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| {{short description|Form of non-scientific healing}} | |||
| {{Alternative medical systems}}'''Alternative medicine''' is any practice that is put forward as having the ] effects of ], but does not originate from ] gathered using the ],{{refn|name=Harrisonquote|group=n}}{{refn|name=NSFquote|group=n|}}{{refn|name=Angellquote|group=n}} is not part of ],{{refn|name=Harrisonquote|group=n}}{{refn|group=n|name=IOMquote}}{{refn|group=n|name=WebMD2014quote}}{{refn|group=n|name=NCCIH2quote}} or is contradicted by scientific evidence or established science.<ref name=ATRAMM/><ref name=AMCER/><ref name=Hines_Sampson_Coulter_Sagan/> It consists of a wide variety of ] practices, products and therapies, ranging from being ] but not well tested, to being directly contradicted by evidence and science, or even harmful or toxic.{{refn|group=n|name=IOMquote}}<ref name=ATRAMM/><ref name=Hines_Sampson_Coulter_Sagan/><ref name="CAM_Sointu_Nissen_Eisenberg"/><ref name=DaguptaHStabler2011/><ref name=FDA_regulatory/> Examples include new and ] practices such as ], ], ], ], various forms of ], ], ], ], and ]. The treatments are those that are not part of the ] healthcare system, and are not clearly backed by ].<ref name=NCCIH1/><ref name=Zollman1999/>{{sfn|IOM Report|2005|p=16–20}}<ref name=WHO/> Despite significant expenditures on testing alternative medicine, including $2.5 billion spent by the United States government, almost none have shown any effectiveness greater than that of false treatments (]), and alternative medicine has been criticized by prominent figures in science and medicine as being ], ], ], or ].<ref name="$2.5 billion"/><ref name=Phytotherapyquoted>''"Science-based medicine, with its emphasis on controlled study, proof, evidence, statistical significance and safety is being rejected in favour of 'alternative medicine' - an atavistic portmanteau of anecdote, hearsay, rumour and hokum.... Probably the most commercially successful and widely used branch of alternative or complementary medicine is 'phytotherapy'. These are the tablets, powders and elixirs, otherwise known as herbal medicine, that are sold in most countries, through health shops and pharmacies as 'nutritional supplements'.... Only a tiny minority of these remedies have been shown to have mild-to moderately beneficial health effects... So why are affluent, otherwise rational, highly educated people (for this is the average user profile) so hungry for phytotherapy?... people still believe that 'natural' equals good and safe despite plenty of evidence to the contrary." ... as far as the human body is concerned, 'natural' is meaningless... Equally, what's so safe about consuming substances that need meet no standards of contents? ..."'', Phytotherapy - good science or big business?, Sara Abdulla, Nature - International Weekly Journal of Science, 5-13-1999 </ref> | |||
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| {{infobox alternative medicine | |||
| | name = | |||
| | synonyms = <!--Please do not remove any synonym without prior consensus, seek consensus on the talk page-->AM, complementary and alternative medicine (CAM), complementary medicine, heterodox medicine, integrative medicine (IM), complementary and integrative medicine (CIM), new-age medicine, pseudomedicine, unconventional medicine, unorthodox medicine, altmed<!--Please do not remove any synonym without prior consensus, seek consensus on the talk page--> | |||
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| | caption = Alternative therapies often make bombastic claims and frequently include anecdotes from healthy-looking individuals claiming successful treatment. | |||
| | classification = | |||
| | modality = | |||
| | claims = Alternatives to science-based medicine | |||
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| }} | |||
| {{Alternative medical systems|general}} | |||
| <!--References for the lead are contained in the article body. Also see article version ID 890900314, which contains the references in the comments.--> | |||
| '''Alternative medicine''' is any practice that aims to achieve the healing effects of medicine despite lacking ], ], ] or evidence of effectiveness. Unlike modern ], which employs the ] to test plausible therapies by way of ] ]s, producing repeatable ] of either effect or of no effect, alternative therapies reside outside of mainstream medicine{{refn|name=Harrisonquote|group=n}}{{refn |name=WebMD2014quote|group=n}} and do not originate from using the scientific method, but instead rely on ]s, ]s, religion, tradition, ], belief in ] "]", ], ], propaganda, fraud, or other unscientific sources. Frequently used terms for relevant practices are '''] medicine''', ''']''', '''unorthodox medicine''', '''holistic medicine''', '''fringe medicine''', and '''unconventional medicine''', with little distinction from ]. | |||
| Some alternative practices are based on theories that contradict the established science of how the human body works; others appeal to the ] or ] to explain their effect or lack thereof. In others, the practice has plausibility but lacks a positive ] outcome probability. Research into alternative therapies often fails to follow proper research protocols (such as ]-controlled trials, ] and calculation of ]), providing invalid results. History has shown that if a method is proven to work, it eventually ceases to be alternative and becomes mainstream medicine. | |||
| '''Complementary medicine''' is alternative medicine used together with conventional medical treatment, in a ] not confirmed using the scientific method that it "complements" (improves the efficacy of) the treatment.{{refn|group=n|name=FinalReport|The ''Final Report'' (2002) of the White House Commission on Complementary and Alternative Medicine Policy states: "The Commissioners believe and have repeatedly stated in this Report that our response should be to hold all systems of health and healing, including conventional and CAM, to the same rigorous standards of good science and health services research. Although the Commissioners support the provision of the most accurate information about the state of the science of all CAM modalities, they believe that it is premature to advocate the wide implementation and reimbursement of CAM modalities that are yet unproven."<ref name="whccamp.hhs.gov"/>}}<ref name=NSF_2002/><ref name=Ernst_1995/><ref name=Joyce_1994/> '''CAM''' is the abbreviation for '''complementary and alternative medicine'''.<ref name=ernstinterview/><ref name=CassilethDeng2004/> ''']''' (or integrative health) is the combination of the practices and methods of alternative medicine with conventional medicine.<ref name=BMJ_May/> | |||
| Much of the perceived effect of an alternative practice arises from a belief that it will be effective, the ], or from the treated condition resolving on its own (]). This is further exacerbated by the tendency to turn to alternative therapies upon the failure of medicine, at which point the condition will be at its worst and most likely to spontaneously improve. In the absence of this bias, especially for diseases that are not expected to get better by themselves such as cancer or ], multiple studies have shown significantly worse outcomes if patients turn to alternative therapies. While this may be because these patients avoid effective treatment, some alternative therapies are actively harmful (e.g. ] from ], or the intentional ingestion of ]) or actively interfere with effective treatments. | |||
| ] and treatments are not included as science-based treatments that are taught in ], and are not used in medical practice where treatments are based on what is established using the scientific method. Alternative therapies lack such ], and their effectiveness is either ] or ] or impossible to prove.{{refn|group=n|According to the Tzu Chi Institute, a Canadian centre established to evaluate complementary and alternative therapies, "alternative therapies are those lacking scientific validation that are excluded from medical school training programs and uninsured by health plans."<ref name=IGPIAMAYP/>}}<ref name=ATRAMM/><ref name=NSF_2002/><ref name=Angell1998/><ref name=NP/> Alternative medicine is usually based on ], tradition, ], belief in ] energies, ], ], propaganda, or fraud.<ref name=ATRAMM/><ref name=AMCER/><ref name=Hines_Sampson_Coulter_Sagan/><ref name=NSF_2002/> Regulation and licensing of alternative medicine and ]s varies from country to country, and state to state. | |||
| The alternative medicine sector is a highly profitable industry with a strong lobby,<ref name="ConsumerHealth9th"/> and faces far less regulation over the use and marketing of unproven treatments. '''Complementary medicine''' ('''CM'''), '''complementary and alternative medicine''' ('''CAM'''), '''integrated medicine''' or '''integrative medicine''' ('''IM'''), and ''']''' attempt to combine alternative practices with those of mainstream medicine. ] practices become "alternative" when used outside their original settings and without proper scientific explanation and evidence. Alternative methods are often marketed as more "]" or "]" than methods offered by medical science, that is sometimes derogatorily called "]" by supporters of alternative medicine. Billions of dollars have been spent studying alternative medicine, with few or no positive results and many methods thoroughly disproven. | |||
| The scientific community has criticized alternative medicine as being based on misleading statements, ], ], ], ], or poor ]ology. Promoting alternative medicine has been called dangerous and ].{{refn|name=Groopmanquote|group=n|"Kessler refers to a lack of efficacy but never pushes back at Hatch by enumerating the dangers that unregulated products pose to the public, the dangers that fill the pages of Offit’s book."<ref name=Groopman/>}}<ref name=Weisleder/> Testing alternative medicine has been called a waste of scarce medical research resources.<ref name=Wadman/><ref>{{cite journal|last1=Gorski|first1=DH|last2=Novella|first2=SP|title=Clinical trials of integrative medicine: testing whether magic works?|journal=Trends in Molecular Medicine|date=September 2014|volume=20|issue=9|pages=473–6|doi=10.1016/j.molmed.2014.06.007|pmid=25150944}}</ref> Critics have said "there is really no such thing as alternative medicine, just medicine that works and medicine that doesn't",<ref name=Dawkins2003a/> and "Can there be any reasonable 'alternative' ?"<ref name=Relman1998/> | |||
| {{TOC limit}} | {{TOC limit|4}} | ||
| ==Definitions and terminology== | |||
| ==Types== | |||
| {{see also|Terminology of alternative medicine}} | |||
| ]: "There cannot be two kinds of medicine – conventional and alternative."<ref name=Angell1998/>]] | |||
| The terms ''alternative medicine'', ''complementary medicine'', ''integrative medicine,'' ''holistic medicine'', ''natural medicine'', ''unorthodox medicine'', ''fringe medicine'', ''unconventional medicine'', and ''] medicine'' are used interchangeably as having the same meaning and are almost synonymous in most contexts.<ref name="Shapiro 08">{{Cite book |last=Shapiro |first=Rose |url=https://books.google.com/books?id=Ib_IbOu_d9gC&pg=PA1 |title=Suckers: How Alternative Medicine Makes Fools of Us All |publisher=Random House |year=2010 |isbn=978-1-4090-5916-5 |page=8 |quote=Further rebranding has given rise to the notion of 'integrated medicine'.}}</ref><ref name=Bombardieri2000 /><ref name="Shuval2012" /><ref name="Freedman2011" /> Terminology has shifted over time, reflecting the preferred branding of practitioners.<ref name="SBM-brand">Gorski, David (August 15, 2011). . sciencebasedmedicine.org. (Retrieved March 25, 2022).</ref> For example, the ] department studying alternative medicine, currently named the ] (NCCIH), was established as the ''Office of Alternative Medicine'' (OAM) and was renamed the ''National Center for Complementary and Alternative Medicine'' (NCCAM) before obtaining its current name. Therapies are often ] as "natural" or "holistic", implicitly and intentionally suggesting that conventional medicine is "artificial" and "narrow in scope".<ref name="ConsumerHealth9th"/><ref>{{Cite web|url=http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2004:136:0085:0090:en:PDF|title=Directive 2004/24/EC of the European Parliament and of the Council|date=2004-04-30|website=Official Journal of the European Union}}</ref> | |||
| The meaning of the term "alternative" in the expression "alternative medicine", is not that it is an effective alternative to ] (though some alternative medicine promoters may use the loose terminology to give the appearance of effectiveness).<ref name="Sampson_6/1995">{{Cite journal |last=Sampson |first=Wallace |date=June 1995 |title=Antiscience Trends in the Rise of the Alternative Medicine Movement |url=https://nyaspubs.onlinelibrary.wiley.com/doi/10.1111/j.1749-6632.1996.tb23138.x |journal=Annals of the New York Academy of Sciences |volume=775 |issue=1 |pages=188–197 |doi=10.1111/j.1749-6632.1996.tb23138.x |pmid=8678416 |s2cid=2813395 |issn=0077-8923}}</ref><ref name="Kolata">{{Citation |last=Kolata |first=Gina |title=On Fringes of Health Care, Untested Therapies Thrive |date=June 17, 1996 |url=https://www.nytimes.com/1996/06/17/us/on-fringes-of-health-care-untested-therapies-thrive.html |work=] |access-date=December 22, 2015 |author-link=Gina Kolata}}</ref> Loose terminology may also be used to suggest meaning that a dichotomy exists when it does not (e.g., the use of the expressions "Western medicine" and "Eastern medicine" to suggest that the difference is a cultural difference between the Asian east and the European west, rather than that the difference is between ] and treatments that do not work).<ref name="Sampson_6/1995" /> | |||
| {{see also|List of forms of alternative medicine}} | |||
| Alternative medicine consists of a wide range of health care practices, products, and therapies. The shared feature is a claim to heal that is not based on the scientific method. Alternative medicine practices are diverse in their foundations and methodologies.<ref name=NCCIH1 /> Alternative medicine practices may be classified by their cultural origins or by the types of beliefs upon which they are based.<ref name=ATRAMM/><ref name=AMCER/><ref name=NCCIH1/><ref name=NSF_2002/> Methods may incorporate or base themselves on traditional medicinal practices of a particular culture, folk knowledge, supersition,{{sfn|O'Connor|1995|p=}} spiritual beliefs, belief in ] energies (]), ], ], propaganda, fraud, new or different concepts of health and disease, and any bases other than being proven by scientific methods.<ref name=ATRAMM/><ref name=AMCER/><ref name=Hines_Sampson_Coulter_Sagan/><ref name=NSF_2002/> Different cultures may have their own unique traditional or belief based practices developed recently or over thousands of years, and specific practices or entire systems of practices. | |||
| === |
===Alternative medicine=== | ||
| Alternative medicine is defined loosely as a set of products, practices, and theories that are believed or perceived by their users to have the healing effects of medicine,{{refn|name=NSFquote|group=n|"lternative medicine refers to all treatments that have not been proven effective using scientific methods."<ref name="NSF_4/2002" />}}{{refn|"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."{{sfn|IOM Report|2005|p=19}}|name=IOMquote|group=n}} but whose ] has not been established using ]s,{{refn|name=NSFquote|group=n}}{{refn|name=Angellquote|group=n|"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 ... speculation, and testimonials do not substitute for evidence."<ref name=Angell1998/>}}<ref name="Hines_Sampson_Coulter_Sagan" /><ref name="IGPIAMAYP" /><ref name="NP" /><ref name="Sampson_6/1995" /> or whose theory and practice is not part of ],{{refn|group=n|name=IOMquote}}{{refn|group=n|name=Harrisonquote |"The phrase complementary and alternative medicine is used to describe a group of diverse medical and health care systems, practices, and products that have historic origins outside mainstream medicine. Most of these practices are used together with conventional therapies and therefore have been called complementary to distinguish them from alternative practices, those used as a substitute for standard care. ... Until a decade ago or so, 'complementary and alternative medicine' could be defined as practices that are neither taught in medical schools nor reimbursed, but this definition is no longer workable, since medical students increasingly seek and receive some instruction about complementary health practices, and some practices are reimbursed by third-party payers. Another definition, practices that lack an evidence base, is also not useful, since there is a growing body of research on some of these modalities, and some aspects of standard care do not have a strong evidence base."{{sfn|Harrison's Principles of Internal Medicine|2015|loc=chpt. 14-E|p=1}}}}{{refn |name=WebMD2014quote |group=n |"An alternative medical system is a set of practices based on a philosophy different from Western biomedicine."<ref name=WebMD2014/>}}{{refn |group=n |name=NCCIH2quote |"CAM is a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine."<ref name=NCCIH2/>}} or whose theories or practices are directly contradicted by ] or ] used in biomedicine.<ref name="Sampson_6/1995" /><ref name="Hines_Sampson_Coulter_Sagan" /><ref name="AMCER" /> "Biomedicine" or "medicine" is that part of medical science that applies principles of ], ], ], ], and other ]s to ], using scientific methods to establish the effectiveness of that practice. Unlike medicine,{{refn|name=Harrisonquote|group=n}} an alternative product or practice does not originate from using scientific methods, but may instead be based on ], religion, tradition, ], belief in ] energies, ], ], propaganda, fraud, or other unscientific sources.{{refn|name=Angellquote|group=n}}<ref name="Sampson_6/1995" /><ref name="NSF_4/2002" /><ref name="Hines_Sampson_Coulter_Sagan" /><ref name="AMCER" /> | |||
| Some other definitions seek to specify alternative medicine in terms of its social and political marginality to mainstream healthcare.<ref name="Saks1992" /> This can refer to the lack of support that alternative therapies receive from medical scientists regarding access to ], sympathetic coverage in the ], or inclusion in the standard ].<ref name="Saks1992" /> For example, a widely used{{sfn|IOM Report|2005|p=}} definition devised by the ] calls it ''"a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine"''.<ref name="NCCIH1" /> However, these descriptive definitions are inadequate in the present-day when some conventional doctors offer alternative medical treatments and introductory courses or modules can be offered as part of standard undergraduate medical training;<ref name="HOL_Kopelman_Wieland_Astin_Pelletier" /> alternative medicine is taught in more than half of ] and ] are increasingly willing to provide reimbursement for alternative therapies.{{sfn|IOM Report|2005|pp=, }} | |||
| Alternative medical systems can be based on common belief systems that are not consistent with facts of science, such as in ] or ].<ref name=NCCIH1/> | |||
| ===Complementary or integrative medicine=== | |||
| ====Homeopathy==== | |||
| {{anchor|Complementary medicine|Integrative medicine|Integrated medicine}} | |||
| '''Complementary medicine''' (CM) or '''integrative medicine''' (IM) is when alternative medicine is used together with mainstream functional medical treatment in a ] that it improves the effect of treatments.{{refn|group=n|name=FinalReport|The ''Final Report'' (2002) of the White House Commission on Complementary and Alternative Medicine Policy states: "The Commissioners believe and have repeatedly stated in this Report that our response should be to hold all systems of health and healing, including conventional and CAM, to the same rigorous standards of good science and health services research. Although the Commissioners support the provision of the most accurate information about the state of the science of all CAM modalities, they believe that it is premature to advocate the wide implementation and reimbursement of CAM modalities that are yet unproven."<ref name="whccamp.hhs.gov"/>}}<ref name="NSF_4/2002" /><ref name="Ernst_1995" /><ref name="Joyce_1994" /><ref name="BMJ_May" /> For example, ] (piercing the body with needles to influence the flow of a supernatural energy) might be believed to increase the effectiveness or "complement" science-based medicine when used at the same time.<ref name="NCI_PDQ_CAM" /><ref name="Borkan2012" /><ref name="whatiscam" /> Significant ]s caused by alternative therapies may make treatments less effective, notably in ].<ref name="autogenerated2">{{Cite journal |last1=Zeller |first1=T. |last2=Muenstedt |first2=K. |last3=Stoll |first3=C. |last4=Schweder |first4=J. |last5=Senf |first5=B. |last6=Ruckhaeberle |first6=E. |last7=Becker |first7=S. |last8=Serve|first8=H. |last9=Huebner |first9=J. |date=2013-03-01 |title=Potential interactions of complementary and alternative medicine with cancer therapy in outpatients with gynecological cancer in a comprehensive cancer center |journal=Journal of Cancer Research and Clinical Oncology |volume=139 |issue=3 |pages=357–365 |doi=10.1007/s00432-012-1336-6|issn=1432-1335|pmid=23099993|s2cid=29598970 }}</ref><ref name="Arye13">{{Cite journal|last1=Ben-Arye |first1=Eran |last2=Polliack |first2=Aaron |last3=Schiff |first3=Elad |last4=Tadmor |first4=Tamar |last5=Samuels |first5=Noah|date=2013-12-01|title=Advising patients on the use of non-herbal nutritional supplements during cancer therapy: a need for doctor-patient communication |journal=Journal of Pain and Symptom Management |volume=46 |issue=6 |pages=887–896 |doi=10.1016/j.jpainsymman.2013.02.010 |pmid=23707384 |issn=1873-6513|doi-access=free }}</ref><ref name="Li et al., 2018" /> | |||
| Several medical organizations differentiate between complementary and alternative medicine including the UK ] (NHS),<ref>{{Cite web |date=March 1, 2022 |title=Complementary and alternative medicine |url=https://www.nhs.uk/conditions/complementary-and-alternative-medicine/ |access-date=2023-05-06 |publisher=] |language=en}}</ref> ],<ref>{{Cite web |date=4 April 2022 |title=The difference between complementary and alternative therapies (CAMs) |url=https://www.cancerresearchuk.org/about-cancer/treatment/complementary-alternative-therapies/about/difference-between-therapies |access-date=2023-05-06 |publisher=] |language=en}}</ref> and the US ] (CDC), the latter of which states that "''Complementary medicine'' is used in addition to standard treatments" whereas "''Alternative medicine'' is used instead of standard treatments."<ref>{{Cite web |date=2022-06-09 |title=Complementary and Alternative Medicine for Cancer Patients |url=https://www.cdc.gov/cancer/survivors/patients/complementary-alternative-medicine.htm |access-date=2023-05-06 |website=Centers for Disease Control and Prevention |language=en-us}}</ref> | |||
| Homeopathy is a system developed in a belief that a substance that causes the symptoms of a disease in healthy people will cure similar symptoms in sick people.{{refn|name=Hahnemannquote|group=n|In his book ''The Homœopathic Medical Doctrine'' ] the creator of homeopathy wrote: "Observation, reflection, and experience have unfolded to me that the best and true method of cure is founded on the principle, ''].'' To cure in a mild, prompt, safe, and durable manner, it is necessary to choose in each case a medicine that will excite an affection similar (''{{lang|el|ὅμοιος πάθος}}'') to that against which it is employed."{{sfn|Hahnemann|1833|p=, }}}} It was developed before knowledge of ]s and ]s, and of basic chemistry, which shows that repeated dilution as practiced in homeopathy produces only water and that homeopathy is scientifically implausible.<ref name=Ernst2002/><ref name=HCReport2010/><ref name=shang/><ref name=NCCIH_homeopathy/> Homeopathy is considered ] in the ].<ref name=Wahlberg/> | |||
| Complementary and integrative interventions are used to improve fatigue in adult cancer patients.<ref>{{Cite journal |last1=Belloni |first1=Silvia |last2=Bonucci |first2=Massimo |last3=Arrigoni |first3=Cristina |last4=Dellafiore |first4=Federica |last5=Caruso |first5=Rosario |date=2023-01-01 |title=A Systematic Review of Systematic Reviews and a Pooled Meta-Analysis on Complementary and Integrative Medicine for Improving Cancer-Related Fatigue |url=https://www.sciencedirect.com/science/article/pii/S0149291822004052 |journal=Clinical Therapeutics |language=en |volume=45 |issue=1 |pages=e54–e73 |doi=10.1016/j.clinthera.2022.12.001 |pmid=36566113 |s2cid=255049739 |issn=0149-2918}}</ref><ref>{{Cite journal |last1=Greenlee |first1=Heather |last2=Zick |first2=Suzanna M. |last3=Rosenthal |first3=David |last4=Cohen |first4=Lorenzo |last5=Cassileth |first5=Barrie |last6=Tripathy |first6=Debu |date=March 2015 |title=Integrative oncology — strong science is needed for better patient care |journal=Nature Reviews Cancer |language=en |volume=15 |issue=3 |page=165 |doi=10.1038/nrc3822-c1 |pmid=25693833 |s2cid=8053861 |issn=1474-1768|doi-access=free }}</ref> | |||
| ====Naturopathic medicine==== | |||
| ] has described integrative medicine as an attempt to bring pseudoscience into academic ]<ref name="Gorski2010" /> with skeptics such as Gorski and ] referring to this with the pejorative term "]".<ref>{{Cite journal |last=Caldwell |first=Elizabeth Frances |date=2017-07-03 |title=Quackademia? Mass-Media Delegitimation of Homeopathy Education |url=https://www.tandfonline.com/doi/full/10.1080/09505431.2017.1316253 |journal=Science as Culture |language=en |volume=26 |issue=3 |pages=380–407 |doi=10.1080/09505431.2017.1316253 |s2cid=151442812 |issn=0950-5431}}</ref> ] described Integrative medicine as "a synonym for 'alternative' medicine that, at its worst, integrates sense with nonsense. At its best, integrative medicine supports both consensus treatments of science-based medicine and treatments that the science, while promising perhaps, does not justify"<ref name="Carroll_integrative">]. . ]</ref> ] has criticized the field of alternative medicine for ] the same practices as integrative medicine.<ref name="Shapiro 08" /> | |||
| Naturopathic medicine is based on a belief that the body heals itself using a supernatural ] that guides bodily processes,<ref name=SarrisWardle2010/> a view in conflict with the paradigm of ].<ref name=Jagtenberg2006/> Many naturopaths have opposed ],<ref name=Ernst2001/> and "scientific evidence does not support claims that naturopathic medicine can cure ] or any other disease".<ref name=ACS/> | |||
| CAM is an abbreviation of the phrase ''complementary and alternative medicine''.<ref name="ernstinterview" /><ref name="CassilethDeng2004" /><ref name="Tyreman 209–17">{{Cite journal |last=Tyreman |first=Stephen |date=2011-05-01 |title=Values in complementary and alternative medicine|journal=Medicine, Health Care and Philosophy |volume=14 |issue=2 |pages=209–217 |doi=10.1007/s11019-010-9297-5 |issn=1572-8633 |pmid=21104324|s2cid=32143622 }}</ref> The 2019 ] (WHO) Global Report on Traditional and Complementary Medicine states that the terms complementary and alternative medicine "refer to a broad set of health care practices that are not part of that country's own traditional or conventional medicine and are not fully integrated into the dominant health care system. They are used interchangeably with traditional medicine in some countries."<ref name="WHO_2019">{{Cite report |date=2019 |title=WHO global report on traditional and complementary medicine |url=https://apps.who.int/iris/bitstream/handle/10665/312342/9789241515436-eng.pdf?sequence=1&isAllowed=y |journal=World Health Organization |location=Geneva |isbn=978-92-4-151543-6 |access-date=2022-12-06 |url-status=live |archive-url=https://web.archive.org/web/20220729214610/https://apps.who.int/iris/bitstream/handle/10665/312342/9789241515436-eng.pdf?sequence=1&isAllowed=y |archive-date=2022-07-29 |archive-format=PDF}}</ref> | |||
| ===Traditional ethnic systems=== | |||
| The Integrative Medicine Exam by the ]<ref name="ABPS_IM_test">{{cite web | title=Integrative Medicine Exam Description | publisher=] | date=July 16, 2021 | url=https://www.abpsus.org/integrative-medicine-description/ | access-date=March 11, 2022}}</ref> includes the following subjects: ], ], ], Movement Therapies, Expressive Arts, ], ], ], ], ], ],<!--The wikilink deliberately points to the Alternative medicine article, not the mainstream medicine article.--> ], and ].<ref name="ABPS_IM_test" /> | |||
| Alternative medical systems may be based on ] practices, such as ], ] in India, or practices of other cultures around the world.<ref name=NCCIH1/> | |||
| ===Other terms=== | |||
| ====Traditional Chinese medicine==== | |||
| {{see also|Traditional medicine}} | |||
| Traditional medicine (TM) refers to certain practices within a culture which have existed since before the advent of medical science,<ref name="WakeFitie_2022">{{cite journal |last1=Wake |first1=Getu Engida |last2=Fitie |first2=Girma Wogie |title=Magnitude and Determinant Factors of Herbal Medicine Utilization Among Mothers Attending Their Antenatal Care at Public Health Institutions in Debre Berhan Town, Ethiopia |journal=Frontiers in Public Health |date=29 April 2022 |volume=10 |page=883053 |doi=10.3389/fpubh.2022.883053 |pmid=35570953 |pmc=9098925 |issn=2296-2565|quote="Traditional medicine is defined as the ways of protecting and restoring health that existed before the arrival of modern medicine. It is underestimated part of healthcare that finds in almost every country in the world. Traditional medicine has been being used in the maintenance of health and the prevention, diagnosis, improvement, or treatment of physical and mental illness." |doi-access=free }}</ref><ref name="CheGeorgeIjinu2017">{{cite book | title = Pharmacognosy | last1 = Che | first1 = C.-T. | last2 = George | first2 = V. | last3 = Ijinu | first3 = T.P. | last4 = Pushpangadan | first4 = P. | last5 = Andrae-Marobela | first5 = K. | chapter = Traditional Medicine | date = 2017 | pages = 15–30 | publisher = Elsevier | doi = 10.1016/B978-0-12-802104-0.00002-0 | isbn = 978-0-12-802104-0 |quote="Traditional medicine, as defined by the World Health Organization, is the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement, or treatment of physical and mental illness. Some traditional medicine systems are supported by huge volumes of literature and records of the theoretical concepts and practical skills; others pass down from generation to generation through verbal teaching."}}</ref> Many TM practices are based on "holistic" approaches to disease and health, versus the scientific evidence-based methods in conventional medicine.<ref name="UNESCO_IBEC_2010">{{cite book |title=Draft preliminary report on traditional medicine and its ethical implications |date=2010 |publisher=UNESCO International Bioethics Committee |location=Paris |page=5 |url=https://unesdoc.unesco.org/ark:/48223/pf0000189592_eng |access-date=29 March 2023|quote="Whereas traditional medicine is based on analogical reasoning and a holistic approach to disease and health, conventional medicine rests on scientific knowledge and is evidence-based."}}</ref><ref name="LiWeng_2017">{{cite journal |last1=Li |first1=Fu-Shuang |last2=Weng |first2=Jing-Ke |title=Demystifying traditional herbal medicine with modern approach |journal=Nature Plants |date=31 July 2017 |volume=3 |issue=8 |page=17109 |doi=10.1038/nplants.2017.109 |pmid=28758992 |bibcode=2017NatPl...317109L |s2cid=2127457 |url=https://www.nature.com/articles/nplants2017109 |language=en |issn=2055-0278|quote="Although the initial development of these holistic traditional herbal prescriptions predated modern science, the process was based on thousands of years of phenotype-based and personalized human clinical trials. Meanwhile, meticulous descriptions of disease symptoms and systematic medical theories have also been recorded by generations of herbal doctors, relating therapeutic properties of diverse medicinal plants to their utility in treating specific symptoms. Yet most of the foundational concepts in the traditional medical systems—for example, the concepts of yin versus yang and cold versus hot in traditional Chinese medicine—are disconnected from the modern descriptions of normal and disease states in the language of physiology and molecular biology. The lack of modern scientific and clinical evidence for safety, efficacy and action mechanisms further prevented those holistic herbal medicine prescriptions from being accepted beyond their culture of origin."}}</ref> The 2019 WHO report defines traditional medicine as "the sum total of the knowledge, skill and practices based on the theories, beliefs and experiences ] to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness."<ref name="WHO_2019" /> When used outside the original setting and in the absence of scientific evidence, TM practices are typically referred to as "alternative medicine".<ref name="JansenBaker_2021">{{cite journal |last1=Jansen |first1=C. |last2=Baker |first2=J.D. |last3=Kodaira |first3=E. |last4=Ang |first4=L. |last5=Bacani |first5=A.J. |last6=Aldan |first6=J.T. |last7=Shimoda |first7=L.M.N. |last8=Salameh |first8=M. |last9=Small-Howard |first9=A.L. |last10=Stokes |first10=A.J. |last11=Turner |first11=H. |last12=Adra |first12=C.N. |title=Medicine in motion: Opportunities, challenges and data analytics-based solutions for traditional medicine integration into western medical practice |journal=Journal of Ethnopharmacology |date=March 2021 |volume=267 |page=113477 |doi=10.1016/j.jep.2020.113477|pmid=33098971 |pmc=7577282 |quote="When adopted outside its traditional or root culture, traditional medicine is often classified as a form of alternative medicine (AM), for example by Western professional medical organizations, insurers and healthcare systems. This problematically leads to lack of regulation (e.g., in the U.S. where these approaches are at best relegated to the nutraceutical market largely outside the FDA sphere of regulation) and a lack of fidelity to original formulations, dose schedules, delivery methods and indications."| issn = 0378-8741}}</ref><ref name="Tabish_2008">{{cite journal |last1=Tabish |first1=Syed Amin |title=Complementary and Alternative Healthcare: Is it Evidence-based? |journal=International Journal of Health Sciences |date=2008 |volume=2 |issue=1 |pages=V–IX |pmid=21475465 |pmc=3068720 |issn=1658-3639|quote="Complementary and alternative healthcare and medical practices (CAM) is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. The list of practices that are considered as CAM changes continually as CAM practices and therapies that are proven safe and effective become accepted as the "mainstream" healthcare practices...Alternative medicine is commonly categorized together with complementary medicine under the umbrella term "complementary and alternative medicine". Complementary medicine refers to therapies that complement traditional western (or allopathic) medicine and is used together with conventional medicine, and alternative medicine is used in place of conventional medicine. Alternative medicine refers to therapeutic approaches taken in place of traditional medicine and used to treat or ameliorate disease."}}</ref><ref name="Fontanarosa1998"/> | |||
| '''{{Visible anchor|Holistic medicine}}''' is another rebranding of alternative medicine. In this case, the words ''balance'' and ''holism'' are often used alongside ''complementary'' or ''integrative'', claiming to take into fuller account the "whole" person, in contrast to the supposed reductionism of medicine.<ref name="Beresford pp. 721–724">{{cite journal | last=Beresford | first=M. J. | title=Medical reductionism: lessons from the great philosophers | journal=QJM | publisher=Oxford University Press (OUP) | volume=103 | issue=9 | date=15 April 2010 | issn=1460-2725 | doi=10.1093/qjmed/hcq057 | pages=721–724 | pmid=20395240 | quote=Unfortunately, the term 'holistic medicine' has been somewhat hijacked by alternative therapists and is often thought mistakenly to be at odds with conventional medicine.| doi-access=free }}</ref><ref name="ZUCKER 1979 pp. 39–42">{{cite journal |last=Zucker |first=Arthur |date=January 1979 |title=Reductionism and holistic medicine |journal=Journal of Social and Biological Systems |publisher=Elsevier BV |volume=2 |issue=1 |pages=39–42 |doi=10.1016/0140-1750(79)90019-8 |issn=0140-1750}}</ref> | |||
| ] mixture]] | |||
| ] is a combination of traditional practices and beliefs developed over thousands of years in China, together with modifications made by the Communist party. Common practices include herbal medicine, ] (insertion of needles in the body at specified points), massage (Tui na), exercise (]), and dietary therapy. The practices are based on belief in a supernatural energy called ], considerations of ] and ], traditional use of herbs and other substances found in China, a belief that a map of the body is contained on the tongue which reflects changes in the body, and an incorrect model of the anatomy and physiology of internal organs.<ref name=ATRAMM/><ref name=BeyersteinSampson1996/><ref name=LuNeedham1980/><ref name=Maciocia1995/><ref name=Matuk2006/><ref name=Deshpande1987/> | |||
| ===Challenges in defining alternative medicine=== | |||
| The ] Chairman ], in response to the lack of modern medical practitioners, revived acupuncture and its theory was rewritten to adhere to the political, economic and logistic necessities of providing for the medical needs of China's population.<ref name=Crozier/>{{Page needed|date=March 2011}} In the 1950s the "history" and theory of traditional Chinese medicine was rewritten as communist propaganda, at Mao's insistence, to correct the supposed "bourgeois thought of Western doctors of medicine".{{sfn|Taylor|2005|p=109}} ] gained attention in the United States when President ] visited China in 1972, and the delegation was shown a patient undergoing major surgery while fully awake, ostensibly receiving acupuncture rather than ]. Later it was found that the patients selected for the surgery had both a high ] and received heavy indoctrination before the operation; these demonstration cases were also frequently receiving ] surreptitiously through an ] that observers were told contained only fluids and nutrients.<ref name=BeyersteinSampson1996/> ]s found acupuncture is not effective for a wide range of conditions.<ref name=Ernst2009>{{cite journal|last1=Ernst|first1=Edzard|title=Acupuncture: What Does the Most Reliable Evidence Tell Us?|journal=Journal of Pain and Symptom Management|volume=37|issue=4|year=2009|pages=709–714|issn=0885-3924|doi=10.1016/j.jpainsymman.2008.04.009|pmid=18789644}}</ref> A systematic review of ]s found that for reducing pain, real acupuncture was no better than sham acupuncture.<ref name=Ernst_Lee_Choi/> Although, other reviews have found that acupuncture is successful at reducing ], where as sham acupuncture was not found to be better than a ] as well as no-acupuncture groups.<ref>{{Cite journal|title = Acupuncture for chronic pain: Individual patient data meta-analysis|url = http://dx.doi.org/10.1001/archinternmed.2012.3654|journal = Archives of Internal Medicine|date = 2012-10-22|issn = 0003-9926|pmc = 3658605|pmid = 22965186|pages = 1444–1453|volume = 172|issue = 19|doi = 10.1001/archinternmed.2012.3654|author1 = Vickers|first1 = A. J.|last2 = Cronin|first2 = A. M.|last3 = Maschino|first3 = A. C.|last4 = Lewith|first4 = G|last5 = MacPherson|first5 = H|last6 = Foster|first6 = N. E.|last7 = Sherman|first7 = K. J.|last8 = Witt|first8 = C. M.|last9 = Linde|first9 = K|author10 = Acupuncture Trialists' Collaboration}}</ref> | |||
| Prominent members of the science<ref name="Offit2013" /><ref name="Dawkins2003a" /> and biomedical science community<ref name="Angell1998" /> say that it is not meaningful to define an alternative medicine that is separate from a conventional medicine because the expressions "conventional medicine", "alternative medicine", "complementary medicine", "integrative medicine", and "holistic medicine" do not refer to any medicine at all.<ref name="Angell1998" /><ref name="Offit2013" /><ref name="Dawkins2003a" /><ref name="Fontanarosa1998" /> Others say that alternative medicine cannot be precisely defined because of the diversity of theories and practices it includes, and because the boundaries between alternative and conventional medicine overlap, are porous, and change.{{sfn|Harrison's Principles of Internal Medicine|2015|loc=chpt. 14-E|p=1}}{{sfn|IOM Report|2005|pp=14–20}} Healthcare practices categorized as alternative may differ in their historical origin, theoretical basis, ], ] and in their relationship to the medical mainstream.{{sfn|Sointu|2012|p=}} Under a definition of alternative medicine as "non-mainstream", treatments considered alternative in one location may be considered conventional in another.<ref name="Nissen2013" /> | |||
| Critics say the expression is deceptive because it implies there is an effective alternative to science-based medicine, and that ''complementary'' is deceptive because it implies that the treatment increases the effectiveness of (complements) science-based medicine, while alternative medicines that have been tested nearly always have no measurable positive effect compared to a ].<ref name="Sampson_6/1995" /><ref name="Gorski2010" /><ref name="Skep_Dic_comp_med" /><ref name="Novella2010" /> Journalist ] wrote that "there is really no such thing as alternative medicine, just medicine that works and medicine that doesn't",<ref name=Dawkins2003a/><ref name="Jeffrey2015">{{Cite journal |last=Jeffery |first=Nick |date=2015 |title=There is no such thing as alternative medicine |department=Editorial |journal=Journal of Small Animal Practice |language=en |volume=56 |issue=12 |pages=687–688 |doi=10.1111/jsap.12427 |issn=1748-5827 |pmid=26735773 |doi-access=free}}</ref> a notion later echoed by ]: "The truth is there's no such thing as conventional or alternative or complementary or integrative or holistic medicine. There's only medicine that works and medicine that doesn't. And the best way to sort it out is by carefully evaluating scientific studies—not by visiting Internet chat rooms, reading magazine articles, or talking to friends."<ref name="Offit2013" /> | |||
| ====Ayurvedic medicine==== | |||
| ==Types== | |||
| ] is a traditional medicine of India. Ayurveda believes in the existence of three elemental substances, the ] (called Vata, Pitta and Kapha), and states that a balance of the doshas results in health, while imbalance results in disease. Such disease-inducing imbalances can be adjusted and balanced using traditional herbs, minerals and heavy metals. Ayurveda stresses the use of plant-based medicines and treatments, with some animal products, and added minerals, including ], ], lead, ].{{citation needed|date=June 2015}} | |||
| {{see also|List of forms of alternative medicine}} | |||
| Alternative medicine consists of a wide range of health care practices, products, and therapies. The shared feature is a claim to heal that is not based on the scientific method. Alternative medicine practices are diverse in their foundations and methodologies.<ref name="NCCIH1" /> Alternative medicine practices may be classified by their cultural origins or by the types of beliefs upon which they are based.<ref name="NSF_4/2002" /><ref name="Sampson_6/1995" /><ref name="AMCER" /><ref name="NCCIH1" /> Methods may incorporate or be based on traditional medicinal practices of a particular culture, folk knowledge, superstition,{{sfn|O'Connor|1995|p=}} spiritual beliefs, belief in supernatural energies (antiscience), pseudoscience, errors in reasoning, propaganda, fraud, new or different concepts of health and disease, and any bases other than being proven by scientific methods.<ref name="NSF_4/2002" /><ref name="Sampson_6/1995" /><ref name="Hines_Sampson_Coulter_Sagan" /><ref name="AMCER" /> Different cultures may have their own unique traditional or belief based practices developed recently or over thousands of years, and specific practices or entire systems of practices. | |||
| {{Clear}} | |||
| ===Unscientific belief systems=== | |||
| Safety concerns have been raised about Ayurveda, with two U.S. studies finding about 20 percent of Ayurvedic Indian-manufactured ]s contained toxic levels of heavy metals such as ], ] and ]. Other concerns include the use of herbs containing toxic compounds and the lack of quality control in Ayurvedic facilities. Incidents of ] have been attributed to the use of these compounds in the United States.{{sfn|Wujastyk|2003|p=xviii}}{{sfn|Mishra|2004|p=8}}<ref name=DaguptaHStabler2011/><ref name=Valiathan2006/><ref name=CDC/><ref name="Saper2008"/> | |||
| ], an alternative medicine supplement]] | |||
| Alternative medicine, such as using ] or ] in place of ], is based on belief systems not grounded in science.<ref name="NCCIH1" /> | |||
| {| class="wikitable" | |||
| ===Supernatural energies and relationship of energy and physics=== | |||
| ! | |||
| !Proposed mechanism | |||
| !Issues | |||
| |- | |||
| !] | |||
| |Naturopathic medicine is based on a belief that the body heals itself using a supernatural ] that guides bodily processes.<ref name="SarrisWardle2010" /> | |||
| |In conflict with the paradigm of ].<ref name="Jagtenberg2006" /> Many naturopaths have opposed ],<ref name="Ernst2001" /> and "scientific evidence does not support claims that naturopathic medicine can cure cancer or any other disease".<ref name="ACS" /> | |||
| |- | |||
| !] | |||
| |A belief that a substance that causes the symptoms of a disease in healthy people cures similar symptoms in sick people.{{refn|In his book ''The Homœopathic Medical Doctrine'' ] the creator of homeopathy wrote: "Observation, reflection, and experience have unfolded to me that the best and true method of cure is founded on the principle, ''].'' To cure in a mild, prompt, safe, and durable manner, it is necessary to choose in each case a medicine that will excite an affection similar (''{{lang|el|ὅμοιος πάθος}}'') to that against which it is employed."{{sfn|Hahnemann|1833|pp=, }}|name=Hahnemannquote|group=n}} | |||
| |Developed before knowledge of ]s and ]s, or of basic chemistry, which shows that repeated dilution as practiced in homeopathy produces only water, and that homeopathy is not scientifically valid.<ref name="Ernst2002" /><ref name="HCReport2010" /><ref name="shang" /><ref name="NCCIH_homeopathy" /> | |||
| |} | |||
| ===Traditional ethnic systems=== | |||
| ], some other traditional medical systems, and some ] practices, it is believed that healing energies flow from the palms of the healer into the patient near ], influencing disease.]] | |||
| ] mixture]] | |||
| ] involves insertion of needles in the body.]] | |||
| Alternative medical systems may be based on traditional medicine practices, such as ] (TCM), Ayurveda in India, or practices of other cultures around the world.<ref name="NCCIH1" /> Some useful applications of traditional medicines have been researched and accepted within ordinary medicine, however the underlying belief systems are seldom scientific and are not accepted. | |||
| Traditional medicine is considered alternative when it is used outside its home region; or when it is used together with or instead of known functional treatment; or when it can be reasonably expected that the patient or practitioner knows or should know that it will not work – such as knowing that the practice is based on superstition. | |||
| The belief in the existence of bodily energies, such as biofields, is common in alternative medicine.<ref name=NCCIH1/> | |||
| {| class="wikitable" | |||
| ! | |||
| !Claims | |||
| !Issues | |||
| |- | |||
| |] | |||
| |Traditional practices and beliefs from China, together with modifications made by the Communist party make up TCM. Common practices include herbal medicine, ] (insertion of needles in the body at specified points), massage (Tui na), exercise (]), and dietary therapy. | |||
| |The practices are based on belief in a supernatural energy called ], considerations of ] and ], traditional use of herbs and other substances found in China, a belief that the tongue contains a map of the body that reflects changes in the body, and an incorrect model of the anatomy and physiology of internal organs.<ref name="ATRAMM" /><ref name="BeyersteinSampson1996" /><ref name="LuNeedham1980" /><ref name="Maciocia1995" /><ref name="Matuk2006" /><ref name="Deshpande1987" /> | |||
| |- | |||
| |] | |||
| |Traditional medicine of India. Ayurveda believes in the existence of three elemental substances, the ] (called Vata, Pitta and Kapha), and states that a balance of the doshas results in health, while imbalance results in disease. Such disease-inducing imbalances can be adjusted and balanced using traditional herbs, minerals and heavy metals. Ayurveda stresses the use of plant-based medicines and treatments, with some animal products, and added minerals, including ], ], lead and ].{{Clarify|date=October 2017}} | |||
| |Safety concerns have been raised about Ayurveda, with two U.S. studies finding about 20 percent of Ayurvedic Indian-manufactured ]s contained toxic levels of heavy metals such as lead, ] and ]. A 2015 study of users in the United States also found elevated blood lead levels in 40 percent of those tested. Other concerns include the use of herbs containing toxic compounds and the lack of quality control in Ayurvedic facilities. Incidents of ] have been attributed to the use of these compounds in the United States.{{sfn|Wujastyk|2003|p=xviii}}{{sfn|Mishra|2004|p=8}}<ref name="DaguptaHStabler2011" /><ref name="Valiathan2006" /><ref name="CDC" /><ref name="Saper2008" /><ref>{{cite web|last1=Hall|first1=Harriet|title=Ayurveda: Ancient Superstition, Not Ancient Wisdom|url=https://www.csicop.org/specialarticles/show/ayurveda_ancient_superstition_not_ancient_wisdom|website=Skeptical Inquirer|access-date=1 February 2018|date=2017-12-14}}</ref><ref>{{cite journal|vauthors=Breeher L, Mikulski MA, Czeczok T, Leinenkugel K, Fuortes LJ|title=A cluster of lead poisoning among consumers of Ayurvedic medicine|journal=International Journal of Occupational and Environmental Health|date=6 Apr 2015|volume=21|issue=4|pages=303–307|doi=10.1179/2049396715Y.0000000009|pmid=25843124|pmc=4727589}}</ref> | |||
| |} | |||
| === |
===Supernatural energies=== | ||
| Bases of belief may include belief in existence of supernatural energies undetected by the science of physics, as in biofields, or in belief in properties of the energies of physics that are inconsistent with the laws of physics, as in energy medicine.<ref name="NCCIH1" /> | |||
| {| class="wikitable" | |||
| ! | |||
| !Claims | |||
| !Issues | |||
| |- | |||
| |] | |||
| |Intended to influence energy fields that, it is purported, surround and penetrate the body.<ref name="NCCIH1" /> | |||
| |Advocates of ] such as ] have criticized the lack of empirical evidence to support the existence of the putative energy fields on which these therapies are predicated.{{sfn|Sagan|1996}} | |||
| |- | |||
| |] therapy | |||
| |Use verifiable electromagnetic fields, such as pulsed fields, alternating-current, or direct-current fields in an unconventional manner.<ref name="NCCIH1" /> | |||
| |Asserts that magnets can be used to defy the laws of ] to influence health and disease. | |||
| |- | |||
| |] | |||
| |] aims to treat "]s" which are claimed to put pressure on nerves. | |||
| |Chiropractic was based on the belief that manipulating the spine unblocks the flow of a supernatural ] called ], thereby affecting health and disease. Vertebral subluxation is a pseudoscientific entity not proven to exist. | |||
| |- | |||
| |] | |||
| |Practitioners place their palms on the patient near ] that they believe are centers of supernatural energies in the belief that these supernatural energies can transfer from the practitioner's palms to heal the patient. | |||
| |Lacks credible scientific evidence.<ref name="rosa">{{cite journal | doi = 10.1001/jama.279.13.1005 | pmid=9533499 | volume=279 | issue=13 | title=A close look at therapeutic touch | date=April 1998 |vauthors=Rosa L, Rosa E, Sarner L, Barrett S| journal=JAMA | pages=1005–1010| doi-access=free }}</ref> | |||
| |} | |||
| ===Herbal remedies and other substances=== | |||
| ] therapies are intended to influence energy fields that, surround, flow within, and penetrate the body.<ref name=NCCIH1/> Skeptics have described the lack of empirical evidence to support the existence of these energies, although new evidence has shown that these energies consist of electromagnetic waves and, in part, quantum particles. | |||
| {{Main|Herbal medicine}} | |||
| ] involves insertion of needles in the body.]] | |||
| Substance based practices use substances found in nature such as herbs, foods, non-vitamin supplements and megavitamins, animal and fungal products, and minerals, including use of these products in traditional medical practices that may also incorporate other methods.<ref name="NCCIH1" /><ref name="Abdulla1999">{{cite journal|last1=Abdulla|first1=Sara|title=Phytotherapy – good science or big business?|journal=Nature|date=May 13, 1999|doi=10.1038/news990513-8|quote=Science-based medicine, with its emphasis on controlled study, proof, evidence, statistical significance and safety is being rejected in favour of 'alternative medicine' – an atavistic portmanteau of anecdote, hearsay, rumour and hokum. ... Probably the most commercially successful and widely used branch of alternative or complementary medicine is 'phytotherapy'. These are the tablets, powders and elixirs, otherwise known as herbal medicine, that are sold in most countries, through health shops and pharmacies as 'nutritional supplements'. ... Only a tiny minority of these remedies have been shown to have mild-to moderately beneficial health effects ... So why are affluent, otherwise rational, highly educated people (for this is the average user profile) so hungry for phytotherapy? ... people still believe that 'natural' equals good and safe despite plenty of evidence to the contrary. ... as far as the human body is concerned, 'natural' is meaningless ... Equally, what's so safe about consuming substances that need meet no standards of contents?}}</ref><ref>{{cite journal|last1=De Smet|first1=Peter A.G.M.|title=The Role of Plant-Derived Drugs and Herbal Medicines in Healthcare|journal=Drugs|date=December 1997|volume=54|issue=6|pages=801–840|doi=10.2165/00003495-199754060-00003|pmid=9421691|s2cid=46970414}}</ref> Examples include healing claims for non-vitamin supplements, ], ], ], ], ], and ].<ref name="NCCIHSurvey" /> ], or phytotherapy, includes not just the use of plant products, but may also include the use of animal and mineral products.<ref name="Abdulla1999" /> It is among the most commercially successful branches of alternative medicine, and includes the tablets, powders and elixirs that are sold as "nutritional supplements".<ref name="Abdulla1999" /> Only a very small percentage of these have been shown to have any efficacy, and there is little regulation as to standards and safety of their contents.<ref name="Abdulla1999" /> | |||
| ] "]" the spine]] | |||
| ] is a component of traditional Chinese medicine. It is believed that the vital energy called ] flows through the universe and through the body. Acupuncture is a technique which aims to channel the flow of this energy and prevent blockage of this energy which can lead to disease.<ref name=LuNeedham1980/> | |||
| In westernized versions of Japanese ], the palms are placed on the patient near ], or centers of energy. Healing energy can be transferred from the palms of the practitioner to the patient. | |||
| ====Energy medicines==== | |||
| ]-based therapies use verifiable electromagnetic fields, such as pulsed fields, alternating-current, or direct-current fields.<ref name=NCCIH1/> These forms of alternative medicine apply the concept of energy healing with the use of modern technology.] also uses the concept of energy manipulation to treat disease. | |||
| ===Holistic health and 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".<ref name=NCCIH1/> Mind body medicines includes healing claims made in ], ], ], ], ], ], ], and ].<ref name=NCCIH1/> | |||
| Yoga, a method of traditional stretches, exercises, and meditations in ], may also be classified as an energy medicine insofar as its healing effects are believed to be due to a healing "life energy" that is absorbed into the body through the breath, and is thereby believed to treat a wide variety of illnesses and complaints.<ref name=Raub2002/> | |||
| Since the 1990s, ] (t'ai chi ch'uan) classes that purely emphasise health have become popular in hospitals, clinics, as well as community and senior centers. This has occurred as the ] generation has aged and the art's reputation as a low-stress training method for seniors has become better known.<ref name=Yip2002/><ref name=sgma/> There has been some divergence between those that say they practice t'ai chi ch'uan primarily for self-defence, those that practice it for its ] appeal (see '']'' below), and those that are more interested in its benefits to physical and mental health. | |||
| ], chi kung, or chi gung, is a practice of aligning body, breath, and mind for health, meditation, and martial arts training. With roots in traditional Chinese medicine, ], and ], qigong is traditionally viewed as a practice to cultivate and balance ] (chi) or what has been translated as "life energy".<ref name=Cohen1997/> | |||
| ===Herbal remedies and other substances used=== | |||
| Substance based practices use substances found in nature such as herbs, foods, non-vitamin supplements and megavitamins, animal and fungal products, and minerals, including use of these products in traditional medical practices that may also incorporate other methods.<ref name=NCCIH1/><ref name=Phytotherapyquoted/><ref>{{cite journal|last1=De Smet|first1=Peter A.G.M.|title=The Role of Plant-Derived Drugs and Herbal Medicines in Healthcare|journal=Drugs|date=December 1997|volume=54|issue=6|pages=801–840|doi=10.2165/00003495-199754060-00003|pmid=9421691}}</ref> Examples include healing claims for nonvitamin supplements, ], ], ], ], ], and ].<ref name=NCCIHSurvey/> ], or ], includes not just the use of plant products, but may also include the use of animal and mineral products.<ref name=Phytotherapyquoted/> It is among the most commercially successful branches of alternative medicine, and includes the tablets, powders and elixirs that are sold as "nutritional supplements".<ref name=Phytotherapyquoted/> Only a very small percentage of these have been shown to have any efficacy, and there is little regulation as to standards and safety of their contents.<ref name=Phytotherapyquoted/> This may include use of known toxic substances, such as use of the poison ] in traditional Chinese medicine.<ref name=NCCIHSurvey/> | |||
| ===Body manipulation=== | |||
| ] ] the spine.]] | |||
| ] and body-based practices feature the manipulation or movement of body parts, such as is done in ] and ] manipulation. | |||
| ], also known as osteopathic manipulative treatment, is a core set of techniques of ] and ] distinguishing these fields from ].<ref name=Howell1999/> | |||
| ===Religion, faith healing, and prayer=== | ===Religion, faith healing, and prayer=== | ||
| {{see also|Shamanism}} | |||
| {| class="wikitable" | |||
| ! | |||
| !Claims | |||
| !Issues | |||
| |- | |||
| |Christian ] | |||
| |There is a divine or spiritual intervention in healing. | |||
| |Lack of evidence for effectiveness.<ref name="Pearce_Simpson1998">{{cite journal|last1=Pearce|first1=Alison|last2=Simpson|first2=Neil|title=A paediatrician's guide to complementary medicine|journal=Current Paediatrics|date=March 1998|volume=8|issue=1|pages=62–67|doi=10.1016/S0957-5839(98)80061-4}}</ref> Unwanted outcomes, such as death and disability, "have occurred when faith healing was elected instead of medical care for serious injuries or illnesses".<ref>{{cite web|title=Faith Healing – Making Treatment Decisions|publisher=American Cancer Society|date=June 15, 2009|url=http://www.cancer.org/docroot/ETO/content/ETO_5_3X_Faith_Healing.asp|access-date=May 28, 2018|archive-date=February 12, 2010|archive-url=https://web.archive.org/web/20100212221706/http://www.cancer.org/docroot/ETO/content/ETO_5_3X_Faith_Healing.asp}}</ref> A 2001 double-blind study of 799 discharged coronary surgery patients found that "intercessory prayer had no significant effect on medical outcomes after hospitalization in a coronary care unit."<ref name="Aviles_et_al2001">{{cite journal|last1=Aviles|first1=Jennifer M.|last2=Whelan|first2=Sr Ellen|last3=Hernke|first3=Debra A.|last4=Williams|first4=Brent A.|last5=Kenny|first5=Kathleen E.|last6=O'Fallon|first6=W. Michael|last7=Kopecky|first7=Stephen L.|s2cid=7300728|title=Intercessory Prayer and Cardiovascular Disease Progression in a Coronary Care Unit Population: A Randomized Controlled Trial|journal=Mayo Clinic Proceedings|date=December 2001|volume=76|issue=12|pages=1192–1198|doi=10.4065/76.12.1192|pmid=11761499}}</ref> | |||
| |} | |||
| ===NCCIH classification=== | |||
| Religion based healing practices, such as use of ] and the laying of hands in ] ], and shamanism, rely on belief in divine or spiritual intervention for healing. | |||
| The United States agency ] (NCCIH) has created a classification system for branches of complementary and alternative medicine that divides them into five major groups. These groups have some overlap, and distinguish two types of energy medicine: ''veritable'' which involves scientifically observable energy (including ], ] and ]) and ''putative'', which invokes physically undetectable or unverifiable energy.<ref name="NCCIH_EMed" /> None of these energies have any evidence to support that they affect the body in any positive or health promoting way.<ref name="ConsumerHealth9th"/> | |||
| # Whole medical systems: Cut across more than one of the other groups; examples include traditional Chinese medicine, naturopathy, homeopathy, and ayurveda. | |||
| ] is a practice of many cultures around the world, in which a practitioner reaches an ] in order to encounter and interact with the spirit world or channel supernatural energies in the belief they can heal.<ref>.</ref> | |||
| # Mind-body interventions: Explore the interconnection between the mind, body, and spirit, under the premise that they affect "bodily functions and symptoms". A connection between mind and body is conventional medical fact, and this classification does not include therapies with proven function such as ]. | |||
| # "Biology"-based practices: Use substances found in nature such as herbs, foods, vitamins, and other natural substances. (As used here, "biology" does ''not'' refer to the science of ], but is a usage newly coined by NCCIH in the primary source used for this article. "Biology-based" as coined by NCCIH may refer to chemicals from a nonbiological source, such as use of the poison lead in traditional Chinese medicine, and to other nonbiological substances.) | |||
| ===Exploitation of ignorance and flawed reasoning=== | |||
| # Manipulative and body-based practices: feature manipulation or movement of body parts, such as is done in bodywork, chiropractic, and osteopathic manipulation. | |||
| # Energy medicine: is a domain that deals with putative and verifiable energy fields: | |||
| Some alternative medicine practices may be based on pseudoscience, ignorance, or flawed reasoning.<ref name=Beyerstein2001/> This can lead to fraud.<ref name=ATRAMM/> | |||
| #* ] therapies are intended to influence energy fields that are purported to surround and penetrate the body. The existence of such energy fields have been disproven. | |||
| #* ]-based therapies use verifiable electromagnetic fields, such as pulsed fields, alternating-current, or direct-current fields in a non-scientific manner. | |||
| Practitioners of electricity and magnetism based healing methods may deliberately exploit a patient's ignorance of physics in order to defraud them.<ref name=NSF_2002/> | |||
| ===Gallery=== | |||
| <gallery> | |||
| File:Fallerjfa.JPG|Christian ], ] intervention, and ] | |||
| File:Dhanvantari-at-Ayurveda-expo.jpg|Indian ] includes a belief that the spiritual balance of mind influences disease. | |||
| File:Hierbas medicinales mercado medieval.jpg|Medicinal herbs in a traditional Spanish market | |||
| File:Market Pharmacy Tana MS5179.jpg|]s in ] | |||
| File:Traditional Chinese medicine in Xi'an market.jpg|Assorted dried plant and animal parts used in traditional Chinese medicine | |||
| File:Doña ramona.jpg|] healer in ]. | |||
| File:American medical botany, being a collection of the native medicinal plants of the United States, containing their botanical history and chemical analysis, and properties and uses in medicine, diet and (14764623455).jpg|] (herbal medicine): an engraving of ''] glauca'' in ]'s "American medical botany" | |||
| </gallery> | |||
| ==Definitions and terminology== | |||
| "'''Alternative medicine'''" is a loosely defined set of products, practices, and theories that are believed or perceived by their users to have the healing effects of ],{{refn|name=NSFquote|group=n|"lternative medicine refers to all treatments that have not been proven effective using scientific methods."<ref name=NSF_2002/>}}{{refn|"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."{{sfn|IOM Report|2005|p=19}}|name=IOMquote|group=n}} but whose ] has not been clearly established using ]s,{{refn|name=NSFquote|group=n}}{{refn|name=Angellquote|group=n|"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... speculation, and testimonials do not substitute for evidence."<ref name=Angell1998/>}}<ref name=ATRAMM/><ref name=Hines_Sampson_Coulter_Sagan/><ref name=IGPIAMAYP/><ref name=NP/> whose theory and practice is not part of ],{{refn|group=n|name=IOMquote}}{{refn|group=n|name=Harrisonquote|"The phrase complementary and alternative medicine is used to describe a group of diverse medical and health care systems, practices, and products that have historic origins outside mainstream medicine. Most of these practices are used together with conventional therapies and therefore have been called complementary to distinguish them from alternative practices, those used as a substitute for standard care. ... Until a decade ago or so, "complementary and alternative medicine" could be defined as practices that are neither taught in medical schools nor reimbursed, but this definition is no longer workable, since medical students increasingly seek and receive some instruction about complementary health practices, and some practices are reimbursed by third-party payers. Another definition, practices that lack an evidence base, is also not useful, since there is a growing body of research on some of these modalities, and some aspects of standard care do not have a strong evidence base."{{sfn|Harrison's Principles of Internal Medicine|2015|loc=chpt. 14-E|p=1}}}}{{refn|name=WebMD2014quote|group=n|"An alternative medical system is a set of practices based on a philosophy different from Western biomedicine."<ref name=WebMD2014/>}}{{refn|group=n|name=NCCIH2quote|"CAM is a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine."<ref name=NCCIH2/>}} or whose theories or practices are directly contradicted by ] or ] used in biomedicine.<ref name=ATRAMM/><ref name=AMCER/><ref name=Hines_Sampson_Coulter_Sagan/> "Biomedicine" is that part of ] that applies principles of ], ], ], ], and other ]s to ], using scientific methods to establish the effectiveness of that practice. Alternative medicine is a diverse group of medical and health care systems, practices, and products that originate outside of biomedicine,{{refn|name=Harrisonquote|group=n}} are not considered part of biomedicine,<ref name=NCCIH1/>{{sfn|IOM Report|2005|p=19}} are not widely used by the biomedical healthcare professions,<ref name=BMA_1993_1st/> and are not taught as skills practiced in biomedicine.<ref name=BMA_1993_1st/> Unlike biomedicine,{{refn|name=Harrisonquote|group=n}} an alternative medicine product or practice does not originate from the sciences or from using scientific methodology, but may instead be based on ]s, ], tradition, ], belief in ] energies, ], ], ], ], or other unscientific sources.{{refn|name=Angellquote|group=n}}<ref name=ATRAMM/><ref name=Hines_Sampson_Coulter_Sagan/><ref name=NSF_2002/> The expression "alternative medicine" refers to a diverse range of related and unrelated products, practices, and theories, originating from widely varying sources, cultures, theories, and belief systems, and ranging from biologically plausible practices and products and practices with some evidence, to practices and theories that are directly contradicted by basic science or clear evidence, and products that have proven to be ineffective or even toxic and harmful.{{refn|group=n|name=IOMquote}}<ref name="CAM_Sointu_Nissen_Eisenberg"/><ref name=DaguptaHStabler2011/> | |||
| "Alternative medicine", "complementary medicine", "holistic medicine", "natural medicine", "unorthodox medicine", "fringe medicine", "unconventional medicine", and "] medicine" may be used interchangeably as having the same meaning (]) in some contexts,<ref name=Bombardieri2000/><ref name=Shuval2012/><ref name=Freedman2011/> but may have different meanings in other contexts, for example, unorthodox medicine may refer to biomedicine that is different from what is commonly practiced, and fringe medicine may refer to biomedicine that is based on ], which may be scientifically valid but is not mainstream. | |||
| ]: "There cannot be two kinds of medicine — conventional and alternative".]] | |||
| The meaning of the term "alternative" in the expression "alternative medicine", is not that it is an actual effective alternative to ], although some alternative medicine promoters may use the loose terminology to give the appearance of effectiveness.<ref name=ATRAMM/> ] stated that "alternative medicine" is "a new name for snake oil. There's medicine that works and medicine that doesn't work."<ref name=Kolata >{{Citation |last=Kolata |first=Gina |author-link=Gina Kolata |date=June 17, 1996 |title=On Fringes of Health Care, Untested Therapies Thrive |publisher='']'' |url=http://www.nytimes.com/1996/06/17/us/on-fringes-of-health-care-untested-therapies-thrive.html?pagewanted=all |accessdate=December 22, 2015 }}</ref> Loose terminology may also be used to suggest meaning that a dichotomy exists when it does not, e.g., the use of the expressions "western medicine" and "eastern medicine" to suggest that the difference is a cultural difference between the Asiatic east and the European west, rather than that the difference is between ] and treatments which don't work.<ref name=ATRAMM/> | |||
| "'''Complementary medicine'''" refers to use of alternative medical treatments alongside conventional medicine, in the belief that it increases the effectiveness of the science-based medicine.<ref name=NCI_PDQ_CAM/><ref name=Borkan2012/><ref name=whatiscam/> An example of "complementary medicine" is use of ] (sticking needles in the body to influence the flow of a supernatural energy), along with using science-based medicine, in the belief that the acupuncture increases the effectiveness or "complements" the science-based medicine.<ref name=whatiscam/> "CAM" is an abbreviation for "complementary and alternative medicine". | |||
| The expression "''']'''" (or "integrated medicine") is used in two different ways. One use refers to a belief that medicine based on science can be "integrated" with practices that are not. Another use refers only to a combination of alternative medical treatments with conventional treatments that have some scientific proof of efficacy, in which case it is identical with CAM.<ref name=BMJ_May/> "holistic medicine" (or holistic health) is an alternative medicine practice which claim to treat the "whole person" and not just the illness itself. | |||
| "''']'''" and "]" refer to prescientific practices of a culture, not to what is traditionally practiced in cultures where medical science dominates. "]" typically refers to prescientific traditional medicines of Asia. "]", when referring to modern practice, typically refers to ], and not to alternative medicines practiced in the west (Europe and the Americas). "Western medicine", "biomedicine", "]", "]", "]", "]", "]", "]", "]", "]", "]", and "]", are sometimes used interchangeably as having the same meaning, when contrasted with alternative medicine, but these terms may have different meanings in some contexts, e.g., some practices in medical science are not supported by rigorous scientific testing so "medical science" is not strictly identical with "science-based medicine", and "standard medical care" may refer to "]" when contrasted with other biomedicine that is less used or less recommended.{{refn|group=n|name=NCIDictionaryquote|The National Cancer Institute's Dictionary of Cancer Terms, states that, "Orthodox medicine ... also called allopathic medicine, biomedicine, conventional medicine, mainstream medicine, and Western medicine";<ref name=NCIDictionary1/> the same source states that, "Standard medical care" is "lso called best practice, standard of care, and standard therapy."<ref name=NCIDictionary2/>}}{{sfn|Harrison's Principles of Internal Medicine|2015|loc=chpt. 14-E|p=1}}<ref name=Ezzo2001/> | |||
| === Problems with definition === | |||
| Prominent members of the science<ref name=Dawkins2003a/><ref name=Offit2013/> and biomedical science community<ref name=Angell1998/> assert that it is not meaningful to define an alternative medicine that is separate from a conventional medicine, that the expressions "conventional medicine", "alternative medicine", "complementary medicine", "integrative medicine", and "holistic medicine" do not refer to anything at all.<ref name=Angell1998/><ref name=Dawkins2003a/><ref name=Offit2013/><ref name=Fontanarosa1998/> Their criticisms of trying to make such artificial definitions include: "There's no such thing as conventional or alternative or complementary or integrative or holistic medicine. There's only medicine that works and medicine that doesn't;"<ref name=Angell1998/><ref name=Dawkins2003a/><ref name=Offit2013/> "By definition, alternative medicine has either not been proved to work, or been proved not to work. You know what they call alternative medicine that's been proved to work? Medicine;"<ref name=Helmuth/> "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;"<ref name=Angell1998/> and "There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking."<ref name=Fontanarosa1998/> | |||
| Others in both the biomedical and CAM communities point out that CAM ''cannot'' be precisely defined because of the diversity of theories and practices it includes, and because the boundaries between CAM and biomedicine overlap, are porous, and change.{{sfn|Harrison's Principles of Internal Medicine|2015|loc=chpt. 14-E|p=1}}{{sfn|IOM Report|2005|p=14–20}} The expression "complementary and alternative medicine" (CAM) resists easy definition because the health systems and practices to which it refers are diffuse and its boundaries are poorly defined.<ref name="CAM_Sointu_Nissen_Eisenberg"/>{{sfn|Ruggie|2004|p=}}{{refn|group=n|Mary Ruggie in Chapter 2 of ''Marginal to Mainstream: Alternative Medicine in America'' said, "By the mid-1990s, the notion that some alternative therapies could be complementary to conventional medicine began to change the status of...alternative medicine. The 21st century is witnessing yet another terminological innovation, in which CAM and conventional medicine are becoming integrative."{{sfn|Ruggie|2004}}}} | |||
| Healthcare practices categorized as alternative may differ in their historical origin, theoretical basis, ], ] and in their relationship to the medical mainstream.{{sfn|Sointu|2012|p=}} Some alternative therapies, including ] and ], have antique origins in East or South Asia and are entirely alternative medical systems;<ref>{{harvnb|Sointu|2012|p=}}.<br />{{harvnb|IOM Report|2005|p=}}.</ref> others, such as homeopathy and chiropractic, have origins in Europe or the United States and emerged in the eighteenth and nineteenth centuries.{{sfn|Gevitz|1997|pp=}} Some, such as ] and chiropractic, employ manipulative physical methods of treatment; others, such as ] and ], are based on ]s.{{sfn|IOM Report|2005|p=}} Treatments considered alternative in one location may be considered conventional in another.<ref name=Nissen2013/> Thus, chiropractic is not considered alternative in Denmark and likewise ] is no longer thought of as an alternative therapy in the United States.<ref name=Nissen2013/> | |||
| ===Different types of definitions=== | |||
| One common feature of all definitions of alternative medicine is its designation as "other than" conventional medicine.{{sfn|IOM Report|2005|p=}} For example, the widely referenced {{sfn|IOM Report|2005|p=}} descriptive definition of complementary and alternative medicine devised by the ] of the ], states that it is "a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine."<ref name=NCCIH1/> For conventional medical practitioners, it does not necessarily follow that either it or its practitioners would no longer be considered alternative.{{refn|group=n|As David J. Hufford, Professor and Director at the Doctors Kienle Center for Humanistic Medicine at the ],<ref name=HuffordUPenn/> has argued: "Simply because an herbal remedy comes to be used by physicians does not mean that herbalists cease to practice, or that the practice of the one becomes like that of the other."<ref name=Hufford2004a/>}} | |||
| Some definitions seek to specify alternative medicine in terms of its social and political marginality to mainstream healthcare.<ref name=Saks1992/> This can refer to the lack of support that alternative therapies receive from the medical establishment and related bodies regarding access to ], sympathetic coverage in the ], or inclusion in the standard ].<ref name=Saks1992/> In 1993, the ], one among many professional organizations who have attempted to define alternative medicine, stated that it{{refn|group=n|The BMA used the term non-conventional medicine instead of alternative medicine.<ref name=BMA_1993_1st/>}} referred to "those forms of treatment which are not widely used by the conventional healthcare professions, and the skills of which are not taught as part of the undergraduate curriculum of conventional medical and paramedical healthcare courses".<ref name=BMA_1993_1st/> In a US context, an influential definition coined in 1993 by the Harvard-based physician,<ref name=Artus2007/> David M. Eisenberg,<ref name=Eisenberg_Bio/> characterized alternative medicine "as interventions neither taught widely in medical schools nor generally available in US hospitals".<ref>{{harvnb|Eisenberg et al.|1993}}.<br />{{harvnb|Eisenberg et al.|1998}}.</ref> These descriptive definitions are inadequate in the present-day when some conventional doctors offer alternative medical treatments and CAM introductory courses or modules can be offered as part of standard undergraduate medical training;<ref name="HOL_Kopelman_Wieland_Astin_Pelletier"/> alternative medicine is taught in more than 50 per cent of ] and increasingly ] are willing to provide reimbursement for CAM therapies.{{sfn|IOM Report|2005|pp=, }} In 1999, 7.7% of US hospitals reported using some form of CAM therapy; this proportion had risen to 37.7% by 2008.<ref name=Salomonsen_AHA/> | |||
| An expert panel at a conference hosted in 1995 by the US Office for Alternative Medicine (OAM),<ref name=Wieland2011/>{{refn|group=n|The Office for Alternative Medicine, part of the National Institutes of Health, was renamed NCCAM in 1998.<ref name=FDA_regulatory/>}} devised a ]<ref name=Wieland2011/> of alternative medicine as "a broad domain of healing resources ... other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period."<ref name="CAM_RMC1997"/> This definition has been widely adopted by CAM researchers,<ref name=Wieland2011/> cited by official government bodies such as the UK Department of Health,<ref name=UKDoH_CAM/> attributed as the definition used by the ],<ref name=ZollChanCoulRobeAdamArtu/> and, with some modification,{{dubious|date=June 2015}} was preferred in the 2005 consensus report of the ], ''Complementary and Alternative Medicine in the United States''.{{refn|group=n|name=IOMquote}} | |||
| The 1995 OAM conference definition, an expansion of Eisenberg's 1993 formulation, is silent regarding questions of the medical effectiveness of alternative therapies.<ref name=Hufford2004/> Its proponents hold that it thus avoids ] about differing forms of medical knowledge and, while it is an essentially political definition, this should not imply that the dominance of mainstream ] is solely due to political forces.<ref name=Hufford2004 /> According to this definition, alternative and ] can only be differentiated with reference to what is "intrinsic to the politically dominant health system of a particular society of culture".<ref name=Kopelman2004/> However, there is neither a reliable method to distinguish between cultures and ]s, nor to attribute them as dominant or subordinate, nor any accepted criteria to determine the dominance of a cultural entity.<ref name=Kopelman2004/> If the culture of a politically dominant healthcare system is held to be equivalent to the perspectives of those charged with the medical management of leading healthcare institutions and programs, the definition fails to recognize the potential for division either within such an elite or between a healthcare elite and the wider population.<ref name=Kopelman2004/> | |||
| ] definitions distinguish alternative medicine from the biomedical mainstream in its provision of therapies that are unproven, unvalidated or ineffective and support of theories which have no recognized scientific basis.{{sfn|IOM Report|2005|p=}} These definitions characterize practices as constituting alternative medicine when, used independently or in place of ], they are put forward as having the healing effects of medicine, but which are not based on ] gathered with the ].<ref name=NCCIH1/><ref name=NSF_2002/><ref name=Angell1998/><ref name=NCI_PDQ_CAM/><ref name=Borkan2012/><ref name=Kong2005/> Exemplifying this perspective, a 1998 editorial co-authored by ], a former editor of the '']'', argued that: | |||
| : "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."<ref name=Angell1998/> | |||
| This line of division has been subject to criticism, however, as not all forms of standard medical practice have adequately demonstrated evidence of benefit, {{refn|name=Harrisonquote|group=n}}<ref name=Ezzo2001/>{{sfn|IOM Report|2005|p=17–18}} and it is also unlikely in most instances that conventional therapies, if proven to be ineffective, would ever be classified as CAM.<ref name=Wieland2011/> | |||
| === Regional definitions === | |||
| Public information websites maintained by the governments of the US and of the UK make a distinction between "alternative medicine" and "complementary medicine", but mention that these two overlap. The National Center for Complementary and Integrative Health (NCCIH) of the National Institutes of Health (NIH) (a part of the ]) states that "alternative medicine" refers to using a non-mainstream approach in place of conventional medicine and that "complementary medicine" generally refers to using a non-mainstream approach together with conventional medicine, and comments that the boundaries between complementary and conventional medicine overlap and change with time.<ref name=NCCIH1/> | |||
| The ] website ''NHS Choices'' (owned by the ]), adopting the terminology of NCCIH, states that when a treatment is used alongside conventional treatments, to help a patient cope with a health condition, and not as an alternative to conventional treatment, this use of treatments can be called "complementary medicine"; but when a treatment is used instead of conventional medicine, with the intention of treating or curing a health condition, the use can be called "alternative medicine".<ref name=NHS_Choices_CAM/> | |||
| Similarly, the public information website maintained by the ] (NHMRC) of the Commonwealth of Australia uses the acronym "CAM" for a wide range of health care practices, therapies, procedures and devices not within the domain of conventional medicine. In the Australian context this is stated to include acupuncture; aromatherapy; chiropractic; homeopathy; massage; meditation and relaxation therapies; naturopathy; osteopathy; reflexology, traditional Chinese medicine; and the use of vitamin supplements.<ref name=NHMRC_CAM/> | |||
| The ] "Council for Alternative Medicine" (Sundhedsstyrelsens Råd for Alternativ Behandling (SRAB)), an independent institution under the National Board of Health (Danish: ''Sundhedsstyrelsen''), 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 are allowed to perform the treatments.<ref name=VIFAB_definition/> | |||
| ===National traditions or dominant practices=== | |||
| In ''General Guidelines for Methodologies on Research and Evaluation of Traditional Medicine'', published in 2000 by the ] (WHO), complementary and alternative medicine were defined as a broad set of health care practices that are not part of that country's own tradition and are not integrated into the dominant health care system.<ref name="WHO_Trad_Med_Defs"/>{{sfn|WHO|2000}} Some herbal therapies are mainstream in Europe but are alternative in the US.<ref name=Cotter2005/> | |||
| ==History== | ==History== | ||
| {{Main|History of alternative medicine}} | |||
| The history of alternative medicine may refer to the history of a group of diverse medical practices that were collectively promoted as "alternative medicine" beginning in the 1970s, to the collection of individual histories of members of that group, or to the history of western medical practices that were labeled "irregular practices" by the western medical establishment.<ref name="Sampson_6/1995" /><ref name="QMHCHF" /><ref name="Whorton_2003">{{Cite web |last=Whorton |first=James |date=2003 |title=Countercultural Healing: A brief History of Alternative Medicine in America |url=https://www.pbs.org/wgbh/pages/frontline/shows/altmed/clash/history.html |access-date=2022-03-25 |website=PBS Frontline}}</ref><ref name="RiseRise_6/2004">{{Cite journal |last1=Coulter |first1=Ian D. |last2=Willis |first2=Evan M. |date=2004-06-07 |title=The rise and rise of complementary and alternative medicine: a sociological perspective |journal=] |volume=180 |issue=11 |pages=587–589 |doi=10.5694/j.1326-5377.2004.tb06099.x |issn=0025-729X |pmid=15174992|s2cid=15983789 }}</ref><ref name="Whorton_9/2002">{{Cite book |last=Whorton |first=James C. |url=https://books.google.com/books?id=N21eyOQlE0kC |title=Nature Cures: The History of Alternative Medicine in America |year=2002 |publisher=Oxford University Press |isbn=978-0-19-534978-8 |language=en}}</ref> It includes the histories of ] and of ]. Before the 1970s, western practitioners that were not part of the increasingly science-based medical establishment were referred to "irregular practitioners", and were dismissed by the medical establishment as unscientific and as practicing quackery.<ref name="QMHCHF" /><ref name="Whorton_2003" /> Until the 1970s, irregular practice became increasingly marginalized as ] and fraud, as western medicine increasingly incorporated scientific methods and discoveries, and had a corresponding increase in success of its treatments.<ref name="Whorton_9/2002" /> In the 1970s, irregular practices were grouped with traditional practices of nonwestern cultures and with other unproven or disproven practices that were not part of biomedicine, with the entire group collectively marketed and promoted under the single expression "alternative medicine".<ref name="Sampson_6/1995" /><ref name="QMHCHF">Quack Medicine: A History of Combating Health Fraud in Twentieth-Century America, Eric W. Boyle, </ref><ref name="Whorton_2003" /><ref name="Whorton_9/2002" /><ref name="FrontlineAF">{{cite web |date=November 3, 2003 |title=The Alternative Fix: Introduction |url=https://www.pbs.org/wgbh/pages/frontline/shows/altmed/etc/synopsis.html |website=www.pbs.org |publisher=PBS Frontline}}</ref> | |||
| Use of alternative medicine in the west began to rise following the ] of the 1960s, as part of the rising ] of the 1970s.<ref name="Sampson_6/1995" /><ref>{{Cite magazine |last=Wallis |first=Claudia |date=November 4, 1991 |title=Cover Stories: Why New Age Medicine Is Catching On |language=en-US |volume=138 |magazine=Time |issue=18 |url=http://content.time.com/time/magazine/article/0,9171,155810,00.html |access-date=2022-03-25 |issn=0040-781X}}</ref><ref name="ENAB">{{cite book |title=New Age Medicine, Encyclopedia of New Age Beliefs |first1=John |last1=Ankerberg |first2=John |last2=Weldon |year=1996 |pages=470–508 |publisher=Harvest House Publishers |isbn=978-1-56507-160-5 |url=https://books.google.com/books?id=SghdYBbMds0C&pg=PA479 }}</ref> This was due to misleading ] of "alternative medicine" being an effective "alternative" to biomedicine, changing social attitudes about not using ] and challenging ] and ] of any kind, sensitivity to giving equal measure to beliefs and practices of other cultures (]), and growing frustration and desperation by patients about limitations and ]s of science-based medicine.<ref name="Sampson_6/1995" /><ref name="Whorton_2003" /><ref name="Whorton_9/2002" /><ref name="RiseRise_6/2004" /><ref name="FrontlineAF" /><ref name="ENAB" /><ref name="AMBMJ" /> At the same time, in 1975, the ], which played the central role in fighting quackery in the United States, abolished its quackery committee and closed down its Department of Investigation.<ref name="QMHCHF" />{{rp|xxi}}<ref name="AMBMJ">{{cite journal |quote=One of the few growth industries in contemporary Britain is alternative medicine. An apparently endless stream of books, articles, and radio and television programmes urge on the public the virtues of treatments ranging from meditation to drilling a hole in the skull to let in more oxygen. |pmc=1548588|year=1983|last1=Smith|first1=T|title=Alternative medicine|journal=British Medical Journal (Clinical Research Ed.)|volume=287|issue=6388|pages=307–308|pmid=6307462|doi=10.1136/bmj.287.6388.307}}</ref> By the early to mid 1970s the expression "alternative medicine" came into widespread use, and the expression became mass marketed as a collection of "natural" and effective treatment "alternatives" to science-based biomedicine.<ref name="Sampson_6/1995" /><ref name="AMBMJ" /><ref>{{Cite book |last=Kruger |first=Helen |url=https://books.google.com/books?id=S5_8AAAACAAJ&q=Other+healers,+other+cures:+A+guide+to+alternative+medicine,+Helen+Kruger |title=Other Healers, Other Cures: A Guide to Alternative Medicine |date=1974 |publisher=Bobbs-Merrill |isbn=978-0-672-51708-2 |language=en}}</ref><ref>{{cite book |last=Law |first=Donald |year=1975 |title=A Guide to Alternative Medicine |url=https://books.google.com/books?id=BwlPPgAACAAJ |publisher=Turnstone Press |isbn=978-0-85500-107-0 }}</ref> By 1983, mass marketing of "alternative medicine" was so pervasive that the '']'' (''BMJ'') pointed to "an apparently endless stream of books, articles, and radio and television programmes urge on the public the virtues of (alternative medicine) treatments ranging from meditation to drilling a hole in the skull to let in more oxygen".<ref name="AMBMJ" /> | |||
| The ] may refer to the history of a group of diverse medical practices that were collectively promoted as "alternative medicine" beginning in the 1970s, to the collection of individual histories of members of that group, or to the history of western medical practices that were labeled "irregular practices" by the western medical establishment.<ref name=ATRAMM/><ref name=QMHCHF/><ref name=CHBHAMA>Countercultural Healing: A brief History of Alternavie Medicine in America, James Whorton, ], Nov 4 2003, </ref><ref name=NCHAMA>Nature Cures - The History of Alternative Medicine in America, James C. Whorton, Oxford University Press, 2002, </ref><ref name=RRCAM>The Rise and Rise of Complementary and Alternative Medicine: a Sociological Perspective, Ian D Coulter and Evan M Willis, Medical Journal of Australia, 2004; 180 (11): 587-589</ref> It includes the histories of ] and of ]. Before the 1970s, western practitioners that were not part of the increasingly science-based medical establishment were referred to "irregular practitioners", and were dismissed by the medical establishment as unscientific and as practicing ].<ref name=QMHCHF/><ref name=CHBHAMA/> Until the 1970's, irregular practice became increasingly marginalized as ] and fraud, as western medicine increasingly incorporated scientific methods and discoveries, and had a corresponding increase in success of its treatments.<ref name=NCHAMA/> In the 1970s, irregular practices were grouped with traditional practices of nonwestern cultures and with other unproven or disproven practices that were not part of biomedicine, with the entire group collectively marketed and promoted under the single expression "alternative medicine".<ref name=ATRAMM/><ref name=QMHCHF>Quack Medicine: A History of Combating Health Fraud in Twentieth-Century America, Eric W. Boyle, </ref><ref name=CHBHAMA/><ref name=NCHAMA/><ref name=FrontlineAF/> | |||
| An analysis of trends in the criticism of complementary and alternative medicine (CAM) in five prestigious American medical journals during the period of reorganization within medicine (1965–1999) was reported as showing that the medical profession had responded to the growth of CAM in three phases, and that in each phase, changes in the medical marketplace had influenced the type of response in the journals.<ref name="Winnick2005_2009" /> Changes included relaxed medical licensing, the development of ], rising consumerism, and the establishment of the USA Office of Alternative Medicine (later National Center for Complementary and Alternative Medicine, currently National Center for Complementary and Integrative Health).{{refn|group=n|According to the medical historian ]: | |||
| Use of alternative medicine in the west began to rise following the ] of the 1960s, as part of the rising ] of the 1970s.<ref name=ATRAMM/><ref>The New Age of Alternative Medicine, Why New Age Medicine Is Catching On, Claudia Wallis, Time Magazine, 11-4-1991, </ref><ref name=ENAB/> This was due to misleading ] of "alternative medicine" being an effective "alternative" to biomedicine, changing social attitudes about not using ] and challenging ] and ] of any kind, sensitivity to giving equal measure to beliefs and practices of other cultures (]), and growing frustration and desperation by patients about limitations and ]s of ].<ref name=ATRAMM/><ref name=CHBHAMA/><ref name=NCHAMA/><ref name=RRCAM/><ref name=FrontlineAF/><ref name=ENAB/><ref name=AMBMJ/> At the same time, in 1975, the ], which played the central role in fighting quackery in the United States, abolished its quackery committee and closed down its Department of Investigation.<ref name=QMHCHF/>{{rp|xxi}}<ref name=AMBMJ>{{cite journal |quote=One of the few growth industries in contemporary Britain is alternative medicine. An apparently endless stream of books, articles, and radio and television programmes urge on the public the virtues of treatments ranging from meditation to drilling a hole in the skull to let in more oxygen. |pmc=1548588|year=1983|author1=Smith|first1=T|title=Alternative medicine|journal=British Medical Journal (Clinical research ed.)|volume=287|issue=6388|pages=307–308|pmid=6307462|doi=10.1136/bmj.287.6388.307}}</ref> By the early to mid 1970s the expression "alternative medicine" came into widespread use, and the expression became mass marketed as a collection of "natural" and effective treatment "alternatives" to science-based biomedicine.<ref name=ATRAMM/><ref name=AMBMJ/><ref>Other healers, other cures: A guide to alternative medicine, Helen Kruger, 1974, </ref><ref></ref> By 1983, mass marketing of "alternative medicine" was so pervasive that the ] (BMJ) pointed to "an apparently endless stream of books, articles, and radio and television programmes urge on the public the virtues of (alternative medicine) treatments ranging from meditation to drilling a hole in the skull to let in more oxygen".<ref name=AMBMJ/> In this 1983 article, the BMJ wrote, "one of the few growth industries in contemporary Britain is alternative medicine", noting that by 1983, "33% of patients with rheumatoid arthritis and 39% of those with backache admitted to having consulted an alternative practitioner".<ref name=AMBMJ/> | |||
| {{blockquote|In 1991 the Senate Appropriations Committee responsible for funding the National Institutes of Health (NIH) declared itself "not satisfied that the conventional medical community as symbolized at the NIH has fully explored the potential that exists in unconventional medical practices."<ref>{{Cite journal |last1= Young |first1= J.H. |title= The Development of the Office of Alternative Medicine in the National Institutes of Health, 1991–1996 |doi= 10.1353/bhm.1998.0110 |journal= Bulletin of the History of Medicine |volume= 72 |issue= 2 |pages= 279–298 |year= 1998 |pmid= 9628052 |s2cid= 26685737 }}</ref>}}}} | |||
| By about 1990, the American alternative medicine industry had grown to a $27 Billion per year, with polls showing 30% of Americans were using it.<ref name=ENAB/><ref name=PAMNIH/> Moreover, polls showed that Americans made more visits for alternative therapies than the total number of visits to primary care doctors, and American out-of-pocket spending (non-insurance spending) on alternative medicine was about equal to spending on biomedical doctors.<ref name=QMHCHF/>{{rp|172}} In 1991, ] ran a cover story, "The New Age of Alternative Medicine: Why New Age Medicine Is Catching On".<ref name=ENAB>New Age Medicine, Encyclopedia of New Age Beliefs; John Ankerberg, John Weldon, 1996, p. 470-508, </ref><ref name=PAMNIH/> In 1993, the ] reported one in three Americans as using alternative medicine.<ref name=ENAB/> In 1993, the ] ran a ] special, ], with Moyers commenting that "...people by the tens of millions are using alternative medicine. If established medicine does not understand that, they are going to lose their clients."<ref name=ENAB/> | |||
| ===Medical education=== | |||
| Another explosive growth began in the 1990s, when senior level political figures began promoting alternative medicine, investing large sums of government medical research funds into testing alternative medicine, including testing of scientifically implausible treatments, and relaxing government regulation of alternative medicine products as compared to biomedical products.<ref name=ATRAMM/><ref name=QMHCHF/>{{rp|xxi}}<ref name=CHBHAMA/><ref name=NCHAMA/><ref name=RRCAM/><ref name=FrontlineAF></ref><ref name=TAMUUS>Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. Eisenberg DM1, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, Kessler RC., JAMA. 1998 Nov 11;280(18):1569-75, </ref><ref name=TT>Edzard Ernst; Singh, Simon (2008), Trick or Treatment: The Undeniable Facts about Alternative Medicine, New York: W. W. Norton, ISBN 0-393-06661-4</ref> Beginning with a 1991 appropriation of $2 million for funding research of alternative medicine research, federal spending grew to a cumulative total of about $2.5 billion by 2009, with 50% of Americans using alternative medicine by 2013.<ref name="$2.5 billion"/><ref name=BRAUSAToday/> | |||
| Mainly as a result of reforms following the ] of 1910<ref name="Flexner_Report" /> medical education in established ] in the US has generally not included alternative medicine as a teaching topic.{{refn|group=n|As the medical professor ] noted in 2010: "Flexner pointed out that the scientific method of thinking applied to medical practice. By scientific method, he meant testing ideas with well-planned experiments to establish accurate facts. The clinician's diagnosis was equivalent to the scientist's hypothesis: both ] and hypothesis required the test of an experiment. Flexner argued that mastery of the scientific method of problem solving was the key for physicians to manage medical uncertainty and to practice in the most cost-effective way."<ref name=Ludmerer2010/>}} Typically, their teaching is based on current practice and scientific knowledge about: anatomy, physiology, histology, embryology, neuroanatomy, pathology, pharmacology, microbiology and immunology.<ref name="Bianco" /> Medical schools' teaching includes such topics as doctor-patient communication, ethics, the art of medicine,<ref name="Stanford_Curriculum" /> and engaging in complex clinical reasoning (medical decision-making).<ref name="Yale_Curriculum" /> Writing in 2002, Snyderman and Weil remarked that by the early twentieth century the Flexner model had helped to create the 20th-century academic health center, in which education, research, and practice were inseparable. While this had much improved medical practice by defining with increasing certainty the ] basis of disease, a single-minded focus on the pathophysiological had diverted much of mainstream American medicine from clinical conditions that were not well understood in mechanistic terms, and were not effectively treated by conventional therapies.<ref name="Snyderman2002" /> | |||
| By 2001 some form of CAM training was being offered by at least 75 out of 125 medical schools in the US.<ref name="Berman2001" /> Exceptionally, the School of Medicine of the ], includes a research institute for integrative medicine (a member entity of the ]).<ref name="UM_CAM_Field" /><ref name="UM_CIM" /> Medical schools are responsible for conferring medical degrees, but a physician typically may not legally practice medicine until licensed by the local government authority. Licensed ] who have attended one of the established medical schools there have usually graduated Doctor of Medicine (MD).<ref name="Medline_MD" /> All states require that applicants for MD licensure be graduates of an approved medical school and complete the ] (USMLE).<ref name="Medline_MD" /> | |||
| ] at a press conference.]] | |||
| In 1991, pointing to a need for testing because of the widespread use of alternative medicine without authoritative information on its efficacy, United States Senator ] used $2 million of his discretionary funds to create the ] (OSUMP), later renamed to be the ] (OAM).<ref name=QMHCHF/>{{rp|170}}<ref name=NC/><ref name=NCCAME/> The OAM was created to be within the ] (NIH), the scientifically prestigious primary agency of the United States government responsible for biomedical and health-related research.<ref name=QMHCHF/>{{rp|170}}<ref name=NC/><ref name=NCCAME/> The mandate was to investigate, evaluate, and validate effective alternative medicine treatments, and alert the public as the results of testing its efficacy.<ref name=PAMNIH>The Politics of Alternative Medicine at the National Institutes of Health, Eric W. Boyle, Presentation to the conference of the Society for History in the Federal Government, College Park, Maryland, March 5, 2010, </ref><ref name=NC/><ref name=NCCAME></ref><ref>"OAM’s Legislative History," Office of Alternative Medicine Series (OAMS), Office of NIH History Archives, National Institutes of Health, Box 4, Folder 7</ref> | |||
| ==Efficacy== | |||
| Sen. Harkin had become convinced his allergies were cured by taking ] pills, and was urged to make the spending by two of his influential constituents.<ref name=PAMNIH/><ref name=NC/><ref name=NCCAME/> Bedell, a longtime friend of Sen. Harkin, was a former member of the ] who believed that alternative medicine had twice cured him of diseases after mainstream medicine had failed, claiming that cow's milk ] cured his ], and an herbal derivative from ] had prevented post surgical recurrence of his ].<ref name=QMHCHF/><ref name=PAMNIH/> Wiewel was a promoter of unproven cancer treatments involving a mixture of blood sera that the ] had banned from being imported.<ref name=PAMNIH/> Both Bedell and Wiewel became members of the advisory panel for the OAM. The company that sold the bee pollen was later fined by the ] for making false health claims about their bee-pollen products reversing the aging process, curing allergies, and helping with weight loss.<ref>"Arizona company agrees to pay $200,000 to settle FTC charges it made false health claims about bee-pollen products," FTC News Notes, December 30, 1992.</ref> | |||
| ], an authority on scientific study of alternative therapies and diagnoses and the first university professor of CAM, in 2012 ]] | |||
| There is a general scientific consensus that alternative therapies lack the requisite ], and their effectiveness is either unproved or disproved.<ref name="NSF_4/2002" /><ref name="Sampson_6/1995" /><ref name="Kent1997" /><ref name="Goldrosen2004" /> Many of the claims regarding the efficacy of alternative medicines are controversial, since research on them is frequently of low quality and methodologically flawed.{{sfn|IOM Report|2005}} ], marked differences in product quality and standardisation, and some companies making unsubstantiated claims call into question the claims of efficacy of isolated examples where there is evidence for alternative therapies.<ref name="Sarris2012" /> | |||
| ''The Scientific Review of Alternative Medicine'' points to confusions in the general population – a person may attribute symptomatic relief to an otherwise-ineffective therapy just because they are taking something (the placebo effect); the natural recovery from or the cyclical nature of an illness (the ]) gets misattributed to an alternative medicine being taken; a person not diagnosed with science-based medicine may never originally have had a true illness diagnosed as an alternative disease category.<ref name="Alcock1999" /> | |||
| In 1993, Britain's ], who claimed that homeopathy and other alternative medicine was an effective alternative to biomedicine, established the ] (FIH), as a charity to explore "how safe, proven complementary therapies can work in conjunction with mainstream medicine".<ref name=Booth>{{cite news| title=Prince Charles's aide at homeopathy charity arrested on suspicion of fraud | author=Robert Booth | publisher=guardian.co.uk |date=26 April 2010| url=http://www.guardian.co.uk/uk/2010/apr/26/prince-charles-aide-homeopathy-charity-arrested | location=London}}</ref> The FIH received government funding through grants from Britain's ].<ref name=Booth/> | |||
| ], the first university professor of Complementary and Alternative Medicine, characterized the evidence for many alternative techniques as weak, nonexistent, or negative<ref name="goodbadugly" /> and in 2011 published his estimate that about 7.4% were based on "sound evidence", although he believes that may be an overestimate.<ref name="Ernst2011" /> Ernst has concluded that 95% of the alternative therapies he and his team studied, including acupuncture, herbal medicine, homeopathy, and ], are "statistically indistinguishable from placebo treatments", but he also believes there is something that conventional doctors can usefully learn from the chiropractors and homeopath: this is the therapeutic value of the placebo effect, one of the strangest phenomena in medicine.<ref name="Economist2011" /><ref name="HHH2008" /> | |||
| In 1994, Sen. Harkin (D) and Senator ] (R) introduced the ] (]).<ref name=NCDLP2000/><ref name=1993SOPA/> The act reduced authority of the FDA to monitor products sold as "natural" treatments.<ref name=NCDLP2000/> Labeling standards were reduced to allow health claims for supplements based only on unconfirmed preliminary studies that were not subjected to scientific peer review, and the act made it more difficult for the FDA to promptly seize products or demand proof of safety where there was evidence of a product being dangerous.<ref name=1993SOPA></ref> The Act became known as the "]" following a ] editorial under that name.<ref name=NCDLP2000/> | |||
| In 2003, a project funded by the CDC identified 208 condition-treatment pairs, of which 58% had been studied by at least one ] (RCT), and 23% had been assessed with a ].<ref name="Katz2003" /> According to a 2005 book by a US ] panel, the number of RCTs focused on CAM has risen dramatically. | |||
| Senator Harkin complained about the "unbendable rules of ]", citing his use of bee pollen to treat his allergies, which he claimed to be effective even though it was biologically implausible and efficacy was not established using scientific methods.<ref name=NC>{{cite book | title = Natural causes: death, lies, and politics in America's vitamin and herbal supplement industry | author=Dan Hurley | publisher = ] | year = 2006 | location = New York | isbn = 978-0-7679-2042-1}}</ref><ref name=SMPCAT/> Sen. Harkin asserted that claims for alternative medicine efficacy be allowed not only without conventional scientific testing, even when they are biologically implausible, "It is not necessary for the scientific community to understand the process before the American public can benefit from these therapies."<ref name=NCDLP2000/> Following passage of the act, sales rose from about $4 billion in 1994, to $20 billion by the end of 2000, at the same time as evidence of their lack of efficacy or harmful effects grew.<ref name=NCDLP2000>Book Review, ''Natural Causes: Death, Lies, and Politics in America's Vitamin and Herbal Supplement Industry'', Donald Marcus, M.D., New England Journal of Medicine, 6-21-2007; 356:2659, DOI: 10.1056/NEJMbkrev57733, </ref> Senator Harkin came into open public conflict with the first OAM Director ] and OAM board members from the scientific and biomedical community.<ref name=NCCAME/> Jacobs' insistence on rigorous scientific methodology caused friction with Senator Harkin.<ref name=NC/><ref name=SMPCAT>Shadow Medicine: The Placebo in Conventional and Alternative Therapies, John S. Halle, </ref><ref>Toward an Integrative Medicine: Merging Alternative Therapies with Biomedicine, Hans A. Baer, </ref> Increasing political resistance to the use of scientific methodology was publicly criticized by Dr. Jacobs and another OAM board member complained that "nonsense has trickled down to every aspect of this office".<ref name=NC/><ref name=SMPCAT/> In 1994, Senator Harkin appeared on television with cancer patients who blamed Dr. Jacobs for blocking their access to untested cancer treatment, leading Jacobs to resign in frustration.<ref name=NC/><ref name=SMPCAT/> | |||
| {{as of|2005}}, the ] 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%), 4.8% concluded no effect, 0.7% 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 more developed 2004 Cochrane database, while the conventional review used the initial 1998 Cochrane database.{{sfn|IOM Report|2005|pp=}} | |||
| In 1995, ], a promoter of ] and political ally of Senator Harkin, became the director of the OAM, and continued in that role until 1999.<ref>National Center for Complementary and Integrative Health (NCCIH), Skeptics Dictionary, </ref> In 1997, the NCCAM budget was increased from $12 million to $20 million annually.<ref name=OAMGUB/> From 1990 to 1997, use of alternative medicine in the US increased by 25%, with a corresponding 50% increase in expenditures.<ref name=Eisenberg1998>{{cite journal |title= Trends in alternative medicine use in the United States, 1990-1997: Results of a follow-up national survey |url= http://jama.jamanetwork.com/article.aspx?articleid=188148 |journal= JAMA |last1= Eisenberg |first1= D.M.|last2= Davis |first2= R.B. |last3= Ettner |first3= S.L. |last4= Appel |first4= S. |last5= Wilkey |first5= S. |last6= Van Rompay |first6= M. |last7= Kessler |first7= R.C. |volume= 280 |issue= 18 |pages= 1569–75 |pmid= 9820257 |doi= 10.1001/jama.280.18.1569 |year= 1998 |ref={{harvid|Eisenberg et al.|1998}}|displayauthors= 1 }}</ref> The OAM drew increasing criticism from eminent members of the scientific community with letters to the Senate Appropriations Committee when discussion of renewal of funding OAM came up.<ref name=QMHCHF/>{{rp|175}} Nobel laureate ] wrote that prestigious NIH should not be degraded to act as a cover for quackery, calling the OAM "an embarrassment to serious scientists."<ref name=QMHCHF/>{{rp|175}}<ref name=OAMGUB/> The president of the ] wrote complaining that the government was spending money on testing products and practices that "violate basic laws of physics and more clearly resemble witchcraft".<ref name=QMHCHF/>{{rp|175}}<ref name=OAMGUB>Office Of Alternative Medicine Gets Unexpected Boost, Paul Smaglik, The Scientist, 11-10-1997, </ref> In 1998, the President of the North Carolina Medical Association publicly called for shutting down the OAM.<ref name=WNCCAMSBD>Why the National Center for Complementary and Alternative Medicine (NCCAM) Should Be Defunded, Wallace I. Sampson, M.D, Quackwatch, </ref> | |||
| Alternative therapies do not "complement" (improve the effect of, or mitigate the side effects of) functional medical treatment.{{refn|group=n|name=FinalReport}}<ref name="NSF_4/2002" /><ref name=Ernst_1995/><ref name=Joyce_1994/><ref name=BMJ_May/> Significant drug interactions caused by alternative therapies may instead negatively impact functional treatment by making ]s less effective, such as interference by herbal preparations with ].<ref name=":0"/><ref name="Arye13" /> | |||
| In 1998, NIH director and Nobel laureate ] came into conflict with Senator Harkin by pushing to have more NIH control of alternative medicine research.<ref name=SSOAGGRAM/> The NIH Director placed the OAM under more strict scientific NIH control.<ref name=OAMGUB/><ref name=SSOAGGRAM/> Senator Harkin responded by elevating OAM into an independent NIH "center", just short of being its own "institute", and renamed to be the ] (NCCAM). NCCAM had a mandate to promote a more rigorous and scientific approach to the study of alternative medicine, research training and career development, outreach, and "integration". In 1999, the NCCAM budget was increased from $20 million to $50 million.<ref name=WNCCAMSBD/><ref name=SSOAGGRAM/> The United States Congress approved the appropriations without dissent. In 2000, the budget was increased to about $68 million, in 2001 to $90 million, in 2002 to $104 million, and in 2003, to $113 million.<ref name=WNCCAMSBD/> | |||
| In the same way as for conventional therapies, drugs, and interventions, it can be difficult to test the efficacy of alternative medicine in ]s. In instances where an established, effective, treatment for a condition is already available, the ] 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 ] or difficult-to-interpret results.<ref name="Bodeker2002" /> | |||
| In 2004, modifications of the ]'s 2001 ], regulating all medicine products, were made with the expectation of influencing development of the European market for alternative medicine products.<ref name=RFCAME/> Regulation of alternative medicine in Europe was loosened with "a simplified registration procedure" for traditional herbal medicinal products.<ref name=RFCAME/><ref name=D200183EC/> Plausible "efficacy" for traditional medicine was redefined to be based on long term popularity and testimonials ("the pharmacological effects or efficacy of the medicinal product are plausible on the basis of long-standing use and experience."), without scientific testing.<ref name=RFCAME/><ref name=D200183EC>Directive 2001/83/EC of the European Parliament and of the Council, 11-6-2001 with later amendments, </ref> The ] (HMPC) was created within the ] in London (EMEA). A special working group was established for homeopathic remedies under the ].<ref name=RFCAME/> | |||
| Cancer researcher ] has stated: | |||
| Through 2004, alternative medicine that was traditional to Germany continued to be a regular part of the health care system, including ] and ].<ref name=RFCAME>The regulatory framework for complementary and alternative medicines in Europe, Knöss W1, Stolte F, Reh K., Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2008 Jul;51(7):771-8. doi: 10.1007/s00103-008-0584-8, </ref> The ] mandated that science-based medical authorities consider the "particular characteristics" of complementary and alternative medicines.<ref name=RFCAME/> By 2004, homeopathy had grown to be the most used alternative therapy in France, growing from 16% of the population using homeopathic medicine in 1982, to 29% by 1987, 36% percent by 1992, and 62% of French mothers using homeopathic medicines by 2004, with 94.5% of French pharmacists advising pregnant women to use homeopathic remedies.<ref name=HME1>Homeopathic Medicine: Europe's #1 Alternative for Doctors, Dana Ullman, Huffington Post, 11-17-2011, </ref> {{as of|2004}}, 100 million people in ] depended solely on traditional German homeopathic remedies for their medical care.<ref name=HBI>Homoeopathy booming in India, Prasad R" ''Lancet'' 370:November 17, 2007,1679-80</ref> {{as of|2010}}, homeopathic remedies continued to be the leading alternative treatment used by European physicians.<ref name=HME1/> By 2005, sales of ] and ] had grown to $930 million Euros, a 60% increase from 1995.<ref name=HME1/><ref></ref> | |||
| {{blockquote|Contrary to much popular and scientific writing, many ] have been investigated in good-quality clinical trials, and they have been shown to be ineffective. The label "unproven" is inappropriate for such therapies; it is time to assert that many alternative cancer therapies have been "disproven".<ref name="Vickers" />}} | |||
| In 2008, London's '']'' published a letter from ] that asked the FIH to recall two guides promoting alternative medicine, saying: "the majority of alternative therapies appear to be clinically ineffective, and many are downright dangerous." In 2010, Brittan's FIH closed after allegations of fraud and money laundering led to arrests of its officials.<ref name=Booth/> | |||
| ==Perceived mechanism of effect== | |||
| In 2009, after a history of 17 years of government testing and spending of nearly $2.5 billion on research had produced almost no clearly proven efficacy of alternative therapies, Senator Harkin complained, "One of the purposes of this center was to investigate and validate alternative approaches. Quite frankly, I must say publicly that it has fallen short. It think quite frankly that in this center and in the office previously before it, most of its focus has been on disproving things rather than seeking out and approving."<ref name=SSOAGGRAM/><ref>Full Committee Hearing, Integrative Care: A Pathway to a Healthier Nation, SD 4-30 (Feb. 26, 2009), United States Senate, </ref><ref name=THWS>Tom Harkin’s War on Science, Peter Lipson, Discover Magazine editor's opinion in New York Times, 3-2-2009, </ref> Members of the scientific community criticized this comment as showing Senator Harkin did not understand the basics of scientific inquiry, which tests hypotheses, but never intentionally attempts to "validate approaches".<ref name=SSOAGGRAM/> Members of the scientific and biomedical communities complained that after a history of 17 years of being tested, at a cost of over $2.5 Billion on testing scientifically and biologically implausible practices, almost no alternative therapy showed clear efficacy.<ref name="$2.5 billion">{{cite news |url= http://www.msnbc.msn.com/id/31190909/ |title= $2.5 billion spent, no alternative cures found |work= ] |department= Alternative Medicine |agency= ] |date= 2009-06-10 |archiveurl= https://web.archive.org/web/20090613033017/http://www.msnbc.msn.com/id/31190909 |archivedate= 2009-06-13 |deadurl= no}}</ref> In 2009, the NCCAM's budget was increased to about $122 million.<ref name=SSOAGGRAM>Scientists Speak Out Against Federal Funds for Research on Alternative Medicine, David Brown, Washington Post, 3-17-2009, </ref> Overall NIH funding for CAM research increased to $300 Million by 2009.<ref name=SSOAGGRAM/> By 2009, Americans were spending $34 Billion annually on CAM.<ref></ref> | |||
| Anything classified as alternative medicine by definition does not have a proven healing or medical effect.<ref name=Angell1998/><ref name="Sampson_6/1995" /><ref name="Hines_Sampson_Coulter_Sagan" /><ref name="IGPIAMAYP" /><ref name="NP" /> However, there are different mechanisms through which it can be perceived to "work". The common denominator of these mechanisms is that effects are ] to the alternative treatment. [[Image:Altmed function 2.svg|thumb|right|350px|How alternative therapies "work": | |||
| <br />a) '''Misinterpreted ]''' – the individual gets better without treatment. | |||
| <br />b) '''] or false treatment effect''' – an individual receives "alternative therapy" and is convinced it will help. The conviction makes them more likely to get better. | |||
| <br />c) '''] effect''' – an individual is convinced that standard treatment will not work, and that alternative therapies will work. This decreases the likelihood standard treatment will work, while the placebo effect of the "alternative" remains. | |||
| <br />d) '''No adverse effects''' – Standard treatment is replaced with "alternative" treatment, getting rid of adverse effects, but also of improvement. | |||
| <br />e) '''Interference''' – Standard treatment is "complemented" with something that interferes with its effect. This can both cause worse effect, but also decreased (or even increased) side effects, which may be interpreted as "helping". | |||
| Researchers, such as ], ]s and ], use ]s to reveal such effects, allowing physicians to offer a therapeutic solution best known to work. "Alternative treatments" often refuse to use trials or make it deliberately hard to do so.]] | |||
| Since 2009, according to Art. 118a of the ], the Swiss Confederation and the ] shall within the scope of their powers ensure that consideration is given to complementary medicine.<ref>{{cite web |url= https://www.admin.ch/opc/en/classified-compilation/19995395/index.html#a118a/ |title= Federal Constitution of the Swiss Confederation |at=Art. 118a Complementary medicine |location= CH }}</ref> | |||
| ===Placebo effect=== | |||
| In 2012, the ] (JAMA) published a criticism that study after study had been funded by NCCAM, but "failed to prove that complementary or alternative therapies are anything more than placebos".<ref name=ITPWS/> The JAMA criticism pointed to large wasting of research money on testing scientifically implausible treatments, citing "NCCAM officials spending $374,000 to find that inhaling lemon and lavender scents does not promote wound healing; $750,000 to find that prayer does not cure AIDS or hasten recovery from breast-reconstruction surgery; $390,000 to find that ancient Indian remedies do not control type 2 diabetes; $700,000 to find that magnets do not treat arthritis, carpal tunnel syndrome, or migraine headaches; and $406,000 to find that coffee enemas do not cure pancreatic cancer."<ref name=ITPWS>Is taxpayer money well spent or wasted on alternative-medicine research?, Susan Perry, 5-8-2012, ], </ref> It was pointed out that negative results from testing were generally ignored by the public, that people continue to "believe what they want to believe, arguing that it does not matter what the data show: They know what works for them".<ref name=ITPWS/> Continued increasing use of CAM products was also blamed on the lack of FDA ability to regulate alternative products, where negative studies do not result in FDA warnings or FDA-mandated changes on labeling, whereby few consumers are aware that many claims of many supplements were found not to have not to be supported.<ref name=ITPWS/> | |||
| A placebo is a treatment with no intended therapeutic value. An example of a placebo is an inert pill, but it can include more dramatic interventions like ]. The ''placebo effect'' is the concept that patients will perceive an improvement after being treated with an inert treatment. The opposite of the placebo effect is the ''nocebo effect'', when patients who expect a treatment to be harmful will perceive harmful effects after taking it. | |||
| Placebos do not have a physical effect on diseases or improve overall outcomes, but patients may report improvements in subjective outcomes such as pain and nausea.<ref name=CochraneHrob2010>{{cite journal | vauthors = Hróbjartsson A, Gøtzsche PC | title = Placebo interventions for all clinical conditions | journal = The Cochrane Database of Systematic Reviews | volume = 106 | issue = 1 | pages = CD003974 | date = January 2010 | pmid = 20091554 | doi = 10.1002/14651858.CD003974.pub3 | pmc = 7156905 | editor1-last = Hróbjartsson | editor1-first = Asbjørn | url = http://nordic.cochrane.org/sites/nordic.cochrane.org/files/public/uploads/ResearchHighlights/Placebo%20interventions%20for%20all%20clinical%20conditions%20(Cochrane%20review).pdf | access-date = 2019-03-25 | archive-date = 2019-04-02 | archive-url = https://web.archive.org/web/20190402005647/https://nordic.cochrane.org/sites/nordic.cochrane.org/files/public/uploads/ResearchHighlights/Placebo%20interventions%20for%20all%20clinical%20conditions%20(Cochrane%20review).pdf }}</ref> A 1955 study suggested that a substantial part of a medicine's impact was due to the placebo effect.<ref name="Hrob2001"/><ref name=CochraneHrob2010/> However, reassessments found the study to have flawed methodology.<ref name="Hrob2001">{{cite journal | vauthors = Hróbjartsson A, Gøtzsche PC | title = Is the placebo powerless? An analysis of clinical trials comparing placebo with no treatment | journal = The New England Journal of Medicine | volume = 344 | issue = 21 | pages = 1594–1602 | date = May 2001 | pmid = 11372012 | doi = 10.1056/NEJM200105243442106 | doi-access = free }}</ref><ref name="Kienle & Kiene"/> This and other modern reviews suggest that other factors like natural recovery and ] should also be considered.<ref name=CochraneHrob2010/><ref name="Kienle & Kiene"/> | |||
| By 2013, 50% of Americans were using CAM.<ref name=BRAUSAToday>Book raises alarms about alternative medicine, Liz Szabo, USA TODAY, July 2, 2013, </ref> {{as of|2013}}, CAM medicinal products in Europe continued to be exempted from documented efficacy standards required of other medicinal products.<ref name=LSRCAME>Legal Status and Regulation of Complementary andAlternative Medicine in Europe; Solveig Wiesener, Torkel Falkenberg, Gabriella Hegyid, Johanna Hök, Paolo Roberti di Sarsina, Vinjar Fønnebø; Forsch Komplementmed 2012; 19(suppl 2):29–36, Nov. 2012, </ref> | |||
| All of these are reasons why alternative therapies may be credited for improving a patient's condition even though the objective effect is non-existent, or even harmful.<ref name=":0"/><ref name="Gorski2010"/><ref name=Novella2010/> ] argues that alternative treatments should be treated as a placebo, rather than as medicine.<ref name="Gorski2010"/> Almost none have performed significantly better than a placebo in clinical trials.<ref name="ATRAMM" /><ref name="Skep_Dic_comp_med" /><ref name="$2.5 billion"/><ref name=Abdulla1999/> Furthermore, distrust of conventional medicine may lead to patients experiencing the nocebo effect when taking effective medication.<ref name=":0"/> | |||
| In 2014 the NCCAM was renamed to the ] (NCCIH) with a new charter requiring that 12 of the 18 council members shall be selected with a preference to selecting leading representatives of complementary and alternative medicine, 9 of the members must be licensed practitioners of alternative medicine, 6 members must be general public leaders in the fields of public policy, law, health policy, economics, and management, and 3 members must represent the interests of individual consumers of complementary and alternative medicine.<ref name=NCCIHC></ref> | |||
| === |
===Regression to the mean=== | ||
| A patient who receives an inert treatment may report improvements afterwards that it did not cause.<ref name=CochraneHrob2010/><ref name="Kienle & Kiene">{{cite journal | vauthors = Kienle GS, Kiene H | title = The powerful placebo effect: fact or fiction? | journal = Journal of Clinical Epidemiology | volume = 50 | issue = 12 | pages = 1311–1318 | date = December 1997 | pmid = 9449934 | doi = 10.1016/s0895-4356(97)00203-5 }}</ref> Assuming it was the cause without evidence is an example of the regression fallacy. This may be due to a natural recovery from the illness, or a fluctuation in the symptoms of a long-term condition.<ref name="Kienle & Kiene"/> The concept of ] implies that an extreme result is more likely to be followed by a less extreme result. | |||
| ===Other factors=== | |||
| Much of what is now categorized as alternative medicine was developed as independent, complete medical systems. These were developed long before biomedicine and use of scientific methods. Each system was developed in relatively isolated regions of the world where there was little or no medical contact with pre-scientific western medicine, or with each other's systems. Examples are ] and the ] of ]. | |||
| There are also reasons why a placebo treatment group may outperform a "no-treatment" group in a test which are not related to a patient's experience. These include patients reporting more favourable results than they really felt due to politeness or "experimental subordination", ], and misleading wording of questions.<ref name="Kienle & Kiene"/> In their 2010 systematic review of studies into placebos, ] and ] write that "even if there were no true effect of placebo, one would expect to record differences between placebo and no-treatment groups due to bias associated with lack of ]."<ref name=CochraneHrob2010/> Alternative therapies may also be credited for perceived improvement through decreased use or effect of medical treatment, and therefore either decreased ] or ] towards standard treatment.<ref name=":0">{{Cite journal |last1=Zeller |first1=T. |last2=Muenstedt |first2=K. |last3=Stoll |first3=C. |last4=Schweder |first4=J. |last5=Senf|first5=B.|last6=Ruckhaeberle|first6=E.|last7=Becker|first7=S. |last8=Serve |first8=H. |last9=Huebner |first9=J. |date=2013-03-01 |title=Potential interactions of complementary and alternative medicine with cancer therapy in outpatients with gynecological cancer in a comprehensive cancer center|journal=Journal of Cancer Research and Clinical Oncology |volume=139 |issue=3 |pages=357–365 |doi=10.1007/s00432-012-1336-6 |issn=1432-1335|pmid=23099993|s2cid=29598970 }}</ref> | |||
| ==Use and regulation== | |||
| Other alternative medicine practices, such as ], were developed in western Europe and in opposition to western medicine, at a time when western medicine was based on unscientific theories that were dogmatically imposed by western religious authorities. Homeopathy was developed prior to discovery of the basic principles of ], which proved homeopathic remedies contained nothing but water. But homeopathy, with its remedies made of water, was harmless compared to the unscientific and dangerous orthodox western medicine practiced at that time, which included use of ]s and ], often resulting in permanent disfigurement or death.<ref name=CHBHAMA/> | |||
| ===Appeal=== | |||
| Practitioners of complementary medicine usually discuss and advise patients as to available alternative therapies. Patients often express interest in mind-body complementary therapies because they offer a non-drug approach to treating some health conditions.<ref name="Sobel2000"/> | |||
| In addition to the social-cultural underpinnings of the popularity of alternative medicine, there are several psychological issues that are critical to its growth, notably psychological effects, such as the will to believe,<ref name=Beyerstein /> ]es that help maintain self-esteem and promote harmonious social functioning,<ref name=Beyerstein /> and the '']'' fallacy.<ref name=Beyerstein /> | |||
| Other alternative practices such as ] and ] were developed in the United States at a time that western medicine was beginning to incorporate scientific methods and theories, but the biomedical model was not yet totally dominant. Practices such as chiropractic and osteopathic, each considered to be irregular practices by the western medical establishment, also opposed each other, both rhetorically and politically with licensing legislation. Osteopathic practitioners added the courses and training of biomedicine to their licensing, and licensed Doctor of Osteopathic Medicine holders began diminishing use of the unscientific origins of the field. Without the original nonscientific practices and theories, osteopathic medicine is now considered the same as biomedicine. | |||
| In a 2018 interview with '']'', Edzard Ernst stated: "The present popularity of complementary and alternative medicine is also inviting criticism of what we are doing in mainstream medicine. It shows that we aren't fulfilling a certain need-we are not giving patients enough time, compassion, or empathy. These are things that complementary practitioners are very good at. Mainstream medicine could learn something from complementary medicine."<ref name="Rimmer_Abi_2018">{{cite journal |last1=Rimmer |first1=Abi |title=Empathy and ethics: five minutes with Edzard Ernst |journal=BMJ |date=25 January 2018 |volume=360 |pages=k309 |doi=10.1136/bmj.k309|pmid=29371199 |s2cid=3511158 }}</ref> | |||
| ==="Irregular practitioners" === | |||
| ====Marketing==== | |||
| {{main article|History of alternative medicine}} | |||
| Alternative medicine is a profitable industry with large media advertising expenditures. Accordingly, alternative practices are often portrayed positively and compared favorably to ].<ref name="ConsumerHealth9th" /> | |||
| ''Further information: ]'' | |||
| The popularity of complementary & alternative medicine (CAM) may be related to other factors that Ernst mentioned in a 2008 interview in '']'': | |||
| Until the 1970s, western practitioners that were not part of the medical establishment were referred to "irregular practitioners", and were dismissed by the medical establishment as unscientific, as practicing ].<ref name=CHBHAMA/> Irregular practice became increasingly marginalized as ] and fraud, as western medicine increasingly incorporated scientific methods and discoveries, and had a corresponding increase in success of its treatments. | |||
| {{blockquote|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.<ref name="Con?">{{cite news |last=Laurance |first=Jeremy |url= https://www.independent.ie/lifestyle/health/the-big-con-26450124.html |title= Complementary therapies: The big con? |newspaper= ] |access-date= 2010-04-23 |location= London |date= 2008-04-22 |url-status= live |archive-url= https://web.archive.org/web/20100417080412/http://www.independent.co.uk/life-style/health-and-families/features/complementary-therapies-the-big-con-813248.html | archive-date= 2010-04-17}}</ref>}} | |||
| Dating from the 1970s, medical professionals, sociologists, anthropologists and other commentators noted the increasing visibility of a wide variety of health practices that had neither derived directly from nor been verified by ].<ref name=Bivins2011/> Since that time, those who have analyzed this trend have deliberated over the most apt language with which to describe this emergent health field.<ref name=Bivins2011/> A variety of terms have been used, including heterodox, irregular, fringe and alternative medicine while others, particularly medical commentators, have been satisfied to label them as instances of quackery.<ref name=Bivins2011/> The most persistent term has been alternative medicine but its use is problematic as it assumes a value-laden dichotomy between a medical fringe, implicitly of borderline acceptability at best, and a privileged medical orthodoxy, associated with validated medico-scientific norms.<ref name=Jutte2001/> The use of the category of alternative medicine has also been criticized as it cannot be studied as an independent entity but must be understood in terms of a regionally and temporally specific medical orthodoxy.<ref name=DeBlecourt1999/> Its use can also be misleading as it may erroneously imply that a real medical alternative exists.<ref name=Jutte1999/> As with near-synonymous expressions, such as unorthodox, complementary, marginal, or quackery, these linguistic devices have served, in the context of processes of professionalisation and market competition, to establish the authority of official medicine and police the boundary between it and its unconventional rivals.<ref name=Jutte2001/> | |||
| ]]] | |||
| Paul Offit proposed that "alternative medicine becomes quackery" in four ways: by recommending against conventional therapies that are helpful, promoting potentially harmful therapies without adequate warning, draining patients' bank accounts, or by promoting "magical thinking".<ref name=Offit2013/> Promoting alternative medicine has been called dangerous and ].{{refn|name=Groopmanquote|group=n|"Kessler refers to a lack of efficacy but never pushes back at Hatch by enumerating the dangers that unregulated products pose to the public, the dangers that fill the pages of Offit's book."<ref name=Groopman>{{cite news |author=Jerome Groopman |title=The Quackish Cult of Alternative Medicine. Dr. Paul Offit's battle against charlatanism |url=http://www.newrepublic.com/article/114899/paul-offits-do-you-believe-magic-reviewed-dangers |newspaper=] |date= October 19, 2013 |access-date=2015-02-03 |author-link=Jerome Groopman }}</ref>}}<ref name=Weisleder>{{cite journal|last1=Weisleder|first1=P|s2cid=19719686|title=Unethical prescriptions: alternative therapies for children with cerebral palsy.|journal=Clinical Pediatrics|date=January 2010|volume=49|issue=1|pages=7–11|doi=10.1177/0009922809340438|pmid=19628756}}</ref> | |||
| An early instance of the influence of this modern, or western, scientific medicine outside Europe and North America is ].<ref name=Bullock1980/>{{refn|group=n|] (formerly Beijing Medical University) was the first of the kind in China to teach western medicine and train medical professionals.{{citation needed|date=November 2013}}}}{{refn|group=n|For an encyclopaedic account of the development of "western" medicine in the period leading up to the reforms in the medical schools of US resulting from the Flexner Report, published at the time of that report, see the article, ], in the 1911 Encyclopædia Britannica by ].}} | |||
| ] | |||
| From a historical perspective, the emergence of alternative medicine, if not the term itself, is typically dated to the 19th century.<ref name="Porter_Ramsey_Loudon"/> This is despite the fact that there are variants of Western non-conventional medicine that arose in the late-eighteenth century or earlier and some non-Western medical traditions, currently considered alternative in the West and elsewhere, which boast extended historical pedigrees.<ref name=Jutte2001/> Alternative medical systems, however, can only be said to exist when there is an identifiable, regularized and authoritative standard medical practice, such as arose in the West during the nineteenth century, to which they can function as an alternative.{{sfn|Bivins|2007|p=171}} | |||
| ====Social factors==== | |||
| During the late eighteenth and nineteenth centuries regular and irregular medical practitioners became more clearly differentiated throughout much of Europe and,<ref name="Brunton_Brown"/> as the nineteenth century progressed, most Western states converged in the creation of legally delimited and semi-protected medical markets.<ref name=Pickstone2006/> It is at this point that an "official" medicine, created in cooperation with the state and employing a scientific rhetoric of ], emerges as a recognizable entity and that the concept of alternative medicine as a historical category becomes tenable.<ref name=Ramsey1999/> | |||
| Authors have speculated on the socio-cultural and psychological reasons for the appeal of alternative medicines among the 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 ] among the public at large and a concomitant increase in antiscientific attitudes and new age ].<ref name="Beyerstein" /> Related to this are vigorous marketing<ref name="Weber" /> of extravagant claims by the alternative medical community combined with inadequate media scrutiny and attacks on critics.<ref name="Beyerstein" /><ref name="Beyerstein2001" /> Alternative medicine is criticized for taking advantage of the least fortunate members of society.<ref name="ConsumerHealth9th"/> | |||
| There is also an increase in ] toward conventional medicine and pharmaceutical companies,<ref name="Li et al., 2018" /> 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.<ref name="Beyerstein2001" /> Many patients lack access to contemporary medicine, due to a lack of private or public ], which leads them to seek out lower-cost alternative medicine.<ref name="Barnes2004" /> Medical doctors are also aggressively marketing alternative medicine to profit from this market.<ref name="Weber" /> | |||
| As part of this process, professional adherents of mainstream medicine in countries such as Germany, France, and Britain increasingly invoked the scientific basis of their discipline as a means of engendering internal professional unity and of external differentiation in the face of sustained market competition from homeopaths, naturopaths, mesmerists and other nonconventional medical practitioners, finally achieving a degree of imperfect dominance through alliance with the state and the passage of regulatory legislation.<ref name=Jutte2001/><ref name=Jutte1999/> In the US the ], based in Baltimore, Maryland, opened in 1893, with ] and ] among the founding physicians, and was the first medical school devoted to teaching "German scientific medicine".<ref name=Silverman2011/> | |||
| Patients can be averse to the painful, unpleasant, and sometimes-dangerous ] 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 ] can have potential to cause life-threatening ] reactions in a very few individuals. 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 therapies to avoid the adverse effects of conventional treatments.<ref name="Beyerstein" /><ref name="Beyerstein2001" /> | |||
| Buttressed by the increased authority arising from significant advances in the medical sciences of the late 19th century onwards—including the development and application of the ] by the chemist ] and the surgeon ], of ] co-founded by ] (in 1885 appointed professor of ] at the ]), and of the use of ]s (]s)—the 1910 ] called upon ] to follow the model set by the Johns Hopkins School of Medicine and adhere to mainstream science in their teaching and research. This was in a belief, mentioned in the Report's introduction, that the preliminary and professional training then prevailing in medical schools should be reformed in view of the new means for diagnosing and combating disease being made available to physicians and surgeons by the sciences on which medicine depended.{{refn|group=n|In his introduction to the Flexner Report, Henry S. Pritchett stated, "The fundamental sciences upon which medicine depends have been greatly extended. The laboratory has come to furnish alike to the physician and to the surgeon a new means for diagnosing and combating disease. The education of the medical practitioner under these changed conditions makes entirely different demands in respect of both preliminary and professional training."<ref name=Pritchett1910/>}}<ref name=Hiatt2003/> | |||
| Among putative medical practices available at the time which later became known as "alternative medicine" were homeopathy (founded in Germany in the early 19c.) and chiropractic (founded in North America in the late 19c.). These conflicted in principle with the developments in medical science upon which the Flexner reforms were based, and they have not become compatible with further advances of medical science such as listed in ], 1900–1999 and 2000–present, nor have Ayurveda, acupuncture or other kinds of alternative medicine.{{citation needed|date=June 2015}} | |||
| At the same time "]" was being developed as a specialist branch of western medicine in research establishments such as ] founded in 1898 by ], ], founded in 1899 by ] and ], instituted in 1912. A distinction was being made between western scientific medicine and indigenous systems. An example is given by an official report about indigenous systems of medicine in India, including Ayurveda, submitted by ] and others in 1923. This stated that the first question the Committee considered was "to decide whether the indigenous systems of medicine were scientific or not".<ref name=Usman1925/><ref name=Madras1984/>{{sfn|Bivins|2007|pp=164–170}} | |||
| By the later twentieth century the term 'alternative medicine' entered public discourse,{{refn|group=n|The earliest occurrence of the term "alternative medicine" in an English language publication was only in 1974, according to the ].<ref name=OED/>}}<ref name=BMA_Cant_Saks/> but it was not always being used with the same meaning by all parties. ] remarked in 1998 that in the best kind of medical practice, all proposed treatments must be tested objectively, and that in the end there will only be treatments that pass and those that do not, those that are proven worthwhile and those that are not. He asked 'Can there be any reasonable "alternative"?'<ref name=Relman1998/> But also in 1998 the then ], ],<ref name=HistoryMakers_HHS_Satcher_Bio/> issued public information about eight common alternative treatments (including acupuncture, holistic and massage), together with information about common diseases and conditions, on nutrition, diet, and lifestyle changes, and about helping consumers to decipher fraud and quackery, and to find healthcare centers and doctors who practiced alternative medicine.<ref name=New_Millennium/> | |||
| By 1990, approximately 60 million Americans had used one or more complementary or alternative therapies to address health issues, according to a nationwide survey in the US published in 1993 by David Eisenberg.<ref name=Eisenberg1993/> A study published in the November 11, 1998 issue of the ] reported that 42% of Americans had used complementary and alternative therapies, up from 34% in 1990.<ref name=Eisenberg1998/> However, despite the growth in patient demand for complementary medicine, most of the early alternative/complementary medical centers failed.<ref name=Bravewell2007/> | |||
| ====Medical education since 1910==== | |||
| Mainly as a result of reforms following the Flexner Report of 1910<ref name=Flexner_Report/> ] in established ] in the US has generally not included alternative medicine as a teaching topic.{{refn|group=n|As the medical professor ] noted in 2010: "Flexner pointed out that the scientific method of thinking applied to medical practice. By scientific method, he meant the testing of ideas by well-planned experiments in which accurate facts were carefully obtained. The clinician's diagnosis was equivalent to the scientist's hypothesis: both ] and hypothesis needed to be submitted to the test of an experiment... Flexner argued that mastery of the scientific method of problem solving was the key for physicians to manage medical uncertainty and to practice in the most cost-effective way."<ref name=Ludmerer2010/>}} Typically, their teaching is based on current practice and scientific knowledge about: anatomy, physiology, histology, embryology, neuroanatomy, pathology, pharmacology, microbiology and immunology.<ref name=Bianco/> Medical schools' teaching includes such topics as doctor-patient communication, ethics, the art of medicine,<ref name=Stanford_Curriculum/> and engaging in complex clinical reasoning (medical decision-making).<ref name=Yale_Curriculum/> Writing in 2002, Snyderman and Weil remarked that by the early twentieth century the Flexner model had helped to create the 20th-century academic health center in which education, research and practice were inseparable. While this had much improved medical practice by defining with increasing certainty the ] basis of disease, a single-minded focus on the pathophysiological had diverted much of mainstream American medicine from clinical conditions which were not well understood in mechanistic terms and were not effectively treated by conventional therapies.<ref name=Snyderman2002/> | |||
| By 2001 some form of CAM training was being offered by at least 75 out of 125 medical schools in the US.<ref name=Berman2001/> Exceptionally, the School of Medicine of the ] includes a research institute for integrative medicine (a member entity of the Cochrane Collaboration).<ref name=UM_CIM/><ref name=UM_CAM_Field/> Medical schools are responsible for conferring medical degrees, but a physician typically may not legally practice medicine until licensed by the local government authority. Licensed ] who have attended one of the established medical schools there have usually graduated Doctor of Medicine (MD).<ref name=Medline_MD/> All states require that applicants for MD licensure be graduates of an approved medical school and complete the ].<ref name=Medline_MD/> | |||
| The British Medical Association, in its publication ''Complementary Medicine, New Approach to Good Practice'' (1993), gave as a working definition of non-conventional therapies (including acupuncture, chiropractic and homeopathy): "those forms of treatment which are not widely used by the orthodox health-care professions, and the skills of which are not part of the undergraduate curriculum of orthodox medical and paramedical health-care courses".{{sfn|BMA|1993}} By 2000 some medical schools in the UK were offering CAM familiarisation courses to undergraduate medical students while some were also offering modules specifically on CAM.<ref name="Walton_Science_and_Technology_Committee"/> | |||
| ====Proponents and opponents==== | |||
| The ] Complementary Medicine Field explains its "Scope and Topics" by giving a broad and general definition for complementary medicine as including practices and ideas which 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, and which complement mainstream medicine in three ways: by contributing to a common whole, by satisfying a demand not met by conventional practices, and by diversifying the conceptual framework of medicine.<ref name=Cochrane_CAM_Field/> | |||
| Proponents of an ]{{refn|group=n|"Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients";<ref name=Sackett1996/> "Evidence based medicine, whose philosophical origins extend back to mid-19th century Paris and earlier, remains a hot topic for clinicians, public health practitioners, purchasers, planners, and the public. British centres for evidence based practice have been established or planned in adult medicine, child health, surgery, pathology, pharmacotherapy, nursing, general practice, and dentistry; the Cochrane Collaboration and Britain's Centre for Review and Dissemination in York are providing systematic reviews of the effects of health care".<ref name=Sackett1996/>}}<ref name=Nuffield_Trust/><ref name=Belsey2009/><ref name=Nuffield2/><ref name=Bardsley2011/> such as the Cochrane Collaboration (founded in 1993 and from 2011 providing input for WHO resolutions) take a position that ''all'' systematic reviews of treatments, whether "mainstream" or "alternative", ought to be held to the current standards of scientific method.<ref name=UM_CAM_Field/> In a study titled ''Development and classification of an operational definition of complementary and alternative medicine for the Cochrane Collaboration'' (2011) it was proposed that indicators that a therapy is accepted include government licensing of practitioners, coverage by ], statements of approval by government agencies, and recommendation as part of a practice guideline; and that if something is currently a standard, accepted therapy, then it is not likely to be widely considered as CAM.<ref name=Wieland2011/> | |||
| That alternative medicine has been on the rise "in countries where Western science and scientific method generally are accepted as the major foundations for healthcare, and 'evidence-based' practice is the dominant paradigm" was described as an "]" in the Medical Journal of Australia.<ref name=Coulter2004/> | |||
| Critics in the US say the expression is deceptive because it implies there is an effective alternative to science-based medicine, and that ''complementary'' is deceptive because the word implies that the treatment increases the effectiveness of (complements) science-based medicine, while alternative medicines which have been tested nearly always have no measurable positive effect compared to a ].<ref name=ATRAMM/><ref name=Skep_Dic_comp_med/><ref name=Novella2010/><ref name=Gorski2010/> | |||
| Some opponents, focused upon health fraud, misinformation, and quackery as public health problems in the US, are highly critical of alternative medicine, notably ] and ] founders of ] and ], co-founder of ] and webmaster of ].<ref name=NCAHF_mission/> Grounds for opposing alternative medicine which have been stated in the US and elsewhere are: | |||
| *that it is usually based on ], tradition, ], belief in ] energies, ], ], propaganda, or fraud.<ref name=ATRAMM/><ref name=NSF_2002/><ref name=Beyerstein2001/><ref name=Other_sources/> | |||
| *that alternative therapies typically lack any ], and their effectiveness is either ] or ].<ref name=ATRAMM/><ref name=Kent1997/><ref name=Goldrosen2004/>{{dubious|date=January 2013}} | |||
| *that the treatments are those that are not part of the conventional, science-based healthcare system.<ref name=NCCIH1/><ref name="WHO_Trad_Med_Defs"/>{{sfn|IOM Report|2005|pp=}}<ref name=Zollman1999/> | |||
| *that research on alternative medicine is frequently of low quality and methodologically flawed.{{sfn|IOM Report|2005}}{{Full citation needed|date=September 2013}} | |||
| *that where alternative treatments are used in place of conventional science-based medicine, even with the very safest alternative medicines, failure to use or delay in using conventional science-based medicine has resulted in deaths.<ref name=Lilienfeld2002/><ref name=Hughes2010/> | |||
| *that methods may incorporate or base themselves on ], ], spiritual beliefs, ignorance or misunderstanding of scientific principles, errors in reasoning, or newly conceived approaches claiming to heal.<ref name=ATRAMM/><ref name=Beyerstein2001/><ref name=Acharya2008/> | |||
| ] has proposed four ways that "alternative medicine becomes quackery":<ref name=Offit2013/> | |||
| # "...by recommending against conventional therapies that are helpful." | |||
| # "...by promoting potentially harmful therapies without adequate warning." | |||
| # "...by draining patients' bank accounts,..." | |||
| # "...by promoting magical thinking,..."<ref name=Offit2013/> | |||
| ==NCCIH classification== | |||
| A United States government agency, the National Center on Complementary and Integrative Health (]), has created its own classification system for branches of complementary and alternative medicine. It classifies complementary and alternative therapies into five major groups, which have some overlap and two types of energy medicine are distinguished: one, "Veritable" involving scientifically observable ], including ], ] and ]; the other "Putative" which invoke physically undetectable or unverifiable energy.<ref name=NCCIH_EMed/> | |||
| Alternative medicine practices and beliefs are diverse in their foundations and methodologies. The wide range of treatments and practices referred to as alternative medicine includes some stemming from nineteenth century North America, such as chiropractic and naturopathy, others, mentioned by Jütte, that originated in eighteenth- and nineteenth-century Germany, such as homeopathy and ],<ref name=Jutte1999/> and some that have originated in China or India, while African, Caribbean, Pacific Island, Native American, and other regional cultures have traditional medical systems as diverse as their diversity of cultures.<ref name=NCCIH1/> | |||
| Examples of CAM as a broader term for unorthodox treatment and diagnosis of illnesses, disease, infections, etc.,<ref name=Ernst_Cohen/> include ], ], ], ], ], ], ], ], ], ], relaxation therapies, ] and ].<ref name=Ernst_Cohen/> CAM differs from conventional medicine. It is normally private medicine and not covered by ].<ref name=Ernst_Cohen/> It is paid out of pocket by the patient and is an expensive treatment.<ref name=Ernst_Cohen/> CAM tends to be a treatment for upper class or more educated people.<ref name=Eisenberg1998/> | |||
| The NCCIH classification system is - | |||
| # Whole medical systems: cut across more than one of the other groups; examples include traditional Chinese medicine, naturopathy, homeopathy, and ayurveda | |||
| # Mind-body interventions: explore the interconnection between the mind, body, and spirit, under the premise that the mind can affect "bodily functions and symptoms" | |||
| # "Biology"-based practices: use substances found in nature such as herbs, foods, vitamins, and other natural substances. (Note that as used here, "biology" does ''not'' refer to the science of ], but is a usage newly coined by NCCIH in the primary source used for this article. "Biology-based" as coined by NCCIH may refer to chemicals from a nonbiological source, such as use of the poison ] in traditional Chinese medicine, and to other nonbiological substances.) | |||
| # Manipulative and body-based practices: feature manipulation or movement of body parts, such as is done in chiropractic and osteopathic manipulation | |||
| # Energy medicine: is a domain that deals with putative and verifiable energy fields: | |||
| #* ] 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. | |||
| #* ]-based therapies use verifiable electromagnetic fields, such as pulsed fields, alternating-current, or direct-current fields in an unconventional manner. | |||
| ===Examples=== | |||
| Alternative therapies based on ] use verifiable electromagnetic fields, such as pulsed fields, alternating-current, or direct-current fields in an unconventional manner rather than claiming the existence of imponderable or supernatural energies.<ref name=NCCIH1/> | |||
| Substance based practices use substances found in nature such as herbs, foods, non-vitamin supplements and megavitamins, and minerals, and includes traditional herbal remedies with herbs specific to regions in which the cultural practices arose.<ref name=NCCIH1/> Nonvitamin supplements include ], ], ], ], ] or pills, and ], when used under a claim to have healing effects.<ref name=NCCIHSurvey/> | |||
| Mind-body interventions, working under the premise that the mind can affect "bodily functions and symptoms",<ref name=NCCIH1/> include healing claims made in hypnotherapy,<ref name=Shine2003/> and in ], ], ], ], tai chi and yoga.<ref name=NCCIH1/> Meditation practices including mantra meditation, mindfulness meditation, yoga, tai chi, and qi gong have many uncertainties. According to an ] review, the available evidence on meditation practices through September 2005 is of poor methodological quality and definite conclusions on the effects of meditation in healthcare cannot be made using existing research.<ref name="OpsinaBond2007"/><ref name="OpsinaBond2008"/> | |||
| Naturopathy is based on a belief in ], which posits that a special energy called vital energy or vital force guides bodily processes such as ], reproduction, growth, and adaptation.<ref name="SarrisWardle2010"/> The term was coined in 1895<ref name="AMA_CoSA_rpt12"/> by John Scheel and popularized by ], the "father of U.S. naturopathy".<ref name=Baer2001/> Today, naturopathy is primarily practiced in the United States and Canada.<ref name="Romeyke2011"/> Naturopaths in unregulated jurisdictions may use the Naturopathic Doctor designation or other titles regardless of level of education.<ref name="Iowa_BoM"/> | |||
| Traditional Chinese medicine is based on a concept of vital energy, or ],<ref name="Ho2000"/> flowing in the body along specific pathways. These purported pathways consist of 12 primary meridians. TCM has many branches including, acupuncture, massage, feng shui, herbs, as well as ].<ref name=Lu2002/> TCM diagnosis is primarily based on looking at the tongue, which is claimed to show the condition of the organs, as well as feeling the pulse of the radial artery, which is also claimed to show the condition of the organs.<ref name="Maclocia1995"/> | |||
| ==Criticism== | |||
| {{Reduced pull quote|1=right | |||
| |2=There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking. | |||
| |3=P.B. Fontanarosa|4='']'' (1998)<ref name=Fontanarosa1998/> | |||
| }} | |||
| ===Legitimacy=== | |||
| "CAM", meaning "complementary and alternative medicine", is not as well researched as conventional medicine which undergoes intense research before being released to the public.<ref name=Ernst_Cohen/> Funding for research is also sparse making it difficult to do further research for effectiveness of CAM.<ref name=Ernst4/> Most funding for CAM is funded by government agencies.<ref name=Ernst_Cohen/> Proposed research for CAM are rejected by most private funding agencies because the results of research are not reliable.<ref name=Ernst_Cohen/> The research for CAM has to meet certain standards from research ethics committees which most CAM researchers find almost impossible to meet.<ref name=Ernst_Cohen/> Because the results of CAM are not quantifiable, it is hard to prove its effectiveness and it appears to work in a more ] sense.<ref name=Ernst_Cohen/> CAM is thought to help the patient in a mental or psychological sense since the research for CAM is hit and miss.<ref name=Ernst_Cohen/> Even with the little research done on it, CAM has not been proven to be effective.<ref name=Ernst3/> This creates an issue of whether the patient is receiving all the information about the treatment that is necessary for the patient to be well informed.<ref name=Ernst_Cohen/> | |||
| ], a neurologist at Yale School of Medicine, wrote that government funded studies of integrating alternative medicine techniques into the mainstream are "used to lend an appearance of legitimacy to treatments that are not legitimate." Marcia Angell argued that it was "a new name for ]."<ref name="Brown2009" /> Angell considered that critics felt that healthcare practices should be classified based solely on ], and if a treatment had been rigorously tested and found safe and effective, science-based medicine will adopt it regardless of whether it was considered "alternative" to begin with.<ref name=Angell1998 /> It is possible for a method to change categories (proven vs. unproven), based on increased knowledge of its effectiveness or lack thereof. A prominent supporter of this position is ], former editor of the ] (JAMA).<ref name=Fontanarosa1998/> | |||
| Writing in 1999 in ''CA: A Cancer Journal for Clinicians'' ] mentioned a 1997 letter to the ] Subcommittee on Public Health and Safety, which had deplored the lack of critical thinking and scientific rigor in OAM-supported research, had been signed by four Nobel Laureates and other prominent scientists. (This was supported by the ] (NIH).)<ref name="Cassileth1999"/> | |||
| In March 2009 a staff writer for '']'' reported that the impending national discussion about broadening access to health care, improving medical practice and saving money was giving a group of scientists an opening to propose shutting down the ]. They quoted one of these scientists, ], a genome researcher and computational biologist at the University of Maryland, as saying "One of our concerns is that NIH is funding pseudoscience." They noted that the vast majority of studies were based on fundamental misunderstandings of ] and ], and had shown little or no effect.<ref name="Brown2009"/> | |||
| Writers such as ] (1934-1996), a noted astrophysicist, advocate of ] and the author of '']'' (1996), have described the lack of empirical evidence to support the existence of the putative energy fields on which these therapies are predicated.{{sfn|Sagan|1996}} | |||
| The ] budget has been criticized<ref name="Brown2009"/> because, despite the duration and intensity of studies to measure the efficacy of alternative medicine, there had been no effective CAM treatments supported by scientific evidence {{as of|2002|lc=y}}, according to the QuackWatch website; the NCCIH budget has been on a sharp and sustained rise.<ref name="QuackWatch_defund_NCCAM" /> Critics of the Center argue that the plausibility of interventions such as botanical remedies, diet, relaxation therapies and yoga should not be used to support research on implausible interventions based on superstition and belief in the supernatural, and that the plausible methods can be studied just as well in other parts of NIH, where they should be made to compete on an equal footing with other research projects.<ref name="Brown2009"/> | |||
| Sampson has also pointed out that CAM tolerated ] without thorough reason and experiment.<ref name="SampsonAtwood2005"/> Barrett has pointed out 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.<ref name="$2.5 billion"/> Barrett also expressed concern that, just because some "alternatives" have merit, there is the impression that the rest deserve equal consideration and respect even though most are worthless, since they are all classified under the one heading of alternative medicine.<ref name="Quackwatch_wary"/> | |||
| A 2002 report on public attitudes and understanding issued by the ] defined the term "alternative medicine" as treatments that had not been proven effective using scientific methods, and described them as giving more weight to ancient traditions and anecdotes over biological science and clinical trials.<ref name=NSF_2002/> | |||
| English evolutionary biologist ], in his 2003 book '']'' (chapter 4.4), defined alternative medicine as a "set of practices that cannot be tested, refuse to be tested, or consistently fail tests."<ref name=Dawkins2003/> Another essay in the same book (chapter 1.4) quoted an article by ] in '']'': "There is really no such thing as alternative medicine, just medicine that works and medicine that doesn't."<ref name=Dawkins2003a/> | |||
| Dawkins argued that if a technique is demonstrated effective in properly performed trials it ceases to be alternative and simply becomes medicine.<ref name="Holloway2003"/> | |||
| ===Terminology=== | |||
| Use of the terms "Complementary and alternative medicine (CAM)" and "alternative medicine" have been criticized. | |||
| Criticisms have come from individuals such as Wallace Sampson in an article in Annals of the New York Academy of Sciences, June 1995.<ref name=ATRAMM/> Sampson argued that proponents of alternative medicine often used terminology which was loose or ambiguous to create the appearance that a choice between "alternative" effective treatments existed when it did not, or that there was effectiveness or scientific validity when it did not exist, or to suggest that a dichotomy existed when it did not, or to suggest that consistency with science existed when it might not; that the term "'''alternative'''" was to suggest that a patient had a choice between effective treatments when there was not; that use of the word "'''conventional'''" or "'''mainstream'''" was to suggest that the difference between alternative medicine and science-based medicine was the prevalence of use, rather than lack of a scientific basis of alternative medicine as compared to "conventional" or "mainstream" science-based medicine; that use of the term "'''complementary'''" or "'''integrative'''" was to suggest that purported supernatural energies of alternative medicine could complement or be integrated into science-based medicine. "''Integrative medicine''" or "integrated medicine" is used to refer to the belief that medicine based on science would be improved by "integration" with alternative medical treatments practices that are not, and is substantially similar in use to the term "complementary and alternative medicine".<ref name=BMJ_May/> | |||
| Sampson has also written that CAM is the "propagation of the absurd", and argues that ''alternative'' and ''complementary'' have been substituted for ''quackery'', ''dubious'', and ''implausible''.<ref name="SampsonAtwood2005"/> | |||
| ], founder and operator of ], has argued 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.<ref name="Quackwatch_wary"/> | |||
| In October 2008, the ] National Center for Complementary and Alternative Medicine (NCCAM) published their perspectives on the terms "Complementary", "Alternative" and "Integrative" medicine.<ref>{{cite web|url=https://nccih.nih.gov/health/integrative-health|title=Complementary, Alternative, or Integrative Health: What’s In a Name?|publisher=]|accessdate=13 April 2016}}</ref> On December 14, 2014 it was announced that the NCCAM, via support of the United States Congress and signed by President ], would be changing its name to the ] (NCCIH) in order to acknowledge the shift in terminology away from "alternative medicine" and to recognize the cultural and scientific support for complementary and integrative approaches to healthcare.<ref>{{cite web|url=https://nccih.nih.gov/news/press/12172014|title=NIH complementary and integrative health agency gets new name|publisher=]|accessdate=13 April 2016}}</ref> | |||
| ===Ethics=== | |||
| CAM is not as well regulated as conventional medicine.<ref name=Ernst_Cohen/> There are ethical concerns about whether people who perform CAM have the proper knowledge to perform the treatments they give to patients.<ref name=Ernst_Cohen/> CAM is often done by non-physicians and does not operate with the same medical licensing laws as conventional medicine.<ref name=Ernst_Cohen/> It is an issue of ].<ref name=Ernst2/> | |||
| According to two writers, Wallace Sampson and K. Butler, marketing is part of the medical training required in ] education, and propaganda methods in alternative medicine have been traced back to those used by ] and ] in their promotion of pseudoscience in medicine.<ref name=ATRAMM/><ref name="ButlerBarrett1992"/> | |||
| In November 2011 ] stated that the "level of misinformation about alternative medicine has now reached the point where it has become dangerous and unethical. So far, alternative medicine has remained an ethics-free zone. It is time to change this."<ref name=Ernst_Guardian/> Ernst requested that ] recall two guides to alternative medicine published by the Foundation for Integrated Health, on the grounds that "hey both contain numerous misleading and inaccurate claims concerning the supposed benefits of alternative medicine" and that "he nation cannot be served by promoting ineffective and sometimes dangerous alternative treatments."<ref name=Henderson2008/> In general, he believes that CAM can and should be subjected to scientific testing.<ref name=goodbadugly />{{refn|group=n|In an article in ''The British Journal of General Practice'' Edzard Ernst et al. stated, <blockquote>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.<ref name=Ernst1995>{{cite journal |last1= Ernst |first1= E. |first2= K.L. |last2= Resch |first3= S. |last3= Mills |first4= R. |last4= Hill |first5= A. |last5= Mitchell |first6= M. |last6= Willoughby |first7= A. |last7= White |title= Complementary medicine — a definition |journal= The British Journal of General Practice |year= 1995 |volume= 45 |issue= 398 |page= 398 |pmc= 1239386 |ref= harv}}</ref></blockquote>}} | |||
| In 2016, a paper published in ] concluded that "there are significant ethical problems, from the perspective of the ethics of commerce, with the production, advertising and selling of complementary and alternative medicines.... Market interactions, in order to be considered ethical, need to involve products that actually work, that are advertised honestly, and that do not have undue effects on innocent third parties. Many examples of CAM fail on one or even all of those counts."<ref>{{Cite journal|title = Alternative Medicine and the Ethics Of Commerce|url = http://onlinelibrary.wiley.com/doi/10.1111/bioe.12226/abstract|journal = Bioethics|date = 2016-02-01|issn = 1467-8519|pages = 77–84|volume = 30|issue = 2|doi = 10.1111/bioe.12226|pmid = 26806450|language = en|first = Chris|last = Macdonald|first2 = Scott|last2 = Gavura}}</ref> | |||
| == Placebo effect == | |||
| A research methods expert and author of "Snake Oil Science", ], has stated that "it's become politically correct to investigate nonsense."<ref name="$2.5 billion"/> There are concerns that just having NIH support is being used to give unfounded "legitimacy to treatments that are not legitimate."<ref name="Brown2009"/> | |||
| Use of placebos in order to achieve a ] in integrative medicine has been criticized as "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".<ref name=Novella2010/><ref name=Gorski2010/> | |||
| Another critic has argued that academic proponents of ] sometimes recommend misleading patients by using known placebo treatments in order to achieve a placebo effect.{{refn|group=n|As a 2010 article in the ''New England Journal of Medicine'' concluded: <blockquote>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.<ref name="Berman2010"/></blockquote>}} 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.<ref name=Kerman2010/> | |||
| ] has been criticized in that its practitioners, trained in science-based medicine, deliberately mislead patients by pretending ]s are not. "]" is a pejorative term used for "]", which is considered to be an infiltration of quackery into academic ].<ref name=Gorski2010/> | |||
| An analysis of trends in the criticism of complementary and alternative medicine (CAM) in five prestigious American medical journals during the period of reorganization within medicine (1965–1999) was reported as showing that the medical profession had responded to the growth of CAM in three phases, and that in each phase there had been changes in the medical marketplace which influenced the type of response in the journals.<ref name="Winnick2005_2009"/> Changes included relaxed medical licensing, the development of managed care, rising consumerism, and the establishment of the USA Office of Alternative Medicine (now ]).{{refn|group=n|According to the medical historian ]:<blockquote>In 1991 the Senate Appropriations Committee responsible for funding the National Institutes of Health (NIH) declared itself "not satisfied that the conventional medical community as symbolized at the NIH has fully explored the potential that exists in unconventional medical practices.<ref>{{Cite journal |last1= Young |first1= J.H. |title= The Development of the Office of Alternative Medicine in the National Institutes of Health, 1991-1996 |doi= 10.1353/bhm.1998.0110 |journal= Bulletin of the History of Medicine |volume= 72 |issue= 2 |pages= 279–98 |year= 1998 |pmid= 9628052 |pmc= |ref= harv }}</ref></blockquote>}} In the "condemnation" phase, from the late 1960s to the early 1970s, authors had ridiculed, exaggerated the risks, and petitioned the state to contain CAM; in the "reassessment" phase (mid-1970s through early 1990s), when increased consumer utilization of CAM was prompting concern, authors had pondered whether patient dissatisfaction and shortcomings in conventional care contributed to the trend; in the "integration" phase of the 1990s physicians began learning to work around or administer CAM, and the subjugation of CAM to scientific scrutiny had become the primary means of control. | |||
| ==Use and regulation== | |||
| ===Prevalence of use=== | ===Prevalence of use=== | ||
| According to research published in 2015, the increasing popularity of CAM needs to be explained by moral convictions or lifestyle choices rather than by economic reasoning.<ref name="Martin_Debons">{{Cite book |last1=Martin |first1=Hélène |last2=Debons |first2=Jérôme |url=https://books.google.com/books?id=Q3QGCAAAQBAJ |title=Routledge Handbook of Complementary and Alternative Medicine: Perspectives from Social Science and Law |year=2015|publisher=Routledge |isbn=978-1-136-68555-2 |editor-last=Gale |editor-first=Nicola K. |location=London and New York |pages=271–291 |language=en |chapter=CAM and conventional medicine in Switzerland: divided in theory, united in practice |editor2-last=McHale |editor2-first=Jean V.}}</ref> | |||
| In ], 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.<ref name="WHO_tradmed_fact" /> | |||
| '''Complementary and alternative medicine''' (CAM) has been described as a broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period. CAM includes all such practices and ideas self-defined by their users as preventing or treating illness or promoting health and well-being. Boundaries within CAM and between the CAM domain and that of the dominant system are not always sharp or fixed.<ref name=Wieland2011/>{{dubious|date=February 2013}} | |||
| In Latin America, inequities against BIPOC communities keep them tied to their traditional practices and therefore, it is often these communities that constitute the majority of users of alternative medicine. Racist attitudes towards certain communities disable them from accessing more urbanized modes of care. In a study that assessed access to care in rural communities of Latin America, it was found that discrimination is a huge barrier to the ability of citizens to access care; more specifically, women of Indigenous and African descent, and lower-income families were especially hurt.<ref>{{Cite journal |last1=Castro |first1=Arachu |last2=Savage |first2=Virginia |last3=Kaufman |first3=Hannah |date=2015 |title=Assessing equitable care for indigenous and afrodescendant women in Latin America |url=https://www.scielosp.org/article/rpsp/2015.v38n2/96-109/en/ |journal=Revista Panamericana de Salud Pública |language=en |volume=38 |issue=2 |pages=96–109 |pmid=26581050 |issn=1020-4989}}</ref> Such exclusion exacerbates the inequities that minorities in Latin America already face. Consistently excluded from many systems of westernized care for socioeconomic and other reasons, low-income communities of color often turn to traditional medicine for care as it has proved reliable to them across generations. | |||
| According to recent research, the increasing popularity of the CAM needs to be explained by moral convictions or lifestyle choices rather than by economic reasoning.<ref>{{cite book|last1=Martin|first1=Hélène|last2=Debons|first2=Jérôme|title=CAM and conventional medicine in Switzerland : divided in theory, united in practice. In N. K. Gale & J. V. McHale, Routledge Handbook of Complementary and Alternative Medecine. Perspectives from social science and law|date=2015|publisher=Routledge|location=London and New York|pages=271–291}}</ref> | |||
| Commentators including ] have proposed adopting a prize system to reward medical research.<ref name="Horrobin1986" /> This stands in opposition to the current mechanism for funding research proposals in most countries around the world. In the US, the NCCIH provides public research funding for alternative medicine. The NCCIH has spent more than US$2.5 billion on such research since 1992 and this research has not demonstrated the efficacy of alternative therapies.<ref name="$2.5 billion" /><ref>{{Cite web |last=Salzberg |first=Steven |date=March 26, 2018 |title=$142 Million For Quack Medicine Buried Inside The New 2018 Budget |url=https://www.forbes.com/sites/stevensalzberg/2018/03/26/142-million-for-quack-medicine-buried-inside-the-new-2018-budget/ |access-date=2019-02-14 |website=Forbes |language=en}}</ref><ref name="nccih_$" /><ref>{{Cite web |last=Gorski |first=David |date=April 4, 2016 |title=NCCIH Strategic Plan 2016–2021, or: Let's try to do some real science for a change |url=https://sciencebasedmedicine.org/nccih-strategic-plan-2016-2021-or-lets-try-to-do-some-real-science-for-a-change/ |access-date=2019-02-14 |website=Science-Based Medicine |language=en-US}}</ref><ref name="Atwood2003" /><ref>{{cite journal |author=Green |first=Saul |year=2001 |title=Stated goals and grants of the Office of Alternative Medicine/National Center for Complementary and Alternative Medicine |url=https://archives.centerforinquiry.org/sram/stated-goals-and-grants-of-the-office-of-alternative-medicinenational-center-for-complementary-and-alternative-medicine/ |journal=Scientific Review of Alternative Medicine |volume=5 |issue=4 |pages=205–207}}</ref> As of 2011, the NCCIH's sister organization in the NIC ] had given out grants of around $105 million each year for several years.<ref name="2011A">{{cite report |title=Annual Report on CAM 2011 |url=https://cam.cancer.gov/docs/annual_report/cam_annual_report_fy11.pdf |archive-url=https://ghostarchive.org/archive/20221009/https://cam.cancer.gov/docs/annual_report/cam_annual_report_fy11.pdf |archive-date=2022-10-09 |url-status=live}}</ref> Testing alternative medicine that has no scientific basis (as in the aforementioned grants) has been called a waste of scarce research resources.<ref name=Wadman>{{cite journal |title=Centre turns away from healing herbs |journal=Nature |volume=462 |issue=7274 |page=711 |last1=Wadman |first1=Meredith |date=7 December 2009 |publisher= Nature Publishing Group |doi=10.1038/462711a |pmid=20010660 |doi-access=free }}</ref><ref>{{cite journal |last1=Gorski |first1=David |last2=Novella |first2=Steven |date=August 20, 2014 |title=Clinical trials of integrative medicine: testing whether magic works? |journal=Trends in Molecular Medicine |volume=20 |issue=9 |pages=473–476 |doi=10.1016/j.molmed.2014.06.007 |pmid=25150944}}</ref> | |||
| About 50% of people in developed countries use some kind of complementary and alternative medicine other than prayer for health.<ref name=Ernst2003/><ref name=Barnes2004/><ref name=Astin1998/> 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.<ref name="Thomas2001"/> About 40% of cancer patients use some form of CAM.<ref name="Horneber2011"/> | |||
| That alternative medicine has been on the rise "in countries where Western science and scientific method generally are accepted as the major foundations for healthcare, and 'evidence-based' practice is the dominant paradigm" was described as an "enigma" in the '']''.<ref name="Coulter2004" /> A 15-year systematic review published in 2022 on the global acceptance and use of CAM among medical specialists found the overall acceptance of CAM at 52% and the overall use at 45%.<ref>{{cite journal |vauthors=Phutrakool P, Pongpirul K |date=January 2022 |title=Acceptance and use of complementary and alternative medicine among medical specialists: a 15-year systematic review and data synthesis |journal=Systematic Reviews |volume=11 |issue=1 |page=10 |doi=10.1186/s13643-021-01882-4 |pmc=8759198 |pmid=35027078 |doi-access=free }}</ref> | |||
| In ], access to essential medicines is severely restricted by lack of resources and ]. ], 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.<ref name="WHO_tradmed_fact"/> | |||
| ====In the |
====In the United States==== | ||
| In the United States, the 1974 ] (CAPTA) required that for states to receive federal money, they had to grant religious exemptions to ] and ] laws regarding religion-based healing practices.<ref>{{Cite journal|last=Merrick |first=Janna | date=June 2003 |title=Spiritual Healing, Sick Kids and the Law: Inequities in the American Healthcare System |journal=American Journal of Law & Medicine |volume=29 |issue=2 |pages=269–299|doi=10.1017/S0098858800002847 |pmid=12961808 |s2cid=27122896 }}</ref> Thirty-one states have child-abuse religious exemptions.<ref>{{Cite web |date=April 2007 |title=Definitions of Child Abuse and Neglect |url=http://www.childwelfare.gov/systemwide/laws_policies/statutes/define.pdf |archive-url=https://web.archive.org/web/20071011062659/http://www.childwelfare.gov/systemwide/laws_policies/statutes/define.pdf |archive-date=11 October 2007 |access-date=2009-02-27 |publisher=Child Welfare Information Gateway}}</ref> | |||
| The use of alternative medicine in the US has increased,<ref name="NSF_4/2002" /><ref name="Eisenberg1998">{{cite journal|last1=Eisenberg|first1=D.M.|last2=Davis|first2=R.B.|last3=Ettner|first3=S.L.|last4=Appel|first4=S.|last5=Wilkey|first5=S.|last6=Van Rompay|first6=M.|last7=Kessler|first7=R.C.|display-authors=1|year=1998|title=Trends in alternative medicine use in the United States, 1990–1997: Results of a follow-up national survey|journal=JAMA|volume=280|issue=18|pages=1569–1575|doi=10.1001/jama.280.18.1569|pmid=9820257|ref={{harvid|Eisenberg et al.|1998}}|doi-access=free}}</ref> with a 50 percent increase in expenditures and a 25 percent increase in the use of alternative therapies between 1990 and 1997 in America.<ref name="Eisenberg1998" /> According to a national survey conducted in 2002, "36 percent of U.S. adults aged 18 years and over use some form of complementary and alternative medicine."<ref name="cdc2002">{{cite journal |author1=Patricia M. Barnes |author2=Eve Powell-Grine |author3=Kim McFann |author4=Richard L. Nahin |title=Complementary and Alternative Medicine Use Among Adults: United States, 2002 |journal=Advance Data from Vital and Health Statistics |date=May 27, 2004 |volume=343 |pages=1–20 |url=https://www.cdc.gov/nchs/data/ad/ad343.pdf |access-date=June 1, 2021 |publisher=CDC}}</ref> Americans spend many billions on the therapies annually.<ref name="Eisenberg1998" /> Most Americans used CAM to treat and/or prevent musculoskeletal conditions or other conditions associated with chronic or recurring pain.<ref name="Barnes2004" /> In America, women were more likely than men to use CAM, with the biggest difference in use of ] including prayer specifically for health reasons".<ref name="Barnes2004" /> In 2008, more than 37% of American hospitals offered alternative therapies, up from 27 percent in 2005, and 25% in 2004.<ref name="Warner2006" /><ref name="AHA2008" /> More than 70% of the hospitals offering CAM were in urban areas.<ref name="AHA2008" /> | |||
| In the United States, the 1974 ] (CAPTA) required states to grant religious exemptions to ] and ] laws, regarding religion-based healing practices, in order to receive federal money.<ref>{{Cite journal|last=Merrick |first=Janna | date=June 2003 |title=Spiritual Healing, Sick Kids and the Law: Inequities in the American Healthcare System |journal=American Journal of Law & Medicine |volume=29 |issue=2 |pages=269–299}}</ref> Thirty-one states have child-abuse religious exemptions.<ref>{{Cite web|url=http://www.childwelfare.gov/systemwide/laws_policies/statutes/define.pdf |title=Definitions of Child Abuse and Neglect |accessdate=2009-02-27 |publisher=Child Welfare Information Gateway |year=2007 |deadurl=yes |archiveurl=https://web.archive.org/web/20071011062659/http://www.childwelfare.gov/systemwide/laws_policies/statutes/define.pdf |archivedate=11 October 2007 }}</ref> | |||
| A survey of Americans found that 88 percent thought that "there are some good ways of treating sickness that medical science does not recognize".<ref name="NSF_4/2002" /> Use of magnets was the most common tool in ] in America, and among users of it, 58 percent described it as at least "sort of scientific", when it is not at all scientific.<ref name="NSF_4/2002" /> In 2002, at least 60 percent of US medical schools have at least some class time spent teaching alternative therapies.<ref name="NSF_4/2002" /> "]" was taught at more than 100 colleges and universities in 75 countries before the practice was debunked by ] for a school science project.<ref name="NSF_4/2002" /><ref name="rosa" /> | |||
| In respect of taxation in the US, the ] has discriminated in favour of medical expenses for acupuncture and chiropractic (and others including ]s) but against homeopathy and the use of non-prescription required medicine.{{refn|group=n|The US Internal Revenue Service provides the following definition of medical expenses: <blockquote>Medical expenses are the costs of diagnosis, cure, mitigation, treatment, or prevention of disease, and the costs for treatments affecting any part or function of the body. These expenses include payments for legal medical services rendered by physicians, surgeons, dentists and other medical practitioners.... primarily to alleviate or prevent a physical or mental defect or illness.'' ''Medicines: You can include expenses amounts you pay for prescribed medicines and drugs. A prescribed drug is one that requires a prescription by a doctor for its use by an individual.<ref name="IRS502">{{cite web |title= Medical and Dental Expenses (Including the Health Coverage Tax Credit) |url= http://www.irs.gov/pub/irs-pdf/p502.pdf |publisher= ], ], ] |page= 2 |volume= Publication 502 |issue= Cat. No. 15002Q |date= 2012-12-10}}</ref></blockquote>}} | |||
| The use of alternative medicine in the US has increased,<ref name=NSF_2002/><ref name=Eisenberg1998/> with a 50 percent increase in expenditures and a 25 percent increase in the use of alternative therapies between 1990 and 1997 in America.<ref name=Eisenberg1998/> Americans spend many billions on the therapies annually.<ref name=Eisenberg1998/> Most Americans used CAM to treat and/or prevent musculoskeletal conditions or other conditions associated with chronic or recurring pain.<ref name="Barnes2004"/> In America, women were more likely than men to use CAM, with the biggest difference in use of ] including prayer specifically for health reasons".<ref name="Barnes2004"/> In 2008, more than 37% of American hospitals offered alternative therapies, up from 26.5 percent in 2005, and 25% in 2004.<ref name="Warner2006"/><ref name="AHA2008"/> More than 70% of the hospitals offering CAM were in urban areas.<ref name="AHA2008"/> | |||
| A survey of Americans found that 88 percent agreed that "there are some good ways of treating sickness that medical science does not recognize".<ref name=NSF_2002/> Use of magnets was the most common tool in ] in America, and among users of it, 58 percent described it as at least "sort of ]", when it is not at all scientific.<ref name=NSF_2002/> In 2002, at least 60 percent of US medical schools have at least some class time spent teaching alternative therapies.<ref name=NSF_2002/> "Therapeutic touch", was taught at more than 100 colleges and universities in 75 countries before the practice was debunked by a nine-year-old child for a school science project.<ref name=NSF_2002/><ref name="Rosa1998"/> | |||
| A 1997 survey found that 13.7% of respondents in the US 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.<ref name=Eisenberg1998/> | |||
| According to ], US regulation of alternative includes state licensing of healthcare providers and scope of practice limits on practice by non-MD healthcare professionals; state-law malpractice rules (standard of care limits on professional negligence); discipline of practitioners by state regulatory boards; and federal regulation such as food and drug law.{{sfn|Cohen|1998|pp=24, 39, 56, 73, 87}} He argues that US regulation of alternative medicine "seeks to integrate biomedical, holistic, and social models of health care in ways that maximize patients’ well-being hile still protecting patients from fraud."{{sfn|Cohen|1998|page= 118}} | |||
| ====Prevalence of use of specific therapies==== | ====Prevalence of use of specific therapies==== | ||
| The most common CAM therapies used in the US in 2002 were prayer (45%), ] (19%), ] (12%), ] (8%), ] (8%), ] (5–6%), ] (5%), ] (4%), ] (3%), ] (3%) and ] (2%).<ref name="Barnes2004" /><ref name="Barnes2008" /> | |||
| In Britain, the most often used alternative therapies were ], ], Bach and other flower remedies, body work therapies including massage, Counseling stress therapies, ], ], ], ], ], nutritional medicine, and ].{{sfn|Sir Walton: Science and Technology Committee|2000}} Ayurvedic medicine remedies are mainly plant based with some use of animal materials.{{sfn|Wujastyk|2003}} Safety concerns include the use of herbs containing toxic compounds and the lack of quality control in Ayurvedic facilities.<ref name="Valiathan2006" /><ref name="Saper2008" /> | |||
| The most common CAM therapies used in the US in 2002 were prayer (45.2%), ] (18.9%), ] (11.6%), ] (7.6%), ] (7.5%), ] (5.1%-6.1%), ] (5.0%), ] (3.5%), ] (3.0%), ] (2.8%) and ] (2.1%)<ref name="Barnes2004"/><ref name="Barnes2008"/> | |||
| According to the ], the most commonly used complementary and alternative medicines (CAM) supported by the NHS in the UK are: acupuncture, aromatherapy, chiropractic, homeopathy, massage, osteopathy and clinical hypnotherapy.<ref name="NHS_Careers_CAM" /> | |||
| In Britain, the most often used alternative therapies were ], ], Bach and other flower remedies, Body work therapies including massage, Counseling stress therapies, ], ], ], ], ], Nutritional medicine, and ].{{sfn|Sir Walton: Science and Technology Committee|2000}} Ayurvedic medicine remedies are mainly plant based with some use of animal materials.{{sfn|Wujastyk|2003}} Safety concerns include the use of herbs containing toxic compounds and the lack of quality control in Ayurvedic facilities.<ref name=Valiathan2006/><ref name=Saper2008/> | |||
| According to the ], the most commonly used complementary and alternative medicines (CAM) supported by the NHS in the UK are: acupuncture, aromatherapy, chiropractic, homeopathy, massage, osteopathy and clinical hypnotherapy.<ref name=NHS_Careers_CAM/> | |||
| ====In palliative care==== | ====In palliative care==== | ||
| Complementary therapies are often used in ] or by practitioners attempting to manage chronic pain in patients. Integrative 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."<ref name="Kellhear2003" /> The non-pharmacologic interventions of complementary medicine can employ ] interventions designed to "reduce pain and concomitant mood disturbance and increase quality of life."<ref name="Menefee2005" /> | |||
| === Regulation === | |||
| Complementary therapies are often used in ] or by practitioners attempting to manage chronic pain in patients. Integrative 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."<ref name=Kellhear2003/> The non-pharmacologic interventions of complementary medicine can employ ] interventions designed to "reduce pain and concomitant mood disturbance and increase quality of life."<ref name="Menefee2005"/> | |||
| {{Further|Regulation of alternative medicine | Regulation and prevalence of homeopathy}}{{Expand section|date=May 2018}}], warn the public about unsafe products.]] | |||
| The alternative medicine lobby has successfully pushed for alternative therapies to be subject to far less regulation than conventional medicine.<ref name="ConsumerHealth9th" /> Some professions of complementary/traditional/alternative medicine, such as chiropractic, have achieved full regulation in North America and other parts of the world{{sfn|WHO|2005}} and are regulated in a manner similar to that governing science-based medicine. In contrast, other approaches may be partially recognized and others have no regulation at all.{{sfn|WHO|2005}} In some cases, promotion of alternative therapies is allowed when there is demonstrably no effect, only a tradition of use. Despite laws making it illegal to market or promote alternative therapies for use in cancer treatment, many practitioners promote them.<ref>{{cite web |date=July 4, 2019 |title=Complementary and alternative therapies |url=http://www.cancerresearchuk.org/about-cancer/cancers-in-general/treatment/complementary-alternative/ |website=www.cancerresearchuk.org |publisher=]}}</ref> | |||
| ===Regulation=== | |||
| Regulation and licensing of alternative medicine ranges widely from country to country, and state to state.{{sfn|WHO|2005}} In Austria and Germany complementary and alternative medicine is mainly in the hands of doctors with ],<ref name=ernstinterview/> and half or more of the American alternative practitioners are licensed MDs.<ref name="Cassileth1996"/> In Germany herbs are tightly regulated: half are prescribed by doctors and covered by health insurance.<ref name="JAMA_book_review"/> | |||
| {{Further|Regulation of alternative medicine | Regulation and prevalence of homeopathy}} | |||
| Government bodies in the US and elsewhere have published information or guidance about alternative medicine. The ] (FDA), has issued online warnings for consumers about medication health fraud.<ref>{{cite web |last1=Research |first1=Center for Drug Evaluation and |title=Medication Health Fraud |url=https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/MedicationHealthFraud/default.htm |website=FDA |access-date=21 May 2022 |language=en |date=5 January 2022}}</ref> This includes a section on Alternative Medicine Fraud, such as a warning that Ayurvedic products generally have not been approved by the FDA before marketing.<ref>{{cite web |last1=Research |first1=Center for Biologics Evaluation and |title=Complementary and Alternative Medicine Products and their Regulation by the Food and Drug Administration |url=https://www.fda.gov/regulatory-information/search-fda-guidance-documents/complementary-and-alternative-medicine-products-and-their-regulation-food-and-drug-administration |website=U.S. Food and Drug Administration |access-date=21 May 2022 |language=en |date=6 May 2020}}</ref> | |||
| ], warn the public about unsafe products.]] | |||
| In Austria and Germany complementary and alternative medicine is mainly in the hands of doctors with ],<ref name=ernstinterview/> and half or more of the American alternative practitioners are licensed MDs.<ref name="Cassileth1996"/> In Germany herbs are tightly regulated: half are prescribed by doctors and covered by health insurance.<ref name="JAMA_book_review"/> | |||
| ==Risks and problems== | |||
| Some professions of complementary/traditional/alternative medicine, such as ], have achieved full regulation in North America and other parts of the world{{sfn|WHO|2005}} and are regulated in a manner similar to that governing science-based medicine. In contrast, other approaches may be partially recognized and others have no regulation at all. Regulation and licensing of alternative medicine ranges widely from country to country, and state to state.{{sfn|WHO|2005}} | |||
| The ] has studied the problematic side of the public's attitudes and understandings of science fiction, pseudoscience, and belief in alternative medicine. They use a quote from ] to describe some issues with alternative medicine: | |||
| Government bodies in the USA and elsewhere have published information or guidance about alternative medicine. The ] (FDA), has issued online warnings for consumers about medication health fraud.<ref>{{cite web|url=http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/MedicationHealthFraud/default.htm|title=Medication Health Fraud|work=fda.gov}}</ref> This includes a section on Alternative Medicine Fraud,<ref>{{cite web|url=http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/MedicationHealthFraud/ucm207747.htm|title=Alternative Medicine Fraud|work=fda.gov}}</ref> such as a warning that Ayurvedic products generally have not been approved by the FDA before marketing.<ref></ref> | |||
| {{blockquote|Alternative medicine is another concern. As used here, alternative medicine refers to all treatments that have not been proven effective using scientific methods. A scientist's view of the situation appeared in a recent book (Park 2000b)":<p> | |||
| ==Efficacy== | |||
| Between homeopathy and herbal therapy lies a bewildering array of untested and unregulated treatments, all labeled ''alternative'' by their proponents. Alternative seems to define a culture rather than a field of medicine—a culture that is not scientifically demanding. It is a culture in which ancient traditions are given more weight than biological science, and anecdotes are preferred over clinical trials. Alternative therapies steadfastly resist change, often for centuries or even millennia, unaffected by scientific advances in the understanding of physiology or disease. Incredible explanations invoking modern physics are sometimes offered for how alternative therapies might work, but there seems to be little interest in testing these speculations scientifically.<ref name="NSF_4/2002" /></p>}} | |||
| Alternative therapies lack the requisite ], and their ] is either ] or ].<ref name=ATRAMM/><ref name=NSF_2002/><ref name=Kent1997/><ref name=Goldrosen2004 /> Many of the claims regarding the efficacy of alternative medicines are controversial, since research on them is frequently of low quality and methodologically flawed.{{sfn|IOM Report|2005}}{{Full citation needed|date=September 2013}} ] (misleading results from only publishing positive results, and not all results), marked differences in product quality and standardisation, and some companies making unsubstantiated claims, call into question the claims of efficacy of isolated examples where herbs may have some evidence of containing chemicals that may affect health.<ref name="Sarris2012"/> ''The Scientific Review of Alternative Medicine'' points to confusions in the general population - a person may attribute symptomatic relief to an otherwise-ineffective therapy just because they are taking something (the placebo effect); the natural recovery from or the cyclical nature of an illness (the ]) gets misattributed to an alternative medicine being taken; a person not diagnosed with science-based medicine may never originally have had a true illness diagnosed as an alternative disease category.<ref name="Alcock1999"/> | |||
| ===Negative outcomes=== | |||
| ] characterized the evidence for many alternative techniques as weak, nonexistent, or negative<ref name=goodbadugly/> and in 2011 published his estimate that about 7.4% were based on "sound evidence", although he believes that may be an overestimate due to various reasons.<ref name=Ernst2011/> Ernst has concluded that 95% of the alternative treatments he and his team studied, including acupuncture, herbal medicine, homeopathy, and reflexology, are "statistically indistinguishable from placebo treatments", but he also believes there is something that conventional doctors can usefully learn from the chiropractors and homeopath: this is the therapeutic value of the placebo effect, one of the strangest phenomena in medicine.<ref name=Economist2011/><ref name=HHH2008/> | |||
| In 2003, a project funded by the CDC identified 208 condition-treatment pairs, of which 58% had been studied by at least one ] (RCT), and 23% had been assessed with a ].<ref name=Katz2003/> According to a 2005 book by a US ] 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.{{sfn|IOM Report|2005|p=}} | |||
| {{as of|2005}}, the ] 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%), 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 more developed 2004 Cochrane database, while the conventional review used the initial 1998 Cochrane database.{{sfn|IOM Report|2005|pp=}} | |||
| Most alternative medical treatments are not ]able,{{citation needed|date=June 2015}} 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.<ref name=Ernst2005/> Some have proposed adopting a ] system to reward medical research.<ref name="Horrobin1986"/> However, public funding for research exists. Increasing the funding for research on alternative medicine techniques is the purpose of the ]. NCCIH 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.<ref name="$2.5 billion"/><ref name=nccih_$/><ref name="Atwood2003"/><ref>{{cite journal | author = Green S | year = 2001 | title = Stated goals and grants of the Office of Alternative Medicine/National Center for Complementary and Alternative Medicine | url = | journal = Scientific Review of Alternative Medicine | volume = 5 | issue = 4| pages = 205–207 }}</ref> | |||
| In the same way as for conventional therapies, drugs, and interventions, it can be difficult to test the efficacy of alternative medicine in ]s. In instances where an established, effective, treatment for a condition is already available, the ] 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.<ref name="Bodeker2002"/> | |||
| Cancer researcher ] has stated: | |||
| : "Contrary to much popular and scientific writing, many ] 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, ], 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'."<ref name=Vickers/> | |||
| Homeopathy is based on the belief that a disease can be cured by a very low dose of substance that creates similar symptoms in a healthy person.{{refn|group=n|name=Hahnemannquote}}<ref name="Stratten_in_Hahnemann"/> This conflicts with fundamental concepts of physics and chemistry and there is no good evidence from reviews of research to support its use.<ref name=Ernst2002/><ref name=NCCIH_homeopathy/><ref name="HoC_Evidence_Check2_homeopathy"/><ref name=Shang2005/> | |||
| == Conflicts of interest == | |||
| Some commentators have said that special consideration must be given to the issue of ] in alternative medicine. ] has said that most researchers into alternative medicine are at risk of "unidirectional bias" because of a generally uncritical belief in their chosen subject.<ref name=unid>{{cite journal |title=Conflicts of Interest in Alternative Medicine |journal=Skeptical Inquirer |author=Ernst E |authorlink=Edzard Ernst |volume=35 |issue=4 |year=2011 |url=http://www.csicop.org/si/show/conflicts_of_interest_in_alternative_medicine}}</ref> Ernst cites as evidence the phenomenon whereby 100% of a sample of acupuncture trials originating in China had positive conclusions.<ref name=unid/> ] contrasts ], in which researchers try to disprove hyphotheses, with what he says is the frequent practice in pseudoscience-based research, of striving to confirm pre-existing notions.<ref name=gorski>{{cite web |author=Gorski D |authorlink=David Gorski |publisher=] |url=https://www.sciencebasedmedicine.org/conflicts-of-interest-in-science-based-medicine/ |date=16 November 2009 |title=Conflicts of interest in science-based medicine}}</ref> ] writes that there is a contrast between the circumstances of alternative medicine practitioners and disinterested scientists: in the case of acupuncture, for example, an acupuncturist would have "a great deal to lose" if acupuncture were rejected by research; but the disinterested skeptic would not lose anything if its effects were confirmed; rather their change of mind would enhance their skeptical credentials.<ref name=hall>{{cite web |author=Hall HA |authorlink=Harriet A. Hall |publisher=] |url=https://www.sciencebasedmedicine.org/conflicts-of-interest/ |date=27 April 2011 |title=Conflicts of interest}}</ref> | |||
| ==Safety== | |||
| {{See also|List of herbs with known adverse effects}} | {{See also|List of herbs with known adverse effects}} | ||
| According to the Institute of Medicine, use of alternative medical techniques may result in several types of harm: | |||
| * "'''Direct harm''', which results in adverse patient outcome."<ref name="NAPCAM2005">{{cite book |url=https://www.nap.edu/catalog/11182/complementary-and-alternative-medicine-in-the-united-states |title=Complementary and Alternative Medicine in the United States |publisher=The National Academies Press |year=2005 |isbn=0-309-09270-1 |pages=298–308 |chapter=Appendix E: Model Guidelines for the Use of Complementary and Alternative Therapies in Medical Practice |doi=10.17226/11182 |pmid=22379647 |access-date=June 14, 2021}}</ref> | |||
| ===Adequacy of regulation and CAM safety=== | |||
| * "'''Economic harm''', which results in monetary loss but presents no health hazard;" | |||
| * "'''Indirect harm''', which results in a delay of appropriate treatment, or in unreasonable expectations that discourage patients and their families from accepting and dealing effectively with their medical conditions;" | |||
| Many of the claims regarding the safety and efficacy of alternative medicine are controversial. Some alternative treatments have been associated with unexpected side effects, which can be fatal.<ref>{{cite journal|last1=Niggemann|first1=B.|last2=Grüber|first2=C.|title=Side-effects of complementary and alternative medicine|journal=Allergy|date=22 February 2003|volume=58|issue=8|pages=707–716|doi=10.1034/j.1398-9995.2003.00219.x|pmid=12859546}}</ref> | |||
| One of the commonly voiced concerns about complementary alternative medicine (CAM) is the manner in which is regulated. There have been significant developments in how CAMs should be assessed prior to re-sale in the United Kingdom and the European Union (EU) in the last 2 years. Despite this, it has been suggested that current regulatory bodies have been ineffective in preventing deception of patients as many companies have re-labelled their drugs to avoid the new laws.<ref name="Colquhoun2012"/> There is no general consensus about how to balance consumer protection (from false claims, toxicity, and advertising) with freedom to choose remedies. | |||
| Advocates of CAM suggest that regulation of the industry will adversely affect patients looking for alternative ways to manage their symptoms, even if many of the benefits may represent the placebo affect.<ref name="Connelly2012"/> Some contend that alternative medicines should not require any more regulation than over-the-counter medicines that can also be toxic in overdose (such as paracetamol).<ref name="Malcolm2012"/> | |||
| ====Interactions with conventional pharmaceuticals==== | ====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, and insulin potentiation therapy. Some herbal remedies can cause dangerous interactions with chemotherapy drugs, radiation therapy, or anesthetics during surgery, among other problems.<ref name=CassilethDeng2004/><ref name=":0"/><ref name="Arye13" /> An example of these dangers was reported by Associate Professor ] of Adelaide University, Australia regarding a patient who almost bled to death on the operating table after neglecting to mention that she had been taking "natural" potions to "build up her strength" before the operation, including a powerful anticoagulant that nearly caused her death.<ref name="Hills1999"/> | |||
| 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, and insulin potentiation therapy. Some herbal remedies can cause dangerous interactions with chemotherapy drugs, radiation therapy, or anesthetics during surgery, among other problems.<ref name=CassilethDeng2004/> An anecdotal example of these dangers was reported by Associate Professor Alastair MacLennan of Adelaide University, Australia regarding a patient who almost bled to death on the operating table after neglecting to mention that she had been taking "natural" potions to "build up her strength" before the operation, including a powerful anticoagulant that nearly caused her death.<ref name="Hills1999"/> | |||
| To ''ABC Online'', MacLennan also gives another possible mechanism: | To ''ABC Online'', MacLennan also gives another possible mechanism: | ||
| {{blockquote|And lastly there's the cynicism and disappointment and depression that some patients get from going on from one alternative medicine to the next, and they find after three months the placebo effect wears off, and they're disappointed and they move on to the next one, and they're disappointed and disillusioned, and that can create depression and make the eventual treatment of the patient with anything effective difficult, because you may not get compliance, because they've seen the failure so often in the past.<ref name="SwanABC"/>}} | |||
| ==== |
====Side-effects==== | ||
| Conventional treatments are subjected to testing for undesired ], whereas alternative therapies, 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 therapies sometimes use the '']'' fallacy, i.e., "That which is natural cannot be harmful." Specific groups of patients such as patients with impaired hepatic or renal function are more susceptible to side effects of alternative remedies.<ref>{{cite journal |last1=Roozbeh |first1=J |last2=Hashempur |first2=M. H. |last3=Heydari |first3=M |date=Nov 2013 |title=Use of herbal remedies among patients undergoing hemodialysis |url=https://www.researchgate.net/publication/258636639 |journal=Iranian Journal of Kidney Diseases |volume=7 |issue=6 |pages=492–495 |pmid=24241097}}</ref><ref>{{cite journal|title=Herbal products: benefits, limits, and applications in chronic liver disease|journal=Evid Based Complement Alternat Med|pmid=22991573|pmc=3443820|doi=10.1155/2012/837939|volume=2012|year=2012|pages=1–19|last1=Del Prete|first1=A|last2=Scalera|first2=A|last3=Iadevaia|first3=M. D.|last4=Miranda|first4=A|last5=Zulli|first5=C|last6=Gaeta|first6=L|last7=Tuccillo|first7=C|last8=Federico|first8=A|last9=Loguercio|first9=C|doi-access=free}}</ref> | |||
| An exception to the normal thinking regarding side-effects is homeopathy. Since 1938, the FDA has regulated homeopathic products in "several significantly different ways from other drugs."<ref name=Stehlin/> 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.<ref name=Stehlin/> | |||
| Conventional treatments are subjected to testing for undesired ], 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 '']'' fallacy, i.e., "that which is natural cannot be harmful". Specific groups of patients such as patients with impaired hepatic or renal function are more susceptible to side effects of alternative remedies.<ref>{{cite journal|title=Use of herbal remedies among patients undergoing hemodialysis|journal=Iran J Kidney Dis|pmid=24241097|url=https://www.researchgate.net/publication/258636639_Use_of_herbal_remedies_among_patients_undergoing_hemodialysis|volume=7|issue=6|date=Nov 2013|pages=492–5|author1=Roozbeh|first1=J|last2=Hashempur|first2=M. H.|last3=Heydari|first3=M}}</ref><ref>{{cite journal|title=Herbal products: benefits, limits, and applications in chronic liver disease|journal=Evid Based Complement Alternat Med|pmid=22991573|pmc=3443820|url=http://www.hindawi.com/journals/ecam/2012/837939/|doi=10.1155/2012/837939|volume=2012|year=2012|pages=837939|author1=Del Prete|first1=A|last2=Scalera|first2=A|last3=Iadevaia|first3=M. D.|last4=Miranda|first4=A|last5=Zulli|first5=C|last6=Gaeta|first6=L|last7=Tuccillo|first7=C|last8=Federico|first8=A|last9=Loguercio|first9=C}}</ref> | |||
| An exception to the normal thinking regarding side-effects is ]. Since 1938, the ] (FDA) has regulated homeopathic products in "several significantly different ways from other drugs."<ref name=Stehlin/> 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.<ref name=Stehlin/> | |||
| ====Treatment delay==== | ====Treatment delay==== | ||
| Alternative medicine may discourage people from getting the best possible treatment.<ref name=MHTG/> 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.<ref name="Navarro2006"/> For this reason, critics argue that therapies that rely on the placebo effect to define success are very dangerous. According to mental health journalist ] in 2002, "unvalidated or scientifically unsupported mental health practices can lead individuals to forgo effective treatments" and refers to this as ]. Individuals who spend large amounts of time and money on ineffective treatments may be left with precious little of either, and may forfeit the opportunity to obtain treatments that could be more helpful. In short, even innocuous treatments can indirectly produce negative outcomes.<ref name=Lilienfeld2002/> 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.<ref name=Hughes2010/> | |||
| 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.<ref name="Navarro2006"/> 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 "]". Individuals who spend large amounts of time and money on ineffective treatments may be left with precious little of either, and may forfeit the opportunity to obtain treatments that could be more helpful. In short, even innocuous treatments can indirectly produce negative outcomes.<ref name=Lilienfeld2002/> | |||
| 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.<ref name=Hughes2010/> | |||
| ====Unconventional cancer "cures"==== | ====Unconventional cancer "cures"==== | ||
| There have always been "many therapies offered outside of conventional cancer treatment centers and based on theories not found in ]. 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.... The label 'unproven' is inappropriate for such therapies; it is time to assert that many alternative cancer therapies have been 'disproven'."<ref name=Vickers/> | |||
| Edzard Ernst has stated: | |||
| There have always been "many therapies offered outside of conventional cancer treatment centers and based on theories not found in ]. 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....The label 'unproven' is inappropriate for such therapies; it is time to assert that many alternative cancer therapies have been 'disproven'."<ref name=Vickers/> | |||
| {{blockquote|any alternative cancer cure is bogus by definition. There will never be an alternative cancer cure. Why? Because if something looked halfway promising, then mainstream oncology would scrutinize it, and if there is anything to it, it would become mainstream almost automatically and very quickly. All curative "alternative cancer cures" are based on false claims, are bogus, and, I would say, even criminal.<ref name=Miller>{{Citation |last=Miller |first=Gabriel |date=2 September 2014 |title=Asking the Experts: Complementary and Alternative Medicine and Cancer |work=] |url=http://www.medscape.com/viewarticle/830553_print |access-date=7 September 2014 }}</ref>}} | |||
| ] has stated: | |||
| ===Rejection of science=== | |||
| : "... any alternative cancer cure is bogus by definition. There will never be an alternative cancer cure. Why? Because if something looked halfway promising, then mainstream oncology would scrutinize it, and if there is anything to it, it would become mainstream almost automatically and very quickly. All curative "alternative cancer cures" are based on false claims, are bogus, and, I would say, even criminal."<ref name=Miller>{{Citation |last=Miller |first=Gabriel |date=2 September 2014 |title=Asking the Experts: Complementary and Alternative Medicine and Cancer |publisher='']'' |url=http://www.medscape.com/viewarticle/830553_print |accessdate=7 September 2014 }}</ref> | |||
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| ===Research funding=== | |||
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| | quote = There is no alternative medicine. There is only scientifically proven,<br /> evidence-based medicine supported by solid data<br /> or unproven medicine, for which scientific evidence is lacking.<br /> — P.B. Fontanarosa, '']'' (1998)<ref name=Fontanarosa1998/> | |||
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| Complementary and alternative medicine (CAM) is not as well researched as conventional medicine, which undergoes intense research before release to the public.<ref name="Ernst_Cohen" /> Practitioners of science-based medicine also discard practices and treatments when they are shown ineffective, while alternative practitioners do not.<ref name="ConsumerHealth9th">{{Cite book |last1=Barrett |first1=Stephen |url=https://books.google.com/books?id=_p4GywAACAAJ |title=Consumer health: a guide to intelligent decisions |last2=Hall |first2=Harriet |last3=Baratz |first3=Robert S. |last4=London |first4=William M. |last5=Kroger |first5=Manfred |publisher=McGraw-Hill |year=2013 |isbn=978-0-07-802848-9 |edition=9th |location=New York |pages=34–35, 134, 137 |oclc=758098687}}</ref> Funding for research is also sparse making it difficult to do further research for effectiveness of CAM.<ref name="Ernst4" /> Most funding for CAM is funded by government agencies.<ref name="Ernst_Cohen" /> Proposed research for CAM are rejected by most private funding agencies because the results of research are not reliable.<ref name="Ernst_Cohen" /> The research for CAM has to meet certain standards from research ethics committees, which most CAM researchers find almost impossible to meet.<ref name="Ernst_Cohen" /> Even with the little research done on it, CAM has not been proven to be effective.<ref name="Ernst3" /> Studies that have been done will be cited by CAM practitioners in an attempt to claim a basis in science. These studies tend to have a variety of problems, such as small samples, various biases, poor research design, lack of controls, negative results, etc. Even those with positive results can be better explained as resulting in false positives due to bias and ].<ref>{{cite journal |last1=Hall |first1=Harriet |author-link1=Harriet Hall |title=Science Envy in Alternative Medicine |journal=] |date=2019 |volume=43 |issue=4 |pages=21–23 |url=https://www.skepdoc.info/science-envy-in-alternative-medicine/ |archive-url=https://web.archive.org/web/20190917171017/https://www.skepdoc.info/science-envy-in-alternative-medicine/ |archive-date=2019-09-17 |access-date=17 September 2019}}</ref> | |||
| Alternative medicine may lead to a false understanding of the body and of the process of science.<ref name="MHTG">{{Cite book |last1=Ernst |first1=Edzard |url=https://books.google.com/books?id=fL5GDwAAQBAJ&pg=PR3 |title=More harm than good?: the moral maze of complementary and alternative medicine |last2=Smith |first2=Kevin |publisher=Springer |year=2018 |isbn=978-3-319-69941-7 |location=Cham, Switzerland |page=18 |oclc=1019807158}}</ref><ref name=Fisken2014>{{Cite journal |last=Fisken|first=Roger A.|date=2014-05-19|title=Teach evidence based, not alternative, medicine |url=http://www.bmj.com/content/348/bmj.g3218 |journal=BMJ |language=en |volume=348 |page=g3218 |doi=10.1136/bmj.g3218|pmid=24839973|s2cid=206902331|issn=1756-1833}}</ref> ], a neurologist at Yale School of Medicine, wrote that government-funded studies of integrating alternative medicine techniques into the mainstream are "used to lend an appearance of legitimacy to treatments that are not legitimate."<ref name="Brown2009" /> ] considered that critics felt that healthcare practices should be classified based solely on ], and if a treatment had been rigorously tested and found safe and effective, science-based medicine will adopt it regardless of whether it was considered "alternative" to begin with.<ref name="Angell1998" /> It is 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 are ], former editor of the '']'' (''JAMA'') and the journal's interim editor-in-chief Phil Fontanarosa.<ref name="Fontanarosa1998" /> | |||
| Funding for research into effectiveness of alternative treatments comes from a variety of public and private sources. In the USA, one conduit for funding and information is the National Center for Complementary and Integrative Medicine (NCCIH). Other governments have various levels of funding; the Dutch government funded CAM research between 1986 and 2003, but formally ended it in 2006.<ref name="Renkens2009"/> | |||
| Writing in 1999 in ''CA: A Cancer Journal for Clinicians'' ] mentioned a 1997 letter to the ]'s Subcommittee on Public Health and Safety, which had deplored the lack of critical thinking and scientific rigor in OAM-supported research, had been signed by four Nobel Laureates and other prominent scientists. (This was supported by the ] (NIH).)<ref name="Cassileth1999" /> | |||
| ==Appeal== | |||
| ]:<br />Q: What do you call Alternative Medicine that survives double-blind laboratory tests?<br />A: Regular Medicine.<ref name="Derkatch_2016_p._215">{{cite book | last=Derkatch | first=C. | title=Bounding Biomedicine: Evidence and Rhetoric in the New Science of Alternative Medicine | publisher=University of Chicago Press | year=2016 | isbn=978-0-226-34584-0 | url=https://books.google.com/books?id=4fvTCwAAQBAJ&pg=PA215 | access-date=March 18, 2023 | page=215}}</ref>]] | |||
| 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.<ref name="Sobel2000"/> 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.<ref name="WebMD2011"/> | |||
| In March 2009, a staff writer for '']'' reported that the impending national discussion about broadening access to health care, improving medical practice and saving money was giving a group of scientists an opening to propose shutting down the National Center for Complementary and Alternative Medicine. They quoted one of these scientists, ], a genome researcher and computational biologist at the University of Maryland, as saying "One of our concerns is that NIH is funding pseudoscience." They noted that the vast majority of studies were based on fundamental misunderstandings of physiology and disease, and had shown little or no effect.<ref name="Brown2009" /> | |||
| Against alternative medicine it has been argued that in addition to the social-cultural underpinnings of the popularity of alternative medicine, there are several psychological issues that are critical to its growth. One of the most critical is the placebo effect, which is a well-established observation in medicine.<ref name="van_Deventer2008"/> Related to it are similar psychological effects such as the will to believe,<ref name=Beyerstein /> ]es that help maintain self-esteem and promote harmonious social functioning,<ref name=Beyerstein /> and the '']'' fallacy.<ref name=Beyerstein /> | |||
| Writers such as ], a noted astrophysicist, advocate of ] and the author of '']'' (1996), have lambasted the lack of empirical evidence to support the existence of the putative energy fields on which these therapies are predicated.{{sfn|Sagan|1996}} | |||
| ===In the UK=== | |||
| Sampson has also pointed out that CAM tolerated contradiction without thorough reason and experiment.<ref name="SampsonAtwood2005" /> Barrett has pointed out that there is a policy at the NIH of never saying something does not work, only that a different version or dose might give different results.<ref name="$2.5 billion" /> Barrett also expressed concern that, just because some "alternatives" have merit, there is the impression that the rest deserve equal consideration and respect even though most are worthless, since they are all classified under the one heading of alternative medicine.<ref name="Quackwatch_wary" /> | |||
| ] in 2012]] | |||
| CAM's popularity may be related to other factors which ] mentioned in an interview in '']'': | |||
| Some critics of alternative medicine are focused upon health fraud, misinformation, and quackery as public health problems, notably ] and ] founders of ] and ], co-founder of ] and webmaster of ].<ref name="NCAHF_mission" /> Grounds for opposing alternative medicine include that: | |||
| <blockquote>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.<ref name="Con?"/></blockquote> | |||
| * Alternative therapies typically lack any ], and their effectiveness either is ] or has been ].<ref name="Sampson_6/1995" /><ref name="Kent1997" /><ref name="Goldrosen2004" /> | |||
| * It is usually based on religion, tradition, ], belief in ] energies, ], ], propaganda, or fraud.<ref name="Beyerstein2001" /><ref name="NSF_4/2002" /><ref name="Sampson_6/1995" /><ref name="Other_sources" /> | |||
| * Methods may incorporate or base themselves on ], ], spiritual beliefs, ignorance or misunderstanding of scientific principles, errors in reasoning, or newly conceived approaches claiming to heal.<ref name="Beyerstein2001" /><ref name="Sampson_6/1995" /><ref name="Acharya2008" /> | |||
| * Research on alternative medicine is frequently of low quality and methodologically flawed.<ref name="NCCIH1" />{{sfn|IOM Report|2005|p=}} | |||
| * Treatments are not part of the conventional, science-based healthcare system.<ref name="WHO_Trad_Med_Defs" /><ref name="NCCIH1" />{{sfn|IOM Report|2005|pp=}}<ref name="Zollman1999" /> | |||
| * Where alternative therapies have replaced conventional science-based medicine, even with the safest alternative medicines, failure to use or delay in using conventional science-based medicine has caused deaths.<ref name="Lilienfeld2002" /><ref name="Hughes2010" /> | |||
| Many alternative medical treatments are not patentable,<ref>{{cite journal |last1=Fonfa |first1=Anne E. |date=September 1, 2017 |title=Patient Perspectives: Barriers to Complementary and Alternative Medicine Therapies Create Problems for Patients and Survivors |journal=Integrative Cancer Therapies |volume=6 |issue=September 2007 |pages=297–300 |doi=10.1177/1534735407306598 |pmid=17761643 |doi-access=free }}</ref> which may lead to less research funding from the private sector. In addition, in most countries, alternative therapies (in contrast to pharmaceuticals) can be marketed without any proof of efficacy – also a disincentive for manufacturers to fund scientific research.<ref name="Ernst2005" /> | |||
| In a paper published in October 2010 entitled ''The public's enthusiasm for complementary and alternative medicine amounts to a critique of mainstream medicine'', Ernst described these views in greater detail and concluded: | |||
| English evolutionary biologist ], in his 2003 book '']'', defined alternative medicine as a "set of practices that cannot be tested, refuse to be tested, or consistently fail tests."<ref name="Dawkins2003" /> Dawkins argued that if a technique is demonstrated effective in properly performed trials then it ceases to be alternative and simply becomes medicine.<ref name="Holloway2003" /> | |||
| <blockquote> is popular. An analysis of the reasons why this is so points towards the therapeutic relationship as a key factor. Providers of CAM tend to build better therapeutic relationships than mainstream healthcare professionals. In turn, this implies that much of the popularity of CAM is a poignant criticism of the failure of mainstream healthcare. We should consider it seriously with a view of improving our service to patients.<ref name=Ernst2010/></blockquote> | |||
| CAM is also often less regulated than conventional medicine.<ref name="Ernst_Cohen" /> There are ethical concerns about whether people who perform CAM have the proper knowledge to treat patients.<ref name="Ernst_Cohen" /> CAM is often done by non-physicians who do not operate with the same medical licensing laws which govern conventional medicine,<ref name="Ernst_Cohen" /> and it is often described as an issue of ].<ref name="Ernst2" /> | |||
| ===In the USA and Canada=== | |||
| According to two writers, Wallace Sampson and K. Butler, marketing is part of the training required in alternative medicine, and propaganda methods in alternative medicine have been traced back to those used by ] and ] in their promotion of pseudoscience in medicine.<ref name="ATRAMM" /><ref name="ButlerBarrett1992" /> | |||
| A study published in 1998 indicates that a majority of alternative medicine use was in conjunction with standard medical treatments.<ref name=Astin1998/> 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 ], 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. | |||
| In November 2011 Edzard Ernst stated that the "level of misinformation about alternative medicine has now reached the point where it has become dangerous and unethical. So far, alternative medicine has remained an ethics-free zone. It is time to change this."<ref name="Ernst_Guardian" /> | |||
| Authors have speculated on the socio-cultural and psychological reasons for the appeal of alternative medicines among the 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 ] among the public at large and a concomitant increase in ] attitudes and ] ].<ref name=Beyerstein /> Related to this are vigorous ]<ref name=Weber/> of extravagant claims by the alternative medical community combined with inadequate media scrutiny and attacks on critics.<ref name=Beyerstein2001/><ref name=Beyerstein/> | |||
| ] criticized the low standard of evidence accepted by the alternative medicine community: | |||
| There is also an increase in ] 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.<ref name=Beyerstein2001/> Many patients lack access to contemporary medicine, due to a lack of private or public ], which leads them to seek out lower-cost alternative medicine.<ref name="Barnes2004"/> Medical doctors are also aggressively marketing alternative medicine to profit from this market.<ref name=Weber/> | |||
| {{blockquote|Science-based medicine has one rigorous standard of evidence, the kind .... CAM has a double standard. They gladly accept a lower standard of evidence for treatments they believe in. However, I suspect they would reject a pharmaceutical if it were approved for marketing on the kind of evidence they accept for CAM.<ref name="Hall_9/2015">{{Citation |last=Hall |first=Harriet |author-link=Harriet Hall |date=September 2015 |title=Evidence: "It Worked for My Aunt Tillie" is Not Enough |website=], Volume 20, Number 3 |url=http://www.skeptic.com/magazine/ |access-date=November 22, 2015}}</ref>}} | |||
| Patients can also be averse to the painful, unpleasant, and sometimes-dangerous ] of biomedical treatments. Treatments for severe diseases such as ] and ] infection have well-known, significant side-effects. Even low-risk medications such as ] can have potential to cause life-threatening ] 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.<ref name=Beyerstein2001/><ref name=Beyerstein/> | |||
| ===Conflicts of interest=== | |||
| Schofield and others, in a systematic review published in 2011, make ten recommendations which they think may increase the effectiveness of consultations in a conventional (here: oncology) setting, such as "Ask questions about CAM use at critical points in the illness trajectory"; "Respond to the person's emotional state"; and "Provide balanced, evidence-based advice". They suggest that this approach may address "... concerns surrounding CAM use encourage informed decision-making about CAM and ultimately, improve outcomes for patients".<ref name="Schofield2010"/> | |||
| Some commentators have said that special consideration must be given to the issue of ] in alternative medicine. Edzard Ernst has said that most researchers into alternative medicine are at risk of "unidirectional bias" because of a generally uncritical belief in their chosen subject.<ref name="unid">{{cite journal |author=Ernst |first=Edzard |author-link=Edzard Ernst |year=2011 |title=Conflicts of Interest in Alternative Medicine |url=http://www.csicop.org/si/show/conflicts_of_interest_in_alternative_medicine |journal=Skeptical Inquirer |volume=35 |issue=4}}</ref> Ernst cites as evidence the phenomenon whereby 100% of a sample of acupuncture trials originating in China had positive conclusions.<ref name="unid" /> David Gorski contrasts evidence-based medicine, in which researchers try to disprove hyphotheses, with what he says is the frequent practice in pseudoscience-based research, of striving to confirm pre-existing notions.<ref name="gorski">{{cite web |author=Gorski |first=David |author-link=David Gorski |date=16 November 2009 |title=Conflicts of interest in science-based medicine |url=https://www.sciencebasedmedicine.org/conflicts-of-interest-in-science-based-medicine/ |website=Science-Based Medicine}}</ref> ] writes that there is a contrast between the circumstances of alternative medicine practitioners and disinterested scientists: in the case of acupuncture, for example, an acupuncturist would have "a great deal to lose" if acupuncture were rejected by research; but the disinterested skeptic would not lose anything if its effects were confirmed; rather their change of mind would enhance their skeptical credentials.<ref name="hall">{{cite web |author=Hall |first=Harriet A. |author-link=Harriet A. Hall |date=27 April 2011 |title=Conflicts of interest |url=https://www.sciencebasedmedicine.org/conflicts-of-interest/ |website=Science-Based Medicine}}</ref> | |||
| ===Use of health and research resources=== | |||
| Research into alternative therapies has been criticized for "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."<ref name="Novella2010" /><ref name="Gorski2010" /> Research methods expert and author of ''Snake Oil Science'', ], has stated that "it's become politically correct to investigate nonsense."<ref name="$2.5 billion" /> A commonly cited statistic is that the US ] had spent $2.5 billion on investigating alternative therapies prior to 2009, with none being found to be effective.<ref name="$2.5 billion" /> | |||
| ==See also== | ==See also== | ||
| * ] | |||
| * ] | * ] | ||
| * ] | * ] | ||
| * ] | |||
| * ] | |||
| * ] | |||
| * ] | * ] | ||
| * |
* ] | ||
| * ], in United States early 19th century | |||
| ==Notes== | |||
| ==Explanatory notes== | |||
| {{reflist|2|group=n}} | {{reflist|2|group=n}} | ||
| ==References== | ==References== | ||
| {{Research help|Med}} | |||
| {{Reflist|30em|refs= | {{Reflist|30em|refs= | ||
| <ref name="$2.5 billion">{{cite news |url= https://www.nbcnews.com/id/wbna31190909 |title= $2.5 billion spent, no alternative cures found |work= ] |department= Alternative Medicine |agency= ] |date= 2009-06-10 }}</ref> | |||
| <ref name="NSF_2002">{{cite book |chapter= Chapter 7: Science and Technology: Public Attitudes and Public Understanding, Section: Belief in Alternative Medicine |chapterurl= http://www.nsf.gov/statistics/seind02/c7/c7s5.htm#c7s5l2a |title= Science and Engineering Indicators - 2002 |url=http://www.nsf.gov/statistics/seind02/ |year=2002 |author= ] |publisher= Division of Science Resources Statistics, ], ] |location= Arlington, Virginia}}</ref> | |||
| <ref name=Acharya2008>{{cite book |last1= Acharya |first1= D. |first2= S. |last2= Anshu |year= 2008 |title= Indigenous Herbal Medicines: Tribal Formulations and Traditional Herbal Practices |publisher= Aavishkar Publishers |location= Jaipur, India |isbn= 978-81-7910-252-7 |page= 440|display-authors= 1 }}</ref> | |||
| <ref name=FDA_regulatory>{{cite web |url= http://www.fda.gov/RegulatoryInformation/Guidances/ucm144657.htm |title= Complementary and Alternative Medicine Products and their Regulation by the Food and Drug Administration |year= 2007 |publisher= Office of Policy and Planning, Office of the Commissioner, ] (FDA), ], ] |ref= {{harvid|FDA|2007}}}} {{PD-notice}}</ref> | |||
| <ref name=ACS>{{Cite web | publisher =] | date =1 Nov 2008 | url =http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/MindBodyandSpirit/naturopathic-medicine | title=Naturopathic Medicine|access-date =20 Nov 2010|archive-url=https://web.archive.org/web/20150403092521/http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/mindbodyandspirit/naturopathic-medicine|archive-date=3 April 2015 }}</ref> | |||
| <ref name="whccamp.hhs.gov">{{cite book |title= Final Report |authors= White House Commission on Complementary and Alternative Medicine Policy |chapter= Chapter 2: Overview of CAM in the United States: Recent History, Current Status, And Prospects for the Future |isbn= 0160514762 |volume= ] Pub. 03-5411 |publisher= US Government Printing Office |url= http://whccamp.hhs.gov/finalreport.html |year= 2002|chapterurl= http://whccamp.hhs.gov/fr2.html}} Chapter 2 2011-08-25.</ref> | |||
| <ref name="AHA2008">{{cite press release |title= Latest Survey Shows More Hospitals Offering Complementary and Alternative Medicine Services |url= http://www.aha.org/presscenter/pressrel/2008/080915-pr-cam.shtml |date= 2008-09-15 |publisher= ] |archive-date= 2012-09-02 |archive-url= https://web.archive.org/web/20120902072431/http://www.aha.org/presscenter/pressrel/2008/080915-pr-cam.shtml |ref= {{harvid|American Hospital Association|2008}} |access-date= 2013-03-14 }}</ref> | |||
| <ref name=WHO>{{cite web |url=http://www.who.int/medicines/areas/traditional/definitions/en/index.html |title=Traditional Medicine: Definitions |publisher=] |year=2000|accessdate=2012-11-11}}</ref> | |||
| <ref name= |
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| <ref name=AMA_CoSA_rpt12>{{Cite journal|title=Alternative Medicine |volume=Report 12 |issue=A-97 |author1=Council on Scientific Affairs, ] |year=1997 |publisher=AMA |page=9 |url=http://www.ama-assn.org/ama/pub/article/2036-2432.html |archive-url=https://web.archive.org/web/20150626140649/http://www.ama-assn.org/ama/pub/article/2036-2432.html |archive-date=26 June 2015 }}</ref> --> | |||
| <ref name=ernstinterview>{{cite web |url=http://www.harcourt-international.com/ernst/interview.cfm |author= Elsevier Science |publisher= Harcourt International |title= Author interview (Edzard Ernst, editor of ''The Desktop Guide to Complementary and Alternative Medicine'') |year= 2002 }}{{dead link|date=July 2016|bot=medic}}{{cbignore|bot=medic}}</ref> | |||
| <ref name= |
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| <ref name=Angell1998>{{cite journal |title= Alternative medicine--The risks of untested and unregulated remedies |last1= Angell |first1= M. |last2= Kassirer |first2= J.P. |author-link= Marcia Angell |journal= ] |volume= 339 |issue= 12 |pages= 839–841 |year= 1998 |doi= 10.1056/NEJM199809173391210 |display-authors= 1|pmid= 9738094 |url= http://kitsrus.com/pdf/nejm_998.pdf |archive-url=https://ghostarchive.org/archive/20221009/http://kitsrus.com/pdf/nejm_998.pdf |archive-date=2022-10-09 |url-status=live |citeseerx= 10.1.1.694.9581 }}</ref> | |||
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| <!-- remarked out | <!-- remarked out | ||
| <ref name=Artus2007>{{cite journal |title= The use of CAM and conventional treatments among primary care consulters with chronic musculoskeletal pain |journal= ] |volume= 8 |page= 26 |year= 2007 |last1= Artus |first1= M. |last2= Croft |first2= P. |last3= Lewis |first3= M. |doi= 10.1186/1471-2296-8-26 |pmid= 17480212 |pmc= 1878478 |ref={{harvid|Artus et al.|2007}}|display-authors= 1 |issue=1}}</ref> --> | |||
| <ref name="fda.gov">{{cite web |url= http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/MedicationHealthFraud/ucm207747.htm |title= Alternative Medicine Fraud |date= 2010-10-25 |accessdate= 2013-03-11 |archiveurl= https://web.archive.org/web/20121018095742/http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/MedicationHealthFraud/ucm207747.htm |archivedate= 2012-10-18 |deadurl= no |series= Information for Consumers (Drugs) |work= FDA website}}</ref> --> | |||
| <ref name=ATRAMM>{{cite journal |last= Sampson |first= W. |author-link= Wallace Sampson | title = Antiscience Trends in the Rise of the "Alternative Medicine" Movement | journal = Annals of the New York Academy of Sciences | volume = 775 | pages = 188–197 | year = 1995 | pmid = 8678416 | doi = 10.1111/j.1749-6632.1996.tb23138.x | issue=1|s2cid= 2813395 }}</ref> | |||
| <ref name=NHS_Careers_CAM>{{cite web|url=http://www.nhscareers.nhs.uk/explore-by-career/wider-healthcare-team/careers-in-the-wider-healthcare-team/clinical-support-staff/complementary-and-alternative-medicine-(cam)/ |title=Complementary and alternative medicine (CAM) |publisher=National Health Service in England (NHS), UK Dept. of Health |work= NHS Careers website |author= |date= |accessdate= 2013-03-11 |archivedate= 2013-04-03 |archiveurl= https://web.archive.org/web/20130403110352/http://www.nhscareers.nhs.uk/explore-by-career/wider-healthcare-team/careers-in-the-wider-healthcare-team/clinical-support-staff/complementary-and-alternative-medicine-%28cam%29/ |deadurl= no}}</ref> | |||
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| <ref name="CAM_Sointu_Nissen_Eisenberg">{{harvnb|IOM Report|2005|pp=, }}.<br />{{harvnb|Sointu|2012|pages=}}.<br />{{harvnb|Nissen et al.|2013}}.<br />{{harvnb|Eisenberg et al.|1993}}.</ref> | |||
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| <ref name=Hufford2004a>{{harvnb|Hufford|2004}}. In {{harvnb|Callahan|2004|p= }}. Quoted in {{harvnb|IOM Report|2005|p= }}.</ref> | |||
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| <ref name=Kopelman2004>{{harvc |last=Kopelman|first=L.|chapter=The Role of Science in Assessing Conventional, Complementary, and Alternative Medicines|in=Callahan|year=2004|pp=}}</ref> | |||
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| --> | |||
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| <ref name=Beyerstein2001>{{cite journal |last= Beyerstein |first= B.L. |authorlink= Barry Beyerstein |title= Alternative medicine and common errors of reasoning |journal= Academic Medicine |volume= 76 |issue= 3 |pages= 230–7 |year= 2001 |pmid= 11242572 |doi= 10.1097/00001888-200103000-00009 |ref= {{harvid|Beyerstein|2001}}}}</ref> | |||
| <ref name="Brown1988">{{cite journal |pmc=1139856 |title=Nineteenth-century American health reformers and the early nature cure movement in Britain |last= Brown |first= P.S. |journal= Medical History |volume= 32 |pages= 174–194 |pmid= 3287059 |issue= 2 |year= 1988 |doi= 10.1017/S0025727300047980 }}</ref> | |||
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| <ref name="Brown2009">{{cite news |url= https://www.washingtonpost.com/wp-dyn/content/article/2009/03/16/AR2009031602139.html |title= Scientists speak out against federal funds for research on alternative medicine |newspaper= ] |date= 2009-03-17 |first= D. |last= Brown | access-date= 2010-04-23}}</ref> | |||
| <ref name=Coulter2004>{{cite journal |title= The rise and rise of complementary and alternative medicine: A sociological perspective |url= https://www.mja.com.au/journal/2004/180/11/rise-and-rise-complementary-and-alternative-medicine-sociological-perspective |first1= I.D. |last1= Coulter |first2= E.M. |last2= Willis |journal= ] |year= 2004 |volume= 180 |issue= 11 |pages= 587–9 |pmid= 15174992 |ref= {{harvid|Coulter et al.|2004}}|displayauthors= 1 }}</ref> | |||
| <ref name="SampsonAtwood2005">{{cite journal |vauthors=Sampson W, Atwood K|s2cid = 43272637 |title = Propagation of the absurd: demarcation of the absurd revisited |journal = Med. J. Aust. |volume = 183 |issue = 11–12 |pages = 580–581 |year = 2005 |pmid = 16336135 |doi = 10.5694/j.1326-5377.2005.tb00040.x}}</ref> | |||
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| <ref name=Eisenberg_Bio>{{cite web|title=David M. Eisenberg, M.D. |url=http://specertified.com/what/team-profile/david-m.-eisenberg-m.d |date= |accessdate=2013-03-14 |archivedate=2013-05-29 |archiveurl=https://web.archive.org/web/20130529173804/http://specertified.com/what/team-profile/david-m.-eisenberg-m.d |work=Health Through Food website |publisher=] Development US Inc. |deadurl=yes |df= }}</ref> | |||
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| <ref name="HOL_Kopelman_Wieland_Astin_Pelletier">{{harvnb|Sir Walton: Science and Technology Committee|2000|loc= }}.<br />{{harvnb|Kopelman|2004}}.<br />{{harvnb|Wieland et al.|2011}}.<br />{{cite journal |last1= Astin |first1= J.A. |last2= Marie |first2= A. |last3= Pelletier |first3= K.R. |last4= Hansen |first4= E. |last5= Haskell |first5= W.L. |title= A review of the incorporation of complementary and alternative medicine by mainstream physicians |journal= ] |year= 1998 |volume= 158 |issue= 21 |pages= 2303–10 |doi= 10.1001/archinte.158.21.2303 |pmid= 9827781 |url= http://archinte.jamanetwork.com/article.aspx?articleid=210591 |ref= harv|displayauthors= 1 }}<br />{{cite journal |last1= Pelletier |first1= K.R. |last2= Marie |first2= A. |last3= Krasner |first3= M. |last4= Haskell |first4= W.L. |title= Current trends in the integration and reimbursement of complementary and alternative medicine by managed care, insurance carriers, and hospital providers |journal= American Journal of Health Promotion |volume= 12 |issue= 2 |year= 1997 |pages= 112–22 |doi= 10.4278/0890-1171-12.2.112 |pmid= 10174663 |ref= harv|displayauthors= 1 }}</ref> | |||
| <ref name="CAM_RMC1997">{{cite journal |author= CAM Research Methodology Conference, April 1995 Panel on Definition and Description |title= Defining and describing complementary and alternative medicine |journal= Alternative Therapies in Health and Medicine |volume= 3 |issue= 2 |pages= 49–57 |year= 1997 |pmid= 9061989 }}</ref> --> | |||
| <!-- remarked out | |||
| <ref name="Walton_Science_and_Technology_Committee">{{harvnb|Sir Walton: Science and Technology Committee|2000|loc = | |||
| <ref name="CAM_Sointu_Nissen_Eisenberg">{{harvnb|IOM Report|2005|pp=, }}.<br />{{harvnb|Sointu|2012|pages=}}.<br />{{harvnb|Nissen et al.|2013}}.<br />{{harvnb|Eisenberg et al.|1993}}.</ref> --> | |||
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<ref name="Cassileth1999">{{cite journal |last= Cassileth |first= B.R. |s2cid= 7889638 |title=Evaluating complementary and alternative therapies for cancer patients |journal= ] |volume= 49 |issue= 6 |pages= 362–375 |year= 1999 |pmid= 11198952 |doi= 10.3322/canjclin.49.6.362 |doi-access= free }}</ref> | ||
| <ref name=CassilethDeng2004>{{cite journal |last1= Cassileth |first1=B.R. |last2= Deng |first2= G. |author-link= Barrie R. Cassileth |title= Complementary and alternative therapies for cancer |journal= The Oncologist |volume= 9 |issue= 1 |pages= 80–89 |year= 2004 |doi= 10.1634/theoncologist.9-1-80 |pmid= 14755017 |s2cid=6453919 |display-authors= 1 |doi-access= free }}</ref> | |||
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| <ref name=Zollman1999>{{cite journal |last1= Zollman |first1= C. |last2= Vickers |first2= A. |title= What is complementary medicine? |department= ABC of complementary medicine |doi= 10.1136/bmj.319.7211.693 |pmid= 10480829 |pmc= 1116545 |journal= BMJ |volume= 319 |issue= 7211 |pages= 693–6 |year= 1999 |ref= {{harvid|Zollman et al.|1999}}|displayauthors= 1 }}</ref> | |||
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| <ref name=ZollChanCoulRobeAdamArtu>{{harvnb|Zollman et al.|1999}}.<br />{{cite journal |title= Complementary and alternative therapies in childhood attention and hyperactivity problems |last1= Chan |first1= E. |last2= Rappaport |first2= L.A. |last3= Kemper |first3= K.J. |journal= Journal of Developmental & Behavioral Pediatrics |year= 2003 |volume= 24 |issue= 1 |pages= 4–8 |pmid= 12584479 |doi= 10.1097/00004703-200302000-00003 |ref= harv|displayauthors= 1 }}<br />{{cite journal |title= Complementary and alternative medicine utilisation in NHS and private clinic settings: A United Kingdom survey of 400 infertility patients |last1= Coulson |first1= C. |last2= Jenkins |first2= J. |journal= Journal of Experimental & Clinical Assisted Reproduction |year= 2005 |volume= 2 |page= 5 |url= http://archive.biomedcentral.com/1743-1050/2/5 |doi= 10.1186/1743-1050-2-5 |pmid= 15807886 |pmc= 1084360 |issue= 1 |ref= harv|displayauthors= 1 }}<br />{{cite journal |title= The social demand for a medicine focused on the person: The contribution of CAM to healthcare and healthgenesis |last= Roberti di Sarsina |first= P. |journal= ] |volume= 4 |issue= S1 |year= 2007 |pages= 45–51 |doi= 10.1093/ecam/nem094 |pmid= 18227933 |pmc= 2206228 |ref= harv}}<br />{{cite journal |title= The use of complementary and alternative medicine by cancer patients |last1= Adams |first1= M. |last2= Jewell |first2= A.P. |journal= International Seminars in Surgical Oncology |year= 2007 |volume= 4 |page= 10 |doi= 10.1186/1477-7800-4-10 |pmid= 17470282 |pmc= 1872026 |ref= harv|displayauthors= 1 |issue=1}}<br />{{harvnb|Artus et al.|2007}}.</ref> | |||
| <ref name="Colquhoun2012">{{cite journal |last= Colquhoun |first= D. |title= Regulation of alternative medicine ‐ Why it doesn't work |journal= Scottish Universities Medical Journal |year= 2012 |volume= 1 |series= EPub |issue= 16 |pages= 1–9 |url= http://sumj.dundee.ac.uk/data/uploads/epub-article/016-sumj.epub.pdf |archive-url=https://ghostarchive.org/archive/20221009/http://sumj.dundee.ac.uk/data/uploads/epub-article/016-sumj.epub.pdf |archive-date=2022-10-09 |url-status=live }}</ref> --> | |||
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| <ref name=Fontanarosa1998>{{cite journal |title= Alternative medicine meets science |last1= Fontanarosa |first1= P.B. |last2= Derman |journal= ] |year= 1998 |volume= 280 |issue= 18 |pages= 1618–9 |doi= 10.1001/jama.280.18.1618 |pmid= 9820267 |ref= {{harvid|Fontanarosa et al.|1998}} |first2= E |last3= Molloy |first3= GR |last4= Tamm |first4= I |last5= Darnell |first5= JE|displayauthors= 1 }}</ref> | |||
| <ref name="Connelly2012">{{cite journal |last= Connelly |first= P. |title= The ethics of acupuncture |journal= Scottish Universities Medical Journal |year= 2012 |volume= 1 |issue= 2 |pages= 165–169 |url= http://sumj.dundee.ac.uk/data/uploads/volume2/sumjv1i2p.165-169.pdf |archive-url=https://ghostarchive.org/archive/20221009/http://sumj.dundee.ac.uk/data/uploads/volume2/sumjv1i2p.165-169.pdf |archive-date=2022-10-09 |url-status=live }}</ref> --> | |||
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| <ref name=Borkan2012>{{cite journal |title= Complementary alternative health care in Israel and the western world |last= Borkan |url= http://www.ijhpr.org/content/1/1/8 |first= J. |year= 2012 |journal= Israel Journal of Health Policy Research |volume= 1 |issue= 1 |page= 8 |doi= 10.1186/2045-4015-1-8 |pmid= 22913745 |pmc= 3424836 |ref= harv}}</ref> | |||
| <ref name=Cotter2005>{{cite book |title= Physical Medicine & Rehabilitation: Principles and Practice |last1= Cotter |first1= A.C. |last2= Shiflett |first2= S.C. |last3= Kuo |first3= D. |editor1-last= DeLisa |editor1-first= J.A. |editor2-last= Gans |editor2-first= B.M. |editor3-last= Walsh |editor3-first= N.E. |chapter= Chapter 19: Complementary and Alternative Medicine |year= 2005 |location= Philadelphia |publisher= Lippincott Williams & Wilkins: Wolters Kluwer |pages= |edition= 4th |volume= 1 |isbn= {{Format ISBN|0781741300}} |ref={{harvid|Cotter et al.|2005}} }}</ref> --> | |||
| <ref name= |
<ref name=Coulter2004>{{cite journal |title= The rise and rise of complementary and alternative medicine: A sociological perspective |url= https://www.mja.com.au/journal/2004/180/11/rise-and-rise-complementary-and-alternative-medicine-sociological-perspective |first1= I.D. |last1= Coulter |first2= E.M. |last2= Willis |journal= ] |year= 2004 |volume= 180 |issue= 11 |pages= 587–589 |pmid= 15174992 |ref= {{harvid|Coulter et al.|2004}}|display-authors= 1 |doi= 10.5694/j.1326-5377.2004.tb06099.x |s2cid= 15983789 }}</ref> | ||
| <ref name=DaguptaHStabler2011>{{cite book |first2=Catherine A|last2=Hammett-Stabler|first1=Amitava|last1=Dasgupta |title=Herbal Supplements: Efficacy, Toxicity, Interactions with Western Drugs, and Effects on Clinical Laboratory Tests |publisher=John Wiley and Sons |location=Hoboken NJ|year=2011 |isbn=978-0-470-43350-8 |pages= }}</ref> | |||
| <ref name=Angell1998>{{cite journal |title= Alternative medicine--The risks of untested and unregulated remedies |last1= Angell |first1= M. |last2= Kassirer |first2= J.P. |authorlink= Marcia Angell |journal= ] |volume= 339 |issue= 12 |pages= 839–41 |year= 1998 |doi= 10.1056/NEJM199809173391210 |ref= harv|displayauthors= 1|pmid= 9738094 }}</ref> | |||
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<ref name=Dawkins2003>{{cite book |last= Dawkins |first= R. |author-link= Richard Dawkins |title= A Devil's Chaplain: Selected Essays |editor-last= Menon |editor-first= L. |year= 2003 |isbn= 978-0-7538-1750-6 |publisher= Weidenfeld & Nicolson |location= London |title-link= A Devil's Chaplain }} (p. in 2004 US ed. {{ISBN|0618335404}}).</ref> | ||
| <ref name=Dawkins2003a>] quoted in {{harvnb|Dawkins|2003}}. (p. in 2004 US ed. {{ISBN|0618335404}}).</ref> | |||
| <ref name=NHS_Choices_CAM>{{Cite web |title= All about complementary and alternative medicine |url= http://www.nhs.uk/Livewell/complementary-alternative-medicine/Pages/complementary-alternative-medicines.aspx |date= 2012-11-23 |accessdate= |archivedate= 2013-02-28 |archiveurl= https://web.archive.org/web/20130228185229/http://www.nhs.uk/Livewell/complementary-alternative-medicine/Pages/complementary-alternative-medicines.aspx |deadurl= no |series= Live Well |work= NHS Choices website |postscript= . |author1= NHS Choices editors |ref= harv}}</ref> | |||
| <ref name=Deshpande1987>{{cite journal|last=Deshpande|first=Vijaya|title=Medieval Transmission of Alchemical and Chemical Ideas between India and China|journal=Indian Journal of History of Science|volume=22|issue=1|date=January 1987|pmid=11622483|url=http://www.new1.dli.ernet.in/data1/upload/insa/INSA_1/20005abf_15.pdf|pages=15–28|archive-url=https://web.archive.org/web/20150505233031/http://www.new1.dli.ernet.in/data1/upload/insa/INSA_1/20005abf_15.pdf|archive-date=2015-05-05}}</ref> | |||
| <ref name=Maciocia1995>{{cite book|title=Tongue Diagnosis in Chinese Medicine|first=Giovanni|last=Maciocia|year=1995|publisher=Eastland Press|location=Seattle|isbn=9780939616190}}</ref> | |||
| <ref name=Economist2011>{{cite news |magazine= ] |url= http://www.economist.com/node/18710090 |title= Alternative Medicine: Think yourself better |date= 2011-05-19 |pages= 83–84 |archive-url= https://web.archive.org/web/20110522121254/http://www.economist.com/node/18710090 |archive-date= 2011-05-22 |url-status= live}}</ref> | |||
| <ref name=NHMRC_CAM>{{Cite journal |title= Complementary and alternative medicines |url= http://www.nhmrc.gov.au/your-health/complementary-and-alternative-medicines |work= NHMRC website |series= Your health |publisher= ], ] |date= 2013-09-27 |accessdate= 2013-09-30 |archiveurl= https://web.archive.org/web/20130928174904/http://www.nhmrc.gov.au/your-health/complementary-and-alternative-medicines |archivedate= 2013-09-28 |deadurl= no |postscript= . |author1= NHMRC |ref= harv}}</ref> | |||
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| <ref name="WHO_Trad_Med_Defs">{{Cite journal |title= Traditional Medicines: Definitions |url= http://www.who.int/medicines/areas/traditional/definitions/en/index.html |work= WHO website |publisher= ] |series= Medicines |accessdate= 2012-11-11 |archiveurl= https://web.archive.org/web/20130927045217/http://www.who.int/medicines/areas/traditional/definitions/en/index.html |archivedate= 2013-09-27 |deadurl= no |postscript= . |author1= Xiaorui Zhang |ref= harv}} Extracted from {{harvnb|WHO|2000}}.</ref> | |||
| <ref name=Eisenberg_Bio>{{cite web|title=David M. Eisenberg, M.D. |url=http://specertified.com/what/team-profile/david-m.-eisenberg-m.d |access-date=2013-03-14 |archive-date=2013-05-29 |archive-url=https://web.archive.org/web/20130529173804/http://specertified.com/what/team-profile/david-m.-eisenberg-m.d |work=Health Through Food website |publisher=] Development US Inc. }}</ref> --> | |||
| <ref name=Ernst2>{{cite journal |last= Ernst |first =E. |title= The ethics of complementary medicine |journal= Journal of Medical Ethics |year= 1996 |volume= 22 |pages= 197–198 |doi= 10.1136/jme.22.4.197 |pmid= 8863142 |issue= 4 |pmc= 1376996 }}</ref> | |||
| <ref name=Cotter2005>{{cite book |title= Physical Medicine & Rehabilitation: Principles and Practice |last1= Cotter |first1= A.C. |last2= Shiflett |first2= S.C. |last3= Kuo |first3= D. |editor1-last= DeLisa |editor1-first= J.A. |editor2-last= Gans |editor2-first= B.M. |editor3-last= Walsh |editor3-first= N.E. |chapter= Chapter 19: Complementary and Alternative Medicine |year= 2005 |location= Philadelphia |publisher= Lippincott Williams & Wilkins: Wolters Kluwer |pages= |edition= 4th |volume= Vol. 1 |isbn= 0781741300 |ref={{harvid|Cotter et al.|2005}} }}</ref> | |||
| <ref name=Ernst3>{{cite book |editor1-first= .E |title= The Desktop Guide to Complementary and Alternative Medicine |year= 2001 |location= Edinburgh |publisher= Mosby |editor2-last= Pittler |editor2-first= M.H. |editor3-last= Stevinson |editor3-first= C. |editor4-last= White |editor4-first= A. |isbn= 978-0-7234-3207-4 |oclc= 492760852 |editor-last= Ernst }}</ref> | |||
| <ref name=Snyderman2002>{{cite journal |title= Integrative medicine: Bringing medicine back to its roots |last1= Snyderman |first1= R. |last2= Weil |first2= A.T. |authorlink= Ralph Snyderman |journal= JAMA Internal Medicine |volume= 162 |issue= 4 |pages= 395–7 |year= 2002 |pmid= 11863470 |doi= 10.1001/archinte.162.4.395 |ref= harv|displayauthors= 1 }}</ref> | |||
| <ref name=Ernst4>{{cite journal |last= Ernst |first= E. |title= Funding research into complementary medicine: The situation in Britain |journal= Complementary Therapies in Medicine |year= 1999 |issue= 4 |pages= 250–253 |doi= 10.1016/S0965-2299(99)80011-9 |volume= 7 |pmid= 10709311 }}</ref> | |||
| <ref name=NCI_PDQ_CAM>{{cite web |title= Complementary and Alternative Medicine in Cancer Treatment (PDQ®): Questions and Answers About Complementary and Alternative Medicine in Cancer Treatment |url= http://www.cancer.gov/cancertopics/pdq/cam/cam-cancer-treatment/patient/page2 |work= NCI website |series= Physician Data Query (PDQ®) |publisher= ], NIH |date= |accessdate= 2012-12-11 |archivedate= 2012-12-15 |archiveurl= https://web.archive.org/web/20121215060456/http://www.cancer.gov/cancertopics/pdq/cam/cam-cancer-treatment/patient/page2 |deadurl= yes}}</ref> | |||
| <ref name= |
<ref name=Ernst2001>{{cite journal | author = Ernst E | title = Rise in popularity of complementary and alternative medicine: reasons and consequences for vaccination | journal = Vaccine | volume = 20 | issue = Suppl 1 | pages = S89–S93 | year = 2001 | pmid = 11587822 | doi = 10.1016/S0264-410X(01)00290-0 }}</ref> | ||
| <ref name= |
<ref name=Ernst2002>{{Cite journal |last1= Ernst |first1= E. |title= A systematic review of systematic reviews of homeopathy |journal= ] |volume= 54 |issue= 6 |pages= 577–582 |year= 2002 |pmid= 12492603 |pmc= 1874503 |doi= 10.1046/j.1365-2125.2002.01699.x }}</ref> | ||
| <ref name=Ernst2005>{{cite journal |last= Ernst |first= E. |s2cid= 2327655 |title= The efficacy of herbal medicine -- An overview |journal= Fundamental & Clinical Pharmacology |volume= 19 |issue= 4 |pages= 405–409 |year= 2005 |pmid= 16011726 |doi= 10.1111/j.1472-8206.2005.00335.x }}</ref> | |||
| <ref name="Porter_Ramsey_Loudon">{{cite book |last= Porter |first= R. |authorlink= Roy Porter |title= Studies in the History of Alternative Medcicine |editor1-last= Cooter |editor1-first= R. |editor2-last= Society for the Social History of Medicine |chapter= Chapter 1: Before the Fringe: <nowiki>'Quackery'</nowiki> and the Eighteenth-Century Medical Market |isbn= 9780333462133 |location= London |publisher= Macmillan in association with ] |year= 1988}}<br />{{harvnb|Ramsey|1999}}<br />{{cite journal |title= A brief history of homeopathy |last= Loudon |first= I. |year= 2006 |journal= Journal of the Royal Society of Medicine |volume= 99 |issue= 12 |pages= 607–10 |pmid= 17139061 |pmc= 1676328 |doi=10.1258/jrsm.99.12.607 |ref= harv}}</ref> | |||
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| <ref name="Brunton_Brown">{{cite book |last= Brunton |first= D. |chapter= Chapter 5: The Emergence of a Modern Profession? |editor-last= Brunton |editor-first= D. |title= Medicine Transformed: Health, Disease and Society in Europe 1800-1930 |year= 2004 |publisher= Manchester University Press in association with the ] |isbn= 9780719067358 |pages= }}<br />{{cite book |title= Medicine and the Market in England and its Colonies, c.1450-c.1850 |editor1-last= Jenner |editor1-first= M.S.R. |editor2-last= Wallis |editor2-first= P. |year= 2007 |location= New York |publisher= Palgrave Macmillan |chapter= Chapter 12: Medicine, Quackery, and the Free Market: The <nowiki>'War'</nowiki> Against Morison's Pills and the Construction of the Medical Profession, c.1830-c.1850 |last= Brown |first= M. |isbn= 9780230506435 |pages= 238–61 }}</ref> | |||
| <ref name=Ernst2008>{{cite journal |title= Chiropractic: A critical evaluation |last= Ersnt |first= E. |journal= ] |year= 2008 |volume= 35 |issue= 5 |pages= 544–562 |doi= 10.1016/j.jpainsymman.2007.07.004 |pmid= 18280103 |url=http://www.jpsmjournal.com/article/S0885-3924(07)00783-X/fulltext }}</ref> | |||
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| <ref name= |
<ref name=Ernst2011>{{cite journal |last= Ernst |first= E. |title= How Much of CAM Is Based on Research Evidence? |journal= Evidence-Based Complementary and Alternative Medicine |year= 2011 |volume= 2011 |page= 676490 |pmid= 19465405 |doi= 10.1093/ecam/nep044 | pmc= 3136881 }}</ref> | ||
| <ref name=ernstinterview>{{cite web|url=http://www.harcourt-international.com/ernst/interview.cfm |archive-url=https://web.archive.org/web/20020302075846/http://www.harcourt-international.com/ernst/interview.cfm |archive-date=2002-03-02 |author=Elsevier Science |publisher=Harcourt International |title=Author interview (Edzard Ernst, editor of ''The Desktop Guide to Complementary and Alternative Medicine'') |year=2002 }}</ref> | |||
| <ref name=Silverman2011>{{cite journal |title= William Henry Welch (1850–1934): The Road to Johns Hopkins |last= Silverman |first= B.D. |journal= Baylor University Medical Center Proceedings |volume= 24 |issue= 3 |year= 2011 |pages= 236–42 |pmid= 21738298 |pmc= 3124910 |ref= harv}}</ref> | |||
| <ref name=Ernst_1995>{{cite journal |last= Ernst |first= E. |author-link= Edzard Ernst |title= Complementary medicine: Common misconceptions |journal= ] |year= 1995 |volume= 88 |issue= 5 |pages=244–247| pmid = 7636814 |pmc= 1295191|quote= Complementary medicine, defined as health care which lies for the most part outside the mainstream of conventional medicine.}}</ref> | |||
| <ref name=Shuval2012>{{cite journal|title=Complementary and Alternative Healthcare in Israel|first1=Judith T.|last1=Shuval|first2=Emma|last2=Averbuch|journal=Israel Journal of Health Policy Research|date=2012|volume=1|issue=7 |pmc=3424827|doi=10.1186/2045-4015-1-7|pmid=22913721}}</ref> | |||
| <ref name=Ernst_Cohen>{{cite journal |last1= Ernst |first1= E. |last2= Cohen |first2= M.H. |last3= Stone |first3= J. |title= Ethical problems arising in evidence based complementary and alternative medicine |journal= ] |year= 2004 |volume= 30 |issue= 2 |pages= 156–159 |doi= 10.1136/jme.2003.007021 |pmid= 15082809 |pmc= 1733834 |display-authors= 1 }}</ref> | |||
| <ref name=Flexner_Report>{{Cite journal |title= ] |url= |year= 1910 |last1= Flexner |first1= A. |authorlink1= Abraham Flexner |author2= The Carnegie Foundation for the Advancement of Teaching (CFAT) |authorlink2= Carnegie Foundation for the Advancement of Teaching |publisher= ], ] |location= Boston |ref= {{harvid|Flexner Report|1910}} |postscript= .}} Available from CFAT: .</ref> | |||
| <ref name=Ernst_Guardian>{{cite news |first= E. |last= Ernst |url= https://www.theguardian.com/science/blog/2011/nov/08/alternative-medicine-ethics-free-zone |title= Alternative medicine remains an ethics-free zone |newspaper= ] | |||
| <ref name=Hiatt2003>{{cite journal |last1= Hiatt |first1= M.D. |last2= Stockton |first2= C.G. |title= The impact of the Flexner Report on the fate of medical schools in North America after 1909 |url= http://www.jpands.org/vol8no2/hiatt.pdf |journal= ] |volume= 8 |issue= 2 |pages= 37–40 |year= 2003 |ref= harv|displayauthors= 1 }}</ref> | |||
| |location= London |date= 2011-11-08 |archive-url= https://web.archive.org/web/20130128052140/http://www.guardian.co.uk/science/blog/2011/nov/08/alternative-medicine-ethics-free-zone |archive-date= 2013-01-28 |url-status= live}}</ref> | |||
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| <ref name=Pritchett1910>{{harvc |last=Pritchett|first=H.S.|author-link=Henry Smith Pritchett|chapter=Introduction|in=Flexner Report|year=1910|p=viii}}</ref> | |||
| <ref name=Ernst_Lee_Choi>{{cite journal|last1=Ernst|first1=E.|last2=Lee|first2=Myeong Soo|last3=Choi|first3=Tae-Young|title=Acupuncture: Does it alleviate pain and are there serious risks? A review of reviews|journal=Pain|volume=152|issue=4|year=2011|pages=755–764|issn=0304-3959|doi=10.1016/j.pain.2010.11.004|pmid=21440191|url=https://www.researchgate.net/publication/50866673_Acupuncture_does_it_alleviate_pain_and_are_there_serious_risks_A_review_of_reviews/file/504635268b703595fc.pdf |archive-url=https://ghostarchive.org/archive/20221009/https://www.researchgate.net/publication/50866673_Acupuncture_does_it_alleviate_pain_and_are_there_serious_risks_A_review_of_reviews/file/504635268b703595fc.pdf |archive-date=2022-10-09 |url-status=live|format=PDF}}</ref> --> | |||
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| <ref name=Bullock1980>{{cite book |title= An American Transplant: The Rockefeller Foundation and Peking Union Medical College |last= Bullock |first= M.B. |authorlink= Mary Brown Bullock |publisher= University of California Press |location= Berkeley, California |year= 1980 |isbn= 9780520035591}}</ref> | |||
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| <ref name=Usman1925>{{cite book |title= The Report of the Committee on the Indigenous Systems of Medicine, Madras (The Usman Report) |first2= M. |last2= Usman |authorlink2= Mohammad Usman of Madras |first3= A.S.K. |last3= Rao |first4= U.R. |last4= Rao |first5= A. |last5= Lakshmipati |first6= M.S. |last6= Ayyar |first7= K.G.N. |last7= Sastri |first8= C.T.A. |last8= Pillai |first9= T.R.R. |last9= Ayyar |first10= A.T. |last10= Palmer |first11= G. |last11= Srinivasamurti |last1= Madras Indigenous Systems of Medicine Committee 1921-23 |location= Madras, India |year= 1925 |publisher= Superintendent, Government Press |oclc= 229483035|displayauthors= 2 }}</ref> | |||
| <ref name="fda.gov">{{cite web |url= https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/MedicationHealthFraud/ucm207747.htm |title= Alternative Medicine Fraud |date= 2010-10-25 |access-date= 2013-03-11 |archive-url= https://web.archive.org/web/20121018095742/https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/MedicationHealthFraud/ucm207747.htm |archive-date= 2012-10-18 |url-status= live |series= Information for Consumers (Drugs) |work= FDA website}}</ref> --> | |||
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| <ref name=LuNeedham1980>{{cite book|title=Celestial Lancets: a History and Rationale of Acupuncture and Moxa|last2= Needham|first2=Joseph|last1=Lu|first1=Gwei-Djen|year=1980|publisher=Cambridge University Press|location=Cambridge and New York|isbn=9780521215138}}</ref> | |||
| <ref name=FDA_regulatory>{{cite web |url= https://www.fda.gov/RegulatoryInformation/Guidances/ucm144657.htm |title= Complementary and Alternative Medicine Products and their Regulation by the Food and Drug Administration |year= 2007 |publisher= Office of Policy and Planning, Office of the Commissioner, ] (FDA), ], ] |ref= {{harvid|FDA|2007}}}} {{PD-notice}}</ref> --> | |||
| <ref name=Flexner_Report>{{Cite report |title= Medical Education in the United States and Canada A Report to the Carnegie Foundation |year= 1910 |last1= Flexner |first1= A. |author-link1= Abraham Flexner |publisher= ], ] |location= Boston |ref= {{harvid|Flexner Report|1910}} |title-link=Flexner Report}} Available from CFAT: {{Webarchive|url=https://web.archive.org/web/20131105125707/http://www.carnegiefoundation.org/sites/default/files/elibrary/Carnegie_Flexner_Report.pdf |date=2013-11-05 }}</ref> | |||
| <ref name=Madras1984>{{cite journal |author= Madras Group |title= What is the role of indigenous medical sciences in our health care system? (Responses of indigenous medical practitioners to the Madras Inquiry sixty years ago) |url= http://ppstbulletins.blogspot.com/2011/10/what-is-role-of-indigenous-medical.html |journal= Patriotic and People Oriented Science and Technology |year= 1984 |volume= 4 |issue= 1 |pages= 64–95 |ref= harv}} Condensed in {{cite journal |title= What is the role of indigenous medical sciences in our health care system? |department= Perspective |year= 1985 |volume= 10 |issue= 3 |pages= 271–7 |url= http://www.vikalpa.com/pdf/articles/1985/1985_july_sep_271_277.pdf |journal= Vikalpa |author1= Madras Group |ref= harv}}</ref> | |||
| <ref name=Fontanarosa1998>{{cite journal |title= Alternative medicine meets science |last1= Fontanarosa |first1= P.B. |last2= Derman |journal= ] |year= 1998 |volume= 280 |issue= 18 |pages= 1618–1619 |doi= 10.1001/jama.280.18.1618 |pmid= 9820267 |ref= {{harvid|Fontanarosa et al.|1998}} |first2= E |last3= Molloy |first3= GR |last4= Tamm |first4= I |last5= Darnell |first5= JE|s2cid= 5485601 |display-authors= 1 }}</ref> | |||
| <ref name=OED>{{cite web|title= alternative medicine, ''n''|website= OED Online |publisher= Oxford English Dictionary |date=March 2015 |url= http://www.oed.com/view/Entry/5803?redirectedFrom=Alternative+medicine |accessdate= 5 June 2015}}{{subscription required}}; {{cite book |year= 1974 |first= Helen|last= Kruger |title= Other Healers, Other Cures: A Guide to Alternative Medicine |url= |location=Indianapolis| publisher= Bobbs-Merrill |isbn= 9780672517082}}</ref> | |||
| <ref name=Freedman2011>{{cite web|title=The Triumph of New-Age Medicine |work=] |first=David H.|last=Freedman|date= July–August 2011|url=https://www.theatlantic.com/magazine/archive/2011/07/the-triumph-of-new-age-medicine/308554/|access-date=6 June 2015|archive-date=10 May 2015|archive-url=https://web.archive.org/web/20150510142230/http://www.theatlantic.com/magazine/archive/2011/07/the-triumph-of-new-age-medicine/308554/|url-status=live}}</ref> | |||
| <ref name=BMA_Cant_Saks>{{harvnb|BMA|1993}}.<br>{{cite book |last1= Cant |first1= S.|last2= Sharma |first2=U. |chapter= Alternative Health Practices and Systems |page= |editor1-last= Albrecht |editor1-first= G.L. |editor2-last= Fitzpatrick |editor2-first= R. |editor3-last= Scrimshaw |editor3-first= S.C. |title= The Handbook of Social Studies in Health and Medicine |url= |year= 1999 |publisher= Sage Publications |isbn= 9781847870964}}<br>{{harvnb|Saks|2003|p=}}.</ref> | |||
| <ref name=Goldrosen2004>{{cite journal |title= Complementary and alternative medicine: assessing the evidence for immunological benefits |last1= Goldrosen |first1= M.H. |last2= Straus |first2= S.E. |journal= ] |department= Perspective |volume= 4 |issue= 11 |pages= 912–921 |year= 2004 |doi= 10.1038/nri1486 |pmid= 15516970 |s2cid= 11708302 |url= https://zenodo.org/record/1233538 |display-authors= 1 |doi-access= free }}</ref> | |||
| <ref name=Relman1998>{{cite news |last1= Relman |first1= A.S. |authorlink= Arnold S. Relman |title= Andrew Weil, the boom in alternative medicine, and the retreat from science. A Trip to Stonesville |magazine= ] |volume= 219 |issue= 24 |pages= 28–36 |date= 1998-12-14}} at ], (2002-03-10) and from there 2002-10-10.</ref> | |||
| <ref name=goodbadugly>{{cite web |url= http://www.healthwatch-uk.org/awardwinners/edzardernst.html |title= The HealthWatch Award 2005: Prof. Edzard Ernst: Complementary medicine: The good the bad and the ugly |last= Ernst |first= E. |publisher= ] |location= UK |archive-url= https://web.archive.org/web/20131016024908/http://www.healthwatch-uk.org/awardwinners/edzardernst.html |archive-date= 2013-10-16 }}</ref> | |||
| <ref name=HistoryMakers_HHS_Satcher_Bio>{{cite web |title= MedicalMakers: David Satcher |url= http://www.thehistorymakers.com/biography/david-satcher-41 |work= ] website |accessdate= 2013-10-06 |archiveurl= https://web.archive.org/web/20130511112015/http://www.thehistorymakers.com/biography/david-satcher-41 |archivedate= 2013-05-11 |deadurl= no}}<br />{{cite web |authors= Office of Public Health and Science |title= David Satcher (1998-2002) |url= http://www.surgeongeneral.gov/library/history/biosatcher.htm |publisher= US HHS |date= 2007-01-04 |accessdate= |archiveurl= https://web.archive.org/web/20071205160010/http://www.surgeongeneral.gov/library/history/biosatcher.htm |archivedate= 2007-12-05}}</ref> | |||
| <ref name="Gorski2010">{{cite web |last= Gorski |first= D. |author-link= David Gorski |title= Credulity about acupuncture infiltrates ''The New England Journal of Medicine'' |url= http://www.sciencebasedmedicine.org/acupuncture-infiltrates-the-new-england-journal-of-medicine/ |date= 2010-08-03 |work= ] |archive-url= https://web.archive.org/web/20130928202243/http://www.sciencebasedmedicine.org/acupuncture-infiltrates-the-new-england-journal-of-medicine/ |archive-date= 2013-09-28 |url-status= live}}</ref> | |||
| <ref name=New_Millennium>{{cite press release |title= U.S. Surgeon General launches new health resources at government gateway website: Alternative health and Spanish language online resources |url= http://www.health.gov/partnerships/media/31899pr.htm |origyear= 1998-03-18 |date= 1999-11-18 |archivedate= 2000-04-16 |archiveurl= https://web.archive.org/web/20000416053214/http://health.gov/partnerships/Media/31899pr.htm |publisher= Partnerships for Health in the New Millennium |series= HHS News |work= Health.gov website |deadurl= no }}</ref> | |||
| <ref name=HCReport2010>{{cite report|last=House of Commons: Science and Technology Committee|title=Evidence Check 2: Homeopathy|date=22 February 2010|series=HC 45, Fourth Report of Session 2009–2010|publisher=The Stationery Office|location=London|url=https://publications.parliament.uk/pa/cm200910/cmselect/cmsctech/45/45.pdf}}</ref> | |||
| <ref name=Bravewell2007>{{cite book |title= Integrative Medicine Best Practices |year= 2007 |url= http://www.bravewell.org/current_projects/best_practices/ |last1= Horrigan |first= B.J. |chapter= Introduction and Summary |chapterurl= http://www.bravewell.org/content/IntroSummary_Best%20Practices_1.pdf |page= 3 |publisher= Bravewell Collaborative |accessdate= 2013-10-06}} Introduction and Summary 2013-05-03.</ref> | |||
| <!--<ref name=Helmuth>{{cite web|last=Helmuth|first=Laura|url=http://www.slate.com/articles/health_and_science/science_of_longevity/2013/09/tim_minchin_s_storm_critique_of_alternative_medicine_and_defense_of_reason.html|title= The Best Critique of Alternative Medicine Ever: It's an Animated Video. And It's Hilarious|website=]|date= 11 September 2013|publisher=The Slate Group|access-date=4 June 2015}}</ref>--> | |||
| <ref name=Ludmerer2010>{{cite journal |last= Ludmerer |first= K.M. |authorlink= Kenneth Ludmerer |title= Commentary: Understanding the Flexner Report |journal= Academic Medicine |volume= 85 |issue= 2 |year= 2010 |pages= 193–6 |url= https://ualearn.blackboard.com/bbcswebdav/pid-303852-dt-content-rid-690898_1/courses/49626.201240/readings/Ludmerer-Flexner-AcadMed.pdf |pmid= 20107341 |doi= 10.1097/ACM.0b013e3181c8f1e7 |ref= harv}}</ref> | |||
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| <ref name=Bianco>{{Cite web |title= How Becoming a Doctor Works: Medical School Curriculum |last= Bianco |first= C. |url= http://people.howstuffworks.com/becoming-a-doctor9.htm |work= ] website |archiveurl= https://web.archive.org/web/20131005044926/http://people.howstuffworks.com/becoming-a-doctor9.htm |archivedate= 2013-10-05 |deadurl= no |postscript= . |ref= harv}}</ref> | |||
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| <ref name="Hills1999">{{cite web |url= http://benhills.com/articles/medical-mayhem/item/94-fake-healers |archive-url= https://web.archive.org/web/20120315061425/http://benhills.com/articles/medical-mayhem/item/94-fake-healers |archive-date= 2012-03-15 |title=Fake healers: Why Australia's $1 billion-a-year alternative medicine industry is ineffective and out of control |date= 2011-09-23 |orig-date= 1999 |access-date= 2008-03-06 |last= Hills |first= B. |author-link= Ben Hills |work= BenHills.com }}</ref> | |||
| <ref name=Yale_Curriculum>{{cite web |title= Medical Student Education Program: Curriculum Overview |url= http://medicine.yale.edu/education/curriculum/curriculum/overview/index.aspx |work= Yale University website |publisher= ] |archiveurl= https://web.archive.org/web/20131004214032/http://medicine.yale.edu/education/curriculum/curriculum/overview/index.aspx |archivedate= 2013-10-04 |deadurl= no}}</ref> | |||
| <ref name=Hines_Sampson_Coulter_Sagan>{{cite book|last=Hines|first=Terence|author-link=Terence Hines|title=Pseudoscience and the Paranormal|location=Amerst, New York|publisher=Prometheue Books|year=2003|edition=2nd|isbn=978-1-57392-979-0}}; {{cite journal|last=Sampson|first=Walter|title=The Need for Educational Reform in Teaching about Alternative Therapies|journal=Academic Medicine|volume=76|issue=3|date=March 2001|pages=248–250|pmid=11242574|doi=10.1097/00001888-200103000-00011|doi-access=free}}; {{cite journal|last1=Coulter|first1=Ian D|last2=Willis|first2=Evan M|title=The Rise and Rise of Complementary and Alternative Medicine: a Sociological Perspective|journal=]|volume=180|issue=11|date=June 2004|pmid=15174992|pages=587–589|url=https://www.mja.com.au/journal/2004/180/11/rise-and-rise-complementary-and-alternative-medicine-sociological-perspective|doi=10.5694/j.1326-5377.2004.tb06099.x|s2cid=15983789}}; {{harvnb|Sagan|1996}}</ref> | |||
| <ref name=Deshpande1987>{{cite journal|last=Deshpande|first=Vijaya|title=Medieval Transmission of Alchemical and Chemical Ideas between India and China|journal=Indian Journal of History of Science|volume=22|issue=1|date=January 1987|pmid=11622483|url=http://www.new1.dli.ernet.in/data1/upload/insa/INSA_1/20005abf_15.pdf|pages=15–28}}</ref> | |||
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| <ref name=Matuk2006>{{cite journal |title=Seeing the Body: The Divergence of Ancient Chinese and Western Medical Illustration |author=Camillia Matuk |journal=Journal of Biocommunication |volume=32 |issue=1 |year=2006 |url=http://www.sesp.northwestern.edu/docs/publications/6074956944509ac426aaa6.pdf |pmid= |doi= }}</ref> | |||
| <ref name="HoC_Evidence_Check2_homeopathy">{{cite book |title= Fourth Report: Evidence Check 2: Homeopathy |author1= Science and Technology Committee, ] |url= https://publications.parliament.uk/pa/cm200910/cmselect/cmsctech/45/45.pdf |orig-date= Session 2009–2010 HC 45 |date= 2010-02-08 |location= London |publisher= The Stationery Office}} .</ref> --> | |||
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| <ref name="HOL_Kopelman_Wieland_Astin_Pelletier">{{harvnb|Sir Walton: Science and Technology Committee|2000|loc= }}.<br />{{harvnb|Kopelman|2004}}.<br />{{harvnb|Wieland et al.|2011}}.<br />{{cite journal |last1= Astin |first1= J.A. |last2= Marie |first2= A. |last3= Pelletier |first3= K.R. |last4= Hansen |first4= E. |last5= Haskell |first5= W.L. |title= A review of the incorporation of complementary and alternative medicine by mainstream physicians |journal= ] |year= 1998 |volume= 158 |issue= 21 |pages= 2303–2310 |doi= 10.1001/archinte.158.21.2303 |pmid= 9827781 |display-authors= 1 |doi-access= free }}<br />{{cite journal |last1= Pelletier |first1= K.R. |last2= Marie |first2= A. |last3= Krasner |first3= M. |last4= Haskell |first4= W.L. |title= Current trends in the integration and reimbursement of complementary and alternative medicine by managed care, insurance carriers, and hospital providers |journal= American Journal of Health Promotion |volume= 12 |issue= 2 |year= 1997 |pages= 112–122 |doi= 10.4278/0890-1171-12.2.112 |pmid= 10174663 |s2cid= 46772634 |display-authors= 1 }}</ref> | |||
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| <ref name="Horrobin1986">{{cite journal |last= Horrobin |first= D.F. |year= 1986 |title= Glittering prizes for research support |journal= Nature |volume= 324 |issue= 6094 |page= 221 |doi= 10.1038/324221a0 |bibcode= 1986Natur.324..221H |s2cid= 28273314 |doi-access= free }}</ref> | |||
| <ref name=UM_CAM_Field>{{cite web |title= Cochrane CAM Field |publisher= Center for Integrative Medicine, School of Medicine, University of Maryland |work= University of Maryland website |url= http://www.compmed.umm.edu/cochrane.asp |archiveurl= https://web.archive.org/web/20130928113542/http://www.compmed.umm.edu/cochrane.asp |archivedate= 2013-09-28 |deadurl= no}}</ref> | |||
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| <ref name=Medline_MD>{{cite web |title= Doctor of medicine profession (MD) |url= https://www.nlm.nih.gov/medlineplus/ency/article/001936.htm |date= 2011-02-03 |accessdate= 2012-12-20 |archiveurl= https://web.archive.org/web/20130127161943/https://www.nlm.nih.gov/medlineplus/ency/article/001936.htm |archivedate= 2013-01-27 |work= ] |publisher= ], NIH}}</ref> | |||
| <ref name=Howell1999>{{cite journal | last= Howell|first= J.D. | title = The Paradox of Osteopathy | journal = New England Journal of Medicine | volume = 341 | issue = 19 | pages = 1465–1468 | year = 1999 | pmid = 10547412 | doi = 10.1056/NEJM199911043411910 }}</ref> --> | |||
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| <ref name=Cochrane_CAM_Field>{{cite web |title= Cochrane Complementary Medicine Field |url= http://onlinelibrary.wiley.com/o/cochrane/clabout/articles/CE000052/frame.html |last1= Manheimer |first1= E. |last2= Berman |first2= B. |publisher= John Wiley & Sons |work= ]|displayauthors= 1 }}{{Subscription required}}.</ref> | |||
| <ref name=Hufford2004>{{harvc |last=Hufford|first=D.J.|chapter=CAM and Cultural Diversity: Ethics and Epistemology Converge|in=Callahan|year=2004|pp=|}}</ref> --> | |||
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| <ref name=Groopman>{{cite news |author=] |title=The Quackish Cult of Alternative Medicine. Dr. Paul Offit's battle against charlatanism |url=http://www.newrepublic.com/article/114899/paul-offits-do-you-believe-magic-reviewed-dangers |quote= |newspaper=] |date= October 19, 2013 |accessdate=2015-02-03 }}</ref> | |||
| <ref name=Hufford2004a>{{harvnb|Hufford|2004}}. In {{harvnb|Callahan|2004|p= }}. Quoted in {{harvnb|IOM Report|2005|p= }}.</ref> --> | |||
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| <ref name=Sackett1996>{{cite journal |title= Evidence based medicine: What it is and what it isn't |last1= Sackett |first1= D.L. |last2= Rosenberg |first2= W.M.C. |last3= Gray |first3= J.A.M. |last4= Haynes |first4= R.B. |last5= Richardson |first5= W.S. |journal= BMJ |volume= 312 |issue= 7023 |pages= 71–2 |year= 1996 |doi= 10.1136/bmj.312.7023.71 |pmc= 2349778 |pmid= 8555924 |ref= harv|displayauthors= 1 }}</ref> | |||
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<ref name=Hughes2010>{{cite news |last= Hughes |first= D. |title= Alternative remedies 'dangerous' for kids says report |url= https://www.bbc.co.uk/news/health-12060507 |date= 2010-12-23 |archive-url= https://web.archive.org/web/20101224181102/http://www.bbc.co.uk/news/health-12060507 |archive-date= 2010-12-24 |url-status= live |work= ]}}</ref> | ||
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| <ref name=Weisleder>{{cite journal|last1=Weisleder|first1=P|title=Unethical prescriptions: alternative therapies for children with cerebral palsy.|journal=Clinical pediatrics|date=January 2010|volume=49|issue=1|pages=7–11|doi=10.1177/0009922809340438|pmid=19628756}}</ref> | |||
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| <ref name=NCAHF_mission>{{cite web |title= NCAHF Mission Statement |url= http://www.ncahf.org/about/mission.html |date= 2009-11-30 |accessdate= 2013-03-11 |work= ] website}}</ref> | |||
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<ref name=Lu2002>{{cite book |title= Celestial Lancets: A History and Rationale of Acupuncture and Moxa |last1= Lu |first= G.D. |last2= Needham |first2= J. |orig-date= 1980 |year= 2002 |publisher= Routledge |location= New York |isbn= {{Format ISBN|0700714588}}|display-authors= 1 }}</ref> --> | ||
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| <ref name= |
<ref name=NCCIH2>{{cite web |url=https://nccih.nih.gov/research/statistics/2007/camsurvey_fs1.htm |title=The Use of Complementary and Alternative Medicine in the United States |publisher=] |date=2015-04-07 |archive-date=2015-06-01 |archive-url=https://web.archive.org/web/20150601182114/https://nccih.nih.gov/research/statistics/2007/camsurvey_fs1.htm |access-date=2015-06-04 }}</ref> | ||
| <ref name=NCCIHSurvey>{{cite press release|title=According to a New Government Survey, 38 Percent of Adults and 12 Percent of Children Use Complementary and Alternative Medicine|url=http://nccih.nih.gov/news/2008/121008.htm|publisher=National Center for Complementary and Integrative Medicine|series=NIH News|location=Bethseda, Maryland|date=10 December 2008|access-date=4 June 2015}}</ref> | |||
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| <ref name="NCCIH_naturopathy">{{cite web |title= Naturopathy: An Introduction |series= Backgrounders |volume= NCCIH Publication No. D372 |publisher= NCCIH |year= 2010 | |
<ref name="NCCIH_naturopathy">{{cite web |title= Naturopathy: An Introduction |series= Backgrounders |volume= NCCIH Publication No. D372 |publisher= NCCIH |year= 2010 |orig-date= 2007 |url= http://nccih.nih.gov/health/naturopathy/D372.pdf |archive-url=https://ghostarchive.org/archive/20221009/http://nccih.nih.gov/health/naturopathy/D372.pdf |archive-date=2022-10-09 |url-status=live |access-date= 2010-11-20}}{{dead link|date=July 2016|bot=medic}}{{cbignore|bot=medic}}</ref>--> | ||
| <!-- updated since access and archive dates available at http://nccih.nih.gov/health/naturopathy/naturopathyintro.htm --> | <!-- updated since access and archive dates available at http://nccih.nih.gov/health/naturopathy/naturopathyintro.htm --> | ||
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| <ref name=NCIDictionary1>{{cite web|title=orthodox medicine|url=http://www.cancer.gov/publications/dictionaries/cancer-terms?CdrID=454746|website=NCI Dictionary of Cancer Terms|publisher=NIH National Cancer Institute|access-date=4 June 2015|archive-url=https://web.archive.org/web/20150604194705/http://www.cancer.gov/publications/dictionaries/cancer-terms?CdrID=454746|archive-date=4 June 2015|url-status=live}}</ref> --> | |||
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| <ref name=NCI_PDQ_CAM>{{cite web |title= Complementary and Alternative Medicine in Cancer Treatment (PDQ®): Questions and Answers About Complementary and Alternative Medicine in Cancer Treatment |url= http://www.cancer.gov/cancertopics/pdq/cam/cam-cancer-treatment/patient/page2 |work= NCI website |series= Physician Data Query (PDQ) |publisher= ], NIH |access-date= 2012-12-11 |archive-date= 2012-12-15 |archive-url= https://web.archive.org/web/20121215060456/http://www.cancer.gov/cancertopics/pdq/cam/cam-cancer-treatment/patient/page2 }}</ref> | |||
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| <ref name="Iowa_BoM">{{cite web |author= Iowa Board of Medicine |title= A Policy Statement on Naturopathy |url= http://medicalboard.iowa.gov/policies/naturopathy.html |date= 2002-02-07 |publisher= State of Iowa |accessdate= 2013-03-11 |archiveurl= https://web.archive.org/web/20130412204820/http://medicalboard.iowa.gov/policies/naturopathy.html |archivedate= 2013-04-12 |deadurl= no}}</ref> | |||
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<ref name=Nissen2013>{{cite journal |title= Researching alternative and complementary therapies: Mapping the field |last1= Nissen |first1= N. |last2= Manderson |first2= L. |journal= Medical Anthropology |volume= 32 |issue= 1 |pages= 1–7 |year= 2013 |doi=10.1080/01459740.2012.718016 |pmid= 23206171 |s2cid= 31843233 |ref= {{harvid|Nissen et al.|2013}}|display-authors= 1 }}</ref> | ||
| <ref name=Novella2010>{{cite web |last= Novella |first= S. |author-link= Steven Novella |title= Acupuncture pseudoscience in ''The New England Journal of Medicine'' |url= http://www.sciencebasedmedicine.org/nc/ |date= 2010-08-04 |work= ] |archive-url= https://web.archive.org/web/20130928202231/http://www.sciencebasedmedicine.org/nc/ |archive-date= 2013-09-28 |url-status= live}}</ref> | |||
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| <ref name="SampsonAtwood2005">{{cite journal | authors= Sampson W, Atwood K | title = Propagation of the absurd: demarcation of the absurd revisited | journal = Med. J. Aust. | volume = 183 | issue = 11-12 | pages = 580–1 | year = 2005 | pmid = 16336135 | doi = | url = | ref = harv }}</ref> | |||
| <ref name=NP>{{cite journal |vauthors=Goldrosen MH, Straus SE |year = 2004 |title = Complementary and alternative medicine: assessing the evidence for immunological benefits |journal = Nature Reviews Immunology |volume = 4 |issue = 11| pages = 912–921 |doi=10.1038/nri1486 |pmid=15516970|s2cid = 11708302 |url = https://zenodo.org/record/1233538 |doi-access = free }}</ref> | |||
| <ref name="$2.5 billion">{{cite news |url= http://www.msnbc.msn.com/id/31190909/ |title= $2.5 billion spent, no alternative cures found |work= ] |department= Alternative Medicine |agency= ] |date= 2009-06-10 |archiveurl= https://web.archive.org/web/20090613033017/http://www.msnbc.msn.com/id/31190909 |archivedate= 2009-06-13 |deadurl= no}}</ref> | |||
| <ref name="NSF_4/2002">{{cite web | author=] |title=Chapter 7: Science and Technology: Public Attitudes and Public Understanding: Science Fiction and Pseudoscience | website=] | date=April 2002 | url=http://www.nsf.gov/statistics/seind02/c7/c7s5.htm | access-date=March 15, 2023 | archive-url=https://web.archive.org/web/20070218150111/http://www.nsf.gov/statistics/seind02/c7/c7s5.htm | archive-date=February 18, 2007 }}</ref> | |||
| <ref name=NP>{{cite journal |vauthors=Goldrosen MH, Straus SE | year = 2004 | title = Complementary and alternative medicine: assessing the evidence for immunological benefits | url = http://www.nature.com/nri/journal/v4/n11/pdf/nri1486.pdf | format = PDF | journal = Nature Perspectives | volume = 4 | issue = 11| pages = 912–921 | doi=10.1038/nri1486 | pmid=15516970}}</ref> | |||
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| <ref name=Nuffield_Trust>{{cite web |title= Our work |url= http://www.nuffieldtrust.org.uk/our-work |work= Nuffield Trust website |publisher= The Nuffield Trust for Research and Policy Studies in Health Services |archive-url= https://web.archive.org/web/20130928221647/http://www.nuffieldtrust.org.uk/our-work |archive-date= 2013-09-28 |url-status= live|date= 2016-12-20 }}</ref> --> | |||
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| <ref name=VIFAB_definition>{{cite web|url=http://www.srab.dk/alternativ+behandling/hvad+er+alternativ+behandling-c7-/vifabs+definition|title=ViFABs definition af alternativ behandling|website=srab.dk|dead-url=yes|archive-url=https://web.archive.org/web/20150417182528/http://www.srab.dk/alternativ+behandling/hvad+er+alternativ+behandling-c7-/vifabs+definition|archive-date=17 April 2015}}</ref> | |||
| <ref name=Nuffield2>{{cite web |title= Research methods & information tools |url= http://www.nuffieldtrust.org.uk/our-work/research-methods-information-tools |work= Nuffield Trust website |publisher= The Nuffield Trust for Research and Policy Studies in Health Services |archive-url= https://web.archive.org/web/20130927122218/http://www.nuffieldtrust.org.uk/our-work/research-methods-information-tools |archive-date= 2013-09-27 |url-status= live |date= 2019-01-28 }}</ref> --> | |||
| <ref name=Offit2013>{{cite book |last= Offit |first= P. |author-link= Paul Offit |title= Do You Believe in Magic?: The Sense and Nonsense of Alternative Medicine |year= 2013 |publisher= HarperCollins |isbn= 978-0-06-222296-1}} Also published in the UK as {{cite book |title= Killing Us Softly: The Sense and Nonsense of Alternative Medicine |isbn= 978-0-00-749173-5|last1= Offit|first1= Dr Paul|year= 2013|publisher= HarperCollins Publishers}}</ref> | |||
| <ref name="QuackWatch_defund_NCCAM">{{cite web |last= Sampson |first= W.I. |url= http://www.quackwatch.org/01QuackeryRelatedTopics/nccam.html |title= Why the National Center for Complementary and Alternative Medicine (NCCAM) Should Be Defunded |publisher= QuackWatch |date= 2002-12-10 |accessdate= 2013-03-11 |archiveurl= https://web.archive.org/web/20130326020026/http://www.quackwatch.org/01QuackeryRelatedTopics/nccam.html |archivedate= 2013-03-26 |deadurl= no}}</ref> | |||
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| <ref name="Quackwatch_wary">{{cite news |first= S. |last= Barrett |title= Be Wary of "Alternative" Health Methods |url= http://www.quackwatch.org/01QuackeryRelatedTopics/altwary.html|authorlink= Stephen Barrett |publisher=]|date= 2004-02-10 |accessdate = 2008-03-03 |archiveurl= https://web.archive.org/web/20080509100851/http://www.quackwatch.org/01QuackeryRelatedTopics/altwary.html |archivedate= 2008-05-09 |deadurl= no}}</ref> | |||
| <ref name="OpsinaBond2007">{{cite book |year= 2007 |last1= Ospina |first1= MB |last2 =Bond |first2= K |last3= Karkhaneh |first3= M |last4= Tjosvold |first4= L |last5= Vandermeer |first5= B |last6= Liang |first6= Y |last7= Bialy |first7= L |last8= Hooton |first8= N |last9= Buscemi |first9= N |last10= Dryden |first10= DM |last11= Klassen |first11= TP |title= Meditation Practices for Health: State of the Research |volume= No. 155 |issue= AHRQ Pub. No. 07-E010 |series= Evidence Reports/Technology Assessments |url= http://archive.ahrq.gov/downloads/pub/evidence/pdf/meditation/medit.pdf |archive-url=https://ghostarchive.org/archive/20221009/http://archive.ahrq.gov/downloads/pub/evidence/pdf/meditation/medit.pdf |archive-date=2022-10-09 |url-status=live |location= Rockville, MD |publisher= ] (AHRQ): (Prepared by the University of Alberta Evidence-based Practice Center under Contract No. 290-02-0023)|display-authors= 1 }} at PubMed. {{cite journal | pmid = 17764203 | pmc=4780968 | issue=155 | title=Meditation practices for health: state of the research | year=2007 | vauthors=Ospina MB, Bond K, Karkhaneh M, Tjosvold L, Vandermeer B, Liang Y, Bialy L, Hooton N, Buscemi N, Dryden DM, Klassen TP | journal=Evid Rep Technol Assess (Full Rep) | pages=1–263 }}</ref> --> | |||
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| <ref name="Berman2010">{{Cite journal|last1=Berman |first1=B.M. |last2=Langevin |first2=H M. |last3=Witt |first3=C.M. |last4=Dubner |first4=R. |title=Acupuncture for chronic low back pain |doi=10.1056/NEJMct0806114 |journal=New England Journal of Medicine |volume=363 |issue=5 |pages=454–61 |year=2010 |pmid=20818865 |url=http://www.nejm.org/doi/full/10.1056/NEJMct0806114 |archiveurl=http://www.webcitation.org/60ZN1jBD9?url=http%3A%2F%2Fwww.nejm.org%2Fdoi%2Ffull%2F10.1056%2FNEJMct0806114 |archivedate=2011-07-30 |pmc= |ref=harv |deadurl=no |df= }}</ref> | |||
| <ref name="OpsinaBond2008">{{cite journal |pmid= 19123875 |year= 2008 |last1= Ospina |first1= MB |last2= Bond |first2= K |last3= Karkhaneh |first3= M |last4 =Buscemi |first4= N |last5= Dryden |first5= DM |last6= Barnes |first6= V |last7= Carlson |first7= LE |last8= Dusek |first8= JA |last9= Shannahoff-Khalsa |first9= D |title= Clinical trials of meditation practices in health care: Characteristics and quality |volume= 14 |issue= 10 |pages= 1199–1213 |doi= 10.1089/acm.2008.0307 |journal= Journal of Alternative and Complementary Medicine|display-authors= 1 }}</ref> --> | |||
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| <ref name="Holloway2003">{{cite news |url= http://www.guardian.co.uk/books/2003/feb/15/scienceandnature.highereducation1 |last= Holloway |first= R. |title= A callous view |newspaper= ] |accessdate= 2010-04-23| location= London |date= 2003-02-14 |department= Books |archiveurl= https://web.archive.org/web/20100411001657/http://www.guardian.co.uk/books/2003/feb/15/scienceandnature.highereducation1| archivedate= 2010-04-11| deadurl= no}}</ref> | |||
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| <ref name=Ernst2>{{cite journal |last= Ernst |first =E. |title= The ethics of complementary medicine |journal= Journal of Medical Ethics |year= 1996 |volume= 22 |pages= 197–8 |doi= 10.1136/jme.22.4.197 |pmid= 8863142 |issue= 4 |pmc= 1376996 |ref= harv}}</ref> | |||
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| <ref name=Vickers>{{cite journal |last1= Vickers |first1= A. |title= Alternative cancer cures: 'Unproven' or 'disproven'? |journal= CA – A Cancer Journal for Clinicians |volume= 54 |issue= 2 |pages= 110–118 |year= 2004 |pmid= 15061600 |doi= 10.3322/canjclin.54.2.110 |citeseerx= 10.1.1.521.2180 |s2cid= 35124492 }}</ref> | |||
| <ref name=Helmuth>{{cite web|last=Helmuth|first=Laura|url=http://www.slate.com/articles/health_and_science/science_of_longevity/2013/09/tim_minchin_s_storm_critique_of_alternative_medicine_and_defense_of_reason.html|title= The Best Critique of Alternative Medicine Ever: It's an Animated Video. And It's Hilarious|website=]|date= 11 September 2013|publisher=The Slate Group|access-date=4 June 2015}}</ref> | |||
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| <ref name=NCCIHSurvey>{{cite press release|title=According to a New Government Survey, 38 Percent of Adults and 12 Percent of Children Use Complementary and Alternative Medicine|url=http://nccih.nih.gov/news/2008/121008.htm|publisher=National Center for Complementary and Integrative Medicine|series=NIH News|location=Bethseda, Maryland|date=10 December 2008|accessdate=4 June 2015}}</ref> | |||
| <ref name=VIFAB_definition>{{cite web|url=http://www.srab.dk/alternativ+behandling/hvad+er+alternativ+behandling-c7-/vifabs+definition |archive-url=https://web.archive.org/web/20130924061206/http://www.srab.dk/alternativ%2Bbehandling/hvad%2Ber%2Balternativ%2Bbehandling-c7-/vifabs%2Bdefinition |archive-date=2013-09-24 |title=ViFABs definition af alternativ behandling |website=srab.dk }}</ref> --> | |||
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| <ref name=ACS>{{Cite web | publisher =] | date =1 Nov 2008 | url =http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/MindBodyandSpirit/naturopathic-medicine | title=Naturopathic Medicine|accessdate =20 Nov 2010|deadurl=yes|archiveurl=https://web.archive.org/web/20150403092521/http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/mindbodyandspirit/naturopathic-medicine|archivedate=3 April 2015 }}</ref> | |||
| <ref name=Wahlberg>{{Cite journal |last1=Wahlberg |first1=A |title=A quackery with a difference – New medical pluralism and the problem of 'dangerous practitioners' in the United Kingdom |journal=Social Science & Medicine |volume=65 |pages=2307–2316 |year=2007 |doi=10.1016/j.socscimed.2007.07.024 |pmid=17719708 |issue=11}}</ref> --> | |||
| <ref name= |
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| <ref name=Economist2011>{{cite news |magazine= ] |url= http://www.economist.com/node/18710090 |title= Alternative Medicine: Think yourself better |date= 2011-05-19 |pages= 83–4 |archiveurl= https://web.archive.org/web/20110522121254/http://www.economist.com/node/18710090 |archivedate= 2011-05-22 |deadurl= no}}</ref> | |||
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| <ref name=ATRAMM>{{cite journal |last= Sampson |first= W. |authorlink= Wallace Sampson | title = Antiscience Trends in the Rise of the "Alternative Medicine" Movement | journal = Annals of the New York Academy of Sciences | volume = 775 | pages = 188–197 | year = 1995 | pmid = 8678416 | pmc = | doi = 10.1111/j.1749-6632.1996.tb23138.x | issue=1}}</ref> | |||
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| }} | }} | ||
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| *{{cite book | |
* {{cite book |author1= Committee on the Use of Complementary and Alternative Medicine by the American Public for the Board on Health Promotion and Disease Prevention, ] |title= Complementary and Alternative Medicine in the United States |url= https://archive.org/details/complementaryalt00inst |year= 2005 |publisher= National Academy Press |location= Washington, D.C. |isbn= 978-0-309-09270-8 |ref= {{harvid|IOM Report|2005}} }} | ||
| * {{cite book |last= Gevitz |first= N. |author-link= Norman Gevitz |editor1-last= Bynum |editor1-first= W.F. |editor2-last= Porter |editor2-first= R.S. |title= Companion Encyclopedia of the History of Medicine |volume= 1 |chapter= Chapter 28: Unorthodox Medical Theories |year= 1997 |orig-date= 1993 |isbn= 978-0-415-16419-1 |publisher= Routledge |location= New York & London |editor2-link= Roy Porter }} | |||
| * {{cite book |authors= Committee on the Use of Complementary and Alternative Medicine by the American Public, Board on Health Promotion and Disease Prevention, ], ] |title= Complementary and Alternative Medicine in the United States |url= http://www.iom.edu/Reports/2005/Complementary-and-Alternative-Medicine-in-the-United-States.aspx |year= 2005 |publisher= National Academy Press |location= Washington, D.C. |isbn= 0309092701 |ref= {{harvid|IOM Report|2005}}}} | |||
| * {{cite book |title= The Homœopathic Medical Doctrine, or "Organon of the Healing Art" |url= https://archive.org/details/bub_gb_EnEFAAAAQAAJ |publisher= W.F. Wakeman |last= Hahnemann |first= S. |author-link= Samuel Hahnemann |year= 1833 |location= Dublin | translator=Devrient, C.H. |others=Annotated by Stratten, S.}} | |||
| * {{cite book |last= Gevitz |first= N. |authorlink= Norman Gevitz |editor1-last= Bynum |editor1-first= W.F. |editor2-last= Porter |editor2-first= R.S. |title= Companion Encyclopedia of the History of Medicine |volume= Vol. 1 |chapter= Chapter 28: Unorthodox Medical Theories |year= 1997 |origyear= 1993 |isbn= 9780415164191 |publisher= Routledge |location= New York & London |editor2-link= Roy Porter |ref=harv }} | |||
| * {{cite book|first1=Dennis L|last1=Kasper|first2=Anthony S.|last2=Fauci|first3=Stephen L.|last3=Hauser|first4=Dan L.|last4=Longo|first5=J. Larry|last5=Jameson|first6=Joseph|last6=Loscalzo|title=Harrison's Principles of Internal Medicine|publisher=McGraw Hill Education|year=2015|location=New York|isbn=978-0-07-180215-4|edition=19th|ref={{harvid|Harrison's Principles of Internal Medicine|2015}}}} | |||
| * {{cite book |title= The Homœopathic Medical Doctrine, or "Organon of the Healing Art" |publisher= W.F. Wakeman |last= Hahnemann |first= S. |authorlink= Samuel Hahnemann |year= 1833 |location= Dublin | others= Translation by Devrient, C.H. Annotated by Stratten, S.|ref=harv}} | |||
| * {{harvc |last=Kopelman|first=L.|chapter=The Role of Science in Assessing Conventional, Complementary, and Alternative Medicines|in=Callahan|year=2004|pp=}} | |||
| * {{cite book|first1=Dennis L|last1=Kasper|first2=Anthony S.|last2=Fauci|first3=Stephen L.|last3=Hauser|first4=Dan L.|last4=Longo|first5=J. Larry|last5=Jameson|first6=Joseph|last6=Loscalzo|title=Harrison's Principles of Internal Medicine|publisher=McGraw Hill Education|year=2015|location=New York|isbn=9780071802154|edition=19th|ref={{harvid|Harrison's Principles of Internal Medicine|2015}}}} | |||
| * {{cite book |title=Scientific Basis for Ayurvedic Therapies |first=Lakshmi Chandra|last= Mishra |publisher=CRC Press|location=Boca Raton|year=2004 |isbn=0-8493-1366- |
* {{cite book |title=Scientific Basis for Ayurvedic Therapies |first=Lakshmi Chandra|last= Mishra |publisher=CRC Press|location=Boca Raton|year=2004 |isbn=978-0-8493-1366-0}} | ||
| * {{cite book|last=O'Connor|first=Bonnie Blair|title=Healing Traditions: Alternative Medicine and the Health Professions|location=Philadelphia|publisher=University of Pennsylvania Press|year=1995|isbn= |
* {{cite book|last=O'Connor|first=Bonnie Blair|title=Healing Traditions: Alternative Medicine and the Health Professions|url=https://archive.org/details/healingtradition0000ocon|url-access=registration|location=Philadelphia|publisher=University of Pennsylvania Press|year=1995|isbn=978-0-8122-1398-0}} | ||
| * {{cite book |last= Ruggie |first= M.|title= Marginal to Mainstream: Alternative Medicine in America |
* {{cite book |last= Ruggie |first= M.|title= Marginal to Mainstream: Alternative Medicine in America |year= 2004 |publisher= Cambridge University Press |isbn=978-0-521-83429-2 }} | ||
| * {{cite book |last= Sagan |first= C. | |
* {{cite book |last= Sagan |first= C. |author-link= Carl Sagan |title= The Demon-Haunted World: Science As a Candle in the Dark |year= 1996 |publisher= Random House |location= New York |isbn= 978-0-394-53512-8 |title-link= The Demon-Haunted World }} | ||
| * {{cite book |last=Saks |first= M.|title= Orthodox and Alternative Medicine: Politics, Professionalization and Health Care |
* {{cite book |last=Saks |first= M.|title= Orthodox and Alternative Medicine: Politics, Professionalization and Health Care |year= 2003 |publisher= Sage Publications |isbn= 978-1-4462-6536-9 }} | ||
| * {{cite book |last= Sointu |first= E. |title= Theorizing Complementary and Alternative Medicines: Wellbeing, Self, Gender, Class |
* {{cite book |last= Sointu |first= E. |title= Theorizing Complementary and Alternative Medicines: Wellbeing, Self, Gender, Class |year= 2012 |publisher= Palgrave Macmillan |location= Basingstoke, England |isbn= 978-0-230-30931-9}} | ||
| * {{cite book | last = Taylor | first = Kim | title = Chinese Medicine in Early Communist China, 1945–63: a Medicine of Revolution | year = 2005 | isbn = 978-0-415-34512-5 |location=London and New York|series=Needham Research Institute Studies| publisher = RoutledgeCurzon}} | |||
| * {{cite book |title= Sixth Report: Complementary and Alternative Medicine |url= http://www.parliament.the-stationery-office.co.uk/pa/ld199900/ldselect/ldsctech/123/12301.htm |authors= Walton J., Sir, Science and Technology Committee, ], ] |year= 2000 |isbn= 9780104831007 |origyear= Session 1999-2000, HL 123 |location= London |publisher= The Stationery Office |ref= {{harvid|Sir Walton: Science and Technology Committee|2000}}}} | |||
| * {{cite book |title= Sixth Report: Complementary and Alternative Medicine |url= http://www.parliament.the-stationery-office.co.uk/pa/ld199900/ldselect/ldsctech/123/12301.htm |author1= Walton J. |year= 2000 |isbn= 978-0-10-483100-7 |orig-date= Session 1999–2000, HL 123 |location= London |publisher= The Stationery Office |ref= {{harvid|Sir Walton: Science and Technology Committee|2000}}}} | |||
| * {{cite book | last = Taylor | first = Kim | title = Chinese Medicine in Early Communist China, 1945–63: a Medicine of Revolution | year = 2005 | isbn = 0-415-34512-X |location=London and New York|series=Needham Research Institute Studies| publisher = RoutledgeCurzon|ref=harv }} | |||
| * {{cite journal |title= Development and classification of an operational definition of complementary and alternative medicine for the Cochrane Collaboration |last1= Wieland |first1= L.S. |last2= Manheimer |first2= E. |last3= Berman |first3= B.M. |journal= Alternative Therapies in Health and Medicine |year= 2011 |volume= 17 |issue= 2 |pages= 50–59 |pmid= 21717826 |pmc= 3196853 |ref={{harvid|Wieland et al.|2011}}|display-authors= 1 }} | |||
| * {{cite book |title= The Roots of Ayurveda: Selections from Sanskrit Medical Writings |editor-last=Wujastyk|editor-first= D.|others=Translated by D. Wujastyk|year= 2003 |location= London and New York |publisher= Penguin Books |isbn= 0140448241|ref=harv}} | |||
| * {{cite book |title= The Roots of Ayurveda: Selections from Sanskrit Medical Writings |editor-last=Wujastyk|editor-first= D.|others=Translated by D. Wujastyk|year= 2003 |location= London and New York |publisher= ] |isbn= 978-0-14-044824-5}} | |||
| * {{cite book |title= General Guidelines for Methodologies on Research and Evaluation of Traditional Medicine |url= http://whqlibdoc.who.int/hq/2000/WHO_EDM_TRM_2000.1.pdf |archive-url=https://ghostarchive.org/archive/20221009/http://whqlibdoc.who.int/hq/2000/WHO_EDM_TRM_2000.1.pdf |archive-date=2022-10-09 |url-status=live |volume= WHO/EDM/TRM/2001.1 |author= World Health Organization |author-mask=0 |year= 2000 |location= Geneva |publisher= World Health Organization (WHO) |quote= This document is not a formal publication of the WHO. The views expressed in documents by named authors are solely the responsibility of those authors. |ref= {{harvid|WHO|2000}}}} | |||
| * {{cite book |title= WHO Guidelines on Basic Training and Safety in Chiropractic |url=https://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf |archive-url=https://ghostarchive.org/archive/20221009/https://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf |archive-date=2022-10-09 |url-status=live |author= World Health Organization |author-mask=0 |year= 2005 |location= Geneva |publisher= WHO |isbn= 978-92-4-159371-7 |ref= {{harvid|WHO|2005}}}} | |||
| ==Further reading== | ==Further reading== | ||
| * {{cite book |last= Bausell |first= R.B |year= 2007 |title= Snake oil science: the truth about complementary and alternative medicine |publisher= Oxford University Press |isbn= 978-0-19-531368-0 |url= https://archive.org/details/isbn_9780195313680 }} | |||
| * {{cite journal |last1= Benedetti |first1= F. |last2= Maggi |first2= G. |last3= Lopiano |first3= L. |last4= Lanotte |first4= M. |last5= Rainero |first5= I. |last6= Vighetti |first6= S. |last7= Pollo |first7= A. |title= Open versus hidden medical treatments: The patient's knowledge about a therapy affects the therapy outcome |journal= Prevention & Treatment |year= 2003 |volume= 6 |issue= 1 |doi= 10.1037/1522-3736.6.1.61a |display-authors= 1 }} | |||
| * {{cite book |last= Bausell |first= R.B |year= 2007 |title= Snake oil science : the truth about complementary and alternative medicine |publisher= Oxford University Press |isbn= 9780195313680}} | |||
| * {{cite book |editor-last= ] |editor-first= J. |title= Snake Oil and Other Preoccupations |year= 2001 |isbn= 978-0-09-942833-6 |chapter= Foreword |first= R. |last= Dawkins |author-link= Richard Dawkins |publisher= Vintage |location= London |chapter-url-access= registration |chapter-url= https://archive.org/details/snakeoilotherpre0000diam }} Reprinted in {{harvnb|Dawkins|2003}}. | |||
| * {{cite journal |last1= Benedetti |first1= F. |last2= Maggi |first2= G. |last3= Lopiano |first3= L. |last4= Lanotte |first4= M. |last5= Rainero |first5= I. |last6= Vighetti |first6= S. |last7= Pollo |first7= A. |title= Open versus hidden medical treatments: The patient's knowledge about a therapy affects the therapy outcome |journal= Prevention & Treatment |year= 2003 |volume= 6 |issue= 1 |doi= 10.1037/1522-3736.6.1.61a |ref= harv|displayauthors= 1 }} | |||
| * {{cite journal |vauthors=Downing AM, Hunter DG | title = Validating clinical reasoning: A question of perspective, but whose perspective? | journal = Manual Therapy | volume = 8 | issue = 2 | pages = 117–119 | year = 2003 | pmid = 12890440 | doi = 10.1016/S1356-689X(02)00077-2 | url = http://eprints.uwe.ac.uk/493/ }} | |||
| * {{cite book |editor-last= ] |editor-first= J. |title= Snake Oil and Other Preoccupations |year= 2001 |isbn= 9780099428336 |chapter= Foreword |first= R. |last= Dawkins |authorlink= Richard Dawkins |publisher= Vintage |location= London}} Reprinted in {{harvnb|Dawkins|2003}}. | |||
| * {{cite journal | |
* {{cite journal | author = Eisenberg DM | title = Advising patients who seek alternative medical therapies | journal = Annals of Internal Medicine | volume = 127 | issue = 1 | pages = 61–69 | date = July 1997 | pmid = 9214254 | doi = 10.7326/0003-4819-127-1-199707010-00010 | s2cid = 23351104 }} | ||
| * {{cite journal | author = |
* {{cite journal | author = Gunn IP | title = A critique of Michael L. Millenson's book, ''Demanding Medical Excellence: Doctors and Accountability in the Information Age, and its Relevance to CRNAs and Nursing'' | journal = AANA Journal |issn=0094-6354 | volume = 66 | issue = 6 | pages = 575–582 | date = December 1998 | pmid = 10488264 }} | ||
| * {{cite book |last=Hand |first= W.D. |year=1980 |chapter=Folk Magical Medicine and Symbolism in the West |title=Magical Medicine |location=Berkeley |publisher=University of California Press |pages=305–319 |isbn= 978-0-520-04129-5 |oclc=6420468}} | |||
| * {{cite journal | author = Gunn IP | title = A critique of Michael L. Millenson's book, ''Demanding Medical Excellence: Doctors and Accountability in the Information Age, and its Relevance to CRNAs and Nursing'' | journal = AANA Journal |publisher=American Association of Nurse Anesthetists |issn=0094-6354 | volume = 66 | issue = 6 | pages = 575–82 | date = December 1998 | pmid = 10488264 | ref = harv }} | |||
| * {{cite book |last= |
* {{cite book |author-link= Ivan Illich |last= Illich |first= I. |title= Limits to Medicine: Medical Nemesis: The Expropriation of Health |publisher= Penguin |year= 1976 |isbn= 978-0-14-022009-4 |oclc= 4134656 |url= https://archive.org/details/limitstomedicine00illi }} | ||
| * {{cite book |author= Mayo Clinic |title= Mayo Clinic Book of Alternative Medicine: The New Approach to Using the Best of Natural Therapies and Conventional Medicine |location= Parsippany, New Jersey |publisher= ] Home Entertainment |year= 2007 |isbn= 978-1-933405-92-6 |author-link= Mayo Clinic |url-access= registration |url= https://archive.org/details/mayoclinicbookof0000unse }} | |||
| * {{cite book |authorlink= Ivan Illich |last= Illich |first= I. |title= Limits to Medicine: Medical Nemesis: The Expropriation of Health |publisher= Penguin |year= 1976 |isbn= 9780140220094 |oclc=4134656 }} | |||
| * {{cite book |last= Planer |first= F.E. |year= 1988 |title= Superstition |edition= Rev. |location= Buffalo, New York |publisher= Prometheus Books |isbn= 978-0-87975-494-5 |oclc= 18616238 |url-access= registration |url= https://archive.org/details/superstition0000plan }} | |||
| * {{cite book |author= ] |title= Mayo Clinic Book of Alternative Medicine: The New Approach to Using the Best of Natural Therapies and Conventional Medicine |location= Parsippany, New Jersey |publisher= ] Home Entertainment |year= 2007 |isbn= 9781933405926}} | |||
| * {{cite web |url= http://www.cwru.edu/med/epidbio/mphp439/Sources_of_Healthcare.htm |last= Rosenfeld |first= A. |title= Where Do Americans Go for Healthcare? |publisher= Case Western Reserve University |location= Cleveland, Ohio |year= c. 2000 |access-date= 2010-09-23 |archive-url= https://web.archive.org/web/20060509074143/http://www.cwru.edu/med/epidbio/mphp439/Sources_of_Healthcare.htm |archive-date= 2006-05-09 }} | |||
| * {{cite journal |first= P., Jr. |last= Stevens |date=November–December 2001 |title= Magical thinking in complementary and alternative medicine |work=] |url= http://www.csicop.org/si/show/magical_thinking_in_complementary_and_alternative_medicine |ref= harv }} | |||
| * {{cite journal|last1=Snyder|first1=Mariah|last2=Lindquist|first2=Ruth|title=Issues in Complementary Therapies: How We Got to Where We Are|journal=Online Journal of Issues in Nursing|date=May 2001|volume=6|issue=2|page=1|url=http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume62001/No2May01/ComplementaryTherapiesIssues.aspx|pmid=11469921|access-date=2017-01-18|archive-url=https://web.archive.org/web/20170203005253/http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume62001/No2May01/ComplementaryTherapiesIssues.aspx|archive-date=2017-02-03}} | |||
| * {{cite book |last= Planer |first= F.E. |year= 1988 |title= Superstition |edition= Rev. |location= Buffalo, New York |publisher= Prometheus Books |isbn= 9780879754945 |oclc= 18616238}} | |||
| * {{cite journal | first= P. Jr. |last= Stevens |date=November–December 2001 |title= Magical thinking in complementary and alternative medicine |journal=] |url= http://www.csicop.org/si/show/magical_thinking_in_complementary_and_alternative_medicine }} | |||
| * {{cite web |url= http://www.cwru.edu/med/epidbio/mphp439/Sources_of_Healthcare.htm |last= Rosenfeld |first= A. |title= Where Do Americans Go for Healthcare? |publisher=Case Western Reserve University |location= Cleveland, Ohio |year= c. 2000 |accessdate= 2010-09-23}} | |||
| * {{cite journal | author = Tonelli MR | title = The limits of evidence-based medicine | journal = Respiratory Care | volume = 46 | issue = 12 | pages = 1435–1440; discussion 1440–1441 | year = 2001 | pmid = 11728302 }} | |||
| * {{cite book |last= Singh |first= S. |authorlink= Simon Singh |first2= E. |last2= Ernst |authorlink2= Edzard Ernst |year= 2008 |title= ] |isbn= 9780393066616 |oclc= 181139440 |publisher= W. W. Norton & Company}} via ]. | |||
| * {{cite book |last= Trivieri |first= L. Jr. |editor-last= Anderson |editor-first= J.W. |title= Alternative Medicine: The Definitive Guide |location= Berkeley |publisher= Ten Speed Press |year= 2002 |isbn= 978-1-58761-141-4 |url-access= registration |url= https://archive.org/details/isbn_9781587611414_0 }} | |||
| * {{cite journal | author = Tonelli MR | title = The limits of evidence-based medicine | journal = Respiratory Care | volume = 46 | issue = 12 | pages = 1435–40; discussion 1440–1 | year = 2001 | pmid = 11728302 | ref = harv }} | |||
| * {{cite book | |
* {{cite book |last1= Wisneski |first1= L.A. |last2= Anderson |first2= L. |title= The scientific basis of integrative medicine |publisher= CRC Press |year= 2005 |isbn= 978-0-8493-2081-1 |display-authors= 1 }} | ||
| * {{cite journal |last= Zalewski |first= Z. |title= Importance of philosophy of science to the history of medical thinking |journal= ] |year= 1999 |volume= 40 |issue= 1 |pages= 8–13 |url= http://www.bsb.mefst.hr/cmj/1999/4001/400102.htm |archive-url= https://web.archive.org/web/20040206092548/http://www.bsb.mefst.hr/cmj/1999/4001/400102.htm |archive-date= 2004-02-06 |pmid= 9933889 }} | |||
| * {{cite book |last= Wisneski |first= L.A. |last2= Anderson |first2= L. |title= The scientific basis of integrative medicine |publisher= CRC Press |year= 2005 |isbn= 9780849320811 |displayauthors= 1 }} | |||
| * {{cite journal |last= Zalewski |first= Z. |title= Importance of philosophy of science to the history of medical thinking |journal= ] |year= 1999 |volume= 40 |issue= 1 |pages= 8–13 |url= http://www.bsb.mefst.hr/cmj/1999/4001/400102.htm |archiveurl= https://web.archive.org/web/20040206092548/http://www.bsb.mefst.hr/cmj/1999/4001/400102.htm |archivedate= 2004-02-06 |ref= harv}} | |||
| ===World Health Organization=== | ===World Health Organization=== | ||
| * | |||
| * {{cite book |title= WHO Global Atlas of Traditional, Complementary and Alternative Medicine |last1= WHO Kobe Centre |last2= Bodeker |first2= G. |last3= Ong |first3= C.K. |last4= Grundy |first4= C. |last5= Burford |first5= G. |last6= Shein |first6= K. |year= 2005 |publisher= WHO |isbn= 978-92-4-156286-7|display-authors=2 }} | |||
| *{{cite book |title= General Guidelines for Methodologies on Research and Evaluation of Traditional Medicine |url= http://whqlibdoc.who.int/hq/2000/WHO_EDM_TRM_2000.1.pdf |volume= WHO/EDM/TRM/2001.1 |author= World Health Organization |authormask=0 |year= 2000 |location= Geneva |publisher= World Health Organization (WHO) |quote= This document is not a formal publication of the WHO. The views expressed in documents by named authors are solely the responsibility of those authors. |ref= {{harvid|WHO|2000}}}} | |||
| *{{cite book |title= WHO Guidelines on Basic Training and Safety in Chiropractic |url= http://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf |author= World Health Organization |authormask=0 |year= 2005 |location= Geneva |publisher= WHO |isbn= 9241593717 |ref= {{harvid|WHO|2005}}}} | |||
| *{{cite book |title= WHO Global Atlas of Traditional, Complementary and Alternative Medicine |last1= WHO Kobe Centre |last2= Bodeker |first2= G. |last3= Ong |first3= C.K. |last4= Grundy |first4= C. |last5= Burford |first5= G. |last6= Shein |first6= K. |year= 2005 |publisher= WHO |isbn= 9789241562867|displayauthors=2 }} | |||
| ===Journals=== | ===Journals=== | ||
| * . Sandpoint, Idaho : Thorne Research, c. 1996 NLM ID: 9705340 {{Webarchive|url=https://web.archive.org/web/20180612162326/https://locatorplus.gov/cgi-bin/Pwebrecon.cgi?DB=local&v2=1&ti=1,1&Search_Arg=9705340&Search_Code=0359&CNT=20&SID=1 |date=2018-06-12 }} | |||
| * Alternative Therapies in Health and Medicine. Aliso Viejo, California : InnoVision Communications, c1995- NLM ID: |
* Alternative Therapies in Health and Medicine. Aliso Viejo, California : InnoVision Communications, c1995- NLM ID: 9502013 {{Webarchive|url=https://web.archive.org/web/20180612163050/https://locatorplus.gov/cgi-bin/Pwebrecon.cgi?DB=local&v2=1&ti=1,1&Search_Arg=9502013&Search_Code=0359&CNT=20&SID=1 |date=2018-06-12 }} | ||
| * . |
* {{Webarchive|url=https://web.archive.org/web/20150924012324/http://www.biomedcentral.com/1472-6882 |date=2015-09-24 }}. London: BioMed Central, 2001 NLM ID: 101088661 {{Webarchive|url=https://web.archive.org/web/20180612162549/https://locatorplus.gov/cgi-bin/Pwebrecon.cgi?DB=local&v2=1&ti=1,1&Search_Arg=101088661&Search_Code=0359&CNT=20&SID=1 |date=2018-06-12 }} | ||
| * |
* Complementary Therapies in Medicine. Edinburgh; New York : Churchill Livingstone, c. 1993 NLM ID: 9308777 {{Webarchive|url=https://web.archive.org/web/20180612162156/https://locatorplus.gov/cgi-bin/Pwebrecon.cgi?DB=local&v2=1&ti=1,1&Search_Arg=9308777&Search_Code=0359&CNT=20&SID=1 |date=2018-06-12 }} | ||
| * Complementary |
* . New York: Hindawi, c. 2004 NLM ID: 101215021 {{Webarchive|url=https://web.archive.org/web/20180914013658/https://locatorplus.gov/cgi-bin/Pwebrecon.cgi?v1=1&ti=1,1&Search_Arg=Evidence%20Based%20Complementary%20and%20Alternative%20Medicine&Search_Code=TKEY&CNT=10&PID=fpUDGDBAnYWR-hE7tDjwdrxtvHm&SEQ=20130926044311&SID=2 |date=2018-09-14 }} | ||
| * . New York: Hindawi, c2004 NLM ID: | |||
| * | * | ||
| * | * New York : Mary Ann Liebert, c. 1995 | ||
| * {{Webarchive|url=https://web.archive.org/web/20100822070458/http://www.sram.org/index.html |date=2010-08-22 }} | |||
| * New York : Mary Ann Liebert, c1995 | |||
| * | |||
| ==External links== | ==External links== | ||
| {{sister project links|voy=no|n=no|species=no|mw=no|m=no|d=Q188504|v=Category:Complementary_and_alternative_medicine}} | |||
| {{ |
{{Library resources box |by=no |onlinebooks=no |others=yes lcheading=Alternative medicine}} | ||
| *{{DMOZ|Health/Alternative/}} | |||
| * : US ] | |||
| * : US ], National Institutes of Health | |||
| * : Denmark, the Ministry of the Interior and Health | |||
| *: from the ] | |||
| * : from the ] | |||
| * : Teaching modules from the ] Integrative Medicine Program | |||
| * : A BBC/Open University television series that examines the evidence scientifically | |||
| * : from the ] | |||
| * | |||
| * and : from ] and ] | |||
| * : from ] | |||
| ===Criticism=== | |||
| * – ], Maryland | |||
| * – ] | |||
| * – ] (See also: ])<!--- DO NOT REMOVE! DOCUMENTATION FOR QUACKWATCH AS A RELIABLE SOURCE ABOUT CAM: Among many other sources listed on the Quackwatch article, the ] lists Quackwatch as one of ten reputable sources of information about Alternative and Complementary Therapies in their book "Cancer Medicine",<ref name=ACS> – ] {{Wayback|url=http://www.ncbi.nlm.nih.gov/books/bv.fcgi?indexed=google&rid=cmed6.table.18497|date =20090306160714}}</ref> and lists it as one of four sources for information about Alternative & Complementary Therapies in an article about on-line cancer information and support.<ref name=ACS_info> – ] {{Wayback|url=http://www.cancer.org/docroot/ESN/content/ESN_2_4X_Cancer_information_and_support_available_online.asp|date =20090211050220 }}</ref> It also uses Quackwatch as a reference in a long series of articles on many forms of alternative medicine.<ref name=ACS_altmed_series> on many forms of alternative medicine on the ] website that use Quackwatch as a source.</ref> --> | |||
| * {{cite journal |title= Review - ''Healing, Hype, or Harm? A Critical Analysis of Complementary or Alternative Medicine'', by Edzard Ernst (Editor) |url= http://metapsychology.mentalhelp.net/poc/view_doc.php?type=book&id=4690&cn=452 |journal= Metapsychology online reviews |volume= 13 |issue= 5 |last= Purday |first= K.M. |date= 2009-01-27 |ref= harv}} | |||
| * Website created by Tim Farley listing cases of people harmed by various alternative treatments | |||
| * A video investigation of state-supported quackery at the National Institutes of Health. – ] | |||
| {{Alternative medicine}} | {{Alternative medicine}} | ||
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Latest revision as of 08:07, 8 December 2024
Form of non-scientific healing
| Alternative medicine | |
|---|---|
| AM, complementary and alternative medicine (CAM), complementary medicine, heterodox medicine, integrative medicine (IM), complementary and integrative medicine (CIM), new-age medicine, pseudomedicine, unconventional medicine, unorthodox medicine, altmed | |
| Claims | Alternatives to science-based medicine |
Alternative medicine is any practice that aims to achieve the healing effects of medicine despite lacking biological plausibility, testability, repeatability or evidence of effectiveness. Unlike modern medicine, which employs the scientific method to test plausible therapies by way of responsible and ethical clinical trials, producing repeatable evidence of either effect or of no effect, alternative therapies reside outside of mainstream medicine and do not originate from using the scientific method, but instead rely on testimonials, anecdotes, religion, tradition, superstition, belief in supernatural "energies", pseudoscience, errors in reasoning, propaganda, fraud, or other unscientific sources. Frequently used terms for relevant practices are New Age medicine, pseudo-medicine, unorthodox medicine, holistic medicine, fringe medicine, and unconventional medicine, with little distinction from quackery.
Some alternative practices are based on theories that contradict the established science of how the human body works; others appeal to the supernatural or superstitious to explain their effect or lack thereof. In others, the practice has plausibility but lacks a positive risk–benefit outcome probability. Research into alternative therapies often fails to follow proper research protocols (such as placebo-controlled trials, blind experiments and calculation of prior probability), providing invalid results. History has shown that if a method is proven to work, it eventually ceases to be alternative and becomes mainstream medicine.
Much of the perceived effect of an alternative practice arises from a belief that it will be effective, the placebo effect, or from the treated condition resolving on its own (the natural course of disease). This is further exacerbated by the tendency to turn to alternative therapies upon the failure of medicine, at which point the condition will be at its worst and most likely to spontaneously improve. In the absence of this bias, especially for diseases that are not expected to get better by themselves such as cancer or HIV infection, multiple studies have shown significantly worse outcomes if patients turn to alternative therapies. While this may be because these patients avoid effective treatment, some alternative therapies are actively harmful (e.g. cyanide poisoning from amygdalin, or the intentional ingestion of hydrogen peroxide) or actively interfere with effective treatments.
The alternative medicine sector is a highly profitable industry with a strong lobby, and faces far less regulation over the use and marketing of unproven treatments. Complementary medicine (CM), complementary and alternative medicine (CAM), integrated medicine or integrative medicine (IM), and holistic medicine attempt to combine alternative practices with those of mainstream medicine. Traditional medicine practices become "alternative" when used outside their original settings and without proper scientific explanation and evidence. Alternative methods are often marketed as more "natural" or "holistic" than methods offered by medical science, that is sometimes derogatorily called "Big Pharma" by supporters of alternative medicine. Billions of dollars have been spent studying alternative medicine, with few or no positive results and many methods thoroughly disproven.
Definitions and terminology
See also: Terminology of alternative medicine
The terms alternative medicine, complementary medicine, integrative medicine, holistic medicine, natural medicine, unorthodox medicine, fringe medicine, unconventional medicine, and new age medicine are used interchangeably as having the same meaning and are almost synonymous in most contexts. Terminology has shifted over time, reflecting the preferred branding of practitioners. For example, the United States National Institutes of Health department studying alternative medicine, currently named the National Center for Complementary and Integrative Health (NCCIH), was established as the Office of Alternative Medicine (OAM) and was renamed the National Center for Complementary and Alternative Medicine (NCCAM) before obtaining its current name. Therapies are often framed as "natural" or "holistic", implicitly and intentionally suggesting that conventional medicine is "artificial" and "narrow in scope".
The meaning of the term "alternative" in the expression "alternative medicine", is not that it is an effective alternative to medical science (though some alternative medicine promoters may use the loose terminology to give the appearance of effectiveness). Loose terminology may also be used to suggest meaning that a dichotomy exists when it does not (e.g., the use of the expressions "Western medicine" and "Eastern medicine" to suggest that the difference is a cultural difference between the Asian east and the European west, rather than that the difference is between evidence-based medicine and treatments that do not work).
Alternative medicine
Alternative medicine is defined loosely as a set of products, practices, and theories that are believed or perceived by their users to have the healing effects of medicine, but whose effectiveness has not been established using scientific methods, or whose theory and practice is not part of biomedicine, or whose theories or practices are directly contradicted by scientific evidence or scientific principles used in biomedicine. "Biomedicine" or "medicine" is that part of medical science that applies principles of biology, physiology, molecular biology, biophysics, and other natural sciences to clinical practice, using scientific methods to establish the effectiveness of that practice. Unlike medicine, an alternative product or practice does not originate from using scientific methods, but may instead be based on hearsay, religion, tradition, superstition, belief in supernatural energies, pseudoscience, errors in reasoning, propaganda, fraud, or other unscientific sources.
Some other definitions seek to specify alternative medicine in terms of its social and political marginality to mainstream healthcare. This can refer to the lack of support that alternative therapies receive from medical scientists regarding access to research funding, sympathetic coverage in the medical press, or inclusion in the standard medical curriculum. For example, a widely used definition devised by the US NCCIH calls it "a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine". However, these descriptive definitions are inadequate in the present-day when some conventional doctors offer alternative medical treatments and introductory courses or modules can be offered as part of standard undergraduate medical training; alternative medicine is taught in more than half of US medical schools and US health insurers are increasingly willing to provide reimbursement for alternative therapies.
Complementary or integrative medicine
Complementary medicine (CM) or integrative medicine (IM) is when alternative medicine is used together with mainstream functional medical treatment in a belief that it improves the effect of treatments. For example, acupuncture (piercing the body with needles to influence the flow of a supernatural energy) might be believed to increase the effectiveness or "complement" science-based medicine when used at the same time. Significant drug interactions caused by alternative therapies may make treatments less effective, notably in cancer therapy.
Several medical organizations differentiate between complementary and alternative medicine including the UK National Health Service (NHS), Cancer Research UK, and the US Center for Disease Control and Prevention (CDC), the latter of which states that "Complementary medicine is used in addition to standard treatments" whereas "Alternative medicine is used instead of standard treatments."
Complementary and integrative interventions are used to improve fatigue in adult cancer patients.
David Gorski has described integrative medicine as an attempt to bring pseudoscience into academic science-based medicine with skeptics such as Gorski and David Colquhoun referring to this with the pejorative term "quackademia". Robert Todd Carroll described Integrative medicine as "a synonym for 'alternative' medicine that, at its worst, integrates sense with nonsense. At its best, integrative medicine supports both consensus treatments of science-based medicine and treatments that the science, while promising perhaps, does not justify" Rose Shapiro has criticized the field of alternative medicine for rebranding the same practices as integrative medicine.
CAM is an abbreviation of the phrase complementary and alternative medicine. The 2019 World Health Organization (WHO) Global Report on Traditional and Complementary Medicine states that the terms complementary and alternative medicine "refer to a broad set of health care practices that are not part of that country's own traditional or conventional medicine and are not fully integrated into the dominant health care system. They are used interchangeably with traditional medicine in some countries."
The Integrative Medicine Exam by the American Board of Physician Specialties includes the following subjects: Manual Therapies, Biofield Therapies, Acupuncture, Movement Therapies, Expressive Arts, Traditional Chinese Medicine, Ayurveda, Indigenous Medical Systems, Homeopathic Medicine, Naturopathic Medicine, Osteopathic Medicine, Chiropractic, and Functional Medicine.
Other terms
See also: Traditional medicineTraditional medicine (TM) refers to certain practices within a culture which have existed since before the advent of medical science, Many TM practices are based on "holistic" approaches to disease and health, versus the scientific evidence-based methods in conventional medicine. The 2019 WHO report defines traditional medicine as "the sum total of the knowledge, skill and practices based on the theories, beliefs and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness." When used outside the original setting and in the absence of scientific evidence, TM practices are typically referred to as "alternative medicine".
Holistic medicine is another rebranding of alternative medicine. In this case, the words balance and holism are often used alongside complementary or integrative, claiming to take into fuller account the "whole" person, in contrast to the supposed reductionism of medicine.
Challenges in defining alternative medicine
Prominent members of the science and biomedical science community say that it is not meaningful to define an alternative medicine that is separate from a conventional medicine because the expressions "conventional medicine", "alternative medicine", "complementary medicine", "integrative medicine", and "holistic medicine" do not refer to any medicine at all. Others say that alternative medicine cannot be precisely defined because of the diversity of theories and practices it includes, and because the boundaries between alternative and conventional medicine overlap, are porous, and change. Healthcare practices categorized as alternative may differ in their historical origin, theoretical basis, diagnostic technique, therapeutic practice and in their relationship to the medical mainstream. Under a definition of alternative medicine as "non-mainstream", treatments considered alternative in one location may be considered conventional in another.
Critics say the expression is deceptive because it implies there is an effective alternative to science-based medicine, and that complementary is deceptive because it implies that the treatment increases the effectiveness of (complements) science-based medicine, while alternative medicines that have been tested nearly always have no measurable positive effect compared to a placebo. Journalist John Diamond wrote that "there is really no such thing as alternative medicine, just medicine that works and medicine that doesn't", a notion later echoed by Paul Offit: "The truth is there's no such thing as conventional or alternative or complementary or integrative or holistic medicine. There's only medicine that works and medicine that doesn't. And the best way to sort it out is by carefully evaluating scientific studies—not by visiting Internet chat rooms, reading magazine articles, or talking to friends."
Types
See also: List of forms of alternative medicineAlternative medicine consists of a wide range of health care practices, products, and therapies. The shared feature is a claim to heal that is not based on the scientific method. Alternative medicine practices are diverse in their foundations and methodologies. Alternative medicine practices may be classified by their cultural origins or by the types of beliefs upon which they are based. Methods may incorporate or be based on traditional medicinal practices of a particular culture, folk knowledge, superstition, spiritual beliefs, belief in supernatural energies (antiscience), pseudoscience, errors in reasoning, propaganda, fraud, new or different concepts of health and disease, and any bases other than being proven by scientific methods. Different cultures may have their own unique traditional or belief based practices developed recently or over thousands of years, and specific practices or entire systems of practices.
Unscientific belief systems
Alternative medicine, such as using naturopathy or homeopathy in place of conventional medicine, is based on belief systems not grounded in science.
| Proposed mechanism | Issues | |
|---|---|---|
| Naturopathy | Naturopathic medicine is based on a belief that the body heals itself using a supernatural vital energy that guides bodily processes. | In conflict with the paradigm of evidence-based medicine. Many naturopaths have opposed vaccination, and "scientific evidence does not support claims that naturopathic medicine can cure cancer or any other disease". |
| Homeopathy | A belief that a substance that causes the symptoms of a disease in healthy people cures similar symptoms in sick people. | Developed before knowledge of atoms and molecules, or of basic chemistry, which shows that repeated dilution as practiced in homeopathy produces only water, and that homeopathy is not scientifically valid. |
Traditional ethnic systems
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Alternative medical systems may be based on traditional medicine practices, such as traditional Chinese medicine (TCM), Ayurveda in India, or practices of other cultures around the world. Some useful applications of traditional medicines have been researched and accepted within ordinary medicine, however the underlying belief systems are seldom scientific and are not accepted.
Traditional medicine is considered alternative when it is used outside its home region; or when it is used together with or instead of known functional treatment; or when it can be reasonably expected that the patient or practitioner knows or should know that it will not work – such as knowing that the practice is based on superstition.
| Claims | Issues | |
|---|---|---|
| Traditional Chinese medicine | Traditional practices and beliefs from China, together with modifications made by the Communist party make up TCM. Common practices include herbal medicine, acupuncture (insertion of needles in the body at specified points), massage (Tui na), exercise (qigong), and dietary therapy. | The practices are based on belief in a supernatural energy called qi, considerations of Chinese astrology and Chinese numerology, traditional use of herbs and other substances found in China, a belief that the tongue contains a map of the body that reflects changes in the body, and an incorrect model of the anatomy and physiology of internal organs. |
| Ayurveda | Traditional medicine of India. Ayurveda believes in the existence of three elemental substances, the doshas (called Vata, Pitta and Kapha), and states that a balance of the doshas results in health, while imbalance results in disease. Such disease-inducing imbalances can be adjusted and balanced using traditional herbs, minerals and heavy metals. Ayurveda stresses the use of plant-based medicines and treatments, with some animal products, and added minerals, including sulfur, arsenic, lead and copper(II) sulfate. | Safety concerns have been raised about Ayurveda, with two U.S. studies finding about 20 percent of Ayurvedic Indian-manufactured patent medicines contained toxic levels of heavy metals such as lead, mercury and arsenic. A 2015 study of users in the United States also found elevated blood lead levels in 40 percent of those tested. Other concerns include the use of herbs containing toxic compounds and the lack of quality control in Ayurvedic facilities. Incidents of heavy metal poisoning have been attributed to the use of these compounds in the United States. |
Supernatural energies
Bases of belief may include belief in existence of supernatural energies undetected by the science of physics, as in biofields, or in belief in properties of the energies of physics that are inconsistent with the laws of physics, as in energy medicine.
| Claims | Issues | |
|---|---|---|
| Biofield therapy | Intended to influence energy fields that, it is purported, surround and penetrate the body. | Advocates of scientific skepticism such as Carl Sagan have criticized the lack of empirical evidence to support the existence of the putative energy fields on which these therapies are predicated. |
| Bioelectromagnetic therapy | Use verifiable electromagnetic fields, such as pulsed fields, alternating-current, or direct-current fields in an unconventional manner. | Asserts that magnets can be used to defy the laws of physics to influence health and disease. |
| Chiropractic | Spinal manipulation aims to treat "vertebral subluxations" which are claimed to put pressure on nerves. | Chiropractic was based on the belief that manipulating the spine unblocks the flow of a supernatural vital energy called Innate Intelligence, thereby affecting health and disease. Vertebral subluxation is a pseudoscientific entity not proven to exist. |
| Reiki | Practitioners place their palms on the patient near Chakras that they believe are centers of supernatural energies in the belief that these supernatural energies can transfer from the practitioner's palms to heal the patient. | Lacks credible scientific evidence. |
Herbal remedies and other substances
Main article: Herbal medicineSubstance based practices use substances found in nature such as herbs, foods, non-vitamin supplements and megavitamins, animal and fungal products, and minerals, including use of these products in traditional medical practices that may also incorporate other methods. Examples include healing claims for non-vitamin supplements, fish oil, Omega-3 fatty acid, glucosamine, echinacea, flaxseed oil, and ginseng. Herbal medicine, or phytotherapy, includes not just the use of plant products, but may also include the use of animal and mineral products. It is among the most commercially successful branches of alternative medicine, and includes the tablets, powders and elixirs that are sold as "nutritional supplements". Only a very small percentage of these have been shown to have any efficacy, and there is little regulation as to standards and safety of their contents.
Religion, faith healing, and prayer
See also: Shamanism| Claims | Issues | |
|---|---|---|
| Christian faith healing | There is a divine or spiritual intervention in healing. | Lack of evidence for effectiveness. Unwanted outcomes, such as death and disability, "have occurred when faith healing was elected instead of medical care for serious injuries or illnesses". A 2001 double-blind study of 799 discharged coronary surgery patients found that "intercessory prayer had no significant effect on medical outcomes after hospitalization in a coronary care unit." |
NCCIH classification
The United States agency National Center for Complementary and Integrative Health (NCCIH) has created a classification system for branches of complementary and alternative medicine that divides them into five major groups. These groups have some overlap, and distinguish two types of energy medicine: veritable which involves scientifically observable energy (including magnet therapy, colorpuncture and light therapy) and putative, which invokes physically undetectable or unverifiable energy. None of these energies have any evidence to support that they affect the body in any positive or health promoting way.
- Whole medical systems: Cut across more than one of the other groups; examples include traditional Chinese medicine, naturopathy, homeopathy, and ayurveda.
- Mind-body interventions: Explore the interconnection between the mind, body, and spirit, under the premise that they affect "bodily functions and symptoms". A connection between mind and body is conventional medical fact, and this classification does not include therapies with proven function such as cognitive behavioral therapy.
- "Biology"-based practices: Use substances found in nature such as herbs, foods, vitamins, and other natural substances. (As used here, "biology" does not refer to the science of biology, but is a usage newly coined by NCCIH in the primary source used for this article. "Biology-based" as coined by NCCIH may refer to chemicals from a nonbiological source, such as use of the poison lead in traditional Chinese medicine, and to other nonbiological substances.)
- Manipulative and body-based practices: feature manipulation or movement of body parts, such as is done in bodywork, chiropractic, and osteopathic manipulation.
- Energy medicine: is a domain that deals with putative and verifiable energy fields:
- Biofield therapies are intended to influence energy fields that are purported to surround and penetrate the body. The existence of such energy fields have been disproven.
- Bioelectromagnetic-based therapies use verifiable electromagnetic fields, such as pulsed fields, alternating-current, or direct-current fields in a non-scientific manner.
History
Main article: History of alternative medicineThe history of alternative medicine may refer to the history of a group of diverse medical practices that were collectively promoted as "alternative medicine" beginning in the 1970s, to the collection of individual histories of members of that group, or to the history of western medical practices that were labeled "irregular practices" by the western medical establishment. It includes the histories of complementary medicine and of integrative medicine. Before the 1970s, western practitioners that were not part of the increasingly science-based medical establishment were referred to "irregular practitioners", and were dismissed by the medical establishment as unscientific and as practicing quackery. Until the 1970s, irregular practice became increasingly marginalized as quackery and fraud, as western medicine increasingly incorporated scientific methods and discoveries, and had a corresponding increase in success of its treatments. In the 1970s, irregular practices were grouped with traditional practices of nonwestern cultures and with other unproven or disproven practices that were not part of biomedicine, with the entire group collectively marketed and promoted under the single expression "alternative medicine".
Use of alternative medicine in the west began to rise following the counterculture movement of the 1960s, as part of the rising new age movement of the 1970s. This was due to misleading mass marketing of "alternative medicine" being an effective "alternative" to biomedicine, changing social attitudes about not using chemicals and challenging the establishment and authority of any kind, sensitivity to giving equal measure to beliefs and practices of other cultures (cultural relativism), and growing frustration and desperation by patients about limitations and side effects of science-based medicine. At the same time, in 1975, the American Medical Association, which played the central role in fighting quackery in the United States, abolished its quackery committee and closed down its Department of Investigation. By the early to mid 1970s the expression "alternative medicine" came into widespread use, and the expression became mass marketed as a collection of "natural" and effective treatment "alternatives" to science-based biomedicine. By 1983, mass marketing of "alternative medicine" was so pervasive that the British Medical Journal (BMJ) pointed to "an apparently endless stream of books, articles, and radio and television programmes urge on the public the virtues of (alternative medicine) treatments ranging from meditation to drilling a hole in the skull to let in more oxygen".
An analysis of trends in the criticism of complementary and alternative medicine (CAM) in five prestigious American medical journals during the period of reorganization within medicine (1965–1999) was reported as showing that the medical profession had responded to the growth of CAM in three phases, and that in each phase, changes in the medical marketplace had influenced the type of response in the journals. Changes included relaxed medical licensing, the development of managed care, rising consumerism, and the establishment of the USA Office of Alternative Medicine (later National Center for Complementary and Alternative Medicine, currently National Center for Complementary and Integrative Health).
Medical education
Mainly as a result of reforms following the Flexner Report of 1910 medical education in established medical schools in the US has generally not included alternative medicine as a teaching topic. Typically, their teaching is based on current practice and scientific knowledge about: anatomy, physiology, histology, embryology, neuroanatomy, pathology, pharmacology, microbiology and immunology. Medical schools' teaching includes such topics as doctor-patient communication, ethics, the art of medicine, and engaging in complex clinical reasoning (medical decision-making). Writing in 2002, Snyderman and Weil remarked that by the early twentieth century the Flexner model had helped to create the 20th-century academic health center, in which education, research, and practice were inseparable. While this had much improved medical practice by defining with increasing certainty the pathophysiological basis of disease, a single-minded focus on the pathophysiological had diverted much of mainstream American medicine from clinical conditions that were not well understood in mechanistic terms, and were not effectively treated by conventional therapies.
By 2001 some form of CAM training was being offered by at least 75 out of 125 medical schools in the US. Exceptionally, the School of Medicine of the University of Maryland, Baltimore, includes a research institute for integrative medicine (a member entity of the Cochrane Collaboration). Medical schools are responsible for conferring medical degrees, but a physician typically may not legally practice medicine until licensed by the local government authority. Licensed physicians in the US who have attended one of the established medical schools there have usually graduated Doctor of Medicine (MD). All states require that applicants for MD licensure be graduates of an approved medical school and complete the United States Medical Licensing Examination (USMLE).
Efficacy
There is a general scientific consensus that alternative therapies lack the requisite scientific validation, and their effectiveness is either unproved or disproved. Many of the claims regarding the efficacy of alternative medicines are controversial, since research on them is frequently of low quality and methodologically flawed. Selective publication bias, marked differences in product quality and standardisation, and some companies making unsubstantiated claims call into question the claims of efficacy of isolated examples where there is evidence for alternative therapies.
The Scientific Review of Alternative Medicine points to confusions in the general population – a person may attribute symptomatic relief to an otherwise-ineffective therapy just because they are taking something (the placebo effect); the natural recovery from or the cyclical nature of an illness (the regression fallacy) gets misattributed to an alternative medicine being taken; a person not diagnosed with science-based medicine may never originally have had a true illness diagnosed as an alternative disease category.
Edzard Ernst, the first university professor of Complementary and Alternative Medicine, characterized the evidence for many alternative techniques as weak, nonexistent, or negative and in 2011 published his estimate that about 7.4% were based on "sound evidence", although he believes that may be an overestimate. Ernst has concluded that 95% of the alternative therapies he and his team studied, including acupuncture, herbal medicine, homeopathy, and reflexology, are "statistically indistinguishable from placebo treatments", but he also believes there is something that conventional doctors can usefully learn from the chiropractors and homeopath: this is the therapeutic value of the placebo effect, one of the strangest phenomena in medicine.
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. According to a 2005 book by a US Institute of Medicine panel, the number of RCTs focused on CAM has risen dramatically.
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%), 4.8% concluded no effect, 0.7% 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 more developed 2004 Cochrane database, while the conventional review used the initial 1998 Cochrane database.
Alternative therapies do not "complement" (improve the effect of, or mitigate the side effects of) functional medical treatment. Significant drug interactions caused by alternative therapies may instead negatively impact functional treatment by making prescription drugs less effective, such as interference by herbal preparations with warfarin.
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.
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. The label "unproven" is inappropriate for such therapies; it is time to assert that many alternative cancer therapies have been "disproven".
Perceived mechanism of effect
Anything classified as alternative medicine by definition does not have a proven healing or medical effect. However, there are different mechanisms through which it can be perceived to "work". The common denominator of these mechanisms is that effects are mis-attributed to the alternative treatment.
a) Misinterpreted natural course – the individual gets better without treatment.
b) Placebo effect or false treatment effect – an individual receives "alternative therapy" and is convinced it will help. The conviction makes them more likely to get better.
c) Nocebo effect – an individual is convinced that standard treatment will not work, and that alternative therapies will work. This decreases the likelihood standard treatment will work, while the placebo effect of the "alternative" remains.
d) No adverse effects – Standard treatment is replaced with "alternative" treatment, getting rid of adverse effects, but also of improvement.
e) Interference – Standard treatment is "complemented" with something that interferes with its effect. This can both cause worse effect, but also decreased (or even increased) side effects, which may be interpreted as "helping". Researchers, such as epidemiologists, clinical statisticians and pharmacologists, use clinical trials to reveal such effects, allowing physicians to offer a therapeutic solution best known to work. "Alternative treatments" often refuse to use trials or make it deliberately hard to do so.
Placebo effect
A placebo is a treatment with no intended therapeutic value. An example of a placebo is an inert pill, but it can include more dramatic interventions like sham surgery. The placebo effect is the concept that patients will perceive an improvement after being treated with an inert treatment. The opposite of the placebo effect is the nocebo effect, when patients who expect a treatment to be harmful will perceive harmful effects after taking it.
Placebos do not have a physical effect on diseases or improve overall outcomes, but patients may report improvements in subjective outcomes such as pain and nausea. A 1955 study suggested that a substantial part of a medicine's impact was due to the placebo effect. However, reassessments found the study to have flawed methodology. This and other modern reviews suggest that other factors like natural recovery and reporting bias should also be considered.
All of these are reasons why alternative therapies may be credited for improving a patient's condition even though the objective effect is non-existent, or even harmful. David Gorski argues that alternative treatments should be treated as a placebo, rather than as medicine. Almost none have performed significantly better than a placebo in clinical trials. Furthermore, distrust of conventional medicine may lead to patients experiencing the nocebo effect when taking effective medication.
Regression to the mean
A patient who receives an inert treatment may report improvements afterwards that it did not cause. Assuming it was the cause without evidence is an example of the regression fallacy. This may be due to a natural recovery from the illness, or a fluctuation in the symptoms of a long-term condition. The concept of regression toward the mean implies that an extreme result is more likely to be followed by a less extreme result.
Other factors
There are also reasons why a placebo treatment group may outperform a "no-treatment" group in a test which are not related to a patient's experience. These include patients reporting more favourable results than they really felt due to politeness or "experimental subordination", observer bias, and misleading wording of questions. In their 2010 systematic review of studies into placebos, Asbjørn Hróbjartsson and Peter C. Gøtzsche write that "even if there were no true effect of placebo, one would expect to record differences between placebo and no-treatment groups due to bias associated with lack of blinding." Alternative therapies may also be credited for perceived improvement through decreased use or effect of medical treatment, and therefore either decreased side effects or nocebo effects towards standard treatment.
Use and regulation
Appeal
Practitioners of complementary medicine usually discuss and advise patients as to available alternative therapies. Patients often express interest in mind-body complementary therapies because they offer a non-drug approach to treating some health conditions.
In addition to the social-cultural underpinnings of the popularity of alternative medicine, there are several psychological issues that are critical to its growth, notably psychological effects, such as the will to believe, cognitive biases that help maintain self-esteem and promote harmonious social functioning, and the post hoc, ergo propter hoc fallacy.
In a 2018 interview with The BMJ, Edzard Ernst stated: "The present popularity of complementary and alternative medicine is also inviting criticism of what we are doing in mainstream medicine. It shows that we aren't fulfilling a certain need-we are not giving patients enough time, compassion, or empathy. These are things that complementary practitioners are very good at. Mainstream medicine could learn something from complementary medicine."
Marketing
Alternative medicine is a profitable industry with large media advertising expenditures. Accordingly, alternative practices are often portrayed positively and compared favorably to "big pharma".
The popularity of complementary & alternative medicine (CAM) may be related to other factors that Ernst mentioned in a 2008 interview in The Independent:
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.
Paul Offit proposed that "alternative medicine becomes quackery" in four ways: by recommending against conventional therapies that are helpful, promoting potentially harmful therapies without adequate warning, draining patients' bank accounts, or by promoting "magical thinking". Promoting alternative medicine has been called dangerous and unethical.
Social factors
Authors have speculated on the socio-cultural and psychological reasons for the appeal of alternative medicines among the 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. Related to this are vigorous marketing of extravagant claims by the alternative medical community combined with inadequate media scrutiny and attacks on critics. Alternative medicine is criticized for taking advantage of the least fortunate members of society.
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. 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. Medical doctors are also aggressively marketing alternative medicine to profit from this market.
Patients can 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. 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 therapies to avoid the adverse effects of conventional treatments.
Prevalence of use
According to research published in 2015, the increasing popularity of CAM needs to be explained by moral convictions or lifestyle choices rather than by economic reasoning.
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.
In Latin America, inequities against BIPOC communities keep them tied to their traditional practices and therefore, it is often these communities that constitute the majority of users of alternative medicine. Racist attitudes towards certain communities disable them from accessing more urbanized modes of care. In a study that assessed access to care in rural communities of Latin America, it was found that discrimination is a huge barrier to the ability of citizens to access care; more specifically, women of Indigenous and African descent, and lower-income families were especially hurt. Such exclusion exacerbates the inequities that minorities in Latin America already face. Consistently excluded from many systems of westernized care for socioeconomic and other reasons, low-income communities of color often turn to traditional medicine for care as it has proved reliable to them across generations.
Commentators including David Horrobin have proposed adopting a prize system to reward medical research. This stands in opposition to the current mechanism for funding research proposals in most countries around the world. In the US, the NCCIH provides public research funding for alternative medicine. The NCCIH has spent more than US$2.5 billion on such research since 1992 and this research has not demonstrated the efficacy of alternative therapies. As of 2011, the NCCIH's sister organization in the NIC Office of Cancer Complementary and Alternative Medicine had given out grants of around $105 million each year for several years. Testing alternative medicine that has no scientific basis (as in the aforementioned grants) has been called a waste of scarce research resources.
That alternative medicine has been on the rise "in countries where Western science and scientific method generally are accepted as the major foundations for healthcare, and 'evidence-based' practice is the dominant paradigm" was described as an "enigma" in the Medical Journal of Australia. A 15-year systematic review published in 2022 on the global acceptance and use of CAM among medical specialists found the overall acceptance of CAM at 52% and the overall use at 45%.
In the United States
In the United States, the 1974 Child Abuse Prevention and Treatment Act (CAPTA) required that for states to receive federal money, they had to grant religious exemptions to child neglect and abuse laws regarding religion-based healing practices. Thirty-one states have child-abuse religious exemptions.
The use of alternative medicine in the US has increased, with a 50 percent increase in expenditures and a 25 percent increase in the use of alternative therapies between 1990 and 1997 in America. According to a national survey conducted in 2002, "36 percent of U.S. adults aged 18 years and over use some form of complementary and alternative medicine." Americans spend many billions on the therapies annually. Most Americans used CAM to treat and/or prevent musculoskeletal conditions or other conditions associated with chronic or recurring pain. In America, women were more likely than men to use CAM, with the biggest difference in use of mind-body therapies including prayer specifically for health reasons". In 2008, more than 37% of American hospitals offered alternative therapies, up from 27 percent in 2005, and 25% in 2004. More than 70% of the hospitals offering CAM were in urban areas.
A survey of Americans found that 88 percent thought that "there are some good ways of treating sickness that medical science does not recognize". Use of magnets was the most common tool in energy medicine in America, and among users of it, 58 percent described it as at least "sort of scientific", when it is not at all scientific. In 2002, at least 60 percent of US medical schools have at least some class time spent teaching alternative therapies. "Therapeutic touch" was taught at more than 100 colleges and universities in 75 countries before the practice was debunked by a nine-year-old child for a school science project.
Prevalence of use of specific therapies
The most common CAM therapies used in the US in 2002 were prayer (45%), herbalism (19%), breathing meditation (12%), meditation (8%), chiropractic medicine (8%), yoga (5–6%), body work (5%), diet-based therapy (4%), progressive relaxation (3%), mega-vitamin therapy (3%) and visualization (2%).
In Britain, the most often used alternative therapies were Alexander technique, aromatherapy, Bach and other flower remedies, body work therapies including massage, Counseling stress therapies, hypnotherapy, meditation, reflexology, Shiatsu, Ayurvedic medicine, nutritional medicine, and yoga. Ayurvedic medicine remedies are mainly plant based with some use of animal materials. Safety concerns include the use of herbs containing toxic compounds and the lack of quality control in Ayurvedic facilities.
According to the National Health Service (England), the most commonly used complementary and alternative medicines (CAM) supported by the NHS in the UK are: acupuncture, aromatherapy, chiropractic, homeopathy, massage, osteopathy and clinical hypnotherapy.
In palliative care
Complementary therapies are often used in palliative care or by practitioners attempting to manage chronic pain in patients. Integrative 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." 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."
Regulation
Further information: Regulation of alternative medicine and Regulation and prevalence of homeopathy | This section needs expansion. You can help by making an edit requestadding to it . (May 2018) |
The alternative medicine lobby has successfully pushed for alternative therapies to be subject to far less regulation than conventional medicine. Some professions of complementary/traditional/alternative medicine, such as chiropractic, have achieved full regulation in North America and other parts of the world and are regulated in a manner similar to that governing science-based medicine. In contrast, other approaches may be partially recognized and others have no regulation at all. In some cases, promotion of alternative therapies is allowed when there is demonstrably no effect, only a tradition of use. Despite laws making it illegal to market or promote alternative therapies for use in cancer treatment, many practitioners promote them.
Regulation and licensing of alternative medicine ranges widely from country to country, and state to state. In Austria and Germany complementary and alternative medicine is mainly in the hands of doctors with MDs, and half or more of the American alternative practitioners are licensed MDs. In Germany herbs are tightly regulated: half are prescribed by doctors and covered by health insurance.
Government bodies in the US and elsewhere have published information or guidance about alternative medicine. The U.S. Food and Drug Administration (FDA), has issued online warnings for consumers about medication health fraud. This includes a section on Alternative Medicine Fraud, such as a warning that Ayurvedic products generally have not been approved by the FDA before marketing.
Risks and problems
The National Science Foundation has studied the problematic side of the public's attitudes and understandings of science fiction, pseudoscience, and belief in alternative medicine. They use a quote from Robert L. Park to describe some issues with alternative medicine:
Alternative medicine is another concern. As used here, alternative medicine refers to all treatments that have not been proven effective using scientific methods. A scientist's view of the situation appeared in a recent book (Park 2000b)":
Between homeopathy and herbal therapy lies a bewildering array of untested and unregulated treatments, all labeled alternative by their proponents. Alternative seems to define a culture rather than a field of medicine—a culture that is not scientifically demanding. It is a culture in which ancient traditions are given more weight than biological science, and anecdotes are preferred over clinical trials. Alternative therapies steadfastly resist change, often for centuries or even millennia, unaffected by scientific advances in the understanding of physiology or disease. Incredible explanations invoking modern physics are sometimes offered for how alternative therapies might work, but there seems to be little interest in testing these speculations scientifically.
Negative outcomes
See also: List of herbs with known adverse effectsAccording to the Institute of Medicine, use of alternative medical techniques may result in several types of harm:
- "Direct harm, which results in adverse patient outcome."
- "Economic harm, which results in monetary loss but presents no health hazard;"
- "Indirect harm, which results in a delay of appropriate treatment, or in unreasonable expectations that discourage patients and their families from accepting and dealing effectively with their medical conditions;"
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, and insulin potentiation therapy. Some herbal remedies can cause dangerous interactions with chemotherapy drugs, radiation therapy, or anesthetics during surgery, among other problems. An 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.
To ABC Online, MacLennan also gives another possible mechanism:
And lastly there's the cynicism and disappointment and depression that some patients get from going on from one alternative medicine to the next, and they find after three months the placebo effect wears off, and they're disappointed and they move on to the next one, and they're disappointed and disillusioned, and that can create depression and make the eventual treatment of the patient with anything effective difficult, because you may not get compliance, because they've seen the failure so often in the past.
Side-effects
Conventional treatments are subjected to testing for undesired side-effects, whereas alternative therapies, 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 therapies sometimes use the appeal to nature fallacy, i.e., "That which is natural cannot be harmful." Specific groups of patients such as patients with impaired hepatic or renal function are more susceptible to side effects of alternative remedies.
An exception to the normal thinking regarding side-effects is homeopathy. Since 1938, the FDA has regulated homeopathic products in "several significantly different ways from other drugs." 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.
Treatment delay
Alternative medicine may discourage people from getting the best possible treatment. 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. 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. 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.
Unconventional cancer "cures"
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.... The label 'unproven' is inappropriate for such therapies; it is time to assert that many alternative cancer therapies have been 'disproven'."
Edzard Ernst has stated:
any alternative cancer cure is bogus by definition. There will never be an alternative cancer cure. Why? Because if something looked halfway promising, then mainstream oncology would scrutinize it, and if there is anything to it, it would become mainstream almost automatically and very quickly. All curative "alternative cancer cures" are based on false claims, are bogus, and, I would say, even criminal.
Rejection of science
There is no alternative medicine. There is only scientifically proven,
evidence-based medicine supported by solid data
or unproven medicine, for which scientific evidence is lacking.
— P.B. Fontanarosa, JAMA (1998)
Complementary and alternative medicine (CAM) is not as well researched as conventional medicine, which undergoes intense research before release to the public. Practitioners of science-based medicine also discard practices and treatments when they are shown ineffective, while alternative practitioners do not. Funding for research is also sparse making it difficult to do further research for effectiveness of CAM. Most funding for CAM is funded by government agencies. Proposed research for CAM are rejected by most private funding agencies because the results of research are not reliable. The research for CAM has to meet certain standards from research ethics committees, which most CAM researchers find almost impossible to meet. Even with the little research done on it, CAM has not been proven to be effective. Studies that have been done will be cited by CAM practitioners in an attempt to claim a basis in science. These studies tend to have a variety of problems, such as small samples, various biases, poor research design, lack of controls, negative results, etc. Even those with positive results can be better explained as resulting in false positives due to bias and noisy data.
Alternative medicine may lead to a false understanding of the body and of the process of science. Steven Novella, a neurologist at Yale School of Medicine, wrote that government-funded studies of integrating alternative medicine techniques into the mainstream are "used to lend an appearance of legitimacy to treatments that are not legitimate." Marcia Angell considered that critics felt that healthcare practices should be classified based solely on scientific evidence, and if a treatment had been rigorously tested and found safe and effective, science-based medicine will adopt it regardless of whether it was considered "alternative" to begin with. It is 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 are George D. Lundberg, former editor of the Journal of the American Medical Association (JAMA) and the journal's interim editor-in-chief Phil Fontanarosa.
Writing in 1999 in CA: A Cancer Journal for Clinicians Barrie R. Cassileth mentioned a 1997 letter to the United States Senate's Subcommittee on Public Health and Safety, which had deplored the lack of critical thinking and scientific rigor in OAM-supported research, had been signed by four Nobel Laureates and other prominent scientists. (This was supported by the National Institutes of Health (NIH).)
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Q: What do you call Alternative Medicine that survives double-blind laboratory tests?
A: Regular Medicine.
In March 2009, a staff writer for The Washington Post reported that the impending national discussion about broadening access to health care, improving medical practice and saving money was giving a group of scientists an opening to propose shutting down the National Center for Complementary and Alternative Medicine. They quoted one of these scientists, Steven Salzberg, a genome researcher and computational biologist at the University of Maryland, as saying "One of our concerns is that NIH is funding pseudoscience." They noted that the vast majority of studies were based on fundamental misunderstandings of physiology and disease, and had shown little or no effect.
Writers such as Carl Sagan, a noted astrophysicist, advocate of scientific skepticism and the author of The Demon-Haunted World: Science as a Candle in the Dark (1996), have lambasted the lack of empirical evidence to support the existence of the putative energy fields on which these therapies are predicated.
Sampson has also pointed out that CAM tolerated contradiction without thorough reason and experiment. Barrett has pointed out that there is a policy at the NIH of never saying something does not work, only that a different version or dose might give different results. Barrett also expressed concern that, just because some "alternatives" have merit, there is the impression that the rest deserve equal consideration and respect even though most are worthless, since they are all classified under the one heading of alternative medicine.
Some critics of alternative medicine are focused upon health fraud, misinformation, and quackery as public health problems, notably Wallace Sampson and Paul Kurtz founders of Scientific Review of Alternative Medicine and Stephen Barrett, co-founder of The National Council Against Health Fraud and webmaster of Quackwatch. Grounds for opposing alternative medicine include that:
- Alternative therapies typically lack any scientific validation, and their effectiveness either is unproven or has been disproved.
- It is usually based on religion, tradition, superstition, belief in supernatural energies, pseudoscience, errors in reasoning, propaganda, or fraud.
- Methods may incorporate or base themselves on traditional medicine, folk knowledge, spiritual beliefs, ignorance or misunderstanding of scientific principles, errors in reasoning, or newly conceived approaches claiming to heal.
- Research on alternative medicine is frequently of low quality and methodologically flawed.
- Treatments are not part of the conventional, science-based healthcare system.
- Where alternative therapies have replaced conventional science-based medicine, even with the safest alternative medicines, failure to use or delay in using conventional science-based medicine has caused deaths.
Many alternative medical treatments are not patentable, which may lead to less research funding from the private sector. In addition, in most countries, alternative therapies (in contrast to pharmaceuticals) can be marketed without any proof of efficacy – also a disincentive for manufacturers to fund scientific research.
English evolutionary biologist Richard Dawkins, in his 2003 book A Devil's Chaplain, defined alternative medicine as a "set of practices that cannot be tested, refuse to be tested, or consistently fail tests." Dawkins argued that if a technique is demonstrated effective in properly performed trials then it ceases to be alternative and simply becomes medicine.
CAM is also often less regulated than conventional medicine. There are ethical concerns about whether people who perform CAM have the proper knowledge to treat patients. CAM is often done by non-physicians who do not operate with the same medical licensing laws which govern conventional medicine, and it is often described as an issue of non-maleficence.
According to two writers, Wallace Sampson and K. Butler, marketing is part of the training required in alternative medicine, and propaganda methods in alternative medicine have been traced back to those used by Hitler and Goebels in their promotion of pseudoscience in medicine.
In November 2011 Edzard Ernst stated that the "level of misinformation about alternative medicine has now reached the point where it has become dangerous and unethical. So far, alternative medicine has remained an ethics-free zone. It is time to change this."
Harriet Hall criticized the low standard of evidence accepted by the alternative medicine community:
Science-based medicine has one rigorous standard of evidence, the kind .... CAM has a double standard. They gladly accept a lower standard of evidence for treatments they believe in. However, I suspect they would reject a pharmaceutical if it were approved for marketing on the kind of evidence they accept for CAM.
Conflicts of interest
Some commentators have said that special consideration must be given to the issue of conflicts of interest in alternative medicine. Edzard Ernst has said that most researchers into alternative medicine are at risk of "unidirectional bias" because of a generally uncritical belief in their chosen subject. Ernst cites as evidence the phenomenon whereby 100% of a sample of acupuncture trials originating in China had positive conclusions. David Gorski contrasts evidence-based medicine, in which researchers try to disprove hyphotheses, with what he says is the frequent practice in pseudoscience-based research, of striving to confirm pre-existing notions. Harriet Hall writes that there is a contrast between the circumstances of alternative medicine practitioners and disinterested scientists: in the case of acupuncture, for example, an acupuncturist would have "a great deal to lose" if acupuncture were rejected by research; but the disinterested skeptic would not lose anything if its effects were confirmed; rather their change of mind would enhance their skeptical credentials.
Use of health and research resources
Research into alternative therapies has been criticized for "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." Research methods expert and author of Snake Oil Science, R. Barker Bausell, has stated that "it's become politically correct to investigate nonsense." A commonly cited statistic is that the US National Institute of Health had spent $2.5 billion on investigating alternative therapies prior to 2009, with none being found to be effective.
See also
- Alternative therapies for developmental and learning disabilities
- Conservation medicine
- Ethnomedicine
- Gallbladder flush
- Psychic surgery
- Siddha medicine
- Thomsonianism, in United States early 19th century
Notes
- ^ "The phrase complementary and alternative medicine is used to describe a group of diverse medical and health care systems, practices, and products that have historic origins outside mainstream medicine. Most of these practices are used together with conventional therapies and therefore have been called complementary to distinguish them from alternative practices, those used as a substitute for standard care. ... Until a decade ago or so, 'complementary and alternative medicine' could be defined as practices that are neither taught in medical schools nor reimbursed, but this definition is no longer workable, since medical students increasingly seek and receive some instruction about complementary health practices, and some practices are reimbursed by third-party payers. Another definition, practices that lack an evidence base, is also not useful, since there is a growing body of research on some of these modalities, and some aspects of standard care do not have a strong evidence base."
- ^ "An alternative medical system is a set of practices based on a philosophy different from Western biomedicine."
- ^ "lternative medicine refers to all treatments that have not been proven effective using scientific methods."
- ^ "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."
- ^ "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 ... speculation, and testimonials do not substitute for evidence."
- "CAM is a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine."
- ^ The Final Report (2002) of the White House Commission on Complementary and Alternative Medicine Policy states: "The Commissioners believe and have repeatedly stated in this Report that our response should be to hold all systems of health and healing, including conventional and CAM, to the same rigorous standards of good science and health services research. Although the Commissioners support the provision of the most accurate information about the state of the science of all CAM modalities, they believe that it is premature to advocate the wide implementation and reimbursement of CAM modalities that are yet unproven."
- In his book The Homœopathic Medical Doctrine Samuel Hahnemann the creator of homeopathy wrote: "Observation, reflection, and experience have unfolded to me that the best and true method of cure is founded on the principle, similia similibus curentur. To cure in a mild, prompt, safe, and durable manner, it is necessary to choose in each case a medicine that will excite an affection similar (ὅμοιος πάθος) to that against which it is employed."
- According to the medical historian James Harvey Young:
In 1991 the Senate Appropriations Committee responsible for funding the National Institutes of Health (NIH) declared itself "not satisfied that the conventional medical community as symbolized at the NIH has fully explored the potential that exists in unconventional medical practices."
- As the medical professor Kenneth M. Ludmerer noted in 2010: "Flexner pointed out that the scientific method of thinking applied to medical practice. By scientific method, he meant testing ideas with well-planned experiments to establish accurate facts. The clinician's diagnosis was equivalent to the scientist's hypothesis: both medical diagnosis and hypothesis required the test of an experiment. Flexner argued that mastery of the scientific method of problem solving was the key for physicians to manage medical uncertainty and to practice in the most cost-effective way."
- "Kessler refers to a lack of efficacy but never pushes back at Hatch by enumerating the dangers that unregulated products pose to the public, the dangers that fill the pages of Offit's book."
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Traditional medicine is defined as the ways of protecting and restoring health that existed before the arrival of modern medicine. It is underestimated part of healthcare that finds in almost every country in the world. Traditional medicine has been being used in the maintenance of health and the prevention, diagnosis, improvement, or treatment of physical and mental illness.
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Traditional medicine, as defined by the World Health Organization, is the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement, or treatment of physical and mental illness. Some traditional medicine systems are supported by huge volumes of literature and records of the theoretical concepts and practical skills; others pass down from generation to generation through verbal teaching.
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Whereas traditional medicine is based on analogical reasoning and a holistic approach to disease and health, conventional medicine rests on scientific knowledge and is evidence-based.
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Although the initial development of these holistic traditional herbal prescriptions predated modern science, the process was based on thousands of years of phenotype-based and personalized human clinical trials. Meanwhile, meticulous descriptions of disease symptoms and systematic medical theories have also been recorded by generations of herbal doctors, relating therapeutic properties of diverse medicinal plants to their utility in treating specific symptoms. Yet most of the foundational concepts in the traditional medical systems—for example, the concepts of yin versus yang and cold versus hot in traditional Chinese medicine—are disconnected from the modern descriptions of normal and disease states in the language of physiology and molecular biology. The lack of modern scientific and clinical evidence for safety, efficacy and action mechanisms further prevented those holistic herbal medicine prescriptions from being accepted beyond their culture of origin.
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When adopted outside its traditional or root culture, traditional medicine is often classified as a form of alternative medicine (AM), for example by Western professional medical organizations, insurers and healthcare systems. This problematically leads to lack of regulation (e.g., in the U.S. where these approaches are at best relegated to the nutraceutical market largely outside the FDA sphere of regulation) and a lack of fidelity to original formulations, dose schedules, delivery methods and indications.
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Complementary and alternative healthcare and medical practices (CAM) is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. The list of practices that are considered as CAM changes continually as CAM practices and therapies that are proven safe and effective become accepted as the "mainstream" healthcare practices...Alternative medicine is commonly categorized together with complementary medicine under the umbrella term "complementary and alternative medicine". Complementary medicine refers to therapies that complement traditional western (or allopathic) medicine and is used together with conventional medicine, and alternative medicine is used in place of conventional medicine. Alternative medicine refers to therapeutic approaches taken in place of traditional medicine and used to treat or ameliorate disease.
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Further reading
- Bausell, R.B (2007). Snake oil science: the truth about complementary and alternative medicine. Oxford University Press. ISBN 978-0-19-531368-0.
- Benedetti, F.; et al. (2003). "Open versus hidden medical treatments: The patient's knowledge about a therapy affects the therapy outcome". Prevention & Treatment. 6 (1). doi:10.1037/1522-3736.6.1.61a.
- Dawkins, R. (2001). "Foreword". In Diamond, J. (ed.). Snake Oil and Other Preoccupations. London: Vintage. ISBN 978-0-09-942833-6. Reprinted in Dawkins 2003.
- Downing AM, Hunter DG (2003). "Validating clinical reasoning: A question of perspective, but whose perspective?". Manual Therapy. 8 (2): 117–119. doi:10.1016/S1356-689X(02)00077-2. PMID 12890440.
- Eisenberg DM (July 1997). "Advising patients who seek alternative medical therapies". Annals of Internal Medicine. 127 (1): 61–69. doi:10.7326/0003-4819-127-1-199707010-00010. PMID 9214254. S2CID 23351104.
- Gunn IP (December 1998). "A critique of Michael L. Millenson's book, Demanding Medical Excellence: Doctors and Accountability in the Information Age, and its Relevance to CRNAs and Nursing". AANA Journal. 66 (6): 575–582. ISSN 0094-6354. PMID 10488264.
- Hand, W.D. (1980). "Folk Magical Medicine and Symbolism in the West". Magical Medicine. Berkeley: University of California Press. pp. 305–319. ISBN 978-0-520-04129-5. OCLC 6420468.
- Illich, I. (1976). Limits to Medicine: Medical Nemesis: The Expropriation of Health. Penguin. ISBN 978-0-14-022009-4. OCLC 4134656.
- Mayo Clinic (2007). Mayo Clinic Book of Alternative Medicine: The New Approach to Using the Best of Natural Therapies and Conventional Medicine. Parsippany, New Jersey: Time Home Entertainment. ISBN 978-1-933405-92-6.
- Planer, F.E. (1988). Superstition (Rev. ed.). Buffalo, New York: Prometheus Books. ISBN 978-0-87975-494-5. OCLC 18616238.
- Rosenfeld, A. (c. 2000). "Where Do Americans Go for Healthcare?". Cleveland, Ohio: Case Western Reserve University. Archived from the original on 2006-05-09. Retrieved 2010-09-23.
- Snyder, Mariah; Lindquist, Ruth (May 2001). "Issues in Complementary Therapies: How We Got to Where We Are". Online Journal of Issues in Nursing. 6 (2): 1. PMID 11469921. Archived from the original on 2017-02-03. Retrieved 2017-01-18.
- Stevens, P. Jr. (November–December 2001). "Magical thinking in complementary and alternative medicine". Skeptical Inquirer.
- Tonelli MR (2001). "The limits of evidence-based medicine". Respiratory Care. 46 (12): 1435–1440, discussion 1440–1441. PMID 11728302.
- Trivieri, L. Jr. (2002). Anderson, J.W. (ed.). Alternative Medicine: The Definitive Guide. Berkeley: Ten Speed Press. ISBN 978-1-58761-141-4.
- Wisneski, L.A.; et al. (2005). The scientific basis of integrative medicine. CRC Press. ISBN 978-0-8493-2081-1.
- Zalewski, Z. (1999). "Importance of philosophy of science to the history of medical thinking". CMJ. 40 (1): 8–13. PMID 9933889. Archived from the original on 2004-02-06.
World Health Organization
- Benchmarks for training in traditional / complementary and alternative medicine
- WHO Kobe Centre; Bodeker, G.; et al. (2005). WHO Global Atlas of Traditional, Complementary and Alternative Medicine. WHO. ISBN 978-92-4-156286-7. Summary.
Journals
- Alternative Medicine Review: A Journal of Clinical Therapeutics. Sandpoint, Idaho : Thorne Research, c. 1996 NLM ID: 9705340 Archived 2018-06-12 at the Wayback Machine
- Alternative Therapies in Health and Medicine. Aliso Viejo, California : InnoVision Communications, c1995- NLM ID: 9502013 Archived 2018-06-12 at the Wayback Machine
- BMC Complementary and Alternative Medicine Archived 2015-09-24 at the Wayback Machine. London: BioMed Central, 2001 NLM ID: 101088661 Archived 2018-06-12 at the Wayback Machine
- Complementary Therapies in Medicine. Edinburgh; New York : Churchill Livingstone, c. 1993 NLM ID: 9308777 Archived 2018-06-12 at the Wayback Machine
- Evidence Based Complementary and Alternative Medicine: eCAM. New York: Hindawi, c. 2004 NLM ID: 101215021 Archived 2018-09-14 at the Wayback Machine
- Forschende Komplementärmedizin / Research in Complementary Medicine
- Journal for Alternative and Complementary Medicine New York : Mary Ann Liebert, c. 1995
- Scientific Review of Alternative Medicine (SRAM) Archived 2010-08-22 at the Wayback Machine
External links
Library resources aboutAlternative medicine
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