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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 the use and promotion 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. They differ from experimental medicine in that the latter employs responsible investigation, and accepts results that show it to be 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 some the treatment is so much worse that its use is unethical. Alternative practices, products, and therapies range from only ineffective to 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. 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 mainstream 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 physical interventions to treat or suppress symptoms or pathophysiologic 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.

Since ancient times, in many parts of the world a number of herbs reputed to possess abortifacient properties have been used in folk medicine. Among these are: tansy, pennyroyal, black cohosh, and the now-extinct silphium.[101]:4447, 6263, 15455, 23031 Historian of science Ann Hibner Koblitz has written of the probable protoscientific origins of this folk knowledge in observation of farm animals. Women who knew that grazing on certain plants would cause an animal to abort (with negative economic consequences for the farm) would be likely to try out those plants on themselves in order to avoid an unwanted pregnancy.[102]:120

However, modern users of these plants often lack knowledge of the proper preparation and dosage. The historian of medicine John Riddle has spoken of the “broken chain of knowledge” caused by urbanization and modernization,[101]:167205 and Koblitz has written that “folk knowledge about effective contraception techniques often disappears over time or becomes inextricably mixed with useless or harmful practices.”[102]:vii The ill-informed or indiscriminant use of herbs as abortifacients can cause serious and even lethal side-effects.[103][104]

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][119][120] Examples include healing claims for nonvitamin supplements, fish oil, Omega-3 fatty acid, glucosamine, echinacea, flaxseed oil, and ginseng.[121] Herbal medicine, or phytotherapy, includes not just the use of plant products, but may also include the use of animal and mineral products.[119] It is among the most commercially successful branches of alternative medicine, and includes the tablets, powders and elixirs that are sold as “nutritional supplements”.[119] 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.[119] This may include use of known toxic substances, such as use of the poison lead in traditional Chinese medicine.[121]

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.[125] 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][126][127][128][129] 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.[126][127] 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.[128] 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][126][127][128][130]

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][131][132] 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][127][128][129][130][132][133] 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.[126]:xxi[133] 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][133][134][135] 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”.[133]

Mainly as a result of reforms following the Flexner Report of 1910[136] 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.[138] Medical schools’ teaching includes such topics as doctor-patient communication, ethics, the art of medicine,[139] and engaging in complex clinical reasoning (medical decision-making).[140] 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.[141]

By 2001 some form of CAM training was being offered by at least 75 out of 125 medical schools in the US.[142] 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][143] 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).[144] All states require that applicants for MD licensure be graduates of an approved medical school and complete the United States Medical Licensing Exam (USMLE).[144]

There is a general scientific consensus that alternative therapies lack the requisite scientific validation, and their effectiveness is either unproved or disproved.[1][4][145][146] 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.[148]

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.[149]

Edzard Ernst characterized the evidence for many alternative techniques as weak, nonexistent, or negative[150] and in 2011 published his estimate that about 7.4% were based on “sound evidence”, although he believes that may be an overestimate.[151] 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.[152][153]

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.[154] 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.[156]

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”.[157]

A research methods expert and author of Snake Oil Science, R. Barker Bausell, has stated that “it’s become politically correct to investigate nonsense.”[158] There are concerns that just having NIH support is being used to give unfounded “legitimacy to treatments that are not legitimate.”[159]

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.[161]

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.[162] 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.[164]

In addition to the social-cultural underpinnings of the popularity of alternative medicine, there are several psychological issues that are critical to its growth. One of the most critical is the placebo effect a well-established observation in medicine.[165] Related to it are similar psychological effects, such as the will to believe,[166] cognitive biases that help maintain self-esteem and promote harmonious social functioning,[166] and the post hoc, ergo propter hoc fallacy.[166]

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.[167]

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.[166] Related to this are vigorous marketing[168] of extravagant claims by the alternative medical community combined with inadequate media scrutiny and attacks on critics.[166][169]

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.[169] 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.[170] Medical doctors are also aggressively marketing alternative medicine to profit from this market.[168]

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.[166][169]

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.[171]

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.[172]

Some have proposed adopting a prize system to reward medical research.[173] 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.[158][174][175][176]

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.[177]

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.[178] Thirty-one states have child-abuse religious exemptions.[179]

The use of alternative medicine in the US has increased,[1][180] with a 50 percent increase in expenditures and a 25 percent increase in the use of alternative therapies between 1990 and 1997 in America.[180] Americans spend many billions on the therapies annually.[180] Most Americans used CAM to treat and/or prevent musculoskeletal conditions or other conditions associated with chronic or recurring pain.[170] 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”.[170] In 2008, more than 37% of American hospitals offered alternative therapies, up from 27 percent in 2005, and 25% in 2004.[181][182] More than 70% of the hospitals offering CAM were in urban areas.[182]

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][118]

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%)[170][183]

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.[184] 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.[112][114]

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.[186]

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.”[187] 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.”[188]

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.[189] In Germany herbs are tightly regulated: half are prescribed by doctors and covered by health insurance.[190]

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.[192] This includes a section on Alternative Medicine Fraud,[193] such as a warning that Ayurvedic products generally have not been approved by the FDA before marketing.[194]

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.[195]

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.[196] 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.[197] 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).[198]

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.[199]

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.[200]

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.[201][202]

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.”[203] 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.[203]

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.[204] 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.[205] 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.[206]

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’.”[157]

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.[207]

“CAM”, meaning “complementary and alternative medicine”, is not as well researched as conventional medicine, which undergoes intense research before release to the public.[208] Funding for research is also sparse making it difficult to do further research for effectiveness of CAM.[209] Most funding for CAM is funded by government agencies.[208] Proposed research for CAM are rejected by most private funding agencies because the results of research are not reliable.[208] The research for CAM has to meet certain standards from research ethics committees, which most CAM researchers find almost impossible to meet.[208] Even with the little research done on it, CAM has not been proven to be effective.[210]

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.”[159] 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).)[211]

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.[159]

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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

Link:

Complementary and Alternative Medicine: Get the Facts on CAM

Eugenics in the United States – Wikipedia

Eugenics, the set of beliefs and practices which aims at improving the genetic quality of the human population,[2][3] played a significant role in the history and culture of the United States prior to its involvement in World War II.[4]

Eugenics was practiced in the United States many years before eugenics programs in Nazi Germany,[5] which were largely inspired by the previous American work.[6][7][8] Stefan Khl has documented the consensus between Nazi race policies and those of eugenicists in other countries, including the United States, and points out that eugenicists understood Nazi policies and measures as the realization of their goals and demands.[9]

During the Progressive Era of the late 19th and early 20th century, eugenics was considered a method of preserving and improving the dominant groups in the population; it is now generally associated with racist and nativist elements, as the movement was to some extent a reaction to a change in emigration from Europe, rather than scientific genetics.[10]

The American eugenics movement was rooted in the biological determinist ideas of Sir Francis Galton, which originated in the 1880s. Galton studied the upper classes of Britain, and arrived at the conclusion that their social positions were due to a superior genetic makeup.[11] Early proponents of eugenics believed that, through selective breeding, the human species should direct its own evolution. They tended to believe in the genetic superiority of Nordic, Germanic and Anglo-Saxon peoples; supported strict immigration and anti-miscegenation laws; and supported the forcible sterilization of the poor, disabled and “immoral”.[12] Eugenics was also supported by African American intellectuals such as W. E. B. Du Bois, Thomas Wyatt Turner, and many academics at Tuskegee University, Howard University, and Hampton University; however, they believed the best blacks were as good as the best whites and “The Talented Tenth” of all races should mix.[13] W. E. B. Du Bois believed “only fit blacks should procreate to eradicate the race’s heritage of moral iniquity.”[13][14]

The American eugenics movement received extensive funding from various corporate foundations including the Carnegie Institution, Rockefeller Foundation, and the Harriman railroad fortune.[7] In 1906 J.H. Kellogg provided funding to help found the Race Betterment Foundation in Battle Creek, Michigan.[11] The Eugenics Record Office (ERO) was founded in Cold Spring Harbor, New York in 1911 by the renowned biologist Charles B. Davenport, using money from both the Harriman railroad fortune and the Carnegie Institution. As late as the 1920s, the ERO was one of the leading organizations in the American eugenics movement.[11][15] In years to come, the ERO collected a mass of family pedigrees and concluded that those who were unfit came from economically and socially poor backgrounds. Eugenicists such as Davenport, the psychologist Henry H. Goddard, Harry H. Laughlin, and the conservationist Madison Grant (all well respected in their time) began to lobby for various solutions to the problem of the “unfit”. Davenport favored immigration restriction and sterilization as primary methods; Goddard favored segregation in his The Kallikak Family; Grant favored all of the above and more, even entertaining the idea of extermination.[16] The Eugenics Record Office later became the Cold Spring Harbor Laboratory.

Eugenics was widely accepted in the U.S. academic community.[7] By 1928, there were 376 separate university courses in some of the United States’ leading schools, enrolling more than 20,000 students, which included eugenics in the curriculum.[17] It did, however, have scientific detractors (notably, Thomas Hunt Morgan, one of the few Mendelians to explicitly criticize eugenics), though most of these focused more on what they considered the crude methodology of eugenicists, and the characterization of almost every human characteristic as being hereditary, rather than the idea of eugenics itself.[18]

By 1910, there was a large and dynamic network of scientists, reformers, and professionals engaged in national eugenics projects and actively promoting eugenic legislation. The American Breeder’s Association was the first eugenic body in the U.S., established in 1906 under the direction of biologist Charles B. Davenport. The ABA was formed specifically to “investigate and report on heredity in the human race, and emphasize the value of superior blood and the menace to society of inferior blood.” Membership included Alexander Graham Bell, Stanford president David Starr Jordan and Luther Burbank.[19][20] The American Association for the Study and Prevention of Infant Mortality was one of the first organizations to begin investigating infant mortality rates in terms of eugenics.[21] They promoted government intervention in attempts to promote the health of future citizens.[22][verification needed]

Several feminist reformers advocated an agenda of eugenic legal reform. The National Federation of Women’s Clubs, the Woman’s Christian Temperance Union, and the National League of Women Voters were among the variety of state and local feminist organization that at some point lobbied for eugenic reforms.[23]

One of the most prominent feminists to champion the eugenic agenda was Margaret Sanger, the leader of the American birth control movement. Margaret Sanger saw birth control as a means to prevent unwanted children from being born into a disadvantaged life, and incorporated the language of eugenics to advance the movement.[24][25] Sanger also sought to discourage the reproduction of persons who, it was believed, would pass on mental disease or serious physical defects. She advocated sterilization in cases where the subject was unable to use birth control.[24] She rejected euthanasia.[26] For Sanger, it was individual women and not the state who should determine whether or not to have a child.[27][28]

In the Deep South, women’s associations played an important role in rallying support for eugenic legal reform. Eugenicists recognized the political and social influence of southern clubwomen in their communities, and used them to help implement eugenics across the region.[29] Between 1915 and 1920, federated women’s clubs in every state of the Deep South had a critical role in establishing public eugenic institutions that were segregated by sex.[30] For example, the Legislative Committee of the Florida State Federation of Women’s Clubs successfully lobbied to institute a eugenic institution for the mentally retarded that was segregated by sex.[31] Their aim was to separate mentally retarded men and women to prevent them from breeding more “feebleminded” individuals.

Public acceptance in the U.S. was the reason eugenic legislation was passed.Almost 19 million people attended the PanamaPacific International Exposition in San Francisco, open for 10 months from 20 February to 4 December 1915.[32][33] The PPIE was a fair devoted to extolling the virtues of a rapidly progressing nation, featuring new developments in science, agriculture, manufacturing and technology. A subject that received a large amount of time and space was that of the developments concerning health and disease, particularly the areas of tropical medicine and race betterment (tropical medicine being the combined study of bacteriology, parasitology and entomology while racial betterment being the promotion of eugenic studies). Having these areas so closely intertwined, it seemed that they were both categorized in the main theme of the fair, the advancement of civilization. Thus in the public eye, the seemingly contradictory[clarification needed] areas of study were both represented under progressive banners of improvement and were made to seem like plausible courses of action to better American society.[34][35]

Beginning with Connecticut in 1896, many states enacted marriage laws with eugenic criteria, prohibiting anyone who was “epileptic, imbecile or feeble-minded”[36] from marrying.[37]

The first state to introduce a compulsory sterilization bill was Michigan, in 1897 but the proposed law failed to garner enough votes by legislators to be adopted. Eight years later Pennsylvania’s state legislators passed a sterilization bill that was vetoed by the governor. Indiana became the first state to enact sterilization legislation in 1907,[38] followed closely by Washington and California in 1909. Sterilization rates across the country were relatively low (California being the sole exception) until the 1927 Supreme Court case Buck v. Bell which legitimized the forced sterilization of patients at a Virginia home for the mentally retarded. The number of sterilizations performed per year increased until another Supreme Court case, Skinner v. Oklahoma, 1942, complicated the legal situation by ruling against sterilization of criminals if the equal protection clause of the constitution was violated. That is, if sterilization was to be performed, then it could not exempt white-collar criminals.[39] The state of California was at the vanguard of the American eugenics movement, performing about 20,000 sterilizations or one third of the 60,000 nationwide from 1909 up until the 1960s.[40]

While California had the highest number of sterilizations, North Carolina’s eugenics program which operated from 1933 to 1977, was the most aggressive of the 32 states that had eugenics programs.[41] An IQ of 70 or lower meant sterilization was appropriate in North Carolina.[42] The North Carolina Eugenics Board almost always approved proposals brought before them by local welfare boards.[42] Of all states, only North Carolina gave social workers the power to designate people for sterilization.[41] “Here, at last, was a method of preventing unwanted pregnancies by an acceptable, practical, and inexpensive method,” wrote Wallace Kuralt in the March 1967 journal of the N.C. Board of Public Welfare. “The poor readily adopted the new techniques for birth control.”[42]

The Immigration Restriction League was the first American entity associated officially with eugenics. Founded in 1894 by three recent Harvard University graduates, the League sought to bar what it considered inferior races from entering America and diluting what it saw as the superior American racial stock (upper class Northerners of Anglo-Saxon heritage). They felt that social and sexual involvement with these less-evolved and less-civilized races would pose a biological threat to the American population. The League lobbied for a literacy test for immigrants, based on the belief that literacy rates were low among “inferior races”. Literacy test bills were vetoed by Presidents in 1897, 1913 and 1915; eventually, President Wilson’s second veto was overruled by Congress in 1917. Membership in the League included: A. Lawrence Lowell, president of Harvard, William DeWitt Hyde, president of Bowdoin College, James T. Young, director of Wharton School and David Starr Jordan, president of Stanford University.[43]

The League allied themselves with the American Breeder’s Association to gain influence and further its goals and in 1909 established a Committee on Eugenics chaired by David Starr Jordan with members Charles Davenport, Alexander Graham Bell, Vernon Kellogg, Luther Burbank, William Ernest Castle, Adolf Meyer, H. J. Webber and Friedrich Woods. The ABA’s immigration legislation committee, formed in 1911 and headed by League’s founder Prescott F. Hall, formalized the committee’s already strong relationship with the Immigration Restriction League. They also founded the Eugenics Record Office, which was headed by Harry H. Laughlin.[44] In their mission statement, they wrote:

Society must protect itself; as it claims the right to deprive the murderer of his life so it may also annihilate the hideous serpent of hopelessly vicious protoplasm. Here is where appropriate legislation will aid in eugenics and creating a healthier, saner society in the future.[44]

Money from the Harriman railroad fortune was also given to local charities, in order to find immigrants from specific ethnic groups and deport, confine, or forcibly sterilize them.[7]

With the passage of the Immigration Act of 1924, eugenicists for the first time played an important role in the Congressional debate as expert advisers on the threat of “inferior stock” from eastern and southern Europe.[45][46] The new act, inspired by the eugenic belief in the racial superiority of “old stock” white Americans as members of the “Nordic race” (a form of white supremacy), strengthened the position of existing laws prohibiting race-mixing.[47] Eugenic considerations also lay behind the adoption of incest laws in much of the U.S. and were used to justify many anti-miscegenation laws.[48]

Stephen Jay Gould asserted that restrictions on immigration passed in the United States during the 1920s (and overhauled in 1965 with the Immigration and Nationality Act) were motivated by the goals of eugenics. During the early 20th century, the United States and Canada began to receive far higher numbers of Southern and Eastern European immigrants. Influential eugenicists like Lothrop Stoddard and Harry Laughlin (who was appointed as an expert witness for the House Committee on Immigration and Naturalization in 1920) presented arguments they would pollute the national gene pool if their numbers went unrestricted.[49][50] It has been argued that this stirred both Canada and the United States into passing laws creating a hierarchy of nationalities, rating them from the most desirable Anglo-Saxon and Nordic peoples to the Chinese and Japanese immigrants, who were almost completely banned from entering the country.[47][51]

Both class and race factored into eugenic definitions of “fit” and “unfit.” By using intelligence testing, American eugenicists asserted that social mobility was indicative of one’s genetic fitness.[52] This reaffirmed the existing class and racial hierarchies and explained why the upper-to-middle class was predominantly white. Middle-to-upper class status was a marker of “superior strains.”[31] In contrast, eugenicists believed poverty to be a characteristic of genetic inferiority, which meant that those deemed “unfit” were predominantly of the lower classes.[31]

Because class status designated some more fit than others, eugenicists treated upper and lower class women differently. Positive eugenicists, who promoted procreation among the fittest in society, encouraged middle class women to bear more children. Between 1900 and 1960, Eugenicists appealed to middle class white women to become more “family minded,” and to help better the race.[53] To this end, eugenicists often denied middle and upper class women sterilization and birth control.[54]

Since poverty was associated with prostitution and “mental idiocy,” women of the lower classes were the first to be deemed “unfit” and “promiscuous.”[31]

In 1907, Indiana passed the first eugenics-based compulsory sterilization law in the world. Thirty U.S. states would soon follow their lead.[55][56] Although the law was overturned by the Indiana Supreme Court in 1921,[57] the U.S. Supreme Court, in Buck v. Bell, upheld the constitutionality of the Virginia Sterilization Act of 1924, allowing for the compulsory sterilization of patients of state mental institutions in 1927.[58]

Some states sterilized “imbeciles” for much of the 20th century. Although compulsory sterilization is now considered an abuse of human rights, Buck v. Bell was never overturned, and Virginia did not repeal its sterilization law until 1974.[59] The most significant era of eugenic sterilization was between 1907 and 1963, when over 64,000 individuals were forcibly sterilized under eugenic legislation in the United States.[60] Beginning around 1930, there was a steady increase in the percentage of women sterilized, and in a few states only young women were sterilized. From 1930 to the 1960s, sterilizations were performed on many more institutionalized women than men.[31] By 1961, 61 percent of the 62,162 total eugenic sterilizations in the United States were performed on women.[31] A favorable report on the results of sterilization in California, the state with the most sterilizations by far, was published in book form by the biologist Paul Popenoe and was widely cited by the Nazi government as evidence that wide-reaching sterilization programs were feasible and humane.[61][62]

Men and women were compulsorily sterilized for different reasons. Men were sterilized to treat their aggression and to eliminate their criminal behavior, while women were sterilized to control the results of their sexuality.[31] Since women bore children, eugenicists held women more accountable than men for the reproduction of the less “desirable” members of society.[31] Eugenicists therefore predominantly targeted women in their efforts to regulate the birth rate, to “protect” white racial health, and weed out the “defectives” of society.[31]

A 1937 Fortune magazine poll found that 2/3 of respondents supported eugenic sterilization of “mental defectives”, 63% supported sterilization of criminals, and only 15% opposed both.[63][64]

In the 1970s, several activists and women’s rights groups discovered several physicians to be performing coerced sterilizations of specific ethnic groups of society. All were abuses of poor, nonwhite, or mentally retarded women, while no abuses against white or middle-class women were recorded.[65] Several court cases such as Madrigal v. Quilligan, a class action suit regarding forced or coerced postpartum sterilization of Latina women following cesarean sections, and Relf v. Weinberger,[66] the sterilization of two young black girls by tricking their illiterate mother into signing a waiver, helped bring to light some of the widespread abuses of sterilization supported by federal funds.[67][68]

After World War II, Dr. Clarence Gamble revived the eugenics movement in the United States through sterilization. Dr. Gamble supported the eugenics movement throughout his life. He worked as a researcher at Harvard Medical school and was well off financially, as the Procter and Gamble fortune was inherited by him. Gamble, a proponent of birth control, contributed to the founding of public birth control clinics. These were the first public clinics in the United States. Until the 1960’s and 1970’s, Gamble’s ideal form of eugenics, sterilization, was seen in various cases. Doctors told mothers that their daughters needed shots, but they were actually sterilizing them. Hispanic women were often sterilized due to the fact that they could not read the consent forms that doctors had given them. Poorer white people, African Americans, and Native American people were also targeted for forced sterilization.[69]

The number of eugenic sterilizations is agreed upon by most scholars and journalists. They claim that there were 64,000 cases of eugenic sterilization in the United States, but this number does not take into account the sterilizations that took place after 1963. Around this time was when women from different minority groups were singled out for sterilization. If the sterilizations after 1963 are taken into account, the number of eugenic sterilizations in the United States increases to 80,000. Half of these sterilizations took place after World War II. Sterilization still occurs today, in some states, drug addicts can get paid to be sterilized. Eugenic sterilization programs before World War II were mostly conducted on prisoners, or people in mental hospitals. After the war, eugenic sterilization was aimed more towards poor people and minorities. There were even judges who would force people on parole to be sterilized. People supported this revival of eugenic sterilizations because they thought it would help bring an end to some issues, like poverty and mental illness. Supporters also thought that these programs would save taxpayer money and boost the economy.[70]

In 1972, United States Senate committee testimony brought to light that at least 2,000 involuntary sterilizations had been performed on poor black women without their consent or knowledge.[71] An investigation revealed that the surgeries were all performed in the South, and were all performed on black welfare mothers with multiple children.[71] Testimony revealed that many of these women were threatened with an end to their welfare benefits until they consented to sterilization.[71] These surgeries were instances of sterilization abuse, a term applied to any sterilization performed without the consent or knowledge of the recipient, or in which the recipient is pressured into accepting the surgery. Because the funds used to carry out the surgeries came from the U.S. Office of Economic Opportunity, the sterilization abuse raised older suspicions, especially amongst the black community, that “federal programs were underwriting eugenicists who wanted to impose their views about population quality on minorities and poor women.”[31]

Native American women were also victims of sterilization abuse up into the 1970s.[72] The organization WARN (Women of All Red Nations) publicized that Native American women were threatened that, if they had more children, they would be denied welfare benefits. The Indian Health Service also repeatedly refused to deliver Native American babies until their mothers, in labor, consented to sterilization. Many Native American women unknowingly gave consent, since directions were not given in their native language. According to the General Accounting Office, an estimate of 3,406 Indian women were sterilized.[72] The General Accounting Office stated that the Indian Health Service had not followed the necessary regulations, and that the “informed consent forms did not adhere to the standards set by the United States Department of Health, Education, and Welfare (HEW).”[73]

In 2013, it was reported that 148 female prisoners in two California prisons were sterilized between 2006 and 2010 in a supposedly voluntary program, but it was determined that the prisoners did not give consent to the procedures.[74] In September 2014, California enacted Bill SB1135 that bans sterilization in correctional facilities, unless the procedure is required to save an inmate’s life.[75]

Edwin Black wrote that one of the methods that was suggested to get rid of “defective germ-plasm in the human population” was euthanasia.[7] A 1911 Carnegie Institute report explored eighteen methods for removing defective genetic attributes, and method number eight was euthanasia.[7] The most commonly suggested method of euthanasia was to set up local gas chambers.[7] However, many in the eugenics movement did not believe that Americans were ready to implement a large-scale euthanasia program, so many doctors had to find clever ways of subtly implementing eugenic euthanasia in various medical institutions.[7] For example, a mental institution in Lincoln, Illinois fed its incoming patients milk infected with tuberculosis (reasoning that genetically fit individuals would be resistant), resulting in 3040% annual death rates.[7] Other doctors practiced euthanasia through various forms of lethal neglect.[7]

In the 1930s, there was a wave of portrayals of eugenic “mercy killings” in American film, newspapers, and magazines. In 1931, the Illinois Homeopathic Medicine Association began lobbying for the right to euthanize “imbeciles” and other defectives.[76] The Euthanasia Society of America was founded in 1938.[77]

Overall, however, euthanasia was marginalized in the U.S., motivating people to turn to forced segregation and sterilization programs as a means for keeping the “unfit” from reproducing.[7]

Mary deGormo, a former teacher, was the first person to combine ideas about health and intelligence standards with competitions at state fairs, in the form of baby contests. She developed the first such contest, the “Scientific Baby Contest” for the Louisiana State Fair in Shreveport, in 1908. She saw these contests as a contribution to the “social efficiency” movement, which was advocating for the standardization of all aspects of American life as a means of increasing efficiency.[21] DeGarmo was assisted by Doctor Jacob Bodenheimer, a pediatrician who helped her develop grading sheets for contestants, which combined physical measurements with standardized measurements of intelligence.[78]

The contest spread to other U.S. states in the early twentieth century. In Indiana, for example, Ada Estelle Schweitzer, a eugenics advocate and director of the Indiana State Board of Health’s Division of Child and Infant Hygiene, organized and supervised the state’s Better Baby contests at the Indiana State Fair from 1920 to 1932. It was among the fair’s most popular events. During the contest’s first year at the fair, a total of 78 babies were examined; in 1925 the total reached 885. Contestants peaked at 1,301 infants in 1930, and the following year the number of entrants was capped at 1,200. Although the specific impact of the contests was difficult to assess, statistics helped to support Schweitzer’s claims that the contests helped reduce infant mortality.[79]

The intent of the contest was to educate the public about raising healthier children; however, its exclusionary practices reinforced social class and racial discrimination. In Indiana, for example, the contestants were limited to white infants; African American and immigrant children were barred from the competition for ribbons and cash prizes. In addition, the scoring was biased toward white, middle-class babies.[80][81] The contest procedure included recording each child’s health history, as well as evaluations of each contestant’s physical and mental health and overall development using medical professionals. Using a process similar to the one introduced at the Louisiana State Fair, and contest guidelines that the AMA and U.S. Children’s Bureau recommended, scoring for each contestant began with 1,000 points. Deductions were made for defects, including a child’s measurements below a designated average. The contestant with the most points (and the fewest defections) was declared the winner.[82][83][84]

Standardization through scientific judgment was a topic that was very serious in the eyes of the scientific community, but has often been downplayed as just a popular fad or trend. Nevertheless, a lot of time, effort, and money was put into these contests and their scientific backing, which would influence cultural ideas as well as local and state government practices.[85][86]

The National Association for the Advancement of Colored People promoted eugenics by hosting “Better Baby” contests and the proceeds would go to its anti-lynching campaign.[13]

First appearing in 1920 at the Kansas Free Fair, Fitter Family competitions, continued all the way up to World War II. Mary T. Watts and Dr. Florence Brown Sherbon,[87][88] both initiators of the Better Baby Contests in Iowa, took the idea of positive eugenics for babies and combined it with a determinist concept of biology to come up with fitter family competitions.[89]

There were several different categories that families were judged in: Size of the family, overall attractiveness, and health of the family, all of which helped to determine the likelihood of having healthy children. These competitions were simply a continuation of the Better Baby contests that promoted certain physical and mental qualities.[90] At the time, it was believed that certain behavioral qualities were inherited from one’s parents. This led to the addition of several judging categories including: generosity, self-sacrificing, and quality of familial bonds. Additionally, there were negative features that were judged: selfishness, jealousy, suspiciousness, high-temperedness, and cruelty. Feeblemindedness, alcoholism, and paralysis were few among other traits that were included as physical traits to be judged when looking at family lineage.[91]

Doctors and specialists from the community would offer their time to judge these competitions, which were originally sponsored by the Red Cross.[91] The winners of these competitions were given a Bronze Medal as well as champion cups called “Capper Medals.” The cups were named after then Governor and Senator, Arthur Capper and he would present them to “Grade A individuals”.[92]

The perks of entering into the contests were that the competitions provided a way for families to get a free health check up by a doctor as well as some of the pride and prestige that came from winning the competitions.[91]

By 1925 the Eugenics Records Office was distributing standardized forms for judging eugenically fit families, which were used in contests in several U.S. states.[93]

Concerns about eugenics arose in the African American community after the implementation of the Negro Project of 1939, which was proposed by Margaret Sanger who was the founder of Planned Parenthood.[94] In this plan, Sanger offered birth control to Black families in the United States to give them the chance to have a better life than what the group had been experiencing in the United States.[95] She also noted that the project was proposed to empower women. The Project often sought after prominent African American leaders to spread knowledge regarding birth control and the perceived positive effects it would have on the African American community, such as poverty and the lack of education.[96] Because of this, Sanger believed that African American ministers in the South would be useful to gain the trust of people within disadvantaged, African American communities as the Church was a pillar within the community.[96] Also, political leaders such as W.E.B. Dubois were quoted in the Project proposal criticizing Black people in the United States for having many children and for being less intelligent than their white counterparts:

… the mass of ignorant Negroes still breed carelessly and disastrously, so that the increase among Negroes, even more than the increase among Whites, is from that part of the population least intelligent and fit, and least able to rear their children properly.[95]

Even though The Negro Project received a lot of praise from white leaders and eugenicists of the time, it is important to note that Margaret Sanger wanted to clear concerns that this was not a project to terminate African Americans.[96] To add to the clarification, she received support from prominent African American leaders such as Mary McLeod Bethune and Adam Clayton Powell Jr.[95] These leaders and many more would later serve on the Negro National Advisory Council of Planned Parenthood Federation of America in 1942.

Still, many modern activists criticize Margaret Sanger for practicing eugenics on the African American community. Angela Davis, a leader who is associated with the Black Panther Party, made claims of Margaret Sanger targeting the African American community to reduce the population:

Calling for the recruitment of Black ministers to lead local birth control committees, the Federation’s proposal suggested that Black people should be rendered as vulnerable as possible to their birth control propaganda.[97]

Eugenics has been supported by members of the African American community for a long time.[when?] For example, Dr. Thomas Wyatt Turner, a professor at Howard University and a well respected scientist incorporated eugenics into his classes. The NAACP founder asked his students how eugenics can affect society in a good way in 1915. Eugenics seemed to be[weaselwords] accepted by all kinds of people. W.E.B DuBois, a historian and civil rights leader had some beliefs that lined up with eugenics. He believed in developing the best versions of African Americans in order for his race to succeed. Dr. Martin Luther King Jr. even received an award from Planned Parenthood in 1966 and in his acceptance speech, given by his wife, King discussed how large families are no longer functional in an urban setting. King claimed that in the cities, African Americans who continued to have children were over populating the ghettos. She continued by saying that having this many unwanted children is a bad problem that needs to be controlled, a belief that aligns with the eugenics movement.[98]

After the eugenics movement was well established in the United States, it spread to Germany. California eugenicists began producing literature promoting eugenics and sterilization and sending it overseas to German scientists and medical professionals.[7] By 1933, California had subjected more people to forceful sterilization than all other U.S. states combined. The forced sterilization program engineered by the Nazis was partly inspired by California’s.[8]

The Rockefeller Foundation helped develop and fund various German eugenics programs,[99] including the one that Josef Mengele worked in before he went to Auschwitz.[7]

Upon returning from Germany in 1934, where more than 5,000 people per month were being forcibly sterilized, the California eugenics leader C. M. Goethe bragged to a colleague:

You will be interested to know that your work has played a powerful part in shaping the opinions of the group of intellectuals who are behind Hitler in this epoch-making program. Everywhere I sensed that their opinions have been tremendously stimulated by American thought … I want you, my dear friend, to carry this thought with you for the rest of your life, that you have really jolted into action a great government of 60 million people.[7]

Eugenics researcher Harry H. Laughlin often bragged that his Model Eugenic Sterilization laws had been implemented in the 1935 Nuremberg racial hygiene laws.[100] In 1936, Laughlin was invited to an award ceremony at Heidelberg University in Germany (scheduled on the anniversary of Hitler’s 1934 purge of Jews from the Heidelberg faculty), to receive an honorary doctorate for his work on the “science of racial cleansing”. Due to financial limitations, Laughlin was unable to attend the ceremony and had to pick it up from the Rockefeller Institute. Afterwards, he proudly shared the award with his colleagues, remarking that he felt that it symbolized the “common understanding of German and American scientists of the nature of eugenics.”[101]

Henry Friedlander wrote that although the German and American eugenics movements were similar, the US did not follow the same slippery slope as Nazi eugenics because American “federalism and political heterogeneity encouraged diversity even with a single movement.” In contrast, the German eugenics movement was more centralized and had fewer diverse ideas.[102] Unlike the American movement, one publication and one society, the German Society for Racial Hygiene, represented all German eugenicists in the early 20th century.[102][103]

After 1945, however, historians began to try to portray the US eugenics movement as distinct and distant from Nazi eugenics.[104] Jon Entine wrote that eugenics simply means “good genes” and using it as synonym for genocide is an “all-too-common distortion of the social history of genetics policy in the United States.” According to Entine, eugenics developed out of the Progressive Era and not “Hitler’s twisted Final Solution.”[105]

After Hitler’s advanced idea of eugenics, the movement lost its place in society for a bit of time. Although eugenics was not thought about much, aspects like sterilization were still going on, just not at such a public level. Although as technology developed so did the movement, the new technologies made way for genetic engineering. Instead of sterilizing people to ultimately get rid of “undesirable” people, genetic engineering “changes or removes genes to prevent disease or improve the body in some significant way.”[106]

One positive of genetic engineering is its ability to cure and prevent life-threatening diseases. Genetic engineering began in the 1970s, this is when scientists began to clone and engineer genes. From this scientists were able to create human insulin, the first-ever genetically-engineered drug. Because of this development, over the years scientists were able to create new drugs to treat devastating diseases. For example, in the early 1990s, a group of scientists were able to use a gene-drug to treat severe combined immunodeficiency in a little girl. This disease forces victims to live inside a sanitized bubble. Due to the gene therapy, the girl was cured and able to live outside of her plastic bubble.[107] Developments like this are being made constantly because of genetic engineering, however genetic engineering also has many negatives.

One negative of genetic engineering is the practice of eliminating “undesirable traits” within humans and its ethics. This ultimately causes a link between genetic engineering and eugenics. This practice creates many social issues in society. Many people believe using genetic engineering to essentially “perfect” the human race is a damaging practice. For example, with current genetic tests, parents are able to test a fetus for any life-threatening diseases that may impact the child’s life and then choose to abort the baby.[106] The public fears this will cause issues due to the fact that practices like these may be used to eliminate entire groups of people, like the way Hitler used the idea. The basis of Hitler’s movement was to create a superior Aryan race, he wanted to eliminate every other race. While he did not have the genetic engineering technology then, this technology could be used with similar tactics as Hitler with permanent modifications to human germ lines and the ability to terminate a pregnancy that won’t produce the best baby.[108] Genetic engineering can also lead to trait selection and enhancement in embryos. One dilemma with this application is that most genes have an effect on more than one area of the body. For example, there is a gene that deals with memory, when scientists altered this gene to improve memory and learning in mice, it also increased their sensitivity to pain. There is also the issue of whether it is ethical to do such a thing to embryos because they cannot consent to the procedure. This also leads to issues within a socio-economic standpoint. Many people see this as an opportunity for the rich to continue to improve their children when the poor are left to “suffer” with their “undesirable” genes.[109]

The 1978 Federal Sterilization Regulations, created by the United States Department of Health, Education and Welfare or HEW, (now the United States Department of Health and Human Services) outline a variety of prohibited sterilization practices that were often used previously to coerce or force women into sterilization.[110] These were intended to prevent such eugenics and neo-eugenics as resulted in the involuntary sterilization of large groups of poor and minority women. Such practices include: not conveying to patients that sterilization is permanent and irreversible, in their own language (including the option to end the process or procedure at any time without conceding any future medical attention or federal benefits, the ability to ask any and all questions about the procedure and its ramifications, the requirement that the consent seeker describes the procedure fully including any and all possible discomforts and/or side-effects and any and all benefits of sterilization); failing to provide alternative information about methods of contraception, family planning, or pregnancy termination that are nonpermanent and/or irreversible (this includes abortion); conditioning receiving welfare and/or Medicaid benefits by the individual or his/her children on the individuals “consenting” to permanent sterilization; tying elected abortion to compulsory sterilization (cannot receive a sought out abortion without “consenting” to sterilization); using hysterectomy as sterilization; and subjecting minors and the mentally incompetent to sterilization.[110][67][111] The regulations also include an extension of the informed consent waiting period from 72 hours to 30 days (with a maximum of 180 days between informed consent and the sterilization procedure).[67][110][111]

However, several studies have indicated that the forms are often dense and complex and beyond the literacy aptitude of the average American, and those seeking publicly funded sterilization are more likely to possess below-average literacy skills.[112] High levels of misinformation concerning sterilization still exist among individuals who have already undergone sterilization procedures, with permanence being one of the most common gray factors.[112][113] Additionally, federal enforcement of the requirements of the 1978 Federal Sterilization Regulation is inconsistent and some of the prohibited abuses continue to be pervasive, particularly in underfunded hospitals and lower income patient hospitals and care centers.[67][111]

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Eugenics in the United States – Wikipedia

Eugenics – Wikipedia

Eugenics (; from Greek eugenes ‘well-born’ from eu, ‘good, well’ and genos, ‘race, stock, kin’)[2][3] is a set of beliefs and practices that aims at improving the genetic quality of a human population.[4][5] The exact definition of eugenics has been a matter of debate since the term was coined by Francis Galton in 1883. The concept predates this coinage, with Plato suggesting applying the principles of selective breeding to humans around 400BCE.

Frederick Osborn’s 1937 journal article “Development of a Eugenic Philosophy”[6] framed it as a social philosophythat is, a philosophy with implications for social order. That definition is not universally accepted. Osborn advocated for higher rates of sexual reproduction among people with desired traits (positive eugenics), or reduced rates of sexual reproduction and sterilization of people with less-desired or undesired traits (negative eugenics).

Alternatively, gene selection rather than “people selection” has recently been made possible through advances in genome editing,[7] leading to what is sometimes called new eugenics, also known as neo-eugenics, consumer eugenics, or liberal eugenics.

While eugenic principles have been practiced as far back in world history as ancient Greece, the modern history of eugenics began in the early 20th century when a popular eugenics movement emerged in the United Kingdom[8] and spread to many countries including the United States, Canada[9] and most European countries. In this period, eugenic ideas were espoused across the political spectrum. Consequently, many countries adopted eugenic policies with the intent to improve the quality of their populations’ genetic stock. Such programs included both “positive” measures, such as encouraging individuals deemed particularly “fit” to reproduce, and “negative” measures such as marriage prohibitions and forced sterilization of people deemed unfit for reproduction. People deemed unfit to reproduce often included people with mental or physical disabilities, people who scored in the low ranges of different IQ tests, criminals and deviants, and members of disfavored minority groups. The eugenics movement became negatively associated with Nazi Germany and the Holocaust when many of the defendants at the Nuremberg trials attempted to justify their human rights abuses by claiming there was little difference between the Nazi eugenics programs and the U.S. eugenics programs.[10] In the decades following World War II, with the institution of human rights, many countries gradually began to abandon eugenics policies, although some Western countries, among them the United States and Sweden, continued to carry out forced sterilizations.

Since the 1980s and 1990s, when new assisted reproductive technology procedures became available such as gestational surrogacy (available since 1985), preimplantation genetic diagnosis (available since 1989), and cytoplasmic transfer (first performed in 1996), fear has emerged about a possible revival of eugenics.

A major criticism of eugenics policies is that, regardless of whether “negative” or “positive” policies are used, they are susceptible to abuse because the criteria of selection are determined by whichever group is in political power at the time. Furthermore, negative eugenics in particular is considered by many to be a violation of basic human rights, which include the right to reproduction. Another criticism is that eugenic policies eventually lead to a loss of genetic diversity, resulting in inbreeding depression due to lower genetic variation.

Seneca the Younger

The concept of positive eugenics to produce better human beings has existed at least since Plato suggested selective mating to produce a guardian class.[12] In Sparta, every Spartan child was inspected by the council of elders, the Gerousia, which determined if the child was fit to live or not. In the early years of ancient Rome, a Roman father was obliged by law to immediately kill his child if they were physically disabled.[13] Among the ancient Germanic tribes, people who were cowardly, unwarlike or “stained with abominable vices” were put to death, usually by being drowned in swamps.[14][15]

The first formal negative eugenics, that is a legal provision against birth of inferior human beings, was promulgated in Western European culture by the Christian Council of Agde in 506, which forbade marriage between cousins.[16]

This idea was also promoted by William Goodell (18291894) who advocated the castration and spaying of the insane.[17][18]

The idea of a modern project of improving the human population through a statistical understanding of heredity used to encourage good breeding was originally developed by Francis Galton and, initially, was closely linked to Darwinism and his theory of natural selection.[19] Galton had read his half-cousin Charles Darwin’s theory of evolution, which sought to explain the development of plant and animal species, and desired to apply it to humans. Based on his biographical studies, Galton believed that desirable human qualities were hereditary traits, though Darwin strongly disagreed with this elaboration of his theory.[20] In 1883, one year after Darwin’s death, Galton gave his research a name: eugenics.[21] With the introduction of genetics, eugenics became associated with genetic determinism, the belief that human character is entirely or in the majority caused by genes, unaffected by education or living conditions. Many of the early geneticists were not Darwinians, and evolution theory was not needed for eugenics policies based on genetic determinism.[19] Throughout its recent history, eugenics has remained controversial.

Eugenics became an academic discipline at many colleges and universities and received funding from many sources.[24] Organizations were formed to win public support and sway opinion towards responsible eugenic values in parenthood, including the British Eugenics Education Society of 1907 and the American Eugenics Society of 1921. Both sought support from leading clergymen and modified their message to meet religious ideals.[25] In 1909 the Anglican clergymen William Inge and James Peile both wrote for the British Eugenics Education Society. Inge was an invited speaker at the 1921 International Eugenics Conference, which was also endorsed by the Roman Catholic Archbishop of New York Patrick Joseph Hayes.[25]

Three International Eugenics Conferences presented a global venue for eugenists with meetings in 1912 in London, and in 1921 and 1932 in New York City. Eugenic policies were first implemented in the early 1900s in the United States.[26] It also took root in France, Germany, and Great Britain.[27] Later, in the 1920s and 1930s, the eugenic policy of sterilizing certain mental patients was implemented in other countries including Belgium,[28] Brazil,[29] Canada,[30] Japan and Sweden.

In addition to being practiced in a number of countries, eugenics was internationally organized through the International Federation of Eugenics Organizations. Its scientific aspects were carried on through research bodies such as the Kaiser Wilhelm Institute of Anthropology, Human Heredity, and Eugenics, the Cold Spring Harbour Carnegie Institution for Experimental Evolution, and the Eugenics Record Office. Politically, the movement advocated measures such as sterilization laws. In its moral dimension, eugenics rejected the doctrine that all human beings are born equal and redefined moral worth purely in terms of genetic fitness. Its racist elements included pursuit of a pure “Nordic race” or “Aryan” genetic pool and the eventual elimination of “unfit” races.

Early critics of the philosophy of eugenics included the American sociologist Lester Frank Ward,[39] the English writer G. K. Chesterton, the German-American anthropologist Franz Boas, who argued that advocates of eugenics greatly over-estimate the influence of biology,[40] and Scottish tuberculosis pioneer and author Halliday Sutherland. Ward’s 1913 article “Eugenics, Euthenics, and Eudemics”, Chesterton’s 1917 book Eugenics and Other Evils, and Boas’ 1916 article “Eugenics” (published in The Scientific Monthly) were all harshly critical of the rapidly growing movement. Sutherland identified eugenists as a major obstacle to the eradication and cure of tuberculosis in his 1917 address “Consumption: Its Cause and Cure”,[41] and criticism of eugenists and Neo-Malthusians in his 1921 book Birth Control led to a writ for libel from the eugenist Marie Stopes. Several biologists were also antagonistic to the eugenics movement, including Lancelot Hogben.[42] Other biologists such as J. B. S. Haldane and R. A. Fisher expressed skepticism in the belief that sterilization of “defectives” would lead to the disappearance of undesirable genetic traits.[43]

Among institutions, the Catholic Church was an opponent of state-enforced sterilizations.[44] Attempts by the Eugenics Education Society to persuade the British government to legalize voluntary sterilization were opposed by Catholics and by the Labour Party.[45] The American Eugenics Society initially gained some Catholic supporters, but Catholic support declined following the 1930 papal encyclical Casti connubii.[25] In this, Pope Pius XI explicitly condemned sterilization laws: “Public magistrates have no direct power over the bodies of their subjects; therefore, where no crime has taken place and there is no cause present for grave punishment, they can never directly harm, or tamper with the integrity of the body, either for the reasons of eugenics or for any other reason.”[46]

As a social movement, eugenics reached its greatest popularity in the early decades of the 20th century, when it was practiced around the world and promoted by governments, institutions, and influential individuals. Many countries enacted[47] various eugenics policies, including: genetic screenings, birth control, promoting differential birth rates, marriage restrictions, segregation (both racial segregation and sequestering the mentally ill), compulsory sterilization, forced abortions or forced pregnancies, ultimately culminating in genocide.

The scientific reputation of eugenics started to decline in the 1930s, a time when Ernst Rdin used eugenics as a justification for the racial policies of Nazi Germany. Adolf Hitler had praised and incorporated eugenic ideas in Mein Kampf in 1925 and emulated eugenic legislation for the sterilization of “defectives” that had been pioneered in the United States once he took power. Some common early 20th century eugenics methods involved identifying and classifying individuals and their families, including the poor, mentally ill, blind, deaf, developmentally disabled, promiscuous women, homosexuals, and racial groups (such as the Roma and Jews in Nazi Germany) as “degenerate” or “unfit”, and therefore led to segregation, institutionalization, sterilization, euthanasia, and even mass murder. The Nazi practice of euthanasia was carried out on hospital patients in the Aktion T4 centers such as Hartheim Castle.

By the end of World War II, many discriminatory eugenics laws were abandoned, having become associated with Nazi Germany.[50] H. G. Wells, who had called for “the sterilization of failures” in 1904,[51] stated in his 1940 book The Rights of Man: Or What are we fighting for? that among the human rights, which he believed should be available to all people, was “a prohibition on mutilation, sterilization, torture, and any bodily punishment”.[52] After World War II, the practice of “imposing measures intended to prevent births within [a national, ethnical, racial or religious] group” fell within the definition of the new international crime of genocide, set out in the Convention on the Prevention and Punishment of the Crime of Genocide.[53] The Charter of Fundamental Rights of the European Union also proclaims “the prohibition of eugenic practices, in particular those aiming at selection of persons”.[54] In spite of the decline in discriminatory eugenics laws, some government mandated sterilizations continued into the 21st century. During the ten years President Alberto Fujimori led Peru from 1990 to 2000, 2,000 persons were allegedly involuntarily sterilized.[55] China maintained its one-child policy until 2015 as well as a suite of other eugenics based legislation to reduce population size and manage fertility rates of different populations.[56][57][58] In 2007 the United Nations reported coercive sterilizations and hysterectomies in Uzbekistan.[59] During the years 2005 to 2013, nearly one-third of the 144 California prison inmates who were sterilized did not give lawful consent to the operation.[60]

Developments in genetic, genomic, and reproductive technologies at the end of the 20th century have raised numerous questions regarding the ethical status of eugenics, effectively creating a resurgence of interest in the subject.Some, such as UC Berkeley sociologist Troy Duster, claim that modern genetics is a back door to eugenics.[61] This view is shared by White House Assistant Director for Forensic Sciences, Tania Simoncelli, who stated in a 2003 publication by the Population and Development Program at Hampshire College that advances in pre-implantation genetic diagnosis (PGD) are moving society to a “new era of eugenics”, and that, unlike the Nazi eugenics, modern eugenics is consumer driven and market based, “where children are increasingly regarded as made-to-order consumer products”.[62] In a 2006 newspaper article, Richard Dawkins said that discussion regarding eugenics was inhibited by the shadow of Nazi misuse, to the extent that some scientists would not admit that breeding humans for certain abilities is at all possible. He believes that it is not physically different from breeding domestic animals for traits such as speed or herding skill. Dawkins felt that enough time had elapsed to at least ask just what the ethical differences were between breeding for ability versus training athletes or forcing children to take music lessons, though he could think of persuasive reasons to draw the distinction.[63]

Lee Kuan Yew, the Founding Father of Singapore, started promoting eugenics as early as 1983.[64][65]

In October 2015, the United Nations’ International Bioethics Committee wrote that the ethical problems of human genetic engineering should not be confused with the ethical problems of the 20th century eugenics movements. However, it is still problematic because it challenges the idea of human equality and opens up new forms of discrimination and stigmatization for those who do not want, or cannot afford, the technology.[66]

Transhumanism is often associated with eugenics, although most transhumanists holding similar views nonetheless distance themselves from the term “eugenics” (preferring “germinal choice” or “reprogenetics”)[67] to avoid having their position confused with the discredited theories and practices of early-20th-century eugenic movements.

Prenatal screening can be considered a form of contemporary eugenics because it may lead to abortions of children with undesirable traits.[68]

The term eugenics and its modern field of study were first formulated by Francis Galton in 1883,[69] drawing on the recent work of his half-cousin Charles Darwin.[70][71] Galton published his observations and conclusions in his book Inquiries into Human Faculty and Its Development.

The origins of the concept began with certain interpretations of Mendelian inheritance and the theories of August Weismann. The word eugenics is derived from the Greek word eu (“good” or “well”) and the suffix -gens (“born”), and was coined by Galton in 1883 to replace the word “stirpiculture”, which he had used previously but which had come to be mocked due to its perceived sexual overtones.[73] Galton defined eugenics as “the study of all agencies under human control which can improve or impair the racial quality of future generations”.[74]

Historically, the term eugenics has referred to everything from prenatal care for mothers to forced sterilization and euthanasia.[75] To population geneticists, the term has included the avoidance of inbreeding without altering allele frequencies; for example, J. B. S. Haldane wrote that “the motor bus, by breaking up inbred village communities, was a powerful eugenic agent.”[76] Debate as to what exactly counts as eugenics continues today.[77]

Edwin Black, journalist and author of War Against the Weak, claims eugenics is often deemed a pseudoscience because what is defined as a genetic improvement of a desired trait is often deemed a cultural choice rather than a matter that can be determined through objective scientific inquiry.[78] The most disputed aspect of eugenics has been the definition of “improvement” of the human gene pool, such as what is a beneficial characteristic and what is a defect. Historically, this aspect of eugenics was tainted with scientific racism and pseudoscience.[79][80][81]

Early eugenists were mostly concerned with factors of perceived intelligence that often correlated strongly with social class. Some of these early eugenists include Karl Pearson and Walter Weldon, who worked on this at the University College London.[20]

Eugenics also had a place in medicine. In his lecture “Darwinism, Medical Progress and Eugenics”, Karl Pearson said that everything concerning eugenics fell into the field of medicine. He basically placed the two words as equivalents. He was supported in part by the fact that Francis Galton, the father of eugenics, also had medical training.[82]

Eugenic policies have been conceptually divided into two categories.[75] Positive eugenics is aimed at encouraging reproduction among the genetically advantaged; for example, the reproduction of the intelligent, the healthy, and the successful. Possible approaches include financial and political stimuli, targeted demographic analyses, in vitro fertilization, egg transplants, and cloning.[83] The movie Gattaca provides a fictional example of a dystopian society that uses eugenics to decided what you are capable of and your place in the world. Negative eugenics aimed to eliminate, through sterilization or segregation, those deemed physically, mentally, or morally “undesirable”. This includes abortions, sterilization, and other methods of family planning.[83] Both positive and negative eugenics can be coercive; abortion for fit women, for example, was illegal in Nazi Germany.[84]

Jon Entine claims that eugenics simply means “good genes” and using it as synonym for genocide is an “all-too-common distortion of the social history of genetics policy in the United States.” According to Entine, eugenics developed out of the Progressive Era and not “Hitler’s twisted Final Solution”.[85]

According to Richard Lynn, eugenics may be divided into two main categories based on the ways in which the methods of eugenics can be applied.[86]

The first major challenge to conventional eugenics based upon genetic inheritance was made in 1915 by Thomas Hunt Morgan. He demonstrated the event of genetic mutation occurring outside of inheritance involving the discovery of the hatching of a fruit fly (Drosophila melanogaster) with white eyes from a family with red eyes. Morgan claimed that this demonstrated that major genetic changes occurred outside of inheritance and that the concept of eugenics based upon genetic inheritance was not completely scientifically accurate. Additionally, Morgan criticized the view that subjective traits, such as intelligence and criminality, were caused by heredity because he believed that the definitions of these traits varied and that accurate work in genetics could only be done when the traits being studied were accurately defined.[123] Despite Morgan’s public rejection of eugenics, much of his genetic research was absorbed by eugenics.[124][125]

The heterozygote test is used for the early detection of recessive hereditary diseases, allowing for couples to determine if they are at risk of passing genetic defects to a future child.[126] The goal of the test is to estimate the likelihood of passing the hereditary disease to future descendants.[126]

Recessive traits can be severely reduced, but never eliminated unless the complete genetic makeup of all members of the pool was known, as aforementioned. As only very few undesirable traits, such as Huntington’s disease, are dominant, it could be argued[by whom?] from certain perspectives that the practicality of “eliminating” traits is quite low.[citation needed]

There are examples of eugenic acts that managed to lower the prevalence of recessive diseases, although not influencing the prevalence of heterozygote carriers of those diseases. The elevated prevalence of certain genetically transmitted diseases among the Ashkenazi Jewish population (TaySachs, cystic fibrosis, Canavan’s disease, and Gaucher’s disease), has been decreased in current populations by the application of genetic screening.[127]

Pleiotropy occurs when one gene influences multiple, seemingly unrelated phenotypic traits, an example being phenylketonuria, which is a human disease that affects multiple systems but is caused by one gene defect.[128] Andrzej Pkalski, from the University of Wrocaw, argues that eugenics can cause harmful loss of genetic diversity if a eugenics program selects a pleiotropic gene that could possibly be associated with a positive trait. Pekalski uses the example of a coercive government eugenics program that prohibits people with myopia from breeding but has the unintended consequence of also selecting against high intelligence since the two go together.[129]

Eugenic policies could also lead to loss of genetic diversity, in which case a culturally accepted “improvement” of the gene pool could very likelyas evidenced in numerous instances in isolated island populations result in extinction due to increased vulnerability to disease, reduced ability to adapt to environmental change, and other factors both known and unknown. A long-term, species-wide eugenics plan might lead to a scenario similar to this because the elimination of traits deemed undesirable would reduce genetic diversity by definition.[130]

Edward M. Miller claims that, in any one generation, any realistic program should make only minor changes in a fraction of the gene pool, giving plenty of time to reverse direction if unintended consequences emerge, reducing the likelihood of the elimination of desirable genes.[131] Miller also argues that any appreciable reduction in diversity is so far in the future that little concern is needed for now.[131]

While the science of genetics has increasingly provided means by which certain characteristics and conditions can be identified and understood, given the complexity of human genetics, culture, and psychology, at this point no agreed objective means of determining which traits might be ultimately desirable or undesirable. Some diseases such as sickle-cell disease and cystic fibrosis respectively confer immunity to malaria and resistance to cholera when a single copy of the recessive allele is contained within the genotype of the individual. Reducing the instance of sickle-cell disease genes in Africa where malaria is a common and deadly disease could indeed have extremely negative net consequences.

However, some genetic diseases cause people to consider some elements of eugenics.

Societal and political consequences of eugenics call for a place in the discussion on the ethics behind the eugenics movement.[132] Many of the ethical concerns regarding eugenics arise from its controversial past, prompting a discussion on what place, if any, it should have in the future. Advances in science have changed eugenics. In the past, eugenics had more to do with sterilization and enforced reproduction laws.[133] Now, in the age of a progressively mapped genome, embryos can be tested for susceptibility to disease, gender, and genetic defects, and alternative methods of reproduction such as in vitro fertilization are becoming more common.[134] Therefore, eugenics is no longer ex post facto regulation of the living but instead preemptive action on the unborn.[135]

With this change, however, there are ethical concerns which lack adequate attention, and which must be addressed before eugenic policies can be properly implemented in the future. Sterilized individuals, for example, could volunteer for the procedure, albeit under incentive or duress, or at least voice their opinion. The unborn fetus on which these new eugenic procedures are performed cannot speak out, as the fetus lacks the voice to consent or to express his or her opinion.[136] Philosophers disagree about the proper framework for reasoning about such actions, which change the very identity and existence of future persons.[137]

A common criticism of eugenics is that “it inevitably leads to measures that are unethical”.[138] Some fear future “eugenics wars” as the worst-case scenario: the return of coercive state-sponsored genetic discrimination and human rights violations such as compulsory sterilization of persons with genetic defects, the killing of the institutionalized and, specifically, segregation and genocide of races perceived as inferior.[139] Health law professor George Annas and technology law professor Lori Andrews are prominent advocates of the position that the use of these technologies could lead to such human-posthuman caste warfare.[140][141]

In his 2003 book Enough: Staying Human in an Engineered Age, environmental ethicist Bill McKibben argued at length against germinal choice technology and other advanced biotechnological strategies for human enhancement. He writes that it would be morally wrong for humans to tamper with fundamental aspects of themselves (or their children) in an attempt to overcome universal human limitations, such as vulnerability to aging, maximum life span and biological constraints on physical and cognitive ability. Attempts to “improve” themselves through such manipulation would remove limitations that provide a necessary context for the experience of meaningful human choice. He claims that human lives would no longer seem meaningful in a world where such limitations could be overcome with technology. Even the goal of using germinal choice technology for clearly therapeutic purposes should be relinquished, since it would inevitably produce temptations to tamper with such things as cognitive capacities. He argues that it is possible for societies to benefit from renouncing particular technologies, using as examples Ming China, Tokugawa Japan and the contemporary Amish.[142]

Some, for example Nathaniel C. Comfort from Johns Hopkins University, claim that the change from state-led reproductive-genetic decision-making to individual choice has moderated the worst abuses of eugenics by transferring the decision-making from the state to the patient and their family.[143] Comfort suggests that “the eugenic impulse drives us to eliminate disease, live longer and healthier, with greater intelligence, and a better adjustment to the conditions of society; and the health benefits, the intellectual thrill and the profits of genetic bio-medicine are too great for us to do otherwise.”[144] Others, such as bioethicist Stephen Wilkinson of Keele University and Honorary Research Fellow Eve Garrard at the University of Manchester, claim that some aspects of modern genetics can be classified as eugenics, but that this classification does not inherently make modern genetics immoral. In a co-authored publication by Keele University, they stated that “[e]ugenics doesn’t seem always to be immoral, and so the fact that PGD, and other forms of selective reproduction, might sometimes technically be eugenic, isn’t sufficient to show that they’re wrong.”[145]

In their book published in 2000, From Chance to Choice: Genetics and Justice, bioethicists Allen Buchanan, Dan Brock, Norman Daniels and Daniel Wikler argued that liberal societies have an obligation to encourage as wide an adoption of eugenic enhancement technologies as possible (so long as such policies do not infringe on individuals’ reproductive rights or exert undue pressures on prospective parents to use these technologies) in order to maximize public health and minimize the inequalities that may result from both natural genetic endowments and unequal access to genetic enhancements.[146]

Original position, a hypothetical situation developed by American philosopher John Rawls, has been used as an argument for negative eugenics.[147][148]

Notes

Bibliography

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Eugenics – Wikipedia

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, unconventional medicine, unorthodox medicineHow alternative treatments “work”:

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 the use and promotion 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. They differ from experimental medicine in that the latter employs responsible investigation, and accepts results that show it to be 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 some the treatment is so much worse that its use is unethical. Alternative practices, products, and therapies range from only ineffective to 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. 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, making it less effective, notably in cancer.

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 mainstream 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 physical interventions to treat or suppress symptoms or pathophysiologic 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.

Since ancient times, in many parts of the world a number of herbs reputed to possess abortifacient properties have been used in folk medicine. Among these are: tansy, pennyroyal, black cohosh, and the now-extinct silphium.[101]:4447, 6263, 15455, 23031 Historian of science Ann Hibner Koblitz has written of the probable protoscientific origins of this folk knowledge in observation of farm animals. Women who knew that grazing on certain plants would cause an animal to abort (with negative economic consequences for the farm) would be likely to try out those plants on themselves in order to avoid an unwanted pregnancy.[102]:120

However, modern users of these plants often lack knowledge of the proper preparation and dosage. The historian of medicine John Riddle has spoken of the “broken chain of knowledge” caused by urbanization and modernization,[101]:167205 and Koblitz has written that “folk knowledge about effective contraception techniques often disappears over time or becomes inextricably mixed with useless or harmful practices.”[102]:vii The ill-informed or indiscriminant use of herbs as abortifacients can cause serious and even lethal side-effects.[103][104]

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][119][120] Examples include healing claims for nonvitamin supplements, fish oil, Omega-3 fatty acid, glucosamine, echinacea, flaxseed oil, and ginseng.[121] Herbal medicine, or phytotherapy, includes not just the use of plant products, but may also include the use of animal and mineral products.[119] It is among the most commercially successful branches of alternative medicine, and includes the tablets, powders and elixirs that are sold as “nutritional supplements”.[119] 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.[119] This may include use of known toxic substances, such as use of the poison lead in traditional Chinese medicine.[121]

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.[125] 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][126][127][128][129] 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.[126][127] 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.[128] 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][126][127][128][130]

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][131][132] 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][127][128][129][130][132][133] 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.[126]:xxi[133] 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][133][134][135] 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”.[133]

Mainly as a result of reforms following the Flexner Report of 1910[136] 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.[138] Medical schools’ teaching includes such topics as doctor-patient communication, ethics, the art of medicine,[139] and engaging in complex clinical reasoning (medical decision-making).[140] 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.[141]

By 2001 some form of CAM training was being offered by at least 75 out of 125 medical schools in the US.[142] 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][143] 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).[144] All states require that applicants for MD licensure be graduates of an approved medical school and complete the United States Medical Licensing Exam (USMLE).[144]

There is a general scientific consensus that alternative therapies lack the requisite scientific validation, and their effectiveness is either unproved or disproved.[1][4][145][146] 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.[148]

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.[149]

Edzard Ernst characterized the evidence for many alternative techniques as weak, nonexistent, or negative[150] and in 2011 published his estimate that about 7.4% were based on “sound evidence”, although he believes that may be an overestimate.[151] 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.[152][153]

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.[154] 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.[156]

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”.[157]

A research methods expert and author of Snake Oil Science, R. Barker Bausell, has stated that “it’s become politically correct to investigate nonsense.”[158] There are concerns that just having NIH support is being used to give unfounded “legitimacy to treatments that are not legitimate.”[159]

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.[161]

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.[162] 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.[164]

In addition to the social-cultural underpinnings of the popularity of alternative medicine, there are several psychological issues that are critical to its growth. One of the most critical is the placebo effect a well-established observation in medicine.[165] Related to it are similar psychological effects, such as the will to believe,[166] cognitive biases that help maintain self-esteem and promote harmonious social functioning,[166] and the post hoc, ergo propter hoc fallacy.[166]

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.[167]

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.[166] Related to this are vigorous marketing[168] of extravagant claims by the alternative medical community combined with inadequate media scrutiny and attacks on critics.[166][169]

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.[169] 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.[170] Medical doctors are also aggressively marketing alternative medicine to profit from this market.[168]

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.[166][169]

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.[171]

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.[172]

Some have proposed adopting a prize system to reward medical research.[173] 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.[158][174][175][176]

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.[177]

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.[178] Thirty-one states have child-abuse religious exemptions.[179]

The use of alternative medicine in the US has increased,[1][180] with a 50 percent increase in expenditures and a 25 percent increase in the use of alternative therapies between 1990 and 1997 in America.[180] Americans spend many billions on the therapies annually.[180] Most Americans used CAM to treat and/or prevent musculoskeletal conditions or other conditions associated with chronic or recurring pain.[170] 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”.[170] In 2008, more than 37% of American hospitals offered alternative therapies, up from 27 percent in 2005, and 25% in 2004.[181][182] More than 70% of the hospitals offering CAM were in urban areas.[182]

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][118]

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%)[170][183]

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.[184] 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.[112][114]

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.[186]

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.”[187] 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.”[188]

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.[189] In Germany herbs are tightly regulated: half are prescribed by doctors and covered by health insurance.[190]

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.[192] This includes a section on Alternative Medicine Fraud,[193] such as a warning that Ayurvedic products generally have not been approved by the FDA before marketing.[194]

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.[195]

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.[196] 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.[197] 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).[198]

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.[199]

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.[200]

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.[201][202]

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.”[203] 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.[203]

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.[204] 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.[205] 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.[206]

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’.”[157]

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.[207]

“CAM”, meaning “complementary and alternative medicine”, is not as well researched as conventional medicine, which undergoes intense research before release to the public.[208] Funding for research is also sparse making it difficult to do further research for effectiveness of CAM.[209] Most funding for CAM is funded by government agencies.[208] Proposed research for CAM are rejected by most private funding agencies because the results of research are not reliable.[208] The research for CAM has to meet certain standards from research ethics committees, which most CAM researchers find almost impossible to meet.[208] Even with the little research done on it, CAM has not been proven to be effective.[210]

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.”[159] 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).)[211]

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.[159]

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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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Complementary and Alternative Medicine: Get the Facts on CAM

Undergraduate Degree Programs | NanoEngineering

The Department of NanoEngineering offers undergraduate programs leading to theB.S. degreesinNanoengineeringandChemical Engineering. The Chemical Engineering and NanoEngineering undergraduate programs areaccredited by the Engineering Accreditation Commission of ABET. The undergraduate degree programs focus on integrating the various sciences and engineering disciplines necessary for successful careers in the evolving nanotechnology industry.These two degree programshave very different requirements and are described in separate sections.

B.S. NanoEngineering

TheNanoEngineering Undergraduate Program became effective Fall 2010.Thismajor focuses on nanoscale science, engineering, and technology that have the potential to make valuable advances in different areas that include, to name a few, new materials, biology and medicine, energy conversion, sensors, and environmental remediation. The program includes affiliated faculty from the Department of NanoEngineering, Department of Mechanical and Aerospace Engineering, Department of Chemistry and Biochemistry, and the Department of Bioengineering. The NanoEngineering undergraduate program is tailored to provide breadth and flexibility by taking advantage of the strength of basic sciences and other engineering disciplines at UC San Diego. The intention is to graduate nanoengineers who are multidisciplinary and can work in a broad spectrum of industries.

B.S. Chemical Engineering

The Chemical Engineering undergraduate program is housed within the NanoEngineering Department. The program is made up of faculty from the Department of Mechanical and Aerospace Engineering, Department of Chemistry and Biochemistry, the Department of Bioengineering and the Department of NanoEngineering. The curricula at both the undergraduate and graduate levels are designed to support and foster chemical engineering as a profession that interfaces engineering and all aspects of basic sciences (physics, chemistry, and biology). As of Fall 2008, the Department of NanoEngineering has taken over the administration of the B.S. degree in Chemical Engineering.

Academic Advising

Upon admission to the major, students should consult the catalog or NanoEngineering website for their program of study, and their undergraduate/graduate advisor if they have questions. Because some course and/or curricular changes may be made every year, it is imperative that students consult with the departments student affairs advisors on an annual basis.

Students can meet with the academic advisors during walk-in hours, schedule an appointment, or send messages through the Virtual Advising Center (VAC).

Program Alterations/Exceptions to Requirements

Variations from or exceptions to any program or course requirements are possible only if the Undergraduate Affairs Committee approves a petition before the courses in question are taken.

Independent Study

Students may take NANO 199 or CENG 199, Independent Study for Undergraduates, under the guidance of a NANO or CENG faculty member. This course is taken as an elective on a P/NP basis. Under very restrictive conditions, however, it may be used to satisfy upper-division Technical Elective or Nanoengineering Elective course requirements for the major. Students interested in this alternative must have completed at least 90 units and earned a UCSD cumulative GPA of 3.0 or better. Eligible students must identify a faculty member with whom they wish to work and propose a two-quarter research or study topic. Please visit the Student Affairs office for more information.

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Undergraduate Degree Programs | NanoEngineering

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

Continued here:

Complementary and Alternative Medicine: Get the Facts on CAM

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, unconventional medicine, unorthodox medicineHow alternative treatments “work”:

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 the use and promotion 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. They differ from experimental medicine in that the latter employs responsible investigation, and accepts results that show it to be 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 some the treatment is so much worse that its use is unethical. Alternative practices, products, and therapies range from only ineffective to 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. 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. 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, making it less effective, notably in cancer.

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 mainstream 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 physical interventions to treat or suppress symptoms or pathophysiologic 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.

Since ancient times, in many parts of the world a number of herbs reputed to possess abortifacient properties have been used in folk medicine. Among these are: tansy, pennyroyal, black cohosh, and the now-extinct silphium.[101]:4447, 6263, 15455, 23031 Historian of science Ann Hibner Koblitz has written of the probable protoscientific origins of this folk knowledge in observation of farm animals. Women who knew that grazing on certain plants would cause an animal to abort (with negative economic consequences for the farm) would be likely to try out those plants on themselves in order to avoid an unwanted pregnancy.[102]:120

However, modern users of these plants often lack knowledge of the proper preparation and dosage. The historian of medicine John Riddle has spoken of the “broken chain of knowledge” caused by urbanization and modernization,[101]:167205 and Koblitz has written that “folk knowledge about effective contraception techniques often disappears over time or becomes inextricably mixed with useless or harmful practices.”[102]:vii The ill-informed or indiscriminant use of herbs as abortifacients can cause serious and even lethal side-effects.[103][104]

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][119][120] Examples include healing claims for nonvitamin supplements, fish oil, Omega-3 fatty acid, glucosamine, echinacea, flaxseed oil, and ginseng.[121] Herbal medicine, or phytotherapy, includes not just the use of plant products, but may also include the use of animal and mineral products.[119] It is among the most commercially successful branches of alternative medicine, and includes the tablets, powders and elixirs that are sold as “nutritional supplements”.[119] 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.[119] This may include use of known toxic substances, such as use of the poison lead in traditional Chinese medicine.[121]

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.[125] 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][126][127][128][129] 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.[126][127] 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.[128] 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][126][127][128][130]

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][131][132] 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][127][128][129][130][132][133] 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.[126]:xxi[133] 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][133][134][135] 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”.[133]

Mainly as a result of reforms following the Flexner Report of 1910[136] 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.[138] Medical schools’ teaching includes such topics as doctor-patient communication, ethics, the art of medicine,[139] and engaging in complex clinical reasoning (medical decision-making).[140] 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.[141]

By 2001 some form of CAM training was being offered by at least 75 out of 125 medical schools in the US.[142] 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][143] 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).[144] All states require that applicants for MD licensure be graduates of an approved medical school and complete the United States Medical Licensing Exam (USMLE).[144]

There is a general scientific consensus that alternative therapies lack the requisite scientific validation, and their effectiveness is either unproved or disproved.[1][4][145][146] 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.[148]

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.[149]

Edzard Ernst characterized the evidence for many alternative techniques as weak, nonexistent, or negative[150] and in 2011 published his estimate that about 7.4% were based on “sound evidence”, although he believes that may be an overestimate.[151] 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.[152][153]

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.[154] 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.[156]

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”.[157]

A research methods expert and author of Snake Oil Science, R. Barker Bausell, has stated that “it’s become politically correct to investigate nonsense.”[158] There are concerns that just having NIH support is being used to give unfounded “legitimacy to treatments that are not legitimate.”[159]

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.[161]

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.[162] 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.[164]

In addition to the social-cultural underpinnings of the popularity of alternative medicine, there are several psychological issues that are critical to its growth. One of the most critical is the placebo effect a well-established observation in medicine.[165] Related to it are similar psychological effects, such as the will to believe,[166] cognitive biases that help maintain self-esteem and promote harmonious social functioning,[166] and the post hoc, ergo propter hoc fallacy.[166]

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.[167]

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.[166] Related to this are vigorous marketing[168] of extravagant claims by the alternative medical community combined with inadequate media scrutiny and attacks on critics.[166][169]

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.[169] 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.[170] Medical doctors are also aggressively marketing alternative medicine to profit from this market.[168]

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.[166][169]

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.[171]

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.[172]

Some have proposed adopting a prize system to reward medical research.[173] 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.[158][174][175][176]

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.[177]

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.[178] Thirty-one states have child-abuse religious exemptions.[179]

The use of alternative medicine in the US has increased,[1][180] with a 50 percent increase in expenditures and a 25 percent increase in the use of alternative therapies between 1990 and 1997 in America.[180] Americans spend many billions on the therapies annually.[180] Most Americans used CAM to treat and/or prevent musculoskeletal conditions or other conditions associated with chronic or recurring pain.[170] 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”.[170] In 2008, more than 37% of American hospitals offered alternative therapies, up from 27 percent in 2005, and 25% in 2004.[181][182] More than 70% of the hospitals offering CAM were in urban areas.[182]

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][118]

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%)[170][183]

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.[184] 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.[112][114]

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.[186]

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.”[187] 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.”[188]

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.[189] In Germany herbs are tightly regulated: half are prescribed by doctors and covered by health insurance.[190]

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.[192] This includes a section on Alternative Medicine Fraud,[193] such as a warning that Ayurvedic products generally have not been approved by the FDA before marketing.[194]

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.[195]

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.[196] 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.[197] 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).[198]

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.[199]

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.[200]

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.[201][202]

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.”[203] 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.[203]

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.[204] 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.[205] 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.[206]

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’.”[157]

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.[207]

“CAM”, meaning “complementary and alternative medicine”, is not as well researched as conventional medicine, which undergoes intense research before release to the public.[208] Funding for research is also sparse making it difficult to do further research for effectiveness of CAM.[209] Most funding for CAM is funded by government agencies.[208] Proposed research for CAM are rejected by most private funding agencies because the results of research are not reliable.[208] The research for CAM has to meet certain standards from research ethics committees, which most CAM researchers find almost impossible to meet.[208] Even with the little research done on it, CAM has not been proven to be effective.[210]

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.”[159] 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).)[211]

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.[159]

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.

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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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Complementary and Alternative Medicine: Get the Facts on CAM

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, unconventional medicine, unorthodox medicineHow alternative treatments “work”:

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”.[citation needed]

Alternative medicine, fringe medicine, pseudomedicine or simply questionable medicine is the use and promotion 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. They differ from experimental medicine in that the latter employs responsible investigation, and accepts results that show it to be 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 some the treatment is so much worse that its use is unethical. Alternative practices, products, and therapies range from only ineffective to 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. 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. 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, making it less effective, notably in cancer.

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 mainstream 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 physical interventions to treat or suppress symptoms or pathophysiologic 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.

Since ancient times, in many parts of the world a number of herbs reputed to possess abortifacient properties have been used in folk medicine. Among these are: tansy, pennyroyal, black cohosh, and the now-extinct silphium.[101]:4447, 6263, 15455, 23031 Historian of science Ann Hibner Koblitz has written of the probable protoscientific origins of this folk knowledge in observation of farm animals. Women who knew that grazing on certain plants would cause an animal to abort (with negative economic consequences for the farm) would be likely to try out those plants on themselves in order to avoid an unwanted pregnancy.[102]:120

However, modern users of these plants often lack knowledge of the proper preparation and dosage. The historian of medicine John Riddle has spoken of the “broken chain of knowledge” caused by urbanization and modernization,[101]:167205 and Koblitz has written that “folk knowledge about effective contraception techniques often disappears over time or becomes inextricably mixed with useless or harmful practices.”[102]:vii The ill-informed or indiscriminant use of herbs as abortifacients can cause serious and even lethal side-effects.[103][104]

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][119][120] Examples include healing claims for nonvitamin supplements, fish oil, Omega-3 fatty acid, glucosamine, echinacea, flaxseed oil, and ginseng.[121] Herbal medicine, or phytotherapy, includes not just the use of plant products, but may also include the use of animal and mineral products.[119] It is among the most commercially successful branches of alternative medicine, and includes the tablets, powders and elixirs that are sold as “nutritional supplements”.[119] 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.[119] This may include use of known toxic substances, such as use of the poison lead in traditional Chinese medicine.[121]

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.[125] 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][126][127][128][129] 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.[126][127] 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.[128] 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][126][127][128][130]

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][131][132] 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][127][128][129][130][132][133] 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.[126]:xxi[133] 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][133][134][135] 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”.[133]

Mainly as a result of reforms following the Flexner Report of 1910[136] 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.[138] Medical schools’ teaching includes such topics as doctor-patient communication, ethics, the art of medicine,[139] and engaging in complex clinical reasoning (medical decision-making).[140] 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.[141]

By 2001 some form of CAM training was being offered by at least 75 out of 125 medical schools in the US.[142] 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][143] 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).[144] All states require that applicants for MD licensure be graduates of an approved medical school and complete the United States Medical Licensing Exam (USMLE).[144]

There is a general scientific consensus that alternative therapies lack the requisite scientific validation, and their effectiveness is either unproved or disproved.[1][4][145][146] 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.[148]

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.[149]

Edzard Ernst characterized the evidence for many alternative techniques as weak, nonexistent, or negative[150] and in 2011 published his estimate that about 7.4% were based on “sound evidence”, although he believes that may be an overestimate.[151] 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.[152][153]

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.[154] 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.[156]

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”.[157]

A research methods expert and author of Snake Oil Science, R. Barker Bausell, has stated that “it’s become politically correct to investigate nonsense.”[158] There are concerns that just having NIH support is being used to give unfounded “legitimacy to treatments that are not legitimate.”[159]

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.[161]

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.[162] 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.[164]

In addition to the social-cultural underpinnings of the popularity of alternative medicine, there are several psychological issues that are critical to its growth. One of the most critical is the placebo effect a well-established observation in medicine.[165] Related to it are similar psychological effects, such as the will to believe,[166] cognitive biases that help maintain self-esteem and promote harmonious social functioning,[166] and the post hoc, ergo propter hoc fallacy.[166]

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.[167]

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.[166] Related to this are vigorous marketing[168] of extravagant claims by the alternative medical community combined with inadequate media scrutiny and attacks on critics.[166][169]

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.[169] 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.[170] Medical doctors are also aggressively marketing alternative medicine to profit from this market.[168]

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.[166][169]

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.[171]

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.[172]

Some have proposed adopting a prize system to reward medical research.[173] 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.[158][174][175][176]

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.[177]

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.[178] Thirty-one states have child-abuse religious exemptions.[179]

The use of alternative medicine in the US has increased,[1][180] with a 50 percent increase in expenditures and a 25 percent increase in the use of alternative therapies between 1990 and 1997 in America.[180] Americans spend many billions on the therapies annually.[180] Most Americans used CAM to treat and/or prevent musculoskeletal conditions or other conditions associated with chronic or recurring pain.[170] 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”.[170] In 2008, more than 37% of American hospitals offered alternative therapies, up from 27 percent in 2005, and 25% in 2004.[181][182] More than 70% of the hospitals offering CAM were in urban areas.[182]

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][118]

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%)[170][183]

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.[184] 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.[112][114]

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.[186]

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.”[187] 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.”[188]

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.[189] In Germany herbs are tightly regulated: half are prescribed by doctors and covered by health insurance.[190]

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.[192] This includes a section on Alternative Medicine Fraud,[193] such as a warning that Ayurvedic products generally have not been approved by the FDA before marketing.[194]

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.[195]

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.[196] 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.[197] 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).[198]

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 anecdotal 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.[199]

To ABC Online, MacLennan also gives another possible mechanism:

And lastly [sic] 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.[200]

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.[201][202]

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.”[203] 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.[203]

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.[204] 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.[205] 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.[206]

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’.”[157]

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.[207]

“CAM”, meaning “complementary and alternative medicine”, is not as well researched as conventional medicine, which undergoes intense research before release to the public.[208] Funding for research is also sparse making it difficult to do further research for effectiveness of CAM.[209] Most funding for CAM is funded by government agencies.[208] Proposed research for CAM are rejected by most private funding agencies because the results of research are not reliable.[208] The research for CAM has to meet certain standards from research ethics committees, which most CAM researchers find almost impossible to meet.[208] Even with the little research done on it, CAM has not been proven to be effective.[210]

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.”[159] 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).)[211]

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.[159]

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.

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Alternative medicine – Wikipedia

5 Kinds of Complementary and Alternative Medicine (CAM)

Complementary and alternative medicine comes in a broad range of forms. Here’s a look at five widely practiced types of complementary and alternative medicine:

According to the National Center for Complementary and Integrative Health (NCCIH), the most commonly used complementary medicine approaches in the U.S. fall into one of two subgroups: natural products or mind-body practices.

In the 2012 National Health Interview Survey (or NHIS, a report conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics), researchers determined that 17.7 percent of American adults had used a dietary supplement other than vitamins and minerals in the past year. The most commonly used natural product was fish oil, an omega-3-rich substance said to protect against conditions such as heart disease.

The second category of most commonly practiced complementary medicine approaches, according to the NCCIH, mind-body therapies typically involve using specific techniques to boost the mind’s capacity to influence bodily function and enhance health.

Hypnotherapy is a popular type of mind-body therapy. Also known as hypnosis, it’s been found to promote weight loss, alleviate back pain, and aid in smoking cessation in some scientific studies.

A self-directed practice long used to promote calm, meditation is a mind-body therapy that shows promise as an approach to achieving healthier blood pressure and sounder sleep. There’s also some evidence that meditation may benefit people struggling with chronic pain.

Although yoga is often practiced as a form of exercise and a means of reducing stress, it’s also used as a mind-body therapy. Indeed, some research indicates that yoga may help manage conditions like anxiety, insomnia, migraines, and depression.

The NCCIH notes that yoga’s popularity has significantly increased in recent years, with almost twice as many U.S. adults practicing yoga in 2012 as in 2002.

Many proponents of complementary and alternative medicine use therapies and healing practices from alternative medical systems, such as homeopathy and naturopathic medicine.

Alternative medical systems also include traditional medical systems from other countries, such as Ayurveda (a form of alternative medicine that originated in India) and traditional Chinese medicine (TCM). Within TCM are a number of therapies frequently used in the U.S. today, including acupuncture, acupressure, and herbal medicine.

This type of complementary and alternative medicine is based on manipulation and/or movement of one or more parts of the body.

In some cases, manipulative and body-based methods involve participating in classes or individual sessions with the aim of changing your movement habits. For example, the Alexander Techniqueinvolves relearning basic movements (such as standing and sitting) in order to reduce muscle tension, while the Feldenkrais Method involves creating new patterns of movement in order to improve physical function and overall wellbeing.

Other types of manipulative and body-based methods used in complementary and alternative medicine focus on applying specific treatments to address health issues. These methods include reflexology, osteopathy, and rolfing.

Another type of complementary and alternative medicine, energy therapies are generally based on the idea that energy fields surround and penetrate the human body. Practitioners of energy therapies often aim to manipulate biofields by applying pressure and/or placing the hands in or through these energy fields.

While the existence of such energy fields has not been scientifically proven, there’s some evidence that certain energy therapies may have beneficial effects.

For instance, preliminary research has shown that practicing qigongmay help control chronic pain and lower blood pressure while Therapeutic Touch may help soothe osteoarthritis pain. In addition, there’s some evidence that reiki may help lessen pain, promote healthy sleep, and reduce anxiety.

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5 Kinds of Complementary and Alternative Medicine (CAM)

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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Complementary and Alternative Medicine: Get the Facts on CAM

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, unconventional medicine, unorthodox medicineHow alternative treatments “work”:

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 feel 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 the use and promotion 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. They differ from experimental medicine in that the latter employs responsible investigation, and accepts results that show it to be 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 some the treatment is so much worse that its use is unethical. Alternative practices, products, and therapies range from only ineffective to 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. 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. 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, making it less effective, notably in cancer.

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 the term used to describe the combined use of alternative medicine with functional medical treatment, in the 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 mainstream 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 physical interventions to treat or suppress symptoms or pathophysiologic 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.

Since ancient times, in many parts of the world a number of herbs reputed to possess abortifacient properties have been used in folk medicine. Among these are: tansy, pennyroyal, black cohosh, and the now-extinct silphium.[101]:4447, 6263, 15455, 23031 Historian of science Ann Hibner Koblitz has written of the probable protoscientific origins of this folk knowledge in observation of farm animals. Women who knew that grazing on certain plants would cause an animal to abort (with negative economic consequences for the farm) would be likely to try out those plants on themselves in order to avoid an unwanted pregnancy.[102]:120

However, modern users of these plants often lack knowledge of the proper preparation and dosage. The historian of medicine John Riddle has spoken of the “broken chain of knowledge” caused by urbanization and modernization,[101]:167205 and Koblitz has written that “folk knowledge about effective contraception techniques often disappears over time or becomes inextricably mixed with useless or harmful practices.”[102]:vii The ill-informed or indiscriminant use of herbs as abortifacients can cause serious and even lethal side-effects.[103][104]

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][119][120] Examples include healing claims for nonvitamin supplements, fish oil, Omega-3 fatty acid, glucosamine, echinacea, flaxseed oil, and ginseng.[121] Herbal medicine, or phytotherapy, includes not just the use of plant products, but may also include the use of animal and mineral products.[119] It is among the most commercially successful branches of alternative medicine, and includes the tablets, powders and elixirs that are sold as “nutritional supplements”.[119] 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.[119] This may include use of known toxic substances, such as use of the poison lead in traditional Chinese medicine.[121]

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.[125] 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][126][127][128][129] 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.[126][127] 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.[128] 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][126][127][128][130]

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][131][132] 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][127][128][129][130][132][133] 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.[126]:xxi[133] 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][133][134][135] 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”.[133]

Mainly as a result of reforms following the Flexner Report of 1910[136] 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.[138] Medical schools’ teaching includes such topics as doctor-patient communication, ethics, the art of medicine,[139] and engaging in complex clinical reasoning (medical decision-making).[140] 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.[141]

By 2001 some form of CAM training was being offered by at least 75 out of 125 medical schools in the US.[142] 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][143] 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).[144] All states require that applicants for MD licensure be graduates of an approved medical school and complete the United States Medical Licensing Exam (USMLE).[144]

There is a general scientific consensus that alternative therapies lack the requisite scientific validation, and their effectiveness is either unproved or disproved.[1][4][145][146] 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.[148]

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.[149]

Edzard Ernst characterized the evidence for many alternative techniques as weak, nonexistent, or negative[150] and in 2011 published his estimate that about 7.4% were based on “sound evidence”, although he believes that may be an overestimate.[151] 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.[152][153]

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.[154] 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.[156]

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”.[157]

A research methods expert and author of Snake Oil Science, R. Barker Bausell, has stated that “it’s become politically correct to investigate nonsense.”[158] There are concerns that just having NIH support is being used to give unfounded “legitimacy to treatments that are not legitimate.”[159]

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.[161]

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.[162] 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.[164]

In addition to the social-cultural underpinnings of the popularity of alternative medicine, there are several psychological issues that are critical to its growth. One of the most critical is the placebo effect a well-established observation in medicine.[165] Related to it are similar psychological effects, such as the will to believe,[166] cognitive biases that help maintain self-esteem and promote harmonious social functioning,[166] and the post hoc, ergo propter hoc fallacy.[166]

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.[167]

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.[166] Related to this are vigorous marketing[168] of extravagant claims by the alternative medical community combined with inadequate media scrutiny and attacks on critics.[166][169]

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.[169] 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.[170] Medical doctors are also aggressively marketing alternative medicine to profit from this market.[168]

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.[166][169]

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.[171]

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.[172]

Some have proposed adopting a prize system to reward medical research.[173] 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.[158][174][175][176]

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.[177]

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.[178] Thirty-one states have child-abuse religious exemptions.[179]

The use of alternative medicine in the US has increased,[1][180] with a 50 percent increase in expenditures and a 25 percent increase in the use of alternative therapies between 1990 and 1997 in America.[180] Americans spend many billions on the therapies annually.[180] Most Americans used CAM to treat and/or prevent musculoskeletal conditions or other conditions associated with chronic or recurring pain.[170] 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”.[170] In 2008, more than 37% of American hospitals offered alternative therapies, up from 27 percent in 2005, and 25% in 2004.[181][182] More than 70% of the hospitals offering CAM were in urban areas.[182]

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][118]

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%)[170][183]

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.[184] 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.[112][114]

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.[186]

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.”[187] 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.”[188]

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.[189] In Germany herbs are tightly regulated: half are prescribed by doctors and covered by health insurance.[190]

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.[192] This includes a section on Alternative Medicine Fraud,[193] such as a warning that Ayurvedic products generally have not been approved by the FDA before marketing.[194]

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.[195]

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.[196] 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.[197] 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).[198]

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 anecdotal 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.[199]

To ABC Online, MacLennan also gives another possible mechanism:

And lastly [sic] 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.[200]

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.[201][202]

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.”[203] 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.[203]

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.[204] 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.[205] 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.[206]

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’.”[157]

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.[207]

“CAM”, meaning “complementary and alternative medicine”, is not as well researched as conventional medicine, which undergoes intense research before release to the public.[208] Funding for research is also sparse making it difficult to do further research for effectiveness of CAM.[209] Most funding for CAM is funded by government agencies.[208] Proposed research for CAM are rejected by most private funding agencies because the results of research are not reliable.[208] The research for CAM has to meet certain standards from research ethics committees, which most CAM researchers find almost impossible to meet.[208] Even with the little research done on it, CAM has not been proven to be effective.[210]

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.”[159] 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).)[211]

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.[159]

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.

See the article here:

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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Complementary and Alternative Medicine: Get the Facts on CAM

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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Complementary and Alternative Medicine: Get the Facts on CAM

Category:Alternative medicine – Wikipedia

Alternative medicine encompasses methods used in both complementary medicine and alternative medicine, known collectively as complementary and alternative medicine (CAM). These methods are used in place of (“alternative to”), or in addition to (“complementary to”), conventional medical treatments. The terms are primarily used in the western world, and include several traditional medicine techniques practiced throughout the world.

If you add something to this category it should also be added to list of forms of alternative medicine.

This category has the following 10 subcategories, out of 10 total.

The following 106 pages are in this category, out of 106 total. This list may not reflect recent changes (learn more).

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Category: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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Complementary and Alternative Medicine: Get the Facts on CAM

Amazon Best Sellers: Best Alternative Medicine

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Amazon Best Sellers: Best Alternative Medicine

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, unconventional medicine, unorthodox medicineHow alternative treatments “work”: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”.Researchers such as epidemiologists, clinical statisticians and pharmacologists use clinical trials to tease out such effects, allowing doctors to offer only that which has been shown to work. “Alternative treatments” often refuse to use trials or make it deliberately hard to do so.

Alternative medicine, fringe medicine, pseudomedicine or simply questionable medicine is the use and promotion 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. They differ from experimental medicine in that the latter employs responsible investigation, and accepts results that show it to be 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 some the treatment is so much worse that its use is unethical. Alternative practices, products, and therapies range from only ineffective to 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. 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. 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, making it less effective, notably in cancer.

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 the term used to describe the combined use of alternative medicine with functional medical treatment, in the 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 mainstream 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 physical interventions to treat or suppress symptoms or pathophysiologic 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.

Since ancient times, in many parts of the world a number of herbs reputed to possess abortifacient properties have been used in folk medicine. Among these are: tansy, pennyroyal, black cohosh, and the now-extinct silphium.[101]:4447, 6263, 15455, 23031 Historian of science Ann Hibner Koblitz has written of the probable protoscientific origins of this folk knowledge in observation of farm animals. Women who knew that grazing on certain plants would cause an animal to abort (with negative economic consequences for the farm) would be likely to try out those plants on themselves in order to avoid an unwanted pregnancy.[102]:120

However, modern users of these plants often lack knowledge of the proper preparation and dosage. The historian of medicine John Riddle has spoken of the “broken chain of knowledge” caused by urbanization and modernization,[101]:167205 and Koblitz has written that “folk knowledge about effective contraception techniques often disappears over time or becomes inextricably mixed with useless or harmful practices.”[102]:vii The ill-informed or indiscriminant use of herbs as abortifacients can cause serious and even lethal side-effects.[103][104]

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][119][120] Examples include healing claims for nonvitamin supplements, fish oil, Omega-3 fatty acid, glucosamine, echinacea, flaxseed oil, and ginseng.[121] Herbal medicine, or phytotherapy, includes not just the use of plant products, but may also include the use of animal and mineral products.[119] It is among the most commercially successful branches of alternative medicine, and includes the tablets, powders and elixirs that are sold as “nutritional supplements”.[119] 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.[119] This may include use of known toxic substances, such as use of the poison lead in traditional Chinese medicine.[121]

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.[125] 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][126][127][128][129] 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.[126][127] 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.[128] 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][126][127][128][130]

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][131][132] 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][127][128][129][130][132][133] 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.[126]:xxi[133] 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][133][134][135] 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”.[133]

Mainly as a result of reforms following the Flexner Report of 1910[136] 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.[138] Medical schools’ teaching includes such topics as doctor-patient communication, ethics, the art of medicine,[139] and engaging in complex clinical reasoning (medical decision-making).[140] 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.[141]

By 2001 some form of CAM training was being offered by at least 75 out of 125 medical schools in the US.[142] 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][143] 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).[144] All states require that applicants for MD licensure be graduates of an approved medical school and complete the United States Medical Licensing Exam (USMLE).[144]

There is a general scientific consensus that alternative therapies lack the requisite scientific validation, and their effectiveness is either unproved or disproved.[1][4][145][146] 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.[148]

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.[149]

Edzard Ernst characterized the evidence for many alternative techniques as weak, nonexistent, or negative[150] and in 2011 published his estimate that about 7.4% were based on “sound evidence”, although he believes that may be an overestimate.[151] 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.[152][153]

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.[154] 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.[156]

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”.[157]

A research methods expert and author of Snake Oil Science, R. Barker Bausell, has stated that “it’s become politically correct to investigate nonsense.”[158] There are concerns that just having NIH support is being used to give unfounded “legitimacy to treatments that are not legitimate.”[159]

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.[161]

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.[162] 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.[164]

In addition to the social-cultural underpinnings of the popularity of alternative medicine, there are several psychological issues that are critical to its growth. One of the most critical is the placebo effect a well-established observation in medicine.[165] Related to it are similar psychological effects, such as the will to believe,[166] cognitive biases that help maintain self-esteem and promote harmonious social functioning,[166] and the post hoc, ergo propter hoc fallacy.[166]

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.[167]

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.[166] Related to this are vigorous marketing[168] of extravagant claims by the alternative medical community combined with inadequate media scrutiny and attacks on critics.[166][169]

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.[169] 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.[170] Medical doctors are also aggressively marketing alternative medicine to profit from this market.[168]

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.[166][169]

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.[171]

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.[172]

Some have proposed adopting a prize system to reward medical research.[173] 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.[158][174][175][176]

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.[177]

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.[178] Thirty-one states have child-abuse religious exemptions.[179]

The use of alternative medicine in the US has increased,[1][180] with a 50 percent increase in expenditures and a 25 percent increase in the use of alternative therapies between 1990 and 1997 in America.[180] Americans spend many billions on the therapies annually.[180] Most Americans used CAM to treat and/or prevent musculoskeletal conditions or other conditions associated with chronic or recurring pain.[170] 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”.[170] In 2008, more than 37% of American hospitals offered alternative therapies, up from 27 percent in 2005, and 25% in 2004.[181][182] More than 70% of the hospitals offering CAM were in urban areas.[182]

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][118]

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%)[170][183]

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.[184] 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.[112][114]

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.[186]

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.”[187] 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.”[188]

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.[189] In Germany herbs are tightly regulated: half are prescribed by doctors and covered by health insurance.[190]

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.[192] This includes a section on Alternative Medicine Fraud,[193] such as a warning that Ayurvedic products generally have not been approved by the FDA before marketing.[194]

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.[195]

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.[196] 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.[197] 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).[198]

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 anecdotal 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.[199]

To ABC Online, MacLennan also gives another possible mechanism:

And lastly [sic] 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.[200]

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.[201][202]

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.”[203] 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.[203]

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.[204] 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.[205] 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.[206]

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’.”[157]

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.[207]

“CAM”, meaning “complementary and alternative medicine”, is not as well researched as conventional medicine, which undergoes intense research before release to the public.[208] Funding for research is also sparse making it difficult to do further research for effectiveness of CAM.[209] Most funding for CAM is funded by government agencies.[208] Proposed research for CAM are rejected by most private funding agencies because the results of research are not reliable.[208] The research for CAM has to meet certain standards from research ethics committees, which most CAM researchers find almost impossible to meet.[208] Even with the little research done on it, CAM has not been proven to be effective.[210]

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.”[159] 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).)[211]

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.[159]

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.[212] 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.[158] 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.[213]

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Alternative medicine – Wikipedia


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