a.k.a. Complementary, Holistic, Unconventional, New, Planet, New Age,

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Alternative Medicine 1

• a.k.a. Complementary, Holistic, Unconventional,
  New, Planet, New Age, Medicine/Health/Therapy/He
  aling,

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Alternative to What???

• alternative to scientific medicine
• based largely on experimental research (often
  incl. double-blind clinical trials)
• conventional medicine depends significantly on
  pharmaceuticals and surgery (but not enough on
  prevention!)
• compare progress of both (as well as popularity)
• consider credentialing and accreditation
• evidence-based medicine

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Popular Areas of A.M.

• relaxation techniques
• chiropractic
• massage
• imagery
• spiritul healing
• weight-loss programs
• macrobiotics other such diets

• herbal medicine
• megavitamins
• self-help groups
• energy healing
• biofeedback
• hypnosis
• homeopathy
• acupuncture
• folk remedies
• etc.

David Eisenberg et al., NEJM 1/28/93, p. 246
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Typical Problems for Which Patients See
Alternative Providers

• back problems
• anxiety
• headache
• sprains and strains

• insomnia
• depression
• arthritis
• allergies

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Scope of Alternative Medicine

• Most of worlds population depends on it much
  more than on scientific medicinewhich is often
  unavailable or too expensive.
• 20 billion industry in U.S.
• 75 paid out of pocket
• few of total U.S. healthcare bill
• more visits to alternative providers than to
  primary care physicians
• NIH National Center for Complementary and
  Alternative Medicine
• nccam.nih.gov
• 50 M budget
• (was 2 M in 1992 for OAM)

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David Eisenberg surveys (90, 97)
NEJM JAMA

• 629 million visits
• 21.2 B (12.2 B not covered by insurance)
• 83 million Americans (25? since 1990 )
• 47? visits 45? spending (since 1990)

Center for Alternative Medicine Research, Beth
Israel Deaconess Medical Center, Boston
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Alternative Care in U.S. (1997)
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Aspects of Alternative Medicine

• ancient wisdom
• religious undercurrent
• New Age spiritualism
• faith healing
• empiricism (experientialism)
• substitute personal experience for scientific
  knowledge
• mysticism ( extreme skepticism)
• mind/body dualism
• often anti-science
• energy vibrations (red flag)

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Vital Force

• nonmaterial, divine, or personal form of energy
  (or vibrations)
• little or no relation to physics usage
• Qi (chi) chakras innate intelligence psychic
  energy etc.
• acupuncture Qi and body interact through
  elaborate system of channels (nonexistent)
• energy undetectable by instruments or objective
  tests
• only subjective

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Main Approaches

• Mind/Body
• biofeedback, relaxation, hypnosis,
• stress and emotions are known to play a role in
  physical health
• neuroimmunology new field
• Alternative drugs
• cancer treatments (shark cartilage!??)
• other herbal remedies
• Treatments at odds with Western medicine (and
  science)
• chiropractic, acupuncture, homeopathy,

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Considerations

• Most ailments (80) are self limiting!
• Many are psychogenic.
• Placebo effect is strong! (double blind?)
• Are A.M. treatments safe and effective?
• There are dangers in avoiding (or deferring)
  mainstream medical care for serious organic
  ailments.
• How does one determine which treatments work, and
  which do not? What is the evidence? and how
  solid is it?
• Beware quackery and con artists ().

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Placebo Effect Clinical Trials

• Placebo
• sugar (glucose) pill, saline injection, sham
  treatment
• surprisingly effective (typically 30-40!!)
• used as control in clinical trials
• Double-blind trials
• patient practitioner unaware of whether patient
  receives actual drug or placebo
• randomization encoded labeling
• statistical analysis (large studies preferred)
• expensive
• gold standard but not always possible

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Clinical Trial Phases (new drugs or treatments)

• Phase I safety, safe dosage range, side effects
  ( 50 subjects)
• Phase II effectiveness and more on safety
  (200 subjects)
• Phase III confirm effectiveness, monitor side
  effects, compare other drugs or treatments, plan
  safe usage (2,000 subjects)
• Phase IV continued study after it has gone to
  market (incl. long-term side effects)

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Major Themes of A.M.

• spiritual healing
• yoga ayurveda
• natural healing
• naturopathy homeopathy
• hands-on healing
• acupressure, reflexology
• therapeutic touch (mostly hands off !!)

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Homeopathy
Samuel Hahnemann 1755-1843

• Law of Similars
• like cures like
• Law of Infinitesimals
• infinite dilution
• unaware of Avogadros number!
• Considered pseudoscience today
• but remains popular commercially successful
• placebo effect
• Note Sen. Royal Copeland, MD, sponsor of Food,
  Drug, and Cosmetic Act (1938 FDA), saw to it
  that homeopathic medicines were not included (re
  safety effectiveness) Copeland was a
  homeopath

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Therapeutic Touch

• Emily Rosa
• fourth-grade science fair project
• Could therapeutic touch practitioners actually
  detect a human energy field?
• Results No!
• published in JAMA
• JAMA 2791005-1010 (April 1, 1998)

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Conclusions(Rosa et al., 1998)
Twenty-one experienced TT practitioners were
unable to detect the investigator's energy
field. Their failure to substantiate TT's most
fundamental claim is unrefuted evidence that the
claims of TT are groundless and that further
professional use is unjustified.