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This article is part of a series on
Alternative medicine
General information
Fringe medicine and science
Conspiracy theories
Classifications
Traditional medicine
Alternative diagnoses

The term alternative medicine covers any healing practice "that does not fall within the realm of conventional medicine."[1] Commonly cited examples include homeopathy, naturopathy, acupuncture, chiropractic, and herbal medicine, though many other practices use the term. Alternative medicine is often grouped with complementary medicine using the umbrella term complementary and alternative medicine (CAM), although some of the most significant researchers of alternative medicine are opposed to this convenient grouping.[2][3]

Alternative medicine practices are as diverse in their foundations as in their methodologies. Specific practices may incorporate or base themselves on traditional or pre-scientific understandings of medicine, folk knowledge, spiritual, metaphysical, or religious beliefs, or newly contrived 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.

A 1998 systematic review of studies assessing its prevalence in 13 countries concluded that about 31% of adults use some form of complementary and alternative medicine.[4] Alternative medicine varies from country to country; Dr. Edzard Ernst believes that in Austria and Germany CAM is mainly in the hands of physician,[3] although some estimates suggest that half of CAM is administered by physicians in the US.[5] In Germany, herbs are tightly regulated, with half prescribed by doctors and covered by health insurance based on their Commission E legislation.[6]

History of alternative medicine

The term "alternative medicine" is only meaningful as compared to modern scientific medicine and the development of the scientific method. Historically, the disciplines currently called "alternative" were the mainstream medical disciplines of historical cultures. Since the rise of the scientific method in the west, some historical remedies have been adopted, in whole or in part as mainstream practices, while others have not.

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.[7] 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.[8] 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.[9]

Edzard Ernst wrote in the Medical Journal of Australia that "about half the general population in developed countries use complementary and alternative medicine (CAM)."[10] 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, though this figure drops to 36.0% if prayer specifically for health reasons is excluded.[7] 25% of people who use CAM do so because a medical professional suggested it.[11] Another study suggests a similar figure of 40%..[12] A British telephone survey by the BBC of 1204 adults in 1998 shows that around 20% of adults in Britain had used alternative medicine in the past 12 months.[13]

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.[14] 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."[15]

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.[16]

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,[17] Gonsalkorale 2003,[18] and Berga 2003[19]) 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,[20] and Linde 1997.[21]

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.[22][23][24] 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."[25] Accredited Naturopathic colleges and universities are also increasing in number and popularity in the U.S.A.

In Britain, no conventional medical schools offer courses that teach the clinical practice of alternative medicine.[citation needed] However, alternative medicine is taught in several unconventional schools as part of their curriculum.[citation needed] Teaching is based mostly on theory and understanding of alternative medicine, with emphasis on being able to communicate with alternative medicine specialists.[citation needed] To obtain competence in practicing clinical alternative medicine, qualifications must be obtained from individual medical societies.[citation needed] The student must have graduated and be a qualified doctor.[citation needed] 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.

Public use in the US

A botánicas such as this one in Jamaica Plain, Massachusetts cater to the Latino community and sell 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:[7]

  • 74.6% had used some form of complementary and alternative medicine (CAM).
  • 62.1% had done so within the preceding twelve months.
  • When prayer specifically for health reasons is excluded, these figures fall to 49.8% and 36.0%, respectively.
  • 45.2% had in the last twelve months used prayer for health reasons, either through praying for their own health or through others praying for them.
  • 54.9% used CAM in conjunction with conventional medicine.
  • 14.8% "sought care from a licensed or certified" practitioner, suggesting that "most individuals who use CAM prefer to treat themselves."
  • Most people used CAM to treat and/or prevent musculoskeletal conditions or other conditions associated with chronic or recurring pain.
  • "Women were more likely than men to use CAM. The largest sex differential is seen in the use of mind-body therapies including prayer specifically for health reasons".
  • "Except for the groups of therapies that included prayer specifically for health reasons, use of CAM increased as education levels increased".
  • The most common CAM therapies used in the U.S. in 2002 were prayer (45.2%), herbalism (18.9%), breathing meditation (11.6%), meditation (7.6%), chiropractic medicine (7.5%), yoga (5.1%), body work (5.0%), diet-based therapy (3.5%), progressive relaxation (3.0%), mega-vitamin therapy (2.8%) and Visualization (2.1%)

Relationship of alternative medicine to public policy

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.[26] [27] Dietary supplements, their ingredients, safety, and claims, are a continual source of controversy.[28] 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.[29] In other cases, controversy over mainstream medicine causes questions about the nature of a treatment, such as water fluoridation.[30] 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.[31] Government regulators continue to attempt to find a regulatory balance.[32]

Regulation

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.[33]

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 U.S.A. for instance, 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 is no regulation or safety standards in place. [34]

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 or contamination [35] This problem is magnified by international commerce, since different countries have different types degrees of regulation. This can make it difficult for consumers to properly evaluate risks and qualities of given medicines.

Alternative vs. 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."[36] They advocate a classification based on evidence-based medicine, i.e., scientifically proven evidence of efficacy (or lack thereof). 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,"[37]Richard Dawkins, Professor of the Public Understanding of Science at Oxford,[38][39][40], and Stephen Barrett, founder and operator of Quackwatch, an alternative medicine watchdog site.[41] Other 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 with the above commentators that all treatments, whether "mainstream" or "alternative", ought to be held to standards of the scientific method.[42][43][44] Oxford University Press publishes a peer-reviewed journal entitled Evidence-based Complementary and Alternative Medicine (eCAM).[45]

Testing of efficacy

Although proponents of alternative medicine often cite the large number of studies which have been performed, critics point out that there are no statistics on exactly how many of those studies were controlled, double blind, peer-reviewed experiments, or how many produced results supporting alternative medicine or parts thereof. They [who?] contend that many forms of alternative medicine are rejected by conventional medicine because the efficacy of the treatments has not been demonstrated through double-blind randomized controlled trials; in contrast, conventional drugs reach the market only after such trials have proved their efficacy. Willful misrepresentation of the research status of an alternative remedy or therapy qualifies as pseudoscience. Several countries including the USA have laws regarding the claims that alternative therapies can make [46].

Some [who?] argue that less research is carried out on alternative medicine because many alternative medicine techniques cannot be patented, and hence there is little financial incentive to study them. Drug research, by contrast, can be very lucrative, which has resulted in funding of trials by pharmaceutical companies. Many people, including conventional and alternative medical practitioners, contend that this funding has led to corruption of the scientific process for approval of drug usage, and that ghostwritten work has appeared in major peer-reviewed medical journals.[47][48] Increasing the funding for research of alternative medicine techniques was the purpose of the U.S. 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.[49] The German Federal Institute for Drugs and Medical Devices Commission E has studied many herbal remedies for efficacy.[50]

Some[who?] 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.[51] CAM proponents point out this may also apply in cases where conventional treatments have been used. To this, CAM critics point out that this does not account for conventional medical success in double blind clinical trials. CAM proponents, however, do not typically question conventional medical successes revealed in double blind clinical trials.

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.[2] 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.[52]

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".[53]

Side-effects

Conventional treatments are subjected to testing for undesired side-effects, whereas alternative treatments generally are not subjected to such testing at all. However, any treatment — whether conventional or alternative — that has a biological or psychological impact on a patient may also have potentially dangerous biological or psychological side-effects. Nevertheless, 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".

Homeopathy, however, is insulated from direct side effects by the known laws of chemistry and physics. Homeopathic preparations, termed "remedies," are extremely dilute, often far beyond the point where a single molecule of the original active ingredient is likely to remain.

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.[citation needed] 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.[54]

Notable cases where alternative therapies are adopted by mainstream medicine

Secondary metabolites in thousands of plants are regularly tested by drug companies in search of new therapies. Deadly nightshade contains atropine, a potent (and dangerous) substance useful in the treatment of a number of disorders, including as an antidote for nerve agents. Chemicals isolated from Foxglove are used in the treatment of epilepsy; Opiates derived from poppies are highly effective painkillers, and THC, found in cannabis sativa is used to counter the effects of chemotherapy. Chemotherapy itself owes some of its constituent drugs to plant alkaloids. These name just a few of the most prominent classes of drugs derived from natural sources which have been adopted as treatments by alternative therapies.

In the US, many medical insurers and some hospitals integrate chiropractic and massage therapy as adjuncts to mainstream medical care.[citation needed]

Notable situations where alternative therapies have been misused or classical therapies have petered out

There have been a number of high-profile cases where bad faith on the part of quacks and unethical businessmen, or poorly informed salespeople have harmed people under the guise of helping them. In one case, related to the sale of vitamins, a test was conducted by NBC "on 21 over-the-counter vitamins, [where] only half were found to have the correct amounts of vitamins or minerals that are indicated on their labels."[55]

As of 2008, mandrake, a classical herb with a number of purported mystical properties has not yielded any purported medical benefit. Likewise amanita muscaria, a mushroom used for its psychoactive properties and purported mystical properties for millenia has been shown to contain ibotenic acid, a brain lesioning agent.

Appeal of alternative medicine

A study published in 1998 [56] 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.[57] Related to this are vigorous marketing[58] of extravagant claims by the alternative medical community combined with inadequate media scrutiny and attacks on critics.[57][59] 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.[59] 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.[60] Some medical doctors are also aggressively marketing alternative medicine to profit from this market.[58] Non-medical entrepreneurs who prey upon individuals by misusing the appeal of alternative therapies are referred to as quacks.[citation needed]

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.[61] Related to it are similar psychological effects such as the will to believe[57], cognitive biases that help maintain self-esteem and promote harmonious social functioning[57], and post hoc, ergo propter hoc fallacy.[57] 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, leaving individuals open to the idea of alternatives. 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.[57][59]

References

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  38. ^ 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
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  41. ^ 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. Barrett, Stephen (February 10 2004). "Be Wary of "Alternative" Health Methods". Stephen Barrett, M.D. Quackwatch. Retrieved 2008-03-03. {{cite news}}: Check date values in: |date= (help)
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Further reading

Dictionary definitions

World Health Organization publication

Journals dedicated to alternative medicine research

Further reading

  • Bausell, R. Barker (2007), Snake Oil Science: The Truth About Complementary and Alternative Medicine, Oxford University Press, ISBN 978-0-19-531368-0
  • Benedetti F, Maggi G, Lopiano L. "Open Versus Hidden Medical Treatments: The Patient's Knowledge About a Therapy Affects the Therapy Outcome." Prevention & Treatment, 2003; 6(1), APA online
  • Diamond, J. Snake Oil and Other Preoccupations, 2001, ISBN 0-09-942833-4 , foreword by Richard Dawkins reprinted in Dawkins, R., A Devil's Chaplain, 2003, ISBN 0-7538-1750-0 .
  • Downing AM, Hunter DG. "Validating clinical reasoning: a question of perspective, but whose perspective?" Man Ther, 2003; 8(2): 117-9. PMID 12890440 Manual Therapy Online
  • Eisenberg DM. "Advising patients who seek alternative medical therapies." Ann Intern Med 1997; 127:61-69. PMID 9214254
  • Goldberg, Burton. Anderson, John & Trivieri, Larry “Alternative Medicine: The Definitive Guide”, Ten Speed Press, 2002 ISBN 978-1587611414
  • 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
  • Hand, Wayland D. 1980 "Folk Magical Medicine and Symbolism in the West", in Magical Medicine, Berkeley: University of California Press, pp. 305-319.
  • Illich, Ivan. Limits to Medicine. Medical Nemesis: The expropriation of Health. Penguin Books, 1976.
  • Feinstein, D., & Eden D. Six Pillars of Energy Medicine: Clinical Strengths of a Complementary Paradigm, Alternative Therapies in Health and Medicine 2008, 14(1), 44-54.
  • Lazarou, J. Pomeranz, BH. Corey, PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies, J of the American Medical Association 1998, 279, 1200-1205.
  • Mayo Clinic. Mayo Clinic Book of Alternative Medicine: The New Approach to Using the Best of Natural Therapies and Conventional Medicine, Parsippany, NJ: Time Inc Home Entertainment, 2007, ISBN 978-1933405926.
  • Murray, Michael, & Joseph Pizzorno. Encyclopedia of Natural Medicine, New York: Three Rivers Press, 1997 (second edition), ISBN 978-0761511571.
  • Ninivaggi, F. J., An Elementary Textbook of Ayurveda: Medicine with a Six Thousand Year Old Tradition, International Universities/Psychosocial Press, Madison, CT, 2001.
  • Ninivaggi, F. J., "Ayurveda: A Comprehensive Guide to Traditional Indian Medidine for the West", Praeger Press/Greenwood, Westport, CT, 2008.
  • Pert, Candace B., Molecules of Emotion: Why You Feel the Way You Feel, Scribners, 1997, ISBN 0-684-84634-9
  • Phillips Stevens Jr. Nov./Dec. 2001 "Magical Thinking in Complementary and Alternative Medicine", Skeptical Inquirer Magazine, Nov.Dec 2001
  • Planer, Felix E. 1988 Superstition, Revised ed. Buffalo, New York: Prometheus Books
  • Rosenfeld, Anna, Where Do Americans Go for Healthcare?, Case Western Reserve University, Cleveland, Ohio, USA.
  • Tonelli MR. "The limits of evidence-based medicine." Respir Care, 2001; 46(12): 1435-40; discussion 1440-1. Review. PMID 11728302 PMID: 11863470
  • Trudeau, Kevin, Natural Cures "They" Don't Want You to Know About, Alliance Publishing Group, ISBN 0-9755995-9-3; Mass Market Edition, 2007.
  • Trudeau, Kevin, More Natural "Cures" Revealed, Alliance Publishing Group, 2006, ISBN 0-9755995-4-2.
  • Wisneski, Leonard A. and Lucy Anderson, The Scientific Basis of Integrative Medicine, CRC Press, 2005. ISBN 0-8493-2081-X.
  • Zalewski Z. "Importance of Philosophy of Science to the History of Medical Thinking." CMJ 1999; 40: 8-13. CMJ online

External links

Criticism

Advocacy

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