Complementary (alternative therapies used with modern medical system treatments) and Alternative (used instead of modern medical system treatments) are collectively termed “CAM Therapies”.  While the use of these therapies is growing, as of 2012, 18% of the population used natural products (supplements, herbs, vitamins), 11% used deep breathing techniques, 10% Yoga, Tai Chi or Qi Gong, 8% chiropractic or osteopathic manipulation, 8% meditation, 7% massage, 2% homeopathy, 2% progressive relaxation, and 2% guided imagery.  

         CAM therapies have in the past had relatively little research into their outcomes but an effort by the US Government and researchers around the US have demonstrated some of the treatments have proven benefit, albeit usually measurably small benefits.  Much of the research done by CAM therapists from 1990 to today do not meet the minimum study design standards to be considered proof.  Most are of the type “I did this technique and they got better”, not using any comparative group, control group, and the studies are enormously biased since the person performing the techniques have economic incentive for the technique to show positive results.  In some cases such as Chinese studies, most of the results and reviews of techniques are absurdly positive, not reproducible in any other environment other than China, and are not a pure evaluation of a technique (in Chinese medicine, multiple techniques are used simultaneously).  Therefore we discount studies performed in China as non-scientific and inherently biased.

         CAM Therapies are divided into 1. Medical systems (such as Ayurvedic, Traditional Chinese, Anthrosophic, Chiropractic, Homeopathy, Naturopathy, etc),  2. Substances (including chemicals sold as supplements, vitamins, herbs, essential oils, etc)  3. Bodywork (such as massage, aquatherapy, tai chi, etc)   4. Mindwork (hypnosis, meditation, etc. )  5. Energy therapies. 

         A summary of the major techniques in CAM medicine is found below along with scientific documentation if available.  The lack of scientific documentation does not mean a therapy does not work, but that it has not been tested and is simply speculative.  Many CAM therapies are speculative, and advertising for these are based on testimonials (individuals claiming great relief), historical use (has been used for hundreds of years), or claims based on animal or lab studies that have never been used in humans.  Therefore, many of the therapies are speculative, experimental, and do not rise to the standards of care required by the medical system in the US.  Testimonials are largely fabricated or based on placebo response.  Historical means there is a tradition of use, not that the treatment works.  Animal studies or lab studies do not translate directly into human results due to our different anatomies and physiologies.  These therapies are mainly unregulated or nearly unregulated by any authority or agency, and the safety or effectiveness of these therapies do not require proof.  They do result in injury and death, regardless of their claims of “safety”, but as they are unregulated, there is nothing that will be done to protect the population against their use except in extreme cases.

         Levels of evidence from highest to lowest used in this monograph are:

alpha level- systematic reviews of randomized controlled trials: these may uncover poor construction, biases, high dropout rates, statistical analysis aberrations, etc. that reduce the values of randomized controlled trials.

beta level- individual randomized controlled trials, 

gamma level- non-randomized trials with case controls, 

delta level- case series uncontrolled (frequently used in alternative medicine- no placebo control, sham control or comparative group; these types of studies are subject to extreme bias of the author since most of the data is collected and analyzed by the same person doing the trial, and without a control, placebo factors are of unknown significance but statistically play a role in 30-40% of trials.

epsilon level- case reports,

zeta level- animal experiments or lab studies, 

omega level- theoretical only, no evidence. 

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The presence of alpha level evidence (for or against a procedure) is more important than everything below that level of evidence.  The lack of alpha evidence for or against a procedure or technique does not invalidate the intervention, but the next level down evidence is then weighted.  Most modern medical evidence is alpha or beta level.  Most alternative therapy evidence is delta, epsilon, or omega level.  But where higher levels of evidence exist for CAM therapies, they are presented here.  Sources of scientific studies information: National Library of Medicine