User:MykReeve/Alternative medicine

Issues in Alternative Medicine

Medical research and alternative medicine

One significant concern is that there is often little scientific verification that many alternative medicine treatments actually work, and many of the studies cited in support of alternative medicine are not considered up to the normal double blind peer reviewed standard.

However, there is a significant quantity of research being carried out into fields of alternative medicine. MedLine, a database of biomedical articles dating back to the 1950s maintained by the National Library of Medicine, identifies 370,000 research papers in subjects classified as alternative medicine which have been published since 1966. MedLine itself does not indicate how many of these studies were controlled or double-blind peer-reviewed experiments, however, all of these papers were published in research journals.

The scientific community argues that many studies carried out on alternative medicine treatments are flawed as they use testimonials and hearsay as evidence, on the grounds that observer bias can distort results. They argue that the only way to counter observer bias is to run a double blind experiment, where neither the patient nor the practitioner knows whether the real treatment is being given or if a placebo has been administered. This research should then be reviewed by peers to determine the validity of the research methodology.

Alternative medicine chafes at the restrictions of government agencies which approve medical treatments (such as the American Food and Drug Administration), and their adherence to these experimental evaluation methods, seeking to bring new ideas and methods to the public more rapidly. The mainstream medical community maintain that official oversight is needed to prevent quackery, while advocates of alternative medicine loudly protest that their contributions and discoveries are being unfairly dismissed, overlooked or suppressed.

Practitioners of many alternative medicine treatments argue that these conventional experimental evaluation methods cannot be applied to their fields. For example, some problems recognised in Ernst 2003 include;

• Double-blind trials are difficult for many alternative medicine techniques, which involve hands-on manipulation by trained practitioners that cannot easily be replaced by an equivalent placebo, or which require a holistic approach to treatment that cannot be reduced to a single variable.
• Claimed effects of alternative medical practices are often subtle (requiring large sample sizes) and appear only after long periods of treatment (requiring long studies).

Nonetheless, increasing numbers of mainstream doctors and scientists believe that new research into alternative medicine is revealing evidence that some alternative health treatments are effective (e.g. Michelson et al. 2003; Gonsalkorale et al. 2003; Berga et al. 2003).

Further evidence that serious academic research into alternative medicine is being pursued comes from the existence of the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health (NIH) in the United States, which provides funding and other support for research into alternative medicine.

It should be noted, however, that one significant reason why less research is carried out on alternative medicine, is that many alternative medicine techniques cannot be patented, and hence there is less financial incentive to their study. Drug research, by contrast, can be very lucrative, which has resulted in funding of trials by pharmaceutical companies. Many people, including conventional and alternative medical practitioners, point out that this funding has led to corruption of the scientific process for approval of drug usage, and that ghostwritten work has appeared in major peer-reviewed medical journals.

Contemporary use of alternative medicine

Edzard Ernst wrote in the Medical Journal of Australia that "about half the general population in developed countries [use] complementary and alternative medicine (CAM)" (Ernst 2003), and it is certainly true that physicians that are subject to disciplinary actions of state licensing boards do offer alternative medicine services to their patients.

Increasing numbers of medical colleges have begun offering training courses in alternative medicine. For example, the University of Arizona College of Medicine offers a program in Integrative Medicine under the leadership of Dr Andrew Weil which trains physicians in various branches of alternative medicine which "neither rejects conventional medicine, nor embraces alternative practices uncritically."

However, despite this evidence of the increasing contemporary use of alternative medicine, in countries where healthcare is state-funded or funded by medical insurance, alternative therapies are often not covered, and must be paid for by the patient. This has led to the concern that gullible or desperate people may be exploited.

There is also a concern among conventional medical practitioners that patients may delay seeking conventional medicine that could be more effective, whilst they undergo alternative therapies, potentially resulting in harm.

Finally, there is the issue of regulation. in some countries, some branches of alternative medicine are not properly regulated. This means that there is no external control on practitioners, and no real way of knowing what training or expertise they possess.

Diversity of alternative medicine treatments

One point which is often overlooked by critics of alternative medicine is that their criticisms need not apply to all the different branches – it is not valid to lump them all together.

Alternative medicine as an alternative

Several conventional physicians have voiced criticisms of evidence-based medicine (Tonelli 2001, Downing 2003), in effect supporting the value of various branches of alternative medicine.

Alternative medicine may provide some health benefits through patient empowerment, by offering more choices to the public, including treatments that are simply not available in conventional medicine. Any positive effects that such alternative medicine treatments offer, even if they are only based on placebo effects, still provide benefits to overall patient health that traditional medicine might not have provided.

History and alternative medicine

From the 19th century and on into the early 20th century, new ideas about infection and disease were pioneered by Semmelweis and Pasteur, only to meet opposition and ridicule from an establishment which refused to examine the claims of these pioneers. Ignored or ostracized, these pioneers and others like Lister stolidly continued to work and amass evidence showing their theories were true, but it took years before the mainstream adopted them. At the same time, numerous snake oil salesmen sold remedies which had little physical benefit, and in some cases caused serious physical harm. Regulatory agencies like the US's FDA and NIH sought to remedy this contradiction by creating standards to verify the benefits offered by medicines, and a great number of falsifiable drugs and treatments were discarded as a result.

The boundary line between alternative and mainstream medicine has moved over time. Methods once considered alternative have later been adopted by conventional medicine as physicians have gradually incorporated effective branches of alternative medicine into their conventional medical practices. Supporters of alternative treatments suggest that much of what is currently called alternative medicine will be similarly assimilated into the mainstream in the future.

Proponents of alternative medicine treatments also point to the fact that conventional medicine has not historically been as rooted in science as it is publicly represented to be. One such proponent writes "[Michael L.] Millenson decries the lack of scientific-based medical practice and medicine's failure to wake up due to its own historical studies. He cites data that 85% of current practice has not been scientifically validated despite medicine's claims of the physician-scientist" (Gunn 1998).

Supporters of evidence based medicine respond that just because the scientific process was not formalised in the past, this does not mean that science should not underpin current and future medical practice.

Other observations

At least one report (Crossing the Quality Chasm: A New Health System for the 21st Century, published by the Committee on Quality of Health Care in America) has indicated that medical practice tends to lag behind accepted medical knowledge by 15-20 years. Thus, many medicine techniques dubbed “alternative” may actually be considered conventional, but practising physicians may either be unaware of it or lack the necessary training.

Social critic Ivan Illich believes that conventional and alternative medical practices are generally equally effective, for two reasons. Firstly, conventional practices are more effective at dealing with illnesses caused by microbes, whereas alternative practices are more effective at dealing with illnesses that are psychosomatic. Illich holds that conventional and alternative practices are equally effective at dealing with illness that are self-limiting (Illich 1976). In other words, Illich has suggested that conventional medicine treats illnesses that the human body would heal naturally all by itself without any form of treatment.