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Goldstein describes how the prior personal experiences—political, physical, and emotional—of individual physicians were instrumental in the introduction of complementary and integrative medicine into medical school facilities and curricula. He applies parallel arguments to past research on patient‐driven movements, which has emphasized the effects of personal experiences on involvement and leadership for those at risk for or affected by a particular condition or disease in the study of professionally driven movements. From eight of the medical schools currently belonging to the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM), fourteen individuals, including five deans and nine other integrative medicine advocates, attended a key organizational meeting during the summer of 1999. Goldstein interviews a number of these participants about the extent to which attendees conceptualized their actions at the time of the meeting as part of a social movement and the degree to which personal experiences of participants were significant factors in their participation. The chapter findings indicate that most participants were conscious of being part of a social movement and recalled this as quite important. Additionally, many respondents reported self‐perceptions as “wounded healers” and saw movement participation as a means to address this status.

The use of unproven therapies or complementary and alternative medicine (CAM) continues to evoke strong debate and diverse views within the medical community. Many doctors are concerned about the lack of scientifically credible research to support the claims of CAM proponents. However, a large and growing number of cancer patients use CAM. Evidence indicates that clinicians neglect to appropriately discuss issues surrounding CAM use with their patients. Improving CAM-related communication between clinicians and cancer patients has been widely advocated by researchers, medical practitioners, CAM practitioners, and patients. Assisting clinicians to initiate and engage patients in discussions about CAM is an essential contribution to improving health-related communication. This chapter presents a definition of CAM, explores the rationale supporting the need to improve communication about CAM, and considers evidence-based guidelines about how to discuss CAM in a conventional oncology setting. The practical application of the guidelines is then described through the development and implementation of a communication skills workshop for training health professionals.

This chapter examines the rise of postmodernism in the second half of the twentieth century and the epistemological challenges it forced upon the core values of scientific positivism. Postmodernism viewed objectivity as an illusion, a set of images or metanarratives that fragmented both reason and meaning. Applied to medicine, it questioned the “truth” of the physician's reductionist account of illness, including those conclusions drawn from evidence-based medicine (EBM). It also revolted against patient objectification, inferring that the “truth” of an illness is no longer in the physician's objectivist and biomedical account, but in the patient's narrative. This resulted in the rise of complementary and alternative medicine (CAM), a more intuitive and individualized approach to medicine. This new representation of illness involves social, psychological, and cultural components; innovative new discourses on pain, suffering, and empathy; and perceived limitations of the dominant biochemical model.

Cancer progression is not affected by placebo treatments; however symptoms can be reduced by placebos. Nocebo effects are crucially involved in anticipatory nausea and vomiting before a cancer chemotherapy session, with a basic mechanism of classical conditioning. In sports medicine, physical performance in sports activities is boosted by placebos and this poses some important ethical questions about doping. Placebo surgery may induce improvement as well. However, surgical clinical trials with placebos raise many ethical questions. Some alternative and complementary therapies, like acupuncture, have both a specific effect and a big placebo component. It is also important to realize that placebo and placebo-related effects represent a good model for the better understanding of the mechanisms underlying the patient-provider interaction.

This chapter presents case studies to illustrate the desired skills, attitudes, and knowledge required to develop proficiency in discussing and advising patients about using complementary and alternative medicine (CAM). It addresses a number of questions such as: What non-pharmacological therapies are available for symptom control in the palliative patient? Why do cancer patients use complementary and alternative therapies? Where do patients get information about CAM? Are there any concerns about natural health products interacting with prescription medications? What is the proposed biological mechanism of action for acupuncture in pain relief?

Buddhists in the United States fall into two main camps: ethnic Asians, for whom Buddhism represents the primary religious component of their cultural heritage, and non-Asian converts to Buddhism. These two broad groupings manifest significant differences in their perspectives and practice of complementary and alternative medicine (CAM), with important implications for the American health care system. This chapter focuses primarily on selected CAM practices among US Buddhists under the general heading of folk healing, which includes behaviors often identified with popular religion or folk religiosity. Two kinds of folk healing are discussed: herbalism and appeal to spiritual or supramundane healing forces. Supramundane healing forces could be classified under several CAM designations, such as mental and spiritual healing (healing power from the mind or divine sources); nonlocality (unmediated healing at a distance); biofield medicine (use of energy fields in or around the body); and even the placebo response in certain cases (healing effected through a patient's belief in the treatment). This chapter also considers the practice of Buddhist meditation.

Following a front-page story in the New York Times in 1972 by James Reston about his experiences with acupuncture in a Chinese hospital, virtually every article on complementary and alternative medicine (CAM) in United States media has featured this modality as CAM's poster child, with the patient presented as a wide-eyed face bristling with needles. To a lesser degree, Chinese herbs have made the news as well. This chapter examines constructions of race in the United States; the ways that Chinese healing practices interface with issues of religious identity and expression for Chinese American practitioners; tensions between conversion and appropriation, particularly as both pertain to European American practitioners; and a different aspect of acculturation, the phenomenon of medicalization. These issues are reviewed in relation to broader issues of cross-cultural transmission in the context of globalization.

This chapter identifies the differences that separate homeopathy from biomedicine. The tension between homeopathy and conventional medicine is essentially that of two epistemologically different systems; one whose view of disease causation begins at the metaphysical level, and the other whose view begins at the cellular level. Conventional medicine believes that the causation of disease begins at the cellular level, and follows a complex course whose outcomes must be carefully analyzed to separate out bias and chance. In contrast, homeopathy views disease causation as highly individualized, meaning different things in different settings. In many ways, homeopathy is the poster child of complementary and alternative medicine (CAM) in that it faces the dilemma of justifying itself as a faith-based system, a form of psychotherapy or chaplaincy, a paranormal system that will eventually be explained to the satisfaction of reductionist science, or simply the equivalent of the placebo effect.

In many parts of the developed world today, patients with cancer have access not only to standard medical and surgical care but also to a wide range of other therapies that are grounded in a more ‘holistic’ philosophy of health and healing. Complementary and alternative, holistic, integrative, natural, unorthodox, mind-body-spirit are some of the many names given to a large and varied group of therapies that have become popular in cancer care. Approaches include lifestyle modifications through diet and exercise; psychological and spiritual support for individuals and groups; creative expression through art and music; and a range of other therapies grouped under the umbrella term complementary and alternative medicine (CAM). In this introductory chapter, the philosophy of holistic healthcare is discussed along with the reasons for the increased acceptance and popularity of these therapies, the attitudes of nurses and other professionals in oncology toward CAM, unwanted effects and limitations of the therapies, and some aspects of service delivery.

The task of navigating the maze of potential complementary and alternative medicine (CAM) treatments and integrating CAM into a personal cancer care plan is often complex, time-consuming, and stressful. It can also be empowering, health enhancing, and life transforming. A trusted and wise guide can provide valuable support for people along this journey. There are many facets to the role of a guide, depending on the individuals concerned and their circumstances. These might include helping them decide what they want from CAM, finding the right therapy and therapist, evaluating CAM interventions, preventing adverse effects, and co-ordinating their care while keeping sight of the bigger picture. Family doctors have a range of skills and attributes that make them eminently suited to being such a guide and this can be a tremendously satisfying and rewarding role.

Integrative medicine is becoming more and more accepted by mainstream academic medical centers and funding agencies. This chapter discusses and defines integrative medicine, complementary and alternative medicine (CAM), and science based medicine (SBM). Examples of each are discussed and comparisons are used to explore the pseudoscience behind integrative medicine and CAM.

Chapter Two examines how medical commentators on complementary and alternative medicine (CAM) situate their texts in medical journals, on subjects not typically under the purview of such journals, in relation to the historical-professional dynamics that have shaped biomedicine. It examines a set of coordinated journal theme issues on CAM as textual artifacts within the context of professional discourse as instances of constitutive rhetoric, calling forth a medical community that places research on CAM as already under its purview. The chapter examines peer review practices and shows how the theme issues define and categorize CAM in terms that preserve biomedicine’s historical coherence as a firmly defined discipline while simultaneously stretching its limits to reach practices formerly beyond its scope. This process functions as a form epideictic rhetoric, reinforcing conventional community values and the perceived borders separating health practices, even while some community members ostensibly seek to eradicate those borders.

This chapter examines whether complementary and alternative medicine (CAM) should be covered by health insurance. It first considers the philosophical and practical obstacles to science in medicine before discussing the (sometimes) unfounded bias that paints all alternative medicine as quackery and the (sometimes) unwarranted confidence that portrays all conventional medicine as science. In order to respond appropriately to the health-related needs of patients, the chapter argues that health plans must avoid a double standard by using the same criteria for evaluating conventional and alternative modalities. A just system should promote good care within prudent limits by avoiding waste and harm, and by requiring empirical substantiation of the value of all interventions, conventional as well as alternative ones.

This chapter examines scientific boundary work in popular reporting on biomedical research on complementary and alternative medicine (CAM), particularly a special report in Newsweek magazine on the “new science of alternative medicine.” It articulates a rhetoric of popular medicine vis-à-vis theoretical models of popular science developed in rhetoric, discourse studies, and social studies of science to argue that health reporting is both typical of and exceptional in science reporting: it is typical because medicine’s research values, generic forms, and institutional structures are closely aligned with those of science, yet it is exceptional because members of the public are significantly more invested as a rhetorical audience of medical reporting, due both to their own bodily experience and expertise, and to their need for health information. The chapter argues that CAM research demonstrates the bidirectional nature of science reporting, in contrast to the unidirectional model proposed by earlier theorists, because the major push for CAM research was motivated, in the first instance, by overwhelming public interest in and use of CAM therapies.

Many parents of children and adolescents with cancer investigate complementary and alternative medicine (CAM) to help manage the side effects associated with conventional medications and augment their efficacy and to help cope with the diagnosis. Parents pursue CAM to ensure that they have ‘left no stone unturned’ and feel they are doing all they can to help their child fight cancer or to support their child during cancer therapy. The high prevalence of CAM use has also brought attention to the potential for adverse interactions with conventional therapy, particularly when biological therapies (nutrition or herbal supplements) are used in combination with conventional agents. This chapter discusses considerations regarding CAM for children with cancer and describes selected CAM therapies such as acupuncture and acupressure, massage and reflexology, movement therapies, and herbal and nutritional supplements. The use of CAM on survivors of childhood cancer and its role in palliative care are also explored.

Sociological research on the governance of complementary and alternative medicine (CAM) in Western societies has vastly increased in the last decades. Yet there has been a less marked expression of qualitative studies which put such governance into comparative perspective. Furthermore, research has shown that CAM regulation in Western countries has been very diverse, and so is probably best conceptualised on a spectrum containing several regulatory models. This chapter investigates CAM’s modes of governance in two historically, culturally and politically related countries, Brazil and Portugal. It analyses the extent to which CAM governance has changed over time in these two countries, the main modes of CAM governance in these same countries, and the implications of these modes of CAM governance for CAM professionals themselves and the public. It is concluded that Brazil and Portugal present some similar patterns in the way they govern CAM, but also contrasting differences, particularly in relation to the status of these therapies within the public and the private health care systems, and the implications of this status for CAM professionals themselves and the wider public.