The American National Center for Complementary and Alternative Medicine (NCCAM) studies examples including naturopathy, chiropractic medicine, herbalism, traditional Chinese medicine, Ayurveda, meditation, yoga, biofeedback, hypnosis, homeopathy, acupuncture, and nutritional-based therapies, in addition to a range of other practices.
It is frequently grouped with complementary medicine or integrative medicine, which generally refers to the same interventions when used in conjunction with mainstream techniques, under the umbrella term complementary and alternative medicine, or CAM. Some researchers in alternative medicine oppose this grouping, preferring to emphasize differences of approach, but nevertheless use the term CAM, which has become standard."Although heterogeneous, the major CAM systems have many common characteristics, including a focus on individualizing treatments, treating the whole person, promoting self-care and self-healing, and recognizing the spiritual nature of each individual. In addition, many CAM systems have characteristics commonly found in mainstream health care, such as a focus on good nutrition and preventive practices. Unlike mainstream medicine, CAM often lacks or has only limited experimental and clinical study; however, scientific investigation of CAM is beginning to address this knowledge gap. Thus, boundaries between CAM and mainstream medicine, as well as among different CAM systems, are often blurred and are constantly changing."
Alternative medicine practices are as diverse in their foundations as in their methodologies. Practices may incorporate or base themselves on traditional medicine, folk knowledge, spiritual beliefs, or newly conceived approaches to healing. Jurisdictions where alternative medical practices are sufficiently widespread may license and regulate them. The claims made by alternative medicine practitioners are generally not accepted by the medical community because evidence-based assessment of safety and efficacy is either not available or has not been performed for these practices. If scientific investigation establishes the safety and effectiveness of an alternative medical practice, it then becomes mainstream medicine and is no longer "alternative", and may therefore become widely adopted by conventional practitioners.
Because alternative techniques tend to lack evidence, or may even have repeatedly failed to work in tests, some have advocated defining it as non-evidence based medicine, or not medicine at all. Some researchers state that the evidence-based approach to defining CAM is problematic because some CAM is tested, and research suggests that many mainstream medical techniques lack solid evidence.
A 1998 systematic review of studies assessing its prevalence in 13 countries concluded that about 31% of cancer patients use some form of complementary and alternative medicine.Alternative medicine varies from country to country. Edzard Ernst says that in Austria and Germany CAM is mainly in the hands of physicians, while some estimates suggest that at least half of American alternative practitioners are physicians. In Germany, herbs are tightly regulated, with half prescribed by doctors and covered by health insurance based on their Commission E legislation.
Terms
The term 'alternative medicine' is generally used to describe practices used independently or in place of conventional medicine. The term 'complementary medicine' is primarily used to describe practices used in conjunction with or to complement conventional medical treatments. NCCAM suggests "using aromatherapy therapy in which the scent of essential oils from flowers, herbs, and trees is inhaled in an attempt to promote health and well-being and to help lessen a patient's discomfort following surgery" as an example of complementary medicine. The terms 'integrative' or 'integrated medicine' indicate combinations of conventional and alternative medical treatments which have some scientific proof of efficacy; such practices are viewed by advocates as the best examples of complementary medicine.
Ralph Snyderman and Andrew Weil state that "integrative medicine is not synonymous with complementary and alternative medicine. It has a far larger meaning and mission in that it calls for restoration of the focus of medicine on health and healing and emphasizes the centrality of the patient-physician relationship."The combination of orthodox and complementary medicine with an emphasis on prevention and lifestyle changes is known as integrated medicine.
Characterization
There is no clear and consistent definition for either alternative or complementary medicine. In Western culture it is often defined as any healing practice "that does not fall within the realm of conventional medicine", or "that which has not been shown consistently to be effective."Self characterization
The National Center for Complementary and Alternative Medicine (NCCAM) defines CAM as "a group of diverse medical and health care systems, practices, and products, that are not currently part of conventional medicine."The Danish Knowledge and Research Center for Alternative Medicine (Danish abbreviation: ViFAB. ViFAB is an independent institution under the Danish Ministry of the Interior and Health. ViFAB's webstite: www.vifab.dk/uk) uses the term “alternative medicine” for: - Treatments performed by therapists who are not authorized health care professionals. - Treatments performed by authorized health care professionals, but which are based on methods otherwise mainly used outside the health care system. People without a health care authorisation must be able to perform the treatments.
The Cochrane Complementary Medicine Field finds that what is considered complementary or alternative practices in one country may be considered conventional medical practices in another. Their definition is therefore general: "complementary medicine includes all such practices and ideas 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."
For example, biofeedback is commonly used within the Physical Medicine & Rehabilitation community, but is considered alternative within the medical community as a whole, and some herbal therapies are mainstream in Europe, but are alternative in the United States. David M. Eisenberg, an integrative medicine researcher,defines it as "medical interventions not taught widely at US medical schools or generally available at US. hospitals," NCCAM states that formerly unproven remedies may be incorporated into conventional medicine if they are shown to be safe and effective.
Barrie R. Cassileth, a researcher of complementary and alternative medicine, has summed up the situation as "not all mainstream physicians are pleased with CAM, with current efforts to integrate CAM into mainstream medicine, or with a separate NIH research entity for "alternative" medicine.
Scientific community
- Institutions
- Scientists
There is a debate among medical researchers over whether any therapy may be properly classified as 'alternative medicine'. Some claim that there is only medicine which has been adequately tested and that which has not. They feel that health care practices should be classified based solely on scientific evidence. If a treatment has been rigorously tested and found safe and effective traditional medicine will adopt it regardless of if it was considered alternative to begin with. It is thus possible for a method to change categories (proven vs. unproven), based on increased knowledge of its effectiveness or lack thereof. Prominent supporters of this position include George D. Lundberg, former editor of the Journal of the American Medical Association (JAMA).
Stephen Barrett, founder and operator of Quackwatch, argues that practices labeled "alternative" should be reclassified as either genuine, experimental, or questionable. Here he defines genuine as being methods that have sound evidence for safety and effectiveness, experimental as being unproven but with a plausible rationale for effectiveness, and questionable as groundless without a scientifically plausible rationale. He has concerns that just because some "alternative" have merit, there is the impression that the rest deserve equal consideration and respect even though most are worthless.He says that there is a policy at the NIH of never saying something doesn't work only that a different version or dose might give different results.
Edzard Ernst, professor of complementary medicine, characterizes the evidence for many alternative techniques as weak, nonexistent, or negative, but states that evidence exists for others, in particular certain herbs and acupuncture.
Richard Dawkins, an evolutionary biologist, defines alternative medicine as a "set of practices which cannot be tested, refuse to be tested, or consistently fail tests." He also states that "there is no alternative medicine. There is only medicine that works and medicine that doesn't work." He says that if a technique is demonstrated effective in properly performed trials, it ceases to be alternative and simply becomes medicine.
A letter by four Nobel Laureates and other prominent scientists deplored the lack of critical thinking and scientific rigor in National Institutes of Health supported alternative medicine research. In 2009 a group of scientists made a proposal to shut down the National Center for Complementary and Alternative Medicine. They argued that the vast majority of studies were based on unconventional understandings of physiology and disease and have shown little or no effect. Further, they argue that the field's more-plausible interventions such as diet, relaxation, yoga and botanical remedies can be studied just as well in other parts of NIH, where they would need to compete with conventional research projects.
These concerns are supported by negative results in almost all studies conducted over ten years at a cost of $2.5 billion by the NCCAM.R. Barker Bausell, a research methods expert and author of "Snake Oil Science" states that "it's become politically correct to investigate nonsense." There are concerns that just having NIH support is being used to give unfounded "legitimacy to treatments that are not legitimate."
Wallace Sampson, an editor of Scientific Review of Alternative Medicine and a Stanford University professor of medicine write that CAM is the "propagation of the absurd" based on the example that alternative and complementary have been substituted for quackery, dubious and implausible and concerns that CAM tolerates contradiction without through reason and experiment.
Classifications
NCCAM has developed one of the most widely used classification systems for the branches of complementary and alternative medicine. It classifies complementary and alternative therapies into five major groups which have some overlap.- Whole medical systems: cut across more than one of the other groups; examples include Traditional Chinese medicine, Naturopathy, Homeopathy and Ayurveda.
- 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".
- Biologically based practices: use substances found in nature such as herbs, foods, vitamins, and other natural 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:
- Biofield therapies are intended to influence energy fields that purportedly surround and penetrate the body. No empirical evidence has been found to support the existence of the putative energy fields on which these therapies are predicated.
- Bioelectromagnetic-based therapies use verifiable electromagnetic fields, such as pulsed fields, alternating-current or direct-current fields in an unconventional manner.
Usage
Further information: List of branches of alternative medicine
Many people utilize mainstream medicine for diagnosis and basic information, while turning to alternatives for therapy or health-enhancing measures. Studies indicate that alternative approaches are often used in conjunction with conventional medicine. This is referred to by NCCAM as integrative (or integrated) medicine because it "combines treatments from conventional medicine and CAM for which there is some high-quality evidence of safety and effectiveness."According to Andrew T. Weil M.D., a leading proponent of integrative medicine, the principles of integrative medicine include: appropriate use of conventional and CAM methods; patient participation; promotion of health as well as treatment of disease; and a preference for natural, minimally-invasive methods.
A 1997 survey found that 13.7% of respondents in the United States had sought the services of both a medical doctor and an alternative medicine practitioner. The same survey found that 96% of respondents who sought the services of an alternative medicine practitioner also sought the services of a medical doctor in the past 12 months. Medical doctors are often unaware of their patient's use of alternative medical treatments as only 38.5% of the patients alternative therapies were discussed with their medical doctor.
Edzard Ernst, Professor of Complementary Medicine at the University of Exeter, wrote in the Medical Journal of Australia that "about half the general population in developed countries use complementary and alternative medicine (CAM)." Survey results released in May 2004 by the National Center for Complementary and Alternative Medicine, part of the United States National Institutes of Health, found that in 2002 62.1% of adults in the country had used some form of CAM in the past 12 months and 75% across lifespan (though these figure drop to 36.0% and 50% if prayer specifically for health reasons is excluded); this study included yoga, meditation, herbal treatments and the Atkins diet as CAM. 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. Ernst has been active politically on this issue as well, publicly requesting that Prince Charles recall two guides to alternative medicine published by the Foundation for Integrated Health, on the grounds that "[t]hey both contain numerous misleading and inaccurate claims concerning the supposed benefits of alternative medicine" and that "[t]he nation cannot be served by promoting ineffective and sometimes dangerous alternative treatments." In general, he believes that CAM can and should be subjected to scientific testing.
The use of alternative medicine in developed countries appears to be increasing. A 1998 study showed that the use of alternative medicine had risen from 33.8% in 1990 to 42.1% in 1997. 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." 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 health care or be integrated into the health care system. In Africa, traditional medicine is used for 80% of primary health care, and in developing nations as a whole over one third of the population lack access to essential medicines.
Advocates of alternative medicine hold that the various alternative treatment methods are effective in treating a wide range of major and minor medical conditions, and that recently published research (such as Michalsen, 2003, 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.
Complementary therapies are often used in palliative care or by practitioners attempting to manage chronic pain in patients. Complementary medicine is considered more acceptable in the interdisciplinary approach used in palliative care than in other areas of medicine. "From its early experiences of care for the dying, palliative care took for granted the necessity of placing patient values and lifestyle habits at the core of any design and delivery of quality care at the end of life. If the patient desired complementary therapies, and as long as such treatments provided additional support and did not endanger the patient, they were considered acceptable." 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."
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. 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. "Complementary medicine treatments used for pain include: acupuncture, low-level laser therapy, meditation, aroma therapy, Chinese medicine, dance therapy, music therapy, massage, herbalism, therapeutic touch, yoga, osteopathy, chiropractic, naturopathy, and homeopathy."
In defining complementary medicine in the UK, the House of Lords Select Committee determined that the following therapies were the most often used to complement conventional medicine: Alexander technique, Aromatherapy, Bach and other flower remedies, Body work therapies including massage, Counselling stress therapies, hypnotherapy, Meditation, Reflexology, Shiatsu, Maharishi Ayurvedic medicine, Nutritional medicine, and Yoga.
United States
- 74.6% had used some form of complementary and alternative medicine (CAM).
- 62.1% had done so within the preceding twelve months.
- When prayer specifically for health reasons is excluded, these figures fall to 49.8% and 36.0%, respectively.
- 45.2% had in the last twelve months used prayer for health reasons, either through praying for their own health or through others praying for them.
- 54.9% used CAM in conjunction with conventional medicine.
- 14.8% "sought care from a licensed or certified" practitioner, suggesting that "most individuals who use CAM prefer to treat themselves."
- Most people used CAM to treat and/or prevent musculoskeletal conditions or other conditions associated with chronic or recurring pain.
- "Women were more likely than men to use CAM. The largest sex differential is seen in the use of mind-body therapies including prayer specifically for health reasons".
- "Except for the groups of therapies that included prayer specifically for health reasons, use of CAM increased as education levels increased".
- The most common CAM therapies used in the US in 2002 were prayer (45.2%), herbalism (18.9%), breathing meditation (11.6%), meditation (7.6%), chiropractic medicine (7.5%), yoga (5.1%), body work (5.0%), diet-based therapy (3.5%), progressive relaxation (3.0%), mega-vitamin therapy (2.8%) and Visualization (2.1%)
A 2008 survey of US hospitals by Health Forum, a subsidiary of the American Hospital Association, found that more than 37 percent of responding hospitals indicated they offer one or more alternative medicine therapies, up from 26.5 percent in 2005. Additionally, hospitals in the southern Atlantic states were most likely to include CAM, followed by east north central states and those in the middle Atlantic. More than 70% of the hospitals offering CAM were in urban areas.
The National Science Foundation has also conducted surveys of the popularity of alternative medicine. After describing the negative impact science fiction in the media has on public attitudes and understandings of pseudoscience, and defining alternative medicine as all treatments that have not been proven effective using scientific methods, as well as mentioning the concerns of individual scientists, organizations, and members of the science policymaking community, it commented that "nevertheless, the popularity of alternative medicine appears to be increasing."
In the state of Texas, physicians may be partially protected from charges of unprofessional conduct or failure to practice medicine in an acceptable manner, and thus from disciplinary action, when they prescribe alternative medicine in a complementary manner, if board specific practice requirements are satisfied and the therapies utilized do not present "a safety risk for the patient that is unreasonably greater than the conventional treatment for the patient's medical condition."
Source:
wikipedia.org
