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Alternative medicine

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Alternative Medicine (for etymological meaning see: [1]) refers to methods and treatments that are not used by science based medicine (or evidence based medicine, EBM). Alternative treatments almost always fall into the realm of pseudomedicine. Especially it's supporters use also terms like complementary medicine, experience based medicine and integrative medicine. Complementary and alternative medicine are often called CAM. Richard Dawkins has 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, 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 that 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 ("alternative") or together ("complementary") with conventional, established therapy.[6] A treatment is considered established, when it's clinical efficacy has been demonstrated in prospective, randomized trials or a biological rationale establishes the treatment as reasonable. An Anglo-Australian group of researchers demonstrated with a computional model in 2009 that for some odd reason the methods which have 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]

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

Appeal

For the popularity of offers outside of science-based medicine a variety of factors were identified. A study from 1998 listed the following factors: More education, poorer health status, a holistic orientation to health, having had a transformational experience that changed the person's worldview, any of the following health problems: anxiety; back problems; chronic pain; urinary tract problems, and classification in a cultural group identifiable by their commitment to environmentalism, commitment to feminism, and interest in spirituality and personal growth psychology. Dissatisfaction with conventional medicine did not predict use of alternative medicine. Only 4.4% of those surveyed reported relying primarily on alternative therapies. The study concluded, that people find these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life.[12]

In addition, arguments like "healing practitioners commit more time to patients than doctors" are frequently heard. Disappointments and distrust for conventional therapies play a role. Many patients and customers find pleasure in the more or less explicit criticism of mainstream medicine" or "the pharmaceutical industry" which is not uncommon in alternative medicine circles. When people become sick, any promise of a cure is beguiling.[13] 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. Edzard Ernst showed in a study that this notion is wrong and side effects may indeed occur.[14]

In an interview with "The Independent" Ernst blames the providers, customers 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."[15]

Business in Germany

The number of CAM providers is rising in Germany. From 1993 to 2000 the number of healing practitioners rose as the most important non-medical CAM-profession by  90% (from 11/100.000 to 21/100.000 persons). The CAM-offerings of doctors rose in the same period by 125% (from 19/100.000 to 43/100.000).[16]

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).[17] Five billion Euros are paid by the patients themselves. Four billions are refunded by insurance companies. 40.000 doctors offer respective treatments.[18] Another estimate estimates that the total turnover is about 20% of the whole Spa industry in Germany which has an annual volume of 50 billion Euro, and would therefore be about 10 billion Euros per year.[19] The worldwide turnover is estimated at 60 billion U.S. dollar.[20] According to figures by the economic research company "Global Insight" the annual turnover of the spa industry is now estimated at about 73 billion Euros.

Business in USA

A 2008 survey of US hospitals by Health Forum, a subsidiary of the American Hospital Association, found that more than 37 percent of responding hospitals indicated they offer one or more alternative medicine therapies, up from 26.5 percent in 2005. More than 70% of the hospitals offering CAM were in urban areas.[21]

Sales figures for alternative and complementary medicine in United States are also known. The National Health Statistic Report states in an article from July 30, 2009 for 2007[22] that U.S- patients have spent 33.9 billion dollar for CAM services and products. Homoeopathy accounted for 3 billions, Qigong for 4 billions. Expenditure for food supplements like vitamins and minerals are not included in this sum.[23] In 1997 between 36 and 47  billion U.S. dollars were spent on complementary medicine. Of these, 12 to 20 billion USD were paid out of the one's own pocket for complementary therapists.[24] This is half of the sum spent out of pocket for medical services. According to a further source 27 billion dollars were spent in 2002 for complementary and alternative medical treatments by the consumers.[25] According to a study by author McGinnis four times as much money was spent in USA in 1987 on complementary medicine than for all cancer research.[26] 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. The National Center for Complementary and Alternative Medicine in USA has an annual budget of 122 million dollars, financed by the state.

Research

Funding for research in the field of alternative medicine comes usually from private foundations in Germany, 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. dollar.[27]

Currently (2010), the "National Center for Complementary and Alternative Medicine" (NCCAM) and the "Office of Cancer Complementary and Alternative Medicine" (OCCAM) spend together 240 million U.S. dollar of taxpayers money from the NIH (National Institute of Health).[28]

The typical patient

The typical patient or customer can be characterized by the following attributes:

  • young (30-50 years)[29]
  • higher education
  • tends to be politically "left" or "green"[30]
  • relatively high income
  • female

Criticism

Users of alternative medical methods refer in the question of effectiveness often only to their own experiences, which are based on a selective perception of the past. Such retrospective observations are not evident by nature. The occasional argument, Who heals is right is not sensible because causality and correlation are often confused in anecdotal experiences 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 formulated "holistic approach" (usually associated with "of body, mind and soul") remains a pure promise within alternative medicine that would be difficult to implement because of time and financial constraints (see holistic after Issels).

Potential danger

Alternative medicine involves several dangers and risks[31][32][33]:

  • rejection of effective diagnostic and therapy in favor of pseudomedicine methods without proof of effectiveness leading to protraction of the illness or appearance of avoidable symptoms
  • misdiagnoses because of inadequate medical training of alternative medicine practitioners
  • deterioration of therapeutic prospects due to futile pseudomedical efforts
  • development of guilty feelings at failure, towards oneself or towards family members
  • psychological and financial abuse through the healing supply, which often shows sect-like structure
  • development of psychological dependency an addiction to the treatment
  • deaths and lasting damage due to inappropriate procedures

A study by the Royal Children's Hospital in Melbourne published in December 2010 investigated 39 cases where children were hurt due to alternative medical treatments. In 30 cases a correlation between damage to the patients and the use of alternative medical therapies or the denial of prescribed medicines could be found. Four of the children died because the parents refused medical treatment. An eight-month-old malnourished infant died of septic shock because he had been set on a diet of "naturopathic" rice milk because of an alleged obstruction since his third month of life. A 10-month-old baby died also of septic shock because he was set on a restrictive diet against chronic dermatitis. A further child died after multiple epileptic seizures after the parents hat stopped the anti-epileptic drug treatment for fear of side effects and treated it with an alternative medical remedy. A fourth child suffered fatal bleeding because the parents refused treatment with clotting factors in favour of a complimentary medical treatment[34][35]

Intimidation and actions against critics

Individuals or institutions that have a critical view of alternative medicine and indicate its pseudomedicinecharacter must expect personal attacks. Two women who asked critical questions at an event Helmut Pilhar about Germanic New Medicine in Frankfurt, Germany. were "accompanied home" by "bald gentlemen". The two women had to call police. A cellular therapist tried to stop a critic with a court order and from giving his assessment of cellular therapy.[36] A further example are civil actions against the 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 on the scene and have ten natural healers give them a diagnosis. Stern offered generous payment for the report and requested a second part that should present victims of alternative methods by name. To prove that the journalists had indeed visited natural healers a photographer was documenting it. Each attended healer imputed the subject with several diseases: A total of 38 different diseases and an myriad of ailments and allergies were diagnosed and more than 130 drugs prescribed. When the report "Wunderheiler und Krankbeter" (miracle healers and patient prayers) was published in Stern 49/1991, the raised criticism was met by outrage and massive protests by healing practitioners that the editors postponed and later cancelled the second part fearing the loss of readers. The rights were returned to the autors.[37]

In a TV-show of the German station ZDF on September 5, 2007 titled "Heilen mit dem Nichts?"(Healing with nothing?) the journalist Joachim Bublath reported about scientific findings on homoeopathy (including an analysis of the renowned journal The Lancet [4]) that questioned a possible effectiveness of this controversial method beyond placebos. This led to a call from advocates of homoeopathy to spam and ZDF shied away by deleting the websites citing the Lancet figures.[38][39]

Literature

(mostly 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
  • Singh Simon, Ernst Edzard, Trick or Treatment: The Undeniable Facts about Alternative Medicine, (2008) Random House
  • 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
  • Randi J.: Flim-Flam! Buffalo: Prometheus 1982, chapter 9 (The medical humbugs)
  • Siebert A.: Strafrechtliche Grenzen ärztlicher Therapiefreiheit. Berlin: Springer 1983
  • Stalker D., C. Glymour (eds.): Examining holistic medicine. Buffalo: Prometheus 1985
  • Ernst E.: The Desktop Guide to Complementary and Alternative Medicine. An evidence-based approach. Mosby, Harcourt Publishers Limited 2001
  • R. Barker Bausell: Snake Oil Science. The Truth about Complementary and Alternative Medicine, B&T, 2007
  • Weber Tobias: Christian Ullmanns „Fakten über die andere Medizin“. Skeptiker 19 (3/06) 103-106
  • Margaret Thaler Singer und Janja Lalich: (1996) "Crazy" Therapies - What are they? Do They Work? San Francisco: Jossey-Bass Publishers, 1996
  • Ernst E. How to get rich quickly with 'alternative' medicine Skeptical Inquirer 2009, Mar-Apr S. 57

See also: Helsana-Study

Weblinks

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).
  2. ↑ Dawkins, Richard (2003). A Devil's Chaplain. United States: Houghton Mifflin. p. 58. ISBN 978-0-618-33540-4.
  3. ↑ Storm!!!!!!!!, by Tim Minchin, April 8, 2011, accessed June, 4 2011
  4. ↑ Cosmo Learning: Alternative medicine, accessed June, 4 2011
  5. ↑ GWUP-Tagung in Wien, zweiter Tag: Homöopathie und der Mozart-Effekt, Florian Freistetter, ScienceBlogs, accessed June, 4 2011
  6. ↑ What Is Complementary and Alternative Medicine?, National Center for Complementary and Alternative Medicine NCCAM, accessed June 03, 2011
  7. ↑ Tanaka MM, Kendal JR, Laland KN (2009) From Traditional Medicine to Witchcraft: Why Medical Treatments Are Not Always Efficacious. PLoS ONE 4(4): e5192. doi:10.1371/journal.pone.0005192 [1]
  8. ↑ http://www.newscientist.com/article/dn17064-quack-remedies-spread-by-virtue-of-being-useless.html
  9. ↑ complementary medicine in the Skeptic Dictionary, accessed June, 4 2011
  10. ↑ http://www.uni-marburg.de/ivv/download/praesentationen/adhs081217trott page 10
  11. ↑ axiom. Dictionary.com. Dictionary.com Unabridged. Random House, Inc. http://dictionary.reference.com/browse/axiom (accessed: June 03, 2011).
  12. ↑ Astin JA (May 1998). "Why patients use alternative medicine: results of a national study". JAMA 279 (19): 1548–53.
  13. ↑ Beyerstein BL (March 2001). "Alternative medicine and common errors of reasoning". Academic Medicine 76 (3): 230–7.
  14. ↑ Complimentary Medicine, N. C. Abbot, A. R. White & E. Ernst, Nature 381, 361 (30 May 1996), doi:10.1038/381361a0
  15. ↑ Complementary therapies: The big con?, The Independent, April 22, 2008, accessed June 4, 2011
  16. ↑ Susanne Weinbrenner, MPH FG Management in health care, Technical University of Berlin Berlin
  17. ↑ Anja Achenbach: Millionenmarkt Naturheilkunde. In: Financial Times, January 21, 2009
  18. ↑ http://www.aerzteblatt.de/v4/archiv/artikel.asp?src=heft&id=57593 Deutsches Ärzteblatt 104, Issue 46, November 16, 2007
  19. ↑ Horst Klinkmann, Third National Conference for Health Economics (Rostock)
  20. ↑ Tanaka MM, Kendal JR, Laland KN (2009) From Traditional Medicine to Witchcraft: Why Medical Treatments Are Not Always Efficacious. PLoS ONE 4(4): e5192. doi:10.1371/journal.pone.0005192 [2]
  21. ↑ Latest Survey Shows More Hospitals Offering Complementary and Alternative Medicine Services, Press Release, American Hospital Association, accessed June 4, 2011
  22. ↑ Richard L. Nahin, Patricia M. Barnes, Barbara J. Stussman, Barbara Bloom. NHSR, Number 18 n July 30, 2009. Costs of Complementary and Alternative Medicine (CAM) and Frequency of Visits to CAM Practitioners: United States, 2007
  23. ↑ http://www.quackometer.net/blog/2009/07/what-would-34-billion-of-quack-money.html
  24. ↑ Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, Kessler RC. Trends in alternative medicine use in the United States, 1990–1997: results of a follow-up national survey. JAMA 1998;280:1569–75
  25. ↑ Curt G.A.: Introduction: Complementary and Alternative Medicine in Cancer Treatment. Sem Oncol 2002; 29: 529-530
  26. ↑ McGinnis L.S.: Alternative therapies, 1990. An overview. Cancer 1991; 67 (6 Suppl): 1788-1792
  27. ↑ http://content.usatoday.net/dist/custom/gci/InsidePage.aspx?cId=azcentral&sParam=30941257.story
  28. ↑ Salzberg S. Save taxpayer $$$: Eliminate alternative medicine research. Forbes.com, 18. Juni 2010 [3]
  29. ↑ Richardson MA, Ramirez T, Palmer JL (2000): Complementary/alternative medicine use in a comprehensive cancer center and the implications for oncology. J Clin Oncol 18: 2505-2514
  30. ↑ Lee MM, Lin SS, Wrensch MR (2000): Alternative therapies used by women with breast cancer in four ethnic populations. J Natl Cancer Inst 92: 42-47
  31. ↑ Markman M (2002): Safety issues in using complementary and alternative medicine. J Clin Oncol 20: 39-41
  32. ↑ http://sekten-info-nrw.de/index.php?option=com_content&task=view&id=59&Itemid=36
  33. ↑ http://www.eurekalert.org/pub_releases/2010-12/bmj-cmc122210.php (engl.)
  34. ↑ http://www.aerzteblatt.de/nachrichten/44039/Paediatrie--Tod-nach-Alternativmedizin.htm
  35. ↑ http://adc.bmj.com/content/early/2010/11/24/adc.2010.183152.short?q=w_adc_ahead_tab
  36. ↑ LG Stuttgart AZ 17 0 289/76 Claims 500,000 German Mark
  37. ↑ http://kritischgedacht.wordpress.com/2007/12/25/sanfte-alternative/
  38. ↑ http://www.promed-ev.de/modules/news/article.php?storyid=110
  39. ↑ http://docs.google.com/gview?a=v&q=cache%3AyI15cEvKzLYJ%3Awww.bdhn-ev.de%2Fuploads%2Fmedia%2FDie_modernen_Wunderheiler.pdf+%22Die+modernen+Wunderheiler%22+Aufruf&hl=de&gl=de&sig=AFQjCNEeIW2yCgFsl__3f69O5E8oV-HJCQ&pli=1
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