Overview
Alternative medicine (AM), often coupled with the term “complementary,” is the practice of various healing techniques in place of traditional medicine. AM is not commonly taught in medical schools, and most AM practices are not covered by health insurance in the United States. AM practices are derived from ancient methods and beliefs and from social behaviors, spirituality, and newer approaches. AM bases good health on a balance of body systems (mental, spiritual, and physical), whereas conventional medicine views good health as the absence of disease.
Much of AM, with the exception of herbal supplements, is based on all aspects of the person being intertwined. This principle is called holism. It is believed that disharmony that undermines balance among these aspects can stress the body and lead to illness. Therefore, in an effort to alleviate sickness, therapies focus on bolstering the body’s own defenses while restoring balance. Similar to Western medicine, however, AM emphasizes proper nutrition and preventive practices.
Before the 1990s, AM was dismissed by most American medical professionals, mostly because there was no supporting scientific evidence of its therapeutic effects. With an increasing number of AM practitioners, and with health consumer acceptance, it has become more common to integrate alternative therapies into mainstream health care. AM journals, organizations, courses of study, Web sites, and government-supported clinical trials are now common in the United States.
Mechanisms of Action
Only theories exist on the mechanisms of action for alternative remedies, so many advocates believe that the scientific method does not apply to this type of practice. Instead, AM advocates rely on anecdotes and theories, which include the theory that AM defies biologic mechanisms and should, therefore, be understood as less harmful than conventional methods. In many cases, simply publishing anecdotes in popular books and magazines is enough evidence for the general support of therapeutic claims.
Oftentimes, alternative remedies are discovered through trial and error. A specific alternative method may work for one person but not for another. Practitioners sometimes have to try several different approaches for the same issue in different persons. Also, one type of approach could be useful for several different health issues.
Language is another obstacle to understanding the way alternative therapies
work. For instance, there are no direct translations for the types of energy in
Ayurvedic
medicine known as vata,
pitta, and kapha, making it impossible to
integrate these types of components into controlled scientific trials for the
purpose of determining a mechanism of action.
Uses
Alternative medicine is commonly used for relatively minor health problems (such as fatigue, insomnia, or back pain). For the most part, AM is utilized for health enhancement in a relatively healthy patient.
An increasingly popular application of alternative therapies is in integrative
medicine, which is the combination of alternative and conventional remedies.
Integrative
medicine is emerging into mainstream medical practice because
of supporting clinical evidence of its benefits. One example of integrated
medicine is the use aromatherapy to minimize nausea after a course of
chemotherapy.
Early History
The term “alternative medicine” has been in use since the late eighteenth
century. The Greek physician Hippocrates, known as the founder of
medicine, introduced this concept during a time when humans were questioning
whether or not the practice of medicine is an art. Furthermore, Hippocrates
believed the mind and body both play a role in the healing process. Ironically
enough, the mind/body healing process is essentially the basis of many alternative
therapies.
Several healing systems existed in the nineteenth century. Treatment procedures
ranged from bleeding and purging to folk medicine and quackery. Many of these
approaches were dangerous and often fatal, leading people to revolt against these
extreme measures of medical practice. By midcentury, the general public showed its
disappointment with standard therapies and began to turn to alternative methods.
As a result, the first alternative medicine system in the West was implemented by
Samuel
Thomson, who used botanicals for healing. The plant drugs, he
believed, either evacuated or heated the body. After his death in 1840, the
Thomsonianism system fell from use.
Homeopathy was promoted by Samuel
Hahnemann, a German physician who treated many disease
symptoms with a series of drug dilutions. The term “allopathy” was coined by
Hahnemann while he was in the United States. Mainstream medicine adopted allopathy
as a standard medical term, and it has remained a part of health-care
terminology.
Also at midcentury, Americans were introduced to hydropathy. This Austrian treatment called for a variety of baths (usually cold) to eliminate toxins and for strict lifestyle changes (such as in diet, exercise, and sleep). Several other popular remedies during this time were magnetism and hypnosis healing, which was introduced by Franz Mesmer.
Because of so many AM options, New York-based Wooster Beach decided to combine the various treatment approaches that were based on clinical expertise, calling his new approach eclectic medicine. Eclectic medicine advocated for care that incorporates more than one type of therapy or method. A modern form of eclectic medicine is acupuncture with chiropractic or osteopathic care. Eclectic medicine was well received from 1820 through the 1930s.
The second generation of alternative medical systems began in the second half
of the nineteenth century. In the 1870s, Andrew Taylor
Still pioneered the technique of musculoskeletal
manipulation, better known as osteopathy. Following closely was
Daniel David
Palmer, who introduced chiropractic
medicine. By the late nineteenth century, osteopathic and chiropractic schools
were offering formal training. Naturopathy, using the body’s natural
healing powers, also became increasingly popular near the end of this century.
The Twentieth Century
By 1900, about 20 percent of all practitioners were AM physicians. Upon the discovery of novel drugs, such as antibiotics, in the 1930s and 1940s, the once highly acclaimed alternative therapies became nearly obsolete. Even doctors of osteopathic and chiropractic medicine were forced not to treat patients, and schools that once offered training in these disciples had to close their doors.
With immigration on the rise, especially in the 1970s, American physicians
began to discover acupuncture, Chinese herbal medicine, and Ayurvedic
medicine.
The philosophy of healing now faced much questioning by American physicians.
Controversy erupted between medical doctors and AM practitioners. AM was denounced
as unscientific, and AM practice was considered unethical. The American Medical
Association’s code of ethics even prohibited medical doctors
from consulting with persons who used alternative remedies.
By the late twentieth century, physicians were again allowed to consult with AM practitioners, and osteopathy and chiropractic were more and more accepted by the medical mainstream. The general public had become dissatisfied with traditional medicine. Americans felt that health care was impersonal, that pharmaceuticals caused harm, and that medical care was costly.
In 1992, the National Institutes of Health established the Office of
Alternative Medicine (now called the National Center for Complementary and Alternative
Medicine) in an effort to examine and report on the efficacy
of alternative methods. By 1995, the first journal dedicated to alternative
therapies and health was in circulation. The notion of mind/body healing was
regaining respect in mainstream medical practice.
A 1998 government report documented that four out of every ten American adults had used some type of alternative therapy in 1997. In addition, more than $20 billion was spent by Americans on alternative health care. By 2002, three out of four American adults had used some type of alternative remedy. With alternative medicine on the rise in the United States, the need for evidence-based alternative methods became clear.
Scientific Evidence
Testing alternative therapies for scientific relevance presents several
challenges. First, many therapies existed long before the development of Western
scientific, analytical methods. For instance, chiropractic procedures were
discovered before scientific understandings of the nervous system. Second,
mechanisms of action and proposed outcomes of alternative therapies are not
clearly understood. Third, interventions may be a combination of treatments. For
example, an Ayurvedic practitioner may prescribe herbal supplements, yoga, and
dietary restrictions. The problem here is determining what intervention cured a
certain problem. Finally, designing standardized placebo-controlled clinical
trials is difficult. An example of this is the challenge of
trying to create artificial yoga, chiropractic, or Tai Chi procedures.
New methods and study designs are needed to investigate alternative therapies for scientific support. It is encouraging to know, however, that thousands of trials are under way.
Conclusions
The combination of limited knowledge of the effects of AM and its increased use by health consumers produces a dangerous situation. Many products and procedures are not regulated, leading to the potential for risks. Herb-drug interactions may occur because of contamination or because of the poor quality of ingredients. Finally, not all AM practitioners are licensed or formally trained.
Bibliography
Alternative Medicine Center. http://www.altmed.net. A user-friendly guide to alternative medicine.
Goldberg, Burton. Alternative Medicine: The Definitive Guide. Tiburon, Calif.: Future Medicine, 1998. This book provides an overview of many different alternative medicine approaches.
Journal of Alternative and Complementary Medicine. http://www.liebertpub.com. A Web-based journal for practitioners seeking to integrate alternative medicine into their practice.
Marti, James E. The Alternative Health and Medicine Encyclopedia. 2d ed. Detroit: Visible Ink Press, 1997. This edition offers more than three hundred therapies for more than seventy disease states. It is easy to read and offers basic facts on a variety of alternative therapies.
Micozzi, Marc. Fundamentals of Complementary and Alternative Medicine. 3d ed. St. Louis, Mo.: Saunders/Elsevier, 2006. This book offers good background on the foundation and context of alternative therapies. Each entry also includes a list of further readings and related organizations.
Nash, Barbara. From Acupressure to Zen: An Encyclopedia of Natural Therapies. Upland, Pa.: Diane, 1998. This book provides an overview of basic information on many different alternative medicine approaches and natural therapies.
National Center for Complementary and Alternative Medicine. http://nccam.nih.gov. A U.S. government site that offers research-based information on complementary and alternative therapies.
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