Alternative medicine

Alternative medicine broadly describes methods and practices used in place of, or in addition to, conventional medical treatments. The precise scope of alternative medicine is a matter of some debate and depends to a great extent on the definition of "conventional medicine." Many practitioners regard the distinction as false, preferring "good medicine" (which demonstrably works) and "bad medicine."

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

Detractors of alternative medicine may also define it as "diagnosis, treatment, or therapy which can be provided legally by persons who are not licensed to diagnose and treat illness," although some medical doctors find value using alternative therapies in the practice of "complementary medicine."

Many in the scientific community define alternative medicine as any treatment, the efficacy and safety of which has not been verified through peer-reviewed, controlled studies. This form of definition is not based on political views, turf protection, or economic interests, but hinges exclusively on questions of effectiveness and safety. It is thus possible for a method to change categories in either direction, based on increased knowledge of its effectiveness or lack thereof.

Some techniques and therapies once considered to be "alternative", have - upon being proven to be effective - been accepted into mainstream medicine.

The opposite is equally true, with methods once thought to be effective being dropped when it has been discovered that their only effect was because of the placebo effect, or when their side effects were found to result in an unfavorable safety-to-benefit ratio.

Various advocates and critics of alternative therapies believe that the term "alternative medicine" is misleading. Some advocates believe that Western therapies are the "alternative" in that they were preceded by traditional therapies. Others believe that the term was invented by advocates of "allopathic" medicine in an attempt to discredit natural therapies. Critics of alternative therapies assert that they are not effective and consequently are not a legitimate alternative to conventional medicine. Richard Dawkins, professor of the Public Understanding of Science at Oxford University, defines alternative medicine as "that set of practices that cannot be tested, refuse to be tested or consistently fail tests" (See Diamond 2003). Many on both sides believe that alternative therapies can become accepted as conventional medicine if they are scientifically proven to be effective.

Complementary and alternative medicine
The National Center for Complementary and Alternative Medicine defines complementary and alternative medicine as "a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine". One distinction that the NCCAM makes is that complementary medicine is used in conjunction with conventional medicine whereas alternative medicine is used in place of conventional medicine. The NCCAM also defines integrative medicine as the combination of "mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness".

"Importantly, integrative medicine is not synonymous with complementary and alternative medicine (CAM). It has a far larger meaning and mission in that it calls for restoration of the focus of medicine on health and healing and emphasizes the centrality of the patient-physician relationship." (Snyderman, Weil 2002)

Regulation
Jurisdiction differs concerning which branches of alternative medicine are legal, which are regulated, and which (if any) are provided by a government-controlled health service or reimbursed by a private health medical insurance company.

A number of alternative medicine advocates disagree with the restrictions of government agencies that approve medical treatments (such as the American Food and Drug Administration) and the agencies' adherence to experimental evaluation methods. They claim that this impedes those seeking to bring useful and effective treatments and approaches to the public, and protest that their contributions and discoveries are unfairly dismissed, overlooked or suppressed. Alternative medicine providers often argue that health fraud should be dealt with appropriately when it occurs.

Contemporary use of alternative medicine
Edzard Ernst wrote in the Medical Journal of Australia that "about half the general population in developed countries use complementary and alternative medicine (CAM)" (Ernst 2003). A survey (Barnes et al 2004) released in May 2004 by the National Center for Complementary and Alternative Medicine, part of the National Institutes of Health in the United States, found that in 2002, 36% of Americans used some form of alternative therapy in the past 12 months &mdash; a category that included yoga, meditation, herbal treatments and the Atkins diet. If prayer was counted as an alternative therapy, the figure rose to 62.1%. Another study by Astin et al (1998) 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 & White 1999)

The use of alternative medicine appears to be increasing. Eisenburg et al carried out a study in 1998 which showed that 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".

Medical education
Increasing numbers of medical colleges have begun offering courses in alternative medicine. For example, the University of Arizona College of Medicine offers a program in Integrative Medicine under the leadership of Dr. Andrew Weil which trains physicians in various branches of alternative medicine which "neither rejects conventional medicine, nor embraces alternative practices uncritically." In three separate research surveys that surveyed the 125 medical schools offering a MD degree, the 19 medical schools offering a DO degree, and 585 schools of nursing in the United States: 60 percent of U.S. medical schools offering a MD degree teach CAM, 95% of Osteopathic medical school teach CAM, and 84.8% of US schools of nursing teach CAM. (Wetzel et al 1998, Saxon et al 2004, Fenton & Morris 2003)

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

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

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

Advocates of alternative medicine hold that alternative medicine may provide health benefits through patient empowerment, by offering more choices to the public, including treatments that are simply not available in conventional medicine.

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

Some physicians are willing to embrace some aspects of alternative medicine.

Although advocates of alternative medicine acknowledge that the placebo effect may play a role in the benefits that some receive from alternative therapies, they point out that this does not diminish their validity. Skeptics are confounded by this view and claim that it is acknowledgement of the inefficacy of alternative treatments.

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

Patients should however always inform their medical doctor they are using alternative medicine. Some patients do not tell their medical doctors since they fear it will hurt their patient-doctor relationship. However some alternative treatments may interact with orthodox medical treatments.

The issue of alternative medicine interfering with conventional medical practices is minimized when it is only turned to after the conventional medicine path has been exhausted. Many patients believe alternative medicine can help in coping with chronic illnesses for which conventional medicine offers no cure and only management. It is becoming more common for a patient's own MD to suggest alternatives when they cannot offer a treatment.

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

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

Proponents of the various forms of alternative medicine reject criticism as being founded in prejudice, financial self-interest, or ignorance.

Lack of proper testing
Despite the large number of studies regarding alternative therapies, critics contend that there are no statistics on exactly how many of these studies were controlled, double-blind peer-reviewed experiments or how many produced results supporting alternative medicine or parts thereof. They contend that many forms of alternative medicine are rejected by conventional medicine because the efficacy of the treatments has not been demonstrated through double-blind randomized controlled trials. Some skeptics of alternative practices point out that a person may attribute symptomatic relief to an otherwise ineffective therapy due to the natural recovery from or the cyclical nature of an illness, the placebo effect, or the possibility that the person never originally had a true illness.

Problems with known tests and studies
Critics contend that observer bias and poor study design invalidate the results of many studies carried out by alternative medicine promoters.

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

Some argue that less research is carried out on alternative medicine because many alternative medicine techniques cannot be patented, and hence there is little financial incentive to study them. Drug research, by contrast, can be very lucrative, which has resulted in funding of trials by pharmaceutical companies. Many people, including conventional and alternative medical practitioners, contend that this funding has led to corruption of the scientific process for approval of drug usage, and that ghostwritten work has appeared in major peer-reviewed medical journals. (Flanagin et al. 1998, Larkin 1999). Increasing the funding for research of alternative medicine techniques was the purpose of the National Center for Complementary and Alternative Medicine. NCCAM and its predecessor, the Office of Alternative Medicine, have spent more than $200 million on such research since 1991. The German Federal Institute for Drugs and Medical Devices Commission E has studied many herbal remedies for efficacy. 

Safety
Critics contend that "dubious therapies can cause death, serious injury, unnecessary suffering, and disfigurement" and that some people have been hurt or killed directly from the various practices or indirectly by failed diagnoses or the subsequent avoidance of conventional medicine which they believe is truly efficacious.

Alternative medicine critics agree with its proponents that people should be free to choose whatever method of healthcare they want, but stipulate that people must be informed as to the safety and efficacy of whatever method they choose. People who choose alternative medicine may think they are choosing a safe, effective medicine, while they may only be getting quack remedies.

Delay in seeking conventional medical treatment
They state that those who have had 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, they contend that therapies that rely on the placebo effect to define success are very dangerous.

Danger can be increased when used as a complement to conventional medicine
A Norwegian multicentre study examined the association between the use of alternative medicines (AM) and cancer survival. 515 patients using standard medical care for cancer were followed for eight years. 22% of those patients used AM concurrently with their standard care.

The study revealed that death rates were 30% higher in AM users than in those who did not use AM: "The use of AM seems to predict a shorter survival from cancer." -- Does use of alternative medicine predict survival from cancer? Eur J Cancer 2003 Feb;39(3):372-7

Issues of regulation
Critics contend that some branches of alternative medicine are often not properly regulated in some countries to identify who practices or know what training or expertise they may possess. Critics argue that the governmental regulation of any particular alternative therapy does necessitate that the therapy is effective.

Dictionary definitions

 * Complementary medicine

World Health Organization publication

 * WHO Global Atlas of Traditional, Complementary and Alternative Medicine

Journals dedicated to alternative medicine research

 * Alternative therapies in health and medicine. Aliso Viejo, CA : InnoVision Communications, c1995- NLM ID: 9502013
 * Alternative medicine review : a journal of clinical therapeutic. Sandpoint, Idaho : Thorne Research, Inc., c1996- NLM ID: 9705340
 * BMC complementary and alternative medicine. London : BioMed Central, 2001- NLM ID: 101088661
 * Complementary therapies in medicine. Edinburgh ; New York : Churchill Livingstone, c1993- NLM ID: 9308777
 * Evidence based complementary and alternative medicine
 * Evidence Based journal of Integrative medicine
 * Journal of Integrative medicine.
 * The journal of alternative and complementary medicine : research on paradigm, practice, and policy. New York, NY : Mary Ann Liebert, Inc., c1995- NLM ID: 9508124
 * Journal of alternative & complementary medicine. London : Argus Health Publications, c1989- NLM ID: 9883124
 * Journal for Alternative and Complementary Medicine
 * Scientific Review of Alternative Medicine (SRAM)

Research articles cited in the text

 * 1) Astin JA  "Why patients use alternative medicine: results of a national study" JAMA 1998; 279(19): 1548-1553
 * 2) Barnes P, Powell-Griner E, McFann K, Nahin R. "Complementary and Alternative Medicine Use Among Adults: United States, 2002." Advanced data from vital health and statistics 2004; Hyattsville, Maryland:NCHS Online
 * 3) 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
 * 4) Berga SL, Marcus MD, Loucks TL. "Recovery of ovarian activity in women with functional hypothalamic amenorrhea who were treated with cognitive behavior therapy." Fertility and Sterility 2003; 80(4): 976-981 Abstract
 * 5) Downing AM, Hunter DG. "Validating clinical reasoning: a question of perspective, but whose perspective?" Man Ther, 2003; 8(2): 117-9. PMID 12890440  Manual Therapy Online
 * 6) Eisenberg DM.  "Advising patients who seek alternative medical therapies."  Ann Intern Med  1997; 127:61-69. PMID 9214254
 * 7) Eisenberg, DM, Davis RB, Ettner SL "Trends in alternative medicine use in the United States 1990-1997."  JAMA, 1998; 280:1569-1575. PMID 9820257
 * 8) Ernst E. "Obstacles to research in complementary and alternative medicine." Medical Journal of Australia, 2003; 179'(6): 279-80. PMID 12964907 http://www.mja.com.au/public/issues/179_06_150903/ern10442_fm-1.html MJA online]
 * 9) Fenton MV, Morris DL. "The integration of holistic nursing practices and complementary and alternative modalities into curricula of schools of nursing." Altern Ther Health Med, 2003; 9(4):62-7. PMID 12868254
 * 10) Flanagin A, Carey LA, Fontanarosa PB. "Prevalence of articles with honorary authors and ghost authors in peer-reviewed medical journals." JAMA, 1998; 280(3):222-4. Full text
 * 11) Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ. "Long term benefits of hypnotherapy for irritable bowel syndrome." Gut, 2003; 52(11):1623-9. PMID 14570733
 * 12) Gunn IP. "A critique of Michael L. Millenson's book, Demanding medical excellence: doctors and accountability in the information age, and its relevance to CRNAs and nursing." AANA J, 1998 66(6):575-82. Review. PMID 10488264
 * 13) Kleijnen J, Knipschild P, ter Riet G. "Clinical trials of homoeopathy." BMJ, 1991; 302:316-23. Erratum in: BMJ, 1991;302:818. PMID 1825800
 * 14) Larkin M. "Whose article is it anyway?" Lancet, 1999; 354:136. Editorial
 * 15) Linde K, Clausius N, Ramirez G. "Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials." Lancet, 1997; 350: 834-43. Erratum in: Lancet 1998 Jan 17;351(9097):220. PMID 9310601
 * 16) Michalsen A, Ludtke R, Buhring M. "Thermal hydrotherapy improves quality of life and hemodynamic function in patients with chronic heart failure." Am Heart J, 2003; 146(4):E11. PMID 14564334
 * 17) Saxon DW, Tunnicliff G, Brokaw JJ, Raess BU. "Status of complementary and alternative medicine in the osteopathic medical school curriculum." J Am Osteopath Assoc 2004; 104(3):121-6. PMID 15083987
 * 18) Snyderman R, Weil AT. "Integrative medicine: bringing medicine back to its roots." Arch Intern Med 2002; 162:395&#8211;397.
 * 19) Tonelli MR. "The limits of evidence-based medicine." Respir Care, 2001; 46(12): 1435-40; discussion 1440-1. Review. PMID 11728302 PMID: 11863470
 * 20) Vickers A. "Alternative Cancer Cures: "Unproven" or "Disproven"?" CA Cancer J Clin 2004; 54: 110-118. Online
 * 21) Wetzel MS, Eisenberg DM, Kaptchuk TJ. "Courses involving complementary and alternative medicine at US medical schools." JAMA 1998; 280(9):784 -787. PMID 9729989
 * 22) Zalewski Z. "Importance of Philosophy of Science to the History of Medical Thinking." CMJ 1999; 40: 8-13. CMJ online

Other works that discuss alternative medicine

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

General information

 * The National Center for Complementary and Alternative Medicine - US National Institutes of Health
 * Institute for Complementary Medicine (ICM), UK - includes article "What is Complementary Medicine?"
 * Complementary and Alternative Medicine on PubMed - Alternative Medicine Research Database
 * Web pages for new BBC/Open University television series "Alternative Medicine" that examines the evidence scientifically.

Advocacy

 * Consumer focused alternative medicine information - in English and Spanish
 * Complementary and alternative medicine information - Columbia University supported and ad-free
 * WholeHealth Networks' CAM education website - created by practicing MD's
 * Traditional and Alternative Medicine - both clinical and alternative health perspectives
 * Alternative Medicine: Chinese medicine
 * Alternative Medicine: Osteopathy
 * Circle of Healers - Alternative Medicine News and Resources
 * A History of Western Natural Healing Practices
 * What is Medicine? - Historical perspective of various modes of medicine
 * "Weil's integrative medicine gathering steam", by Carla McClain, Arizona Daily Star, Published: 01-20-2004
 * Alternative Medicine Becoming Mainstream
 * Alternative Health &amp; Complementary Medicine UK Directory
 * Alternative Medicine and Natural Health Information and news on alternative medicine
 * Comprehensive list of Alternative Medicine Websites

Critiques

 * Skeptic's Dictionary: Alternative Medicine
 * Alternative medicine: A Skeptical Look
 * Quackwatch: Your Guide to Health Fraud, Quackery, and Intelligent Decisions

طب بديل Naturmedicin Alternativmedizin Alternatiivmeditsiin Medicina alternativa Médecine parallèle 대체의학 Medicina alternativa רפואה אלטרנטיבית Alternatieve geneeswijze 代替医療 Alternativ medisin Medycyna niekonwencjonalna Medicina alternativa Альтернативная медицина Vaihtoehtoinen hoitomuoto Alternativmedicin Альтернативна медицина