Alternative medicine

Alternative medical systems
Acupuncture • Anthroposophic medicine • Ayurveda • Chiropractic • Herbalism • Homeopathy • Naturopathy • Neural therapy • Osteopathy • Traditional medicine (Chinese • Tibetan)
NCCAM classifications
Whole medical systems • Mind-body interventions • Biologically based therapies • Manipulative therapy • Energy therapies
See also
Alternative medicine • Glossary of alternative medicine • List of people in alternative medicine

The term alternative medicine, as used in the modern western world, encompasses any healing practice "that does not fall within the realm of conventional medicine."[1] Commonly cited examples[2] include naturopathy, chiropractic, herbalism, traditional Chinese medicine, Ayurveda, meditation, yoga, biofeedback, hypnosis, homeopathy, acupuncture, and diet-based therapies, in addition to a range of other practices. It is frequently grouped with complementary medicine, which generally refers to the same interventions when used in conjunction with mainstream techniques,[3][4][5] under the umbrella term complementary and alternative medicine, or CAM. Some significant researchers in alternative medicine oppose this grouping, preferring to emphasize differences of approach, but nevertheless use the term CAM, which has become standard.[6][7]

Alternative medicine practices are as diverse in their foundations as in their methodologies. Practices may incorporate or base themselves on traditional medicine, folk knowledge, spiritual beliefs, or newly conceived approaches to healing. Jurisdictions where alternative medical practices are sufficiently widespread may license and regulate them. The claims made by alternative medicine practitioners are generally not accepted by the medical community because evidence-based assessment is not available for the safety and efficacy of many of these practices. If scientific investigation establishes the safety and effectiveness of an alternative medical practice, it may be adopted by conventional practitioners.[8][9] Because alternative techniques tend to lack evidence, some have advocated defining it as non-evidence based medicine, or not medicine at all. Some researchers have noted that the evidence-based approach to defining CAM is problematic because some CAM is tested, and research suggests that many mainstream medical techniques lack solid evidence.[10]

A 1998 systematic review of studies assessing its prevalence in 13 countries concluded that about 31% of cancer patients use some form of complementary and alternative medicine.[11] Alternative medicine varies from country to country; Dr. Edzard Ernst believes that in Austria and Germany CAM is mainly in the hands of physicians,[7] although some estimates suggest that half of CAM is administered by physicians in the US.[12] In Germany, herbs are tightly regulated, with half prescribed by doctors and covered by health insurance based on their Commission E legislation.[13]

Contents

Definitions and categorizations

General terms

There is no clear and consistent definition as to the exact nature of alternative or complementary medicines.[14]:17 In a 2005 report entitled Complementary and Alternative Medicine in the United States[14] the Institute of Medicine (IOM) adopted this definition:

"Complementary and Alternative Medicine (CAM) is a broad domain of resources that encompasses health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the dominant health system of a particular society or culture in a given historical period. CAM includes such resources perceived by their users as associated with positive health outcomes. Boundaries within CAM and between the CAM domain and the domain of the dominant system are not always sharp or fixed."[14]

Other groups and individuals have offered various definitions and distinguishing characteristics. The National Center for Complementary and Alternative Medicine (NCCAM) defines CAM as "a group of diverse medical and health care systems, practices, and products, that are not currently part of conventional medicine."[9] NCCAM has developed what the IOM calls "[o]ne of the most widely used classification structures"[14] for the branches of complementary and alternative medicine.[9] The Cochrane Complementary Medicine Field says:

"What are considered complementary or alternative practices in one country may be considered conventional medical practices in another. Therefore, our definition is broad and general: complementary medicine includes all such practices and ideas which are outside the domain of conventional medicine in several countries and defined by its users as preventing or treating illness, or promoting health and well-being. These practices complement mainstream medicine by 1) contributing to a common whole, 2) satisfying a demand not met by conventional practices, and 3) diversifying the conceptual framework of medicine."[15]

David M. Eisenberg defines it as "medical interventions not taught widely at US medical schools or generally available at US. hospitals,"[16] while Richard Dawkins sardonically defines it as a "set of practices which cannot be tested, refuse to be tested, or consistently fail tests."[17]

The term "alternative medicine" is generally used to describe practices used independently or in place of conventional medicine. The term "complementary medicine" is primarily used to describe practices used in conjunction with or to complement conventional medical treatments. NCCAM suggests "using aromatherapy therapy in which the scent of essential oils from flowers, herbs, and trees is inhaled in an attempt to promote health and well-being and to help lessen a patient's discomfort following surgery"[9] as an example of complementary medicine. The terms "integrative" or "integrated medicine" indicate combinations of conventional and alternative medical treatments which have some scientific proof of efficacy; such practices are viewed by advocates as the best examples of complementary medicine.[9] Ralph Snyderman and Andrew Weil go so far as to claim that "integrative medicine is not synonymous with complementary and alternative medicine. It has a far larger meaning and mission in that it calls for restoration of the focus of medicine on health and healing and emphasizes the centrality of the patient-physician relationship."[18] The combination of orthodox and complementary medicine with an emphasis on prevention and lifestyle changes is known as Integrated health.

Relation to evidence-based medicine

Some scientists reject the use of the classification of any therapy as 'alternative medicine' on the grounds that "[t]here is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work."[8] These scientists advocate a classification based on scientific evidence, and claim that "[w]hat most sets alternative medicine apart, in our view, is that it has not been scientifically tested and its advocates largely deny the need for such testing." The US Institute of Medicine analyzed this approach to defining alternative medicine, which it called normative, and found it problematic because some CAM is tested, and much of mainstream medicine lacks strong evidence. The IOM noted that in a study of 160 Cochrane systematic reviews of mainstream techniques, 20% were ineffective and 21% had insufficient evidence.[14] The IOM therefore defined alternative medicine broadly as the nondominant approach in a given culture and historical period. A similar definition has been adopted by the Cochrane Collaboration,[15] which is the leading body of evidence-based medicine, and official government bodies such as the UK Department of Health.[19]

Well-known proponents of evidence-based medicine, such as the Cochrane Collaboration and Edzard Ernst, Professor of Complementary Medicine at the University of Exeter, use the term alternative medicine but agree that all treatments, whether "mainstream" or "alternative", ought to be held to standards of the scientific method.[20] Their view is that evidence-based medicine is an ideal state which has not yet been achieved by either current mainstream or alternative medicine. Ernst characterizes the evidence for many alternative techniques as weak, nonexistent, or negative, but notes that compelling evidence exists for others, particularly certain herbs and acupuncture[21] – although this evidence does not mean these treatments are mainstream, especially not worldwide. What is alternative varies by discipline as well and country. For example, biofeedback is commonly used within the Physical Medicine & Rehabilitation community, but is considered alternative within the medical community as a whole, and some herbal therapies are mainstream in Europe, but are alternative in the United States.[22]

Criticisms of CAM by mainstream physicians have been numerous. Barrie R. Cassileth has succinctly summed up the situation:

"Not all mainstream physicians are pleased with CAM, with current efforts to integrate CAM into mainstream medicine, or with a separate NIH research entity for "alternative" medicine.[23][24][8] Vigorous opposition to CAM as "pseudo science" based on "absurd beliefs" continues to be voiced. CAM's deviation from basic scientific principles, implicit, for example, in homeopathy and therapeutic touch, are decried. A 1997 letter to the US Senate Subcommittee on Public Health and Safety signed by four Nobel Laureates and other prominent scientists deplored the lack of critical thinking and scientific rigor in OAM-supported research."[25]

According to the NCCAM,[9] formerly unproven remedies may be incorporated into conventional medicine if they are shown to be safe and effective. Several scientists share this point of view and state that "[o]nce a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted."[8] According to them it is possible for a method to change categories (proven vs. unproven) in either direction, based on increased knowledge of its effectiveness or lack thereof. Prominent proponents of this position are George D. Lundberg, former editor of the Journal of the American Medical Association (JAMA), and Phil B. Fontanarosa, Senior Editor of JAMA,"[26] Richard Dawkins, Professor of the Public Understanding of Science at Oxford,[27][28][29] and Stephen Barrett, founder and operator of Quackwatch, who argues that techniques currently labeled "alternative" should be reclassified as "genuine, experimental, or questionable. Genuine alternatives are comparable methods that have met science-based criteria for safety and effectiveness. Experimental alternatives are unproven but have a plausible rationale and are undergoing responsible investigation. ... Questionable alternatives are groundless and lack a scientifically plausible rationale. ... Blurring these distinctions enables promoters of quackery to argue that because some practices labeled "alternative" have merit, the rest deserve equal consideration and respect. Enough is known, however, to conclude that most questionable "alternatives" are worthless.[30][21][31] Oxford University Press publishes a peer-reviewed journal entitled Evidence-based Complementary and Alternative Medicine (eCAM).[32]

M.R. Tonelli argues that CAM cannot be evidence-based unless the definition of evidence is changed. He states that "the methods of developing knowledge within CAM currently have limitations and are subject to bias and varied interpretation. CAM must develop and defend a rational and coherent method for assessing causality and efficacy, though not necessarily one based on the results of controlled clinical trials."[33] Further, A review of Michael L. Millenson's book Demanding Medical Excellence: Doctors and Accountability in the Information Age described it as "a wake up call to both medicine and nursing" due to what Millenson calls a "lack of scientific-based medical practice". According to the review, the book states that "85% of current practice has not been scientifically validated" and that it suggests that users of the research presented by Medline should question research articles rather than assuming they are accurate simply because of where they are published. The review states that Millenson's thesis and conclusion call for all health researchers and policy makers do a better job in assuring valid methodology and avoidance of bias in published research.[34] Michael Dixon, the Director of the NHS Alliance stated that “People argue against complementary therapies on the basis of a lack of evidence. But I’d say only 10 per cent of what doctors do in primary care is evidence-based."[35] Angell and Kassirer acknowledge that "many treatments used in conventional medicine have not been rigorously tested, either" but note that the scientific community is generally aware that this is a failing that needs to be remedied."[8]

Many CAM methods are criticized by the activist non-profit organization Quackwatch.[36]

NCCAM classifications

NCCAM classifies complementary and alternative therapies into five major groups. The classification are rather loose, and there can be some overlap.[9]

Contemporary use of alternative medicine

Further information: List of branches of alternative medicine

Many people utilize mainstream medicine for diagnosis and basic information, while turning to alternatives for what they believe to be health-enhancing measures. Studies indicate that alternative approaches are often used in conjunction with conventional medicine.[43] This is referred to by NCCAM as integrative (or integrated) medicine because it "combines treatments from conventional medicine and CAM for which there is some high-quality evidence of safety and effectiveness."[9] According to Andrew T. Weil M.D., a leading proponent of integrative medicine, the principles of integrative medicine include: appropriate use of conventional and CAM methods; patient participation; promotion of health as well as treatment of disease; and a preference for natural, minimally-invasive methods.[44] A 1997 survey found that 13.7% of respondents in the United States had sought the services of both a medical doctor and an alternative medicine practitioner. The same survey found that 96% of respondents who sought the services of an alternative medicine practitioner also sought the services of a medical doctor in the past 12 months. Medical doctors are often unaware of their patient's use of alternative medical treatments as only 38.5% of the patients alternative therapies were discussed with their medical doctor.[45]

Age-adjusted percent of adults who have used complementary and alternative medicine: United States, 2002[46]

Edzard Ernst, Professor of Complementary Medicine at the University of Exeter, wrote in the Medical Journal of Australia that "about half the general population in developed countries use complementary and alternative medicine (CAM)."[47]Survey results released in May 2004 by the National Center for Complementary and Alternative Medicine, part of the United States National Institutes of Health, found that in 2002 62.1% of adults in the country had used some form of CAM in the past 12 months and 75% across lifespan (though these figure drop to 36.0% and 50% if prayer specifically for health reasons is excluded); this study included yoga, meditation, herbal treatments and the Atkins diet as CAM.[43][48] Another study suggests a similar figure of 40%.[49] A British telephone survey by the BBC of 1209 adults in 1998 shows that around 20% of adults in Britain had used alternative medicine in the past 12 months.[50] Ernst has been active politically on this issue as well, publicly requesting that Prince Charles recall two guides to alternative medicine published by the Foundation for Integrated Health, on the grounds that “[t]hey both contain numerous misleading and inaccurate claims concerning the supposed benefits of alternative medicine" and that "[t]he nation cannot be served by promoting ineffective and sometimes dangerous alternative treatments.”[51] In general, he believes that CAM can and should be subjected to scientific testing.[52][21][31]

The use of alternative medicine in developed countries appears to be increasing. A 1998 study showed that the use of alternative medicine had risen from 33.8% in 1990 to 42.1% in 1997.[53] In the United Kingdom, a 2000 report ordered by the House of Lords suggested that "...limited data seem to support the idea that CAM use in the United Kingdom is high and is increasing."[54] In developing nations, access to essential medicines is severely restricted by lack of resources and poverty. Traditional remedies, often closely resembling or forming the basis for alternative remedies, may comprise primary health care or be integrated into the health care system. In Africa, traditional medicine is used for 80% of primary health care, and in developing nations as a whole over one third of the population lack access to essential medicines.[55]

Advocates of alternative medicine hold that the various alternative treatment methods are effective in treating a wide range of major and minor medical conditions, and contend that recently published research (such as Michalsen, 2003,[56] Gonsalkorale 2003,[57] and Berga 2003[58]) proves the effectiveness of specific alternative treatments. They assert that a PubMed search revealed over 370,000 research papers classified as alternative medicine published in Medline-recognized journals since 1966 in the National Library of Medicine database. See also Kleijnen 1991,[59] and Linde 1997.[60]

Complementary therapies are often used in palliative care or by practitioners attempting to manage chronic pain in patients. Complementary medicine is considered more acceptable in the interdisciplinary approach used in palliative care than in other areas of medicine. "From its early experiences of care for the dying, palliative care took for granted the necessity of placing patient values and lifestyle habits at the core of any design and delivery of quality care at the end of life. If the patient desired complementary therapies, and as long as such treatments provided additional support and did not endanger the patient, they were considered acceptable."[61] The non-pharmacologic interventions of complementary medicine can employ mind-body interventions designed to "reduce pain and concomitant mood disturbance and increase quality of life."[62] Physicians who practice complementary medicine usually discuss and advise patients as to available complementary therapies. Patients often express interest in mind-body complementary therapies because they offer a non-drug approach to treating some health conditions.[63] Some mind-body techniques, such as cognitive-behavioral therapy, were once considered complementary medicine, but are now a part of conventional medicine in the United States.[64] "Complementary medicine treatments used for pain include: acupuncture, low-level laser therapy, meditation, aroma therapy, Chinese medicine, dance therapy, music therapy, massage, herbalism, therapeutic touch, yoga, osteopathy, chiropractic, naturopathy, and homeopathy."[65]

The use of alternative medicine appears to be increasing, as a 1998 study showed that the use of alternative medicine had risen from 33.8% in 1990 to 42.1% in 1997.[66] In the United Kingdom, a 2000 report ordered by the House of Lords suggested that "...limited data seem to support the idea that CAM use in the United Kingdom is high and is increasing."[54]

In defining complementary medicine in the UK, the House of Lords Select Committee determined that the following therapies were the most often used to complement conventional medicine:[67] Alexander technique, Aromatherapy, Bach and other flower remedies, Body work therapies including massage, Counselling stress therapies, hypnotherapy, Meditation, Reflexology, Shiatsu, Maharishi Ayurvedic medicine, Nutritional medicine, and Yoga.

Public use in the US

A botánicas, such as this one in Massachusetts, caters to the Latino community and sells folk medicine alongside statues of saints, candles decorated with prayers, and other items.

A 2002 survey of US adults 18 years and older conducted by the National Center for Health Statistics (CDC) and the National Center for Complementary and Alternative Medicine indicated:[43]

In the state of Texas, physicians may be partially protected from charges of unprofessional conduct or failure to practice medicine in an acceptable manner, and thus from disciplinary action, when they prescribe alternative medicine in a complementary manner, if board specific practice requirements are satisfied and the therapies utilized do not present "a safety risk for the patient that is unreasonably greater that the conventional treatment for the patient's medical condition."[68]

Medical education

In the United States, increasing numbers of medical colleges have started offering courses in alternative medicine. For example, in three separate research surveys that surveyed 729 schools (125 medical schools offering an MD degree, 25 medical schools offering a Doctor of Osteopathic medicine degree, and 585 schools offering a nursing degree), 60% of the standard medical schools, 95% of osteopathic medical schools and 84.8% of the nursing schools teach some form of CAM.[69][70][71] The University of Arizona College of Medicine offers a program in Integrative Medicine under the leadership of Dr. Andrew Weil which trains physicians in various branches of alternative medicine which "...neither rejects conventional medicine, nor embraces alternative practices uncritically."[72] Accredited Naturopathic colleges and universities are also increasing in number and popularity in Canada and the USA. (See Naturopathic medical school in North America)

Similarly "unconventional medicine courses are widely represented at European universities. They cover a wide range of therapies. Many of them are used clinically. Research work is underway at several faculties,"[73] but "only 40% of the responding [European] universities were offering some form of CAM training."[74]

In Britain, no conventional medical schools offer courses that teach the clinical practice of alternative medicine. However, alternative medicine is taught in several unconventional schools as part of their curriculum. Teaching is based mostly on theory and understanding of alternative medicine, with emphasis on being able to communicate with alternative medicine specialists. To obtain competence in practicing clinical alternative medicine, qualifications must be obtained from individual medical societies. The student must have graduated and be a qualified doctor. The British Medical Acupuncture Society, which offers medical acupuncture certificates to doctors, is one such example, as is the College of Naturopathic Medicine UK and Ireland.

Regulation

Due to the uncertain nature of various alternative therapies and the wide variety of claims different practitioners make, alternative medicine has been a source of vigorous debate, even over the definition of alternative medicine.[75][76] Dietary supplements, their ingredients, safety, and claims, are a continual source of controversy.[77] In some cases, political issues, mainstream medicine and alternative medicine all collide, such as the case where synthetic drugs are legal but the herbal sources of the same active chemical are banned.[78] In other cases, controversy over mainstream medicine causes questions about the nature of a treatment, such as water fluoridation.[79] Alternative medicine and mainstream medicine debates can also spill over into freedom of religion discussions, such as the right to decline lifesaving treatment for one's children because of religious beliefs.[80] Government regulators continue to attempt to find a regulatory balance.[81]

Jurisdiction differs concerning which branches of alternative medicine are legal, which are regulated, and which (if any) are provided by a government-controlled health service or reimbursed by a private health medical insurance company. The United Nations Committee on Economic, Social and Cultural Rights - article 34 (Specific legal obligations) of the General Comment No. 14 (2000) on The right to the highest attainable standard of health - states that

"Furthermore, obligations to respect include a State's obligation to refrain from prohibiting or impeding traditional preventive care, healing practices and medicines, from marketing unsafe drugs and from applying coercive medical treatments, unless on an exceptional basis for the treatment of mental illness or the prevention and control of communicable diseases."[82]

Specific implementations of this article are, of course, left to member states.

A number of alternative medicine advocates disagree with the restrictions of government agencies that approve medical treatments. In the USA, for example, critics claim that the Food and Drug Administration's criteria for experimental evaluation methods impedes those seeking to bring useful and effective treatments and approaches to the public, and protest that their contributions and discoveries are unfairly dismissed, overlooked or suppressed. Alternative medicine providers recognize that health fraud occurs, and argue that it should be dealt with appropriately when it does, but that these restrictions should not extend to what they view as legitimate health care products.

In New Zealand alternative medicine products are classified as food products, so there are no regulations or safety standards in place.[83]

The production of modern pharmaceuticals is strictly regulated to ensure that medicines contain a standardized quantity of active ingredients and are free from contamination. Alternative medicine products are not subject to the same governmental quality control standards, and consistency between doses can vary. This leads to uncertainty in the chemical content and biological activity of individual doses. This lack of oversight means that alternative health products are vulnerable to adulteration and contamination.[84] This problem is magnified by international commerce, since different countries have different types and degrees of regulation. This can make it difficult for consumers to properly evaluate the risks and qualities of given products.

Alternative and evidence-based medicine

Testing of efficacy

Many alternative therapies have been tested with varying results. In 2003, a project funded by the CDC identified 208 condition-treatment pairs, of which 58% had been studied by at least one randomized controlled trial (RCT), and 23% had been assessed with a meta-analysis.[85] According a 2005 book by a US Institute of Medicine panel, the number of RCTs focused on CAM has risen dramatically. The book cites Vickers (1998), who found that many of the CAM-related RCTs are in the Cochrane register, but 19% of these trials were not in MEDLINE, and 84% were in conventional medical journals.[14]:133

As of 2005 the Cochrane Library had 145 CAM-related Cochrane systematic reviews and 340 non-Cochrane systematic reviews. An analysis of the conclusions of only the 145 Cochrane reviews was done by two readers. In 83% of the cases, the readers agreed. In the 17% in which they disagreed, a third reader agreed with one of the initial readers to set a rating. These studies found that for CAM, 38.4% concluded positive effect or possibly positive (12.4%) effect, 4.8% concluded no effect, 0.69% concluded harmful effect, and 56.6% concluded insufficient evidence. An assessment of conventional treatments found that 41.3% concluded positive or possibly positive effect, 20% concluded no effect, 8.1% concluded net harmful effects, and 21.3% concluded insufficient evidence. However, the CAM review used the 2004 Cochrane database while the conventional review used the 1998 Cochrane database.[14]:135-136

Most alternative medical treatments are not patentable, which may lead to less research funded by the private sector;[86] some have proposed adopting a prize system to reward medical research.[87] However, public funding for research exists. Increasing the funding for research of alternative medicine techniques was the purpose of the US National Center for Complementary and Alternative Medicine. NCCAM and its predecessor, the Office of Alternative Medicine, have spent more than $1 billion on such research since 1992.[88] The German Federal Institute for Drugs and Medical Devices Commission E has studied many herbal remedies for efficacy.[89] The lack of legal pressure to prove efficacy may also reduce the amount of research.[86]

Some skeptics of alternative practices point out that a person may attribute symptomatic relief to an otherwise ineffective therapy due to the placebo effect, the natural recovery from or the cyclical nature of an illness (the regression fallacy), or the possibility that the person never originally had a true illness.[90] CAM proponents point out this may also apply in cases where conventional treatments have been used.

In the same way as for conventional therapies, drugs, and interventions, it can be difficult to test the efficacy of alternative medicine in clinical trials. In instances where an established, effective, treatment for a condition is already available, the Helsinki Declaration states that withholding such treatment is unethical in most circumstances. Use of standard-of-care treatment in addition to an alternative technique being tested may produce confounded or difficult-to-interpret results.[91]

Testing of safety

Interactions with conventional pharmaceuticals

Forms of alternative medicine that are biologically active can be dangerous even when used in conjunction with conventional medicine. Examples include immuno-augmentation therapy, shark cartilage, bioresonance therapy, oxygen and ozone therapies, insulin potentiation therapy. Some herbal remedies can cause dangerous interactions with chemotherapy drugs, radiation therapy or anesthetics during surgery, among other problems.[6] An anecdotal example of these dangers was reported by Associate Professor Alastair MacLennan of Adelaide University, Australia regarding a patient who almost bled to death on the operating table after neglecting to mention that she had been taking "natural" potions to "build up her strength" before the operation, including a powerful anticoagulant that nearly caused her death.[92]

To ABC Online, MacLennan also gives another possible mechanism:

"And lastly there’s the cynicism and disappointment and depression that some patients get from going on from one alternative medicine to the next, and they find after three months the placebo effect wears off, and they’re disappointed and they move on to the next one, and they’re disappointed and disillusioned, and that can create depression and make the eventual treatment of the patient with anything effective difficult, because you may not get compliance, because they’ve seen the failure so often in the past".[93]

Potential side-effects

Conventional treatments are subjected to testing for undesired side-effects, whereas alternative treatments generally are not subjected to such testing at all. Any treatment — whether conventional or alternative — that has a biological or psychological effect on a patient may also have potentially dangerous biological or psychological side-effects. Attempts to refute this fact with regard to alternative treatments sometimes use the appeal to nature fallacy, i.e. "that which is natural cannot be harmful".

An exception to the normal thinking regarding side-effects is Homeopathy. Since 1938 the FDA has regulated homeopathic products in "several significantly different ways from other drugs."[94] Homeopathic preparations, termed "remedies," are extremely dilute, often far beyond the point where a single molecule of the original active (and possibly toxic) ingredient is likely to remain. They are thus considered safe on that count, but "their products are exempt from good manufacturing practice requirements related to expiration dating and from finished product testing for identity and strength," and their alcohol concentration may be much higher than allowed in conventional drugs.[94]

Treatment delay

Those who have experienced or perceived success with one alternative therapy for a minor ailment may be convinced of its efficacy and persuaded to extrapolate that success to some other alternative therapy for a more serious, possibly life-threatening illness. For this reason, critics contend that therapies that rely on the placebo effect to define success are very dangerous. According to mental health journalist Scott Lilienfeld in 2002, "unvalidated or scientifically unsupported mental health practices can lead individuals to forgo effective treatments" and refers to this as “opportunity cost.” Individuals who spend large amounts of time and money on ineffective treatments may be left with precious little of either, and may forfeit the opportunity to obtain treatments that could be more helpful. In short, even innocuous treatments can indirectly produce negative outcomes.[95]

Appeal of alternative medicine

An alternative medicine center in Durham, North Carolina.

A study published in 1998[49] indicates that a majority of alternative medicine use was in conjunction with standard medical treatments. Approximately 4.4 percent of those studied used alternative medicine as a replacement for conventional medicine. The research found that those who used alternative medicine tended to have higher education or report poorer health status. Dissatisfaction with conventional medicine was not a meaningful factor in the choice, but rather the majority of alternative medicine users appear to be doing so largely because "they find these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life." In particular, subjects reported a holistic orientation to health, a transformational experience that changed their worldview, identification with a number of groups committed to environmentalism, feminism, psychology, and/or spirituality and personal growth, or that they were suffering from a variety of common and minor ailments - notably anxiety, back problems, and chronic pain.

Authors have speculated on the socio-cultural and psychological reasons for the appeal of alternative medicines among that minority whose use them in lieu of conventional medicine. There are several socio-cultural reasons for the interest in these treatments centered around the low level of scientific literacy among the public at large and a concomitant increase in antiscientific attitudes and new age mysticism.[96] Related to this are vigorous marketing[97] of extravagant claims by the alternative medical community combined with inadequate media scrutiny and attacks on critics.[96][98] There is also an increase in conspiracy theories towards conventional medicine and pharmaceutical companies, mistrust of traditional authority figures, such as the physician, and a dislike of the current delivery methods of scientific biomedicine, all of which have lead patients to seek out alternative medicine to treat a variety of ailments.[98] Many patients lack access to contemporary medicine, due to a lack of private or public health insurance, which lead them to seek out lower-cost alternative medicine.[43] Medical doctors are also aggressively marketing alternative medicine to profit from this market.[97]

In addition to the social-cultural underpinnings of the popularity of alternative medicine, there are several psychological issues that are critical to its growth. One of the most critical is the placebo effect, which is a well-established observation in medicine.[99] Related to it are similar psychological effects such as the will to believe,[96] cognitive biases that help maintain self-esteem and promote harmonious social functioning,[96] and the post hoc, ergo propter hoc fallacy.[96] Patients can also be averse to the painful, unpleasant, and sometimes dangerous side effects of biomedical treatments. Treatments for severe diseases such as cancer and HIV infection have well-known, significant side effects. Even low-risk medications such as antibiotics can potentially cause life-threatening anaphylactic reactions in a very few individuals. More commonly, many medications may cause minor but bothersome symptoms such as cough or upset stomach. In all of these cases, patients may be seeking out alternative treatments to avoid the adverse effects of conventional treatments.[96][98]

References

  1. ↑ Bratman, MD, Steven (1997). The Alternative Medicine Sourcebook. Lowell House. pp. 7. ISBN 1565656261. 
  2. ↑ Definition of Complementary medicine, MedicineNet.com
  3. ↑ White House Commission on Complementary and Alternative Medicine Policy, Chapter 2, March 2002.
  4. ↑ Ernst E. Complementary medicine: Common misconceptions. Journal of the Royal Society of Medicine 1995;88(5):244-247.
  5. ↑ Joyce CR . Placebo and complementary medicine. Lancet 1994;344(8932):1279-1281.
  6. ↑ 6.0 6.1 Cassileth BR, Deng G. (2004) Complementary and Alternative Therapies for Cancer The Oncologist PMID 14755017
  7. ↑ 7.0 7.1 Elsevier Science - Interview with Edzard Ernst, editor of The Desktop Guide to Complementary and Alternative Medicine
  8. ↑ 8.0 8.1 8.2 8.3 8.4 Angell M, Kassirer JP (1998). "Alternative medicine--the risks of untested and unregulated remedies" (PDF). N. Engl. J. Med. 339 (12): 839–41. doi:10.1056/NEJM199809173391210. PMID 9738094. http://kitsrus.com/pdf/nejm_998.pdf. Retrieved on 2007-12-28.  "It is time for the scientific community to stop giving alternative medicine a free ride. There cannot be two kinds of medicine -- conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted. But assertions, speculation, and testimonials do not substitute for evidence. Alternative treatments should be subjected to scientific testing no less rigorous than that required for conventional treatments."
  9. ↑ 9.0 9.1 9.2 9.3 9.4 9.5 9.6 9.7 "What is Complementary and Alternative Medicine (CAM)?". National Center for Complementary and Alternative Medicine at the National Institutes of Health. Retrieved on 2006-07-11.
  10. ↑ Kopelman LM (2004). The Role of Science in Assessing Conventional, Complementary, and Alternative Medicines. In: The Role of Complementary and Alternative Medicine: Accommodating Pluralism (Hastings Center Studies in Ethics Series, Callahan D, editor). Washington, D.C: Georgetown University Press. pp. 36–53. ISBN 1-58901-016-7. 
  11. ↑ Ernst & Cassileth (1998). The prevalence of complementary/Alternative medicine in cancer
  12. ↑ Cassileth, Barrie R. Alternative and Complementary Cancer Treatments The Oncologist, Vol. 1, No. 3, 173–179, June 1996
  13. ↑ JAMA - Sign In Page
  14. ↑ 14.0 14.1 14.2 14.3 14.4 14.5 14.6 Committee on the Use of Complementary and Alternative Medicine by the American Public. (2005). Complementary and Alternative Medicine in the United States. National Academies Press.
  15. ↑ 15.0 15.1 E Manheimer, B Berman, Cochrane Complementary Medicine Field: Scope and topics, 2007
  16. ↑ Unconventional Medicine in the United States -- Prevalence, Costs, and Patterns of Use. Eisenberg D, et al. N Engl J Med 1993; 328:246-252.
  17. ↑ Richard Dawkins Dawkins, Richard (2003). A Devil's Chaplain. Weidenfeld & Nicolson. 
  18. ↑ Snyderman, R.; Weil, A. T. (2002-02-25). "Integrative Medicine: Bringing Medicine Back To Its Roots". Archives of Internal Medicine. Retrieved on 2006-07-11. PMID 11863470
  19. ↑ UK DOH. Complementary and alternative medicine.
  20. ↑ The Cochrane Collaboration Complementary Medicine Field. Retrieved 5 August 2006.
  21. ↑ 21.0 21.1 21.2 The HealthWatch Award 2005: Prof. Edzard Ernst, Complementary medicine: the good the bad and the ugly. Retrieved 5 August 2006
  22. ↑ Spiegel D, Lake J. (2006). Complementary and Alternative Medicine in Health Care.
  23. ↑ Park RL, Goodenough U: Buying snake oil with tax dollars. New York Times, January 3, 1996, A11.
  24. ↑ Quackwatch.org
  25. ↑ Barrie R. Cassileth. "Evaluating Complementary and Alternative Therapies for Cancer Patients." CA Cancer J Clin 1999;49:353-361
  26. ↑ Alternative medicine meets science. Fontanarosa P.B., and Lundberg G.D. JAMA. 1998; 280: 1618-1619.
  27. ↑ He defines alternative medicine as a "...set of practices which cannot be tested, refuse to be tested, or consistently fail tests. If a healing technique is demonstrated to have curative properties in properly controlled double-blind trials, it ceases to be alternative. It simply...becomes medicine.Simonyi Professorship web site
  28. ↑ A callous world. Richard Holloway. Book review Richard Dawkins A Devil's Chaplain. The Guardian, February 15, 2003.
  29. ↑ There is no alternative medicine. There is only medicine that works and medicine that doesn't work.Dawkins, Richard (003). A Devil's Chaplain. Weidenfeld & Nicolson. 
  30. ↑ Barrett, Stephen (February 10, 2004). "Be Wary of "Alternative" Health Methods", Stephen Barrett, M.D., Quackwatch. Retrieved on 2008-03-03. 
  31. ↑ 31.0 31.1 "Complementary medicine is 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 British General Practitioner 1995; 45:506.
  32. ↑ Evidence-based Complementary and Alternative Medicine
  33. ↑ Tonelli MR, Callahan TC (2001). "Why alternative medicine cannot be evidence-based". Academic medicine : journal of the Association of American Medical Colleges 76 (12): 1213–20. PMID 11739043. 
  34. ↑ Gunn IP. "A critique of Michael L. Millenson's book, Demanding medical excellence: doctors and accountability in the information age, and its relevance to CRNAs and nursing." AANA J, 1998 66(6):575-82. Review. PMID 10488264
  35. ↑ Simon Crompton, "Back to the future: Complementary therapies get real," Times Online, Times Newspapers Ltd., January 17, 2004.
  36. ↑ Barrett, Stephen. "Quackwatch", Your Guide to Quackery, Health Fraud, and Intelligent Decisions, Quackwatch. Retrieved on 2008-03-04. 
  37. ↑ Whole Medical Systems: An Overview. NCCAM
  38. ↑ Mind-Body Medicine: An Overview. NCCAM
  39. ↑ Biologically Based Practices: An Overview. NCCAM
  40. ↑ Manipulative and Body-Based Practices: An Overview. NCCAM
  41. ↑ Energy Medicine: An Overview - NCCAM
  42. ↑ Energy Medicine
  43. ↑ 43.0 43.1 43.2 43.3 Barnes PM, Powell-Griner E, McFann K, Nahin RL (May 2004). "Complementary and alternative medicine use among adults: United States, 2002". Adv Data (343): 1–19. PMID 15188733. http://www.cdc.gov/nchs/PRESSROOM/04news/adultsmedicine.htm. 
  44. ↑ Weil, Andrew. "What is Integrative Medicine". Retrieved on 2008-03-06.
  45. ↑ "Complementary and Alternative Medicine Use Among Adults: United States, 2002". Advance Data (National Center for Complementary and Alternative Medicine, National Institutes of Health) No. 343, May 27, 2004, p4. http://nccam.nih.gov/news/report.pdf. 
  46. ↑ Ernst E. "Obstacles to research in complementary and alternative medicine." Medical Journal of Australia, 2003; 179 (6): 279-80. PMID 12964907 MJA online
  47. ↑ Reasons people use CAM. NCCAM
  48. ↑ 49.0 49.1 Astin JA (May 1998). "Why patients use alternative medicine: results of a national study". JAMA 279 (19): 1548–53. PMID 9605899. http://jama.ama-assn.org/cgi/content/full/279/19/1548. Retrieved on 2008-07-08. 
  49. ↑ Thomas KJ, Nicholl JP, Coleman P. Use and expenditure on complementary medicine in England: a population based survey. Complement Ther Med. 2001 Mar;9(1):2-11. PMID: 11264963
  50. ↑ Mark Henderson, Science Editor, "Prince of Wales's guide to alternative medicine ‘inaccurate’" Times Online, April 17, 2008
  51. ↑ The Cochrane Collaboration Complementary Medicine Field, www.compmed.umm.edu/Cochrane/index.html. Retrieved 5 August 2006.
  52. ↑ Eisenberg, DM, Davis RB, Ettner SL "Trends in alternative medicine use in the United States 1990-1997." JAMA, 1998; 280:1569-1575. PMID 9820257
  53. ↑ 54.0 54.1 House of Lords report on CAM
  54. ↑ "Traditional medicine". Fact sheet 134. World Health Organization (2003-05). Retrieved on 2008-03-06.
  55. ↑ Michalsen A, Ludtke R, Buhring M. "Thermal hydrotherapy improves quality of life and hemodynamic function in patients with chronic heart failure." Am Heart J, 2003; 146 (4):E11. PMID 14564334
  56. ↑ Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ. "Long term benefits of hypnotherapy for irritable bowel syndrome." Gut, 2003; 52 (11):1623-9. PMID 14570733
  57. ↑ Berga SL, Marcus MD, Loucks TL. "Recovery of ovarian activity in women with functional hypothalamic amenorrhea who were treated with cognitive behavior therapy." Fertility and Sterility 2003; 80 (4): 976-981 Abstract
  58. ↑ Kleijnen J, Knipschild P, ter Riet G. "Clinical trials of homoeopathy." BMJ, 1991; 302:316-23. Erratum in: BMJ, 1991; 302:818. PMID 1825800
  59. ↑ Linde K, Clausius N, Ramirez G. "Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials." Lancet, 1997; 350:834-43. Erratum in: Lancet 1998 17 January;351(9097):220. PMID 9310601
  60. ↑ Allan Kellehear, Complementary medicine: is it more acceptable in palliative care practice? MJA 2003; 179 (6 Suppl): S46-S48 online
  61. ↑ Lynette A. Menefee, Daniel A. Monti, Complementary Medicine-Mind-Body Techniques: Nonpharmacologic and Complementary Approaches to Cancer Pain Management, JAOA, Vol 105, No suppl_5, November 2005, 15-20.
  62. ↑ Sobel DS. The cost-effectiveness of mind-body medicine interventions. Prog Brain Res. 2000;122:393-412. Abstract
  63. ↑ Complementary Medicine - Mind-Body Interventions, WebMD, Inc., 2007
  64. ↑ Glossary, Continuum Health Partners, 2005.
  65. ↑ Saw S, Tong L, Chua W, Chia K, Koh D, Tan D, Katz J (2005). "Incidence and progression of myopia in Singaporean school children". Invest Ophthalmol Vis Sci 46 (1): 51–7. doi:10.1167/iovs.04-0565. PMID 15623754. 
  66. ↑ House of Lords Select Committee on Science and Technology. 2000. Complementary and Alternative Medicine. London: The Stationery Office.
  67. ↑ Tex. Admin. Code § 200.3. Complementary and Integrative Medicine: An Update for Texas Physicians
  68. ↑ Wetzel MS, Eisenberg DM, Kaptchuk TJ. "Courses involving complementary and alternative medicine at US medical schools." JAMA 1998; 280 (9):784 -787. PMID 9729989
  69. ↑ Saxon DW, Tunnicliff G, Brokaw JJ, Raess BU. "Status of complementary and alternative medicine in the osteopathic medical school curriculum." J Am Osteopath Assoc 2004; 104 (3):121-6. PMID 15083987
  70. ↑ Fenton MV, Morris DL. "The integration of holistic nursing practices and complementary and alternative modalities into curricula of schools of nursing." Altern Ther Health Med, 2003; 9 (4):62-7. PMID 12868254
  71. ↑ University of Arizona position on Alternative Medicine
  72. ↑ Barberis L, de Toni E, Schiavone M, Zicca A, Ghio R. Unconventional medicine teaching at the Universities of the European Union. J Altern Complement Med. 2001 Aug;7(4):337-43. PMID: 11558776 Abstract
  73. ↑ Varga O, Márton S, Molnár P. Status of complementary and alternative medicine in European medical schools. Forsch Komplement Med (2006). 2006 Feb;13(1):41-5. Epub 2006 Jan 3. PMID: 16582550 Abstract
  74. ↑ Can Mainstream Medicine and Alternative Therapies Coexist?
  75. ↑ Mary Ann Liebert, Inc. - The Journal of Alternative and Complementary Medicine - 12(7):601
  76. ↑ CNN - Nutritionist calls for tighter regulation of supplements - September 17, 1999
  77. ↑ Former Surgeon General: Mainstream Medicine Has Endorsed Medical Marijuana | DrugReporter | AlterNet
  78. ↑ Informed Public Debate Needed On Water Fluoridation
  79. ↑ CBofMH_v20_no1
  80. ↑ Dietary Supplement Regulation: FDA Public Hearing April 4, Written Comments Due May 4 - The Body
  81. ↑ Committee on Economic, Social and Cultural Rights. General Comment No. 14 (2000) The right to the highest attainable standard of health : . 11/08/2000. E/C.12/2000/4. http://www.unhchr.ch/tbs/doc.nsf/(symbol)/E.C.12.2000.4.en
  82. ↑ David Schnauer: Therapeutics bill must pass - 06 Jul 2007 - Legislation news - NZ Herald
  83. ↑ Agin, Dan (2006-10-03). Junk Science: how politicians, corporations, and other hucksters betray us. Thomas Dunne Books. pp. Ch. 8. ISBN 978-0312352417. 
  84. ↑ Katz DL, Williams AL, Girard C, et al (2003). "The evidence base for complementary and alternative medicine: methods of Evidence Mapping with application to CAM". Altern Ther Health Med 9 (4): 22–30. PMID 12868249. 
  85. ↑ 86.0 86.1 Ernst E (August 2005). "The efficacy of herbal medicine--an overview". Fundam Clin Pharmacol 19 (4): 405–9. doi:10.1111/j.1472-8206.2005.00335.x. PMID 16011726. 
  86. ↑ Horrobin DF. (1986). Glittering prizes for research support. Nature Vol. 324, p. 221.
  87. ↑ "NCCAM Funding: Appropriations History". NCCAM (2008-01-09). Retrieved on 2008-04-02.
  88. ↑ CSICOP.org article on alternative medicine
  89. ↑ James Alcock PhD, Alternative Medicine and the Psychology of Belief, The Scientific Review of Alternative Medicine, Fall/Winter 1999 Volume 3 ~ Number 2. available online
  90. ↑ Bodeker, G, Kronenberg, F. (2002). A public health agenda for traditional, complementary, and alternative medicine. American Journal of Public Health, 92(10), 1582-1591. [1]
  91. ↑ Hills, Ben. "Fake healers. Why Australia’s $1 billion-a-year alternative medicine industry is ineffective and out of control.". Medical Mayhem. Retrieved on 2008-03-06.
  92. ↑ Swan, Norman (2000-10-02). "Alternative Medicine - Part Three", The Health Report, ABC Radio National. Retrieved on 2008-03-06. 
  93. ↑ 94.0 94.1 Isadora Stehlin. "Homeopathy: Real Medicine or Empty Promises?" - FDA Consumer magazine (December 1996)
  94. ↑ Lilienfeld, Scott O. (2002). "Our Raison d’Être". The Scientific Review of Mental Health Practice 1 (1). http://www.srmhp.org/0101/raison-detre.html. Retrieved on 2008-01-28. 
  95. ↑ 96.0 96.1 96.2 96.3 96.4 96.5 Beyerstein BL (1999). "Psychology and 'Alternative Medicine' Social and Judgmental Biases That Make Inert Treatments Seem to Work". The Scientific Review of Alternative Medicine 3 (2). http://www.sram.org/0302/bias.html. Retrieved on 2008-07-07. 
  96. ↑ 97.0 97.1 Weber DO (1998). "Complementary and alternative medicine. Considering the alternatives". Physician Exec 24 (6): 6–14. PMID 10351720. 
  97. ↑ 98.0 98.1 98.2 Beyerstein BL (March 2001). "Alternative medicine and common errors of reasoning". Acad Med 76 (3): 230–7. PMID 11242572. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=1040-2446&volume=76&issue=3&spage=230. 
  98. ↑ van Deventer MO (May 2008). "Meta-placebo: Do doctors have to lie about giving a fake treatment?". Med. Hypotheses 71: 335. doi:10.1016/j.mehy.2008.03.040. PMID 18485613. 

Further reading

Dictionary definitions

World Health Organization publication

Journals dedicated to alternative medicine research

Further reading

External links

Criticism

Advocacy

Traditional medicine
East Asian
Kampo | Traditional Chinese medicine | Traditional Korean medicine | Traditional Mongolian medicine | Traditional Tibetan medicine
 Palm Fruit I IMG 2100.jpg
South & Southeast Asian
Ayurveda | Siddha medicine | Unani | Jamu (Indonesia) | Thai traditional medicine | Sri Lankan Ayurveda
Mediterranean & Near Eastern
Islamic medicine | Byzantine medicine | Ancient Iranian Medicine | Ancient Egyptian medicine | Ancient Greek medicine
African
Muti | Sangoma | Nganga | Inyanga | Yoruba medicine
Other regions
Ayahuasca | Traditional Brazilian medicine | Bush medicine
General
Alternative medicine | Herbal medicine | Naturopathic medicine | Prehistoric medicine | Health care | Medieval medicine  | History of alternative medicine