Our Older Alt-Med Articles
 
   

Our Older Alt-Med Articles

This section is maintained by Frank M. Painter, D.C.
Send all comments or additions to:   Frankp@chiro.org>
 
   

Victor Herbert, MD, JD: A Prominent Alt Med Critic Passes On
A medical doctor, attorney, and author, Herbert was widely known in alternative medicine circles as one of the most prominent and vociferous critics of the field of alternative medicine, its practitioners, and its proponents.

James Coburn: A Prominent Alt Med Proponent Passes On
James Coburn appeared in over 80 films. He was forced to put his career on hold in the 1980s when he developed crippling rheumatoid arthritis but that he eventually returned to work, citing the fact that dietary supplements had helped him to recover his health. After his experiences with alternative medicine, Coburn became a proponent of medical freedom of choice and nutritional supplements and often spoke about the issues.

Alternative, Complementary, or Integrative?
Complementary Therapies in Medicine 2003 (Mar);   11 (1):   2–3

In the last thirty years there has been a change in how the non-orthodox therapies and medicines that are described, discussed and critiqued in this journal are identified. Once known as alternative medicine they became complementary medicine and are now beginning to be seen as part of integrative medicine. How has this change in nomenclature occurred? What has driven it and what are the implications for the future of both the orthodox and the non-orthodox?

Characteristics of Visits to Licensed Acupuncturists, Chiropractors, Massage Therapists, and Naturopathic Physicians
J Am Board Fam Pract 2002 (Nov);   15 (6):   463–480 ~ FULL TEXT

Adobe Acrobat File ~ 91 KB   More than 80% of visits to CAM providers were by young and middle-aged adults, and roughly two thirds were by women. Children comprised 10% of visits to naturopathic physicians but only 1% to 4% of all visits to other CAM providers. At least two thirds of visits resulted from self-referrals, and only 4% to 12% of visits were from conventional physician referrals. Most visits to chiropractors and naturopathic physicians, but less than one third of visits to acupuncturists and massage therapists, were covered by insurance.

Patterns and Perceptions of Care for Treatment of Back and Neck Pain: Results of a National Survey
Spine 2003 (Feb 1);   28 (3):   292–297

Chiropractic, massage, relaxation techniques, and other complementary methods all play an important role in the care of patients with back or neck pain. Treatment for back and neck pain was responsible for a large proportion of all complementary provider visits made in 1997. The frequent use and perceived helpfulness of commonly used complementary methods for these conditions warrant further investigation.

The Challenge of Educating Physicians about Complementary and Alternative Medicine
Acad Med 2002 (Sep);   77 (9):   847–850   ~ FULL TEXT

The rapid growth of complementary/alternative medicine (CAM) predated both the 1992 establishment of the Office of Alternative Medicine at the National Institutes of Health and the release of Dr. David Eisenberg's 1993 groundbreaking article on the widespread use of CAM. Since these two watershed events, the use of nontraditional medical modalities has seen exponential expansion. Most physicians are not prepared to respond knowledgeably about CAM modalities, and, indeed, sorting out the viable CAM modalities can be a difficult task. Additional factors are poor and inadequate dialogue between physicians and CAM practitioners, doubts about CAM practitioners' competence, a lack of readily identifiable and recognizable qualifications of such practitioners, and the risk of offering unrealistic hope of a cure. All these factors place the patient in a sometimes perilously uncertain position. Incorporating systematic presentation of CAM information into the curricula of medical schools would provide future physicians the necessary tools and knowledge to enable their patients to use CAM modalities appropriately, with limited risks.

Tired of Killer Cures?
The Washington Post Tuesday, August 20, 2002; Page HE01

The signs and symptoms of crisis in our health care system have become front-page news in recent weeks. Treatments that were routine -- widely accepted by physicians and embraced by the public -- have proven inappropriate, possibly dangerous and wasteful.

Acupuncture -- A Complementary Treatment in General Practice
Tidsskr Nor Laegeforen 2002 (May 10);   122 (9):   921–923

This review found that: Acupuncture is the complementary treatment most commonly used by general (medical) practitioners. UNFORTUNATELY: "78% had acupuncture courses of less than four weeks' duration" AND THE MAJOR COMPLAINT WAS "Lack of time was regarded as the major limitation to the use of acupuncture." YEAH...ESPECIALLY THE TIME THEY INVESTED IN LEARNING IT! UGH!

The Obstacles and Barriers to CAM Research
Anthony Rosner, PhD, Research Director of FCER

The efforts to launch and develop a National Center for Complementary and Alternative Medicine within the framework of the NIH are indeed admirable, taking the Center from a humble $2M annual budget in 1991 to one that approaches $70M today. This has taken place despite the comments of highly visible and influential individuals within the medical community to discredit alternative medicine in virtually any shape or form. Following are what I believe to be the most significant barriers to research efforts in alternative medicine, the barriers having either remained in place or only recently having been removed.

Debunking the Placebo Effect
Any beneficial effect derived from natural remedies such as vitamins, minerals and herbs is often discounted as being nothing more than the consumer's belief that they will work. With an air of authority, skeptics claim that natural medicine is quackery, effective only because of the placebo effect. In 1955, Henry K. Beecher, M.D., was the first to report on the so-called placebo effect. Beecher claimed that about 35 percent of the time, patients who took a pill containing no active ingredients experienced an improvement in their condition.

In 1997, researchers at the Institute for Applied Theory and Methodologies in Health Care, in Frieburg, Germany, decided to look into Beecher's theory. Reporting in the Journal of Clinical Epidemiology, they scrutinized the 15 different clinical studies cited by Beecher. Here is what they found.

Prince Charles Calls for Research Into Alternative Medicine
The Times – Dec 30, 2000 ––   The Prince of Wales is calling for millions of pounds to be spent on researching alternative medicines, which could lead to their widespread availability on the NHS. He said current funding levels were "pitiful", and called for a national strategy for investigating the clinical effects of complementary treatments.

“Alternative and Complementary Medicine”
Marc Micozzi, M.D., Ph.D. – An interview with Daniel Redwood ~ FULL TEXT

Dr. Micozzi was the founding editor of the Journal of Alternative and Complementary Medicine and now serves on the editorial board of Alternative Therapies in Health and Medicine. He edited the landmark 1996 textbook, Fundamentals of Complementary and Alternative Medicine, and is the series editor for a forth coming group of textbooks on various aspects of alternative medicine.

What Role for Chiropractic in Health Care?
New England Journal of Medicine 1998 (Oct 8);   339(15)

On September 18, 1895, Daniel David Palmer manipulated the spine of Harvey Lilliard, allegedly restoring Mr. Lilliard's sense of hearing and founding the practice of chiropractic.1 From this beginning, despite decades of persecution from government and organized medicine, chiropractors have become the third largest group of health professionals in the United States (after physicians and dentists) who have primary contact with patients. Chiropractors are licensed to practice in all 50 states.

A Comparative Study of Chiropractic and Medical Education
Altern Ther Health Med 1998 (Sep);   4 (5):   64–75

Considerable commonality exists between chiropractic and medical programs. Regarding the basic sciences, these programs are more similar than dissimilar, both in the types of subjects offered and in the time allotted to each subject. The programs also share some common areas in the clinical sciences. Chiropractic and allopathic medicine differ the greatest in clinical practice, which in medical school far exceeds that in chiropractic school. The therapies that chiropractic and medical students learn are distinct from one another, and the settings in which students receive clinical training are different and isolated from one another. With these similarities and differences established, future studies should examine the quality of the 2 educational programs in detail.

Chiropractic: An Alternative Healing Art Enters The Mainstream
The movie Lorenzo's Oil offers a powerful illustration of the forces that have propelled the alternative health movement since its inception. In the movie, young Lorenzo's parents, faced with a severely ill child whose disease has no known medical cure, move heaven and earth (and a reluctant medical establishment) to save his life. Against all odds, they succeed. The intensity of their refusal to accept things as they are, and the way they demand of both themselves and others a willingness to explore unorthodox alternative healing methods, are precisely the factors that have enabled chiropractic and other natural healing arts to survive and even thrive in the face of determined opposition from organized medicine.

Understanding Alternative Health Care
J Neuromusculoskeletal System 1998;   6 (3):   95–99 ~ FULL TEXT

It is first useful to ask in what sense AHC is alternative. Alternative to what? It is not necessarily alternative to medicine. Some of the most prominent advocates/theorists of the alternative health care movement are medical physicians, and there are many instances of alternative therapies being used by medical physicians in medical settings. What does set AHC apart are the metaphysical belief systems upon which most are predicated. Most systems propose novel physical or biological laws, or the existence of as yet undiscovered forces: chiropractic has its innate Intelligence and subluxations, acupuncture has its meridians and chi, and homeopathy has its laws of infinitesimals and similars. Alternative status derives principally from these beliefs and the means by which they are conceived and examined alternative, therefore, to the conventions of the scientific method, and to the orthodox understanding of the nature of health and disease.

Physicians' Attitudes Toward Complementary or Alternative Medicine: A Regional Survey
J Am Board Fam Pract 1995 (Sep);   8 (5):   361–366

More than 70 to 90 percent of the physicians considered complementary medical therapies, such as diet and exercise, behavioral medicine, counseling and psychotherapy, and hypnotherapy, to be legitimate medical practices. A majority had referred patients to nonphysicians for these therapies or used some of them in their own practices. Homeopathy, Native American medicine, and traditional Oriental medicine were not favored as legitimate medical practice.

Use of Unconventional Therapies by Individuals with Multiple Sclerosis
Clin Rehabil 2003 Mar;   17 (2):   181–191

More than half of the responding sample (57.1%) had used at least one CAM modality. The longer that people had MS and the less satisfied they were with conventional health care the more likely they were to use CAM therapies. The most common reasons for using CAMs were the desire to use holistic health care (i.e., treatments that recognized the interrelatedness of mind, body and spirit) and dissatisfaction with conventional medicine. Ingested herbs were the most frequently used CAM modalities (26.6%), followed by chiropractic manipulation (25.5%), massage (23.3%) and acupuncture (19.9%).

Alternative Medicine in Canada: Use and Public Attitudes
The Fraser Institute 1999 (Mar);   Vancouver, BC

The majority of Canadians have used some form of alternative medicine. They are spending a large amount of their own money on these therapies, most of which are only partially covered by provincial health insurance plans.

Ethical Considerations of Complementary and Alternative Medical Therapies in Conventional Medical Settings
Ann Intern Med 2002 (Oct 15);   137 (8):   660–664   ~ FULL TEXT

Increasing use of complementary and alternative medical (CAM) therapies by patients, health care providers, and institutions has made it imperative that physicians consider their ethical obligations when recommending, tolerating, or proscribing these therapies. The authors present a risk-benefit framework that can be applied to determine the appropriateness of using CAM therapies in various clinical scenarios. The major relevant issues are the severity and acuteness of illness; the curability of the illness by conventional forms of treatment; the degree of invasiveness, associated toxicities, and side effects of the conventional treatment; the availability and quality of evidence of utility and safety of the desired CAM treatment; the level of understanding of risks and benefits of the CAM treatment combined with the patient's knowing and voluntary acceptance of those risks; and the patient's persistence of intention to use CAM therapies.

Cross-cultural Differences in GPs' Attitudes Towards Complementary and Alternative Medicine: A Survey Comparing Regions of the UK and Germany
Complement Ther Med 2002 (Sep);   10 (3):   141–147 ~ FULL TEXT

There are small national differences in referring patients to various CAM modalities. Both nations have an overall positive attitude toward and a high interest in CAM. Lack of scientific evidence and information on training opportunities were important points that were continuously raised by GPs in both countries.

Confronting the Communication Gap Between Conventional and Alternative Medicine: A Survey of Physicians' Attitudes
Altern Ther Health Med 1999 (Mar);   5 (2):   61–66

Data were obtained on the following: (1) physicians' level of familiarity with 23 different alternative therapies, (2) the question of whether physicians used the therapies themselves, (3) physicians' assessment of the potential benefits and harm of each therapy, and (4) physicians' response to the prospect of their patients using these therapies.

NCCAM Welcomes Six New Members To Advisory Council
August 23, 2002   The National Center for Complementary and Alternative Medicine (NCCAM) welcomes six new members to its National Advisory Council on Complementary and Alternative Medicine. The new members include a chiropractor, the physicist that invented PET scanning, an osteopath, an acupuncturist, a pharmacologist and a psychoneuroimmunologist.

A Regional Survey of Health Insurance Coverage for Complementary and Alternative Medicine: Current Status and Future Ramifications
J Altern Complement Med 2001 (Jun);   7 (3);   269–273   ~ FULL TEXT

This Adobe Acrobat FULL TEXT article (85KB) found: Current health insurance coverage of CAM is limited essentially to chiropractic medicine, acupuncture and massage therapy. Coverage of CAM is made confusing by different policies, practitioner requirements, and health plans within each carrier.

Assessing Efficacy of Complementary Medicine: Adding Qualitative Research Methods to the "Gold Standard"
J Altern Complement Med 2002 (Jun);   8 (3):   275–281

Randomized controlled trials (RCTs) have an important place in the assessment of the efficacy of complementary and alternative medicine (CAM). However, they address only one, limited, question, namely whether an intervention has-statistically-an effect. They do not address why the intervention works, how participants are experiencing the intervention, and/or how they give meaning to these experiences.

Are Physicians Aware of the Risks of Alternative Medicine?
Journal of Community Health 2001 (Jun);   26 (3):   159–174

Evidence supports the fact that alternative medical therapies play an increasingly prominent role in healthcare. Relevantly, this study posed three questions: (1) Do physicians ask their patients about their use of herbs/dietary supplements? (2) Do physicians use the available resources to evaluate the possible drug interactions and/or side effects of the dietary supplements? and (3) Are physicians aware of the side effects, drug interactions and contraindications of ten commonly used herbs?

Eat Right and Take a Multivitamin
New England Journal of Medicine 1998 (Apr 9);   338 (15):  1060–1061 ~ FULL TEXT

Since the mid– 1970s, 25 percent of American adults have regularly consumed a multivitamin containing 400 µg of folic acid. The current evidence suggests that people who take such supplements and their children are healthier. This evidence raises the question ofwhether physicians and other health care professionals should recommend that all adults take a multivitamin daily.

Use of Alternative Therapies for Menopause Symptoms: Results of a Population-based Survey
Obstet Gynecol 2002 (Jul);   100 (1):   18–25

The proportion of women who used each therapy was 76.1% for any therapy, 43.1% for stress management, 37.0% for over-the-counter alternative remedies, 31.6% for chiropractic, 29.5% for massage therapy, 22.9% for dietary soy, 10.4% for acupuncture, 9.4% for naturopath or homeopath, and 4.6% for herbalists.

Which Complementary and Alternative Therapies Benefit Which Conditions? A survey of the Opinions of 223 Professional Organizations
Complement Ther Med 2001 (sep);   9 (3):   178–185

The recommendations by CAM organizations responding to this survey may provide guidance to health care professionals wishing to advise or refer patients interested in using CAM.

Attitudes to and Use of Complementary Medicine Among Physicians in the United Kingdom
Complement Ther Med 2001 (Sep);   9 (3):   167–172

CAM is used by physicians more frequently in private as compared to NHS practice. Acupuncture, aromatherapy and manipulative medicine (osteopathy and chiropractic) are the most commonly referred to and the most commonly practised therapies. Eighty seven percent of those using CAM themselves, or as part of their clinical team's commitment, had not had any CAM training. Attitudes to CAM were generally positive, particularly among those in palliative care, rehabilitation, nuclear medicine, and genito-urinary medicine.

Alternative Medicine and General Practitioners:
Opinions and Behaviour

Can Fam Physician 1995 (Jun);   41:   1005–1011

Acupuncture, chiropractic, and hypnosis were considered most useful and reflexology, naturopathy, and homeopathy least useful. Results showed 56% of general practitioners believed that alternative medicine has ideas and methods from which conventional medicine could benefit, 54% referred to alternative practitioners, and 16% practised some form of alternative medicine.

Complementary and Alternative Medicine:
Canadian Physiatrists' Attitudes and Behavior

Arch Phys Med Rehabil 2000 (May);   81 (5):   662–667

The therapies rated highest in usefulness were acupuncture (85%), biofeedback (81%), and chiropractic (80%). Sixty-three percent believed that alternative medicine had ideas and methods that would be of benefit to physiatrists. Only 9% believed it to be a threat to public health.

Complementary Therapy Use by Nursing, Pharmacy and Biomedical Science Students
Nurs Health Sci 2001 (Mar);   3 (1):   19–27

Overall, 78% of students had used a complementary therapy in the past year and 56% had visited a complementary therapy practitioner. The results suggest that these students have favorable attitudes towards complementary therapies and that many choose to use them as part of normal health care.

Surveys of Complementary and Alternative Medicine: Part I. General Trends and Demographic Groups
J Altern Complement Med 2001 (Apr);   7 (2):   195–208

There is now a substantial body of literature on various facets of CAM use. Six national surveys to date are briefly discussed and summarized in a table. Some surveys have been conducted at a regional level.

Who Seeks Alternative Health Care?
A Profile of the Users of Five Modes of Treatment

J Altern Complement Med 1997 Summer;   3 (2):   127–140

This article compares the social and health characteristics of patients of five kinds of practitioners: family physicians (used as a baseline group); chiropractors; acupuncturist/traditional Chinese medicine doctors; naturopaths; and Reiki practitioners. The data were gathered in a large Canadian city during the period 1994 to 1995.

Current Trends in the Integration and Reimbursement of Complementary and Alternative Medicine by Managed Care, Insurance Carriers, and Hospital Providers
Am J Health Promot 1997 (Nov);   12 (2):   112–122

Consumer demand for CAM is motivating more insurers and hospitals to assess the benefits of incorporating CAM. Outcomes studies for both allopathic and CAM therapies are needed to help create a health care system based upon treatments that work, whether they are mainstream, complementary, or alternative.

Nurses' Perceptions of Complementary and Alternative Medical Therapies
Journal of Community Health 2001 (Jun);   26 (3):   175–189

The purpose of this study was to identify the perceptions of nurses toward the effectiveness and safety, as well as their recommendations for and personal use of complementary and alternative medical therapies. A random sample of 1000 nurses throughout the United States were surveyed. You may also enjoy the sidebar article Nurses and CAM: Chiropractic Gets High Marks for Safety and Effectiveness.+

Use of Alternative Therapies: Estimates From the 1994 Robert Wood Johnson Foundation National Access to Care Survey
J Pain Symptom Manage 1997 (Feb);   13 (2):   83–89

The results indicate that nearly 10% of the U.S. population, almost 25 million persons, saw a professional in 1994 for at least one of the following four therapies: chiropractic, relaxation techniques, therapeutic massage, or acupuncture.

NCCAM and the Royal College of Physicians Meet in London ~ FULL TEXT
On January 23–24, 2001, NCCAM and the Royal College of Physicians (RCP) cosponsored an extraordinary conference in London, England, “Can Alternative Medicine Be Integrated into Mainstream Care?” You may also enjoy reviewing the FULL TEXT of the House of Lords Report on CAM

Harvard Receives $10 Million Donation to Study Alternative Medicine
Harvard Medical School has been named the recipient of a $10 million gift from the Bernard Osher Foundation. The gift will be used to support the school's Division for Research and Education in Complementary and Integrative Medical Therapies, and to establish a new institute that will examine the safety, efficacy, and cost-effectiveness of alternative forms of care.

Alternative Medicine - Learning From the Past, Examining the Present, Advancing to the Future
JAMA 1998 (Nov 11); 280 (18) Editorial: 1616–1618 ~ FULL TEXT

Medical practices outside the mainstream of “official” medicine have always been an important part of the public's health care. Healers and herbalists, bonesetters and barbers, shamans and spiritualists have offered the public a multiplicity of ways to address the confusion and suffering that accompany disease.

Alternative Medicine and the Conventional Practitioner
Wayne Jonas, MD, Director, Office of Alternative Medicine, NIH
JAMA 1998 (Mar 4);   279 (9):   708–709 ~ FULL TEXT

Complementary and alternative medicine (CAM) represents that subset of practices that are not an integral part of the dominant health care system in the United States but are still used by patients to supplement their health care.[1] Surveys have operationally defined CAM as those practices used for the prevention and treatment of disease that are not taught widely in medical schools nor generally available in hospitals.[2]

Alternative Medicine Meets Science
JAMA 1998 (Nov 11); 280 (18) Editorial: 1618–1619 ~ FULL TEXT

There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking. Whether a therapeutic practice is “Eastern” or “Western,” is unconventional or mainstream, or involves mind-body techniques or molecular genetics is largely irrelevant except for historical purposes and cultural interest. We recognize that there are vastly different types of practitioners and proponents of the various forms of alternative medicine and conventional medicine, and that there are vast differences in the skills, capabilities, and beliefs of individuals within them and the nature of their actual practices.

Director of Center for Mind-Body Medicine to Chair White House Commission on Complementary and Alternative Medicine Policy:   Alternative Medical Techniques Will Reshape Health care in the 21st Century
WASHINGTON, July 13 /PRNewswire/ --
President Clinton today announced the appointment of Dr. James Gordon, Director of the Center for Mind-Body Medicine, as Chairman of the White House Commission on Complementary and Alternative Medicine (CAM)Policy. The Commission will be providing a report to the President on legislative and administrative initiatives, in order to maximize CAM healthcare to all Americans. Dr. Gordon will be the Chair of the Commission, which is composed of 19 others from the conventional medical and CAM communities.

“Conventional” and “Unconventional” Medicine:
Can They Be Integrated?

Archives of Internal Medicine 1998 (Nov 9); 158 (20):   2215–2224   ~ FULL TEXT

THIS ISSUE of the ARCHIVES, as well as the 8 other specialty journals and JAMA, is dedicated to complementary, alternative, and integrated medicine. Complementary and alternative medicine are also termed unconventional medical therapy, which Eisenberg et al1 have defined as "medical interventions that are not taught extensively at US medical schools or generally provided at US hospitals." Conventional medicine can then be defined as medical interventions that are taught extensively at US medical schools and generally provided at US hospitals.

Astounding Increases in Alternative Care, Reveals New Eisenberg Study
Dynamic Chiropractic January 1, 1999

The results of a 1991 telephone survey by David Eisenberg, MD, woke up the health care community. Thirty-six percent of the respondents said they'd been to an alternative provider in 1990, a far higher use of unconventional therapies than had been previously reported.1 Expenditures for alternative therapies in 1990 was $13.7 billion, $10.3 of which was paid out-of-pocket. These figures were all the more astounding, because the out-of-pocket expenditures for 1990 for hospitalizations in the U.S. were $12.8 billion.

Dr. Eisenberg Addresses “Implications of Alternative Medicine”
Dynamic Chiropractic November 3, 1997

In beginning his talk, Dr. Eisenberg asked for a show of hands from the group of 700–800 doctors and clinicians with the question, "How many of you, or a close friend or family member, have used chiropractic or acupuncture in the last year?" About 80 percent of the audience raised their hands.

Palmer's Research Director Represents Chiropractic at Alternative Care Meetings
William Meeker, DC, MPH, director of research, Palmer Center for Chiropractic Research, was invited to speak at two meetings in Boston, Mass., focusing on complementary and alternative medicine (CAM). The meetings were sponsored by the Harvard Medical School teaching hospital, Beth Israel Deaconess Medical Center and the National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health.

2020 Vision:   NIH Heads Foresee the Future
JAMA 1999 (Dec 22); 282 (24):   2287–2290

As a result of rigorous scientific investigation, several therapeutic and preventive modalities currently deemed elements of complementary and alternative medicine will have proven effective. Therefore, by 2020, these interventions will have been incorporated into conventional medical education and practice, and the term "complementary and alternative medicine" will be superseded by the concept of "integrative medicine."

Is Integrative Medicine the Medicine of the Future? A Debate Between Arnold S. Relman, MD, and Andrew Weil, MD
The Scientist 1999 (May 10):   13 (10):   1 ~ FULL TEXT

Integrative medicine, the combining of alternative and conventional medical methods, was the subject of a debate held recently at the University of Arizona (UA) College of Medicine. The opponents were Arnold S. Relman, editor-in-chief emeritus of the New England Journal of Medicine and professor emeritus of medicine and social medicine at Harvard Medical School, and Andrew Weil, director of the UA program in integrative medicine and best-selling author of eight books that have made the Harvard-educated physician a leading advocate of integrative medicine. Last December, an article by Relman appeared in The New Republic that sharply attacked Weil's writings.1 Their subsequent debate consisted of opening remarks, rebuttals, questions, and closing remarks that have been edited in the following text. Sentences and paragraphs have been deleted or transposed where appropriate.

An Apple a Day...Why More and More People Are Turning to 'Alternative' Medicine
Scientific American 1999;   March 15

In a recent EXPLORE! feature, Unhealthy Options, we examined the controversy over what is known as alternative medicine--treatments such as chiropractic manipulation, acupuncture, homeopathy, megavitamins, herbal therapy and others. A rush of studies to determine if these treatments are indeed effective or merely hype has produced mixed results--some work, some of the time--and yet that hasn't dampened their popularity.

Alternative Medicine:   An MD's view
Medical Computing Today August 1997

Whether yesterday's fad or tomorrow's paradigm, alternative medical therapies such as acupuncture, chiropractic, homeopathy and herbal medicine are part of today's American health care. First, the number of devotees is staggering; David Eisenberg, MD, noted in his landmark 1993 article (1) that an estimated 60 million Americans tried at least one of several alternative medical therapies-and more than 70 percent of them never told their physician they had or were doing so. This full article is no longer available online.

1999 The Landmark Report II:   HMOs and Alternative Care
Undeniably, the demand for alternative care among health care consumers is growing, as evidenced by several recent studies on the use of alternative medicine among the general public. Todate, however, there has been little published information about the perceptions of a key link in the future of alternative care – the HMOs which lie at the center of the managed care system in the United States.

1998 The Landmark Report I:   Public Perceptions of Alternative Care
Selected Findings of U.S. Adults on Their Attitudes, Perceptions, and Behavior With Respect to Alternative Care.

Alternative Health Care:
Its Use by Individuals With Physical Disabilities

Arch Phys Med Rehabil 1998 (Nov);   79 (11):   1440–1447

Physically disabled individuals are more likely to use alternative therapies than the general population and to see providers for them, have their use recommended by their physicians, and be reimbursed by their health insurance for them. A high prevalence of dysphoria is found among those with disabilities, for which a combination of alternative and conventional therapies is often used.

Why Unconventional Medicine?
New England Journal of Medicine 1993 (Jan 28);   328 (4):   282–283

The careful national survey reported by Eisenberg et al. in this issue of the Journal1 tells us that in a given year about a third of all American adults use unconventional medical treatments, such as relaxation techniques, chiropractic, therapeutic massage, special diets, and megavitamins. Unconventional techniques are most often used for back problems, headache, arthritis, musculoskeletal pain, insomnia, depression, and anxiety.

A Walk on the Wild Side of Allopathic Medicine:
Going Ballistic Instead of Holistic

Anthony Rosner,PhD   (Director of the FCER)

The New England Journal of Medicine publishes a study by Balon, Aker et al., that concludes: "The addition of chiropractic spinal manipulation to usual medical care for four months had no effect on the control of childhood asthma." This statement is based upon the failure of active intervention and manipulation patient groups in a clinical trial to be differentiated in both measurements of quality of life (including nighttime symptoms) and airway function. (1) However, the same authors had already concluded 17 months earlier (2) that with nighttime symptoms there was a significant difference between the same two patient groups at the highly robust null probability level of p<0.001. This discrepancy was not mentioned by the authors in their NEJM paper.

Complementary Therapies:
Have they become accepted in General Practice?

Medical Journal of Australia 2000;   172:  105–109

There is evidence in Australia of widespread acceptance of acupuncture, meditation, hypnosis and chiropractic by GPs and lesser acceptance of the other therapies. These findings generate an urgent need for evidence of these therapies'effectiveness.

Alternative and Complementary Medicine in Canadian Medical Schools:
A Survey

CMAJ 1999;   160:   816–7 ~ FULL TEXT

In spring 1998 we undertook a survey of all 16 Canadian medical schools to determine what education is being provided in the area of complementary and alternative medicine in the undergraduate medical curriculum.

Complementary and Alternative Medicine:
An Educational, Attitudinal and Research Challenge

Medical Journal of Australia 2000;   172:   102–103

CAM is difficult to define. The British Medical Association (BMA) has suggested that it encompasses treatments not taught as part of the medical undergraduate curriculum.4 The major CAM treatments are usually considered to be acupuncture, homoeopathy, herbal medicine, manipulative medicine (osteopathy and chiropractic) and nutritional medicine, although this is based on patient and practitioner use rather than on definitive evidence.5 Further, the use of CAM treatments varies regionally. For example, while homoeopathy is particularly popular among general practitioners in the United Kingdom and Holland,6,7 acupuncture seems to be the CAM treatment of choice in Australia.8 This is not necessarily related to evidence of efficacy, but correlates with a number of historical and cultural factors, including, in Australia, the enthusiasm of a small number of medically qualified acupuncturists in the late 1970s and early 1980s, which led to the reimbursement of acupuncture through Medicare.

The Physician's Role in Health Promotion Revisited –– A Survey of Primary Care Practitioner
New England Journal of Medicine 1996 (Apr 11);   334 (15):   996–998

In 1981, a study of the role of primary care physicians concluded that there was a lack of consensus about many of the surgeon general's recommendations for health promotion and that most primary care physicians felt unprepared for this role and unable to change patients' behavior. Since physicians are in a unique position to influence the behavior of patients, attaining national goals for health promotion requires their enthusiastic agreement and active participation. We sought to examine the extent to which primary care physicians practicing in Massachusetts in 1994 agreed with the recommendations of the surgeon general for the year 2000 and the extent to which they considered themselves prepared and able to change patients' health-related behavior. We compared the responses of the 1981 and 1994 samples in order to assess the extent to which the responses of today's primary care practitioners differed from those of their counterparts 13 years earlier.

How to Use Alternative and Complementary Medicine
A WebMD article

More and more patients are finding that alternative medicine has a great deal to offer, especially for treating chronic conditions with which Western Medicine has little success. The vast majority of patients, however, do not see conventional and unconventional therapies as an either/or proposition. Rather, they seek to make informed, personal choices about how to integrate both. For this reason, "complementary" or "integrative" medicine have become the favored designations for this emerging field.

Coverage for Alternative Treatments Rises, and Trend Has Yet to Peak
CNN (Cable News Network)   November 23, 1999
Managed care organizations and health insurance companies are becoming more open-minded about covering alternative treatments. Fueling the trend: consumer demand, a growing body of evidence that some of the treatments work and, much less often, government mandates. In Washington state, a law that requires insurance carriers to cover various categories of providers is back in effect after legal wrangling with the insurance industry. Earlier this year, the U.S. Supreme Court decided not to hear the case.

The Alternative Medicine Handbook: The Complete Reference Guide to Alternative and Complementary Therapies
New England Journal of Medicine 1998;   Sept 17 339 (1–2)

Unconventional medical care was once thought to be the exclusive domain of the charlatan and the gullible minority. Currently referred to as complementary and alternative medicine by its proponents, its influence has now spread from the tabloid headlines and talk shows to the examining rooms of even the most sophisticated urban medical centers. The movement is driven by twin engines: aggressive marketing by "health-oriented" companies and the demands of patients who are aware of the accomplishments of science and who seek cures for every health problem.

Complementary Care:   When Is It Appropriate?   Who Will Provide It?
Annals of Internal Medicine (AIM), 1998;  (July 1) 129:  65–66 ~ FULL TEXT

The Agency for Health Care Policy and Research (AHCPR) recently made history when it concluded that spinal manipulative therapy is the most effective and cost-effective treatment for acute low back pain [1]. The 1994 guidelines for acute low back pain developed by AHCPR concluded that spinal manipulation hastens recovery from acute low back pain and recommended that this therapy be used in combination with or as an alternative to nonsteroidial anti-inflammatory drugs [1]. At the same time, AHCPR concluded that various traditional methods, such as bed rest, traction, and other physical and pharmaceutical therapies were less effective than spinal manipulation and cautioned against lumbar surgery except in the most severe cases. Perhaps most significantly, the guidelines state that unlike nonsurgical interventions, spinal manipulation offers both pain relief and functional improvement. One might conclude that for acute low back pain not caused by fracture, tumor, infection, or the cauda equina syndrome, spinal manipulation is the treatment of choice.

Weighing the Alternatives:
Lessons from the Paradoxes of Alternative Medicine

Annals of Internal Medicine 1998;  (Dec 15)   129:   1068–1070 ~ FULL TEXT

Many conventional practitioners have responded to the emergence of alternative medicine by acquiring a new understanding of practices that they had previously considered to be "on the fringe" [5]. Others have incorporated "alternative" concepts and practices directly into their own daily patient care. Medical schools have opened their curricula to this previously forbidden area [6]; books, journals, and courses on the topic proliferate. But despite all this casting about, the simple fact that our patients are turning to alternative medicine remains baffling and disturbing, if only because it tells us that they need something that our much-vaunted scientific health-care system currently doesn't provide. Our distress echoes the feelings of parents whose children reject their advice and values: How can it be that alternative practices, shrouded in mystery, grow and flourish, while a century and half of effort by scientific medicine to demystify disease and its treatment-our spectacular success in defining pathophysiology, standardizing tests and treatments, and purifying drugs-is seen as inadequate, even dangerous? Where did we go wrong?

The Persuasive Appeal of Alternative Medicine
Annals of Internal Medicine 1998;  (Dec 15)   129:   1061–1065   ~ FULL TEXT

Alternative medicine has a major presence and persuasive attraction in the industrialized western world.The extent to which these practices have clinical efficacy according to biomedical criteria is a matter of ongoing research and debate. It may be that independent of any such efficacy, the attraction of alternative medicine is related to the power of its underlying shared beliefs and cultural assumptions.

U.S. Drug Safety Monitoring Must Be Expanded
JAMA 1998 (May 20);   279 (19):   1571–1573

Thomas J. Moore of the Center for Health Policy Research at George Washington University Medical Center in Washington, D.C., and colleagues, note that an estimated 1.5 million people require hospitalization and 100,000 die each year because of injuries linked to prescription drugs.

Is Integrative Medicine the Future? Relman-Weil Debate Focuses on Scientific Evidence Issues
The Scientist 1999 (May 10):   13 (10):   1

Relman's comments all sound so scientific and reasonable! I love this guy! The truth is that "science-based medicine" has rarely held itself up to the same scrutiny they routinely demand of alternative approaches. Less than 15% of medical procedures have ever been tested within a randomized clinical trial! The retired editor of NEJM demonstrates the hypocrisy of modern medicine, and makes it even clearer why the public is choosing alternative approaches. Enjoy this heavily edited debate.


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