Complementary and alternative medicine

The term complementary and alternative medicine (CAM) is an umbrella term for alternative medicine and complementary medicine.

Alternative medicine describes practices used in place of conventional medical treatments. Complementary medicine describes practices used in conjunction and cooperation with conventional medicine.

The list of therapies included under CAM changes gradually. If and when an approach regarded as "unproven therapy" is proven to be safe and effective, it may be adopted into conventional health care and over time may cease to be considered "alternative".

Definitions and descriptions
"Complementary and alternative medicine (CAM) is 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 the domain of the dominant system are not always sharp or fixed."

The National Center for Complementary and Alternative Medicine defines complementary and alternative medicine as "a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine". It also defines integrative medicine as " [combining] mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness".

CAM has been described as comprising "a diverse group of treatments, ranging from symptomatic interventions to be used in conjunction with traditional therapies—therapeutic touch or meditation—to unique treatments meant to replace conventional chemotherapy or surgery. CAM includes complex and longstanding fields of study, such as acupuncture, ayurvedic medicine, and homoeopathy, but can also be as straightforward as taking a specific dietary supplement to lower blood pressure or blood lipid concentrations."

Ralph Snyderman and Andrew Weil state "integrative medicine is not synonymous with complementary and alternative medicine (CAM). It has a far larger meaning and mission in that it calls for restoration of the focus of medicine on health and healing and emphasizes the centrality of the patient-physician relationship".

In a frequently-cited review, David M. Eisenberg used the term "unconventional medicine" to signify "medical interventions not taught widely at U.S. medical schools or generally available at U.S. hospitals."

Criticisms of the term
Some scientists reject the above classification 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 [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."


 * 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).

Regulation
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).

Contemporary use of CAM
Many people utilize mainstream medicine for diagnosis and basic information, while turning to alternatives for what they believe to be health-enhancing measures. However, studies indicate that the majority of people use alternative approaches in conjunction with conventional medicine.

Edzard Ernst wrote in the Medical Journal of Australia that "about half the general population in developed countries use complementary and alternative medicine (CAM)." A survey released in May 2004 by the National Center for Complementary and Alternative Medicine, part of the National Institutes of Health in the United States, found that in 2002, 36% of Americans used some form of alternative therapy in the past 12 months, 50% in a lifetime &mdash; a category that included yoga, meditation, herbal treatments and the Atkins diet. If prayer was counted as an alternative therapy, the figure rose to 62.1%. 25% of people who use CAM do so because medical professional suggested it. Another study suggests a similar figure of 40%. 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, as 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
Increasing numbers of medical colleges have begun offering courses in alternative medicine. For example, the University of Arizona College of Medicine offers a program in Integrative Medicine under the leadership of Dr. Andrew Weil which trains physicians in various branches of alternative medicine which "...neither rejects conventional medicine, nor embraces alternative practices uncritically." In three separate research surveys that surveyed 729 schools in the United States (125 medical schools offering an MD degree, 19 medical schools offering a Doctor of Osteopathy degree, and 585 schools offering a nursing degree), 60% of the standard medical schools, 95% of osteopathic medical schools and 84.8% of the nursing schools teach some form of CAM. Accredited Naturopathic colleges and universities are increasing in number and popularity in the U.S.A. They offer the most complete medical training in complimentary medicines that is available today. See Naturopathic medicine.

In the UK, no medical schools offer courses that teach the clinical practice of alternative medicine. However, alternative medicine is taught in several schools as part of the curriculum. Teaching is based mostly on theory and understanding 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.

Public use in the US
The NCCAM surveyed the American public on complementary and alternative medicine use in 2002. According to the survey:
 * 50 percent of U.S. adults age 18 years and over used some form of complementary and alternative medicine (CAM).
 * When prayer specifically for health reasons is included in the definition of CAM, the number of adults using some form of CAM in 2002 rose to 62 percent.
 * The majority of individuals (54.9%) used CAM in conjunction with conventional medicine.
 * Most people use CAM to treat and/or prevent musculoskeletal conditions or other conditions associated with chronic or recurring pain.
 * "The fact that only 14.8% of adults sought care from a licensed or certified CAM practitioner suggests that most individuals who use CAM prefer to treat themselves."
 * "Women were more likely than men to use CAM. The largest sex differential is seen in the use of mind-body therapies including prayer specifically for health reasons".
 * "Except for the groups of therapies that included prayer specifically for health reasons, use of CAM increased as education levels increased".
 * The most common CAM therapies used in the USA in 2002 were prayer (45.2%), herbalism (18.9%), breathing meditation (11.6%), meditation (7.6%), chiropractic medicine (7.5%), yoga (5.1%), body work (5.0%), diet-based therapy (3.5%), progressive relaxation (3.0%), mega-vitamin therapy (2.8%) and Visualization (2.1%)

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 CAM as a complement to conventional medicine
A major objection to alternative medicine is that it may be done in place of conventional medical treatments. As long as alternative treatments are used alongside conventional treatments, the majority of medical doctors find most forms of complementary medicine acceptable. Consistent with previous studies, the CDC recently reported that the majority of individuals in the United States (i.e., 54.9%) used CAM in conjunction with conventional medicine.

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.

The issue of alternative medicine interfering with conventional medical practices is minimized when it is turned to only after conventional treatments have been exhausted. Many patients feel that alternative medicine may help in coping with chronic illnesses for which conventional medicine offers no cure, only management. Over time, it has become more common for a patient's own MD to suggest alternatives when they cannot offer effective treatment.

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

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.

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 which they believe is redundant.

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 (which may not, however, be revealed to the public in a timely manner), 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.

Sociological and psychological explanations for belief in CAM efficacy
There are both social/cultural and psychological reasons:

Social or cultural reasons:


 * 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:


 * 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)

Integrative medicine
Integrative medicine is a branch of alternative medicine which claims to limit itself to methods with strong scientific evidence of efficacy and safety. The main proponent of integrative medicine is Andrew T. Weil M.D., who founded the Program in Integrative Medicine at the University of Arizona in 1994 based on a phrase coined by Elson Haas, MD. It is claimed that responsible alternative health product providers who have had medical studies conducted on their products often publish these studies online..

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
 * Evidence Based journal of Integrative 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)

Other works that discuss alternative medicine

 * 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.
 * Dillard, James and Terra Ziporyn. Alternative Medicine for Dummies.  Foster City, CA:  IDG Books Worldwide, Inc., 1998.
 * Goldberg, Burton. Anderson, John & Trivieri, Larry “Alternative Medicine: The Definitive Guide”, Ten Speed Press, 2002 ISBN 978-1587611414
 * 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.
 * 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.
 * 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.

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

طب بديل Алтернативна медицина Alternativmedizin Alternatiivmeditsiin Medicina alternativa Médecine non conventionnelle Alternativna medicina Medicina alternativa רפואה אלטרנטיבית Alternatív gyógymód Alternatieve geneeswijze 代替医療 Alternativ medisin Medycyna niekonwencjonalna Medicina alternativa Альтернативная медицина Alternative medicine Алтернативна медицина Uskomuslääkintä Alternativmedicin Alternatif tıp Альтернативна медицина