Complementary and alternative medicine (CAM) is a term used to describe a wide range of therapies and practices, examples of which include the use of the following:
For more detailed information about CAM, please see CATIE's Practical Guide to Complementary Therapies available at http://www.catie.ca/comp_e.nsf/
In one Canadian poll, 70% of respondents said they had used CAM at some point in their life. Results from other surveys in the U.S. and Canada report that, in general, CAM use has been increasing in recent years. Data from those surveys suggest that the profile of a CAM user in North America is likely to appear as follows:
- age - 25-40
- has an income greater than $US 50,000 or $CAN 60,000
- achieved post-secondary education
- resides in the western part of this continent
CAM and HIV
In people with chronic health conditions, CAM use is generally high. Researchers in Ontario conducted a study to find out more about the use of CAM by people with HIV/AIDS (PHAs) who were attending HIV clinics.
The research team randomly selected a sample of subjects from the HIV Ontario Observational Database (HOOD) project for detailed interviews and collected data between August 1999 and September 2001.
A total of 104 PHAs agreed to be interviewed and their profile was as follows:
- 49 females, 55 males
- average age – 43 years
- average length of time known to be HIV positive – 8 years
- 37% had a household income of $20,000
- 36% were employed, while the remainder were on government income assistance or receiving long-term disability
- 46% had a post-graduate education
- 55% had symptoms of AIDS in the past
- about half the subjects had a viral load below the 500 copy mark
Results - Use of CAM
Not all studies on CAM use the same definition of what constitutes CAM. Some studies exclude multivitamins, while others do not. The Ontario researchers collected as much data as they could and did different analyses. If multivitamins were defined as belonging to CAM, then 90% of subjects reported using CAM. If multivitamins were excluded, then 77% of subjects used CAM. Either way, CAM use was high.
Results - CAM and HIV
About 51% of CAM use was related to HIV infection, but only 38% of the subjects' treating physicians knew that their patients were taking CAM. When researchers further analysed their data, they found that even PHAs who were highly satisfied with their medical care still did not tell their doctors about CAM use.
Why was CAM used?
According to the researchers, "the most commonly cited reason for PHAs using CAM was to support their "general well-being." Other reasons included management of HIV drug side effects. A total of 81% of subjects reported an overall improvement in health because of CAM use.
Interestingly, nine subjects believed that "it was possible to treat HIV infection solely with CAM." Five subjects who held this belief were also taking anti-HIV medications.
Cost of CAM
Half of the subjects paid for CAM "out of pocket," that is, without receiving any reimbursement. Differing amounts of money were spent on CAM; for instance, about half the subjects spent less than $50 per month on CAM, while 23% of subjects spent at least $100 every month. One-third of subjects received CAM at no cost because it was subsidized by an AIDS service organization.
In this study, 80 subjects used CAM and 24 did not. As in most surveys, CAM users in this study were likely to be female and have high levels of satisfaction with their conventional medical care. CAM users were also more likely to be also taking prescription drugs than subjects who were not CAM users.
A shift in CAM use
In the time before HAART, surveys found that PHAs used CAM to fortify their immune systems and prevent life-threatening infections. In the current study, CAM was "often used for managing the physical and psychological effects of illness and side effects of conventional therapy."
A disturbing finding from this study was the lack of communication between PHAs and physicians about the use of CAM. More than half of all subjects who used CAM did not report this to their treating physician. In turn, physicians were not likely to ask their patients about CAM use. Because some natural health products, particularly herbs, can interact with HAART and other medications, it is essential that better communication and understanding between doctors and their patients occur. Perhaps a follow-up project for the research team is to find out and document why there is not enough conversation between medical doctors and their patients about complementary therapies. This would be an important exercise, as surveys have shown that the
use of CAM is increasing. Also, research into the discussions between CAM practitioners and their patients would be another area to explore.
1. Furler MD, Einarson TR, Walmsley S, et al. Use of complementary and alternative medicine by HIV-infected outpatients in Ontario, Canada. AIDS Patient Care STDS. 2003 Apr;17(4):155-68.