Complementary and alternative medicine (CAM) / Complementary and integrative medicine (CIM) -- how are they different?

You will see many examples in the research literature where the definitions of complementary and alternative medicine (CAM) are confused or unclear. This is an example where the concepts of CAM are not universally understood in the same way, and so the terms get muddled.

For our purposes at POEM we will define the terms in the following way--there are actually 2 aspects of the complementary/alternative distinction: structural and functional, so it's not enough to just say "complementary" or "alternative".

To be clear about what we mean by "complementary" or "alternative", we need to specify whether we mean structurally or functionally as well.

Both aspects have the presence or absence of a basis for integration with biomedicine as the fundamental distinction between the two; the difference lies in how that distinction is used.

"Structural" refers to what is built into the system, and "functional" refers to how people use the system in real life.

Structural complementary medicine (SCM) or structural integrative medicine (SIM) has a basis for integration with biomedicine built into it, because it does not contradict the shared body of biomedical knowledge that all members have access to. Massage, as it is defined in PubMed's Medical Subject Headings (MeSH):

Group of systematic and scientific manipulations of body tissues best performed with the hands for the purpose of affecting the nervous and muscular systems and the general circulation.

does not entail any beliefs or claims that contradict the body of cumulative observed evidence from biomedicine, and so this kind of massage is a form of structural complementary medicine.

Structural complementary medicine provides a basis for integration with biomedicine because practitioners of SCM can send a consistent, unified message along with the rest of the healthcare team to a client/patient, so that the client/patient--in a time of stressful illness--is not faced with the additional burden of sorting out and judging among contradictory messages that underlie treatment plans and clinical decision-making.

Because SCM provides a basis for integration, it can loosely be considered as a synonym for "integrative", although "integrative" has connotations of a fully-developed, more mature profession that is still under development, rather than something that we've already achieved.

Structural alternative medicine (SAM) does not have a basis for integration with biomedicine built into it, because it does contradict the shared body of biomedical knowledge that all members have access to. The energy healing claims built into many systems of bodywork constitute structural alternative medicine, as the physicist Victor Stenger explains how those claims fundamentally contradict physics:

Much of Complementary and Alternative Medicine is non-scientific, violating many well established principles of physics and relying on anecdotal evidence of little scientific merit. In particular, no scientific basis exists for the notion of special vital forces or energy fields associated with living organisms. Medical journals should follow the lead of most scientific journals and not publish extraordinary claims without extraordinary evidence...Energy therapies and other forms of CAM are based on the ancient notion that living matter possesses some special vital force or energy that is separate from matter. Today this energy is mistakenly associated with electromagnetic or quantum fields. However, no evidence for any special vital forces, energies, or fields has ever been found. Modern physics has shown that energy and matter are the same entity and finds no evidence for continuous fields. The quantum fields of theoretical physics are directly connected, one-to-one, to particles, the quanta of the fields. A consistent picture of elementary particles and forces that successfully describes all current observations exists within the framework of the standard model.

Living matter is composed of the same particles acted on by the same forces as non-living matter. Quantum mechanics provides no basis for paranormal or holistic claims while all of modern physics remains totally materialistic and reductionistic. No mega-paradigm shift occurred in the twentieth century comparable to that of Newton in the seventeenth century.

Reports of extraordinary claims should not be published unless the evidence is extraordinary. The violation of established physical law is sufficient to ignore such claims until extraordinary evidence is presented.

The lack of a basis for integration with biomedicine on the part of structural alternative medicine means that the system causes the client/patient to have the additional burden of sorting out conflicting claims from the people who are supposed to be working together as professionals for the benefit of that client/patient on a unified healthcare team.

Functional complementary medicine (FCM) is used in conjunction with biomedical treatment. For example, if a cancer patient is receiving chemotherapy, and also uses massage to deal with the nausea and fatigue resulting from the chemotherapy, massage would be a complementary treatment in this case.

Here again, there is no conflict between it and the work of other members of the professional healthcare team, because it makes no claims that contradict or undermine a unified message to the client/patient.

Functional alternative medicine (FAM) is used instead of biomedical treatment. If that same cancer patient fears the results of seeking medical care, or is uninsured and cannot afford it, and chooses massage as her only intervention instead, massage would be an alternative treatment in that case.

Although there do not have to be conflicting messages to the client/patient--either structural complementary medicine or structural alternative medicine can be practiced in a functionally alternative way--the lack of coordination with a professional healthcare team in the practice of functional alternative medicine can pose real physical, emotional, and financial risks to the client/patient.