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| Alternative Medicine | |
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| This article is part of the CAM series of articles. | |
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| Alternative medical systems - edit |
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| NCCAM classifications |
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Alternative medicine includes practices that differ from conventional medicine. Some alternative medicine practices are homeopathy, naturopathy, chiropractic, and herbal medicine. A typical definition is "every available approach to healing that does not fall within the realm of conventional medicine".Bratman, MD, Steven (1997). The Alternative Medicine Sourcebook. Lowell House, p 7. ISBN 1565656261.
Alternative medicine practices may be based on unconventional belief systems or philosophies; biological data and observations or biochemical principles;Henderson, et al. "Use of anabolic agents anti-catabolic agents and antioxidant agents for protection treatment and repair of connective tissues in humans and animals", US Patent 6,451,771. September 17, 2002 and some may not follow the scientific method. They may incorporate spiritual, metaphysical, or religious underpinnings, untested practices, pre-modern medical traditions, or newly developed approaches to healing. If an alternative medical approach, previously unproven according to orthodox scientific or regulatory methodologies, is subsequently shown to be safe and effective, it may then be adopted by conventional practitioners and no longer considered "alternative".
"Alternative medicine" is often categorized together with complementary medicine using the umbrella term Complementary and alternative medicine or CAM.
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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.
In article 34 (Specific legal obligations) of the General Comment No. 14 (2000) on The right to the highest attainable standard of health of the Committee on Economic, Social and Cultural Rights (United Nations), it is stated that
Obligations to respect (the right to health) include a State\'s obligation to refrain from prohibiting or impeding traditional preventive care, healing practices and medicines, from marketing unsafe drugs and from applying coercive medical treatmentsCOMMITTEE ON ECONOMIC, SOCIAL AND CULTURAL RIGHTS. General Comment No. 14 (2000) The right to the highest attainable standard of health : . 11/08/2000. E/C.12/2000/4. http://www.unhchr.ch/tbs/doc.nsf/(symbol)/E.C.12.2000.4.en
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.
Many people utilize mainstream medicine for diagnosis and basic information, while turning to alternatives for what they believe to be health-enhancing measures. Studies indicate that alternative approaches are often used in conjunction with conventional medicine.
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 E. "Obstacles to research in complementary and alternative medicine." Medical Journal of Australia, 2003; 179 (6): 279-80. PMID 12964907 MJA online Survey results released in May 2004 by the National Center for Complementary and Alternative Medicine, part of the United States National Institutes of Health, found that in 2002 62.1% of adults in the country had used some form of CAM in the past 12 months, though this figure drops to 36.0% if prayer specifically for health reasons is excluded.Barnes, P. M.; Powell-Griner, E.; McFann, K.; Nahin, R. L. (2004). "Complementary and Alternative Medicine Use Among Adults: United States, 2002". National Center for Health Statistics. 25% of people who use CAM do so because a medical professional suggested it.Reasons people use CAM Another study suggests a similar figure of 40%.Astin JA "Why patients use alternative medicine: results of a national study" JAMA 1998; 279(19): 1548-1553 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.[citation needed]
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.Eisenberg, DM, Davis RB, Ettner SL "Trends in alternative medicine use in the United States 1990-1997." JAMA, 1998; 280:1569-1575. PMID 9820257 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."House of Lords report on CAM
In many developing countries, allopathic medicine is available to few, due to lack of resources and poverty; therefore, traditional remedies may comprise the vast majority of medical treatment offered. Such traditional remedies often closely resemble alternative therapies. Traditional medicine. Fact sheet 134. World Health Organization (2003-05). Retrieved on 2008-03-06.
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The examples and perspective in this article or section may not represent a worldwide view of the subject. Please improve this article or discuss the issue on the talk page. |
Increasing numbers of medical colleges have started offering courses in alternative medicine. For example, in three separate research surveys that surveyed 729 schools in the United States (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.Wetzel MS, Eisenberg DM, Kaptchuk TJ. "Courses involving complementary and alternative medicine at US medical schools." JAMA 1998; 280 (9):784 -787. PMID 9729989 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 15083987Fenton 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 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."University of Arizona position on Alternative Medicine Accredited Naturopathic colleges and universities are also increasing in number and popularity in the U.S.A. They offer the most complete medical training in complementary medicines that is available today.[citation needed] See Naturopathic medicine.
In Britain, no conventional medical schools offer courses that teach the clinical practice of alternative medicine.[citation needed] However, alternative medicine is taught in several unconventional schools as part of their curriculum.[citation needed] Teaching is based mostly on theory and understanding of alternative medicine, with emphasis on being able to communicate with alternative medicine specialists.[citation needed] To obtain competence in practicing clinical alternative medicine, qualifications must be obtained from individual medical societies.[citation needed] The student must have graduated and be a qualified doctor.[citation needed] The British Medical Acupuncture Society, which offers medical acupuncture certificates to doctors, is one such example, as is the College of Naturopathic Medicine UK and Ireland.
A 2002 survey of US adults 18 years and older conducted by the National Center for Health Statistics (CDC) the National Center for Complementary and Alternative Medicine indicated:CAM Use by U.S. Adults
Alternative therapies provide some services not available from conventional medicine. Examples are patient empowerment and treatment methods that follow the biopsychosocial model of health.Vickers A. "Alternative Cancer Cures: "Unproven" or "Disproven"?" CA Cancer J Clin 2004; 54: 110-118. Online
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,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 Gonsalkorale 2003,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 and Berga 2003Berga 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) 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,Kleijnen J, Knipschild P, ter Riet G. "Clinical trials of homoeopathy." BMJ, 1991; 302:316-23. Erratum in: BMJ, 1991; 302:818. PMID 1825800 and Linde 1997.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
Evidence-based medicine (EBM) applies the scientific method to medical practice, and aims for the ideal that healthcare professionals should make "conscientious, explicit, and judicious use of current best evidence" in their everyday practice. Prof. Edzard Ernst is a notable proponent of applying EBM to CAM.
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. Researchers who judge treatments using the scientific method are concerned by this viewpoint, since it fails to address the possible inefficacy of alternative treatments.
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This article or section may contain original research or unverified claims. Please improve the article by adding references. See the talk page for details. (September 2007) |
A major objection to alternative medicine is that it is done in place of conventional medical treatments. As long as alternative treatments are used alongside conventional treatments, the majority of medical doctors find most forms of complementary medicine acceptable.[citation needed] A recent study of US adults indicated that a slim majority (54.9%) of CAM users cited as a factor in their decision a belief that it would help when combined with conventional medical treatments.
It is highly advisable for patients to inform their medical doctor when they are using any form of alternative medicine. Some alternative treatments may interact with orthodox medical treatments, and such potential conflicts should be explored in the interest of the patient. However, many fear that conventional practitioners may be biased or uninformed about alternative care and worry that disclosure of use may damage their doctor-patient relationship.[citation needed]
The issue of alternative medicine interfering with conventional medical practices is minimized when it is turned to only after conventional treatments have been exhausted. Many patients feel that alternative medicine may help in coping with chronic illnesses for which conventional medicine offers no cure, only management.[citation needed] Over time, it has become more common for a patient\'s own MD to suggest alternatives when they cannot offer effective treatment.[citation needed]
Alternative medicine is commonly categorised together with complementary medicine under the umbrella term \'complementary and alternative medicine\' (CAM for short). Some scientists reject this and the above classifications and to varying degrees reject the term "alternative medicine" itself.
The following four commentators argue for classifying treatments based on the objectively verifiable criteria of the scientific method, not based on the changing curricula of various medical schools or social sphere of usage. They advocate a classification based on evidence-based medicine, i.e., scientifically proven evidence of efficacy (or lack thereof). According to them it is possible for a method to change categories (proven vs. unproven) in either direction, based on increased knowledge of its effectiveness or lack thereof:
Barrett, Stephen. "Be Wary of "Alternative" Health Methods", Stephen Barrett, M.D., Quackwatch, February 10, 2004. Retrieved on 2008-03-03.
Other well-known proponents of evidence-based medicine, such as the Cochrane Collaboration and Edzard Ernst, Professor of Complementary Medicine at the University of Exeter, use the term "alternative medicine" but agree with the above commentators that all treatments, whether "mainstream" or "alternative", ought to be held to standards of the scientific method.The Cochrane Collaboration Complementary Medicine Field. Retrieved 5 August 2006.The HealthWatch Award 2005: Prof. Edzard Ernst, Complementary medicine: the good the bad and the ugly. Retrieved 5 August 2006"Complementary medicine is diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy or by diversifying the conceptual frameworks of medicine." Ernst et al British General Practitioner 1995; 45:506. Oxford University Press publishes a peer-reviewed journal entitled Evidence-based Complementary and Alternative Medicine (eCAM).Evidence-based Complementary and Alternative Medicine
Some commentators maintain that some or all fields of alternative medicine are pseudoscientific, or contain significant pseudoscientific elements. In the late 20th century systematic investigation of the evidence-base proceeded, and at least one university department of alternative and complementary medicine was established, at the University of Exeter under Professor Edzard Ernst for this purpose.
Due to the wide range of therapies that are considered to be "alternative medicine" few criticisms apply across the board, except possibly that of not being scientifically supported or even testable. Proponents of CAM typically address this basic criticism by arguing that it is a self-fulfilling prophecy: critics believe that there is no plausibility to CAMs because they find little or no proofs, while it is plausibility that should inform the scientific research for proofs.
Proponents of alternative therapy have an obligation to provide grounds for biological plausibility, such as sound theoretical or preclinical data, or for clinical plausibility, in the form of authentic, well-prepared case reports, in order to justify the investment of time and energy in exploring the merits of a novel anticancer therapy. But plausibility, not proof, should be sufficient to initiate the process. Hoffer LJ (2001). "Proof versus plausibility: rules of engagement for the struggle to evaluate alternative cancer therapies". CMAJ : Canadian Medical Association journal = journal de l\'Association medicale canadienne 164 (3): 351-3. PMID 11232135.
In other words, proponents of CAMs argue that skeptics, in saying that theories or anecdotal and preclinical data do not constitute proof, merely state the obvious but do not actually engage in the evaluation of CAMs. Criticisms directed at specific branches of alternative medicine range from the fairly minor (conventional treatment is believed to be more effective in a particular area) to incompatibility with the known laws of physics (for example, in homeopathy). Critics argue that alternative medicine practitioners may not have an accredited medical degree or be licensed physicians or general practitioners, and may make sweeping claims without demonstrated expertise. However, unless a new system of medicine becomes established, it does not receive accreditation of any kind except by its own professional organizations. This is the route homeopathy, ayurveda, siddha, unani, and naturopathy had to follow in those countries where they are now offered by accredited institutions. Proponents of the various forms of alternative medicine reject criticism regarded as being founded in prejudice, financial self-interest, or ignorance. Refutations of criticism sometimes take the form of an appeal to nature - that which is natural is necessarily good.
Although proponents of alternative medicine often cite the large number of studies which have been performed, critics point out that there are no statistics on exactly how many of those studies were controlled, double blind, peer-reviewed experiments, or how many produced results supporting alternative medicine or parts thereof. They contend that many forms of alternative medicine are rejected by conventional medicine because the efficacy of the treatments has not been demonstrated through double-blind randomized controlled trials; in contrast, conventional drugs reach the market only after such trials have proved their efficacy.
Some argue that less research is carried out on alternative medicine because many alternative medicine techniques cannot be patented, and hence there is little financial incentive to study them. Drug research, by contrast, can be very lucrative, which has resulted in funding of trials by pharmaceutical companies. Many people, including conventional and alternative medical practitioners, contend that this funding has led to corruption of the scientific process for approval of drug usage, and that ghostwritten work has appeared in major peer-reviewed medical journals.Larkin M. "Whose article is it anyway?" Lancet, 1999; 354:136. EditorialFlanagin 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 Increasing the funding for research of alternative medicine techniques was the purpose of the U.S. National Center for Complementary and Alternative Medicine. NCCAM and its predecessor, the Office of Alternative Medicine, have spent more than $200 million on such research since 1991.[citation needed] The German Federal Institute for Drugs and Medical Devices Commission E has studied many herbal remedies for efficacy.CSICOP.org article on alternative medicine
Some skeptics of alternative practices point out that a person may attribute symptomatic relief to an otherwise ineffective therapy due to the placebo effect, the natural recovery from or the cyclical nature of an illness (the regression fallacy), or the possibility that the person never originally had a true illness.James Alcock PhD, Alternative Medicine and the Psychology of Belief, The Scientific Review of Alternative Medicine, Fall/Winter 1999 Volume 3 ~ Number 2. available online CAM proponents point out this may also apply in cases where conventional treatments have been used. To this, CAM critics point out that this does not account for conventional medical success in double blind clinical trials. CAM proponents, however, do not typically question conventional medical successes revealed in double blind clinical trials.
Critics contend that people have been hurt or killed directly from the various alternative practices or indirectly by failed diagnoses or avoidance of conventional medicine. Proponents counter that harm from conventional medical practice, known as iatrogenesis, is a major cause of death and injury. Deaths have been reported due to the use of alternative medicines such as colloidal silver.Myoclonic status epilepticus following repeated oral ingestion of colloidal silver PMID 15111684
Alternative medicine critics agree with its proponents that people should be free to choose whatever method of healthcare they want, but stipulate that people must be informed as to the safety and efficacy of whatever method they choose. People who choose alternative medicine may think they are choosing a safe, effective medicine, while they may only be getting quack remedies. The use of Grapefruit seed extract is an example of quackery, since multiple studies demonstrate its universal antimicrobial effect is due to synthetic antimicrobial contamination.Ganzera M, Aberham A, Stuppner H. Development and validation of an HPLC/UV/MS method for simultaneous determination of 18 preservatives in grapefruit seed extract. Institute of Pharmacy, University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria. J Agric Food Chem. 2006 May 31;54(11):3768-72. AbstractTakeoka, G., Dao, L., Wong, R.Y., Lundin, R., Mahoney N. Identification of benzethonium chloride in commercial grapefruit seed extracts. J Agric Food Chem. 2001 49(7):3316–20. Abstractvon Woedtke, T., Schlüter, B., Pflegel, P., Lindequist, U.; Jülich, W.-D. Aspects of the antimicrobial efficacy of grapefruit seed extract and its relation to preservative substances contained. Pharmazie 1999 54:452–456. AbstractSakamoto, S., Sato, K., Maitani, T., Yamada, T. Analysis of components in natural food additive “grapefruit seed extract” by HPLC and LC/MS. Bull. Natl. Inst. Health Sci. 1996, 114:38–42. AbstractTakeoka, G.R., Dao, L.T., Wong, R.Y., Harden L.A. Identification of benzalkonium chloride in commercial grapefruit seed extracts. J Agric Food Chem. 2005 53(19):7630–6. Abstract
Those who have experienced or perceived success with one alternative therapy for a minor ailment may be convinced of its efficacy and persuaded to extrapolate that success to some other alternative therapy for a more serious, possibly life-threatening illness. For this reason, critics contend that therapies that rely on the placebo effect to define success are very dangerous. According to Lilienfeld (2002) "unvalidated or scientifically unsupported mental health practices can lead individuals to forgo effective treatments" and refers to this as “opportunity cost.” Individuals who spend large amounts of time and money on ineffective treatments may be left with precious little of either, and may forfeit the opportunity to obtain treatments that could be more helpful. In short, even innocuous treatments can indirectly produce negative outcomes. Lilienfeld, Scott O. (2002). "Our Raison d’Être". The Scientific Review of Mental Health Practice 1 (1). Retrieved on 2008-01-28.
A Norwegian multicentre study examined the association between the use of alternative medicine and cancer survival. 515 patients using standard medical care for cancer were followed for eight years. 22% of those patients used alternative medicine concurrently with their standard care. The study revealed that death rates were 30% higher in alternative medicine users than in those who did not use alternative medicine (AM): "The use of AM seems to predict a shorter survival from cancer."Risberg T, et al. Does use of alternative medicine predict survival from cancer? Eur J Cancer 2003 Feb;39(3):372-7 Abstract
Associate Professor Alastair MacLennan of the Department of Obstetrics and Gynaecology in Adelaide University, Australia reports that a patient almost bled to death on the operating table. She had failed to mention that she had been taking "natural" potions to "build up her strength" before the operation, including a powerful anticoagulant which nearly caused her death. Hills, Ben. Fake healers. Why Australia’s $1 billion-a-year alternative medicine industry is ineffective and out of control.. Medical Mayhem. Retrieved on 2008-03-06.
To ABC Online, MacLennan also gives another possible mechanism:
Conventional treatments are subjected to testing for undesired side-effects, whereas alternative treatments generally are not subjected to such testing at all. However, any treatment — whether conventional or alternative — that has a biological or psychological impact on a patient may also have potentially dangerous biological or psychological side-effects. Nevertheless, attempts to refute this fact with regard to alternative treatments sometimes use the appeal to nature fallacy, i.e. "that which is natural cannot be harmful".
Homeopathy, however, is insulated from direct side effects by the known laws of chemistry and physics. Homeopathic preparations, termed "remedies," are extremely dilute, often far beyond the point where a single molecule of the original active ingredient is likely to remain.
Similar problems as those related to self-medication also apply to parts of alternative medicine. For example, an alternative medicine may instantly make symptoms better, but actually worsen problems in the long run. The result may be addiction[citation needed] and deteriorating health.
The production of modern pharmaceuticals is strictly regulated to ensure that every pill in every batch contains a standard quantity of active ingredients and is free from contamination. Alternative medicine products are not subject to such quality control regulation, and homogeneity at encapsulation and batch-to-batch consistency are sometimes compromised. This leads to uncertainty in the chemical content and biological activity of each pill. Additionally, alternative health products are sometimes adulterated or contaminated with prescription medications or toxic ingredients, such as lead.Agin, Dan (2006-10-03). Junk Science: how politicians, corporations, and other hucksters betray us. Thomas Dunne Books, Ch. 8. ISBN 978-0312352417.
Critics contend[attribution needed] that some branches of alternative medicine are often not properly regulated in some countries, making it difficult to impossible for consumers to evaluate practitioner training and expertise. Critics contend that governmental regulation of any particular alternative therapy does necessarily indicate that the therapy is safe and effective. The most sensible course in such a case could be to simply ensure that the sold treatment is not dangerous, but the problem would then remain to know if it does what its proponents say it does.[clarify]
Critics cite both socio-cultural and psychological reasons to explain why people would chose to use alternative medicines in lieu of conventional medicine.
According to the NCCAM, integrative medicine, or integrated medicine, "combines treatments from conventional medicine and CAM for which there is some high-quality evidence of safety and effectiveness.U.S. National Center for Complementary and Alternative Medicine. What is CAM? It is a healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle.[citation needed] It emphasizes the therapeutic relationship[citation needed] and makes use of all appropriate therapies, whether they are classified as conventional or alternative.
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. Weil, Andrew. What is Integrative Medicine. Retrieved on 2008-03-06.
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