E-drug: Summary of Alternative Medicine
---------------------------------------------
With Apologies for Cross Posting
Dear Members:
First, Thank so much for the "avalanche" of answers to issue. I'll
try to do a summary of your answers.
1.- J�r�me Dumoulin wrote "A simple definition of alternative medicine is
medicine tools and technologies of which are not "evidence based"
according present rules of scientific evidence. This definition is
broad, may be too much, but simple to use. I used it successfully to
analyse drug expendures in France." jerome.dumoulin@upmf-grenoble.fr
2.- Reinhard Wentz wrote "I doubt whether there is an 'official' or
'authoritative' definition of complementary or alternative medicine (?by
definition, there can't be??), but the MeSH definition may be a reasonable
start".r.wentz@ich.ucl.ac.uk
3.- William D. Grant wrote "try the following it is the site of the US
National Insitutute of Medicine Complementary and Alternative Medicine
Institute
http://nccam.nih.gov/" grantw@mailbox.hscsyr.edu
4.- Judith Deutsch (deutsch@UMDNJ.EDU) wrote "There are several
definitions of alternative and complementary therapies I have listed
a few below). You may want to visit the NCCAM web page as a starting
point.
http://altmed.od.nih.gov/nccam/
I like the WHO definition:
Complementary and alternative medicine (CAM) covers a broad range of
healing philosophies, approaches, and therapies. It generally is
defined as those treatments and health care practices not taught
widely in medical schools, not generally used in hospitals, and not
usually reimbursed by medical insurance companies.� (NCCAM, 1999)
underlying model of action is different from standard Western
Scientific understanding (Shifflet, 1998) usually lies outside the
official health sector (WHO)
neither taught widely in US medical schools nor generally available in US
hospitals (Eisenberg, NEJM, 1993) practices of unregistered
(non-licensed) practitioners (GMC)
5.- Stephen M. Perle (perle@bridgeport.edu)
" The NIH Center for Complementary and Alternative Medicine describes
CAM as: Complementary and alternative medicine (CAM) covers a broad
range of healing philosophies, approaches, and therapies. Generally ,
it is
defined as those treatments and healthcare practices not taught widely
in medical schools, not generally used in hospitals, and not usually
reimbursed by medical insurance companies.
Many therapies are termed "holistic," which generally means that the
healthcare practitioner considers the whole person, including physical,
mental, emotional, and spiritual aspects. Many therapies are also known
as "preventive," which means that the practitioner educates and treats
the person to prevent health problems from arising, rather than treating
symptoms after problems have occurred.
People use these treatments and therapies in a variety of ways.
Therapies are used alone (often referred to as alternative), in
combination with other alternative therapies, or in addition to
conventional therapies (sometimes referred to as complementary).
Some approaches are consistent with physiological principles of Western
medicine, while others constitute healing systems with a different
origin. While some therapies are far outside the realm of accepted
Western medical theory and practice, others are becoming established in
mainstream medicine.
http://nccam.nih.gov/nccam/fcp/faq/#what-is
6.- Preston H. Long (drplong@mindspring.com)
"My 17 years in the CAM field has shown me that all CAM's are difficult to
define thus impossible to prove one way or the other."
7.- Norman Vetter (Vetter@cf.ac.uk)
" Forgive me being obvious but I have never seen the point of these phrases
'alternative', 'complimentary' etc. Archie Cochrane said 'Use anything that
works'. Medicine it seems to me should include anything that works and
exclude anything that doesn't.
The tricky bit is when we have things that don't seem to do much good or
much obvious harm, or approaches which have not yet been properly
researched, when traditional medicine has the benefit of being vaguely
understood by the establishment practitioners but non traditional does not
have that benefit. The non-traditional then has to jump through the evidence
hoops before becoming part of the establishment, whereas traditional just
sticks there 'till someone blows it out of the water.
It's tough, but I see no easy way around it. We are gradually getting to the
sacred cows of traditional medicine (mixed metaphor heaven).
8.- Peter Ellis (pellis@mail.usyd.edu.au)
"I think that Norman Vetter's comments raise some interesting
questions when defining 'what works'.
The difficulty here is defining the outcome of interest. In oncology the
use of complementary therapies is high. Trials of 'traditional
medicines' have focused on 'hard' outcomes such as survival or more
recently time to disease progression. However there may be other
outcomes which are important to individual patients. I think that
you are correct that complementary medicines are often frowned upon
for a variety of reasons. There is a lack of high quality evidence
regarding their usage, which adds uncertainty to the question of
benefit. However, many patients choose to take such therapies. In my
anecdotal experience, this decision is not influenced greatly by an
explicit discussion of the uncertainty
of the benefits and harms of complementary therapies.
We need better evidence regarding what 'works'. However I feel that
patient focused outcomes need to be considered so that we ask the
right questions.
9.- Andrews Vickers (vickersa@mskcc.org)
"The key think from the point of view of a survey is not the definition
(there really isn't any good definition of complementary medicine) but the
questionnaire you use. I am cc'ing this message to Rebecca Rees, a
colleague with experience who may be able to refer you to a
published version of a good quality survey instrument for
complementary medicine use. In short, you need to ask about each
complementary medicine practice separately than combine these data
into a single prevalence score.
http://www.bmj.com/cgi/collection/complementary_medicine
10.- Roy M. Poses (royposes@brownvm.brown.edu)
Did anyone else find this "official" definition extremely vague? I
don't know how one would operationalize it into a study.
First of all, it is easy to think of "conventional" treatments that fit most
of this definition. For example, influenza vaccine receives little attention
in most medical schools, is not used often in hospitals, and at least up to
the last few years, was not always reimbursed by insurance in the US.
Furthermore, it is preventative, and can be used alone or in
conjunction with other interventions.
The definition of "holistic" seems to be a non-sequitur in a definition of
"alternative or complementary" treatments, because it seems to refer
to the thought processes of the practioner rather than the therapy
he/she employs.