Alternative medicine consists of products or treatments used for health benefits, but is not always evidence-based. It is often based on cultural and traditional health practices or more recent disproved theories that have remained popular within certain fringe groups. Common types include homeopathy, acupuncture, herbalism and bio-identical hormone therapy.
Generally speaking, complimentary medicine is less regulated, or self-regulated, and should be required to meet the same standards as conventional medicine. Despite little evidence for alternative medicine, public support is growing.
According to a study released by the U.S. Center for Disease Control and Prevention in 2002, use of complementary and alternative medicine increased substantially during the 1990s. The study estimated that the U.S. public spent between $36 billion and $47 billion on alternative therapies in 1997. To put that in perspective, that's more than the U.S. public paid out-of-pocket for all hospitalizations and about half that paid for physician services that year.
Why is the use of alternative medicine growing? Few studies have looked into the social parameters of alternative therapy; however, growing wait times for Canadian medical treatments and financial barriers to care in the U.S. may be a possibility. Also, people are increasingly trusting doctors and pharmaceutical companies less - possibly a paradoxical result of the advent of evidence-based medicine. Most people aren't concerned with the fatality of minor bacterial infections, the devastation of epidemics like measles or polio or the agony of surgery without anesthesia thanks to advances in conventional medicine. Instead, people are now faced with occasional complications from treatments and drugs.
Furthermore, there are a number of popular personalities endorsing alternate treatments. Oprah, one of the more influential celebrities, often supports uncommon treatments on her talk show and invites personalities to discuss dissenting views of conventional medicine. Susanne Somers, an endorser of bio-identical hormones whose personal health regimen has included injecting high doses of estrogen into her vagina for several years now, and Jenny McCarthy, a playmate turned-anti-vaccination advocate, are two of the most infamous. However, other mainstream media and international organizations have actively criticized alternative medicine and those who advocate it.
Newsweek ran an article this May criticizing Oprah for endorsing unfounded and sometimes dangerous cure-alls on her talk-show. "Why Health Advice on 'Oprah' Could Make You Sick" explained that while voicing these views is not dangerous, giving an unbalanced misrepresentation of health topics to the 40 million viewers of her show and 2 million magazine readers who trust her is.
For example, Somers argues bio-identical hormones derived from plant sources instead of animal ones are inherently safer and can alleviate aging, prevent diseases and postpone symptoms of menopause. Such assertions go unquestioned on Oprah, even though hormone therapy can have dangerous side effects.
Using hormones like estrogen and progesterone to prevent symptoms of menopause has been studied in clinical trials, however, preliminary studies by the Women's Health Initiative ended earlier than planned in 2002 when it became apparent the health risks out-weighed the benefits. Further research showed estrogen was helpful, but only in very low dosages for short periods. The U.S. Food and Drug Administration states that bio-identical hormones have no safety advantages over animal derived hormones, with many clinical trials to support this.
Is there evidence that complementary and alternative treatments do work? In order for a drug or treatment to be considered conventional medicine, they must have proven efficacy in clinical trials. Since complementary and alternative medicine are separate entities, they are usually not supported by rigorous testing. Research conducted by medical institutions and even organizations advocating alternative treatments shows that homeopathy, acupuncture and herbalism do not work- at least not any more than placebos.
The U.S. National Center for Complementary and Alternative Medicine recently released the results of a $2.5 billion study carried out over 10 years on a number of alternative treatments. Echinacea extracts for colds, yoga for fatigue, shark cartilage for arthritis, ginkgo biloba for memory and hundreds of other claims were tested to see if they truly had any effect. What did they find? Not much. Apparently, ginger capsules may help with nausea symptoms from chemotherapy while yoga, massage, meditation and other relaxation methods help with stress, soreness and fatigue. Everything else appeared to be inconclusive at best. So why so much money on this project?
"There's very little basic science behind these things. Most of it begins with a tradition, or personal testimony and people's beliefs, even as a fad. And then pressure comes, 'It's being popular, it's being used, it should be studied.' It turns things upside down," said Dr. Edward Campion, a senior editor who reviews alternative medicine research submitted to the New England Journal of Medicine, in an interview with the Associated Press.
Public pressure to pursue research into complementary and alternative medicine sets a double standard between such treatments and conventional ones. Conventional medicine requires evidence or at least a plausible mechanism before research is pursued, whereas a popular whim can get funding almost instantly. This vested public interest also means that the results from such studies are usually prone to being labeled as "inconclusive" when the evidence suggests a placebo effect is the only reason for possible results.
A study published in Archives of Internal Medicine in May tested the efficacy of acupuncture in 638 adults. Each subject received one of four treatments: standard acupuncture, acupuncture with non-specific placement of the needles, placebo acupuncture using tooth picks that did not penetrate the skin and standard physiotherapy. The results? The first three treatments were significantly more effective than physiotherapy alone.
However, there was no statistical difference between the three, meaning that manipulating energy flow with ancient Chinese principles, randomly sticking a needle in someone's back or just poking them with tooth picks are all equally effective forms of treatment for chronic back pain. In most cases, this set of results would be considered a clear-cut, textbook placebo effect, showing that acupuncture is not a viable treatment. However, the authors of the study decided that this was inconclusive evidence.
"It remains unclear whether acupuncture or our simulated method of acupuncture provide physiologically important stimulation or represent placebo or nonspecific effects," concluded the study.
There are some exceptions, especially in the case of supplements like Vitamin C and stimulants like caffeine, where sufficient evidence does exist for their inclusion in conventional medicine. However, both are marketed as alternative treatments.
Why would companies choose to market something as a natural health product as opposed to a conventional treatment? There are less regulations on testing the product, which means fewer expensive studies, and fewer regulations on labelling. You don't have to include a few minutes listing possible side effects like a TV drug ad if you are marketing a natural health product- that is unless serious side effects are reported after you release it. The single down side for companies is that natural health products are only allowed to make vague claims like "this product may help boost your immune system" and are not allowed to make assertions like "this product is effective medicine for pain." It's a small price to pay, though, because most consumers are not aware of this detail and are very much aware of uncomfortable adverse reactions.
If these treatments have no real effect, then what's the harm in people using them? Well first off, it is ethically void to sell a product or service to a person claiming it will help them with their personal health when there is no data to support such a claim. If people are unaware of differences between alternative and conventional medicine, there is the risk they will opt out of effective treatments for options that will be effectively useless.
The World Health Organization, typically very sensitive to traditional and regional medicinal practices, condemned the use of homeopathy for treatment of HIV, tuberculosis, malaria, infant diarrhoea and influenza. Homeopathy involves diluting active ingredients to such a point that it is unlikely even trace amounts will be found. It's practitioner's claim that when a substance that cause similar symptoms in a healthy person are administered to an ill person in micro-doses, it can be an effective treatment. For example, homeopathic sleeping pills contain extremely minute levels of caffeine.
The WHO warning came after the Voice of Young Science Network, a group of medics from the United Kingdom and Africa who advocate evidence-based medicine, sent an open letter listing their concerns.
"Those of us working with the most rural and impoverished people of the world already struggle to deliver the medical help that is needed," said the letter. "When homeopathy stands in place of effective treatment, lives are lost."
Even in areas where evidence-based medicine is widely available, effective treatments are still occasionally passed up for alternative medicine, leading to preventable deaths. On May 5th 2009, the Sydney Morning Herald ran a story of a couple who stood trial for manslaughter by gross criminal negligence in connection to the death of their infant daughter. Thomas Sam and his wife Manju Sam refused to send their daughter to a skin specialist for her severe eczema even after they were advised to do so by a nurse and doctor. Instead, the couple sought help from homeopaths and natural medicine practitioners, despite their daughter's skin bleeding when her clothes were changed.
All in all this example is a bit extreme, but it should be noted that Thomas Sam was a homeopath and had strong feelings regarding the potency of his own practice. However, it does take extreme cases for the public to take notice of issues raised by alternative medicine. In a CDC study, 28 per cent of adults surveyed who used complimentary and alternative medicine in the U.S. did so because they believed conventional medical treatments would not help them. It's also apparent that some herbal products may have potentially fatal consequences when taken in conjunction with pharmaceutical drugs. This problem is compounded when patients don't tell their doctors they are taking herbal products and doctors aren't familiar with the effects of non-pharmaceutical remedies.
In June 2009, the U.S. Food and Drug Administration issued a warning to consumers regarding Zicam's line of homeopathic nasal sprays supposed to reduce the duration and severity of the common cold. Normally homeopathic treatments have such a small dilution of the ingredients that an astronomically insignificant amount is present. However, in the case of the Zicam sprays, the company did add an active ingredient to their product. Zinc was present at a high enough concentration that it caused some people to permanently lose their sense of smell. One-hundred and thirty cases were reported to the FDA.
Even if you believe in the mantra "buyer beware," natural health products should not be less regulated than more conventional drugs. Both are sold for the same intended purpose. Proper regulation and clinical trials are necessary to ensure the safety and effectiveness of all treatments, regardless of their origins or celebrity spokesperson.
What? Treatment is determined by the Law of Similars, where substances that cause symptoms in a healthy person will be able to cure a sick person of those symptoms if given in a micro-dose.
What does it claim to cure? Everything.
Why isn't it accepted as conventional? The micro-doses are so low that no active ingredient could possibly be contained in the treatment you're given. Essentially they are passing out water.
What? According to the National Center for Complementary and Alternative Medicine, a "vital energy or life force" regulates "spiritual, emotional, mental, and physical health." This energy can be blocked and acupuncture an effective treatment.
What does it claim to cure? Many acupuncturists treat back pain exclusively, but others promote it as a general cure-all. There are also acupuncturists who treat pets.
Why isn't it accepted as conventional? While this practice is an old tradition, there is no way to scientifically test the mechanism, Qi.
What? Based on traditional folk medicine, herbs are used in various ways to treat an array of issues.
What does it claim to cure? Depends who you ask. There is little consensus on the limits of herbalism.
Why isn't it accepted as conventional? Some plants have components to them that are effective. For example, the active ingredient in Aspirin is salicylic acid, a compound first derived from white willow bark. However, just because something is natural does not mean that it is better. For example, Aspirin is rather symptomless, but white willow bark often causes upset stomach.
Who? Bio-Identical Hormones
What? According the alternative medicine community, bio-identical hormones are produced from plants and are safer than their animal derived counterparts.
What does it claim to cure? Postpones aging and menopause.
Why isn't it accepted as conventional? In 2008 the FDA made a statement that bio-identical hormones, which are less regulated, are not safer than other types of hormones.