Complementary and Alternative medicine
In Western culture, alternative medicine is any healing practice "that does not fall within the realm of conventional medicine", or "that which has not been shown consistently to be effective." It is often opposed to evidence based medicine and encompasses therapies with an historical or cultural, rather than a scientific, basis. The American National Center for Complementary and Alternative Medicine (NCCAM) cites examples including naturopathy, chiropractic, herbalism, traditional Chinese medicine, Ayurveda, meditation, yoga, biofeedback, hypnosis, homeopathy, acupuncture, and nutritional-based therapies, in addition to a range of other practices. It is frequently grouped with complementary medicine, which generally refers to the same interventions when used in conjunction with mainstream techniques, under the umbrella term complementary and alternative medicine, or CAM. Some researchers in alternative medicine oppose this grouping, preferring to emphasise differences of approach, but nevertheless use the term CAM, which has become standard.
Complementary and alternative medicine practices are as diverse in their foundations as in their methodologies. Practices may incorporate or base themselves on traditional medicine, folk knowledge, spiritual beliefs, or newly conceived approaches to healing. Jurisdictions where complementary and alternative medical practices are sufficiently widespread may license and regulate them. The claims made by complementary and alternative medicine practitioners are generally not accepted by the medical community because evidence-based assessment of safety and efficacy is either not available or has not been performed for these practices. If scientific investigation establishes the safety and effectiveness of a complementary or alternative medical practice, whereupon it becomes mainstream medicine and is no longer "alternative", and may therefore become widely adopted by conventional practitioners. Because complementary and alternative techniques tend to lack evidence, or may even have repeatedly failed to work in tests, some have advocated defining it as non-evidence based medicine, or not medicine at all. Some researchers state that the evidence-based approach to defining complementary and alternative medicine is problematic because some complementary and alternative medicine is tested, and research suggests that many mainstream medical techniques lack solid 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. Complementary and alternative medicine varies from country to country. Edzard Ernst says that in Austria and Germany complementary and alternative medicine is mainly in the hands of physicians, while some estimates suggest that at least half of American complementary and alternative practitioners are physicians. In Germany, herbs are tightly regulated, with half prescribed by doctors and covered by health insurance based on their Commission E legislation.
Terms used in complementary and alternative medicine
The term "alternative medicine" is generally used to describe practices used independently or in place of conventional medicine. The 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" 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; advocates view such practices as the best examples of complementary medicine.
Ralph Snyderman and Andrew Weil state, "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 emphasises the centrality of the patient-physician relationship." The combination of orthodox and complementary medicine with an emphasis on prevention and lifestyle changes is known as integrated medicine.
Characterisation of complementary and alternative medicine
There is no clear and consistent definition for either alternative or complementary medicine. In Western culture it is often defined as any healing practice "that does not fall within the realm of conventional medicine", or "that which has not been shown consistently to be effective."
Self characterisation
The National Center for Complementary and Alternative Medicine (NCCAM) defines complementary and alternative medicine as "a group of diverse medical and health care systems, practices, and products, that are not currently part of conventional medicine." 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 which 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." 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. David M. Eisenberg, an integrative medicine researcher, defines it as "medical interventions not taught widely at US medical schools or generally available at US. hospitals," NCCAM states that formerly unproven remedies may be incorporated into conventional medicine if they are shown to be safe and effective.
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.
Scientific community
Institutions
The National Science Foundation has defined alternative medicine as "all treatments that have not been proven effective using scientific methods." The Institute of Medicine (IOM) in 2005 defined complementary and alternative medicine (CAM) as the non-dominant approach to medicine in a given culture and historical period. The Cochrane Collaboration, and official government bodies such as the UK Department of Health have adopted a similar definition. 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.
Scientists
Numerous mainstream scientists and physicians have commented on and criticised complementary and 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 which has been adequately tested and that which has not. They feel that health care 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 if it was considered alternative to begin with. 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).
Stephen Barrett, founder and operator of Quackwatch, argues that practices labelled "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 rational for effectiveness, and questionable as groundless without a scientifically plausible rationale. He has concerns that just because some "alternative" have merit, there is the impression that the rest deserve equal consideration and respect even though most are worthless. 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.
Edzard Ernst, professor of complementary medicine, characterises the evidence for many alternative techniques as weak, nonexistent, or negative, but states that evidence exists for others, in particular certain herbs and acupuncture.
Richard Dawkins, an evolutionary biologist, defines alternative medicine as a "set of practices which cannot be tested, refuse to be tested, or consistently fail tests." He says that if a technique is demonstrated effective in properly performed trials, it ceases to be alternative and simply becomes medicine.
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. 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. 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. R. Barker Bausell, a research methods expert and author of "Snake Oil Science" states that "it's become politically correct to investigate nonsense." There are concerns that just having NIH support is being used to give unfounded "legitimacy to treatments that are not legitimate."
Wallace Sampson, an editor of Scientific Review of Alternative Medicine and a Stanford University professor of medicine writes that complementary and alternative medicine 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 complementary and alternative medicine tolerates contradiction without through reason and experiment.
Popular press
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." 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."
Classifications of complementary and alternative medicine
NCCAM has developed one of the most widely used classification systems for the branches of complementary and alternative medicine. It classifies complementary and alternative therapies into five major groups, which have, some overlap.
- Whole medical systems: cut across more than one of the other groups; examples include Traditional Chinese medicine and Ayurveda.
- Mind-body medicine: takes a holistic approach to health that explores the interconnection between the mind, body, and spirit. It works under the premise that the mind can affect "bodily functions and symptoms".
- Biologically based practices: use substances found in nature such as herbs, foods, vitamins, and other natural substances.
- Manipulative and body-based practices: feature manipulation or movement of body parts, such as is done in chiropractic and osteopathic manipulation.
- Energy medicine: is a domain that deals with putative and verifiable energy fields:
- Biofield therapies are intended to influence energy fields that purportedly surround and penetrate the body. No empirical evidence has been found to support the existence of the putative energy fields on which these therapies are predicated.
- Bioelectromagnetic-based therapies use verifiable electromagnetic fields, such as pulsed fields, alternating-current or direct-current fields in an unconventional manner.
Usage of complementary and alternative medicine
Many people utilise mainstream medicine for diagnosis and basic information, while turning to alternatives for what they believe to be health-enhancing measures. Studies indicate that complementary and alternative approaches are often used in conjunction with conventional medicine. 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." According to Andrew T. Weil M.D., a leading proponent of integrative medicine, the principles of integrative medicine include: appropriate use of conventional, and complementary and/or alternative medicine methods; patient participation; promotion of health as well as treatment of disease; and a preference for natural, minimally-invasive methods. A 1997 survey found that 13.7% of respondents in the United States had sought the services of both a medical doctor and a complementary or alternative medicine practitioner. The same survey found that 96% of respondents who sought the services of a complementary or 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 complementary or alternative medical treatments as only 38.5% of the patient’s complementary or alternative therapies were discussed with their medical doctor.
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)." 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 complementary and alternative medicine 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. Another study suggests a similar figure of 40%. A British telephone survey by the BBC of 1209 adults in 1998 shows that around 20% of adults in Britain had used complementary or alternative medicine in the past 12 months. 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." In general, he believes that complementary and alternative medicine can and should be subjected to scientific testing.
The use of complementary and alternative medicine in developed countries appears to be increasing. A 1998 study showed that the use of complementary and alternative medicine had risen from 33.8% in 1990 to 42.1% in 1997. 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." 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 health care or be integrated into the health care system. In Africa, traditional medicine is used for 80% of primary health care, and in developing nations as a whole over one third of the population lack access to essential medicines.
Advocates of complementary and 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, Gonsalkorale 2003, and Berga 2003) 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.
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." 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." 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. Some mind-body techniques, such as cognitive-behavioural therapy, were once considered complementary medicine, but are now a part of conventional medicine in the Western World. "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."
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: 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.
United States
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:
- 74.6% had used some form of complementary and alternative medicine (CAM).
- 62.1% had done so within the preceding twelve months.
- When prayer specifically for health reasons is excluded, these figures fall to 49.8% and 36.0%, respectively.
- 45.2% had in the last twelve months used prayer for health reasons, either through praying for their own health or through others praying for them.
- 54.9% used CAM in conjunction with conventional medicine.
- 14.8% "sought care from a licensed or certified" practitioner, suggesting that "most individuals who use CAM prefer to treat themselves."
- Most people used CAM to treat and/or prevent musculoskeletal conditions or other conditions associated with chronic or recurring pain.
- "Women were more likely than men to use CAM. The largest sex differential is seen in the use of mind-body therapies including prayer specifically for health reasons".
- "Except for the groups of therapies that included prayer specifically for health reasons, use of CAM increased as education levels increased".
- The most common CAM therapies used in the US in 2002 were prayer (45.2%), herbalism (18.9%), breathing meditation (11.6%), meditation (7.6%), chiropractic medicine (7.5%), yoga (5.1%), body work (5.0%), diet-based therapy (3.5%), progressive relaxation (3.0%), mega-vitamin therapy (2.8%) and Visualization (2.1%)
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.
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 complementary and alternative medicine, followed by east north central states and those in the middle Atlantic. More than 70% of the hospitals offering complementary and alternative medicine were in urban areas.
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, organisations, and members of the science policymaking community, it commented that "nevertheless, the popularity of alternative medicine appears to be increasing."
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 utilised do not present "a safety risk for the patient that is unreasonably greater than the conventional treatment for the patient's medical condition."
Education in complementary and alternative medicine
In the United States, increasing numbers of medical colleges have started offering courses in alternative medicine. For example, 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 complementary or alternative medicine. 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 which "...neither rejects conventional medicine, nor embraces alternative practices uncritically." Accredited Naturopathic colleges and universities are also increasing in number and popularity in Canada and the USA.
Similarly "unconventional medicine courses are widely represented at European universities. They cover a wide range of therapies. Many of them are used clinically. Research work is underway at several faculties," but "only 40% of the responding [European] universities were offering some form of complementary and alternative medicine training."
In contrast to unconventional schools in Britain, no conventional medical schools offer courses that teach the clinical practice of alternative medicine. The British Medical Acupuncture Society offers medical acupuncture certificates to doctors, as does the College of Naturopathic Medicine UK and Ireland.
Regulation of complementary and alternative medicine
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. Dietary supplements, their ingredients, safety, and claims, are a continual source of controversy. 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. In other cases, controversy over mainstream medicine causes questions about the nature of a treatment, such as water fluoridation. 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. Government regulators continue to attempt to find a regulatory balance.
Jurisdiction differs concerning which branches of complementary and 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."
Specific implementations of this article are left to member states.
A number of complementary and 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. Complementary and alternative medicine providers recognise 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 health care products.
In New Zealand alternative medicine products are classified as food products, so there are no regulations or safety standards in place.
In Australia, the topic is termed as complementary medicine and the Therapeutic Goods Administration has issued various guidance and standards. Australian regulatory guidelines for complementary medicines (ARGCM) demands that the pesticides, fumigants, toxic metals, microbial toxins, radionuclides and microbial contaminations etc., present in herbal substances should be monitored, although the guidance does not request for the evidences of these traits. However, for the herbal substances in pharmacopoeial monographes, the detailed information should be supplied to relevant authorities
The production of modern pharmaceuticals is strictly regulated to ensure that medicines contain a standardised quantity of active ingredients and are free from contamination. Complementary and 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 complementary and alternative health products are vulnerable to adulteration and contamination. 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.
Alternative and evidence-based medicine
Testing of efficacy
Many complementary and 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 randomised controlled trial (RCT), and 23% had been assessed with a meta-analysis. According to a 2005 book by a US Institute of Medicine panel, the number of RCTs focused on complementary and alternative medicine has risen dramatically. The book cites Vickers (1998), who found that many of the complementary and alternative medicine-related RCTs are in the Cochrane register, but 19% of these trials were not in MEDLINE, and 84% were in conventional medical journals.
As of 2005 the Cochrane Library had 145 complementary and alternative medicine-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 complementary and alternative medicine, 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 complementary and alternative medicine review used the 2004 Cochrane database while the conventional review used the 1998 Cochrane database.
Most complementary and alternative medical treatments are not patentable, which may lead to less research funded by the private sector. Additionally, 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. Some have proposed adopting a prize system to reward medical research. However, public funding for research exists. Increasing the funding for research of alternative medicine techniques was 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 $1 billion on such research since 1992.
Some sceptics 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.
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.
In 2009 the complaints of critics were vindicated by the highly publicised negative results of ten years of big studies funded by the National Center for Complementary and Alternative Medicine (formerly OAM):
"Ten years ago the government set out to test herbal and other alternative health remedies to find the ones that work. After spending $2.5 billion, the disappointing answer seems to be that almost none of them do."
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. In this article, clinical trial data on a number of alternative cancer cures including Livingston-Wheeler, Di Bella Multitherapy, antineoplastons, vitamin C, hydrazine sulfate, Laetrile, and psychotherapy are reviewed. The label "unproven" is inappropriate for such therapies; it is time to assert that many alternative cancer therapies have been "disproven."
Testing of safety
Interactions with conventional pharmaceuticals
Forms of complementary and 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. 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.
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".
Potential side-effects
Conventional treatments are subjected to testing for undesired side-effects, whereas complementary and alternative treatments generally 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 potentially 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." 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.
Treatment delay
Those who have experienced or perceived success with one complementary or 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 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.
A 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):
"Death rates were higher in AM users (79%) than in those who did not use AM (65%).... The use of AM seems to predict a shorter survival from cancer."
A commentary on the Norwegian study by The Cancer Center stated:
"This clinical trial appears to be the first study demonstrating a negative relationship between use of CAM and survival of cancer patients. The researchers hypothesised that this relationship may be due to an unknown prognostic factor, and suggested it was not due to CAM therapies, which they considered rather innocuous overall. The authors concluded that these results suggest patients may estimate the gravity of their situation more accurately than their physicians."
Appeal of complementary and alternative medicine
A study published in 1998 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 who 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 health care 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 - notably 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 whose use them in lieu of conventional medicine. There are several socio-cultural reasons for the interest in these treatments centred around the low level of scientific literacy among the public at large and a concomitant increase in antiscientific attitudes and new age mysticism. Related to this are vigorous marketing of extravagant claims by the complementary and alternative medical community combined with inadequate media scrutiny and attacks on critics. There is also an increase in conspiracy theories towards 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 complementary and alternative medicine to treat a variety of ailments. Many patients lack access to contemporary medicine, due to a lack of private or public health insurance, which lead them to seek out lower-cost alternative medicine. Medical doctors are also aggressively marketing complementary and alternative medicine to profit from this market.
In addition to the social-cultural underpinnings of the popularity complementary and 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. Related to it are similar psychological effects such as the will to believe, cognitive biases that help maintain self-esteem and promote harmonious social functioning, and the post hoc, ergo propter hoc fallacy. 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 potentially cause life-threatening anaphylactic reactions in a very few individuals. More commonly, many medications may cause minor but bothersome symptoms such as cough or upset stomach. In all of these cases, patients may be seeking out complementary or alternative treatments to avoid the adverse effects of conventional treatments.
Its popularity may be related to other factors. In an interview with Edzard Ernst, The Independent wrote:
"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."
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