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Regulation 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.In article 34 (Specific legal obligations) of the General Comment No. 14 (2000) on The right to the highest attainable standard of health of the Committee on Economic, Social and Cultural Rights (United Nations), it is stated that
Obligations to respect (the right to health) include a States obligation to refrain from prohibiting or impeding traditional preventive care, healing practices and medicines, from marketing unsafe drugs and from applying coercive medical treatments'' COMMITTEE ON ECONOMIC, SOCIAL AND CULTURAL RIGHTS. General Comment No. 14 (2000) The right to the highest attainable standard of health : . 11/08/2000. E/C.12/2000/4. http://www.unhchr.ch/tbs/doc.nsf/(symbol)/E.C.12.2000.4.enA number of alternative medicine advocates disagree with the restrictions of government agencies that approve medical treatments (such as the American Food and Drug Administration) and the agencies' adherence to experimental evaluation methods. They claim that this impedes those seeking to bring useful and effective treatments and approaches to the public, and protest that their contributions and discoveries are unfairly dismissed, overlooked or suppressed. Alternative medicine providers often argue that health fraud should be dealt with appropriately when it occurs.In India, which is the home of several alternative systems of medicines, Ayurveda, Siddha, Unani, and Homeopathy are licenced by the government, despite lack of reputable scientific evidence. Naturopathy will also be licensed soon because several Universities now offer bachelors degrees in it. Other activities connected with AM/CM, such as Panchakarma and massage therapy related to Ayurveda are also licenced by the government now. Research into and licensing of these activities is carried out by the Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH).Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH)
Contemporary use of alternative medicine Many people utilize mainstream medicine for diagnosis and basic information, while turning to alternatives for what they believe to be health-enhancing measures. However, studies indicate that a majority of people use alternative approaches in conjunction with conventional medicine.Edzard Ernst wrote in the Medical Journal of Australia that "about half the general population in developed countries use complementary and alternative medicine (CAM)."Ernst E. "Obstacles to research in complementary and alternative medicine." Medical Journal of Australia, 2003; 179 (6): 279-80. PMID 12964907 MJA online A survey released in May 2004 by the National Center for Complementary and Alternative Medicine, part of the National Institutes of Health in the United States, found that in 2002, 36% of Americans used some form of alternative therapy in the past 12 months, 50% in a lifetime — a category that included yoga, meditation, herbal treatments and the Atkins diet. If prayer was counted as an alternative therapy, the figure rose to 62.1%. 25% of people who use CAM do so because a medical professional suggested it.Reasons people use CAM Another study suggests a similar figure of 40%.Astin JA "Why patients use alternative medicine: results of a national study" JAMA 1998; 279(19): 1548-1553 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.The use of alternative medicine 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.Eisenberg, DM, Davis RB, Ettner SL "Trends in alternative medicine use in the United States 1990-1997." JAMA, 1998; 280:1569-1575. PMID 9820257 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."House of Lords report on CAM
Medical educationIncreasing numbers of medical colleges have started offering courses in alternative medicine. For example, the University of Arizona College of Medicine offers a program in Integrative Medicine under the leadership of Dr. Andrew Weil which trains physicians in various branches of alternative medicine which "...neither rejects conventional medicine, nor embraces alternative practices uncritically."University of Arizona position on Alternative Medicine In three separate research surveys that surveyed 729 schools in the United States (125 medical schools offering an MD degree, 25 medical schools offering a Doctor of Osteopathy 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.Wetzel MS, Eisenberg DM, Kaptchuk TJ. "Courses involving complementary and alternative medicine at US medical schools." JAMA 1998; 280 (9):784 -787. PMID 9729989 Saxon DW, Tunnicliff G, Brokaw JJ, Raess BU. "Status of complementary and alternative medicine in the osteopathic medical school curriculum." J Am Osteopath Assoc 2004; 104 (3):121-6. PMID 15083987Fenton MV, Morris DL. "The integration of holistic nursing practices and complementary and alternative modalities into curricula of schools of nursing." Altern Ther Health Med, 2003; 9 (4):62-7. PMID 12868254 Accredited Naturopathic colleges and universities are increasing in number and popularity in the U.S.A. They offer the most complete medical training in complimentary medicines that is available today. See Naturopathic medicine. In Britain, no conventional medical schools offer courses that teach the clinical practice of alternative medicine. . However, alternative medicine is taught in several unconventional schools as part of their curriculum. . Teaching is based mostly on theory and understanding of alternative medicine, with emphasis on being able to communicate with alternative medicine specialists. . To obtain competence in practicing clinical alternative medicine, qualifications must be obtained from individual medical societies. . The student must have graduated and be a qualified doctor. . The British Medical Acupuncture Society, which offers medical acupuncture certificates to doctors, is one such example, as is the College of Naturopathic Medicine UK and Ireland.
Public use in the USThe NCCAM surveyed the American public on complementary and alternative medicine use in 2002. According to the survey:
Support for alternative medicine Alternative therapies provide some services not available from conventional medicine. Examples are patient empowerment and treatment methods that follow the biopsychosocial model of health Vickers A. "Alternative Cancer Cures: "Unproven" or "Disproven"?" CA Cancer J Clin 2004; 54: 110-118. Online.
EfficacyAdvocates of alternative medicine hold that the various alternative treatment methods are effective in treating a wide range of major and minor medical conditions, and contend that recently published research (such as Michalsen, 2003,Michalsen A, Ludtke R, Buhring M. "Thermal hydrotherapy improves quality of life and hemodynamic function in patients with chronic heart failure." Am Heart J, 2003; 146 (4):E11. PMID 14564334 Gonsalkorale 2003,Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ. "Long term benefits of hypnotherapy for irritable bowel syndrome." Gut, 2003; 52 (11):1623-9. PMID 14570733 and Berga 2003Berga SL, Marcus MD, Loucks TL. "Recovery of ovarian activity in women with functional hypothalamic amenorrhea who were treated with cognitive behavior therapy." Fertility and Sterility 2003; 80 (4): 976-981 Abstract) 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,Kleijnen J, Knipschild P, ter Riet G. "Clinical trials of homoeopathy." BMJ, 1991; 302:316-23. Erratum in: BMJ, 1991; 302:818. PMID 1825800 and Linde 1997.Linde K, Clausius N, Ramirez G. "Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials." Lancet, 1997; 350:834-43. Erratum in: Lancet 1998 Jan 17;351(9097):220. PMID 9310601Evidence-based medicine (EBM) applies the scientific method to medical practice, and aims for the ideal that healthcare professionals should make "conscientious, explicit, and judicious use of current best evidence" in their everyday practice. Prof. Edzard Ernst is a notable proponent of applying EBM to CAM.Although advocates of alternative medicine acknowledge that the placebo effect may play a role in the benefits that some receive from alternative therapies, they point out that this does not diminish their validity. Researchers who judge treatments using the scientific method are concerned by this viewpoint, since it fails to address the possible inefficacy of alternative treatments.
Use of alternative medicine alongside conventional medicineA major objection to alternative medicine is that it is done in place of conventional medical treatments. As long as alternative treatments are used alongside conventional treatments, the majority of medical doctors find most forms of complementary medicine acceptable. Consistent with previous studies, the CDC recently reported that the majority of individuals in the United States (i.e., 54.9%) used CAM in conjunction with conventional medicine. It is advisable for patients to inform their medical doctor when they are using alternative medicine, because some alternative treatments may interact with orthodox medical treatments, and such potential conflicts should be explored in the interest of the patient. However, many conventional practitioners are biased or uninformed about alternatives, and patients are often reluctant to share this information with their medical doctors since they fear it will hurt their doctor-patient relationship.The issue of alternative medicine interfering with conventional medical practices is minimized when it is turned to only after conventional treatments have been exhausted. Many patients feel that alternative medicine may help in coping with chronic illnesses for which conventional medicine offers no cure, only management. Over time, it has become more common for a patient's own MD to suggest alternatives when they cannot offer effective treatment.
Criticism of alternative medicine See also List of branches of alternative medicine for specific criticisms of different types of CAMAlternative medicine is commonly categorised together with complementary medicine under the umbrella term 'complementary and alternative medicine' (CAM for short). Some scientists reject this and the above classifications and to varying degrees reject the term "alternative medicine" itself. The following three commentators argue for classifying treatments based on the objectively verifiable criteria of the scientific method, not based on the changing curricula of various medical schools or social sphere of usage. They advocate a classification based on evidence-based medicine, i.e., scientifically proven evidence of efficacy (or lack thereof). According to them it is possible for a method to change categories (proven vs. nonproven) in either direction, based on increased knowledge of its effectiveness or lack thereof:
Proponents of alternative therapy have an obligation to provide grounds for biological plausibility, such as sound theoretical or preclinical data, or for clinical plausibility, in the form of authentic, well-prepared case reports, in order to justify the investment of time and energy in exploring the merits of a novel anticancer therapy. But plausibility, not proof, should be sufficient to initiate the process.In other words, proponents of CAMs argue that skeptics, in saying that theories or anecdotal and preclinical data do not constitute proof, merely state the obvious but do not actually engage in the evaluation of CAMs. Criticisms directed at specific branches of alternative medicine range from the fairly minor (conventional treatment is believed to be more effective in a particular area) to incompatibility with the known laws of physics (for example, in homeopathy). Critics argue that alternative medicine practitioners may not have an accredited medical degree or be licensed physicians or general practitioners and make sweeping claims without demonstrated expertise. This cannot always be considered a serious criticism, because unless a new system of medicine becomes established, it does not receive accreditation of any kind, except by its own professional organizations. This is the route homeopathy, ayurveda, siddha, unani, and naturopathy had to follow in those countries where it is now offered by accredited institutions. Proponents of the various forms of alternative medicine reject criticism as being founded in prejudice, financial self-interest, or ignorance. Refutations of criticism sometimes take the form of an appeal to nature.
Lack of proper testingAlthough proponents of alternative medicine often cite the large number of studies which have been performed, critics point out that there are no statistics on exactly how many of those studies were controlled, double blind, peer-reviewed experiments, or how many produced results supporting alternative medicine or parts thereof. They contend that many forms of alternative medicine are rejected by conventional medicine because the efficacy of the treatments has not been demonstrated through double-blind randomized controlled trials; in contrast, conventional drugs reach the market only after such trials have proved their efficacy. Some argue that less research is carried out on alternative medicine because many alternative medicine techniques cannot be patented, and hence there is little financial incentive to study them. Drug research, by contrast, can be very lucrative, which has resulted in funding of trials by pharmaceutical companies. Many people, including conventional and alternative medical practitioners, contend that this funding has led to corruption of the scientific process for approval of drug usage, and that ghostwritten work has appeared in major peer-reviewed medical journals.Larkin M. "Whose article is it anyway?" Lancet, 1999; 354:136. EditorialFlanagin A, Carey LA, Fontanarosa PB. "Prevalence of articles with honorary authors and ghost authors in peer-reviewed medical journals." JAMA, 1998; 280(3):222-4. Full text Increasing the funding for research of alternative medicine techniques was the purpose of the National Center for Complementary and Alternative Medicine. NCCAM and its predecessor, the Office of Alternative Medicine, have spent more than $200 million on such research since 1991. The German Federal Institute for Drugs and Medical Devices Commission E has studied many herbal remedies for efficacy.CSICOP.org article on alternative medicineSome skeptics of alternative practices point out 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.James Alcock PhD, Alternative Medicine and the Psychology of Belief, The Scientific Review of Alternative Medicine, Fall/Winter 1999 Volume 3 ~ Number 2. available online CAM proponents point out this may also apply in cases where conventional treatments have been used. To this, CAM critics point out that this does not account for conventional medical success in double blind clinical trials. CAM proponents, however, don't typically question conventional medical successes revealed in double blind clinical trials.
SafetyCritics contend that some people have been hurt or killed directly from the various practices or indirectly by failed diagnoses or the subsequent avoidance of conventional medicine. Proponents counter that harm from conventional medical practice, known as iatrogenesis, is a major cause of death and injury. Deaths have been reported, due to the use of alternative medicines such as colloidal silverMyoclonic status epilepticus following repeated oral ingestion of colloidal silver PMID 15111684.Alternative medicine critics agree with its proponents that people should be free to choose whatever method of healthcare they want, but stipulate that people must be informed as to the safety and efficacy of whatever method they choose. People who choose alternative medicine may think they are choosing a safe, effective medicine, while they may only be getting quack remedies. Grapefruit seed extract is an example of quackery when multiple studies demonstrate its universal antimicrobial effect is due to synthetic antimicrobial contamination.Ganzera M, Aberham A, Stuppner H. Development and validation of an HPLC/UV/MS method for simultaneous determination of 18 preservatives in grapefruit seed extract. Institute of Pharmacy, University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria. J Agric Food Chem. 2006 May 31;54(11):3768-72. AbstractTakeoka, G., Dao, L., Wong, R.Y., Lundin, R., Mahoney N. Identification of benzethonium chloride in commercial grapefruit seed extracts. J Agric Food Chem. 2001 49(7):3316-20. Abstractvon Woedtke, T., Schlüter, B., Pflegel, P., Lindequist, U.; Jülich, W.-D. Aspects of the antimicrobial efficacy of grapefruit seed extract and its relation to preservative substances contained. Pharmazie 1999 54:452-456. AbstractSakamoto, S., Sato, K., Maitani, T., Yamada, T. Analysis of components in natural food additive “grapefruit seed extract” by HPLC and LC/MS. Bull. Natl. Inst. Health Sci. 1996, 114:38-42. AbstractTakeoka, G.R., Dao, L.T., Wong, R.Y., Harden L.A. Identification of benzalkonium chloride in commercial grapefruit seed extracts. J Agric Food Chem. 2005 53(19):7630-6. Abstract
Delay in seeking conventional medical treatmentThose who have had 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. For this reason, critics contend that therapies that rely on the placebo effect to define success are very dangerous. According to Lilienfeld (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 consequences[http://www.srmhp.org/0101/raison-detre.html].
Danger can be increased when used as a complement to conventional medicineA Norwegian multicentre study examined the association between the use of alternative medicine and cancer survival. 515 patients using standard medical care for cancer were followed for eight years. 22% of those patients used alternative medicine concurrently with their standard care. The study revealed that death rates were 30% higher in alternative medicine users than in those who did not use alternative medicine (AM): "The use of AM seems to predict a shorter survival from cancer."Risberg T, et al. Does use of alternative medicine predict survival from cancer? Eur J Cancer 2003 Feb;39(3):372-7 [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&list_uids=12565991&dopt=Citation]Associate Professor Alastair MacLennan of the Department of Obstetrics and Gynaecology in Adelaide University, Australia reports that a patient of his almost bled to death on the operating table. She had failed to mention she had been taking "natural" potions to "build up her strength" for the operation - one of them turned out to be a powerful anticoagulant which nearly caused her death. [http://benhills.com/articles/articles/MED06a.html]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". [http://www.abc.net.au/rn/talks/8.30/helthrpt/stories/s195441.htm]
Danger from undesired side-effectsConventional treatments are subjected to testing for undesired side-effects, whereas alternative treatments generally are not subjected to such testing at all. However, any treatment — whether conventional or alternative — that has a biological or psychological impact on a patient may also have potentially dangerous biological or psychological side-effects. Nevertheless, 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".Homeopathy, however, is regarded as being safe in terms of such side effects since, according to known physics and chemistry, it cannot possibly have more effect on the patient than simple water does.
Danger related to self-medicationSimilar problems as those related to self-medication also apply to parts of alternative medicine. For example, an alternative medicine may instantly make symptoms better, but actually worsen problems in the long run. The result may be addiction and deteriorating health.
Issues of regulationCritics contend that some branches of alternative medicine are often not properly regulated in some countries to identify who practices or know what training or expertise they may possess. Critics argue that the governmental regulation of any particular alternative therapy does necessitate that the therapy is effective. The most sensible course in such a case could be to simply ensure that the sold treatment is not dangerous, but the problem would then remain to know if it does what its proponents say it does.
Explanations for the appeal of alternative medicineCritics cite both socio-cultural and psychological reasons to explain why people would chose to use alternative medicines in lieu of conventional medicine.Socio-cultural reasons cited include:
Integrative medicine Integrative medicine combines treatments from conventional medicine and CAM for which there is some high-quality evidence of safety and effectiveness United States National Institutes of Health, National Center for Complementary and Alternative Medicine. CAM at the NIH / Focus on Complementary and Alternative Medicine (newsletter), Volume XIV, No. 2 (Spring 2007), "New Integrative Medicine Consult Service Established". The main proponent of integrative medicine is Andrew T. Weil M.D., who founded the Program in Integrative Medicine at the University of Arizona in 1994 based on a phrase coined by Elson Haas, MD.
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