ALTERNATIVE MEDICINES

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ALTERNATIVE MEDICINES

Alternative medicine is any practice that is put forward as having the healing effects of medicine but is not based on evidence gathered using scientific methods.  It consists of a wide range of health care practices, products and therapies, using alternative medical diagnoses and treatments which typically have not been included in the degree courses of established medical schools or used in conventional medicine.  Examples of alternative medicine include homeopathy, naturopathy, chiropractic, energy medicine and acupuncture.

Complementary medicine is alternative medicine used together with conventional medical treatment in a belief, not proven by using scientific methods, that it “complements” the treatment.  CAM is the abbreviation for Complementary and alternative medicine.  Integrative medicine (or integrative health) is the combination of the practices and methods of alternative medicine with conventional medicine.

The term alternative medicine is used in information issued by public bodies in the Commonwealth of Australia, the United Kingdom and the United States of America.  Regulation and licensing of alternative medicine and health care providers varies from country to country, and state to state.

The expression “complementary and alternative medicine” (CAM) resists easy definition because the health systems and practices to which it refers are diffuse and its boundaries are poorly defined.  Healthcare practices categorized as alternative may differ in their historical origin, theoretical basis, diagnostic technique, therapeutic practice and in their relationship to the medical mainstream. Some alternative therapies, including Traditional Chinese Medicine and Ayurveda, have antique, non-Western origins and are entirely alternative medical systems; others, such as homeopathy and chiropractic, are native to the West and emerged in the eighteenth and nineteenth centuries. Some, such as osteopathy and chiropractic, employ manipulative physical methods of treatment; others, such as meditation and prayer, are based on mind-body interventions.  Treatments considered alternative in one location may be considered conventional in another.  Thus, chiropractic is not considered alternative in Denmark and likewise osteopathic medicine is no longer thought of as an alternative therapy in the United States.

One common feature of all definitions of alternative medicine is its designation as “other than” conventional medicine. For example, the widely referenced descriptive definition of complementary and alternative medicine states that it is “a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine.” This definition has been criticized as, if an alternative therapy, both effective and safe, is adopted by conventional medical practitioners, it does not necessarily follow that either it or its practitioners would no longer be considered alternative.   Complementary and alternative medicine 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 or well-being. Boundaries within CAM and between the CAM domain and that of the dominant system are not always sharp or fixed.

There are proponents that hold alternative medications seek to avoid differing forms of medical knowledge and, while it is an essentially political definition, this should not imply that the dominance of mainstream biomedicine is solely due to political forces. According to this definition, alternative and mainstream medicine can only be differentiated with reference to what is “intrinsic to the politically dominant health system of a particular society of culture”.  However, there is neither a reliable method to distinguish between cultures and subcultures, nor to attribute them as dominant or subordinate, nor any accepted criteria to determine the dominance of a cultural entity.  If the culture of a politically dominant healthcare system is held to be equivalent to the perspectives of those charged with the medical management of leading healthcare institutions and programs, the definition fails to recognize the potential for division either within such an elite or between a healthcare elite and the wider population.   Some say there is no alternative medicine, there is only scientifically proven, evidence based medicine supported by sold data of unproven medicine, for which scientific data is severely lacking.

Normative definitions distinguish alternative medicine from the biomedical mainstream in its provision of therapies that are unproven, unvalidated or ineffective and support of theories which have no recognized scientific basis. These definitions characterize practices as constituting alternative medicine when, used independently or in place of evidence-based medicine, they are put forward as having the healing effects of medicine, but which are not based on evidence gathered with the scientific method.  “It is time for the scientific community to stop giving alternative medicine a free ride. There cannot be two kinds of medicine – conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted. But assertions, speculation, and testimonials do not substitute for evidence. Alternative treatments should be subjected to scientific testing no less rigorous than that required for conventional treatments.

Complementary medicine” refers to use of alternative medicine alongside conventional science based medicine, in the belief that it increases the effectiveness.  In Australia even alternative medicine includes:   acupuncture; aromatherapy; chiropractic; homeopathy; massage; meditation and relaxation therapies; naturopathy; osteopathy; reflexology, traditional Chinese medicine; and the use of vitamin supplements.

Some herbal therapies are mainstream in Europe but are alternative in the US.

Dating from the 1970s, medical professionals, sociologists, anthropologists and other commentators noted the increasing visibility of a wide variety of health practices that had neither derived directly from nor been verified by biomedical science. Since that time, those who have analyzed this trend have deliberated over the most apt language with which to describe this emergent health field.   A variety of terms have been used, including heterodox, irregular, fringe and alternative medicine while others, particularly medical commentators, have been satisfied to label them as instances of quackery. The most persistent term has been alternative medicine but its use is problematic as it assumes a value-laden dichotomy between medical fringes, implicitly of borderline acceptability at best, and a privileged medical orthodoxy, associated with validated medico-scientific norms.   The use of the category of alternative medicine has also been criticized as it cannot be studied as an independent entity but must be understood in terms of a regionally and temporally specific medical orthodoxy.  Its use can also be misleading as it may erroneously imply that a real medical alternative exists.   As with near-synonymous expressions, such as unorthodox, complementary, marginal, or quackery, these linguistic devices have served, in the context of processes of professionalization and market competition, to establish the authority of official medicine and police the boundary between it and its unconventional rivals.

 During the late eighteenth and nineteenth centuries regular and irregular medical practitioners became more clearly differentiated throughout much of Europe and, as the nineteenth century progressed, most Western states converged in the creation of legally delimited and semi-protected medical markets.   It is at this point that an “official” medicine, created in cooperation with the state and employing a scientific rhetoric of legitimacy, emerges as a recognizable entity and that the concept of alternative medicine as a historical category becomes tenable.  As part of this process, professional adherents of mainstream medicine in countries such as Germany, France, and Britain increasingly invoked the scientific basis of their discipline as a means of engendering internal professional unity and of external differentiation in the face of sustained market competition from homeopaths, naturopaths, mesmerists and other nonconventional medical practitioners, finally achieving a degree of imperfect dominance through alliance with the state and the passage of regulatory legislation.

 Critics in the US say the expression is deceptive because it implies there is an effective alternative to science-based medicine, and that complementary is deceptive because the word implies that the treatment increases the effectiveness of science-based medicine, while alternative medicines which have been tested nearly always have no measurable positive effect compared to a placebo.    Grounds for opposing alternative medicine which have been stated in the US and elsewhere are:   that it is usually based on religion, tradition, superstition, belief in supernatural energies, pseudoscience, errors in reasoning, propaganda, or fraud;  that alternative therapies typically lack any scientific validation, and their effectiveness is either unproved or disproved; that the treatments are those that are not part of the conventional, science-based healthcare system; that research on alternative medicine is frequently of low quality and methodologically flawed;  that where alternative treatments are used in place of conventional science-based medicine, even with the very safest alternative medicines, failure to use or delay in using conventional science-based medicine has resulted in deaths; that methods may incorporate or base themselves on traditional medicine, folk knowledge, spiritual beliefs, ignorance or misunderstanding of scientific principles, errors in reasoning, or newly conceived approaches claiming to heal;  Alternative medicine practices and beliefs are diverse in their foundations and methodologies, and typically make use of preparations and dosages other than such as are included in the Pharmacopeia recognized by established medical schools. The wide range of treatments and practices referred to as alternative medicine includes some stemming from nineteenth century North America, such as chiropractic and naturopathy, others that originated in eighteenth- and nineteenth-century Germany, such as homeopathy and hydropathy, and some that have originated in China or India, while African, Caribbean, Pacific Island, Native American, and other regional cultures have traditional medical systems as diverse as their diversity of cultures.

Examples of CAM as a broader term for unorthodox treatment and diagnosis of illnesses, disease, infections, etc., include yoga, acupuncture, aromatherapy, chiropractic, herbalism, homeopathy, hypnotherapy, massage, osteopathy, reflexology, relaxation therapies, spiritual healing and tai chi.  CAM differs from conventional medicine. It is normally private medicine and not covered by health insurance.  It is paid out of pocket by the patient and is an expensive treatment.   CAM tends to be a treatment for upper class or more educated people.

Alternative therapies based on electricity or magnetism use verifiable electromagnetic fields, such as pulsed fields, alternating-current, or direct-current fields in an unconventional manner rather than claiming the existence of imponderable or supernatural energies.

Substance based practices use substances found in nature such as herbs, foods, non-vitamin supplements and megavitamins, and minerals, and includes traditional herbal remedies with herbs specific to regions in which the cultural practices arose. Non-vitamin supplements include fish oil, Omega-3 fatty acid, glucosamine, Echinacea, flaxseed oil or pills, and ginseng, when used under a claim to have healing effects.

Mind-body interventions, working under the premise that the mind can affect “bodily functions and symptoms”, include healing claims made in hypnotherapy, and in guided imagery, meditation, progressive relaxation, qigong, tai chi and yoga. Meditation practices including mantra meditation, mindfulness meditation, yoga, tai chi, and qi gong have many uncertainties. Naturopathy is based on a belief in vitalism, which posits that a special energy called vital energy or vital force guides bodily processes such as metabolism, reproduction, growth, and adaptation. The term was coined in 1895  by the “father of U.S. naturopathy”.  Today, naturopathy is primarily practiced in the United States and Canada.  Naturopaths in unregulated jurisdictions may use the Naturopathic Doctor designation or other titles regardless of level of education.

Traditional Chinese medicine is based on a concept of vital energy, or Qi, flowing in the body along specific pathways. These purported pathways consist of 12 primary meridians. TCM has many branches including, acupuncture, massage, Feng shui, herbs, as well as Chinese astrology.  TCM diagnosis is primarily based on looking at the tongue, which is claimed to show the condition of the organs, as well as feeling the pulse of the radial artery, which is also claimed to show the condition of the organs.

Proponents of alternative medicine often used terminology which was loose or ambiguous to create the appearance that a choice between “alternative” effective treatments existed when it did not, or that there was effectiveness or scientific validity when it did not exist, or to suggest that a dichotomy existed when it did not, or to suggest that consistency with science existed when it might not; that the term “alternative” was to suggest that a patient had a choice between effective treatments when there was not; that use of the word “conventional” or “mainstream” was to suggest that the difference between alternative medicine and science based medicine was the prevalence of use, rather than lack of a scientific basis of alternative medicine as compared to “conventional” or “mainstream” science based medicine; that use of the term “complementary” or “integrative” was to suggest that purported supernatural energies of alternative medicine could complement or be integrated into science based medicine. “Integrative medicine” or “integrated medicine” is used to refer to the belief that medicine based on science would be improved by “integration” with alternative medical treatments practices that are not, and is substantially similar in use to the term “complementary and alternative medicine”.

Use of placebos in order to achieve a placebo effect in integrative medicine has been criticized as “diverting research time, money, and other resources from more fruitful lines of investigation in order to pursue a theory that has no basis in biology”.

Integrative medicine may mislead patients by pretending placebos are not.  “Quackademic medicine” is a pejorative term used for “integrative medicine,” which is considered to be an infiltration of quackery into academic science-based medicine.

 Kathy Kiefer

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