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* Claimed effects of alternative medical practices are often subtle (requiring large sample sizes) and appear only after long periods of treatment (requiring long studies). * Claimed effects of alternative medical practices are often subtle (requiring large sample sizes) and appear only after long periods of treatment (requiring long studies).
* Ethical issues arise in conducting double-blind studies where the researchers or patients strongly believe that one treatment is superior to another. * Ethical issues arise in conducting double-blind studies where the researchers or patients strongly believe that one treatment is superior to another.
* Some alternative medicine techniques are closely tied to religious or philosophical beliefs. Practitioners of these techniques may resist scientific scrutiny, fearing that negative experimental results will be used to question these underlying beliefs.


These research design difficulties make it difficult for skeptical researchers to do meaningful double-blind research that proponents of alternatives will accept as being valid research. Nevertheless, hundreds of new research articles are being published on the broad area of alternative medicine weekly. These research design difficulties make it difficult for skeptical researchers to do meaningful double-blind research that proponents of alternatives will accept as being valid research. Nevertheless, hundreds of new research articles are being published on the broad area of alternative medicine weekly.

Revision as of 15:26, 17 January 2004

Alternative medicine is a broad term for any method of treatment that stand outside the framework of conventional, evidence-based medicine.

While alternative medicine is usually supposed to replace conventional treatments, the combination of alternative and conventional medicine is referred to as complementary medicine. The term Integrative medicine was invented by Andrew Weil, MD and is said to refer to "the best of both conventional and complementary medicine".

Overview

Some kinds of alternative medicine can be practised by the individual without the need for working with an alternative medicine practitioner. Others need to be carried out though alternative medicine clinics, GPs or businesses which advertise such services. When the service is performed by a conventional physician it is called complementary or integrative medicine.

Legal jurisdictions differ as to which branches of alternative medicine are legal, which are regulated, and which (if any) are provided by a state health service. Some practitioners and branches of alternative medicine have been investigated by state or national agencies for health-related fraud (commonly known as quackery), and in a few cases criminal charges have been brought.

Branches of alternative medicine

The most often used branches of alternative medicine in the United States are (Eisenberg et al, 1998):

  1. chiropractic
  2. acupuncture
  3. chinese medicine
  4. homeopathy
  5. naturopathy
  6. massage therapy
  7. biofeedback
  8. hypnosis

Psychologists provide alternative medical services when they use biofeedback, hypnotherapy, or cognitive behavior therapy to treat a medical condition. There is a relatively new field in psychology called Health psychology.

Other branches of alternative/complementary medicine include:

Support and criticism for alternative medicine

Support

Advocates of alternative medicine point to a number of different general arguments that tend to support the validity of using alternative methods of treatment to treat specific medical conditions.

  1. Edzard Ernst writes in the Medical Journal of Australia that: "About half the general population in developed countries uses complementary and alternative medicine (CAM). Yet many conventional healthcare professionals refuse to take CAM seriously; one often-voiced argument is "there is no research in CAM". Certainly, for some modalities there is no compelling evidence base, and some of the research into CAM has methodological flaws and biases. On the other hand, many doctors and medical educators are uninformed about the quality evidence that does exist." (Ernst, 2003)
  2. A search on PubMed reveals that there are over 370,000 research papers classified as alternative medicine published since 1966 in the National Library of Medicine database (such as Kleijnen 1991, Linde 1997, Michalsen 2003, Gonsalkorale 2003, and Berga 2003). There are no publicly available statistics on exactly how many of these studies were controlled or double-blind peer-reviewed experiments. They were, however, all published in research journals recognized by Medline.
  3. The question of the effectiveness of various alternative medicines has to be considered independently for each method, as well as for each medical condition or disease treated.It is not valid to lump them all together as one. When exploring the individual branches of alternative medicine several questions need to be answered in order to decide if the methos is valis or quackery
    1. What is the method of treatment utilized?
    2. What are its therapeutic effects?
    3. What medical conditions does it effectively treat?
    4. What modes of action could plausibly account for these therapeutic effects?
    5. What harm, if any, could result from this treatment?
  4. In the United States, the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health, provides funding and other support for research in alternative medicine. This neither approves or negates CAM, as the the NIH often funds speculative research that eventually has no practical value. It does, however, show that there is serious academic research being persued, without outright dismissal into the questions raised by CAM.
  5. Some of the strongest support for the value of clinical experience in alternative medicine comes from conventional physicians who have voiced their criticisms of evidence-based medicine (Tonelli 2001, Downing 2003). These physicians, while arguing about their need to apply population evidence to the patient standing before them, are in effect supporting the value of eclectic branches of alternative medicine which place great value upon the clinical experience of the practitioner.
  6. The boundary lines between alternative and mainstream medicine have changed over time. Methods once considered alternative have later been adopted by conventional medicine as physicians gradually incorporate effective branches of alternative medicine of treatment in their conventional medical practices. Supporters of alternative methods suggest that much of what is currently called alternative medicine will be similarly assimilated by the mainstream in the future. Critics support a view that any medicine that can be proven is destined to be implemented in the name of the common good, so provable CAM will eventually be implemented.
  7. Alternative medicine offers a choice to the buying public, to have treatments that are simple not available from conventional medical.This argument covers a range of topics, such as patient empowerment, alternative methods of pain management, treatment methods that support the Biopsychosocial model of health, and finally some patients are specifically in search for cures for their specific health concerns, stress reduction services and other preventative health services that simply are not what conventional medicine is currently known for.
  8. Any positive effects on patients, even if only based on placebo effects, still provides benefits to overall patient health that traditional medicine may not have provided.
  9. The scientific basis of alternative medicine is not as bad as the critics represent it to be (Ernst 2003) because conventional medicine in reality has not been as science-based as it is publicly represented to be (Zalewksi 1999). Michael L. "Millenson decries the lack of scientific-based medical practice and medicine's failure to wake up due to its own historical studies. He cites data that 85% of current practice has not been scientifically validated despite medicine's claims of the physician-scientist." (Gunn 1998) Alternative medicine proponents argue that the mere fact that evidence-based medicine is being promoted speaks historically to a practice of medicine that was not completely based on science.
  10. Social critic Ivan Illich believes that Western and alternative medical practices are generally equally effective, for two reasons. First, Western practices are more effective at dealing with illnesses caused by microbes, whereas alternative practices are more effective at dealing with illnesses that are psychosomatic. Illich holds that Western and alternative practices are equally effective at dealing with illnesses that are self-limiting. (Illich 1976) In other words, Illich has suggested that conventional medicine treats illnesses that the human body would heal naturally all by itself without any form of treatment.

Concerns

The primary concern for those who do not support alternative medicine is that all too frequently there is no proper scientific verification that they actually work! Some of the studies cited in support of alternative medicine are not considered up to the normal double blind peer reviewed standard.

In countries where healthcare is paid for by State or privately-funded medical insurance systems, alternative therapies are frequently not covered by these schemes and these treatments are paid for by the patient. This leads to a concern that gullible or desperate people may be being exploited.

In addition, there is a concern that people may delay seeking conventional treatment, whilst they undergo alternative therapies. This may be dangerous to their health.

Finally, critics of alternative medicine are concerned that some branches are not properly regulated. This means that there is no external control on practitioners and no real way of knowing what training or expertise they may possess.

Science and alternative medicine

While mainstream conventional medicine is commonly thought of as relying on the scientific method for results, as stated above, 85% of current medical practice has not been scientifically validated. Large scale trials of new drugs which are usually funded by pharmaceutical companies are undertaken to see if they really are better than the alternatives. Medical research writing companies often ghostwrite drug research papers, which peer reviewed respectable journals like NEJM, Lancet, JAMA, and BMJ have been unable to prevent from being published (Flanagin 1998, Larkin 1999).

The science community argues that it is impossible to use testimonials, hearsay and mystical arguments as proof, because observer bias distorts recollection. The only way to counter observer bias is to run a double blind experiment, where neither the patient nor the practitioner knows whether the real treatment is being given or if a placebo has been administered.

Proponents of alternative medicine counter by saying that you cannot use methods suitable for testing drugs for non-drug forms of alternative treatment methods. Furthermore, much evidence dismissed as hearsay in fact represents clinical experience. Many branches of alternative medicine place great value upon the clinical experience of the practitioner.

In addition, some proponents of alternative medicine argue that the lack of evaluation of conventional medical practices prior to the 1990s means that it cannot be truly claimed that conventional medicine practitioners relied upon the scientific method for their results. However conventional medical practitioners and scientists would not agree that this means that science should not underpin medical practice.

Proponents of alternative medicine argue that some branches of alternative medicine were viewed as quackery in the past, but are accepted as mainstream medicine now.

Some mainstream doctors and some scientists agree that new research may be revealing evidence that a small number of alternative health treatments might be effective (Michelson et al, 2003; Gonsalkorale et al, 2003; Berga et al, 2003). They are treatments claimed to have resulted from peer-reviewed studies. As such, in a few cases, the boundary lines between alternative and mainstream medicine may change over time. In principle, methods considered alternative at one time may later be adopted by conventional medicine and treatments.

Experimental evaluation of alternative medicine is often difficult. Some of the problems that arise (Ernst, 2003) are:

  • Double-blind trials are difficult for many alternative medical techniques, which involve hands-on manipulation by trained practitioners that cannot easily be replaced by an equivalent placebo, or which require a holistic approach to treatment that cannot easily be reduced to a single variable.
  • Claimed effects of alternative medical practices are often subtle (requiring large sample sizes) and appear only after long periods of treatment (requiring long studies).
  • Ethical issues arise in conducting double-blind studies where the researchers or patients strongly believe that one treatment is superior to another.

These research design difficulties make it difficult for skeptical researchers to do meaningful double-blind research that proponents of alternatives will accept as being valid research. Nevertheless, hundreds of new research articles are being published on the broad area of alternative medicine weekly.

References

Dictionary definitons

Journals dedicated to alternative medicine research

Research articles cited in the text

  1. Kleijnen J, Knipschild P, ter Riet G. Clinical trials of homoeopathy. BMJ. 1991 Feb 9;302(6772):316-23. Erratum in: BMJ 1991 Apr 6;302(6780):818. PMID: 1825800 Abstract
  2. Linde K, Clausius N, Ramirez G. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet. 1997 Sep 20;350(9081):834-43. Erratum in: Lancet 1998 Jan 17;351(9097):220. PMID: 9310601 Abstract
  3. 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 Oct;146(4):E11. PMID: 14564334 Abstract
  4. Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ. Long term benefits of hypnotherapy for irritable bowel syndrome. Gut. 2003 Nov;52(11):1623-9. PMID: 14570733 Abstract
  5. 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 , Volume 80, Issue 4, Pages 976-981 (October 2003) Abstract
  6. Eisenberg DM, Davis RB, Ettner SL. Trends in alternative medicine use in the United States, 1990-1997. JAMA. 1998; 280:1569-1575. PMID: 9820257 Abstract
  7. Ernst E. Obstacles to research in complementary and alternative medicine. Medical Journal of Australia. 2003 Sep 15;179(6):279-80. PMID: 12964907 MJA online
  8. Zalewski, Z. Importance of Philosophy of Science to the History of Medical Thinking. CMJ 1999; 40: 8-13. CMJ online
  9. Downing AM, Hunter DG. Validating clinical reasoning: a question of perspective, but whose perspective? Man Ther. 2003 May;8(2):117-9. Review. PMID: 12890440 Manual Therapy Online
  10. Tonelli MR. The limits of evidence-based medicine. Respir Care. 2001 Dec;46(12):1435-40; discussion 1440-1. Review. PMID: 11728302 Abstract
  11. 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 Dec;66(6):575-82. Review. PMID: 10488264 Abstract
  12. Flanagin A, Carey LA, Fontanarosa PB. Prevalence of articles with honorary authors and ghost authors in peer-reviewed medical journals. JAMA. 1998 Jul 15;280(3):222-4. Abstract
  13. Larkin M. Whose article is it anyway? Lancet. 1999 Jul 10;354(9173):136. Editorial

Other works that discuss alternative medicine

  • WHERE DO AMERICANS GO FOR HEALTHCARE? by Anna Rosenfeld, Case Western Reserve University, Cleveland, Ohio, USA.
  • Planer, Felix E. 1988 Superstition Revised ed. Buffalo, New York: Prometheus Books
  • Hand, Wayland D. 1980 Folk Magical Medicine and Symbolism in the West in Magical Medicine Berkeley: University of California Press, pp. 305-319.
  • Phillips Stevens Jr. Nov./Dec. 2001 Magical Thinking in Complementary and Alternative Medicine Skeptical Inquier Magazine, Nov.Dec/2001
  • Illich I. Limits to Medicine. Medical Nemesis: The expropriation of Health. Penguin Books, 1976.

External links

General information about alternative medicine

Advocacy of alternative medicine

Critiques of alternative medicine