Category Archives: Alternative Medicine

Complementary and alternative medicine might make you think of pungent herbal teas, chanting, or meditation. In fact, both herbal remedies and meditation, as well as dozens of other treatments, fall under the heading of complementary and alternative medicine (CAM).

Although there is no strict definition of CAM, it generally includes any healing practices that are not part of mainstream medicine that means any practice that is not widely taught in medical schools or frequently used by doctors or in hospitals.

Both alternative and complementary medicine use the same kinds of remedies to treat health conditions. The difference is that alternative medicine is used instead of conventional medical treatments and therapies. Complementary medicine is used in addition to conventional medical treatments and therapies, not as a replacement.

The boundaries of CAM in the United States are constantly changing as different types of care become more accepted by doctors and more requested by patients. A few practices (such as hypnosis) that were dismissed as nonsense 20 years ago are now considered helpful therapies in addition to traditional medicine.

So, are there any complementary health approaches that might beright for your family?

In the United States, the lead agency that's charged with scientific research into CAM is the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH). NIH classifies two general areas of complementary and alternative care:

In addition to these different practices, CAM can refer to different types of medical philosophies. These alternative medical systems are entire fields of theory and practice, and many date back to centuries before the conventional medicine we use in the West today. Examples of alternative medical systems include traditional Chinese medicine (TCM), Ayurveda, homeopathic medicine, and naturopathic medicine.

Alternative medical systems incorporate many of the practices listed above into their treatments. For example, the TCM practice of acupuncture may be combined with herbal medicine and qi gong. And Ayurveda includes the mind-body therapies of meditation and yoga, along with the practice of taking specific herbs for health reasons.

Some CAM practices are supported by scientific research, while others have not been fullystudied yet. Sometimes experts have scientific evidence that a CAM practice (like acupuncture) works, but they don't have a clear understanding as to why it works.

CAM is frequently distinguished by its holistic methods, which means that the doctor or practitioner treats the "whole" person and not just the disease or condition. With CAM, many practitioners also address patients' emotional and spiritual needs. This "high touch" approach differs from the "high tech" practice of traditional medicine, which tends to concentrate on the physical side of an illness.

CAM is starting to make its way into mainstream hospitals and doctors' offices. New centers for integrative medicine offer a mix of traditional and complementary treatments. There, you might receive a prescription for pain medication (as you might get from a traditional health care provider) and massage therapy to treat a chronic back problem. Such centers usually employ both medical doctors and certified or licensed specialists in the various CAM therapies.

Despite the growth of the field, complementary health approaches usually are not covered by medical insurance. This is largely because few scientific studies have been done to prove whether the treatments are effective (unlike traditional medicine, which relies heavily on studies). Rather, most CAM therapies are based on longstanding practice and word-of-mouth stories of success.

The lack of scientific study means that some potential problems associated with CAM therapies may be difficult to identify. What's more, almost all of the studies that have been done involved adults as test subjects; there is little research on the effects of CAM on children. Although approaches such as prayer, massage, and yoga are generally considered safe complements to regular medical treatment, some therapies particularly herbal remedies and other dietary supplements might have risks.

Unlike prescription and over-the-counter (OTC) medicines, dietary supplements are not rigorously regulated by the U.S.Food and Drug Administration (FDA). They face no extensive tests before they are marketed and they do not have to meet quality standards. That means when you buy an herbal supplement like ginseng you might not know what you're getting: The amount of the ingredient may be more or less than what is stated on the label; the herb may not be the right plant species; or the supplement may be contaminated with other herbs, pesticides, metals, or other ingredients like prescription drugs.

"Natural" does not equal "safe," and many parents don't realize that some supplements can actually cause health problems for their kids. For example, certain herbal supplements can cause high blood pressure, liver damage, or allergic reactions. Talk to your doctor before giving your child any dietary supplement.

Parents might also give their kids much more of an herb than recommended, thinking that because it's natural, higher doses won't hurt. But many plants contain potent chemicals; approximately 25% of all prescription drugs are derived from plants.

Choosing a practitioner can pose another problem. Although many states have licensing boards for specialists in acupuncture or massage, for instance, there is no organization in the United States that monitors alternative care providers or establishes standards of treatment. Basically, almost anyone can claim to be a practitioner, whether he or she has any training.

Perhaps the greatest risk, however, is the potential for people to delay or stop traditional medical treatment in favor of an alternative therapy. Illnesses such as diabetes and cancer require the care of a doctor. Relying entirely on alternative therapies for any serious chronic or acute conditions can jeopardize a child's health.

Many parents turn to a cup of chamomile tea or ginger as a wayto soothe symptoms of the flu or an upset stomach. Anxious kids can learn to relax with the help of meditation or yoga. Some CAM therapies may be helpful for a child when used to complement traditional care.

If you want to try CAM for your child, talk with your doctor or pharmacist to make sure it is safe and will not conflict with any traditional care your child receives. Your doctor also can give you information about treatment options and perhaps recommend a reputable practitioner.

By coordinating complementary approaches with traditional care, you don't have to choose between them. Instead, you can get the best of both.

Date reviewed: March 2014

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Complementary and Alternative Medicine - KidsHealth

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Complementary and Alternative Medicine

It seems alternative medicine is sweeping the country. Newspapers, magazines, books, TV -- it's starting to look like a fad. But the truth is, alternative medical treatments have been around in this country for centuries and promise to be with us for as long as people need healing.

There are traditions that go back millennia, and there are relatively new schools of thought based on recent discoveries. Some are still the primary health care systems in their native lands, and some have struggled to be recognized throughout their existence. The one thing they have in common, though, is that in this country, they have been relegated to the margins of medicine.

To understand what alternative medicine is, you have to know what it's an alternative to. In the United States, the medical establishment consists of a system of medical schools, hospitals, and M.D.s that many would call traditional medicine. But there is really nothing traditional about it. In fact, traditional medicine would be a better description of many of the alternative therapies in this article -- time-honored beliefs and practices relied on for generations.

Conventional would be a better word to describe modern Western medicine, often called allopathic medicine. It is predominant in most of the Western world because it is the convention, the mode of thinking that is currently in vogue. That is not to say that allopathic medicine is just a fad. It is a valuable resource for health and healing, but it is not the only one. It is one system among many.

All of this may seem like a pointless discussion of words -- allopathic, alternative, conventional, traditional -- but the way we talk about them can mean a great deal. People's access to health care options -- and even who will pay for what -- depends on what people say about different modes of therapy.

However, more and more, patients, insurance companies, and even conventional doctors are recognizing the value of alternative therapies. Meditation managing high blood pressure without drugs, biofeedback treating bowel disorders without surgery, and mind/body medicine giving hope and quality of life to the terminally ill are just a few examples of the benefits of alternative medicine that conventional medicine simply cannot offer.

Nothing can replace a well-informed health care consumer, and no one knows this better than doctors and practitioners. Knowing your options is part of being well informed, but so is communicating with your practitioner effectively. In the pages that follow, you will dozens of articles describing how to treat various conditions with alternative medicine. Use these articles to access information and practitioners; use it to discuss options with your health care provider; share it with family and friends who might be looking for alternatives. Become well-informed and turn that power into good health. Let's get started on the next page with an examination of alternative medicines for women's health issues.

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Alternative Medicine | HowStuffWorks

Introduction

Definitions

What Is Alternative Medicine?

What is Complementary Medicine?

What is Holistic Medicine?

What is Natural Medicine?

HolisticOnLine Philosophy

What is the Difference Between Conventional and Holistic Medicine?

How Popular Is Alternative Medicine?

Classification of Alternative Systems of Medical Practice

Some of the alternative therapies currently under study with grants from NIH

Approaching Complementary and Alternative Therapies

Assess the Safety and Effectiveness of the Therapy

Examine the Practitioner's Expertise

Consider the Service Delivery

Consider the Costs

Consult Your Health Care Provider

Guest Articles

Integrative Medicine And Its FutureThe balance between conventional medicine and alternative medicine is a delicate one. Right now, both schools of thought refuse to work together, and the general public is who suffers. (12/2004)

Alternative and Complementary Medicine Therapies Home

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Home, Alternative Medicine, Complementary Medicine ...

Herbalism (also herbology or herbal medicine) is use of plants for medicinal purposes, and the study of botany for such use. Plants have been the basis for medical treatments through much of human history, and such traditional medicine is still widely practiced today. Modern medicine recognizes herbalism as a form of alternative medicine, as the practice of herbalism is not strictly based on evidence gathered using the scientific method. Modern medicine, does, however, make use of many plant-derived compounds as the basis for evidence-tested pharmaceutical drugs, phytotherapy, and phytochemistry works to apply modern standards of effectiveness testing to herbs and medicines that are derived from natural sources. The scope of herbal medicine is sometimes extended to include fungal and bee products, as well as minerals, shells and certain animal parts.

Archaeological evidence indicates that the use of medicinal plants dates at least to the Paleolithic, approximately 60,000 years ago. Written evidence of herbal remedies dates back over 5,000 years, to the Sumerians, who created lists of plants. A number of ancient cultures wrote about plants and their medical uses in books called herbals. In ancient Egypt, herbs are mentioned in Egyptian medical papyri, depicted in tomb illustrations, or on rare occasions found in medical jars containing trace amounts of herbs.[1] Among the oldest, lengthiest, and most important medical papyri of ancient Egypt is the Ebers Papyrus dating from about 1550 BC, and covering more than 700 drugs, mainly of plant origin.[2] The earliest known Greek herbals were those of Theophrastus of Eresos who in the 4th c. B.C. wrote in Greek Historia Plantarum, of Diocles of Carystus who wrote during the 3rd century B.C, and of Krateuas who wrote in the 1st century B.C. Only a few fragments of these works have survived intact, but from what remains scholars have noted that there is a large amount of overlap with the Egyptian herbals.[3] Seeds likely used for herbalism have been found in the archaeological sites of Bronze Age China dating from the Shang Dynasty.[4] Over a hundred of the 224 drugs mentioned in the Huangdi Neijing, an early Chinese medical text, are herbs.[5] Herbs were also common in the medicine of ancient India, where the principal treatment for diseases was diet.[6]De Materia Medica, originally written in Greek, by Pedanius Dioscorides ( ; c. 40 90 AD) of Anazarbus, Cilicia, a Greek physician, pharmacologist and botanist, is a particularly important example of such writings.[7] The documentation of herbs and their uses was a central part of both Western and Eastern medical scholarship through to the 1600s, and these works played an important role in the development of the science of botany.

The World Health Organization (WHO) estimates that 80 percent of the population of some Asian and African countries presently use herbal medicine for some aspect of primary health care.[8] Pharmaceuticals are prohibitively expensive for most of the world's population, half of whom lived on less than $2 U.S. per day in 2002.[9] In comparison, herbal medicines can be grown from seed or gathered from nature for little or no cost.

Many of the pharmaceuticals currently available to physicians have a long history of use as herbal remedies, including opium, aspirin, digitalis, and quinine. According to the World Health Organization, approximately 25% of modern drugs used in the United States have been derived from plants.[10] At least 7,000 medical compounds in the modern pharmacopoeia are derived from plants.[11] Among the 120 active compounds currently isolated from the higher plants and widely used in modern medicine today, 80% show a positive correlation between their modern therapeutic use and the traditional use of the plants from which they are derived.[12]

In 2015 the Australian Government's Department of Health published the results of a review of alternative therapies that sought to determine if any were suitable for being covered by health insurance; Herbalism was one of 17 topics evaluated for which no clear evidence of effectiveness was found.[13]

In a 2010 survey of the most common 1000 plant-derived compounds, only 156 had clinical trials published. Preclinical studies (tissue-culture and animal studies) were reported for about one-half of the plant products, while 12% of the plants, although available in the Western market, had "no substantial studies" of their properties. Strong evidence was found that 5 were toxic or allergenic, so that their use ought to be discouraged or forbidden. Nine plants had considerable evidence of therapeutic effect.[14]

According to Cancer Research UK, "there is currently no strong evidence from studies in people that herbal remedies can treat, prevent or cure cancer".[15]

The U.S. National Center for Complementary and Integrative Health of the National Institutes of Health funds clinical trials of the effectiveness of herbal medicines and provides fact sheets summarizing the effectiveness and side effects of many plant-derived preparations.[16]

The use of herbal remedies is more prevalent in patients with chronic diseases such as cancer, diabetes, asthma and end-stage renal disease.[17][18][19] Multiple factors such as gender, age, ethnicity, education and social class are also shown to have association with prevalence of herbal remedies use.[20]

A survey released in May 2004 by the National Center for Complementary and Integrative Health focused on who used complementary and alternative medicines (CAM), what was used, and why it was used. The survey was limited to adults, aged 18 years and over during 2002, living in the United States. According to this survey, herbal therapy, or use of natural products other than vitamins and minerals, was the most commonly used CAM therapy (18.9%) when all use of prayer was excluded.[21][22]

Herbal remedies are very common in Europe. In Germany, herbal medications are dispensed by apothecaries (e.g., Apotheke). Prescription drugs are sold alongside essential oils, herbal extracts, or herbal teas. Herbal remedies are seen by some as a treatment to be preferred to pure medical compounds that have been industrially produced.[23]

In India the herbal remedy is so popular that the government of India has created a separate departmentAYUSHunder the Ministry of Health & Family Welfare. The National Medicinal Plants Board was also established in 2000 by the Indian government in order to deal with the herbal medical system.[24]

There are many forms in which herbs can be administered, the most common of which is in the form of a liquid that is drunk by the patienteither an herbal tea or a (possibly diluted) plant extract.[25] Whole herb consumption is also practiced either fresh, in dried form or as fresh juice.[citation needed]

Several methods of standardization may be determining the amount of herbs used. One is the ratio of raw materials to solvent. However different specimens of even the same plant species may vary in chemical content. For this reason, thin layer chromatography is sometimes used by growers to assess the content of their products before use. Another method is standardization on a signal chemical.[26]

Herbal teas, or tisanes, are the resultant liquid of extracting herbs into water, though they are made in a few different ways. Infusions are hot water extracts of herbs, such as chamomile or mint, through steeping. Decoctions are the long-term boiled extracts, usually of harder substances like roots or bark. Maceration is the old infusion of plants with
high mucilage-content, such as sage, thyme, etc. To make macerates, plants are chopped and added to cold water. They are then left to stand for 7 to 12 hours (depending on herb used). For most macerates 10 hours is used.[27]

Tinctures are alcoholic extracts of herbs, which are generally stronger than herbal teas.[28] Tinctures are usually obtained by combining 100% pure ethanol (or a mixture of 100% ethanol with water) with the herb. A completed tincture has an ethanol percentage of at least 25% (sometimes up to 90%).[27] Herbal wine and elixirs are alcoholic extract of herbs, usually with an ethanol percentage of 12-38%.[27] Herbal wine is a maceration of herbs in wine, while an elixir is a maceration of herbs in spirits (e.g., vodka, grappa, etc.).[29]Extracts include liquid extracts, dry extracts, and nebulisates. Liquid extracts are liquids with a lower ethanol percentage than tinctures. They are usually made by vacuum distilling tinctures. Dry extracts are extracts of plant material that are evaporated into a dry mass. They can then be further refined to a capsule or tablet.[27] A nebulisate is a dry extract created by freeze-drying.[citation needed]Vinegars are prepared in the same way as tinctures, except using a solution of acetic acid as the solvent.[citation needed]Syrups are extracts of herbs made with syrup or honey. Sixty-five parts of sugar are mixed with thirty-five parts of water and herb. The whole is then boiled and macerated for three weeks.[27]

The exact composition of an herbal product is influenced by the method of extraction. A tea will be rich in polar components because water is a polar solvent. Oil on the other hand is a non-polar solvent and it will absorb non-polar compounds. Alcohol lies somewhere in between.[25]

Many herbs are applied topically to the skin in a variety of forms. Essential oil extracts can be applied to the skin, usually diluted in a carrier oil. Many essential oils can burn the skin or are simply too high dose used straight; diluting them in olive oil or another food grade oil such as almond oil can allow these to be used safely as a topical.[30][unreliable source?] Salves, oils, balms, creams and lotions are other forms of topical delivery mechanisms. Most topical applications are oil extractions of herbs. Taking a food grade oil and soaking herbs in it for anywhere from weeks to months allows certain phytochemicals to be extracted into the oil. This oil can then be made into salves, creams, lotions, or simply used as an oil for topical application. Many massage oils, antibacterial salves, and wound healing compounds are made this way. One can also make a poultice or compress using the whole herb or the appropriate part of the plant, which is usually crushed or dried and re-hydrated with a small amount of water and then applied directly in a bandage, cloth, or just as is.[citation needed]

Inhalation, as in aromatherapy, can be used as a mood changing treatment[31][32] to fight a sinus infection or cough [33][citation needed], or to cleanse the skin on a deeper level (steam rather than direct inhalation here)[citation needed]

A number of herbs are thought to be likely to cause adverse effects.[34] Furthermore, "adulteration, inappropriate formulation, or lack of understanding of plant and drug interactions have led to adverse reactions that are sometimes life threatening or lethal.[35]" Proper double-blind clinical trials are needed to determine the safety and efficacy of each plant before they can be recommended for medical use.[36] Although many consumers believe that herbal medicines are safe because they are "natural", herbal medicines and synthetic drugs may interact, causing toxicity to the patient. Herbal remedies can also be dangerously contaminated, and herbal medicines without established efficacy, may unknowingly be used to replace medicines that do have corroborated efficacy.[37]

Standardization of purity and dosage is not mandated in the United States, but even products made to the same specification may differ as a result of biochemical variations within a species of plant.[38] Plants have chemical defense mechanisms against predators that can have adverse or lethal effects on humans. Examples of highly toxic herbs include poison hemlock and nightshade.[39] They are not marketed to the public as herbs, because the risks are well known, partly due to a long and colorful history in Europe, associated with "sorcery", "magic" and intrigue.[40] Although not frequent, adverse reactions have been reported for herbs in widespread use.[41] On occasion serious untoward outcomes have been linked to herb consumption. A case of major potassium depletion has been attributed to chronic licorice ingestion.,[42] and consequently professional herbalists avoid the use of licorice where they recognize that this may be a risk. Black cohosh has been implicated in a case of liver failure.[43] Few studies are available on the safety of herbs for pregnant women,[44] and one study found that use of complementary and alternative medicines are associated with a 30% lower ongoing pregnancy and live birth rate during fertility treatment.[45] Examples of herbal treatments with likely cause-effect relationships with adverse events include aconite, which is often a legally restricted herb, ayurvedic remedies, broom, chaparral, Chinese herb mixtures, comfrey, herbs containing certain flavonoids, germander, guar gum, liquorice root, and pennyroyal.[46] Examples of herbs where a high degree of confidence of a risk long term adverse effects can be asserted include ginseng, which is unpopular among herbalists for this reason, the endangered herb goldenseal, milk thistle, senna, against which herbalists generally advise and rarely use, aloe vera juice, buckthorn bark and berry, cascara sagrada bark, saw palmetto, valerian, kava, which is banned in the European Union, St. John's wort, Khat, Betel nut, the restricted herb Ephedra, and Guarana.[35]

There is also concern with respect to the numerous well-established interactions of herbs and drugs.[35] In consultation with a physician, usage of herbal remedies should be clarified, as some herbal remedies have the potential to cause adverse drug interactions when used in combination with various prescription and over-the-counter pharmaceuticals, just as a patient should inform a herbalist of their consumption of orthodox prescription and other medication.

For example, dangerously low blood pressure may result from the combination of an herbal remedy that lowers blood pressure together with prescription medicine that has the same effect. Some herbs may amplify the effects of anticoagulants.[47] Certain herbs as well as common fruit interfere with cytochrome P450, an enzyme critical to much drug metabolism.[48]

A 2013 study published in the journal BMC Medicine found that one-third of herbal supplements sampled contained no trace of the herb listed on the label. The study found products adulterated with filler including allergens such as soy, wheat, and black walnut. One bottle labeled as St. John's Wort was found to actually contain Alexandrian senna, a laxative.[49]

Researchers at the University of Adelaide found in 2014 that almost 20 per cent of herbal remedies surveyed were not registered with the Therapeutic Goods Administration, despite this being a condition for their sale. They also found that nearly 60 per cent of products surveyed had ingredients that did not match what was on the label. Out of 121 products, only 15 had ingredients that matched their TGA listing and packaging.[50]

In 2015 the New York Attorney General issued cease and desist
letters to four major U.S. retailers (GNC, Target, Walgreens, and Walmart) who are accused of selling herbal supplements that were mislabeled and potentially dangerous. 24 products were tested by DNA barcoding as part of the investigation, all but five contained DNA that did not match the products' labels. The investigation was prompted by the 2013 BMC study.[51][52]

A herbalist is:[53][54][55]

Herbalists must learn many skills, including the wildcrafting or cultivation of herbs, diagnosis and treatment of conditions or dispensing herbal medication, and preparations of herbal medications. Education of herbalists varies considerably in different areas of the world. Lay herbalists and traditional indigenous medicine people generally rely upon apprenticeship and recognition from their communities in lieu of formal schooling.

In some countries formalized training and minimum education standards exist, although these are not necessarily uniform within or between countries. For example, in Australia the currently self-regulated status of the profession (as of April 2008) results in different associations setting different educational standards, and subsequently recognising an educational institution or course of training. The National Herbalists Association of Australia is generally recognised as having the most rigorous professional standard within Australia.[56] In the United Kingdom, the training of medical herbalists is done by state funded Universities. For example, Bachelor of Science degrees in herbal medicine are offered at Universities such as University of East London, Middlesex University, University of Central Lancashire, University of Westminster, University of Lincoln and Napier University in Edinburgh at the present.[citation needed]

The World Health Organization (WHO), the specialized agency of the United Nations (UN) that is concerned with international public health, published Quality control methods for medicinal plant materials in 1998 in order to support WHO Member States in establishing quality standards and specifications for herbal materials, within the overall context of quality assurance and control of herbal medicines.[57]

In the European Union (EU), herbal medicines are now regulated under the European Directive on Traditional Herbal Medicinal Products.

In the United States, herbal remedies are regulated dietary supplements by the Food and Drug Administration under current good manufacturing practice (cGMP) policy for dietary supplements.[citation needed] Manufacturers of products falling into this category are not required to prove the safety or efficacy of their product so long as they don't make 'medical' claims or imply being other than for 'dietary supplement' use, though the FDA may withdraw a product from sale should it prove harmful.[58][59]

The National Nutritional Foods Association, the industry's largest trade association, has run a program since 2002, examining the products and factory conditions of member companies, giving them the right to display the GMP (Good Manufacturing Practices) seal of approval on their products.[citation needed]

Some herbs, such as cannabis and coca, are outright banned in most countries though coca is legal in most of the South American countries where it is grown. The Cannabis plant is used as an herbal medicine, and as such is legal in some parts of the world. Since 2004, the sales of ephedra as a dietary supplement is prohibited in the United States by the Food and Drug Administration.,[60] and subject to Schedule III restrictions in the United Kingdom.

Native Americans medicinally used about 2,500 of the approximately 20,000 plant species that are native to North America.[61]

Some researchers trained in both western and traditional Chinese medicine have attempted to deconstruct ancient medical texts in the light of modern science. One idea is that the yin-yang balance, at least with regard to herbs, corresponds to the pro-oxidant and anti-oxidant balance. This interpretation is supported by several investigations of the ORAC ratings of various yin and yang herbs.[62][63]

In India, Ayurvedic medicine has quite complex formulas with 30 or more ingredients, including a sizable number of ingredients that have undergone "alchemical processing", chosen to balance "Vata", "Pitta" or "Kapha".[64][65]

In Ladakh, Lahul-Spiti and Tibet, the Tibetan Medical System is prevalent, also called the 'Amichi Medical System'. Over 337 species of medicinal plants have been documented by C.P. Kala. Those are used by Amchis, the practitioners of this medical system.[66][67]

In Tamil Nadu, Tamils have their own medicinal system now popularly called Siddha medicine. The Siddha system is entirely in the Tamil language. It contains roughly 300,000 verses covering diverse aspects of medicine. This work includes herbal, mineral and metallic compositions used as medicine. Ayurveda is in Sanskrit, but Sanskrit was not generally used as a mother tongue and hence its medicines are mostly taken from Siddha and other local traditions.[68]

In Indonesia, especially among the Javanese, the jamu traditional herbal medicine is an age old tradition preserved for centuries. Jamu is thought to have originated in the Mataram Kingdom era, some 1300 years ago.[69] The bas-reliefs on Borobudur depicts the image of people ground herbs with stone mortar and pestle, drink seller, physician and masseuse treating their clients.[70] All of these scenes might be interpreted as a traditional herbal medicine and health-related treatments in ancient Java. The Madhawapura inscription from Majapahit period mentioned a specific profession of herbs mixer and combiner (herbalist), called Acaraki.[70] The medicine book from Mataram dated from circa 1700 contains 3,000 entries of jamu herbal recipes, while Javanese classical literature Serat Centhini (1814) describes some jamu herbal concoction recipes.[70]

Though highly possible influenced by Indian Ayurveda system, Indonesia is a vast archipelago with numerous indigenous plants not to be found in India, which include plants similar to Australia beyond the Wallace Line. Indonesians might experimented and figure out the medicinal uses of these native herbal plants. Jamu may vary from region to region, and often not written down, especially in remote areas of the country.[71] Although primarily herbal, materials acquired from animals, such as honey, royal jelly, milk and ayam kampung eggs are also often used in jamu.

According to Eisenburg: The Chinese and Western medical models are like two frames of reference in which identical phenomena are studied. Neither frame of reference provides an unobstructed view of health and illness. Each is incomplete and in need of refinement." Specifically, the traditional Chinese medical model could effect change on the recognized, and expected, phenomena of detachment to patients as people and estrangement unique to the clinical and impersonal relationships between patient and physician of the Western school of medicine.[72]

Four approaches to the use of plants as medicine include:[73]

1. The magical/shamanicAlmost all societies, with the exception of cultures influenced by Western-style industrialization, recognize this kind of use. The practitioner is regarded as endowed with gifts or powers that allow him/her to use herbs in a way that is hidden from the average person, and the herbs are said to affect the spirit or soul of the person.

2. The energeticThis approach includes the major systems of Traditional Chinese Medicine, Ayurveda, and Unani. He
rbs are regarded as having actions in terms of their energies and affecting the energies of the body. The practitioner may have extensive training, and ideally be sensitive to energy, but need not have supernatural powers.

3. The functional dynamicThis approach was used by early physiomedical practitioners, whose doctrine forms the basis of contemporary practice in the UK. Herbs have a functional action, which is not necessarily linked to a physical compound, although often to a physiological function, but there is no explicit recourse to concepts involving energy.

4. The chemicalModern practitioners - called Phytotherapists - attempt to explain herb actions in terms of their chemical constituents. It is generally assumed that the specific combination of secondary metabolites in the plant are responsible for the activity claimed or demonstrated, a concept called synergy.

Herbalists tend to use extracts from parts of plants, such as the roots or leaves but not isolate particular phytochemicals.[74] Pharmaceutical medicine prefers single ingredients on the grounds that dosage can be more easily quantified. It is also possible to patent single compounds, and therefore generate income. Herbalists often reject the notion of a single active ingredient, arguing that the different phytochemicals present in many herbs will interact to enhance the therapeutic effects of the herb and dilute toxicity.[75] Furthermore, they argue that a single ingredient may contribute to multiple effects. Herbalists deny that herbal synergism can be duplicated with synthetic chemicals They argue that phytochemical interactions and trace components may alter the drug response in ways that cannot currently be replicated with a combination of a few potentially active ingredients.[76][77] Pharmaceutical researchers recognize the concept of drug synergism but note that clinical trials may be used to investigate the efficacy of a particular herbal preparation, provided the formulation of that herb is consistent.[78]

In specific cases the claims of synergy[79] and multifunctionality[80] have been supported by science. The open question is how widely both can be generalized. Herbalists would argue that cases of synergy can be widely generalized, on the basis of their interpretation of evolutionary history, not necessarily shared by the pharmaceutical community. Plants are subject to similar selection pressures as humans and therefore they must develop resistance to threats such as radiation, reactive oxygen species and microbial attack in order to survive.[81] Optimal chemical defenses have been selected for and have thus developed over millions of years.[82] Human diseases are multifactorial and may be treated by consuming the chemical defences that they believe to be present in herbs. Bacteria, inflammation, nutrition and ROS (reactive oxygen species) may all play a role in arterial disease.[83] Herbalists claim a single herb may simultaneously address several of these factors. Likewise a factor such as ROS may underlie more than one condition.[84] In short herbalists view their field as the study of a web of relationships rather than a quest for single cause and a single cure for a single condition.

In selecting herbal treatments herbalists may use forms of information that are not applicable to pharmacists. Because herbs can moonlight as vegetables, teas or spices they have a huge consumer base and large-scale epidemiological studies become feasible. Ethnobotanical studies are another source of information.[85] For example, when indigenous peoples from geographically dispersed areas use closely related herbs for the same purpose that is taken as supporting evidence for its efficacy.[citation needed] Herbalists contend that historical medical records and herbals are underutilized resources.[86] They favor the use of convergent information in assessing the medical value of plants. An example would be when in-vitro activity is consistent with traditional use.

Indigenous healers often claim to have learned by observing that sick animals change their food preferences to nibble at bitter herbs they would normally reject.[87] Field biologists have provided corroborating evidence based on observation of diverse species, such as chickens, sheep, butterflies, and chimpanzee.The habit has been shown to be a physical means of purging intestinal parasites. Lowland gorillas take 90% of their diet from the fruits of Aframomum melegueta, a relative of the ginger plant, that is a potent antimicrobial and apparently keeps shigellosis and similar infections at bay.[88] Current research focuses on the possibility that this plants also protects gorillas from fibrosing cardiomyopathy which has a devastating effect on captive animals.[89]

Sick animals tend to forage plants rich in secondary metabolites, such as tannins and alkaloids.[90] Since these phytochemicals often have antiviral, antibacterial, antifungal and antihelminthic properties, a plausible case can be made for self-medication by animals in the wild.[88]

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Herbalism - Wikipedia, the free encyclopedia

Complementary and alternative medicine

What's considered an alternative therapy is a moving target. Get the facts about what CAM means and its changing role in health care.

Complementary and alternative medicine has never been more popular. Nearly 40 percent of adults report using complementary and alternative medicine, also called CAM for short. Doctors are embracing CAM therapies, too, often combining them with mainstream medical therapies spawning the term "integrative medicine."

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

Keep in mind that the distinctions between therapies aren't always clear-cut, and some systems use techniques from more than one category.

A system isn't just a single practice or remedy such as massage but many practices that center on a philosophy, such as the power of nature or the presence of energy in your body. Examples of whole medical systems include:

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

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

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Complementary and alternative medicine - Mayo Clinic

What is alternative medicine? Alternative medicine practices are used instead of standard medical treatments. Alternative medicine is distinct from complementary medicine which is meant to accompany, not to replace, standard medical practices. Alternative medical practices are generally not recognized by the medical community as standard or conventional medical approaches.

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

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

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

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

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

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

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

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Complementary and Alternative Medicine (CAM): Health and ...

Alternative medicine is any practice that is put forward as having the healing effects of medicine, but does not originate from evidence gathered using the scientific method,[n 1][n 2][n 3] is not part of biomedicine,[n 1][n 4][n 5][n 6] or is contradicted by scientific evidence or established science.[1][2][3] It consists of a wide variety of health care practices, products and therapies, ranging from being biologically plausible but not well tested, to being directly contradicted by evidence and science, or even harmful or toxic.[n 4][1][3][4][5][6] Examples include new and traditional medicine practices such as homeopathy, naturopathy, chiropractic, energy medicine, various forms of acupuncture, traditional Chinese medicine, Ayurvedic medicine, Sekkotsu, and Christian faith healing. The treatments are those that are not part of the science-based healthcare system, and are not clearly backed by scientific evidence.[7][8][10] Despite significant expenditures on testing alternative medicine, including $2.5 billion spent by the United States government, almost none have shown any effectiveness greater than that of false treatments (placebo), and alternative medicine has been criticized by prominent figures in science and medicine as being quackery, nonsense, fraudulent, or unethical.[11][12]

Complementary medicine is alternative medicine used together with conventional medical treatment, in a belief not confirmed using the scientific method that it "complements" (improves the efficacy of) the treatment.[n 7][14][15][16]CAM is the abbreviation for complementary and alternative medicine.[17][18]Integrative medicine (or integrative health) is the combination of the practices and methods of alternative medicine with conventional medicine.[19]

Alternative medical diagnoses and treatments are not included as science-based treatments that are taught in medical schools, and are not used in medical practice where treatments are based on what is established using the scientific method. Alternative therapies lack such scientific validation, and their effectiveness is either unproved or disproved.[n 8][1][14][21][22] Alternative medicine is usually based on religion, tradition, superstition, belief in supernatural energies, pseudoscience, errors in reasoning, propaganda, or fraud.[1][2][3][14] Regulation and licensing of alternative medicine and health care providers varies from country to country, and state to state.

The scientific community has criticized alternative medicine as being based on misleading statements, quackery, pseudoscience, antiscience, fraud, or poor scientific methodology. Promoting alternative medicine has been called dangerous and unethical.[n 9][24] Testing alternative medicine has been called a waste of scarce medical research resources.[25][26] Critics have said "there is really no such thing as alternative medicine, just medicine that works and medicine that doesn't",[27] and "Can there be any reasonable 'alternative' [to medicine based on evidence]?"[28]

Alternative medicine consists of a wide range of health care practices, products, and therapies. The shared feature is a claim to heal that is not based on the scientific method. Alternative medicine practices are diverse in their foundations and methodologies.[7] Alternative medicine practices may be classified by their cultural origins or by the types of beliefs upon which they are based.[1][2][7][14] Methods may incorporate or base themselves on traditional medicinal practices of a particular culture, folk knowledge, supersition, spiritual beliefs, belief in supernatural energies (antiscience), pseudoscience, errors in reasoning, propaganda, fraud, new or different concepts of health and disease, and any bases other than being proven by scientific methods.[1][2][3][14] Different cultures may have their own unique traditional or belief based practices developed recently or over thousands of years, and specific practices or entire systems of practices.

Alternative medical systems can be based on common belief systems that are not consistent with facts of science, such as in naturopathy or homeopathy.[7]

Homeopathy is a system developed in a belief that a substance that causes the symptoms of a disease in healthy people will cure similar symptoms in sick people.[n 10] It was developed before knowledge of atoms and molecules, and of basic chemistry, which shows that repeated dilution as practiced in homeopathy produces only water and that homeopathy is scientifically implausible.[31][32][33][34] Homeopathy is considered quackery in the medical community.[35]

Naturopathic medicine is based on a belief that the body heals itself using a supernatural vital energy that guides bodily processes,[36] a view in conflict with the paradigm of evidence-based medicine.[37] Many naturopaths have opposed vaccination,[38] and "scientific evidence does not support claims that naturopathic medicine can cure cancer or any other disease".[39]

Alternative medical systems may be based on traditional medicine practices, such as traditional Chinese medicine, Ayurveda in India, or practices of other cultures around the world.[7]

Traditional Chinese medicine is a combination of traditional practices and beliefs developed over thousands of years in China, together with modifications made by the Communist party. Common practices include herbal medicine, acupuncture (insertion of needles in the body at specified points), massage (Tui na), exercise (qigong), and dietary therapy. The practices are based on belief in a supernatural energy called qi, considerations of Chinese Astrology and Chinese numerology, traditional use of herbs and other substances found in China, a belief that a map of the body is contained on the tongue which reflects changes in the body, and an incorrect model of the anatomy and physiology of internal organs.[1][40][41][42][43][44]

The Chinese Communist Party Chairman Mao Zedong, in response to the lack of modern medical practitioners, revived acupuncture and its theory was rewritten to adhere to the political, economic and logistic necessities of providing for the medical needs of China's population.[45][pageneeded] In the 1950s the "history" and theory of traditional Chinese medicine was rewritten as communist propaganda, at Mao's insistence, to correct the supposed "bourgeois thought of Western doctors of medicine".Acupuncture gained attention in the United States when President Richard Nixon visited China in 1972, and the delegation was shown a patient undergoing major surgery while fully awake, ostensibly receiving acupuncture rather than anesthesia. Later it was found that the patients selected for the surgery had both a high pain tolerance and received heavy indoctrination before the operation; these demonstration cases were also frequently receiving morphine surreptitiously through an intravenous drip that observers were told contained only fluids and nutrients.[40]Cochrane reviews found acupuncture is not effective for a wide range of conditions.[47] A systematic review of systematic reviews found that for reducing pain, real acupuncture was no better than sham acupuncture.[48] Although, other reviews have found that acupuncture is successful at reducing chronic pain, where as sham acupuncture was not found to be better than a placebo as well as no-acupuncture groups.[49]

Ayurvedic medicine is a traditional medicine of India. Ayurveda believes in the existence of three elemental substances, the doshas (called Vata, Pitta and Kapha), and states that a balance of the doshas results in health, while imbalanc
e results in disease. Such disease-inducing imbalances can be adjusted and balanced using traditional herbs, minerals and heavy metals. Ayurveda stresses the use of plant-based medicines and treatments, with some animal products, and added minerals, including sulfur, arsenic, lead, copper sulfate.[citation needed]

Safety concerns have been raised about Ayurveda, with two U.S. studies finding about 20 percent of Ayurvedic Indian-manufactured patent medicines contained toxic levels of heavy metals such as lead, mercury and arsenic. Other concerns include the use of herbs containing toxic compounds and the lack of quality control in Ayurvedic facilities. Incidents of heavy metal poisoning have been attributed to the use of these compounds in the United States.[5][52][53][54]

Bases of belief may include belief in existence of supernatural energies undetected by the science of physics, as in biofields, or in belief in properties of the energies of physics that are inconsistent with the laws of physics, as in energy medicine.[7]

Biofield therapies are intended to influence energy fields that, it is purported, surround and penetrate the body.[7] Writers such as noted astrophysicist and advocate of skeptical thinking (Scientific skepticism) Carl Sagan (1934-1996) have described the lack of empirical evidence to support the existence of the putative energy fields on which these therapies are predicated.

Acupuncture is a component of traditional Chinese medicine. In acupuncture, it is believed that a supernatural energy called qi flows through the universe and through the body, and helps propel the blood, blockage of which leads to disease.[41] It is believed that insertion of needles at various parts of the body determined by astrological calculations can restore balance to the blocked flows, and thereby cure disease.[41]

Chiropractic was developed in the belief that manipulating the spine affects the flow of a supernatural vital energy and thereby affects health and disease.

In the western version of Japanese Reiki, the palms are placed on the patient near Chakras, believed to be centers of supernatural energies, in a belief that the supernatural energies can transferred from the palms of the practitioner, to heal the patient.

Bioelectromagnetic-based therapies use verifiable electromagnetic fields, such as pulsed fields, alternating-current, or direct-current fields in an unconventional manner.[7]Magnetic healing does not claim existence of supernatural energies, but asserts that magnets can be used to defy the laws of physics to influence health and disease.

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".[7] Mind body medicines includes healing claims made in yoga, meditation, deep-breathing exercises, guided imagery, hypnotherapy, progressive relaxation, qi gong, and tai chi.[7]

Yoga, a method of traditional stretches, exercises, and meditations in Hinduism, may also be classified as an energy medicine insofar as its healing effects are believed to be due to a healing "life energy" that is absorbed into the body through the breath, and is thereby believed to treat a wide variety of illnesses and complaints.[56]

Since the 1990s, tai chi (t'ai chi ch'uan) classes that purely emphasise health have become popular in hospitals, clinics, as well as community and senior centers. This has occurred as the baby boomers generation has aged and the art's reputation as a low-stress training method for seniors has become better known.[57][58] There has been some divergence between those that say they practice t'ai chi ch'uan primarily for self-defence, those that practice it for its aesthetic appeal (see wushu below), and those that are more interested in its benefits to physical and mental health.

Qigong, chi kung, or chi gung, is a practice of aligning body, breath, and mind for health, meditation, and martial arts training. With roots in traditional Chinese medicine, philosophy, and martial arts, qigong is traditionally viewed as a practice to cultivate and balance qi (chi) or what has been translated as "life energy".[59]

Substance based practices use substances found in nature such as herbs, foods, non-vitamin supplements and megavitamins, animal and fungal products, and minerals, including use of these products in traditional medical practices that may also incorporate other methods.[7][12][60] Examples include healing claims for nonvitamin supplements, fish oil, Omega-3 fatty acid, glucosamine, echinacea, flaxseed oil, and ginseng.[61]Herbal medicine, or phytotherapy, includes not just the use of plant products, but may also include the use of animal and mineral products.[12] It is among the most commercially successful branches of alternative medicine, and includes the tablets, powders and elixirs that are sold as "nutritional supplements".[12] Only a very small percentage of these have been shown to have any efficacy, and there is little regulation as to standards and safety of their contents.[12] This may include use of known toxic substances, such as use of the poison lead in traditional Chinese medicine.[61]

Manipulative and body-based practices feature the manipulation or movement of body parts, such as is done in bodywork and chiropractic manipulation.

Osteopathic manipulative medicine, also known as osteopathic manipulative treatment, is a core set of techniques of osteopathy and osteopathic medicine distinguishing these fields from mainstream medicine.[62]

Religion based healing practices, such as use of prayer and the laying of hands in Christian faith healing, and shamanism, rely on belief in divine or spiritual intervention for healing.

Shamanism is a practice of many cultures around the world, in which a practitioner reaches an altered states of consciousness in order to encounter and interact with the spirit world or channel supernatural energies in the belief they can heal.[63]

Some alternative medicine practices may be based on pseudoscience, ignorance, or flawed reasoning.[64] This can lead to fraud.[1]

Practitioners of electricity and magnetism based healing methods may deliberately exploit a patient's ignorance of physics in order to defraud them.[14]

"Alternative medicine" is a loosely defined set of products, practices, and theories that are believed or perceived by their users to have the healing effects of medicine,[n 2][n 4] but whose effectiveness has not been clearly established using scientific methods,[n 2][n 3][1][3][20][22] whose theory and practice is not part of biomedicine,[n 4][n 1][n 5][n 6] or whose theories or practices are directly contradicted by scientific evidence or scientific principles used in biomedicine.[1][2][3] "Biomedicine" is that part of medical science that applies principles of biology, physiology, molecular biology, biophysics, and other natural sciences to clinical practice, using scientific methods to establish the effectiveness of that practice. Alternative medicine is a diverse group of medical and health care systems, practices, and products that originate outside of biomedicine,[n 1] are not considered part of biomedicine,[7] are not widely used by the biomedical healthcare professions,[69] and are not taught as skills practiced in biomedicine.[69] Unlike biomedicine,[n 1] an alternative medicine product or practice does not originate from the sciences or from using scientific methodology, but may instead
be based on testimonials, religion, tradition, superstition, belief in supernatural energies, pseudoscience, errors in reasoning, propaganda, fraud, or other unscientific sources.[n 3][1][3][14] The expression "alternative medicine" refers to a diverse range of related and unrelated products, practices, and theories, originating from widely varying sources, cultures, theories, and belief systems, and ranging from biologically plausible practices and products and practices with some evidence, to practices and theories that are directly contradicted by basic science or clear evidence, and products that have proven to be ineffective or even toxic and harmful.[n 4][4][5]

"Alternative medicine", "complementary medicine", "holistic medicine", "natural medicine", "unorthodox medicine", "fringe medicine", "unconventional medicine", and "new age medicine" may be used interchangeably as having the same meaning (synonyms) in some contexts,[70][71][72] but may have different meanings in other contexts, for example, unorthodox medicine may refer to biomedicine that is different from what is commonly practiced, and fringe medicine may refer to biomedicine that is based on fringe science, which may be scientifically valid but is not mainstream.

The meaning of the term "alternative" in the expression "alternative medicine", is not that it is an actual effective alternative to medical science, although some alternative medicine promoters may use the loose terminology to give the appearance of effectiveness.[1]Marcia Angell stated that "alternative medicine" is "a new name for snake oil. There's medicine that works and medicine that doesn't work."[73] Loose terminology may also be used to suggest meaning that a dichotomy exists when it does not, e.g., the use of the expressions "western medicine" and "eastern medicine" to suggest that the difference is a cultural difference between the Asiatic east and the European west, rather than that the difference is between evidence-based medicine and treatments which don't work.[1]

"Complementary medicine" refers to use of alternative medical treatments alongside conventional medicine, in the belief that it increases the effectiveness of the science-based medicine.[74][75][76] An example of "complementary medicine" is use of acupuncture (sticking needles in the body to influence the flow of a supernatural energy), along with using science-based medicine, in the belief that the acupuncture increases the effectiveness or "complements" the science-based medicine.[76] "CAM" is an abbreviation for "complementary and alternative medicine".

The expression "Integrative medicine" (or "integrated medicine") is used in two different ways. One use refers to a belief that medicine based on science can be "integrated" with practices that are not. Another use refers only to a combination of alternative medical treatments with conventional treatments that have some scientific proof of efficacy, in which case it is identical with CAM.[19] "holistic medicine" (or holistic health) is an alternative medicine practice which claim to treat the "whole person" and not just the illness itself.

"Traditional medicine" and "folk medicine" refer to prescientific practices of a culture, not to what is traditionally practiced in cultures where medical science dominates. "Eastern medicine" typically refers to prescientific traditional medicines of Asia. "Western medicine", when referring to modern practice, typically refers to medical science, and not to alternative medicines practiced in the west (Europe and the Americas). "Western medicine", "biomedicine", "mainstream medicine", "medical science", "science-based medicine", "evidence-based medicine", "conventional medicine", "standard medicine", "orthodox medicine", "allopathic medicine", "dominant health system", and "medicine", are sometimes used interchangeably as having the same meaning, when contrasted with alternative medicine, but these terms may have different meanings in some contexts, e.g., some practices in medical science are not supported by rigorous scientific testing so "medical science" is not strictly identical with "science-based medicine", and "standard medical care" may refer to "best practice" when contrasted with other biomedicine that is less used or less recommended.[n 11][79]

Prominent members of the science[27][80] and biomedical science community[21] assert that it is not meaningful to define an alternative medicine that is separate from a conventional medicine, that the expressions "conventional medicine", "alternative medicine", "complementary medicine", "integrative medicine", and "holistic medicine" do not refer to anything at all.[21][27][80][81] Their criticisms of trying to make such artificial definitions include: "There's no such thing as conventional or alternative or complementary or integrative or holistic medicine. There's only medicine that works and medicine that doesn't;"[21][27][80] "By definition, alternative medicine has either not been proved to work, or been proved not to work. You know what they call alternative medicine that's been proved to work? Medicine;"[82] "There cannot be two kinds of medicine conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted;"[21] and "There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking."[81]

Others in both the biomedical and CAM communities point out that CAM cannot be precisely defined because of the diversity of theories and practices it includes, and because the boundaries between CAM and biomedicine overlap, are porous, and change. The expression "complementary and alternative medicine" (CAM) resists easy definition because the health systems and practices to which it refers are diffuse and its boundaries are poorly defined.[4][n 12] Healthcare practices categorized as alternative may differ in their historical origin, theoretical basis, diagnostic technique, therapeutic practice and in their relationship to the medical mainstream. Some alternative therapies, including traditional Chinese medicine (TCM) and Ayurveda, have antique origins in East or South Asia and are entirely alternative medical systems;[87] others, such as homeopathy and chiropractic, have origins in Europe or the United States and emerged in the eighteenth and nineteenth centuries. Some, such as osteopathy and chiropractic, employ manipulative physical methods of treatment; others, such as meditation and prayer, are based on mind-body interventions. Treatments considered alternative in one location may be considered conventional in another.[90] Thus, chiropractic is not considered alternative in Denmark and likewise osteopathic medicine is no longer thought of as an alternative therapy in the United States.[90]

One common feature of all definitions of alternative medicine is its designation as "other than" conventional medicine. For example, the widely referenced descriptive definition of complementary and alternative medicine devised by the US National Center for Complementary and Integrative Health (NCCIH) of the National Institutes of Health (NIH), states that it is "a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine."[7] For conventional med
ical practitioners, it does not necessarily follow that either it or its practitioners would no longer be considered alternative.[n 13]

Some definitions seek to specify alternative medicine in terms of its social and political marginality to mainstream healthcare.[95] This can refer to the lack of support that alternative therapies receive from the medical establishment and related bodies regarding access to research funding, sympathetic coverage in the medical press, or inclusion in the standard medical curriculum.[95] In 1993, the British Medical Association (BMA), one among many professional organizations who have attempted to define alternative medicine, stated that it[n 14] referred to "those forms of treatment which are not widely used by the conventional healthcare professions, and the skills of which are not taught as part of the undergraduate curriculum of conventional medical and paramedical healthcare courses".[69] In a US context, an influential definition coined in 1993 by the Harvard-based physician,[96] David M. Eisenberg,[97] characterized alternative medicine "as interventions neither taught widely in medical schools nor generally available in US hospitals".[98] These descriptive definitions are inadequate in the present-day when some conventional doctors offer alternative medical treatments and CAM introductory courses or modules can be offered as part of standard undergraduate medical training;[99] alternative medicine is taught in more than 50 per cent of US medical schools and increasingly US health insurers are willing to provide reimbursement for CAM therapies. In 1999, 7.7% of US hospitals reported using some form of CAM therapy; this proportion had risen to 37.7% by 2008.[101]

An expert panel at a conference hosted in 1995 by the US Office for Alternative Medicine (OAM),[102][n 15] devised a theoretical definition[102] of alternative medicine as "a broad domain of healing resources... other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period."[103] This definition has been widely adopted by CAM researchers,[102] cited by official government bodies such as the UK Department of Health,[104] attributed as the definition used by the Cochrane Collaboration,[105] and, with some modification,[dubious discuss] was preferred in the 2005 consensus report of the US Institute of Medicine, Complementary and Alternative Medicine in the United States.[n 4]

The 1995 OAM conference definition, an expansion of Eisenberg's 1993 formulation, is silent regarding questions of the medical effectiveness of alternative therapies.[106] Its proponents hold that it thus avoids relativism about differing forms of medical knowledge and, while it is an essentially political definition, this should not imply that the dominance of mainstream biomedicine is solely due to political forces.[106] According to this definition, alternative and mainstream medicine can only be differentiated with reference to what is "intrinsic to the politically dominant health system of a particular society of culture".[107] However, there is neither a reliable method to distinguish between cultures and subcultures, nor to attribute them as dominant or subordinate, nor any accepted criteria to determine the dominance of a cultural entity.[107] If the culture of a politically dominant healthcare system is held to be equivalent to the perspectives of those charged with the medical management of leading healthcare institutions and programs, the definition fails to recognize the potential for division either within such an elite or between a healthcare elite and the wider population.[107]

Normative definitions distinguish alternative medicine from the biomedical mainstream in its provision of therapies that are unproven, unvalidated or ineffective and support of theories which have no recognized scientific basis. These definitions characterize practices as constituting alternative medicine when, used independently or in place of evidence-based medicine, they are put forward as having the healing effects of medicine, but which are not based on evidence gathered with the scientific method.[7][14][21][74][75][109] Exemplifying this perspective, a 1998 editorial co-authored by Marcia Angell, a former editor of the New England Journal of Medicine, argued that:

This line of division has been subject to criticism, however, as not all forms of standard medical practice have adequately demonstrated evidence of benefit, [n 1][79] and it is also unlikely in most instances that conventional therapies, if proven to be ineffective, would ever be classified as CAM.[102]

Public information websites maintained by the governments of the US and of the UK make a distinction between "alternative medicine" and "complementary medicine", but mention that these two overlap. The National Center for Complementary and Integrative Health (NCCIH) of the National Institutes of Health (NIH) (a part of the US Department of Health and Human Services) states that "alternative medicine" refers to using a non-mainstream approach in place of conventional medicine and that "complementary medicine" generally refers to using a non-mainstream approach together with conventional medicine, and comments that the boundaries between complementary and conventional medicine overlap and change with time.[7]

The National Health Service (NHS) website NHS Choices (owned by the UK Department of Health), adopting the terminology of NCCIH, states that when a treatment is used alongside conventional treatments, to help a patient cope with a health condition, and not as an alternative to conventional treatment, this use of treatments can be called "complementary medicine"; but when a treatment is used instead of conventional medicine, with the intention of treating or curing a health condition, the use can be called "alternative medicine".[111]

Similarly, the public information website maintained by the National Health and Medical Research Council (NHMRC) of the Commonwealth of Australia uses the acronym "CAM" for a wide range of health care practices, therapies, procedures and devices not within the domain of conventional medicine. In the Australian context this is stated to include acupuncture; aromatherapy; chiropractic; homeopathy; massage; meditation and relaxation therapies; naturopathy; osteopathy; reflexology, traditional Chinese medicine; and the use of vitamin supplements.[112]

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

In General Guidelines for Methodologies on Research and Evaluation of Traditional Medicine, published in 2000 by the World Health Organization (WHO), complementary and alternative medicine were defined as a broad set of health care practices that are not part of that country's own tradition and are not integrated into the dominant health care system.[114] Some herbal therapies are mainstream in Europe but are alternative in the US.[116]

The history of alternative medicine may refer to the history of a group of diverse medical practices that were collectively promoted as "alternative medicine" beginning in the 1970s, to the collection of individual histories of members of that group, or to the history of western medical practices that were labeled "irregular practices" by the western medical establishment.[1][117][118][119][120] It includes the histories of complementary m
edicine and of integrative medicine. Before the 1970s, western practitioners that were not part of the increasingly science-based medical establishment were referred to "irregular practitioners", and were dismissed by the medical establishment as unscientific and as practicing quackery.[117][118] Until the 1970's, irregular practice became increasingly marginalized as quackery and fraud, as western medicine increasingly incorporated scientific methods and discoveries, and had a corresponding increase in success of its treatments.[119] In the 1970s, irregular practices were grouped with traditional practices of nonwestern cultures and with other unproven or disproven practices that were not part of biomedicine, with the entire group collectively marketed and promoted under the single expression "alternative medicine".[1][117][118][119][121]

Use of alternative medicine in the west began to rise following the counterculture movement of the 1960s, as part of the rising new age movement of the 1970s.[1][122][123] This was due to misleading mass marketing of "alternative medicine" being an effective "alternative" to biomedicine, changing social attitudes about not using chemicals and challenging the establishment and authority of any kind, sensitivity to giving equal measure to beliefs and practices of other cultures (cultural relativism), and growing frustration and desperation by patients about limitations and side effects of science-based medicine.[1][118][119][120][121][123][124] At the same time, in 1975, the American Medical Association, which played the central role in fighting quackery in the United States, abolished its quackery committee and closed down its Department of Investigation.[117]:xxi[124] By the early to mid 1970s the expression "alternative medicine" came into widespread use, and the expression became mass marketed as a collection of "natural" and effective treatment "alternatives" to science-based biomedicine.[1][124][125][126] By 1983, mass marketing of "alternative medicine" was so pervasive that the British Medical Journal (BMJ) pointed to "an apparently endless stream of books, articles, and radio and television programmes urge on the public the virtues of (alternative medicine) treatments ranging from meditation to drilling a hole in the skull to let in more oxygen".[124] In this 1983 article, the BMJ wrote, "one of the few growth industries in contemporary Britain is alternative medicine", noting that by 1983, "33% of patients with rheumatoid arthritis and 39% of those with backache admitted to having consulted an alternative practitioner".[124]

By about 1990, the American alternative medicine industry had grown to a $27 Billion per year, with polls showing 30% of Americans were using it.[123][127] Moreover, polls showed that Americans made more visits for alternative therapies than the total number of visits to primary care doctors, and American out-of-pocket spending (non-insurance spending) on alternative medicine was about equal to spending on biomedical doctors.[117]:172 In 1991, Time magazine ran a cover story, "The New Age of Alternative Medicine: Why New Age Medicine Is Catching On".[123][127] In 1993, the New England Journal of Medicine reported one in three Americans as using alternative medicine.[123] In 1993, the Public Broadcasting System ran a Bill Moyers special, Healing and the Mind, with Moyers commenting that "...people by the tens of millions are using alternative medicine. If established medicine does not understand that, they are going to lose their clients."[123]

Another explosive growth began in the 1990s, when senior level political figures began promoting alternative medicine, investing large sums of government medical research funds into testing alternative medicine, including testing of scientifically implausible treatments, and relaxing government regulation of alternative medicine products as compared to biomedical products.[1][117]:xxi[118][119][120][121][128][129] Beginning with a 1991 appropriation of $2 million for funding research of alternative medicine research, federal spending grew to a cumulative total of about $2.5 billion by 2009, with 50% of Americans using alternative medicine by 2013.[11][130]

In 1991, pointing to a need for testing because of the widespread use of alternative medicine without authoritative information on its efficacy, United States Senator Tom Harkin used $2 million of his discretionary funds to create the Office for the Study of Unconventional Medical Practices (OSUMP), later renamed to be the Office of Alternative Medicine (OAM).[117]:170[131][132] The OAM was created to be within the National Institute of Health (NIH), the scientifically prestigious primary agency of the United States government responsible for biomedical and health-related research.[117]:170[131][132] The mandate was to investigate, evaluate, and validate effective alternative medicine treatments, and alert the public as the results of testing its efficacy.[127][131][132][133]

Sen. Harkin had become convinced his allergies were cured by taking bee pollen pills, and was urged to make the spending by two of his influential constituents.[127][131][132] Bedell, a longtime friend of Sen. Harkin, was a former member of the United States House of Representatives who believed that alternative medicine had twice cured him of diseases after mainstream medicine had failed, claiming that cow's milk colostrum cured his Lyme disease, and an herbal derivative from camphor had prevented post surgical recurrence of his prostate cancer.[117][127] Wiewel was a promoter of unproven cancer treatments involving a mixture of blood sera that the Food and Drug Administration had banned from being imported.[127] Both Bedell and Wiewel became members of the advisory panel for the OAM. The company that sold the bee pollen was later fined by the Federal Trade Commission for making false health claims about their bee-pollen products reversing the aging process, curing allergies, and helping with weight loss.[134]

In 1993, Britain's Prince Charles, who claimed that homeopathy and other alternative medicine was an effective alternative to biomedicine, established the Foundation for Integrated Health (FIH), as a charity to explore "how safe, proven complementary therapies can work in conjunction with mainstream medicine".[135] The FIH received government funding through grants from Britain's Department of Health.[135]

In 1994, Sen. Harkin (D) and Senator Orrin Hatch (R) introduced the Dietary Supplement Health and Education Act (DSHEA).[136][137] The act reduced authority of the FDA to monitor products sold as "natural" treatments.[136] Labeling standards were reduced to allow health claims for supplements based only on unconfirmed preliminary studies that were not subjected to scientific peer review, and the act made it more difficult for the FDA to promptly seize products or demand proof of safety where there was evidence of a product being dangerous.[137] The Act became known as the "The 1993 Snake Oil Protection Act" following a New York Times editorial under that name.[136]

Senator Harkin complained about the "unbendable rules of randomized clinical trials", citing his use of bee pollen to treat his allergies, which he claimed to be effective even though it was biologically implausible and efficacy was not established using scientific methods.[131][138] Sen. Harkin asserted that claims for alternative medicine efficacy be allowed not only without conventional scientific testing, even when they are biologically implausible, "It is not necessary for the scientific community to understand the process before the American public can b
enefit from these therapies."[136] Following passage of the act, sales rose from about $4 billion in 1994, to $20 billion by the end of 2000, at the same time as evidence of their lack of efficacy or harmful effects grew.[136] Senator Harkin came into open public conflict with the first OAM Director Joseph M. Jacobs and OAM board members from the scientific and biomedical community.[132] Jacobs' insistence on rigorous scientific methodology caused friction with Senator Harkin.[131][138][139] Increasing political resistance to the use of scientific methodology was publicly criticized by Dr. Jacobs and another OAM board member complained that "nonsense has trickled down to every aspect of this office".[131][138] In 1994, Senator Harkin appeared on television with cancer patients who blamed Dr. Jacobs for blocking their access to untested cancer treatment, leading Jacobs to resign in frustration.[131][138]

In 1995, Wayne Jonas, a promoter of homeopathy and political ally of Senator Harkin, became the director of the OAM, and continued in that role until 1999.[140] In 1997, the NCCAM budget was increased from $12 million to $20 million annually.[141] From 1990 to 1997, use of alternative medicine in the US increased by 25%, with a corresponding 50% increase in expenditures.[142] The OAM drew increasing criticism from eminent members of the scientific community with letters to the Senate Appropriations Committee when discussion of renewal of funding OAM came up.[117]:175 Nobel laureate Paul Berg wrote that prestigious NIH should not be degraded to act as a cover for quackery, calling the OAM "an embarrassment to serious scientists."[117]:175[141] The president of the American Physical Society wrote complaining that the government was spending money on testing products and practices that "violate basic laws of physics and more clearly resemble witchcraft".[117]:175[141] In 1998, the President of the North Carolina Medical Association publicly called for shutting down the OAM.[143]

In 1998, NIH director and Nobel laureate Harold Varmus came into conflict with Senator Harkin by pushing to have more NIH control of alternative medicine research.[144] The NIH Director placed the OAM under more strict scientific NIH control.[141][144] Senator Harkin responded by elevating OAM into an independent NIH "center", just short of being its own "institute", and renamed to be the National Center for Complementary and Alternative Medicine (NCCAM). NCCAM had a mandate to promote a more rigorous and scientific approach to the study of alternative medicine, research training and career development, outreach, and "integration". In 1999, the NCCAM budget was increased from $20 million to $50 million.[143][144] The United States Congress approved the appropriations without dissent. In 2000, the budget was increased to about $68 million, in 2001 to $90 million, in 2002 to $104 million, and in 2003, to $113 million.[143]

In 2004, modifications of the European Parliament's 2001 Directive 2001/83/EC, regulating all medicine products, were made with the expectation of influencing development of the European market for alternative medicine products.[145] Regulation of alternative medicine in Europe was loosened with "a simplified registration procedure" for traditional herbal medicinal products.[145][146] Plausible "efficacy" for traditional medicine was redefined to be based on long term popularity and testimonials ("the pharmacological effects or efficacy of the medicinal product are plausible on the basis of long-standing use and experience."), without scientific testing.[145][146] The Committee on Herbal Medicinal Products (HMPC) was created within the European Medicines Agency in London (EMEA). A special working group was established for homeopathic remedies under the Heads of Medicines Agencies.[145]

Through 2004, alternative medicine that was traditional to Germany continued to be a regular part of the health care system, including homeopathy and anthroposophic medicine.[145] The German Medicines Act mandated that science-based medical authorities consider the "particular characteristics" of complementary and alternative medicines.[145] By 2004, homeopathy had grown to be the most used alternative therapy in France, growing from 16% of the population using homeopathic medicine in 1982, to 29% by 1987, 36% percent by 1992, and 62% of French mothers using homeopathic medicines by 2004, with 94.5% of French pharmacists advising pregnant women to use homeopathic remedies.[147] As of 2004[update], 100 million people in India depended solely on traditional German homeopathic remedies for their medical care.[148] As of 2010[update], homeopathic remedies continued to be the leading alternative treatment used by European physicians.[147] By 2005, sales of homeopathic remedies and anthroposophical medicine had grown to $930 million Euros, a 60% increase from 1995.[147][149]

In 2008, London's The Times published a letter from Edzard Ernst that asked the FIH to recall two guides promoting alternative medicine, saying: "the majority of alternative therapies appear to be clinically ineffective, and many are downright dangerous." In 2010, Brittan's FIH closed after allegations of fraud and money laundering led to arrests of its officials.[135]

In 2009, after a history of 17 years of government testing and spending of nearly $2.5 billion on research had produced almost no clearly proven efficacy of alternative therapies, Senator Harkin complained, "One of the purposes of this center was to investigate and validate alternative approaches. Quite frankly, I must say publicly that it has fallen short. It think quite frankly that in this center and in the office previously before it, most of its focus has been on disproving things rather than seeking out and approving."[144][150][151] Members of the scientific community criticized this comment as showing Senator Harkin did not understand the basics of scientific inquiry, which tests hypotheses, but never intentionally attempts to "validate approaches".[144] Members of the scientific and biomedical communities complained that after a history of 17 years of being tested, at a cost of over $2.5 Billion on testing scientifically and biologically implausible practices, almost no alternative therapy showed clear efficacy.[11] In 2009, the NCCAM's budget was increased to about $122 million.[144] Overall NIH funding for CAM research increased to $300 Million by 2009.[144] By 2009, Americans were spending $34 Billion annually on CAM.[152]

Since 2009, according to Art. 118a of the Swiss Federal Constitution, the Swiss Confederation and the Cantons of Switzerland shall within the scope of their powers ensure that consideration is given to complementary medicine.[153]

In 2012, the Journal of the American Medical Association (JAMA) published a criticism that study after study had been funded by NCCAM, but "failed to prove that complementary or alternative therapies are anything more than placebos".[154] The JAMA criticism pointed to large wasting of research money on testing scientifically implausible treatments, citing "NCCAM officials spending $374,000 to find that inhaling lemon and lavender scents does not promote wound healing; $750,000 to find that prayer does not cure AIDS or hasten recovery from breast-reconstruction surgery; $390,000 to find that ancient Indian remedies do not control type 2 diabetes; $700,000 to find that magnets do not treat arthritis, carpal tunnel syndrome, or migraine headaches; and $406,000 to find that coffee enemas do not cure pancreatic cancer."[154] It was pointed out that negative results from testing were generally ignored by the public,
that people continue to "believe what they want to believe, arguing that it does not matter what the data show: They know what works for them".[154] Continued increasing use of CAM products was also blamed on the lack of FDA ability to regulate alternative products, where negative studies do not result in FDA warnings or FDA-mandated changes on labeling, whereby few consumers are aware that many claims of many supplements were found not to have not to be supported.[154]

By 2013, 50% of Americans were using CAM.[130] As of 2013[update], CAM medicinal products in Europe continued to be exempted from documented efficacy standards required of other medicinal products.[155]

In 2014 the NCCAM was renamed to the National Center for Complementary and Integrative Health (NCCIH) with a new charter requiring that 12 of the 18 council members shall be selected with a preference to selecting leading representatives of complementary and alternative medicine, 9 of the members must be licensed practitioners of alternative medicine, 6 members must be general public leaders in the fields of public policy, law, health policy, economics, and management, and 3 members must represent the interests of individual consumers of complementary and alternative medicine.[156]

Much of what is now categorized as alternative medicine was developed as independent, complete medical systems. These were developed long before biomedicine and use of scientific methods. Each system was developed in relatively isolated regions of the world where there was little or no medical contact with pre-scientific western medicine, or with each other's systems. Examples are traditional Chinese medicine and the Ayurvedic medicine of India.

Other alternative medicine practices, such as homeopathy, were developed in western Europe and in opposition to western medicine, at a time when western medicine was based on unscientific theories that were dogmatically imposed by western religious authorities. Homeopathy was developed prior to discovery of the basic principles of chemistry, which proved homeopathic remedies contained nothing but water. But homeopathy, with its remedies made of water, was harmless compared to the unscientific and dangerous orthodox western medicine practiced at that time, which included use of toxins and draining of blood, often resulting in permanent disfigurement or death.[118]

Other alternative practices such as chiropractic and osteopathic manipulative medicine were developed in the United States at a time that western medicine was beginning to incorporate scientific methods and theories, but the biomedical model was not yet totally dominant. Practices such as chiropractic and osteopathic, each considered to be irregular practices by the western medical establishment, also opposed each other, both rhetorically and politically with licensing legislation. Osteopathic practitioners added the courses and training of biomedicine to their licensing, and licensed Doctor of Osteopathic Medicine holders began diminishing use of the unscientific origins of the field. Without the original nonscientific practices and theories, osteopathic medicine is now considered the same as biomedicine.

Further information: Rise of modern medicine

Until the 1970s, western practitioners that were not part of the medical establishment were referred to "irregular practitioners", and were dismissed by the medical establishment as unscientific, as practicing quackery.[118] Irregular practice became increasingly marginalized as quackery and fraud, as western medicine increasingly incorporated scientific methods and discoveries, and had a corresponding increase in success of its treatments.

Dating from the 1970s, medical professionals, sociologists, anthropologists and other commentators noted the increasing visibility of a wide variety of health practices that had neither derived directly from nor been verified by biomedical science.[157] Since that time, those who have analyzed this trend have deliberated over the most apt language with which to describe this emergent health field.[157] A variety of terms have been used, including heterodox, irregular, fringe and alternative medicine while others, particularly medical commentators, have been satisfied to label them as instances of quackery.[157] The most persistent term has been alternative medicine but its use is problematic as it assumes a value-laden dichotomy between a medical fringe, implicitly of borderline acceptability at best, and a privileged medical orthodoxy, associated with validated medico-scientific norms.[158] The use of the category of alternative medicine has also been criticized as it cannot be studied as an independent entity but must be understood in terms of a regionally and temporally specific medical orthodoxy.[159] Its use can also be misleading as it may erroneously imply that a real medical alternative exists.[160] As with near-synonymous expressions, such as unorthodox, complementary, marginal, or quackery, these linguistic devices have served, in the context of processes of professionalisation and market competition, to establish the authority of official medicine and police the boundary between it and its unconventional rivals.[158]

An early instance of the influence of this modern, or western, scientific medicine outside Europe and North America is Peking Union Medical College.[161][n 16][n 17]

From a historical perspective, the emergence of alternative medicine, if not the term itself, is typically dated to the 19th century.[162] This is despite the fact that there are variants of Western non-conventional medicine that arose in the late-eighteenth century or earlier and some non-Western medical traditions, currently considered alternative in the West and elsewhere, which boast extended historical pedigrees.[158] Alternative medical systems, however, can only be said to exist when there is an identifiable, regularized and authoritative standard medical practice, such as arose in the West during the nineteenth century, to which they can function as an alternative.

During the late eighteenth and nineteenth centuries regular and irregular medical practitioners became more clearly differentiated throughout much of Europe and,[164] as the nineteenth century progressed, most Western states converged in the creation of legally delimited and semi-protected medical markets.[165] It is at this point that an "official" medicine, created in cooperation with the state and employing a scientific rhetoric of legitimacy, emerges as a recognizable entity and that the concept of alternative medicine as a historical category becomes tenable.[166]

As part of this process, professional adherents of mainstream medicine in countries such as Germany, France, and Britain increasingly invoked the scientific basis of their discipline as a means of engendering internal professional unity and of external differentiation in the face of sustained market competition from homeopaths, naturopaths, mesmerists and other nonconventional medical practitioners, finally achieving a degree of imperfect dominance through alliance with the state and the passage of regulatory legislation.[158][160] In the US the Johns Hopkins University School of Medicine, based in Baltimore, Maryland, opened in 1893, with William H. Welch and William Osler among the founding physicians, and was the first medical school devoted to teaching "German scientific medicine".[167]

Buttressed by the increased authority arising from significant advances in the medical sciences of the late 19th century onwardsincluding the development and application of the
germ theory of disease by the chemist Louis Pasteur and the surgeon Joseph Lister, of microbiology co-founded by Robert Koch (in 1885 appointed professor of hygiene at the University of Berlin), and of the use of X-rays (Rntgen rays)the 1910 Flexner Report called upon American medical schools to follow the model set by the Johns Hopkins School of Medicine and adhere to mainstream science in their teaching and research. This was in a belief, mentioned in the Report's introduction, that the preliminary and professional training then prevailing in medical schools should be reformed in view of the new means for diagnosing and combating disease being made available to physicians and surgeons by the sciences on which medicine depended.[n 18][169]

Among putative medical practices available at the time which later became known as "alternative medicine" were homeopathy (founded in Germany in the early 19c.) and chiropractic (founded in North America in the late 19c.). These conflicted in principle with the developments in medical science upon which the Flexner reforms were based, and they have not become compatible with further advances of medical science such as listed in Timeline of medicine and medical technology, 19001999 and 2000present, nor have Ayurveda, acupuncture or other kinds of alternative medicine.[citation needed]

At the same time "Tropical medicine" was being developed as a specialist branch of western medicine in research establishments such as Liverpool School of Tropical Medicine founded in 1898 by Alfred Lewis Jones, London School of Hygiene & Tropical Medicine, founded in 1899 by Patrick Manson and Tulane University School of Public Health and Tropical Medicine, instituted in 1912. A distinction was being made between western scientific medicine and indigenous systems. An example is given by an official report about indigenous systems of medicine in India, including Ayurveda, submitted by Mohammad Usman of Madras and others in 1923. This stated that the first question the Committee considered was "to decide whether the indigenous systems of medicine were scientific or not".[170][171]

By the later twentieth century the term 'alternative medicine' entered public discourse,[n 19][174] but it was not always being used with the same meaning by all parties. Arnold S. Relman remarked in 1998 that in the best kind of medical practice, all proposed treatments must be tested objectively, and that in the end there will only be treatments that pass and those that do not, those that are proven worthwhile and those that are not. He asked 'Can there be any reasonable "alternative"?'[28] But also in 1998 the then Surgeon General of the United States, David Satcher,[175] issued public information about eight common alternative treatments (including acupuncture, holistic and massage), together with information about common diseases and conditions, on nutrition, diet, and lifestyle changes, and about helping consumers to decipher fraud and quackery, and to find healthcare centers and doctors who practiced alternative medicine.[176]

By 1990, approximately 60 million Americans had used one or more complementary or alternative therapies to address health issues, according to a nationwide survey in the US published in 1993 by David Eisenberg.[177] 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.[142] However, despite the growth in patient demand for complementary medicine, most of the early alternative/complementary medical centers failed.[178]

Mainly as a result of reforms following the Flexner Report of 1910[179]medical education in established medical schools in the US has generally not included alternative medicine as a teaching topic.[n 20] Typically, their teaching is based on current practice and scientific knowledge about: anatomy, physiology, histology, embryology, neuroanatomy, pathology, pharmacology, microbiology and immunology.[181] Medical schools' teaching includes such topics as doctor-patient communication, ethics, the art of medicine,[182] and engaging in complex clinical reasoning (medical decision-making).[183] Writing in 2002, Snyderman and Weil remarked that by the early twentieth century the Flexner model had helped to create the 20th-century academic health center in which education, research and practice were inseparable. While this had much improved medical practice by defining with increasing certainty the pathophysiological basis of disease, a single-minded focus on the pathophysiological had diverted much of mainstream American medicine from clinical conditions which were not well understood in mechanistic terms and were not effectively treated by conventional therapies.[184]

By 2001 some form of CAM training was being offered by at least 75 out of 125 medical schools in the US.[185] Exceptionally, the School of Medicine of the University of Maryland, Baltimore includes a research institute for integrative medicine (a member entity of the Cochrane Collaboration).[186][187] Medical schools are responsible for conferring medical degrees, but a physician typically may not legally practice medicine until licensed by the local government authority. Licensed physicians in the US who have attended one of the established medical schools there have usually graduated Doctor of Medicine (MD).[188] All states require that applicants for MD licensure be graduates of an approved medical school and complete the United States Medical Licensing Exam (USMLE).[188]

The British Medical Association, in its publication Complementary Medicine, New Approach to Good Practice (1993), gave as a working definition of non-conventional therapies (including acupuncture, chiropractic and homeopathy): "those forms of treatment which are not widely used by the orthodox health-care professions, and the skills of which are not part of the undergraduate curriculum of orthodox medical and paramedical health-care courses". By 2000 some medical schools in the UK were offering CAM familiarisation courses to undergraduate medical students while some were also offering modules specifically on CAM.[190]

The Cochrane Collaboration Complementary Medicine Field explains its "Scope and Topics" by giving a broad and general definition for complementary medicine as including 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, and which complement mainstream medicine in three ways: by contributing to a common whole, by satisfying a demand not met by conventional practices, and by diversifying the conceptual framework of medicine.[191]

Proponents of an evidence-base for medicine[n 21][193][194][195][196] such as the Cochrane Collaboration (founded in 1993 and from 2011 providing input for WHO resolutions) take a position that all systematic reviews of treatments, whether "mainstream" or "alternative", ought to be held to the current standards of scientific method.[187] In a study titled Development and classification of an operational definition of complementary and alternative medicine for the Cochrane Collaboration (2011) it was proposed that indicators that a therapy is accepted include government licensing of practitioners, coverage by health insurance, statements of approval by government agencies, and recommendation as part of a practice guideline; and that if something is currently a standard, accepted therapy, then it is not likely to be widely considered as CAM.[102
]

That alternative medicine has been on the rise "in countries where Western science and scientific method generally are accepted as the major foundations for healthcare, and 'evidence-based' practice is the dominant paradigm" was described as an "enigma" in the Medical Journal of Australia.[197]

Critics in the US say the expression is deceptive because it implies there is an effective alternative to science-based medicine, and that complementary is deceptive because the word implies that the treatment increases the effectiveness of (complements) science-based medicine, while alternative medicines which have been tested nearly always have no measurable positive effect compared to a placebo.[1][198][199][200]

Some opponents, focused upon health fraud, misinformation, and quackery as public health problems in the US, are highly critical of alternative medicine, notably Wallace Sampson and Paul Kurtz founders of Scientific Review of Alternative Medicine and Stephen Barrett, co-founder of The National Council Against Health Fraud and webmaster of Quackwatch.[201] Grounds for opposing alternative medicine which have been stated in the US and elsewhere are:

Paul Offit has proposed four ways that "alternative medicine becomes quackery":[80]

A United States government agency, the National Center on Complementary and Integrative Health (NCCIH), has created its own classification system for branches of complementary and alternative medicine. It classifies complementary and alternative therapies into five major groups, which have some overlap and two types of energy medicine are distinguished: one, "Veritable" involving scientifically observable energy, including magnet therapy, colorpuncture and light therapy; the other "Putative" which invoke physically undetectable or unverifiable energy.[210]

Alternative medicine practices and beliefs are diverse in their foundations and methodologies. The wide range of treatments and practices referred to as alternative medicine includes some stemming from nineteenth century North America, such as chiropractic and naturopathy, others, mentioned by Jtte, that originated in eighteenth- and nineteenth-century Germany, such as homeopathy and hydropathy,[160] and some that have originated in China or India, while African, Caribbean, Pacific Island, Native American, and other regional cultures have traditional medical systems as diverse as their diversity of cultures.[7]

Examples of CAM as a broader term for unorthodox treatment and diagnosis of illnesses, disease, infections, etc.,[211] include yoga, acupuncture, aromatherapy, chiropractic, herbalism, homeopathy, hypnotherapy, massage, osteopathy, reflexology, relaxation therapies, spiritual healing and tai chi.[211] CAM differs from conventional medicine. It is normally private medicine and not covered by health insurance.[211] It is paid out of pocket by the patient and is an expensive treatment.[211] CAM tends to be a treatment for upper class or more educated people.[142]

The NCCIH classification system is -

Alternative therapies based on electricity or magnetism use verifiable electromagnetic fields, such as pulsed fields, alternating-current, or direct-current fields in an unconventional manner rather than claiming the existence of imponderable or supernatural energies.[7]

Substance based practices use substances found in nature such as herbs, foods, non-vitamin supplements and megavitamins, and minerals, and includes traditional herbal remedies with herbs specific to regions in which the cultural practices arose.[7] Nonvitamin supplements include fish oil, Omega-3 fatty acid, glucosamine, echinacea, flaxseed oil or pills, and ginseng, when used under a claim to have healing effects.[61]

Mind-body interventions, working under the premise that the mind can affect "bodily functions and symptoms",[7] include healing claims made in hypnotherapy,[212] and in guided imagery, meditation, progressive relaxation, qi gong, tai chi and yoga.[7] Meditation practices including mantra meditation, mindfulness meditation, yoga, tai chi, and qi gong have many uncertainties. According to an AHRQ review, the available evidence on meditation practices through September 2005 is of poor methodological quality and definite conclusions on the effects of meditation in healthcare cannot be made using existing research.[213][214]

Naturopathy is based on a belief in vitalism, which posits that a special energy called vital energy or vital force guides bodily processes such as metabolism, reproduction, growth, and adaptation.[36] The term was coined in 1895[215] by John Scheel and popularized by Benedict Lust, the "father of U.S. naturopathy".[216] Today, naturopathy is primarily practiced in the United States and Canada.[217] Naturopaths in unregulated jurisdictions may use the Naturopathic Doctor designation or other titles regardless of level of education.[218]

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A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch)

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. 1997-2013 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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