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Alternative medicine

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Alternative medicine broadly describes diagnosis, treatment or therapy used in place of conventional medical treatments.

Complementary medicine refers to using alternative treatments alongside conventional medical treatment. Integrative medicine essentially means the same thing as complementary medicine. Collectively, these variations on alternative medicine are often referred to as complementary and alternative medicine (or simply as CAM).

Overview

Some kinds of alternative medicine can be practiced by the individual without the need for working with an alternative medicine practitioner. Others need to be carried out though alternative medicine clinics, GPs or businesses 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 a state health service. Some practitioners and branches of alternative medicine have been investigated by state or national agencies for health-related fraud (commonly known as quackery), and in a few cases criminal charges have been brought. Regulation does not, however, say anything about the efficacy of the methods used.

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. hypnosis
  7. massage therapy
  8. naturopathy

Psychologists provide alternative medical services when they use biofeedback, hypnotherapy, or cognitive behavior therapy to treat a medical condition. There is a relatively new field in psychology called Health psychology.

Diagnostic specialties of alternative medicine include:

Other branches of alternative/complementary medicine include:

Criticism and Support and for alternative medicine

Criticisms

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, compared to no treatment, this is often ascribed to the placebo effect.

Criticisms of alternative medicine are complicated by the wide variety of alternative medical practices. Critics often dismiss the entire field of alternative medicine based on the failure of one particular method. This however also works the other way around. For instance, if some homeopathic remedy seems to be working, homeopaths will claim this is proof that homeopathy works. But, if ever some homeopathic remedy would ever be shown to work with a certain condition, this would only prove that particular remedy works with that particular condition, and not anything more.

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, aromatherapists, magnetic healers, naturopaths and so on. Though hundreds have tried, no-one has ever passed even the preliminary test to win the million dollars.

Some doctors 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 safe and 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. Herbal preparation also vary much in potency and are often contaminated. Currently, alternative medicines are often sold as "dietary supplements," exploiting a loophole in government regulation.

It should also be noted that many if not most scientists feel that the very term "alternative medicine" is misleading, on the grounds that these treatments are not a true alternative to conventional medicine, which is tested thoroughly before sale. Practices terming themselves "alternative medicine" have 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. 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 an alternative method to be healed, while they may only be getting quack remedies.

The scientific community argues that many studies carried out by alternative medicine promoters are flawed, as they 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.

Alternative medicine chafes at the restrictions of government agencies which approve medical treatments (such as the American Food and Drug Administration), and their adherence to these experimental evaluation methods, seeking to bring new ideas and methods to the public more rapidly. The mainstream medical community maintain that official oversight is needed to help prevent quackery (which unregulated medical practices will be more prone to, and is the reason for the heavy regulation of conventional medical practice), while some advocates of alternative medicine strongly protest that their contributions and discoveries are being unfairly dismissed, overlooked or suppressed. The alternative medicine industry argues that health fraud, when it comes up, should be dealt with appropriately.

Nonetheless, 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), notes that several studies have found evidence that the psychosocial treatment of patients by psychologists is linked to survival advantages, but comments that these results are not consistently replicated. The same review also cites studies indicating that several complementary therapies can provide health benefits by affecting cancer-related symptoms, for example, by reducing pain and improving the mood of patients.

Some argue that less research is carried out on alternative medicine because some alternative medicine techniques cannot be patented, and hence there is less of a 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 general arguments that tend to support the validity of using alternative methods of treatment to treat specific medical conditions.

  • 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 along side standard conventional medical treatments, most physicians find complementary medicine totally acceptable (see comments about alternative versus complementary medicine in Vickers 2004).
  • Since the physical mode of action utilized by alternative methods of treatment do not always 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 dollar JREF challenge only tends to support the belief in a scientific basis of some forms of alternative medicine. In short, few individuals wish to prove in alternative medicine the effectiveness of psychic, supernatural or paranormal ability precisely because few legally recognized practitioners use that basis for effectiveness in their practice. Practitioners who do believe in a supernatural basis for their results are often reviled in both conventional, and alternative, communities.
  • The criticism voiced about homeopathic remedies applies equally well to conventional medicine as it does to any alternative treatment method. Specific alternative treatment methods are never used as universal cures for all that ails you. Specific medicines and treatment methods are designed to only treat a specific health condition just like in conventional medicine.
  • 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.
  • The criticism voiced about the need to regulate and control herbal medicines and dietary supplements is a call by the medical community for these over-the-counter products to be available by prescription only. This would force consumers to pay for prescriptions and significantly higher prices for their vitamins, minerals, and herbs.
  • The final response to the above criticisms is that the opposition primarily assumes that alternative medicine works by magic and equates many 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 list of very questionable conventional medical practices is quite long and includes such things as conventional hospitals soliciting the public to get expensive and possibly unnecessary tests which may, or may not, show signs of illness.
  • 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.
  • 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. This neither approves or negates CAM, as the NIH often funds speculative research that eventually has no practical value. It does, however, show that there is serious academic research being pursued, without outright dismissal into the questions raised by CAM.
  • Those physicians that practice complementary medicine must obviously see some added value in alternative forms of treatments for their patients.
  • The placebo effect is a problem only when conducting research. When it comes to actually treating patients the placebo effect always benefits the patient (Benedetti et al. 2003). Alternative medicine always tries to capitalize on the positive effect of the placebo effect while conventional medicine tends to see the placebo effect always as a problem.

Additionally, some who have no trust in the validity of certain alternative medicines with no side effects support their use for benign illnesses; the argument is that patients would otherwise seek treatments with actual effects, including side effects.

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), and it is certainly true that physicians that are subject to disciplinary actions of state licensing boards do offer alternative medicine services to their patients.

Increasing numbers of medical colleges have begun offering training 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."

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

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.

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 them all together. When exploring the individual branches of alternative medicine six questions need to be answered. The answers to these question 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?
  5. What, if any, can possible forms of damage be a result of this treatment?
  6. What, if any, other treatments are being replaced, where known beneficial effects are being replaced by unproven effects?

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 some 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

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. Medical Nemesis: The expropriation of Health. Penguin Books, 1976.

General information about alternative medicine

Advocacy of alternative medicine

Critiques of alternative medicine

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