Alternative medicine Totally Explained

Everything about Alternative Medicine totally explained

Alternative Medicine
This article is part of the CAM series of articles.

Alternative medicine includes practices that differ from conventional medicine. A typical definition is "every available approach to healing that doesn't fall within the realm of conventional medicine". Commonly cited examples are homeopathy, naturopathy, chiropractic, and herbal medicine.
Alternative medicine practices are based on unscientific belief systems or philosophies. They may incorporate spiritual, metaphysical, or religious underpinnings, untested practices, pre-modern medical traditions, or newly developed approaches to healing. If an alternative medical approach, previously unproven according to orthodox scientific or regulatory methodologies, is subsequently shown to be safe and effective, it may then be adopted by conventional practitioners and no longer considered "alternative."
"Alternative medicine" is often categorized together with complementary medicine using the umbrella term Complementary and alternative medicine or CAM.

Regulation

Jurisdiction differs concerning which branches of alternative medicine are legal, which are regulated, and which (if any) are provided by a government-controlled health service or reimbursed by a private health medical insurance company.
In article 34 (Specific legal obligations) of the General Comment No. 14 (2000) on The right to the highest attainable standard of health of the Committee on Economic, Social and Cultural Rights (United Nations), it's stated that

Obligations to respect (the right to health) include a State's obligation to refrain from prohibiting or impeding traditional preventive care, healing practices and medicines, from marketing unsafe drugs and from applying coercive medical treatments

A number of alternative medicine advocates disagree with the restrictions of government agencies that 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 useful and effective treatments and approaches to the public, and protest that their contributions and discoveries are unfairly dismissed, overlooked or suppressed. Alternative medicine providers often argue that health fraud should be dealt with appropriately when it occurs.

Contemporary use of alternative medicine

Many people utilize mainstream medicine for diagnosis and basic information, while turning to alternatives for what they believe to be health-enhancing measures. Studies indicate that alternative approaches are often used in conjunction with conventional medicine. Survey results released in May 2004 by the National Center for Complementary and Alternative Medicine, part of the United States National Institutes of Health, found that in 2002 62.1% of adults in the country had used some form of CAM in the past 12 months, though this figure drops to 36.0% if prayer specifically for health reasons is excluded. 25% of people who use CAM do so because a medical professional suggested it. Another study suggests a similar figure of 40%. A British telephone survey by the BBC of 1204 adults in 1998 shows that around 20% of adults in Britain had used alternative medicine in the past 12 months.
The use of alternative medicine in developed countries appears to be increasing. A 1998 study showed that the use of alternative medicine had risen from 33.8% in 1990 to 42.1% in 1997. In the United Kingdom, a 2000 report ordered by the House of Lords suggested that "...limited data seem to support the idea that CAM use in the United Kingdom is high and is increasing."
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 health care or be integrated into the health care system. In Africa, traditional medicine is used for 80% of primary health care, and in developing nations as a whole over one third of the population lack access to essential medicines.

Medical education

Increasing numbers of medical colleges have started offering courses in alternative medicine. For example, in three separate research surveys that surveyed 729 schools in the United States (125 medical schools offering an MD degree, 25 medical schools offering a Doctor of Osteopathic medicine degree, and 585 schools offering a nursing degree), 60% of the standard medical schools, 95% of osteopathic medical schools and 84.8% of the nursing schools teach some form of CAM. 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." Accredited Naturopathic colleges and universities are also increasing in number and popularity in the U.S.A. They offer the most complete medical training in complementary medicines that's available today. See Naturopathic medicine.
In Britain, no conventional medical schools offer courses that teach the clinical practice of alternative medicine. However, alternative medicine is taught in several unconventional schools as part of their curriculum. Teaching is based mostly on theory and understanding of alternative medicine, with emphasis on being able to communicate with alternative medicine specialists. To obtain competence in practicing clinical alternative medicine, qualifications must be obtained from individual medical societies. The student must have graduated and be a qualified doctor. The British Medical Acupuncture Society

, which offers medical acupuncture certificates to doctors, is one such example, as is the College of Naturopathic Medicine UK and Ireland.

Public use in the US

A 2002 survey of US adults 18 years and older conducted by the National Center for Health Statistics (CDC) the National Center for Complementary and Alternative Medicine indicated:

74.6% had used some form of complementary and alternative medicine (CAM).
62.1% had done so within the preceding twelve months.
When prayer specifically for health reasons is excluded, these figures fall to 49.8% and 36.0%, respectively.
45.2% had in the last twelve months used prayer for health reasons, either through praying for their own health or through others praying for them.
54.9% used CAM in conjunction with conventional medicine.
14.8% "sought care from a licensed or certified" practitioner, suggesting that "most individuals who use CAM prefer to treat themselves."
Most people used CAM to treat and/or prevent musculoskeletal conditions or other conditions associated with chronic or recurring pain.
"Women were more likely than men to use CAM. The largest sex differential is seen in the use of mind-body therapies including prayer specifically for health reasons".
"Except for the groups of therapies that included prayer specifically for health reasons, use of CAM increased as education levels increased".
The most common CAM therapies used in the U.S. in 2002 were prayer (45.2%), herbalism (18.9%), breathing meditation (11.6%), meditation (7.6%), chiropractic medicine (7.5%), yoga (5.1%), body work (5.0%), diet-based therapy (3.5%), progressive relaxation (3.0%), mega-vitamin therapy (2.8%) and Visualization (2.1%)

Support for alternative medicine

Advocates of alternative medicine hold that the various alternative treatment methods are effective in treating a wide range of major and minor medical conditions, and contend that recently published research (such as Michalsen, 2003, Gonsalkorale 2003, and Berga 2003) proves the effectiveness of specific alternative treatments. They assert that a PubMed search revealed over 370,000 research papers classified as alternative medicine published in Medline-recognized journals since 1966 in the National Library of Medicine database. See also Kleijnen 1991, and Linde 1997.

Criticism of alternative medicine

Alternative medicine is commonly categorised together with complementary medicine under the umbrella term 'complementary and alternative medicine' (CAM for short). Some scientists reject this and the above classifications and to varying degrees reject the term "alternative medicine" itself.
The following four commentators argue for classifying treatments based on the objectively verifiable criteria of the scientific method, not based on the changing curricula of various medical schools or social sphere of usage. They advocate a classification based on evidence-based medicine, for example, scientifically proven evidence of efficacy (or lack thereof). According to them it's possible for a method to change categories (proven vs. unproven) in either direction, based on increased knowledge of its effectiveness or lack thereof:

Marcia Angell, former editor-in-chief of the New England Journal of Medicine, states that "...since many alternative remedies have recently found their way into the medical mainstream [there] can't 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's found to be reasonably safe and effective, it'll be accepted."

George D. Lundberg, former editor of the Journal of the American Medical Association (JAMA), and Phil B. Fontanarosa, Senior Editor of JAMA, state: "There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking. Whether a therapeutic practice is 'Eastern' or 'Western,' is unconventional or mainstream, or involves mind-body techniques or molecular genetics is largely irrelevant except for historical purposes and cultural interest. As believers in science and evidence, we must focus on fundamental issues—namely, the patient, the target disease or condition, the proposed or practiced treatment, and the need for convincing data on safety and therapeutic efficacy."

Richard Dawkins, Professor of the Public Understanding of Science at Oxford, defines alternative medicine as a "...set of practices which can't be tested, refuse to be tested, or consistently fail tests. If a healing technique is demonstrated to have curative properties in properly controlled double-blind trials, it ceases to be alternative. It simply...becomes medicine." He also states that "There is no alternative medicine. There is only medicine that works and medicine that doesn't work."

Stephen Barrett, an alternative medicine critic, argues that techniques currently labeled "alternative" should be reclassified as "genuine, experimental, or questionable. Genuine alternatives are comparable methods that have met science-based criteria for safety and effectiveness. Experimental alternatives are unproven but have a plausible rationale and are undergoing responsible investigation. ... Questionable alternatives are groundless and lack a scientifically plausible rationale. ... Blurring these distinctions enables promoters of quackery to argue that because some practices labeled "alternative" have merit, the rest deserve equal consideration and respect. Enough is known, however, to conclude that most questionable "alternatives" are worthless." Other well-known proponents of evidence-based medicine, such as the Cochrane Collaboration and Edzard Ernst, Professor of Complementary Medicine at the University of Exeter, use the term "alternative medicine" but agree with the above commentators that all treatments, whether "mainstream" or "alternative", ought to be held to standards of the scientific method. Oxford University Press publishes a peer-reviewed journal entitled Evidence-based Complementary and Alternative Medicine (eCAM).

Efficacy

Lack of proper testing

Although proponents of alternative medicine often cite the large number of studies which have been performed, critics point out that there are no statistics on exactly how many of those studies were controlled, double blind, peer-reviewed experiments, or how many produced results supporting alternative medicine or parts thereof. They contend that many forms of alternative medicine are rejected by conventional medicine because the efficacy of the treatments hasn't been demonstrated through double-blind randomized controlled trials; in contrast, conventional drugs reach the market only after such trials have proved their efficacy.
Some argue that less research is carried out on alternative medicine because many alternative medicine techniques can't be patented, and hence there's little 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, contend 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. Increasing the funding for research of alternative medicine techniques was the purpose of the U.S. National Center for Complementary and Alternative Medicine. NCCAM and its predecessor, the Office of Alternative Medicine, have spent more than $1 billion on such research since 1992. The German Federal Institute for Drugs and Medical Devices Commission E has studied many herbal remedies for efficacy.
Some skeptics of alternative practices point out that a person may attribute symptomatic relief to an otherwise ineffective therapy due to the placebo effect, the natural recovery from or the cyclical nature of an illness (the regression fallacy), or the possibility that the person never originally had a true illness. CAM proponents point out this may also apply in cases where conventional treatments have been used. To this, CAM critics point out that this doesn't account for conventional medical success in double blind clinical trials. CAM proponents, however, don't typically question conventional medical successes revealed in double blind clinical trials.

Safety

Critics contend that people have been hurt or killed directly from the various alternative practices or indirectly by failed diagnoses or avoidance of conventional medicine. Proponents counter that harm from conventional medical practice, known as iatrogenesis, is a major cause of death and injury. Deaths have been reported due to the use of alternative medicines such as colloidal silver. Colloidal silver was used before 1938 as an antibiotic, resulting in an "alarming increase" in cases of Argyria. Since 1995 it has been promoted as an alternative medicine, sparking heavy critique from a victim from the 1940s: "Colloidal silver (CSP) isn't a new alternative remedy. It is an old, discarded traditional one that homeopaths and other people calling themselves "alternative health-care practitioners" have pulled out of the garbage pail of useless and dangerous drugs and therapies, things mainstream medicine threw away decades ago."
Alternative medicine critics agree with its proponents that people should be free to choose whatever method of healthcare they want, but stipulate that people must be informed as to the safety and efficacy of whatever method they choose. People who choose alternative medicine may think they're choosing a safe, effective medicine, while they may only be getting quack remedies. The use of Grapefruit seed extract is an example of quackery, since multiple studies demonstrate its universal antimicrobial effect is due to synthetic antimicrobial contamination.

Delay in seeking conventional medical treatment

Those who have 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 contend that therapies that rely on the placebo effect to define success are very dangerous. According to Lilienfeld (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.

Danger can be increased when used as a complement to conventional medicine

A Norwegian multicentre study examined the association between the use of alternative medicine and cancer survival. 515 patients using standard medical care for cancer were followed for eight years. 22% of those patients used alternative medicine concurrently with their standard care. The study revealed that death rates were 30% higher in alternative medicine users than in those who didn't use alternative medicine (AM): "The use of AM seems to predict a shorter survival from cancer." Associate Professor Alastair MacLennan of the Department of Obstetrics and Gynaecology in Adelaide University, Australia reports that a patient almost bled to death on the operating table. She had failed to mention that she'd been taking "natural" potions to "build up her strength" before the operation, including a powerful anticoagulant which 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".

Danger from undesired side-effects

Conventional treatments are subjected to testing for undesired side-effects, whereas alternative treatments generally are not subjected to such testing at all. However, any treatment — whether conventional or alternative — that has a biological or psychological impact on a patient may also have potentially dangerous biological or psychological side-effects. Nevertheless, attempts to refute this fact with regard to alternative treatments sometimes use the appeal to nature fallacy, for example "that which is natural can't be harmful". Homeopathy, however, is insulated from direct side effects by the known laws of chemistry and physics. Homeopathic preparations, termed "remedies," are extremely dilute, often far beyond the point where a single molecule of the original active ingredient is likely to remain.

Danger related to self-medication

Similar problems as those related to self-medication also apply to parts of alternative medicine. For example, an alternative medicine may instantly make symptoms better, but actually worsen problems in the long run. The result may be addiction and deteriorating health.

Issues of regulation

The production of modern pharmaceuticals is strictly regulated to ensure that every pill in every batch contains a standard quantity of active ingredients and is free from contamination. Alternative medicine products are not subject to such quality control regulation, and homogeneity at encapsulation and batch-to-batch consistency are sometimes compromised. This leads to uncertainty in the chemical content and biological activity of each pill. Additionally, alternative health products are sometimes adulterated or contaminated with prescription medications or toxic ingredients, such as lead.
Critics contend that some branches of alternative medicine are often not properly regulated in some countries, making it difficult to impossible for consumers to evaluate practitioner training and expertise. Critics contend that governmental regulation of any particular alternative therapy does necessarily indicate that the therapy is safe and effective. The most sensible course in such a case could be to simply ensure that the sold treatment isn't dangerous, but the problem would then remain to know if it does what its proponents say it does.

Critics' explanations for the appeal of alternative medicine

Critics cite both socio-cultural and psychological reasons to explain why people would chose to use alternative medicines in lieu of conventional medicine.

Socio-cultural reasons cited include:

the low level of scientific literacy among the public at large

an increase in anti-intellectualism and antiscientific attitudes riding on the coattails of new age mysticism According to Andrew T. Weil M.D., a leading proponent of integrative medicine, the principles of integrative medicine include: appropriate use of conventional and CAM methods; patient participation; promotion of health as well as treatment of disease; and a preference for natural, minimally-invasive methods.

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