Alternative medicine
Encyclopedia
Alternative medicine is any healing practice, "that does not fall within the realm of conventional medicine
." It is based on historical or cultural traditions, rather than on scientific evidence.
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. Alternative medicine varies from country to country. Jurisdictions where alternative medical practices are sufficiently widespread may license and regulate them. Edzard Ernst
has said that in Austria and Germany complementary and alternative medicine is mainly in the hands of physicians, while some estimates suggest that at least half of American alternative practitioners are physicians. In Germany herbs are tightly regulated: half are prescribed by doctors and covered by health insurance based on their Commission E
legislation.
Alternative medicine is frequently grouped with complementary medicine or integrative medicine
, which, in general, refers to the same interventions when used in conjunction with mainstream techniques, under the umbrella term complementary and alternative medicine, or CAM. Some researchers in alternative medicine object to this categorization, preferring to emphasize differences of approach, but nevertheless use the term CAM, which has become standard. Critics maintain that the terms “complementary” and “alternative medicine” are deceptive euphemism
s meant to give an impression of medical authority.
Alternative medicine methods are diverse in their foundations and methodologies. Methods may incorporate or base themselves on traditional medicine
, folk knowledge
, spiritual beliefs, or newly conceived approaches to healing. "Although heterogeneous, the major CAM systems have many common characteristics, including a focus on individualizing treatments, treating the whole person, promoting self-care and self-healing, and recognizing the spiritual nature of each individual. In addition, many CAM systems have characteristics commonly found in mainstream healthcare, such as a focus on good nutrition and preventive practices. Unlike mainstream medicine, CAM often lacks or has only limited experimental and clinical study; however, scientific investigation of CAM is beginning to address this knowledge gap. Thus, boundaries between CAM and mainstream medicine, as well as among different CAM systems, are often blurred and are constantly changing."
Claims about the efficacy of alternative medicine tend to lack evidence, and have been shown to repeatedly fail during testing. Some researchers state 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.
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" as an example of complementary medicine. The terms 'integrative' or 'integrated medicine' indicate combinations of conventional and alternative medical treatments that have some scientific proof of efficacy; such practices are viewed by advocates as the best examples of complementary medicine.
Ralph Snyderman
and Andrew Weil
state 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." The combination of orthodox and complementary medicine with an emphasis on prevention and lifestyle changes is known as integrated medicine.
it is often defined as any healing practice "that does not fall within the realm of conventional medicine
", or "that which has not been shown consistently to be effective."
The Danish Knowledge and Research Center for Alternative Medicine (Danish abbreviation: ViFAB. ViFAB is an independent institution under the Danish Ministry of the Interior and Health. ViFAB's webstite: www.vifab.dk/uk) uses the term “alternative medicine” for:
– Treatments performed by therapists that are not authorized healthcare professionals
– Treatments performed by authorized healthcare professionals, but those based on methods otherwise used mainly outside the healthcare system. People without a healthcare authorisation must be able to perform the treatments.
The Cochrane
Complementary Medicine Field finds that what is considered complementary or alternative practices in one country may be considered conventional medical practices in another. Their definition is, therefore, general: "complementary medicine includes all such practices and ideas that 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."
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. David M. Eisenberg, an integrative medicine researcher, defines it as "medical interventions not taught widely at US medical schools or generally available at US. hospitals," NCCAM states that formerly unproven remedies may be incorporated into conventional medicine if they are shown to be safe and effective.
Barrie R. Cassileth
, a researcher of complementary and alternative medicine, has summed up the situation as "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.
has defined alternative medicine as "all treatments that have not been proven effective using scientific methods." In a consensus report released in 2005, entitled Complementary and Alternative Medicine in the United States, the Institute of Medicine
(IOM) defined complementary and alternative medicine (CAM) as the non-dominant approach to medicine in a given culture and historical period. A similar definition has been adopted by the Cochrane Collaboration, and official government bodies such as the UK Department of Health. Proponents of evidence-based medicine, such as the Cochrane Collaboration
, use the term alternative medicine but agree that all treatments, whether "mainstream" or "alternative", ought to be held to the standards of the scientific method.
There is a debate among medical researchers over whether any therapy may be properly classified as 'alternative medicine'. Some claim that there is only medicine that has been adequately tested and that which has not. They feel that healthcare practices should be classified based solely on scientific evidence
. If a treatment has been rigorously tested and found safe and effective traditional medicine will adopt it regardless of if it was considered alternative to begin with. It is thus possible for a method to change categories (proven vs. unproven), based on increased knowledge of its effectiveness or lack thereof. Prominent supporters of this position include George D. Lundberg, former editor of the Journal of the American Medical Association
(JAMA).
Stephen Barrett
, founder and operator of Quackwatch
, argues that practices labeled "alternative" should be reclassified as either genuine, experimental, or questionable. Here he defines genuine as being methods that have sound evidence for safety and effectiveness, experimental as being unproven but with a plausible rationale for effectiveness, and questionable as groundless without a scientifically plausible rationale. He has concerns that just because some "alternatives" have merit, there is the impression that the rest deserve equal consideration and respect even though most are worthless. He says that there is a policy at the NIH of never saying something doesn't work only that a different version or dose might give different results.
Edzard Ernst
, professor of complementary medicine, characterizes the evidence for many alternative techniques as weak, nonexistent, or negative, but states that evidence exists for others, in particular certain herbs and acupuncture. Ernst has concluded that 95% of the alternative treatments he and his team have studied, including acupuncture, herbal medicine, homeopathy, and reflexology, are, according to The Economist
, "statistically indistinguishable from placebo treatments."
Richard Dawkins
, an evolutionary biologist, defines alternative medicine as a "set of practices that cannot be tested, refuse to be tested, or consistently fail tests." He also states that "there is no alternative medicine. There is only medicine that works and medicine that doesn't work." He says that if a technique is demonstrated effective in properly performed trials, it ceases to be alternative and simply becomes medicine.
A letter by four Nobel Laureates and other prominent scientists deplored the lack of critical thinking and scientific rigor in National Institutes of Health
supported alternative medicine research. In 2009 a group of scientists made a proposal to shut down the National Center for Complementary and Alternative Medicine. They argued that the vast majority of studies were based on unconventional understandings of physiology and disease and have shown little or no effect. Further, they argue that the field's more-plausible interventions such as diet, relaxation, yoga and botanical remedies can be studied just as well in other parts of NIH, where they would need to compete with conventional research projects.
These concerns are supported by negative results in almost all studies conducted over ten years at a cost of $2.5 billion by the NCCAM. R. Barker Bausell, a research methods expert and author of "Snake Oil Science" states that "it's become politically correct to investigate nonsense." There are concerns that just having NIH support is being used to give unfounded "legitimacy to treatments that are not legitimate."
Wallace Sampson, an editor of Scientific Review of Alternative Medicine
and a Stanford University professor of medicine write that CAM is the "propagation of the absurd" based on the example that alternative and complementary have been substituted for quackery, dubious and implausible and concerns that CAM tolerates contradiction without thorough reason and experiment.
and herbal remedies." The Australian comedian Tim Minchin
, in his nine minute beat poem "Storm", states that alternative medicine is that which "has either not been proved to work or been proved not to work", and then he quips "You know what they call 'alternative medicine' that’s been proved to work? Medicine."
and basic information, while turning to alternatives for therapy or health-enhancing measures. Studies indicate that alternative approaches are often used in conjunction with conventional medicine. 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." 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.
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.
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)." 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. Another study suggests a similar figure of 40%.
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. 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." In general, he believes that CAM can and should be subjected to scientific testing.
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. 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." 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 healthcare or be integrated into the healthcare system. In Africa, traditional medicine is used for 80% of primary healthcare, and in developing nations as a whole over one-third of the population lack access to essential medicines.
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 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. See also Kleijnen 1991, and Linde 1997.
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." 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."
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. 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. "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."
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: 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.
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:
In 2004, a survey of nearly 1,400 U.S. hospitals found that more than one in four offered alternative and complementary therapies such as acupuncture, homeopathy, and massage therapy.
A 2008 survey of US hospitals by Health Forum, a subsidiary of the American Hospital Association
, found that more than 37 percent of responding hospitals indicated they offer one or more alternative medicine therapies, up from 26.5 percent in 2005. Additionally, hospitals in the southern Atlantic states were most likely to include CAM, followed by east north central states and those in the middle Atlantic. More than 70% of the hospitals offering CAM were in urban areas.
In 2011 the Millennium Cohort Study (United States) found that 39% of the then currently enrolled 44,287 cohort members reported using at least one CAM therapy.
The National Science Foundation
has also conducted surveys of the popularity of alternative medicine. After describing the negative impact science fiction
in the media has on public attitudes and understandings of pseudoscience
, and defining alternative medicine as all treatments that have not been proven effective using scientific methods, as well as mentioning the concerns of individual scientists, organizations, and members of the science policymaking community, it commented that "nevertheless, the popularity of alternative medicine appears to be increasing."
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 than the conventional treatment for the patient's medical condition."
22.5 % had used alternative medicine within the previous year.
The most popular types of therapies within the previous year (2005) are:
More results of statistical surveys on alternative medicine in Denmark is available on ViFABs (Knowledge and Research Center for Alternative Medicines) home page, see the pages on Statistics: http://www.vifab.dk/uk/alternative+medicine/statistics
College of Medicine offers a program in Integrative Medicine under the leadership of Andrew Weil
that trains physicians in various branches of alternative medicine that "...neither rejects conventional medicine nor embraces alternative practices uncritically." Accredited Naturopathic colleges and universities are also increasing in number and popularity in Canada and the USA. (See Naturopathic medical school in North America
).
A 2001 survey of European universities found that unconventional medicine courses are widely represented at European universities. They cover a wide range of therapies and many of them are used clinically. Research work is underway at several faculties. A 2006 survey showed that 40% of the responding European universities were offering some form of CAM training."
In other cases, controversy over mainstream medicine causes questions about the nature of a treatment, such as water fluoridation. 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. Government regulators continue to attempt to find a regulatory balance.
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
Specific implementations of this article are left to member states.
A number of alternative medicine advocates disagree with the restrictions of government agencies that approve medical treatments. In the United States, for example, critics say 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 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 healthcare products.
In New Zealand, alternative medicine products are classified as food products, so there are no regulations or safety standards in place.
In Australia, the topic is termed as complementary medicine and the Therapeutic Goods Administration
has issued various guidances and standards. Australian regulatory guidelines for complementary medicines (ARGCM) demands that the pesticides, fumigants, toxic metals, microbial toxins, radionuclides, and microbial contaminations present in herbal substances should be monitored, although the guidance does not request for the evidences of these traits. However, for the herbal substances in pharmacopoeial monographes, the detailed information should be supplied to relevant authorities
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. 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.
Denmark : Herbal and dietary supplements is the designation of a range of products, which have in common their status as medicine belonging under the Danish Medicines Act.In the Danish Medicines Act there exist four types of herbal and dietary supplements: Herbal medicinal products, Strong vitamin and mineral preparations, Traditional botanical medicinal products and Homeopathic medicinal products. Some dietary supplements fall within a special category of products, which differ from the above in that they are not authorized medicinal products. Dietary supplements are regulated under the Food Act and are registered by the Danish Veterinary and Food Administration.
treatments supported by scientific evidence to date. Despite this, the National Center for Complementary and Alternative Medicine budget has been on a sharp sustained rise to support complementary medicine. In fact, the whole CAM field has been called by critics the SCAM.
"There really is no such thing as alternative medicine--only medicine that has been proved to work and medicine that has not." Arnold Relman, editor in chief emeritus of The New England Journal of Medicine. Speaking of government funding studies of integrating alternative medicine techniques into the mainstream, Steven Novella
, a neurologist at Yale School of Medicine wrote that it "is used to lend an appearance of legitimacy to treatments that are not legitimate." Marcia Angell, executive editor of The New England Journal of Medicine says, "It's a new name for snake oil."
(RCT), and 23% had been assessed with a meta-analysis
. According to 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.
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.
Lists of the Cochrane Reviews on alternative medicine including summaries of the results sorted by type of therapy (updated monthly) are made available at ViFABs (Knowledge and Research Center for Alternative Medicines) home page, see the lists here: http://www.vifab.dk/uk/cochrane+and+alternative+medicine
Most alternative medical treatments are not patent
able, which may lead to less research funding from the private sector. In addition, in most countries, alternative treatments (in contrast to pharmaceuticals) can be marketed without any proof of efficacy—also a disincentive for manufacturers to fund scientific research. Some have proposed adopting a prize
system to reward medical research. However, public funding for research exists. Increasing the funding for research on alternative medicine techniques is 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 $2.5 billion on such research since 1992; this research has largely not demonstrated the efficacy of alternative treatments.
Some skeptics of alternative practices say 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.
In the same way as for conventional therapies, drugs, and interventions, it can be difficult to test the efficacy of alternative medicine in clinical trial
s. 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.
Cancer researcher Andrew J. Vickers has stated:
To ABC Online, MacLennan also gives another possible mechanism:
, whereas alternative treatments, in general, 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 potential to possess 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 U.S. Food and Drug Administration (FDA) has regulated homeopathic products in "several significantly different ways from other drugs." 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.
". 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.
Between 2001 and 2003, four children died in Australia because their parents chose ineffective naturopathic, homeopathic, or other alternative medicines and diets rather than conventional therapies. In all, they found 17 instances in which children were significantly harmed by a failure to use conventional medicine.
are difficult or impossible to cure, there have always been many therapies offered outside of conventional cancer treatment centers and based on theories not found in biomedicine
. These alternative cancer cures have often been described as "unproven," suggesting that appropriate clinical trials have not been conducted and that the therapeutic value of the treatment is unknown. However, many alternative cancer treatments have been investigated in good-quality clinical trials, and they have been shown to be ineffective.
is the combination of the practices and methods of alternative/complementary medicine with conventional medicine. It may include preventive medicine
and patient-centered medicine
. It may also include practices not normally referred to as medicine, such as using prayer
, meditation
, socializing, and recreation
as therapies. Its academic proponents sometimes recommend misleading patients by using known placebo treatments in order to achieve a placebo effect. However, a 2010 survey of family physicians found that 56% of respondents said they had used a placebo in clinical practice as well. Eighty-five percent of respondents believed placebos can have both psychological and physical benefits. A number of universities and hospitals have departments of integrative medicine.
Criticism of integrative medicine includes about proposing to lie to patients about alternative medicines known to be no more than a placebo in order to achieve a placebo effect
, and “diverting research time, money, and other resources from more fruitful lines of investigation in order to pursue a theory that has no basis in biology”.
"Quackademic medicine
" is a pejorative term used for “integrative medicine
”, when considered to be an infiltration of quackery into academic science-based medicine, and was picked up by science-based medicine anti-ACM critics.
, which revealed that in 1990 approximately 60 million Americans had used one or more complementary or alternative therapies to address health issues. A study published in the November 11, 1998 issue of the Journal of the American Medical Association
reported that 42% of Americans had used complementary and alternative therapies, up from 34% in 1990. However, despite the growth in patient demand for complementary medicine, most of the early alternative/complementary medical centers failed.
Authors have speculated on the socio-cultural and psychological reasons for the appeal of alternative medicines among that minority using them in lieu of conventional medicine. There are several socio-cultural reasons for the interest in these treatments centered on the low level of scientific literacy
among the public at large and a concomitant increase in antiscientific
attitudes and new age
mysticism
. Related to this are vigorous marketing
of extravagant claims by the alternative medical community combined with inadequate media scrutiny and attacks on critics.
There is also an increase in conspiracy theories
toward 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 led patients to seek out alternative medicine to treat a variety of ailments. Many patients lack access to contemporary medicine, due to a lack of private or public health insurance
, which leads them to seek out lower-cost alternative medicine. Medical doctors are also aggressively marketing alternative medicine to profit from this market.
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. Related to it are similar psychological effects such as the will to believe, cognitive bias
es that help maintain self-esteem and promote harmonious social functioning, and the post hoc, ergo propter hoc fallacy.
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 have potential to cause life-threatening anaphylactic reactions in a very few individuals. Also, 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.
Its popularity may be related to other factors. In an interview with Edzard Ernst
, The Independent
wrote:
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
." It is based on historical or cultural traditions, rather than on scientific evidence.
A 1998 systematic review
Systematic review
A systematic review is a literature review focused on a research question that tries to identify, appraise, select and synthesize all high quality research evidence relevant to that question. Systematic reviews of high-quality randomized controlled trials are crucial to evidence-based medicine...
of studies assessing its prevalence in 13 countries concluded that about 31% of cancer patients use some form of complementary and alternative medicine. Alternative medicine varies from country to country. Jurisdictions where alternative medical practices are sufficiently widespread may license and regulate them. Edzard Ernst
Edzard Ernst
Edzard Ernst is the first Professor of Complementary Medicine in the world, at the University of Exeter, England....
has said that in Austria and Germany complementary and alternative medicine is mainly in the hands of physicians, while some estimates suggest that at least half of American alternative practitioners are physicians. In Germany herbs are tightly regulated: half are prescribed by doctors and covered by health insurance based on their Commission E
Commission E
The German Commission E Monographs are a therapeutic guide to herbal medicine with 380 monographs evaluating the safety and efficacy of herbs for licensed medical prescribing in Germany. The commission itself was formed in 1978, and no longer exists....
legislation.
Alternative medicine is frequently grouped with complementary medicine or integrative medicine
Integrative medicine
Integrative medicine or integrative health is the combination of the practices and methods of alternative medicine with conventional medicine. The term is relatively recent, and is mainly promoted by proponents of alternative therapies in the west...
, which, in general, refers to the same interventions when used in conjunction with mainstream techniques, under the umbrella term complementary and alternative medicine, or CAM. Some researchers in alternative medicine object to this categorization, preferring to emphasize differences of approach, but nevertheless use the term CAM, which has become standard. Critics maintain that the terms “complementary” and “alternative medicine” are deceptive euphemism
Euphemism
A euphemism is the substitution of a mild, inoffensive, relatively uncontroversial phrase for another more frank expression that might offend or otherwise suggest something unpleasant to the audience...
s meant to give an impression of medical authority.
Alternative medicine methods are diverse in their foundations and methodologies. Methods may incorporate or base themselves on traditional medicine
Traditional medicine
Traditional medicine comprises unscientific knowledge systems that developed over generations within various societies before the era of modern medicine...
, folk knowledge
Home remedy
A home remedy is a treatment to cure a disease or ailment that employs certain spices, vegetables, or other common items. Home remedies may or may not have medicinal properties that treat or cure the disease or ailment in question, as they are typically passed along by laypersons...
, spiritual beliefs, or newly conceived approaches to healing. "Although heterogeneous, the major CAM systems have many common characteristics, including a focus on individualizing treatments, treating the whole person, promoting self-care and self-healing, and recognizing the spiritual nature of each individual. In addition, many CAM systems have characteristics commonly found in mainstream healthcare, such as a focus on good nutrition and preventive practices. Unlike mainstream medicine, CAM often lacks or has only limited experimental and clinical study; however, scientific investigation of CAM is beginning to address this knowledge gap. Thus, boundaries between CAM and mainstream medicine, as well as among different CAM systems, are often blurred and are constantly changing."
Claims about the efficacy of alternative medicine tend to lack evidence, and have been shown to repeatedly fail during testing. Some researchers state 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.
Terms
The term 'alternative medicine' is generally used to describe practices used independently or in place of conventional medicine.Term 'complementary medicine' is primarily used to describe practices used in conjunction with or to complement conventional medical treatments. NCCAM suggests "using aromatherapyAromatherapy
Aromatherapy is a form of alternative medicine that uses volatile plant materials, known as essential oils, and other aromatic compounds for the purpose of altering a person's mind, mood, cognitive function or health....
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" as an example of complementary medicine. The terms 'integrative' or 'integrated medicine' indicate combinations of conventional and alternative medical treatments that have some scientific proof of efficacy; such practices are viewed by advocates as the best examples of complementary medicine.
Ralph Snyderman
Ralph Snyderman
Ralph Snyderman, M.D., is Chancellor Emeritus at Duke University and James B. Duke Professor of Medicine. He served as Chancellor for Health Affairs and Dean of the School of Medicine from 1989 to July 2004...
and Andrew Weil
Andrew Weil
Andrew Thomas Weil is an American author and physician, who established the field of integrative medicine which attempts to integrate alternative and conventional medicine. Weil is the author of several best-selling books and operates a website and monthly newsletter promoting general health and...
state 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." The combination of orthodox and complementary medicine with an emphasis on prevention and lifestyle changes is known as integrated medicine.
History
The use of plants as medicines predates written human history. A 60 000-year-old Neanderthal burial site, "Shanidar IV", in northern Iraq has yielded large amounts of pollen from 8 plant species, 7 of which are used now as herbal remediesCharacterization
There is no clear and consistent definition for either alternative or complementary medicine. In Western cultureWestern culture
Western culture, sometimes equated with Western civilization or European civilization, refers to cultures of European origin and is used very broadly to refer to a heritage of social norms, ethical values, traditional customs, religious beliefs, political systems, and specific artifacts and...
it is often defined as any healing practice "that does not fall within the realm of conventional medicine
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
", or "that which has not been shown consistently to be effective."
Self characterization
The National Center for Complementary and Alternative Medicine (NCCAM) defines CAM as "a group of diverse medical and healthcare systems, practices, and products, that are not currently part of conventional medicine."The Danish Knowledge and Research Center for Alternative Medicine (Danish abbreviation: ViFAB. ViFAB is an independent institution under the Danish Ministry of the Interior and Health. ViFAB's webstite: www.vifab.dk/uk) uses the term “alternative medicine” for:
– Treatments performed by therapists that are not authorized healthcare professionals
– Treatments performed by authorized healthcare professionals, but those based on methods otherwise used mainly outside the healthcare system. People without a healthcare authorisation must be able to perform the treatments.
The Cochrane
Cochrane Collaboration
The Cochrane Collaboration is a group of over 28,000 volunteers in more than 100 countries who review the effects of health care interventions tested in biomedical randomized controlled trials. A few more recent reviews have also studied the results of non-randomized, observational studies...
Complementary Medicine Field finds that what is considered complementary or alternative practices in one country may be considered conventional medical practices in another. Their definition is, therefore, general: "complementary medicine includes all such practices and ideas that 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."
For example, biofeedback
Biofeedback
Biofeedback is the process of becoming aware of various physiological functions using instruments that provide information on the activity of those same systems, with a goal of being able to manipulate them at will...
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. David M. Eisenberg, an integrative medicine researcher, defines it as "medical interventions not taught widely at US medical schools or generally available at US. hospitals," NCCAM states that formerly unproven remedies may be incorporated into conventional medicine if they are shown to be safe and effective.
Barrie R. Cassileth
Barrie R. Cassileth
Barrie R. Cassileth, PhD, is a researcher of complementary and alternative medicine, and has published extensively on alternative cancer treatments. She founded the Integrative Medicine Service at the Memorial Sloan-Kettering Cancer Center, where she remains the chief, and holds the Laurance S....
, a researcher of complementary and alternative medicine, has summed up the situation as "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.
Institutions
The United States' National Science FoundationNational Science Foundation
The National Science Foundation is a United States government agency that supports fundamental research and education in all the non-medical fields of science and engineering. Its medical counterpart is the National Institutes of Health...
has defined alternative medicine as "all treatments that have not been proven effective using scientific methods." In a consensus report released in 2005, entitled Complementary and Alternative Medicine in the United States, the Institute of Medicine
Institute of Medicine
The Institute of Medicine is a not-for-profit, non-governmental American organization founded in 1970, under the congressional charter of the National Academy of Sciences...
(IOM) defined complementary and alternative medicine (CAM) as the non-dominant approach to medicine in a given culture and historical period. A similar definition has been adopted by the Cochrane Collaboration, and official government bodies such as the UK Department of Health. Proponents of evidence-based medicine, such as the Cochrane Collaboration
Cochrane Collaboration
The Cochrane Collaboration is a group of over 28,000 volunteers in more than 100 countries who review the effects of health care interventions tested in biomedical randomized controlled trials. A few more recent reviews have also studied the results of non-randomized, observational studies...
, use the term alternative medicine but agree that all treatments, whether "mainstream" or "alternative", ought to be held to the standards of the scientific method.
Scientists
Numerous mainstream scientists and physicians have commented on and criticised alternative medicine.There is a debate among medical researchers over whether any therapy may be properly classified as 'alternative medicine'. Some claim that there is only medicine that has been adequately tested and that which has not. They feel that healthcare practices should be classified based solely on scientific evidence
Evidence-based medicine
Evidence-based medicine or evidence-based practice aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments and diagnostic tests...
. If a treatment has been rigorously tested and found safe and effective traditional medicine will adopt it regardless of if it was considered alternative to begin with. It is thus possible for a method to change categories (proven vs. unproven), based on increased knowledge of its effectiveness or lack thereof. Prominent supporters of this position include George D. Lundberg, former editor of the Journal of the American Medical Association
Journal of the American Medical Association
The Journal of the American Medical Association is a weekly, peer-reviewed, medical journal, published by the American Medical Association. Beginning in July 2011, the editor in chief will be Howard C. Bauchner, vice chairman of pediatrics at Boston University’s School of Medicine, replacing ...
(JAMA).
Stephen Barrett
Stephen Barrett
Stephen Joel Barrett is a retired American psychiatrist, author, co-founder of the National Council Against Health Fraud , and the webmaster of Quackwatch. He runs a number of websites dealing with quackery and health fraud. He focuses on consumer protection, medical ethics, and scientific...
, founder and operator of Quackwatch
Quackwatch
Quackwatch is an American non-profit organization founded by Stephen Barrett with the stated aim being to "combat health-related frauds, myths, fads, fallacies, and misconduct" and with a primary focus on providing "quackery-related information that is difficult or impossible to get elsewhere."...
, argues that practices labeled "alternative" should be reclassified as either genuine, experimental, or questionable. Here he defines genuine as being methods that have sound evidence for safety and effectiveness, experimental as being unproven but with a plausible rationale for effectiveness, and questionable as groundless without a scientifically plausible rationale. He has concerns that just because some "alternatives" have merit, there is the impression that the rest deserve equal consideration and respect even though most are worthless. He says that there is a policy at the NIH of never saying something doesn't work only that a different version or dose might give different results.
Edzard Ernst
Edzard Ernst
Edzard Ernst is the first Professor of Complementary Medicine in the world, at the University of Exeter, England....
, professor of complementary medicine, characterizes the evidence for many alternative techniques as weak, nonexistent, or negative, but states that evidence exists for others, in particular certain herbs and acupuncture. Ernst has concluded that 95% of the alternative treatments he and his team have studied, including acupuncture, herbal medicine, homeopathy, and reflexology, are, according to The Economist
The Economist
The Economist is an English-language weekly news and international affairs publication owned by The Economist Newspaper Ltd. and edited in offices in the City of Westminster, London, England. Continuous publication began under founder James Wilson in September 1843...
, "statistically indistinguishable from placebo treatments."
Richard Dawkins
Richard Dawkins
Clinton Richard Dawkins, FRS, FRSL , known as Richard Dawkins, is a British ethologist, evolutionary biologist and author...
, an evolutionary biologist, defines alternative medicine as a "set of practices that cannot be tested, refuse to be tested, or consistently fail tests." He also states that "there is no alternative medicine. There is only medicine that works and medicine that doesn't work." He says that if a technique is demonstrated effective in properly performed trials, it ceases to be alternative and simply becomes medicine.
A letter by four Nobel Laureates and other prominent scientists deplored the lack of critical thinking and scientific rigor in National Institutes of Health
National Institutes of Health
The National Institutes of Health are an agency of the United States Department of Health and Human Services and are the primary agency of the United States government responsible for biomedical and health-related research. Its science and engineering counterpart is the National Science Foundation...
supported alternative medicine research. In 2009 a group of scientists made a proposal to shut down the National Center for Complementary and Alternative Medicine. They argued that the vast majority of studies were based on unconventional understandings of physiology and disease and have shown little or no effect. Further, they argue that the field's more-plausible interventions such as diet, relaxation, yoga and botanical remedies can be studied just as well in other parts of NIH, where they would need to compete with conventional research projects.
These concerns are supported by negative results in almost all studies conducted over ten years at a cost of $2.5 billion by the NCCAM. R. Barker Bausell, a research methods expert and author of "Snake Oil Science" states that "it's become politically correct to investigate nonsense." There are concerns that just having NIH support is being used to give unfounded "legitimacy to treatments that are not legitimate."
Wallace Sampson, an editor of Scientific Review of Alternative Medicine
Scientific Review of Alternative Medicine
Scientific Review of Alternative Medicine and Aberrant Medical Practices is a scientific journal published by the Commission for Scientific Medicine and Mental Health...
and a Stanford University professor of medicine write that CAM is the "propagation of the absurd" based on the example that alternative and complementary have been substituted for quackery, dubious and implausible and concerns that CAM tolerates contradiction without thorough reason and experiment.
Popular press
The Washington Post reports that a growing number of traditionally trained physicians practice integrative medicine, which it defines as "conventional medical care that incorporates strategies such as acupuncture, reikiReiki
is a spiritual practice developed in 1922 by Japanese Buddhist Mikao Usui. The teaching was continued and adapted by various teachers. It uses a technique commonly called palm healing as a form of complementary and alternative medicine and is sometimes classified as oriental medicine by some...
and herbal remedies." The Australian comedian Tim Minchin
Tim Minchin
Timothy David "Tim" Minchin is a British-Australian comedian, actor, and musician.Tim Minchin is best known for his musical comedy, which has featured in six CDs, three DVDs and a number of live comedy shows which he has performed internationally. He has also appeared on television in Australia,...
, in his nine minute beat poem "Storm", states that alternative medicine is that which "has either not been proved to work or been proved not to work", and then he quips "You know what they call 'alternative medicine' that’s been proved to work? Medicine."
Classifications
NCCAM has developed one of the most widely used classification systems for the branches of complementary and alternative medicine. It classifies complementary and alternative therapies into five major groups, which have some overlap.- Whole medical systems: cut across more than one of the other groups; examples include Traditional Chinese medicineTraditional Chinese medicineTraditional Chinese Medicine refers to a broad range of medicine practices sharing common theoretical concepts which have been developed in China and are based on a tradition of more than 2,000 years, including various forms of herbal medicine, acupuncture, massage , exercise , and dietary therapy...
, Naturopathy, HomeopathyHomeopathyHomeopathy is a form of alternative medicine in which practitioners claim to treat patients using highly diluted preparations that are believed to cause healthy people to exhibit symptoms that are similar to those exhibited by the patient...
, and AyurvedaAyurvedaAyurveda or ayurvedic medicine is a system of traditional medicine native to India and a form of alternative medicine. In Sanskrit, words , meaning "longevity", and , meaning "knowledge" or "science". The earliest literature on Indian medical practice appeared during the Vedic period in India,... - Mind-body medicine: takes a holistic approach to health that explores the interconnection between the mind, body, and spirit. It works under the premise that the mind can affect "bodily functions and symptoms"
- Biology-based practices: use substances found in nature such as herbs, foods, vitamins, and other natural substances
- Manipulative and body-based practices: feature manipulation or movement of body parts, such as is done in chiropracticChiropracticChiropractic is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. It is generally categorized as complementary and alternative medicine...
and osteopathicOsteopathyOsteopathy and osteopathic medicine are often used interchangeably for the philosophy and system of alternative medical practice first proposed by A. T. Still MD, DO in 1874....
manipulation - Energy medicineEnergy medicineEnergy medicine is one of five domains of "complementary and alternative medicine" identified by the National Center for Complementary and Alternative Medicine in the United States...
: is a domain that deals with putative and verifiable energy fields:- Biofield therapies are intended to influence energy fields that, it is purported, surround and penetrate the body. No empirical evidence has been found to support the existence of the putative energy fields on which these therapies are predicated.
- BioelectromagneticBioelectromagnetismBioelectromagnetism refers to the electrical, magnetic or electromagnetic fields produced by living cells, tissues or organisms. Examples include the cell membrane potential and the electric currents that flow in nerves and muscles, as a result of action potentials...
-based therapies use verifiable electromagnetic fields, such as pulsed fields, alternating-current, or direct-current fields in an unconventional manner.
Usage
Many people utilize mainstream medicine for diagnosisMedical diagnosis
Medical diagnosis refers both to the process of attempting to determine or identify a possible disease or disorder , and to the opinion reached by this process...
and basic information, while turning to alternatives for therapy or health-enhancing measures. Studies indicate that alternative approaches are often used in conjunction with conventional medicine. 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." According to Andrew T. Weil
Andrew Weil
Andrew Thomas Weil is an American author and physician, who established the field of integrative medicine which attempts to integrate alternative and conventional medicine. Weil is the author of several best-selling books and operates a website and monthly newsletter promoting general health and...
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.
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.
Edzard Ernst
Edzard Ernst
Edzard Ernst is the first Professor of Complementary Medicine in the world, at the University of Exeter, England....
, 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)." Survey results released in May 2004 by the National Center for Complementary and Alternative Medicine, part of the United States National Institutes of Health
National Institutes of Health
The National Institutes of Health are an agency of the United States Department of Health and Human Services and are the primary agency of the United States government responsible for biomedical and health-related research. Its science and engineering counterpart is the National Science Foundation...
, 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. Another study suggests a similar figure of 40%.
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. 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." In general, he believes that CAM can and should be subjected to scientific testing.
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. In the United Kingdom, a 2000 report ordered by the House of Lords
House of Lords
The House of Lords is the upper house of the Parliament of the United Kingdom. Like the House of Commons, it meets in the Palace of Westminster....
suggested that "...limited data seem to support the idea that CAM use in the United Kingdom is high and is increasing." In developing nations
Developing country
A developing country, also known as a less-developed country, is a nation with a low level of material well-being. Since no single definition of the term developing country is recognized internationally, the levels of development may vary widely within so-called developing countries...
, access to essential medicines is severely restricted by lack of resources and poverty
Poverty
Poverty is the lack of a certain amount of material possessions or money. Absolute poverty or destitution is inability to afford basic human needs, which commonly includes clean and fresh water, nutrition, health care, education, clothing and shelter. About 1.7 billion people are estimated to live...
. Traditional remedies
Traditional medicine
Traditional medicine comprises unscientific knowledge systems that developed over generations within various societies before the era of modern medicine...
, often closely resembling or forming the basis for alternative remedies, may comprise primary healthcare or be integrated into the healthcare system. In Africa, traditional medicine is used for 80% of primary healthcare, and in developing nations as a whole over one-third of the population lack access to essential medicines.
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 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
PubMed
PubMed is a free database accessing primarily the MEDLINE database of references and abstracts on life sciences and biomedical topics. The United States National Library of Medicine at the National Institutes of Health maintains the database as part of the Entrez information retrieval system...
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, and Linde 1997.
Complementary therapies are often used in palliative care
Palliative care
Palliative care is a specialized area of healthcare that focuses on relieving and preventing the suffering of patients...
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." The non-pharmacologic interventions of complementary medicine can employ mind-body
Mind-Body Intervention
Mind–body interventions is the name of a U.S. National Center for Complementary and Alternative Medicine classification that covers a variety of techniques designed to enhance the mind's capacity to affect bodily function and symptoms....
interventions designed to "reduce pain and concomitant mood disturbance and increase quality of life."
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. 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. "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."
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: 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.
United States
National Center for Health Statistics
National Center for Health Statistics is a division of the United States federal agency the Centers for Disease Control and Prevention . As such, NCHS is under the United States Department of Health and Human Services...
(CDC) and the National Center for Complementary and Alternative Medicine indicated:
- 74.6% had used some form of complementary and alternative medicine (CAM).
- 62.1% had done so within the preceding twelve months.
- When prayerPrayerPrayer is a form of religious practice that seeks to activate a volitional rapport to a deity through deliberate practice. Prayer may be either individual or communal and take place in public or in private. It may involve the use of words or song. When language is used, prayer may take the form of...
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."
- The Dietary Supplement Industry is expected to be $250 Billion by 2016 worldwide
- 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 US in 2002 were prayer (45.2%), herbalismHerbalismHerbalism is a traditional medicinal or folk medicine practice based on the use of plants and plant extracts. Herbalism is also known as botanical medicine, medical herbalism, herbal medicine, herbology, herblore, and phytotherapy...
(18.9%), breathing meditation (11.6%), meditation (7.6%), chiropractic medicine (7.5%), yoga (5.1%), body workBody work (alternative medicine)Bodywork is a term used in alternative medicine to describe any therapeutic or personal development technique that involves working with the human body in a form involving manipulative therapy, breath work, or energy medicine...
(5.0%), diet-based therapy (3.5%), progressive relaxation (3.0%), mega-vitamin therapyOrthomolecular medicineOrthomolecular medicine is a form of complementary and alternative medicine that seeks to maintain health and prevent or treat diseases by optimizing nutritional intake and/or prescribing supplements...
(2.8%) and VisualizationVisualization (cam)The technique of visualization consists of creating a mental image of a desired outcome, and repeatedly playing that image in the mind....
(2.1%)
In 2004, a survey of nearly 1,400 U.S. hospitals found that more than one in four offered alternative and complementary therapies such as acupuncture, homeopathy, and massage therapy.
A 2008 survey of US hospitals by Health Forum, a subsidiary of the American Hospital Association
American Hospital Association
The American Hospital Association is an organization that promotes the quality provision of health care by hospitals and health care networks through such efforts as promoting effective public policy and providing information related to health care and health administration to health care...
, found that more than 37 percent of responding hospitals indicated they offer one or more alternative medicine therapies, up from 26.5 percent in 2005. Additionally, hospitals in the southern Atlantic states were most likely to include CAM, followed by east north central states and those in the middle Atlantic. More than 70% of the hospitals offering CAM were in urban areas.
In 2011 the Millennium Cohort Study (United States) found that 39% of the then currently enrolled 44,287 cohort members reported using at least one CAM therapy.
The National Science Foundation
National Science Foundation
The National Science Foundation is a United States government agency that supports fundamental research and education in all the non-medical fields of science and engineering. Its medical counterpart is the National Institutes of Health...
has also conducted surveys of the popularity of alternative medicine. After describing the negative impact science fiction
Science fiction
Science fiction is a genre of fiction dealing with imaginary but more or less plausible content such as future settings, futuristic science and technology, space travel, aliens, and paranormal abilities...
in the media has on public attitudes and understandings of pseudoscience
Pseudoscience
Pseudoscience is a claim, belief, or practice which is presented as scientific, but which does not adhere to a valid scientific method, lacks supporting evidence or plausibility, cannot be reliably tested, or otherwise lacks scientific status...
, and defining alternative medicine as all treatments that have not been proven effective using scientific methods, as well as mentioning the concerns of individual scientists, organizations, and members of the science policymaking community, it commented that "nevertheless, the popularity of alternative medicine appears to be increasing."
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 than the conventional treatment for the patient's medical condition."
Denmark
45.2 % of the Danish population aged 16 or above had in 2005 used alternative medicine at some point in life.22.5 % had used alternative medicine within the previous year.
The most popular types of therapies within the previous year (2005) are:
- Massage, osteopathy or other manipulative techniques (13.2 percent)
- ReflexologyReflexologyReflexology, or zone therapy, is an alternative medicine involving the physical act of applying pressure to the feet, hands, or ears with specific thumb, finger, and hand techniques without the use of oil or lotion...
(6.1 percent) - AcupunctureAcupunctureAcupuncture is a type of alternative medicine that treats patients by insertion and manipulation of solid, generally thin needles in the body....
(5.4 percent)
More results of statistical surveys on alternative medicine in Denmark is available on ViFABs (Knowledge and Research Center for Alternative Medicines) home page, see the pages on Statistics: http://www.vifab.dk/uk/alternative+medicine/statistics
Use among medical students
68 % of the medical students in Denmark were in 2008 using or had used alternative therapy. The most commonly used types of alternative medicine were:- Herbal medicines and Dietary supplements (50 percent)
- AcupunctureAcupunctureAcupuncture is a type of alternative medicine that treats patients by insertion and manipulation of solid, generally thin needles in the body....
(18 percent) - ReflexologyReflexologyReflexology, or zone therapy, is an alternative medicine involving the physical act of applying pressure to the feet, hands, or ears with specific thumb, finger, and hand techniques without the use of oil or lotion...
(18 percent).
Education
In the United States, increasing numbers of medical colleges have started offering courses in alternative and complementary medicine. A 1998 study reported "There is tremendous heterogeneity and diversity in content, format, and requirements among courses in complementary and alternative medicine at US medical schools". Common topics included chiropractic, acupuncture, homeopathy, herbal therapies, and mind-body techniques. 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. The University of ArizonaUniversity of Arizona
The University of Arizona is a land-grant and space-grant public institution of higher education and research located in Tucson, Arizona, United States. The University of Arizona was the first university in the state of Arizona, founded in 1885...
College of Medicine offers a program in Integrative Medicine under the leadership of Andrew Weil
Andrew Weil
Andrew Thomas Weil is an American author and physician, who established the field of integrative medicine which attempts to integrate alternative and conventional medicine. Weil is the author of several best-selling books and operates a website and monthly newsletter promoting general health and...
that trains physicians in various branches of alternative medicine that "...neither rejects conventional medicine nor embraces alternative practices uncritically." Accredited Naturopathic colleges and universities are also increasing in number and popularity in Canada and the USA. (See Naturopathic medical school in North America
Naturopathic medical school in North America
A naturopathic medical school in Canada and the United States is a four year graduate institution which confers the first professional degree in naturopathic medicine, the Doctor of Naturopathic Medicine or ND degree....
).
A 2001 survey of European universities found that unconventional medicine courses are widely represented at European universities. They cover a wide range of therapies and many of them are used clinically. Research work is underway at several faculties. A 2006 survey showed that 40% of the responding European universities were offering some form of CAM training."
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. Dietary supplements, their ingredients, safety, and claims, are a continual source of controversy. In some cases, political issues, mainstream medicine and alternative medicine all collide, such as in cases where synthetic drugs are legal but the herbal sources of the same active chemical are banned.In other cases, controversy over mainstream medicine causes questions about the nature of a treatment, such as water fluoridation. 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. Government regulators continue to attempt to find a regulatory balance.
Jurisdiction
Jurisdiction
Jurisdiction is the practical authority granted to a formally constituted legal body or to a political leader to deal with and make pronouncements on legal matters and, by implication, to administer justice within a defined area of responsibility...
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
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
. 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
Specific implementations of this article are left to member states.
A number of alternative medicine advocates disagree with the restrictions of government agencies that approve medical treatments. In the United States, for example, critics say 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 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 healthcare products.
In New Zealand, alternative medicine products are classified as food products, so there are no regulations or safety standards in place.
In Australia, the topic is termed as complementary medicine and the Therapeutic Goods Administration
Therapeutic Goods Administration
The Therapeutic Goods Administration is the regulatory body for therapeutic goods in Australia . It is a Division of the Australian Department of Health and Ageing established under the Therapeutic Goods Act 1989 ...
has issued various guidances and standards. Australian regulatory guidelines for complementary medicines (ARGCM) demands that the pesticides, fumigants, toxic metals, microbial toxins, radionuclides, and microbial contaminations present in herbal substances should be monitored, although the guidance does not request for the evidences of these traits. However, for the herbal substances in pharmacopoeial monographes, the detailed information should be supplied to relevant authorities
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. 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.
Denmark : Herbal and dietary supplements is the designation of a range of products, which have in common their status as medicine belonging under the Danish Medicines Act.In the Danish Medicines Act there exist four types of herbal and dietary supplements: Herbal medicinal products, Strong vitamin and mineral preparations, Traditional botanical medicinal products and Homeopathic medicinal products. Some dietary supplements fall within a special category of products, which differ from the above in that they are not authorized medicinal products. Dietary supplements are regulated under the Food Act and are registered by the Danish Veterinary and Food Administration.
Alternative therapists
Denmark has a registration system for alternative therapy practitioners, RAB.Criticism
The NCCAM budget has been criticized because despite the duration and intensity of studies about the efficacy of alternative medicine, there have been exactly zero effective CAMCam
A cam is a rotating or sliding piece in a mechanical linkage used especially in transforming rotary motion into linear motion or vice-versa. It is often a part of a rotating wheel or shaft that strikes a lever at one or more points on its circular path...
treatments supported by scientific evidence to date. Despite this, the National Center for Complementary and Alternative Medicine budget has been on a sharp sustained rise to support complementary medicine. In fact, the whole CAM field has been called by critics the SCAM.
"There really is no such thing as alternative medicine--only medicine that has been proved to work and medicine that has not." Arnold Relman, editor in chief emeritus of The New England Journal of Medicine. Speaking of government funding studies of integrating alternative medicine techniques into the mainstream, Steven Novella
Steven Novella
Steven P. Novella is an American clinical neurologist, assistant professor and Director of General Neurology at Yale University School of Medicine...
, a neurologist at Yale School of Medicine wrote that it "is used to lend an appearance of legitimacy to treatments that are not legitimate." Marcia Angell, executive editor of The New England Journal of Medicine says, "It's a new name for snake oil."
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 trialRandomized controlled trial
A randomized controlled trial is a type of scientific experiment - a form of clinical trial - most commonly used in testing the safety and efficacy or effectiveness of healthcare services or health technologies A randomized controlled trial (RCT) is a type of scientific experiment - a form of...
(RCT), and 23% had been assessed with a meta-analysis
Meta-analysis
In statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses. In its simplest form, this is normally by identification of a common measure of effect size, for which a weighted average might be the output of a meta-analyses. Here the...
. According to a 2005 book by a US Institute of Medicine
Institute of Medicine
The Institute of Medicine is a not-for-profit, non-governmental American organization founded in 1970, under the congressional charter of the National Academy of Sciences...
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.
As of 2005, the Cochrane Library
Cochrane Library
The Cochrane Library is a collection of databases in medicine and other healthcare specialties provided by the Cochrane Collaboration and other organisations. At its core is the collection of Cochrane Reviews, a database of systematic reviews and meta-analyses which summarize and interpret the...
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.
Lists of the Cochrane Reviews on alternative medicine including summaries of the results sorted by type of therapy (updated monthly) are made available at ViFABs (Knowledge and Research Center for Alternative Medicines) home page, see the lists here: http://www.vifab.dk/uk/cochrane+and+alternative+medicine
Most alternative medical treatments are not patent
Patent
A patent is a form of intellectual property. It consists of a set of exclusive rights granted by a sovereign state to an inventor or their assignee for a limited period of time in exchange for the public disclosure of an invention....
able, which may lead to less research funding from the private sector. In addition, in most countries, alternative treatments (in contrast to pharmaceuticals) can be marketed without any proof of efficacy—also a disincentive for manufacturers to fund scientific research. Some have proposed adopting a prize
Prize
A prize is an award to be given to a person or a group of people to recognise and reward actions or achievements. Official prizes often involve monetary rewards as well as the fame that comes with them...
system to reward medical research. However, public funding for research exists. Increasing the funding for research on alternative medicine techniques is 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 $2.5 billion on such research since 1992; this research has largely not demonstrated the efficacy of alternative treatments.
Some skeptics of alternative practices say that a person may attribute symptomatic relief to an otherwise-ineffective therapy due to the placebo effect
Placebo effect
Placebo effect may refer to:* Placebo effect, the tendency of any medication or treatment, even an inert or ineffective one, to exhibit results simply because the recipient believes that it will work...
, the natural recovery from or the cyclical nature of an illness (the regression fallacy
Regression fallacy
The regression fallacy is an informal fallacy. It ascribes cause where none exists. The flaw is failing to account for natural fluctuations. It is frequently a special kind of the post hoc fallacy.-Explanation:...
), or the possibility that the person never originally had a true illness.
In the same way as for conventional therapies, drugs, and interventions, it can be difficult to test the efficacy of alternative medicine in clinical trial
Clinical trial
Clinical trials are a set of procedures in medical research and drug development that are conducted to allow safety and efficacy data to be collected for health interventions...
s. 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.
Cancer researcher Andrew J. Vickers has stated:
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. 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.To ABC Online, MacLennan also gives another possible mechanism:
Potential side-effects
Conventional treatments are subjected to testing for undesired side-effectsAdverse effect (medicine)
In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery.An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or...
, whereas alternative treatments, in general, 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 potential to possess dangerous biological or psychological side-effects. Attempts to refute this fact with regard to alternative treatments sometimes use the appeal to nature
Appeal to nature
An appeal to nature is a type of argument that depends on an understanding of nature as a source of intelligibility for its claims, and which relies on that understanding for its outcome...
fallacy, i.e., "that which is natural cannot be harmful".
An exception to the normal thinking regarding side-effects is Homeopathy
Homeopathy
Homeopathy is a form of alternative medicine in which practitioners claim to treat patients using highly diluted preparations that are believed to cause healthy people to exhibit symptoms that are similar to those exhibited by the patient...
. Since 1938, the U.S. Food and Drug Administration (FDA) has regulated homeopathic products in "several significantly different ways from other drugs." 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.
Treatment delay
Those having 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 argue 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 costOpportunity cost
Opportunity cost is the cost of any activity measured in terms of the value of the best alternative that is not chosen . It is the sacrifice related to the second best choice available to someone, or group, who has picked among several mutually exclusive choices. The opportunity cost is also the...
". 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.
Between 2001 and 2003, four children died in Australia because their parents chose ineffective naturopathic, homeopathic, or other alternative medicines and diets rather than conventional therapies. In all, they found 17 instances in which children were significantly harmed by a failure to use conventional medicine.
Unconventional cancer "cures"
Perhaps because many forms of cancerCancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
are difficult or impossible to cure, there have always been many therapies offered outside of conventional cancer treatment centers and based on theories not found in biomedicine
Biomedicine
Biomedicine is a branch of medical science that applies biological and other natural-science principles to clinical practice,. Biomedicine, i.e. medical research, involves the study of physiological processes with methods from biology, chemistry and physics. Approaches range from understanding...
. These alternative cancer cures have often been described as "unproven," suggesting that appropriate clinical trials have not been conducted and that the therapeutic value of the treatment is unknown. However, many alternative cancer treatments have been investigated in good-quality clinical trials, and they have been shown to be ineffective.
Research funding
Although the Dutch government funded CAM research between 1986 and 2003, it formally ended funding in 2006.Integrative medicine, complementary medicine, fringe medicine
Integrative medicineIntegrative medicine
Integrative medicine or integrative health is the combination of the practices and methods of alternative medicine with conventional medicine. The term is relatively recent, and is mainly promoted by proponents of alternative therapies in the west...
is the combination of the practices and methods of alternative/complementary medicine with conventional medicine. It may include preventive medicine
Preventive medicine
Preventive medicine or preventive care refers to measures taken to prevent diseases, rather than curing them or treating their symptoms...
and patient-centered medicine
Patient-centered care
Patient-centered care presumes active involvement of patients and their families in the design of new care models and in decision-making about individual options for treatment...
. It may also include practices not normally referred to as medicine, such as using prayer
Prayer
Prayer is a form of religious practice that seeks to activate a volitional rapport to a deity through deliberate practice. Prayer may be either individual or communal and take place in public or in private. It may involve the use of words or song. When language is used, prayer may take the form of...
, meditation
Meditation
Meditation is any form of a family of practices in which practitioners train their minds or self-induce a mode of consciousness to realize some benefit....
, socializing, and recreation
Recreation
Recreation is an activity of leisure, leisure being discretionary time. The "need to do something for recreation" is an essential element of human biology and psychology. Recreational activities are often done for enjoyment, amusement, or pleasure and are considered to be "fun"...
as therapies. Its academic proponents sometimes recommend misleading patients by using known placebo treatments in order to achieve a placebo effect. However, a 2010 survey of family physicians found that 56% of respondents said they had used a placebo in clinical practice as well. Eighty-five percent of respondents believed placebos can have both psychological and physical benefits. A number of universities and hospitals have departments of integrative medicine.
Criticism of integrative medicine includes about proposing to lie to patients about alternative medicines known to be no more than a placebo in order to achieve a placebo effect
Placebo effect
Placebo effect may refer to:* Placebo effect, the tendency of any medication or treatment, even an inert or ineffective one, to exhibit results simply because the recipient believes that it will work...
, and “diverting research time, money, and other resources from more fruitful lines of investigation in order to pursue a theory that has no basis in biology”.
"Quackademic medicine
Quackademic medicine
Quackademic medicine is a pejorative term used by some in the science based medicine community for “integrative medicine” , when considered to be the infiltration of quackery into academic medicine, the attempt to lie to patients in order to achieve a larger placebo effect, or an attempt at...
" is a pejorative term used for “integrative medicine
Integrative medicine
Integrative medicine or integrative health is the combination of the practices and methods of alternative medicine with conventional medicine. The term is relatively recent, and is mainly promoted by proponents of alternative therapies in the west...
”, when considered to be an infiltration of quackery into academic science-based medicine, and was picked up by science-based medicine anti-ACM critics.
History
Fueled by a nationwide survey published in 1993 by David EisenbergDavid Eisenberg
David S. Eisenberg is an American biochemist best known for his contributions to structural and computational molecular biology...
, which revealed that in 1990 approximately 60 million Americans had used one or more complementary or alternative therapies to address health issues. A study published in the November 11, 1998 issue of the Journal of the American Medical Association
Journal of the American Medical Association
The Journal of the American Medical Association is a weekly, peer-reviewed, medical journal, published by the American Medical Association. Beginning in July 2011, the editor in chief will be Howard C. Bauchner, vice chairman of pediatrics at Boston University’s School of Medicine, replacing ...
reported that 42% of Americans had used complementary and alternative therapies, up from 34% in 1990. However, despite the growth in patient demand for complementary medicine, most of the early alternative/complementary medical centers failed.
Appeal
A study published in 1998 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 having 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 healthcare 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 – notable ones being 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 using them in lieu of conventional medicine. There are several socio-cultural reasons for the interest in these treatments centered on the low level of scientific literacy
Scientific literacy
Scientific literacy encompasses written, numerical, and digital literacy as they pertain to understanding science, its methodology, observations, and theories.-Definition:...
among the public at large and a concomitant increase in antiscientific
Antiscience
Antiscience is a position that rejects science and the scientific method. People holding antiscientific views are generally skeptical that science is an objective method, as it purports to be, or that it generates universal knowledge. They also contend that scientific reductionism in particular is...
attitudes and new age
New Age
The New Age movement is a Western spiritual movement that developed in the second half of the 20th century. Its central precepts have been described as "drawing on both Eastern and Western spiritual and metaphysical traditions and then infusing them with influences from self-help and motivational...
mysticism
Mysticism
Mysticism is the knowledge of, and especially the personal experience of, states of consciousness, i.e. levels of being, beyond normal human perception, including experience and even communion with a supreme being.-Classical origins:...
. Related to this are vigorous marketing
Advertising
Advertising is a form of communication used to persuade an audience to take some action with respect to products, ideas, or services. Most commonly, the desired result is to drive consumer behavior with respect to a commercial offering, although political and ideological advertising is also common...
of extravagant claims by the alternative medical community combined with inadequate media scrutiny and attacks on critics.
There is also an increase in conspiracy theories
Conspiracy theory
A conspiracy theory explains an event as being the result of an alleged plot by a covert group or organization or, more broadly, the idea that important political, social or economic events are the products of secret plots that are largely unknown to the general public.-Usage:The term "conspiracy...
toward 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 led patients to seek out alternative medicine to treat a variety of ailments. Many patients lack access to contemporary medicine, due to a lack of private or public health insurance
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
, which leads them to seek out lower-cost alternative medicine. Medical doctors are also aggressively marketing alternative medicine to profit from this market.
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
Placebo effect
Placebo effect may refer to:* Placebo effect, the tendency of any medication or treatment, even an inert or ineffective one, to exhibit results simply because the recipient believes that it will work...
, which is a well-established observation in medicine. Related to it are similar psychological effects such as the will to believe, cognitive bias
Cognitive bias
A cognitive bias is a pattern of deviation in judgment that occurs in particular situations. Implicit in the concept of a "pattern of deviation" is a standard of comparison; this may be the judgment of people outside those particular situations, or may be a set of independently verifiable...
es that help maintain self-esteem and promote harmonious social functioning, and the post hoc, ergo propter hoc fallacy.
Patients can also be averse to the painful, unpleasant, and sometimes-dangerous side effects
Adverse effect
In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery.An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or...
of biomedical treatments. Treatments for severe diseases such as cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
and HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
infection have well-known, significant side-effects. Even low-risk medications such as antibiotics can have potential to cause life-threatening anaphylactic reactions in a very few individuals. Also, 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.
Its popularity may be related to other factors. In an interview with Edzard Ernst
Edzard Ernst
Edzard Ernst is the first Professor of Complementary Medicine in the world, at the University of Exeter, England....
, The Independent
The Independent
The Independent is a British national morning newspaper published in London by Independent Print Limited, owned by Alexander Lebedev since 2010. It is nicknamed the Indy, while the Sunday edition, The Independent on Sunday, is the Sindy. Launched in 1986, it is one of the youngest UK national daily...
wrote:
Academic resources
- Journal of alternative and complementary medicineJournal of Alternative and Complementary MedicineThe Journal of Alternative and Complementary Medicine is a peer-reviewed medical journal published by Mary Ann Liebert, Inc. since 1995. It includes observational and analytical reports on alternative medicine treatments...
- Cochrane and alternative medicine full lists of updated reviews found on Knowledge and Research Center for Alternative Medicine
See also
- Alternative cancer treatments
- Health freedom movement
- History of alternative medicineHistory of alternative medicineHistory of alternative medicine is a record of historical events that can be related to the many different branches of alternative medicine.-Middle East:...
- List of branches of alternative medicine
- Program for Evaluating Complementary MedicineProgram for Evaluating Complementary MedicineIn 1998, the Swiss government began a comprehensive Program for Evaluating Complementary Medicine to study the role and effectiveness of complementary medicine, which was playing an ever-increasing role in the Swiss medical system.According to the PEK Report, results of the evaluation were...
- Shakoor v Situ
- Traditional medicineTraditional medicineTraditional medicine comprises unscientific knowledge systems that developed over generations within various societies before the era of modern medicine...
Further reading
- 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
- Bivins, Roberta "Alternative Medicine?: A History" Oxford University Press 2008
- Diamond, J. Snake Oil and Other Preoccupations, 2001, ISBN 978-0-09-942833-6 , foreword by Richard DawkinsRichard DawkinsClinton Richard Dawkins, FRS, FRSL , known as Richard Dawkins, is a British ethologist, evolutionary biologist and author...
reprinted in Dawkins, R., A Devil's Chaplain, 2003, ISBN 978-0-7538-1750-6 .; http://books.google.com/books?id=bZjlC2LELlICpreview at Google BooksGoogle Book SearchGoogle Books is a service from Google that searches the full text of books that Google has scanned, converted to text using optical character recognition, and stored in its digital database. The service was formerly known as Google Print when it was introduced at the Frankfurt Book Fair in October...
]
World Health Organization publication
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 New York, NY : Mary Ann Liebert, Inc., c1995
- Scientific Review of Alternative Medicine (SRAM)
- Journal Of Dietary Supplements
External links
- The National Center for Complementary and Alternative Medicine: U.S. National Institutes of HealthNational Institutes of HealthThe National Institutes of Health are an agency of the United States Department of Health and Human Services and are the primary agency of the United States government responsible for biomedical and health-related research. Its science and engineering counterpart is the National Science Foundation...
- The Office of Cancer Complementary and Alternative Medicine: U.S. National Cancer InstituteNational Cancer InstituteThe National Cancer Institute is part of the National Institutes of Health , which is one of 11 agencies that are part of the U.S. Department of Health and Human Services. The NCI coordinates the U.S...
, National Institutes of Health - Knowledge and Research Center for Alternative Medicine: Denmark, the Ministry of the Interior and Health
- Guidelines For Using Complementary and Alternative Methods: from the American Cancer SocietyAmerican Cancer SocietyThe American Cancer Society is the "nationwide community-based voluntary health organization" dedicated, in their own words, "to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and...
- Complementary and Alternative Medicine Index: from the University of Maryland Medical CenterUniversity of Maryland, BaltimoreUniversity of Maryland, Baltimore, was founded in 1807. It comprises some of the oldest professional schools in the nation and world. It is the original campus of the University System of Maryland. Located on 60 acres in downtown Baltimore, Maryland, it is part of the University System of Maryland...
- Integrative Medicine Podcasts and Handouts: Teaching modules from the University of Wisconsin Integrative Medicine Program
- "Alternative Medicine": A BBC/Open University television series that examines the evidence scientifically
- "Complementary and alternative medicine: What is it?": from the Mayo ClinicMayo ClinicMayo Clinic is a not-for-profit medical practice and medical research group specializing in treating difficult patients . Patients are referred to Mayo Clinic from across the U.S. and the world, and it is known for innovative and effective treatments. Mayo Clinic is known for being at the top of...
- Natural Standard Research Collaboration
- A Different Way to Heal? and Videos: from PBSPublic Broadcasting ServiceThe Public Broadcasting Service is an American non-profit public broadcasting television network with 354 member TV stations in the United States which hold collective ownership. Its headquarters is in Arlington, Virginia....
and Scientific American FrontiersScientific American FrontiersScientific American Frontiers was an American television program primarily focused on informing the public about new technologies and discoveries in science and medicine. It was a companion program to the Scientific American magazine. The show was produced for PBS in the U.S... - Who Gets to Validate Alternative Medicine?: from PBSPublic Broadcasting ServiceThe Public Broadcasting Service is an American non-profit public broadcasting television network with 354 member TV stations in the United States which hold collective ownership. Its headquarters is in Arlington, Virginia....
Criticism
- Davis, Adam Brooke. "A Few Words About Folk Medicine/" Folklorist argues against uncritical use of traditional healing practices, especially by non-members of the cultures which generate the traditions
- What is Complementary and Alternative Medicine? – Steven NovellaSteven NovellaSteven P. Novella is an American clinical neurologist, assistant professor and Director of General Neurology at Yale University School of Medicine...
, MD - "Alternative" health practice – Skeptic's DictionarySkeptic's DictionaryThe Skeptic's Dictionary is a collection of cross-referenced skeptical essays by Robert Todd Carroll, published on his website skepdic.com and in a printed book. The skepdic.com site was launched in 1994 and the book was published in 2003 with nearly 400 entries. As of January 2011 the website has...
- Quackwatch.org – Stephen BarrettStephen BarrettStephen Joel Barrett is a retired American psychiatrist, author, co-founder of the National Council Against Health Fraud , and the webmaster of Quackwatch. He runs a number of websites dealing with quackery and health fraud. He focuses on consumer protection, medical ethics, and scientific...
(See also: QuackwatchQuackwatchQuackwatch is an American non-profit organization founded by Stephen Barrett with the stated aim being to "combat health-related frauds, myths, fads, fallacies, and misconduct" and with a primary focus on providing "quackery-related information that is difficult or impossible to get elsewhere."...
) - Healing, Hype, or Harm? A Critical Analysis of Complementary or Alternative Medicine, by Edzard Ernst (Editor) (2008), reviewed in Metapsychology.
- What's the harm? Website listing cases of people harmed by various alternative treatments.