Alternative medicine
From Wikipedia,
Alternative medicine includes practices that differ from conventional medicine.
A typical definition is "every available approach to healing that does not fall within the realm of conventional medicine".[1]
Commonly cited examples are homeopathy, naturopathy, chiropractic, and herbal medicine.
Alternative medicine practices may be based on unconventional belief systems or philosophies; biological data and observations or biochemical principles;[2] and some may not follow the scientific method.
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 is 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[3]
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.[4]
Edzard Ernst wrote in the Medical Journal of Australia that "about half the general population in developed countries use complementary and alternative medicine (CAM)."[5] 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.[6] 25% of people who use CAM do so because a medical professional suggested it.[7] Another study suggests a similar figure of 40%.[8] 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.[9]
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.[10] 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."[11]
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.[12]
[edit] Medical education
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The examples and perspective in this article or section may not represent a worldwide view of the subject. Please improve this article or discuss the issue on the talk page. |
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.[13][14][15] 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."[16] 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 is available today.[citation needed] See Naturopathic medicine.
In Britain, no conventional medical schools offer courses that teach the clinical practice of alternative medicine.[citation needed] However, alternative medicine is taught in several unconventional schools as part of their curriculum.[citation needed] Teaching is based mostly on theory and understanding of alternative medicine, with emphasis on being able to communicate with alternative medicine specialists.[citation needed] To obtain competence in practicing clinical alternative medicine, qualifications must be obtained from individual medical societies.[citation needed] The student must have graduated and be a qualified doctor.[citation needed] 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.
[edit] 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:[6][4]
- 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%)
[edit] Support for alternative medicine
Alternative therapies provide some services not available from conventional medicine. Examples are patient empowerment and treatment methods that follow the biopsychosocial model of health.[17]
[edit] Efficacy
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,[18] Gonsalkorale 2003,[19] and Berga 2003[20]) 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,[21] and Linde 1997.[22]
Although advocates of alternative medicine acknowledge that the placebo effect may play a role in the benefits that some receive from alternative therapies, they point out that this does not diminish their validity. Researchers who judge treatments using the scientific method are concerned by this viewpoint, since it fails to address the possible inefficacy of alternative treatments.
[edit] Criticism of alternative medicine
- Further information: List of branches 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, i.e., scientifically proven evidence of efficacy (or lack thereof). According to them it is 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] 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."[23]
- 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."[24]
- Richard Dawkins, Professor of the Public Understanding of Science at Oxford,[25] defines alternative medicine as a "...set of practices which cannot 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."[26] He also states that "There is no alternative medicine. There is only medicine that works and medicine that doesn't work."[27]
- 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."[28]
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.[29][30][31] Oxford University Press publishes a peer-reviewed journal entitled Evidence-based Complementary and Alternative Medicine (eCAM).[32]
Some commentators maintain that some or all fields of alternative medicine are pseudoscientific, or contain significant pseudoscientific elements. In the late 20th century systematic investigation of the evidence-base proceeded, and at least one university department of alternative and complementary medicine was established, at the University of Exeter under Professor Edzard Ernst for this purpose.
Due to the wide range of therapies that are considered to be "alternative medicine" few criticisms apply across the board, except possibly that of not being scientifically supported or even testable. Proponents of CAM typically address this basic criticism by arguing that it is a self-fulfilling prophecy: critics believe that there is no plausibility to CAMs because they find little or no proofs, while it is plausibility that should inform the scientific research for proofs.
Proponents of alternative therapy have an obligation to provide grounds for biological plausibility, such as sound theoretical or preclinical data, or for clinical plausibility, in the form of authentic, well-prepared case reports, in order to justify the investment of time and energy in exploring the merits of a novel anticancer therapy. But plausibility, not proof, should be sufficient to initiate the process. [33]
In other words, proponents of CAMs argue that skeptics, in saying that theories or anecdotal and preclinical data do not constitute proof, merely state the obvious but do not actually engage in the evaluation of CAMs. Criticisms directed at specific branches of alternative medicine range from the fairly minor (conventional treatment is believed to be more effective in a particular area) to incompatibility with the known laws of physics (for example, in homeopathy). Critics argue that alternative medicine practitioners may not have an accredited medical degree or be licensed physicians or general practitioners, and may make sweeping claims without demonstrated expertise. However, unless a new system of medicine becomes established, it does not receive accreditation of any kind except by its own professional organizations. This is the route homeopathy, ayurveda, siddha, unani, and naturopathy had to follow in those countries where they are now offered by accredited institutions. Proponents of the various forms of alternative medicine reject criticism regarded as being founded in prejudice, financial self-interest, or ignorance. Refutations of criticism sometimes take the form of an appeal to nature - that which is natural is necessarily good.
[edit] Efficacy
[edit] 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 has not 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 cannot be patented, and hence there is 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.[34][35] 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.[36] The German Federal Institute for Drugs and Medical Devices Commission E has studied many herbal remedies for efficacy.[37]
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.[38] CAM proponents point out this may also apply in cases where conventional treatments have been used. To this, CAM critics point out that this does not account for conventional medical success in double blind clinical trials. CAM proponents, however, do not typically question conventional medical successes revealed in double blind clinical trials.
[edit] 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.[citation needed] Deaths have been reported due to the use of alternative medicines such as colloidal silver.[39] Colloidal silver was used before 1938 as an antibiotic, resulting in an "alarming increase"[40] 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) is not 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."[41]
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 are 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.[42][43][44][45][46]
[edit] 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.[47]
[edit] 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 did not use alternative medicine (AM): "The use of AM seems to predict a shorter survival from cancer."[48]
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 had been taking "natural" potions to "build up her strength" before the operation, including a powerful anticoagulant which nearly caused her death.[49]
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".[50]
[edit] 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, i.e. "that which is natural cannot 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.
[edit] 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[citation needed] and deteriorating health.
[edit] 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.[51]
Critics contend[attribution needed] 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 is not dangerous, but the problem would then remain to know if it does what its proponents say it does.[clarify]
[edit] 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[52]
- an increase in anti-intellectualism and antiscientific attitudes riding on the coattails of new age mysticism[52]
- vigorous marketing of extravagant claims by the "alternative" medical community[52]
- inadequate media scrutiny and attacks on critics[52]
- increasing social malaise (conspiracy theories) and mistrust of traditional authority figures - the antidoctor backlash.[52]
- dislike of the delivery methods of scientific biomedicine.[52]
- Psychological reasons cited include
- the placebo effect
- the will to believe[52]
- self-serving biases that help maintain self-esteem and promote harmonious social functioning[52]
- demand characteristics - the obligation to respond in kind when someone does them a good turn[52]
- post hoc, ergo propter hoc fallacy ("after this, therefore because of this"; the basis of most superstitious beliefs)[52]
- psychological distortion, such as confirmation bias and cognitive dissonance (inability to respond to criticism of alternative medicine in order to reduce one's cognitive dissonance)
- patients' unpleasant personal experiences with hospitals, doctors, and nurses and perceptions of rude, cold interpersonal interactions.
- emotionally positive and psychologically affirming experiences with alternative practitioners.
- 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 potentially cause life-threatening anaphylactic reactions in a very few individuals. More commonly, many medications may cause minor but bothersome symptoms such as cough or upset stomach.
- Economic reasons include
- Lack of access to scientific biomedicine, due to lack of private health insurance, societal resources or government funding.
[edit] Integrative medicine
According to the NCCAM, integrative medicine, or integrated medicine, "combines treatments from conventional medicine and CAM for which there is some high-quality evidence of safety and effectiveness.[53] It is a healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle.[citation needed] It emphasizes the therapeutic relationship[citation needed] and makes use of all appropriate therapies, whether they are classified as conventional or alternative.
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.[54]
[edit] See also
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