How to write a CAMpod!

The CAM in UME Project
How to write a CAMpod!
CAMpods for CAM Practices and Products
A manual to help develop curriculum templates on Complementary and
Alternative Medicine (CAM) for Undergraduate Medical Education (UME)
© October, 2006
Marja Verhoef, PhD
Rebecca Brundin-Mather, MASc
Michael Epstein, PhD
Heather Boon, PhD
Alan Neville, MD
John Crellin, MD
Mark Ware, MD
The CAM in UME Project
Table of Contents
What is a CAMpod? ......................................................................................................................... 1
How to write a CAMpod? ................................................................................................................. 1
‘P’ is for Purpose.................................................................................................................... 2
1.1 Rationale for including this topic in UME ............................................................................ 2
1.2 Key CAM Competencies .................................................................................................... 2
‘O’ is for Overview ................................................................................................................. 3
‘D’ is for Discussion ................................................................................................................ 3
3.1 Potential questions for discussion or reflection ................................................................... 3
3.2 Readings......................................................................................................................... 4
3.2.1 Annotated Readings................................................................................................ 4
3.2.2 Recommended Readings ......................................................................................... 4
3.2.3 CAMpod Citations ................................................................................................... 5
Appendix A: CAMpod example......................................................................................................... 6
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What is a CAMpod?
A primary goal of the CAM in UME Project is to help medical school instructors develop a basic
understanding of complementary and alternative medicine (CAM) in modern societies and to impart this
knowledge to medical students as well as the necessary skills and attitudes. In developing an
educational program to meet this goal, the Project’s working group began to develop summary
documents on important areas or issues in CAM. These summary documents are called CAMpods.
Developed with a particular focus to undergraduate medical education (UME) teaching, CAMpods can be
used as single units (e.g., to add a CAM perspective in sessions on respirology for example) or together
to develop a comprehensive course for medical students.
Specifically, a CAMpod is:
a high-level outline for a specific CAM topic. It includes three sections:
a Purpose for including the CAM topic in UME;
an Overview of important concepts on the topic; and
a selection of Discussion questions and key resources/readings.
a template for what could be included in UME curricula, but not in and of itself the material that
should be taught. The POD facilitates teaching by emphasizing important content, key resources,
and discussion points.
peer-reviewed. All CAMpods will be reviewed by one or more experts to verify content accuracy.
succinct, but also comprehensive. We recommend between 2-6 pages.
estimated to take between 2 and 12 hours to write depending on the author’s familiarity with the
topic and the amount of available information to summarize.
CAMpods support the topic-based structure of the national CAM in UME curriculum. Each CAMpod falls
into one of three overarching categories:
1. Foundations for CAM. CAMpods may be on topics that are not directly CAM focused, but provide
an excellent segue to CAM topics. For example, Belief Systems, Communication, and EvidenceBased Medicine, and Stress. Foundations for CAM also includes topics that provide fundamental
information about CAM. For example, What is CAM? CAM Use, and CAM Regulations.
2. CAM Practices and Products. CAMpods are on prominent CAM therapies and natural health
products. For example, Chiropratic, Massage Therapy, Herbalism, and Echinacea.
3. CAM in Clinical Practice. CAMpods are on the CAM use for specific medical conditions. For
example, CAM for Chronic Pain, and CAM for Cancer.
How to write a CAMpod
CAMpod authors need to preface the three primary POD sections with the following information:
CAMpod Title:
The title of the CAMpod (e.g., Naturopathy; NHP Regulations)
Project Curriculum Section:
CAM Practices and Products
The names and credentials of all the POD authors.
Institutional Affiliation:
The primary institutional affiliation of each POD author.
Creation Date:
The date the POD was submitted to the Project Manager for peer
review. This will change to the date the POD is uploaded into the digital
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repository after peer review and final edits.
Revision Date:
This is only completed if the POD has been revised after having already
been available on the digital repository.
Synonyms/Related Terms:
This may or may not be relevant to your POD. For example, the
CAMpod on Chiropractic lists other commonly used terms for the
practitioner and the practice such as Chiropractor and Chiropractice.
Key Words:
A brief list of key words to describe your POD [they may include
synonyms/related terms]. The key words will serve to help index the
POD into our digital repository of resources. If you wish, you can access
a list of CAM medical subject heading and unique descriptors at:
How to Use this POD:
A brief standardized statement or description on how instructors can use
the CAMpod as a teaching tool. Please refer to the CAMpod example in
Appendix A of this manual. You may also note unique suggestions
as to how the POD content could be integrated into existing
curriculum, including recommended teaching formats and learning
1. “P” is for Purpose
The Purpose section should include an opening statement summarizing what the CAMpod is about. For
This CAMpod will include….
The concepts discussed in this CAMpod are….
This CAMpod provides….
This CAMpod contains the following….and is intended to….
Rationale for including this topic in UME
You must provide a rationale for including this topic in UME. A brief background or context of the topic
will help elucidate why it is important for practicing physicians to know about it. For example, the
rationale may include some mention of the degree of use of the practice or product, the current state of
evidence and safety, and relevance to medical practice. The database of CAM surveys on the CAM in
UME Project web site [forthcoming] may be able to provide you with a quick link to Canadian data on
your topic.
Key CAM Competenices
In the future we will ask authors to indicate which core CAM competencies for undergraduate medical
education their CAMpod addresses. These competencies will be available by April 2007. Because the
CAM competencies have not been finalized by consensus, authors are not yet required to complete this
2. “O” is for Overview
The overview section should identify the important content regarding your topic (and should be
consistent with the stated competencies). The CAM Practices and Products PODs might include the
following sub-topics or headings:
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Clinical Implications
Clinical Applications
Education of practitioner
Regulation of the practice
It is important that there be enough information provided for each subtopic that would allow an
instructor who may be relatively unfamiliar with the CAM topic to develop curriculum content. This
description could also include references that will direct the reader to an excellent overview of the subtopic. Any sources that you use should be cited in the body text using the author(s) last name and
publication year. The full citation should be included in CAMpod Citations section (see below).
If information on a particular subtopic is limited, this should be noted in the CAMpod.
3. “D” is for Discussion
The discussion section is critical to tie the POD content together as well as to illustrate how the POD
applies to undergraduate medical education. As such, this section should include:
Potential questions for discussion or reflection
These are questions or issues to help instructors engage their students with the content. The focus
should be on issues physicians should think about as they practice medicine. They could have clinical
relevance and require decision-making, communication, and critical thinking skills, or focus on health care
in general or the Canadian health care system. Examples could include:
Do you think there is enough evidence about St.John’s Wort to recommend it to patients?
What should I tell an asthma patient who asks about Chelation Therapy? (or standardized herbal
preparations, or seeing an environmental medicine doctor, etc)
What are you doing for yourself? (to elicit self-care practices)
What supports the tension between conventional medicine and complementary medicine? Is it
What do you think about patients asking for CAM? (to reflect on students own attitudes and
There are questions or issues that will be common to several CAMpods such as those focused on
evidence and ethics. Thus, it may be helpful to take the time to look at other PODs already available in
the CAM in UME Digital Resource Repository.
The readings section will direct users to high-quality, accessible, up-to-date, and reliable information
pertaining to this topic. It should include:
3.2.1 Annotated Readings
Please provide 1–3 key annotations of quality resources (textbooks, websites, reviews, etc). Annotations
describe (summarize) and evaluate (critically analyze) the content. An annotation differs from an
abstract or summary, as the latter typically only describe or summarize the content of the reading, and
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do not critically evaluate it.
Tips and suggestions for annotated readings:
Provide a brief paragraph summarizing the content of this reading (i.e., What useful information
does this reading contain?)
Provide specific information that evaluates the reading (i.e., What is the quality of this resource?)
Use adjectives that accurately describe the resource (e.g., comprehensive, simple, detailed,
Do not use first person language (I, me, my).
Example: [CAMpod: Chiropractic. O’Hara, 2004]
Kaptchuk, T. J. and D.M. Eisenberg. “Chiropractic: origins, controversies, and contributions.” Arch Intern
Med. 158, no. 20 (1998): 2215-24.
This article provides a good overview of the history, theory, and development of chiropractic
including scientific evidence that supports its efficacy. The sometimes controversial position of
chiropractic in society and within healthcare is examined. The general acceptance of chiropractic
by the public is considered.
3.2.2 Recommended Readings
A list of key references of quality resources (textbooks, articles, web-sites, reviews, etc). We recommend
including no more than 10 references (the fewer the better) list in reverse chronology.
Example: [CAMpod: Chiropractic. O’Hara, 2004]
Hurwitz EL, Morgenstern H, Harber P, Kominski GF, Belin TR, Yu F, Adams AH. A randomized trial of
medical care with and without physical therapy and chiropractic care with and without physical
modalities for patients with low back pain: 6-month follow-up outcomes from the UCLA Low Back
Pain Study. Spine 2002;27:2193-204.
Waddell G, McIntosh A, Hutchinson A, Feder G, Lewis M, (1999). Low Back Pain Evidence Review
London: Royal College of General Practitioners.
Miller W. Use of Alternative Health Care Practitioners by Canadians. Canadian Journal of Public Health
1997; 88(3):154-58.
Hurwitz EL, Aker PD et al. Manipulation and mobilization of the cervical spine: a systematic review of the
literature. Spine 1996;21:1746-60.
Verhoef MJ, Sutherland LR. Alternative Medicine and General Practitioners: Opinions and Behaviours.
Canadian Family Physician 1995; 41:1005-1011.
Meade TW, Dyer S, Browne W, Frank AO. Randomised comparison of chiropractic and hospital outpatient
management for low back pain patients: results from an extended follow-up. Br Med J 1995;311:349351.
Manga P, Angus D, Papadopoulos C, Swan W. The Effectiveness and Cost-effectiveness of Chiropractic
Management of Low-Back Pain, Commissioned by the Ontario Chiropractic Association. Funded by
the Ontario Ministry of Health, 1993.
3.2.3 CAMpod Citations
Please list all cited sources from the body of the CAMpod (e.g., in the Purpose or Overview sections).
Please cite them by authors’ last name rather numerically. APA format is preferred, but not essential.
Please refer to the following web site for formatting assistance:
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Appendix A
CAMpod Example
CAMpod Title:
Project Curriculum Section:
Institutional Affiliation:
Creation Date:
Revision Date (if applicable):
Synonyms and Related Terms:
Key Words:
How instructors can use the Pod:
Rationale for including this topic in UME
Key CAM Competencies
Heading 1
Heading 2
Heading 3
Questions for student discussion and/or reflection
Annotated Readings
CAMpod Citations
Authors of CAMpods on Practices and Products: Please note that the following example
is from the Foundations for CAM section as a suitable example from the Practice section
has not been complete.
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The CAM in UME Project
CAMpod Title: What is CAM?
Project Curriculum Section: Foundations for CAM
Author: Rebecca Brundin-Mather, MASc
Institution: University of Calgary
Creation Date: May 6, 2006
Revision Date: July 28, 2006
Synonyms and Related Terms: Integrative Medicine, Complementary and Alternative Health Care,
Alternative Medicine, Traditional Medicine, Unorthodox Medicine,
Unconventional Medicine
Key Words: definition, typology, classification
How to Use this Pod: This CAMPod offers selected definitions for complementary and
alternative medicine. It is intended for to be used as a teaching aid for undergraduate medical
education (UME) instructors by providing instructors with a synopsis of information well as ideas
for student discussion around the points contained within. Instructors can use the points and
references to generate their own curriculum materials. Other particularly useful teaching /
learning resources on this topic will also be identified in this CAMPod.
1. Purpose
This CAMPod provides examples of CAM definitions and classification schemes. The selected definitions
illustrate variation as to what is, and is not, complementary medicine. Such variation or shifts may be a
result of public opinion and/or academic debate which, in turn, may or may not be driven by scientific
Rationale for including this topic in UME
Approximately one to three quarters of Canadians report using CAM at least once in their life either via a
practitioner or via self-care (Park, 2005; Ramsay et al., 1999). Utilization in specific chronic diseases
appears to be even higher (insert survey table here). But what is CAM? In trying to teach medical
students about CAM, instructors must navigate and reconcile (1) the breadth and diversity of CAM
products and practices, and (2) the lack of consensus and shared understandings about basic definitions
and terminology. It is important to know what falls under the umbrella of CAM in order to:
• understand the public’s interest in using products and practices outside of conventional medicine;
• develop a valid body of knowledge about its use and its determinants;
• create policy and regulation to ensure patient/public safety; and
• appreciate the impact that varying definitions of CAM have on utilization statistics.
Key CAM Competencies
The information in this CAMPod will contribute to fulfilling CanMEDS competencies in the roles of
medical expert and scholar.
More specifically, the content of this CAMPod will contribute to meeting the following CAM-focused
learning objectives from the list of consensus-based CAM competencies for undergraduate medical
Knowledge 1 Describe definitions of CAM, classification schemes for CAM, and definitions of several
prominent CAM practices.
© Brundin-Mather, 2006
2. Overview
The definition of CAM has been debated over the past 10 years, more so as CAM has become a focus of
public and academic attention. However, because the field is so large, diverse, and dynamic there is no
single definition, or even term, that is globally accepted. * It is important to recognize that boundaries
between the CAM field and that of the dominant system are not always clear or fixed. Some prominent
definitions of CAM include the following:
In Eisenberg et al.’s groundbreaking 1993 article on the prevalence, cost, and patterns of use of
unconventional therapy in the in the United States, the authors defined unconventional therapies
(i.e., CAM) as Interventions not taught widely at U.S. medical schools or generally available at U.S.
Edzard Ernst, a well-known CAM researcher at the University of Exeter in the UK, defined
complementary and alternative medicine as the diagnosis, treatment and/or prevention which
complements mainstream medicine by contributing to a common whole, by satisfying a demand not
met by orthodoxy or by diversifying the conceptual frameworks of medicine (Ernst et al., 1995).
The Cochrane Collaboration describes CAM as a broad domain of healing resources that
encompasses all health systems, modalities, and practices and their accompanying theories and
beliefs, other than those intrinsic to the politically dominant health system of a particular society or
culture in a given historical period. CAM includes all such practices and ideas self-defined by their
users as preventing or treating illness or promoting health and well-being (from Zollman & Vickers,
The United States Congress adopted the term Complementary and Alternative Medicine (CAM) in
1998, replacing the former label, Alternative Medicine, which was adopted in 1992. The distinction
between complementary medicine and alternative medicine is based on use.
Complementary medicine is used together with conventional medicine. An example of a
complementary therapy is using aromatherapy to help lessen a patient's discomfort following
Alternative medicine is used in place of conventional medicine. An example of an alternative
therapy is using a special diet to treat cancer instead of undergoing surgery, radiation, or
chemotherapy that has been recommended by a conventional doctor.
The U.S. National Center for Complementary and Alternative Medicine (NCCAM), formerly the Office
of Alternative Medicine, provides what is perhaps the most current and commonly used definition.
The definition states that CAM includes broad range of healing philosophies, approaches, therapies,
and products that are not presently considered to be part of conventional medicine--that is, medicine
as practiced by holders of M.D. (medical doctor) or D.O. (doctor of osteopathy) degrees and their
The World Health Organization consciously uses the term Traditional Medicine in order to globally reflect the use of health
practices, approaches, knowledge and beliefs incorporating plan, animal and mineral based medicines, spiritual therapies, manual
techniques and exercises, applied singularly or in combination to treat, diagnose, and prevent illnesses or maintain well-being. The
WHO indicates that “in industrialized countries, adaptations of traditional medicine are sometimes termed “Complementary” or
“Alternative” (CAM) ( In this case, they are a broad set of health care
practices that are not part of that country's own tradition and are not integrated into the dominant health care system (see: Using the term “traditional medicine” as a synonym for CAM
clearly muddies an already murky area.
© Brundin-Mather, 2006
allied health professionals, such as physical therapists, psychologists, and registered nurses (NCCAM,
Health Canada uses the term, Complementary and Alternative Health Care (CAHC) (Approches
complémentaires et parallèles en santé) rather than Complementary and Alternative Medicine. The
intent is to recognize that health care goes beyond the scope of medicine and includes other
conventional practices such as nursing, physiotherapy, and psychology for example.
There is a growing interest and movement to use the term Integrative Medicine. While NCCAM
defines Integrative Medicine (IM) as the combination of mainstream medical therapies and CAM
therapies for which there is some high-quality scientific evidence of safety and effectiveness, many
others suggest that IM is more than the combination of conventional and CAM therapies. The
Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) states that it is the
practice of medicine that reaffirms the importance of the relationship between practitioner and
patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate
therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and
healing). To reconcile different definitions, some individuals have begun using the term
Complementary and Integrative Medicine. Please refer to the CAMpod, Integrative Medicine
for additional information.
The distinction between CAM and Conventional Medicine
Some experts argue that there is no complementary or alternative medicine, only unproven medicine
for which scientific evidence is lacking (Fontanarosa & Lundberg, 1998).
Historically, there are many terms used to differentiate conventional and unconventional therapies.
Since 1998 the term CAM or Complementary Medicine has largely been used in place of
unconventional medicine; however, there is still no international consensus or standardization of
Dalen (1998, p.2179)
presents some examples in
his editorial ‘Conventional'
and 'unconventional'
medicine -- can they be
Establishing boundaries
between conventional or main stream medicine and CAM is a complex and sometimes confusing
endeavour, challenged by different definitions over time and across cultures.
Many practices that were contrary to conventional medicine of the time were often referred
to as quackery. Wikipedia defines quackery the unethical practice of promising healthrelated benefits for which there is little or no basis. Quack is a term used for a person who
dispenses false medical advice or treatment ( Though
used more extensively 100 years ago, the term continues to be used (e.g., Quackwatch).
Yet, how do we know if a person is committing quackery? The answer may center on
acceptable evidence for the efficacy and safety of the practice in question. As evidence for
the efficacy and safety of a therapy grows, it becomes adopted into conventional health care.
For example, biofeedback used to be marginalized, but as an evidence base supporting its
use developed, it has been incorporated into mainstream medicine.
© Brundin-Mather, 2006
In Dalen’s opinion (1998), “the principal distinguishing characteristic of unconventional and
conventional medicine therapies is their source of introduction. Conventional therapies are
introduced by mainstream Western physicians and scientists, whereas most unconventional
modalities are introduced by "outsiders" (p.2180).
What is complementary or alternative medicine in one country or culture may be main
stream in another. For example, according to WHO, up to 80% of Africans use traditional
medicine for primary health care. The labels “unconventional medicine” or “complementary
medicine” are largely a product of Western medicine.
There are several classification schemes to help define CAM. The National Center for
Complementary and Alternative Medicine (NCCAM) in the United States has put forth a leading
typology that classifies CAM therapies into 5 domains:
1. Alternative Medical Systems: Complete systems of theory and practice e.g. Homeopathy,
Ayurveda and Traditional Chinese Medicine.
2. Mind-Body Interventions: e.g. Support groups (now considered conventional), cognitive
therapy, meditation, visualization, art, music, dance therapy.
3. Biologically Based Therapies: Herbs, vitamins, foods and other dietary products.
4. Manipulative and Body-Based Methods: Chiropractic, osteopathy and massage.
5. Energy Therapies: e.g.: Qi Gong, Therapeutic Touch, Reiki
A relatively recent proposal for classifying the practices of all health care (conventional,
complementary, alternative, and traditional) is based on “primary mode of therapeutic action”
(Jones 2005). There are six categories, each with several subdivisions: (1) biochemical, (2)
biomechanical, (3) mind-body, (4) energy, (5) psychological (symbolic), and (6) nonlocal. Jones
outlines the benefits of organizing health care by primary mode of therapeutic action including
establishing common ground and language for all “medicine.”
Other initiatives to classify CAM include Tataryn (2002), Kaptchuk & Eisenberg (2001), and Caspi et al
Rona Achilles’s paper in Perspectives on Complementary and Alternative Health Care: a collection of
papers for Health Canada (2001) offers a provisional list of key characteristics that distinguish CAM
from conventional medicine such as: works with the body’s own self-healing mechanism; holistic;
patient is active participant/person responsibility; and achieves well being to name a few.
3. Discussion
Questions for Discussion and/or Reflection
How have definitions of CAM changed over time? Is one definition better than others?
As students to think about other descriptive terms that they have heard for CAM? (e.g., ethno
medicine, indigenous)
Is CAM all quackery?
Establish justification for what is CAM? Is acupuncture CAM? Can a practice applied in one context
be conventional (e.g., acupuncture for nausea and vomiting) and not in another (e.g., acupuncture
© Brundin-Mather, 2006
for osteoarthritis). Further, is acupuncture a complementary therapy when it is practiced by a
medical doctor?
What do we call the medicine we provide in Canada?
How do we go about defining this enormous and diverse field?
Reflect and comment on the following quote: It is not that there are many alternatives to
biomedicine, but that biomedicine in one of many alternatives (Micozzi, 2001, p.109, Proceedings of
Education of Health Professionals).
Why differences and not similarities between CAM and conventional medicine emphasized?
What are some of the benefits and/or problems of Jones’ proposal to organize health care by
primary mode of therapeutic action?
How might the lack of a common definition for CAM impact research on CAM use?
Is it necessary to establish a shared definition of CAM in order to have a meaningful and productive
dialogue about CAM?
3.2.1 Annotated Readings
[none provided at this time]
3.2.2 References
National Center for Complementary and Alternative Medicine. Get the Facts: What is Complementary and
Alternative Medicine. Available from URL: Accessed: March
13, 2006.
Jones CH. The spectrum of therapeutic influences and integrative health care: classifying health care
practices by mode of therapeutic action. J Altern Complement Med. 2005 Oct;11(5):937-44.
Anderson NB (editor). Encyclopaedia of health and behaviour. Thousand Oaks: Sage Publications. 2004.
Caspi O, Sechrest L, Pitluk HC, et al. On the definition of complementary, alternative and integrative
medicine : societal mega-stereotypes vs. the patients’ perspectives. Altern Ther Health Med 2003;
Achilles R. Defining complementary and alternative health care. In Perspectives on Complementary and
Alternative Health Care: a collection of papers for Health Canada. Ottawa, 2001. Available at:
Zollman C, Vickers A. ABC of complementary medicine: What is complementary medicine? BMJ
1999;319:693-696 (11 September).
Dalen J. "'Conventional' and 'unconventional' medicine -- can they be integrated?" Archives of Int Med
Crellin JK, Andersen RR, Conner JTH (eds). Alternative Health Care in Canada. Nineteenth and Twentieth
Century Perspectives. Toronto: Canadian Scolars Press, 1997.
© Brundin-Mather, 2006
3.2.3 CAMpod Citations
Achilles R. Defining complementary and alternative health care. In Perspectives on Complementary and
Alternative Health Care: a collection of papers for Health Canada. Ottawa, 2001. Available at:
Caspi O, Sechrest L, Pitluk HC, et al. On the definition of complementary, alternative and integrative
medicine : societal mega-stereotypes vs. the patients’ perspectives. Altern Ther Health Med 2003;
Consortium of Academic Health Centers for Integrative Medicine. Available from URL: Accessed: March 13, 2006.
Dalen J. "'Conventional' and 'unconventional' medicine -- can they be integrated?" Archives of Int Med,
Eisenberg, DM, et al. Unconventional Medicine in the United States: prevalence, costs, and patterns of
use. NEJM. 1993: 328:246-252.
Ernst E, Resch KL, Mills S, Hill R, Mitchell A, Willoughby M, et al. Complementary medicine
Br J Gen Pract 1995; 45: 506
a definition.
Fontanarosa PB, Lundberg GD. Alternative medicine meets science. JAMA. 1998 Nov 11;280(18):1618-9.
Jones CH. The spectrum of therapeutic influences and integrative health care: classifying health care
practices by mode of therapeutic action. J Altern Complement Med. 2005 Oct;11(5):937-44.
Kaptchuk TJ, Eisenberg DM. Varieties of healing: 2. A taxonomy of unconventional healing practices.
Ann Intern Med 2001; 135:196-204.
Micozzi . Education of Health Professionals in Complementary/Alternative Medicine. Proceedings of a
Conference Chaired by Alfred P. Fishman. Edited by Mary Hager. New York: Josiah Macy, Jr.
Foundation, 2001
National Center for Complementary and Alternative Medicine. Get the Facts: What is Complementary and
Alternative Medicine. Available from URL: Accessed: March
13, 2006.
Tataryn D. Paradigms of health and disease: A framework for classifying and understanding
complementary and alternative medicine. J Altern Complement Med 2002;8-877-892.
Zollman C, Vickers A. ABC of complementary medicine: What is complementary medicine? BMJ
1999;319:693-696 (11 September).
© Brundin-Mather, 2006