Course Presenter(s):
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Course Description:
Meditation as a practice undertaken for its health or mental health benefits is considered to fall under the category of complementary or alternative medicine (CAM). Funding to study CAM interventions including meditation have increased dramatically as has use of meditation by the US population. This course focuses on the research support for meditation as a form of CAM and its changing patterns of usage.
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Founding of the NCCAM
Mindfulness, as well as other forms of meditation, as practices undertaken
for their physical or mental health benefits are considered to fall under the
category of complementary or alternative medicine (CAM). Although many forms of
CAM have been practiced in the U.S. for centuries, the U.S. government did not
allocate any significant research funds to evaluate such alternative therapies
until the National Institute of Health (NIH) established the Office of
Alternative Medicine (OAM) in 1992 (with a starting budget of only 2 million
dollars).Its founding was due to pressure put on Congress by consumers who
wanted better data on which to base their health decisions. In 1998, the
underfunded OAM was elevated in status to become the National Center for Complementary and
Alternative Medicine (NCCAM) with a budget of 50 million dollars.
By 2009 the NCCAM’s annual budget had increased to 105 million dollars.
Interview with, Josephine P. Briggs, M.D., Director of NCCAM (This interview
gives an overview of NCCAM’s mission and a statement of the importance of its
work. 3:40)
Just what is CAM? Defining the term “complimentary and alternative medicine”
is challenging because the field is very broad and constantly changing. NCCAM
defines CAM as a group of diverse medical and health care systems, practices,
and products that are not generally considered part of conventional medicine.
According to NCCAM "complementary medicine" refers to the use of
non-conventional medicine together with conventional medicine.
Most use of CAM by Americans is complementary. "Alternative medicine" refers to
the use of non-conventinal medicine in place of conventional
medicine. NCCAM considers conventional medicine (also called Western or
allopathic medicine) to be the mainstream approach practiced by holders of M.D.
(medical doctor) and D.O. (doctor of osteopathy) degrees as well as by allied
health professionals, such as psychologists, social workers, and nurses. The
boundaries between CAM and conventional medicine are not absolute, and specific
CAM practices may, over time, become widely accepted and included within the
context of conventional medicine.
The NIH recognized that there were many promising non-conventional therapies
that needed to be tested in the most appropriate manner (not only in
double-blind experimental trials). They charged NCCAM with the mission to
conduct and support basic and applied research and training, and to disseminate
information on complementary and alternative medicine to practitioners and the
public. Renaming the OAM as the NCCAM empowered it to fund its research grants
and other projects directly. As an office, its projects could only be funded
through collaboration with other institutes or outside agencies. As a result of
increased NCCAM funding and a renewed interest in the academic and research
community (driven at least partially by patient demand and evidence of
widespread usage by patients), research on alternative therapies is growing.
The NCCAM is now funding an extensive variety of research projects on CAM at
research centers around the U.S. The use of centers to facilitate research is a
widely-employed strategy at NIH. Such centers often have a specific research
focus such as schizophrenia, rehabilitation, addiction, HIV/AIDS, stroke, aging,
asthma and many other health areas.
In 2009, NCCAM funded 419 CAM research projects with 20, or about 5%,
involving the study of meditation. These 20 research projects are evenly split
between those addressing mental health issues, physical health issues, and basic
research into how meditation works. Twelve of the 20 projects specifically
target mindfulness as the form of meditation being studied. The following is a
sampling of research institutions receiving NCCAM funding for meditation
research, highlighting those that focus on mindfulness, along with a link to the
detailed NCCAM description of the research being conducted:
Categories of CAM
The NCCAM lists four categories of CAM:
- Natural products (herbs, vitamins, minerals, etc.)
- Mind-body medicine (meditation, yoga, acupuncture, hypnotherapy, Chi Gong,
etc.)
- Manipulative and Body-based practices (chiropractice and massage therapy.)
- Other CAMs (movement therapies, such as the Feldenkrais method, energy
medicine, such as Reiki and magnet therapy, and whole medical systems, such as
Chinese medicine, Ayurvedic medicine, or homeopathy.)
The NCCAM considers meditation to be a Mind-Body modality. NCCAM defines
mind-body medicine as an approach which focuses on
interactions among the brain/mind, the rest of the body, and behavior, and
ways in which emotional, mental, social, spiritual, and behavioral factors can
directly affect health.
Meditation, the NCCAM umbrella under which mindfulness falls, includes
interventions that employ a variety of techniques designed to facilitate the
mind's capacity to affect bodily function and symptoms. NCCAM
Meditation: An Introduction
Meditation practices, including mindfulness, in their spiritually sanitized
forms (meditation practices taught outside the belief and ritual systems of any
religious tradition) are sometimes further subcategorized as a Behavioral
Medicine intervention. Behavioral Medicine is an interdisciplinary field of
(conventional) medicine concerned with the development and integration of
knowledge in the biological, behavioral, psychological, and social sciences that
are relevant to health and illness. (The Society of
Behavioral Medicine ) Mindfulness-based Stress Reduction (MBSR) is
an example of spiritually-sanitized meditation, which, due to the extensive
research supporting its efficacy, has now been accepted as a mainstream
Behavioral Medicine treatment treatment for particular medical problems, such as
chronic pain. For more on MBSR, see our MBSR course.
Prevalence of CAM
In 1993, the New England Journal of Medicine published a study which was
disseminated by many news services. The study found that 1/3 of all people in
treatment for a medical condition are also receiving an alternative therapy. For
cancer patients and people with AIDS, the percentage is over 50%. Yet 72%
concealed their use of alternative therapies from their physicians.
David Eisenberg, MD et al. Unconventional
medicine in the United States. Prevalence, costs, and patterns of use.
N Engl J Med 1993 Jan 28;328(4):246-52
The same researchers replicated their study in 1998 and found a statistically
significant increase in use of alternative therapies from 33.8% in 1990 to 42.1%
in 1997 (P<.001). Extrapolating their data, the authors further concluded
that visits to alternative therapists exceeded the number of visits to
physicians!
Trends in Alternative Medicine Use in the United States,
1990-1997: Results of a Follow-up National Survey by David Eisenberg, MD et al.
JAMA 1998 Nov 11; 280(18):1569-75
An analysis of two surveys of CAM usage in 2002 showed that the prevalence of
CAM usage had remained at the 1997 level.
Tindle, HA, Davis, RB, Phillips, RS, and Eisenberg, DM. Trends in Use
of Complementary and Alternative Medicine by US Adults: 1997-2002,
Alternative Therapies in Health and Medicine, 2005, Jan-Feb: 11 (1): 42-9.
A 2007 follow-up survey showed that CAM usage had dropped a bit to 38% of
adults. This study also revealed that by far the largest reason for CAM usage
was chronic pain, especially back pain.
Economic statistics from the same survey show that Americans spent nearly $34
billion out of pocket for CAM in 2007. This represented about 11% of all
out-of-pocket health care spending and 1.5% of total American spending on
healthcare.
Use of Meditation as a Form of CAM
Meditation as a form of mind-body CAM, which for the NCCAM includes
mindfulness, continues to grow in popularity. The 2002 U.S. government study
showed that 7.2 % of over 23,000 respondents (representing more than 15 million
people) had used meditation in the past 12 months. When the same survey was
replicated in 2007, those reporting the use of meditation had increased
significantly to above the 9.4% (representing 20 million people, or a 33%
increase over 2002). The 2007 survey also asked about CAM use in a sample of
9,417 children. The results showed that 1% (representing 725,000 children) had
used meditation in the past 12 months.
According to NCCAM, people use meditation as CAM for various physical and
mental health problems, such as:
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Anxiety
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Pain (such as that associated with arthritis or fibromyalgia)
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Depression
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Stress
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Insomnia
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Physical or emotional symptoms that may be associated with chronic
illnesses (such as heart disease, HIV/AIDS, and cancer) and their
treatment.
Meditation is also used to promote overall wellness. In a study subjects in
the meditation condition reported significant decreases from baseline in the
effect of daily hassles (24%), psychological distress, (44%), and medical
symptoms (46%) that were maintained at the 3-month follow-up compared to control
subjects.
Williams KA, Kolar MM, Reger BE, Pearson JC. Evaluation of a
Wellness-Based Mindfulness Stress Reduction intervention: a controlled
trial. Am J Health Promot. 2001 Jul-Aug;15(6):422-32.