Talk:Alternative medicine

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Contents

[edit] Website survey

I found the following content that was hidden in the text and needs to find a proper "home" in the article:

  • A survey of websites providing information about breast cancer found that about one in twenty such sites contained inaccurate information, and that CAM websites were 15 times more likely to contain inaccuracies.[1][2]

-- Brangifer (talk) 13:52, 21 October 2009 (UTC)

[edit] "Variouis bodies of evidence" & Other Issues

from the first paragraph: "Alternative medicine is often based on the belief that a particular health regimen has efficacious effects even while there exists various bodies of evidence to contradict such a belief under the rigorous standards of evidence based medicine."

It is unlikely that there exist large or substantial bodies of evidence to CONTRADICT such beliefs. There may be no published evidence to SUPPORT such beliefs, but generally there is little in the way of evidence to "contradict" or disprove.

Also: "the rigorous standards of evidence based medicine" is a boast, which implies that those standards are superior to one's own personal experience with any health or medical practice. In truth, those rigorous standards ARE superior, but not for individuals and their personal practices. They are superior for representing what happens on average across a population; on that score they win, hands down. But they are of limited use in predicting what will happen with a given individual, and they are of even more limited use in composing a personal plan of health care. Unless this distinction is made clear, then the passage as it stands in the opening paragraph is misleading.

Further, in the section "Relation to Evidence-Based Medicine", we find this: "The IOM found that in a study of 160 Cochrane systematic reviews of mainstream techniques, 20% were ineffective and 21% had insufficient evidence.[16]"

Reference #16 is to this book: http://www.nap.edu/catalog.php?record_id=11182#toc Complementary and Alternative Medicine in the United States [authored by the NAS' Institute of Medicine]

I'm trying to find a correspondence between the assertion above, from the article, and what I am reading in that book.

For example, here's a snippet from pages 135-6, describing the Cochrane and other reviews:

http://books.nap.edu/openbook.php?record_id=11182&page=135 "The largest number of treatments described in the reviews were classified as insufficient evidence of an effect (n = 82; 56.6 percent), followed by positive effect (n = 36; 24.8 percent) and possibly positive effect (n = 18; 12.4 percent). Only one review described a treatment that was classified as harmful (Caraballoso et al., 2003) (see Table 5-2). The reviews describing treatments classified as having positive effects are listed in Table 5-3. Although this exercise suggests that there is strong evidence for the effectiveness of some CAM therapies, much more research is required, as demonstrated by the large proportion of reviews of treatments classified as insufficient evidence of an effect. The fact that only one of the treatments in the Cochrane reviews fell into the harmful effect category suggests that clinical trials of CAM therapies have posed little risk to the participants. Some interesting findings emerge when the results of the evaluation of Cochrane reviews of CAM therapies are compared with the results of the earlier study (Ezzo et al., 2001) evaluating Cochrane reviews of conventional therapies: insufficient evidence of an effect was determined for a larger proportion of CAM therapies (56.6 percent for CAM versus 21.3 percent for conventional medicine), CAM therapies were less likely to be classified as harmful (8.1 percent for conventional medicine versus 0.69 percent for CAM) or as having no effect (20.0 percent for conventional medicine versus 4.8 percent for CAM), and classification of the therapies as having positive or a possibly positive effect was approximately equal for CAM and conventional medicine therapies (41.3 percent for conventional medicine versus 38.4 percent for CAM)." END OF QUOTE

Perhaps the article could reflect in more detail, and more accurately, what the Institute of Medicine said. —Preceding unsigned comment added by Alan2012 (talk • contribs) 15:28, 30 October 2009 (UTC)

[edit] $2.5 billion spent, no alternative cures found

(This subsection is from the archives and is copied here as it deals with the claims of efficacy made above.) - Brangifer (talk) 06:42, 31 October 2009 (UTC)

This news (which isn't news to skeptics) is very significant and is published by a very reliable news source:

$2.5 billion spent, no alternative cures found. Big, government-funded studies show most work no better than placebos
BETHESDA, Md. - Ten years ago the government set out to test herbal and other alternative health remedies to find the ones that work. After spending $2.5 billion, the disappointing answer seems to be that almost none of them do.[3]

These paragraphs say it all:

"There's been a deliberate policy of never saying something doesn't work. It's as though you can only speak in one direction," and say a different version or dose might give different results, said Dr. Stephen Barrett, a retired physician who runs Quackwatch, a web site on medical scams.
Critics also say the federal center's research agenda is shaped by an advisory board loaded with alternative medicine practitioners. They account for at least nine of the board's 18 members, as required by its government charter. Many studies they approve for funding are done by alternative therapy providers; grants have gone to board members, too.
"It's the fox guarding the chicken coop," said Dr. Joseph Jacobs, who headed the Office of Alternative Medicine, a smaller federal agency that preceded the center's creation. "This is not science, it's ideology on the part of the advocates."[3]

Now how and where should this be included? -- Brangifer (talk) 05:30, 11 June 2009 (UTC)

In passing, if/when this material is added to the article, it should be the study that is cited primarily, not the news coverage of it. The news coverage will be useful too, especially since it will likely cover important things like reactions to the study, but the study is the real deal. I mention this because the text above implies that MSNBC is "the source", when it's really reporting on "the source". Cheers, --PLUMBAGO 07:14, 11 June 2009 (UTC)
Quite right. Both the original source and the news reports should be used, since using the reactions to the report are what prevents this from being OR. The reaction of Dr. Joseph Jacobs is rather interesting, since he was one of those responsible for creating the atmosphere in which the situation could exist in the first place, but he seems to have realized that it ended up being something different, and that the critics had been right all along. Barrett has been writing about this abuse for years, once again demonstrating him as a RS for commentary on such matters. -- Brangifer (talk) 13:53, 11 June 2009 (UTC)

Just because "government spends X and no alternative cures found," doesn't mean there are no alternative cures, it just means that "government spent X and no alternative cures found," ergo, this news article really belongs in "inefficient government programs" or something similar, not in "alternative medicine."71.201.83.52 (talk) 07:59, 6 September 2009 (UTC)

That's not actually what the source says, though. The source says that these claims have been made in various alternative medical outlets for decades. When they were actually systematically tested, none have turned out to be valid. In the US, most systematic medical research is funded by the government, but the source clearly concerns the lack of demonstrable efficacy of the tested remedies. MastCell Talk 23:40, 6 September 2009 (UTC)

It is difficult to see how this sensationalistic news item (which itself grossly misrepresents the actual published science) can be considered in any way a counterweight to the conclusions of authoritative reviewers writing at the books.nap.edu link immediately above, concluding that "classification of the therapies as having positive or a possibly positive effect are approximately equal for CAM and conventional medicine therapies (41.3 percent for conventional medicine versus 38.4 percent for CAM". But then -- hey! -- this is Wikipedia, which is dominated by intellectually dishonest, self-styled "skeptics". —Preceding unsigned comment added by Alan2012 (talk • contribs) 13:13, 8 December 2009 (UTC)

[edit] Definition of "Integrative" (vs. Complementary/Alt)

It might be helpful to read some of the literature on the subject.

......................

http://www.amazon.com/Integrative-Medicine-David-Rakel/dp/0721692885

Integrative Medicine (Hardcover) ~ David Rakel (Editor)

Product Description

This groundbreaking text provides the first definitive clinical reference for the rapidly growing field of integrative medicine. Using a clinical, disease-oriented approach, Integrative Medicine offers practical guidance for safely and effectively integrating complementary and alternative therapies into regular primary care practice. Drawing on available scientific evidence and the author’s first-hand experience, it covers therapies such as botanicals, supplements, mind-body, lifestyle choices, nutrition, exercise, spirituality, and more.

From the Publisher

A discussion of the philosophy of integrative medicine is followed by sections that specifically define the pharmaceutical treatments as well as the nutritional, mind-body, supplemental, and botanical treatments for common disease states. An emphasis on disease prevention helps the reader direct patients toward health maintenance and wellness. An invaluable Tools for Your Practice section offers advice on topics such as Exercises for Back Pain, Recommending Meditation, and The Elimination Diet.

About the Author

David Rakel, MD, Assistant Professor, Department of Family Medicine; Medical Director, Integrative Medicine Program, University of Wisconsin Medical School, Madison, WI

Product Details

  • Hardcover: 800 pages
  • Publisher: Saunders (June 15, 2002)
  • Language: English
  • ISBN-10: 0721692885
  • ISBN-13: 978-0721692883

http://www.amazon.com/Integrative-Medicine-Benjamin-Kligler/dp/007140239X

Integrative Medicine (Hardcover) ~ Benjamin Kligler (Author), Roberta Lee (Author)

The number of individuals turning to unconventional medical therapies continues to increase each year. Now, more than ever, today's medical and health care professionals require the knowledge and skills to successfully bridge the gap between conventional therapies and complementary/alternative medicine (CAM).

McGraw-Hill now introduces the latest compilation of integrative approaches to many conditions and syndromes. This work reflects the authors' synthesis of many years of clinical experience and the theories underlying the many alternative modalities and traditional medical practices. Clinicians will find this text a highly effective resource.

Built on the evidence-based expertise developed at New York City's Beth Israel Center for Health & Healing -- the largest integrative medicine practice in the United States -- INTEGRATIVE MEDICINE uniquely combines a body systems approach with practical case studies, to clearly illustrate how clinicians can successfully incorporate conventional and CAM therapies into their daily practice.

Earn CME credits! Also available: Kligler/Lee: Integrative Medicine CME Study Guide (ISBN 0-07-140238-1) Features 1000 multiple-choice Q&As keyed to the Integrative Medicine text AND includes a bonus 100-question test for CME credit from Innovisions!

Product Details

  • Hardcover: 700 pages
  • Publisher: McGraw-Hill Professional; 1 edition (April 2, 2004)
  • Language: English
  • ISBN-10: 007140239X
  • ISBN-13: 978-0071402392

http://www.amazon.com/Textbook-Integrative-Mental-Health-Care/dp/1588902994

Textbook of Integrative Mental Health Care (Hardcover) ~ James Lake (Author)

Complete coverage of the conceptual foundations of integrative mental health care allows the practitioner to gain a firm understanding of the philosophy and clinical methodology of integrative medicine. The textbook also describes evidence-based paradigms that enable the practitioner to develop assessment techniques and individualized treatment plans that address the unique needs of each patient.

This textbook will help psychiatrists, psychologists, and mental health care professionals develop safe and effective integrative approaches for the evaluation and treatment of emotional and mental problems.

About the Author

James H. Lake , M.D. Clinical Assistant Professor, Dept. of Psychiatry and Behavioral Sciences, Stanford University Hospital; Chairperson, American Psychiatric Association Caucus on Complementary, Alternative and Integrative Approaches in Mental Healthcare; Board-certified Psychiatrist in Private Practice, Monterey, CA, USA (Author)

Product Details

  • Hardcover: 400 pages
  • Publisher: Thieme New York; 1 edition (October 2, 2006)
  • Language: English
  • ISBN-10: 1588902994
  • ISBN-13: 978-1588902993

SNIPPETS ONLY (full text is at the URL):

http://ecam.oxfordjournals.org/cgi/content/full/nem104

eCAM Advance Access originally published online on September 26, 2007

eCAM 2008 5(4):409-413; doi:10.1093/ecam/nem104

Commentary

Divining integrative medicine

Steven H. Stumpf1, Simon J. Shapiro2 and Mary L. Hardy3

1Stumpf Consulting, Calabasas, 2BWell Clinic, Santa Monica and 3Simms-Mann Health and Wellness Program, Venice Family Clinic, Los Angeles, CA, USA

Keywords: Complementary medicine – Integrative Medicine – Traditional Chinese Medicine

Introduction

Medicine, like scientific inquiry, is necessarily dynamic. As our understanding of health and disease continues to grow, medicine as we know it will change. Alternative therapies and perspectives that are coming to light will be illuminated by modern methods of inquiry applied to pre-modern healing systems. At the same time, patient demands and cultural concerns about health and healing influence the expansion of conventional medicine. The integrative medicine movement is a reflection of how these issues have tumbled together creating a medical field that is at once undefined and almost indescribable.

[snip]

what comprises integrative medicine exactly? It is not complementary and alternative medicine (CAM). (5) It is a phenomenon that has defined itself, with requirements for membership self-determined by each practitioner who chooses to promote her practice as integrative medicine.

[snip]

Integrative medicine has gone through several generations of ‘definitional’ changes. The greatest change is from CAM to integrative. One of the major—and earliest (1999)—CAM textbooks was Essentials of CAM, edited by Wayne Jonas and Jeffery Levin (6). Although the title still reflected the model of CAM, the introduction of evidence-based medicine was prominent. One of the introductory chapters is ‘How to Practice Evidence-Based CAM.’ Two more recent textbooks, Integrative Medicine by Benjamin Kligler and Roberta Lee (7), and Integrative Medicine by David Rakel (8) both prefer the term integrative to CAM. The preface in Kligler asserts this new medicine is ‘renewing the soul of [conventional] medicine’. The foreword to Rakel, authored by Andrew Weil, draws a clear distinction between CAM and integrative medicine. Weil distinguishes CAM as modality-focused, especially regarding treatments not taught in conventional schools of medicine. He also distinguishes integrative medicine as evidence-based. Rakel's integrative approach puts a ‘holistic understanding of the patient’ at the center of the interaction (8). This emphasis on the patient continues in the Kligler and Lee textbook both in the forward, also written by Andrew Weil, and in the preface. These similarities are not surprising as all three authors trained with Andrew Weil.

The most important textbook written from a ‘CAM’ perspective is the Textbook of Natural Medicine edited by Pizzorno and Murray (9), both naturopathic physicians. They do not present the materials as an integrative medicine textbook even though many naturopaths consider themselves the prototype integrative physician. It is presented as a science-based textbook of natural medicine, in effect, an evidence-based practice model. Interestingly, the first chapter is ‘Eastern Origins of Integrative Medicine and Modern Applications’. The first edition was written in 1993 (currently in 3rd edition).

One of the earliest physician-edited textbooks on integrative medicine is the Micozzi series. The first edition was published in 1996 prior to Jonas. One can easily track the nuances driving definitional change with each new Micozzi text. The 2006 third edition of Fundamentals of Complementary and Integrative Medicine (10) was titled Fundamentals of Complementary and Alternative Medicine (italics added) in the first two editions. The prefaces in each edition illustrate the context-laden drivers for arriving at a suitable definition. In the brief half-page preface to the 1996 first edition, CAM is ‘a classic consumer movement and a current social phenomenon of significant dimensions.’ (11) CAM is also metaphysical as the reader is assured his views will expand regarding how ‘light, time, touch, sensation, energy and mind enter into health and medicine.’

[snip]

For the consumer and many providers the term CAM has already been supplanted by the term integrative medicine. Integrative medicine may hold more relevance for a widening range of providers that self-identify with the new medicine. For example, the American Medical Students Association's Humanistic Medicine Action Committee simply combines the two terms, publishing an ‘ICAM’ newsletter and hosting an online ‘ICAM’ resource center—Integrative, Complementary and Alternative Medicine (13).

Defining the concept of integrative medicine is one first step towards understanding the phenomenon. However, a definition is more likely to emerge from key issues that are shaping the future of integrative medicine. These issues inevitably come to the fore when practice races ahead of regulation. They are clinical care, research, education standards, as well as economic opportunities. We allude to these topics here with intention to address them more substantially in subsequent reports. Identification among integrative medicine providers could progress from our current state of self-determination to bilateral peer approval and finally bilateral certification (Fig. 1).

There is no unifying conceptual framework (14) of integrative medicine just as there are no unifying training standards or scope of practice. Attempts at one unifying definition are limited by context, often seeming speaker-dependent. In terms of collaborative medical practice in which the patient and doctor are partners, integrative medicine has been described as ‘a comprehensive, primary care system that emphasizes wellness and healing of the whole person (bio-psycho-socio-spiritual dimensions) as major goals, above and beyond suppression of a specific somatic disease.’ (15) From the perspective of scientific research, for example NCCAM (the National Center for Complementary and Alternative Medicine under the National Institutes of Health), complementary and alternative medicine includes ‘healthcare practices outside the realm of conventional medicine, which are yet to be validated using scientific methods.’ (16) According to NCCAM, integrative medicine ‘combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness.’ (17) A more transcendent view defines integrative medicine as ‘healing-oriented medicine that re-emphasizes the relationship between patient and physician, and integrates the best of complementary and alternative medicine with the best of conventional medicine.’ (18)

[snip]

We do not challenge the sincerity of the previous efforts to define integrative medicine. We have tried to show that the definition is malleable and, like CAM before it, depends on the perspective of the definer (22). The markers of definitional change have moved from observing the power of consumer economic choice, to spiritual regeneration of a mechanistic medicine, to the expansion of choice based on scientific evidence. In addition to a multitude of new treatment options, CAM offers conventional medicine a philosophy of holism (23), ‘new’ ways of looking at the complex phenomena of health and disease (24), and the concept of inherent healing capacity (vis medicatrix naturae), while conventional medicine offers CAM rigorous means to scientifically examine these practices and ideas (25). Integrative medicine, at its current stage of development, incorporates the best practices of CAM and conventional medicine into a unified treatment plan, a goal that requires both camps to step into the integrative circle and examine themselves and each other with an open mind. Integration of medical disciplines will first require movement from isolation to collaboration before real integration occurs (Fig. 3). —Preceding unsigned comment added by Alan2012 (talk • contribs) 15:38, 30 October 2009 (UTC)

[edit] Suggested Merge: Home Remedy and Folk Medicine into Alternative Medicine

The two articles Home remedy and Folk medicine are short and not especially well-written or fleshed out. It also seems to me as though the information in the two (at least that part of the information which should be kept) could be covered within the Alternative medicine article. Truncat (talk) 03:08, 17 November 2009 (UTC)

[edit] References

Please keep this section at the bottom. TO ADD A NEW SECTION, just click the EDIT link at the right and add the new section ABOVE this one. Then copy the heading into the edit summary box.

  1. ^ Predictors of inaccurate online breast cancer information
  2. ^ Elmer V. Bernstam, Muhammad F. Walji, Smitha Sagaram, Deepak Sagaram, Craig W. Johnson, Funda Meric-Bernstam (2008). "Commonly cited website quality criteria are not effective at identifying inaccurate online information about breast cancer". Cancer In press: 1206. doi:10.1002/cncr.23308. http://www3.interscience.wiley.com/cgi-bin/abstract/117908535/ABSTRACT?CRETRY=1&SRETRY=0. Retrieved 2008-02-12. 
  3. ^ a b $2.5 billion spent, no alternative cures found. Big, government-funded studies show most work no better than placebos. Associated Press, June 10, 2009


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