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[This article was originally published in the 2004 Journal of Local Public Health

by the Massachusetts Association of Health Boards (www.mahb.org)]

AN INTRODUCTION TO COMPLEMENTARY AND ALTERNATIVE MEDICINE FOR HEALTH BOARDS


By Maggie Hentschel and Karl Berger
Integrative Medicine Alliance1
The World Health Organization at its 1978 international conference held in the Soviet Union produced the Alma-Ata Health Declaration, which was designed to serve governments as a basis for planning health care that would reach people at all levels of society. The declaration reaffirmed that “health, which is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.” In its widest form the practice of medicine, that is to say the promotion and care of health, is concerned with this ideal.”2
In the past decade we have seen an increased awareness of complementary and alternative medicine (CAM) in both public and governmental sectors. What today is called alternative medicine covers a wide range of disciplines, most of which are guided by the “healing model” of holistic medicine, which emphasizes the complex interplay between multiple factors: biochemical, environmental, psychological, and spiritual, as opposed to the biomedical model which reduces disease to a disturbance in biochemical process and relies heavily on the “curative model” of care.
Healthcare providers today are faced with challenging issues of health-promotion, disease prevention and management of chronic illnesses for which conventional medicine has offered only limited success. An increasingly knowledgeable patient population is now fueling the CAM movement by seeking alternatives to traditional treatments. The use of CAM modalities by Americans between 1990 and 1997 increased from 34% to 42% of the general population. In addition, the total number of visits to CAM providers increased from 427 million to 629 million within this same time period. This number exceeds the total visits to all primary care physicians combined (386 million) in 1997.3

Just a decade ago, alternative therapies were readily dismissed by physicians as fringe medicine, however today CAM is now beginning to earn attention and academic stature. The growing number of CAM clinics affiliated with hospitals, the expansion of CAM courses within academic medical education, and the increase in CAM benefits offered by insurers offer clear evidence of this trend.


The costs of CAM approaches and their potential risks and benefits provide a public health rationale for subjecting them to critical appraisal. In pursuit of this vision, the US Congress authorized in 1998 the establishment of a new component of the National Institutes of Health—the National Center for Complementary and Alternative Medicine (“NCCAM”)—with a mandate to conduct CAM research, train CAM investigators, and disseminate authoritative information to practitioners and the public.4 That same year, the Journal of the American Medical Assoc. (JAMA) published a series of scientific studies in a special issue dedicated to alternative medicine. This was the first such effort by a mainstream US medical journal and was an attempt to meet doctors' needs for high-quality scientific information on treatments that more and more patients are trying.
Complementary and Alternative Medicine Therapies by Category5

According to NCCAM, CAM is defined as a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine.


The many diverse CAM therapies are frequently grouped into five overlapping categories: biologically based therapies, manipulative and body-based interventions, mind-body interventions, “energy” therapies, and alternative medical systems. Below is an overview of some of the common CAM therapies in each category and some basic information on training and licensure. For more information on Licensing, Certifying and Training Standards for CAM therapies than what is provided below, the American Medical Student Association has some good reference information.6

Biologically Based Therapies

Naturopathic Medicine


Naturopathic medicine is a distinct system of primary health care - an art, science, philosophy and practice of diagnosis, treatment and prevention of illness. Naturopathic physicians are primary health care practitioners, whose diverse techniques include modern and traditional, scientific and empirical methods. The priciples of Naturopathic medicine are based upon the objective observation of the nature of health and disease, and are continually reexamined in the light of scientific advances. Methods used are consistent with these principles and are chosen upon the basis of patient individuality.
The training program for a naturopathic physician (ND) resembles in part that of a medical physician (MD), and takes place through a 4-year post-graduate training program. The general standard for licensure is graduation from an accredited 4-year ND program, and successful completion of the state licensing board exam. NDs are licensed in every New England State with the exception of Massachusetts and Rhode Island. Legislation to license NDs in Massachusetts, An Act for the Registration of Naturopathic

Doctors (SB661/HB 2603), has recently been under consideration by the Massachusetts legislature, over the strenuous objections of the Massachusetts Medical Society. Currently, there are over 15 naturopathic physicians based in the Bay State.


Herbal Medicine


Herbal medicine is one of the oldest holistic systems of medicine. It uses plants, plant parts, their water or solvent extracts, essential oils, gums, resins, exudates or other form of advanced products made from plant parts used therapeutically to provide proactive support of various physiological systems; or, in a more conventional medical sense, to treat, cure, or prevent a disease in animals or humans. Its therapies are based on the body's capacity to heal itself. It is incorporated in a diverse number of systems of medicine. Many current medications are derived from plants, for example digoxin, tamoxifen, aspirin, morphine, and others.
The practice of herbal medicine is a diverse field with practitioners from many several medicinal traditions using herbal medicine in many different ways. Each tradition has its own standards and as a result there is no formal standard for training. Some healing modalities, including Chinese Herbology and Naturopathic Medicine, have their own certification and licensing processes.

Nutritional Supplements


Because CAM practitioners commonly stress that each individual is unique on a biochemical level, many consider individualized nutritional supplementation to be an effective mode of prevention and treatment. Popularized in the 1970's by Dr. Linus Pauling, this modality is used widely by the general public. The practice of nutritional supplementation is broad and it includes everything from megavitamin therapies and other preparations containing a range of ingredients that can be natural or synthetic.

Nutrition


Nutrition started to become more important as a healing practice in the beginning of the 20th century. Nutritional practices are directed at those who are trying to maintain health and decrease symptoms of illnesses through balanced diets. Alternative practitioners embrace a number of diets that are being evaluated as adjunct therapies for chronic conditions such as cancer, inflammatory disease, cardiovascular disorders, allergies, etc. Examples are macrobiotic diet, raw foods diet, detoxification diet, Gerson therapy, vegetarianism, veganism, the Hay diet and the Pritkin diet.
While no global standard exists for the education requirements for dietitians/nutritionists, there are general standards required by individual licensing, certifying and registering bodies. There are currently 46 states that regulate dietitians or nutritionists through licensure, certification or registration. Both nutritionists and dieticians require licensure in Massachusetts.

Manipulative and Body Based Therapies

Alexander Technique


In the late 19th century, an Australian actor, Frederick Matthias Alexander, observed a correlation between correct posture of the body and the ability to perform certain tasks. In the therapy he developed that is his namesake, stresses are reduced by teaching patients how to hold their bodies and how to move in healthful alignment. Patients’ awareness of the way they move and position their bodies helps their body systems to function more efficiently. Many municipalities in Massachusetts have licensed fully-trained practitioners of Alexander Technique and other forms of movement education such as the Feldenkrais® Method (see below) in conjunction with massage therapy. About 40 members of the American Society for the Alexander Technique, one of the profession’s certifying bodies, are based in Massachusetts.

Chiropractic


Founded in 1895 by D.D. Palmer of Iowa, chiropractic is a system of healing, based on the belief that restoring normal nerve function can cure disease. Chiropractors practice manipulation, especially of the spinal column, along with massage, physical therapy techniques, nutrition counseling, heat therapy and traction. This is one of the most accepted forms of CAM in the United States. Their practice is conservative, non-invasive and does not involve pharmaceutical products or surgery.
Doctors of chiropractic attend accredited chiropractic colleges and can currently be licensed in all 50 states, and their services are reimbursed by many medical insurance plans. Each state has its own state licensing board to monitor the practice of chiropractic, including Massachusetts, whose Board of Chiropractors oversees approximately 1,930 licensees in the Commonwealth.

The Feldenkrais® Method


A system of movement education developed in the 1940s by a Russian born atomic physicist, Dr. Moshe Feldenkrais®, this method teaches patients to avoid certain postures and positions that could lead to the development of disorders of the nervous system. Exercises which emphasize posture and breathing are central to this system. According to research, cerebral palsy and multiple sclerosis patients have found Feldenkrais® therapeutic. Initially taught in Israel and the United States, it has been adopted throughout the world. Many municipalities in Massachusetts have licensed fully-trained practitioners of the Feldenkrais® Method and other forms of movement education such as the Feldenkrais® Method (see below) in conjunction with massage therapy. About 35 practitioners in the Feldenkrais® Guild of North America are based in Massachusetts.

Massage


Massage is an ancient form of healing and maintaining good health. It has been used in many different cultures. Massage has been shown to promote circulation, enhance the immune system's ability to fight illness, relieve muscle pain, and promote digestion. In addition to the physiological benefits of this modality, massage has definite psychological benefits-- it can be used to increase self esteem and to decrease symptoms of depression and is often integrated into various complementary therapies.
There are numerous schools that teach a variety of styles and approaches. While standards differ, training typically includes: anatomy, physiology, pathology, massage theory and technique, and supervised practice. The Commission on Massage Therapy Accreditation currently accredits about 70 schools in the United States. 500 hours is of training is considered to be the average requirement for state or local licensing, although licensing criteria for massage therapy differ greatly by state. Currently 32 states license massage therapy across the country. Last year, with the support of a range of Massachusetts professional bodywork organizations, Massachusetts Rep. Antonio Cabral (D-New Bedford) introduced House Bill 3155, which would establish statewide licensing, and may be up for vote this year.

Osteopathy


Andrew Taylor Still founded the discipline of osteopathy in the 19th century in reaction to hospital conditions and the medicine he saw practiced during the American Civil War. Osteopaths emphasize the relationship between the musculoskeletal system and organ function and use physical manipulation to correct malfunctions. The first osteopathic medical school was established in 1892 in Kirksville, Missouri. Osteopathic doctors are licensed to practice medicine in all states in the United States and have the same professional rights and responsibilities as medical doctors. Their techniques range from gentle massage to high velocity mobilization of the joints and therefore, these practices are particularly useful in treating back and joint pain. Osteopathy emphasizes treating the whole person.
Training of osteopathic physicians parallels that of allopathic physicians. There are 19 four-year osteopathic medical schools in the United States and coursework is similar to that of allopathic medical school, with an additional 300-500 hours of musculo-skeletal coursework. Osteopathic physicians are licensed to practice in all 50 states. DOs are licensed by the states in which they practice. The Massachusetts Board of Registration in Medicine licenses osteopathic physicians in the Bay State, as it does medical doctors and acupuncturists.
Reflexology

Reflexology is a therapy based on the ancient tradition of foot massage. Early twentieth century physicians discovered that there are organs in the body that can be affected by pressure applied to certain zones in the feet or hands. Stimulation of natural healing powers of the entire body occurs when the feet and hands are massaged. This therapy is commonly used in combination with aromatherapy or naturopathy. Reflexology is not licensed in Massachusetts, and the field does not have a unifying certifying body, making it difficult to gauge its prevalence in the Commonwealth.


Rolfing

Dr. Ida Rolf originally developed Rolfing in the 1950s. Rolfing contains elements of massage and is based on realignment and remolding of fascia by using elbows, fingers and knuckles. The main uses of this modality are improvement of posture, therapy for sports injury, and alleviation of persistent muscle pain and respiratory problems. In addition, Rolfing has been used to prevent postural or stress related problems. Athletes, dancers and singers often find Rolfing beneficial. Many municipalities in Massachusetts consider Rolfing to be a form of massage or bodywork and license it as such. There are about 20 Rolfers practicing in Massachusetts who are certified by the Rolf Institute, Rolfing’s preeminent professional organization in the US.



Mind-body Interventions


Western medicine traditionally viewed the mind and body as separate entities. However, in the late 20th century, an appreciation began to develop for the interrelationship between the two.

Biofeedback


The word "biofeedback" was coined in 1969 to describe laboratory procedures that trained research subjects to alter their brain activity, blood pressure, muscle tension, heart rate and other bodily functions that are not normally controlled voluntarily. Biofeedback training is a type of behavior therapy that attempts to change learned responses to stress. It can be very successful in alleviating symptoms (e.g., pain and muscle tension) of a disorder, and its effects can be especially lasting if used in combination with psychotherapy when a patient learns to understand his reactions to stress. Migraine headaches, gastrointestinal cramping (e.g., colitis), high blood pressure, tics, and the frequency and severity of epileptic seizures are some of the ailments treated by biofeedback.
No license is required to practice biofeedback. Therapists can become certified through the Biofeedback Certification Institute of America (BCIA), www.BCIA.org, which is the only certifying agency in the United States. Eleven BCIA-certified therapists practice in Massachusetts, although many more biofeedback therapists do so who are generally licensed in another health care field and practice according to those guidelines.

Hypnotherapy (Hypnosis)


Hypnosis is a special psychological state with certain physiological attributes, resembling sleep only superficially and marked by a functioning of the individual at a level of awareness other than the ordinary conscious state. This state is characterized by a degree of increased receptiveness and responsiveness in which inner experiential perceptions are given as much significance as is generally given to external reality. Hypnotherapy is psychotherapy that facilitates suggestion, reeducation, or analysis by hypnosis. It has been officially endorsed as a therapeutic method by medical, psychiatric, dental, and psychological associations throughout the world. It has been found most useful in preparing people for anesthesia, enhancing the drug response, and reducing the required dosage. In childbirth it is particularly helpful, because it is effective in alleviating the mother's discomfort while avoiding drug-induced impairment of the child's physiological function. Hypnosis is highly regarded in the management of otherwise intractable pain, including that of terminal cancer. It is valuable in reducing the widespread fear of dental procedures; the very people whom dentists find most difficult to treat frequently respond best to hypnotic suggestion.
No license is required to practice hypotherapy in the United States. Several organizations, including the American Society of Clinical Hypnosis (ASCH), www.asch.net, and Society for Clinical and Experimental Hypnosis, have developed codes of ethics that define and limit persons who can be taught hypnosis. There are over 100 ASCH professional members in Massachusetts, whose ranks include many doctors, psychologists, and social workers. The ASCH has developed a voluntary certification program in an effort to implement a standard into the training of practitioners.

Meditation/Mindfulness


Meditation is private devotion or mental exercise consisting in any of innumerable techniques of concentration, contemplation, and abstraction, regarded as conducive to heightened spiritual awareness or somatic calm. The practice of meditation has occurred worldwide since ancient times in a variety of contexts. In recent medical and psychological studies, skilled meditation practitioners have proved effective in controlling pulse and respiratory rates and to varying degrees, in the symptomatic control of migraine headache, hypertension, and hemophilia, among other conditions.
There is currently no formal licensure or certification process for meditation instructors due to the large body of meditation traditions as well as differing opinions in training requirements.

Yoga


In a very basic sense, yoga is a system of exercises for attaining bodily or mental control and well-being. The Sanskrit word "Yoga" comes from the root yug (to join), or yoke (to bind together or to concentrate). Essentially, yoga describes a means of uniting or a method of discipline: to join the body to the mind and together join to the self (soul), or the union between the individual self and the transcendental self. In his classical work The Yoga Sutras, a 2000-year-old treatise on yogic philosophy, the Indian sage Patanjali defines Yoga as "that which restrains the thought process and makes the mind serene."
Yoga has been practiced in India for thousands of years, and is traditionally used by spiritual seekers as a system of self-development for purification of the body and mind. Yoga is proposed to be a preventive as well as curative system of the body, mind, and spirit.
Many different schools of yoga exist and each has its own curriculum for training new teachers. Therefore there are no commonly agreed training standards. No license is required to teach yoga and each school has its own certification process.

Energy - Bioenergetic Therapies

Acupuncture


Acupuncture is an ancient Oriental form of medicine practiced for millenia. Acupuncture is based on dualistic philosophy of balancing the two cosmic forces of yin and yang. Disease occurs when imbalance blocks the vital life force or qi (chi), which flows through 12 pathways in the body to the major organ areas. The aim is to restore the physical, emotional and spiritual balance of the person. It involves the insertion of small needles into the body at hundreds of points along the 14 vertical meridians and other specialized pathways. Other techniques associated with acupuncture are moxibustion and cupping. Moxibustion is the warming of acupuncture points with smoldering herbs. Cupping is the application of wood, metal or glass cups containing a partial vacuum to the acupuncture site to create blood congestion and is used in treating back pain, sprains, soft tissue injury and to relieve lung congestion.
Researchers have postulated that acupuncture works by stimulating the body to release natural pain killers such as endorphins or enkephalins. Another theory suggests that acupuncture stimulates the release of neurotransmitters such as serotonin or noradrenaline. Others have posited that the minor stimulation of acupuncture points selectively acts on impulse transmission to the central nervous system, thus closing certain neurological "gates" and blocking the transmission of pain impulses from other parts of the body. Another theory suggests that acupuncture causes the body to release vasodialators and histamines. Acupuncture has been proven successful in relieving pain and providing anesthesia.
There are currently more than 50 schools and colleges of acupuncture in the United States, most of which are accredited by the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM). The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) certifies graduates of ACAOM accredited programs. Licensure for acupuncture is available in 35 states, including Massachusetts, where it is managed by the Massachusetts Board of Registration in Medicine. There are over 400 NCCAOM-certified acupuncturists in Massachusetts.

Qi Gong


Also originating in ancient China, Qi Gong (Chi Kung) is the practice of focused exercises to promote health and well being. All exercises or forms involve four basic elements: mind, sight, movement and breathing. As well as personal healing, some practitioners can heal others by focusing their Chi on the person who is ill.


Therapeutic and Healing Touch


Therapeutic Touch is a non-oriental practice of energetic healing. Dr. Dolores Krieger developed it in the 1970. In practicing therapeutic touch, the healer moves their hands 2 to 4 inches above the patient's body in an effort to sense the trouble spots, the blocked energy within the patient's body. The healer's hands sweep over the patient's body and act as a conduit for energies to be rebalanced to come through the healer into the patient. Healing Touch is considered very similar or even synonymous with Therapeutic Touch.
Therapeutic Touch (TT) is taught worldwide, primarily at universities, and nursing and medical schools and is still most widely utilized by the nursing profession. There is no formal licensing or certifying process for Therapeutic Touch. The scope of practice for nurses in Massachusetts covers the use of both Therapeutic Touch and Healing Touch.

Reiki (pronounced “ray-kee”)


This term can be translated from Japanese as “universal energy of life.” The practice is based on methods from ancient Tibetan medicine. In the mid-1800’s Professor M. Usui rediscovered and propagated this system, and in the 20th century its use reached the US. Students learn Reiki by studying with a Reiki Master. The Master initiates students through a process of energy attunement. Reiki involves the practitioner placing their hands on a number of chakras or energy points on the surface of the patient, who is typically fully clothed. Practitioners then channel this universal energy from the top of their heads down through their hands and into the patient's body.
Reiki is not currently regulated, and there is no formal licensure or common certification process. Several schools have their own certification processes based on their individual method of training. The scope of practice for nurses in Massachusetts covers the use of Reiki.

Religious and Spiritual Healing Practices


Religious/spiritual worldviews locate a person's or group's experiences in a larger, sacred framework. Religious/spiritual stories, texts, rituals, symbols, words, and actions transform the participant's experience of self and others. Many religious/spiritual teachings shape how one relates to others and to the world. A major area addressed by religion/spirituality is the question of suffering, which is often related to how illness, dying, death, and life beyond death are understood. Most religious/spiritual traditions include healing as a key aspect, whether through prayer, laying on of hands, ritual, and/or other practices. In some cases, healing refers to the expectation that the person who is sick will be fully cured. In other cases, it involves healing on a deeper level that may or may not correspond to a "cure." Indeed, in some cases, full healing may be thought to take place only after death.

Prayer and Ritual


Prayer for the sick or intercessional prayer is classified as a paranormal phenomenon. A cleric or lay person, sometimes a small group or congregation, offer prayers to a higher power in order to bring about individual healing. Western medicine has no explanation for the miraculous healing that is sometimes reported. However, this practice has become the subject of serious clinical research.

Laying on of Hands (Faith Healing)


Closely related to prayers for the sick, the laying on of hands involves the act of touching the patient while prayers for healing are offered to a higher power. The practice can be lead by a cleric who acts as an intermediary between the higher power and the patient. However, in certain groups, such as charismatic Christians, many people may lay their hands on the patient.


ALTERNATIVE SYSTEMS OF MEDICAL THOUGHT

Ayurveda


Ayurvedic medicine is the oldest system of medicine in the world, principally practiced in India. This system of medicine is named after the Sanskrit words for “Knowledge of Life”. Mental, emotional and physical health based on balancing three doshas or "vital energies." This is done through diet, yoga, breathing, exercises, massage, herbal and animal remedies as well as purifying techniques. Currently, the Indian government is sponsoring research to validate Ayurvedic medicine and to integrate its practices into Western medicine.
In India the education and training requirements for Ayurvedic medicine are on a par similar to those for a medical doctor. In the United States there are a number of schools that teach Ayurvedic principles and there is no consensus as to the graduation requirements. The California College of Ayurveda (CCA), currently offers the most complete training program. Graduates receive certification from the CCA, as well as American Institute of Vedic Studies (AIV). There is no formal certifying or licensing in the United States, other than that offered by the CCA.

Homeopathy


Homeopathy is a system of medicine founded in the late eighteenth century by Samuel Hahnemann, a German physician. The science of homeopathy suggests that homeopathic remedies stimulate the body's ability to heal itself. Homeopathy is primarily based on a theory of "like cures like", where a substance causing symptoms in a healthy individual will become a cure for similar symptoms in someone who is ill. Such substances that originate from animal, plant or mineral sources are diluted multiple times to produce homeopathic remedies. Homeopathy is a popular form of medicine throughout the world. It is widely accepted in Great Britain, France, Germany, Australia, and India and is experiencing renewed interest in the United States.
The Council for Homeopathic Education in the US accredits homeopathic training programs, of which there are more than 30 in the United States. Most of the accredited training programs are post-graduate programs intended for MDs and DOs and offer didactic education as well as clinical experience. The certification process depends upon the background of the practitioner. Most physicians practice homeopathic medicine under the licensure provided by their state medical boards.. Currently, MDs and DOs are the only professions licensed to practice homeopathy in all states.

Traditional Chinese Medicine


Traditional Chinese Medicine (TCM) is based on the philosophy of balance between two cosmic forces, yin and yang and the unobstructed flow of the life force (qi). It involves several modalities such as acupuncture and Qi Gong (see above), Chinese herbology, and Asian bodywork therapies such as shiatsu.
In Chinese herbal medicine, herbs may be taken as teas, which are often bad tasting or raw. Herbs can also be packaged into pills or capsules. Herbal prescription is based on Chinese herbal lore, which matches the TCM interpretation of the symptoms of the patient with herbs, which address those conditions. The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) certifies graduates of ACAOM accredited programs in Chinese Herbology. There are 97 NCCAOM-certified practitioners of Chinese Herbology in Massachusetts, most whom are also licensed acupuncturists.
Asian Bodywork therapy is based on the same TCM principles as acupuncture and Chinese Herbology, but instead uses manual pressure, massage, and manipulation to strengthen and enhance the flow of qi through the body. Massachusetts has over 100 professional practitioners of Asian bodywork therapies such as shiatsu (a Japanese variety) or tuina (a Chinese variety). They are commonly considered licensable as massage therapists in the municipalities where they practice.

Addressing the Challenge of Integrating Conventional and Alternative Medicine- Integrative Medicine Alliance

Is it possible to conceive of an integrative approach to healthcare—one that would bring together the best of what both conventional medicine and CAM have to offer? The great variety of alternative therapies pose equally great challenges for Boards of Health that in a responsible way wish to draw upon the resources of qualified local alternative therapists as part of a more comprehensive, integrative approach to promoting the health of their communities.


Many CAM therapies emphasize the importance of a healthy lifestyle and embrace a preventative model of healthcare that is consistent with the public health paradigm. Yet most of these therapies do not have a licensing structure in place, making the qualifications of many holistic practitioners harder to assess. While clinical trials on the effectiveness of these therapies are growing in number, and universities are beginning to undertaking more systematic research, comprehensive and definitive results are many years away.
Nonetheless, Boards of Health need to appreciate that these therapies are widespread in their communities and as such need to be acknowledged, understood, and possibly utilized.
The Integrative Medicine Alliance (IMA) was established in 1999 to advance the public’s health by building bridges between conventional healthcare and CAM in New England, and to provide educational resources for healthcare professionals and the general public in the field of holistic and integrative healthcare. Its work has focused on three areas.


  • Website: The IMA maintains a popular website offering resources in the field of holistic and integrative healthcare, at www.IntegrativeMedAlliance.org. The site provides information for those who are seeking more information about CAM and how to find qualified practitioners, and suggests resources for healthcare professionals seeking to learn about ongoing integrative medical research and practice in New England. In addition, the IMA publishes a free online newsletter focusing on developments in holistic and integrative care in New England.




  • Mobile Clinic: In order to provide opportunities for caregivers, healthcare administrators and the general public who wish to experience alternative therapies first-hand, the IMA’s Mobile Clinic arranges for teams of qualified volunteer CAM therapists to give educational “mini-treatments” and informational talks in hospitals, schools, and health departments, and at health-related events. Therapies on offer have included massage, chiropractic, acupuncture, Reiki and therapeutic touch. Host institutions have included Beth Israel Deaconess Medical Center, the Mass. College of Pharmacy and Health Sciences, and VA Boston Healthcare.




  • Workshops and Forums: The IMA offers workshops and forums which support bridge-building between New England’s conventional and alternative healing professions. Their aim is to bring together key stakeholders in different forms of healthcare for dialogue, consensus-building, and collaborative problem-solving.


Useful Resources for Boards of Health


Biologically based therapies

Websites


American Association of Naturopathic Physicians – http://www.naturopathic.org
American Botanical Council - http://www.herbalgram.org
American Herbalists Guild - http://www.americanherbalistsguild.com
American Herbal Pharmacopoiea - http://www.herbal-ahp.org

[The American Herbal Pharmacopoiea publishes high quality monographs on leading herbs in the U.S. market. The monographs cover both standards for identity and quality as well as comprehensive and detailed discussions of herbal therapeutics, including toxicology, pharmacology, posology, and clinical trials.]


American Herbal Products Association - http://www.ahpa.org

[The American Herbal Products Association is the trade association of the herbal products industry.]


Ephedra Education Council - http://ephedrafacts.com

[The Ephedra Education Council is an industry-backed group that attempts to promote a rational assessment of the various issues surrounding the somewhat controversial aspects of the relative risks of the popular herb ephedra (aka ma huang, Ephedra sinica), as well as news of recent clinical trials on ephedra-containing products.]


Herb Research Foundation - http://www.herbs.org

[This is the nonprofit Herb Research Foundation (HFR) in Boulder, CO. HRF provides information on herbs from its extensive files for a fee.]


The Institute for Functional Medicine - http://www.functionalmedicine.org
Massachusetts Chiropractic Society – http://www.masschiro.org
Metagenics - http://www.metagenics.com
Natural Medicines Comprehensive Database – http://www.naturaldatabase.com
Natural Standard health information database (subscription service) – http://www.naturalstandard.com
United Plant Savers - http://www.plantsavers.org

[United Plant Savers is a grass-roots organization dedicated to the preservation of medicinal plants of North America. UpS has prepared a list of “at risk” plants, both native and introduced, in North America whose future prospects are compromised due to their being collected from the wild as a result of their increased popularity as commercial medicinal plants.]


Tufts Nutrition Navigator - http://navigator.tufts.edu

Bibliography


Blumenthal M, et al. The ABC Clinical Guide to Herbs. Austin, TX: American Botanical Council, 2003. (in press).
Cousens, Gabriel. Conscious Eating. HarperCollins, 2000.
Gaby, Alan; Wright, Jonathan. Nutritional Therapy in Medical Practice: (audiotapes and reference manual) Wright-Gaby Seminars, 2001. 717-249-5403.
Gaby, Alan; Wright, Jonathan. The Patient’s Book of Natural Healing. Prima, 1999.
Griggs, Barbara. The Green Pharmacy-History of Western Herbal Medicine. Western Herbal, 1981.
McGuffin M, Hobbs C, Upton R, Goldberg A. The American Herbal Product Association’s Botanical Safety Handbook. Boca Raton, FL: CRC Press, 1997.
Mills S, Bone K. Principles and Practice of Phytotherapy. New York: Churchill-Livingstone, 2000.
Weil, Andrew. Natural Health, Natural Medicine. Houghton-Mifflin, 1990.
Weiss RF, Fintelmann V. Herbal Medicine. 2nd English edition. New York: Thieme, 2000.
Werbach MR. Nutritional Influences on illness. Third Line Press

Manipulative and body-based interventions

Websites


American Academy of Osteopathy (AAO) - http://www.academyofosteopathy.org
American Association of Colleges of Osteopathic Medicine (AACOM) - http://www.aacom.org
American Chiropractic Association (ACA) - http://www.amerchiro.org
American Massage Therapy Association (AMTA) - http://www.amtamassage.org
American Osteopathic Association (AOA) - http://www.aoa-net.org
American Society for the Alexander Technique – http://www.alexandertech.org
Center for Consortial Chiropractic Research (CCCR) - http://www.c3r.org
Feldenkrais® Educational Foundation of North America – http://www.feldenkrais.com
The National Certification of Therapeutic Massage and Bodywork (NCTMB) - http://www.nctmb.com
The Rolf Institute – http://www.rolf.org
The Touch Research Institute (TRI) - http://www.miami.edu/touch-research

Bibliography


Beck M. Milady’s Therapy and Practice of Therapeutic Massage. Albany: Milady’s Publishing Company, 1994.
Field T. Touch Therapy. London: Churchill Livingstone, 2000.
Fritz S. Mosby’s Fundamentals of Therapeutic Massage 2nd Ed. St. Louis: Mosby’s-Yearbook, Inc., 2000.
Montagu A. Touching: The Human Significance of the Skin. New York: Harper and Row, 1986.
Tappan FM. Healing Massage Techniques: Holistic, Classic and Emerging Methods. Norwalk: Appleton & Lange, 1988.
Bergmann T, Lawrence D, Peterson D. Chiropractic Technique: Principles and Procedures. Churchill Livingstone, 1993.
Coughlin P (ed.). Principles and Practice of Manual Therapeutics. Churchill Livingstone, 2002.
Redwood D (ed.). Contemporary Chiropractic. Churchill and Livingstone, 1997.
Schiowitz S, DiGiovanna E. An Osteopathic Approach to Diagnosis and Treatment, 2nded. Lippincott, 1999.
Ward R (ed.). Foundations of Osteopathic Medicine. Williams and Wilkins, 1996.

Mind-body interventions

Websites


The American Institute of Stress - http://www.stress.org
Biofeedback Society of New England – http://www.biofeedback.net/NE
Center for Mind-Body Medicine - http://www.cmbm.org
Center for Mindfulness in Medicine, Healthcare and Society - http://www.umassmed.edu/cfm
Mind/Body Medicine Webpage - http://www.healthy.net/clinic/therapy/mind
The Mind/Body Medical Institute - http://www.mbmi.org
New England Society of Clinical Hypnosis – http://www.nesch.org
Bibliography

Ballantine, Rudolph. Radical Healing, Integrating the World’s Great Therapeutic Traditions to Create a New Transformed Medicine. New York: Harmony Books, 1997.


Benson, Herbert. The Relaxation Response. New York: Avon Books, 1975.
Hanno, Kirk; Weisbrod, Jo; Ericson, Kay. Psychosocial and Behavioral Aspects of Medicine. Baltimore: Lippincott, Williams and Wilkins, 2003.
Justice, Blair. Who Gets Sick: Thinking and Health. Houston : Peak Press, 1987.
Ornstein R, Thompson RF. The Amazing Brain. Boston: Houghton Mifflin, 1984.
Siegel BS. Love, Medicine, and Miracles. New York: Harper and Row, 1986.
Tart, Charles. Open Mind, Discriminating Mind: Reflections on Human Possibilities. San Francisco: Harper and Rowe, 1989.

“Energy” or Bioenergetic therapies

Websites

Bioelectromagnetics Society - http://www.bioelectromagnetics.org/resources.php


Healing Touch International - http://www.healingtouch.net
Nurse Healer Practitioners Associates International (NH-PAI) - http://www.therapeutic-touch.org
International Society for the Study of Subtle Energies and Energy Medicine - http://www.issseem.org
Qigong Institute - http://www.qigonginstitute.org
Touch Research Institute - http://www.miami.edu/touch-research

Bibliography


Becker RO, Seldon G. The Body Electric: Electromagnetism and the Foundation of Life. New York: William Morrow, 1985.
Burr HS. Blueprint for Immortality: The Electric Patterns of Life. Essex, UK: Neville Spearman Publ., 2000.
Gandhi OP. Biological Effects and Medical Applications of Electromagnetic Fields. Englewood Cliffs, NJ: Prentice Hall, 1990.
Gerber R. Vibrational Medicine: New Choices for Healing Ourselves. Santa Fe, NM: Bear & Co., 1996.
Oschman JL. Energy Medicine: The Scientific Basis. New York: Churchhill Livingstone, 2000.

Alternative medical systems

Websites


Acupuncture.com - http://www.acupuncture.com

[General site for acupuncturists, physicians, and the public with links to acupuncture information and research.]


Acupuncture Today - http://www.acupuncturetoday.com/links.html

[A bi-monthly update on acupuncture related information, legislation, and TCM topics for practitioners and patients.]


American Academy of Medical Acupuncture - http://www.medicalacupuncture.org/cme/cme/cmes.html
American Organization for Bodywork Therapies of Asia – http://www.aobta.org
Ayurvedic Health Center - http://www.ayurvedic.com

Deepak Chopra Center - http://www.chopra.com


The Ayurvedic Institute - http://www.Ayurveda.com
The National Institute of Ayurvedic Medicine - http://niam.com/corp-web/AVSchool.htm
International Association of Yoga Therapists - http://www.iayt.org/Yogatherapy.html
Vedic Lifesciences - www.ayuherbal.com/ayueducation.htm
The Yoga Journal - www.Yogajournal.com
World Health Organization, Acupuncture and Oriental Medicine Reports

http://www.acucouncil.org/reports.html
Beinfield H, Korngold E. Between Heaven and Earth, A Guide To Chinese Medicine. New York: Ballantine Books, 1991.
Lad DV. Ayurvedic Medicine. In: WB Jonas and JS Levin (eds.). Essentials of Complementary and Alternative Medicine. Philadelphia: Lippincott, Williams, and Wilkins, 1999; 200-215.
Lad, Vasant. Ayurveda: The Science of Self-Healing. Lotus Press: Santa Fe, 1984.
Kapchuck T. The Web That Has No Weaver. New York: Congdon & Weed; 1983.
Kraftsow G. Yoga for Wellness. New York: Arkana, 1999.

Integrative Medicine Resources

Collaboration for Healthcare Renewal Foundation – http://www.thecollaboration.org

Integrative Medicine Alliance – http://www.IntegrativeMedAlliance.org

Integrative Medicine Communications (subscription) – http://www.onemedicine.com





Selected Hospital & Health Systems Resources in the Northeast

Beth Israel Medical Center New York, New York: The Continuum Center for Health and Healing - http://www.healthandhealingny.org


Children's Hospital of Boston The Center for Holistic Pediatric Education and Research (CHPER) - http://www.childrenshospital.org/holistic
Children's Hospital of Boston, Boston Medical Center, Massachusetts College of Pharmacy and Health Sciences HolisticKids.org: Pediatric Integrative Medicine Education Project: an educational resource for medical students on pediatric rotation, pediatric residents, fellows. - http://www.holistickids.org
Columbia University, College of Physicians & Surgeon, The Richard and Hinda Rosenthal Center for Complementary & Alternative Medicine - http://www.rosenthal.hs.columbia.edu
Courses on Complementary Medicine and Alternative Therapies (CAM) Taught At Conventional U.S. Medical Schools - http://www.healthwwweb.com/courses.html.
Dana Farber Cancer Institute, Boston, Massachussetts: Zakim Center for Integrated Therapies - http://www.dana-farber.org/pat/support/zakim_default.asp
Hackensack University Medical Center, Hackensack New Jersey: Complementary Medicine Program - http://www.humed.com/compmed/index.shtml
Harvard Medical School Osher Institute and Division of Research and Education in Complementary and Integrative Therapies – http://www.osher.hms.harvard.edu
Maine Medical Center Family Practice Residency Program: Integrative Medicine: Goal "is to design, implement, and evaluate an educational program in CAM and Integrative Medicine for our residents" - http://www.mmc.org/services/integrativemedicine/default.htm

Memorial Sloane-Kettering Cancer Center New York, New York - Information Resource: About Herbs, Botanicals & Other Products: "objective information for oncologists and healthcare professionals, including a clinical summary for each agent and details about constituents, adverse effects, interactions, and potential benefits or problems" - http://www.mskcc.org/mskcc/html/11570.cfm



About the Authors



Maggie Hentschel is a freelance writer and business consultant living in the Boston area, she can be reached at: maggie_yg@yahoo.com.
Karl Berger is Founder of the Integrative Medicine Alliance, and can be reached at Karlo@KarloBerger.com.

1 The Integrative Medicine Alliance (IMA) is an independent, 501(c)(3) non-profit organization that seeks to advance the public’s health by bridging the gap between alternative and conventional medicine in New England. Founded in 1999, the IMA brings together the world’s medical healing traditions to promote an integrative model of safe, affordable and effective healthcare for all. For more information about the IMA, to become a member, or to receive our free bimonthly newsletter, email admin@integrativemedalliance.org, call (781) 648-9866, or visit the IMA’s website at www.IntegrativeMedAlliance.org.

2 Medicine. Encyclopædia Britannica. Retrieved March 25, 2004, from Encyclopædia Britannica Online.

http://search.eb.com/eb/article?eu=119076

3 Eisenberg DM, Davis RB, Ettner SL, et al. Unconventional Medicine in the U.S.: Prevalence, Costs, and Patterns of Use. JAMA. 1998; 290: 1569-1575.

4 Annu. Rev. Med. 2004. 55:239–54 doi: 10.1146/annurev.med.55.091902.103657

First published online as a Review in Advance on Aug. 14, 2003



5 Sources for CAM Therapies by Category include: Dictionary of Alternative Medicine. Joseph C. Segen, M.D. Appleton and Lange 1998; Encyclopædia Britannica. Retrieved April 4, 2004, from Encyclopædia Britannica Online.

6 American Medical Student Association Educational Development for Complementary & Alternative Medicine (EDCAM): "has received a five-year grant from the National Center for Complementary and Alternative Medicine (NCCAM) to develop, promote, and disseminate Complementary and Alternative Medicine (CAM) education curricula and programs at allopathic and osteopathic medical institutions." http://www.amsa.org/humed/CAM


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