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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 others.

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 medicine.

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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