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Complementary and alternative medicine

From OSSCI’s Special Interest Group on Alternative Medicine:

North Americans spend over $30 billion annually on Complementary and Alternative Medicine (CAM) – from acupuncture to therapeutic touch. More than one-third of adults now use at least one form of “alternative” health care each year (where “alternative” is loosely defined as those practices which aren’t generally taught in medical schools or offered at most hospitals).1

The most frequent health problems treated by alternative practitioners are chronic pain, anxiety or chronic fatigue syndrome, sprains/muscle strains, addictive problems, arthritis, and headaches.

The most frequently cited benefits of CAM by patients are: partial relief from symptoms/pain; the treatment works better than standard medicine’s; and the treatment promotes health rather than just focusing on illness.

Users of CAM are on average more educated and believe they’re in poorer health. (More educated people are exposed to non-traditional forms of health care through reading and are more likely to question conventional authority.) Many of these are the “worried well”; people who experience and report symptoms that have no physiological explanation.2

Why is CAM now so popular? According to a recent survey:

  1. patients are dissatisfied with conventional treatments because they are ineffective, produce adverse effects, or are “impersonal, too technologically oriented, and/or too costly”;
  2. patients seek greater “personal control” or “empowerment” over their health-care decisions;
  3. alternative medicine is more compatible with patients’ worldview, values or spiritual/religious philosophy.

It should be of great concern that the last reason turns out to be the most important of all because it is not congruent with a rational, efficient and effective health-care policy.4

Unlike conventional medicine, the majority of alternative therapies have not been scientifically tested. Many of its advocates even deny the need for or applicability of clinical testing, relying instead on anecdotes, “natural” remedies, or ancient theories for justification.

Most CAMs adopt a form of vitalism; the notion that the human body contains an “energy field” (e.g., chi, ki, prana, orgone, life force, aura…) whose disturbance leads to pain and dis-ease. This view is rejected by modern medicine. In the same way, CAM practitioners emphasize terms like “wellness” and “natural” that convey little meaning. Moreover, they incorrectly maintain that CAM treats the cause of disease, while conventional medicine merely treats symptoms.

Biomedicine has remained relatively silent during the CAM explosion of the past generation. This is a serious mistake according to a recent editorial:5

“It is time for the scientific community to stop giving alternative medicine a free ride. There cannot be two kinds of medicine — conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted. But assertions, speculation, and testimonials do not substitute for evidence. Alternative treatments should be subjected to scientific testing no less rigorous than that required for conventional treatments.”

And finally, it is a popular misperception that alternative therapies are harmless, even if they are no better than a placebo (“sugar pill”) because:

  1. Money spent on CAM could be better spent on scientific research for serious ailments.
  2. In rare instances, the delay resulting from not seeking conventional therapy could have dramatic consequences for a patient with a serious condition.
  3. Tacit support of CAM by governments legitimizes anti- and pseudoscientific health-care practices.


1 Eisenberg DM et al. Unconventional medicine in the United States: prevalence, costs, and patterns of use. N Engl J Med. 1993;328:246-252.
2 Barsky AJ, Borus JF. Somatization: and medicalization in the era of managed care. JAMA. 1995;274:1931-1934.
3 Astin JA. Why Patients Use Alternative Medicine. JAMA. 1998;279:1548-1553.
4 Canadians for Rational Health Policy.
5 Angell M, Kassirer JP. Alternative Medicine – The Risks of Untested and Unregulated Remedies. N Engl J Med. 1998;339:839.

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