Alternative medicine

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Alternative Medicine (for etymological meaning see: [1]) refers to methods and treatments not used by science based medicine (or evidence based medicine, EBM). Its supporters in particular also apply terms like complementary medicine, experience based medicine, and integrative medicine. Complementary and alternative medicine are often abbreviateded as CAM. Richard Dawkins stated that "there is no alternative medicine. There is only medicine that works and medicine that doesn't work."[2], a view that is also shared by Tim Minchin in his animated poem "Storm"[3]

Edzard Ernst, retired Professor of Complementary Medicine at the University of Exeter, England, argues that the term "Complementary and Alternative Medicine" ("CAM") is an almost nonsensical umbrella term, and distinctions between its modalities must be made. All treatments, whether "mainstream" or "alternative", ought to be held to standards of the scientific method. The evidence-based medicine is an ideal state which has not yet been achieved by either current mainstream or alternative medicine. Ernst characterizes the evidence for many alternative techniques as weak, nonexistent, or negative, but states that some evidence exists for about 20 treatments, particularly certain herbs and acupuncture – although this evidence does not mean these treatments are mainstream, especially not worldwide.[4][5]

A National Center for Complementary and Alternative Medicine NCCAM in USA defines complementary and alternative therapies as treatments which are used in place of ("alternative") or together ("complementary") with conventional, established therapy.[6] A treatment is considered established when its clinical efficacy has been demonstrated in prospective, randomized trials or a biological rationale establishes the treatment as reasonable. In 2009, an Anglo-Australian group of researchers demonstrated with a computional model that for some odd reason those methods with little or no effect at all show a tendency to spread quickly.[7][8]

The terms alternative medicine and complementary medicine are therefore euphemisms, as they do not offer a real alternative and are just ineffective or less effective pseudomedical methods. This also applies to the "experience based medicine" which tries to invoke anecdotal cures instead of solid proof as a positive quality.[9] Almost all alternative treatments belong into the realm of pseudomedicine.

The concepts of alternative and complementary medicine are usually based on an axiom (a self-evident truth that requires no proof).[10][11]

CAM has turned into a big business, the worldwide turnover is estimated at more than 60 billion U.S. Dollars.[7]

The typical patient

The typical patient or customer, according to studies, can be characterized by the following attributes:[12]

  • young (30-50 years)[13]
  • higher education
  • poorer health status
  • tends to be politically "left" or "green"[14]
  • relatively high income
  • female
  • a holistic orientation to health
  • suffers from anxiety, back problems, chronic pain or urinary tract problems

Appeal

For the popularity of offers outside of science-based medicine a variety of factors were identified.

People seeking alternative treatments were found to have had had a transformational experience that changed the person's worldview and often showed commitment to environmentalism, commitment to feminism, and interest in spirituality and personal growth psychology. One study found that dissatisfaction with conventional medicine did not predict use of alternative medicine. Only 4.4% of those surveyed reported relying primarily on alternative therapies. It concluded that people find these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations towards health and life.[12] Still, arguments like "alternative practitioners devote more time to patients than doctors" are frequently heard.

Other studies found that disappointments with and distrust of conventional therapies play a role. Many patients and clients find pleasure in the more or less explicit criticism of mainstream medicine" or "the pharmaceutical industry" which is not uncommon in alternative medicine circles. Often, an anti-scientific attitude is mixed with New Age mysticism. Vigorous marketing and extravagant claims create false hope. When people become sick, any promise of a cure is appealing.[15]

An appeal may also result from the typical features of pseudomedical treatments, such as simple, clear explanations for the alleged therapeutic effect or lack of side effects. In a study, Edzard Ernst showed this notion is wrong and side effects may indeed occur.[16]

In an interview with "The Independent", Ernst blames providers, clients, and the doctors whose neglect, he says, has created the opening into which alternative therapists have stepped:

"People are told lies. There are 40 million websites and 39.9 million tell lies, sometimes outrageous lies. They mislead cancer patients, who are encouraged not only to pay their last penny but to be treated with something that shortens their lives. "At the same time, people are gullible. It needs gullibility for the industry to succeed. It doesn't make me popular with the public, but it's the truth."[17]

Business in Germany

The number of CAM providers in Germany is rising. Between 1993 and 2000, the number of alternative practitioners as the most important non-medical CAM-profession increased by  90% (from 11/100.000 to 21/100.000 persons). During the same period, the CAM supply of doctors increased by 125% (from 19/100.000 to 43/100.000).[18] 65% of population and nearly all cancer patients use the services provided by CAM at least once a year.[5]

Every year herbal remedies for about two billion Euros are prescribed in Germany and about nine billion Euros are spent on complimentary and alternative medical procedures (2006).[19] Five billion Euros are paid by the patients themselves, four billions are refunded by health insurances. 40.000 doctors offer respective treatments.[20]

Another estimate valued the total turnover at about 20% of the entire so-called Wellness industry in Germany, which has an annual volume of 50 billion Euro.[21]

Business in USA

A 2008 survey of US hospitals by Health Forum, a subsidiary of the American Hospital Association, found that more than 37% of responding hospitals indicated they offer one or more alternative medicine therapies, up from 26.5% in 2005. More than 70% of the hospitals offering CAM were in urban areas.[22]

The National Health Statistic Report in an article dated July 30, 2009[23] states that U.S patients have spent 33.9 billion Dollars on CAM services and products in 2007. Homoeopathy accounted for 3 billions, Qigong for 4 billions. Expenditure for food supplements like vitamins and minerals were not included in this amount.[24] In 1997, between 36 and 47  billion U.S. Dollars were spent on complementary medicine. Of these, 12 to 20 billion USD were paid by patients for complementary therapists.[25] This is half of the amount spent by patients on medical services.

A study found that 27 billion dollars were spent on complementary and alternative medical treatments by consumers in 2002.[26] A further study found that, in 1987, four times as much money was spent in the USA on complementary medicine than on all cancer research.[27] In 1981 Laetrile, a then popular ineffective, alternative cancer drug made from apricot kernels had a turnover of 2 billion U.S. dollars. In the same period 0.2 billion dollars were spent on chemotherapy.

Research

In Germany, funding for research in the field of alternative medicine usually comes from private foundations, such as:

  • Karl und Veronica Carstens-Foundation (27 million Euro). It sponsored 1.5 million Euro in May 2008 for an endowed chair of alternative medicine at the Berlin Charité.
  • Krupp Foundation
  • Kneipp Foundation
  • Gerhard Kienle Foundation
  • Erich Rothenfußer Foundation

The manufacturers of alternative medical products are also funding research in this field. German companies Bionorica and Schwabe have research budgets of 17 and 25 million Euro. While it is not possible to patent substances that occur in nature (such as plants), special techniques for preparation can be patented.

Since 1999, the National Center for Complementary and Alternative Medicine (NCCAM) has funded research on alternative medicine with 2,5 billion U.S. Dollars.

The National Center for Complementary and Alternative Medicine in USA has an annual budget of 122 million dollars, financed by the government, and spent $2.5 billion on studies of CAM therapies.[28][29] The NCCAM budget has been criticized because despite the duration and intensity of studies, there have been exactly zero effective CAM treatments supported by scientific evidence to date.[30][31] R. Barker Bausell, a research methods expert and author of "Snake Oil Science" states that "it's become politically correct to investigate nonsense."[32]

Wallace Sampson, an editor of Scientific Review of Alternative Medicine and a Stanford University professor of medicine, comments CAM is the "propagation of the absurd" based on the example that alternative and complementary have been substituted for dubious and implausible quackery.

Currently (2010), the "National Center for Complementary and Alternative Medicine" (NCCAM) and the "Office of Cancer Complementary and Alternative Medicine" (OCCAM) spend a combined 240 million U.S. Dollars of taxpayers' money from the NIH (National Institute of Health).[33]

Criticism

As far as effectiveness is concerned, users of alternative medical methods often only refer to their own experience which is based on a selective perception of the past. Such retrospective observations are not evident by nature. The argument used occasionally, "He who heals is right", is not sensible because causality and correlation are often confused in anecdotal experience and reports. In other words, an illness treated with globules might just as well have gone away by itself.

The notion of a postulated and fuzzy phrased "holistic approach" (usually associated with "of body, mind and soul") remains a mere promise within alternative medicine and would be difficult to implement because of time and financial constraints.

Potential danger

Alternative medicine involves several dangers and risks[34][35][36]:

  • rejection of effective diagnostics and therapies in favour of pseudo-medical methods without proof of effectiveness leading to protraction of the illness or appearance of avoidable symptoms
  • misdiagnoses because of inadequate medical training of alternative practitioners
  • deterioration of therapeutic prospects due to futile pseudomedical efforts
  • development of guilt feelings at failure, towards oneself or family members
  • psychological and financial exploitation by a CAM method displaying cult-like structures
  • development of psychological dependency or addiction
  • deaths or permanent damage due to inappropriate procedures

A study by the Royal Children's Hospital in Melbourne published in December 2010 investigated 39 cases in which children suffered damage fpllowing alternative medical treatments. In 30 cases, a correlation between damage to the patients and use of alternative medical therapies or denial of prescribed medicines was established. Four of the children died because their parents refused medical treatment. An malnourished infant of eight months died of septic shock because he had been put on a diet of "naturopathic" rice milk due to an alleged constipation since his third month of life. A baby of ten months also died of septic shock because he was put on a restrictive diet against a chronic eczema. Another child died from multiple epileptic seizures after parents had stopped the anti-epileptic drug medication for fear of side effects, using an alternative remedy instead. A fourth child suffered fatal bleeding because the parents refused a therapy with anticoagulants in favour of a complementary medical treatment.[37][38]

Intimidation and actions against critics

Individuals or institutions with a critical view of alternative medicine pointing out its pseudo-medicalcharacter must expect personal attacks. Two women who asked critical questions of the lecturer at an event on Germanic New Medicine in Frankfurt, Germany were "accompanied home" by "bald-headed gentlemen". The two women had to call the police. A cellular therapist tried to stop a critic with a court order and from giving his assessment of cellular therapy.[39] A further example are civil actions against the former project Paralexx which led to a temporary shutdown.

The German consumer protection foundation "Stiftung Warentest" wanted to publish a book with a critical analysis and evaluation of natural and alternative medicine. The magazine "Stern" seized the opportunity to do a prior publication: Krista Federspiel, one of the two authors and her colleague Hans Weiss offered to do a undercover report visiting ten alternative practicians to obtain a diagnosis. "Stern" offered generous payment for the report and requested a second part presenting victims of alternative methods by name. To prove the journalists had indeed seen these alternative practicians, a photographer documented the visits. Each prcitioner attended imputed the subject with several diseases: A total of 38 different diseases and a myriad of ailments and allergies were diagnosed, and more than 130 drugs prescribed. When the report titled "Wunderheiler und Krankbeter" (Miracle Healers and Faith Un-Healers) was published in "Stern" 49/1991, the criticism raised was met by outrage and massive protests by alternative practitioners to such an extent that editors postponed and later cancelled the second part, fearing the loss of readers. The rights were returned to the authors.[40]

In a show aired by German TV station ZDF on September 5, 2007 titled "Heilen mit dem Nichts?"(Healing with nothing?), journalist Joachim Bublath reported about scientific results on homoeopathy (including an analysis of the renowned journal The Lancet[41]) which questioned a possible effectiveness of this controversial method beyond placebos. This led to a call from advocates of homoeopathy to spam the station's website and ZDF shied away by deleting the site citing the Lancet figures.[42][43]

Versions of this article in other languages

Literature

(German)

  • Shermer M. und Lee Traynor: Heilungsversprechen - Alternativmedizin zwischen Versuch und Irrtum, Skeptisches Jahrbuch III, Alibri, 2004, ISBN 3-932710-86-X
  • Ullmann Christian: Fakten über die „andere Medizin“. Augsburg: Foitzick 2006
  • Lambeck Martin, Irrt die Physik?: (2003) Über alternative Medizin und Esoterik, Beck Verlag
  • Heyll Uwe, Wasser, Fasten, Luft und Licht: Die Geschichte der Naturheilkunde in Deutschland, (2006) Campus Verlag
  • Goldner C: Alternative Diagnose- und Therapieverfahren: Eine kritische Bestandsaufnahme. Alibri 2008 ISBN-10: 3865690432
  • Federspiel K., I. Lackinger-Karger: Kursbuch Seele. Köln: Kiepenheuer & Witsch 1996 (544 S.)
  • Beyerstein B.L.: Warum falsche Therapien zu wirken scheinen. In Shermer/Traynor (s. u.)
  • Harder Bernd: Stimmt es, dass Recht hat, wer heilt? Skeptiker 2/07, 74-75
  • Much Theodor: Der veräppelte Patient?: Alternativmedizin zwischen (Aber-)Glauben und Wissenschaft. Verlag: EDITION VA bENE, Klosterneuburg; 2003. ISBN-10: 3851671430
  • Oepen I.: An den Grenzen der Schulmedizin. Eine Analyse umstrittener Methoden. Köln: Dt. Ärzte-Verlag 1985
  • Oepen I., O. Prokop (Hrsg.): Außenseitermethoden in der Medizin. Ursprünge, Gefahren, Konsequenzen. WBG 1989
  • Oepen I. (1993): Unkonventionelle medizinische Verfahren, Stuttgart.
  • Oepen I., Amardeo Sarma (Hrsg.)(1998): Paramedizin - Analysen und Kommentare, Muenster.
  • Oepen I., R. Scheidt: Wunderheiler heute. Eine kritische Literaturstudie. München: Zuckschwerdt 1989
  • Siebert A.: Strafrechtliche Grenzen ärztlicher Therapiefreiheit. Berlin: Springer 1983
  • Weber Tobias: Christian Ullmanns „Fakten über die andere Medizin“. Skeptiker 19 (3/06) 103-106

(English)

  • Randi J.: Flim-Flam! Buffalo: Prometheus 1982, chapter 9 (The medical humbugs)
  • Stalker D., C. Glymour (eds.): Examining holistic medicine. Buffalo: Prometheus 1985
  • R. Barker Bausell: Snake Oil Science. The Truth about Complementary and Alternative Medicine, B&T, 2007
  • Margaret Thaler Singer und Janja Lalich: (1996) "Crazy" Therapies - What are they? Do They Work? San Francisco: Jossey-Bass Publishers, 1996
  • Ernst E.: The Desktop Guide to Complementary and Alternative Medicine. An evidence-based approach. Mosby, Harcourt Publishers Limited 2001
  • Ernst E. How to get rich quickly with 'alternative' medicine Skeptical Inquirer 2009, Mar-Apr S. 57
  • Singh Simon, Ernst Edzard, Trick or Treatment: The Undeniable Facts about Alternative Medicine, (2008) Random House
  • Ben Goldacre, Bad Science: Quacks, Hacks, and Big Pharma Flacks, Faber & Faber; ISBN 978-0865479180

See also: Helsana-Study

Weblinks (mostly in German language)

References

  1. "alternative": etymological meaning. Adj. "1580s, "offering one or the other of two," from M.L. alternativus, from L. alternatus, pp. of alternare (see alternate). Sense of "the other of two which may be chosen" is recorded from 1838. Adj. use, "purporting to be a superior choice to what is in general use" was current by 1970 (earliest ref. is to the media); e.g. alternative energy (1975).", Source: Dictionary.com. Online Etymology Dictionary. Douglas Harper, Historian. http://dictionary.reference.com/browse/alternative (accessed: June 03, 2011).
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  30. Scientists Speak Out Against Federal Funds for Research on Alternative Medicine, David Brown, Washington Post, March 17, 2009
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  38. http://adc.bmj.com/content/early/2010/11/24/adc.2010.183152.short?q=w_adc_ahead_tab
  39. LG Stuttgart AZ 17 0 289/76 Claims 500,000 German Mark
  40. http://kritischgedacht.wordpress.com/2007/12/25/sanfte-alternative/
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