CAMbrella Final Report

Work package 1:

Terminology and definitions of CAM methods

Leading beneficiary: University of Zurich (UZH)

The overall aim of this work package was to develop a pragmatic definition of 'Complementary and Alternative Medicine' (CAM), that is acceptable Europe-wide, and could be used systematically to research the prevalence and legal status of CAM in Europe, as well as to investigate the citizens' demands and providers' perspectives related to CAM in general and within the CAMbrella coordinating activities. The specific objectives were to:

  • identify and analyse the existing terms and definitions of CAM used in scientific publications of researchers and by organisations (e.g. World Health Organisation – WHO) 
  • integrate aspects of terms and definitions of CAM used in surveys about its use or prevalence and publications of stakeholders
  • provide a core set of CAM disciplines and methods used consistently all over Europe and an additional list of country specific CAM disciplines and methods to take into account the different traditions and cultures of the EU member states
  • develop a practical pan-European definition of CAM, its disciplines and respective methods.

Description of work:
WP1 carried out a detailed search in the data base PUBMED for various lead terms such as ‘alternative medicine’ linked to ‘definition’ without any restriction to language or date of publication. It also screened a large amount of (nationally published) scientific literature about CAM terminology for provision of definitions. Definitions from the home pages of relevant CAM organisations were also incorporated.

In order to develop a rough estimate for a core set of disciplines used across Europe, the WP developed a questionnaire about the awareness, knowledge and use of major disciplines for each country to be answered by national experts in the field. It soon became evident that there are few experts with a broad enough overview of the many disciplines in their country; thus the WP was not able to identify experts for all 27+12 European countries and had to stick to the participating countries in CAMbrella.

Worldwide, the terms used for defining CAM, CAM methods and procedures, or therapies related to CAM vary greatly. A certain method, procedure or therapy might be regarded as part of CAM in one country while in other countries the very same procedure might not be related to CAM, but to normal life style, conventional medicine, psychology or philosophy. There is a huge variety of definitions which is impractical, both as concerns research purposes and with regard to EU conformity. There are numerous other terms which are widely used as synonyms for 'CAM', along with terms used outside the scientific literature, including, for instance 'experience-based medicine' (Erfahrungsheilkunde), 'holistic medicine' (Ganzheitsmedizin), 'natural medicine' (medicina naturista, Naturheilkunde), and 'other medicine' (médecine deuxième). Other terms include ‘traditional medicine (TM)’ and ‘person-centred medicine.’

There is a great variety of classification systems for the many disciplines and methods covered by CAM and it is almost impossible to place them into a hierarchy. No real operational definition is available to determine which of them would relate to CAM. After long and most intensive discussions the working group agreed on a pragmatic definition (see below) based on the WHO definition from 2000 which addresses the issue of an overlap between CAM and conventional medicine:

‘CAM, as utilized by European citizens, represents a variety of different medical systems and therapies based on the knowledge, skills and practices derived from theories, philosophies and experiences used to maintain and improve health, as well as to prevent, diagnose, relieve or treat physical and mental illnesses. CAM therapies are mainly used outside conventional health care, but in many countries some therapies are being adopted or adapted by conventional health care’
(Falkenberg T et al. Towards a Pan-European Definition of Complementary and Alternative Medicine – a Realistic Ambition? Forsch Komplementmed 2012;19(suppl 2):6-8). (74)

The following seem to be among the most important CAM disciplines in the EU (in alphabetical order): acupuncture (various methods), anthroposophic medicine, herbal medicine, homeopathy, manual therapies (chiropractic, massage, osteopathy, reflexology), natural medicine (including aromatherapy, herbal medicine, nutrition, food supplements, exercise, lifestyle advice and psychological techniques), and Traditional Chinese Medicine (various methods and related techniques).

Some of the presumed country-specific disciplines/methods are classified as conventional medicine rather than CAM in other countries, e.g. balneology, which is related to physical medicine in Germany and elsewhere. There are examples which might be considered as relevant country-specific disciplines (not exhaustive): Austria: energetic medicine; Denmark: visualization; France: mesotherapy; Germany: breath therapy, neural therapy (according to Ferdinand Huneke), hydrotherapy or water therapy according to Sebastian Kneipp; Hungary: dance therapy; Sweden: naprapathy, Rosen method. It seems that with regard to a range of methods, the patterns of use are similar in certain groups of culturally related countries like Scandinavia, the Mediterranean nations and German-speaking countries.