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Alternative medicine – Wikipedia

Alternative medicineAM, complementary and alternative medicine (CAM), complementary medicine, heterodox medicine, integrative medicine (IM), complementary and integrative medicine (CIM), new-age medicine, pseudomedicine, unconventional medicine, unorthodox medicine

Alternative therapies often make bombastic claims, and frequently include anecdotes from healthy-looking individuals claiming successful treatment.

Form of non-scientific healing

Alternative medicine are generally practices that lack biological plausibility and are untested or untestable. In a few cases they are proven ineffective. Complementary medicine (CM), complementary and alternative medicine (CAM), integrated medicine or integrative medicine (IM), and holistic medicine are among many rebrandings of the same phenomenon. While the aim is to achieve the healing effects of medicine, alternative therapies share in common that they reside outside medical science, and rely on pseudoscience. The alternative is distinct from the experimental, which employs scientific method to test plausible therapies by way of responsible and ethical clinical trials, producing evidence of either effect or of no effect. Research into alternative treatments often fails to follow proper research protocol and denies calculalaton of prior probability, providing invalid results. Traditional practices become “alternative” when used outside their original settings without proper scientific explanation and evidence. Frequently used derogatory terms for the alternative are new-age or pseudo, with little distinction from quackery.

In some cases, laws of nature are violated by the claims of alternative practices; in others the practice is plausibly effective but so dangerous to the patient that any use is unethical. Alternative practices often resort to the supernatural or superstitious to explain their effect, and range from ineffective to harmful and toxic.

Much of the perceived effect of an alternative practice arises from a belief that it will be effective (placebo effect), or from the treated condition resolving on its own (the natural course of disease). This is further exacerbated by how alternative treatments are most often turned to upon the failure of medicine. At this point the condition will be at its worst and most likely to spontaneously improve. In diseases that don’t tend to get better by themselves, such as cancer or HIV, multiple studies have shown significantly worse outcomes if patients turn to alternative therapies. While this may be because advanced disease causes patients to lose hope in medicine, it has also been shown that some alternative treatments actively interfere with medicine.

The alternative sector is a highly profitable industry with a strong lobby. Often juxtaposed to the derided “big pharma”, the alternative-industry profits from less regulation and is allowed to promote practices which are proven to have no effect. Despite many countries having laws against marketing or promoting alternative therapies for many conditions, there is active promotion of use in cancer, autoimmune disease, infectious disease and among children. Billions of dollars have been spent studying the “alternative”, with little to no positive results. Some of the successful practices are only considered alternative under very specific definitions, such as those which include all physical activity under the umbrella of “alternative medicine”.

Alternative medicine is defined loosely as a set of products, practices, and theories that are believed or perceived by their users to have the healing effects of medicine,[n 1][n 2] but whose effectiveness has not been established using scientific methods,[n 1][n 3][4][5][6][7] or whose theory and practice is not part of biomedicine,[n 2][n 4][n 5][n 6] or whose theories or practices are directly contradicted by scientific evidence or scientific principles used in biomedicine.[4][5][11] “Biomedicine” or “medicine” is that part of medical science that applies principles of biology, physiology, molecular biology, biophysics, and other natural sciences to clinical practice, using scientific methods to establish the effectiveness of that practice. Unlike medicine,[n 4] an alternative product or practice does not originate from using scientific methods, but may instead be based on hearsay, religion, tradition, superstition, belief in supernatural energies, pseudoscience, errors in reasoning, propaganda, fraud, or other unscientific sources.[n 3][1][4][5]

In General Guidelines for Methodologies on Research and Evaluation of Traditional Medicine, published in 2000 by the World Health Organization (WHO), complementary and alternative medicine were defined as a broad set of health care practices that are not part of that country’s own tradition and are not integrated into the dominant health care system.[12]

The expression also refers to a diverse range of related and unrelated products, practices, and theories ranging from biologically plausible practices and products and practices with some evidence, to practices and theories that are directly contradicted by basic science or clear evidence, and products that have been conclusively proven to be ineffective or even toxic and harmful.[n 2][14][15]

The terms alternative medicine, complementary medicine, integrative medicine, holistic medicine, natural medicine, unorthodox medicine, fringe medicine, unconventional medicine, and new age medicine are used interchangeably as having the same meaning and are almost synonymous in most contexts.[16][17][18][19]

The meaning of the term “alternative” in the expression “alternative medicine”, is not that it is an effective alternative to medical science, although some alternative medicine promoters may use the loose terminology to give the appearance of effectiveness.[4][20] Loose terminology may also be used to suggest meaning that a dichotomy exists when it does not, e.g., the use of the expressions “western medicine” and “eastern medicine” to suggest that the difference is a cultural difference between the Asiatic east and the European west, rather than that the difference is between evidence-based medicine and treatments that do not work.[4]

Complementary medicine (CM) or integrative medicine (IM) is when alternative medicine is used together with functional medical treatment, in a belief that it improves the effect of treatments.[n 7][1][22][23][24] However, significant drug interactions caused by alternative therapies may instead negatively influence treatment, making treatments less effective, notably cancer therapy.[25][26] Both terms refer to use of alternative medical treatments alongside conventional medicine,[27][28][29] an example of which is use of acupuncture (sticking needles in the body to influence the flow of a supernatural energy), along with using science-based medicine, in the belief that the acupuncture increases the effectiveness or “complements” the science-based medicine.[29]

CAM is an abbreviation of the phrase complementary and alternative medicine.[30][31] It has also been called sCAM or SCAM with the addition of “so-called” or “supplements”.[32][33] The words balance and holism are often used, claiming to take into account a “whole” person, in contrast to the alleged reductionism of conventional medicine. Due to its many names the field has been criticized for intense rebranding of what are essentially the same practices.[16]

Besides the usual issues with alternative medicine, integrative medicine has been described by its critics as an attempt to bring pseudoscience into academic science-based medicine,[34] leading to the pejorative term “quackademic medicine”.

Traditional medicine refers to the pre-scientific practices of a certain culture, contrary to what is typically practiced in other cultures where medical science dominates.

“Eastern medicine” typically refers to the traditional medicines of Asia where conventional bio-medicine penetrated much later.

The words balance and holism are often used alongside complementary or integrative medicine, claiming to take into account a “whole” person, in contrast to the supposed reductionism of medicine. Due to its many names the field has been criticized for intense rebranding of what are essentially the same practices.[16]

Prominent members of the science[35][36] and biomedical science community[3] say that it is not meaningful to define an alternative medicine that is separate from a conventional medicine, that the expressions “conventional medicine”, “alternative medicine”, “complementary medicine”, “integrative medicine”, and “holistic medicine” do not refer to any medicine at all.[35][3][36][37]

Others in both the biomedical and CAM communities say that CAM cannot be precisely defined because of the diversity of theories and practices it includes, and because the boundaries between CAM and biomedicine overlap, are porous, and change. The expression “complementary and alternative medicine” (CAM) resists easy definition because the health systems and practices it refers to are diffuse, and its boundaries poorly defined.[14][n 8] 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 (TCM) and Ayurveda, have antique origins in East or South Asia and are entirely alternative medical systems;[42] others, such as homeopathy and chiropractic, have origins in Europe or the United States 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.[45] 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.[45]

Critics say the expression is deceptive because it implies there is an effective alternative to science-based medicine, and that complementary is deceptive because it implies that the treatment increases the effectiveness of (complements) science-based medicine, while alternative medicines that have been tested nearly always have no measurable positive effect compared to a placebo.[4][46][47][34]

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 devised by the US National Center for Complementary and Integrative Health (NCCIH) of the National Institutes of Health (NIH), 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”.[50] For conventional medical practitioners, it does not necessarily follow that either it or its practitioners would no longer be considered alternative.[n 9]

Some definitions seek to specify alternative medicine in terms of its social and political marginality to mainstream healthcare.[53] This can refer to the lack of support that alternative therapies receive from the medical establishment and related bodies regarding access to research funding, sympathetic coverage in the medical press, or inclusion in the standard medical curriculum.[53] In 1993, the British Medical Association (BMA), one among many professional organizations who have attempted to define alternative medicine, stated that it[n 10] referred to “…those forms of treatment which are not widely used by the conventional healthcare professions, and the skills of which are not taught as part of the undergraduate curriculum of conventional medical and paramedical healthcare courses”.[54] In a US context, an influential definition coined in 1993 by the Harvard-based physician,[55] David M. Eisenberg,[56] characterized alternative medicine “as interventions neither taught widely in medical schools nor generally available in US hospitals”.[57] These descriptive definitions are inadequate in the present-day when some conventional doctors offer alternative medical treatments and CAM introductory courses or modules can be offered as part of standard undergraduate medical training;[58] alternative medicine is taught in more than 50 per cent of US medical schools and increasingly US health insurers are willing to provide reimbursement for CAM therapies. In 1999, 7.7% of US hospitals reported using some form of CAM therapy; this proportion had risen to 37.7% by 2008.[60]

An expert panel at a conference hosted in 1995 by the US Office for Alternative Medicine (OAM),[61][n 11] devised a theoretical definition[61] of alternative medicine as “a broad domain of healing resources… other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period”.[63] This definition has been widely adopted by CAM researchers,[61] cited by official government bodies such as the UK Department of Health,[64] attributed as the definition used by the Cochrane Collaboration,[65] and, with some modification,[dubious discuss] was preferred in the 2005 consensus report of the US Institute of Medicine, Complementary and Alternative Medicine in the United States.[n 2]

The 1995 OAM conference definition, an expansion of Eisenberg’s 1993 formulation, is silent regarding questions of the medical effectiveness of alternative therapies.[66] Its proponents hold that it thus avoids relativism about 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.[66] 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”.[67] 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.[67] 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.[67]

Normative definitions distinguish alternative medicine from the biomedical mainstream in its provision of therapies that are unproven, unvalidated, or ineffective and support of theories with 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 are not based on evidence gathered with the scientific method.[1][3][27][28][50][69] Exemplifying this perspective, a 1998 editorial co-authored by Marcia Angell, a former editor of The New England Journal of Medicine, argued that:

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.[3]

This line of division has been subject to criticism, however, as not all forms of standard medical practice have adequately demonstrated evidence of benefit,[n 4][70] and it is also unlikely in most instances that conventional therapies, if proven to be ineffective, would ever be classified as CAM.[61]

Similarly, the public information website maintained by the National Health and Medical Research Council (NHMRC) of the Commonwealth of Australia uses the acronym “CAM” for a wide range of health care practices, therapies, procedures and devices not within the domain of conventional medicine. In the Australian context this is stated to include acupuncture; aromatherapy; chiropractic; homeopathy; massage; meditation and relaxation therapies; naturopathy; osteopathy; reflexology, traditional Chinese medicine; and the use of vitamin supplements.[72]

The Danish National Board of Health’s “Council for Alternative Medicine” (Sundhedsstyrelsens Rd for Alternativ Behandling (SRAB)), an independent institution under the National Board of Health (Danish: Sundhedsstyrelsen), uses the term “alternative medicine” for:

Proponents of an evidence-base for medicine[n 12][75][76][77][78] such as the Cochrane Collaboration (founded in 1993 and from 2011 providing input for WHO resolutions) take a position that all systematic reviews of treatments, whether “mainstream” or “alternative”, ought to be held to the current standards of scientific method.[79] In a study titled Development and classification of an operational definition of complementary and alternative medicine for the Cochrane Collaboration (2011) it was proposed that indicators that a therapy is accepted include government licensing of practitioners, coverage by health insurance, statements of approval by government agencies, and recommendation as part of a practice guideline; and that if something is currently a standard, accepted therapy, then it is not likely to be widely considered as CAM.[61]

Alternative medicine consists of a wide range of health care practices, products, and therapies. The shared feature is a claim to heal that is not based on the scientific method. Alternative medicine practices are diverse in their foundations and methodologies.[50] Alternative medicine practices may be classified by their cultural origins or by the types of beliefs upon which they are based.[1][4][11][50] Methods may incorporate or be based on traditional medicinal practices of a particular culture, folk knowledge, superstition, spiritual beliefs, belief in supernatural energies (antiscience), pseudoscience, errors in reasoning, propaganda, fraud, new or different concepts of health and disease, and any bases other than being proven by scientific methods.[1][4][5][11] Different cultures may have their own unique traditional or belief based practices developed recently or over thousands of years, and specific practices or entire systems of practices.

Alternative medicine, such as using naturopathy or homeopathy in place of conventional medicine, is based on belief systems not grounded in science.[50]

Alternative medical systems may be based on traditional medicine practices, such as traditional Chinese medicine (TCM), Ayurveda in India, or practices of other cultures around the world.[50] Some useful applications of traditional medicines have been researched and accepted within ordinary medicine, however the underlying belief systems are seldom scientific and are not accepted.

Traditional medicine is considered alternative when it is used outside its home region; or when it is used together with or instead of known functional treatment; or when it can be reasonably expected that the patient or practitioner knows or should know that it will not work such as knowing that the practice is based on superstition.

Bases of belief may include belief in existence of supernatural energies undetected by the science of physics, as in biofields, or in belief in properties of the energies of physics that are inconsistent with the laws of physics, as in energy medicine.[50]

Substance based practices use substances found in nature such as herbs, foods, non-vitamin supplements and megavitamins, animal and fungal products, and minerals, including use of these products in traditional medical practices that may also incorporate other methods.[50][104][105] Examples include healing claims for nonvitamin supplements, fish oil, Omega-3 fatty acid, glucosamine, echinacea, flaxseed oil, and ginseng.[106] Herbal medicine, or phytotherapy, includes not just the use of plant products, but may also include the use of animal and mineral products.[104] It is among the most commercially successful branches of alternative medicine, and includes the tablets, powders and elixirs that are sold as “nutritional supplements”.[104] Only a very small percentage of these have been shown to have any efficacy, and there is little regulation as to standards and safety of their contents.[104] This may include use of known toxic substances, such as use of the poison lead in traditional Chinese medicine.[106]

A US agency, National Center on Complementary and Integrative Health (NCCIH), has created a classification system for branches of complementary and alternative medicine that divides them into five major groups. These groups have some overlap, and distinguish two types of energy medicine: veritable which involves scientifically observable energy (including magnet therapy, colorpuncture and light therapy) and putative, which invokes physically undetectable or unverifiable energy.[110] None of these energies have any evidence to support that they effect the body in any positive or health promoting way.[111]

The history of alternative medicine may refer to the history of a group of diverse medical practices that were collectively promoted as “alternative medicine” beginning in the 1970s, to the collection of individual histories of members of that group, or to the history of western medical practices that were labeled “irregular practices” by the western medical establishment.[4][112][113][114][115] It includes the histories of complementary medicine and of integrative medicine. Before the 1970s, western practitioners that were not part of the increasingly science-based medical establishment were referred to “irregular practitioners”, and were dismissed by the medical establishment as unscientific and as practicing quackery.[112][113] Until the 1970s, irregular practice became increasingly marginalized as quackery and fraud, as western medicine increasingly incorporated scientific methods and discoveries, and had a corresponding increase in success of its treatments.[114] In the 1970s, irregular practices were grouped with traditional practices of nonwestern cultures and with other unproven or disproven practices that were not part of biomedicine, with the entire group collectively marketed and promoted under the single expression “alternative medicine”.[4][112][113][114][116]

Use of alternative medicine in the west began to rise following the counterculture movement of the 1960s, as part of the rising new age movement of the 1970s.[4][117][118] This was due to misleading mass marketing of “alternative medicine” being an effective “alternative” to biomedicine, changing social attitudes about not using chemicals and challenging the establishment and authority of any kind, sensitivity to giving equal measure to beliefs and practices of other cultures (cultural relativism), and growing frustration and desperation by patients about limitations and side effects of science-based medicine.[4][113][114][115][116][118][119] At the same time, in 1975, the American Medical Association, which played the central role in fighting quackery in the United States, abolished its quackery committee and closed down its Department of Investigation.[112]:xxi[119] By the early to mid 1970s the expression “alternative medicine” came into widespread use, and the expression became mass marketed as a collection of “natural” and effective treatment “alternatives” to science-based biomedicine.[4][119][120][121] By 1983, mass marketing of “alternative medicine” was so pervasive that the British Medical Journal (BMJ) pointed to “an apparently endless stream of books, articles, and radio and television programmes urge on the public the virtues of (alternative medicine) treatments ranging from meditation to drilling a hole in the skull to let in more oxygen”.[119]

An analysis of trends in the criticism of complementary and alternative medicine (CAM) in five prestigious American medical journals during the period of reorganization within medicine (19651999) was reported as showing that the medical profession had responded to the growth of CAM in three phases, and that in each phase, changes in the medical marketplace had influenced the type of response in the journals.[122] Changes included relaxed medical licensing, the development of managed care, rising consumerism, and the establishment of the USA Office of Alternative Medicine (later National Center for Complementary and Alternative Medicine, currently National Center for Complementary and Integrative Health).[n 14]

Mainly as a result of reforms following the Flexner Report of 1910[124] medical education in established medical schools in the US has generally not included alternative medicine as a teaching topic.[n 15] Typically, their teaching is based on current practice and scientific knowledge about: anatomy, physiology, histology, embryology, neuroanatomy, pathology, pharmacology, microbiology and immunology.[126] Medical schools’ teaching includes such topics as doctor-patient communication, ethics, the art of medicine,[127] and engaging in complex clinical reasoning (medical decision-making).[128] Writing in 2002, Snyderman and Weil remarked that by the early twentieth century the Flexner model had helped to create the 20th-century academic health center, in which education, research, and practice were inseparable. While this had much improved medical practice by defining with increasing certainty the pathophysiological basis of disease, a single-minded focus on the pathophysiological had diverted much of mainstream American medicine from clinical conditions that were not well understood in mechanistic terms, and were not effectively treated by conventional therapies.[129]

By 2001 some form of CAM training was being offered by at least 75 out of 125 medical schools in the US.[130] Exceptionally, the School of Medicine of the University of Maryland, Baltimore includes a research institute for integrative medicine (a member entity of the Cochrane Collaboration).[79][131] Medical schools are responsible for conferring medical degrees, but a physician typically may not legally practice medicine until licensed by the local government authority. Licensed physicians in the US who have attended one of the established medical schools there have usually graduated Doctor of Medicine (MD).[132] All states require that applicants for MD licensure be graduates of an approved medical school and complete the United States Medical Licensing Exam (USMLE).[132]

There is a general scientific consensus that alternative therapies lack the requisite scientific validation, and their effectiveness is either unproved or disproved.[1][4][133][134] Many of the claims regarding the efficacy of alternative medicines are controversial, since research on them is frequently of low quality and methodologically flawed. Selective publication bias, marked differences in product quality and standardisation, and some companies making unsubstantiated claims call into question the claims of efficacy of isolated examples where there is evidence for alternative therapies.[136]

The Scientific Review of Alternative Medicine points to confusions in the general population a person may attribute symptomatic relief to an otherwise-ineffective therapy just because they are taking something (the placebo effect); the natural recovery from or the cyclical nature of an illness (the regression fallacy) gets misattributed to an alternative medicine being taken; a person not diagnosed with science-based medicine may never originally have had a true illness diagnosed as an alternative disease category.[137]

Edzard Ernst characterized the evidence for many alternative techniques as weak, nonexistent, or negative[138] and in 2011 published his estimate that about 7.4% were based on “sound evidence”, although he believes that may be an overestimate.[139] Ernst has concluded that 95% of the alternative treatments he and his team studied, including acupuncture, herbal medicine, homeopathy, and reflexology, are “statistically indistinguishable from placebo treatments”, but he also believes there is something that conventional doctors can usefully learn from the chiropractors and homeopath: this is the therapeutic value of the placebo effect, one of the strangest phenomena in medicine.[140][141]

In 2003, a project funded by the CDC identified 208 condition-treatment pairs, of which 58% had been studied by at least one randomized controlled trial (RCT), and 23% had been assessed with a meta-analysis.[142] According to a 2005 book by a US Institute of Medicine panel, the number of RCTs focused on CAM has risen dramatically.

As of 2005[update], the Cochrane Library had 145 CAM-related Cochrane systematic reviews and 340 non-Cochrane systematic reviews. An analysis of the conclusions of only the 145 Cochrane reviews was done by two readers. In 83% of the cases, the readers agreed. In the 17% in which they disagreed, a third reader agreed with one of the initial readers to set a rating. These studies found that, for CAM, 38.4% concluded positive effect or possibly positive (12.4%), 4.8% concluded no effect, 0.7% concluded harmful effect, and 56.6% concluded insufficient evidence. An assessment of conventional treatments found that 41.3% concluded positive or possibly positive effect, 20% concluded no effect, 8.1% concluded net harmful effects, and 21.3% concluded insufficient evidence. However, the CAM review used the more developed 2004 Cochrane database, while the conventional review used the initial 1998 Cochrane database.

In the same way as for conventional therapies, drugs, and interventions, it can be difficult to test the efficacy of alternative medicine in clinical trials. In instances where an established, effective, treatment for a condition is already available, the Helsinki Declaration states that withholding such treatment is unethical in most circumstances. Use of standard-of-care treatment in addition to an alternative technique being tested may produce confounded or difficult-to-interpret results.[144]

Cancer researcher Andrew J. Vickers has stated:

Contrary to much popular and scientific writing, many alternative cancer treatments have been investigated in good-quality clinical trials, and they have been shown to be ineffective. The label “unproven” is inappropriate for such therapies; it is time to assert that many alternative cancer therapies have been “disproven”.[145]

A placebo is a medical treatment with no intended therapeutic value. An example of a placebo is an inert pill, but it can include more dramatic interventions like sham surgery. The placebo effect is the concept that patients will perceive an improvement after being treated with an inert treatment. The opposite of the placebo effect would be the nocebo effect, when patients who expect a treatment to be harmful will perceive harmful effects after taking it.

Placebos do not have a physical effect on diseases or improve overall outcomes, but patients may report improvements in subjective outcomes such as pain and nausea.[146] A 1955 study suggested that a substantial part of a medicine’s impact was due to the placebo effect.[147][146] The study was found to have flawed methodology in a 1997 reassessment.[148] This and other modern reviews suggest that other factors like natural recovery and reporting bias should also be considered.[146][148]

All of these are reasons why alternative therapies may be credited for improving a patient’s condition even though the objective effect is non-existent, or even harmful.[149][34][47] David Gorski argues that alternatives treatments should be treated as a placebo, rather than as medicine.[34] Almost none have performed significantly better than a placebo in clinical trials.[4][46][150][104] Furthermore, distrust of conventional medicine may lead to patients experiencing the nocebo effect when taking effective medication.[149]

A patient who receives an inert treatment may report improvements afterwards that it did not cause.[146][148] Assuming it was the cause without evidence is an example of the regression fallacy. This may be due to a natural recovery from the illness, or a fluctuation in the symptoms of a long-term condition.[148] The concept of regression toward the mean implies that an extreme result is more likely to be followed by a less extreme result.

There are also reasons why a placebo treatment group may outperform a “no-treatment” group in a test which are not related to a patient’s experience. These include patients reporting more favourable results than they really felt due to “politeness” or “experimental subordination”, observer bias and misleading wording of questions.[148] In their 2010 systematic review of studies into placebos, Asbjrn Hrbjartsson and Peter C. Gtzsche write that “even if there were no true effect of placebo, one would expect to record differences between placebo and no-treatment groups due to bias associated with lack of blinding.”[146]

Practitioners of complementary medicine usually discuss and advise patients as to available alternative therapies. Patients often express interest in mind-body complementary therapies because they offer a non-drug approach to treating some health conditions.[151]

In addition to the social-cultural underpinnings of the popularity of alternative medicine, there are several psychological issues that are critical to its growth, notably psychological effects, such as the will to believe,[152] cognitive biases that help maintain self-esteem and promote harmonious social functioning,[152] and the post hoc, ergo propter hoc fallacy.[152]

The popularity of complementary & alternative medicine (CAM) may be related to other factors that Edzard Ernst mentioned in an interview in The Independent:

Why is it so popular, then? Ernst blames the providers, customers and the doctors whose neglect, he says, has created the opening into which alternative therapists have stepped. “People are told lies. There are 40 million websites and 39.9 million tell lies, sometimes outrageous lies. They mislead cancer patients, who are encouraged not only to pay their last penny but to be treated with something that shortens their lives. “At the same time, people are gullible. It needs gullibility for the industry to succeed. It doesn’t make me popular with the public, but it’s the truth.[153]

Paul Offit proposed that “alternative medicine becomes quackery” in four ways: by recommending against conventional therapies that are helpful, promoting potentially harmful therapies without adequate warning, draining patients’ bank accounts, or by promoting “magical thinking.”[35]

Authors have speculated on the socio-cultural and psychological reasons for the appeal of alternative medicines among the minority using them in lieu of conventional medicine. There are several socio-cultural reasons for the interest in these treatments centered on the low level of scientific literacy among the public at large and a concomitant increase in antiscientific attitudes and new age mysticism.[152] Related to this are vigorous marketing[154] of extravagant claims by the alternative medical community combined with inadequate media scrutiny and attacks on critics.[152][155]

There is also an increase in conspiracy theories toward conventional medicine and pharmaceutical companies, mistrust of traditional authority figures, such as the physician, and a dislike of the current delivery methods of scientific biomedicine, all of which have led patients to seek out alternative medicine to treat a variety of ailments.[155] Many patients lack access to contemporary medicine, due to a lack of private or public health insurance, which leads them to seek out lower-cost alternative medicine.[156] Medical doctors are also aggressively marketing alternative medicine to profit from this market.[154]

Patients can be averse to the painful, unpleasant, and sometimes-dangerous side effects of biomedical treatments. Treatments for severe diseases such as cancer and HIV infection have well-known, significant side-effects. Even low-risk medications such as antibiotics can have potential to cause life-threatening anaphylactic reactions in a very few individuals. Many medications may cause minor but bothersome symptoms such as cough or upset stomach. In all of these cases, patients may be seeking out alternative treatments to avoid the adverse effects of conventional treatments.[152][155]

According to recent research, the increasing popularity of the CAM needs to be explained by moral convictions or lifestyle choices rather than by economic reasoning.[157]

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 healthcare or be integrated into the healthcare system. In Africa, traditional medicine is used for 80% of primary healthcare, and in developing nations as a whole over one-third of the population lack access to essential medicines.[158]

Some have proposed adopting a prize system to reward medical research.[159] However, public funding for research exists. In the US increasing the funding for research on alternative medicine is the purpose of the US National Center for Complementary and Alternative Medicine (NCCAM). NCCAM has spent more than US$2.5 billion on such research since 1992 and this research has not demonstrated the efficacy of alternative treatments.[150][160][161][162][163][164] The NCCAM’s sister organization in the NIC Office of Cancer Complementary and Alternative Medicine gives grants of around $105 million every year.[165]

That alternative medicine has been on the rise “in countries where Western science and scientific method generally are accepted as the major foundations for healthcare, and ‘evidence-based’ practice is the dominant paradigm” was described as an “enigma” in the Medical Journal of Australia.[166]

In the United States, the 1974 Child Abuse Prevention and Treatment Act (CAPTA) required that for states to receive federal money, they had to grant religious exemptions to child neglect and abuse laws regarding religion-based healing practices.[167] Thirty-one states have child-abuse religious exemptions.[168]

The use of alternative medicine in the US has increased,[1][169] with a 50 percent increase in expenditures and a 25 percent increase in the use of alternative therapies between 1990 and 1997 in America.[169] Americans spend many billions on the therapies annually.[169] Most Americans used CAM to treat and/or prevent musculoskeletal conditions or other conditions associated with chronic or recurring pain.[156] In America, women were more likely than men to use CAM, with the biggest difference in use of mind-body therapies including prayer specifically for health reasons”.[156] In 2008, more than 37% of American hospitals offered alternative therapies, up from 27 percent in 2005, and 25% in 2004.[170][171] More than 70% of the hospitals offering CAM were in urban areas.[171]

A survey of Americans found that 88 percent thought that “there are some good ways of treating sickness that medical science does not recognize”.[1] Use of magnets was the most common tool in energy medicine in America, and among users of it, 58 percent described it as at least “sort of scientific”, when it is not at all scientific.[1] In 2002, at least 60 percent of US medical schools have at least some class time spent teaching alternative therapies.[1] “Therapeutic touch” was taught at more than 100 colleges and universities in 75 countries before the practice was debunked by a nine-year-old child for a school science project.[1][103]

The most common CAM therapies used in the US in 2002 were prayer (45%), herbalism (19%), breathing meditation (12%), meditation (8%), chiropractic medicine (8%), yoga (56%), body work (5%), diet-based therapy (4%), progressive relaxation (3%), mega-vitamin therapy (3%) and Visualization (2%)[156][172]

In Britain, the most often used alternative therapies were Alexander technique, Aromatherapy, Bach and other flower remedies, Body work therapies including massage, Counseling stress therapies, hypnotherapy, Meditation, Reflexology, Shiatsu, Ayurvedic medicine, Nutritional medicine, and Yoga.[173] Ayurvedic medicine remedies are mainly plant based with some use of animal materials. Safety concerns include the use of herbs containing toxic compounds and the lack of quality control in Ayurvedic facilities.[97][99]

According to the National Health Service (England), the most commonly used complementary and alternative medicines (CAM) supported by the NHS in the UK are: acupuncture, aromatherapy, chiropractic, homeopathy, massage, osteopathy and clinical hypnotherapy.[175]

Complementary therapies are often used in palliative care or by practitioners attempting to manage chronic pain in patients. Integrative 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.”[176] 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.”[177]

In Austria and Germany complementary and alternative medicine is mainly in the hands of doctors with MDs,[30] and half or more of the American alternative practitioners are licensed MDs.[178] In Germany herbs are tightly regulated: half are prescribed by doctors and covered by health insurance.[179]

Some professions of complementary/traditional/alternative medicine, such as chiropractic, have achieved full regulation in North America and other parts of the world and are regulated in a manner similar to that governing science-based medicine. In contrast, other approaches may be partially recognized and others have no regulation at all. Regulation and licensing of alternative medicine ranges widely from country to country, and state to state.

Government bodies in the US and elsewhere have published information or guidance about alternative medicine. The U.S. Food and Drug Administration (FDA), has issued online warnings for consumers about medication health fraud.[181] This includes a section on Alternative Medicine Fraud,[182] such as a warning that Ayurvedic products generally have not been approved by the FDA before marketing.[183]

Many of the claims regarding the safety and efficacy of alternative medicine are controversial. Some alternative treatments have been associated with unexpected side effects, which can be fatal.[184]

A commonly voiced concerns about complementary alternative medicine (CAM) is the way it’s regulated. There have been significant developments in how CAMs should be assessed prior to re-sale in the United Kingdom and the European Union (EU) in the last 2 years. Despite this, it has been suggested that current regulatory bodies have been ineffective in preventing deception of patients as many companies have re-labelled their drugs to avoid the new laws.[185] There is no general consensus about how to balance consumer protection (from false claims, toxicity, and advertising) with freedom to choose remedies.

Advocates of CAM suggest that regulation of the industry will adversely affect patients looking for alternative ways to manage their symptoms, even if many of the benefits may represent the placebo affect.[186] Some contend that alternative medicines should not require any more regulation than over-the-counter medicines that can also be toxic in overdose (such as paracetamol).[187]

Forms of alternative medicine that are biologically active can be dangerous even when used in conjunction with conventional medicine. Examples include immuno-augmentation therapy, shark cartilage, bioresonance therapy, oxygen and ozone therapies, and insulin potentiation therapy. Some herbal remedies can cause dangerous interactions with chemotherapy drugs, radiation therapy, or anesthetics during surgery, among other problems.[31] An example of these dangers was reported by Associate Professor Alastair MacLennan of Adelaide University, Australia regarding a patient who almost bled to death on the operating table after neglecting to mention that she had been taking “natural” potions to “build up her strength” before the operation, including a powerful anticoagulant that nearly caused her death.[188]

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.[189]

Conventional treatments are subjected to testing for undesired side-effects, whereas alternative treatments, in general, are not subjected to such testing at all. Any treatment whether conventional or alternative that has a biological or psychological effect on a patient may also have potential to possess dangerous biological or psychological side-effects. 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.” Specific groups of patients such as patients with impaired hepatic or renal function are more susceptible to side effects of alternative remedies.[190][191]

An exception to the normal thinking regarding side-effects is Homeopathy. Since 1938, the U.S. Food and Drug Administration (FDA) has regulated homeopathic products in “several significantly different ways from other drugs.”[192] Homeopathic preparations, termed “remedies”, are extremely dilute, often far beyond the point where a single molecule of the original active (and possibly toxic) ingredient is likely to remain. They are, thus, considered safe on that count, but “their products are exempt from good manufacturing practice requirements related to expiration dating and from finished product testing for identity and strength”, and their alcohol concentration may be much higher than allowed in conventional drugs.[192]

Those having experienced or perceived 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.[193] For this reason, critics argue that therapies that rely on the placebo effect to define success are very dangerous. According to mental health journalist Scott Lilienfeld in 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 outcomes.[194] Between 2001 and 2003, four children died in Australia because their parents chose ineffective naturopathic, homeopathic, or other alternative medicines and diets rather than conventional therapies.[195]

There have always been “many therapies offered outside of conventional cancer treatment centers and based on theories not found in biomedicine. These alternative cancer cures have often been described as ‘unproven,’ suggesting that appropriate clinical trials have not been conducted and that the therapeutic value of the treatment is unknown.” However, “many alternative cancer treatments have been investigated in good-quality clinical trials, and they have been shown to be ineffective….The label ‘unproven’ is inappropriate for such therapies; it is time to assert that many alternative cancer therapies have been ‘disproven’.”[145]

Edzard Ernst has stated:

any alternative cancer cure is bogus by definition. There will never be an alternative cancer cure. Why? Because if something looked halfway promising, then mainstream oncology would scrutinize it, and if there is anything to it, it would become mainstream almost automatically and very quickly. All curative “alternative cancer cures” are based on false claims, are bogus, and, I would say, even criminal.[196]

“CAM”, meaning “complementary and alternative medicine”, is not as well researched as conventional medicine, which undergoes intense research before release to the public.[197] Funding for research is also sparse making it difficult to do further research for effectiveness of CAM.[198] Most funding for CAM is funded by government agencies.[197] Proposed research for CAM are rejected by most private funding agencies because the results of research are not reliable.[197] The research for CAM has to meet certain standards from research ethics committees, which most CAM researchers find almost impossible to meet.[197] Even with the little research done on it, CAM has not been proven to be effective.[199]

Steven Novella, a neurologist at Yale School of Medicine, wrote that government funded studies of integrating alternative medicine techniques into the mainstream are “used to lend an appearance of legitimacy to treatments that are not legitimate.”[200] Marcia Angell considered that critics felt that healthcare practices should be classified based solely on scientific evidence, and if a treatment had been rigorously tested and found safe and effective, science-based medicine will adopt it regardless of whether it was considered “alternative” to begin with.[3] It is possible for a method to change categories (proven vs. unproven), based on increased knowledge of its effectiveness or lack thereof. A prominent supporter of this position is George D. Lundberg, former editor of the Journal of the American Medical Association (JAMA).[37]

Writing in 1999 in CA: A Cancer Journal for Clinicians Barrie R. Cassileth mentioned a 1997 letter to the US Senate Subcommittee on Public Health and Safety, which had deplored the lack of critical thinking and scientific rigor in OAM-supported research, had been signed by four Nobel Laureates and other prominent scientists. (This was supported by the National Institutes of Health (NIH).)[201]

In March 2009 a staff writer for the Washington Post reported that the impending national discussion about broadening access to health care, improving medical practice and saving money was giving a group of scientists an opening to propose shutting down the National Center for Complementary and Alternative Medicine. They quoted one of these scientists, Steven Salzberg, a genome researcher and computational biologist at the University of Maryland, as saying “One of our concerns is that NIH is funding pseudoscience.” They noted that the vast majority of studies were based on fundamental misunderstandings of physiology and disease, and had shown little or no effect.[200]

Writers such as Carl Sagan, a noted astrophysicist, advocate of scientific skepticism and the author of The Demon-Haunted World: Science as a Candle in the Dark (1996), have lambasted the lack of empirical evidence to support the existence of the putative energy fields on which these therapies are predicated.

Sampson has also pointed out that CAM tolerated contradiction without thorough reason and experiment.[202] Barrett has pointed out 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.[150] Barrett also expressed concern that, just because some “alternatives” have merit, there is the impression that the rest deserve equal consideration and respect even though most are worthless, since they are all classified under the one heading of alternative medicine.[203]

Some critics of alternative medicine are focused upon health fraud, misinformation, and quackery as public health problems, notably Wallace Sampson and Paul Kurtz founders of Scientific Review of Alternative Medicine and Stephen Barrett, co-founder of The National Council Against Health Fraud and webmaster of Quackwatch.[204] Grounds for opposing alternative medicine include that:

Many alternative medical treatments are not patentable,[210] which may lead to less research funding from the private sector. In addition, in most countries, alternative treatments (in contrast to pharmaceuticals) can be marketed without any proof of efficacy also a disincentive for manufacturers to fund scientific research.[211]

English evolutionary biologist Richard Dawkins, in his 2003 book A Devil’s Chaplain, defined alternative medicine as a “set of practices that cannot be tested, refuse to be tested, or consistently fail tests.”[212] Dawkins argued that if a technique is demonstrated effective in properly performed trials then it ceases to be alternative and simply becomes medicine.[213]

CAM is also often less regulated than conventional medicine.[197] There are ethical concerns about whether people who perform CAM have the proper knowledge to treat patients.[197] CAM is often done by non-physicians who do not operate with the same medical licensing laws which govern conventional medicine,[197] and it is often described as an issue of non-maleficence.[214]

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Alternative medicine – Wikipedia

Integrative medicine: Alternative becomes mainstream …

Integrative medicine: Alternative becomes mainstream

What’s considered an alternative therapy is a moving target. Learn the lingo and get the facts.

Complementary medicine has never been more popular. Nearly 30 percent of adults report using complementary and alternative medicine (CAM). Doctors are embracing CAM therapies, too, often combining them with mainstream medical therapies spawning the term “integrative medicine.”

Exactly what’s considered complementary medicine changes constantly as treatments undergo testing and move into the mainstream. To make sense of the many therapies available, it helps to look at how they’re classified by the National Center for Complementary and Integrative Health (NCCIH):

Examples include dietary supplements and herbal remedies. These treatments use ingredients found in nature. Examples of herbs include ginseng, ginkgo and echinacea; examples of dietary supplements include selenium, glucosamine sulfate and SAMe. Herbs and supplements can be taken as teas, oils, syrups, powders, tablets or capsules.

Mind-body techniques strengthen the communication between your mind and your body. CAM practitioners say these two systems must be in harmony for you to stay healthy. Examples of mind-body connection techniques include meditation, prayer, relaxation and art therapies.

Manipulation and body-based practices use human touch to move or manipulate a specific part of your body. They include chiropractic and osteopathic manipulation and massage.

Some CAM practitioners believe an invisible energy force flows through your body, and when this energy flow is blocked or unbalanced, you can become sick. Different traditions call this energy by different names, such as chi, prana and life force. The goal of these therapies is to unblock or re-balance your energy force. Energy therapies include qi gong, healing touch and reiki.

There are other approaches to complementary health that focus on a system, rather than just a single practice or remedy, such as massage. These systems center on a philosophy, such as the power of nature or the presence of energy in your body. Examples of these approaches include:

Many conventional doctors practicing today didn’t receive training in CAM or integrative medicine, so they may not feel comfortable making recommendations or addressing questions in this area.

Doctors also have good reason to be cautious when it comes to some CAM. Conventional medicine values therapies that have been demonstrated through research and testing to be safe and effective. While scientific evidence exists for some CAM therapies, for many there are key questions that are yet to be answered.

In addition, some CAM practitioners make exaggerated claims about curing diseases, and some ask you to forgo treatment from your conventional doctor. For these reasons, many doctors are cautious about recommending these therapies.

One reason for the lack of research in alternative treatments is that large, carefully controlled medical studies are costly. Trials for conventional therapies are often funded by big companies that develop and sell drugs. Fewer resources are available to support trials of CAM therapies. That’s why NCCIH was established to foster research into CAM and make the findings available to the public.

Work with your conventional medical doctor to help you make informed decisions regarding CAM treatments. Even if your doctor can’t recommend a specific practitioner, he or she can help you understand possible risks and benefits before you try a treatment.

It’s especially important to involve your doctor if you are pregnant, have medical problems or take prescription medicine. And don’t stop or change your conventional treatment such as the dose of your prescription medications without talking to your doctor first. Finally, be sure to keep your doctor updated on any alternative therapies you’re using, including herbal and dietary supplements.

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Integrative medicine: Alternative becomes mainstream …

Alternative medicine – Wikipedia

Alternative medicineAM, complementary and alternative medicine (CAM), complementary medicine, heterodox medicine, integrative medicine (IM), complementary and integrative medicine (CIM), new-age medicine, pseudomedicine, unconventional medicine, unorthodox medicine

Alternative therapies often make bombastic claims, and frequently include anecdotes from healthy-looking individuals claiming successful treatment.

Form of non-scientific healing

Alternative medicine are generally practices that lack biological plausibility and are untested or untestable. In a few cases they are proven ineffective. Complementary medicine (CM), complementary and alternative medicine (CAM), integrated medicine or integrative medicine (IM), and holistic medicine are among many rebrandings of the same phenomenon. While the aim is to achieve the healing effects of medicine, alternative therapies share in common that they reside outside medical science, and rely on pseudoscience. The alternative is distinct from the experimental, which employs scientific method to test plausible therapies by way of responsible and ethical clinical trials, producing evidence of either effect or of no effect. Research into alternative treatments often fails to follow proper research protocol and denies calculalaton of prior probability, providing invalid results. Traditional practices become “alternative” when used outside their original settings without proper scientific explanation and evidence. Frequently used derogatory terms for the alternative are new-age or pseudo, with little distinction from quackery.

In some cases, laws of nature are violated by the claims of alternative practices; in others the practice is plausibly effective but so dangerous to the patient that any use is unethical. Alternative practices often resort to the supernatural or superstitious to explain their effect, and range from ineffective to harmful and toxic.

Much of the perceived effect of an alternative practice arises from a belief that it will be effective (placebo effect), or from the treated condition resolving on its own (the natural course of disease). This is further exacerbated by how alternative treatments are most often turned to upon the failure of medicine. At this point the condition will be at its worst and most likely to spontaneously improve. In diseases that don’t tend to get better by themselves, such as cancer or HIV, multiple studies have shown significantly worse outcomes if patients turn to alternative therapies. While this may be because advanced disease causes patients to lose hope in medicine, it has also been shown that some alternative treatments actively interfere with medicine.

The alternative sector is a highly profitable industry with a strong lobby. Often juxtaposed to the derided “big pharma”, the alternative-industry profits from less regulation and is allowed to promote practices which are proven to have no effect. Despite many countries having laws against marketing or promoting alternative therapies for many conditions, there is active promotion of use in cancer, autoimmune disease, infectious disease and among children. Billions of dollars have been spent studying the “alternative”, with little to no positive results. Some of the successful practices are only considered alternative under very specific definitions, such as those which include all physical activity under the umbrella of “alternative medicine”.

Alternative medicine is defined loosely as a set of products, practices, and theories that are believed or perceived by their users to have the healing effects of medicine,[n 1][n 2] but whose effectiveness has not been established using scientific methods,[n 1][n 3][4][5][6][7] or whose theory and practice is not part of biomedicine,[n 2][n 4][n 5][n 6] or whose theories or practices are directly contradicted by scientific evidence or scientific principles used in biomedicine.[4][5][11] “Biomedicine” or “medicine” is that part of medical science that applies principles of biology, physiology, molecular biology, biophysics, and other natural sciences to clinical practice, using scientific methods to establish the effectiveness of that practice. Unlike medicine,[n 4] an alternative product or practice does not originate from using scientific methods, but may instead be based on hearsay, religion, tradition, superstition, belief in supernatural energies, pseudoscience, errors in reasoning, propaganda, fraud, or other unscientific sources.[n 3][1][4][5]

In General Guidelines for Methodologies on Research and Evaluation of Traditional Medicine, published in 2000 by the World Health Organization (WHO), complementary and alternative medicine were defined as a broad set of health care practices that are not part of that country’s own tradition and are not integrated into the dominant health care system.[12]

The expression also refers to a diverse range of related and unrelated products, practices, and theories ranging from biologically plausible practices and products and practices with some evidence, to practices and theories that are directly contradicted by basic science or clear evidence, and products that have been conclusively proven to be ineffective or even toxic and harmful.[n 2][14][15]

The terms alternative medicine, complementary medicine, integrative medicine, holistic medicine, natural medicine, unorthodox medicine, fringe medicine, unconventional medicine, and new age medicine are used interchangeably as having the same meaning and are almost synonymous in most contexts.[16][17][18][19]

The meaning of the term “alternative” in the expression “alternative medicine”, is not that it is an effective alternative to medical science, although some alternative medicine promoters may use the loose terminology to give the appearance of effectiveness.[4][20] Loose terminology may also be used to suggest meaning that a dichotomy exists when it does not, e.g., the use of the expressions “western medicine” and “eastern medicine” to suggest that the difference is a cultural difference between the Asiatic east and the European west, rather than that the difference is between evidence-based medicine and treatments that do not work.[4]

Complementary medicine (CM) or integrative medicine (IM) is when alternative medicine is used together with functional medical treatment, in a belief that it improves the effect of treatments.[n 7][1][22][23][24] However, significant drug interactions caused by alternative therapies may instead negatively influence treatment, making treatments less effective, notably cancer therapy.[25][26] Both terms refer to use of alternative medical treatments alongside conventional medicine,[27][28][29] an example of which is use of acupuncture (sticking needles in the body to influence the flow of a supernatural energy), along with using science-based medicine, in the belief that the acupuncture increases the effectiveness or “complements” the science-based medicine.[29]

CAM is an abbreviation of the phrase complementary and alternative medicine.[30][31] It has also been called sCAM or SCAM with the addition of “so-called” or “supplements”.[32][33] The words balance and holism are often used, claiming to take into account a “whole” person, in contrast to the alleged reductionism of conventional medicine. Due to its many names the field has been criticized for intense rebranding of what are essentially the same practices.[16]

Besides the usual issues with alternative medicine, integrative medicine has been described by its critics as an attempt to bring pseudoscience into academic science-based medicine,[34] leading to the pejorative term “quackademic medicine”.

Traditional medicine refers to the pre-scientific practices of a certain culture, contrary to what is typically practiced in other cultures where medical science dominates.

“Eastern medicine” typically refers to the traditional medicines of Asia where conventional bio-medicine penetrated much later.

The words balance and holism are often used alongside complementary or integrative medicine, claiming to take into account a “whole” person, in contrast to the supposed reductionism of medicine. Due to its many names the field has been criticized for intense rebranding of what are essentially the same practices.[16]

Prominent members of the science[35][36] and biomedical science community[3] say that it is not meaningful to define an alternative medicine that is separate from a conventional medicine, that the expressions “conventional medicine”, “alternative medicine”, “complementary medicine”, “integrative medicine”, and “holistic medicine” do not refer to any medicine at all.[35][3][36][37]

Others in both the biomedical and CAM communities say that CAM cannot be precisely defined because of the diversity of theories and practices it includes, and because the boundaries between CAM and biomedicine overlap, are porous, and change. The expression “complementary and alternative medicine” (CAM) resists easy definition because the health systems and practices it refers to are diffuse, and its boundaries poorly defined.[14][n 8] 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 (TCM) and Ayurveda, have antique origins in East or South Asia and are entirely alternative medical systems;[42] others, such as homeopathy and chiropractic, have origins in Europe or the United States 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.[45] 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.[45]

Critics say the expression is deceptive because it implies there is an effective alternative to science-based medicine, and that complementary is deceptive because it implies that the treatment increases the effectiveness of (complements) science-based medicine, while alternative medicines that have been tested nearly always have no measurable positive effect compared to a placebo.[4][46][47][34]

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 devised by the US National Center for Complementary and Integrative Health (NCCIH) of the National Institutes of Health (NIH), 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”.[50] For conventional medical practitioners, it does not necessarily follow that either it or its practitioners would no longer be considered alternative.[n 9]

Some definitions seek to specify alternative medicine in terms of its social and political marginality to mainstream healthcare.[53] This can refer to the lack of support that alternative therapies receive from the medical establishment and related bodies regarding access to research funding, sympathetic coverage in the medical press, or inclusion in the standard medical curriculum.[53] In 1993, the British Medical Association (BMA), one among many professional organizations who have attempted to define alternative medicine, stated that it[n 10] referred to “…those forms of treatment which are not widely used by the conventional healthcare professions, and the skills of which are not taught as part of the undergraduate curriculum of conventional medical and paramedical healthcare courses”.[54] In a US context, an influential definition coined in 1993 by the Harvard-based physician,[55] David M. Eisenberg,[56] characterized alternative medicine “as interventions neither taught widely in medical schools nor generally available in US hospitals”.[57] These descriptive definitions are inadequate in the present-day when some conventional doctors offer alternative medical treatments and CAM introductory courses or modules can be offered as part of standard undergraduate medical training;[58] alternative medicine is taught in more than 50 per cent of US medical schools and increasingly US health insurers are willing to provide reimbursement for CAM therapies. In 1999, 7.7% of US hospitals reported using some form of CAM therapy; this proportion had risen to 37.7% by 2008.[60]

An expert panel at a conference hosted in 1995 by the US Office for Alternative Medicine (OAM),[61][n 11] devised a theoretical definition[61] of alternative medicine as “a broad domain of healing resources… other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period”.[63] This definition has been widely adopted by CAM researchers,[61] cited by official government bodies such as the UK Department of Health,[64] attributed as the definition used by the Cochrane Collaboration,[65] and, with some modification,[dubious discuss] was preferred in the 2005 consensus report of the US Institute of Medicine, Complementary and Alternative Medicine in the United States.[n 2]

The 1995 OAM conference definition, an expansion of Eisenberg’s 1993 formulation, is silent regarding questions of the medical effectiveness of alternative therapies.[66] Its proponents hold that it thus avoids relativism about 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.[66] 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”.[67] 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.[67] 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.[67]

Normative definitions distinguish alternative medicine from the biomedical mainstream in its provision of therapies that are unproven, unvalidated, or ineffective and support of theories with 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 are not based on evidence gathered with the scientific method.[1][3][27][28][50][69] Exemplifying this perspective, a 1998 editorial co-authored by Marcia Angell, a former editor of The New England Journal of Medicine, argued that:

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.[3]

This line of division has been subject to criticism, however, as not all forms of standard medical practice have adequately demonstrated evidence of benefit,[n 4][70] and it is also unlikely in most instances that conventional therapies, if proven to be ineffective, would ever be classified as CAM.[61]

Similarly, the public information website maintained by the National Health and Medical Research Council (NHMRC) of the Commonwealth of Australia uses the acronym “CAM” for a wide range of health care practices, therapies, procedures and devices not within the domain of conventional medicine. In the Australian context this is stated to include acupuncture; aromatherapy; chiropractic; homeopathy; massage; meditation and relaxation therapies; naturopathy; osteopathy; reflexology, traditional Chinese medicine; and the use of vitamin supplements.[72]

The Danish National Board of Health’s “Council for Alternative Medicine” (Sundhedsstyrelsens Rd for Alternativ Behandling (SRAB)), an independent institution under the National Board of Health (Danish: Sundhedsstyrelsen), uses the term “alternative medicine” for:

Proponents of an evidence-base for medicine[n 12][75][76][77][78] such as the Cochrane Collaboration (founded in 1993 and from 2011 providing input for WHO resolutions) take a position that all systematic reviews of treatments, whether “mainstream” or “alternative”, ought to be held to the current standards of scientific method.[79] In a study titled Development and classification of an operational definition of complementary and alternative medicine for the Cochrane Collaboration (2011) it was proposed that indicators that a therapy is accepted include government licensing of practitioners, coverage by health insurance, statements of approval by government agencies, and recommendation as part of a practice guideline; and that if something is currently a standard, accepted therapy, then it is not likely to be widely considered as CAM.[61]

Alternative medicine consists of a wide range of health care practices, products, and therapies. The shared feature is a claim to heal that is not based on the scientific method. Alternative medicine practices are diverse in their foundations and methodologies.[50] Alternative medicine practices may be classified by their cultural origins or by the types of beliefs upon which they are based.[1][4][11][50] Methods may incorporate or be based on traditional medicinal practices of a particular culture, folk knowledge, superstition, spiritual beliefs, belief in supernatural energies (antiscience), pseudoscience, errors in reasoning, propaganda, fraud, new or different concepts of health and disease, and any bases other than being proven by scientific methods.[1][4][5][11] Different cultures may have their own unique traditional or belief based practices developed recently or over thousands of years, and specific practices or entire systems of practices.

Alternative medicine, such as using naturopathy or homeopathy in place of conventional medicine, is based on belief systems not grounded in science.[50]

Alternative medical systems may be based on traditional medicine practices, such as traditional Chinese medicine (TCM), Ayurveda in India, or practices of other cultures around the world.[50] Some useful applications of traditional medicines have been researched and accepted within ordinary medicine, however the underlying belief systems are seldom scientific and are not accepted.

Traditional medicine is considered alternative when it is used outside its home region; or when it is used together with or instead of known functional treatment; or when it can be reasonably expected that the patient or practitioner knows or should know that it will not work such as knowing that the practice is based on superstition.

Bases of belief may include belief in existence of supernatural energies undetected by the science of physics, as in biofields, or in belief in properties of the energies of physics that are inconsistent with the laws of physics, as in energy medicine.[50]

Substance based practices use substances found in nature such as herbs, foods, non-vitamin supplements and megavitamins, animal and fungal products, and minerals, including use of these products in traditional medical practices that may also incorporate other methods.[50][104][105] Examples include healing claims for nonvitamin supplements, fish oil, Omega-3 fatty acid, glucosamine, echinacea, flaxseed oil, and ginseng.[106] Herbal medicine, or phytotherapy, includes not just the use of plant products, but may also include the use of animal and mineral products.[104] It is among the most commercially successful branches of alternative medicine, and includes the tablets, powders and elixirs that are sold as “nutritional supplements”.[104] Only a very small percentage of these have been shown to have any efficacy, and there is little regulation as to standards and safety of their contents.[104] This may include use of known toxic substances, such as use of the poison lead in traditional Chinese medicine.[106]

A US agency, National Center on Complementary and Integrative Health (NCCIH), has created a classification system for branches of complementary and alternative medicine that divides them into five major groups. These groups have some overlap, and distinguish two types of energy medicine: veritable which involves scientifically observable energy (including magnet therapy, colorpuncture and light therapy) and putative, which invokes physically undetectable or unverifiable energy.[110] None of these energies have any evidence to support that they effect the body in any positive or health promoting way.[111]

The history of alternative medicine may refer to the history of a group of diverse medical practices that were collectively promoted as “alternative medicine” beginning in the 1970s, to the collection of individual histories of members of that group, or to the history of western medical practices that were labeled “irregular practices” by the western medical establishment.[4][112][113][114][115] It includes the histories of complementary medicine and of integrative medicine. Before the 1970s, western practitioners that were not part of the increasingly science-based medical establishment were referred to “irregular practitioners”, and were dismissed by the medical establishment as unscientific and as practicing quackery.[112][113] Until the 1970s, irregular practice became increasingly marginalized as quackery and fraud, as western medicine increasingly incorporated scientific methods and discoveries, and had a corresponding increase in success of its treatments.[114] In the 1970s, irregular practices were grouped with traditional practices of nonwestern cultures and with other unproven or disproven practices that were not part of biomedicine, with the entire group collectively marketed and promoted under the single expression “alternative medicine”.[4][112][113][114][116]

Use of alternative medicine in the west began to rise following the counterculture movement of the 1960s, as part of the rising new age movement of the 1970s.[4][117][118] This was due to misleading mass marketing of “alternative medicine” being an effective “alternative” to biomedicine, changing social attitudes about not using chemicals and challenging the establishment and authority of any kind, sensitivity to giving equal measure to beliefs and practices of other cultures (cultural relativism), and growing frustration and desperation by patients about limitations and side effects of science-based medicine.[4][113][114][115][116][118][119] At the same time, in 1975, the American Medical Association, which played the central role in fighting quackery in the United States, abolished its quackery committee and closed down its Department of Investigation.[112]:xxi[119] By the early to mid 1970s the expression “alternative medicine” came into widespread use, and the expression became mass marketed as a collection of “natural” and effective treatment “alternatives” to science-based biomedicine.[4][119][120][121] By 1983, mass marketing of “alternative medicine” was so pervasive that the British Medical Journal (BMJ) pointed to “an apparently endless stream of books, articles, and radio and television programmes urge on the public the virtues of (alternative medicine) treatments ranging from meditation to drilling a hole in the skull to let in more oxygen”.[119]

An analysis of trends in the criticism of complementary and alternative medicine (CAM) in five prestigious American medical journals during the period of reorganization within medicine (19651999) was reported as showing that the medical profession had responded to the growth of CAM in three phases, and that in each phase, changes in the medical marketplace had influenced the type of response in the journals.[122] Changes included relaxed medical licensing, the development of managed care, rising consumerism, and the establishment of the USA Office of Alternative Medicine (later National Center for Complementary and Alternative Medicine, currently National Center for Complementary and Integrative Health).[n 14]

Mainly as a result of reforms following the Flexner Report of 1910[124] medical education in established medical schools in the US has generally not included alternative medicine as a teaching topic.[n 15] Typically, their teaching is based on current practice and scientific knowledge about: anatomy, physiology, histology, embryology, neuroanatomy, pathology, pharmacology, microbiology and immunology.[126] Medical schools’ teaching includes such topics as doctor-patient communication, ethics, the art of medicine,[127] and engaging in complex clinical reasoning (medical decision-making).[128] Writing in 2002, Snyderman and Weil remarked that by the early twentieth century the Flexner model had helped to create the 20th-century academic health center, in which education, research, and practice were inseparable. While this had much improved medical practice by defining with increasing certainty the pathophysiological basis of disease, a single-minded focus on the pathophysiological had diverted much of mainstream American medicine from clinical conditions that were not well understood in mechanistic terms, and were not effectively treated by conventional therapies.[129]

By 2001 some form of CAM training was being offered by at least 75 out of 125 medical schools in the US.[130] Exceptionally, the School of Medicine of the University of Maryland, Baltimore includes a research institute for integrative medicine (a member entity of the Cochrane Collaboration).[79][131] Medical schools are responsible for conferring medical degrees, but a physician typically may not legally practice medicine until licensed by the local government authority. Licensed physicians in the US who have attended one of the established medical schools there have usually graduated Doctor of Medicine (MD).[132] All states require that applicants for MD licensure be graduates of an approved medical school and complete the United States Medical Licensing Exam (USMLE).[132]

There is a general scientific consensus that alternative therapies lack the requisite scientific validation, and their effectiveness is either unproved or disproved.[1][4][133][134] Many of the claims regarding the efficacy of alternative medicines are controversial, since research on them is frequently of low quality and methodologically flawed. Selective publication bias, marked differences in product quality and standardisation, and some companies making unsubstantiated claims call into question the claims of efficacy of isolated examples where there is evidence for alternative therapies.[136]

The Scientific Review of Alternative Medicine points to confusions in the general population a person may attribute symptomatic relief to an otherwise-ineffective therapy just because they are taking something (the placebo effect); the natural recovery from or the cyclical nature of an illness (the regression fallacy) gets misattributed to an alternative medicine being taken; a person not diagnosed with science-based medicine may never originally have had a true illness diagnosed as an alternative disease category.[137]

Edzard Ernst characterized the evidence for many alternative techniques as weak, nonexistent, or negative[138] and in 2011 published his estimate that about 7.4% were based on “sound evidence”, although he believes that may be an overestimate.[139] Ernst has concluded that 95% of the alternative treatments he and his team studied, including acupuncture, herbal medicine, homeopathy, and reflexology, are “statistically indistinguishable from placebo treatments”, but he also believes there is something that conventional doctors can usefully learn from the chiropractors and homeopath: this is the therapeutic value of the placebo effect, one of the strangest phenomena in medicine.[140][141]

In 2003, a project funded by the CDC identified 208 condition-treatment pairs, of which 58% had been studied by at least one randomized controlled trial (RCT), and 23% had been assessed with a meta-analysis.[142] According to a 2005 book by a US Institute of Medicine panel, the number of RCTs focused on CAM has risen dramatically.

As of 2005[update], the Cochrane Library had 145 CAM-related Cochrane systematic reviews and 340 non-Cochrane systematic reviews. An analysis of the conclusions of only the 145 Cochrane reviews was done by two readers. In 83% of the cases, the readers agreed. In the 17% in which they disagreed, a third reader agreed with one of the initial readers to set a rating. These studies found that, for CAM, 38.4% concluded positive effect or possibly positive (12.4%), 4.8% concluded no effect, 0.7% concluded harmful effect, and 56.6% concluded insufficient evidence. An assessment of conventional treatments found that 41.3% concluded positive or possibly positive effect, 20% concluded no effect, 8.1% concluded net harmful effects, and 21.3% concluded insufficient evidence. However, the CAM review used the more developed 2004 Cochrane database, while the conventional review used the initial 1998 Cochrane database.

In the same way as for conventional therapies, drugs, and interventions, it can be difficult to test the efficacy of alternative medicine in clinical trials. In instances where an established, effective, treatment for a condition is already available, the Helsinki Declaration states that withholding such treatment is unethical in most circumstances. Use of standard-of-care treatment in addition to an alternative technique being tested may produce confounded or difficult-to-interpret results.[144]

Cancer researcher Andrew J. Vickers has stated:

Contrary to much popular and scientific writing, many alternative cancer treatments have been investigated in good-quality clinical trials, and they have been shown to be ineffective. The label “unproven” is inappropriate for such therapies; it is time to assert that many alternative cancer therapies have been “disproven”.[145]

A placebo is a medical treatment with no intended therapeutic value. An example of a placebo is an inert pill, but it can include more dramatic interventions like sham surgery. The placebo effect is the concept that patients will perceive an improvement after being treated with an inert treatment. The opposite of the placebo effect would be the nocebo effect, when patients who expect a treatment to be harmful will perceive harmful effects after taking it.

Placebos do not have a physical effect on diseases or improve overall outcomes, but patients may report improvements in subjective outcomes such as pain and nausea.[146] A 1955 study suggested that a substantial part of a medicine’s impact was due to the placebo effect.[147][146] The study was found to have flawed methodology in a 1997 reassessment.[148] This and other modern reviews suggest that other factors like natural recovery and reporting bias should also be considered.[146][148]

All of these are reasons why alternative therapies may be credited for improving a patient’s condition even though the objective effect is non-existent, or even harmful.[149][34][47] David Gorski argues that alternatives treatments should be treated as a placebo, rather than as medicine.[34] Almost none have performed significantly better than a placebo in clinical trials.[4][46][150][104] Furthermore, distrust of conventional medicine may lead to patients experiencing the nocebo effect when taking effective medication.[149]

A patient who receives an inert treatment may report improvements afterwards that it did not cause.[146][148] Assuming it was the cause without evidence is an example of the regression fallacy. This may be due to a natural recovery from the illness, or a fluctuation in the symptoms of a long-term condition.[148] The concept of regression toward the mean implies that an extreme result is more likely to be followed by a less extreme result.

There are also reasons why a placebo treatment group may outperform a “no-treatment” group in a test which are not related to a patient’s experience. These include patients reporting more favourable results than they really felt due to “politeness” or “experimental subordination”, observer bias and misleading wording of questions.[148] In their 2010 systematic review of studies into placebos, Asbjrn Hrbjartsson and Peter C. Gtzsche write that “even if there were no true effect of placebo, one would expect to record differences between placebo and no-treatment groups due to bias associated with lack of blinding.”[146]

Practitioners of complementary medicine usually discuss and advise patients as to available alternative therapies. Patients often express interest in mind-body complementary therapies because they offer a non-drug approach to treating some health conditions.[151]

In addition to the social-cultural underpinnings of the popularity of alternative medicine, there are several psychological issues that are critical to its growth, notably psychological effects, such as the will to believe,[152] cognitive biases that help maintain self-esteem and promote harmonious social functioning,[152] and the post hoc, ergo propter hoc fallacy.[152]

The popularity of complementary & alternative medicine (CAM) may be related to other factors that Edzard Ernst mentioned in an interview in The Independent:

Why is it so popular, then? Ernst blames the providers, customers and the doctors whose neglect, he says, has created the opening into which alternative therapists have stepped. “People are told lies. There are 40 million websites and 39.9 million tell lies, sometimes outrageous lies. They mislead cancer patients, who are encouraged not only to pay their last penny but to be treated with something that shortens their lives. “At the same time, people are gullible. It needs gullibility for the industry to succeed. It doesn’t make me popular with the public, but it’s the truth.[153]

Paul Offit proposed that “alternative medicine becomes quackery” in four ways: by recommending against conventional therapies that are helpful, promoting potentially harmful therapies without adequate warning, draining patients’ bank accounts, or by promoting “magical thinking.”[35]

Authors have speculated on the socio-cultural and psychological reasons for the appeal of alternative medicines among the minority using them in lieu of conventional medicine. There are several socio-cultural reasons for the interest in these treatments centered on the low level of scientific literacy among the public at large and a concomitant increase in antiscientific attitudes and new age mysticism.[152] Related to this are vigorous marketing[154] of extravagant claims by the alternative medical community combined with inadequate media scrutiny and attacks on critics.[152][155]

There is also an increase in conspiracy theories toward conventional medicine and pharmaceutical companies, mistrust of traditional authority figures, such as the physician, and a dislike of the current delivery methods of scientific biomedicine, all of which have led patients to seek out alternative medicine to treat a variety of ailments.[155] Many patients lack access to contemporary medicine, due to a lack of private or public health insurance, which leads them to seek out lower-cost alternative medicine.[156] Medical doctors are also aggressively marketing alternative medicine to profit from this market.[154]

Patients can be averse to the painful, unpleasant, and sometimes-dangerous side effects of biomedical treatments. Treatments for severe diseases such as cancer and HIV infection have well-known, significant side-effects. Even low-risk medications such as antibiotics can have potential to cause life-threatening anaphylactic reactions in a very few individuals. Many medications may cause minor but bothersome symptoms such as cough or upset stomach. In all of these cases, patients may be seeking out alternative treatments to avoid the adverse effects of conventional treatments.[152][155]

According to recent research, the increasing popularity of the CAM needs to be explained by moral convictions or lifestyle choices rather than by economic reasoning.[157]

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 healthcare or be integrated into the healthcare system. In Africa, traditional medicine is used for 80% of primary healthcare, and in developing nations as a whole over one-third of the population lack access to essential medicines.[158]

Some have proposed adopting a prize system to reward medical research.[159] However, public funding for research exists. In the US increasing the funding for research on alternative medicine is the purpose of the US National Center for Complementary and Alternative Medicine (NCCAM). NCCAM has spent more than US$2.5 billion on such research since 1992 and this research has not demonstrated the efficacy of alternative treatments.[150][160][161][162][163][164] The NCCAM’s sister organization in the NIC Office of Cancer Complementary and Alternative Medicine gives grants of around $105 million every year.[165]

That alternative medicine has been on the rise “in countries where Western science and scientific method generally are accepted as the major foundations for healthcare, and ‘evidence-based’ practice is the dominant paradigm” was described as an “enigma” in the Medical Journal of Australia.[166]

In the United States, the 1974 Child Abuse Prevention and Treatment Act (CAPTA) required that for states to receive federal money, they had to grant religious exemptions to child neglect and abuse laws regarding religion-based healing practices.[167] Thirty-one states have child-abuse religious exemptions.[168]

The use of alternative medicine in the US has increased,[1][169] with a 50 percent increase in expenditures and a 25 percent increase in the use of alternative therapies between 1990 and 1997 in America.[169] Americans spend many billions on the therapies annually.[169] Most Americans used CAM to treat and/or prevent musculoskeletal conditions or other conditions associated with chronic or recurring pain.[156] In America, women were more likely than men to use CAM, with the biggest difference in use of mind-body therapies including prayer specifically for health reasons”.[156] In 2008, more than 37% of American hospitals offered alternative therapies, up from 27 percent in 2005, and 25% in 2004.[170][171] More than 70% of the hospitals offering CAM were in urban areas.[171]

A survey of Americans found that 88 percent thought that “there are some good ways of treating sickness that medical science does not recognize”.[1] Use of magnets was the most common tool in energy medicine in America, and among users of it, 58 percent described it as at least “sort of scientific”, when it is not at all scientific.[1] In 2002, at least 60 percent of US medical schools have at least some class time spent teaching alternative therapies.[1] “Therapeutic touch” was taught at more than 100 colleges and universities in 75 countries before the practice was debunked by a nine-year-old child for a school science project.[1][103]

The most common CAM therapies used in the US in 2002 were prayer (45%), herbalism (19%), breathing meditation (12%), meditation (8%), chiropractic medicine (8%), yoga (56%), body work (5%), diet-based therapy (4%), progressive relaxation (3%), mega-vitamin therapy (3%) and Visualization (2%)[156][172]

In Britain, the most often used alternative therapies were Alexander technique, Aromatherapy, Bach and other flower remedies, Body work therapies including massage, Counseling stress therapies, hypnotherapy, Meditation, Reflexology, Shiatsu, Ayurvedic medicine, Nutritional medicine, and Yoga.[173] Ayurvedic medicine remedies are mainly plant based with some use of animal materials. Safety concerns include the use of herbs containing toxic compounds and the lack of quality control in Ayurvedic facilities.[97][99]

According to the National Health Service (England), the most commonly used complementary and alternative medicines (CAM) supported by the NHS in the UK are: acupuncture, aromatherapy, chiropractic, homeopathy, massage, osteopathy and clinical hypnotherapy.[175]

Complementary therapies are often used in palliative care or by practitioners attempting to manage chronic pain in patients. Integrative 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.”[176] 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.”[177]

In Austria and Germany complementary and alternative medicine is mainly in the hands of doctors with MDs,[30] and half or more of the American alternative practitioners are licensed MDs.[178] In Germany herbs are tightly regulated: half are prescribed by doctors and covered by health insurance.[179]

Some professions of complementary/traditional/alternative medicine, such as chiropractic, have achieved full regulation in North America and other parts of the world and are regulated in a manner similar to that governing science-based medicine. In contrast, other approaches may be partially recognized and others have no regulation at all. Regulation and licensing of alternative medicine ranges widely from country to country, and state to state.

Government bodies in the US and elsewhere have published information or guidance about alternative medicine. The U.S. Food and Drug Administration (FDA), has issued online warnings for consumers about medication health fraud.[181] This includes a section on Alternative Medicine Fraud,[182] such as a warning that Ayurvedic products generally have not been approved by the FDA before marketing.[183]

Many of the claims regarding the safety and efficacy of alternative medicine are controversial. Some alternative treatments have been associated with unexpected side effects, which can be fatal.[184]

A commonly voiced concerns about complementary alternative medicine (CAM) is the way it’s regulated. There have been significant developments in how CAMs should be assessed prior to re-sale in the United Kingdom and the European Union (EU) in the last 2 years. Despite this, it has been suggested that current regulatory bodies have been ineffective in preventing deception of patients as many companies have re-labelled their drugs to avoid the new laws.[185] There is no general consensus about how to balance consumer protection (from false claims, toxicity, and advertising) with freedom to choose remedies.

Advocates of CAM suggest that regulation of the industry will adversely affect patients looking for alternative ways to manage their symptoms, even if many of the benefits may represent the placebo affect.[186] Some contend that alternative medicines should not require any more regulation than over-the-counter medicines that can also be toxic in overdose (such as paracetamol).[187]

Forms of alternative medicine that are biologically active can be dangerous even when used in conjunction with conventional medicine. Examples include immuno-augmentation therapy, shark cartilage, bioresonance therapy, oxygen and ozone therapies, and insulin potentiation therapy. Some herbal remedies can cause dangerous interactions with chemotherapy drugs, radiation therapy, or anesthetics during surgery, among other problems.[31] An example of these dangers was reported by Associate Professor Alastair MacLennan of Adelaide University, Australia regarding a patient who almost bled to death on the operating table after neglecting to mention that she had been taking “natural” potions to “build up her strength” before the operation, including a powerful anticoagulant that nearly caused her death.[188]

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.[189]

Conventional treatments are subjected to testing for undesired side-effects, whereas alternative treatments, in general, are not subjected to such testing at all. Any treatment whether conventional or alternative that has a biological or psychological effect on a patient may also have potential to possess dangerous biological or psychological side-effects. 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.” Specific groups of patients such as patients with impaired hepatic or renal function are more susceptible to side effects of alternative remedies.[190][191]

An exception to the normal thinking regarding side-effects is Homeopathy. Since 1938, the U.S. Food and Drug Administration (FDA) has regulated homeopathic products in “several significantly different ways from other drugs.”[192] Homeopathic preparations, termed “remedies”, are extremely dilute, often far beyond the point where a single molecule of the original active (and possibly toxic) ingredient is likely to remain. They are, thus, considered safe on that count, but “their products are exempt from good manufacturing practice requirements related to expiration dating and from finished product testing for identity and strength”, and their alcohol concentration may be much higher than allowed in conventional drugs.[192]

Those having experienced or perceived 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.[193] For this reason, critics argue that therapies that rely on the placebo effect to define success are very dangerous. According to mental health journalist Scott Lilienfeld in 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 outcomes.[194] Between 2001 and 2003, four children died in Australia because their parents chose ineffective naturopathic, homeopathic, or other alternative medicines and diets rather than conventional therapies.[195]

There have always been “many therapies offered outside of conventional cancer treatment centers and based on theories not found in biomedicine. These alternative cancer cures have often been described as ‘unproven,’ suggesting that appropriate clinical trials have not been conducted and that the therapeutic value of the treatment is unknown.” However, “many alternative cancer treatments have been investigated in good-quality clinical trials, and they have been shown to be ineffective….The label ‘unproven’ is inappropriate for such therapies; it is time to assert that many alternative cancer therapies have been ‘disproven’.”[145]

Edzard Ernst has stated:

any alternative cancer cure is bogus by definition. There will never be an alternative cancer cure. Why? Because if something looked halfway promising, then mainstream oncology would scrutinize it, and if there is anything to it, it would become mainstream almost automatically and very quickly. All curative “alternative cancer cures” are based on false claims, are bogus, and, I would say, even criminal.[196]

“CAM”, meaning “complementary and alternative medicine”, is not as well researched as conventional medicine, which undergoes intense research before release to the public.[197] Funding for research is also sparse making it difficult to do further research for effectiveness of CAM.[198] Most funding for CAM is funded by government agencies.[197] Proposed research for CAM are rejected by most private funding agencies because the results of research are not reliable.[197] The research for CAM has to meet certain standards from research ethics committees, which most CAM researchers find almost impossible to meet.[197] Even with the little research done on it, CAM has not been proven to be effective.[199]

Steven Novella, a neurologist at Yale School of Medicine, wrote that government funded studies of integrating alternative medicine techniques into the mainstream are “used to lend an appearance of legitimacy to treatments that are not legitimate.”[200] Marcia Angell considered that critics felt that healthcare practices should be classified based solely on scientific evidence, and if a treatment had been rigorously tested and found safe and effective, science-based medicine will adopt it regardless of whether it was considered “alternative” to begin with.[3] It is possible for a method to change categories (proven vs. unproven), based on increased knowledge of its effectiveness or lack thereof. A prominent supporter of this position is George D. Lundberg, former editor of the Journal of the American Medical Association (JAMA).[37]

Writing in 1999 in CA: A Cancer Journal for Clinicians Barrie R. Cassileth mentioned a 1997 letter to the US Senate Subcommittee on Public Health and Safety, which had deplored the lack of critical thinking and scientific rigor in OAM-supported research, had been signed by four Nobel Laureates and other prominent scientists. (This was supported by the National Institutes of Health (NIH).)[201]

In March 2009 a staff writer for the Washington Post reported that the impending national discussion about broadening access to health care, improving medical practice and saving money was giving a group of scientists an opening to propose shutting down the National Center for Complementary and Alternative Medicine. They quoted one of these scientists, Steven Salzberg, a genome researcher and computational biologist at the University of Maryland, as saying “One of our concerns is that NIH is funding pseudoscience.” They noted that the vast majority of studies were based on fundamental misunderstandings of physiology and disease, and had shown little or no effect.[200]

Writers such as Carl Sagan, a noted astrophysicist, advocate of scientific skepticism and the author of The Demon-Haunted World: Science as a Candle in the Dark (1996), have lambasted the lack of empirical evidence to support the existence of the putative energy fields on which these therapies are predicated.

Sampson has also pointed out that CAM tolerated contradiction without thorough reason and experiment.[202] Barrett has pointed out 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.[150] Barrett also expressed concern that, just because some “alternatives” have merit, there is the impression that the rest deserve equal consideration and respect even though most are worthless, since they are all classified under the one heading of alternative medicine.[203]

Some critics of alternative medicine are focused upon health fraud, misinformation, and quackery as public health problems, notably Wallace Sampson and Paul Kurtz founders of Scientific Review of Alternative Medicine and Stephen Barrett, co-founder of The National Council Against Health Fraud and webmaster of Quackwatch.[204] Grounds for opposing alternative medicine include that:

Many alternative medical treatments are not patentable,[210] which may lead to less research funding from the private sector. In addition, in most countries, alternative treatments (in contrast to pharmaceuticals) can be marketed without any proof of efficacy also a disincentive for manufacturers to fund scientific research.[211]

English evolutionary biologist Richard Dawkins, in his 2003 book A Devil’s Chaplain, defined alternative medicine as a “set of practices that cannot be tested, refuse to be tested, or consistently fail tests.”[212] Dawkins argued that if a technique is demonstrated effective in properly performed trials then it ceases to be alternative and simply becomes medicine.[213]

CAM is also often less regulated than conventional medicine.[197] There are ethical concerns about whether people who perform CAM have the proper knowledge to treat patients.[197] CAM is often done by non-physicians who do not operate with the same medical licensing laws which govern conventional medicine,[197] and it is often described as an issue of non-maleficence.[214]

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Alternative medicine – Wikipedia

Alternative Medicine | BlackDoctor

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Anti Aging Medicine | Alternative Medicine | Primary Care …

The Nevada Center is a unique, state of the art, full service medical clinic, offering individualized treatment programs for patients of all ages, and with all medical conditions. The emphasis is on treating the cause of disease, not merely the symptoms. We also specialize in measuring and treating the aging process with individualized programs targeted to increasing the length and quality of life, preventing disease, and maintaining the same level of physical, mental, and emotional well being that characterizes true health. We leave nothing out!

This website also offers Dr. Shallenbergers Super Immune QuickStart, the only one-stop nutritional product available which provides all the supplementary nutrition, detoxification, and immune support that most people will ever need, in an easy and affordable daily smoothie.

Dr. Shallenberger has developed a revolutionary new approach to health, aging, and disease prevention which is described in his groundbreaking two books, Bursting With Energy and The Type 2 Diabetes Breakthrough.

Click here to read An Introduction to Alternative Medicine.

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Anti Aging Medicine | Alternative Medicine | Primary Care …

Alternative medicine? | Yahoo Answers

Complementary and alternative medicine works to both prevent and treat disease in conjunction with traditional medicine.

Many, many pathologies can be prevented or treated with proper diet and lifestyle changes and there are many natural and herbal remedies that will treat disease better and with less side effects than “traditional medicine”. However, there are times and conditions when the only thing one can do is to take pharmaceutical meds to treat certain pathologies.

The two schools of medicine work together and neither is able to completely do without the other.

By the way, no one has ever gone into a coma from a sinus infection.

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Alternative medicine? | Yahoo Answers

BMC Complementary and Alternative Medicine | Articles

Effect of freeze-dried Carica papaya leaf juice on inflammatory cytokines production during dengue virus infection in AG129 mice

Carica papaya leaves have been used for traditional treatment of dengue fever and have been reported to exhibit an immunomodulatory activity by affecting the level of cytokine production in vitro and in vivo. Due…

Authors: Nor Azrina Norahmad, Mohd Ridzuan Mohd Abd Razak, Norazlan Mohmad Misnan, Nur Hana Md Jelas, Umi Rubiah Sastu, Amirrudin Muhammad, Tiffiny Chau Dee Ho, Bazilah Jusoh, Nor Azlina Zolkifli, Ravindran Thayan, Adiratna Mat Ripen, Murizal Zainol and Ami Fazlin Syed Mohamed

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BMC Complementary and Alternative Medicine | Articles

Journal of Alternative and Complementary Medicine, The …

The Journal of Alternative and Complementary Medicine: Paradigm, Practice, and Policy Advancing Integrative Healthis the leading peer-reviewed journal providing scientific research for the evaluation and integration of complementary and alternative medicine into mainstream medical practice. The Journal delivers original research that directly impacts patient care therapies, protocols, and strategies, ultimately improving the quality of healing.

The Journal of Alternative and Complementary Medicine coverage includes:

The Journal of Alternative and Complementary Medicine is under the editorial leadership of Editor-in-Chief John Weeks and other leading investigators. View the entire editorial board.

Audience: Conventional medicine, nursing, psychiatric, and psychology practitioners; alternative medicine practitioners, researchers, and specialists; schools of Oriental medicine; and pharmaceutical, herbal, and other therapeutic industry professionals; among others

The Official Journal of the Society for Acupuncture Research

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Journal of Alternative and Complementary Medicine, The …

The Witch Hunt for Alternative Medicine Practitioners

Old wives tales and recipes for remedies from your grandmother is woven into the fabric of most lives. Many of us grew up with parents who attempted a home cure before buying medicine or (heaven forbid) making an appointment with the doctor.

A couple of generations ago, the average population didnt seek out a doctor unless it was clear that it was a serious illness and had exhausted all efforts at handling the problem at home. When doctors werent available, or affordable, families sought relief in what is now referred to as holistic medicine or alternative medicine.

Before we begin, lets look at the actual terms being used, shall we? Specifically, the terms alternative medicine and traditional medicine. Hmmm the definition of traditional is something that is long-established and time-honored. Since herbs, foods, roots, and other natural remedies have been used formillennia, I would contend that natural medicine should actually be considered to be traditional whereas drug-intensive medicine (which has only been used for a century or two), should actually be considered the alternative medicine.

Do you see how the phrase he who defines the terms wins the argument is true? By convincing the world that drug-intensive medicine is actually traditional medicine, Big Pharma has re-defined the term and persuades people across the globe that this type of medicine is the gold standard when in reality it is not.

Now, I am not asserting that modern medicine is bad. It is indisputablethat incredible advances in medical technology have saved millions of lives from suffering and death. There is no doubt that many doctors and scientists enter their fields with the goal of helping others. You want to trust your doctor. You want to believe that the pill theywant you to try will make you feel better.

However, weve become blind to a very dangerous trend. Too many of us listen to the professional and assume that this doctor has our (thepatients) best interests at heart. As the doc listens to the problem, nods with very little thought, reaches for the prescription pad, and sends youon yourway confidence dwindles.

To make matters worse, a growing majority of patients now ask for drugsby name. They know the one they want based off a commercial seen on television. Its the one thats going to take care of the problem they didnt even know they had.

Over the last several decades, there is a frightening profit over patient approach that is literally changing the way we live and take care of our bodies.

When did we stop even trying? How did we get here? Why do we now run to our doctors begging for pills to handle every little ailment that appears? What has changed that made our thinking go from natural to pharmaceutical?

Eat all the junk you want heres a pill for high blood pressure.Dont exercise at all heres a pill for obesity.That stress is no big deal heres a pill to alter your mood.Gobble up that sugar we have your insulin ready.Smoke and fake-tan and ingest known toxins chemotherapy will fix you.

Why should you care when there is a pill to handle the consequences of the food you eat, the environment you live in, and the lifestyle choices you make?Thankfully that is not the approach taken by those who practice more natural methods of patient care. Sadly, alternative medicine practitionersare on the receiving end of a lot of ugliness.

Natural alternatives are frowned upon in the modern age, and those who seek them out are openly ridiculed. If youre a practitioner of alternative therapies, that ridicule can take on a life of its own.

Its no secret that the allopathic medical community has long scoffed at the ideas and methods of holistic and alternative medicinepractitioners.While shouting publicly about protecting the health of society, they whisper in secret about protecting a health-care monopoly that comes with huge payoffs and kickbacks.

Modern medicine, some physicians, and big pharmaceutical companies dont want us reverting to the old ways for fear of losing the almighty profit prescription and over-the-counter drugshave provided

Does this seem extreme to you?

Consider this the American Medical Association (AMA) has been waging a war against the entire chiropractic community since the 1920s. By spreading mis-truths and propaganda, the AMA attempts to discredit chiropractors as quacks and charlatans. They paint them as modern day snake-oil salesmen who do more harm than good.

As recently as 1987, the American Medical Association (AMA) and several other medical agencies were found guilty of attempting to create a monopoly on health care in the United States.

The courts found theAMAguilty of the following:

Despite being found guilty of these atrocities, and even opening doors slightly to osteopathic physicians, the war continues through massive loopholes. The agencies merely changed the style of their attacks. In 2006, the AMA stated publicly their opposition to the licensing of naturopaths. Psychiatrists jumped on the AMAs bandwagon to shoot down the credibility of psychologists along with naturopaths, chiropractors, and midwives.

They state that their opposition is based on their concern for the safety and quality of care of patients. The war is far from over. The AMA continues to lobby state licensing boards to deny anyone the right to practice if their degree doesnt state Doctor of Medicine or Doctor of Osteopathic Medicine.

They want the states to rewrite the rules according to the game they want to play.

Alternative medicine practitioners are quick to point out some of the biggest reasons why people should seek out care from non-conventional physicians. They highlight statistics that clearly show more people dying from prescription drug side effects, hospital errors, infections contracted at medical facilities, and unnecessary surgeries.

Compare that, if you will, to the relatively low instance of patient harm resulting from alternative care.

If the AMA were concerned, theyd clean up their own dirt instead of sweeping it under the rug and attempting to place blame where it doesnt belong. However, they arent the only culprits

The American Dental Association still supports poisonous mercury in fillings and scoffs at natural dentists using alternative fillings in the interest of patient health. Fluoride has been proven to do far more harm than good, but is still in widespread use with the ADAs proud endorsement.

The American Academy of Pediatrics (AAP) claims to protect children, but refuses to disclose how much of their funding comes from companies that produce and manufacture vaccines. They suppress reports on the truth of how vaccines can be harmful or even life-threatening.

Even the American Cancer Society continues to point fingers elsewhere while they nurture partnerships with pesticide and drug manufacturers. Their conflicts of interest lie between funding and the environmental research on the causes of the cancers they claim to be fighting.

As long as policy makers are under the control and funding of medical and pharmaceutical powerhouses, the natural and alternative physicians and practitioners will continue to have an uphill battle to wage. Every drug that hits the market comes with a media campaign meant to detract from the long list of side effects.

Chiropractors are touted as quacks despite having patients that have shown obvious, documentable, and positive results of treatment.

Naturopaths continue to quietly provide patients with relief via treatments meant to help and cure, not mask or disguise symptoms.

Midwives bring safe, peaceful, low-stress birth experiences to parents. Many parents seek to write their own birth-plan and have it followed without threat of C-section or induction because the doctor is on a timeline or hasnt been trained in alternative methods to support the mother through birth.

Alternative medicine physicians practice despite the challenges. They receive their degrees and go into practice knowing that they will face opposition daily. Online sites are full of negative reviews from people accusing them of quackery. Positive reviews are met with disbelief and even anger from people that found a public option for shaming and negativity based on their beliefs.

Its a modern day witch hunt and the stakes arent burning but they are high. If the AMA ever wins their fight, we may all die from the care they bring to us under the guise of knowledge and concern.

As always, do your own research. Talk to more than one healthcare practitionerbefore making any health decisions. Sometimes a combination of natural and traditional medicine can be the most beneficial for anyone facing an illness or disease such as cancer.

The bottom line is that its your disease, your body, and your choice. Dont let medical bullying and fear influence your decision.

For centuries, people have relied onwhat is now referred to as holistic medicine or alternative medicine.

Since herbs, foods, roots, and other natural remedies have been used formillennia, natural medicine should actually be considered to be traditional whereas drug-intensive medicine should be considered the alternative medicine.

Over the last several decades, there is a frightening profit over patient approach that is literally changing the way we live and take care of our bodies.

Modern medicine, some physicians, and big pharmaceutical companies dont want us reverting to the old ways for fear of losing the almighty profit prescription and over-the-counter drugs have provided.

As long as policy makers are under the control and funding of medical and pharmaceutical powerhouses, the natural and alternative physicians and practitioners will continue to have an uphill battle to wage.

Do your own research. Talk to more than one healthcare practitionerbefore making any decisions. Sometimes a combination of natural and traditional medicine can be the most beneficial whenfacing an illness or disease such as cancer.The bottom line is that its your body and your choice.

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The Witch Hunt for Alternative Medicine Practitioners

Access alternative medicine with help from your health plan …

From yoga to massage to homeopathic care, more and more people are turning to alternative therapies. According to the National Center for Complementary and Integrative Health, 38% of American adults use some form of alternative medicine.

But is it covered by your health plan? The short answer: It might be. Find out how to see which services your plan will cover, and discover other ways your health plan can help reduce your out-of-pocket expenses for alternative treatments.

There are some alternative treatments that your health plan may cover. Acupuncture and chiropractic care may be covered if they’re medically necessary. Many plans include physical therapy, and if massage therapy is determined a part of your therapy, it could be covered, too.

The best way to find out what’s covered is to take a look at your plan details. Sign in at regence.com, and select My benefits. Your Medical Benefit Booklet outlines what kind of treatments are covered under your plan.

If you have further questionslike if you’ll need a prescription, or if you’re limited to a number of visitsreach out to Customer Service.

When choosing a primary care provider, you may be able to go to a naturopath. They’re trained in both natural and conventional approaches to prevent disease and treat illness.

To look for a naturopathic doctor near you, use Find a Doctor and search for “naturopath.” Be sure to sign in first to see providers in your network.

Alternative treatments can be expensivebut you can save money by using the pre-tax dollars set aside in your health savings account (HSA) or flexible spending account (FSA).

Physical therapy, occupational therapy, chiropractic care and acupuncture are all qualified medical expenses. If massage therapy is recommended by a doctor to treat a specific injury or trauma, it qualifies as long as you have a letter from your doctor. Learn more about HSAs and FSAs.

As a Regence member, you have access to programsoffered in addition to your planthat provide discounts on health-related services and products. Through the CHP CAMaffinity Program, you get 20% off services from select providers for chiropractic care, acupuncture, naturopathic medicine and massage therapy.

Using alternative treatments doesn’t mean you have to pay for it all out of your own pocket. Your health plan can help you get the therapies you needor at least make them more affordable. Sign in to your Member Dashboard today to find out more about your specific benefits.

Link:

Access alternative medicine with help from your health plan …

Tennessee Alternative Medicine

sick visits

Sick visits are a quick but precise office visit to test and see if you have a bacterial or viral infection. We can then determine what specific all natural antibiotic or antiviral you need so you can feel better quickly!

No age is too young or old for sick visits!Call in if you have a cold, flu, UTI, strep throat, pink eye, stomach ache, sinus infection, etc. and we will get you in as soon as possible!No need to run to the ‘other’ doctor and get an antibiotic when we have so many safe, effective and fast acting options.

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Tennessee Alternative Medicine

BMC Complementary and Alternative Medicine | Home page

BMC Complementary and Alternative Medicine is an open access journal publishing original peer-reviewed research articles on interventions and resources that complement or replace conventional therapies, with a specific emphasis on research that explores the biological mechanisms of action, as well as their efficacy, safety, costs, patterns of use and/or implementation.

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BMC Complementary and Alternative Medicine | Home page

Alternative Medicine 2019 | Traditional Medicine Conferences …

About Conference

Pulsus provides an opportunity to meet up with peers from both industry and academia and establish a scientific network between them. It comprises of proficient keynote presentations, verbal speeches by eminent speakers, productive poster presentations and exhibitions providing insights on Alternative & Traditional Medicine.

Pulsus Group is an internationally renowned medical peer-review publisher and conferences organizer established in the year 1984 publishes and hosts the work of researchers in a manner that exemplifies the highest standards in research integrity. With a legacy of 30 years of excellence in Medical Publishing, now we are running several International Conferences in the fields of Medical, Clinical, Life Science and, Pharma.

Traditional medicine is the form of folk medicine which has been evolved over years. Alternative medicine is the transformed form of traditional medicine which is substitute for the present western medicine. Folk medicine stands as the backbone of traditional medicine which is believed to provide longstanding remedies. Nowadays, most of the people believe that traditional medicine is safer as it obtained from the natural herbal products. The market value of the traditional medicine is increasing day by day and worldwide annual market value is approaching US$ 60 billion.

World Health Organization (WHO) has made substantial research investments for the development of traditional medicine. Several leading pharmaceutical companies are looking forward for novel chemical compounds that can be used for curing various diseases. Further research and development is needed on to find dosage, production techniques, the mode of action and the effects of herbs for each disease. Also, the clinical trials of the medicine are necessary to prove the safety and efficacy before being recommended in the world market

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Alternative Medicine 2019 | Traditional Medicine Conferences …

Welcome to the Natural Medicines Research Collaboration

I am very happy with these services. Having up to date and scientifically accurate information at one’s fingertips in this complex world of alternative medicine is a major lifesaver. Thank you very much for all you do and I hope that this database continues to be a reliable and convenient source of clinical insight.

Evan McCarvill

The best and most authoritative web site available on herbal medicines.

The World Health Organization (WHO)

At last! An authoritative reference on the many nuances of Alternative Medicine. How to separate the good from the bad and the unknown. An extraordinary piece of work that will become the standard text in this area.

Vincent T. DeVita Jr., MDThe Amy and Joseph Perella Professor of Medicine Yale School of Medicine Former Director, National Cancer Institute

The authors have conducted a systematic and careful review of the scientific literature, and provide clear summaries of what is known about the risks and benefits of herbs and supplements.

Anthony L. Komaroff, MDProfessor of Medicine, Harvard Medical SchoolEditor-in-Chief, Harvard Health Publications

I absolutely love your product. It’s comprehensive, and includes information that other resources do not.

Joan Colburn, MLIS, North Carolina

I checked out your new site and I really like it! It’s easy to navigate – very clean design and professional. The testimonials and all the doctors on the Editorial Board give a lot of confidence and credibility.

Kelly PhippsFounder and CEOKUMA Interactive, Inc.

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Welcome to the Natural Medicines Research Collaboration

Find a Local Chiropractor – Alternative Medicine Now

Welcome to the Chiropractor Directory.

To find a Chiropractor near you, or to learn more about what chiropractic care can do for you, simply click the button below.

Get Started Now

Or if you prefer search through the chiropractic directory listings and find a Chiropractor near you. To get started simply click on the links below for your state

Please consider following Alternative Medicine Now on Facebook for the latest updates, news, events and specials. Simply click the Like button on the right hand side of the page.

To find the latest articles about chiropractic care (or any other topic that interests you), simply visit the alternative medicine homepage.

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List your practice on the largest online directory for holistic health today.

Discover an easier way to get found by more people who are actively searching for you online. Simply click the link to our alternative medicine directory sign up page where you can review the benefits of listing your practice here.

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Find a Local Chiropractor – Alternative Medicine Now

The Big A-Z List Of Complementary And Alternative Therapies

By Kristan Markam and Scott Pittman

Published: November 28, 2016

After years spent watching people close to us suffer with the symptoms of various medical conditions, we were stunned by the positive effects complementary and alternative therapies had on their health and wellness. This led us to form Sacred Soul Holistics to spread awareness of the power of holistic therapies, backed by both scientific clinical studies and hundreds of years of testimonials.

In order to help provide this awareness we have created theBig A-Z List of Complementary and Alternative Therapiesto share around the world. Its been a real labour of love but we are pleased with the results.

It contains:

Please enjoy it with our best wishes.

See also:Journal Of Natural Healing Is New For 2017Integrative Medicine: The New Model For Primary Care

Link:

The Big A-Z List Of Complementary And Alternative Therapies

Alternative medicine – Wikipedia

Form of non-scientific healing

a) Misinterpreted natural course the individual gets better without treatment.b) Placebo effect or false treatment effect an individual receives “alternative therapy” and is convinced it will help. The conviction makes them more likely to get better.c) Nocebo effect an individual is convinced that standard treatment will not work, and that alternative treatment will work. This decreases the likelihood standard treatment will work, while the placebo effect of the “alternative” remains. d) No adverse effects Standard treatment is replaced with “alternative” treatment, getting rid of adverse effects, but also of improvement.e) Interference Standard treatment is “complemented” with something that interferes with its effect. This can both cause worse effect, but also decreased (or even increased) side effects, which may be interpreted as “helping”.

Alternative medicine, fringe medicine, pseudomedicine or simply questionable medicine is promotion or use of practices which are unproven, disproven, impossible to prove, or excessively harmful in relation to their effect in the attempt to achieve the healing effects of medicine. It differs from experimental medicine in that the latter employs responsible investigation, and is discarded when shown ineffective. The scientific consensus is that alternative therapies either do not, or cannot, work. In some cases laws of nature are violated by their basic claims; in others the treatment is so much worse that its use is unethical. Alternative practices, products, and therapies range from those which are simply ineffective to those having known harmful and toxic effects.

Alternative therapies may be credited for perceived improvement through placebo effects, decreased use or effect of medical treatment (and therefore either decreased side effects; or nocebo effects towards standard treatment), or the natural course of the condition or disease. Alternative treatment is not the same as experimental treatment or traditional medicine, although both can be misused in ways that are alternative. Alternative or complementary medicine is dangerous because it may discourage people from getting the best possible treatment, and may lead to a false understanding of the body and of science.

Alternative medicine is used by a significant number of people, though its popularity is often overstated. Large amounts of funding go to testing alternative medicine, with more than US$2.5 billion spent by the United States government alone. None have shown any effect beyond that of false treatment, and most studies showing any effect have been statistical flukes. Alternative medicine is a highly profitable industry, with a strong lobby. This fact is often overlooked by media or intentionally kept hidden, with alternative practice being portrayed positively when compared to “big pharma”. The lobby has successfully pushed for alternative therapies to be subject to far less regulation than conventional medicine. Alternative therapies may even be allowed to promote use when there is demonstrably no effect, only a tradition of use. Regulation and licensing of alternative medicine and health care providers varies between and within countries. Despite laws making it illegal to market or promote alternative therapies for use in cancer treatment, many practitioners promote them. Alternative medicine is criticized for taking advantage of the weakest members of society.

Terminology has shifted over time, reflecting the preferred branding of practitioners. For example, the United States National Institutes of Health department studying alternative medicine, currently named National Center for Complementary and Integrative Health, was established as the Office of Alternative Medicine and was renamed the National Center for Complementary and Alternative Medicine before obtaining its current name. Therapies are often framed as “natural” or “holistic”, in apparent opposition to conventional medicine which is “artificial” and “narrow in scope”, statements which are intentionally misleading. When used together with functional medical treatment, alternative therapies do not “complement” (improve the effect of, or mitigate the side effects of) treatment. Significant drug interactions caused by alternative therapies may instead negatively impact functional treatment by making prescription drugs less effective, such as interference by herbal preparations with warfarin.

Alternative diagnoses and treatments are not part of medicine, or of science-based curricula in medical schools, nor are they used in any practice based on scientific knowledge or experience. Alternative therapies are often based on religious belief, tradition, superstition, belief in supernatural energies, pseudoscience, errors in reasoning, propaganda, fraud, or lies. Alternative medicine is based on misleading statements, quackery, pseudoscience, antiscience, fraud, and poor scientific methodology. Promoting alternative medicine has been called dangerous and unethical. Testing alternative medicine that has no scientific basis has been called a waste of scarce research resources. Critics state that “there is really no such thing as alternative medicine, just medicine that works and medicine that doesn’t”. that the very idea of “alternative” treatments is paradoxical, as any treatment proven to work is by definition “medicine”,

The US NCCIH alone has spent around $2.5bn in grants[1] without validating a single alternative therapy.[2]

Alternative medicine is defined loosely as a set of products, practices, and theories that are believed or perceived by their users to have the healing effects of medicine,[n 1][n 2] but whose effectiveness has not been clearly established using scientific methods,[n 1][n 3][6][7][8][9] or whose theory and practice is not part of biomedicine,[n 2][n 4][n 5][n 6] or whose theories or practices are directly contradicted by scientific evidence or scientific principles used in biomedicine.[6][7][13] “Biomedicine” or “medicine” is that part of medical science that applies principles of biology, physiology, molecular biology, biophysics, and other natural sciences to clinical practice, using scientific methods to establish the effectiveness of that practice. Unlike medicine,[n 4] an alternative product or practice does not originate from using scientific methods, but may instead be based on hearsay, religion, tradition, superstition, belief in supernatural energies, pseudoscience, errors in reasoning, propaganda, fraud, or other unscientific sources.[n 3][3][6][7]

In General Guidelines for Methodologies on Research and Evaluation of Traditional Medicine, published in 2000 by the World Health Organization (WHO), complementary and alternative medicine were defined as a broad set of health care practices that are not part of that country’s own tradition and are not integrated into the dominant health care system.[14]

The expression also refers to a diverse range of related and unrelated products, practices, and theories ranging from biologically plausible practices and products and practices with some evidence, to practices and theories that are directly contradicted by basic science or clear evidence, and products that have been conclusively proven to be ineffective or even toxic and harmful.[n 2][16][17]

The terms alternative medicine, complementary medicine, integrative medicine, holistic medicine, natural medicine, unorthodox medicine, fringe medicine, unconventional medicine, and new age medicine are used interchangeably as having the same meaning and are almost synonymous in most contexts.[18][19][20][21]

The meaning of the term “alternative” in the expression “alternative medicine”, is not that it is an effective alternative to medical science, although some alternative medicine promoters may use the loose terminology to give the appearance of effectiveness.[6][22] Loose terminology may also be used to suggest meaning that a dichotomy exists when it does not, e.g., the use of the expressions “western medicine” and “eastern medicine” to suggest that the difference is a cultural difference between the Asiatic east and the European west, rather than that the difference is between evidence-based medicine and treatments that do not work.[6]

Complementary medicine (CM) or integrative medicine (IM) is when alternative medicine is used together with functional medical treatment, in a belief that it improves the effect of treatments.[n 7][3][24][25][26] However, significant drug interactions caused by alternative therapies may instead negatively influence treatment, making treatments less effective, notably cancer therapy.[27][28] Both terms refer to use of alternative medical treatments alongside conventional medicine,[29][30][31] an example of which is use of acupuncture (sticking needles in the body to influence the flow of a supernatural energy), along with using science-based medicine, in the belief that the acupuncture increases the effectiveness or “complements” the science-based medicine.[31]

CAM is an abbreviation of the phrase complementary and alternative medicine.[32][33] It has also been called sCAM or SCAM with the addition of “so-called” or “supplements”.[34][35] The words balance and holism are often used, claiming to take into account a “whole” person, in contrast to the alleged reductionism of conventional medicine. Due to its many names the field has been criticized for intense rebranding of what are essentially the same practices.[18]

Allopathic medicine or allopathy is an expression commonly used by homeopaths and proponents of other forms of alternative medicine to refer to medicine. It was used to describe the traditional European practice of heroic medicine,[36] but later continued to be used to describe anything that was not homeopathy.[36]

Allopathy refers to the use of pharmacologically active agents or medical interventions to treat or suppress symptoms or pathophysiological processes of diseases or conditions.[37] The German version of the word, allopathisch, was coined in 1810 by the creator of homeopathy, Samuel Hahnemann (17551843).[38] The word was coined from allo- (different) and -pathic (relating to a disease or to a method of treatment).[39] In alternative medicine circles the expression “allopathic medicine” is still used to refer to “the broad category of medical practice that is sometimes called Western medicine, biomedicine, evidence-based medicine, or modern medicine” (see the article on scientific medicine).[40]

Use of the term remains common among homeopaths and has spread to other alternative medicine practices. The meaning implied by the label has never been accepted by conventional medicine and is considered pejorative.[41] More recently, some sources have used the term “allopathic”, particularly American sources wishing to distinguish between Doctors of Medicine (MD) and Doctors of Osteopathic Medicine (DO) in the United States.[38][42] William Jarvis, an expert on alternative medicine and public health,[43] states that “although many modern therapies can be construed to conform to an allopathic rationale (e.g., using a laxative to relieve constipation), standard medicine has never paid allegiance to an allopathic principle” and that the label “allopath” was from the start “considered highly derisive by regular medicine”.[44]

Many conventional medical treatments do not fit the nominal definition of allopathy, as they seek to prevent illness, or remove its cause.[45][46]

Traditional medicine refers to the pre-scientific practices of a certain culture, contrary to what is typically practiced in other cultures where medical science dominates.

“Eastern medicine” typically refers to the traditional medicines of Asia where conventional bio-medicine penetrated much later.

The words balance and holism are often used alongside complementary or integrative medicine, claiming to take into account a “whole” person, in contrast to the supposed reductionism of medicine. Due to its many names the field has been criticized for intense rebranding of what are essentially the same practices.[18]

Prominent members of the science[47][48] and biomedical science community[5] say that it is not meaningful to define an alternative medicine that is separate from a conventional medicine, that the expressions “conventional medicine”, “alternative medicine”, “complementary medicine”, “integrative medicine”, and “holistic medicine” do not refer to any medicine at all.[47][5][48][49]

Others in both the biomedical and CAM communities say that CAM cannot be precisely defined because of the diversity of theories and practices it includes, and because the boundaries between CAM and biomedicine overlap, are porous, and change. The expression “complementary and alternative medicine” (CAM) resists easy definition because the health systems and practices it refers to are diffuse, and its boundaries poorly defined.[16][n 8] 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 European humoral theory, traditional Chinese medicine (TCM) and Ayurveda, have antique origins in East or South Asia and are entirely alternative medical systems;[54] others, such as homeopathy and chiropractic, have origins in Europe or the United States 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.[57] 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.[57]

Critics say the expression is deceptive because it implies there is an effective alternative to science-based medicine, and that complementary is deceptive because it implies that the treatment increases the effectiveness of (complements) science-based medicine, while alternative medicines that have been tested nearly always have no measurable positive effect compared to a placebo.[6][58][59][60]

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 devised by the US National Center for Complementary and Integrative Health (NCCIH) of the National Institutes of Health (NIH), 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”.[63] For conventional medical practitioners, it does not necessarily follow that either it or its practitioners would no longer be considered alternative.[n 9]

Some definitions seek to specify alternative medicine in terms of its social and political marginality to mainstream healthcare.[66] This can refer to the lack of support that alternative therapies receive from the medical establishment and related bodies regarding access to research funding, sympathetic coverage in the medical press, or inclusion in the standard medical curriculum.[66] In 1993, the British Medical Association (BMA), one among many professional organizations who have attempted to define alternative medicine, stated that it[n 10] referred to “…those forms of treatment which are not widely used by the conventional healthcare professions, and the skills of which are not taught as part of the undergraduate curriculum of conventional medical and paramedical healthcare courses”.[67] In a US context, an influential definition coined in 1993 by the Harvard-based physician,[68] David M. Eisenberg,[69] characterized alternative medicine “as interventions neither taught widely in medical schools nor generally available in US hospitals”.[70] These descriptive definitions are inadequate in the present-day when some conventional doctors offer alternative medical treatments and CAM introductory courses or modules can be offered as part of standard undergraduate medical training;[71] alternative medicine is taught in more than 50 per cent of US medical schools and increasingly US health insurers are willing to provide reimbursement for CAM therapies. In 1999, 7.7% of US hospitals reported using some form of CAM therapy; this proportion had risen to 37.7% by 2008.[73]

An expert panel at a conference hosted in 1995 by the US Office for Alternative Medicine (OAM),[74][n 11] devised a theoretical definition[74] of alternative medicine as “a broad domain of healing resources… other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period”.[76] This definition has been widely adopted by CAM researchers,[74] cited by official government bodies such as the UK Department of Health,[77] attributed as the definition used by the Cochrane Collaboration,[78] and, with some modification,[dubious discuss] was preferred in the 2005 consensus report of the US Institute of Medicine, Complementary and Alternative Medicine in the United States.[n 2]

The 1995 OAM conference definition, an expansion of Eisenberg’s 1993 formulation, is silent regarding questions of the medical effectiveness of alternative therapies.[79] Its proponents hold that it thus avoids relativism about 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.[79] 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”.[80] 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.[80] 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.[80]

Normative definitions distinguish alternative medicine from the biomedical mainstream in its provision of therapies that are unproven, unvalidated, or ineffective and support of theories with 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 are not based on evidence gathered with the scientific method.[3][5][29][30][63][82] Exemplifying this perspective, a 1998 editorial co-authored by Marcia Angell, a former editor of The New England Journal of Medicine, argued that:

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.[5]

This line of division has been subject to criticism, however, as not all forms of standard medical practice have adequately demonstrated evidence of benefit,[n 4][83] and it is also unlikely in most instances that conventional therapies, if proven to be ineffective, would ever be classified as CAM.[74]

Similarly, the public information website maintained by the National Health and Medical Research Council (NHMRC) of the Commonwealth of Australia uses the acronym “CAM” for a wide range of health care practices, therapies, procedures and devices not within the domain of conventional medicine. In the Australian context this is stated to include acupuncture; aromatherapy; chiropractic; homeopathy; massage; meditation and relaxation therapies; naturopathy; osteopathy; reflexology, traditional Chinese medicine; and the use of vitamin supplements.[85]

The Danish National Board of Health’s “Council for Alternative Medicine” (Sundhedsstyrelsens Rd for Alternativ Behandling (SRAB)), an independent institution under the National Board of Health (Danish: Sundhedsstyrelsen), uses the term “alternative medicine” for:

Proponents of an evidence-base for medicine[n 12][88][89][90][91] such as the Cochrane Collaboration (founded in 1993 and from 2011 providing input for WHO resolutions) take a position that all systematic reviews of treatments, whether “mainstream” or “alternative”, ought to be held to the current standards of scientific method.[92] In a study titled Development and classification of an operational definition of complementary and alternative medicine for the Cochrane Collaboration (2011) it was proposed that indicators that a therapy is accepted include government licensing of practitioners, coverage by health insurance, statements of approval by government agencies, and recommendation as part of a practice guideline; and that if something is currently a standard, accepted therapy, then it is not likely to be widely considered as CAM.[74]

Alternative medicine consists of a wide range of health care practices, products, and therapies. The shared feature is a claim to heal that is not based on the scientific method. Alternative medicine practices are diverse in their foundations and methodologies.[63] Alternative medicine practices may be classified by their cultural origins or by the types of beliefs upon which they are based.[3][6][13][63] Methods may incorporate or be based on traditional medicinal practices of a particular culture, folk knowledge, superstition, spiritual beliefs, belief in supernatural energies (antiscience), pseudoscience, errors in reasoning, propaganda, fraud, new or different concepts of health and disease, and any bases other than being proven by scientific methods.[3][6][7][13] Different cultures may have their own unique traditional or belief based practices developed recently or over thousands of years, and specific practices or entire systems of practices.

Alternative medicine, such as using naturopathy or homeopathy in place of conventional medicine, is based on belief systems not grounded in science.[63]

Alternative medical systems may be based on traditional medicine practices, such as traditional Chinese medicine (TCM), Ayurveda in India, or practices of other cultures around the world.[63] Some useful applications of traditional medicines have been researched and accepted within ordinary medicine, however the underlying belief systems are seldom scientific and are not accepted.

Traditional medicine is considered alternative when it is used outside its home region; or when it is used together with or instead of known functional treatment; or when it can be reasonably expected that the patient or practitioner knows or should know that it will not work such as knowing that the practice is based on superstition.

Bases of belief may include belief in existence of supernatural energies undetected by the science of physics, as in biofields, or in belief in properties of the energies of physics that are inconsistent with the laws of physics, as in energy medicine.[63]

Substance based practices use substances found in nature such as herbs, foods, non-vitamin supplements and megavitamins, animal and fungal products, and minerals, including use of these products in traditional medical practices that may also incorporate other methods.[63][117][118] Examples include healing claims for nonvitamin supplements, fish oil, Omega-3 fatty acid, glucosamine, echinacea, flaxseed oil, and ginseng.[119] Herbal medicine, or phytotherapy, includes not just the use of plant products, but may also include the use of animal and mineral products.[117] It is among the most commercially successful branches of alternative medicine, and includes the tablets, powders and elixirs that are sold as “nutritional supplements”.[117] Only a very small percentage of these have been shown to have any efficacy, and there is little regulation as to standards and safety of their contents.[117] This may include use of known toxic substances, such as use of the poison lead in traditional Chinese medicine.[119]

A US agency, National Center on Complementary and Integrative Health (NCCIH), has created a classification system for branches of complementary and alternative medicine that divides them into five major groups. These groups have some overlap, and distinguish two types of energy medicine: veritable which involves scientifically observable energy (including magnet therapy, colorpuncture and light therapy) and putative, which invokes physically undetectable or unverifiable energy.[123] None of these energies have any evidence to support that they effect the body in any positive or health promoting way.[36]

The history of alternative medicine may refer to the history of a group of diverse medical practices that were collectively promoted as “alternative medicine” beginning in the 1970s, to the collection of individual histories of members of that group, or to the history of western medical practices that were labeled “irregular practices” by the western medical establishment.[6][124][125][126][127] It includes the histories of complementary medicine and of integrative medicine. Before the 1970s, western practitioners that were not part of the increasingly science-based medical establishment were referred to “irregular practitioners”, and were dismissed by the medical establishment as unscientific and as practicing quackery.[124][125] Until the 1970s, irregular practice became increasingly marginalized as quackery and fraud, as western medicine increasingly incorporated scientific methods and discoveries, and had a corresponding increase in success of its treatments.[126] In the 1970s, irregular practices were grouped with traditional practices of nonwestern cultures and with other unproven or disproven practices that were not part of biomedicine, with the entire group collectively marketed and promoted under the single expression “alternative medicine”.[6][124][125][126][128]

Use of alternative medicine in the west began to rise following the counterculture movement of the 1960s, as part of the rising new age movement of the 1970s.[6][129][130] This was due to misleading mass marketing of “alternative medicine” being an effective “alternative” to biomedicine, changing social attitudes about not using chemicals and challenging the establishment and authority of any kind, sensitivity to giving equal measure to beliefs and practices of other cultures (cultural relativism), and growing frustration and desperation by patients about limitations and side effects of science-based medicine.[6][125][126][127][128][130][131] At the same time, in 1975, the American Medical Association, which played the central role in fighting quackery in the United States, abolished its quackery committee and closed down its Department of Investigation.[124]:xxi[131] By the early to mid 1970s the expression “alternative medicine” came into widespread use, and the expression became mass marketed as a collection of “natural” and effective treatment “alternatives” to science-based biomedicine.[6][131][132][133] By 1983, mass marketing of “alternative medicine” was so pervasive that the British Medical Journal (BMJ) pointed to “an apparently endless stream of books, articles, and radio and television programmes urge on the public the virtues of (alternative medicine) treatments ranging from meditation to drilling a hole in the skull to let in more oxygen”.[131]

Mainly as a result of reforms following the Flexner Report of 1910[134] medical education in established medical schools in the US has generally not included alternative medicine as a teaching topic.[n 14] Typically, their teaching is based on current practice and scientific knowledge about: anatomy, physiology, histology, embryology, neuroanatomy, pathology, pharmacology, microbiology and immunology.[136] Medical schools’ teaching includes such topics as doctor-patient communication, ethics, the art of medicine,[137] and engaging in complex clinical reasoning (medical decision-making).[138] Writing in 2002, Snyderman and Weil remarked that by the early twentieth century the Flexner model had helped to create the 20th-century academic health center, in which education, research, and practice were inseparable. While this had much improved medical practice by defining with increasing certainty the pathophysiological basis of disease, a single-minded focus on the pathophysiological had diverted much of mainstream American medicine from clinical conditions that were not well understood in mechanistic terms, and were not effectively treated by conventional therapies.[139]

By 2001 some form of CAM training was being offered by at least 75 out of 125 medical schools in the US.[140] Exceptionally, the School of Medicine of the University of Maryland, Baltimore includes a research institute for integrative medicine (a member entity of the Cochrane Collaboration).[92][141] Medical schools are responsible for conferring medical degrees, but a physician typically may not legally practice medicine until licensed by the local government authority. Licensed physicians in the US who have attended one of the established medical schools there have usually graduated Doctor of Medicine (MD).[142] All states require that applicants for MD licensure be graduates of an approved medical school and complete the United States Medical Licensing Exam (USMLE).[142]

There is a general scientific consensus that alternative therapies lack the requisite scientific validation, and their effectiveness is either unproved or disproved.[3][6][143][144] Many of the claims regarding the efficacy of alternative medicines are controversial, since research on them is frequently of low quality and methodologically flawed. Selective publication bias, marked differences in product quality and standardisation, and some companies making unsubstantiated claims call into question the claims of efficacy of isolated examples where there is evidence for alternative therapies.[146]

The Scientific Review of Alternative Medicine points to confusions in the general population a person may attribute symptomatic relief to an otherwise-ineffective therapy just because they are taking something (the placebo effect); the natural recovery from or the cyclical nature of an illness (the regression fallacy) gets misattributed to an alternative medicine being taken; a person not diagnosed with science-based medicine may never originally have had a true illness diagnosed as an alternative disease category.[147]

Edzard Ernst characterized the evidence for many alternative techniques as weak, nonexistent, or negative[148] and in 2011 published his estimate that about 7.4% were based on “sound evidence”, although he believes that may be an overestimate.[149] Ernst has concluded that 95% of the alternative treatments he and his team studied, including acupuncture, herbal medicine, homeopathy, and reflexology, are “statistically indistinguishable from placebo treatments”, but he also believes there is something that conventional doctors can usefully learn from the chiropractors and homeopath: this is the therapeutic value of the placebo effect, one of the strangest phenomena in medicine.[150][151]

In 2003, a project funded by the CDC identified 208 condition-treatment pairs, of which 58% had been studied by at least one randomized controlled trial (RCT), and 23% had been assessed with a meta-analysis.[152] According to a 2005 book by a US Institute of Medicine panel, the number of RCTs focused on CAM has risen dramatically.

As of 2005[update], the Cochrane Library had 145 CAM-related Cochrane systematic reviews and 340 non-Cochrane systematic reviews. An analysis of the conclusions of only the 145 Cochrane reviews was done by two readers. In 83% of the cases, the readers agreed. In the 17% in which they disagreed, a third reader agreed with one of the initial readers to set a rating. These studies found that, for CAM, 38.4% concluded positive effect or possibly positive (12.4%), 4.8% concluded no effect, 0.7% concluded harmful effect, and 56.6% concluded insufficient evidence. An assessment of conventional treatments found that 41.3% concluded positive or possibly positive effect, 20% concluded no effect, 8.1% concluded net harmful effects, and 21.3% concluded insufficient evidence. However, the CAM review used the more developed 2004 Cochrane database, while the conventional review used the initial 1998 Cochrane database.

In the same way as for conventional therapies, drugs, and interventions, it can be difficult to test the efficacy of alternative medicine in clinical trials. In instances where an established, effective, treatment for a condition is already available, the Helsinki Declaration states that withholding such treatment is unethical in most circumstances. Use of standard-of-care treatment in addition to an alternative technique being tested may produce confounded or difficult-to-interpret results.[154]

Cancer researcher Andrew J. Vickers has stated:

Contrary to much popular and scientific writing, many alternative cancer treatments have been investigated in good-quality clinical trials, and they have been shown to be ineffective. The label “unproven” is inappropriate for such therapies; it is time to assert that many alternative cancer therapies have been “disproven”.[155]

A research methods expert and author of Snake Oil Science, R. Barker Bausell, has stated that “it’s become politically correct to investigate nonsense.”[156] There are concerns that just having NIH support is being used to give unfounded “legitimacy to treatments that are not legitimate.”[157]

Use of placebos 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.”[59][60]

Another critic has argued that academic proponents of integrative medicine sometimes recommend misleading patients by using known placebo treatments to achieve a placebo effect.[n 15] However, a 2010 survey of family physicians found that 56% of respondents said they had used a placebo in clinical practice as well. Eighty-five percent of respondents believed placebos can have both psychological and physical benefits.[159]

Integrative medicine has been criticized in that its practitioners, trained in science-based medicine, deliberately mislead patients by pretending placebos are not. “quackademic medicine” is a pejorative term used for integrative medicine, which medical professionals consider an infiltration of quackery into academic science-based medicine.[60]

An analysis of trends in the criticism of complementary and alternative medicine (CAM) in five prestigious American medical journals during the period of reorganization within medicine (19651999) was reported as showing that the medical profession had responded to the growth of CAM in three phases, and that in each phase, changes in the medical marketplace had influenced the type of response in the journals.[160] Changes included relaxed medical licensing, the development of managed care, rising consumerism, and the establishment of the USA Office of Alternative Medicine (later National Center for Complementary and Alternative Medicine, currently National Center for Complementary and Integrative Health).[n 16]

Practitioners of complementary medicine usually discuss and advise patients as to available alternative therapies. Patients often express interest in mind-body complementary therapies because they offer a non-drug approach to treating some health conditions.[162]

In addition to the social-cultural underpinnings of the popularity of alternative medicine, there are several psychological issues that are critical to its growth, notably psychological effects, such as the will to believe,[163] cognitive biases that help maintain self-esteem and promote harmonious social functioning,[163] and the post hoc, ergo propter hoc fallacy.[163]

The popularity of complementary & alternative medicine (CAM) may be related to other factors that Edzard Ernst mentioned in an interview in The Independent:

Why is it so popular, then? Ernst blames the providers, customers and the doctors whose neglect, he says, has created the opening into which alternative therapists have stepped. “People are told lies. There are 40 million websites and 39.9 million tell lies, sometimes outrageous lies. They mislead cancer patients, who are encouraged not only to pay their last penny but to be treated with something that shortens their lives. “At the same time, people are gullible. It needs gullibility for the industry to succeed. It doesn’t make me popular with the public, but it’s the truth.[164]

Paul Offit proposed that “alternative medicine becomes quackery” in four ways: by recommending against conventional therapies that are helpful, promoting potentially harmful therapies without adequate warning, draining patients’ bank accounts, or by promoting “magical thinking.”[47]

Authors have speculated on the socio-cultural and psychological reasons for the appeal of alternative medicines among the minority using them in lieu of conventional medicine. There are several socio-cultural reasons for the interest in these treatments centered on the low level of scientific literacy among the public at large and a concomitant increase in antiscientific attitudes and new age mysticism.[163] Related to this are vigorous marketing[165] of extravagant claims by the alternative medical community combined with inadequate media scrutiny and attacks on critics.[163][166]

There is also an increase in conspiracy theories toward conventional medicine and pharmaceutical companies, mistrust of traditional authority figures, such as the physician, and a dislike of the current delivery methods of scientific biomedicine, all of which have led patients to seek out alternative medicine to treat a variety of ailments.[166] Many patients lack access to contemporary medicine, due to a lack of private or public health insurance, which leads them to seek out lower-cost alternative medicine.[167] Medical doctors are also aggressively marketing alternative medicine to profit from this market.[165]

Patients can be averse to the painful, unpleasant, and sometimes-dangerous side effects of biomedical treatments. Treatments for severe diseases such as cancer and HIV infection have well-known, significant side-effects. Even low-risk medications such as antibiotics can have potential to cause life-threatening anaphylactic reactions in a very few individuals. Many medications may cause minor but bothersome symptoms such as cough or upset stomach. In all of these cases, patients may be seeking out alternative treatments to avoid the adverse effects of conventional treatments.[163][166]

According to recent research, the increasing popularity of the CAM needs to be explained by moral convictions or lifestyle choices rather than by economic reasoning.[168]

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 healthcare or be integrated into the healthcare system. In Africa, traditional medicine is used for 80% of primary healthcare, and in developing nations as a whole over one-third of the population lack access to essential medicines.[169]

Some have proposed adopting a prize system to reward medical research.[170] However, public funding for research exists. In the US increasing the funding for research on alternative medicine is the purpose of the US National Center for Complementary and Alternative Medicine (NCCAM). NCCAM has spent more than US$2.5 billion on such research since 1992 and this research has not demonstrated the efficacy of alternative treatments.[156][171][172][173] The NCCAM’s sister organization in the NIC Office of Cancer Complementary and Alternative Medicine gives grants of around $105 million every year.[174]

That alternative medicine has been on the rise “in countries where Western science and scientific method generally are accepted as the major foundations for healthcare, and ‘evidence-based’ practice is the dominant paradigm” was described as an “enigma” in the Medical Journal of Australia.[175]

In the United States, the 1974 Child Abuse Prevention and Treatment Act (CAPTA) required that for states to receive federal money, they had to grant religious exemptions to child neglect and abuse laws regarding religion-based healing practices.[176] Thirty-one states have child-abuse religious exemptions.[177]

The use of alternative medicine in the US has increased,[3][178] with a 50 percent increase in expenditures and a 25 percent increase in the use of alternative therapies between 1990 and 1997 in America.[178] Americans spend many billions on the therapies annually.[178] Most Americans used CAM to treat and/or prevent musculoskeletal conditions or other conditions associated with chronic or recurring pain.[167] In America, women were more likely than men to use CAM, with the biggest difference in use of mind-body therapies including prayer specifically for health reasons”.[167] In 2008, more than 37% of American hospitals offered alternative therapies, up from 27 percent in 2005, and 25% in 2004.[179][180] More than 70% of the hospitals offering CAM were in urban areas.[180]

A survey of Americans found that 88 percent thought that “there are some good ways of treating sickness that medical science does not recognize”.[3] Use of magnets was the most common tool in energy medicine in America, and among users of it, 58 percent described it as at least “sort of scientific”, when it is not at all scientific.[3] In 2002, at least 60 percent of US medical schools have at least some class time spent teaching alternative therapies.[3] “Therapeutic touch” was taught at more than 100 colleges and universities in 75 countries before the practice was debunked by a nine-year-old child for a school science project.[3][116]

The most common CAM therapies used in the US in 2002 were prayer (45%), herbalism (19%), breathing meditation (12%), meditation (8%), chiropractic medicine (8%), yoga (56%), body work (5%), diet-based therapy (4%), progressive relaxation (3%), mega-vitamin therapy (3%) and Visualization (2%)[167][181]

In Britain, the most often used alternative therapies were Alexander technique, Aromatherapy, Bach and other flower remedies, Body work therapies including massage, Counseling stress therapies, hypnotherapy, Meditation, Reflexology, Shiatsu, Ayurvedic medicine, Nutritional medicine, and Yoga.[182] Ayurvedic medicine remedies are mainly plant based with some use of animal materials. Safety concerns include the use of herbs containing toxic compounds and the lack of quality control in Ayurvedic facilities.[110][112]

According to the National Health Service (England), the most commonly used complementary and alternative medicines (CAM) supported by the NHS in the UK are: acupuncture, aromatherapy, chiropractic, homeopathy, massage, osteopathy and clinical hypnotherapy.[184]

Complementary therapies are often used in palliative care or by practitioners attempting to manage chronic pain in patients. Integrative 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.”[185] 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.”[186]

In Austria and Germany complementary and alternative medicine is mainly in the hands of doctors with MDs,[32] and half or more of the American alternative practitioners are licensed MDs.[187] In Germany herbs are tightly regulated: half are prescribed by doctors and covered by health insurance.[188]

Some professions of complementary/traditional/alternative medicine, such as chiropractic, have achieved full regulation in North America and other parts of the world and are regulated in a manner similar to that governing science-based medicine. In contrast, other approaches may be partially recognized and others have no regulation at all. Regulation and licensing of alternative medicine ranges widely from country to country, and state to state.

Government bodies in the US and elsewhere have published information or guidance about alternative medicine. The U.S. Food and Drug Administration (FDA), has issued online warnings for consumers about medication health fraud.[190] This includes a section on Alternative Medicine Fraud,[191] such as a warning that Ayurvedic products generally have not been approved by the FDA before marketing.[192]

Many of the claims regarding the safety and efficacy of alternative medicine are controversial. Some alternative treatments have been associated with unexpected side effects, which can be fatal.[193]

A commonly voiced concerns about complementary alternative medicine (CAM) is the way it’s regulated. There have been significant developments in how CAMs should be assessed prior to re-sale in the United Kingdom and the European Union (EU) in the last 2 years. Despite this, it has been suggested that current regulatory bodies have been ineffective in preventing deception of patients as many companies have re-labelled their drugs to avoid the new laws.[194] There is no general consensus about how to balance consumer protection (from false claims, toxicity, and advertising) with freedom to choose remedies.

Advocates of CAM suggest that regulation of the industry will adversely affect patients looking for alternative ways to manage their symptoms, even if many of the benefits may represent the placebo affect.[195] Some contend that alternative medicines should not require any more regulation than over-the-counter medicines that can also be toxic in overdose (such as paracetamol).[196]

Forms of alternative medicine that are biologically active can be dangerous even when used in conjunction with conventional medicine. Examples include immuno-augmentation therapy, shark cartilage, bioresonance therapy, oxygen and ozone therapies, and insulin potentiation therapy. Some herbal remedies can cause dangerous interactions with chemotherapy drugs, radiation therapy, or anesthetics during surgery, among other problems.[33] An example of these dangers was reported by Associate Professor Alastair MacLennan of Adelaide University, Australia regarding a patient who almost bled to death on the operating table after neglecting to mention that she had been taking “natural” potions to “build up her strength” before the operation, including a powerful anticoagulant that nearly caused her death.[197]

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.[198]

Conventional treatments are subjected to testing for undesired side-effects, whereas alternative treatments, in general, are not subjected to such testing at all. Any treatment whether conventional or alternative that has a biological or psychological effect on a patient may also have potential to possess dangerous biological or psychological side-effects. 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.” Specific groups of patients such as patients with impaired hepatic or renal function are more susceptible to side effects of alternative remedies.[199][200]

An exception to the normal thinking regarding side-effects is Homeopathy. Since 1938, the U.S. Food and Drug Administration (FDA) has regulated homeopathic products in “several significantly different ways from other drugs.”[201] Homeopathic preparations, termed “remedies”, are extremely dilute, often far beyond the point where a single molecule of the original active (and possibly toxic) ingredient is likely to remain. They are, thus, considered safe on that count, but “their products are exempt from good manufacturing practice requirements related to expiration dating and from finished product testing for identity and strength”, and their alcohol concentration may be much higher than allowed in conventional drugs.[201]

Those having experienced or perceived 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.[202] For this reason, critics argue that therapies that rely on the placebo effect to define success are very dangerous. According to mental health journalist Scott Lilienfeld in 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 outcomes.[203] Between 2001 and 2003, four children died in Australia because their parents chose ineffective naturopathic, homeopathic, or other alternative medicines and diets rather than conventional therapies.[204]

There have always been “many therapies offered outside of conventional cancer treatment centers and based on theories not found in biomedicine. These alternative cancer cures have often been described as ‘unproven,’ suggesting that appropriate clinical trials have not been conducted and that the therapeutic value of the treatment is unknown.” However, “many alternative cancer treatments have been investigated in good-quality clinical trials, and they have been shown to be ineffective….The label ‘unproven’ is inappropriate for such therapies; it is time to assert that many alternative cancer therapies have been ‘disproven’.”[155]

Edzard Ernst has stated:

any alternative cancer cure is bogus by definition. There will never be an alternative cancer cure. Why? Because if something looked halfway promising, then mainstream oncology would scrutinize it, and if there is anything to it, it would become mainstream almost automatically and very quickly. All curative “alternative cancer cures” are based on false claims, are bogus, and, I would say, even criminal.[205]

“CAM”, meaning “complementary and alternative medicine”, is not as well researched as conventional medicine, which undergoes intense research before release to the public.[206] Funding for research is also sparse making it difficult to do further research for effectiveness of CAM.[207] Most funding for CAM is funded by government agencies.[206] Proposed research for CAM are rejected by most private funding agencies because the results of research are not reliable.[206] The research for CAM has to meet certain standards from research ethics committees, which most CAM researchers find almost impossible to meet.[206] Even with the little research done on it, CAM has not been proven to be effective.[208]

Steven Novella, a neurologist at Yale School of Medicine, wrote that government funded studies of integrating alternative medicine techniques into the mainstream are “used to lend an appearance of legitimacy to treatments that are not legitimate.”[157] Marcia Angell considered that critics felt that healthcare practices should be classified based solely on scientific evidence, and if a treatment had been rigorously tested and found safe and effective, science-based medicine will adopt it regardless of whether it was considered “alternative” to begin with.[5] It is possible for a method to change categories (proven vs. unproven), based on increased knowledge of its effectiveness or lack thereof. A prominent supporter of this position is George D. Lundberg, former editor of the Journal of the American Medical Association (JAMA).[49]

Writing in 1999 in CA: A Cancer Journal for Clinicians Barrie R. Cassileth mentioned a 1997 letter to the US Senate Subcommittee on Public Health and Safety, which had deplored the lack of critical thinking and scientific rigor in OAM-supported research, had been signed by four Nobel Laureates and other prominent scientists. (This was supported by the National Institutes of Health (NIH).)[209]

In March 2009 a staff writer for the Washington Post reported that the impending national discussion about broadening access to health care, improving medical practice and saving money was giving a group of scientists an opening to propose shutting down the National Center for Complementary and Alternative Medicine. They quoted one of these scientists, Steven Salzberg, a genome researcher and computational biologist at the University of Maryland, as saying “One of our concerns is that NIH is funding pseudoscience.” They noted that the vast majority of studies were based on fundamental misunderstandings of physiology and disease, and had shown little or no effect.[157]

Writers such as Carl Sagan, a noted astrophysicist, advocate of scientific skepticism and the author of The Demon-Haunted World: Science as a Candle in the Dark (1996), have lambasted the lack of empirical evidence to support the existence of the putative energy fields on which these therapies are predicated.

Sampson has also pointed out that CAM tolerated contradiction without thorough reason and experiment.[210] Barrett has pointed out 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.[156] Barrett also expressed concern that, just because some “alternatives” have merit, there is the impression that the rest deserve equal consideration and respect even though most are worthless, since they are all classified under the one heading of alternative medicine.[211]

Some critics of alternative medicine are focused upon health fraud, misinformation, and quackery as public health problems, notably Wallace Sampson and Paul Kurtz founders of Scientific Review of Alternative Medicine and Stephen Barrett, co-founder of The National Council Against Health Fraud and webmaster of Quackwatch.[212] Grounds for opposing alternative medicine include that:

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Alternative medicine – Wikipedia

Alternative medicine – Wikipedia

Alternative medicine, fringe medicine, pseudomedicine or simply questionable medicine is promotion or use of practices which are unproven, disproven, impossible to prove, or excessively harmful in relation to their effect in the attempt to achieve the healing effects of medicine. It differs from experimental medicine in that the latter employs responsible investigation, and is discarded when shown ineffective. The scientific consensus is that alternative therapies either do not, or cannot, work. In some cases laws of nature are violated by their basic claims; in others the treatment is so much worse that its use is unethical. Alternative practices, products, and therapies range from those which are simply ineffective to those having known harmful and toxic effects.

a) Misinterpreted natural course the individual gets better without treatment.b) Placebo effect or false treatment effect an individual receives “alternative therapy” and is convinced it will help. The conviction makes them more likely to get better.c) Nocebo effect an individual is convinced that standard treatment will not work, and that alternative treatment will work. This decreases the likelihood standard treatment will work, while the placebo effect of the “alternative” remains. d) No adverse effects Standard treatment is replaced with “alternative” treatment, getting rid of adverse effects, but also of improvement.e) Interference Standard treatment is “complemented” with something that interferes with its effect. This can both cause worse effect, but also decreased (or even increased) side effects, which may be interpreted as “helping”.

Alternative therapies may be credited for perceived improvement through placebo effects, decreased use or effect of medical treatment (and therefore either decreased side effects; or nocebo effects towards standard treatment), or the natural course of the condition or disease. Alternative treatment is not the same as experimental treatment or traditional medicine, although both can be misused in ways that are alternative. Alternative or complementary medicine is dangerous because it may discourage people from getting the best possible treatment, and may lead to a false understanding of the body and of science.

Alternative medicine is used by a significant number of people, though its popularity is often overstated. Large amounts of funding go to testing alternative medicine, with more than US$2.5 billion spent by the United States government alone. Almost none show any effect beyond that of false treatment, and most studies showing any effect have been statistical flukes. Alternative medicine is a highly profitable industry, with a strong lobby. This fact is often overlooked by media or intentionally kept hidden, with alternative practice being portrayed positively when compared to “big pharma”. The lobby has successfully pushed for alternative therapies to be subject to far less regulation than conventional medicine. Alternative therapies may even be allowed to promote use when there is demonstrably no effect, only a tradition of use. Regulation and licensing of alternative medicine and health care providers varies between and within countries. Despite laws making it illegal to market or promote alternative therapies for use in cancer treatment, many practitioners promote them. Alternative medicine is criticized for taking advantage of the weakest members of society.

Terminology has shifted over time, reflecting the preferred branding of practitioners. For example, the United States National Institutes of Health department studying alternative medicine, currently named National Center for Complementary and Integrative Health, was established as the Office of Alternative Medicine and was renamed the National Center for Complementary and Alternative Medicine before obtaining its current name. Therapies are often framed as “natural” or “holistic”, in apparent opposition to conventional medicine which is “artificial” and “narrow in scope”, statements which are intentionally misleading. When used together with functional medical treatment, alternative therapies do not “complement” (improve the effect of, or mitigate the side effects of) treatment. Significant drug interactions caused by alternative therapies may instead negatively impact functional treatment by making prescription drugs less effective, such as interference by herbal preparations with warfarin.

Alternative diagnoses and treatments are not part of medicine, or of science-based curricula in medical schools, nor are they used in any practice based on scientific knowledge or experience. Alternative therapies are often based on religious belief, tradition, superstition, belief in supernatural energies, pseudoscience, errors in reasoning, propaganda, fraud, or lies. Alternative medicine is based on misleading statements, quackery, pseudoscience, antiscience, fraud, and poor scientific methodology. Promoting alternative medicine has been called dangerous and unethical. Testing alternative medicine that has no scientific basis has been called a waste of scarce research resources. Critics state that “there is really no such thing as alternative medicine, just medicine that works and medicine that doesn’t”, that the very idea of “alternative” treatments is paradoxical, as any treatment proven to work is by definition “medicine”.

Alternative medicine is defined loosely as a set of products, practices, and theories that are believed or perceived by their users to have the healing effects of medicine,[n 1][n 2] but whose effectiveness has not been clearly established using scientific methods,[n 1][n 3][4][5][6][7] or whose theory and practice is not part of biomedicine,[n 2][n 4][n 5][n 6] or whose theories or practices are directly contradicted by scientific evidence or scientific principles used in biomedicine.[4][5][11] “Biomedicine” or “medicine” is that part of medical science that applies principles of biology, physiology, molecular biology, biophysics, and other natural sciences to clinical practice, using scientific methods to establish the effectiveness of that practice. Unlike medicine,[n 4] an alternative product or practice does not originate from using scientific methods, but may instead be based on hearsay, religion, tradition, superstition, belief in supernatural energies, pseudoscience, errors in reasoning, propaganda, fraud, or other unscientific sources.[n 3][1][4][5]

In General Guidelines for Methodologies on Research and Evaluation of Traditional Medicine, published in 2000 by the World Health Organization (WHO), complementary and alternative medicine were defined as a broad set of health care practices that are not part of that country’s own tradition and are not integrated into the dominant health care system.[12]

The expression also refers to a diverse range of related and unrelated products, practices, and theories ranging from biologically plausible practices and products and practices with some evidence, to practices and theories that are directly contradicted by basic science or clear evidence, and products that have been conclusively proven to be ineffective or even toxic and harmful.[n 2][14][15]

The terms alternative medicine, complementary medicine, integrative medicine, holistic medicine, natural medicine, unorthodox medicine, fringe medicine, unconventional medicine, and new age medicine are used interchangeably as having the same meaning and are almost synonymous in most contexts.[16][17][18][19]

The meaning of the term “alternative” in the expression “alternative medicine”, is not that it is an effective alternative to medical science, although some alternative medicine promoters may use the loose terminology to give the appearance of effectiveness.[4][20] Loose terminology may also be used to suggest meaning that a dichotomy exists when it does not, e.g., the use of the expressions “western medicine” and “eastern medicine” to suggest that the difference is a cultural difference between the Asiatic east and the European west, rather than that the difference is between evidence-based medicine and treatments that do not work.[4]

Complementary medicine (CM) or integrative medicine (IM) is when alternative medicine is used together with functional medical treatment, in a belief that it improves the effect of treatments.[n 7][1][22][23][24] However, significant drug interactions caused by alternative therapies may instead negatively influence treatment, making treatments less effective, notably cancer therapy.[25][26] Both terms refer to use of alternative medical treatments alongside conventional medicine,[27][28][29] an example of which is use of acupuncture (sticking needles in the body to influence the flow of a supernatural energy), along with using science-based medicine, in the belief that the acupuncture increases the effectiveness or “complements” the science-based medicine.[29]

CAM is an abbreviation of the phrase complementary and alternative medicine.[30][31] It has also been called sCAM or SCAM with the addition of “so-called” or “supplements”.[32][33]

Allopathic medicine or allopathy is an expression commonly used by homeopaths and proponents of other forms of alternative medicine to refer to medicine. It was used to describe the traditional European practice of heroic medicine,[34] but later continued to be used to describe anything that was not homeopathy.[34]

Allopathy refers to the use of pharmacologically active agents or medical interventions to treat or suppress symptoms or pathophysiological processes of diseases or conditions.[35] The German version of the word, allopathisch, was coined in 1810 by the creator of homeopathy, Samuel Hahnemann (17551843).[36] The word was coined from allo- (different) and -pathic (relating to a disease or to a method of treatment).[37] In alternative medicine circles the expression “allopathic medicine” is still used to refer to “the broad category of medical practice that is sometimes called Western medicine, biomedicine, evidence-based medicine, or modern medicine” (see the article on scientific medicine).[38]

Use of the term remains common among homeopaths and has spread to other alternative medicine practices. The meaning implied by the label has never been accepted by conventional medicine and is considered pejorative.[39] More recently, some sources have used the term “allopathic”, particularly American sources wishing to distinguish between Doctors of Medicine (MD) and Doctors of Osteopathic Medicine (DO) in the United States.[36][40] William Jarvis, an expert on alternative medicine and public health,[41] states that “although many modern therapies can be construed to conform to an allopathic rationale (e.g., using a laxative to relieve constipation), standard medicine has never paid allegiance to an allopathic principle” and that the label “allopath” was from the start “considered highly derisive by regular medicine”.[42]

Many conventional medical treatments do not fit the nominal definition of allopathy, as they seek to prevent illness, or remove its cause.[43][44]

CAM is an abbreviation of complementary and alternative medicine.[30][31] It has also been called sCAM or SCAM with the addition of “so-called” or “supplements”.[32][33] The words balance and holism are often used, claiming to take into account a “whole” person, in contrast to the supposed reductionism of medicine. Due to its many names the field has been criticized for intense rebranding of what are essentially the same practices: as soon as one name is declared synonymous with quackery, a new name is chosen.[16]

Traditional medicine refers to the pre-scientific practices of a certain culture, contrary to what is typically practiced in other cultures where medical science dominates.

“Eastern medicine” typically refers to the traditional medicines of Asia where conventional bio-medicine penetrated much later.

The words balance and holism are often used alongside complementary or integrative medicine, claiming to take into account a “whole” person, in contrast to the supposed reductionism of medicine. Due to its many names the field has been criticized for intense rebranding of what are essentially the same practices.[16]

Prominent members of the science[45][46] and biomedical science community[3] say that it is not meaningful to define an alternative medicine that is separate from a conventional medicine, that the expressions “conventional medicine”, “alternative medicine”, “complementary medicine”, “integrative medicine”, and “holistic medicine” do not refer to any medicine at all.[45][3][46][47]

Others in both the biomedical and CAM communities say that CAM cannot be precisely defined because of the diversity of theories and practices it includes, and because the boundaries between CAM and biomedicine overlap, are porous, and change. The expression “complementary and alternative medicine” (CAM) resists easy definition because the health systems and practices it refers to are diffuse, and its boundaries poorly defined.[14][n 8] 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 (TCM) and Ayurveda, have antique origins in East or South Asia and are entirely alternative medical systems;[52] others, such as homeopathy and chiropractic, have origins in Europe or the United States 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.[55] 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.[55]

Critics say the expression is deceptive because it implies there is an effective alternative to science-based medicine, and that complementary is deceptive because it implies that the treatment increases the effectiveness of (complements) science-based medicine, while alternative medicines that have been tested nearly always have no measurable positive effect compared to a placebo.[4][56][57][58]

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 devised by the US National Center for Complementary and Integrative Health (NCCIH) of the National Institutes of Health (NIH), 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”.[61] For conventional medical practitioners, it does not necessarily follow that either it or its practitioners would no longer be considered alternative.[n 9]

Some definitions seek to specify alternative medicine in terms of its social and political marginality to mainstream healthcare.[64] This can refer to the lack of support that alternative therapies receive from the medical establishment and related bodies regarding access to research funding, sympathetic coverage in the medical press, or inclusion in the standard medical curriculum.[64] In 1993, the British Medical Association (BMA), one among many professional organizations who have attempted to define alternative medicine, stated that it[n 10] referred to “…those forms of treatment which are not widely used by the conventional healthcare professions, and the skills of which are not taught as part of the undergraduate curriculum of conventional medical and paramedical healthcare courses”.[65] In a US context, an influential definition coined in 1993 by the Harvard-based physician,[66] David M. Eisenberg,[67] characterized alternative medicine “as interventions neither taught widely in medical schools nor generally available in US hospitals”.[68] These descriptive definitions are inadequate in the present-day when some conventional doctors offer alternative medical treatments and CAM introductory courses or modules can be offered as part of standard undergraduate medical training;[69] alternative medicine is taught in more than 50 per cent of US medical schools and increasingly US health insurers are willing to provide reimbursement for CAM therapies. In 1999, 7.7% of US hospitals reported using some form of CAM therapy; this proportion had risen to 37.7% by 2008.[71]

An expert panel at a conference hosted in 1995 by the US Office for Alternative Medicine (OAM),[72][n 11] devised a theoretical definition[72] of alternative medicine as “a broad domain of healing resources… other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period”.[74] This definition has been widely adopted by CAM researchers,[72] cited by official government bodies such as the UK Department of Health,[75] attributed as the definition used by the Cochrane Collaboration,[76] and, with some modification,[dubious discuss] was preferred in the 2005 consensus report of the US Institute of Medicine, Complementary and Alternative Medicine in the United States.[n 2]

The 1995 OAM conference definition, an expansion of Eisenberg’s 1993 formulation, is silent regarding questions of the medical effectiveness of alternative therapies.[77] Its proponents hold that it thus avoids relativism about 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.[77] 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”.[78] 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.[78] 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.[78]

Normative definitions distinguish alternative medicine from the biomedical mainstream in its provision of therapies that are unproven, unvalidated, or ineffective and support of theories with 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 are not based on evidence gathered with the scientific method.[1][3][27][28][61][80] Exemplifying this perspective, a 1998 editorial co-authored by Marcia Angell, a former editor of The New England Journal of Medicine, argued that:

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.[3]

This line of division has been subject to criticism, however, as not all forms of standard medical practice have adequately demonstrated evidence of benefit,[n 4][81] and it is also unlikely in most instances that conventional therapies, if proven to be ineffective, would ever be classified as CAM.[72]

Similarly, the public information website maintained by the National Health and Medical Research Council (NHMRC) of the Commonwealth of Australia uses the acronym “CAM” for a wide range of health care practices, therapies, procedures and devices not within the domain of conventional medicine. In the Australian context this is stated to include acupuncture; aromatherapy; chiropractic; homeopathy; massage; meditation and relaxation therapies; naturopathy; osteopathy; reflexology, traditional Chinese medicine; and the use of vitamin supplements.[83]

The Danish National Board of Health’s “Council for Alternative Medicine” (Sundhedsstyrelsens Rd for Alternativ Behandling (SRAB)), an independent institution under the National Board of Health (Danish: Sundhedsstyrelsen), uses the term “alternative medicine” for:

Proponents of an evidence-base for medicine[n 12][86][87][88][89] such as the Cochrane Collaboration (founded in 1993 and from 2011 providing input for WHO resolutions) take a position that all systematic reviews of treatments, whether “mainstream” or “alternative”, ought to be held to the current standards of scientific method.[90] In a study titled Development and classification of an operational definition of complementary and alternative medicine for the Cochrane Collaboration (2011) it was proposed that indicators that a therapy is accepted include government licensing of practitioners, coverage by health insurance, statements of approval by government agencies, and recommendation as part of a practice guideline; and that if something is currently a standard, accepted therapy, then it is not likely to be widely considered as CAM.[72]

Alternative medicine consists of a wide range of health care practices, products, and therapies. The shared feature is a claim to heal that is not based on the scientific method. Alternative medicine practices are diverse in their foundations and methodologies.[61] Alternative medicine practices may be classified by their cultural origins or by the types of beliefs upon which they are based.[1][4][11][61] Methods may incorporate or be based on traditional medicinal practices of a particular culture, folk knowledge, superstition, spiritual beliefs, belief in supernatural energies (antiscience), pseudoscience, errors in reasoning, propaganda, fraud, new or different concepts of health and disease, and any bases other than being proven by scientific methods.[1][4][5][11] Different cultures may have their own unique traditional or belief based practices developed recently or over thousands of years, and specific practices or entire systems of practices.

Alternative medicine, such as using naturopathy or homeopathy in place of conventional medicine, is based on belief systems not grounded in science.[61]

Alternative medical systems may be based on traditional medicine practices, such as traditional Chinese medicine (TCM), Ayurveda in India, or practices of other cultures around the world.[61] Some useful applications of traditional medicines have been researched and accepted within ordinary medicine, however the underlying belief systems are seldom scientific and are not accepted.

Traditional medicine is considered alternative when it is used outside its home region; or when it is used together with or instead of known functional treatment; or when it can be reasonably expected that the patient or practitioner knows or should know that it will not work such as knowing that the practice is based on superstition.

Bases of belief may include belief in existence of supernatural energies undetected by the science of physics, as in biofields, or in belief in properties of the energies of physics that are inconsistent with the laws of physics, as in energy medicine.[61]

Substance based practices use substances found in nature such as herbs, foods, non-vitamin supplements and megavitamins, animal and fungal products, and minerals, including use of these products in traditional medical practices that may also incorporate other methods.[61][115][116] Examples include healing claims for nonvitamin supplements, fish oil, Omega-3 fatty acid, glucosamine, echinacea, flaxseed oil, and ginseng.[117] Herbal medicine, or phytotherapy, includes not just the use of plant products, but may also include the use of animal and mineral products.[115] It is among the most commercially successful branches of alternative medicine, and includes the tablets, powders and elixirs that are sold as “nutritional supplements”.[115] Only a very small percentage of these have been shown to have any efficacy, and there is little regulation as to standards and safety of their contents.[115] This may include use of known toxic substances, such as use of the poison lead in traditional Chinese medicine.[117]

A US agency, National Center on Complementary and Integrative Health (NCCIH), has created a classification system for branches of complementary and alternative medicine that divides them into five major groups. These groups have some overlap, and distinguish two types of energy medicine: veritable which involves scientifically observable energy (including magnet therapy, colorpuncture and light therapy) and putative, which invokes physically undetectable or unverifiable energy.[121] None of these energies have any evidence to support that they effect the body in any positive or health promoting way.[34]

The history of alternative medicine may refer to the history of a group of diverse medical practices that were collectively promoted as “alternative medicine” beginning in the 1970s, to the collection of individual histories of members of that group, or to the history of western medical practices that were labeled “irregular practices” by the western medical establishment.[4][122][123][124][125] It includes the histories of complementary medicine and of integrative medicine. Before the 1970s, western practitioners that were not part of the increasingly science-based medical establishment were referred to “irregular practitioners”, and were dismissed by the medical establishment as unscientific and as practicing quackery.[122][123] Until the 1970s, irregular practice became increasingly marginalized as quackery and fraud, as western medicine increasingly incorporated scientific methods and discoveries, and had a corresponding increase in success of its treatments.[124] In the 1970s, irregular practices were grouped with traditional practices of nonwestern cultures and with other unproven or disproven practices that were not part of biomedicine, with the entire group collectively marketed and promoted under the single expression “alternative medicine”.[4][122][123][124][126]

Use of alternative medicine in the west began to rise following the counterculture movement of the 1960s, as part of the rising new age movement of the 1970s.[4][127][128] This was due to misleading mass marketing of “alternative medicine” being an effective “alternative” to biomedicine, changing social attitudes about not using chemicals and challenging the establishment and authority of any kind, sensitivity to giving equal measure to beliefs and practices of other cultures (cultural relativism), and growing frustration and desperation by patients about limitations and side effects of science-based medicine.[4][123][124][125][126][128][129] At the same time, in 1975, the American Medical Association, which played the central role in fighting quackery in the United States, abolished its quackery committee and closed down its Department of Investigation.[122]:xxi[129] By the early to mid 1970s the expression “alternative medicine” came into widespread use, and the expression became mass marketed as a collection of “natural” and effective treatment “alternatives” to science-based biomedicine.[4][129][130][131] By 1983, mass marketing of “alternative medicine” was so pervasive that the British Medical Journal (BMJ) pointed to “an apparently endless stream of books, articles, and radio and television programmes urge on the public the virtues of (alternative medicine) treatments ranging from meditation to drilling a hole in the skull to let in more oxygen”.[129]

Mainly as a result of reforms following the Flexner Report of 1910[132] medical education in established medical schools in the US has generally not included alternative medicine as a teaching topic.[n 14] Typically, their teaching is based on current practice and scientific knowledge about: anatomy, physiology, histology, embryology, neuroanatomy, pathology, pharmacology, microbiology and immunology.[134] Medical schools’ teaching includes such topics as doctor-patient communication, ethics, the art of medicine,[135] and engaging in complex clinical reasoning (medical decision-making).[136] Writing in 2002, Snyderman and Weil remarked that by the early twentieth century the Flexner model had helped to create the 20th-century academic health center, in which education, research, and practice were inseparable. While this had much improved medical practice by defining with increasing certainty the pathophysiological basis of disease, a single-minded focus on the pathophysiological had diverted much of mainstream American medicine from clinical conditions that were not well understood in mechanistic terms, and were not effectively treated by conventional therapies.[137]

By 2001 some form of CAM training was being offered by at least 75 out of 125 medical schools in the US.[138] Exceptionally, the School of Medicine of the University of Maryland, Baltimore includes a research institute for integrative medicine (a member entity of the Cochrane Collaboration).[90][139] Medical schools are responsible for conferring medical degrees, but a physician typically may not legally practice medicine until licensed by the local government authority. Licensed physicians in the US who have attended one of the established medical schools there have usually graduated Doctor of Medicine (MD).[140] All states require that applicants for MD licensure be graduates of an approved medical school and complete the United States Medical Licensing Exam (USMLE).[140]

There is a general scientific consensus that alternative therapies lack the requisite scientific validation, and their effectiveness is either unproved or disproved.[1][4][141][142] Many of the claims regarding the efficacy of alternative medicines are controversial, since research on them is frequently of low quality and methodologically flawed. Selective publication bias, marked differences in product quality and standardisation, and some companies making unsubstantiated claims call into question the claims of efficacy of isolated examples where there is evidence for alternative therapies.[144]

The Scientific Review of Alternative Medicine points to confusions in the general population a person may attribute symptomatic relief to an otherwise-ineffective therapy just because they are taking something (the placebo effect); the natural recovery from or the cyclical nature of an illness (the regression fallacy) gets misattributed to an alternative medicine being taken; a person not diagnosed with science-based medicine may never originally have had a true illness diagnosed as an alternative disease category.[145]

Edzard Ernst characterized the evidence for many alternative techniques as weak, nonexistent, or negative[146] and in 2011 published his estimate that about 7.4% were based on “sound evidence”, although he believes that may be an overestimate.[147] Ernst has concluded that 95% of the alternative treatments he and his team studied, including acupuncture, herbal medicine, homeopathy, and reflexology, are “statistically indistinguishable from placebo treatments”, but he also believes there is something that conventional doctors can usefully learn from the chiropractors and homeopath: this is the therapeutic value of the placebo effect, one of the strangest phenomena in medicine.[148][149]

In 2003, a project funded by the CDC identified 208 condition-treatment pairs, of which 58% had been studied by at least one randomized controlled trial (RCT), and 23% had been assessed with a meta-analysis.[150] According to a 2005 book by a US Institute of Medicine panel, the number of RCTs focused on CAM has risen dramatically.

As of 2005[update], the Cochrane Library had 145 CAM-related Cochrane systematic reviews and 340 non-Cochrane systematic reviews. An analysis of the conclusions of only the 145 Cochrane reviews was done by two readers. In 83% of the cases, the readers agreed. In the 17% in which they disagreed, a third reader agreed with one of the initial readers to set a rating. These studies found that, for CAM, 38.4% concluded positive effect or possibly positive (12.4%), 4.8% concluded no effect, 0.7% concluded harmful effect, and 56.6% concluded insufficient evidence. An assessment of conventional treatments found that 41.3% concluded positive or possibly positive effect, 20% concluded no effect, 8.1% concluded net harmful effects, and 21.3% concluded insufficient evidence. However, the CAM review used the more developed 2004 Cochrane database, while the conventional review used the initial 1998 Cochrane database.

In the same way as for conventional therapies, drugs, and interventions, it can be difficult to test the efficacy of alternative medicine in clinical trials. In instances where an established, effective, treatment for a condition is already available, the Helsinki Declaration states that withholding such treatment is unethical in most circumstances. Use of standard-of-care treatment in addition to an alternative technique being tested may produce confounded or difficult-to-interpret results.[152]

Cancer researcher Andrew J. Vickers has stated:

Contrary to much popular and scientific writing, many alternative cancer treatments have been investigated in good-quality clinical trials, and they have been shown to be ineffective. The label “unproven” is inappropriate for such therapies; it is time to assert that many alternative cancer therapies have been “disproven”.[153]

A research methods expert and author of Snake Oil Science, R. Barker Bausell, has stated that “it’s become politically correct to investigate nonsense.”[154] There are concerns that just having NIH support is being used to give unfounded “legitimacy to treatments that are not legitimate.”[155]

Use of placebos 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.”[57][58]

Another critic has argued that academic proponents of integrative medicine sometimes recommend misleading patients by using known placebo treatments to achieve a placebo effect.[n 15] However, a 2010 survey of family physicians found that 56% of respondents said they had used a placebo in clinical practice as well. Eighty-five percent of respondents believed placebos can have both psychological and physical benefits.[157]

Integrative medicine has been criticized in that its practitioners, trained in science-based medicine, deliberately mislead patients by pretending placebos are not. “quackademic medicine” is a pejorative term used for integrative medicine, which medical professionals consider an infiltration of quackery into academic science-based medicine.[58]

An analysis of trends in the criticism of complementary and alternative medicine (CAM) in five prestigious American medical journals during the period of reorganization within medicine (19651999) was reported as showing that the medical profession had responded to the growth of CAM in three phases, and that in each phase, changes in the medical marketplace had influenced the type of response in the journals.[158] Changes included relaxed medical licensing, the development of managed care, rising consumerism, and the establishment of the USA Office of Alternative Medicine (later National Center for Complementary and Alternative Medicine, currently National Center for Complementary and Integrative Health).[n 16] In the “condemnation” phase, from the late 1960s to the early 1970s, authors had ridiculed, exaggerated the risks, and petitioned the state to contain CAM; in the “reassessment” phase (mid-1970s through early 1990s), when increased consumer utilization of CAM was prompting concern, authors had pondered whether patient dissatisfaction and shortcomings in conventional care contributed to the trend; in the “integration” phase of the 1990s physicians began learning to work around or administer CAM, and the subjugation of CAM to scientific scrutiny had become the primary means of control.[citation needed]

Practitioners of complementary medicine usually discuss and advise patients as to available alternative therapies. Patients often express interest in mind-body complementary therapies because they offer a non-drug approach to treating some health conditions.[160]

In addition to the social-cultural underpinnings of the popularity of alternative medicine, there are several psychological issues that are critical to its growth, notably psychological effects, such as the will to believe,[161] cognitive biases that help maintain self-esteem and promote harmonious social functioning,[161] and the post hoc, ergo propter hoc fallacy.[161]

The popularity of complementary & alternative medicine (CAM) may be related to other factors that Edzard Ernst mentioned in an interview in The Independent:

Why is it so popular, then? Ernst blames the providers, customers and the doctors whose neglect, he says, has created the opening into which alternative therapists have stepped. “People are told lies. There are 40 million websites and 39.9 million tell lies, sometimes outrageous lies. They mislead cancer patients, who are encouraged not only to pay their last penny but to be treated with something that shortens their lives. “At the same time, people are gullible. It needs gullibility for the industry to succeed. It doesn’t make me popular with the public, but it’s the truth.[162]

Paul Offit proposed that “alternative medicine becomes quackery” in four ways: by recommending against conventional therapies that are helpful, promoting potentially harmful therapies without adequate warning, draining patients’ bank accounts, or by promoting “magical thinking.”[45]

Authors have speculated on the socio-cultural and psychological reasons for the appeal of alternative medicines among the minority using them in lieu of conventional medicine. There are several socio-cultural reasons for the interest in these treatments centered on the low level of scientific literacy among the public at large and a concomitant increase in antiscientific attitudes and new age mysticism.[161] Related to this are vigorous marketing[163] of extravagant claims by the alternative medical community combined with inadequate media scrutiny and attacks on critics.[161][164]

There is also an increase in conspiracy theories toward conventional medicine and pharmaceutical companies, mistrust of traditional authority figures, such as the physician, and a dislike of the current delivery methods of scientific biomedicine, all of which have led patients to seek out alternative medicine to treat a variety of ailments.[164] Many patients lack access to contemporary medicine, due to a lack of private or public health insurance, which leads them to seek out lower-cost alternative medicine.[165] Medical doctors are also aggressively marketing alternative medicine to profit from this market.[163]

Patients can be averse to the painful, unpleasant, and sometimes-dangerous side effects of biomedical treatments. Treatments for severe diseases such as cancer and HIV infection have well-known, significant side-effects. Even low-risk medications such as antibiotics can have potential to cause life-threatening anaphylactic reactions in a very few individuals. Many medications may cause minor but bothersome symptoms such as cough or upset stomach. In all of these cases, patients may be seeking out alternative treatments to avoid the adverse effects of conventional treatments.[161][164]

Complementary and alternative medicine (CAM) has been described as 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 that of the dominant system are not always sharp or fixed.[72][dubious discuss]

According to recent research, the increasing popularity of the CAM needs to be explained by moral convictions or lifestyle choices rather than by economic reasoning.[166]

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 healthcare or be integrated into the healthcare system. In Africa, traditional medicine is used for 80% of primary healthcare, and in developing nations as a whole over one-third of the population lack access to essential medicines.[167]

Some have proposed adopting a prize system to reward medical research.[168] However, public funding for research exists. Increasing the funding for research on alternative medicine techniques is the purpose of the US National Center for Complementary and Alternative Medicine. NCCIH and its predecessor, the Office of Alternative Medicine, have spent more than US$2.5 billion on such research since 1992; this research has largely not demonstrated the efficacy of alternative treatments.[154][169][170][171]

That alternative medicine has been on the rise “in countries where Western science and scientific method generally are accepted as the major foundations for healthcare, and ‘evidence-based’ practice is the dominant paradigm” was described as an “enigma” in the Medical Journal of Australia.[172]

In the United States, the 1974 Child Abuse Prevention and Treatment Act (CAPTA) required that for states to receive federal money, they had to grant religious exemptions to child neglect and abuse laws regarding religion-based healing practices.[173] Thirty-one states have child-abuse religious exemptions.[174]

The use of alternative medicine in the US has increased,[1][175] with a 50 percent increase in expenditures and a 25 percent increase in the use of alternative therapies between 1990 and 1997 in America.[175] Americans spend many billions on the therapies annually.[175] Most Americans used CAM to treat and/or prevent musculoskeletal conditions or other conditions associated with chronic or recurring pain.[165] In America, women were more likely than men to use CAM, with the biggest difference in use of mind-body therapies including prayer specifically for health reasons”.[165] In 2008, more than 37% of American hospitals offered alternative therapies, up from 27 percent in 2005, and 25% in 2004.[176][177] More than 70% of the hospitals offering CAM were in urban areas.[177]

A survey of Americans found that 88 percent thought that “there are some good ways of treating sickness that medical science does not recognize”.[1] Use of magnets was the most common tool in energy medicine in America, and among users of it, 58 percent described it as at least “sort of scientific”, when it is not at all scientific.[1] In 2002, at least 60 percent of US medical schools have at least some class time spent teaching alternative therapies.[1] “Therapeutic touch” was taught at more than 100 colleges and universities in 75 countries before the practice was debunked by a nine-year-old child for a school science project.[1][114]

The most common CAM therapies used in the US in 2002 were prayer (45%), herbalism (19%), breathing meditation (12%), meditation (8%), chiropractic medicine (8%), yoga (56%), body work (5%), diet-based therapy (4%), progressive relaxation (3%), mega-vitamin therapy (3%) and Visualization (2%)[165][178]

In Britain, the most often used alternative therapies were Alexander technique, Aromatherapy, Bach and other flower remedies, Body work therapies including massage, Counseling stress therapies, hypnotherapy, Meditation, Reflexology, Shiatsu, Ayurvedic medicine, Nutritional medicine, and Yoga.[179] Ayurvedic medicine remedies are mainly plant based with some use of animal materials. Safety concerns include the use of herbs containing toxic compounds and the lack of quality control in Ayurvedic facilities.[108][110]

According to the National Health Service (England), the most commonly used complementary and alternative medicines (CAM) supported by the NHS in the UK are: acupuncture, aromatherapy, chiropractic, homeopathy, massage, osteopathy and clinical hypnotherapy.[181]

Complementary therapies are often used in palliative care or by practitioners attempting to manage chronic pain in patients. Integrative 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.”[182] 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.”[183]

In Austria and Germany complementary and alternative medicine is mainly in the hands of doctors with MDs,[30] and half or more of the American alternative practitioners are licensed MDs.[184] In Germany herbs are tightly regulated: half are prescribed by doctors and covered by health insurance.[185]

Some professions of complementary/traditional/alternative medicine, such as chiropractic, have achieved full regulation in North America and other parts of the world and are regulated in a manner similar to that governing science-based medicine. In contrast, other approaches may be partially recognized and others have no regulation at all. Regulation and licensing of alternative medicine ranges widely from country to country, and state to state.

Government bodies in the US and elsewhere have published information or guidance about alternative medicine. The U.S. Food and Drug Administration (FDA), has issued online warnings for consumers about medication health fraud.[187] This includes a section on Alternative Medicine Fraud,[188] such as a warning that Ayurvedic products generally have not been approved by the FDA before marketing.[189]

Many of the claims regarding the safety and efficacy of alternative medicine are controversial. Some alternative treatments have been associated with unexpected side effects, which can be fatal.[190]

A commonly voiced concerns about complementary alternative medicine (CAM) is the way it’s regulated. There have been significant developments in how CAMs should be assessed prior to re-sale in the United Kingdom and the European Union (EU) in the last 2 years. Despite this, it has been suggested that current regulatory bodies have been ineffective in preventing deception of patients as many companies have re-labelled their drugs to avoid the new laws.[191] There is no general consensus about how to balance consumer protection (from false claims, toxicity, and advertising) with freedom to choose remedies.

Advocates of CAM suggest that regulation of the industry will adversely affect patients looking for alternative ways to manage their symptoms, even if many of the benefits may represent the placebo affect.[192] Some contend that alternative medicines should not require any more regulation than over-the-counter medicines that can also be toxic in overdose (such as paracetamol).[193]

Forms of alternative medicine that are biologically active can be dangerous even when used in conjunction with conventional medicine. Examples include immuno-augmentation therapy, shark cartilage, bioresonance therapy, oxygen and ozone therapies, and insulin potentiation therapy. Some herbal remedies can cause dangerous interactions with chemotherapy drugs, radiation therapy, or anesthetics during surgery, among other problems.[31] An example of these dangers was reported by Associate Professor Alastair MacLennan of Adelaide University, Australia regarding a patient who almost bled to death on the operating table after neglecting to mention that she had been taking “natural” potions to “build up her strength” before the operation, including a powerful anticoagulant that nearly caused her death.[194]

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.[195]

Conventional treatments are subjected to testing for undesired side-effects, whereas alternative treatments, in general, are not subjected to such testing at all. Any treatment whether conventional or alternative that has a biological or psychological effect on a patient may also have potential to possess dangerous biological or psychological side-effects. 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.” Specific groups of patients such as patients with impaired hepatic or renal function are more susceptible to side effects of alternative remedies.[196][197]

An exception to the normal thinking regarding side-effects is Homeopathy. Since 1938, the U.S. Food and Drug Administration (FDA) has regulated homeopathic products in “several significantly different ways from other drugs.”[198] Homeopathic preparations, termed “remedies”, are extremely dilute, often far beyond the point where a single molecule of the original active (and possibly toxic) ingredient is likely to remain. They are, thus, considered safe on that count, but “their products are exempt from good manufacturing practice requirements related to expiration dating and from finished product testing for identity and strength”, and their alcohol concentration may be much higher than allowed in conventional drugs.[198]

Those having experienced or perceived 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.[199] For this reason, critics argue that therapies that rely on the placebo effect to define success are very dangerous. According to mental health journalist Scott Lilienfeld in 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 outcomes.[200] Between 2001 and 2003, four children died in Australia because their parents chose ineffective naturopathic, homeopathic, or other alternative medicines and diets rather than conventional therapies.[201]

There have always been “many therapies offered outside of conventional cancer treatment centers and based on theories not found in biomedicine. These alternative cancer cures have often been described as ‘unproven,’ suggesting that appropriate clinical trials have not been conducted and that the therapeutic value of the treatment is unknown.” However, “many alternative cancer treatments have been investigated in good-quality clinical trials, and they have been shown to be ineffective….The label ‘unproven’ is inappropriate for such therapies; it is time to assert that many alternative cancer therapies have been ‘disproven’.”[153]

Edzard Ernst has stated:

any alternative cancer cure is bogus by definition. There will never be an alternative cancer cure. Why? Because if something looked halfway promising, then mainstream oncology would scrutinize it, and if there is anything to it, it would become mainstream almost automatically and very quickly. All curative “alternative cancer cures” are based on false claims, are bogus, and, I would say, even criminal.[202]

“CAM”, meaning “complementary and alternative medicine”, is not as well researched as conventional medicine, which undergoes intense research before release to the public.[203] Funding for research is also sparse making it difficult to do further research for effectiveness of CAM.[204] Most funding for CAM is funded by government agencies.[203] Proposed research for CAM are rejected by most private funding agencies because the results of research are not reliable.[203] The research for CAM has to meet certain standards from research ethics committees, which most CAM researchers find almost impossible to meet.[203] Even with the little research done on it, CAM has not been proven to be effective.[205]

Steven Novella, a neurologist at Yale School of Medicine, wrote that government funded studies of integrating alternative medicine techniques into the mainstream are “used to lend an appearance of legitimacy to treatments that are not legitimate.”[155] Marcia Angell considered that critics felt that healthcare practices should be classified based solely on scientific evidence, and if a treatment had been rigorously tested and found safe and effective, science-based medicine will adopt it regardless of whether it was considered “alternative” to begin with.[3] It is possible for a method to change categories (proven vs. unproven), based on increased knowledge of its effectiveness or lack thereof. A prominent supporter of this position is George D. Lundberg, former editor of the Journal of the American Medical Association (JAMA).[47]

Writing in 1999 in CA: A Cancer Journal for Clinicians Barrie R. Cassileth mentioned a 1997 letter to the US Senate Subcommittee on Public Health and Safety, which had deplored the lack of critical thinking and scientific rigor in OAM-supported research, had been signed by four Nobel Laureates and other prominent scientists. (This was supported by the National Institutes of Health (NIH).)[206]

In March 2009 a staff writer for the Washington Post reported that the impending national discussion about broadening access to health care, improving medical practice and saving money was giving a group of scientists an opening to propose shutting down the National Center for Complementary and Alternative Medicine. They quoted one of these scientists, Steven Salzberg, a genome researcher and computational biologist at the University of Maryland, as saying “One of our concerns is that NIH is funding pseudoscience.” They noted that the vast majority of studies were based on fundamental misunderstandings of physiology and disease, and had shown little or no effect.[155]

Writers such as Carl Sagan, a noted astrophysicist, advocate of scientific skepticism and the author of The Demon-Haunted World: Science as a Candle in the Dark (1996), have lambasted the lack of empirical evidence to support the existence of the putative energy fields on which these therapies are predicated.

Sampson has also pointed out that CAM tolerated contradiction without thorough reason and experiment.[207] Barrett has pointed out 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.[154] Barrett also expressed concern that, just because some “alternatives” have merit, there is the impression that the rest deserve equal consideration and respect even though most are worthless, since they are all classified under the one heading of alternative medicine.[208]

Some critics of alternative medicine are focused upon health fraud, misinformation, and quackery as public health problems, notably Wallace Sampson and Paul Kurtz founders of Scientific Review of Alternative Medicine and Stephen Barrett, co-founder of The National Council Against Health Fraud and webmaster of Quackwatch.[209] Grounds for opposing alternative medicine include that:

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Alternative medicine – Wikipedia

Complementary and Alternative Medicine: Get the Facts on CAM

What is complementary medicine?

Complementary medicine is a group of diagnostic and therapeutic disciplines that are used together with conventional medicine. An example of a complementary therapy is using aromatherapy to help lessen a patient’s discomfort following surgery.

Complementary medicine is usually not taught or used in Western medical schools or hospitals. Complementary medicine includes a large number of practices and systems of health care that, for a variety of cultural, social, economic, or scientific reasons, have not been adopted by mainstream Western medicine.

Complementary medicine is different from alternative medicine. Whereas complementary medicine is used together with conventional medicine, alternative medicine is used in place of conventional medicine. An example of an alternative therapy is using a special diet to treat cancer instead of undergoing surgery, radiation, or chemotherapy that has been recommended by a physician.

Complementary and alternative medicine (CAM) can include the following:

Complementary and alternative cancer treatments are often lumped together. But to a cancer specialist, there is a big difference. Complementary therapy is used in addition to mainstream medical treatment. Alternative therapy is used instead of proven treatment. Another term you may hear is integrative medicine. This means combining CAM and standard care to try to treat cancer in a way that involves your body, mind and spirit. Complementary and alternative medicine (CAM) includes:

What is alternative medicine?

Alternative medicine includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, and spiritual healing.

What are complementary and alternative medicine therapies?

Complementary and alternative medicine therapies fall into five major categories, or domains:

Alternative medical systems are built upon complete systems of theory and practice. Often, these systems have evolved apart from and earlier than the conventional medical approach used in the United States. Examples of alternative medical systems that have developed in Western cultures include homeopathic medicine and naturopathic medicine. Examples of systems that have developed in non-Western cultures include traditional Chinese medicine and Ayurveda.

Mind-body medicine uses a variety of techniques designed to enhance the mind’s capacity to affect bodily function and symptoms. Some techniques that were considered CAM in the past have become mainstream (for example, patient support groups and cognitive-behavioral therapy). Other mind-body techniques are still considered CAM, including meditation, prayer, mental healing, and therapies that use creative outlets such as art, music, or dance.

Biologically based therapies in CAM use substances found in nature, such as herbs, foods, and vitamins. Some examples include dietary supplements,3 herbal products, and the use of other so-called natural but as yet scientifically unproven therapies (for example, using shark cartilage to treat cancer).

Manipulative and body-based methods in CAM are based on manipulation and/or movement of one or more parts of the body. Some examples include chiropractic or osteopathic manipulation, and massage.

Energy therapies involve the use of energy fields. They are of two types:

Questions to ask your doctor when considering complimentary or alternative medicine therapies

Cancer patients using or considering complementary or alternative therapy should discuss this decision with their doctor or nurse, as they would any therapeutic approach. Some complementary and alternative therapies may interfere with standard treatment or may be harmful when used with conventional treatment. It is also a good idea to become informed about the therapy, including whether the results of scientific studies support the claims that are made for it. 1

Choosing a CAM practitioner 1

For additional information, please read”Consumer Financial Issues in CAM.”

SOURCES: 1 National Center for Complementary and Alternative Medicine, National Institutes of Health

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Stem cell – Wikipedia

Stem cells are biological cells that can differentiate into other types of cells and can divide to produce more of the same type of stem cells. They are always and only found in the multicellular organisms.

In mammals, there are two broad types of stem cells: embryonic stem cells, which are isolated from the inner cell mass of blastocysts, and adult stem cells, which are found in various tissues. In adult organisms, stem cells and progenitor cells act as a repair system for the body, replenishing adult tissues. In a developing embryo, stem cells can differentiate into all the specialized cellsectoderm, endoderm and mesoderm (see induced pluripotent stem cells)but also maintain the normal turnover of regenerative organs, such as blood, skin, or intestinal tissues.

There are three known accessible sources of autologous adult stem cells in humans:

Stem cells can also be taken from umbilical cord blood just after birth. Of all stem cell types, autologous harvesting involves the least risk. By definition, autologous cells are obtained from one’s own body, just as one may bank his or her own blood for elective surgical procedures.

Adult stem cells are frequently used in various medical therapies (e.g., bone marrow transplantation). Stem cells can now be artificially grown and transformed (differentiated) into specialized cell types with characteristics consistent with cells of various tissues such as muscles or nerves. Embryonic cell lines and autologous embryonic stem cells generated through somatic cell nuclear transfer or dedifferentiation have also been proposed as promising candidates for future therapies.[2] Research into stem cells grew out of findings by Ernest A. McCulloch and James E. Till at the University of Toronto in the 1960s.[3][4]

The classical definition of a stem cell requires that it possesses two properties:

Two mechanisms exist to ensure that a stem cell population is maintained:

1. Obligatory asymmetric replication: a stem cell divides into one mother cell that is identical to the original stem cell, and another daughter cell that is differentiated.

When a stem cell self-renews it divides and does not disrupt the undifferentiated state. This self-renewal demands control of cell cycle as well as upkeep of multipotency or pluripotency, which all depends on the stem cell.[5]

2. Stochastic differentiation: when one stem cell develops into two differentiated daughter cells, another stem cell undergoes mitosis and produces two stem cells identical to the original.

Potency specifies the differentiation potential (the potential to differentiate into different cell types) of the stem cell.[6]

In practice, stem cells are identified by whether they can regenerate tissue. For example, the defining test for bone marrow or hematopoietic stem cells (HSCs) is the ability to transplant the cells and save an individual without HSCs. This demonstrates that the cells can produce new blood cells over a long term. It should also be possible to isolate stem cells from the transplanted individual, which can themselves be transplanted into another individual without HSCs, demonstrating that the stem cell was able to self-renew.

Properties of stem cells can be illustrated in vitro, using methods such as clonogenic assays, in which single cells are assessed for their ability to differentiate and self-renew.[9][10] Stem cells can also be isolated by their possession of a distinctive set of cell surface markers. However, in vitro culture conditions can alter the behavior of cells, making it unclear whether the cells shall behave in a similar manner in vivo. There is considerable debate as to whether some proposed adult cell populations are truly stem cells.[11]

Embryonic stem cells (ESCs) are the cells of the inner cell mass of a blastocyst, an early-stage embryo.[12] Human embryos reach the blastocyst stage 45 days post fertilization, at which time they consist of 50150 cells. ESCs are pluripotent and give rise during development to all derivatives of the three primary germ layers: ectoderm, endoderm and mesoderm. In other words, they can develop into each of the more than 200 cell types of the adult body when given sufficient and necessary stimulation for a specific cell type. They do not contribute to the extra-embryonic membranes or the placenta.

During embryonic development these inner cell mass cells continuously divide and become more specialized. For example, a portion of the ectoderm in the dorsal part of the embryo specializes as ‘neurectoderm’, which will become the future central nervous system.[13] Later in development, neurulation causes the neurectoderm to form the neural tube. At the neural tube stage, the anterior portion undergoes encephalization to generate or ‘pattern’ the basic form of the brain. At this stage of development, the principal cell type of the CNS is considered a neural stem cell. These neural stem cells are pluripotent, as they can generate a large diversity of many different neuron types, each with unique gene expression, morphological, and functional characteristics. The process of generating neurons from stem cells is called neurogenesis. One prominent example of a neural stem cell is the radial glial cell, so named because it has a distinctive bipolar morphology with highly elongated processes spanning the thickness of the neural tube wall, and because historically it shared some glial characteristics, most notably the expression of glial fibrillary acidic protein (GFAP).[14][15] The radial glial cell is the primary neural stem cell of the developing vertebrate CNS, and its cell body resides in the ventricular zone, adjacent to the developing ventricular system. Neural stem cells are committed to the neuronal lineages (neurons, astrocytes, and oligodendrocytes), and thus their potency is restricted.[13]

Nearly all research to date has made use of mouse embryonic stem cells (mES) or human embryonic stem cells (hES) derived from the early inner cell mass. Both have the essential stem cell characteristics, yet they require very different environments in order to maintain an undifferentiated state. Mouse ES cells are grown on a layer of gelatin as an extracellular matrix (for support) and require the presence of leukemia inhibitory factor (LIF) in serum media. A drug cocktail containing inhibitors to GSK3B and the MAPK/ERK pathway, called 2i, has also been shown to maintain pluripotency in stem cell culture.[16] Human ESCs are grown on a feeder layer of mouse embryonic fibroblasts and require the presence of basic fibroblast growth factor (bFGF or FGF-2).[17] Without optimal culture conditions or genetic manipulation,[18] embryonic stem cells will rapidly differentiate.

A human embryonic stem cell is also defined by the expression of several transcription factors and cell surface proteins. The transcription factors Oct-4, Nanog, and Sox2 form the core regulatory network that ensures the suppression of genes that lead to differentiation and the maintenance of pluripotency.[19] The cell surface antigens most commonly used to identify hES cells are the glycolipids stage specific embryonic antigen 3 and 4 and the keratan sulfate antigens Tra-1-60 and Tra-1-81. By using human embryonic stem cells to produce specialized cells like nerve cells or heart cells in the lab, scientists can gain access to adult human cells without taking tissue from patients. They can then study these specialized adult cells in detail to try and catch complications of diseases, or to study cells reactions to potentially new drugs. The molecular definition of a stem cell includes many more proteins and continues to be a topic of research.[20]

There are currently no approved treatments using embryonic stem cells. The first human trial was approved by the US Food and Drug Administration in January 2009.[21] However, the human trial was not initiated until October 13, 2010 in Atlanta for spinal cord injury research. On November 14, 2011 the company conducting the trial (Geron Corporation) announced that it will discontinue further development of its stem cell programs.[22] ES cells, being pluripotent cells, require specific signals for correct differentiationif injected directly into another body, ES cells will differentiate into many different types of cells, causing a teratoma. Differentiating ES cells into usable cells while avoiding transplant rejection are just a few of the hurdles that embryonic stem cell researchers still face.[23] Due to ethical considerations, many nations currently have moratoria or limitations on either human ES cell research or the production of new human ES cell lines. Because of their combined abilities of unlimited expansion and pluripotency, embryonic stem cells remain a theoretically potential source for regenerative medicine and tissue replacement after injury or disease.[24]

Human embryonic stem cell colony on mouse embryonic fibroblast feeder layer

The primitive stem cells located in the organs of fetuses are referred to as fetal stem cells.[25]There are two types of fetal stem cells:

Adult stem cells, also called somatic (from Greek , “of the body”) stem cells, are stem cells which maintain and repair the tissue in which they are found.[27] They can be found in children, as well as adults.[28]

Pluripotent adult stem cells are rare and generally small in number, but they can be found in umbilical cord blood and other tissues.[29] Bone marrow is a rich source of adult stem cells,[30] which have been used in treating several conditions including liver cirrhosis,[31] chronic limb ischemia [32] and endstage heart failure.[33] The quantity of bone marrow stem cells declines with age and is greater in males than females during reproductive years.[34] Much adult stem cell research to date has aimed to characterize their potency and self-renewal capabilities.[35] DNA damage accumulates with age in both stem cells and the cells that comprise the stem cell environment. This accumulation is considered to be responsible, at least in part, for increasing stem cell dysfunction with aging (see DNA damage theory of aging).[36]

Most adult stem cells are lineage-restricted (multipotent) and are generally referred to by their tissue origin (mesenchymal stem cell, adipose-derived stem cell, endothelial stem cell, dental pulp stem cell, etc.).[37][38] Muse cells (multi-lineage differentiating stress enduring cells) are a recently discovered pluripotent stem cell type found in multiple adult tissues, including adipose, dermal fibroblasts, and bone marrow. While rare, muse cells are identifiable by their expression of SSEA-3, a marker for undifferentiated stem cells, and general mesenchymal stem cells markers such as CD105. When subjected to single cell suspension culture, the cells will generate clusters that are similar to embryoid bodies in morphology as well as gene expression, including canonical pluripotency markers Oct4, Sox2, and Nanog.[39]

Adult stem cell treatments have been successfully used for many years to treat leukemia and related bone/blood cancers through bone marrow transplants.[40] Adult stem cells are also used in veterinary medicine to treat tendon and ligament injuries in horses.[41]

The use of adult stem cells in research and therapy is not as controversial as the use of embryonic stem cells, because the production of adult stem cells does not require the destruction of an embryo. Additionally, in instances where adult stem cells are obtained from the intended recipient (an autograft), the risk of rejection is essentially non-existent. Consequently, more US government funding is being provided for adult stem cell research.[42]

Multipotent stem cells are also found in amniotic fluid. These stem cells are very active, expand extensively without feeders and are not tumorigenic. Amniotic stem cells are multipotent and can differentiate in cells of adipogenic, osteogenic, myogenic, endothelial, hepatic and also neuronal lines.[43]Amniotic stem cells are a topic of active research.

Use of stem cells from amniotic fluid overcomes the ethical objections to using human embryos as a source of cells. Roman Catholic teaching forbids the use of embryonic stem cells in experimentation; accordingly, the Vatican newspaper “Osservatore Romano” called amniotic stem cells “the future of medicine”.[44]

It is possible to collect amniotic stem cells for donors or for autologuous use: the first US amniotic stem cells bank [45][46] was opened in 2009 in Medford, MA, by Biocell Center Corporation[47][48][49] and collaborates with various hospitals and universities all over the world.[50]

Adult stem cells have limitations with their potency; unlike embryonic stem cells (ESCs), they are not able to differentiate into cells from all three germ layers. As such, they are deemed multipotent.

However, reprogramming allows for the creation of pluripotent cells, induced pluripotent stem cells (iPSCs), from adult cells. These are not adult stem cells, but adult cells (e.g. epithelial cells) reprogrammed to give rise to cells with pluripotent capabilities. Using genetic reprogramming with protein transcription factors, pluripotent stem cells with ESC-like capabilities have been derived.[51][52][53] The first demonstration of induced pluripotent stem cells was conducted by Shinya Yamanaka and his colleagues at Kyoto University.[54] They used the transcription factors Oct3/4, Sox2, c-Myc, and Klf4 to reprogram mouse fibroblast cells into pluripotent cells.[51][55] Subsequent work used these factors to induce pluripotency in human fibroblast cells.[56] Junying Yu, James Thomson, and their colleagues at the University of WisconsinMadison used a different set of factors, Oct4, Sox2, Nanog and Lin28, and carried out their experiments using cells from human foreskin.[51][57] However, they were able to replicate Yamanaka’s finding that inducing pluripotency in human cells was possible.

Induced pluripotent stem cells differ from embryonic stem cells. They share many similar properties, such as pluripotency and differentiation potential, the expression of pluripotency genes, epigenetic patterns, embryoid body and teratoma formation, and viable chimera formation,[54][55] but there are many differences within these properties. The chromatin of iPSCs appears to be more “closed” or methylated than that of ESCs.[54][55] Similarly, the gene expression pattern between ESCs and iPSCs, or even iPSCs sourced from different origins.[54] There are thus questions about the “completeness” of reprogramming and the somatic memory of induced pluripotent stem cells. Despite this, inducing adult cells to be pluripotent appears to be viable.

As a result of the success of these experiments, Ian Wilmut, who helped create the first cloned animal Dolly the Sheep, has announced that he will abandon somatic cell nuclear transfer as an avenue of research.[58]

Furthermore, induced pluripotent stem cells provide several therapeutic advantages. Like ESCs, they are pluripotent. They thus have great differentiation potential; theoretically, they could produce any cell within the human body (if reprogramming to pluripotency was “complete”).[54] Moreover, unlike ESCs, they potentially could allow doctors to create a pluripotent stem cell line for each individual patient.[59] Frozen blood samples can be used as a valuable source of induced pluripotent stem cells.[60] Patient specific stem cells allow for the screening for side effects before drug treatment, as well as the reduced risk of transplantation rejection.[59] Despite their current limited use therapeutically, iPSCs hold create potential for future use in medical treatment and research.

To ensure self-renewal, stem cells undergo two types of cell division (see Stem cell division and differentiation diagram). Symmetric division gives rise to two identical daughter cells both endowed with stem cell properties. Asymmetric division, on the other hand, produces only one stem cell and a progenitor cell with limited self-renewal potential. Progenitors can go through several rounds of cell division before terminally differentiating into a mature cell. It is possible that the molecular distinction between symmetric and asymmetric divisions lies in differential segregation of cell membrane proteins (such as receptors) between the daughter cells.[61]

An alternative theory is that stem cells remain undifferentiated due to environmental cues in their particular niche. Stem cells differentiate when they leave that niche or no longer receive those signals. Studies in Drosophila germarium have identified the signals decapentaplegic and adherens junctions that prevent germarium stem cells from differentiating.[62][63]

Stem cell therapy is the use of stem cells to treat or prevent a disease or condition. Bone marrow transplant is a form of stem cell therapy that has been used for many years without controversy.[64][65]

Stem cell treatments may lower symptoms of the disease or condition that is being treated. The lowering of symptoms may allow patients to reduce the drug intake of the disease or condition. Stem cell treatment may also provide knowledge for society to further stem cell understanding and future treatments.[66]

Stem cell treatments may require immunosuppression because of a requirement for radiation before the transplant to remove the person’s previous cells, or because the patient’s immune system may target the stem cells. One approach to avoid the second possibility is to use stem cells from the same patient who is being treated.

Pluripotency in certain stem cells could also make it difficult to obtain a specific cell type. It is also difficult to obtain the exact cell type needed, because not all cells in a population differentiate uniformly. Undifferentiated cells can create tissues other than desired types.[67]

Some stem cells form tumors after transplantation;[68] pluripotency is linked to tumor formation especially in embryonic stem cells, fetal proper stem cells, induced pluripotent stem cells. Fetal proper stem cells form tumors despite multipotency.[69]

Some of the fundamental patents covering human embryonic stem cells are owned by the Wisconsin Alumni Research Foundation (WARF) they are patents 5,843,780, 6,200,806, and 7,029,913 invented by James A. Thomson. WARF does not enforce these patents against academic scientists, but does enforce them against companies.[70]

In 2006, a request for the US Patent and Trademark Office (USPTO) to re-examine the three patents was filed by the Public Patent Foundation on behalf of its client, the non-profit patent-watchdog group Consumer Watchdog (formerly the Foundation for Taxpayer and Consumer Rights).[70] In the re-examination process, which involves several rounds of discussion between the USPTO and the parties, the USPTO initially agreed with Consumer Watchdog and rejected all the claims in all three patents,[71] however in response, WARF amended the claims of all three patents to make them more narrow, and in 2008 the USPTO found the amended claims in all three patents to be patentable. The decision on one of the patents (7,029,913) was appealable, while the decisions on the other two were not.[72][73] Consumer Watchdog appealed the granting of the ‘913 patent to the USPTO’s Board of Patent Appeals and Interferences (BPAI) which granted the appeal, and in 2010 the BPAI decided that the amended claims of the ‘913 patent were not patentable.[74] However, WARF was able to re-open prosecution of the case and did so, amending the claims of the ‘913 patent again to make them more narrow, and in January 2013 the amended claims were allowed.[75]

In July 2013, Consumer Watchdog announced that it would appeal the decision to allow the claims of the ‘913 patent to the US Court of Appeals for the Federal Circuit (CAFC), the federal appeals court that hears patent cases.[76] At a hearing in December 2013, the CAFC raised the question of whether Consumer Watchdog had legal standing to appeal; the case could not proceed until that issue was resolved.[77]

Diseases and conditions where stem cell treatment is being investigated include:

Research is underway to develop various sources for stem cells, and to apply stem cell treatments for neurodegenerative diseases and conditions, diabetes, heart disease, and other conditions.[93] Research is also underway in generating organoids using stem cells, which would allow for further understanding of human development, organogenesis, and modeling of human diseases.[94]

In more recent years, with the ability of scientists to isolate and culture embryonic stem cells, and with scientists’ growing ability to create stem cells using somatic cell nuclear transfer and techniques to create induced pluripotent stem cells, controversy has crept in, both related to abortion politics and to human cloning.

Hepatotoxicity and drug-induced liver injury account for a substantial number of failures of new drugs in development and market withdrawal, highlighting the need for screening assays such as stem cell-derived hepatocyte-like cells, that are capable of detecting toxicity early in the drug development process.[95]

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