Taking Charge of Your Health

Alternative medicine, fringe medicine, pseudomedicine
or simply questionable medicine is promotion or use of practices which are unproven, disproven,
impossible to prove, or excessively harmful in relation to their effect — in the attempt
to achieve the healing effects of medicine. It differs from experimental medicine in that
the latter employs responsible investigation, and is discarded when shown ineffective. The scientific consensus is that alternative
therapies either do not, or cannot, work. In some cases laws of nature are violated
by their basic claims; in others the treatment is so much worse that its use is unethical. Alternative practices, products, and therapies
range from those which are simply ineffective to those having known harmful and toxic effects. Alternative therapies may be credited for
perceived improvement through placebo effects, decreased use or effect of medical treatment
(and therefore either decreased side effects; or nocebo effects towards standard treatment),
or the natural course of the condition or disease. Alternative treatment is not the same as experimental
treatment or traditional medicine, although both can be misused in ways that are alternative. Alternative or complementary medicine is dangerous
because it may discourage people from getting the best possible treatment, and may lead
to a false understanding of the body and of science. Alternative medicine is used by a significant
number of people, though its popularity is often overstated. Large amounts of funding go to testing alternative
medicine, with more than US$2.5 billion spent by the United States government alone. None have shown any effect beyond that of
false treatment, and most studies showing any effect have been statistical flukes. Alternative medicine is a highly profitable
industry, with a strong lobby. This fact is often overlooked by media or
intentionally kept hidden, with alternative practice being portrayed positively when compared
to “big pharma”. The lobby has successfully pushed for alternative
therapies to be subject to far less regulation than conventional medicine. Alternative therapies may even be allowed
to promote use when there is demonstrably no effect, only a tradition of use. Regulation and licensing of alternative medicine
and health care providers varies between and within countries. Despite laws making it illegal to market or
promote alternative therapies for use in cancer treatment, many practitioners promote them. Alternative medicine is criticized for taking
advantage of the weakest members of society. Terminology has shifted over time, reflecting
the preferred branding of practitioners. For example, the United States National Institutes
of Health department studying alternative medicine, currently named National Center
for Complementary and Integrative Health, was established as the Office of Alternative
Medicine and was renamed the National Center for Complementary and Alternative Medicine
before obtaining its current name. Therapies are often framed as “natural” or
“holistic”, in apparent opposition to conventional medicine which is “artificial” and “narrow
in scope”, statements which are intentionally misleading. When used together with functional medical
treatment, alternative therapies do not “complement” (improve the effect of, or mitigate the side
effects of) treatment. Significant drug interactions caused by alternative
therapies may instead negatively impact functional treatment by making prescription drugs less
effective, such as interference by herbal preparations with warfarin. Alternative diagnoses and treatments are not
part of medicine, or of science-based curricula in medical schools, nor are they used in any
practice based on scientific knowledge or experience. Alternative therapies are often based on religious
belief, tradition, superstition, belief in supernatural energies, pseudoscience, errors
in reasoning, propaganda, fraud, or lies. Alternative medicine is based on misleading
statements, quackery, pseudoscience, antiscience, fraud, and poor scientific methodology. Promoting alternative medicine has been called
dangerous and unethical. Testing alternative medicine that has no scientific
basis has been called a waste of scarce research resources. Critics state that “there is really no such
thing as alternative medicine, just medicine that works and medicine that doesn’t”, that
the very idea of “alternative” treatments is paradoxical, as any treatment proven to
work is by definition “medicine”.==Definitions and terminology=====
Alternative medicine===Alternative medicine is defined loosely as
a set of products, practices, and theories that are believed or perceived by their users
to have the healing effects of medicine, but whose effectiveness has not been clearly established
using scientific methods, or whose theory and practice is not part of biomedicine, or
whose theories or practices are directly contradicted by scientific evidence or scientific principles
used in biomedicine. “Biomedicine” or “medicine” is that part of
medical science that applies principles of biology, physiology, molecular biology, biophysics,
and other natural sciences to clinical practice, using scientific methods to establish the
effectiveness of that practice. Unlike medicine, an alternative product or
practice does not originate from using scientific methods, but may instead be based on hearsay,
religion, tradition, superstition, belief in supernatural energies, pseudoscience, errors
in reasoning, propaganda, fraud, or other unscientific sources.In General Guidelines
for Methodologies on Research and Evaluation of Traditional Medicine, published in 2000
by the World Health Organization (WHO), complementary and alternative medicine were defined as a
broad set of health care practices that are not part of that country’s own tradition and
are not integrated into the dominant health care system.The expression also refers to
a diverse range of related and unrelated products, practices, and theories ranging from biologically
plausible practices and products and practices with some evidence, to practices and theories
that are directly contradicted by basic science or clear evidence, and products that have
been conclusively proven to be ineffective or even toxic and harmful.The terms alternative
medicine, complementary medicine, integrative medicine, holistic medicine, natural medicine,
unorthodox medicine, fringe medicine, unconventional medicine, and new age medicine are used interchangeably
as having the same meaning and are almost synonymous in most contexts. The meaning of the term “alternative” in the
expression “alternative medicine”, is not that it is an effective alternative to medical
science, although some alternative medicine promoters may use the loose terminology to
give the appearance of effectiveness. Loose terminology may also be used to suggest
meaning that a dichotomy exists when it does not, e.g., the use of the expressions “western
medicine” and “eastern medicine” to suggest that the difference is a cultural difference
between the Asiatic east and the European west, rather than that the difference is between
evidence-based medicine and treatments that do not work.===Complementary or integrative medicine
===Complementary medicine (CM) or integrative
medicine (IM) is when alternative medicine is used together with functional medical treatment,
in a belief that it improves the effect of treatments. However, significant drug interactions caused
by alternative therapies may instead negatively influence treatment, making treatments less
effective, notably cancer therapy. Both terms refer to use of alternative medical
treatments alongside conventional medicine, an example of which is use of acupuncture
(sticking needles in the body to influence the flow of a supernatural energy), along
with using science-based medicine, in the belief that the acupuncture increases the
effectiveness or “complements” the science-based medicine.CAM is an abbreviation of the phrase
complementary and alternative medicine. It has also been called sCAM or SCAM with
the addition of “so-called” or “supplements”. The words balance and holism are often used,
claiming to take into account a “whole” person, in contrast to the alleged reductionism of
conventional medicine. Due to its many names the field has been criticized
for intense rebranding of what are essentially the same practices.===”Allopathic medicine”===Allopathic
medicine or allopathy is an expression commonly used by homeopaths and proponents of other
forms of alternative medicine to refer to medicine. It was used to describe the traditional European
practice of heroic medicine, but later continued to be used to describe anything that was not
homeopathy.Allopathy refers to the use of pharmacologically active agents or medical
interventions to treat or suppress symptoms or pathophysiological processes of diseases
or conditions. The German version of the word, allopathisch,
was coined in 1810 by the creator of homeopathy, Samuel Hahnemann (1755–1843). The word was coined from allo- (different)
and -pathic (relating to a disease or to a method of treatment). In alternative medicine circles the expression
“allopathic medicine” is still used to refer to “the broad category of medical practice
that is sometimes called Western medicine, biomedicine, evidence-based medicine, or modern
medicine” (see the article on scientific medicine).Use of the term remains common among homeopaths
and has spread to other alternative medicine practices. The meaning implied by the label has never
been accepted by conventional medicine and is considered pejorative. More recently, some sources have used the
term “allopathic”, particularly American sources wishing to distinguish between Doctors of
Medicine (MD) and Doctors of Osteopathic Medicine (DO) in the United States. William Jarvis, an expert on alternative medicine
and public health, states that “although many modern therapies can be construed to conform
to an allopathic rationale (e.g., using a laxative to relieve constipation), standard
medicine has never paid allegiance to an allopathic principle” and that the label “allopath” was
from the start “considered highly derisive by regular medicine”.Many conventional medical
treatments do not fit the nominal definition of allopathy, as they seek to prevent illness,
or remove its cause.===Traditional medicine===Traditional medicine refers to the pre-scientific
practices of a certain culture, contrary to what is typically practiced in other cultures
where medical science dominates. “Eastern medicine” typically refers to the
traditional medicines of Asia where conventional bio-medicine penetrated much later.===Holistic medicine===
The words balance and holism are often used alongside complementary or integrative medicine,
claiming to take into account a “whole” person, in contrast to the supposed reductionism of
medicine. Due to its many names the field has been criticized
for intense rebranding of what are essentially the same practices.===Problems with definition===
Prominent members of the science and biomedical science community say that it is not meaningful
to define an alternative medicine that is separate from a conventional medicine, that
the expressions “conventional medicine”, “alternative medicine”, “complementary medicine”, “integrative
medicine”, and “holistic medicine” do not refer to any medicine at all.Others in both
the biomedical and CAM communities say that CAM cannot be precisely defined because of
the diversity of theories and practices it includes, and because the boundaries between
CAM and biomedicine overlap, are porous, and change. The expression “complementary and alternative
medicine” (CAM) resists easy definition because the health systems and practices it refers
to are diffuse, and its boundaries poorly defined. Healthcare practices categorized as alternative
may differ in their historical origin, theoretical basis, diagnostic technique, therapeutic practice
and in their relationship to the medical mainstream. Some alternative therapies, including traditional
Chinese medicine (TCM) and Ayurveda, have antique origins in East or South Asia and
are entirely alternative medical systems; others, such as homeopathy and chiropractic,
have origins in Europe or the United States and emerged in the eighteenth and nineteenth
centuries. Some, such as osteopathy and chiropractic,
employ manipulative physical methods of treatment; others, such as meditation and prayer, are
based on mind-body interventions. Treatments considered alternative in one location
may be considered conventional in another. Thus, chiropractic is not considered alternative
in Denmark and likewise osteopathic medicine is no longer thought of as an alternative
therapy in the United States.Critics say the expression is deceptive because it implies
there is an effective alternative to science-based medicine, and that complementary is deceptive
because it implies that the treatment increases the effectiveness of (complements) science-based
medicine, while alternative medicines that have been tested nearly always have no measurable
positive effect compared to a placebo.===Different types of definitions===
One common feature of all definitions of alternative medicine is its designation as “other than”
conventional medicine. For example, the widely referenced descriptive
definition of complementary and alternative medicine devised by the US National Center
for Complementary and Integrative Health (NCCIH) of the National Institutes of Health (NIH),
states that it is “a group of diverse medical and health care systems, practices, and products
that are not generally considered part of conventional medicine”. For conventional medical practitioners, it
does not necessarily follow that either it or its practitioners would no longer be considered
alternative.Some definitions seek to specify alternative medicine in terms of its social
and political marginality to mainstream healthcare. This can refer to the lack of support that
alternative therapies receive from the medical establishment and related bodies regarding
access to research funding, sympathetic coverage in the medical press, or inclusion in the
standard medical curriculum. In 1993, the British Medical Association (BMA),
one among many professional organizations who have attempted to define alternative medicine,
stated that it referred to “…those forms of treatment which are not widely used by
the conventional healthcare professions, and the skills of which are not taught as part
of the undergraduate curriculum of conventional medical and paramedical healthcare courses”. In a US context, an influential definition
coined in 1993 by the Harvard-based physician, David M. Eisenberg, characterized alternative
medicine “as interventions neither taught widely in medical schools nor generally available
in US hospitals”. These descriptive definitions are inadequate
in the present-day when some conventional doctors offer alternative medical treatments
and CAM introductory courses or modules can be offered as part of standard undergraduate
medical training; alternative medicine is taught in more than 50 per cent of US medical
schools and increasingly US health insurers are willing to provide reimbursement for CAM
therapies. In 1999, 7.7% of US hospitals reported using
some form of CAM therapy; this proportion had risen to 37.7% by 2008.An expert panel
at a conference hosted in 1995 by the US Office for Alternative Medicine (OAM), devised a
theoretical definition of alternative medicine as “a broad domain of healing resources … other
than those intrinsic to the politically dominant health system of a particular society or culture
in a given historical period”. This definition has been widely adopted by
CAM researchers, cited by official government bodies such as the UK Department of Health,
attributed as the definition used by the Cochrane Collaboration, and, with some modification,
was preferred in the 2005 consensus report of the US Institute of Medicine, Complementary
and Alternative Medicine in the United States.The 1995 OAM conference definition, an expansion
of Eisenberg’s 1993 formulation, is silent regarding questions of the medical effectiveness
of alternative therapies. Its proponents hold that it thus avoids relativism
about differing forms of medical knowledge and, while it is an essentially political
definition, this should not imply that the dominance of mainstream biomedicine is solely
due to political forces. According to this definition, alternative
and mainstream medicine can only be differentiated with reference to what is “intrinsic to the
politically dominant health system of a particular society of culture”. However, there is neither a reliable method
to distinguish between cultures and subcultures, nor to attribute them as dominant or subordinate,
nor any accepted criteria to determine the dominance of a cultural entity. If the culture of a politically dominant healthcare
system is held to be equivalent to the perspectives of those charged with the medical management
of leading healthcare institutions and programs, the definition fails to recognize the potential
for division either within such an elite or between a healthcare elite and the wider population.Normative
definitions distinguish alternative medicine from the biomedical mainstream in its provision
of therapies that are unproven, unvalidated, or ineffective and support of theories with
no recognized scientific basis. These definitions characterize practices as
constituting alternative medicine when, used independently or in place of evidence-based
medicine, they are put forward as having the healing effects of medicine, but are not based
on evidence gathered with the scientific method. Exemplifying this perspective, a 1998 editorial
co-authored by Marcia Angell, a former editor of The New England Journal of Medicine, argued
that: It is time for the scientific community to
stop giving alternative medicine a free ride. There cannot be two kinds of medicine – conventional
and alternative. There is only medicine that has been adequately
tested and medicine that has not, medicine that works and medicine that may or may not
work. Once a treatment has been tested rigorously,
it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective,
it will be accepted. But assertions, speculation, and testimonials
do not substitute for evidence. Alternative treatments should be subjected
to scientific testing no less rigorous than that required for conventional treatments. This line of division has been subject to
criticism, however, as not all forms of standard medical practice have adequately demonstrated
evidence of benefit, and it is also unlikely in most instances that conventional therapies,
if proven to be ineffective, would ever be classified as CAM.Similarly, the public information
website maintained by the National Health and Medical Research Council (NHMRC) of the
Commonwealth of Australia uses the acronym “CAM” for a wide range of health care practices,
therapies, procedures and devices not within the domain of conventional medicine. In the Australian context this is stated to
include acupuncture; aromatherapy; chiropractic; homeopathy; massage; meditation and relaxation
therapies; naturopathy; osteopathy; reflexology, traditional Chinese medicine; and the use
of vitamin supplements.The Danish National Board of Health’s “Council for Alternative
Medicine” (Sundhedsstyrelsens Råd for Alternativ Behandling (SRAB)), an independent institution
under the National Board of Health (Danish: Sundhedsstyrelsen), uses the term “alternative
medicine” for: Treatments performed by therapists that are
not authorized healthcare professionals. Treatments performed by authorized healthcare
professionals, but those based on methods otherwise used mainly outside the healthcare
system. People without a healthcare authorisation
are [also] allowed to perform the treatments.Proponents of an evidence-base for medicine such as the
Cochrane Collaboration (founded in 1993 and from 2011 providing input for WHO resolutions)
take a position that all systematic reviews of treatments, whether “mainstream” or “alternative”,
ought to be held to the current standards of scientific method. In a study titled Development and classification
of an operational definition of complementary and alternative medicine for the Cochrane
Collaboration (2011) it was proposed that indicators that a therapy is accepted include
government licensing of practitioners, coverage by health insurance, statements of approval
by government agencies, and recommendation as part of a practice guideline; and that
if something is currently a standard, accepted therapy, then it is not likely to be widely
considered as CAM.==Types==Alternative medicine consists of a wide range
of health care practices, products, and therapies. The shared feature is a claim to heal that
is not based on the scientific method. Alternative medicine practices are diverse
in their foundations and methodologies. Alternative medicine practices may be classified
by their cultural origins or by the types of beliefs upon which they are based. Methods may incorporate or be based on traditional
medicinal practices of a particular culture, folk knowledge, superstition, spiritual beliefs,
belief in supernatural energies (antiscience), pseudoscience, errors in reasoning, propaganda,
fraud, new or different concepts of health and disease, and any bases other than being
proven by scientific methods. Different cultures may have their own unique
traditional or belief based practices developed recently or over thousands of years, and specific
practices or entire systems of practices.===Unscientific belief systems===
Alternative medicine, such as using naturopathy or homeopathy in place of conventional medicine,
is based on belief systems not grounded in science.====Supplements=======
Traditional ethnic systems===Alternative medical systems may be based on
traditional medicine practices, such as traditional Chinese medicine (TCM), Ayurveda in India,
or practices of other cultures around the world. Some useful applications of traditional medicines
have been researched and accepted within ordinary medicine, however the underlying belief systems
are seldom scientific and are not accepted. Traditional medicine is considered alternative
when it is used outside its home region; or when it is used together with or instead of
known functional treatment; or when it can be reasonably expected that the patient or
practitioner knows or should know that it will not work – such as knowing that the
practice is based on superstition.===Supernatural energies===
Bases of belief may include belief in existence of supernatural energies undetected by the
science of physics, as in biofields, or in belief in properties of the energies of physics
that are inconsistent with the laws of physics, as in energy medicine.===Holistic therapy======
Herbal remedies and other substances used===Substance based practices use substances found
in nature such as herbs, foods, non-vitamin supplements and megavitamins, animal and fungal
products, and minerals, including use of these products in traditional medical practices
that may also incorporate other methods. Examples include healing claims for nonvitamin
supplements, fish oil, Omega-3 fatty acid, glucosamine, echinacea, flaxseed oil, and
ginseng. Herbal medicine, or phytotherapy, includes
not just the use of plant products, but may also include the use of animal and mineral
products. It is among the most commercially successful
branches of alternative medicine, and includes the tablets, powders and elixirs that are
sold as “nutritional supplements”. Only a very small percentage of these have
been shown to have any efficacy, and there is little regulation as to standards and safety
of their contents. This may include use of known toxic substances,
such as use of the poison lead in traditional Chinese medicine.===Religion, faith healing, and prayer======NCCIH classification===
A US agency, National Center on Complementary and Integrative Health (NCCIH), has created
a classification system for branches of complementary and alternative medicine that divides them
into five major groups. These groups have some overlap, and distinguish
two types of energy medicine: veritable which involves scientifically observable energy
(including magnet therapy, colorpuncture and light therapy) and putative, which invokes
physically undetectable or unverifiable energy. None of these energies have any evidence to
support that they effect the body in any positive or health promoting way. Whole medical systems: Cut across more than
one of the other groups; examples include traditional Chinese medicine, naturopathy,
homeopathy, and ayurveda. Mind-body interventions: Explore the interconnection
between the mind, body, and spirit, under the premise that they affect “bodily functions
and symptoms”. A connection between mind and body is conventional
medical fact, and this classification does not include therapies with proven function
such as cognitive behavioral therapy. “Biology”-based practices: Use substances
found in nature such as herbs, foods, vitamins, and other natural substances. (Note that as used here, “biology” does not
refer to the science of biology, but is a usage newly coined by NCCIH in the primary
source used for this article. “Biology-based” as coined by NCCIH may refer
to chemicals from a nonbiological source, such as use of the poison lead in traditional
Chinese medicine, and to other nonbiological substances.) Manipulative and body-based practices: feature
manipulation or movement of body parts, such as is done in bodywork, chiropractic, and
osteopathic manipulation. Energy medicine: is a domain that deals with
putative and verifiable energy fields: Biofield therapies are intended to influence
energy fields that are purported to surround and penetrate the body. The existence of such energy fields have been
disproven. Bioelectromagnetic-based therapies use verifiable
electromagnetic fields, such as pulsed fields, alternating-current, or direct-current fields
in an non-scientific manner.==History==The history of alternative medicine may refer
to the history of a group of diverse medical practices that were collectively promoted
as “alternative medicine” beginning in the 1970s, to the collection of individual histories
of members of that group, or to the history of western medical practices that were labeled
“irregular practices” by the western medical establishment. It includes the histories of complementary
medicine and of integrative medicine. Before the 1970s, western practitioners that
were not part of the increasingly science-based medical establishment were referred to “irregular
practitioners”, and were dismissed by the medical establishment as unscientific and
as practicing quackery. Until the 1970s, irregular practice became
increasingly marginalized as quackery and fraud, as western medicine increasingly incorporated
scientific methods and discoveries, and had a corresponding increase in success of its
treatments. In the 1970s, irregular practices were grouped
with traditional practices of nonwestern cultures and with other unproven or disproven practices
that were not part of biomedicine, with the entire group collectively marketed and promoted
under the single expression “alternative medicine”.Use of alternative medicine in the west began
to rise following the counterculture movement of the 1960s, as part of the rising new age
movement of the 1970s. This was due to misleading mass marketing
of “alternative medicine” being an effective “alternative” to biomedicine, changing social
attitudes about not using chemicals and challenging the establishment and authority of any kind,
sensitivity to giving equal measure to beliefs and practices of other cultures (cultural
relativism), and growing frustration and desperation by patients about limitations and side effects
of science-based medicine. At the same time, in 1975, the American Medical
Association, which played the central role in fighting quackery in the United States,
abolished its quackery committee and closed down its Department of Investigation. By the early to mid 1970s the expression “alternative
medicine” came into widespread use, and the expression became mass marketed as a collection
of “natural” and effective treatment “alternatives” to science-based biomedicine. By 1983, mass marketing of “alternative medicine”
was so pervasive that the British Medical Journal (BMJ) pointed to “an apparently endless
stream of books, articles, and radio and television programmes urge on the public the virtues
of (alternative medicine) treatments ranging from meditation to drilling a hole in the
skull to let in more oxygen”.===Medical education===
Mainly as a result of reforms following the Flexner Report of 1910 medical education in
established medical schools in the US has generally not included alternative medicine
as a teaching topic. Typically, their teaching is based on current
practice and scientific knowledge about: anatomy, physiology, histology, embryology, neuroanatomy,
pathology, pharmacology, microbiology and immunology. Medical schools’ teaching includes such topics
as doctor-patient communication, ethics, the art of medicine, and engaging in complex clinical
reasoning (medical decision-making). Writing in 2002, Snyderman and Weil remarked
that by the early twentieth century the Flexner model had helped to create the 20th-century
academic health center, in which education, research, and practice were inseparable. While this had much improved medical practice
by defining with increasing certainty the pathophysiological basis of disease, a single-minded
focus on the pathophysiological had diverted much of mainstream American medicine from
clinical conditions that were not well understood in mechanistic terms, and were not effectively
treated by conventional therapies.By 2001 some form of CAM training was being offered
by at least 75 out of 125 medical schools in the US. Exceptionally, the School of Medicine of the
University of Maryland, Baltimore includes a research institute for integrative medicine
(a member entity of the Cochrane Collaboration). Medical schools are responsible for conferring
medical degrees, but a physician typically may not legally practice medicine until licensed
by the local government authority. Licensed physicians in the US who have attended
one of the established medical schools there have usually graduated Doctor of Medicine
(MD). All states require that applicants for MD
licensure be graduates of an approved medical school and complete the United States Medical
Licensing Exam (USMLE).==Efficacy==
There is a general scientific consensus that alternative therapies lack the requisite scientific
validation, and their effectiveness is either unproved or disproved. Many of the claims regarding the efficacy
of alternative medicines are controversial, since research on them is frequently of low
quality and methodologically flawed. Selective publication bias, marked differences
in product quality and standardisation, and some companies making unsubstantiated claims
call into question the claims of efficacy of isolated examples where there is evidence
for alternative therapies.The Scientific Review of Alternative Medicine points to confusions
in the general population – a person may attribute symptomatic relief to an otherwise-ineffective
therapy just because they are taking something (the placebo effect); the natural recovery
from or the cyclical nature of an illness (the regression fallacy) gets misattributed
to an alternative medicine being taken; a person not diagnosed with science-based medicine
may never originally have had a true illness diagnosed as an alternative disease category.Edzard
Ernst characterized the evidence for many alternative techniques as weak, nonexistent,
or negative and in 2011 published his estimate that about 7.4% were based on “sound evidence”,
although he believes that may be an overestimate. Ernst has concluded that 95% of the alternative
treatments he and his team studied, including acupuncture, herbal medicine, homeopathy,
and reflexology, are “statistically indistinguishable from placebo treatments”, but he also believes
there is something that conventional doctors can usefully learn from the chiropractors
and homeopath: this is the therapeutic value of the placebo effect, one of the strangest
phenomena in medicine.In 2003, a project funded by the CDC identified 208 condition-treatment
pairs, of which 58% had been studied by at least one randomized controlled trial (RCT),
and 23% had been assessed with a meta-analysis. According to a 2005 book by a US Institute
of Medicine panel, the number of RCTs focused on CAM has risen dramatically. As of 2005, the Cochrane Library had 145 CAM-related
Cochrane systematic reviews and 340 non-Cochrane systematic reviews. An analysis of the conclusions of only the
145 Cochrane reviews was done by two readers. In 83% of the cases, the readers agreed. In the 17% in which they disagreed, a third
reader agreed with one of the initial readers to set a rating. These studies found that, for CAM, 38.4% concluded
positive effect or possibly positive (12.4%), 4.8% concluded no effect, 0.7% concluded harmful
effect, and 56.6% concluded insufficient evidence. An assessment of conventional treatments found
that 41.3% concluded positive or possibly positive effect, 20% concluded no effect,
8.1% concluded net harmful effects, and 21.3% concluded insufficient evidence. However, the CAM review used the more developed
2004 Cochrane database, while the conventional review used the initial 1998 Cochrane database.In
the same way as for conventional therapies, drugs, and interventions, it can be difficult
to test the efficacy of alternative medicine in clinical trials. In instances where an established, effective,
treatment for a condition is already available, the Helsinki Declaration states that withholding
such treatment is unethical in most circumstances. Use of standard-of-care treatment in addition
to an alternative technique being tested may produce confounded or difficult-to-interpret
results.Cancer researcher Andrew J. Vickers has stated: Contrary to much popular and scientific writing,
many alternative cancer treatments have been investigated in good-quality clinical trials,
and they have been shown to be ineffective. The label “unproven” is inappropriate for
such therapies; it is time to assert that many alternative cancer therapies have been
“disproven”.==Mechanism of action=====
Placebo effect===A research methods expert and author of Snake
Oil Science, R. Barker Bausell, has stated that “it’s become politically correct to investigate
nonsense.” There are concerns that just having NIH support
is being used to give unfounded “legitimacy to treatments that are not legitimate.”Use
of placebos to achieve a placebo effect in integrative medicine has been criticized as,
“…diverting research time, money, and other resources from more fruitful lines of investigation
in order to pursue a theory that has no basis in biology.”Another critic has argued that
academic proponents of integrative medicine sometimes recommend misleading patients by
using known placebo treatments to achieve a placebo effect. However, a 2010 survey of family physicians
found that 56% of respondents said they had used a placebo in clinical practice as well. Eighty-five percent of respondents believed
placebos can have both psychological and physical benefits.Integrative medicine has been criticized
in that its practitioners, trained in science-based medicine, deliberately mislead patients by
pretending placebos are not. “quackademic medicine” is a pejorative term
used for integrative medicine, which medical professionals consider an infiltration of
quackery into academic science-based medicine.An analysis of trends in the criticism of complementary
and alternative medicine (CAM) in five prestigious American medical journals during the period
of reorganization within medicine (1965–1999) was reported as showing that the medical profession
had responded to the growth of CAM in three phases, and that in each phase, changes in
the medical marketplace had influenced the type of response in the journals. Changes included relaxed medical licensing,
the development of managed care, rising consumerism, and the establishment of the USA Office of
Alternative Medicine (later National Center for Complementary and Alternative Medicine,
currently National Center for Complementary and Integrative Health). In the “condemnation” phase, from the late
1960s to the early 1970s, authors had ridiculed, exaggerated the risks, and petitioned the
state to contain CAM; in the “reassessment” phase (mid-1970s through early 1990s), when
increased consumer utilization of CAM was prompting concern, authors had pondered whether
patient dissatisfaction and shortcomings in conventional care contributed to the trend;
in the “integration” phase of the 1990s physicians began learning to work around or administer
CAM, and the subjugation of CAM to scientific scrutiny had become the primary means of control.==Use and regulation=====Appeal===Practitioners of complementary medicine usually
discuss and advise patients as to available alternative therapies. Patients often express interest in mind-body
complementary therapies because they offer a non-drug approach to treating some health
conditions.In addition to the social-cultural underpinnings of the popularity of alternative
medicine, there are several psychological issues that are critical to its growth, notably
psychological effects, such as the will to believe, cognitive biases that help maintain
self-esteem and promote harmonious social functioning, and the post hoc, ergo propter
hoc fallacy.====Marketing====The popularity of complementary & alternative
medicine (CAM) may be related to other factors that Edzard Ernst mentioned in an interview
in The Independent: Why is it so popular, then? Ernst blames the providers, customers and
the doctors whose neglect, he says, has created the opening into which alternative therapists
have stepped. “People are told lies. There are 40 million websites and 39.9 million
tell lies, sometimes outrageous lies. They mislead cancer patients, who are encouraged
not only to pay their last penny but to be treated with something that shortens their
lives. “At the same time, people are gullible. It needs gullibility for the industry to succeed. It doesn’t make me popular with the public,
but it’s the truth. Paul Offit proposed that “alternative medicine
becomes quackery” in four ways: by recommending against conventional therapies that are helpful,
promoting potentially harmful therapies without adequate warning, draining patients’ bank
accounts, or by promoting “magical thinking.”====Social factors====
Authors have speculated on the socio-cultural and psychological reasons for the appeal of
alternative medicines among the minority using them in lieu of conventional medicine. There are several socio-cultural reasons for
the interest in these treatments centered on the low level of scientific literacy among
the public at large and a concomitant increase in antiscientific attitudes and new age mysticism. Related to this are vigorous marketing of
extravagant claims by the alternative medical community combined with inadequate media scrutiny
and attacks on critics.There is also an increase in conspiracy theories toward conventional
medicine and pharmaceutical companies, mistrust of traditional authority figures, such as
the physician, and a dislike of the current delivery methods of scientific biomedicine,
all of which have led patients to seek out alternative medicine to treat a variety of
ailments. Many patients lack access to contemporary
medicine, due to a lack of private or public health insurance, which leads them to seek
out lower-cost alternative medicine. Medical doctors are also aggressively marketing
alternative medicine to profit from this market.Patients can be averse to the painful, unpleasant,
and sometimes-dangerous side effects of biomedical treatments. Treatments for severe diseases such as cancer
and HIV infection have well-known, significant side-effects. Even low-risk medications such as antibiotics
can have potential to cause life-threatening anaphylactic reactions in a very few individuals. Many medications may cause minor but bothersome
symptoms such as cough or upset stomach. In all of these cases, patients may be seeking
out alternative treatments to avoid the adverse effects of conventional treatments.===Prevalence of use===
Complementary and alternative medicine (CAM) has been described as a broad domain of healing
resources that encompasses all health systems, modalities, and practices and their accompanying
theories and beliefs, other than those intrinsic to the politically dominant health system
of a particular society or culture in a given historical period. CAM includes all such practices and ideas
self-defined by their users as preventing or treating illness or promoting health and
well-being. Boundaries within CAM and between the CAM
domain and that of the dominant system are not always sharp or fixed.According to recent
research, the increasing popularity of the CAM needs to be explained by moral convictions
or lifestyle choices rather than by economic reasoning.In developing nations, access to
essential medicines is severely restricted by lack of resources and poverty. Traditional remedies, often closely resembling
or forming the basis for alternative remedies, may comprise primary healthcare or be integrated
into the healthcare system. In Africa, traditional medicine is used for
80% of primary healthcare, and in developing nations as a whole over one-third of the population
lack access to essential medicines.Some have proposed adopting a prize system to reward
medical research. However, public funding for research exists. Increasing the funding for research on alternative
medicine techniques is the purpose of the US National Center for Complementary and Alternative
Medicine. NCCIH and its predecessor, the Office of Alternative
Medicine, have spent more than US$2.5 billion on such research since 1992; this research
has largely not demonstrated the efficacy of alternative treatments.That alternative
medicine has been on the rise “in countries where Western science and scientific method
generally are accepted as the major foundations for healthcare, and ‘evidence-based’ practice
is the dominant paradigm” was described as an “enigma” in the Medical Journal of Australia.====In the US====
In the United States, the 1974 Child Abuse Prevention and Treatment Act (CAPTA) required
that for states to receive federal money, they had to grant religious exemptions to
child neglect and abuse laws regarding religion-based healing practices. Thirty-one states have child-abuse religious
exemptions.The use of alternative medicine in the US has increased, with a 50 percent
increase in expenditures and a 25 percent increase in the use of alternative therapies
between 1990 and 1997 in America. Americans spend many billions on the therapies
annually. Most Americans used CAM to treat and/or prevent
musculoskeletal conditions or other conditions associated with chronic or recurring pain. In America, women were more likely than men
to use CAM, with the biggest difference in use of mind-body therapies including prayer
specifically for health reasons”. In 2008, more than 37% of American hospitals
offered alternative therapies, up from 27 percent in 2005, and 25% in 2004. More than 70% of the hospitals offering CAM
were in urban areas.A survey of Americans found that 88 percent thought that “there
are some good ways of treating sickness that medical science does not recognize”. Use of magnets was the most common tool in
energy medicine in America, and among users of it, 58 percent described it as at least
“sort of scientific”, when it is not at all scientific. In 2002, at least 60 percent of US medical
schools have at least some class time spent teaching alternative therapies. “Therapeutic touch” was taught at more than
100 colleges and universities in 75 countries before the practice was debunked by a nine-year-old
child for a school science project.====Prevalence of use of specific therapies
====The most common CAM therapies used in the
US in 2002 were prayer (45%), herbalism (19%), breathing meditation (12%), meditation (8%),
chiropractic medicine (8%), yoga (5–6%), body work (5%), diet-based therapy (4%), progressive
relaxation (3%), mega-vitamin therapy (3%) and Visualization (2%)In Britain, the most
often used alternative therapies were Alexander technique, Aromatherapy, Bach and other flower
remedies, Body work therapies including massage, Counseling stress therapies, hypnotherapy,
Meditation, Reflexology, Shiatsu, Ayurvedic medicine, Nutritional medicine, and Yoga. Ayurvedic medicine remedies are mainly plant
based with some use of animal materials. Safety concerns include the use of herbs containing
toxic compounds and the lack of quality control in Ayurvedic facilities.According to the National
Health Service (England), the most commonly used complementary and alternative medicines
(CAM) supported by the NHS in the UK are: acupuncture, aromatherapy, chiropractic, homeopathy,
massage, osteopathy and clinical hypnotherapy.====In palliative care====
Complementary therapies are often used in palliative care or by practitioners attempting
to manage chronic pain in patients. Integrative medicine is considered more acceptable
in the interdisciplinary approach used in palliative care than in other areas of medicine. “From its early experiences of care for the
dying, palliative care took for granted the necessity of placing patient values and lifestyle
habits at the core of any design and delivery of quality care at the end of life. If the patient desired complementary therapies,
and as long as such treatments provided additional support and did not endanger the patient,
they were considered acceptable.” The non-pharmacologic interventions of complementary
medicine can employ mind-body interventions designed to “reduce pain and concomitant mood
disturbance and increase quality of life.”===
Regulation===In Austria and Germany complementary and alternative
medicine is mainly in the hands of doctors with MDs, and half or more of the American
alternative practitioners are licensed MDs. In Germany herbs are tightly regulated: half
are prescribed by doctors and covered by health insurance.Some professions of complementary/traditional/alternative
medicine, such as chiropractic, have achieved full regulation in North America and other
parts of the world and are regulated in a manner similar to that governing science-based
medicine. In contrast, other approaches may be partially
recognized and others have no regulation at all. Regulation and licensing of alternative medicine
ranges widely from country to country, and state to state.Government bodies in the US
and elsewhere have published information or guidance about alternative medicine. The U.S. Food and Drug Administration (FDA),
has issued online warnings for consumers about medication health fraud. This includes a section on Alternative Medicine
Fraud, such as a warning that Ayurvedic products generally have not been approved by the FDA
before marketing.==Risks and problems=====
Negative outcomes=======
Adequacy of regulation and CAM safety====Many of the claims regarding the safety and
efficacy of alternative medicine are controversial. Some alternative treatments have been associated
with unexpected side effects, which can be fatal.A commonly voiced concerns about complementary
alternative medicine (CAM) is the way it’s regulated. There have been significant developments in
how CAMs should be assessed prior to re-sale in the United Kingdom and the European Union
(EU) in the last 2 years. Despite this, it has been suggested that current
regulatory bodies have been ineffective in preventing deception of patients as many companies
have re-labelled their drugs to avoid the new laws. There is no general consensus about how to
balance consumer protection (from false claims, toxicity, and advertising) with freedom to
choose remedies. Advocates of CAM suggest that regulation of
the industry will adversely affect patients looking for alternative ways to manage their
symptoms, even if many of the benefits may represent the placebo affect. Some contend that alternative medicines should
not require any more regulation than over-the-counter medicines that can also be toxic in overdose
(such as paracetamol).====Interactions with conventional pharmaceuticals
====Forms of alternative medicine that are biologically
active can be dangerous even when used in conjunction with conventional medicine. Examples include immuno-augmentation therapy,
shark cartilage, bioresonance therapy, oxygen and ozone therapies, and insulin potentiation
therapy. Some herbal remedies can cause dangerous interactions
with chemotherapy drugs, radiation therapy, or anesthetics during surgery, among other
problems. An example of these dangers was reported by
Associate Professor Alastair MacLennan of Adelaide University, Australia regarding a
patient who almost bled to death on the operating table after neglecting to mention that she
had been taking “natural” potions to “build up her strength” before the operation, including
a powerful anticoagulant that nearly caused her death.To ABC Online, MacLennan also gives
another possible mechanism: And lastly there’s the cynicism and disappointment
and depression that some patients get from going on from one alternative medicine to
the next, and they find after three months the placebo effect wears off, and they’re
disappointed and they move on to the next one, and they’re disappointed and disillusioned,
and that can create depression and make the eventual treatment of the patient with anything
effective difficult, because you may not get compliance, because they’ve seen the failure
so often in the past.====Side-effects====
Conventional treatments are subjected to testing for undesired side-effects, whereas alternative
treatments, in general, are not subjected to such testing at all. Any treatment – whether conventional or
alternative – that has a biological or psychological effect on a patient may also have potential
to possess dangerous biological or psychological side-effects. 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.” Specific groups of patients such as patients
with impaired hepatic or renal function are more susceptible to side effects of alternative
remedies.An exception to the normal thinking regarding side-effects is Homeopathy. Since 1938, the U.S. Food and Drug Administration
(FDA) has regulated homeopathic products in “several significantly different ways from
other drugs.” Homeopathic preparations, termed “remedies”,
are extremely dilute, often far beyond the point where a single molecule of the original
active (and possibly toxic) ingredient is likely to remain. They are, thus, considered safe on that count,
but “their products are exempt from good manufacturing practice requirements related to expiration
dating and from finished product testing for identity and strength”, and their alcohol
concentration may be much higher than allowed in conventional drugs.=====Treatment delay=====
Those having 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 argue that therapies
that rely on the placebo effect to define success are very dangerous. According to mental health journalist Scott
Lilienfeld in 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. Between 2001 and 2003, four children died
in Australia because their parents chose ineffective naturopathic, homeopathic, or other alternative
medicines and diets rather than conventional therapies.====Unconventional cancer “cures”====
There have always been “many therapies offered outside of conventional cancer treatment centers
and based on theories not found in biomedicine. These alternative cancer cures have often
been described as ‘unproven,’ suggesting that appropriate clinical trials have not been
conducted and that the therapeutic value of the treatment is unknown.” However, “many alternative cancer treatments
have been investigated in good-quality clinical trials, and they have been shown to be ineffective….The
label ‘unproven’ is inappropriate for such therapies; it is time to assert that many
alternative cancer therapies have been ‘disproven’.”Edzard Ernst has stated: any alternative cancer cure is bogus by definition. There will never be an alternative cancer
cure. Why? Because if something looked halfway promising,
then mainstream oncology would scrutinize it, and if there is anything to it, it would
become mainstream almost automatically and very quickly. All curative “alternative cancer cures” are
based on false claims, are bogus, and, I would say, even criminal.===Rejection of science===
“CAM”, meaning “complementary and alternative medicine”, is not as well researched as conventional
medicine, which undergoes intense research before release to the public. Funding for research is also sparse making
it difficult to do further research for effectiveness of CAM. Most funding for CAM is funded by government
agencies. Proposed research for CAM are rejected by
most private funding agencies because the results of research are not reliable. The research for CAM has to meet certain standards
from research ethics committees, which most CAM researchers find almost impossible to
meet. Even with the little research done on it,
CAM has not been proven to be effective.Steven Novella, a neurologist at Yale School of Medicine,
wrote that government funded studies of integrating alternative medicine techniques into the mainstream
are “used to lend an appearance of legitimacy to treatments that are not legitimate.” Marcia Angell considered that critics felt
that healthcare practices should be classified based solely on scientific evidence, and if
a treatment had been rigorously tested and found safe and effective, science-based medicine
will adopt it regardless of whether it was considered “alternative” to begin with. It is possible for a method to change categories
(proven vs. unproven), based on increased knowledge of its effectiveness or lack thereof. A prominent supporter of this position is
George D. Lundberg, former editor of the Journal of the American Medical Association (JAMA).Writing
in 1999 in CA: A Cancer Journal for Clinicians Barrie R. Cassileth mentioned a 1997 letter
to the US Senate Subcommittee on Public Health and Safety, which had deplored the lack of
critical thinking and scientific rigor in OAM-supported research, had been signed by
four Nobel Laureates and other prominent scientists. (This was supported by the National Institutes
of Health (NIH).)In March 2009 a staff writer for the Washington Post reported that the
impending national discussion about broadening access to health care, improving medical practice
and saving money was giving a group of scientists an opening to propose shutting down the National
Center for Complementary and Alternative Medicine. They quoted one of these scientists, Steven
Salzberg, a genome researcher and computational biologist at the University of Maryland, as
saying “One of our concerns is that NIH is funding pseudoscience.” They noted that the vast majority of studies
were based on fundamental misunderstandings of physiology and disease, and had shown little
or no effect.Writers such as Carl Sagan, a noted astrophysicist, advocate of scientific
skepticism and the author of The Demon-Haunted World: Science as a Candle in the Dark (1996),
have lambasted the lack of empirical evidence to support the existence of the putative energy
fields on which these therapies are predicated.Sampson has also pointed out that CAM tolerated contradiction
without thorough reason and experiment. Barrett has pointed out that there is a policy
at the NIH of never saying something doesn’t work only that a different version or dose
might give different results. Barrett also expressed concern that, just
because some “alternatives” have merit, there is the impression that the rest deserve equal
consideration and respect even though most are worthless, since they are all classified
under the one heading of alternative medicine.Some critics of alternative medicine are focused
upon health fraud, misinformation, and quackery as public health problems, notably Wallace
Sampson and Paul Kurtz founders of Scientific Review of Alternative Medicine and Stephen
Barrett, co-founder of The National Council Against Health Fraud and webmaster of Quackwatch. Grounds for opposing alternative medicine
include that: It is usually based on religion, tradition,
superstition, belief in supernatural energies, pseudoscience, errors in reasoning, propaganda,
or fraud. Alternative therapies typically lack any scientific
validation, and their effectiveness is either unproved or disproved. Treatments are not part of the conventional,
science-based healthcare system. Research on alternative medicine is frequently
of low quality and methodologically flawed. Where alternative treatments have replaced
conventional science-based medicine, even with the safest alternative medicines, failure
to use or delay in using conventional science-based medicine has caused deaths. Methods may incorporate or base themselves
on traditional medicine, folk knowledge, spiritual beliefs, ignorance or misunderstanding of
scientific principles, errors in reasoning, or newly conceived approaches claiming to
heal.Many alternative medical treatments are not patentable, which may lead to less research
funding from the private sector. In addition, in most countries, alternative
treatments (in contrast to pharmaceuticals) can be marketed without any proof of efficacy
– also a disincentive for manufacturers to fund scientific research.English evolutionary
biologist Richard Dawkins, in his 2003 book A Devil’s Chaplain, defined alternative medicine
as a “set of practices that cannot be tested, refuse to be tested, or consistently fail
tests.” Dawkins argued that if a technique is demonstrated
effective in properly performed trials then it ceases to be alternative and simply becomes
medicine.CAM is also often less regulated than conventional medicine. There are ethical concerns about whether people
who perform CAM have the proper knowledge to treat patients. CAM is often done by non-physicians who do
not operate with the same medical licensing laws which govern conventional medicine, and
it is often described as an issue of non-maleficence.According to two writers, Wallace Sampson and K. Butler,
marketing is part of the training required in alternative medicine, and propaganda methods
in alternative medicine have been traced back to those used by Hitler and Goebels in their
promotion of pseudoscience in medicine.In November 2011 Edzard Ernst stated that the
“level of misinformation about alternative medicine has now reached the point where it
has become dangerous and unethical. So far, alternative medicine has remained
an ethics-free zone. It is time to change this.”===
Conflicts of interest===Some commentators have said that special consideration
must be given to the issue of conflicts of interest in alternative medicine. Edzard Ernst has said that most researchers
into alternative medicine are at risk of “unidirectional bias” because of a generally uncritical belief
in their chosen subject. Ernst cites as evidence the phenomenon whereby
100% of a sample of acupuncture trials originating in China had positive conclusions. David Gorski contrasts evidence-based medicine,
in which researchers try to disprove hyphotheses, with what he says is the frequent practice
in pseudoscience-based research, of striving to confirm pre-existing notions. Harriet Hall writes that there is a contrast
between the circumstances of alternative medicine practitioners and disinterested scientists:
in the case of acupuncture, for example, an acupuncturist would have “a great deal to
lose” if acupuncture were rejected by research; but the disinterested skeptic would not lose
anything if its effects were confirmed; rather their change of mind would enhance their skeptical
credentials.==Gallery====See also==Conservation medicine
Ethnomedicine Homeopathy
Hypnotherapy Psychic surgery
Siddha medicine Vertebral subluxation==Notes

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