Alternative medicine
Alternative medicine refers to practices that aim to achieve the healing effects of medicine, but that by definition lack biological plausibility, testability, repeatability, or supporting evidence of effectiveness. Such practices are not part of evidence-based medicine. Unlike modern medicine, which employs the scientific method to test plausible therapies by way of responsible and ethical clinical trials, producing repeatable evidence of either effect or of no effect, alternative therapies reside outside of mainstream medicine and do not originate from using the scientific method, but instead rely on testimonials, anecdotes, religion, tradition, superstition, belief in supernatural "energies", pseudoscience, errors in reasoning, propaganda, fraud, or other unscientific sources. Frequently used terms for relevant practices are New Age medicine, pseudo-medicine, unorthodox medicine, holistic medicine, fringe medicine, and unconventional medicine, with little distinction from quackery.
Some alternative practices are based on theories that contradict the established science of how the human body works; others appeal to the supernatural or superstitions to explain their effect or lack thereof. In others, the practice has plausibility but lacks a positive risk–benefit outcome probability. Research into alternative therapies often fails to follow proper research protocols, providing invalid results. History has shown that if a method is proven to work, it eventually ceases to be alternative and becomes mainstream medicine.
Much of the perceived effect of an alternative practice arises from a belief that it will be effective, the placebo effect, or from the treated condition resolving on its own. This is further exacerbated by the tendency to turn to alternative therapies upon the failure of medicine, at which point the condition will be at its worst and most likely to spontaneously improve. In the absence of this bias, especially for diseases that are not expected to get better by themselves such as cancer or HIV infection, multiple studies have shown significantly worse outcomes if patients turn to alternative therapies. While this may be because these patients avoid effective treatment, some alternative therapies are actively harmful or actively interfere with effective treatments.
The alternative medicine sector is a highly profitable industry with a strong lobby, and faces far less regulation over the use and marketing of unproven treatments. Complementary medicine, complementary and alternative medicine, functional medicine, integrated medicine or integrative medicine, and holistic medicine attempt to combine alternative practices with those of mainstream medicine. Traditional medicine practices become "alternative" when used outside their original settings and without proper scientific explanation and evidence. Alternative methods are often marketed as more "natural" or "holistic" than methods offered by medical science, that is sometimes derogatorily called "Big Pharma" by supporters of alternative medicine. Billions of dollars have been spent studying alternative medicine, with few or no positive results and many methods thoroughly disproven.
Definitions and terminology
The terms alternative medicine, complementary medicine, integrative medicine, ''holistic medicine, natural medicine, unorthodox medicine, fringe medicine, unconventional medicine, and new age medicine are used interchangeably as having the same meaning and are almost synonymous in most contexts. Terminology has shifted over time, reflecting the preferred branding of practitioners. For example, the United States National Institutes of Health department studying alternative medicine, currently named the National Center for Complementary and Integrative Health, was established as the Office of Alternative Medicine and was renamed the National Center for Complementary and Alternative Medicine'' before obtaining its current name. Therapies are often framed as "natural" or "holistic", implicitly and intentionally suggesting that conventional medicine is "artificial" and "narrow in scope".The meaning of the term "alternative" in the expression "alternative medicine", is not that it is an effective alternative to medical science. Loose terminology may also be used to suggest meaning that a dichotomy exists when it does not.
Alternative medicine
Alternative medicine is defined loosely as a set of products, practices, and theories that are believed or perceived by their users to have the healing effects of medicine, but whose effectiveness has not been established using scientific methods, or whose theory and practice is not part of biomedicine, or whose theories or practices are directly contradicted by scientific evidence or scientific principles used in biomedicine. "Biomedicine" or "medicine" is that part of medical science that applies principles of biology, physiology, molecular biology, biophysics, and other natural sciences to clinical practice, using scientific methods to establish the effectiveness of that practice. Unlike medicine, an alternative product or practice does not originate from using scientific methods, but may instead be based on hearsay, religion, tradition, superstition, belief in supernatural energies, pseudoscience, errors in reasoning, propaganda, fraud, or other unscientific sources.Some other definitions seek to specify alternative medicine in terms of its social and political marginality to mainstream healthcare. This can refer to the lack of support that alternative therapies receive from medical scientists regarding access to research funding, sympathetic coverage in the medical press, or inclusion in the standard medical curriculum. For example, a widely used definition devised by the US NCCIH calls it "a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine". However, these descriptive definitions are inadequate in the present-day when some conventional doctors offer alternative medical treatments and introductory courses or modules can be offered as part of standard undergraduate medical training; alternative medicine is taught in more than half of US medical schools and US health insurers are increasingly willing to provide reimbursement for alternative therapies.
Complementary or integrative medicine
Complementary medicine or integrative medicine is when alternative medicine is used together with mainstream medical treatment in a belief that it improves the effect of treatments. Several medical organizations differentiate between complementary and alternative medicine including the UK National Health Service, Cancer Research UK, and the US Center for Disease Control and Prevention, the latter of which states that "Complementary medicine is used in addition to standard treatments" whereas "Alternative medicine is used instead of standard treatments." For example, acupuncture might be believed to increase the effectiveness or "complement" science-based medicine when used at the same time. Significant drug interactions caused by alternative therapies may make treatments less effective, notably in cancer therapy.Some mainstream academic medical centers have integrative or functional medicine departments, including the Cleveland Clinic, the Mayo Clinic, Stanford University, UCLA, UC San Francisco and Northwestern University. In contrast, other medical practitioners are unconvinced by these practices. For example, surgical oncologist, David Gorski has described integrative medicine as an attempt to bring pseudoscience into academic science-based medicine with skeptics such as Gorski and David Colquhoun referring to this with the pejorative term "quackademia". Robert Todd Carroll described Integrative medicine as "a synonym for 'alternative' medicine that, at its worst, integrates sense with nonsense. At its best, integrative medicine supports both consensus treatments of science-based medicine and treatments that the science, while promising perhaps, does not justify" Rose Shapiro has criticized the field of alternative medicine for rebranding the same practices as integrative medicine.
CAM is an abbreviation of the phrase complementary and alternative medicine. The 2019 World Health Organization Global Report on Traditional and Complementary Medicine states that the terms complementary and alternative medicine "refer to a broad set of health care practices that are not part of that country's own traditional or conventional medicine and are not fully integrated into the dominant health care system. They are used interchangeably with traditional medicine in some countries."
The Integrative Medicine Exam by the American Board of Physician Specialties includes the following subjects: Manual Therapies, Biofield Therapies, Acupuncture, Movement Therapies, Expressive Arts, Traditional Chinese Medicine, Ayurveda, Indigenous Medical Systems, Homeopathic Medicine, Naturopathic Medicine, Osteopathic Medicine, Chiropractic, and Functional Medicine.
Functional medicine
Functional medicine is a form of alternative medicine that encompasses many unproven and disproven methods and treatments. At its essence, it is a rebranding of complementary and alternative medicine, and as such is pseudoscientific, and has been described as a form of quackery. In the United States, FM practices have been ruled ineligible for course credits by the American Academy of Family Physicians because of concerns they may be harmful. Functional medicine was created by Jeffrey Bland, who founded The Institute for Functional Medicine, which is based in the U.S. state of Washington, in the early 1990s as part of one of his companies, HealthComm. IFM, which promotes functional medicine, became a registered non-profit in 2001. Mark Hyman became an IFM board member and prominent promoter.David Gorski, a surgical oncologist at Wayne State University, has written that FM is not well-defined and performs "expensive and generally unnecessary tests". Gorski says FM's vagueness is a deliberate tactic that makes functional medicine difficult to challenge. In an analysis for the McGill Office for Science and Society, Jonathan Jarry writes "Test enough people and you get a lot of false positives, which generate anxiety, more invasive tests, and sometimes unnecessary treatments." Proponents of functional medicine oppose established medical knowledge and reject its models, instead adopting a model of disease based on the notion of "antecedents", "triggers", and "mediators". These are meant to correspond to the underlying causes of health issues, the immediate causes, and the particular characteristics of a person's illness. A functional medicine practitioner devises a "matrix" from these factors to serve as the basis for treatment. Treatments, practices, and concepts are generally not supported by medical evidence. Patients of functional medicine practitioners may also be told to undertake unnecessary diets that can limit food choices. Jonathan Stea writes that functional medicine, integrative medicine, and CAM "are marketing terms designed to confuse patients, promote pseudoscience, and sow distrust in mainstream medicine."
In the 1990s, integrative medicine started to be marketed by a new term, "functional medicine". FM practitioners claim to diagnose and treat conditions that have been found by research studies not to exist, such as adrenal fatigue and numerous imbalances in body chemistry. For instance, contrary to scientific evidence, Joe Pizzorno, a major figure in FM, claimed that 25% of people in the United States have heavy metal poisoning and need to undergo detoxification. Many scientists state that such detox supplements are a waste of time and money. Detox has been also called "mass delusion". In 2014, the American Academy of Family Physicians withdrew course credits for functional medicine courses, having identified some of its treatments as "harmful and dangerous". In 2018, it partly lifted the ban, but only to allow overview classes, not to teach its practice. The opening of centers for functional medicine at the Cleveland Clinic and George Washington University was described by David Gorski as an "unfortunate" example of "quackademia" – that is, a quackery infiltrating academic medical centers.