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Alternative medicine

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This article is part of a series on
Alternative medicine
Medicinal herbs in a traditional Spanish market
General information
Fringe medicine and science
Controversies
Classifications
Traditional medicine
Alternative diagnoses
Alternative medicine
MeSHD000529

Alternative medicine is any healing practice "that does not fall within the realm of conventional medicine".[1] In some instances, it is based on historical or cultural traditions, rather than a scientific (i.e. evidence-based) basis. Critics assert that the terms “complementary” and “alternative medicine” are deceptive euphemisms meant to give an impression of medical authority.[2][3][4]

It is frequently grouped with complementary medicine or integrative medicine, which, in general, refers to the same interventions when used in conjunction with mainstream techniques,[5][6][7] under the umbrella term complementary and alternative medicine, or CAM. Some researchers in alternative medicine oppose this grouping, preferring to emphasize differences of approach, but nevertheless use the term CAM, which has become standard.[8][9] "Although heterogeneous, the major CAM systems have many common characteristics, including a focus on individualizing treatments, treating the whole person, promoting self-care and self-healing, and recognizing the spiritual nature of each individual. In addition, many CAM systems have characteristics commonly found in mainstream healthcare, such as a focus on good nutrition and preventive practices. Unlike mainstream medicine, CAM often lacks or has only limited experimental and clinical study; however, scientific investigation of CAM is beginning to address this knowledge gap. Thus, boundaries between CAM and mainstream medicine, as well as among different CAM systems, are often blurred and are constantly changing."[5]

Alternative medicine practices are as diverse in their foundations as in their methodologies. Practices may incorporate or base themselves on traditional medicine, folk knowledge, spiritual beliefs, or newly conceived approaches to healing.[10] 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 medical community because evidence-based assessment of safety and efficacy is either not available or has not been performed for these practices. If scientific investigation establishes the safety and effectiveness of an alternative medical practice, it then becomes mainstream medicine and is no longer "alternative", and may therefore become widely adopted by conventional practitioners.[11][12]

Because alternative techniques tend to lack evidence, or may even have repeatedly failed to work in tests, some have advocated defining it as non-evidence based medicine, or not medicine at all. Some researchers state that the evidence-based approach to defining CAM is problematic because some CAM is tested, and research suggests that many mainstream medical techniques lack solid evidence.[13]

A 1998 systematic review of studies assessing its prevalence in 13 countries concluded that about 31% of cancer patients use some form of complementary and alternative medicine.[14] Alternative medicine varies from country to country. Edzard Ernst says that in Austria and Germany CAM is mainly in the hands of physicians,[9] while some estimates suggest that at least half of American alternative practitioners are physicians.[15] In Germany, herbs are tightly regulated, with half prescribed by doctors and covered by health insurance based on their Commission E legislation.[16]

Terms

The term 'alternative medicine' is generally used to describe practices used independently or in place of conventional medicine. The term 'complementary medicine' is primarily used to describe practices used in conjunction with or to complement conventional medical treatments. NCCAM suggests "using aromatherapy therapy in which the scent of essential oils from flowers, herbs, and trees is inhaled in an attempt to promote health and well-being and to help lessen a patient's discomfort following surgery"[12] as an example of complementary medicine. The terms 'integrative' or 'integrated medicine' indicate combinations of conventional and alternative medical treatments that have some scientific proof of efficacy; such practices are viewed by advocates as the best examples of complementary medicine.[12]

Ralph Snyderman and Andrew Weil state that "integrative medicine is not synonymous with complementary and alternative medicine. It has a far larger meaning and mission in that it calls for restoration of the focus of medicine on health and healing and emphasizes the centrality of the patient-physician relationship."[17] The combination of orthodox and complementary medicine with an emphasis on prevention and lifestyle changes is known as integrated medicine.

Characterization

There is no clear and consistent definition for either alternative or complementary medicine.[18]: 17  In Western culture it is often defined as any healing practice "that does not fall within the realm of conventional medicine",[1] or "that which has not been shown consistently to be effective."[19]

Self characterization

The National Center for Complementary and Alternative Medicine (NCCAM) defines CAM as "a group of diverse medical and healthcare systems, practices, and products, that are not currently part of conventional medicine."[12]

The Danish Knowledge and Research Center for Alternative Medicine (Danish abbreviation: ViFAB. ViFAB is an independent institution under the Danish Ministry of the Interior and Health. ViFAB's webstite: www.vifab.dk/uk) uses the term “alternative medicine” for: – Treatments performed by therapists that are not authorized healthcare professionals – Treatments performed by authorized healthcare professionals, but those based on methods otherwise used mainly outside the healthcare system. People without a healthcare authorisation must be able to perform the treatments.

The Cochrane Complementary Medicine Field finds that what is considered complementary or alternative practices in one country may be considered conventional medical practices in another. Their definition is, therefore, general: "complementary medicine includes all such practices and ideas that are outside the domain of conventional medicine in several countries and defined by its users as preventing or treating illness, or promoting health and well-being."[20]

For example, biofeedback is commonly used within the Physical Medicine & Rehabilitation community, but is considered alternative within the medical community as a whole, and some herbal therapies are mainstream in Europe, but are alternative in the United States.[21] David M. Eisenberg, an integrative medicine researcher,[22] defines it as "medical interventions not taught widely at US medical schools or generally available at US. hospitals,"[23] NCCAM states that formerly unproven remedies may be incorporated into conventional medicine if they are shown to be safe and effective.[12]

Barrie R. Cassileth, a researcher of complementary and alternative medicine, has summed up the situation as "not all mainstream physicians are pleased with CAM, with current efforts to integrate CAM into mainstream medicine, or with a separate NIH research entity for "alternative" medicine.[11][24]

Scientific community

Institutions

The United States' National Science Foundation has defined alternative medicine as "all treatments that have not been proven effective using scientific methods."[25] In a consensus report released in 2005, entitled Complementary and Alternative Medicine in the United States, the Institute of Medicine (IOM) defined complementary and alternative medicine (CAM) as the non-dominant approach to medicine in a given culture and historical period.[26] A similar definition has been adopted by the Cochrane Collaboration,[20] and official government bodies such as the UK Department of Health.[27] Proponents of evidence-based medicine, such as the Cochrane Collaboration, use the term alternative medicine but agree that all treatments, whether "mainstream" or "alternative", ought to be held to the standards of the scientific method.[28]

Scientists

Numerous mainstream scientists and physicians have commented on and criticised alternative medicine.

There is a debate among medical researchers over whether any therapy may be properly classified as 'alternative medicine'. Some claim that there is only medicine that has been adequately tested and that which has not.[11] They feel that healthcare practices should be classified based solely on scientific evidence. If a treatment has been rigorously tested and found safe and effective traditional medicine will adopt it regardless of if it was considered alternative to begin with.[11] It is thus possible for a method to change categories (proven vs. unproven), based on increased knowledge of its effectiveness or lack thereof. Prominent supporters of this position include George D. Lundberg, former editor of the Journal of the American Medical Association (JAMA).[29]

Stephen Barrett, founder and operator of Quackwatch, argues that practices labeled "alternative" should be reclassified as either genuine, experimental, or questionable. Here he defines genuine as being methods that have sound evidence for safety and effectiveness, experimental as being unproven but with a plausible rationale for effectiveness, and questionable as groundless without a scientifically plausible rationale. He has concerns that just because some "alternatives" have merit, there is the impression that the rest deserve equal consideration and respect even though most are worthless.[30] He says that there is a policy at the NIH of never saying something doesn't work only that a different version or dose might give different results.[31]

Edzard Ernst, professor of complementary medicine, characterizes the evidence for many alternative techniques as weak, nonexistent, or negative, but states that evidence exists for others, in particular certain herbs and acupuncture.[32] Ernst has concluded that 95% of the alternative treatments he and his team have studied, including acupuncture, herbal medicine, homeopathy, and reflexology, are, according to The Economist, "statistically indistinguishable from placebo treatments."[33]

Richard Dawkins, an evolutionary biologist, defines alternative medicine as a "set of practices that cannot be tested, refuse to be tested, or consistently fail tests."[34] He also states that "there is no alternative medicine. There is only medicine that works and medicine that doesn't work."[35] He says that if a technique is demonstrated effective in properly performed trials, it ceases to be alternative and simply becomes medicine.[36]

A letter by four Nobel Laureates and other prominent scientists deplored the lack of critical thinking and scientific rigor in National Institutes of Health supported alternative medicine research.[37] In 2009 a group of scientists made a proposal to shut down the National Center for Complementary and Alternative Medicine. They argued that the vast majority of studies were based on unconventional understandings of physiology and disease and have shown little or no effect. Further, they argue that the field's more-plausible interventions such as diet, relaxation, yoga and botanical remedies can be studied just as well in other parts of NIH, where they would need to compete with conventional research projects.[38]

These concerns are supported by negative results in almost all studies conducted over ten years at a cost of $2.5 billion by the NCCAM.[39] R. Barker Bausell, a research methods expert and author of "Snake Oil Science" states that "it's become politically correct to investigate nonsense."[31] There are concerns that just having NIH support is being used to give unfounded "legitimacy to treatments that are not legitimate."[38]

Wallace Sampson, an editor of Scientific Review of Alternative Medicine and a Stanford University professor of medicine write that CAM is the "propagation of the absurd" based on the example that alternative and complementary have been substituted for quackery, dubious and implausible and concerns that CAM tolerates contradiction without through reason and experiment.[40]

The Washington Post reports that a growing number of traditionally trained physicians practice integrative medicine, which it defines as "conventional medical care that incorporates strategies such as acupuncture, reiki and herbal remedies."[41] The Australian comedian Tim Minchin, in his nine minute beat poem "Storm", states that alternative medicine is that which "has either not been proved to work or been proved not to work", and then he quips "You know what they call 'alternative medicine' that’s been proved to work? Medicine."[42]

Classifications

NCCAM has developed one of the most widely used classification systems for the branches of complementary and alternative medicine.[12][18] It classifies complementary and alternative therapies into five major groups, which have some overlap.[12]

  1. Whole medical systems: cut across more than one of the other groups; examples include Traditional Chinese medicine, Naturopathy, Homeopathy, and Ayurveda
  2. Mind-body medicine: takes a holistic approach to health that explores the interconnection between the mind, body, and spirit. It works under the premise that the mind can affect "bodily functions and symptoms"
  3. Biology-based practices: use substances found in nature such as herbs, foods, vitamins, and other natural substances
  4. Manipulative and body-based practices: feature manipulation or movement of body parts, such as is done in chiropractic and osteopathic manipulation
  5. Energy medicine: is a domain that deals with putative and verifiable energy fields:
  • Biofield therapies are intended to influence energy fields that, it is purported, surround and penetrate the body. No empirical evidence has been found to support the existence of the putative energy fields on which these therapies are predicated.
  • Bioelectromagnetic-based therapies use verifiable electromagnetic fields, such as pulsed fields, alternating-current, or direct-current fields in an unconventional manner.

Usage

Further information: [[:List of branches of alternative medicine]]
Age-adjusted percent of adults who have used complementary and alternative medicine: United States, 2002[43]

Many people utilize mainstream medicine for diagnosis and basic information, while turning to alternatives for therapy or health-enhancing measures. Studies indicate that alternative approaches are often used in conjunction with conventional medicine.[43] This is referred to by NCCAM as 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."[12] 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.[44]

A 1997 survey found that 13.7% of respondents in the United States had sought the services of both a medical doctor and an alternative medicine practitioner. The same survey found that 96% of respondents who sought the services of an alternative medicine practitioner also sought the services of a medical doctor in the past 12 months. Medical doctors are often unaware of their patient's use of alternative medical treatments as only 38.5% of the patients alternative therapies were discussed with their medical doctor.[45]

Edzard Ernst, Professor of Complementary Medicine at the University of Exeter, wrote in the Medical Journal of Australia that "about half the general population in developed countries use complementary and alternative medicine (CAM)."[46] 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 and 75% across lifespan (though these figure drop to 36.0% and 50% if prayer specifically for health reasons is excluded); this study included yoga, meditation, herbal treatments and the Atkins diet as CAM.[43][47] Another study suggests a similar figure of 40%.[48]

A British telephone survey by the BBC of 1209 adults in 1998 shows that around 20% of adults in Britain had used alternative medicine in the past 12 months.[49] Ernst has been active politically on this issue as well, publicly requesting that Prince Charles recall two guides to alternative medicine published by the Foundation for Integrated Health, on the grounds that "[t]hey both contain numerous misleading and inaccurate claims concerning the supposed benefits of alternative medicine" and that "[t]he nation cannot be served by promoting ineffective and sometimes dangerous alternative treatments."[50] In general, he believes that CAM can and should be subjected to scientific testing.[28][32][51]

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.[45] 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."[52] 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 healthcare or be integrated into the healthcare system. In Africa, traditional medicine is used for 80% of primary healthcare, and in developing nations as a whole over one-third of the population lack access to essential medicines.[53]

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 that recently published research (such as Michalsen, 2003,[54] Gonsalkorale 2003,[55] and Berga 2003)[56] 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,[57] and Linde 1997.[58]

Complementary therapies are often used in palliative care or by practitioners attempting to manage chronic pain in patients. Complementary medicine is considered more acceptable in the interdisciplinary approach used in palliative care than in other areas of medicine. "From its early experiences of care for the dying, palliative care took for granted the necessity of placing patient values and lifestyle habits at the core of any design and delivery of quality care at the end of life. If the patient desired complementary therapies, and as long as such treatments provided additional support and did not endanger the patient, they were considered acceptable."[59] The non-pharmacologic interventions of complementary medicine can employ mind-body interventions designed to "reduce pain and concomitant mood disturbance and increase quality of life."[60]

Physicians who practice complementary medicine usually discuss and advise patients as to available complementary therapies. Patients often express interest in mind-body complementary therapies because they offer a non-drug approach to treating some health conditions.[61] Some mind-body techniques, such as cognitive-behavioral therapy, were once considered complementary medicine, but are now a part of conventional medicine in the United States.[62] "Complementary medicine treatments used for pain include: acupuncture, low-level laser therapy, meditation, aroma therapy, Chinese medicine, dance therapy, music therapy, massage, herbalism, therapeutic touch, yoga, osteopathy, chiropractic, naturopathy, and homeopathy."[63]

In defining complementary medicine in the UK, the House of Lords Select Committee determined that the following therapies were the most often used to complement conventional medicine:[64] Alexander technique, Aromatherapy, Bach and other flower remedies, Body work therapies including massage, Counselling stress therapies, hypnotherapy, Meditation, Reflexology, Shiatsu, Maharishi Ayurvedic medicine, Nutritional medicine, and Yoga.

United States

A botánica, such as this one, caters to the Latino community and sells folk medicine alongside statues of saints, candles decorated with prayers, and other items.

A 2002 survey of US adults 18 years and older conducted by the National Center for Health Statistics (CDC) and the National Center for Complementary and Alternative Medicine indicated:[43]

  • 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 US 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%)

In 2004, a survey of nearly 1,400 U.S. hospitals found that more than one in four offered alternative and complementary therapies such as acupuncture, homeopathy, and massage therapy.[65]

A 2008 survey of US hospitals by Health Forum, a subsidiary of the American Hospital Association, found that more than 37 percent of responding hospitals indicated they offer one or more alternative medicine therapies, up from 26.5 percent in 2005. Additionally, hospitals in the southern Atlantic states were most likely to include CAM, followed by east north central states and those in the middle Atlantic. More than 70% of the hospitals offering CAM were in urban areas.[66]

The National Science Foundation has also conducted surveys of the popularity of alternative medicine. After describing the negative impact science fiction in the media has on public attitudes and understandings of pseudoscience, and defining alternative medicine as all treatments that have not been proven effective using scientific methods, as well as mentioning the concerns of individual scientists, organizations, and members of the science policymaking community, it commented that "nevertheless, the popularity of alternative medicine appears to be increasing."[25]

In the state of Texas, physicians may be partially protected from charges of unprofessional conduct or failure to practice medicine in an acceptable manner, and thus from disciplinary action, when they prescribe alternative medicine in a complementary manner, if board specific practice requirements are satisfied and the therapies utilized do not present "a safety risk for the patient that is unreasonably greater than the conventional treatment for the patient's medical condition."[67]

Denmark

45.2 % of the Danish population aged 16 or above had in 2005 used alternative medicine at some point in life. 22.5 % had used alternative medicine within the previous year.[68]

The most popular types of therapies within the previous year (2005) are:

  • Massage, osteopathy or other manipulative techniques (13.2 percent)
  • Reflexology (6.1 percent)
  • Acupuncture (5.4 percent)

More results of statistical surveys on alternative medicine in Denmark is available on ViFABs (Knowledge and Research Center for Alternative Medicines) home page, see the pages on Statistics: http://www.vifab.dk/uk/alternative+medicine/statistics

Use among medical students

68 % of the medical students in Denmark were in 2008 using or had used alternative therapy.[69] The most commonly used types of alternative medicine were:

Education

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 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.[70][71][72] The University of Arizona College of Medicine offers a program in Integrative Medicine under the leadership of Andrew Weil that trains physicians in various branches of alternative medicine that "...neither rejects conventional medicine nor embraces alternative practices uncritically."[73] Accredited Naturopathic colleges and universities are also increasing in number and popularity in Canada and the USA. (See Naturopathic medical school in North America).

Similarly, "unconventional medicine courses are widely represented at European universities. They cover a wide range of therapies. Many of them are used clinically. Research work is underway at several faculties,"[74] but "only 40% of the responding [European] universities were offering some form of CAM training."[75]

In contrast to unconventional schools in Britain, no conventional medical schools offer courses that teach the clinical practice of alternative medicine.[76] The British Medical Acupuncture Society offers medical acupuncture certificates to doctors, as does the College of Naturopathic Medicine UK and Ireland. In his information book for the general public, Understanding Stress, Professor G. Wilkinson of Liverpool University, recommends various methods of alternative medicine to alleviate stress as follows: acupuncture, alexander technique, aromatherapy,autogenic training, biofeedback, meditation, and yoga.[77]

Regulation

Herbal medicine etc.

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.[78][79] Dietary supplements, their ingredients, safety, and claims, are a continual source of controversy.[80] In some cases, political issues, mainstream medicine and alternative medicine all collide, such as in cases where synthetic drugs are legal but the herbal sources of the same active chemical are banned.[81]

In other cases, controversy over mainstream medicine causes questions about the nature of a treatment, such as water fluoridation.[82] 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.[83] Government regulators continue to attempt to find a regulatory balance.[84]

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. 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

"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."[85]

Specific implementations of this article are left to member states.

A number of alternative medicine advocates disagree with the restrictions of government agencies that approve medical treatments. In the United States, for example, critics say 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 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 healthcare products.

In New Zealand, alternative medicine products are classified as food products, so there are no regulations or safety standards in place.[86]

In Australia, the topic is termed as complementary medicine and the Therapeutic Goods Administration has issued various guidances and standards.[87] Australian regulatory guidelines for complementary medicines (ARGCM) demands that the pesticides, fumigants, toxic metals, microbial toxins, radionuclides, and microbial contaminations present in herbal substances should be monitored, although the guidance does not request for the evidences of these traits.[88] However, for the herbal substances in pharmacopoeial monographes, the detailed information should be supplied to relevant authorities [89]

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 and contamination.[90] This problem is magnified by international commerce, since different countries have different types and degrees of regulation. This can make it difficult for consumers to properly evaluate the risks and qualities of given products.

Denmark [91]: Herbal and dietary supplements is the designation of a range of products, which have in common their status as medicine belonging under the Danish Medicines Act.In the Danish Medicines Act there exist four types of herbal and dietary supplements: Herbal medicinal products,[92] Strong vitamin and mineral preparations,[93] Traditional botanical medicinal products [94] and Homeopathic medicinal products.[95] Some dietary supplements [96] fall within a special category of products, which differ from the above in that they are not authorized medicinal products. Dietary supplements are regulated under the Food Act and are registered by the Danish Veterinary and Food Administration.

Alternative therapists

Denmark has a registration system for alternative therapy practitioners, RAB.[97]

Criticism

The NCCAM budget has been criticized[98] because despite the duration and intensity of studies, there have been exactly zero effective CAM treatments supported by scientific evidence to date.[99] Despite this, the National Center for Complementary and Alternative Medicine budget has been on a sharp sustained rise to support complementary medicine. In fact, the whole CAM field has been called by critics the SCAM.[99]

In a Huffington Post article on homeopathy in France a comment was made "Why is it that when your car is broken you don't seek out an "alternati­ve mechanic?" [100] "There really is no such thing as alternative medicine--only medicine that has been proved to work and medicine that has not." Dr. Arnold Relman, editor in chief emeritus of The New England Journal of Medicine.[101] Speaking of government funding studies of integrating alternative medicine techniques into the mainstream, Dr. Steven Novella, a neurologist at Yale School of Medicine wrote that it "is used to lend an appearance of legitimacy to treatments that are not legitimate." Dr. Marcia Angell, executive editor of The New England Journal of Medicine says, "It's a new name for snake oil." [98]

Alternative and evidence-based medicine

Testing of efficacy

Many alternative therapies have been tested with varying results. In 2003, a project funded by the CDC identified 208 condition-treatment pairs, of which 58% had been studied by at least one randomized controlled trial (RCT), and 23% had been assessed with a meta-analysis.[102] According to a 2005 book by a US Institute of Medicine panel, the number of RCTs focused on CAM has risen dramatically. The book cites Vickers (1998), who found that many of the CAM-related RCTs are in the Cochrane register, but 19% of these trials were not in MEDLINE, and 84% were in conventional medical journals.[18]: 133 

As of 2005, the Cochrane Library had 145 CAM-related Cochrane systematic reviews and 340 non-Cochrane systematic reviews. An analysis of the conclusions of only the 145 Cochrane reviews was done by two readers. In 83% of the cases, the readers agreed. In the 17% in which they disagreed, a third reader agreed with one of the initial readers to set a rating. These studies found that, for CAM, 38.4% concluded positive effect or possibly positive (12.4%) effect, 4.8% concluded no effect, 0.69% concluded harmful effect, and 56.6% concluded insufficient evidence. An assessment of conventional treatments found that 41.3% concluded positive or possibly positive effect, 20% concluded no effect, 8.1% concluded net harmful effects, and 21.3% concluded insufficient evidence. However, the CAM review used the 2004 Cochrane database, while the conventional review used the 1998 Cochrane database.[18]: 135–136 

Lists of the Cochrane Reviews on alternative medicine including summaries of the results sorted by type of therapy (updated monthly) are made available at ViFABs (Knowledge and Research Center for Alternative Medicines) home page, see the lists here: http://www.vifab.dk/uk/cochrane+and+alternative+medicine

Most alternative medical treatments are not patentable, which may lead to less research funding from the private sector. In addition, in most countries, alternative treatments (in contrast to pharmaceuticals) can be marketed without any proof of efficacy—also a disincentive for manufacturers to fund scientific research.[103] Some have proposed adopting a prize system to reward medical research.[104] However, public funding for research exists. Increasing the funding for research on alternative medicine techniques is the purpose of the US National Center for Complementary and Alternative Medicine. NCCAM and its predecessor, the Office of Alternative Medicine, have spent more than $2.5 billion on such research since 1992; this research has largely not demonstrated the efficacy of alternative treatments.[31][105][106]

Some skeptics of alternative practices say 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.[107]

In the same way as for conventional therapies, drugs, and interventions, it can be difficult to test the efficacy of alternative medicine in clinical trials. In instances where an established, effective, treatment for a condition is already available, the Helsinki Declaration states that withholding such treatment is unethical in most circumstances. Use of standard-of-care treatment in addition to an alternative technique being tested may produce confounded or difficult-to-interpret results.[108]

Cancer researcher Andrew J. Vickers has stated:

"Contrary to much popular and scientific writing, many alternative cancer treatments have been investigated in good-quality clinical trials, and they have been shown to be ineffective. In this article, clinical trial data on a number of alternative cancer cures including Livingston-Wheeler, Di Bella Multitherapy, antineoplastons, vitamin C, hydrazine sulfate, Laetrile, and psychotherapy are reviewed. The label "unproven" is inappropriate for such therapies; it is time to assert that many alternative cancer therapies have been "disproven.""[109]

Testing of safety

See also: List of herbs with known adverse effects

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.[110] 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.[111]

To ABC Online, MacLennan also gives another possible mechanism:

"And lastly [sic] 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".[112]

Potential side-effects

Conventional treatments are subjected to testing for undesired side-effects, whereas alternative treatments, in general, are not subjected to such testing at all. Any treatment – whether conventional or alternative – that has a biological or psychological effect on a patient may also have potential to possess dangerous biological or psychological side-effects. 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".

An exception to the normal thinking regarding side-effects is Homeopathy. Since 1938, the U.S. Food and Drug Administration (FDA) has regulated homeopathic products in "several significantly different ways from other drugs."[113] Homeopathic preparations, termed "remedies," are extremely dilute, often far beyond the point where a single molecule of the original active (and possibly toxic) ingredient is likely to remain. They are, thus, considered safe on that count, but "their products are exempt from good manufacturing practice requirements related to expiration dating and from finished product testing for identity and strength," and their alcohol concentration may be much higher than allowed in conventional drugs.[113]

Treatment delay

Those having 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.[114] For this reason, critics argue 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.[115]

Between 2001 and 2003, four children died in Australia because their parents chose ineffective naturopathic, homeopathic, or other alternative medicines and diets rather than conventional therapies.[116] In all, they found 17 instances in which children were significantly harmed by a failure to use conventional medicine.

Unconventional cancer "cures"

Perhaps because many forms of cancer are difficult or impossible to cure, there have always been many therapies offered outside of conventional cancer treatment centers and based on theories not found in biomedicine. These alternative cancer cures have often been described as "unproven," suggesting that appropriate clinical trials have not been conducted and that the therapeutic value of the treatment is unknown. However, many alternative cancer treatments have been investigated in good-quality clinical trials, and they have been shown to be ineffective. [117]

Research funding

Although the Dutch government funded CAM research between 1986 and 2003, it formally ended funding in 2006.[118]

Integrative medicine, complementary medicine, fringe medicine

Integrative medicine is the combination of the practices and methods of alternative/complementary medicine with conventional medicine.[119] It may include preventive medicine and patient-centered medicine. It may also include practices not normally referred to as medicine, such as using prayer, meditation, socializing, and recreation as therapies. Its academic proponents sometimes recommend misleading patients by using known placebo treatments in order to achieve a placebo effect.[120] However, a 2010 survey of family physicians found that 56% of respondents said they had used a placebo in clinical practice as well. Eighty-five percent of respondents believed placebos can have both psychological and physical benefits.[121][122] A number of universities and hospitals have departments of integrative medicine.[123][124][125][126][127][128][129]

Criticism of integrative medicine includes about proposing to lie to patients about alternative medicines known to be no more than a placebo in order to achieve a placebo effect, and “diverting research time, money, and other resources from more fruitful lines of investigation in order to pursue a theory that has no basis in biology”.[4][130]

"Quackademic medicine" is a pejorative term used for “integrative medicine”, when considered to be an infiltration of quackery into academic science-based medicine, and was picked up by science-based medicine anti-ACM critics.[4]

History

Fueled by a nationwide survey published in 1993 by David Eisenberg, which revealed that in 1990 approximately 60 million Americans had used one or more complementary or alternative therapies to address health issues.[131] A study published in the November 11, 1998 issue of the Journal of the American Medical Association reported that 42% of Americans had used complementary and alternative therapies, up from 34% in 1990.[132] However, despite the growth in patient demand for complementary medicine, most of the early alternative/complementary medical centers failed.[133]

Appeal

A study published in 1998[48] 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 replacement for conventional medicine. The research found that those having 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 healthcare 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 – notable ones being 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 using them in lieu of conventional medicine. There are several socio-cultural reasons for the interest in these treatments centered on the low level of scientific literacy among the public at large and a concomitant increase in antiscientific attitudes and new age mysticism.[134] Related to this are vigorous marketing[135] of extravagant claims by the alternative medical community combined with inadequate media scrutiny and attacks on critics.[134][136]

There is also an increase in conspiracy theories toward conventional medicine and pharmaceutical companies, mistrust of traditional authority figures, such as the physician, and a dislike of the current delivery methods of scientific biomedicine, all of which have led patients to seek out alternative medicine to treat a variety of ailments.[136] Many patients lack access to contemporary medicine, due to a lack of private or public health insurance, which leads them to seek out lower-cost alternative medicine.[43] Medical doctors are also aggressively marketing alternative medicine to profit from this market.[135]

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.[137] Related to it are similar psychological effects such as the will to believe,[134] cognitive biases that help maintain self-esteem and promote harmonious social functioning,[134] and the post hoc, ergo propter hoc fallacy.[134]

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. Even low-risk medications such as antibiotics can have potential to cause life-threatening anaphylactic reactions in a very few individuals. Also, 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.[134][136]

Its popularity may be related to other factors. In an interview with Edzard Ernst, The Independent wrote:

"Why is it so popular, then? Ernst blames the providers, customers and the doctors whose neglect, he says, has created the opening into which alternative therapists have stepped. "People are told lies. There are 40 million websites and 39.9 million tell lies, sometimes outrageous lies. They mislead cancer patients, who are encouraged not only to pay their last penny but to be treated with something that shortens their lives. "At the same time, people are gullible. It needs gullibility for the industry to succeed. It doesn't make me popular with the public, but it's the truth."[138]

Academic resources

See also

References

  1. ^ a b Bratman, MD, Steven (1997). The Alternative Medicine Sourcebook. Lowell House. p. 7. ISBN 978-1-56565-626-0.
  2. ^ Carroll RT. "complementary medicine" at The Skeptic's Dictionary
  3. ^ Acupuncture Pseudoscience in the New England Journal of Medicine, Science Based Medicine, Steven Novella, Science-Based Medicine » Acupuncture Pseudoscience in the New England Journal of Medicine
  4. ^ a b c Credulity about acupuncture infiltrates the New England Journal of Medicine, Science Based Medicine, David Gorski, Science-Based Medicine » Credulity about acupuncture infiltrates the New England Journal of Medicine
  5. ^ a b "White House Commission on Complementary and Alternative Medicine Policy". March 2002. {{cite web}}: |chapter= ignored (help)
  6. ^ Ernst E. (1995). "Complementary medicine: Common misconceptions". Journal of the Royal Society of Medicine. 88 (5): 244–247. PMC 1295191. PMID 7636814.
  7. ^ Joyce CR (1994). "Placebo and complementary medicine". Lancet. 344 (8932): 1279–1281. doi:10.1016/S0140-6736(94)90757-9.
  8. ^ Cassileth BR, Deng G (2004). "Complementary and alternative therapies for cancer". The Oncologist. 9 (1): 80–9. doi:10.1634/theoncologist.9-1-80. PMID 14755017.
  9. ^ a b "Interview with [[Edzard Ernst]], editor of The Desktop Guide to Complementary and Alternative Medicine". Elsevier Science. 2002. Archived from the original on 2007-03-11. {{cite web}}: URL–wikilink conflict (help)
  10. ^ Acharya, Deepak and Shrivastava Anshu (2008). Indigenous Herbal Medicines: Tribal Formulations and Traditional Herbal Practices. Jaipur: Aavishkar Publishers Distributor. p. 440. ISBN 978-81-7910-252-7.
  11. ^ a b c d Angell M, Kassirer JP (1998). "Alternative medicine--the risks of untested and unregulated remedies" (PDF). The New England Journal of Medicine. 339 (12): 839–41. doi:10.1056/NEJM199809173391210. PMID 9738094. It is time for the scientific community to stop giving alternative medicine a free ride. 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. But assertions, speculation, and testimonials do not substitute for evidence. Alternative treatments should be subjected to scientific testing no less rigorous than that required for conventional treatments. {{cite journal}}: Unknown parameter |month= ignored (help)
  12. ^ a b c d e f g h "What is Complementary and Alternative Medicine (CAM)?". National Center for Complementary and Alternative Medicine. Archived from the original on 2005-12-08. Retrieved 2006-07-11. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  13. ^ Kopelman, Lorretta M. (2004). "The role of science in assessing conventional, complementary, and alternative medicines". In Callahan D (ed.). The Role of Complementary and Alternative Medicine: Accommodating Pluralism. Washington, DC: Georgetown University Press. pp. 36–53. ISBN 978-1-58901-016-1. OCLC 47791087. {{cite book}}: Unknown parameter |series-title= ignored (help)
  14. ^ Ernst E, Cassileth BR (1998). "The prevalence of complementary/alternative medicine in cancer: a systematic review". Cancer. 83 (4): 777–82. doi:10.1002/(SICI)1097-0142(19980815)83:4<777::AID-CNCR22>3.0.CO;2-O. PMID 9708945. {{cite journal}}: Unknown parameter |month= ignored (help)
  15. ^ Cassileth, Barrie R. (June 1996). "Alternative and Complementary Cancer Treatments". The Oncologist. 1 (3): 173–9. PMID 10387984.
  16. ^ Marty (1999). "The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines". J Amer Med Assoc. 281: 1852–3. doi:10.1001/jama.281.19.1852.
  17. ^ Snyderman R, Weil AT (2002). "Integrative medicine: bringing medicine back to its roots". Archives of Internal Medicine. 162 (4): 395–7. doi:10.1001/archinte.162.4.395. PMID 11863470. {{cite journal}}: Unknown parameter |month= ignored (help)
  18. ^ a b c d Institute of Med (2005). Complementary and Alternative Medicine in the United States. National Academy Press. ISBN 978-0-309-09270-8.
  19. ^ "A few words about folk medicine". Missouri Folklore Society.
  20. ^ a b "Cochrane Complementary Medicine Field". Cochrane COllaboration.
  21. ^ Walter R., PhD. Frontera; DeLisa, Joel A.; Gans, Bruce M.; NICHOLAS E. WALSH (2005). Physical medicine and rehabilitation: principles and practice. Hagerstwon, MD: Lippincott Williams & Wilkins. pp. Chapter 19. ISBN 978-0-7817-4130-9.{{cite book}}: CS1 maint: multiple names: authors list (link)
  22. ^ "David M Eisenberg: FACT".
  23. ^ Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL (1993). "Unconventional medicine in the United States. Prevalence, costs, and patterns of use". N. Engl. J. Med. 328 (4): 246–52. doi:10.1056/NEJM199301283280406. PMID 8418405. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  24. ^ Park RL, Goodenough U: Buying snake oil with tax dollars. New York Times, January 3, 1996, A11.
  25. ^ a b National Science Foundation survey: Science and Technology: Public Attitudes and Public Understanding. Science Fiction and Pseudoscience.
  26. ^ "Complementary and Alternative Medicine in the United States". United States Institute of Medicine. 12 January 2005. pp. 16–20. Retrieved 2011-01-18. Complementary and alternative medicine (CAM) is a broad domain of resources that encompasses health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the dominant health system of a particular society or culture in a given historical period. CAM includes such resources perceived by their users as associated with positive health outcomes. Boundaries within CAM and between the CAM domain and the domain of the dominant system are not always sharp or fixed.
  27. ^ "Complementary and alternative medicine : Department of Health – Public health". Department of Health.
  28. ^ a b "Cochrane CAM Field: Integrative Medicine".
  29. ^ Fontanarosa PB, Lundberg GD (1998). "Alternative medicine meets science". JAMA. 280 (18): 1618–9. doi:10.1001/jama.280.18.1618. PMID 9820267. {{cite journal}}: Unknown parameter |month= ignored (help)
  30. ^ Barrett, Stephen (February 10, 2004). "Be Wary of "Alternative" Health Methods". Stephen Barrett, M.D. Quackwatch. Retrieved 2008-03-03.
  31. ^ a b c "$2.5 billion spent, no alternative cures found – Alternative medicine- msnbc.com". MSNBC. June 10, 2009.
  32. ^ a b "Complementary medicine: the good the bad and the ugly". Edzard Ernst.
  33. ^ The Economist, "Alternative Medicine: Think yourself better", 21 May 2011, pp. 83–84.
  34. ^ Dawkins, Richard (2003). A Devil's Chaplain. Weidenfeld & Nicolson. ISBN 978-0-618-33540-4. {{cite book}}: More than one of |author= and |last= specified (help)
  35. ^ Dawkins, Richard (2003). A Devil's Chaplain. United States: Houghton Mifflin. p. 58. ISBN 978-0-618-33540-4.
  36. ^ "Review: A Devil's Chaplain by Richard Dawkins". The Guardian. London. 2003-02-15. Retrieved 2010-04-23.
  37. ^ Cassileth BR (1999). "Evaluating complementary and alternative therapies for cancer patients". CA Cancer J Clin. 49 (6): 362–75. doi:10.3322/canjclin.49.6.362. PMID 11198952.
  38. ^ a b Brown, David (March 17, 2009). "Scientists Speak Out Against Federal Funds for Research on Alternative Medicine". Washingtonpost. Retrieved 2010-04-23.
  39. ^ Research Results of Complementary and Alternative Medicine [NCCAM Research]
  40. ^ Sampson W, Atwood Iv K (2005). "Propagation of the absurd: demarcation of the absurd revisited". Med. J. Aust. 183 (11–12): 580–1. PMID 16336135.
  41. ^ Aratani, Lori (2009-06-09). "Mainstream Physicians Try Such Alternatives as Herbs, Acupuncture and Yoga". Washington Post. Retrieved 2010-04-23.
  42. ^ Tracy King (2010-01-08). "Tim Minchin's Storm – Official Trailer". Storm Production Blog. Retrieved 2010-01-11.
  43. ^ a b c d e Barnes PM, Powell-Griner E, McFann K, Nahin RL (2004). "Complementary and alternative medicine use among adults: United States, 2002" (PDF). Advance Data (343): 1–19. PMID 15188733. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  44. ^ Weil, Andrew. "What is Integrative Medicine". Retrieved 2008-03-06.
  45. ^ Ernst E (2003). "Obstacles to research in complementary and alternative medicine". The Medical Journal of Australia. 179 (6): 279–80. PMID 12964907. {{cite journal}}: Unknown parameter |month= ignored (help)
  46. ^ Reasons people use CAM. NCCAM
  47. ^ a b Astin JA (1998). "Why patients use alternative medicine: results of a national study". JAMA. 279 (19): 1548–53. doi:10.1001/jama.279.19.1548. PMID 9605899. {{cite journal}}: Unknown parameter |month= ignored (help)
  48. ^ Thomas KJ, Nicholl JP, Coleman P (2001). "Use and expenditure on complementary medicine in England: a population based survey". Complementary Therapies in Medicine. 9 (1): 2–11. doi:10.1054/ctim.2000.0407. PMID 11264963. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  49. ^ Mark Henderson, Science Editor, "Prince of Wales's guide to alternative medicine 'inaccurate'" Times Online, April 17, 2008
  50. ^ "Complementary medicine is diagnosis, treatment and/or prevention that 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.
  51. ^ House of Lords report on CAM Template:WebCite
  52. ^ "Traditional medicine". Fact sheet 134. World Health Organization. 2003-05. Archived from the original on 2008-07-28. Retrieved 2008-03-06. {{cite web}}: Check date values in: |date= (help); Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  53. ^ Michalsen A, Lüdtke R, Bühring M, Spahn G, Langhorst J, Dobos GJ (2003). "Thermal hydrotherapy improves quality of life and hemodynamic function in patients with chronic heart failure". American Heart Journal. 146 (4): 728–33. doi:10.1016/S0002-8703(03)00314-4. PMID 14564334. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  54. ^ Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ (2003). "Long term benefits of hypnotherapy for irritable bowel syndrome". Gut. 52 (11): 1623–9. doi:10.1136/gut.52.11.1623. PMC 1773844. PMID 14570733. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  55. ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 14556820, please use {{cite journal}} with |pmid=14556820 instead.
  56. ^ Kleijnen J, Knipschild P, ter Riet G (1991). "Clinical trials of homoeopathy". BMJ. 302 (6772): 316–23. doi:10.1136/bmj.302.6772.316. PMC 1668980. PMID 1825800. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  57. ^ Linde K, Clausius N, Ramirez G; et al. (1997). "Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials". Lancet. 350 (9081): 834–43. doi:10.1016/S0140-6736(97)02293-9. PMID 9310601. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  58. ^ Allan Kellehear, Complementary medicine: is it more acceptable in palliative care practice? MJA 2003; 179 (6 Suppl): S46-S48 online
  59. ^ Lynette A. Menefee, Daniel A. Monti, Complementary Medicine-Mind-Body Techniques: Nonpharmacologic and Complementary Approaches to Cancer Pain Management, JAOA, Vol 105, No suppl_5, November 2005, 15-20.
  60. ^ Sobel DS (2000). "The cost-effectiveness of mind-body medicine interventions". Progress in Brain Research. 122: 393–412. doi:10.1016/S0079-6123(08)62153-6. PMID 10737073.
  61. ^ Complementary Medicine – Mind-Body Interventions, WebMD, Inc., 2007
  62. ^ Glossary, Continuum Health Partners, 2005.
  63. ^ House of Lords Select Committee on Science and Technology. 2000. Complementary and Alternative Medicine. London: The Stationery Office.
  64. ^ Alternative Medicine Goes Mainstream CBS News. Published July 20, 2006. Retrieved June 13, 2009.
  65. ^ "Press Release : Latest Survey Shows More Hospitals Offering Complementary and Alternative Medicine Services". American Hospital Association. 2008-09-15. Retrieved 2009-11-18.
  66. ^ Tex. Admin. Code § 200.3. Complementary and Integrative Medicine: An Update for Texas Physicians
  67. ^ Alternative Medicine in Denmark 2005 www.vifab.dk/uk
  68. ^ Medical Students and Alternative Medicine, www.vifab.dk/uk
  69. ^ Wetzel MS, Eisenberg DM, Kaptchuk TJ (1998). "Courses involving complementary and alternative medicine at US medical schools". JAMA. 280 (9): 784–7. doi:10.1001/jama.280.9.784. PMID 9729989. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  70. ^ Saxon DW, Tunnicliff G, Brokaw JJ, Raess BU (2004). "Status of complementary and alternative medicine in the osteopathic medical school curriculum". The Journal of the American Osteopathic Association. 104 (3): 121–6. PMID 15083987. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  71. ^ Fenton MV, Morris DL (2003). "The integration of holistic nursing practices and complementary and alternative modalities into curricula of schools of nursing". Alternative Therapies in Health and Medicine. 9 (4): 62–7. PMID 12868254.
  72. ^ University of Arizona Center for Integrative Medicine
  73. ^ Barberis L, de Toni E, Schiavone M, Zicca A, Ghio R (2001). "Unconventional medicine teaching at the Universities of the European Union". Journal of Alternative and Complementary Medicine. 7 (4): 337–43. doi:10.1089/10762800152709679. PMID 11558776. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  74. ^ Varga O, Márton S, Molnár P (2006). "Status of complementary and alternative medicine in European medical schools". Forschende Komplementärmedizin. 13 (1): 41–5. doi:10.1159/000090216. PMID 16582550. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  75. ^ Zmark.net. "Alternative Medicine Schools & Colleges – HealthWorld Online". Healthy.net. Retrieved 2009-11-18.
  76. ^ Wilkinson, G. (2005), Understanding Stress, Family Doctor Publications in association with the Britishi Medical Association, pp110–111.
  77. ^ Can Mainstream Medicine and Alternative Therapies Coexist?
  78. ^ Mary Ann Liebert, Inc. – The Journal of Alternative and Complementary Medicine – 12(7):601
  79. ^ "Nutritionist calls for tighter regulation of supplements". CNN. Retrieved 2010-04-23.
  80. ^ Former Surgeon General: Mainstream Medicine Has Endorsed Medical Marijuana | DrugReporter | AlterNet
  81. ^ Informed Public Debate Needed On Water Fluoridation
  82. ^ Book Review by Janice Dickin – Rennie B. Schoepflin; Christian Science on Trial: Religious Healing in America.
  83. ^ Dietary Supplement Regulation: U.S. Food and Drug Administration Public Hearing
  84. ^ 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 Template:WebCite
  85. ^ David Schnauer: Therapeutics bill must pass – 06 July 2007 – Legislation news – NZ Herald
  86. ^ Therapeutic Goods Administration. "Regulation of complementary medicines". Retrieved 17 May 2009. {{cite web}}: Cite has empty unknown parameter: |coauthors= (help)
  87. ^ Therapeutic Goods Administration (2005). "Australian Regulatory Guidelines for Complementary medicines (ARGCM), Part III Evaluation of Complementary Medicine Substances" (PDF). Retrieved 17 May 2009. {{cite web}}: Cite has empty unknown parameter: |coauthors= (help)
  88. ^ Therapeutic Goods Administration (2006). "EU Guideline – as Adopted in Australia by the TGA – with Amendment" (PDF). Retrieved 17 May 2009. {{cite web}}: Cite has empty unknown parameter: |coauthors= (help)
  89. ^ Agin, Dan (2006-10-03). Junk Science: how politicians, corporations, and other hucksters betray us. Thomas Dunne Books. pp. Ch. 8. ISBN 978-0-312-35241-7.
  90. ^ Herbal and dietary supplements in Denmark www.vifab.dk/uk
  91. ^ Herbal Medicine Products in Denmark www.vifab.dk/uk
  92. ^ Strong vitamin and mineral preparations in Denmark www.vifab.dk/uk
  93. ^ Traditional botanical medicinal products in Denmark
  94. ^ Homeopatic medicinal products in Denmark www.vifab.dk/uk
  95. ^ Dietary supplemnts in Denmark www.vifab.dk/uk
  96. ^ Registration of Alternative Practitioners – RAB, Knowledge and Research Center for Alternative Medicines homepage
  97. ^ a b Scientists Speak Out Against Federal Funds for Research on Alternative Medicine – washingtonpost.com
  98. ^ a b Why the National Center for Complementary and Alternative Medicine (NCCAM) Should Be Defunded
  99. ^ graceland: Homeopathy is part of the national health systems of France
  100. ^ The New England Journal of Medicine, July 1995.
  101. ^ Katz DL, Williams AL, Girard C; et al. (2003). "The evidence base for complementary and alternative medicine: methods of Evidence Mapping with application to CAM". Alternative Therapies in Health and Medicine. 9 (4): 22–30. PMID 12868249. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  102. ^ Ernst E (2005). "The efficacy of herbal medicine--an overview". Fundamental & Clinical Pharmacology. 19 (4): 405–9. doi:10.1111/j.1472-8206.2005.00335.x. PMID 16011726. {{cite journal}}: Unknown parameter |month= ignored (help)
  103. ^ Horrobin DF (1986). "Glittering prizes for research support". Nature. 324 (6094): 221. Bibcode:1986Natur.324..221H. doi:10.1038/324221a0.
  104. ^ "NCCAM Funding: Appropriations History". NCCAM. 2008-01-09. Archived from the original on 2009-06-11. Retrieved 2008-04-02. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  105. ^ Atwood, Kimball C. (2003-09). "The Ongoing Problem with the National Center for Complementary and Alternative Medicine". Skeptical Inquirer. Retrieved 2009-11-18. {{cite news}}: Check date values in: |date= (help); Cite has empty unknown parameter: |coauthors= (help)
  106. ^ James Alcock PhD, Alternative Medicine and the Psychology of Belief, The Scientific Review of Alternative Medicine, Fall/Winter 1999 Volume 3 ~ Number 2. available online
  107. ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 12356597, please use {{cite journal}} with |pmid=12356597 instead.
  108. ^ Andrew Vickers PhD (2004). "Alternative Cancer Cures: "Unproven" or "Disproven"?". CA Cancer J Clin. 54 (2): 110–118. doi:10.3322/canjclin.54.2.110. PMID 15061600.
  109. ^ Cassileth BR, Deng G (2004). "Complementary and alternative therapies for cancer". The Oncologist. 9 (1): 80–9. doi:10.1634/theoncologist.9-1-80. PMID 14755017.
  110. ^ Hills, Ben. "Fake healers. Why Australia's $1 billion-a-year alternative medicine industry is ineffective and out of control". Medical Mayhem. Retrieved 2008-03-06.
  111. ^ Swan, Norman (2000-10-02). "Alternative Medicine – Part Three". The Health Report. ABC Radio National. Retrieved 2008-03-06. {{cite news}}: Cite has empty unknown parameter: |coauthors= (help)
  112. ^ a b Isadora Stehlin. "Homeopathy: Real Medicine or Empty Promises?" – FDA Consumer magazine (December 1996)
  113. ^ "NEJM – Drug-Related Hepatotoxicity". Content.nejm.org. 2006-05-18. doi:10.1056/NEJMra052270. Retrieved 2009-12-16.
  114. ^ Lilienfeld, Scott O. (2002). "Our Raison d'Être". The Scientific Review of Mental Health Practice. 1 (1). Archived from the original on 2007-07-26. Retrieved 2008-01-28. {{cite journal}}: Cite has empty unknown parameter: |coauthors= (help); Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  115. ^ Dominic Hughes (23 December 2010). "Alternative remedies 'dangerous' for kids says report". BBC News.
  116. ^ Vickers, A. (2004). "Alternative Cancer Cures: 'Unproven' or 'Disproven'?". CA. 54 (2): 110–8. doi:10.3322/canjclin.54.2.110. PMID 15061600.
  117. ^ Renckens CN (2009). "A Dutch view of the science of CAM 1986--2003". Eval Health Prof. 32 (4): 431–50. doi:10.1177/0163278709346815. PMID 19926606. {{cite journal}}: Unknown parameter |month= ignored (help)
  118. ^ What Is Complementary and Alternative Medicine? National Center for Complementary and Alternative Medicine. . Retrieved 20 February 2011. Template:WebCite
  119. ^ "real acupuncture treatments were no more effective than sham acupuncture treatments. There was, nevertheless, evidence that both real acupuncture and sham acupuncture were more effective than no treatment, and that acupuncture can be a useful supplement to other forms of conventional therapy for low back pain", Acupuncture for Chronic Low Back Pain, New England Journal of Medicine, 2010; 363:454-461, Brian M. Berman, M.D., Dr. Brian M. Berman, founder of the Center for Integrative Medicine, University of Maryland School of Medicine, and Helene M. Langevin, M.D., Claudia M. Witt, M.D., M.B.A., and Ronald Dubner, D.D.S., Ph.D., MMS: Error
  120. ^ Family physicians believe the placebo effect is th... [Fam Med. 2010] – PubMed result
  121. ^ http://www.stfm.org/fmhub/fm2010/October/Rachel636.pdf
  122. ^ Beth Israel Medical Center, Beth Israel Medical Center: Department of Integrative Medicine
  123. ^ Hartford Hospital, Connecticut, Department of Integrative Medicine – Hartford Hospital, Connecticut
  124. ^ University of Michigan, University of Michigan Integrative Medicine
  125. ^ University of Maryland, Center for Integrative Medicine: University of Maryland School of Medicine
  126. ^ University of North Carolina, Welcome to the Program on Integrative Medicine! – Program on Integrative Medicine
  127. ^ UCSF, UCSF Osher Center for Integrative Medicine
  128. ^ University of Colorado, Integrative Medicine Center, Alternative and Complementary Medicine – University of Colorado Hospital
  129. ^ Acupuncture Pseudoscience in the New England Journal of Medicine, Science Based Medicine, Steven Novella Science-Based Medicine » Acupuncture Pseudoscience in the New England Journal of Medicine
  130. ^ Eisenberg, DM, et al. (1993). “Unconventional Medicine in the United States – Prevalence, Costs, and Patterns of Use.” JAMA: 328:246–252.
  131. ^ Eisenberg DM, Davis RB, Ettner SL, et al. 1998. Trends in alternative medicine use in the United States, 1990–1997: results of a follow-up national survey. JAMA. 1;280 (18):1569–75.
  132. ^ Best Practices in Integrative Medicine: A Report from the Bravewell Clinical Network. Published 2007. The Bravewell Collaborative. Page 4.
  133. ^ a b c d e f Beyerstein BL (1999). "Psychology and 'Alternative Medicine' Social and Judgmental Biases That Make Inert Treatments Seem to Work". The Scientific Review of Alternative Medicine. 3 (2). Retrieved 2008-07-07.
  134. ^ a b Weber DO (1998). "Complementary and alternative medicine. Considering the alternatives". Physician Executive. 24 (6): 6–14. PMID 10351720.
  135. ^ a b c Beyerstein BL (2001). "Alternative medicine and common errors of reasoning". Academic Medicine. 76 (3): 230–7. doi:10.1097/00001888–200103000-00009. PMID 11242572. {{cite journal}}: Check |doi= value (help); Unknown parameter |month= ignored (help)
  136. ^ van Deventer MO (2008). "Meta-placebo: do doctors have to lie about giving a fake treatment?". Medical Hypotheses. 71 (3): 335–9. doi:10.1016/j.mehy.2008.03.040. PMID 18485613. {{cite journal}}: Unknown parameter |month= ignored (help)
  137. ^ "Complementary therapies: The big con? – The Independent". London. 2008-04-22. Retrieved 2010-04-23.

Further reading

World Health Organization publication

Journals dedicated to alternative medicine research

Further reading

Criticism


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