Recent History of CAM in the United States

The history of CAM in the U.S. is a long, complex story that has been shaped by scientific, economic, and social factors. A detailed rendering of this history is beyond the scope of this report. This section instead provides a brief overview of the more recent developments that have helped shape the present status of CAM in this country and its prospects for contributing to the health and well being of our nation.

Early American health care consisted of an eclectic mix of systems. In fact, until the middle of the 19th century, the vast majority of primary medical care in this country was provided by botanical healers, midwives, chiropractors, homeopaths, and an assortment of other lay healers offering a variety herbs and nostrums for a range of illnesses.

This began to change in the latter part of the 19th century, however, with the development and validation of the germ theory and significant scientific advances in antiseptic techniques, anesthesia, and surgery. Beginning in the late 1800s and lasting until the early 20th century, there also was a major revolution in medical education that helped scientific medicine evolve into the dominant health care system of this country.

This revolution in medical education began with the publication of William Osler's (1847-1919) textbook titled "The Principles and Practice of Medicine," in 1892. This book brought diagnostic clarity to medical practice and by 1905 Osler's textbook was the primary medical textbook in the vast majority of U.S. medical schools. This revolution culminated with the release of a report by Abraham Flexner in 1910 that served to crystallize the educational reform movement. After the release of the Flexner's report, many medical institutions that did not meet its standards were driven out of business or forced to implement significantly more rigorous training programs. Schools for many unorthodox healing systems either ceased to exist or became marginalized.

With the isolation and elaboration of life-saving hormones, sulfa drugs, and other antibiotics in the early and middle of the 20th century, conventional medicine cemented its place as the nation's preeminent form of health care in this country. Although most of the other health care systems and their therapies did not disappear, they were considered by most of the public and the mainstream medical community to be unscientific relics of the past. As a result, many were practiced in relative obscurity.

With the reduced threat of infectious diseases and other acute illnesses, conventional medicine turned its focus to the more complex and costly problems of chronic, degenerative illnesses. As a result of public health interventions developed earlier in the 20th century, people began living significantly longer. This gradual aging of the population began to significantly increase the prevalence of chronic conditions, such as arthritis, back pain, diabetes, hypertension, heart disease, and cancer, putting further pressure on conventional medicine to address these conditions.

As the health care system developed more sophisticated means of diagnosing and managing chronic illnesses, the cost of health care began to rise dramatically. Between 1965 and 1975, national health care expenditures more than tripled, rising from just over $41 billion to nearly $130 billion. Although employers and government programs covered some of these increases, out-of-pocket expenditures more than doubled during this same period. Since then costs have continued to rise, with national health care expenditures reaching more than $1.2 trillion in 2000, the latest year for which such figures are available, and they are expected to reach more than $2.6 trillion by 2010.

It was during this time of increasing rates of chronic illness and escalating health care costs that medical pluralism began to reemerge in this country. This reemergence was spurred on by a number of overlapping and sometimes interrelated movements. Beginning in the 1950s, the whole foods and dietary supplement movements began to change American' view of food as not only something they needed to stay alive but also as potential therapeutic agents. In the late 1960s and early 1970s, Americans were increasingly exposed to a variety of traditional health care systems from foreign and indigenous cultures, many of which dated back to antiquity. New York Times writer James Reston's account of his emergency appendectomy in a Chinese hospital during the then Secretary of State Henry Kissinger's visit to China in 1971 was particularly influential in this process. Reston's article described how his post-operative pain and discomfort were relieved by acupuncture and herbs. For most Americans, this was their first glimpse of Traditional Chinese Medicine and its potential uses.

Today, use of CAM approaches and therapies is more prevalent in a number of patient populations in the Unites States, no matter how narrowly or broadly it is defined. Physicians, hospitals, and other conventional health care organizations also are showing a growing interest in CAM. Although such prevalence of use and interest in CAM is not an indication that these practices are effective, it does suggest that those with chronic conditions and the physicians who treat them are looking for more therapeutic options than are widely available in conventional health care settings. Indeed, for some chronic conditions, state-of-the-art conventional therapies have provided only modest gains. For example, according to a number of assessments over the years, expensive mainstream health care approaches to managing chronic lower back pain often have not been very effective. This is perhaps why individuals with back pain are some of the most frequent users of CAM practices.

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• What is CAM? • Overview • Convergence • Evolution • Recent History • Consumer Use • Cancer • Chronic Pain • HIV Infection • Reasons • Conventional • Effectiveness • Differences • Major Types • NCCAM's Role • Definitions • Helpful Links
		Recent History of CAM in the United States The history of CAM in the U.S. is a long, complex story that has been shaped by scientific, economic, and social factors. A detailed rendering of this history is beyond the scope of this report. This section instead provides a brief overview of the more recent developments that have helped shape the present status of CAM in this country and its prospects for contributing to the health and well being of our nation. Early American health care consisted of an eclectic mix of systems. In fact, until the middle of the 19th century, the vast majority of primary medical care in this country was provided by botanical healers, midwives, chiropractors, homeopaths, and an assortment of other lay healers offering a variety herbs and nostrums for a range of illnesses. This began to change in the latter part of the 19th century, however, with the development and validation of the germ theory and significant scientific advances in antiseptic techniques, anesthesia, and surgery. Beginning in the late 1800s and lasting until the early 20th century, there also was a major revolution in medical education that helped scientific medicine evolve into the dominant health care system of this country. This revolution in medical education began with the publication of William Osler's (1847-1919) textbook titled "The Principles and Practice of Medicine," in 1892. This book brought diagnostic clarity to medical practice and by 1905 Osler's textbook was the primary medical textbook in the vast majority of U.S. medical schools. This revolution culminated with the release of a report by Abraham Flexner in 1910 that served to crystallize the educational reform movement. After the release of the Flexner's report, many medical institutions that did not meet its standards were driven out of business or forced to implement significantly more rigorous training programs. Schools for many unorthodox healing systems either ceased to exist or became marginalized. With the isolation and elaboration of life-saving hormones, sulfa drugs, and other antibiotics in the early and middle of the 20th century, conventional medicine cemented its place as the nation's preeminent form of health care in this country. Although most of the other health care systems and their therapies did not disappear, they were considered by most of the public and the mainstream medical community to be unscientific relics of the past. As a result, many were practiced in relative obscurity. With the reduced threat of infectious diseases and other acute illnesses, conventional medicine turned its focus to the more complex and costly problems of chronic, degenerative illnesses. As a result of public health interventions developed earlier in the 20th century, people began living significantly longer. This gradual aging of the population began to significantly increase the prevalence of chronic conditions, such as arthritis, back pain, diabetes, hypertension, heart disease, and cancer, putting further pressure on conventional medicine to address these conditions. As the health care system developed more sophisticated means of diagnosing and managing chronic illnesses, the cost of health care began to rise dramatically. Between 1965 and 1975, national health care expenditures more than tripled, rising from just over $41 billion to nearly $130 billion. Although employers and government programs covered some of these increases, out-of-pocket expenditures more than doubled during this same period. Since then costs have continued to rise, with national health care expenditures reaching more than $1.2 trillion in 2000, the latest year for which such figures are available, and they are expected to reach more than $2.6 trillion by 2010. It was during this time of increasing rates of chronic illness and escalating health care costs that medical pluralism began to reemerge in this country. This reemergence was spurred on by a number of overlapping and sometimes interrelated movements. Beginning in the 1950s, the whole foods and dietary supplement movements began to change American' view of food as not only something they needed to stay alive but also as potential therapeutic agents. In the late 1960s and early 1970s, Americans were increasingly exposed to a variety of traditional health care systems from foreign and indigenous cultures, many of which dated back to antiquity. New York Times writer James Reston's account of his emergency appendectomy in a Chinese hospital during the then Secretary of State Henry Kissinger's visit to China in 1971 was particularly influential in this process. Reston's article described how his post-operative pain and discomfort were relieved by acupuncture and herbs. For most Americans, this was their first glimpse of Traditional Chinese Medicine and its potential uses. Today, use of CAM approaches and therapies is more prevalent in a number of patient populations in the Unites States, no matter how narrowly or broadly it is defined. Physicians, hospitals, and other conventional health care organizations also are showing a growing interest in CAM. Although such prevalence of use and interest in CAM is not an indication that these practices are effective, it does suggest that those with chronic conditions and the physicians who treat them are looking for more therapeutic options than are widely available in conventional health care settings. Indeed, for some chronic conditions, state-of-the-art conventional therapies have provided only modest gains. For example, according to a number of assessments over the years, expensive mainstream health care approaches to managing chronic lower back pain often have not been very effective. This is perhaps why individuals with back pain are some of the most frequent users of CAM practices. Top of Page