Alternative medicine 1845 226144187 2008-07-17T00:45:21Z Levine2112 263965 citations needed. also link to Alt Med needed here as well. This sounds more like [[Traditional medicine]] {{Revisions sandboxed|sandboxed=User:Ludwigs2/sandbox|merge=[[complementary medicine]] and [[Complementary_and_alternative_medicine]]|placedby=[[User_talk:Ludwigs2|<span style="color:darkblue;font-weight:bold">Ludwigs</span><span style="color:green;font-weight:bold">2</span>]] 05:18, 16 July 2008 (UTC)}} {{Refimprove|date=April 2008}} <br> {{Alternative medical systems}} The term '''alternative medicine''' covers any healing practice "that does not fall within the realm of conventional [[medicine]]."<ref name=bratman7>{{cite book |title=The Alternative Medicine Sourcebook |last=Bratman, MD |first=Steven |year=1997 |publisher=Lowell House |pages=p 7|isbn=1565656261}}</ref> Commonly cited examples include [[homeopathy]], [[naturopathy]], [[acupuncture]], [[chiropractic]], and [[herbal medicine]], though many other practices use the term. Alternative medicine is often grouped with [[complementary medicine]] using the [[umbrella term]] [[complementary and alternative medicine]] (CAM), although some of the most significant researchers of alternative medicine are opposed to this convenient grouping.<ref name=CassilethDeng2004>Cassileth BR, Deng G. (2004) [http://www.theoncologist.com/cgi/content/full/9/1/80 Complementary and Alternative Therapies for Cancer]. ''The Oncologist'' PMID 14755017</ref><ref name=ernstinterview>[http://web.archive.org/web/20070311015608/http://www.harcourt-international.com/ernst/interview.cfm Interview with [Edzard Ernst], editor of ''The Desktop Guide to Complementary and Alternative Medicine''. Quote: "The umbrella term 'CAM' is almost nonsensical. The various modalities have very little in common. Distinction is therefore essential."</ref> Alternative medicine practices are as diverse in their foundations as in their methodologies. Specific practices may incorporate or base themselves on traditional or pre-scientific understandings of medicine, [[Home remedy|folk knowledge]], spiritual, metaphysical, or religious beliefs, or newly contrived approaches to healing. Jurisdictions where alternative medical practices are sufficiently widespread may license and regulate them. The claims made by alternative medicine practitioners are generally not accepted by the [[Consensus (medical)|medical]] community because [[Evidence-based medicine|evidence-based]] assessment is not available for the safety and efficacy of many of these practices. If [[Biomedical research|scientific investigation]] establishes the safety and effectiveness of an alternative medical practice it may be adopted by conventional practitioners. A 1998 [[systematic review]] of studies assessing its prevalence in 13 countries concluded that about 31% of adults use some form of [[complementary and alternative medicine]].<ref>Enst E. (1998). http://www3.interscience.wiley.com/journal/75500685/abstract?CRETRY=1&SRETRY=0</ref> Alternative medicine varies from country to country; Dr. [[Edzard Ernst]] believes that in Austria and Germany CAM is mainly in the hands of physician,<ref name=ernstinterview/> although some estimates suggest that half of CAM is administered by physicians in the US.<ref name=Cassileth1996>Cassileth, Barrie R. [http://theoncologist.alphamedpress.org/cgi/content/full/1/3/173 Alternative and Complementary Cancer Treatments] ''The Oncologist'', Vol. 1, No. 3, 173–179, June 1996</ref> In Germany, herbs are tightly regulated, with half prescribed by doctors and covered by health insurance based on their [[Commission E]] legislation.<ref>http://jama.ama-assn.org/cgi/content/full/281/19/1852</ref> ==History of alternative medicine== The term "alternative medicine" is only meaningful as compared to modern scientific medicine and the development of the scientific method. [[History of alternative medicine|Historically]], the disciplines currently called "alternative" were the mainstream medical disciplines of historical cultures. Since the rise of the [[scientific method]] in the west, some historical remedies have been adopted, in whole or in part as mainstream practices, while others have not. ==Contemporary use of alternative medicine== {{further|[[List of branches 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 [[#Use of CAM as a complement to conventional medicine|''in conjunction with'']] conventional medicine.<ref name=Barnes /> This is referred to by NCCAM as [[Glossary of alternative medicine terms#Integrative medicine|integrative (or integrated) medicine]] because it "combines treatments from conventional medicine and CAM for which there is some high-quality evidence of safety and effectiveness.<ref name='whatiscam'>U.S. National Center for Complementary and Alternative Medicine. [http://nccam.nih.gov/health/whatiscam/ What is CAM?]</ref> According to [[Andrew Weil|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.<ref name='Weil'> {{cite web|url=http://www.drweil.com/drw/u/id/ART02054 |title=What is Integrative Medicine |accessdate = 2008-03-06 |last=Weil |first=Andrew }}</ref> [[Edzard Ernst]] wrote in the Medical Journal of Australia that ''"about half the general population in developed countries use complementary and alternative medicine (CAM)''."<ref>Ernst E. "Obstacles to research in complementary and alternative medicine." ''Medical Journal of Australia'', 2003; 179 (6): 279-80. PMID 12964907 [http://www.mja.com.au/public/issues/179_06_150903/ern10442_fm-1.html MJA online]</ref> 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.<ref name=Barnes>{{cite paper | url = http://www.cdc.gov/nchs/PRESSROOM/04news/adultsmedicine.htm | author = Barnes, P. M.; Powell-Griner, E.; McFann, K.; Nahin, R. L. | title = Complementary and Alternative Medicine Use Among Adults: United States, 2002 |date=2004 | publisher = [[National Center for Health Statistics]]}}</ref> 25% of people who use CAM do so because a medical professional suggested it.<ref name=CAM_reason>[http://nccam.nih.gov/news/images/camreason_large.gif Reasons people use CAM]</ref> Another study suggests a similar figure of 40%..<ref name= "pmid9605899"> {{cite journal |author=Astin JA |title=Why patients use alternative medicine: results of a national study |journal=JAMA |volume=279 |issue=19 |pages=1548–53 |year=1998 |month=May |pmid=9605899 |doi= |url=http://jama.ama-assn.org/cgi/content/full/279/19/1548}}</ref> 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.<ref name='Ernst_BBC'> {{cite journal|title=The BBC Survey of Complementary Medicine use in the UK|journal=Complementary Therapies in Medicine|date=2000-03|first=E.|last=Ernst|coauthors=A. White|volume=8|issue=1|pages=32-36|id=PMID 10812758 {{doi|10.1016/S0965-2299(00)90833-1}}|url=http://www.ncbi.nlm.nih.gov/pubmed/10812758|format=|accessdate=2008-04-02 }}</ref> 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.<ref>Eisenberg, DM, Davis RB, Ettner SL "Trends in alternative medicine use in the United States 1990-1997." ''JAMA'', 1998; '''280''':1569-1575. PMID 9820257</ref> 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."<ref>[http://www.parliament.the-stationery-office.co.uk/pa/ld199900/ldselect/ldsctech/123/12301.htm House of Lords report on CAM]</ref> In [[Developing country|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.<ref name='WHO_trad'> {{cite web|url=http://www.who.int/mediacentre/factsheets/fs134/en/ |title=Traditional medicine |accessdate = 2008-03-06 |date=2003-05 |work=Fact sheet 134 |publisher=[[World Health Organization]] }}</ref> 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,<ref>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; 146 (4):E11. PMID 14564334</ref> Gonsalkorale 2003,<ref>Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ. "Long term benefits of hypnotherapy for irritable bowel syndrome." ''Gut'', 2003; 52 (11):1623-9. PMID 14570733</ref> and Berga 2003<ref>Berga SL, Marcus MD, Loucks TL. "Recovery of ovarian activity in women with functional hypothalamic amenorrhea who were treated with cognitive behavior therapy." ''Fertility and Sterility'' 2003; 80 (4): 976-981 [http://www.fertstert.org/article/PIIS0015028203011245/abstract Abstract]</ref>) 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,<ref>Kleijnen J, Knipschild P, ter Riet G. "Clinical trials of homoeopathy." ''BMJ'', 1991; 302:316-23. Erratum in: ''BMJ'', 1991; 302:818. PMID 1825800 </ref> and Linde 1997.<ref>Linde K, Clausius N, Ramirez G. "Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials." ''Lancet'', 1997; 350:834-43. Erratum in: Lancet 1998 [[17 January]];351(9097):220. PMID 9310601</ref> ===Medical education=== {{globalize|section}} In the United States, increasing numbers of medical colleges have started offering courses in alternative medicine. For example, in three separate research surveys that surveyed 729 schools (125 medical schools offering an MD degree, 25 medical schools offering a Doctor of [[Osteopathic medicine in the United States|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.<ref>Wetzel MS, Eisenberg DM, Kaptchuk TJ. "Courses involving complementary and alternative medicine at US medical schools." ''JAMA'' 1998; 280 (9):784 -787. PMID 9729989 </ref><ref>Saxon DW, Tunnicliff G, Brokaw JJ, Raess BU. "Status of complementary and alternative medicine in the osteopathic medical school curriculum." ''J Am Osteopath Assoc'' 2004; 104 (3):121-6. PMID 15083987</ref><ref>Fenton MV, Morris DL. "The integration of holistic nursing practices and complementary and alternative modalities into curricula of schools of nursing." ''Altern Ther Health Med,'' 2003; 9 (4):62-7. PMID 12868254</ref> The [[University of Arizona]] College of Medicine offers a program in [[Integrative Medicine]] under the leadership of [[Andrew Weil|Dr. Andrew Weil]] which trains physicians in various branches of alternative medicine which "...neither rejects conventional medicine, nor embraces alternative practices uncritically."<ref>[http://www.ahsc.arizona.edu/opa/horizons/1997/integrate.htm University of Arizona position on Alternative Medicine]</ref> Accredited Naturopathic colleges and universities are also increasing in number and popularity in the U.S.A. In Britain, no conventional medical schools offer courses that teach the clinical practice of alternative medicine.{{Fact|date=December 2007}} However, alternative medicine is taught in several unconventional schools as part of their curriculum.{{Fact|date=December 2007}} Teaching is based mostly on theory and understanding of alternative medicine, with emphasis on being able to communicate with alternative medicine specialists.{{Fact|date=December 2007}} To obtain competence in practicing clinical alternative medicine, qualifications must be obtained from individual medical societies.{{Fact|date=December 2007}} The student must have graduated and be a qualified doctor.{{Fact|date=December 2007}} The [http://www.medical-acupuncture.co.uk/ 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=== [[Image:Botanica.jpg|right|333px|right|thumb|A [[botánica]]s such as this one in [[Jamaica Plain, Massachusetts|Jamaica Plain]], [[Massachusetts]] cater to the [[Latino]] community and sell [[folk medicine]] alongside statues of [[saint]]s, [[candle]]s decorated with [[prayer]]s, and other items.]] A 2002 survey of US adults 18 years and older conducted by the [[National Center for Health Statistics]] ([[Centers for Disease Control|CDC]]) and the [[National Center for Complementary and Alternative Medicine]] indicated:<ref name=Barnes/> * 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 [[Terms and concepts in alternative medicine#Mind-Body Interventions|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%), [[Terms and concepts in alternative medicine#Breathing Meditation|breathing meditation]] (11.6%), [[Meditation (alternative medicine)|meditation]] (7.6%), [[chiropractic medicine]] (7.5%), [[Yoga (alternative medicine)|yoga]] (5.1%), [[Body work (alternative medicine)|body work]] (5.0%), [[Terms and concepts in alternative medicine#Diet-based therapy|diet-based therapy]] (3.5%), [[Terms and concepts in alternative medicine#Progressive Relaxation|progressive relaxation]] (3.0%), [[Orthomolecular medicine|mega-vitamin therapy]] (2.8%) and [[Visualization (cam)|Visualization]] (2.1%) ==Relationship of alternative medicine to public policy== Due to the uncertain nature of various alternative therapies and the wide variety of claims different practitioners make, alternative medicine has been a source of vigorous debate, even over the definition of alternative medicine.<ref>http://www.yourfamilyshealth.com/alternative_medicine/first_do_no_harm/</ref> <ref>http://www.liebertonline.com/doi/abs/10.1089/acm.2006.12.601</ref> Dietary supplements, their ingredients, safety, and claims, are a continual source of controversy.<ref>http://www.cnn.com/HEALTH/alternative/9909/17/supplement.drug.journal/index.html</ref> In some cases, political issues, mainstream medicine and alternative medicine all collide, such as the case where synthetic drugs are legal but the herbal sources of the same active chemical are banned.<ref> http://www.alternet.org/drugreporter/80582/ </ref> In other cases, controversy over mainstream medicine causes questions about the nature of a treatment, such as water fluoridation.<ref> http://www.medicalnewstoday.com/articles/84666.php</ref> Alternative medicine and mainstream medicine debates can also spill over into freedom of religion discussions, such as the right to decline lifesaving treatment for one's children because of religious beliefs.<ref>http://www.cbmh.ca/archive/00000635/01/cbmhbchm_v21n2dickin.pdf</ref> Government regulators continue to attempt to find a regulatory balance.<ref>http://www.thebody.com/content/art32168.html</ref> ==Regulation== [[Jurisdiction]] differs concerning which branches of alternative medicine are legal, which are regulated, and which (if any) are provided by a government-controlled [[Publicly funded health care|health service]] or reimbursed by a [[Health insurance|private health medical insurance company]]. The United Nations Committee on Economic, Social and Cultural Rights - article 34 (''Specific legal obligations'') of the General Comment No. 14 (2000) on '''''The right to the highest attainable standard of health''''' - states that <blockquote> ''Furthermore, obligations to respect 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, unless on an exceptional basis for the treatment of mental illness or the prevention and control of communicable diseases.''<ref>COMMITTEE ON ECONOMIC, SOCIAL AND CULTURAL RIGHTS. General Comment No. 14 (2000) The right to the highest attainable standard of health : . 11/08/2000. E/C.12/2000/4. http://www.unhchr.ch/tbs/doc.nsf/(symbol)/E.C.12.2000.4.en</ref> </blockquote> Specific implementations of this article are, of course, left to member states. A number of alternative medicine advocates disagree with the restrictions of government agencies that approve medical treatments. In the U.S.A. for instance, critics claim that the [[Food and Drug Administration]]'s criteria for experimental evaluation methods 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 recognize that health fraud occurs, and argue that it should be dealt with appropriately when it does, but that these restrictions should not extend to what they view as legitimate health care products. In New Zealand alternative medicine products are classified as food products, so there is no regulation or safety standards in place. <ref>http://www.nzherald.co.nz/topic/story.cfm?c_id=247&objectid=10449883</ref> The production of modern pharmaceuticals is strictly regulated to ensure that medicines contain a standardized quantity of active ingredients and are free from contamination. Alternative medicine products are not subject to the same governmental quality control standards, and consistency between doses can vary. This leads to uncertainty in the chemical content and biological activity of individual doses. This lack of oversight means that alternative health products are vulnerable to adulteration or contamination <ref name='Agin'>{{cite book | last = Agin | first = Dan | title = Junk Science: how politicians, corporations, and other hucksters betray us | publisher = Thomas Dunne Books | date = 2006-10-03 | pages = Ch. 8 | isbn = 978-0312352417}}</ref> This problem is magnified by international commerce, since different countries have different types degrees of regulation. This can make it difficult for consumers to properly evaluate risks and qualities of given medicines. ==Alternative vs. evidence-based medicine== Some scientists reject the use of the classification of any therapy as 'alternative medicine' on the grounds that "[t]here is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work."<ref name="Angell">[http://content.nejm.org/cgi/content/extract/339/12/839 Alternative medicine--the risks of untested and unregulated remedies.] Angell M, Kassirer JP. ''N Engl J Med'' 1998;339:839.</ref> 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. Prominent proponents of this position are George D. Lundberg, former editor of the [[Journal of the American Medical Association]] (JAMA), and Phil B. Fontanarosa, Senior Editor of JAMA,"<ref name="Fontanarosa">"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.[http://jama.ama-assn.org/cgi/content/extract/280/18/1618 Alternative medicine meets science.] Fontanarosa P.B., and Lundberg G.D. ''JAMA''. 1998; 280: 1618-1619.</ref>[[Richard Dawkins]], Professor of the Public Understanding of Science at [[University of Oxford|Oxford]],<ref name="simonyi">He 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 [[Blind experiment|double-blind trials]], it ceases to be alternative. It simply...becomes medicine.[http://www.simonyi.ox.ac.uk/index.shtml Simonyi Professorship web site]</ref><ref name="Holloway">[http://books.guardian.co.uk/reviews/scienceandnature/0,6121,894941,00.html A callous world.] Richard Holloway. Book review Richard Dawkins ''A Devil's Chaplain''. The Guardian, [[February 15]] [[2003]].</ref><ref>There is no alternative medicine. There is only medicine that works and medicine that doesn't work.{{cite book | last = Dawkins | first = Richard | author = Richard Dawkins | year = 003 | title = A Devil's Chaplain | publisher = Weidenfeld & Nicolson}}</ref>, and [[Stephen Barrett]], founder and operator of [[Quackwatch]], an alternative medicine watchdog site.<ref name="Quackwatch">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. {{cite news|first=Stephen|last=Barrett|title=Be Wary of "Alternative" Health Methods|url=http://www.quackwatch.org/01QuackeryRelatedTopics/altwary.html|work=[[Stephen Barrett|Stephen Barrett, M.D.]]|publisher=[[Quackwatch]]|date=[[February 10]] [[2004]] |accessdate = 2008-03-03|quote=}}</ref> 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.<ref>[http://www.compmed.umm.edu/Cochrane/index.html The Cochrane Collaboration Complementary Medicine Field.] Retrieved [[5 August]] [[2006]].</ref><ref>[http://www.healthwatch-uk.org/awardwinners/edzardernst.html The HealthWatch Award 2005:] Prof. Edzard Ernst, ''Complementary medicine: the good the bad and the ugly.'' Retrieved [[5 August]] [[2006]]</ref><ref>"Complementary medicine is diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy or by diversifying the conceptual frameworks of medicine." Ernst et al ''British General Practitioner'' 1995; 45:506.</ref> [[Oxford University Press]] publishes a peer-reviewed journal entitled ''Evidence-based Complementary and Alternative Medicine'' (eCAM).<ref>''[http://www.oxfordjournals.org/our_journals/ecam/about.html Evidence-based Complementary and Alternative Medicine]''</ref> ===Testing of efficacy=== 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 review|peer-reviewed]] experiments, or how many produced results supporting alternative medicine or parts thereof. They {{who?}} 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 trial]]s; in contrast, conventional drugs reach the market only after such trials have proved their efficacy. Willful misrepresentation of the research status of an alternative remedy or therapy qualifies as [[pseudoscience]]. Several countries including the USA have laws regarding the claims that alternative therapies can make <ref> http://www.cfsan.fda.gov/~dms/hclaims.html </ref>. Some {{who?}} 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 review|peer-reviewed]] medical journals.<ref>Larkin M. "Whose article is it anyway?" ''Lancet'', 1999; '''354''':136. [http://www.thelancet.com/journal/vol354/iss9173/full/llan.354.9173.news.3708.1 Editorial]</ref><ref>Flanagin A, Carey LA, Fontanarosa PB. "Prevalence of articles with honorary authors and ghost authors in peer-reviewed medical journals." ''JAMA'', 1998; '''280'''(3):222-4. [http://jama.ama-assn.org/cgi/content/full/280/3/222 Full text]</ref> 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 $1 billion on such research since 1992.<ref name='nccam_$'> {{cite web|url=http://nccam.nih.gov/about/appropriations/ |title=NCCAM Funding: Appropriations History |accessdate=2008-04-02 |date=2008-01-09 |publisher=[[NCCAM]] }}</ref> The German Federal Institute for Drugs and Medical Devices [[Commission E]] has studied many herbal remedies for efficacy.<ref>[http://www.csicop.org/si/2003-09/alternative-medicine.html CSICOP.org article on alternative medicine]</ref> Some{{who?}} 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.<ref>James Alcock PhD, ''Alternative Medicine and the Psychology of Belief'', The Scientific Review of Alternative Medicine, Fall/Winter 1999 Volume 3 ~ Number 2. [http://www.quackwatch.org/01QuackeryRelatedTopics/altpsych.html available online]</ref> 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. ===Testing of safety=== ====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, insulin potentiation therapy. Some herbal remedies can cause dangerous interactions with chemotherapy drugs, radiation therapy or anesthetics during surgery, among other problems.<ref name=CassilethDeng2004/> An anecdotal 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.<ref name='BenHills'> {{cite web|url=http://benhills.com/articles/articles/MED06a.html |title=Fake healers. Why Australia’s $1 billion-a-year alternative medicine industry is ineffective and out of control. |accessdate = 2008-03-06 |last=Hills |first=Ben |work=Medical Mayhem }}</ref> 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''".<ref name='ABC_Maclennan'>{{cite news | first=Norman | last=Swan | coauthors= | title=Alternative Medicine - Part Three | date=2000-10-02 | publisher=ABC Radio National | url =http://www.abc.net.au/rn/talks/8.30/helthrpt/stories/s195441.htm | work =The Health Report | pages = | accessdate = 2008-03-06 | language = }}</ref> ====Side-effects==== Conventional treatments are subjected to testing for undesired [[Adverse effect (medicine)|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. ====Treatment delay==== 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.{{Fact|date=July 2008}} For this reason, critics contend 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.<ref name='Lilienfeld_2002'> {{cite journal|title=Our Raison d’Être|journal=The Scientific Review of Mental Health Practice|date=2002|first=Scott O.|last=Lilienfeld|coauthors=|volume=1|issue=1|pages=|id= |url=http://www.srmhp.org/0101/raison-detre.html|format=|accessdate = 2008-01-28 }}</ref> ==Notable cases where alternative therapies are adopted by mainstream medicine== Secondary metabolites in thousands of plants are regularly tested by drug companies in search of new therapies. [[Atropa belladonna|Deadly nightshade]] contains atropine, a potent (and dangerous) substance useful in the treatment of a number of disorders, including as an antidote for nerve agents. Chemicals isolated from [[Foxglove]] are used in the treatment of epilepsy; [[Opiates]] derived from poppies are highly effective painkillers, and [[THC]], found in [[cannabis sativa]] is used to counter the effects of chemotherapy. Chemotherapy itself owes some of its constituent drugs to [[Chemotherapy#Plant alkaloids and terpenoids (L01C)|plant alkaloids]]. These name just a few of the most prominent classes of drugs derived from natural sources which have been adopted as treatments by alternative therapies. In the US, many medical insurers and some hospitals integrate chiropractic and massage therapy as adjuncts to mainstream medical care.{{fact}} ==Notable situations where alternative therapies have been misused or classical therapies have petered out== There have been a number of high-profile cases where bad faith on the part of [[Quackery|quacks]] and unethical businessmen, or poorly informed salespeople have harmed people under the guise of helping them.{{cn}} As of 2008, [[Mandrake (plant)|mandrake]], a classical herb with a number of purported mystical properties has not yielded any purported medical benefit.{{cn}} Likewise [[amanita muscaria]], a mushroom used for its psychoactive properties and purported mystical properties for millenia has been shown to contain ibotenic acid, a brain lesioning agent.{{cn}} ==Appeal of alternative medicine== A study published in 1998 <ref>{{cite journal |author=Astin JA |title=Why patients use alternative medicine: results of a national study |journal=JAMA |volume=279 |issue=19 |pages=1548–53 |year=1998 |month=May |pmid=9605899 |doi= |url=http://jama.ama-assn.org/cgi/content/full/279/19/1548|accessdate=2008-07-08}}</ref> indicates that a majority of alternative medicine use was in conjunction with standard medical treatments. Approximately 4.4 percent of those studied used alternative medicine as a [[Medicine#Criticism|replacement]] for conventional medicine. The research found that those who used alternative medicine tended to have higher education or report poorer health status. Dissatisfaction with conventional medicine was not a meaningful factor in the choice, but rather the majority of alternative medicine users appear to be doing so largely because "they find these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life." In particular, subjects reported a holistic orientation to health, a transformational experience that changed their worldview, identification with a number of groups committed to environmentalism, feminism, psychology, and/or spirituality and personal growth, or that they were suffering from a variety of common and minor ailments - notably anxiety, back problems, and chronic pain. Authors have speculated on the socio-cultural and psychological reasons for the appeal of alternative medicines among that minority whose use them ''in lieu'' of conventional medicine. There are several socio-cultural reasons for the interest in these treatments centered around the low level of scientific literacy among the public at large and a concomitant increase in [[antiscience|antiscientific]] attitudes and [[new age]] [[mysticism]].<ref name=Beyerstein /> Related to this are vigorous [[advertising|marketing]]<ref name=Weber>{{cite journal |author=Weber DO |title=Complementary and alternative medicine. Considering the alternatives |journal=Physician Exec |volume=24 |issue=6 |pages=6–14 |year=1998 |pmid=10351720 |doi= |url=}}</ref> of extravagant claims by the alternative medical community combined with inadequate media scrutiny and attacks on critics.<ref name=Beyerstein>{{cite journal|author=Beyerstein BL|url=http://www.sram.org/0302/bias.html|title=Psychology and 'Alternative Medicine' Social and Judgmental Biases That Make Inert Treatments Seem to Work|journal=The Scientific Review of Alternative Medicine|year=1999|Volume=3|issue=2|accessdate=2008-07-07}}</ref><ref name=Beyerstein2>{{cite journal |author=Beyerstein BL |title=Alternative medicine and common errors of reasoning |journal=Acad Med |volume=76 |issue=3 |pages=230–7 |year=2001 |month=March |pmid=11242572 |doi= |url=http://www.academicmedicine.org/pt/re/acmed/fulltext.00001888-200103000-00009.htm;jsessionid=L2hhLh3cFDFv4nKTz24g9LG2V4QnvHwKzn5QSdG0sKPGrd3yxp2L!536197444!181195628!8091!-1?nav=reference | accessdate=2008-07-16}}</ref> There is also an increase in [[conspiracy theory|conspiracy theories]] towards conventional medicine and pharmaceutical companies, [[Health freedom movement|mistrust]] of traditional authority figures, such as the physician, and a dislike of the current delivery methods of scientific biomedicine, all of which have lead patients to seek out alternative medicine to treat a variety of ailments.<ref name=Beyerstein2/> Many patients lack access to contemporary medicine, due to a lack of private or public [[health insurance]], which lead them to seek out lower-cost alternative medicine.<ref>{{cite journal |author=Barnes PM, Powell-Griner E, McFann K, Nahin RL |title=Complementary and alternative medicine use among adults: United States, 2002 |journal=Adv Data |volume= |issue=343 |pages=1–19 |year=2004 |month=May |pmid=15188733 |doi= |url=http://www.cdc.gov/nchs/data/ad/ad343.pdf}}</ref> Some medical doctors are also aggressively marketing alternative medicine to profit from this market.<ref name=Weber/> Non-medical entrepreneurs who prey upon individuals by misusing the appeal of alternative therapies are referred to as [[Quackery|quacks]].{{Fact|date=July 2008}} In addition to the social-cultural underpinnings of the popularity of alternative medicine, there are several psychological issues that are critical to its growth. One of the most critical is the [[placebo effect]], which is a well-established observation in medicine.<ref>{{cite journal |author=van Deventer MO |title=Meta-placebo: Do doctors have to lie about giving a fake treatment? |journal=Med. Hypotheses |volume= |issue= |pages= |year=2008 |month=May |pmid=18485613 |doi=10.1016/j.mehy.2008.03.040 |url=}}</ref> Related to it are similar psychological effects such as the will to believe<ref name=Beyerstein />, [[cognitive bias]]es that help maintain self-esteem and promote harmonious social functioning<ref name=Beyerstein />, and [[post hoc, ergo propter hoc]] fallacy.<ref name=Beyerstein /> Patients can also 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, leaving individuals open to the idea of [[Alternative cancer treatments|alternatives]]. 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. In all of these cases, patients may be seeking out alternative treatments to avoid the adverse effects of conventional treatments.<ref name=Beyerstein/><ref name=Beyerstein2/> ==References== {{reflist|2}} ==Further reading== ===Dictionary definitions=== * [http://cancerweb.ncl.ac.uk/cgi-bin/omd?query=Complementary+medicine&action=Search+OMD Complementary medicine] ===World Health Organization publication=== * [http://www.who.int/bookorders/anglais/detart1.jsp?sesslan=1&codlan=1&codcol=15&codcch=614 WHO Global Atlas of Traditional, Complementary and Alternative Medicine] ===Journals dedicated to alternative medicine research=== * Alternative therapies in health and medicine. Aliso Viejo, CA : InnoVision Communications, c1995- NLM ID: [http://locatorplus.gov/cgi-bin/Pwebrecon.cgi?DB=local&v2=1&ti=1,1&Search_Arg=9502013&Search_Code=0359&CNT=20&SID=1 9502013] * Alternative medicine review : a journal of clinical therapeutic. Sandpoint, Idaho : Thorne Research, Inc., c1996- NLM ID: [http://locatorplus.gov/cgi-bin/Pwebrecon.cgi?DB=local&v2=1&ti=1,1&Search_Arg=9705340&Search_Code=0359&CNT=20&SID=1 9705340] * [http://www.biomedcentral.com/1472-6882 BMC complementary and alternative medicine]. London : BioMed Central, 2001- NLM ID: [http://locatorplus.gov/cgi-bin/Pwebrecon.cgi?DB=local&v2=1&ti=1,1&Search_Arg=101088661&Search_Code=0359&CNT=20&SID=1 101088661] * Complementary therapies in medicine. Edinburgh ; New York : Churchill Livingstone, c1993- NLM ID: [http://locatorplus.gov/cgi-bin/Pwebrecon.cgi?DB=local&v2=1&ti=1,1&Search_Arg=9308777&Search_Code=0359&CNT=20&SID=1 9308777] * [http://ecam.oxfordjournals.org/ Evidence based complementary and alternative medicine] * [http://www.openmindjournals.com/EBInteg.html Evidence Based journal of Integrative medicine] * [http://content.karger.com/ProdukteDB/produkte.asp?Aktion=JournalHome&ProduktNr=224242 Forschende Komplementärmedizin / Research in Complementary Medicine] * [http://www.jintmed.com/ Journal of Integrative medicine.] * [http://www.liebertpub.com/publication.aspx?pub_id=26 Journal for Alternative and Complementary Medicine: research on paradigm, practice, and policy.] New York, NY : Mary Ann Liebert, Inc., c1995-] * [http://www.sram.org/index.html Scientific Review of Alternative Medicine (SRAM)] ===Further reading=== * {{citation | last = Bausell | first = R. Barker | year = 2007 | title = Snake Oil Science: The Truth About Complementary and Alternative Medicine |publisher = [[Oxford University Press]] |ID = ISBN 978-0-19-531368-0 }} * Benedetti F, Maggi G, Lopiano L. "Open Versus Hidden Medical Treatments: The Patient's Knowledge About a Therapy Affects the Therapy Outcome." ''Prevention & Treatment'', 2003; '''6'''(1), [http://journals.apa.org/prevention/volume6/pre0060001a.html APA online] * Diamond, J. ''Snake Oil and Other Preoccupations'', 2001, ISBN 0-09-942833-4 , foreword by [[Richard Dawkins]] reprinted in Dawkins, R., ''A Devil's Chaplain'', 2003, ISBN 0-7538-1750-0 . * Downing AM, Hunter DG. "Validating clinical reasoning: a question of perspective, but whose perspective?" ''Man Ther'', 2003; '''8'''(2): 117-9. PMID 12890440 [http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WN0-487KJXH-3&_coverDate=05%2F31%2F2003&_alid=110095405&_rdoc=1&_fmt=&_orig=search&_qd=1&_cdi=6948&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=8da5eb9e5359691e31c6cee489724da8 Manual Therapy Online] * Eisenberg DM. "Advising patients who seek alternative medical therapies." ''Ann Intern Med'' 1997; '''127''':61-69. PMID 9214254 * Goldberg, Burton. Anderson, John & Trivieri, Larry “Alternative Medicine: The Definitive Guide”, Ten Speed Press, 2002 ISBN 978-1587611414 * Gunn IP. "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 '''66'''(6):575-82. Review. PMID 10488264 * Hand, Wayland D. 1980 "Folk Magical Medicine and Symbolism in the West", in ''Magical Medicine'', Berkeley: University of California Press, pp. 305-319. * [[Ivan Illich|Illich, Ivan]]. ''Limits to Medicine''. ''Medical Nemesis: The expropriation of Health''. Penguin Books, 1976. * Feinstein, D., & [[Donna Eden| Eden D.]] Six Pillars of Energy Medicine: Clinical Strengths of a Complementary Paradigm, Alternative Therapies in Health and Medicine 2008, 14(1), 44-54. * Lazarou, J. Pomeranz, BH. Corey, PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies, J of the American Medical Association 1998, 279, 1200-1205. * [[Mayo Clinic]]. ''Mayo Clinic Book of Alternative Medicine: The New Approach to Using the Best of Natural Therapies and Conventional Medicine'', Parsippany, NJ: Time Inc Home Entertainment, 2007, ISBN 978-1933405926. * Murray, Michael, & Joseph Pizzorno. ''Encyclopedia of Natural Medicine'', New York: Three Rivers Press, 1997 (second edition), ISBN 978-0761511571. * Ninivaggi, F. J., ''An Elementary Textbook of Ayurveda: Medicine with a Six Thousand Year Old Tradition'', International Universities/Psychosocial Press, Madison, CT, 2001. * Ninivaggi, F. J., "Ayurveda: A Comprehensive Guide to Traditional Indian Medidine for the West", Praeger Press/Greenwood, Westport, CT, 2008. * [[Candace Pert|Pert, Candace B.]], ''Molecules of Emotion: Why You Feel the Way You Feel'', Scribners, 1997, ISBN 0-684-84634-9 * Phillips Stevens Jr. Nov./Dec. 2001 "Magical Thinking in Complementary and Alternative Medicine", ''Skeptical Inquirer Magazine'', Nov.Dec 2001 * Planer, Felix E. 1988 ''Superstition'', Revised ed. Buffalo, New York: Prometheus Books * Rosenfeld, Anna, ''Where Do Americans Go for Healthcare?'', Case Western Reserve University, Cleveland, Ohio, USA. * Tonelli MR. "The limits of evidence-based medicine." ''Respir Care'', 2001; '''46'''(12): 1435-40; discussion 1440-1. Review. PMID 11728302 [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11863470 PMID: 11863470] * [[Kevin Trudeau|Trudeau, Kevin]], ''[[Natural Cures "They" Don't Want You to Know About]]'', Alliance Publishing Group, ISBN 0-9755995-9-3; Mass Market Edition, 2007. * Trudeau, Kevin, ''More Natural "Cures" Revealed'', Alliance Publishing Group, 2006, ISBN 0-9755995-4-2. * Wisneski, Leonard A. and Lucy Anderson, ''The Scientific Basis of Integrative Medicine'', CRC Press, 2005. ISBN 0-8493-2081-X. * Zalewski Z. "Importance of Philosophy of Science to the History of Medical Thinking." ''CMJ'' 1999; '''40''': 8-13. [http://web.archive.org/web/20040206092548/http://www.bsb.mefst.hr/cmj/1999/4001/400102.htm CMJ online] ==External links== * [http://nccam.nih.gov/ The National Center for Complementary and Alternative Medicine] - US National Institutes of Health * [http://www.umm.edu/altmed/ Complementary and Alternative Medicine Index](from the [[University of Maryland, Baltimore|University of Maryland]] Medical Center) - Comprehensive guide covering conditions and treatments * [http://www.altcancerinfo.org/ Alternative Cancer Information ] - Hub of Peer-Reviewed literature on Prevention of Metastasis for Patients Diagnosed with Cancer * [http://www.fammed.wisc.edu/integrative/modules Integrative Medicine Podcasts and Handouts ] - Teaching modules with podcasts and handouts for patients, clinicians, residents and medical students from the [http://www.fammed.wisc.edu/integrative University of Wisconsin Integrative Medicine Program ]. * Web pages for [http://www.open2.net/alternativemedicine/index.html new BBC/Open University television series "Alternative Medicine"] that examines the evidence scientifically. * [http://web.archive.org/web/20070113002817/http://www.bl.uk/collections/business/compmein.html The British Library - finding information on the complementary medicines industry] * [http://www.mayoclinic.com/health/alternative-medicine/PN00001 "Complementary and alternative medicine: What is it?"] from the [[Mayo Clinic]] ===Criticism=== * [http://www.pbs.org/saf/1210/index.html A Different Way to Heal?] and [http://www.pbs.org/saf/1210/video/watchonline.htm Videos] - [[PBS]], [[Scientific American Frontiers]] Web Feature * [http://www.theness.com/articles.asp?id=1 What is Complementary and Alternative Medicine?] - [[Steven Novella]], MD * [http://www.skepdic.com/althelth.html "Alternative" health practice] - [[Skeptic's Dictionary]] * [http://www.pbs.org/kcet/closertotruth/explore/show_11.html Who Gets to Validate Alternative Medicine] - PBS article * [http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1476381&blobtype=pdf The case against alternative medicine] - Moses Milstein, DVM (Can Vet J Volume 41, October 2000) ===Advocacy=== * [http://www.herbological.com/images/downloads/HH2.pdf Medline and the mainstream manufacture of misinformation] Critique of the criticisms of alternative medicine <!-- Categorization --> [[Category:Alternative medicine|*0]] [[Category:New Thought movement]] [[ar:طب بديل]] [[bg:Алтернативна медицина]] [[da:Alternativ behandling]] [[de:Alternativmedizin]] [[et:Alternatiivmeditsiin]] [[el:Εναλλακτική ιατρική]] [[es:Medicina alternativa]] [[eo:Alternativa medicino]] [[fr:Médecine non conventionnelle]] [[hr:Alternativna medicina]] [[it:Medicina alternativa]] [[he:רפואה אלטרנטיבית]] [[hu:Alternatív gyógymód]] [[nl:Alternatieve geneeswijzen]] [[ja:代替医療]] [[no:Alternativ medisin]] [[pl:Medycyna niekonwencjonalna]] [[pt:Medicina alternativa]] [[ro:Terapii alternative]] [[ru:Нетрадиционная медицина]] [[simple:Alternative medicine]] [[sl:Zdravilstvo]] [[sr:Алтернативна медицина]] [[fi:Uskomuslääkintä]] [[sv:Alternativmedicin]] [[tr:Alternatif tıp]] [[uk:Альтернативна медицина]]