Alternative Medicines and Therapies
Alternative Medicines and Therapies
Alternatives to conventional medical care are increasingly popular in the United States, and their growing use by consumers represents a major trend in Western medicine. Alternative therapies appear to be used most frequently for medical conditions that are chronic , such as back pain, arthritis , sleep disorders, headache, and digestive problems. Surveys of U.S. consumers have shown that more people visit alternative practitioners each year than visit conventional primary-care physicians. Consumers do not necessarily reject conventional medicine, however. Many simply feel that alternative modalities offer complementary approaches that are more in line with their personal health philosophies.
Alternative Medicine, Complementary Medicine, and Integrative Medicine
The terms alternative medicine and alternative therapies refer to those medical practices that are not considered to be conventional medicine, as practiced in the United States. Other cultures, however, may use one or more of these approaches regularly, and, in fact, many have done so for thousands of years. Most people in the United States who use alternative medicine do so to complement conventional approaches. For example, in addition to using anti-inflammatory drugs to ease muscle pain, they may also use massage, chiropractic , and/or osteopathic manipulation. This practice of complementing conventional medicine with alternative approaches has given rise to the term complementary medicine. Presently, alternative medicine is most commonly referred to as complementary and alternative medicine (CAM). As conventional medical practitioners become familiar with alternative approaches, these approaches are being integrated into conventional medicine, which is giving rise to integrative medicine, in which a combination of therapies representing the best of conventional and alternative medicine is used.
Types of CAM Modalities
The National Center for Complementary and Alternative Medicine divides the various CAM modalities into five categories: (1) alternative medical systems, (2) mind-body interventions, (3) biologically-based treatments, (4) manipulative and body-based methods, and (5) energy therapies. These modalities include a wide variety of approaches, from acupuncture to nutrition to meditation to chiropractic.
Alternative medical systems include medical practices that are traditional in other cultures, such as the ayurvedic medical system of India, Chinese traditional medicine, and traditional Native American and Hawaiian medicine.
|SOURCE: National Center for Complementary and Alternative Medicine|
|Alternative medical systems||Acupuncture, Ayurveda, homeopathy, naturopathy, traditional medical systems, such as aboriginal, African, Middle Eastern, Native American, Chinese, Tibetan, Central and South American|
|Mind-body interventions||Art therapy, dance therapy, hypnosis, meditation, mental healing, music therapy, prayer|
|Biologically-based treatments||Special diets and nutrition therapy, such as macrobiotic diet; herbal (botanical) therapy, vitamin/mineral therapy, orthomolecular therapy|
|Manipulative and body-based methods||Chiropractic, massage therapy, osteopathic manipulation|
|Energy therapies||Biofield therapies, such as Qi gong, Reiki, and Therapeutic Touch; bioelectromagnetic therapies, which involve the unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields, or alternating current or direct current fields|
Mind-body interventions recognize the connection between the physical body and the spiritual self, and include practices such as meditation, prayer, and music therapy. Biologically-based modalities are primarily nutrition-related and vary from special diets such as the macrobiotic diet to the inclusion of dietary supplements in the diet. Body-based methods involve hands-on manipulation of the body, and include such modalities as massage and chiropractic. The energy therapies are based on the concept that the body has an energy field that can be manipulated to promote healing.
Included among the nutrition approaches that make up the biologicallybased modalities is the use of dietary supplements. Dietary supplements may be botanical (herbal ) supplements or nutritional supplements, which include vitamins , minerals , antioxidants , enzymes , metabolites , nonprescription hormones , glandular extracts, and various amino acids , fatty acids , and other nutrients .
The Dietary Supplement Health and Education Act of 1994
Dietary supplement usage in the United States has increased significantly since the passage in 1994 of the Dietary Supplement Health and Education Act (DSHEA, pronounced Dee-shay). This legislation defined dietary supplements as distinct from food and drugs, and it allowed them to be sold without a prescription. The passage of DSHEA provided consumers with the right to purchase dietary supplements that they felt would help them attain their personal health goals. At the same time, DSHEA transferred to consumers the responsibility for making informed choices about the supplements that they used. In contrast to prescription and over-thecounter drugs, where effectiveness and safety must be demonstrated prior to marketing of the drugs, premarket approval is not required of manufacturers of dietary supplements. As a result, there is a greater potential risk that dietary supplements may be ineffective, or even harmful, as compared with drugs.
The dietary supplements industry is not unregulated, it is just not regulated to the extent that U.S. consumers have come to expect for prescription drugs. Instead of the drug manufacturer and the physician working to insure that a drug meets the needs of the patient and that it is both safe and effective, consumers must provide these services for themselves with dietary supplements. It is, therefore, important to know the appropriate use of a dietary supplement, the dose at which it is effective, and whether it is likely to interfere with other medications or dietary supplements being taken. It is also important to know that the manufacturer adheres to high quality standards in the preparation of its products.
Supplement Facts Label
To help consumers make informed choices, dietary supplements now contain a supplement facts panel that clearly labels the product as a dietary supplement and gives information such as the amount of a standard dose, the number of recommended doses per day, the list of components (and how much of each is present in a standard dose), and, if the product is a botanical, the Latin name of the plant and the part of the plant used to prepare the product. This latter information is important because the components responsible for a certain health effect may be in one part of the plant but not in other parts. For example, a consumer purchasing ginger to protect against seasickness would want a product prepared from the roots of the plant, where the active components are, and not the leaves.
In addition, DSHEA established standards for terms, such as high potency and antioxidant, and for the types of claims that could be made for a product. Claims that a dietary supplement may help to prevent or cure a disease cannot be made. Such claims are considered health claims and must be reviewed by the Food and Drug Administration for scientific accuracy prior to approval for use on a product label. Manufacturers may, however, use structure/function claims that state that a product can, for example, "help to promote healthy blood levels of cholesterol ," but they may not state that a product "helps to prevent heart disease ." All structure/function claims must be accompanied by the following disclaimer: "This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease."
Selecting a CAM Modality
When selecting a CAM modality, it is important to have clearly defined health goals. In other words, what are you trying to accomplish, and is this modality an appropriate fit for you? If selecting a therapy, determine if the practitioner of the therapy being considered is a licensed health care practitioner. Licensure does not guarantee the modality will successfully meet one's needs, but it does provide some assurance of training and competency on the part of the practitioner. This information can usually be obtained from the various state boards of medicine, which are responsible for licensing health care professionals.
Selecting quality dietary supplements can be a bit more challenging. Both the natural products industry and the Food and Drug Administration are working to develop uniform standards of quality for dietary supplements. Until these standards are in place, however, consumers must be proactive in determining for themselves what supplements are consistent with their health goals and what manufacturers offer quality products. It is important not to be fooled by hype . Be wary of supplements that sound too good to be true or that promise to cure a medical condition.
Quality natural ingredients and responsible product testing can add significantly to the cost of a dietary supplement. The cheapest supplement is not always the best buy, though a high price does not necessarily guarantee high quality. It is important to investigate the supplement manufacturer whose products are being considered. Manufacturer contact information appears on the supplement facts label. One should inquire whether the manufacturer uses Good Manufacturing Practices, how they ensure the purity of their ingredients, and whether they have their products tested by independent laboratories to verify that the label accurately reflects the product in the supplement container.
Alternative therapies are increasingly being used to complement conventional medicine. The consumer should be knowledgeable of the modality chosen, its intended purpose, and whether it is appropriate for that purpose. In the case of dietary supplements, consumers should educate themselves about the appropriate application for the supplement and the dose that is known to be safe and effective. Although many reputable CAM practitioners and dietary supplement manufacturers exist, consumers should educate themselves about the hallmarks of a quality practitioner or dietary supplement. With CAM modalities in general, and dietary supplements in particular, it is helpful to identify health care professionals who are knowledgeable about CAM and who can provide help in using CAM effectively.
see also Dietary Supplements; Macrobiotic Diet.
Ruth M. DeBusk
Astin, John A. (1998). "Why Patients Use Alternative Medicine: Results of a National Study." Journal of the American Medical Association 279:1548–1553.
Eisenberg, David M.; Davis, Roger B.; Ettner, Susan L.; Appel, Scott; Wilkey, Sonja; Van Rompay, Maria; Kessler, Ronald C. (1998). "Trends in Alternative Medicine Use in the United States, 1990–1997: Results of a Follow-Up National Survey." Journal of the American Medical Association 280:1569–1575.
Eisenberg, David M.; Kessler, Ronald C.; Foster, Cindy; Norlock, Frances E.; Calkins, David R.; and Delbanco, Thomas L. (1993). "Unconventional Medicine in the United States: Prevalence, Costs, and Patterns of Use." New England Journal of Medicine 328:246–252.
Center for Food Safety and Applied Nutrition. "Dietary Supplements." Available from <http://www.cfsan.fda.gov>
Federation of State Medical Boards. "Member Medical Boards." Available from <http://www.fsmb.org/members.htm>
National Center for Complementary and Alternative Medicine. <http://www.nccam.nih.gov>
Office of Disease Prevention and Health Promotion (1997). "Report of the Commission on Dietary Supplement Labels." Available from <http://web.health.gov/dietsupp>
U.S. Food and Drug Administration (1995). "Dietary Supplement Health and Education Act." Available from <http://www.fda.gov>
"Alternative Medicines and Therapies." Nutrition and Well-Being A to Z. . Encyclopedia.com. (October 20, 2017). http://www.encyclopedia.com/food/news-wires-white-papers-and-books/alternative-medicines-and-therapies
"Alternative Medicines and Therapies." Nutrition and Well-Being A to Z. . Retrieved October 20, 2017 from Encyclopedia.com: http://www.encyclopedia.com/food/news-wires-white-papers-and-books/alternative-medicines-and-therapies
The demand for dietary supplements in the United States catapulted what was once a cottage industry into a $14 billion per year business in the year 2000. In 1994, the U.S. Congress formally defined the term dietary supplement as a product taken by mouth that contains a "dietary ingredient" intended to supplement the diet . The dietary ingredients in these products may include vitamins , minerals , herbs, amino acids , enzymes , organ tissues, glandulars, and metabolites . Dietary supplements can also be extracts or concentrates, and may be found in many forms, such as tablets, capsules, liquids, or powders.
The use of dietary supplements is widespread—they are taken by half of American adults. But the use of supplements is not limited to adults. A study published in the November 2001 Journal of the American Dietetic Association showed that dietary supplement use is prevalent among students as well, with 17.6 percent of 1,532 eighth-graders reporting the use of a vitamin-mineral supplement. Herbs, one type of dietary supplement, are widely used throughout the world. In China, traditional medicine encompasses a holistic approach to healing, and herbal remedies are routinely included in self-care. The World Health Organization (WHO) estimates that in developing countries up to 80 percent of indigenous populations rely on herbs for primary health care needs. In France and Germany, 30 to 40 percent of all medical doctors rely on herbal preparations as their primary medicines.
Regulation of Dietary Supplements
In 1994 the U.S. Congress passed the Dietary Supplement Health and Education Act (DSHEA), which President Bill Clinton signed into law the same year. One provision of DSHEA clarified the definition for dietary supplements outlined above. DSHEA also mandated the establishment of the Office of Dietary Supplements (ODS) within the National Institutes of Health. The ODS coordinates research on dietary supplements and acts as a clearinghouse for regulatory issues. It also maintains an excellent resource for consumers, the International Bibliographic Information on Dietary Supplements (IBIDS), which is a database that contains citations published in scientific journals on the topic of dietary supplements. The public can access IBIDS on the ODS website.
DSHEA established a new regulatory framework for supplement safety and for the labeling of dietary supplements by the U.S. Food and Drug Administration (FDA). Dietary supplements are regulated under food law, but with certain provisions that apply only to dietary supplements. For example, dietary supplements escape the stringent approval process that food additives and drugs must go through before being marketed to the public, unless the manufacturer of a dietary supplement makes a claim for therapeutic efficacy .
DSHEA also gave manufacturers the freedom to provide information about product benefits on labels through three types of claims. Health claims describe a relationship between a food substance and a disease or health-related condition. For example, the health claim "diets high in calcium may reduce the risk of osteoporosis " has been authorized by the FDA and may appear on the labels of dietary supplements. Structure function claims may state a benefit related to a nutrient-deficiency disease (such as scurvy , which is caused by a deficiency of vitamin C), as long as the statement tells how widespread the disease is. These claims may also describe the role of a nutrient intended to affect a structure or function—for example, "antioxidants maintain cell integrity," or "calcium builds strong bones." Nutrient content claims describe the level of a nutrient or dietary substance in a product, using FDA-regulated terms such as "good source," "high," or "free." For example, if a label claims a dietary supplement is fat-free, the supplement must contain less than 0.5 grams of fat per serving.
Baby Boomers and Nutritional Supplements
Informed, prosperous, and health-conscious, the baby boomers are known as a generation that plans to fight vigorously against the encroachments of age. During the 1990s, as the boomers began reaching their fifties, they increasingly turned to supplements to ward off osteoporosis, memory loss, and a host of other ailments. With increased demand, the vitamins, minerals, and herbs they sought migrated from health food stores to mass merchandisers. Between 1997 and 2002 the supplement industry experienced a 34 percent jump in sales, to more than $19 billion annually.
However, information on supplement labels cannot be false or misleading. For example, statements that a product will treat, cure, or diagnose a disease are reserved for drugs. That is why the label of the popular herbal extract echinacea may boast that the herb "supports good immune function" but will not claim to "cure your cold."
In Germany, herbs and herbal products are regulated in a different way than in the United States. In 1978, the German Federal Health Agency established the German Commission E to investigate the safety and efficacy of herbal remedies commonly used in Germany. The commission weighed evidence from the literature, from anecdotal reports, and from clinical studies. They subsequently developed monographs on over 400 herbs. These monographs are now used worldwide as essential references on herbal therapy. The commission also established indications (how an herb is used medicinally) and dosage recommendations, resulting in the successful mainstreaming of herbs into medical practice. German physicians frequently prescribe the herbs ginkgo biloba, hawthorn, St. John's wort, horse chestnut, and saw palmetto. Unlike U.S. law, German law allows herb manufacturers to market herbs with drug claims if the herb is proven safe and effective.
Controversies Surrounding the Use of Dietary Supplements
Opponents of DSHEA claim that the issue of public safety is their primary concern. Steven H. Zeisel, of the University of North Carolina School of Public Health and School of Medicine, writes that "DSHEA modifies the regulatory environment so that it becomes possible, even likely, that products will be marketed that inadvertently harm people" (Zeisel, p. 1855). Zeisel believes that the DSHEA legislation makes it easy for small enterprises to market products without investing the time and money needed to prove their product's safety and efficacy. He contrasts the development of a new dietary supplement to that of a new drug or food additive, for which there is a formal process to evaluate safety.
A manufacturer developing a new drug or food additive must conduct safety studies following FDA procedures. Results must be submitted to the FDA for review and approval before the ingredient or drug can be sold to the public. This is not the case for dietary supplements, however, because under DSHEA they are legally in a class by themselves. The FDA must simply be notified of the new product, and the notification must provide information that supports the manufacturer's claim that its product is safe. Once the product is marketed, the FDA is responsible for proving that a dietary supplement is unsafe before it can take action to restrict that product's use or remove it from the marketplace.
Another issue critics of DSHEA cite is the scant quality control of dietary supplements. Quality control is important to assure consumers that a product contains the ingredients stated on the label in the stated amounts. Neither the FDA nor any other federal or state agency routinely tests dietary supplements for quality prior to sale. But some manufacturers of dietary supplements do adhere to Good Manufacturing Practices (GMPs) and make every effort to produce a quality product. Also, the FDA has assisted the industry by proposing GMPs that focus on ensuring the identity, purity, quality, strength, and composition of dietary supplements.
DSHEA supporters fear that increased regulation of dietary supplements will decrease access to beneficial products. National opinion surveys show that many supplement users feel so strongly about the potential health benefits of supplements that they would continue to use them even if the supplements were shown to be ineffective in clinical studies. Consumers value freedom of choice, and many view regulation as an attempt by the government and medical establishment to monopolize treatment options. Clearly, a balance needs to be reached between preserving freedom of choice and ensuring that dietary supplements are safe and effective.
see also Alternative Medicines and Therapies; Food Labels; Health Claims; Quackery; Vitamins, Fat-Soluble; Vitamins, Water-Soluble.
Blendon, R. J.; DesRoches, C. M.; Benson, J. M.; Brodie, M.; and Altman, D. E. (2001). "American's Views on the Use and Regulation of Dietary Supplements." Archives of Internal Medicine 161(6):805–10.
Dwyer, Johanna T.; Garceau, Anne O.; Evans, Marguerite; Li, Donglin; Lytle, Leslie; Hoelscher, Deanna; Nicklas, Theresa A.; and Zive, Michelle (2001). "Do Adolescent Vitamin-Mineral Supplement Users Have Better Nutrient Intakes than Nonusers? Observations from the CATCH Tracking Study." Journal of the American Dietetic Association 101(11):1340–1346.
Fleming, Thomas, ed. (1998). PDR for Herbal Medicines. Montvale, NJ: Medical Economics.
Sarubin, Allison (2000). The Health Professional's Guide to Popular Dietary Supplements. Chicago: American Dietetic Association.
Skidmore-Roth, Linda (2001). Mosby's Handbook of Herbs & Natural Supplements. St. Louis, MO: Mosby.
Somer, Elizabeth (1996). The Essential Guide to Vitamins and Minerals, 2nd edition. New York: HarperPerennial.
Zeisel, Steven H. (1999). "Regulation of Nutraceuticals." Science 285:1853–55.
National Institutes of Health, Office of Dietary Supplements. <http://ods.od.nih.gov>
U.S. Food and Drug Administration Center for Food Safety and Applied Nutrition (2001). "Overview of Dietary Supplements." Available from <http://www.cfsan.fda.gov/~dms>
"Dietary Supplements." Nutrition and Well-Being A to Z. . Encyclopedia.com. (October 20, 2017). http://www.encyclopedia.com/food/news-wires-white-papers-and-books/dietary-supplements
"Dietary Supplements." Nutrition and Well-Being A to Z. . Retrieved October 20, 2017 from Encyclopedia.com: http://www.encyclopedia.com/food/news-wires-white-papers-and-books/dietary-supplements