Complementary and alternative medicine: Difference between revisions

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'''Alternative medicine''' is a set of therapies that are considered whole systems of healthcare that are outside the realm of mainstream healthcare due to their incompatability with current scientific thought. '''Complementary medicine''' is comprised of those systems, or parts of systems, that have shown some efficacy experimentally and therefore are frequently used in conjunction with the mainstream. These practices include [[acupuncture]], [[homeopathy]], [[herbal medicine]], [[faith healing]], [[chiropractic]], and [[prayer]]. Critics argue that these practices are not scientifically or clinically verified, and can lead patients to harm in delaying treatment, and point to evidence of [[scams]] and [[fraud]] perpetuated by practitioners of alternative medicine.
'''Alternative medicine''' is a set of therapies that are considered '''whole''' systems of healthcare that are outside the realm of mainstream healthcare due to their incompatability with current scientific thought.   '''Complementary medicine''' is comprised of those systems, or parts of systems, that have shown some efficacy experimentally and therefore are frequently used in conjunction with the mainstream. These practices include [[acupuncture]], [[homeopathy]], [[Plants, medicinal|herbal medicine]], [[faith healing]], [[chiropractic]], and [[prayer]].  
 
Since some techniques may be found both in whole and complementary systems, it is convenient to speak of '''complementary and alternative medicine (CAM)''' as one broad field.
 
Clearly, an advocate of an alternative system is critical of whatever it is to which they propose an alternative. Conventional, biologically-based medicine is not inherently critical of CAM, although it is fair to say that whole system practitioner on both side are critical of one another.
 
Conventional physicians do express concerns over '''whole systems''', because they may either not identify dangerous conditions that are treatable by conventional medicine, such that the patient does not have the information to decide to give [[informed consent]] to alternative treatment alone. Another aspect of that concern is that some conditions can respond to mainstream medical treatment early in the process, but delay of diagnosis could put the patient in a situation where the conventional treatment would no longer be effective.
 
While some conventional physicians will reject any complementary method for which they do not know the exact mode of action, there are many productive, collaborative treatments by teams of mainstream and complementary (but not whole system) practitioners. For example, it is quite comment for [[pain medicine]] specialists to use complementary methods.
 
Complementary techniques may complement one another. For example, one preliminary clinical trial found that aromatherapy alone, while pleasant, did not speed healing, while using the essential oils of aromatherapy as the lubricants in massage therapy caused more of an effect than massage alone.
 
==Classification of CAM==
To begin a discussion, it is necessary to define the scope of the problem.  The table below is derived from one created by the U.S. [[National Center for Complementary and Alternative Medicine]].
 
{| class="wikitable"
|-
! Major field and  Description
! Subfield
! Subfield
|-
| '''Whole Medical Systems''' comprise 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. These are usually alternative rather than complementary.
| '''Western''' systems include [[homeopathy]] and [[naturopathy]]
| '''Non-western systems''' include classical [[traditional Chinese medicine]]<ref>To be distinguished from the official Chinese "Three Roads" approach corresponds to using TCM in the context of complementary medicine</ref>  and [[ayurveda]]
|-
| '''Mind-Body Medicine''' uses a variety of techniques designed to enhance the mind's capacity to affect bodily function and symptoms.  Some of the "still considered CAM" techniques are more and more accepted.
| '''Accepted as mainstream (not strictly CAM)''' include  patient support groups and [[cognitive-behavioral therapy]]
| '''Still considered CAM''' include [[meditation]], [[visualization]], and [[relaxation (physiology)]] techniques; [[eye motion desensitization reprocessing]]; [[healing prayer]], [[mental healing]], and creative outlets such as [[art therapy]], [[music therapy]] and dance
|-
| '''Biologically based practices'''  in CAM use substances found in nature, such as [[Plants, medicinal|medicinal herbs]], [[diet therapy]], [[vitamin, pharmacologic dosage|pharmacologic doses of vitamins]], [[essential oil]]s, and [[dietary supplement]]s. An example of an unproven method is using shark cartilage to treat cancer.
|-
| '''Manipulative and Body-Based Practices''' involve the controlled use of force against parts of the body, or maneuvers that move body parts out of their usual range of motion. These may be used as whole systems or as complementary methods. They include [[osteopathic manipulation]], [[massage therapy]], [[chiropractic]], and methods involving movement or posture instruction.
|
|-
| '''Energy Medicine''' breaks into therapies that use forces that are, and are not, detectable with conventional scientific instrumentation.
| '''Bioelectromagnetic-based therapies''' involve the unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields, or alternating-current or direct-current fields.
| '''Biofield therapies''' are intended to affect energy fields that purportedly surround and penetrate the human body. These include [[qi gong]] (part of [[traditional Chinese medicine]]), [[reiki]], and [[therapeutic touch]]
|-
|}
 
 
==Criticism (old section)==
 
Critics argue that these practices are not scientifically or clinically verified, and can lead patients to harm in delaying treatment, and point to evidence of [[scams]] and [[fraud]] perpetuated by practitioners of alternative medicine.


Critics of alternative medicine seek alternative explanations for the claims that advocates of such therapies make, mostly in the use of the [[placebo effect]], a surprisingly powerful psychological effect where a person who thinks that a medical intervention is effective boosts their own health. Along with this, patients of alternative treatments are said to exhibit a self-delusional bias, where they accept successes and disregard failures for their favorite alternative practices while not doing similarly for mainstream medicine ([[confirmation bias]]). While some defend alternative medicine on the basis that it is not harmful, there are problems with this: as alternative treatments are often not rigorously tested, it can be difficult to know the side effects of some alternative treatments, especially as the natural sources used for such treatments do not often allow for strict control of doses. This has been observed with the incompatibility between [[St John's Wort]], a herbal remedy often prescribed by alternative medicine practitioners for [[depression]] and a variety of drugs including [[AIDS]] and [[heart disease]] medications<ref>Stephen Barrett, [http://www.quackwatch.org/01QuackeryRelatedTopics/DSH/stjohn.html St. John's Wort], ''Quackwatch''</ref><ref>National Institute of Mental Health (US), [http://www.nimh.nih.gov/health/publications/depression/complete-publication.shtml Depression]</ref>. Critics of alternative medicine also note that it can be dangerous if patients delay seeking conventional treatment in preference for use of alternative medicine.
Critics of alternative medicine seek alternative explanations for the claims that advocates of such therapies make, mostly in the use of the [[placebo effect]], a surprisingly powerful psychological effect where a person who thinks that a medical intervention is effective boosts their own health. Along with this, patients of alternative treatments are said to exhibit a self-delusional bias, where they accept successes and disregard failures for their favorite alternative practices while not doing similarly for mainstream medicine ([[confirmation bias]]). While some defend alternative medicine on the basis that it is not harmful, there are problems with this: as alternative treatments are often not rigorously tested, it can be difficult to know the side effects of some alternative treatments, especially as the natural sources used for such treatments do not often allow for strict control of doses. This has been observed with the incompatibility between [[St John's Wort]], a herbal remedy often prescribed by alternative medicine practitioners for [[depression]] and a variety of drugs including [[AIDS]] and [[heart disease]] medications<ref>Stephen Barrett, [http://www.quackwatch.org/01QuackeryRelatedTopics/DSH/stjohn.html St. John's Wort], ''Quackwatch''</ref><ref>National Institute of Mental Health (US), [http://www.nimh.nih.gov/health/publications/depression/complete-publication.shtml Depression]</ref>. Critics of alternative medicine also note that it can be dangerous if patients delay seeking conventional treatment in preference for use of alternative medicine.

Revision as of 15:15, 13 December 2008

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Alternative medicine is a set of therapies that are considered whole systems of healthcare that are outside the realm of mainstream healthcare due to their incompatability with current scientific thought. Complementary medicine is comprised of those systems, or parts of systems, that have shown some efficacy experimentally and therefore are frequently used in conjunction with the mainstream. These practices include acupuncture, homeopathy, herbal medicine, faith healing, chiropractic, and prayer.

Since some techniques may be found both in whole and complementary systems, it is convenient to speak of complementary and alternative medicine (CAM) as one broad field.

Clearly, an advocate of an alternative system is critical of whatever it is to which they propose an alternative. Conventional, biologically-based medicine is not inherently critical of CAM, although it is fair to say that whole system practitioner on both side are critical of one another.

Conventional physicians do express concerns over whole systems, because they may either not identify dangerous conditions that are treatable by conventional medicine, such that the patient does not have the information to decide to give informed consent to alternative treatment alone. Another aspect of that concern is that some conditions can respond to mainstream medical treatment early in the process, but delay of diagnosis could put the patient in a situation where the conventional treatment would no longer be effective.

While some conventional physicians will reject any complementary method for which they do not know the exact mode of action, there are many productive, collaborative treatments by teams of mainstream and complementary (but not whole system) practitioners. For example, it is quite comment for pain medicine specialists to use complementary methods.

Complementary techniques may complement one another. For example, one preliminary clinical trial found that aromatherapy alone, while pleasant, did not speed healing, while using the essential oils of aromatherapy as the lubricants in massage therapy caused more of an effect than massage alone.

Classification of CAM

To begin a discussion, it is necessary to define the scope of the problem. The table below is derived from one created by the U.S. National Center for Complementary and Alternative Medicine.

Major field and Description Subfield Subfield
Whole Medical Systems comprise 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. These are usually alternative rather than complementary. Western systems include homeopathy and naturopathy Non-western systems include classical traditional Chinese medicine[1] and ayurveda
Mind-Body Medicine uses a variety of techniques designed to enhance the mind's capacity to affect bodily function and symptoms. Some of the "still considered CAM" techniques are more and more accepted. Accepted as mainstream (not strictly CAM) include patient support groups and cognitive-behavioral therapy Still considered CAM include meditation, visualization, and relaxation (physiology) techniques; eye motion desensitization reprocessing; healing prayer, mental healing, and creative outlets such as art therapy, music therapy and dance
Biologically based practices in CAM use substances found in nature, such as medicinal herbs, diet therapy, pharmacologic doses of vitamins, essential oils, and dietary supplements. An example of an unproven method is using shark cartilage to treat cancer.
Manipulative and Body-Based Practices involve the controlled use of force against parts of the body, or maneuvers that move body parts out of their usual range of motion. These may be used as whole systems or as complementary methods. They include osteopathic manipulation, massage therapy, chiropractic, and methods involving movement or posture instruction.
Energy Medicine breaks into therapies that use forces that are, and are not, detectable with conventional scientific instrumentation. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields, or alternating-current or direct-current fields. Biofield therapies are intended to affect energy fields that purportedly surround and penetrate the human body. These include qi gong (part of traditional Chinese medicine), reiki, and therapeutic touch


Criticism (old section)

Critics argue that these practices are not scientifically or clinically verified, and can lead patients to harm in delaying treatment, and point to evidence of scams and fraud perpetuated by practitioners of alternative medicine.

Critics of alternative medicine seek alternative explanations for the claims that advocates of such therapies make, mostly in the use of the placebo effect, a surprisingly powerful psychological effect where a person who thinks that a medical intervention is effective boosts their own health. Along with this, patients of alternative treatments are said to exhibit a self-delusional bias, where they accept successes and disregard failures for their favorite alternative practices while not doing similarly for mainstream medicine (confirmation bias). While some defend alternative medicine on the basis that it is not harmful, there are problems with this: as alternative treatments are often not rigorously tested, it can be difficult to know the side effects of some alternative treatments, especially as the natural sources used for such treatments do not often allow for strict control of doses. This has been observed with the incompatibility between St John's Wort, a herbal remedy often prescribed by alternative medicine practitioners for depression and a variety of drugs including AIDS and heart disease medications[2][3]. Critics of alternative medicine also note that it can be dangerous if patients delay seeking conventional treatment in preference for use of alternative medicine.

Some alternative treatments have been tested through scientific means and when found beneficial have been integrated into normal medical practice. An example of this is acupuncture, which many doctors now use as part of pain relief for some ailments because of the release of endorphins[4]. Some scientific studies have shown that it is effective but have not confirmed the metaphysics upon which it is based—that of qi[5], "vital energy" or the existence of "meridians".[6].

References

  1. To be distinguished from the official Chinese "Three Roads" approach corresponds to using TCM in the context of complementary medicine
  2. Stephen Barrett, St. John's Wort, Quackwatch
  3. National Institute of Mental Health (US), Depression
  4. NHS Direct Health Encyclopedia (UK), Acupuncture
  5. qi is the correct spelling in pinyin, which is the Romanization scheme approved by the Chinese government and used by (probably) most western scholars today. "Ch'i" (note the apostrophe!) is the correct spelling in the Wade-Giles system, which was widely used before pinyin, survives in many older texts, and is still used by some western scholars today.
  6. Robert Todd Carroll, "Acupuncture" in the Skeptic's Dictionary