Alternative medicine
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Main article: Complementary and alternative medicine

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The term Alternative medicine covers any healing practice "that does not fall within the realm of conventional medicine."^[1] Commonly cited examples are homeopathy, naturopathy, acupuncture, chiropractic, and herbal medicine, though many other practices use the term. Alternative medicine is often categorized together with complementary medicine using the umbrella term Complementary and alternative medicine or CAM.

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.

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.^[2] 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.^[3] 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.^[4]

Edzard Ernst wrote in the Medical Journal of Australia that "about half the general population in developed countries use complementary and alternative medicine (CAM)."^[5] 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.^[2] 25% of people who use CAM do so because a medical professional suggested it.^[6] Another study suggests a similar figure of 40%.^[7] 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.^[8]

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.^[9] 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."^[10]

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.^[11]

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,^[12] Gonsalkorale 2003,^[13] and Berga 2003^[14]) 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,^[15] and Linde 1997.^[16]

Medical education

The examples and perspective in this section may not represent a worldwide view of the subject. Please improve this article or discuss the issue on the talk page.

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.^[17][18][19] 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."^[20] Accredited Naturopathic colleges and universities are also increasing in number and popularity in the U.S.A. They offer the most complete medical training in complementary medicines that is available today.^{citation needed} See Naturopathic medicine.

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) the National Center for Complementary and Alternative Medicine indicated:^[2]

• 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%)

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

Obligations to respect (the right to health) include a State's obligation to refrain from prohibiting or impeding traditional preventive care, healing practices and medicines...^[21]

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. ^[22]

The production of modern pharmaceuticals is strictly regulated to ensure that every pill in every batch contains a standard quantity of active ingredients and is free from contamination. Alternative medicine products are not subject to the same governmental quality control standards, and homogeneity at encapsulation and batch-to-batch consistency are sometimes compromised. 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 ^[23] This problem is magnified by international commerce, since different countries have different degrees of regulation. This makes 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."^[24] 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,"^[25]Richard Dawkins, Professor of the Public Understanding of Science at Oxford,^[26][27][28], and Stephen Barrett, founder and operator of Quackwatch, an alternative medicine watchdog site.^[29] 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.^[30][31][32] Oxford University Press publishes a peer-reviewed journal entitled Evidence-based Complementary and Alternative Medicine (eCAM).^[33]

Efficacy

Lack of proper testing

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 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.

Some 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.^[34][35] 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.^[36] The German Federal Institute for Drugs and Medical Devices Commission E has studied many herbal remedies for efficacy.^[37]

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.^[38] 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.

Safety

Critics contend that people have been hurt or killed directly from the various alternative practices or indirectly by failed diagnoses or avoidance of conventional medicine. Proponents counter that harm from conventional medical practice, known as iatrogenesis, is a major cause of death and injury.^{citation needed} Deaths have been reported due to the use of alternative medicines such as colloidal silver.^[39] Colloidal silver was used before 1938 as an antibiotic, resulting in an "alarming increase"^[40] in cases of Argyria. Since 1995 it has been promoted as an alternative medicine, sparking heavy critique from a victim from the 1940s: "Colloidal silver (CSP) is not a new alternative remedy. It is an old, discarded traditional one that homeopaths and other people calling themselves "alternative health-care practitioners" have pulled out of the garbage pail of useless and dangerous drugs and therapies, things mainstream medicine threw away decades ago."^[41]

Alternative medicine critics agree with its proponents that people should be free to choose whatever method of healthcare they want, but stipulate that people must be informed as to the safety and efficacy of whatever method they choose. People who choose alternative medicine may think they are choosing a safe, effective medicine, while they may only be getting quack remedies. The use of Grapefruit seed extract is an example of quackery, since multiple studies demonstrate its universal antimicrobial effect is due to synthetic antimicrobial contamination.^{[42][43][44][45][46]}

Delay in seeking conventional medical treatment

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 Lilienfeld (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.^[47]

Danger can be increased when used as a complement to conventional medicine

A Norwegian multicentre study examined the association between the use of alternative medicine and cancer survival. 515 patients using standard medical care for cancer were followed for eight years. 22% of those patients used alternative medicine concurrently with their standard care. The study revealed that death rates were 30% higher in alternative medicine users than in those who did not use alternative medicine (AM): "The use of AM seems to predict a shorter survival from cancer."^[48]

Associate Professor Alastair MacLennan of the Department of Obstetrics and Gynaecology in Adelaide University, Australia reports that a patient almost bled to death on the operating table. She had failed to mention that she had been taking "natural" potions to "build up her strength" before the operation, including a powerful anticoagulant which nearly caused her death.^[49]

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".^[50]

Danger from undesired 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.

Issues of regulation

The production of modern pharmaceuticals is strictly regulated to ensure that every pill in every batch contains a standard quantity of active ingredients and is free from contamination. Alternative medicine products are not subject to such quality control regulation, and homogeneity at encapsulation and batch-to-batch consistency are sometimes compromised. This leads to uncertainty in the chemical content and biological activity of each pill. Additionally, alternative health products are sometimes adulterated or contaminated with prescription medications or toxic ingredients, such as lead.^[23]

Critics contend^who? that some branches of alternative medicine are often not properly regulated in some countries, making it difficult to impossible for consumers to evaluate practitioner training and expertise. Critics contend that governmental regulation of any particular alternative therapy does necessarily indicate that the therapy is safe and effective. The most sensible course in such a case could be to simply ensure that the sold treatment is not dangerous, but the problem would then remain to know if it does what its proponents say it does.^clarify

Critics' explanations for the appeal of alternative medicine

Critics cite both socio-cultural and psychological reasons to explain why people would chose to use alternative medicines in lieu of conventional medicine.

Socio-cultural reasons cited include

• the low level of scientific literacy among the public at large^[51]
• an increase in anti-intellectualism and antiscientific attitudes riding on the coattails of new age mysticism^[51]
• vigorous marketing of extravagant claims by the "alternative" medical community^[51]
• inadequate media scrutiny and attacks on critics^[51]
• increasing social malaise (conspiracy theories) and mistrust of traditional authority figures - the antidoctor backlash.^[51]
• dislike of the delivery methods of scientific biomedicine.^[51]

Psychological reasons cited include

• the placebo effect
• the will to believe^[51]
• self-serving biases that help maintain self-esteem and promote harmonious social functioning^[51]
• demand characteristics - the obligation to respond in kind when someone does them a good turn^[51]
• post hoc, ergo propter hoc fallacy ("after this, therefore because of this"; the basis of most superstitious beliefs)^[51]
• psychological distortion, such as confirmation bias and cognitive dissonance (inability to respond to criticism of alternative medicine in order to reduce one's cognitive dissonance)
• patients' unpleasant personal experiences with hospitals, doctors, and nurses and perceptions of rude, cold interpersonal interactions.
• emotionally positive and psychologically affirming experiences with alternative practitioners.
• 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.

Economic reasons include

• Lack of access to scientific biomedicine, due to lack of private health insurance, societal resources or government funding.

See also

• Complementary and alternative medicine
• Complementary medicine
• New Thought
• List of branches of alternative medicine
• Criticism of medicine
• History of alternative medicine
• Traditional medicine
• Faith Healing
• Health freedom movement
• Megavitamin therapy
• Naturopathic Medicine
• Orthomolecular medicine

Further reading

Dictionary definitions

• Complementary medicine

World Health Organization publication

• WHO Global Atlas of Traditional, Complementary and Alternative Medicine

Journals dedicated to alternative medicine research

• Alternative therapies in health and medicine. Aliso Viejo, CA : InnoVision Communications, c1995- NLM ID: 9502013
• Alternative medicine review : a journal of clinical therapeutic. Sandpoint, Idaho : Thorne Research, Inc., c1996- NLM ID: 9705340
• BMC complementary and alternative medicine. London : BioMed Central, 2001- NLM ID: 101088661
• Complementary therapies in medicine. Edinburgh ; New York : Churchill Livingstone, c1993- NLM ID: 9308777
• Evidence based complementary and alternative medicine
• Evidence Based journal of Integrative medicine
• Forschende Komplementärmedizin / Research in Complementary Medicine
• Journal of Integrative medicine.
• Journal for Alternative and Complementary Medicine: research on paradigm, practice, and policy. New York, NY : Mary Ann Liebert, Inc., c1995-]
• Scientific Review of Alternative Medicine (SRAM)

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

• The National Center for Complementary and Alternative Medicine - US National Institutes of Health
• Complementary and Alternative Medicine Index(from the University of Maryland Medical Center) - Comprehensive guide covering conditions and treatments
• Alternative Cancer Information - Hub of Peer-Reviewed literature on Prevention of Metastasis for Patients Diagnosed with Cancer
• Integrative Medicine Podcasts and Handouts - Teaching modules with podcasts and handouts for patients, clinicians, residents and medical students from the University of Wisconsin Integrative Medicine Program .
• Web pages for new BBC/Open University television series "Alternative Medicine" that examines the evidence scientifically.
• The British Library - finding information on the complementary medicines industry
• "Complementary and alternative medicine: What is it?" from the Mayo Clinic

Criticism

• A Different Way to Heal? and Videos - PBS, Scientific American Frontiers Web Feature
• What is Complementary and Alternative Medicine? - Steven Novella, MD
• "Alternative" health practice - Skeptic's Dictionary
• Who Gets to Validate Alternative Medicine - PBS article
• The case against alternative medicine - Moses Milstein, DVM (Can Vet J Volume 41, October 2000)

Advocacy

• Medline and the mainstream manufacture of misinformation Critique of the criticisms of alternative medicine

Footnotes