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Alternative medicine

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Alternative medicine is a broad term for any method that seeks to prevent or heal disease, or care for the body, mind, or soul through methods outside of the practices of mainstream western medicine. Alternative medicine provides an "alternative" to more commonly accepted medical practices. Those Western medical practitioners who accept some elements of alternative medicine refer to them as "complementary medicine."

Some alternative medicine advocates see themselves as promoting wellness, rather than treating disease, and refuse to be categorized within the conventional medical system's framework. Many alternative practitioners claim that they can help a body heal itself by using a form of energy (such as Qi) or religious power, not always measurable by scientific apparatus.

"Alternative medicine" is not a fixed category, as specific elements of medical practice pass in and out of professional and scientific sanction. Therefore, it is not generally meaningful to ask, for instance, Does alternative medicine work? Rather, one must address individual practices and therapies, which may be "alternative" in one time and locality and "mainstream" in another. The majority of this article deals with practices which are considered outside the medical mainstream in modern Western culture.

Availability

Many forms of alternative medicine are widely available in all nations.

Some kinds of alternative medicine can be practised by oneself, without the need for working with an alternative medicine practitioner. Others need to done though alternative medicine clinics or offices which advertise such services. When the service is performed by a conventional physician it is called complementary or integrative medicine.

Legal jurisdictions differ as to which branches of alternative medicine are legal, which are regulated, and which (if any) are provided by the state health service. Some practitioners and some branches of alternative medicine have been investigated by state or national agencies for health related fraud (quackery), and in some cases criminal charges have been brought.

Branches of alternative medicine

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

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

Psychologists can provide alternative medical services such as biofeedback and hypnotherapy. Biofeedback is listed as a form of alternative medicine in many different dictionaries.

Other branches of alternative/complementary medicine include:

Criticisms of alternative medicine

Most forms of alternative medicine are not used in conventional medicine because they have not been shown to work through randomized controlled trials, double-blind experimental validation of their techniques, nor has the efficacy of their treatment been verified. Where alternative methods provide temporary pain relief, compared to no treatment, this is ascribed to the placebo effect.

Criticisms of alternative medicine are complicated by the wide variety of alternative medical practices. Often, critics focus on a single practice, and argue that its failures generalize to the field as a whole.

But critics say that major branches of alternative medicine, such as homeopathy, should be willing to be examined under agreed test conditions. The James Randi Educational Foundation has pledged to pay one million US dollars to any homeopath or any other person who can tell, by any means, the difference between homeopathic water and regular water under test conditions agreed to by both parties. The same goes for acupuncturists, aroma therapists, magnetic healers, naturopaths etc, but though hundreds have tried, no-one has ever passed even the preliminary test to win the million dollars".

Some elements of the medical profession have called for alternative therapies, particularly herbal medicines, to be regulated in the same way as conventional medicine. This would require these treatments to be proven effective in scientific trials, a hurdle that these critics strongly believe would not be met; some herbal preparations, like ephedra, have been proven to be actually dangerous.

It should also be noted that many if not most scientists feel that the very term "alternative medicine" is misleading, because these treatments are not a true alternative to conventional medicine, which can be and in many cases is required to be proven to work. Also, alternative medicine has caused deaths indirectly when patients have used it in attempts to treat such conditions as appendicitis, and several of its forms (particularly herbal medicine, chiropractic, and acupuncture) are at least potentially dangerous.

Support for alternative medicine

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

  1. An obvious response to the above criticism is that alternative medicine is in the business of curing people rather than in winning the One Million Dollar Paranormal Challenge offered by the James Randi Educational Foundation. Second, since the physical mode of action utilized by alternative methods of treatment do not consist of the psychic, supernatural or paranormal ability of the practitioner the fact that no-one has ever passed even the preliminary test to win the million dollars challenge only tends to support the scientific basis of alternative medicine. In short, no one wishes to prove in alternative medicine the effectiveness of psychic, supernatural or paranormal ability precisely because no legally recognized practitioner uses that nonsense in their practice.
  2. Another, obvious response to the above criticism is that specific alternative treatment methods have been in fact shown to be effective for specific medical conditions in recently published research (such as Michalsen 2003, Gonsalkorale 2003, and Berga 2003). The validity of any published research is not at question here. Favorable research has in fact been published in research journals recognized by Medline.
  3. The final response to the above criticisms is that the opposition primarily assumes that alternative medicine works by magic and equates all branches of alternative medicine with quackery and health fraud. Professionalized alternative medicine no more works by magic than do prescription medications possess magical curative powers. Quackery and health fraud is a legal matter where the law should be allowed to take its course. The opposition turns a blind eye to health fraud committed by conventional medicine. The list of very questionable conventional medical practices is quite long and includes such things as conventional hospitals soliciting the public to get expensive and totally unnecessary body scans, hormone replacement therapy, and annual mammograms.
  4. Social critic Ivan Illich believes that Western and alternative medical practices are generally equally effective, for two reasons. First, Western practices are more effective at dealing with illnesses caused by microbes, whereas alternative practices are more effective at dealing with illnesses that are psychosomatic. Illich holds that Western and alternative practices are equally effective at dealing with illnesses that are self-limiting. (Illich 1976) In other words, Illich has suggested that conventional medicine treats illnesses that the human body would heal naturally all by itself without any form of treatment.
  5. Edzard Ernst writes in the Medical Journal of Australia that: "About half the general population in developed countries uses complementary and alternative medicine (CAM). Yet many conventional healthcare professionals refuse to take CAM seriously; one often-voiced argument is "there is no research in CAM". Certainly, for some modalities there is no compelling evidence base, and some of the research into CAM has methodological flaws and biases. On the other hand, many doctors and medical educators are uninformed about the quality evidence that does exist." (Ernst, 2003)
  6. A search on PubMed reveals that there are over 370,000 research papers classified as alternative medicine published 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 or double-blind peer-reviewed experiments. They were, however, all published in research journals recognized by Medline.
  7. In another argument, the question of the effectiveness of various techniques used by practitioners of alternative medicine has to be considered independently for each method, as well as for each medical condition or disease treated. When exploring the individual branches of alternative medicine four questions need to be answered. The answers to these questions will reveal whether or not each branch of alternative medicine is mostly quackery or something that the public should seriously consider using.
    1. What is the method of treatment utilized?
    2. What are its therapeutic effects?
    3. What medical conditions does it effectively treat?
    4. What modes of action could plausibly account for these therapeutic effects?
  8. In the United States, the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health, provides funding and other support for research in alternative medicine.
  9. Some of the strongest support for the value of clinical experience in alternative medicine comes from conventional physicians who have voiced their criticisms of evidence-based medicine (Tonelli 2001, Downing 2003). These physicians while arguing about their need to apply population evidence to the patient standing before them are in effect supporting the value of eclectic branches of alternative medicine which place great value upon the clinical experience of the practitioner.
  10. 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 in 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.
  11. An argument can be made that it is not so much a question of proving what is right about alternative medicine, but rather in pointing out what is specifically wrong with conventional medicine. Alternative medicine simply provides the buying public with services not commonly available from conventional medicine. This argument covers a range of topics, such as patient empowerment, alternative methods of pain management, treatment methods that support the Biopsychosocial model of health, and finally some patients are specifically in search for cures for their specific health concerns, stress reduction services and other preventative health services that simply are not what conventional medicine is known for.
  12. A concluding argument in favor of alternative medicine can be made that the scientific basis of alternative medicine is not as bad as the critics represent it to be (Ernst 2003) because conventional medicine in reality has not been as science-based as it is publicly represented to be (Zalewksi 1999). Michael L. "Millenson decries the lack of scientific-based medical practice and medicine's failure to wake up due to its own historical studies. He cites data that 85% of current practice has not been scientifically validated despite medicine's claims of the physician-scientist." (Gunn 1998) Alternative medicine proponents argue that the mere fact that evidence-based medicine is being promoted speaks historically to a practice of medicine that was not completely based on science.

Comparing alternative medicine to conventional medicine

Practitioners of mainstream conventional medicine rely on the scientific method for results. They argue that it is impossible to use testimonials, hearsay and mystical arguments as proof. Proponents of alternative medicine counter that much evidence dismissed as hearsay in fact represents clinical experience. Eclectic branches of alternative medicine place greater value upon the clinical experience of the practitioner than on their science.

Some proponents of alternative medicine argue that the lack of evaluation of such practices prior to the 1990s means that it cannot be truly claimed that conventional medicine practitioners relied upon the scientific method for their results. Even if this were true, though, supporters of conventional medicine would not agree that this means that science should not underpin medical practice.

Science and alternative medicine

Proponents of alternative medicine argue that some branches of alternative medicine were viewed as quackery in the past, but are accepted as mainstream medicine now.

Some mainstream doctors and some scientists agree that new research may be revealing evidence that a small number of alternative health treatments might be effective (Michelson et al, 2003; Gonsalkorale et al, 2003; Berga et al, 2003). They are treatments claimed to have resulted from peer-reviewed studies. As such, in a few cases, the boundary lines between alternative and mainstream medicine may change over time. In principle, methods considered alternative at one time may later be adopted by conventional medicine. treatments.

Experimental evaluation of alternative medicine is often difficult. Some of the problems that arise (Ernst, 2003) are:

  • Double-blind trials are difficult for many alternative medical techniques, which involve hands-on manipulation by trained practitioners that cannot easily be replaced by an equivalent placebo, or which require a holistic approach to treatment that cannot easily be reduced to a single variable.
  • Claimed effects of alternative medical practices are often subtle (requiring large sample sizes) and appear only after long periods of treatment (requiring long studies).
  • Ethical issues arise in conducting double-blind studies where the researchers or patients strongly believe that one treatment is superior to another.
  • Practitioners of some branches of alternative medicine may oppose experimental testing of practices whose justification involves a mystical or religious framework, fearing that the outcome of (possibly biased) tests may call the broader framework into question.

These difficulties often discourage work by trained scientists on alternative medicine, and can lead to a negative feedback loop where a lack of rigorous research leads to a perception of poor credibility, which in turn limits further research.

References

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 WM, Miller V, Afzal A, Whorwell PJ. Long term benefits of hypnotherapy for irritable bowel syndrome. Gut. 2003 Nov;52(11):1623-9. PMID: 14570733 Abstract
  5. 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 , Volume 80, Issue 4, Pages 976-981 (October 2003) Abstract
  6. Eisenberg DM, Davis RB, Ettner SL. 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 AM, Hunter DG. 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 MR. The limits of evidence-based medicine. Respir Care. 2001 Dec;46(12):1435-40; discussion 1440-1. Review. PMID: 11728302 Abstract
  11. 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 Dec;66(6):575-82. Review. PMID: 10488264 Abstract

Other works that discuss alternative medicine

  • 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 Inquier Magazine, Nov.Dec/2001
  • Illich I. Limits to medicine. London: Marion Boyars, 1976.

See also

General information about alternative medicine

Advocacy of alternative medicine

Critiques of alternative medicine

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