Alternative Medicine: An Overview.

Introduction

In the United States and Western Europe, the terms “alternative medicine“ and “alternative therapy“ are used to describe techniques that fall outside the accepted, conventional understanding of evidence-based medicine. Alternative therapies fall broadly into two categories: those that developed in regions such as Asia, India, Africa, Latin America, or Native America, and those invented in Europe or the modern United States.

Medical research has indicated that some alternative therapies produce a positive result in patients. However, in several cases, researchers either have been unable to determine the mechanisms underlying these effects or were not convinced that the therapies warrant further study. Researchers at the National Institutes of Health (NIH) have discussed and evaluated the use of certain forms of alternative medicine, such as acupuncture. In the second edition of his influential 1983 book on traditional Chinese medicine (TCM), The Web That Has No Weaver, Ted Kaptchuk, an expert on Eastern medicine in the United States, provides an exemplary list of studies on acupuncture alone that takes up thirty pages.

Many believe that alternative medicine works by virtue of the placebo effect, making it necessary for supporters of alternative treatments to measure the performance of their treatments against that of a placebo. The use of placebos as direct treatment or in clinical trials is widely considered unethical in cases where an effective treatment is known to exist, making it difficult to ethically construct such a trial—though not impossible; Dr. Franklin G. Miller, a senior faculty member of the NIH Clinical Center’s Department of Bioethics, has proposed several models that could be followed.

Some believe that science can eventually discover the mechanisms underlying alternative medicines, while others believe that either the nature of alternative medicines or the predispositions common to Western science and philosophy will prevent scientists from understanding or accepting alternative treatments. Such predispositions include a linear cause-and-effect concept. WhileTCM, for example, perceives the human being as a whole in their life context and sickness as a disharmony in the equilibrium of this whole, Western medicine looks for a category of disease it can isolate and then treat directly. The debate has branched into several related issues, including whether research funding should be used to study the effects of alternative therapies, the licensing and federal regulation of alternative medicines, and the ethics of condoning therapies that have not been proved effective by scientific research.

Understanding the Discussion

Acupuncture: A form of medicine developed in China that treats ailments or provides anesthesia by inserting needles into specific points in a patient’s body along the meridian system.

Alternative medicine: Various therapeutic methods that do not follow generally accepted practices in Western medicine or science and may or may not be understood in terms of their physiological effect.

Chiropractic: A form of therapy in which the spine or joints are manipulated with respect to their relationship to the central nervous system.

Contact-based therapy: Common in most alternative forms of medicine, the idea that direct face-to-face contact is an indispensable prerequisite for reaching a judgment on a patient’s individual and specific condition.

Folk medicine: Therapies derived from cultural traditions or that use local remedies and food substances in place of synthetic drugs or surgery.

Homeopathy: A therapy that administers in minute amounts substances that when given in greater amounts produce symptoms similar to those of the disease in healthy individuals.

Naturopathy: Any system of therapy that uses only naturally occurring herbs and foods, sometimes in conjunction with noninvasive contact such as massage, and rejects the use of synthetic drugs or surgery.

Placebo: A substance with no known pharmacological or physiological effect that is believed by the patient to be a reliable medicine.

Scientific method: A scientific process in which a problem is identified, data relating to the problem is reviewed, a hypothesis is formed, and experiments are performed to test the validity of the hypothesis.

History

Many alternative medicines evolved from folk medicines that predate the invention of the scientific method. By trial and error, tribal cultures discovered that certain zoological, botanical, and mineral substances found in their native environments could be used for healing purposes. Through either intentional or inadvertent experimentation, many early communities identified correlations between the body and symptoms such as pain or nausea.

Each culture developed herbal and contact-based therapies in keeping with their individual philosophies, religious beliefs, and cultural norms. Within many of these cultures, medicine evolved into a theoretical system. For instance, the earliest books on TCM were written between 305 and 204 BCE, by which time healers had been practicing techniques for centuries. In the twentieth century, a number of successful drugs were derived from TCM herbal treatments, including ephedrine and pseudoephedrine. Artemisia annua, a type of wormwood traditionally given to treat fevers, was used to develop a highly effective antimalarial drug called artemisinin.

In ancient Greece and Rome, a variety of folk medicines were used among the general populace. Philosophers began to develop a scientific philosophy based on experimentation that eventually led to the scientific method. As physicians in Europe and the Middle East began using experimental methods, the distinction between scientific and folk medicine grew wider.

Most folk medicine blends aspects of a culture’s spiritual practices with physiology and experimentation. In India, China, Japan, Egypt, and many tribal cultures, traditional medicine has remained intertwined with native philosophy. In Europe and the Middle East, Christian and Islamic institutions at first rejected and then accepted the development of scientific medicine, eventually abandoning folk medicine.

In 1668, Italian scientist Francesco Redi conducted some of the first experiments using the basic scientific method. In the nineteenth century, applying the scientific method in chemistry for medical purposes eventually led to the formulation of synthetic compounds, and health professionals began to rely less on the use of herbal and naturopathic remedies.

Some practitioners continued to develop alternative medicines to avoid surgery or the occasionally hazardous effects of synthetic medicines. Two examples are the development of homeopathy by German physician Samuel Hahnemann around 1807 and the development of chiropractic medicine in 1895 by Canadian educator Daniel Palmer.

Even as scientific medicine dominated Western culture, interest in naturopathic remedies remained substantial, and alternative medicines from Asia and India continued to be used by ethnic populations in Western countries. However, use of naturopathic medicine began to decline in the 1940s, following the invention of antibiotics. In the 1950s, scientists began experimenting with placebos, and the hypothesis was developed that alternative medicines were similar to placebos in their effect. Although evidence shows some placebos can benefit patients, this theory has led many physicians to distrust the efficacy of alternative therapies.

During the 1960s and 1970s, there was a renewed interest in alternative medicine. Information about alternative therapies became more available, and people began to experiment with foreign medicines, including acupuncture and herbal medicine from Asia. Some physicians in the United States and Europe lobbied to ban or restrict alternative therapies that were viewed as possible health risks. Practitioners and other supporters lobbied for legislation that would legitimize and formally license alternative medicine. In 1991 Congress established the Office of Alternative Medicine (OAM) , to promote the scientific examination of alternative therapies. The OAM was renamed the National Center for Complementary and Alternative Medicine and, later, the National Center for Complementary and Integrative Health.

During the 1990s pharmaceutical companies began producing concentrated versions of some herbal supplements. Some of these supplements were released to the public without scientific evaluation, resulting in health concerns and increased pressure to update regulation of alternative therapies. The legal system struggled to keep up with pharmaceutical companies and with growing public interest in alternative remedies.

In light of the opioid addiction epidemic of the 2010s, insurers and prescribers began looking for, and switching patients to, alternative means of pain management, such as chiropractic or acupuncture. Since around 2012, the US federal government and medical centers have funded research into the possible biological mechanism by which acupuncture may work in an effort to find an even more effect pain management technique.

Alternative Medicine Today

In the 2020s, interest in alternative medicine continues to grow. Many medical professionals remain skeptical of alternative therapies, but public interest has convinced the government to invest more resources in research. Some physicians have begun to use alternative treatments in conjunction with scientific medicine, at which point the treatments are deemed "complementary" or "integrative" rather than "alternative." In some cases, this represents a fundamental shift in the relationship between conventional and alternative medicine, while in other cases physicians are simply making economic decisions based on public demand.

Some physicians feel that the licensing requirements for alternative medicine practitioners are not stringent enough and that some therapies represent a health hazard, as certain herbs and substances used in traditional Asian medicine and homeopathy have been shown to have negative health effects. In addition, critics of alternative therapies argue that they have no benefit beyond the placebo effect and should therefore not be treated as legitimate medicine. Supporters point to controlled experiments in which alternative therapies have been shown to perform better than placebos, but a number of systematic reviews have found that the controls used in these experiments were insufficient, and more rigorously controlled trials have generally shown little to no effect.

A common defense against such criticism is the claim that scientifically controlled trials divorce alternative therapies from the individualized treatment and rituals necessary for them to succeed. Supporters of alternative medicine argue that Western pharmaceutical companies have created misconceptions about naturopathy by removing herbal supplements from their context within traditional treatments. For example, an herbalist may only use certain substances in conjunction with other substances that modify the overall effect. Practitioners fear that misuse of herbal remedies could substantially damage the practice of alternative medicine.

Traditional Chinese medicine TCM, by far the largest sector of alternative medicine, is still practiced in the 2020s. Some Chinese herbal medicines have proven successful in clinical settings; for instance, a 2022 systematic review of CAM interventions for treating COVID-19 symptoms found evidence that TCM herbal medications were effective. The same reviewers cautioned that the evidence of most CAM interventions for treating COVID-19 symptoms still needed to be evaluated, as did CAM interventions for acute COVID-19 and long COVID.

Similarly, mainstream interest in Ayurveda (traditional Indian medicine) and practice of yoga for mental and physical health have grown too. Turmeric, another common herbal remedy used in traditional Indian, Chinese, and other Asian medicine, has been investigated as a potential cancer treatment due to the anti-inflammatory and immunomodulatory effects of curcumin, an active ingredient in the plant.

Skeptics of alternative medicine point out that trials assessing the clinical effectiveness of TCM and other alternative medicine for other diseases and conditions have generally been inconclusive or of insufficient methodological rigor. Critics such as former OAM head Joseph Jacobs argue that the alternative medicine industry profits enormously while patients fail to receive the relief or cure they truly need, through misplaced trust in the treatments' efficacy and delayed conventional care. This, they suggest, results in poor health outcomes and wasteful private and public expenditure.

These essays and any opinions, information or representations contained therein are the creation of the particular author and do not necessarily reflect the opinion of EBSCO Information Services.

Bibliography

Cloud, John. “Beyond Drugs.” Time, 7 Mar. 2011, pp. 80–88.

Deardorff, Julie. “Alternative Medicines Can Help, Harm Kids.“ Chicago Tribune, 16 Feb. 2011. Accessed 4 Feb. 2014. Evans, Dylan. Placebo: Mind over Matter in Modern Medicine. 2004. New York: Oxford UP, 2014.

Goldacre, Ben. Bad Science: Quacks, Hacks, and Big Pharma Flacks. New York: Giroux, 2010.

Harrington, Anne. The Cure Within: A History of Mind-Body Medicine. New York: Norton, 2008.

Interlandi, Jeneen. “The Acupuncture Myth.” Scientific American, vol. 315, no. 2, Aug. 2016, p. 24. Points of View Reference Center, doi:10.1038/scientificamerican0816-24. Accessed 27 Aug. 2019.

Jeon, Sae-Rom, et al. "Complementary and Alternative Medicine (CAM) Interventions for COVID-19: An Overview of Systematic Reviews." Integrative Medicine Research, vol. 11, no. 3, 2022, doi.org/10.1016/j.imr.2022.100842. Accessed 27 Mar. 2024.

Johnston, Robert D., ed. The Politics of Healing: Histories of Alternative Medicine in Twentieth-Century North America. New York: Routledge, 2004. Kaptchuk, Ted. The Web That Has No Weaver: Understanding Chinese Medicine. 2nd ed. New York: McGraw, 2000.

Krainin, Todd, and Stephanie Slade. “The Alternative Medicine Racket.” Reason, vol. 47, no. 7, Dec. 2015, p. 28. Points of View Reference Center, search.ebscohost.com/login.aspx?direct=true&db=pwh&AN=110672951&site=pov-live. Accessed 27 Aug. 2019.

Maino, Dominick M. “Evidence Based Medicine and CAM: A Review.” Optometry & Vision Development, vol. 43, no. 1, 2012, pp. 13–17. Academic Search Complete. Accessed 14 Oct. 2015. Miller, Franklin G., et al. “Ethical Issues Concerning Research in Complementary and Alternative Medicine.” The Ethical Challenges of Human Research: Selected Essays. By Miller. New York: Oxford UP, 2012, pp. 105–17.

Offit, Paul. “Alternative Medicines Are Popular, but Do Any of Them Really Work?” Washington Post, 11 Nov. 2013. Accessed 14 Nov. 2014. Olver, Ian, and Monica Robotin, eds. Perspectives on Complementary and Alternative Medicine. London: Imperial Coll P, 2012.

Possamai-Inesedy, Alphia, and Suzanne Cochrane. “The Consequences of Integrating Complementary and Alternative Medicine: An Analysis of Impacts on Practice.” Health Sociology Review, vol. 22, no. 11, 2013, pp. 65–74. Academic Search Complete. Accessed 4 Feb. 2014.