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Alternative medicine

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Alternative medicine is a broad term for any diagnostic method, method of treatment or therapy whose theoretical bases and techniques diverge from generally accepted medical methods.

Alternative medicine is a broad term for any treatment that seeks to prevent or heal disease, or care for the body, mind, or soul through methods that have not been verified through peer-reviewed, controlled studies. (Medical treatments proven to work by multiple peer-reviewed, controlled studies are part of conventional medicine.) Sometimes alternative medicine is known as complementary medicine.

Alternative medicine refers to alternative treatments used in place of conventional medical treatments. While complementary medicine refers to using alternative treatments alongside conventional medical treatment. The term integrative medicine essentially means the same thing as complementary medicine. Collectively, all 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.

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:

Criticisms of alternative medicine

Many forms of alternative medicine are rejected by conventional medicine because these methods have not been shown to work through randomized controlled trials, double-blind experimental validation of their techniques. The efficacy of their treatment has not 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.


The scientific community argues that many studies carried out by alternative medicine promoters are flawed, as they use testimonials and hearsay as evidence. Scientists and medical doctors hold that observer bias can distort results. 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.

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.

Practitioners of many alternative medicine treatments argue that these conventional experimental evaluation methods cannot always be applied to their fields. For example, some problems recognised in Ernst 2003 include;

  • Double-blind trials are difficult for many alternative medicine 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 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).

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).

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.

History and alternative medicine

The boundary line between alternative and mainstream medicine has moved over time. Methods once considered alternative have later been adopted by conventional medicine as physicians have gradually incorporated effective branches of alternative medicine into their conventional medical practices. Supporters of alternative treatments suggest that much of what is currently called alternative medicine will be similarly assimilated into the mainstream in the future.

At least one report (Crossing the Quality Chasm: A New Health System for the 21st Century, published by the Committee on Quality of Health Care in America) has indicated that medical practice tends to lag behind accepted medical knowledge by 15-20 years. Thus, many medicine techniques dubbed “alternative” may actually be considered conventional, but practising physicians may either be unaware of it or lack the necessary training.

Proponents of alternative medicine treatments also point to the fact that conventional medicine has not historically been as rooted in science as it is publicly represented to be. One such proponent writes "[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).

Supporters of evidence-based medicine respond that just because the scientific process was not formalised in the past, this does not mean that science should not underpin current and future medical practice

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

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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