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This story starts about 35 years ago in a small city called New Orleans on the Esplanade Avenue side of Bourbon Street (the less "theatrical" end of the street). Inside the small health food store, a young woman mixed herbs and bagged 1 and 2 lb bags of brown rice and wheat berries (as they came only in 50 and 100 lb bags). "Brain and Belly Tea" sold exceptionally well; it consisted of gotu kola herb (for the "brain") with spearmint and peppermint (for the belly). At the time, Celestial Seasonings was still an unknown tea company, but in 1972 Red Zinger Herb Tea was introduced along with a host of other herbal concoctions by Celestial Seasonings. Arrowhead Mills and other companies started to make reasonable-size bags of grains. This made the young woman's work much easier, and so the young woman decided to go to nursing school.
Over 20 years went by and the not-so-young-anymore woman wrote a book on case management and snuck in a half-page on alternative medicine. It was a mere laundry list of possibilities, but it was a bold move (she thought). Also at that time, the National Institutes of Health (NIH) was given a whopping $2 million budget for the study of "unconventional" healing methods. In 1992, Congress established the Office of Alternative Medicine. Over the next several years, as billions of consumer dollars were spent on alternative medicine, the Office of Alternative Medicine's budget increased and those who used complementary and alternative medicine (CAM) modalities were no longer referred to as "Watercress sandwich" eaters. Consider the looming NIH budget increases:
* FY 1992: $2.0 million
* FY 1993: $2.0 million
* FY 1994: $3.4 million
* FY 1995: $5.4 million
* FY 1996: $7.7 million
* FY 1997: $12.0 million
* FY 1998: $19.5 million (National Center for Complementary and Alternative Medicine [NCCAM], 2005)
In 1999, the really-not-so-young-anymore woman wrote a book on advanced case management-dedicating almost one-quarter of the text to CAM. In that same year, the NCCAM became 1 of the 27 institutes and centers that make up the NIH. Today, NCCAM is well known for research into CAM healing practices, training CAM researchers, and disseminating authoritative information to the public and professionals. Last year (2005), the NCCAM budget reached $123.1 million. But look at the quick trajectory of increased dollars over the years; the dollars demonstrate that CAM has already moved into mainstream medicine-and must be taken seriously by the case manager.
* FY 1999: $50.0 million
* FY 2000: $68.7 million
* FY 2001: $89.2 million
* FY 2002: $104.6 million
* FY 2003: $114.1 million
* FY 2004: $117.7 million
* FY 2005: $123.1 million (NCCAM, 2005)
Some countries are taught integration of conventional and CAM modalities within their current nursing curriculum. This has not been the traditional method in American schools. However, the consumer has spoken, and CAM modalities are here to stay. The case manager must be aware of what the patients/clients are taking and doing for a complete assessment. There are consequences to "mixing and matching" herbs and prescriptions. Lippincott's Case Management is pleased to launch its new CAM Department. This issue's department details how to evaluate chiropractic care and chiropractic records.
The CAM story is vast and includes an incredible number of healing techniques. Some are ancient; others could be discovered only by using the newest technology and scientific understanding. Some are well known: chiropractic, acupuncture, homeopathy, therapeutic massage, herbal medicines, or biofeedback. Others are not as well known, but have extraordinary "stories" of improved quality of life behind them: bioacoustics/sound therapy, magnetic therapies, Bach Flower Remedies, and one of my personal favorites [horizontal ellipsis] hippotherapy (no, not about hippopotami but horses1) (American Hippotherapy Association, 2005).
One day, research may blur the lines between complementary and conventional medicines. But until research "proves" why people using CAM methods improve, keep an open mind-there is more to healing than we have been taught. The $123.1 million budget in 2005 by the NIH tells an unfolding story.
American Hippotherapy Association. (2005). Present use of hippotherapy in the United States. Retrieved March 5, 2005, from http://www.americanhippotherapyassociation.org/aha_hpot_A-use.htm[Context Link]
National Center for Complementary and Alternative Medicine. (2005). About the National Center for Complementary and Alternative Medicine. Retrieved December 23, 2005, from http://nccam.nih.gov/about/aboutnccam/index.htm[Context Link]
1Hippotherapy is a term that refers to the use of the movement of a horse as a tool by physical therapists, occupational therapists, and speech-language pathologists to address impairments, functional limitations, and disabilities in patients with neuromusculoskeletal dysfunction. [Context Link]
The NCCAM Web site (http://nccam.nih.gov) includes publications, information for researchers, frequently asked questions, and links to other CAM-related resources.
Toll-free in the United States: 1-888-644-6226
TTY (for deaf or hard-of-hearing callers): 1-866-464-3615
NCCAM Web site: http://nccam.nih.gov
Address: NCCAM Clearinghouse, P.O. Box 7923, Gaithersburg, MD 20898
Fax-on-Demand service: 1-888-644-6226
The NCCAM Clearinghouse provides information about CAM and about NCCAM.
Web site: http://ods.od.nih.gov
Address: 6100 Executive Blvd., Bethesda, MD 20892
The ODS, whose mission is to explore the potential role of dietary supplements to improve healthcare, promotes the scientific study of dietary supplements through conducting and coordinating scientific research and compiling and disseminating research results. It provides all its public information through its Web site. One of its services is the International Bibliographic Information on Dietary Supplements (IBIDS) database, at http://ods.od.nih.gov/databases/ibids.html.
Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html
CAM on PubMed, a database accessible via the Internet, was developed jointly by the NCCAM and the National Library of Medicine (NLM). It contains bibliographic citations to articles in scientifically based, peer-reviewed journals on CAM. These citations are a subset of the NLM's PubMed system that contains more than 12 million journal citations from the MEDLINE database and additional life science journals important to health researchers, practitioners, and consumers. CAM on PubMed displays links to publishers' Web sites; some sites offer the full text of articles.
Web site: http://clinicaltrials.gov
http://ClinicalTrials.gov provides patients, family members, healthcare professionals, and members of the public access to information on clinical trials for a wide range of diseases and conditions. The NIH, through its NLM, has developed this site in collaboration with all NIH Institutes and the U.S. Food and Drug Administration. The site currently contains more than 6,200 clinical studies sponsored by NIH, other federal agencies, and the pharmaceutical industry in more than 69,000 locations worldwide.
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