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Alternative medicine

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Alternative medicine broadly describes methods and practices used in place of conventional medical treatments. It may also be described as "diagnosis, treatment, or therapy which can be provided legally by persons who are not licensed to diagnose and treat illness" — although practitioners are frequently so licensed.

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The definition of what is and is not 'alternative' changes with time, generally as the result of research and public acceptance. This change in status can work in either direction.

Complementary medicine uses "alternative" methods and practices alongside conventional medical treatment. Integrative medicine, as defined by the National Center for Complementary and Alternative Medicine, combines conventional medical treatments and alternative treatments for which there is some high-quality scientific evidence of their safety and effectiveness . Collectively, these variations on alternative medicine are often referred to as complementary and alternative medicine (or simply as CAM).

When the service is performed by a conventional physician it may be termed integrative medicine.


Branches of alternative medicine

The most often used branches of alternative medicine in the United States are (Eisenberg et al., 1998):

  1. acupuncture
  2. biofeedback
  3. Chinese medicine
  4. chiropractic
  5. homeopathy
  6. hypnotherapy
  7. massage therapy
  8. naturopathy

Diagnostic specialties of alternative medicine include:

Other branches of alternative/complementary medicine include:

Alternative medicine and the law

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

Criticism and support for alternative medicine

Criticisms

Some people define alternative medicine in a derogatory way. Richard Dawkins, professor of the Public Understanding of Science at Oxford, defines alternative medicine as "that set of practices that cannot be tested, refuse to be tested or consistently fail tests" (See Diamond 2003). Some feel that the very term "alternative medicine" is misleading, on the belief that these treatments are not a true alternative to regulated conventional medicine.

There is no strict definition as to what constitutes "conventional" or "mainstream" medicines, as opposed to the tag "alternative." One possible definition is that "conventional medicine" is that which is recognized as valid medicine by the majority of the scientific and the health community in the Western world, which aims for standards of proof of efficiency based on double-blind studies and explanations as to the workings of drugs based on biology and biochemistry. Another is that "conventional medicine" is what is licensed as valid medicine by the local governing authority.

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

Lack of proper testing

Many forms of alternative medicine are rejected by conventional medicine because the efficacy of the treatments has not been shown through double-blind randomized controlled trials. Where alternative methods provide temporary symptomatic relief, this has been explained by Barry L. Beyerstein, Ph.D as being due to the placebo effect, or to natural healing, or to the cyclic nature of some illnesses.

Poor diagnosis

One of the most important concerns of mainstream medical doctors is that alternative medical practitioners sometimes fail to correctly diagnose illnesses, and therefore do not provide safe therapies every time. William T. Jarvis, Ph.D contends in the web article "How Quackery Harms Cancer Patients" that "Dubious therapies can cause death, serious injury, unnecessary suffering, and disfigurement" and gives an example of how an unlicenced naturopath caused a severe disfigurement of a patient.

Criticisms differ for the various branches

Due to the wide range of types of alternative medicine few criticisms apply across the board. 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 potential violations of the laws of physics (for example, in homeopathy).

Regulation

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

Testing and studies

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

Testimonials are especially useless in this procedure, because by chance alone some people will get cured and will be able to testify that the method really helped them. Furthermore, if the majority of people using a method do not notice any benefit or even get worse, there will still be a minority that can testify that the method really helped for them.

Nonetheless, many mainstream doctors and scientists are open to revising their views of any specific new treatment, if new peer-reviewed evidence comes available. 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, point out 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).

Support

Advocates of alternative medicine point to a number of different arguments that tend to support the validity of using alternative methods of treatment to treat specific medical conditions.

Some conventional doctors support CAM

Some physicians who talk about alternative medical treatments methods do so in a more positive way. In a recent newspaper interview, Dr. Russell Greenfield, said: "I tell them 'I'm one of you' and that we have the data - we have the studies, we're not making this up," when talking to other physicians. Dr. Greenfield was referring to published studies on the beneficial effect of saw palmetto on enlarged prostates, and how body work, or massage therapy, is effective for treating lower back pain. Another example from this interview is physician Dr. Karen Koffler who said : "I've learned how to balance the intellectual processes of medicine with an intuitive understanding of what this person, this patient really needs to gain strength for healing. That is never taught in medical school and is lost entirely from medicine now." (See McClain 2004).

Alternative medicine is not dangerous, if it is complementary

The primary objection of the medical community to alternative medicine is that it is done in place of conventional medical treatments. As long as alternative treatments are used alongside standard conventional medical treatments, most physicians find complementary medicine acceptable (see comments about alternative versus complementary medicine in Vickers 2004).

Those physicians that practice complementary medicine must obviously belive they see some added value in alternative forms of treatments for their patients. Further, the boundary lines between alternative and mainstream medicine have changed over time. Methods once considered alternative have later been adopted by conventional medicine as physicians gradually incorporate effective branches of alternative medicine of treatment into their conventional medical practices. Supporters of alternative methods suggest that much of what is currently called alternative medicine will be similarly assimilated by the mainstream in the future.

Scientific research on alternative therapies

A search on PubMed reveals that there are 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). There are no publicly available 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.

Specific alternative treatment methods have been shown to be effective for specific medical conditions in recently published research (such as Michalsen 2003, Gonsalkorale 2003, and Berga 2003). Favorable research has been published in research journals recognized by Medline.


Alternative medicine as an alternative for the public searching for complementary services

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

The placebo effect

The placebo effect is a problem only when conducting research. In the treatment of patients, the placebo effect always benefits the patient (Benedetti et al. 2003). Alternative medicine tries to capitalize on the positive effects of the placebo effect.

Contemporary use of alternative medicine

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

A survey released in May 2004 by the National Center for Complementary and Alternative Medicine, part of the National Institutes of Health in the United States, found that in 2002, more than one-third of Americans used some form of alternative therapy - a category that included yoga, meditation, herbal treatments and the Atkins diet. If prayer was counted as an alternative therapy, the figure rose to almost two-thirds. Consistent with previous studies, this study found that the majority of individuals (i.e., 54.9%) used CAM in conjunction with conventional medicine ( page 6).

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

Issues of regulation

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

The current regulatory system and alternative medicine

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

Other issues

A point often overlooked by some critics of alternative medicine is that their criticisms need not apply to all the different branches — it is not valid to lump all the branches together.

Several health research authors have voiced criticisms of evidence-based medicine (Tonelli 2001, Downing 2003), in effect supporting the value of eclectic branches of alternative medicine which place great value upon the clinical experience of the practitioner.

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. Any positive effects that such alternative medicine treatments offer, even if they are only based on placebo effects, still provide benefits to overall patient health that traditional medicine might not have provided.

References

Dictionary definitions

Journals dedicated to alternative medicine research

Research articles cited in the text

  1. Kleijnen, J., Knipschild, P., ter Riet, G. Clinical trials of homoeopathy. BMJ. 1991 Feb 9;302(6772):316-23. Erratum in: BMJ 1991 Apr 6;302(6780):818. PMID: 1825800 Abstract
  2. Linde, K., Clausius, N., Ramirez, G. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet. 1997 Sep 20;350(9081):834-43. Erratum in: Lancet 1998 Jan 17;351(9097):220. PMID: 9310601 Abstract
  3. Michalsen, A., Ludtke, R., Buhring, M. Thermal hydrotherapy improves quality of life and hemodynamic function in patients with chronic heart failure. Am Heart J. 2003 Oct;146(4):E11. PMID: 14564334 Abstract
  4. Gonsalkorale, W.M., Miller, V., Afzal, A., Whorwell, P.J. Long term benefits of hypnotherapy for irritable bowel syndrome. Gut. 2003 Nov;52(11):1623-9. PMID: 14570733 Abstract
  5. Berga, S.L., Marcus, M.D., Loucks, T.L. Recovery of ovarian activity in women with functional hypothalamic amenorrhea who were treated with cognitive behavior therapy. Fertility and Sterility , Volume 80, Issue 4, Pages 976-981 (October 2003) Abstract
  6. Eisenberg, D.M., Davis, R.B., Ettner, S.L. Trends in alternative medicine use in the United States, 1990-1997. JAMA. 1998; 280:1569-1575. PMID: 9820257 Abstract
  7. Ernst, E. Obstacles to research in complementary and alternative medicine. Medical Journal of Australia. 2003 Sep 15;179(6):279-80. PMID: 12964907 MJA online
  8. Zalewski, Z. Importance of Philosophy of Science to the History of Medical Thinking. CMJ 1999; 40: 8-13. CMJ online
  9. Downing, A.M., Hunter, D.G. Validating clinical reasoning: a question of perspective, but whose perspective? Man Ther. 2003 May;8(2):117-9. Review. PMID: 12890440 Manual Therapy Online
  10. Tonelli, M.R. The limits of evidence-based medicine. Respir Care. 2001 Dec;46(12):1435-40; discussion 1440-1. Review. PMID: 11728302 Abstract
  11. Gunn, I.P. A critique of Michael L. Millenson's book, Demanding medical excellence: doctors and accountability in the information age, and its relevance to CRNAs and nursing. AANA J. 1998 Dec;66(6):575-82. Review. PMID: 10488264 Abstract
  12. Flanagin, A., Carey, L.A., Fontanarosa, P.B. Prevalence of articles with honorary authors and ghost authors in peer-reviewed medical journals. JAMA. 1998 Jul 15;280(3):222-4. Abstract
  13. Larkin, M. Whose article is it anyway? Lancet. 1999 Jul 10;354(9173):136. Editorial
  14. Vickers, A. Alternative Cancer Cures: "Unproven" or "Disproven"? CA Cancer J Clin 2004 54: 110-118. Online
  15. Benedetti,F., Maggi,G., Lopiano, L. Open Versus Hidden Medical Treatments: The Patient's Knowledge About a Therapy Affects the Therapy Outcome. Prevention & Treatment, Volume 6, Article 1, posted June 23, 2003. APA online
  16. Eisenberg DM. Advising patients who seek alternative medical therapies. Ann Intern Med. 1997; 127:61-69. PMID: 9214254 Abstract

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.

External links

General information about alternative medicine

Advocacy of alternative medicine

Critiques of alternative medicine

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