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Gale Encyclopedia of Public Health:
Alternative, Complementary, and Integrative Medicine |
Conventional Medicine and Public Health
Traditionally, public health relies extensively on conventional (allopathic) medicine in its mission to prevent and treat disease. It accepts reductionistic methods to identify the origin of illness at the cellular and subcellular level, and then applies these principles in assessing and addressing risk factors in populations. This results in a three-tiered approach to the delivery of public health services: (1) primary prevention, which involves efforts to reduce exposure to risk factors for injury and illness; (2) secondary prevention, which involves the identification and control of disease in its early stages; and (3) tertiary prevention, which attempts to control the impact of existing illness and injury through prolonged treatment and rehabilitative services.
Paralleling the growth of technology-based medicine (and its effectiveness), however, has been a simultaneous rise in chronic illnesses that are resistant to current treatment modalities and very costly to society. Leading causes of morbidity in the early 1900s, such as trauma and infectious disease, have been supplanted by chronic conditions such as cancer, heart disease, and HIV (human immunodeficiency virus) infection. This requires the development of a new model of health care that is multidimensional and that recognizes all factors influencing health and illness. At a public health level, multidimensional problems require multidimensional interventions, which is the basis of the integrative medical approach.
Complementary and Alternative Medicine
In 1948, the World Health Organization (WHO) defined health as "a complete state of physical, mental, and social well-being and not merely the absence of disease or infirmity." The public increasingly embraces "holistic" medicine when seeking treatment for chronic medical conditions. This philosophical shift has led to a sharp increase in the use of complementary and alternative medicine (CAM), defined as modalities (e.g., acupuncture, herbal therapy, massage therapy), employed in place of, or as adjuncts to, conventional medical therapies. Surveys reveal that almost half of the U.S. population turns to such modalities, with acceptance and use of CAM expanding during the 1990s. Studies showing that CAM use tends to be higher among patients with diseases (e.g., cancer, arthritis), that are often inadequately treated by conventional approaches may suggest an inherent dissatisfaction with Western medicine. Research suggests, however, that the public is actually turning to CAM because its doctrines parallel their own personal values and belief systems. For example, patients want physicians who regard them as whole persons—minds and spirits as well as bodies—and who believe in the healing power of nature. In fact, although CAM therapies are very diverse, ranging from well-established cultural traditions (e.g., Chinese traditional medicine) to quasi-allopathic modalities marginally supported by current science (e.g., chelation therapy), most share common underlying philosophies. These include a belief in the interconnectedness of mind and body and respect for the innate mechanisms of healing.
Integrative Medicine
Practioners of conventional medicine are justifiably proud of the achievements of their profession—most notably the diagnostic, pharmacological, and surgical advances of the twentieth century. Total reliance on such technologies, however, has led to the dismissal of CAM modalities as archaic or ineffective. The result has been increasing divisiveness between proponents and opponents of unconventional therapies.
The descriptive phrase "integrative medicine," coined in the late twentieth century, characterizes a new model of health care rooted both in conventional and alternative medicine. In the broadest sense, integrative medicine employs modalities drawn from all medical therapeutic paradigms, providing patients with individualized treatment plans optimized for their specific clinical situations. The underlying philosophy recognizes and relies upon the innate healing capacity of the human body and emphasizes the importance of the relationship between practitioner and patient in fostering this capacity.
While incorporating aspects of both conventional medicine and CAM, integrative medicine does not uncritically accept either without evidence of validity and efficacy. Additionally, in weighing both the benefits and risks inherent to any therapy, regardless of its origin, the integrative practitioner initially selects the least invasive, least toxic, and least costly interventions appropriate to the situation.
A cornerstone of the integrative model is the assertion that health and healing optimally occur when all factors that influence the organism are addressed. To quote Sir William Osler (1849–1919), "It is more important to know what sort of patient has a disease than what sort of disease a patient has." Therefore, although a patient presents specific symptoms, the integrative practitioner inquires into all lifestyle, psychosocial, and spiritual influences affecting quality of life. The ensuing treatment plan includes recommendations such as dietary change, increase in physical activity, and stress reduction in addition to any specific therapies. Positive coping skills such as biofeedback, yoga, prayer, meditation, and community involvement are promoted.
Although the breadth and depth of CAM is beyond the scope of this chapter, a few of the more recognized and researched modalities are listed below:
Fundamental to the integrative model is the therapeutic relationship between the patient and doctor. Practitioners recognize that they are not the source of healing, but the means by which patients discover, or rediscover, their innate capacity to regain health. Therapeutic modalities, whether conventional or alternative, are simply adjuncts to this process; patients must take responsibility for their own health and well-being. To this end, each therapeutic decision is the result of a consideration of all appropriate modalities, whether conventional or CAM. Patients are thus active partners in choosing therapies consistent with their values and philosophical beliefs.
Integrative Medicine and the Future of Health Care
No one denies the existence of a crisis in the delivery and financing of health care. The arrangement of unregulated fee-for-service practices, reimbursement through managed care, and costly defensive medicine has complicated rather than alleviated the burden of escalating chronic illness associated with an aging population. The ensuing national debate has focused upon repair of this system, rather than the creation of a new design.
An integrative approach to public health redefines the ideology of the system rather than attempting to repair the current model. It looks to equitable and universal access to health maintenance services, and focuses on disease prevention as well as on current treatments, which may not always be effective. Decisions regarding the provision of health care therefore do not simply originate from within the medical and reimbursement sectors, but become a social contract among individuals, providers, hospitals, academic institutions, corporations, communities, and governmental agencies. Individuals become accountable for the impact their behavioral choices have upon the community as well as on their own personal wellbeing. Health care providers and hospitals work to prevent illness as well as treat it, emphasizing accountability to the individual and the community over financial profit. Academic institutions develop programs that promote the synergistic training of students of medicine, nursing, pharmacy, and others involved in patient care. Corporations recognize the overall value of healthy employees and invest in individual and organized wellness programs. Communities acknowledge that health in not only the result of good medical care, but also of adequate housing, sanitation, and education. Finally, government serves as a safety net, ensuring access to medical care when all other resources fail, as well as enacting and enforcing legislation designed to protect both the individual and the health care system. Thus, the concept of integrative medicine encompasses not only the health of the individual, but of society as a whole.
(SEE ALSO: Chinese Traditional Medicine; Holistic Medicine; Prevention; Preventive Health Behavior; Preventive Medicine)
Bibliography
Astin, J. A. (1998). "Why Patients Use Alternative Medicine: Results of a National Study." Journal of American Medical Association 279(19):1548–1553.
Donnelly, W. J.; Spykerboer, J. E.; and Thong, Y. H. (1985). "Are Patients Who Use Alternative Medicine Dissatisfied with Orthodox Medicine?" Medical Journal of Australia 142(10):539–541.
Eisenberg, D. M.; Davis, R. B.; Ettner, S. L.; Appel, S.; Wilkey, S.; Van Rompay, M.; and Kessler, R. C.(1998). "Trends in Alternative Medicine Use in the United States, 1990–1997: Results of a Follow-up National Survey." Journal of American Medical Association 280(18):1569–1575.
Gaudet, T. W. (1998). "Integrative Medicine: The Evolution of a New Approach to Medicine and to Medical Education." Integrative Medicine 1(2):67–73.
Kaptchuk, T. J., and Eisenberg, D. M. (1998). "The Persuasive Appeal of Alternative Medicine." Annals of Internal Medicine 129(12):1061–1065.
Maizes, V., and Caspi, O. (1999). "The Principles and Challenges of Integrative Medicine." Western Journal of Medicine 171(3):148–149.
Rees, L., and Weil, A. (2000). "Integrated Medicine." British Medical Journal 322(7279):119–120.
Weil, A. (2000). "The Significance of Integrated Medicine for the Future of Medical Education." American Journal of Medicine 108(5):441–443.
— WILLIAM BENDA; ANDREW WEIL
Gale Encyclopedia of US History:
Alternative Medicine |
Alternative medical practices have arisen in or have easily been transported to the United States, where social values and political infrastructure have encouraged many forms to flourish. The pervading American value placed in persons having autonomy with respect to making decisions over their own bodies; the skepticism toward any professional group having a monopoly on a given field; and Article 10 of the U.S. Constitution, which reserves to each state the exclusive power to set standards, make rules, and license practitioners in their jurisdictions, have enabled the public and small groups of unorthodox practitioners to shape laws that limit the powers of the dominant orthodox medical profession and protect the interests of alternative minority groups. In Europe and most other countries, licensure and medical policy are centralized, and alternative practitioners and their supporters must win one large battle to gain political recognition or face being marginalized. In the United States, alternative medical movements have been able to fight simultaneous battles in several states, winning some and using those successes to institutionalize, build followings, set standards, and continue their struggles in other jurisdictions.
Although alternative medicine has existed throughout the country's history, the greatest growth of alternative medical movements occurred during three eras, when more broad-based social ideologies nurtured the philosophical premises and political aims of such movements. These ideologies were Jacksonian Democracy (roughly the 1820s to the 1840s), populism (1880s–1910s), and New Age thought (1970s–1990s).
The Era of Jacksonian Democracy
President Andrew Jackson and many of his followers trumpeted the virtues of "the common man, " feared large centralized institutions, and had a distrust of professionals, particularly when the latter sought special privileges or exclusive rights based upon expertise to practice in fields traditionally open to those with or without formal training. Consistent with these beliefs, three large alternative medical movements arose during this time.
Samuel Thomson, a self-trained root doctor from New Hampshire, believed that all disorders were caused by obstructed perspiration. He argued that fever was the body's effort to eliminate disease and that orthodox physicians, with their bleedings, blisterings, and use of drugs like mercury, arsenic, and antimony, were jeopardizing the lives of patients and causing many deaths. Thomson believed anyone could treat disease using six classes of remedies consisting of botanical drugs and the steam bath, all designed to produce great internal heat, eliminate the cold, and allow the body to reestablish its natural balance. Thomson wrote a popular book, prepared kits of his medicine, sold individual rights to his practice, and encouraged followers to defeat or repeal medical licensure laws that restricted the practice of medicine to formally trained physicians. Although Thomson was antiprofessional, other alternative groups that employed a wider range of botanical drugs emerged, including Eclectic Medicine, which established schools, journals, and hospitals and won status for its practitioners as physicians.
The second major group of medical reformers, part of the so-called popular health movement, believed that physicians were largely unnecessary because most diseases could be prevented by individuals adopting healthy habits. The most prominent American lecturer and writer in this movement, Sylvester Graham, maintained that disease resulted from excessive stimulation of the tissues. Any food that caused too much stimulation had to be avoided, including tea, coffee, alcohol, pastries, and all fleshy meats. Graham also used the doctrine of overstimulation to warn of the powerful dangers of too much sexual energy. Eating meat, he argued, produced a heightened sex drive, which was health destroying. One of his innovations was a cracker that still bears his name, which was initially designed in part to discourage overstimulation of this type.
The most significant European import during this era was Homeopathy, a system of practice originated by the German physician Samuel Hahnemann. Brought to America in the 1820s, homeopathy encompassed two essential principles. The first principle was that the drug best able to cure a given illness would be that which could produce the symptoms of that illness in a healthy person. The second principle was that the smaller the dose, the more powerful the effect. One active part per hundred was shaken in a vial, and one part of that solution was mixed with another ninety-nine inactive parts, and so on, usually thirty times. By the end of the nineteenth century, homeopaths constituted 10 percent and the eclectics 5 percent of the physician and surgeon population in the United States.
The Era of Populism
Midwestern populism encompassed a distrust of large East Coast–controlled businesses and institutions, a belief that elites had gained too much power, and a sense that common people had too little say in shaping government and law in their own interests. As opposed to Jacksonian Democracy, many populists were not against creating laws governing the professions as long as the interests of competing groups were protected. In the 1870s and 1880s, new medical licensure laws were enacted; however, homeopathic and eclectic physicians were given the same rights as orthodox physicians. Challenging this hegemony were two groups—osteopathy and chiropractic.
Osteopathy was founded by Andrew Taylor Still, an apprenticeship-trained Midwestern physician. Still, who had practiced for a time as a bonesetter, believed that disease was the result of an obstruction or imbalance of the fluids caused by misplaced bones, particularly of the spinal column. These misplacements could be corrected through physical manipulation. He established an infirmary and school in Kirksville, Missouri, in 1892. Still's followers relatively quickly gained some measure of legal protection, established other colleges, and gradually expanded osteopathy's scope of practice to incorporate drugs and surgery. Eventually, D.O.s (doctors of osteopathic medicine) won equal rights along with M.D.s as full-fledged physicians and surgeons in every state and equal recognition by the federal government. As homeopathic and eclectic medicine faded after the beginning of the twentieth century, osteopathy became, and remained, the only equivalent professional rival of allopathic medicine, although the differences between the two groups have faded considerably.
Chiropractic appeared within a decade of the emergence of osteopathy and was founded in Davenport, Iowa, by Daniel David Palmer. Like Still, Palmer believed that diseases were due to misplaced bones. Many early chiropractors or D.C.s (doctors of chiropractic) were initially charged with practicing osteopathy without a license, but they demonstrated to courts and eventually legislatures that their diagnostic and treatment techniques were different. Unlike osteopathic physicians, who grew to encompass the full range of medical training and skills, chiropractors, despite the addition of some adjuncts, continued to center their activities on spinal manipulation and quickly became associated in the public mind with that technique, though osteopathy had historical priority.
"new Age" Thought
Fueled by America's continued participation in the Vietnam War and frustration with the perceived failure of government to produce meaningful change consistent with their own beliefs, a growing number of middle-class Americans in the 1970s shifted their attention from reforming society by legislative action to focusing on the potential for personal improvement. Drawing upon the rich traditions of other cultures, and often incorporating metaphysical and spiritual understandings of the basis and meaning of life, millions of Americans turned to a variety of disparate health beliefs and practices, including traditional Chinese and Ayurvedic medicine; crystals and scented candles; rolfing and other body treatments; imaging and other psychological interventions; alternative diets; herbs, vitamins, and other supplements; and a rediscovery of homeopathic and botanical remedies. By the end of the twentieth century, more money was spent by Americans on alternative practitioners and remedies than on visits to the offices of conventional primary care physicians.
This movement also reflected a growing frustration with the way orthodox medicine was practiced. Too little time was spent listening to patients, and while science had contributed to the treatment of acute diseases, many patients with chronic illnesses wanted more relief from their conditions than conventional physicians could provide. The number of alternative treatments that became available provided patients with new choices and new hopes. Experience by physicians with some of these modalities, and later research indicating value in some forms of alternative treatment, encouraged a growing number of conventionally trained physicians to incorporate these methods under the banner of "holistic" or "integrative" medicine. The continued popularity of these most recent forms of alternative medicine will, as in earlier periods, depend not only on the perceived efficacy of the respective practices over time but also on the broader social trends and ideologies that facilitated the emergence and growth of these practices.
Bibliography
Berman, Alex, and Michael A. Flannery. America's Botanico-Medical Movements: Vox Populi. New York: Pharmaceutical Products Press, 2001.
Gevitz, Norman. The D.O.'s: Osteopathic Medicine in America. Baltimore: Johns Hopkins University Press, 1991.
———, ed. Other Healers: Unorthodox Medicine in America. Baltimore: Johns Hopkins University Press, 1988.
Haller, John S. Medical Protestants: The Eclectics in American Medicine, 1825–1939. Carbondale: Southern Illinois University Press, 1994.
Kaufman, Martin. Homeopathy in America: The Rise and Fall of a Medical Heresy. Baltimore: Johns Hopkins University Press, 1971.
McGuire, Meredith. Ritual Healing in Suburban America. New Brunswick, N.J.: Rutgers University Press, 1988.
Moore, J. Stuart. Chiropractic in America: The History of a Medical Alternative. Baltimore: Johns Hopkins University Press, 1993.
Whorton, James C. Crusaders for Fitness: The History of American Health Reformers. Princeton, N.J.: Princeton University Press, 1982.
Answer of the Day:
Alternative medicine |
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| Echinacea |
| Altair 8800 | |
| Alvin Ailey |
From our Archives: Today's Highlights, March 1, 2005
Columbia Encyclopedia:
alternative medicine |
Dictionary of Cultural Literacy: Health:
alternative medicine |
Medical practice or therapy that uses methods that have not been associated with the traditional, standard care most generally taught and executed by AMA-certified medical schools.
Saunders Veterinary Dictionary:
alternative medicine |
Wikipedia on Answers.com:
Alternative medicine |
Medicinal herbs in a traditional Spanish market
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| Acupuncture · Anthroposophic medicine · Herbalism · Homeopathy · Naturopathy · Orthopathy · Osteopathy/Chiropractic |
| Traditional medicine |
| Chinese · Mongolian · Tibetan · Unani · Siddha · Ayurveda |
| NCCAM classifications |
| Whole medical systems · Mind-body interventions · Biologically based therapies · Manipulative therapy · Energy therapies |
| See also |
| Alternative medicine · Glossary · People |
| Alternative medicine | |
|---|---|
| Intervention | |
| MeSH | D000529 |
Alternative medicine is any healing practice "that does not fall within the realm of conventional medicine."[1] It is based on historical or cultural traditions, rather than on scientific evidence.
A 1998 systematic review of studies assessing its prevalence in 13 countries concluded that about 31% of cancer patients use some form of complementary and alternative medicine.[2] Alternative medicine varies from country to country. Jurisdictions where alternative medical practices are sufficiently widespread may license and regulate them. Edzard Ernst has said that in Austria and Germany complementary and alternative medicine is mainly in the hands of physicians,[3] while some estimates suggest that at least half of American alternative practitioners are physicians.[4] In Germany herbs are tightly regulated: half are prescribed by doctors and covered by health insurance based on their Commission E legislation.[5]
Alternative medicine is frequently grouped with complementary medicine or integrative medicine, which, in general, refers to the same interventions when used in conjunction with mainstream techniques,[6][7][8] under the umbrella term complementary and alternative medicine, or CAM. Some researchers in alternative medicine object to this categorization, preferring to emphasize differences of approach, but nevertheless use the term CAM, which has become standard.[3][9] Critics maintain that the terms “complementary” and “alternative medicine” are deceptive euphemisms meant to give an impression of medical authority.[10][11][12]
Alternative medicine methods are diverse in their foundations and methodologies. Methods may incorporate or base themselves on traditional medicine, folk knowledge, spiritual beliefs, or newly conceived approaches to healing.[13] "Although heterogeneous, the major CAM systems have many common characteristics, including a focus on individualizing treatments, treating the whole person, promoting self-care and self-healing, and recognizing the spiritual nature of each individual. In addition, many CAM systems have characteristics commonly found in mainstream healthcare, such as a focus on good nutrition and preventive practices. Unlike mainstream medicine, CAM often lacks or has only limited experimental and clinical study; however, scientific investigation of CAM is beginning to address this knowledge gap. Thus, boundaries between CAM and mainstream medicine, as well as among different CAM systems, are often blurred and are constantly changing."[6]
Claims about the efficacy of alternative medicine tend to lack evidence, and have been shown to repeatedly fail during testing. Some researchers state that the evidence-based approach to defining CAM is problematic because some CAM is tested, and research suggests that many mainstream medical techniques lack solid evidence.[14]
The term 'alternative medicine' is generally used to describe practices used independently or in place of conventional medicine.Term 'complementary medicine' is primarily used to describe practices used in conjunction with or to complement conventional medical treatments. NCCAM suggests "using aromatherapy therapy in which the scent of essential oils from flowers, herbs, and trees is inhaled in an attempt to promote health and well-being and to help lessen a patient's discomfort following surgery"[15] as an example of complementary medicine. The terms 'integrative' or 'integrated medicine' indicate combinations of conventional and alternative medical treatments that have some scientific proof of efficacy; such practices are viewed by advocates as the best examples of complementary medicine.[15]
Ralph Snyderman and Andrew Weil state that "integrative medicine is not synonymous with complementary and alternative medicine. It has a far larger meaning and mission in that it calls for restoration of the focus of medicine on health and healing and emphasizes the centrality of the patient-physician relationship."[16] The combination of orthodox and complementary medicine with an emphasis on prevention and lifestyle changes is known as integrated medicine.
The use of plants as medicines predates written human history. A 60 000-year-old Neanderthal burial site, "Shanidar IV", in northern Iraq has yielded large amounts of pollen from 8 plant species, 7 of which are used now as herbal remedies[17]
There is no clear and consistent definition for either alternative or complementary medicine.[18]:17 In Western culture it is often defined as any healing practice "that does not fall within the realm of conventional medicine",[1] or "that which has not been shown consistently to be effective."[19]
The National Center for Complementary and Alternative Medicine (NCCAM) defines CAM as "a group of diverse medical and healthcare systems, practices, and products, that are not currently part of conventional medicine."[15]
The Danish Knowledge and Research Center for Alternative Medicine (Danish abbreviation: ViFAB. ViFAB is an independent institution under the Danish Ministry of the Interior and Health. ViFAB's webstite: www.vifab.dk/uk) uses the term “alternative medicine” for: – Treatments performed by therapists that are not authorized healthcare professionals – Treatments performed by authorized healthcare professionals, but those based on methods otherwise used mainly outside the healthcare system. People without a healthcare authorisation must be able to perform the treatments.
The Cochrane Complementary Medicine Field finds that what is considered complementary or alternative practices in one country may be considered conventional medical practices in another. Their definition is, therefore, general: "complementary medicine includes all such practices and ideas that are outside the domain of conventional medicine in several countries and defined by its users as preventing or treating illness, or promoting health and well-being."[20]
For example, biofeedback is commonly used within the Physical Medicine & Rehabilitation community, but is considered alternative within the medical community as a whole, and some herbal therapies are mainstream in Europe, but are alternative in the United States.[21] David M. Eisenberg, an integrative medicine researcher,[22] defines it as "medical interventions not taught widely at US medical schools or generally available at US. hospitals,"[23] NCCAM states that formerly unproven remedies may be incorporated into conventional medicine if they are shown to be safe and effective.[15]
Barrie R. Cassileth, a researcher of complementary and alternative medicine, has summed up the situation as "not all mainstream physicians are pleased with CAM, with current efforts to integrate CAM into mainstream medicine, or with a separate NIH research entity for "alternative" medicine.[24][25]
The United States' National Science Foundation has defined alternative medicine as "all treatments that have not been proven effective using scientific methods."[26] In a consensus report released in 2005, entitled Complementary and Alternative Medicine in the United States, the Institute of Medicine (IOM) defined complementary and alternative medicine (CAM) as the non-dominant approach to medicine in a given culture and historical period.[27] A similar definition has been adopted by the Cochrane Collaboration,[20] and official government bodies such as the UK Department of Health.[28] Proponents of evidence-based medicine, such as the Cochrane Collaboration, use the term alternative medicine but agree that all treatments, whether "mainstream" or "alternative", ought to be held to the standards of the scientific method.[29]
Numerous mainstream scientists and physicians have commented on and criticised alternative medicine.
There is a debate among medical researchers over whether any therapy may be properly classified as 'alternative medicine'. Some claim that there is only medicine that has been adequately tested and that which has not.[24] They feel that healthcare practices should be classified based solely on scientific evidence. If a treatment has been rigorously tested and found safe and effective traditional medicine will adopt it regardless of whether it was considered "alternative" to begin with.[24] It is thus possible for a method to change categories (proven vs. unproven), based on increased knowledge of its effectiveness or lack thereof. Prominent supporters of this position include George D. Lundberg, former editor of the Journal of the American Medical Association (JAMA).[30]
Stephen Barrett, founder and operator of Quackwatch, argues that practices labeled "alternative" should be reclassified as either genuine, experimental, or questionable. Here he defines genuine as being methods that have sound evidence for safety and effectiveness, experimental as being unproven but with a plausible rationale for effectiveness, and questionable as groundless without a scientifically plausible rationale. He has concerns that just because some "alternatives" have merit, there is the impression that the rest deserve equal consideration and respect even though most are worthless.[31] He says that there is a policy at the NIH of never saying something doesn't work only that a different version or dose might give different results.[32]
Edzard Ernst, professor of complementary medicine, characterizes the evidence for many alternative techniques as weak, nonexistent, or negative, but states that evidence exists for others, in particular certain herbs and acupuncture.[33] Ernst has concluded that 95% of the alternative treatments he and his team have studied, including acupuncture, herbal medicine, homeopathy, and reflexology, are, according to The Economist, "statistically indistinguishable from placebo treatments."[34]
Richard Dawkins, an evolutionary biologist, defines alternative medicine as a "set of practices that cannot be tested, refuse to be tested, or consistently fail tests."[35] He also states that "there is no alternative medicine. There is only medicine that works and medicine that doesn't work."[36] He says that if a technique is demonstrated effective in properly performed trials, it ceases to be alternative and simply becomes medicine.[37]
A letter by four Nobel Laureates and other prominent scientists deplored the lack of critical thinking and scientific rigor in National Institutes of Health supported alternative medicine research.[38] In 2009 a group of scientists made a proposal to shut down the National Center for Complementary and Alternative Medicine. They argued that the vast majority of studies were based on unconventional understandings of physiology and disease and have shown little or no effect. Further, they argue that the field's more-plausible interventions such as diet, relaxation, yoga and botanical remedies can be studied just as well in other parts of NIH, where they would need to compete with conventional research projects.[39]
These concerns are supported by negative results in almost all studies conducted over ten years at a cost of $2.5 billion by the NCCAM.[40] R. Barker Bausell, a research methods expert and author of "Snake Oil Science" states that "it's become politically correct to investigate nonsense."[32] There are concerns that just having NIH support is being used to give unfounded "legitimacy to treatments that are not legitimate."[39]
Wallace Sampson, an editor of Scientific Review of Alternative Medicine and a Stanford University professor of medicine write that CAM is the "propagation of the absurd" based on the example that alternative and complementary have been substituted for quackery, dubious and implausible and concerns that CAM tolerates contradiction without thorough reason and experiment.[41]
The Washington Post reports that a growing number of traditionally trained physicians practice integrative medicine, which it defines as "conventional medical care that incorporates strategies such as acupuncture, reiki and herbal remedies."[42] The Australian comedian Tim Minchin, in his nine minute beat poem "Storm", states that alternative medicine is that which "has either not been proved to work or been proved not to work", and then he quips "You know what they call 'alternative medicine' that’s been proved to work? Medicine."[43]
NCCAM has developed one of the most widely used classification systems for the branches of complementary and alternative medicine.[15][18] It classifies complementary and alternative therapies into five major groups, which have some overlap.[15]
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Many people utilize mainstream medicine for diagnosis and basic information, while turning to alternatives for therapy or health-enhancing measures. Studies indicate that alternative approaches are often used in conjunction with conventional medicine.[44] This is referred to by NCCAM as integrative (or integrated) medicine because it "combines treatments from conventional medicine and CAM for which there is some high-quality evidence of safety and effectiveness."[15] According to Andrew T. Weil M.D., a leading proponent of integrative medicine, the principles of integrative medicine include: appropriate use of conventional and CAM methods; patient participation; promotion of health as well as treatment of disease; and a preference for natural, minimally-invasive methods.[45]
A 1997 survey found that 13.7% of respondents in the United States had sought the services of both a medical doctor and an alternative medicine practitioner. The same survey found that 96% of respondents who sought the services of an alternative medicine practitioner also sought the services of a medical doctor in the past 12 months. Medical doctors are often unaware of their patient's use of alternative medical treatments as only 38.5% of the patients alternative therapies were discussed with their medical doctor.[46]
Edzard Ernst, Professor of Complementary Medicine at the University of Exeter, wrote in the Medical Journal of Australia that "about half the general population in developed countries use complementary and alternative medicine (CAM)."[47] Survey results released in May 2004 by the National Center for Complementary and Alternative Medicine, part of the United States National Institutes of Health, found that in 2002 62.1% of adults in the country had used some form of CAM in the past 12 months and 75% across lifespan (though these figure drop to 36.0% and 50% if prayer specifically for health reasons is excluded); this study included yoga, meditation, herbal treatments and the Atkins diet as CAM.[44][48] Another study suggests a similar figure of 40%.[49]
A British telephone survey by the BBC of 1209 adults in 1998 shows that around 20% of adults in Britain had used alternative medicine in the past 12 months.[50] Ernst has been active politically on this issue as well, publicly requesting that Prince Charles recall two guides to alternative medicine published by the Foundation for Integrated Health, on the grounds that "[t]hey both contain numerous misleading and inaccurate claims concerning the supposed benefits of alternative medicine" and that "[t]he nation cannot be served by promoting ineffective and sometimes dangerous alternative treatments."[51] In general, he believes that CAM can and should be subjected to scientific testing.[29][33][52]
The use of alternative medicine in developed countries appears to be increasing. A 1998 study showed that the use of alternative medicine had risen from 33.8% in 1990 to 42.1% in 1997.[46] In the United Kingdom, a 2000 report ordered by the House of Lords suggested that "...limited data seem to support the idea that CAM use in the United Kingdom is high and is increasing."[53] 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.[54]
Advocates of alternative medicine hold that the various alternative treatment methods are effective in treating a wide range of major and minor medical conditions, and that recently published research (such as Michalsen, 2003,[55] Gonsalkorale 2003,[56] and Berga 2003)[57] proves the effectiveness of specific alternative treatments. They assert that a PubMed search revealed over 370,000 research papers classified as alternative medicine published in Medline-recognized journals since 1966 in the National Library of Medicine database. See also Kleijnen 1991,[58] and Linde 1997.[59]
Complementary therapies are often used in palliative care or by practitioners attempting to manage chronic pain in patients. Complementary medicine is considered more acceptable in the interdisciplinary approach used in palliative care than in other areas of medicine. "From its early experiences of care for the dying, palliative care took for granted the necessity of placing patient values and lifestyle habits at the core of any design and delivery of quality care at the end of life. If the patient desired complementary therapies, and as long as such treatments provided additional support and did not endanger the patient, they were considered acceptable."[60] 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."[61]
Physicians who practice complementary medicine usually discuss and advise patients as to available complementary therapies. Patients often express interest in mind-body complementary therapies because they offer a non-drug approach to treating some health conditions.[62] Some mind-body techniques, such as cognitive-behavioral therapy, were once considered complementary medicine, but are now a part of conventional medicine in the United States.[63] "Complementary medicine treatments used for pain include: acupuncture, low-level laser therapy, meditation, aroma therapy, Chinese medicine, dance therapy, music therapy, massage, herbalism, therapeutic touch, yoga, osteopathy, chiropractic, naturopathy, and homeopathy."[64]
In defining complementary medicine in the UK, the House of Lords Select Committee determined that the following therapies were the most often used to complement conventional medicine:[65] Alexander technique, Aromatherapy, Bach and other flower remedies, Body work therapies including massage, Counselling stress therapies, hypnotherapy, Meditation, Reflexology, Shiatsu, Maharishi Ayurvedic medicine, Nutritional medicine, and Yoga.
A 2002 survey of US adults 18 years and older conducted by the National Center for Health Statistics (CDC) and the National Center for Complementary and Alternative Medicine indicated:[44]
In 2004, a survey of nearly 1,400 U.S. hospitals found that more than one in four offered alternative and complementary therapies such as acupuncture, homeopathy, and massage therapy.[66]
A 2008 survey of US hospitals by Health Forum, a subsidiary of the American Hospital Association, found that more than 37 percent of responding hospitals indicated they offer one or more alternative medicine therapies, up from 26.5 percent in 2005. Additionally, hospitals in the southern Atlantic states were most likely to include CAM, followed by east north central states and those in the middle Atlantic. More than 70% of the hospitals offering CAM were in urban areas.[67]
In 2011 the Millennium Cohort Study (United States) found that 39% of the then currently enrolled 44,287 cohort members reported using at least one CAM therapy.[68]
The National Science Foundation has also conducted surveys of the popularity of alternative medicine. After describing the negative impact science fiction in the media has on public attitudes and understandings of pseudoscience, and defining alternative medicine as all treatments that have not been proven effective using scientific methods, as well as mentioning the concerns of individual scientists, organizations, and members of the science policymaking community, it commented that "nevertheless, the popularity of alternative medicine appears to be increasing."[26]
In the state of Texas, physicians may be partially protected from charges of unprofessional conduct or failure to practice medicine in an acceptable manner, and thus from disciplinary action, when they prescribe alternative medicine in a complementary manner, if board specific practice requirements are satisfied and the therapies utilized do not present "a safety risk for the patient that is unreasonably greater than the conventional treatment for the patient's medical condition."[69]
45.2 % of the Danish population aged 16 or above had in 2005 used alternative medicine at some point in life. 22.5 % had used alternative medicine within the previous year.[70]
The most popular types of therapies within the previous year (2005) are:
More results of statistical surveys on alternative medicine in Denmark is available on ViFABs (Knowledge and Research Center for Alternative Medicines) home page, see the pages on Statistics: http://www.vifab.dk/uk/alternative+medicine/statistics
68 % of the medical students in Denmark were in 2008 using or had used alternative therapy.[71] The most commonly used types of alternative medicine were:
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The examples and perspective in this section may not represent a worldwide view of the subject. Please improve this article and discuss the issue on the talk page. (January 2010) |
In the United States, increasing numbers of medical colleges have started offering courses in alternative and complementary medicine. A 1998 study reported "There is tremendous heterogeneity and diversity in content, format, and requirements among courses in complementary and alternative medicine at US medical schools". Common topics included chiropractic, acupuncture, homeopathy, herbal therapies, and mind-body techniques. In three separate research surveys that surveyed 729 schools (125 medical schools offering an MD degree, 25 medical schools offering a Doctor of Osteopathic medicine degree, and 585 schools offering a nursing degree), 60% of the standard medical schools, 95% of osteopathic medical schools and 84.8% of the nursing schools teach some form of CAM.[72][73][74] The University of Arizona College of Medicine offers a program in Integrative Medicine under the leadership of Andrew Weil that trains physicians in various branches of alternative medicine that "...neither rejects conventional medicine nor embraces alternative practices uncritically."[75] Accredited Naturopathic colleges and universities are also increasing in number and popularity in Canada and the USA. (See Naturopathic medical school in North America).
A 2001 survey of European universities found that unconventional medicine courses are widely represented at European universities. They cover a wide range of therapies and many of them are used clinically. Research work is underway at several faculties.[76] A 2006 survey showed that 40% of the responding European universities were offering some form of CAM training."[77]
Universities in the United Kingdom have been dropping their degree courses in alternative medicine, and as of 2012, no more degrees will be offered in such courses as homeopathy, naturopathy, and reflexology.[78][79]
Due to the uncertain nature of various alternative therapies and the wide variety of claims different practitioners make, alternative medicine has been a source of vigorous debate, even over the definition of alternative medicine.[80][81] Dietary supplements, their ingredients, safety, and claims, are a continual source of controversy.[82] In some cases, political issues, mainstream medicine and alternative medicine all collide, such as in cases where synthetic drugs are legal but the herbal sources of the same active chemical are banned.[83]
In other cases, controversy over mainstream medicine causes questions about the nature of a treatment, such as water fluoridation.[84] Alternative medicine and mainstream medicine debates can also spill over into freedom of religion discussions, such as the right to decline lifesaving treatment for one's children because of religious beliefs.[85] Government regulators continue to attempt to find a regulatory balance.[86]
Jurisdiction differs concerning which branches of alternative medicine are legal, which are regulated, and which (if any) are provided by a government-controlled health service or reimbursed by a private health medical insurance company. The United Nations Committee on Economic, Social and Cultural Rights – article 34 (Specific legal obligations) of the General Comment No. 14 (2000) on The right to the highest attainable standard of health – states that
Furthermore, obligations to respect include a State's obligation to refrain from prohibiting or impeding traditional preventive care, healing practices and medicines, from marketing unsafe drugs and from applying coercive medical treatments, unless on an exceptional basis for the treatment of mental illness or the prevention and control of communicable diseases.—[87]
Specific implementations of this article are left to member states.
A number of alternative medicine advocates disagree with the restrictions of government agencies that approve medical treatments. In the United States, for example, critics say that the Food and Drug Administration's criteria for experimental evaluation methods impedes those seeking to bring useful and effective treatments and approaches to the public, and that their contributions and discoveries are unfairly dismissed, overlooked or suppressed. Alternative medicine providers recognize that health fraud occurs, and argue that it should be dealt with appropriately when it does, but that these restrictions should not extend to what they view as legitimate healthcare products.
In New Zealand, alternative medicine products are classified as food products, so there are no regulations or safety standards in place.[88]
In Australia, the topic is termed as complementary medicine and the Therapeutic Goods Administration has issued various guidances and standards.[89] Australian regulatory guidelines for complementary medicines (ARGCM) demands that the pesticides, fumigants, toxic metals, microbial toxins, radionuclides, and microbial contaminations present in herbal substances should be monitored, although the guidance does not request for the evidences of these traits.[90] However, for the herbal substances in pharmacopoeial monographes, the detailed information should be supplied to relevant authorities [91]
The production of modern pharmaceuticals is strictly regulated to ensure that medicines contain a standardized quantity of active ingredients and are free from contamination. Alternative medicine products are not subject to the same governmental quality control standards, and consistency between doses can vary. This leads to uncertainty in the chemical content and biological activity of individual doses. This lack of oversight means that alternative health products are vulnerable to adulteration and contamination.[92] This problem is magnified by international commerce, since different countries have different types and degrees of regulation. This can make it difficult for consumers to properly evaluate the risks and qualities of given products.
Denmark [93]: Herbal and dietary supplements is the designation of a range of products, which have in common their status as medicine belonging under the Danish Medicines Act.In the Danish Medicines Act there exist four types of herbal and dietary supplements: Herbal medicinal products,[94] Strong vitamin and mineral preparations,[95] Traditional botanical medicinal products [96] and Homeopathic medicinal products.[97] Some dietary supplements [98] fall within a special category of products, which differ from the above in that they are not authorized medicinal products. Dietary supplements are regulated under the Food Act and are registered by the Danish Veterinary and Food Administration.
Denmark has a registration system for alternative therapy practitioners, RAB.[99]
The NCCAM budget has been criticized[100] because despite the duration and intensity of studies about the efficacy of alternative medicine, there have been exactly zero effective CAM treatments supported by scientific evidence to date.[101] Despite this, the National Center for Complementary and Alternative Medicine budget has been on a sharp sustained rise to support complementary medicine. In fact, the whole CAM field has been called by critics the SCAM.[101]
"There really is no such thing as alternative medicine--only medicine that has been proved to work and medicine that has not." Arnold Relman, editor in chief emeritus of The New England Journal of Medicine.[102][Full citation needed] Speaking of government funding studies of integrating alternative medicine techniques into the mainstream, Steven Novella, a neurologist at Yale School of Medicine wrote that it "is used to lend an appearance of legitimacy to treatments that are not legitimate." Marcia Angell, executive editor of The New England Journal of Medicine says, "It's a new name for snake oil."[100]
Many alternative therapies have been tested with varying results. 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.[103] According to a 2005 book by a US Institute of Medicine panel, the number of RCTs focused on CAM has risen dramatically. The book cites Vickers (1998), who found that many of the CAM-related RCTs are in the Cochrane register, but 19% of these trials were not in MEDLINE, and 84% were in conventional medical journals.[18]:133
As of 2005, 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%) effect, 4.8% concluded no effect, 0.69% 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 2004 Cochrane database, while the conventional review used the 1998 Cochrane database.[18]:135-136
Lists of the Cochrane Reviews on alternative medicine including summaries of the results sorted by type of therapy (updated monthly) are made available at ViFABs (Knowledge and Research Center for Alternative Medicines) home page, see the lists here: http://www.vifab.dk/uk/cochrane+and+alternative+medicine
Most alternative medical treatments are not patentable, which may lead to less research funding from the private sector. In addition, in most countries, alternative treatments (in contrast to pharmaceuticals) can be marketed without any proof of efficacy—also a disincentive for manufacturers to fund scientific research.[104] Some have proposed adopting a prize system to reward medical research.[105] 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. NCCAM and its predecessor, the Office of Alternative Medicine, have spent more than $2.5 billion on such research since 1992; this research has largely not demonstrated the efficacy of alternative treatments.[32][106][107]
Some skeptics of alternative practices say that a person may attribute symptomatic relief to an otherwise-ineffective therapy due to the placebo effect, the natural recovery from or the cyclical nature of an illness (the regression fallacy), or the possibility that the person never originally had a true illness.[108]
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.[109]
Cancer researcher Andrew J. Vickers has stated:
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, insulin potentiation therapy. Some herbal remedies can cause dangerous interactions with chemotherapy drugs, radiation therapy, or anesthetics during surgery, among other problems.[111] 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.[112]
To ABC Online, MacLennan also gives another possible mechanism:
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".
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."[114] 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.[114]
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.[115] 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.[116]
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.[117] In all, they found 17 instances in which children were significantly harmed by a failure to use conventional medicine.
Perhaps because many forms of cancer are difficult or impossible to cure, 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. [118]
Although the Dutch government funded CAM research between 1986 and 2003, it formally ended funding in 2006.[119]
Integrative medicine is the combination of the practices and methods of alternative/complementary medicine with conventional medicine.[120] It may include preventive medicine and patient-centered medicine. It may also include practices not normally referred to as medicine, such as using prayer, meditation, socializing, and recreation as therapies. Its academic proponents sometimes recommend misleading patients by using known placebo treatments in order to achieve a placebo effect.[121] 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.[122][123] A number of universities and hospitals have departments of integrative medicine.[124][125][126][127][128][129][130]
Criticism of integrative medicine includes about proposing to lie to patients about alternative medicines known to be no more than a placebo in order to achieve a placebo effect, and “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”.[12][131]
"Quackademic medicine" is a pejorative term used for “integrative medicine”, when considered to be an infiltration of quackery into academic science-based medicine, and was picked up by science-based medicine anti-ACM critics.[12]
Fueled by a nationwide survey published in 1993 by David Eisenberg, which revealed that in 1990 approximately 60 million Americans had used one or more complementary or alternative therapies to address health issues.[132] A study published in the November 11, 1998 issue of the Journal of the American Medical Association reported that 42% of Americans had used complementary and alternative therapies, up from 34% in 1990.[133] However, despite the growth in patient demand for complementary medicine, most of the early alternative/complementary medical centers failed.[134]
A study published in 1998[49] indicates that a majority of alternative medicine use was in conjunction with standard medical treatments. Approximately 4.4 percent of those studied used alternative medicine as a replacement for conventional medicine. The research found that those having used alternative medicine tended to have higher education or report poorer health status. Dissatisfaction with conventional medicine was not a meaningful factor in the choice, but rather the majority of alternative medicine users appear to be doing so largely because "they find these healthcare alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life." In particular, subjects reported a holistic orientation to health, a transformational experience that changed their worldview, identification with a number of groups committed to environmentalism, feminism, psychology, and/or spirituality and personal growth, or that they were suffering from a variety of common and minor ailments – notable ones being anxiety, back problems, and chronic pain.
Authors have speculated on the socio-cultural and psychological reasons for the appeal of alternative medicines among that 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.[135] Related to this are vigorous marketing[136] of extravagant claims by the alternative medical community combined with inadequate media scrutiny and attacks on critics.[135][137]
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.[137] 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.[44] Medical doctors are also aggressively marketing alternative medicine to profit from this market.[136]
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, which is a well-established observation in medicine.[138] Related to it are similar psychological effects such as the will to believe,[135] cognitive biases that help maintain self-esteem and promote harmonious social functioning,[135] and the post hoc, ergo propter hoc fallacy.[135]
Patients can also 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. Also, 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.[135][137]
Schofield et al., in a systematic review published in 2011, make ten recommendations which they think may increase the effectiveness of consultations in a conventional (here: oncology) setting, such as "Ask questions about CAM use at critical points in the illness trajectory"; "Respond to the person's emotional state"; and "Provide balanced, evidence-based advice". They suggest that this approach may address "... concerns surrounding CAM use [and] encourage informed decision-making about CAM and ultimately, improve outcomes for patients".[139]
CAM's popularity may be related to other factors which Edzard Ernst mentions in an interview in The Independent:
In a paper published in October 2010 entitled The public's enthusiasm for complementary and alternative medicine amounts to a critique of mainstream medicine, Ernst describes these views in greater detail and concludes:
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