1. Office of Public Health & Environmental Hazards Introduction to Complementary and Alternative Medicine in the VA Jeanette E. Akhter, M.D., M.Ac War Related Illness and Injury Center Washington, DC

2. Important Questions  1. What is CAM?  2. Why is it important for me to know about it?  3. Is the VA involved in CAM?

3. Definition of CAM “Diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine” (NCCAM)

4. National Center for Complementary and Alternative Medicine (NCCAM)  Federal Government's lead agency for scientific research on CAM  1 of the 27 institutes and centers that make up the National Institutes of Health (NIH) within the U.S. Department of Health and Human Services  http://nccam.nih.gov

5. NCCAM's mission  To explore CAM practices using rigorous scientific methods and build an evidence base regarding the safety and effectiveness of these practices  Basic, translational ("bench-to-bedside"), and clinical research  Research capacity building and training  Education and outreach programs

6. Further Definition  " Complementary medicine" refers to use of CAM together with conventional medicine. Most use of CAM by Americans is complementary.  "Alternative medicine" refers to use of CAM in place of conventional medicine.  "Integrative medicine" (also called integrated medicine) refers to a practice that combines both conventional and CAM treatments for which there is evidence of safety and effectiveness.

7. Types of CAM  Natural products  Mind-body medicine  Manipulative and body-based practices  Movement therapies  Traditional healers  Energy field manipulation

8. Types of CAM  Whole medical systems  Ayurvedic medicine  Traditional Chinese medicine  Acupuncture  Herbs  Homeopathy  Naturopathy

9. CAM Online Education Series  10 lectures with videos and transcripts  A question and answer transcript  An optional online test  Additional resource links  A certificate of completion

10. Why incorporate CAM in the VA? Numerous Veterans have complex and difficult-to-diagnose, difficult-to treat health problems following deployment

11. Treatment  First response: Provide the highest quality traditional western medical care available  Sometimes results are not completely satisfactory  Residual pain  Side effects of treatments  Veterans, their families, and their care providers seek additional beneficial therapies

12. Use of CAM in US The 2007 National Health Interview Survey (NHIS) showed that approximately 38 percent of adults use CAM.

13. VHAHCS Complementary and Alternative Medicine  2002 VA Health Agency Information Group Study  84% of VAs offered either in-house CAM therapies or referred out  Study being repeated this year

14. VA Central Office preparing publication of guidelines for CAM  Standardization of criteria to determine which CAM modalities should be integrated into VA care  Credentialing requirements for practitioners  Mechanisms for CAM delivery  Documentation, billing, etc.