Alternative medicine

National Institutes of Health classifies alternative medicine as an unrelated group of non-orthodox therapeutic practices, often with explanatory systems that do not follow conventional biomedical explanations or more seriously, based on pseudoscience. Others more generally define it as medical interventions not taught at United States medical schools or not available at United States hospitals.

Alternative therapies include, but are not limited to the following disciplines: folk medicine, herbal medicine , diet fads, homeopathy, faith healing, new age healing, chiropractic, acupuncture , naturopathy, massage, and music therapy. Studies suggest these therapies are sought out by individuals who suffer a variety of medical problems. In general, alternative medical practice that fits three criteria: it is not taught in the standard medical school curriculum; there is not sufficient scientific evidence that the treatment is safe and effective against a specific disease ; and insurance companies do not reimburse the patient for its cost.

Such a definition could include nearly all unproven but ineffective practices that offer little in benefit but draw billions of health care dollars from desperate patients. The use of laetrile (a derivative of apricot pits) to treat cancer and chelation therapy to remove cholesterol deposits from severely affected arteries are cases in point. Both are highly touted by their practitioners, both have been tested under rigid scientific research standards, and both have been found ineffective and useless. The primary harm of such treatments lies in the fact that patients who utilize them often do not seek more effective, mainstream medical care.

The first known example of alternative medicine in the United States was the introduction and patenting in 1797 of a "mechanical tractor" to pull bad electricity , alleged to be the source of all illnesses, from the body. A chief justice of the Supreme Court, several members of Congress, and the retired president, George Washington, all used this device.

Although some alternative medical practices are clearly ineffective and sometimes dangerous, others have achieved a degree of acceptability in the eyes of organized medicine. Among these are naturopathy, yoga, biofeedback , hypnotism, acupuncture, chiropractic medicine, homeopathy, and relaxation techniques.

Naturopathy

The practitioner of naturopathic medicine considers the person as a whole, treats symptoms such as fever as a natural manifestation of the body's defense mechanism that should not be interrupted, and works to heal disease by altering the patient's diet, lifestyle, or work habits. The basis of naturopathy can be traced back through Native American practices, to India, China, and ancient Greece.

In naturopathy, the body's power to heal is acknowledged to be a powerful process that the practitioner should enhance using natural remedies. Fever, inflammation , and other symptoms are not the underlying cause of disease, but are reflections of the body's attempt to rid itself of the underlying cause. The disease itself originates from spiritual, physical, or emotional roots, and the cause must be identified in order that effective therapy may be applied. The patient is viewed holistically and not as a collection of symptoms; the cure is gauged to be safe and not harmful to the patient. The practitioner is a teacher who is trained to recognize the underlying problems and teach the patient to adopt a healthier lifestyle, diet, or attitude to forestall disease. The naturopathic practitioner is a specialist in preventive medicine who believes prevention can best be achieved by teaching patients to live in ways that maintain good health.

In addition to advising the patient on lifestyle changes to prevent disease, the naturopathic practitioner may also call upon acupuncture, homeopathy, physical therapy , and other means to strengthen the patient's ability to fight disease. Herbal preparations as well as vitamin and mineral supplements may be used to strengthen weakened immune systems. Stressful situations must be eased so that the digestive system can function properly, and any spiritual disharmony is identified and corrected.

Naturopaths are trained in herbal medicine, clinical dietetics, hydrotherapy, acupuncture, and other noninvasive means to treat disease. They provide therapy for chronic as well as acute conditions, and may work beside physicians to help patients recover from major surgery . The naturopath does only minor surgery and depends upon natural remedies for the bulk of patient therapy. Naturopathy is not widely accepted by physicians, although some practitioners are also doctors of medicine (M.D.).

Lifestyle changes

Lifestyle changes can be as simple as getting more exercise or as complex as completely redesigning the diet. Exercise in moderation is a preventive measure against heart disease, stroke , and other serious conditions. It is only when such exercise programs become excessive or all consuming that they may be harmful. Some people use very high daily doses of vitamins in an attempt to forestall the aging process or to assist the body in ridding itself of cancer or the HIV virus . Megadoses of vitamins have not been proven effective for these purposes. Vitamins play a specific role in the metabolism and excess vitamins simply are stored in the fat or are eliminated from the body through the kidneys.

Changes to achieve a more balanced intake of nutrients or to reduce the amount of fat in the diet are beneficial, but dietary programs that add herbal supplements to the diet may be ineffective or even harmful. Chinese and Far Eastern cultures use herbal therapy to achieve weight loss, delay aging, or increase strength. Dietary supplements of Chinese herbs have become increasingly popular among Westerners, although most Americans do not know specifically what herbs they are consuming. Laboratory tests have raised questions about the effectiveness of many of these herbs; some may have high lead content and therefore are potentially toxic.

Relaxation

Many practices are included under the general term of relaxation. Relaxation techniques are generally accepted as beneficial to individuals who are otherwise unable to sleep , in pain , under ongoing job-related stress , or recovering from surgery. Various relaxation techniques frequently are used in hospitals to help patients deal with pain or to help them sleep.

In the simplest form of relaxation therapy, the individual is taught to lie quietly and to consciously relax each part of the body. Beginning with the feet and progressing through the ankles, calves, thighs, abdomen, and so forth up to the neck and forehead, each part of the body is told to relax and the individual focuses his thoughts on the body part that is being told to relax. It is possible to feel the muscles of the leg or the arm relaxing under this focused attention.

The ancient practice of yoga is also considered a relaxation technique. The practice of assuming a specified position (the lotus position, for example), clearing the mind of the sources of stress, and concentrating on one's inner being for a short time can be beneficial. Following a yoga session, the individual often is less stressed and can order his thoughts in a more organized manner. Transcendental meditation is a variation of yoga that consists of assuming specific body positions and chanting a mantra, a word or two that is repeated and serves to concentrate the mind. This practice is claimed to clear the mind of stressful thoughts and anxiety , and enables the practitioner to reorder his priorities in a more relaxed manner.

Yet another variation on relaxation came into widespread use in the late 1960s. Biofeedback became a popular practice that initiated an industry devoted to manufacturing the devices needed to practice it effectively. Biofeedback is a process by which an individual consciously controls certain physiologic processes. These can be processes that normally are subject to thought control, such as muscle tension, or those that are not, such as heart rate . To effect such control, the person is connected to a gauge or signal device that changes tone with changes in the organ being controlled. This visual or auditory signal provides evidence of the effectiveness of the person's effort. The heart rate can be monitored by the scale of a tone or a blip on a small screen. The tone lowers in pitch or the blip appears with decreasing frequency as the heart rate slows. The goal is for the individual to learn to influence the signal in front of him and, having acquired this proficiency, to be able to accomplish the same physiologic changes without the visual or auditory signal. Biofeedback has been used successfully to reduce stress, eliminate headaches, control asthma attacks, and relieve pain.

Hypnotism, despite its use for entertainment purposes, also has a place in medical practice. Hypnotism was first introduced to the medical community in the late eighteenth century by a German physician, Franz Anton Mesmer (1734–1815), and was first called mesmerism. Mesmerism fell out of favor in France when a scientific committee failed to verify Mesmer's claims for the practice. The name was later changed to hypnotism (from the Greek word hypnos for sleep) by James Braid (1795–1860), an English ophthalmologist. Although technically hypnotism is not sleep, the name stuck.

Sigmund Freud (1856–1939) adopted hypnotism into his practice in the nineteenth century. Early in his use of the practice he praised its benefits, writing two scientific papers on hypnotism and employing it to treat his patients. By the early 1890s, however, Freud abandoned hypnotism in favor of his own methods of analysis. It was not until the 1950s that the British and American medical societies approved the use of hypnosis as an adjunct to pain treatment. In clinical use, hypnotism is called hypnotherapy, and it is used to treat both physical and psychological disorders. The patient is placed in a trance-like state so that the physician may delve into the deepest levels of the mind to relieve such conditions as migraine headaches, muscle aches, chronic headaches, and postoperative pain. This trance-like condition can be induced by the practitioner or by the patient. It is achieved by first relaxing the body and then by concentrating the patient's attention on a single object or idea, shifting his thoughts away from the immediate environment. In the lightest form of hypnosis, the superficial level, the patient may accept suggestions but will not always take steps to carry them out. Therapists try to reach the deeper state of hypnosis, the somnambulistic stage, in which the patient is readily susceptible to suggestion and carries out instructions while hypnotized as well as after he has come out of the trance (post-hypnotic suggestion).

While in the trance the patient can be induced to ignore pain, to fully relax, or to carry out other beneficial suggestions by the therapist. Also the therapist may suggest that the patient can hypnotize himself when he needs relief from pain or needs to blunt his appetite. The patient is given a simple ritual to follow including specific words to say to place himself in a hypnotic trance. He will then convince himself that his pain has been relieved or that he has eaten a sufficient amount. Upon recovering his normal level of consciousness he will find that his pain is less or that he has no need for additional food.

Unlike portrayals of hypnotists in films, a therapist cannot hypnotize anyone who does not want to be hypnotized. It is essential that the patient and therapist have a close rapport, that the patient fully believes the practice will be of benefit to him, and that the surroundings are devoid of distracting stimuli. Even when in a trance, the patient will not carry out any act he would find morally unacceptable in his waking state. The hypnotist cannot place someone in a trance, for example, and direct him to steal a car or rob a bank. The subject will awaken with the shock of the suggestion.

Chiropractic medicine

Chiropractic medicine is founded on the hypothesis that many human diseases and disorders stem from deviations or subluxations of the spine, which impinge on the spinal nerves, causing pain or disfunction of the affected organs. Treatment consists of determining which of the vertebrae have shifted and then realigning them properly. This may be accomplished in a single treatment or may require a series of treatments over time.

Chiropractic, derived from the Greek words for "practice by the hands," was developed by a Canadian-born Iowa grocer, Daniel David Palmer (1845–1913), in 1895. Palmer believed that the source of illness was the misalignment, or subluxation, of the spinal column in such a way that the vertebrae impinged upon the spinal nerves that passed from the spinal cord, between the vertebrae, to the various organs and muscles of the body. This constriction of the spinal nerve prevented the neural impulses from flowing properly, thus making it impossible for the brain to regulate body functions and leaving tissues susceptible to diseases. Correcting the subluxation would, therefore, restore the neural impulses and strengthen the body.

In 1898, Palmer established the Palmer College of Chiropractic in Davenport, Iowa. In 1910 he published a textbook on chiropractic, which outlined his theories. Since then, the number of chiropractic schools has increased to 16 with a total enrollment of approximately 10,000. To practice as a doctor of chiropractic (D.C.) an individual must complete the four years of chiropractic school and pass a licensing test. Some states specify that entry into a chiropractic college requires only a high school diploma and others require two years of college prior to entry.

Chiropractors themselves differ in the definition of their specialty—this has led to the formation of two separate professional organizations. The International Chiropractors Association advocates chiropractic therapy limited to spinal manipulation only, while members of the American Chiropractors Association endorse a wider range of therapeutics including physical therapy, diathermy (heating of body tissues with electromagnetic radiation , electric current , and ultrasonic waves), and dietary counseling in addition to the basic spinal manipulation.

Chiropractors do not prescribe medication or perform surgery. Only with great reluctance did the American Medical Association recognize chiropractic as a legitimate specialty. The practice is still approached with skepticism by many in the mainstream medical community because no chiropractic school is recognized by any accrediting body and because the practice itself is based on unsound, unscientific principles. Still, many physicians refer patients with back pain to chiropractors who are more skilled at manipulating misaligned vertebrae.

Acupuncture

Acupuncture is a form of therapy developed by the ancient Chinese and subsequently refined by Chinese practitioners. It consists of inserting needles through the skin in very specific places to alleviate pain, cure disease, or provide anesthesia for surgery. Acupuncture as a palliative is accepted among the medical community. Its use as a cure for serious disease or for anesthesia is not endorsed by many physicians.

For the practitioner of acupuncture, the human body is a collection of thousands of acupuncture points that lie along specific lines or meridians. Twelve pairs of meridians are plotted on the body, one of each pair on each side. An additional meridian, the Conception Vessel, courses along the midline of the front of the body and another, the Governor Vessel, along the spine. The meridians are connected by extrameridians. Additional acupuncture points lie outside the meridians on areas such as the ear lobes, fingers, toes, and so forth.

Each meridian is a course for the perceived flow of energy through the body and that flow may be connected to an organ removed from the actual location of the meridian. Needles are inserted at points along the meridian that are specific for a given organ. For example, although the liver lies in the right side of the abdomen, the acupuncture points for liver disease may include areas on the opposite side of the body as well as one of the earlobes.

Acupuncture therapy consists of first locating the source of pain, then deciding upon the appropriate meridian and acupuncture points. Needles used in acupuncture may be short, for use in less-fleshy areas, or long for use in areas with copious flesh or muscle. The needle is simply inserted into the proper acupuncture point and rotated. The needles are left in place for a given time and rotated periodically while they are in place. Some patients find dramatic relief from pain with acupuncture and a number of physicians have incorporated the procedure into their practices.

In the Far East, acupuncture is a recognized form of therapy, and it is combined with herbal medicine, diet restrictions, and exercise. Not only is it used for pain relief, but it is also used frequently as anesthesia during surgery and for the treatment of serious diseases such as cancer. No scientific proof has been offered that it is effective against serious diseases, though its anesthetic and analgesic properties have been demonstrated.

Homeopathy

Homeopathy is a term derived from the Greek words meaning "similar suffering." It is a system in which diluted plant , mineral, or animal substances are given to stimulate the body's natural healing powers. Homeopathy was developed in the late eighteenth century by Samuel Hahnemann (17551–1843), a German physician. Hahnemann conducted experiments to improve standard therapy, which then consisted of bloodletting and administering purgatives made with mercury, which were highly toxic. In one of his experiments he ingested an extract of cinchona, the bark from a Peruvian tree used by the natives to treat malaria . Hahnemann consumed large doses of the bark and developed the symptoms of malaria. From this he concluded that if large doses resulted in symptoms of the disease, small doses should stimulate the body's own disease-fighting mechanism.

Homeopathy is based upon three principles formulated by Hahnemann. The first is the law of similars, stating that like cures like. The second is the law of infinitesimal dose, stating that the potency of a remedy is a reflection of how much it is diluted. Third is the holistic medical model, stating that any illness is specific to the individual who has it.

The law of similars is seen in more traditional medical practice in the use of immunizations. Inoculations of attenuated or dead viruses or bacteria are given to stimulate the production of antibodies to resist a full-scale invasion of the same virus or bacterium. Thus, immunizing a child against poliomyelitis consists of administering a solution containing the dead polio virus; this results in the formation of antibodies that are available to repel the living polio virus if the child is exposed to it.

Homeopathy is much more accepted in Europe , Latin America, and India than it is in the United States. It is touted as a low-cost, nontoxic, effective means of delivering medication that can cure even chronic diseases, including those that conventional medications fail to cure. In France, pharmacies are required to stock homeopathic remedies in addition to regular pharmaceutical drugs. Hospital and outpatient clinics specializing in homeopathy are part of the British health care system and the practice of homeopathy is a recognized postgraduate medical specialty.

In the United States homeopathy has only begun to be accepted by the mainstream medical community. Approximately 3,000 physicians or other health care providers endorse the practice. Though it excites little enthusiasm among practicing physicians in America, homeopathy is an ongoing specialty, and the production of homeopathic remedies is regulated by the Food and Drug Administration to assure their purity, and proper labeling and dispensing.

See also Acupressure.

Resources

books

Cohen, Michael. Complementary Medicine: Legal Boundaries and Regulatory Perspectives Baltimore: Johns Hopkins University Press, 1999.

Goldberg, Burton, John W. Anderson, and Larry Trivieri. Alternative Medicine: The Definitive Guide. 2nd. ed. Ten Speed Press, 2002.

Pierce, Andrea, and John A. Gans. The American Pharmaceutical Association Practical Guide to Natural Medicines New York: William Morrow & Co., 1999.

Rakel, David, ed., and Charles Dickens. Integrative Medicine Philadelphia: W.B. Saunders, 2002.

organizations

National Institutes of Health. "National Center for Complementary and Alternative Medicine" <nccam.nih.gov> (February 4, 2003).

Larry Blaser

KEY TERMS

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Acupuncture

—A form of therapy developed by the ancient Chinese in which needles are inserted through the skin in very specific places to alleviate pain, cure disease, or provide anesthesia for surgery.

Chiropractic

—The theory that many human diseases and disorders stem from deviations or subluxations of the spine, which impinge on the spinal nerves, causing pain or disfunction of the affected organs.

Homeopathy

—A system in which diluted plant, mineral, or animal substances are given to stimulate the body's natural healing powers. Homeopathy is based upon three principles: the law of similars, the law of infinitesimal dose, and the holistic medical model.

Hypnotherapy

—The clinical use of hypnotism to treat both physical and psychological disorders, whereby the patient is placed in a trance-like state by the practitioner or by the patient and the patient's attention focuses on a single object or idea in order to relax.

Naturopathy

—Form of alternative medicine that focuses on the patient holistically and views symptoms such as fever as a natural manifestation of the body's defense mechanism that should not be interrupted. Patients are taught to adopt a healthier lifestyle, diet, or attitude to forestall disease development.