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v t e

Alternative medicine has been defined as "therapeutic or preventive health care practices, such as homeopathy, naturopathy, chiropractic, and herbal medicine, that do not follow generally accepted medical methods and may not have a scientific explanation for their effectiveness." It describes practices used in place of conventional medical treatments.

Alternative medicine practices, unlike mainstream evidence-based medicine, are often based in belief systems not derived from the scientific method. Alternative medicines may therefore incorporate spiritual, metaphysical, or religious underpinnings, untested practices, pre-modern or non-western medical traditions, or newly developed approaches to healing. If an alternative medical approach, initially untested, is subsequently shown to be safe and effective, it may then be adopted by conventional practitioners and no longer considered "alternative".

"Alternative medicine" is often categorized together with complementary medicine using the umbrella term Complementary and alternative medicine or CAM.

Contemporary use of alternative medicine

Many people utilize mainstream medicine for diagnosis and basic information, while turning to alternatives for what they believe to be health-enhancing measures.

A stud;y on the publics use of alternatives suggests that 40% use alternative medicine. 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.

The use of alternative medicine appears to be increasing. A 1998 study showed that the use of alternative medicine had risen from 33.8% in 1990 to 42.1% in 1997. In the United Kingdom, a 2000 report ordered by the House of Lords suggested that "...limited data seem to support the idea that CAM use in the United Kingdom is high and is increasing."

Medical education

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In one research study of 25 schools offering a Doctor of Osteopathy degree, 95% of osteopathic medical schools teach some form of alternative medicine. Accredited Naturopathic colleges and universities are increasing in number and popularity in the U.S.A. They offer the most complete medical training in alternative medicine that is available today. See Naturopathic medicine.

In Britain, no conventional medical schools offer courses that teach the clinical practice of alternative medicine. However, alternative medicine is taught in several unconventional schools as part of their curriculum. Teaching is based mostly on theory and understanding of alternative medicine, with emphasis on being able to communicate with alternative medicine specialists. To obtain competence in practicing clinical alternative medicine, qualifications must be obtained from individual medical societies. The student must have graduated and be a qualified doctor. The British Medical Acupuncture Society, which offers medical acupuncture certificates to doctors, is one such example, as is the College of Naturopathic Medicine UK and Ireland.

Support for alternative medicine

Alternative therapies provide some services not available from conventional medicine. Examples are patient empowerment and treatment methods that follow the biopsychosocial model of health .

Efficacy

Advocates of alternative medicine hold that the various alternative treatment methods are effective in treating a wide range of major and minor medical conditions, and contend that recently published research (such as Michalsen, 2003, Gonsalkorale 2003, and Berga 2003) proves the effectiveness of specific alternative treatments. They assert that a PubMed search revealed over 370,000 research papers classified as alternative medicine published in Medline-recognized journals since 1966 in the National Library of Medicine database. See also Kleijnen 1991, and Linde 1997.

Advocates of alternative medicine hold that alternative medicine may provide health benefits through patient empowerment, by offering more choices to the public, including treatments that are simply not available in conventional medicine:

"Most Americans who consult alternative providers would probably jump at the chance to consult a physician who is well trained in scientifically based medicine and who is also open-minded and knowledgeable about the body's innate mechanisms of healing, the role of lifestyle factors in influencing health, and the appropriate uses of dietary supplements, herbs, and other forms of treatment, from osteopathic manipulation to Chinese and Ayurvedic medicine. In other words, they want competent help in navigating the confusing maze of therapeutic options that are available today, especially in those cases in which conventional approaches are relatively ineffective or harmful."

Evidence-based medicine (EBM) applies the scientific method to medical practice, and aims for the ideal that healthcare professionals should make "conscientious, explicit, and judicious use of current best evidence" in their everyday practice. Prof. Edzard Ernst is a notable proponent of applying EBM to CAM.

Although advocates of alternative medicine acknowledge that the placebo effect may play a role in the benefits that some receive from alternative therapies, they point out that this does not diminish their validity. Researchers who judge treatments using the scientific method are concerned by this viewpoint, since it fails to address the possible inefficacy of alternative treatments.

Use of alternative medicine alongside conventional medicine

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A major objection to alternative medicine is that it is done in place of conventional medical treatments.

It is advisable for patients to inform their medical doctor when they are using alternative medicine, because some alternative treatments may interact with orthodox medical treatments, and such potential conflicts should be explored in the interest of the patient. However, many conventional practitioners are biased or uninformed about alternatives, and patients are often reluctant to share this information with their medical doctors since they fear it will hurt their doctor-patient relationship.

Criticism of alternative medicine

See also List of branches of alternative medicine for specific criticisms of different types of CAM

Alternative medicine is commonly categorised together with complementary medicine under the umbrella term 'complementary and alternative medicine' (CAM for short). Some scientists reject this and the above classifications and to varying degrees reject the term "alternative medicine" itself.

The following three commentators argue for classifying treatments based on the objectively verifiable criteria of the scientific method, not based on the changing curricula of various medical schools or social sphere of usage. They advocate a classification based on evidence-based medicine, i.e., scientifically proven evidence of efficacy (or lack thereof). According to them it is possible for a method to change categories (proven vs. nonproven) in either direction, based on increased knowledge of its effectiveness or lack thereof:

• Marcia Angell, former editor-in-chief of the New England Journal of Medicine, states that "...since many alternative remedies have recently found their way into the medical mainstream 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."

• George D. Lundberg, former editor of the Journal of the American Medical Association (JAMA), and Phil B. Fontanarosa, Senior Editor of JAMA, state: "There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking. Whether a therapeutic practice is 'Eastern' or 'Western,' is unconventional or mainstream, or involves mind-body techniques or molecular genetics is largely irrelevant except for historical purposes and cultural interest. As believers in science and evidence, we must focus on fundamental issues—namely, the patient, the target disease or condition, the proposed or practiced treatment, and the need for convincing data on safety and therapeutic efficacy."

• Richard Dawkins, Professor of the Public Understanding of Science at Oxford, defines alternative medicine as a "...set of practices which cannot be tested, refuse to be tested, or consistently fail tests. If a healing technique is demonstrated to have curative properties in properly controlled double-blind trials, it ceases to be alternative. It simply...becomes medicine." He also states that "There is no alternative medicine. There is only medicine that works and medicine that doesn't work."

Other well-known proponents of evidence-based medicine, such as the Cochrane Collaboration and Edzard Ernst, Professor of Complementary Medicine at the University of Exeter, use the term "alternative medicine" but agree with the above commentators that all treatments, whether "mainstream" or "alternative", ought to be held to standards of the scientific method. Oxford University Press publishes a peer-reviewed journal entitled Evidence-based Complementary and Alternative Medicine (eCAM).

Some commentators maintain that some or all fields of alternative medicine are pseudoscientific, or contain significant pseudoscientific elements. In the late 20th century systematic investigation of the evidence-base proceeded, and at least one university department of alternative and complementary medicine was established, at the University of Exeter under Professor Edzard Ernst for this purpose.

Due to the wide range of therapies that are considered to be "alternative medicine" few criticisms apply across the board, except possibly that of not being scientifically supported or even testable. Proponents of CAM typically address this basic criticism by arguing that it is a self-fulfilling prophecy: critics believe that there is no plausibility to CAMs because they find little or no proofs, while it is plausibility that should inform the scientific research for proofs.

Proponents of alternative therapy have an obligation to provide grounds for biological plausibility, such as sound theoretical or preclinical data, or for clinical plausibility, in the form of authentic, well-prepared case reports, in order to justify the investment of time and energy in exploring the merits of a novel anticancer therapy. But plausibility, not proof, should be sufficient to initiate the process.

In other words, proponents of CAMs argue that skeptics, in saying that theories or anecdotal and preclinical data do not constitute proof, merely state the obvious but do not actually engage in the evaluation of CAMs. Criticisms directed at specific branches of alternative medicine range from the fairly minor (conventional treatment is believed to be more effective in a particular area) to incompatibility with the known laws of physics (for example, in homeopathy). Critics argue that alternative medicine practitioners may not have an accredited medical degree or be licensed physicians or general practitioners and make sweeping claims without demonstrated expertise. This cannot always be considered a serious criticism, because unless a new system of medicine becomes established, it does not receive accreditation of any kind, except by its own professional organizations. This is the route homeopathy, ayurveda, siddha, unani, and naturopathy had to follow in those countries where it is now offered by accredited institutions. Proponents of the various forms of alternative medicine reject criticism as being founded in prejudice, financial self-interest, or ignorance. Refutations of criticism sometimes take the form of an appeal to nature.

Efficacy

Lack of proper testing

Although proponents of alternative medicine often cite the large number of studies which have been performed, critics point out that there are no statistics on exactly how many of those studies were controlled, double blind, peer-reviewed experiments, or how many produced results supporting alternative medicine or parts thereof. They contend that many forms of alternative medicine are rejected by conventional medicine because the efficacy of the treatments has not been demonstrated through double-blind randomized controlled trials; in contrast, conventional drugs reach the market only after such trials have proved their efficacy.

Some argue that less research is carried out on alternative medicine because many alternative medicine techniques cannot be patented, and hence there is little financial incentive to study them. Drug research, by contrast, can be very lucrative, which has resulted in funding of trials by pharmaceutical companies. Many people, including conventional and alternative medical practitioners, contend that this funding has led to corruption of the scientific process for approval of drug usage, and that ghostwritten work has appeared in major peer-reviewed medical journals. Increasing the funding for research of alternative medicine techniques was the purpose of the National Center for Complementary and Alternative Medicine. NCCAM and its predecessor, the Office of Alternative Medicine, have spent more than $200 million on such research since 1991. The German Federal Institute for Drugs and Medical Devices Commission E has studied many herbal remedies for efficacy.

Some skeptics of alternative practices point out that a person may attribute symptomatic relief to an otherwise ineffective therapy due to the placebo effect, the natural recovery from or the cyclical nature of an illness (the regression fallacy), or the possibility that the person never originally had a true illness. CAM proponents point out this may also apply in cases where conventional treatments have been used. To this, CAM critics point out that this does not account for conventional medical success in double blind clinical trials. CAM proponents, however, don't typically question conventional medical successes revealed in double blind clinical trials.

Safety

Critics contend that some people have been hurt or killed directly from the various practices or indirectly by failed diagnoses or the subsequent avoidance of conventional medicine. Proponents counter that harm from conventional medical practice, known as iatrogenesis, is a major cause of death and injury.

Alternative medicine critics agree with its proponents that people should be free to choose whatever method of healthcare they want, but stipulate that people must be informed as to the safety and efficacy of whatever method they choose. People who choose alternative medicine may think they are choosing a safe, effective medicine, while they may only be getting quack remedies. Grapefruit seed extract is an example of quackery when multiple studies demonstrate its universal antimicrobial effect is due to synthetic antimicrobial contamination.

Delay in seeking conventional medical treatment

Those who have had success with one alternative therapy for a minor ailment may be convinced of its efficacy and persuaded to extrapolate that success to some other alternative therapy for a more serious, possibly life-threatening illness. For this reason, critics contend that therapies that rely on the placebo effect to define success are very dangerous. According to Lilienfeld (2002) "unvalidated or scientifically unsupported mental health practices can lead individuals to forgo effective treatments" and refers to this as “opportunity cost.” Individuals who spend large amounts of time and money on ineffective treatments may be left with precious little of either, and may forfeit the opportunity to obtain treatments that could be more helpful. In short, even innocuous treatments can indirectly produce negative consequences.

Danger can be increased when used as a complement to conventional medicine

A Norwegian multicentre study examined the association between the use of alternative medicine and cancer survival. 515 patients using standard medical care for cancer were followed for eight years. 22% of those patients used alternative medicine concurrently with their standard care. The study revealed that death rates were 30% higher in alternative medicine users than in those who did not use alternative medicine (AM): "The use of AM seems to predict a shorter survival from cancer."

Associate Professor Alastair MacLennan of the Department of Obstetrics and Gynaecology in Adelaide University, Australia reports that a patient of his almost bled to death on the operating table. She had failed to mention she had been taking "natural" potions to "build up her strength" for the operation - one of them turned out to be a powerful anticoagulant which 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".

Danger from undesired side-effects

Conventional treatments are subjected to testing for undesired side-effects, whereas alternative treatments generally are not subjected to such testing at all. However, any treatment — whether conventional or alternative — that has a biological or psychological impact on a patient may also have potentially dangerous biological or psychological side-effects. Nevertheless, attempts to refute this fact with regard to alternative treatments sometimes use the appeal to nature fallacy, i.e. "that which is natural cannot be harmful".

Homeopathy, however, is regarded as being safe in terms of such side effects since, according to known physics and chemistry, it cannot possibly have more effect on the patient than simple water does.

Danger related to self-medication

Similar problems as those related to self-medication also apply to parts of alternative medicine. For example, an alternative medicine may instantly make symptoms better, but actually worsen problems in the long run. The result may be addiction and deteriorating health.

Issues of regulation

Critics contend that some branches of alternative medicine are often not properly regulated in some countries to identify who practices or know what training or expertise they may possess. Critics argue that the governmental regulation of any particular alternative therapy does necessitate that the therapy is effective. The most sensible course in such a case could be to simply ensure that the sold treatment is not dangerous, but the problem would then remain to know if it does what its proponents say it does.

Explanations for the appeal of alternative medicine

Critics cite both socio-cultural and psychological reasons to explain why people would chose to use alternative medicines in lieu of conventional medicine.

Socio-cultural reasons cited include:

• the low level of scientific literacy among the public at large
• an increase in anti-intellectualism and antiscientific attitudes riding on the coattails of new age mysticism
• vigorous marketing of extravagant claims by the "alternative" medical community
• inadequate media scrutiny and attacking critics
• increasing social malaise (conspiracy theories) and mistrust of traditional authority figures - the antidoctor backlash
• dislike of the delivery methods of scientific biomedicine.

Psychological reasons cited include:

• the placebo effect
• the will to believe
• self-serving biases that help maintain self-esteem and promote harmonious social functioning
• demand characteristics - the obligation to respond in kind when someone does them a good turn
• post hoc, ergo propter hoc fallacy ("after this, therefore because of this"; the basis of most superstitious beliefs)
• psychological distortion, such as confirmation bias and cognitive dissonance (inability to respond to criticism of alternative medicine in order to reduce one's cognitive dissonance)

Legal status

Jurisdiction differs concerning which branches of alternative medicine are legal, which are regulated, and which (if any) are provided by a government-controlled health service or reimbursed by a private health medical insurance company.

In article 34 (Specific legal obligations) of the General Comment No. 14 (2000) on The right to the highest attainable standard of health of the Committee on Economic, Social and Cultural Rights (United Nations), it is stated that

Obligations to respect (the right to health) include a State's obligation to refrain from prohibiting or impeding traditional preventive care, healing practices and medicines, from marketing unsafe drugs and from applying coercive medical treatments

A number of alternative medicine advocates disagree with the restrictions of government agencies that approve medical treatments (such as the American Food and Drug Administration) and the agencies' adherence to experimental evaluation methods. They claim that this impedes those seeking to bring useful and effective treatments and approaches to the public, and protest that their contributions and discoveries are unfairly dismissed, overlooked or suppressed. Alternative medicine providers often argue that health fraud should be dealt with appropriately when it occurs.

In India, which is the home of several alternative systems of medicines, Ayurveda, Siddha, Unani, and Homeopathy are licenced by the government, despite lack of reputable scientific evidence. Naturopathy will also be licensed soon because several Universities now offer bachelors degrees in it. Other activities connected with AM/CM, such as Panchakarma and massage therapy related to Ayurveda are also licenced by the government now. Research into and licensing of these activities is carried out by the Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH).

See also

• Complementary and alternative medicine
• Criticism of medicine
• History of alternative medicine
• Pseudoscience
• Traditional medicine

Further reading

Dictionary definitions

• Complementary medicine

World Health Organization publication

• WHO Global Atlas of Traditional, Complementary and Alternative Medicine

Journals dedicated to alternative medicine research

• Alternative therapies in health and medicine. Aliso Viejo, CA : InnoVision Communications, c1995- NLM ID: 9502013
• Alternative medicine review : a journal of clinical therapeutic. Sandpoint, Idaho : Thorne Research, Inc., c1996- NLM ID: 9705340
• BMC complementary and alternative medicine. London : BioMed Central, 2001- NLM ID: 101088661
• Complementary therapies in medicine. Edinburgh ; New York : Churchill Livingstone, c1993- NLM ID: 9308777
• Evidence based complementary and alternative medicine
• Journal of Integrative medicine.
• Journal for Alternative and Complementary Medicine: research on paradigm, practice, and policy. New York, NY : Mary Ann Liebert, Inc., c1995-]
• Scientific Review of Alternative Medicine (SRAM)

Further reading

• Bausell, R. Barker (2007), Snake Oil Science: The Truth About Complementary and Alternative Medicine, Oxford University Press, ISBN 978-0-19-531368-0
• Benedetti F, Maggi G, Lopiano L. "Open Versus Hidden Medical Treatments: The Patient's Knowledge About a Therapy Affects the Therapy Outcome." Prevention & Treatment, 2003; 6(1), APA online
• Diamond, J. Snake Oil and Other Preoccupations, 2001, ISBN 0-09-942833-4 , foreword by Richard Dawkins reprinted in Dawkins, R., A Devil's Chaplain, 2003, ISBN 0-7538-1750-0 .
• Downing AM, Hunter DG. "Validating clinical reasoning: a question of perspective, but whose perspective?" Man Ther, 2003; 8(2): 117-9. PMID 12890440 Manual Therapy Online
• Eisenberg DM. "Advising patients who seek alternative medical therapies." Ann Intern Med 1997; 127:61-69. PMID 9214254
• Goldberg, Burton. Anderson, John & Trivieri, Larry “Alternative Medicine: The Definitive Guide”, Ten Speed Press, 2002 ISBN 978-1587611414
• Gunn IP. "A critique of Michael L. Millenson's book, Demanding medical excellence: doctors and accountability in the information age, and its relevance to CRNAs and nursing." AANA J, 1998 66(6):575-82. Review. PMID 10488264
• Hand, Wayland D. 1980 "Folk Magical Medicine and Symbolism in the West", in Magical Medicine, Berkeley: University of California Press, pp. 305-319.
• Illich, Ivan. Limits to Medicine. Medical Nemesis: The expropriation of Health. Penguin Books, 1976.
• Lazarou, J. Pomeranz, BH. Corey, PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies, J of the American Medical Association 1998, 279, 1200-1205.
• Mayo Clinic. Mayo Clinic Book of Alternative Medicine: The New Approach to Using the Best of Natural Therapies and Conventional Medicine, Parsippany, NJ: Time Inc Home Entertainment, 2007, ISBN 978-1933405926.
• Murray, Michael, & Joseph Pizzorno. Encyclopedia of Natural Medicine, New York: Three Rivers Press, 1997 (second edition), ISBN 978-0761511571.
• Ninivaggi, F. J., An Elementary Textbook of Ayurveda: Medicine with a Six Thousand Year Old Tradition, International Universities/Psychosocial Press, Madison, CT, 2001.
• Pert, Candace B., Molecules of Emotion: Why You Feel the Way You Feel, Scribners, 1997, ISBN 0-684-84634-9
• Phillips Stevens Jr. Nov./Dec. 2001 "Magical Thinking in Complementary and Alternative Medicine", Skeptical Inquirer Magazine, Nov.Dec 2001
• Planer, Felix E. 1988 Superstition, Revised ed. Buffalo, New York: Prometheus Books
• Rosenfeld, Anna, Where Do Americans Go for Healthcare?, Case Western Reserve University, Cleveland, Ohio, USA.
• Tonelli MR. "The limits of evidence-based medicine." Respir Care, 2001; 46(12): 1435-40; discussion 1440-1. Review. PMID 11728302 PMID: 11863470
• Trudeau, Kevin, Natural Cures "They" Don't Want You to Know About, Alliance Publishing Group, ISBN 0-9755995-9-3; Mass Market Edition, 2007.
• Trudeau, Kevin, More Natural "Cures" Revealed, Alliance Publishing Group, 2006, ISBN 0-9755995-4-2.
• Wisneski, Leonard A. and Lucy Anderson, The Scientific Basis of Integrative Medicine, CRC Press, 2005. ISBN 0-8493-2081-X.
• Zalewski Z. "Importance of Philosophy of Science to the History of Medical Thinking." CMJ 1999; 40: 8-13. CMJ online

External links

• The National Center for Complementary and Alternative Medicine - US National Institutes of Health
• Complementary and Alternative Medicine on PubMed - Alternative Medicine Research Database
• Complementary and Alternative Medicine Index(from the University of Maryland Medical Center) - Comprehensive guide covering conditions and treatments
• Alternative Cancer Information - Hub of Peer-Reviewed literature on Prevention of Metastasis for Patients Diagnosed with Cancer
• Integrative Medicine Podcasts and Handouts - Teaching modules with podcasts and handouts for patients, clinicians, residents and medical students from the University of Wisconsin Integrative Medicine Program .
• Web pages for new BBC/Open University television series "Alternative Medicine" that examines the evidence scientifically.
• The Huichol Indians - learn more about ancient alternative medicine.
• "Complementary and alternative medicine: What is it?" from the Mayo Clinic

Criticism

• A Different Way to Heal? and Videos - PBS, Scientific American Frontiers Web Feature
• What is Complementary and Alternative Medicine? - By Steven Novella MD
• Skepdic Article on Alternative Medicine
• Who Gets to Validate Alternative Medicine - PBS article
• Biotherapy with leeches and maggots

Advocacy

• Medline and the mainstream manufacture of misinformation Critique of the criticisms of alternative medicine

• Medical Herbal Remedies

Footnotes

1. alternative medicine, The American Heritage Dictionary of the English Language, Fourth Edition, 2003, Houghton Mifflin Company.
2. Astin JA "Why patients use alternative medicine: results of a national study" JAMA 1998; 279(19): 1548-1553
3. Eisenberg, DM, Davis RB, Ettner SL "Trends in alternative medicine use in the United States 1990-1997." JAMA, 1998; 280:1569-1575. PMID 9820257
4. House of Lords report on CAM
5. Saxon DW, Tunnicliff G, Brokaw JJ, Raess BU. "Status of complementary and alternative medicine in the osteopathic medical school curriculum." J Am Osteopath Assoc 2004; 104 (3):121-6. PMID 15083987
6. Vickers A. "Alternative Cancer Cures: "Unproven" or "Disproven"?" CA Cancer J Clin 2004; 54: 110-118. Online
7. Michalsen A, Ludtke R, Buhring M. "Thermal hydrotherapy improves quality of life and hemodynamic function in patients with chronic heart failure." Am Heart J, 2003; 146 (4):E11. PMID 14564334
8. Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ. "Long term benefits of hypnotherapy for irritable bowel syndrome." Gut, 2003; 52 (11):1623-9. PMID 14570733
9. Berga SL, Marcus MD, Loucks TL. "Recovery of ovarian activity in women with functional hypothalamic amenorrhea who were treated with cognitive behavior therapy." Fertility and Sterility 2003; 80 (4): 976-981 Abstract
10. Kleijnen J, Knipschild P, ter Riet G. "Clinical trials of homoeopathy." BMJ, 1991; 302:316-23. Erratum in: BMJ, 1991; 302:818. PMID 1825800
11. Linde K, Clausius N, Ramirez G. "Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials." Lancet, 1997; 350:834-43. Erratum in: Lancet 1998 Jan 17;351(9097):220. PMID 9310601
12. Snyderman R & Weil AT. "Integrative medicine: bringing medicine back to its roots." Arch Intern Med 2002; 162:395-397.
13. Alternative medicine--the risks of untested and unregulated remedies. Angell M, Kassirer JP. N Engl J Med 1998;339:839.
14. Alternative medicine meets science. Fontanarosa P.B., and Lundberg G.D. JAMA. 1998; 280: 1618-1619.
15. Simonyi Professorship web site
16. A callous world. Richard Holloway. Book review Richard Dawkins A Devil's Chaplain. The Guardian, February 15, 2003.
17. Dawkins, Richard (003). A Devil's Chaplain. Weidenfeld & Nicolson. {{cite book}}: Check date values in: |year= (help); More than one of |author= and |last= specified (help)
18. The Cochrane Collaboration Complementary Medicine Field. Retrieved 5 August 2006.
19. The HealthWatch Award 2005: Prof. Edzard Ernst, Complementary medicine: the good the bad and the ugly. Retrieved 5 August 2006
20. "Complementary medicine is diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy or by diversifying the conceptual frameworks of medicine." Ernst et al British General Practitioner 1995; 45:506.
21. Evidence-based Complementary and Alternative Medicine
22. Hoffer LJ (2001). "Proof versus plausibility: rules of engagement for the struggle to evaluate alternative cancer therapies". CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 164 (3): 351–3. PMID 11232135.
23. Larkin M. "Whose article is it anyway?" Lancet, 1999; 354:136. Editorial
24. Flanagin A, Carey LA, Fontanarosa PB. "Prevalence of articles with honorary authors and ghost authors in peer-reviewed medical journals." JAMA, 1998; 280(3):222-4. Full text
25. CSICOP.org article on alternative medicine
26. James Alcock PhD, Alternative Medicine and the Psychology of Belief, The Scientific Review of Alternative Medicine, Fall/Winter 1999 Volume 3 ~ Number 2. available online
27. Ganzera M, Aberham A, Stuppner H. Development and validation of an HPLC/UV/MS method for simultaneous determination of 18 preservatives in grapefruit seed extract. Institute of Pharmacy, University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria. J Agric Food Chem. 2006 May 31;54(11):3768-72. Abstract
28. Takeoka, G., Dao, L., Wong, R.Y., Lundin, R., Mahoney N. Identification of benzethonium chloride in commercial grapefruit seed extracts. J Agric Food Chem. 2001 49(7):3316–20. Abstract
29. von Woedtke, T., Schlüter, B., Pflegel, P., Lindequist, U.; Jülich, W.-D. Aspects of the antimicrobial efficacy of grapefruit seed extract and its relation to preservative substances contained. Pharmazie 1999 54:452–456. Abstract
30. Sakamoto, S., Sato, K., Maitani, T., Yamada, T. Analysis of components in natural food additive “grapefruit seed extract” by HPLC and LC/MS. Bull. Natl. Inst. Health Sci. 1996, 114:38–42. Abstract
31. Takeoka, G.R., Dao, L.T., Wong, R.Y., Harden L.A. Identification of benzalkonium chloride in commercial grapefruit seed extracts. J Agric Food Chem. 2005 53(19):7630–6. Abstract
32. Risberg T, et al. Does use of alternative medicine predict survival from cancer? Eur J Cancer 2003 Feb;39(3):372-7
33. ^ Beyerstein BL. Psychology and 'Alternative Medicine' Social and Judgmental Biases That Make Inert Treatments Seem to Work. The Scientific Review of Alternative Medicine/ Fall/Winter 1999 Volume 3 ~ Number 2
34. COMMITTEE ON ECONOMIC, SOCIAL AND CULTURAL RIGHTS. General Comment No. 14 (2000) The right to the highest attainable standard of health : . 11/08/2000. E/C.12/2000/4. http://www.unhchr.ch/tbs/doc.nsf/(symbol)/E.C.12.2000.4.en
35. Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH)

• Alternative medicine