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Alternative medicine

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Alternative medicine broadly describes methods and practices used in place of, or in addition to, conventional medical treatments. The precise scope of alternative medicine is a matter of some debate and depends to a great extent on the definition of "conventional medicine." Positions on the distinction between the two include those who reject the safety and efficacy of the other, and a number of positions in between.

The debate on alternative medicine is complicated further by the diversity of treatments that are categorized as "alternative." These include practices that incorporate spiritual, metaphysical, or religious underpinnings; non-European medical traditions; newly developed approaches to healing; and a number of others. Proponents of one class of alternative medicine may reject others.

Detractors from alternative medicine may also define it as "diagnosis, treatment, or therapy which can be provided legally by persons who are not licensed to diagnose and treat illness", although some licensed practitioners also use aspects of alternative medicine.

Conversely, many proponents of various forms of alternative medicine reject such criticism as being founded in prejudice, financial self-interest, and ignorance.

Many in the scientific community define alternative medicine as any treatment, the efficacy and safety of which has not been verified through peer-reviewed, controlled studies, whether or not such studies have been undertaken.

Complementary medicine uses both alternative medicine methods and practices alongside conventional medical treatment. Integrative medicine, as defined by the National Center for Complementary and Alternative Medicine, combines conventional medical treatments and alternative treatments for which there is some peer-reviewed evidence of their safety and efficacy. "Importantly, integrative medicine is not synonymous with complementary and alternative medicine (CAM). 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." (Snyderman, Weil 2002) Collectively, these variations on alternative medicine are often referred to as complementary and alternative medicine (or simply as CAM).

Contents

Alternative medicine and the law

Legal jurisdictions differ as to which branches of alternative medicine are legal, which are regulated, and which (if any) are provided by a government-controlled health service. Regulation does not, however, necessarily reflect the effectiveness of the methods used. Some practitioners and branches of alternative medicine have been investigated by governmental agencies for health fraud, and in a few cases criminal charges have been brought.

Support for alternative medicine

Efficacy

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, Gonsalkorale 2003, and Berga 2003) 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 (such as Kleijnen 1991, Linde 1997, Michalsen 2003, Gonsalkorale 2003, and Berga 2003).

Advocates of alternative medicine hold that alternative medicine may provide health benefits through patient empowerment, by offering more choices to the public, including treatments that are simply not available in conventional medicine. However, a choice by the patient about which treatment to use can only be made if the patient is properly informed about the pros and cons. The field of medicine is complicated and not even medical doctors are knowledgeable in every topic and need to rely on specialists for many things. A patient does not have the time to study everything before making a decision. Patients need to be able to trust their doctor's advice and should be told if a treatment has no scientific basis.

"Most Americans who consult alternative providers would probably jump at the chance to consult a physician who is well trained in scientifically based medicine and who is also open-minded and knowledgeable about the body's innate mechanisms of healing, the role of lifestyle factors in influencing health, and the appropriate uses of dietary supplements, herbs, and other forms of treatment, from osteopathic manipulation to Chinese and Ayurvedic medicine. In other words, they want competent help in navigating the confusing maze of therapeutic options that are available today, especially in those cases in which conventional approaches are relatively ineffective or harmful." (Snyderman, Weil 2002)

Advocates of alternative medicine hold that alternative treatments may provide benefits to patients' health that traditional medicine cannot.

Some physicians are willing to embrace some aspects of alternative medicine. Dr. Russell Greenfield states: "I tell them 'I'm one of you' and that we have the data - we have the studies, we're not making this up," when talking to other physicians. Greenfield was referring to published studies on the beneficial effect of saw palmetto on enlarged prostates, and how body work, or massage therapy, is effective for treating lower back pain.

Dr. Karen Koffler states: "I've learned how to balance the intellectual processes of medicine with an intuitive understanding of what this person, this patient really needs to gain strength for healing. That is never taught in medical school and is lost entirely from medicine now." (McClain 2004).

Danger reduced when used as a complement to conventional medicine

A major objection to alternative medicine is that it is done in place of conventional medical treatments. As long as alternative treatments are used alongside standard conventional medical treatments, most medical doctors find most forms of complementary medicine acceptable (Vickers 2004). Consistent with previous studies, the CDC recently reported that the majority of individuals in the United States (i.e., 54.9%) used CAM in conjunction with conventional medicine. (CDC Advance Data Report #343, 2002)

Patients should however always inform their medical doctor they are using alternative medicine. Some patients do not tell their medical doctors since they fear it will hurt their patient-doctor relationship. Some alternative treatments however can interfere with regular treatments. An example is the combination of chemotherapy and large doses of vitamin C, which can severely damage the kidneys.

Those medical doctors that practice complementary medicine believe there is some value in alternative forms of treatments.

The boundary lines between alternative and mainstream medicine have changed over time. Some methods once considered alternative have later been adopted by conventional medicine, when confirmed by controlled studies. Many very old conventional medical practices are now seen as alternative medicine, as modern controlled studies have shown that certain treatments were not actually effective. Supporters of alternative methods suggest that much of what is currently called alternative medicine will be similarly assimilated by the mainstream in the future.

As an alternative for the public searching for complementary services

Alternative medicine provide the public with services not available from conventional medicine. This argument covers a range of areas, such as patient empowerment, alternative methods of pain management, treatment methods that support the biopsychosocial model of health, cures for specific health concerns, stress reduction services, other preventative health services that are not typically a part of conventional medicine, and of course complementary medicine's palliative care which is practiced by such world renowned cancer centers such as Memorial Sloan-Kettering (see Vickers 2004).

The placebo effect

Advocates of alternative medicine believe that the placebo effect is substantially beneficial to those receiving alternative therapies.

Criticism of alternative medicine

Due to the wide range of therapies that are considered to be "alternative medicine" few criticisms apply across the board. For more information about a particular therapy or branch of alternative medicine, including specific criticism, please refer to the following link: List of branches of alternative medicine.

Criticisms directed at specific branches of alternative medicine range from the fairly minor (conventional treament is believed to be more effective in a particular area) to incompatibility with the known laws of physics (for example, in homeopathy).

Efficacy

Lack of proper testing

Despite the large number of studies regarding alternative therapies, critics contend that there are no statistics on exactly how many of these 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. Where alternative methods provide temporary symptomatic relief, this has been explained as being due to the placebo effect, or to natural healing, or to the cyclic nature of some illnesses.

Not proven to be an alternative

Some doctors and scientists feel that the term "alternative medicine" is misleading, as these treatments have not been proven to be an effective alternative to regulated conventional medicine. However, conventional medicine can overlap with alternative medicine, when and only when the alternative treatment is proven to be effective.

Richard Dawkins, professor of the Public Understanding of Science at Oxford University, defines alternative medicine as "that set of practices that cannot be tested, refuse to be tested or consistently fail tests" (See Diamond 2003).

Safety

Safety issues

Practices termed as "alternative medicine" have caused deaths indirectly when patients have used alternatives in attempts to treat such conditions as appendicitis and failed. Proponents of alternative medicine say that people should be free to choose whatever method of healthcare they want. Critics agree that people should be free to choose, but when choosing people must be certain that whatever method they choose will be safe and effective. People who choose alternative medicine may think they are choosing a safe, effective medicine, while they may only be getting quack remedies. This can be a particular issue in the treatment of children and individuals whose capacity to evaluate the treatment is impaired, and of animals.

Delay in seeking conventional medical treatment

There is a concern that patients may delay seeking conventional medicine that could be more effective, whilst they undergo alternative therapies, potentially resulting in harm.

Relying on the placebo effect is therefore dangerous, since it may convince people that the alternative treatment works while it is the placebo effect. People who are thus convinced that alternative medicine helped them with a mere inconvenience may be tempted to use (ineffective) alternative medicine for a serious, possibly life-threatening illness.

Poor diagnosis

Medical doctors hold that alternative medical practitioners sometimes fail to correctly diagnose illnesses, and therefore do not provide safe therapies every time. William T. Jarvis, Ph.D contends in the web article "How Quackery Harms Cancer Patients" that "Dubious therapies can cause death, serious injury, unnecessary suffering, and disfigurement" and gives an example of how an unlicenced naturopath caused a severe disfigurement of a patient. [1] (http://www.quackwatch.org/01QuackeryRelatedTopics/harmquack.html)

Issues of regulation

In countries where healthcare is state-funded or funded by medical insurance, alternative therapies are often not covered, and must be paid for by the patient. Further, in some countries, some branches of alternative medicine are not properly regulated. So there is no governmental control on who practices, and no real way of knowing what training or expertise they possess in these countries.

The current regulatory system and alternative medicine

Many alternative medicine advocates chafe at the restrictions of government agencies which approve medical treatments (such as the American Food and Drug Administration) and the agencies' adherence to experimental evaluation methods. They claim that this impedes those seeking to bring new ideas and methods to the public more rapidly, and protest that their contributions and discoveries are unfairly dismissed, overlooked or suppressed. The alternative medicine industry argues that health fraud, when it occurs, should be dealt with appropriately.

Testing and studies

The scientific community argues that many studies carried out by alternative medicine promoters are flawed, as they often use testimonials and hearsay as evidence, leaving the results open to observer bias. They argue that the only way to counter observer bias is to run a double blind experiment, where neither the patient nor the practitioner knows whether the real treatment is being given or if a placebo has been administered. This research should then be reviewed by peers to determine the validity of the research methodology.

Testimonials are especially useless in this procedure, because by chance alone some people will get cured and will be able to testify that the method really helped them - this can be explained by post hoc reasoning of the regressive fallacy. Furthermore, if the majority of people using a method do not notice any benefit or even get worse, there will still be a minority that can testify that the method really helped for them. [2] (http://www.quackwatch.org/01QuackeryRelatedTopics/altbelief.html)

A review of the effectiveness of certain alternative medicine techniques for cancer treatment (Vickers 2004), while finding that most of these treatments are not merely "unproven" but are proven not to work, notes that several studies have found evidence that the psychosocial treatment of patients by psychologists is linked to survival advantages (although it comments that these results are not consistently replicated). The same review, while specifically noting that "complementary therapies for cancer-related symptoms were not part of this review", cites studies indicating that several complementary therapies can provide benefits by, for example, reducing pain and improving the mood of patients.

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. (Flanagin et al. 1998, Larkin 1999). Increasing the funding for research of alternative medicine techniques was the purpose of the National Center for Complementary and Alternative Medicine. NCCAM and its predecessor, the Office of Alternative Medicine, have spent more than $200 million on such research since 1991. [3] (http://www.csicop.org/si/2003-09/alternative-medicine.html)

Openness to specific alternative techniques

Nearly all mainstream doctors and scientists are open to revising their views of any specific new treatment, if new peer-reviewed evidence comes available. And many have, such as the physicians quoted above.

As such, the boundaries of alternative medicine have changed over time. A number of techniques once considered to be alternative medicine have reached the status of conventional medicine.

Contemporary use of alternative medicine

Edzard Ernst wrote in the Medical Journal of Australia that "about half the general population in developed countries [use] complementary and alternative medicine (CAM)" (Ernst 2003),

A survey (http://nccam.nih.gov/news/2004/052704.htm) released in May 2004 by the National Center for Complementary and Alternative Medicine, part of the National Institutes of Health in the United States, found that in 2002, more than one-third of Americans used some form of alternative therapy — a category that included yoga, meditation, herbal treatments and the Atkins diet. If prayer was counted as an alternative therapy, the figure rose to almost two-thirds.

Increasing numbers of medical colleges have begun offering courses in alternative medicine. For example, 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." [4] (http://www.ahsc.arizona.edu/opa/horizons/1997/integrate.htm) In three separate research surveys that surveyed the 125 medical schools offering a MD degree, the 19 medical schools offering a DO degree, and 585 schools of nursing in the United States: 60 percent of U.S. medical schools offering a MD degree teach CAM, 95% of Osteopathic medical school teach CAM, and 84.8% of US schools of nursing teach CAM. (Wetzel, Eisenberg, Kaptchuk 1998; Saxon, Tunnicliff, Brokaw, Raess 2004; Fenton, Morris 2003)

In the UK a number of universities offer courses in areas of alternative medicine including homeopathy and acupuncture.


See also

References

Dictionary definitions

  • Alternative Medicine (http://www.bartleby.com/61/21/A0232125.html)
  • Complementary medicine (http://cancerweb.ncl.ac.uk/cgi-bin/omd?query=Complementary+medicine&action=Search+OMD)
  • Integrative Medicine (http://www.ahsc.arizona.edu/opa/horizons/1997/integrate.htm): "Program Goals-Train physicians to combine the best ideas and practices of conventional and alternative medicine."

Journals dedicated to alternative medicine research

  • Alternative therapies in health and medicine. Aliso Viejo, CA : InnoVision Communications, c1995- NLM ID: 9502013 (http://locatorplus.gov/cgi-bin/Pwebrecon.cgi?DB=local&v2=1&ti=1,1&Search_Arg=9502013&Search_Code=0359&CNT=20&SID=1)
  • Alternative medicine review : a journal of clinical therapeutic. Sandpoint, Idaho : Thorne Research, Inc., c1996- NLM ID: 9705340 (http://locatorplus.gov/cgi-bin/Pwebrecon.cgi?DB=local&v2=1&ti=1,1&Search_Arg=9705340&Search_Code=0359&CNT=20&SID=1)
  • BMC complementary and alternative medicine (http://www.biomedcentral.com/1472-6882). London : BioMed Central, 2001- NLM ID: 101088661 (http://locatorplus.gov/cgi-bin/Pwebrecon.cgi?DB=local&v2=1&ti=1,1&Search_Arg=101088661&Search_Code=0359&CNT=20&SID=1)
  • Complementary therapies in medicine. Edinburgh ; New York : Churchill Livingstone, c1993- NLM ID: 9308777 (http://locatorplus.gov/cgi-bin/Pwebrecon.cgi?DB=local&v2=1&ti=1,1&Search_Arg=9308777&Search_Code=0359&CNT=20&SID=1)
  • The journal of alternative and complementary medicine : research on paradigm, practice, and policy. (http://www.catchword.com/titles/10755535.htm) New York, NY : Mary Ann Liebert, Inc., c1995- NLM ID: 9508124 (http://locatorplus.gov/cgi-bin/Pwebrecon.cgi?DB=local&v2=1&ti=1,1&Search_Arg=9508124&Search_Code=0359&CNT=20&SID=1)
  • Journal of alternative & complementary medicine. London : Argus Health Publications, c1989- NLM ID: 9883124 (http://locatorplus.gov/cgi-bin/Pwebrecon.cgi?DB=local&v2=1&ti=1,1&Search_Arg=9883124&Search_Code=0359&CNT=20&SID=1)

Research articles cited in the text

  1. Kleijnen, J., Knipschild, P., ter Riet, G. Clinical trials of homoeopathy. BMJ. 1991 Feb 9;302(6772):316-23. Erratum in: BMJ 1991 Apr 6;302(6780):818. PMID 1825800
  2. Linde, K., Clausius, N., Ramirez, G. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet. 1997 Sep 20;350(9081):834-43. Erratum in: Lancet 1998 Jan 17;351(9097):220. PMID 9310601
  3. 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 Oct;146(4):E11. PMID 14564334
  4. Gonsalkorale, W.M., Miller, V., Afzal, A., Whorwell, P.J. Long term benefits of hypnotherapy for irritable bowel syndrome. Gut. 2003 Nov;52(11):1623-9. PMID 14570733
  5. Berga, S.L., Marcus, M.D., Loucks, T.L. Recovery of ovarian activity in women with functional hypothalamic amenorrhea who were treated with cognitive behavior therapy. Fertility and Sterility, Volume 80, Issue 4, Pages 976-981 (October 2003) Abstract (http://www.fertstert.org/article/PIIS0015028203011245/abstract)
  6. Eisenberg, D.M., Davis, R.B., Ettner, S.L. Trends in alternative medicine use in the United States, 1990-1997. JAMA. 1998; 280:1569-1575. PMID 9820257
  7. Ernst, E. Obstacles to research in complementary and alternative medicine. Medical Journal of Australia. 2003 Sep 15;179(6):279-80. PMID 12964907 MJA online (http://www.mja.com.au/public/issues/179_06_150903/ern10442_fm-1.html)
  8. Zalewski, Z. Importance of Philosophy of Science to the History of Medical Thinking. CMJ 1999; 40: 8-13. CMJ online (http://www.bsb.mefst.hr/cmj/1999/4001/400102.htm)
  9. Downing, A.M., Hunter, D.G. Validating clinical reasoning: a question of perspective, but whose perspective? Man Ther. 2003 May;8(2):117-9. Review. PMID 12890440 Manual Therapy Online (http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WN0-487KJXH-3&_coverDate=05%2F31%2F2003&_alid=110095405&_rdoc=1&_fmt=&_orig=search&_qd=1&_cdi=6948&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=8da5eb9e5359691e31c6cee489724da8)
  10. Tonelli, M.R. The limits of evidence-based medicine. Respir Care. 2001 Dec;46(12):1435-40; discussion 1440-1. Review. PMID 11728302
  11. Gunn, I.P. 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 Dec;66(6):575-82. Review. PMID 10488264
  12. Flanagin, A., Carey, L.A., Fontanarosa, P.B. Prevalence of articles with honorary authors and ghost authors in peer-reviewed medical journals. JAMA. 1998 Jul 15;280(3):222-4. Full text (http://jama.ama-assn.org/cgi/content/full/280/3/222)
  13. Larkin, M. Whose article is it anyway? Lancet. 1999 Jul 10;354(9173):136. Editorial (http://www.thelancet.com/journal/vol354/iss9173/full/llan.354.9173.news.3708.1)
  14. Vickers, A. Alternative Cancer Cures: "Unproven" or "Disproven"? CA Cancer J Clin 2004 54: 110-118. Online (http://caonline.amcancersoc.org/cgi/content/full/54/2/110)
  15. Benedetti,F., Maggi,G., Lopiano, L. Open Versus Hidden Medical Treatments: The Patient's Knowledge About a Therapy Affects the Therapy Outcome. Prevention & Treatment, Volume 6, Article 1, posted June 23, 2003. APA online (http://journals.apa.org/prevention/volume6/pre0060001a.html)
  16. Eisenberg DM. Advising patients who seek alternative medical therapies. Ann Intern Med. 1997; 127:61-69. PMID 9214254
  17. Snyderman R, Weil AT. Integrative medicine: bringing medicine back to its roots. Arch Intern Med. 2002;162:395–397. PMID: 11863470 (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11863470)
  18. Barnes P, Powell-Griner E, McFann K, Nahin R. CDC Advance Data Report #343. Complementary and Alternative Medicine Use Among Adults: United States, 2002. May 27, 2004. Online (http://nccam.nih.gov/news/report.pdf)
  19. Wetzel MS, Eisenberg DM, Kaptchuk TJ. Courses involving complementary and alternative medicine at US medical schools. JAMA. 1998;280(9):784 -787. PMID 9729989
  20. 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 Mar;104(3):121-6. PMID 15083987
  21. 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 Jul-Aug;9(4):62-7. PMID 12868254

Other works that discuss alternative medicine

  • Diamond, J. Snake Oil and Other Preoccupations 2001 (ISBN 0099428334), foreword by Richard Dawkins reprinted in Dawkins, R. A Devil's Chaplain 2003 (ISBN 0753817500).
  • WHERE DO AMERICANS GO FOR HEALTHCARE? (http://www.cwru.edu/med/epidbio/mphp439/Sources_of_Healthcare.htm) by Anna Rosenfeld, Case Western Reserve University, Cleveland, Ohio, USA.
  • Planer, Felix E. 1988 Superstition Revised ed. Buffalo, New York: Prometheus Books
  • Hand, Wayland D. 1980 Folk Magical Medicine and Symbolism in the West in Magical Medicine Berkeley: University of California Press, pp. 305-319.
  • Phillips Stevens Jr. Nov./Dec. 2001 Magical Thinking in Complementary and Alternative Medicine Skeptical Inquirer Magazine, Nov.Dec/2001
  • Illich I. Limits to Medicine. Medical Nemesis: The expropriation of Health. Penguin Books, 1976.
  • Dillard, James and Terra Ziporyn. Alternative Medicine for Dummies. Foster City, CA: IDG Books Worldwide, Inc., 1998.

External links

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de:Alternativmedizin et:Alternatiivmeditsiin es:Medicina complementaria y alternativa ko:대체의학 it:Medicina alternativa nl:Alternatieve geneeswijze ja:代替医療 no:Alternativ medisin pl:Medycyna niekonwencjonalna fi:Vaihtoehtoinen lketiede sv:Alternativmedicin

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