Complementary and Alternative Medicine: Separating the Wheat
from the Chaff
The growing popularity of "alternative" medicine is accompanied
by an increasingly clear de facto distinction between alternative
and complementary therapies. Alternative treatments are used
instead of conventional regimens. They can be dangerous clinically
and can delay patients' receipt of needed mainstream care.
Alternatives include unproven and highly controversial biologic
treatments such as antineoplastons, a cancer therapy, and shark
cartilage for cancer and osteoporosis.
Despite widespread media coverage of alternative medicine, only
a small percentage of patients actually forgo conventional care in
favor of alternatives. Complementary therapies, used in conjunction
with mainstream treatment, are much more common. They are applied
adjunctively within the medical system or at home to ease transient
discomforts. They tend to be noninvasive and free of side effects,
and are used primarily to enhance emotional and physical well-being
and help control symptoms. Healthy people, too, use them as part of
a wellness program.
Complementary therapies become alternative when promoted as
remedies for serious illnesses, as when mental imagery, touch
therapy, herbal remedies, or other adjunctive measures are sold as
cure-oriented alternatives to conventional treatment. It is not the
therapy itself, but its goal or the intention behind its use that
defines a regimen as alternative versus complementary.
Already ensconced in mainstream European medicine, complementary
medicine is achieving rapid acceptance in North America as well. It
has found a place now in medical schools, academic research
centers, insurance policies, and the federal government. Virtually
every National Institute of Health funds studies of unconventional
approaches relevant to its primary mission.
At least half of alternative practitioners are physicians,
typically family physicians, generalists and psychiatrists. More
than 60% of physicians refer their patients to complementary
practitioners. Non-mainstream medicine is extremely popular with
the public, with better-educated people using it more often than
Patients have many motives for using these therapies. Widespread
frustration exists concerning establishment medicine's inability to
effectively treat chronic illnesses. Inadequate pain control often
moves patients to seek more effective and less toxic alternatives.
Nonsedating techniques such as acupuncture may be useful.
Patients want more gentle, effective, and "natural" approaches
to chronic illnesses. They complain about the impersonality of
modern medical care and hurried interactions with physicians.
Complementary therapies can be cost efficient as well as responsive
to patients' needs.
What is needed now is a clinically responsible balance between
the science of medicine and the presumed comfort of complementary
About the Author
Dr Cassileth is adjunct professor of medicine, University of North
Carolina, and is the author of The Alternative Medicine Handbook:
The Complete Reference Guide to Alternative and Complementary
Therapies (New York: W.W. Norton and Company, January, 1998).
Source: Medical Practice Communicator Author: Barrie R.
Cassileth, PhD [Medical Practice Communicator 5(1):3, 1998. ©
1998 HMI Inc.]
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