
Magnetic therapy	165/419	80/337	18/447	3.57
Massage	552/33	495/46	360/195	7.04
Meditation	545/40	429/100	193/357	6.05
Music therapy	324/460	241/224	76/422	5.07
Naturopathy	100/484	61/245	19/427	3.46
Nutritional therapy	252/233	205/236	54/418	5.10
Osteopathy	423/161	309/180	86/419	5.83
Ozone therapy	43/539	24/362	7/426	2.82
Reiki	100/482	60/335	25/411	3.26
Reflexology	512/73	360/167	137/408	5.59
Relaxation	540/39	460/78	297/249	6.42
Shiatsu	325/255	183/255	49/247	4.62
Spiritual healing	450/105	228/263	67/446	4.45
Talk therapies and counseling	195/88	416/114	162/378	6.31
Traditional Chinese medicine	487/96	289/217	62/472	5.24
Therapeutic touch	200/383	108/313	18/440	3.69
Visualization	184/400	122/298	55/405	3.99
Voice and sound therapy	150/432	82/332	19/430	3.62
Yoga	559/23	430/113	183/381	6.17

Two clear findings were noted in the study. The first showed that while each of the therapies was rated on four different scales, there tended to be a high intercorrelation between each rating. The more people had heard of a therapy, for instance, the more likely they were to have tried it. In fact, of the ten therapies people had heard of most, nine of them also ranked in the top ten in terms of being tried.

"It seems quite clear that these different ratings are related," wrote Professor Adrian Furhnam, the study's author. "People are most likely to try those therapies they have heard of that they believe work."

The major exception to this rule, surprisingly, was acupuncture. Only 9.2% of those surveyed had ever tried it, ranking below such arcane forms of care as visualization (12%) and Bach flower remedies (17.5%).

Why the disparity between acupuncture and other forms of care? Although the paper didn't discuss the reasons behind such low use, geography may have played a factor (the population base hailed from the southeast of England, an area which may suffer from a lack of qualified acupuncture practitioners). Gender and education may also have played a role (more than twice as many women as men took the survey, and a third of the survey participants had no formal education beyond a school-leaving certificate).

Despite these factors, the survey produced another important finding: a pattern that provided some information about the average person's thoughts toward complementary therapies.

"It seems as if lay peoples' perception of CAM therapies is as much a function of knowledge based on media interest as their understanding of the philosophy or method underlying these therapies," wrote Furnham. "Experts tend to classify CAM therapies into structural, biomechanical or 'psychological' while lay people seem equally happy to classify them in terms primarily of familiarity and perceived effectiveness.

"Clearly, these results have implications for the education of lay people about CAM therapies," Furnham concluded. They also suggested that further studies be conducted, and that "more qualitative methods may be used to get a better insight into lay peoples' understanding of the nature of these therapies and the mechanisms and processes underlying them."

Reference

• Furnham A. How the public classify complementary medicine: a factor analytic study. Complementary Therapies in Medicine 2000(8):82-87.

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