Alternative Medicine

Alternative medicine refers to practices that aim to achieve the healing effects of medicine, but that by definition lack biological plausibility, testability, repeatability, or supporting evidence of effectiveness. Such practices are not part of evidence-based medicine. Unlike modern medicine, which employs the scientific method to test plausible therapies by way of responsible and ethical clinical trials, producing repeatable evidence of either effect or of no effect, alternative therapies reside outside of mainstream medicine[n 1][n 2] and do not originate from using the scientific method, but instead rely on testimonials, anecdotes, religion, tradition, superstition, belief in supernatural "energies", pseudoscience, errors in reasoning, propaganda, fraud, or other unscientific sources. Frequently used terms for relevant practices are 

New Agemedicine, pseudo-medicine, unorthodox medicine, holistic medicine, fringe medicine, and unconventional medicine, with little distinction from quackery.


Some alternative practices are based on theories that contradict the established science of how the human body works; others appeal to the supernatural or superstitions to explain their effect or lack thereof. In others, the practice has plausibility but lacks a positive risk–benefit outcome probability. Research into alternative therapies often fails to follow proper research protocols (such as placebo-controlled trials, blind experimentsand calculation of prior probability), providing invalid results. History has shown that if a method is proven to work, it eventually ceases to be alternative and becomes mainstream medicine.


Much of the perceived effect of an alternative practice arises from a belief that it will be effective, the placebo effect, or from the treated condition resolving on its own (the natural course of disease). This is further exacerbated by the tendency to turn to alternative therapies upon the failure of medicine, at which point the condition will be at its worst and most likely to spontaneously improve. In the absence of this bias, especially for diseases that are not expected to get better by themselves such as cancer or HIV infection, multiple studies have shown significantly worse outcomes if patients turn to alternative therapies. While this may be because these patients avoid effective treatment, some alternative therapies are actively harmful (such as cyanide poisoningfrom amygdalin, or the intentional ingestion of hydrogen peroxide) or actively interfere with effective treatments.


The alternative medicine sector is a highly profitable industry with a strong lobby,[1] and faces far less regulation over the use and marketing of unproven treatments. Complementary medicine (CM), complementary and alternative medicine (CAM), functional medicine (FM), integrated medicine or integrative medicine (IM), and holistic medicine attempt to combine alternative practices with those of mainstream medicine. Traditional medicine practices become "alternative" when used outside their original settings and without proper scientific explanation and evidence. Alternative methods are often marketed as more "natural" or "holistic" than methods offered by medical science, that is sometimes derogatorily called "Big Pharma" by supporters of alternative medicine. Billions of dollars have been spent studying alternative medicine, with few or no positive results and many methods thoroughly disproven.



Neil deGrasse Tyson:
Q: What do you call Alternative Medicine that survives double-blind laboratory tests?
A: Regular Medicine.[2]


The terms alternative medicine, complementary medicine, integrative medicine, holistic medicine, natural medicine, unorthodox medicine, fringe medicine, unconventional medicine, and new agemedicine are used interchangeably as having the same meaning and are almost synonymous in most contexts.[3][4][5][6] Terminology has shifted over time, reflecting the preferred branding of practitioners.[7] For example, the department of the United States National Institutes of Health studying alternative medicine is currently named the National Center for Complementary and Integrative Health (NCCIH), but it was established as the Office of Alternative Medicine (OAM) and then renamed the National Center for Complementary and Alternative Medicine (NCCAM) before now. Therapies are often framed as "natural" or "holistic", implicitly and intentionally suggesting that conventional medicine is "artificial" and "narrow in scope".[1]


The meaning of the term "alternative" in the expression "alternative medicine", is not that it is an effective alternative to medical science (though some alternative medicine promoters may use the loose terminology to give the appearance of effectiveness).[8][9] Loose terminology may also be used to suggest meaning that a dichotomy exists when it does not (such as the use of the expressions Western medicineand Eastern medicine to suggest a cultural difference between the Asian east and the European west, rather than that the difference is between evidence-based medicine and treatments that do not work).[8]


Alternative medicine

Alternative medicine is defined loosely as a set of products, practices, and theories that are believed or perceived by their users to have the healing effects of medicine,[n 3][n 4] but whose effectiveness has not been established using scientific methods,[n 3][n 5][13][14][15][8] or whose theory and practice is not part of biomedicine,[n 4][n 1][n 2][n 6] or whose theories or practices are directly contradicted by scientific evidence or scientific principles used in biomedicine.[8][13][19] "Biomedicine" or "medicine" 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.


Unlike medicine,[n 1] an alternative product or practice does not originate from using scientific methods, but may instead be based on hearsay, religion, tradition, superstition, belief in supernatural energies, pseudoscience, errors in reasoning, propaganda, fraud, or other unscientific sources.[n 5][8][10][13][19]

Some other definitions seek to specify alternative medicine in terms of its social and political marginality to mainstream healthcare.[20]This can refer to the lack of support that alternative therapies receive from medical scientists regarding access to research funding, sympathetic coverage in the medical press, or inclusion in the standard medical curriculum.[20] 


For example, a widely used[21]definition devised by the National Center for Complementary and Alternative Medicine (NCCIH) calls it "a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine".[22] However, these descriptive definitions are inadequate in the present-day when some conventional doctors offer alternative medical treatments and introductory courses or modules can be offered as part of standard undergraduate medical training;[23] alternative medicine is taught in more than half of US medical schools and US health insurers are increasingly willing to provide reimbursement for alternative therapies.[24]



Complementary medicine (CM) or integrative medicine (IM) is when alternative medicine is used together with mainstream medical treatment in a belief that it improves the effect of treatments.[n 7][10][26][27][28] Several medical organizations differentiate between complementary and alternative medicine including the UK National Health Service (NHS),[29] Cancer Research UK,[30] and the US Center for Disease Control and Prevention (CDC), the latter of which states that "Complementary medicine is used in addition to standard treatments" whereas "Alternative medicine is used instead of standard treatments."[31] For example, acupuncture (piercing the body with needles to influence the flow of energy) might be believed to increase the effectiveness or "complement" science-based medicine when used at the same time.[32][33][34] Significant drug interactions caused by alternative therapies may make treatments less effective, notably in cancer therapy.[35][36][37]


Some mainstream academic medical centers have integrative or functional medicine departments, including the Cleveland Clinic, the Mayo Clinic,[38] Stanford University,[39] UCLA,[40] UC San Francisco[41] and Northwestern University.[42] In contrast, other medical practitioners are unconvinced by these practices. For example, surgical oncologist, David Gorski has described integrative medicine as an attempt to bring pseudoscience into academic science-based medicine[43] with skeptics such as Gorski and David Colquhoun referring to this with the pejorative term "quackademia".[44] Robert Todd Carroll described integrative medicine as "a synonym for 'alternative' medicine that, at its worst, integrates sense with nonsense. At its best, integrative medicine supports both consensus treatments of science-based medicine and treatments that the science, while promising perhaps, does not justify"[45] Rose Shapiro has criticized the field of alternative medicine for rebranding the same practices as integrative medicine.[3]


CAM is an acronym for complementary and alternative medicine.[46][47][48] The 2019 World Health Organization (WHO) Global Report on Traditional and Complementary Medicine states that the terms complementary and alternative medicine "refer to a broad set of health care practices that are not part of that country's own traditional or conventional medicine and are not fully integrated into the dominant health care system. They are used interchangeably with traditional medicine in some countries."[49]


The Integrative Medicine Exam by the American Board of Physician Specialties[50] includes the following subjects: Manual Therapies, Biofield Therapies, Acupuncture, Movement Therapies, Expressive Arts, Traditional Chinese Medicine, Ayurveda, Indigenous Medical Systems, Homeopathic Medicine, Naturopathic Medicine, Osteopathic Medicine, Chiropractic, and Functional Medicine.[50]


Functional medicine

Functional medicine (FM) is a form of alternative medicine that encompasses many unproven and disproven methods and treatments.[51][52][53] At its essence, it is a rebranding of complementary and alternative medicine (CAM),[54] and as such is pseudoscientific,[55]and has been described as a form of quackery.[56][57][58][59][54] In the US, FM practices have been ruled ineligible for course credits by the American Academy of Family Physicians because of concerns they may be harmful.[60][61] Functional medicine was created by Jeffrey Bland,[62] who founded The Institute for Functional Medicine (IFM), which is based in the US state of Washington, in the early 1990s as part of one of his companies, HealthComm.[63] IFM, which promotes functional medicine, became a registered non-profit in 2001.[64] Mark Hyman became an IFM board member and prominent promoter.[62][64]


David Gorski, a surgical oncologist at Wayne State University, has written that FM is not well-defined and performs "expensive and generally unnecessary tests".[65] Gorski says FM's vagueness is a deliberate tactic that makes functional medicine difficult to challenge.[66] In an analysis for the Office for Science and Society at McGill University, Jonathan Jarry writes "Test enough people and you get a lot of false positives, which generate anxiety, more invasive tests, and sometimes unnecessary treatments."[67] Proponents of functional medicine oppose established medical knowledge and reject its models, instead adopting a model of disease based on the notion of "antecedents", "triggers", and "mediators". These are meant to correspond to the underlying causes of health issues, the immediate causes, and the particular characteristics of a person's illness.


A functional medicine practitioner devises a "matrix" from these factors to serve as the basis for treatment.[68] Treatments, practices, and concepts are generally not supported by medical evidence.[51] Patients of functional medicine practitioners may also be told to undertake unnecessary diets that can limit food choices.[67] Jonathan Stea writes that functional medicine, integrative medicine, and CAM "are marketing terms designed to confuse patients, promote pseudoscience, and sow distrust in mainstream medicine."[69]


In the 1990s, integrative medicine started to be marketed by a new term, "functional medicine".[70] FM practitioners claim to diagnose and treat conditions that have been found by research studies not to exist, such as adrenal fatigue and numerous imbalances in body chemistry.[71][72] For instance, contrary to scientific evidence, Joe Pizzorno, a major figure in FM, claimed that 25% of people in the United States have heavy metal poisoning and need to undergo detoxification.[60] Many scientists state that such detox supplements are a waste of time and money.[73] Detox has been also called "mass delusion".[74] 


In 2014, the American Academy of Family Physicians withdrew course credits for functional medicine courses, having identified some of its treatments as "harmful and dangerous".[60] In 2018, it partly lifted the ban, but only to allow overview classes, not to teach its practice.[61] The opening of centers for functional medicine at the Cleveland Clinic and George Washington University was described by David Gorski as an "unfortunate" example of "quackademia" — that is, a quackery infiltrating academic medical centers.[54]


Other terms

See also: Traditional medicine

Traditional medicine (TM) refers to certain practices within a culture which have existed since before the advent of medical science,[75][76] Many TM practices are based on "holistic" approaches to disease and health, versus the scientific evidence-based methods in conventional medicine.[77][78] The 2019 WHO report defines traditional medicine as "the sum total of the knowledge, skill and practices based on the theories, beliefs and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness."[49] When used outside the original setting and in the absence of scientific evidence, TM practices are typically referred to as "alternative medicine".[79][80][81]


Holistic medicine is another rebranding of alternative medicine. In this case, the words balance and holism are often used alongside complementary or integrative, claiming to take into fuller account the "whole" person, in contrast to the supposed reductionism of medicine.[82][83]


Challenges in defining alternative medicine

Prominent members of the science[84][85] and biomedical science community[12] say that it is not meaningful to define an alternative medicine that is separate from a conventional medicine because the expressions "conventional medicine", "alternative medicine", "complementary medicine", "integrative medicine", and "holistic medicine" do not refer to any medicine at all.[12][84][85][81] Others say that alternative medicine cannot be precisely defined because of the diversity of theories and practices it includes, and because the boundaries between alternative and conventional medicine overlap, are porous, and change.[16][86] 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.[87] Under a definition of alternative medicine as "non-mainstream", treatments considered alternative in one location may be considered conventional in another.[88]


Critics say the expression is deceptive because it implies there is an effective alternative to science-based medicine, and that complementary is deceptive because it implies that the treatment increases the effectiveness of (complements) science-based medicine, while alternative medicines that have been tested nearly always have no measurable positive effect compared to a placebo.[8][43][89][90] Journalist John Diamond wrote that "there is really no such thing as alternative medicine, just medicine that works and medicine that doesn't",[85][91] a notion later echoed by Paul Offit: "The truth is 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. And the best way to sort it out is by carefully evaluating scientific studies—not by visiting Internet chat rooms, reading magazine articles, or talking to friends."[84]



Complementary medicine (CM) or integrative medicine (IM) is when alternative medicine is used together with mainstream medical treatment in a belief that it improves the effect of treatments.[n 7][10][26][27][28] Several medical organizations differentiate between complementary and alternative medicine including the UK National Health Service (NHS),[29] Cancer Research UK,[30] and the US Center for Disease Control and Prevention (CDC), the latter of which states that "Complementary medicine is used in addition to standard treatments" whereas "Alternative medicine is used instead of standard treatments."[31] For example, acupuncture (piercing the body with needles to influence the flow of energy) might be believed to increase the effectiveness or "complement" science-based medicine when used at the same time.[32][33][34] Significant drug interactions caused by alternative therapies may make treatments less effective, notably in cancer therapy.[35][36][37]


Some mainstream academic medical centers have integrative or functional medicine departments, including the Cleveland Clinic, the Mayo Clinic,[38] Stanford University,[39] UCLA,[40] UC San Francisco[41] and Northwestern University.[42] In contrast, other medical practitioners are unconvinced by these practices. For example, surgical oncologist, David Gorski has described integrative medicine as an attempt to bring pseudoscience into academic science-based medicine[43] with skeptics such as Gorski and David Colquhoun referring to this with the pejorative term "quackademia".[44] Robert Todd Carroll described integrative medicine as "a synonym for 'alternative' medicine that, at its worst, integrates sense with nonsense. At its best, integrative medicine supports both consensus treatments of science-based medicine and treatments that the science, while promising perhaps, does not justify"[45] Rose Shapiro has criticized the field of alternative medicine for rebranding the same practices as integrative medicine.[3]


CAM is an acronym for complementary and alternative medicine.[46][47][48] The 2019 World Health Organization (WHO) Global Report on Traditional and Complementary Medicine states that the terms complementary and alternative medicine "refer to a broad set of health care practices that are not part of that country's own traditional or conventional medicine and are not fully integrated into the dominant health care system. They are used interchangeably with traditional medicine in some countries."[49]


The Integrative Medicine Exam by the American Board of Physician Specialties[50] includes the following subjects: Manual Therapies, Biofield Therapies, Acupuncture, Movement Therapies, Expressive Arts, Traditional Chinese Medicine, Ayurveda, Indigenous Medical Systems, Homeopathic Medicine, Naturopathic Medicine, Osteopathic Medicine, Chiropractic, and Functional Medicine.[50]


Functional medicine

Functional medicine (FM) is a form of alternative medicine that encompasses many unproven and disproven methods and treatments.[51][52][53] At its essence, it is a rebranding of complementary and alternative medicine (CAM),[54] and as such is pseudoscientific,[55]and has been described as a form of quackery.[56][57][58][59][54] In the US, FM practices have been ruled ineligible for course credits by the American Academy of Family Physicians because of concerns they may be harmful.[60][61] Functional medicine was created by Jeffrey Bland,[62] who founded The Institute for Functional Medicine (IFM), which is based in the US state of Washington, in the early 1990s as part of one of his companies, HealthComm.[63] IFM, which promotes functional medicine, became a registered non-profit in 2001.[64] Mark Hyman became an IFM board member and prominent promoter.[62][64]


David Gorski, a surgical oncologist at Wayne State University, has written that FM is not well-defined and performs "expensive and generally unnecessary tests".[65] Gorski says FM's vagueness is a deliberate tactic that makes functional medicine difficult to challenge.[66] In an analysis for the Office for Science and Society at McGill University, Jonathan Jarry writes "Test enough people and you get a lot of false positives, which generate anxiety, more invasive tests, and sometimes unnecessary treatments."[67] 


Proponents of functional medicine oppose established medical knowledge and reject its models, instead adopting a model of disease based on the notion of "antecedents", "triggers", and "mediators". These are meant to correspond to the underlying causes of health issues, the immediate causes, and the particular characteristics of a person's illness. A functional medicine practitioner devises a "matrix" from these factors to serve as the basis for treatment.[68] Treatments, practices, and concepts are generally not supported by medical evidence.[51] 


Patients of functional medicine practitioners may also be told to undertake unnecessary diets that can limit food choices.[67] Jonathan Stea writes that functional medicine, integrative medicine, and CAM "are marketing terms designed to confuse patients, promote pseudoscience, and sow distrust in mainstream medicine."[69]


In the 1990s, integrative medicine started to be marketed by a new term, "functional medicine".[70] FM practitioners claim to diagnose and treat conditions that have been found by research studies not to exist, such as adrenal fatigue and numerous imbalances in body chemistry.[71][72] For instance, contrary to scientific evidence, Joe Pizzorno, a major figure in FM, claimed that 25% of people in the United States have heavy metal poisoning and need to undergo detoxification.[60] Many scientists state that such detox supplements are a waste of time and money.[73] 


Detox has been also called "mass delusion".[74] In 2014, the American Academy of Family Physicians withdrew course credits for functional medicine courses, having identified some of its treatments as "harmful and dangerous".[60] In 2018, it partly lifted the ban, but only to allow overview classes, not to teach its practice.[61] The opening of centers for functional medicine at the Cleveland Clinic and George Washington University was described by David Gorski as an "unfortunate" example of "quackademia" — that is, a quackery infiltrating academic medical centers.[54]


Other terms

See also: Traditional medicine

Traditional medicine (TM) refers to certain practices within a culture which have existed since before the advent of medical science,[75][76] Many TM practices are based on "holistic" approaches to disease and health, versus the scientific evidence-based methods in conventional medicine.[77][78] The 2019 WHO report defines traditional medicine as "the sum total of the knowledge, skill and practices based on the theories, beliefs and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness."[49] When used outside the original setting and in the absence of scientific evidence, TM practices are typically referred to as "alternative medicine".[79][80][81]


Holistic medicine is another rebranding of alternative medicine. In this case, the words balance and holism are often used alongside complementary or integrative, claiming to take into fuller account the "whole" person, in contrast to the supposed reductionism of medicine.[82][83]


Challenges in defining alternative medicine

Prominent members of the science[84][85] and biomedical science community[12] say that it is not meaningful to define an alternative medicine that is separate from a conventional medicine because the expressions "conventional medicine", "alternative medicine", "complementary medicine", "integrative medicine", and "holistic medicine" do not refer to any medicine at all.[12][84][85][81] Others say that alternative medicine cannot be precisely defined because of the diversity of theories and practices it includes, and because the boundaries between alternative and conventional medicine overlap, are porous, and change.[16][86] 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.[87] Under a definition of alternative medicine as "non-mainstream", treatments considered alternative in one location may be considered conventional in another.[88]


Critics say the expression is deceptive because it implies there is an effective alternative to science-based medicine, and that complementary is deceptive because it implies that the treatment increases the effectiveness of (complements) science-based medicine, while alternative medicines that have been tested nearly always have no measurable positive effect compared to a placebo.[8][43][89][90] Journalist John Diamond wrote that "there is really no such thing as alternative medicine, just medicine that works and medicine that doesn't",[85][91] a notion later echoed by Paul Offit: "The truth is 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. And the best way to sort it out is by carefully evaluating scientific studies—not by visiting Internet chat rooms, reading magazine articles, or talking to friends."[84]




Unscientific belief systems

Alternative medicine, such as using naturopathy or homeopathy in place of conventional medicine, is based on belief systems not grounded in science.[22]

Proposed mechanismIssuesNaturopathyNaturopathic medicine is based on a belief that the body heals itself using a supernatural vital energy that guides bodily processes.[93]In conflict with the paradigm of evidence-based medicine.[94] Many naturopaths have opposed vaccination,[95] and "scientific evidence does not support claims that naturopathic medicine can cure cancer or any other disease".[96]HomeopathyA belief that a substance that causes the symptoms of a disease in healthy people cures similar symptoms in sick people.[n 8]Developed before knowledge of atoms and molecules, or of basic chemistry, which shows that repeated dilution as practiced in homeopathy produces only water, and that homeopathy is not scientifically valid.[98][99][100][101]


Traditional ethnic systems

Alternative medical systems may be based on traditional medicine practices, such as traditional Chinese medicine (TCM), Ayurveda in India, or practices of other cultures around the world.[22] Some useful applications of traditional medicines have been researched and accepted within ordinary medicine, however the underlying belief systems are seldom scientific and are not accepted.


Traditional medicine is considered alternative when it is used outside its home region; or when it is used together with or instead of known functional treatment; or when it can be reasonably expected that the patient or practitioner knows or should know that it will not work – such as knowing that the practice is based on superstition.


ClaimsIssuesTraditional Chinese medicineTraditional practices and beliefs from China, together with modifications made by the Communist party make up TCM. 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 the tongue contains a map of the body that reflects changes in the body, and an incorrect model of the anatomy and physiology of internal organs.[102][103][104][105][106][107]


AyurvedaTraditional 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 imbalance 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 and copper(II) sulfate.[clarification 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. A 2015 study of users in the United States also found elevated blood lead levels in 40 percent of those tested. 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.[108][109][110][111][112][113][114][115]


Supernatural energies

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.[22]


ClaimsIssuesBiofield therapyIntended to influence energy fields that, it is purported, surround and penetrate the body.[22]Advocates of scientific skepticism such as Carl Saganhave criticized the lack of empirical evidence to support the existence of the putative energy fields on which these therapies are predicated.[116]BioelectromagnetictherapyUse verifiable electromagnetic fields, such as pulsed fields, alternating-current, or direct-current fields in an unconventional manner.[22]Asserts that magnets can be used to defy the laws of physics to influence health and disease.


ChiropracticSpinal manipulation aims to treat "vertebral subluxations" which are claimed to put pressure on nerves.Chiropractic was based on the belief that manipulating the spine unblocks the flow of a supernatural vital energycalled Innate Intelligence, thereby affecting health and disease. Vertebral subluxation is a pseudoscientific entity not proven to exist.ReikiPractitioners place their palms on the patient near Chakras that they believe are centers of supernatural energies in the belief that these supernatural energies can transfer from the practitioner's palms to heal the patient.Lacks credible scientific evidence.[117]


Herbal remedies and other substances

Main article: Herbal medicine

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.[22][118][119] Examples include healing claims for non-vitamin supplements, fish oil, Omega-3 fatty acid, glucosamine, echinacea, flaxseed oil, and ginseng.[120] 


Herbal medicine, or phytotherapy, includes not just the use of plant products, but may also include the use of animal and mineral products.[118] It is among the most commercially successful branches of alternative medicine, and includes the tablets, powders and elixirs that are sold as "nutritional supplements".[118] 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.[118]



Religion, faith healing, and prayer

See also: Shamanism

ClaimsIssuesFaith healingThere is a divine or spiritual intervention in healing.Lack of evidence for effectiveness.[121] Unwanted outcomes, such as death and disability, "have occurred when faith healing was elected instead of medical care for serious injuries or illnesses".[122] A 2001 double-blind study of 799 discharged coronary surgery patients found that "intercessory prayer had no significant effect on medical outcomes after hospitalization in a coronary care unit."[123]


NCCIH classification

Ready-to-drink traditional Chinese medicine mixture

The United States agency National Center for Complementary and Integrative Health(NCCIH) has created a classification system for branches of complementary and alternative medicine that divides them into five major groups. These groups have some overlap, and distinguish two types of energy medicine: veritable which involves scientifically observable energy (including magnet therapy, colorpuncture and light therapy) and putative, which invokes physically undetectable or unverifiable energy.[124] None of these energies have any evidence to support that they affect the body in any positive or health promoting way.[1]


  1. Whole medical systems: Cut across more than one of the other groups; examples include traditional Chinese medicine, naturopathy, homeopathy, and ayurveda.
  2. Mind-body interventions: Explore the interconnection between the mind, body, and spirit, under the premise that they affect "bodily functions and symptoms". A connection between mind and body is conventional medical fact, and this classification does not include therapies with proven function such as cognitive behavioral therapy.
  3. "Biology"-based practices: Use substances found in nature such as herbs, foods, vitamins, and other natural substances. (As used here, "biology" does not refer to the science of biology, but is a usage newly coined by NCCIH in the primary source used for this article. "Biology-based" as coined by NCCIH may refer to chemicals from a nonbiological source, such as use of the poison lead in traditional Chinese medicine, and to other nonbiological substances.)
  4. Manipulative and body-based practices: feature manipulation or movement of body parts, such as is done in bodywork, chiropractic, and osteopathic manipulation.
  5. Energy medicine: is a domain that deals with putative and verifiable energy fields:
  • Biofield therapies are intended to influence energy fields that are purported to surround and penetrate the body. The existence of such energy fields have been disproven.
  • Bioelectromagnetic-based therapies use verifiable electromagnetic fields, such as pulsed fields, alternating-current, or direct-current fields in a non-scientific manner.


History

Main article: History of alternative medicine

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.[8][125][126][127][128] It includes the histories of complementary medicine 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.[125][126] 


Until the 1970s, 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.[128] 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".[8][125][126][128][129]


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.[8][130][131] 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.[8][126][128][127][129][131][132] 


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.[125]: xxi  [132] 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.[8][132][133][134] 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".[132]


An analysis of trends in the criticism of complementary and alternative medicine (CAM) in five prestigious American medical journals during the period of reorganization within medicine (1965–1999) was reported as showing that the medical profession had responded to the growth of CAM in three phases, and that in each phase, changes in the medical marketplace had influenced the type of response in the journals.[135] Changes included relaxed medical licensing, the development of managed care, rising consumerism, and the establishment of the USA Office of Alternative Medicine (later National Center for Complementary and Alternative Medicine, currently National Center for Complementary and Integrative Health).[n 9]



Medical education

Mainly as a result of reforms following the Flexner Report of 1910[137] medical education in established medical schools in the US has generally not included alternative medicine as a teaching topic.[n 10] Typically, their teaching is based on current practice and scientific knowledge about: anatomy, physiology, histology, embryology, neuroanatomy, pathology, pharmacology, microbiology and immunology.[139] Medical schools' teaching includes such topics as doctor-patient communication, ethics, the art of medicine,[140] and engaging in complex clinical reasoning (medical decision-making).[141] 


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 that were not well understood in mechanistic terms, and were not effectively treated by conventional therapies.[142]


By 2001 some form of CAM training was being offered by at least 75 out of 125 medical schools in the US.[143] 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).[144][145] 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).[146] All states require that applicants for MD licensure be graduates of an approved medical school and complete the United States Medical Licensing Examination (USMLE).[146]

Efficacy


Edzard Ernst, an authority on scientific study of alternative therapies and diagnoses and the first university professor of CAM, in 2012 


There is a general scientific consensus that alternative therapies lack the requisite scientific validation, and their effectiveness is either unproved or disproved.[10][8][147][148] Many of the claims regarding the efficacy of alternative medicines are controversial, since research on them is frequently of low quality and methodologically flawed.[149] Selective publication bias, marked differences in product quality and standardisation, and some companies making unsubstantiated claims call into question the claims of efficacy of isolated examples where there is evidence for alternative therapies.[150]


The Scientific Review of Alternative Medicine points to confusions in the general population – a person may attribute symptomatic relief to an otherwise-ineffective therapy just because they are taking something (the placebo effect); the natural recovery from or the cyclical nature of an illness (the regression fallacy) gets misattributed to an alternative medicine being taken; a person not diagnosed with science-based medicine may never originally have had a true illness diagnosed as an alternative disease category.[151]


Edzard Ernst, the first university professor of Complementary and Alternative Medicine, characterized the evidence for many alternative techniques as weak, nonexistent, or negative[152] and in 2011 published his estimate that about 7.4% were based on "sound evidence", although he believes that may be an overestimate.[153] Ernst has concluded that 95% of the alternative therapies he and his team studied, including acupuncture, herbal medicine, homeopathy, and reflexology, are "statistically indistinguishable from placebo treatments", but he also believes there is something that conventional doctors can usefully learn from the chiropractors and homeopath: this is the therapeutic value of the placebo effect, one of the strangest phenomena in medicine.[154][155]


In 2003, a project funded by the CDC identified 208 condition-treatment pairs, of which 58% had been studied by at least one randomized controlled trial (RCT), and 23% had been assessed with a meta-analysis.[156] According to a 2005 book by a US Institute of Medicine panel, the number of RCTs focused on CAM has risen dramatically.


As of 2005, the Cochrane Library had 145 CAM-related Cochrane systematic reviews and 340 non-Cochrane systematic reviews. An analysis of the conclusions of only the 145 Cochrane reviews was done by two readers. In 83% of the cases, the readers agreed. In the 17% in which they disagreed, a third reader agreed with one of the initial readers to set a rating. These studies found that, for CAM, 38.4% concluded positive effect or possibly positive (12.4%), 4.8% concluded no effect, 0.7% concluded harmful effect, and 56.6% concluded insufficient evidence.


An assessment of conventional treatments found that 41.3% concluded positive or possibly positive effect, 20% concluded no effect, 8.1% concluded net harmful effects, and 21.3% concluded insufficient evidence. However, the CAM review used the more developed 2004 Cochrane database, while the conventional review used the initial 1998 Cochrane database.[157]


Alternative therapies do not "complement" (improve the effect of, or mitigate the side effects of) functional medical treatment.[n 7][10][26][27][28] Significant drug interactions caused by alternative therapies may instead negatively impact functional treatment by making prescription drugs less effective, such as interference by herbal preparations with warfarin.[158][36]


In the same way as for conventional therapies, drugs, and interventions, it can be difficult to test the efficacy of alternative medicine in clinical trials. In instances where an established, effective, treatment for a condition is already available, the Helsinki Declarationstates that withholding such treatment is unethical in most circumstances. Use of standard-of-care treatment in addition to an alternative technique being tested may produce confounded or difficult-to-interpret results.[159]



Cancer researcher Andrew J. Vickers has stated:

Contrary to much popular and scientific writing, many alternative cancer treatments have been investigated in good-quality clinical trials, and they have been shown to be ineffective. The label "unproven" is inappropriate for such therapies; it is time to assert that many alternative cancer therapies have been "disproven".[160]

Perceived mechanism of effect

Anything classified as alternative medicine by definition does not have a proven healing or medical effect.[12][8][13][14][15] However, there are different mechanisms through which it can be perceived to "work". The common denominator of these mechanisms is that effects are mis-attributed to the alternative treatment. 


How alternative therapies "work":


a) Misinterpreted natural course – the individual gets better without treatment.
b) Placebo effect or false treatment effect – an individual receives "alternative therapy" and is convinced it will help. The conviction makes them more likely to get better.
c) Nocebo effect – an individual is convinced that standard treatment will not work, and that alternative therapies will work. This decreases the likelihood standard treatment will work, while the placebo effect of the "alternative" remains.
d) No adverse effects – Standard treatment is replaced with "alternative" treatment, getting rid of adverse effects, but also of improvement.
e) Interference – Standard treatment is "complemented" with something that interferes with its effect. This can both cause worse effect, but also decreased (or even increased) side effects, which may be interpreted as "helping". Researchers, such as epidemiologists, clinical statisticians and pharmacologists, use clinical trials to reveal such effects, allowing physicians to offer a therapeutic solution best known to work. "Alternative treatments" often refuse to use trials or make it deliberately hard to do so.


Placebo effect

A placebo is a treatment with no intended therapeutic value. An example of a placebo is an inert pill, but it can include more dramatic interventions like sham surgery. The placebo effect is the concept that patients will perceive an improvement after being treated with an inert treatment. The opposite of the placebo effect is the nocebo effect, when patients who expect a treatment to be harmful will perceive harmful effects after taking it.


Placebos do not have a physical effect on diseases or improve overall outcomes, but patients may report improvements in subjective outcomes such as pain and nausea.[161] A 1955 study suggested that a substantial part of a medicine's impact was due to the placebo effect.[162][161] However, reassessments found the study to have flawed methodology.[162][163] This and other modern reviews suggest that other factors like natural recovery and reporting bias should also be considered.[161][163]


All of these are reasons why alternative therapies may be credited for improving a patient's condition even though the objective effect is non-existent, or even harmful.[158][43][90] David Gorski argues that alternative treatments should be treated as a placebo, rather than as medicine.[43] Almost none have performed significantly better than a placebo in clinical trials.[102][89][164][118] Furthermore, distrust of conventional medicine may lead to patients experiencing the nocebo effect when taking effective medication.[158]


Regression to the mean

A patient who receives an inert treatment may report improvements afterwards that it did not cause.[161][163] Assuming it was the cause without evidence is an example of the regression fallacy. This may be due to a natural recovery from the illness, or a fluctuation in the symptoms of a long-term condition.[163] The concept of regression toward the mean implies that an extreme result is more likely to be followed by a less extreme result.



Other factors

There are also reasons why a placebo treatment group may outperform a "no-treatment" group in a test which are not related to a patient's experience. These include patients reporting more favourable results than they really felt due to politeness or "experimental subordination", observer bias, and misleading wording of questions.[163] 


In their 2010 systematic review of studies into placebos, Asbjørn Hróbjartsson and Peter C. Gøtzsche write that "even if there were no true effect of placebo, one would expect to record differences between placebo and no-treatment groups due to bias associated with lack of blinding."[161] Alternative therapies may also be credited for perceived improvement through decreased use or effect of medical treatment, and therefore either decreased side effects or nocebo effects towards standard treatment.[158]


Use and regulationAppeal

Practitioners of complementary medicine usually discuss and advise patients as to available alternative therapies. Patients often express interest in mind-body complementary therapies because they offer a non-drug approach to treating some health conditions.[165]


In addition to the social-cultural underpinnings of the popularity of alternative medicine, there are several psychological issues that are critical to its growth, notably psychological effects, such as the will to believe,[166] cognitive biases that help maintain self-esteem and promote harmonious social functioning,[166] and the post hoc, ergo propter hoc fallacy.[166]



In a 2018 interview with The BMJ, Edzard Ernst stated: "The present popularity of complementary and alternative medicine is also inviting criticism of what we are doing in mainstream medicine. It shows that we aren't fulfilling a certain need-we are not giving patients enough time, compassion, or empathy. These are things that complementary practitioners are very good at. Mainstream medicine could learn something from complementary medicine."[167]


Marketing

Alternative medicine is a profitable industry with large media advertising expenditures. Accordingly, alternative practices are often portrayed positively and compared favorably to "big pharma".[1]

The popularity of complementary & alternative medicine (CAM) may be related to other factors that Ernst mentioned in a 2008 interview in The Independent:

Why is it so popular, then? Ernst blames the providers, customers and the doctors whose neglect, he says, has created the opening into which alternative therapists have stepped. "People are told lies. There are 40 million websites and 39.9 million tell lies, sometimes outrageous lies. They mislead cancer patients, who are encouraged not only to pay their last penny but to be treated with something that shortens their lives." At the same time, people are gullible. It needs gullibility for the industry to succeed. It doesn't make me popular with the public, but it's the truth.[168]

Paul Offit proposed that "alternative medicine becomes quackery" in four ways: by recommending against conventional therapies that are helpful, promoting potentially harmful therapies without adequate warning, draining patients' bank accounts, or by promoting "magical thinking".[84] Promoting alternative medicine has been called dangerous and unethical.[n 11][170]



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