Definition:
Alternative Medicine
(Modified Revision as of 22:48,
24 Jun 2004)
Alternative medicine
broadly describes methods and practices used in
place of conventional medical
treatments.The definition of what is and is
not 'alternative' changes with time, generally as
the result of research and public acceptance.
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Branches of alternative medicine
The most often used branches
of alternative medicine in the United States are
(Eisenberg et al., 1998):
- acupuncture
- biofeedback
- Chinese
medicine
- chiropractic
- homeopathy
- hypnotherapy
- massage
therapy
- naturopathy
Psychologists provide alternative medical services
when they use biofeedback, hypnotherapy, or cognitive
behavior therapy to treat a medical condition.
A relatively new field in psychology is 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
derogatory way. Some feel that the very term
"alternative medicine" is misleading, on the
belief that these treatments are not a true alternative
to regulated conventional medicine.
There is a concern that patients may delay
seeking conventional medicine that could be more
effective, whilst they undergo alternative therapies,
potentially resulting in harm.
Lack of proper testing
Many forms of alternative medicine are
rejected by some physicians because the efficacy of
the treatments has not been shown through double-blind randomized
controlled trials in their opinion. 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
illnesses. Beyerstein's criticisms apply as much, if
not more, to conventional medicine than they do to
alternative forms of treatment.
Poor diagnosis
One of the concerns of mainstream
medical doctors is that alternative medical
practitioners sometimes fail to correctly diagnose
illnesses.
Criticisms differ for the various
branches
Due to the range of Alternative medicine
few criticisms apply across the board.
Regulation
Practices terming themselves
"alternative medicine" have caused deaths
indirectly when patients have used alternatives 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
want to be certain that whatever method they choose
will be safe and effective.
Testing and studies
Some 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.
The response to these criticisms is that
these critics are promoting medical scientism rather
than science.
Nonetheless, many mainstream doctors and
scientists are open to revising their views of any
specific new treatment. A review of the effectiveness
of certain alternative medicine techniques for cancer
treatment (Vickers 2004), found that most of these
treatments are not merely "unproven" but
are proven not to work. The same review, while
specifically noting that "complementary
therapies for cancer-related symptoms were not part
of this review", cites studies indicating that
several complementary therapies can provide benefits
by, for example, reducing pain and improving the mood
of patients.
Support
Advocates of alternative medicine point to a
number of different arguments that tend to support the
validity of using alternative methods of treatment to
treat specific medical conditions.
Some conventional doctors support CAM
Some physicians who talk about
alternative medical treatments methods do so in a
more positive way. In a recent newspaper interview,
Dr. Russell Greenfield, said: "I tell them
'I'm one of you' and that we have the data - we have
the studies, we're not making this up,"
when talking to other physicians. Dr. Greenfield was
referring to published studies on the beneficial
effect of saw palmetto on enlarged prostates, and how body work, or
massage therapy, is
effective for treating lower back pain. Another
example from this interview is physician Dr. Karen
Koffler who said : "I've learned how to
balance the intellectual processes of medicine with
an intuitive understanding of what this person, this
patient really needs to gain strength for healing.
That is never taught in medical school and is lost
entirely from medicine now." (See McClain
2004).
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 alongside standard
conventional medical treatments, most physicians find
complementary medicine acceptable (see comments about
alternative versus complementary medicine in Vickers
2004).
Those physicians that practice
complementary medicine must obviously believe they
see some added value in alternative forms of
treatments for their patients. 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.
Scientific research on alternative
therapies
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).
Specific alternative treatment methods
have been shown to be effective for specific medical
conditions in recently published research (such as
Michalsen 2003, Gonsalkorale 2003, and Berga 2003).
Favorable research has been published in research
journals recognized by Medline.
Alternative medicine as an alternative
for the public searching for complementary services
Alternative medicine can provide the
buying public with services not commonly available
from conventional medicine. This argument covers a
range of areas, such as patient empowerment,
alternative methods of pain management,
treatment methods that support the biopsychosocial model
of health, cures for specific health concerns, stress
reduction services, other preventative health
services that are not typically a part of
conventional medicine, and of course complementary
medicine's palliative care which is
practiced by such world renown cancer centers such as
Memorial
Sloan-Kettering (see Vickers 2004).
The placebo effect
When a patient benefits from alternative
medical treatment, the benefit can be accounted for
by a number of different factors: the placebo effect, the
treatment itself, or from a combination of both.
Hence, the placebo effect is really only a problem
when conducting research, because when a patient
benefits from it, it is obviously a positive factor
that aids a patient's recovery. Furthermore, the "close
interaction of the health care provider with his or
her patient is likely to enhance the perception of
the treatment that is being performed."(Benedetti
et al. 2003). Alternative medicine strives to
capitalize on this effect, while medical doctors
generally consider the placebo effect only to be a
negative factor that should be minimized during
treatment.
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),
A survey
released in May 2004 by the National
Center for Complementary and Alternative Medicine,
part of the National Institutes
of Health in the United States, found that in 2002,
more than one-third of Americans used some form of
alternative therapy - a category that included yoga,
meditation, herbal treatments and the Atkins diet. If prayer was counted as an alternative
therapy, the figure rose to almost two-thirds. Consistent
with previous studies, this study found that the majority
of individuals (i.e., 54.9%) used CAM in conjunction with
conventional medicine (
page 6).
Increasing numbers of medical colleges have
begun offering 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." [4]
In the UK a number of universties offer
courses in areas of alternative medicine including
homeopathy and acupuncture.
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.
The current regulatory system and
alternative medicine
Many alternative medicine advocates
chafe at the restrictions of government agencies
which approve medical treatments (such as the
American Food and Drug
Administration) and the agencies' adherence to
experimental evaluation methods. They claim that this
impedes those seeking to bring new ideas and methods
to the public more rapidly, and protest that their
contributions and discoveries are unfairly dismissed,
overlooked or suppressed. The alternative medicine
industry argues that health fraud, when it occurs,
should be dealt with appropriately.
Other issues
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 all the branches together.
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 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- Zalewski, Z. Importance of Philosophy of Science
to the History of Medical Thinking. CMJ 1999; 40:
8-13. CMJ
online 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
- Tonelli, M.R. The limits of evidence-based
medicine. Respir Care. 2001 Dec;46(12):1435-40;
discussion 1440-1. Review. PMID: 11728302 Abstract
- 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
- 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
- Larkin, M. Whose article is it anyway? Lancet.
1999 Jul 10;354(9173):136. Editorial
- Vickers, A. Alternative Cancer Cures:
"Unproven" or "Disproven"? CA
Cancer J Clin 2004 54: 110-118. Online
- 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
- Eisenberg DM. Advising patients who seek
alternative medical therapies. Ann Intern Med.
1997; 127:61-69. PMID: 9214254 Abstract
Other works that discuss alternative
medicine
- WHERE
DO AMERICANS GO FOR HEALTHCARE? by Anna
Rosenfeld, Case Western Reserve University,
Cleveland, Ohio, USA.
- 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.
External links
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