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Criticisms of alternative medicine are complicated by the wide variety of alternative medical practices. Critics have been known to dismiss the entire field of alternative medicine based on the failure of one particular method.
Criticisms of alternative medicine are complicated by the wide variety of alternative medical practices. Critics have been known to dismiss the entire field of alternative medicine based on the failure of one particular method.


On the other hand, many branches of altenative medicine have failed scientific tests. Homeopathy was tested by the team at the [[BBC]]'s [[Horizon]] program. There was a 1 million dollar prize money up for grabs. It failed [http://www.bbc.co.uk/science/horizon/2002/homeopathy.shtml]. Iridology has undergone several tests and failed them all.[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3147081&dopt=Abstract]. Naturopathy has been investigated by the [[Australian Commitee of Enquiry]] with a view to regulating the industry. The committee concluded, "The Committee does not recommend licensing of naturopaths as a vocational group as it considers that such licensing may give a form of official imprimatur to practices which the Committee considers to be unscientific and, at the best, of marginal efficacy." [http://www.naturowatch.org/hx/australia.html]. In the United States, the situation is currently different. There are currently four colleges in North American, three on the West Coast of the US (in Seattle, Portland, and Scottsdale) and one in Toronto, Canada that teach Natropathy. Although licensure is currently granted to NDs in 12 states throughout the US as well as the District of Columbia, the West Coast, particularly the Pacific Northwest, is the best with regard to regulation, licensure, and reimbursement, and in the state of Washington naturopaths are considered primary care providers. (See Eisenberg 1997, and Dillard & Ziporyn 1998). A problem with herbal remedies is the high toxicity of a few ([[ephedra]] and [[St. John's Wort]], for example) and the assumption by patients that herbal remedies are not as strong as synthetic drugs, resulting in misdoses. [http://www.fda.gov/oc/initiatives/ephedra/december2003/][http://www.netdoctor.co.uk/special_reports/depression/stjwort.htm][http://www.ftc.gov/opa/2001/07/chrisenter.htm][http://www.hc-sc.gc.ca/english/protection/warnings/2002/2002_56e.htm]
On the other hand, many branches of altenative medicine have failed scientific tests. Homeopathy was tested by the team at the [[BBC]]'s [[Horizon]] program. There was a 1 million dollar prize money up for grabs. It failed . Iridology has undergone several tests and failed them all. Naturopathy has been investigated by the [[Australian Commitee of Enquiry]] with a view to regulating the industry. The committee concluded, "The Committee does not recommend licensing of naturopaths as a vocational group as it considers that such licensing may give a form of official imprimatur to practices which the Committee considers to be unscientific and, at the best, of marginal efficacy." . In the United States, the situation is currently different. There are currently four colleges in North American, three on the West Coast of the US (in Seattle, Portland, and Scottsdale) and one in Toronto, Canada that teach Natropathy. Although licensure is currently granted to NDs in 12 states throughout the US as well as the District of Columbia, the West Coast, particularly the Pacific Northwest, is the best with regard to regulation, licensure, and reimbursement, and in the state of Washington naturopaths are considered primary care providers. (See Eisenberg 1997, and Dillard & Ziporyn 1998). A problem with herbal remedies is the high toxicity of a few ([[ephedra]] and [[St. John's Wort]], for example) and the assumption by patients that herbal remedies are not as strong as synthetic drugs, resulting in misdoses.


====Regulation====
====Regulation====

Revision as of 03:47, 19 May 2004

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


The definition of what is and is not 'alternative' changes with time, generally as the result of research. It is not a fixed category and practitioners of some treatments and techniques (for example, hypnosis, acupuncture) often described as 'alternative' are not regarded as alternative by many in the mainstream.

Complementary medicine refers to using alternative methods and practices 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 governmental agencies for health fraud, and in a few cases criminal charges have been brought. Regulation does not, however, say anything about the effectiveness 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. hypnotherapy
  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 for alternative medicine

Criticisms

Some people define alternative medicine in a rather more 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." Some feel that the very term "alternative medicine" is misleading, on the grounds 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 what 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.

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 ilnesses.

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 all of the time. William T. Jarvis, Ph.D contents 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 forms

Criticisms of alternative medicine are complicated by the wide variety of alternative medical practices. Critics have been known to dismiss the entire field of alternative medicine based on the failure of one particular method.

On the other hand, many branches of altenative medicine have failed scientific tests. Homeopathy was tested by the team at the BBC's Horizon program. There was a 1 million dollar prize money up for grabs. It failed . Iridology has undergone several tests and failed them all. Naturopathy has been investigated by the Australian Commitee of Enquiry with a view to regulating the industry. The committee concluded, "The Committee does not recommend licensing of naturopaths as a vocational group as it considers that such licensing may give a form of official imprimatur to practices which the Committee considers to be unscientific and, at the best, of marginal efficacy." . In the United States, the situation is currently different. There are currently four colleges in North American, three on the West Coast of the US (in Seattle, Portland, and Scottsdale) and one in Toronto, Canada that teach Natropathy. Although licensure is currently granted to NDs in 12 states throughout the US as well as the District of Columbia, the West Coast, particularly the Pacific Northwest, is the best with regard to regulation, licensure, and reimbursement, and in the state of Washington naturopaths are considered primary care providers. (See Eisenberg 1997, and Dillard & Ziporyn 1998). A problem with herbal remedies is the high toxicity of a few (ephedra and St. John's Wort, for example) and the assumption by patients that herbal remedies are not as strong as synthetic drugs, resulting in misdoses.

Regulation

Practices terming themselves "alternative medicine" have caused deaths indirectly when patients have used it 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, 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 many 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.

Osteopathy is still being attacked as alternative medicine.

One of the biggest arguments in support of alternative treatments is that the practice of Osteopathy is still classified and attacked as alternative medicine by critics. This is despite the fact that medical students for both the D.O. (Doctors of Osteopathy) and M.D. degree follow essentially the same set of studies, except for one course in manipulation and increased emphasis on primary care among the osteopathic community. Osteopaths are fully-licensed physicians in all fifty states of the United States.

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 along side standard conventional medical treatments, most physicians find complementary medicine acceptable (see comments about alternative versus complementary medicine in Vickers 2004).

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.

Current research does in fact support the use of many alternative therapies, when used as complementary medicine.

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 or double-blind peer-reviewed experiments.

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.

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 CAM is being seriously looked into.

The scientific basis of alternative medicine is actually 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 [conventional medical] 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.


Alternative medicine offers alternatives to the public searching for complementary services.

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.

The placebo effect is the patient's friend.

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 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 [use] complementary and alternative medicine (CAM)" (Ernst 2003) In many cases, 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. (Malik et al 2003)

There are many accredited colleges and universities worldwide that teach Naturopathy. Licensure is currently granted to NDs in 12 states throughout the US as well as the District of Columbia, the West Coast, particularly the Pacific Northwest and in the state of Washington naturopaths are considered primary care providers. (See Eisenberg 1997, and Dillard & Ziporyn 1998).

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.

Alternative medicine advocates chafe at the restrictions of government agencies which approve medical treatments (such as the American Food and Drug Administration) and their adherence to their experimental evaluation methods. It is claimed that this impeedes those seeking to bring new ideas and methods to the public more rapidly. 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.

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. Is a more dangerous alternative treatment, or the safer version of complementary medicine, being used?

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
  16. Eisenberg DM. Advising patients who seek alternative medical therapies. Ann Intern Med. 1997; 127:61-69. PMID: 9214254 Abstract
  17. Malik IA, Gopalan SUse of CAM results in delay in seeking medical advice for breast cancer.Eur J Epidemiol. 2003;18(8):817-22. 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 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.

General information about alternative medicine

Advocacy of alternative medicine

Critiques of alternative medicine

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