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Alternative Medicine Whole Medical Systems
Alternative Medicine: Whole Medical Systems
Table of Contents
Alternative Medicine: Whole Medical Systems
II. Anthroposophical Medicine
VII. Naturopathic Medicine
VIII. Orthomolecular Medicine
IX. Traditional Chinese Medicine
By: Nicole Gibbon
Alternative Medicine is an umbrella term for a large number of practices that fall outside the scope of conventional medicine (Institute of Medicine, 2005). This umbrella is so large that it contains the entire alphabet. Alternative medicine is any healing practice that does not fall within the realm of conventional medicine, or that has not been shown consistently to be effective (Institute of Medicine, 2005). It is often opposed to evidence based medicine and encompasses therapies with a historical or cultural, rather than a scientific, basis (Eisenberg, Kessler, Foster, Norlock, Calkins, & Delbanco, 1993).
Alternative medicine is frequently grouped with complementary medicine, which generally refers to the same interventions when used in conjunction with mainstream techniques, under another umbrella term: complementary and alternative medicine, or CAM (Institute of Medicine, 2005). Although heterogeneous, the major CAM systems have many common characteristics, including a focus on individualizing treatments, treating the whole person, promoting self-care and self-healing, and recognizing the spiritual nature of each individual. In addition, many CAM systems have characteristics commonly found in mainstream health care, such as a focus on good nutrition and preventive practices (Institute of Medicine, 2005). Unlike mainstream medicine, CAM often lacks or has only limited experimental and clinical study.
Alternative medicine practices are as diverse in their foundations as in their methodologies. Practices may incorporate or base themselves on traditional medicine, folk knowledge, spiritual beliefs, or newly conceived approaches to healing. Because alternative techniques tend to lack evidence, or may even have repeatedly failed to work in tests, some have advocated defining it as non-evidence based medicine, or not medicine at all (Barrett, 2004). The National Center for Complimentary and Alternative Medicine (NCCAM) has developed one of the most widely used classification systems for the branches of complementary and alternative medicine. NCCAM classifies complementary and alternative therapies into five major groups that have some overlap. The first is whole medical systems: cut across more than one of the other groups. Mind-body medicine takes a holistic approach to health that explores the interconnection between the mind, body, and spirit. It works under the premise that the mind can affect “bodily functions and symptoms”. Biologically based practices use substances found in nature such as herbs, foods, vitamins, and other natural substances. Manipulative and body-based practices feature manipulation or movement of body parts, such as is done in chiropractic and osteopathic manipulation. Energy medicine is a domain that deals with putative and verifiable energy fields including biofield therapies (intended to influence energy fields that purportedly surround and penetrate the body; no empirical evidence has been found to support the existence of the putative energy fields on which these therapies are predicated) and bioelectromagnetic-based therapies (use verifiable electromagnetic fields, such as pulsed fields, alternating-current or direct-current fields in an unconventional manner).
A 1997 survey found that 13.7% of respondents in the United States had sought the services of both a medical doctor and an alternative medicine practitioner (Eisenberg, Davis, & Etter, 1998). The same survey found that 96% of respondents who sought the services of an alternative medicine practitioner also sought the services of a medical doctor in the past 12 months. Medical doctors are often unaware of their patient’s use of alternative medical treatments as only 38.5% of the patients alternative therapies were discussed with their medical doctor (Eisenberg, Davis, & Etter, 1998).
Survey results released in May 2004 by the National Center for Complementary and Alternative Medicine, part of the United States National Institutes of Health, found that in 2002 62.1% of adults in the country had used some form of CAM in the past 12 months and 75% across lifespan (though these figure drop to 36.0% and 50% if prayer specifically for health reasons is excluded); this study included yoga, meditation, herbal treatments and the Atkins diet as CAM. Another study suggests a similar figure of 40% (Barnes, Powell-Griner, McFann, & Nahin, 2004).
The use of alternative medicine in developed countries appears to be increasing. A 1998 study showed that the use of alternative medicine had risen from 33.8% in 1990 to 42.1% in 1997 (Eisenberg, Davis, & Etter, 1998). In developing nations, access to essential medicines is severely restricted by lack of resources and poverty. Traditional remedies, often closely resembling or forming the basis for alternative remedies, may comprise primary health care or be integrated into the health care system. In Africa, traditional medicine is used for 80% of primary health care, and in developing nations as a whole over one third of the population lack access to essential medicines. A 2002 survey of US adults 18 years and older conducted by the National Center for Health Statistics (CDC) and the National Center for Complimentary and Alternative Medicine indicated (Barnes, Powell-Griner, McFann, & Nahin, 2004):
74.6% had used some form of complementary and alternative medicine (CAM).
62.1% had done so within the preceding twelve months.
When prayer specifically for health reasons is excluded, these figures fall to 49.8% and 36.0%, respectively.
45.2% had in the last twelve months used prayer for health reasons, either through praying for their own health or through others praying for them.
54.9% used CAM in conjunction with conventional medicine.
14.8% “sought care from a licensed or certified” practitioner, suggesting that “most individuals who use CAM prefer to treat themselves.”
Most people used CAM to treat and/or prevent musculoskeletal conditions or other conditions associated with chronic or recurring pain.
“Women were more likely than men to use CAM. The largest sex differential is seen in the use of mind-body therapies including prayer specifically for health reasons”.
“Except for the groups of therapies that included prayer specifically for health reasons, use of CAM increased as education levels increased”.
The most common CAM therapies used in the US in 2002 were prayer (45.2%), herbalism (18.9%), breathing mediation (11.6%), mediation (7.6%), chiropractic medicine (7.5%), yoga (5.1%), body work (5.0%), diet-based therapy (3.5%), progressive relaxation (3.0%), mega-vitamin therapy (2.8%) and visualization (2.1%)
In 2004, a survey of nearly 1,400 U.S. hospitals found that more than one in four offered alternative and complementary therapies such as acupuncture, homeopathy, and massage therapy massage (Barnes, Powell-Griner, McFann, & Nahin, 2004). 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. Additionally, hospitals in the southern Atlantic states were most likely to include CAM, followed by east north central states and those in the middle Atlantic. More than 70% of the hospitals offering CAM were in urban areas.
The National Science Foundation has also conducted surveys of the popularity of alternative medicine. After describing the negative impact science fiction in the media has on public attitudes and understandings of pseudoscience, and defining alternative medicine as all treatments that have not been proven effective using scientific methods, as well as mentioning the concerns of individual scientists, organizations, and members of the science policymaking community, it commented that “nevertheless, the popularity of alternative medicine appears to be increasing.”
A survey released in May 2004 by the NCCAM focused on who used complementary and alternative medicines (CAM), what was used, and why it was used. The survey was limited to adults, aged 18 years and over during 2002, living in the United States (Barnes, Powell-Griner, McFann, & Nahin, 2004). According to this survey, herbal therapy, or use of natural products other than vitamins and minerals, was the most commonly used CAM therapy (18.9%) when all use of prayer was excluded (Barnes, Powell-Griner, McFann, & Nahin, 2004). Herbal remedies are very common in Europe. Prescription drugs are sold alongside essential oils, herbal extracts, or herbal teas. Herbal remedies are seen by some as a treatment to be preferred to pure medical compounds that have been industrially produced. Few medical practitioners practice orthomolecular medicine, but megavitamin treatments are increasingly found in over the counter retail products and naturopathic textbooks (Barnes, Powell-Griner, McFann, & Nahin, 2004).
In the U.S., chiropractic is the largest alternative medical profession, and is the third largest doctored profession, behind medicine and dentistry (Eisenberg, Davis, & Etter, 1998). The percentage of population that utilizes chiropractic care at any given time generally falls into a range from 6% to 12% in the U.S. and Canada, with a global high of 20% in Alberta. Chiropractors are the most common CAM providers for children and adolescents, who consume up to 14% of all visits to chiropractors. The vast majority who seek chiropractic care do so for relief from back and neck pain and other neuromusculoskeletal complaints. Satisfaction rates are typically higher for chiropractic care compared to medical care, with a 1998 U.S. survey reporting 83% of respondents satisfied or very satisfied with their care; quality of communication seems to be a consistent predictor of patient satisfaction with chiropractors (Eisenberg, Davis, & Etter, 1998).
Public perception of chiropractic compares unfavorably with mainstream medicine with regard to ethics and honesty: in a 2006 Gallup Poll of U.S. adults, chiropractors rated last among seven health care professions for being very high or high in honesty and ethical standards, with 36% of poll respondents rating chiropractors very high or high; the corresponding ratings for the other professions ranged from 62% for dentists to 84% for nurses (Eisenberg, Davis, & Etter, 1998). Many chiropractors have sought to address their minor status within the U.S. medical community by attending practice-building seminars to assist chiropractors to persuade their patients of the efficacy of their treatments, increase their revenue, and boost their morale as unorthodox medical practitioners. Unsubstantiated claims about the efficacy of chiropractic have continued to be made by individual chiropractors and chiropractic associations. The largest chiropractic associations in the U.S. and Canada distributed patient brochures that contained unsubstantiated claims. Sustained chiropractic care is promoted as a preventative tool but unnecessary manipulation could possibly present a risk to patients. Some chiropractors are concerned by the routine unjustified claims chiropractors have made.
Utilization of chiropractic care is sensitive to the costs incurred by the co-payment by the patient. The use of chiropractic declined from 9.9% of U.S. adults in 1997 to 7.4% in 2002; this was the largest relative decrease among CAM professions, which overall had a stable use rate (Eisenberg, Davis, & Etter, 1998). As of 2007 only 7% of the U.S. population is being reached by chiropractic. Employment of U.S. chiropractors is expected to increase 14% between 2006 and 2016, faster than the average for all occupations.
This chapter talks more in depth about Whole Medical System with an overview of alternative medicine. Whole medical systems contain eight sections including anthroposohical medicine, ayurveda, chiropratic, heralism, homeophathy, naturopathic medicine, orthomolecular medicine, and traditional Chinese medicine. Anthroposophical medicine focuses on strengthening the patient’s organism and individuality. The self-determination, autonomy and dignity of patients is a central theme; therapies are intended to enhance a patient’s capacities to heal. Ayurvedic medicine is a system of traditional medicine native to the Indian subcontinent composed of a metaphysics of the “five great elements” (Prithvi- earth, Aap-water, Tej-fire, Vaayu-air and Akash-ether), all of which compose the Universe, including the human body. Ayurveda deals elaborately with measures of healthful living during the entire span of life and its various phases. It stresses a balance of three elemental energies or humors: vata (air & space – “wind”), pitta (fire & water – “bile”) and kapha (water & earth – “phlegm”). Ayurveda also focuses on exercise, yoga, meditation, and massage. Thus, body, mind, and spirit/consciousness need to be addressed both individually and in unison for health to ensue.
Chiropractic is a health care discipline and profession that emphasizes diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially the spine, under the hypothesis that these disorders affect general health via the nervous system. Herbalism (Acharya & Shrivastava, 2008) is a traditional medicinal or folk medicine practice based on the use of plants and plant extracts. Homeopathy is a form of alternative medicine in which practitioners use highly diluted preparations.Homeopathic remedies are prepared by serial dilution with shaking by forceful striking, after each dilution under the assumption that this increases the effect.
Orthomolecular medicine, or megavitamin therapy, is a form of CAM that seeks to prevent or treat diseases, with a goal of attaining optimal health, using nutrients prescribed as dietary supplements or derived from diets. Orthomolecular medicine focuses on what it sees as the right nutritional molecules in the right amounts for the individual. Supplements are prescribed at high levels or “megadoses” beyond the Dietary Reference Intake.
Naturopathic ideology focuses on naturally occurring and minimally invasive methods, trusting to the “healing power of nature.” Prevention through stress reduction and a healthy diet and lifestyle is emphasized. Traditional Chinese Medicine (TCM) is largely based on the philosophical concept that the universe is made of an energy called qi. This energy can be any state of matter or energy in existence. TCM believes that the body is a small universe unto itself that is a complex of subsystems of energy and matter, and that these systems work together to maintain a healthy mind and body.
This chapter is broken into sections taking a deeper look at each alternative medicine. A in depth description of the history of that medicine is given to increase the understanding of the theory behind how each works. The sections then describe characteristics of the medicine and explain how the medicine classifies itself. Knowledge of each medicine is passed on and each section looks at how the educational process has developed. With advanced research, each medicine has been tested for efficacy and safety producing regulations that will be elaborated on within each of the following sections.
II. Anthroposophical Medicine
The term anthroposophy is from the Greek, “human” and “wisdom”. It is listed by Nathan Bailey (1742) as meaning “the knowledge of the nature of man”. Rudolf Steiner began using the word to refer to his philosophy in the early 1900s as an alternative theosophy, with a longer history with a meaning of “divine wisdom”. The early work of the founder of anthroposophy, Rudolf Steiner, culminated in his Philosophy of Freedom. Here, Steiner developed a concept of free will is based upon inner experiences. By the beginning of the twentieth century, Steiner’s interests were leading him further and further into explicitly spiritual areas of research. The first steps towards an anthroposophical approach to medicine were made before 1920, when homeopathic physicians and pharmacists began working with Rudolf Steiner, who recommended new medicinal substances as well as specific methods for preparing these . In 1921, Dr. Ita Wegman opened the first anthroposophic medical clinic, now known as the Ita Wegman Clinic, in Arlesheim, Switzerland. At Wegman’s request, Steiner regularly visited the clinic and
Young Rudolf Steiner via Wikimedia commons
suggested treatment regimes for particular patients. In 1925, Wegman and Steiner wrote the first book on the anthroposophic approach to medicine, Fundamentals of Therapy.
The clinic expanded and soon opened a branch in Ascona. Wegman lectured widely, visiting Holland and England particularly frequently, and an increasing number of doctors began to include the anthroposophic approach in their practices.
Anthroposophy describes a broad evolution of human consciousness as follows. Early stages of human evolution possess an intuitive perception of reality, including a clairvoyant perception of spiritual realities. Humanity has progressively evolved an increasing reliance on intellectual faculties and a corresponding loss of intuitive or clairvoyant experiences, which have become atavistic. The increasing intellectualization of consciousness, initially a progressive direction of evolution, has led to an excessive reliance on abstraction and a loss of contact with both natural and spiritual realities. However, in order to go further, new capacities must be developed which combine the clarity of intellectual thought with the imagination, and beyond this with consciously achieved inspiration and intuitive insights.
Anthroposophy speaks of the reincarnation of the human spirit: that the human being passes between stages of existence, incarnating into an earthly body, living on earth, leaving the body behind and entering into the spiritual worlds before returning to be born again into a new life on earth. After the death of the physical body, the human spirit recapitulates the past life, perceiving its events as the objects of its actions experienced them. A complex transformation takes place between the review of the past life and the preparation for the next life; the individual’s karmic condition eventually leading to a choice of parents, physical body, disposition and capacities which will provide the challenges and opportunities needed for further development, which includes karmically chosen tasks for the future life.
Lucifer and his counterpart Ahriman, figure in anthroposophy as two polar, generally evil
influences on world and human evolution. Steiner described both positive and negative aspects of both figures, however: Lucifer as the light spirit which “plays on human pride and offers the delusion of divinity”, but also motivates creativity and spirituality; Ahriman as the dark spirit which tempts human beings to “deny their link with divinity and to live entirely in material plane”, but also stimulates intellectuality and technology. Both figures exert a negative effect on humanity when their influence becomes misplaced or one-sided, yet their influences are necessary for human freedom to unfold. According to anthroposophy, each human being has the task to find a balance between these opposing influences, and each is helped in this task by the mediation of the
Representative of Humanity
, also known as the Christ being, a spiritual entity who stands between and harmonizes the two extremes.
Anthroposophical medicine approaches disease as an imbalance in the biological organism and employs treatment strategies intended to restore this balance. Anthroposophical approaches include anthroposophical medicines based upon modified homeopathic principles, physical therapies including massage therapy and artistic therapies. Many of these are intended to support the patient’s capacity for self-healing. Anthroposophical medicine is based upon the anthroposophical view of the human being that considers the patient’s: physical constitution, life or etheric body, seen as the organizing principle directing growth and regeneration, astral body, understood as the bearer of affect and consciousness and ego, seen as the capacity for self-reflection and free will. Anthroposophical doctors generally restrict the use of antibiotics, antipyretics, and have a differentiated individual approach to vaccinations. Some children treated by anthroposophic doctors are vaccinated only against tetanus and polio, and some vaccinations are given later than recommended by health authorities.
Anthroposophy is a path of knowledge, to guide the spiritual in the human being to the spiritual in the universe. Anthroposophists are those who experience, as an essential need of life, certain questions on the nature of the human being and the universe, just as one experiences hunger and thirst. Steiner’s stated prerequisites to beginning on a spiritual path include a willingness to take up serious cognitive studies, a respect for factual evidence, and a responsible attitude. Central to progress on the path itself is a harmonious cultivation of the following qualities: control over one’s own thinking, control over one’s will, composure, positivity, and impartiality.
Steiner saw meditation as a concentration and enhancement of the power of thought. By focusing consciously on an idea, feeling or intention the meditant seeks to arrive at pure thinking, a state exemplified by but not confined to pure mathematics. In Steiner’s view, conventional sensory-material knowledge is achieved through relating perception and concepts. The anthroposophic path of esoteric training articulates three further stages of supersensory knowledge, which do not necessarily follow strictly sequentially in any single individual’s spiritual progress. Through focusing on symbolic patterns, images and poetic mantras, the meditant can achieve consciously directed imaginations which allow sensory phenomena to appear as the expression of underlying beings of a soul-spiritual nature. By transcending such imaginative pictures, the meditant can become conscious of the meditative activity itself, which leads to experiences of expressions of soul-spiritual beings unmediated by sensory phenomena or qualities. Steiner calls this stage Inspiration. By intensifying the will-forces through exercises such as a chronologically reversed review of the day’s events, a further stage of inner independence from sensory experience is achieved, leading to direct contact, and even union, with spiritual beings without loss of individual awareness.
Steiner gave several series of lectures to physicians and medical students; out of this grew a complementary medical movement which now includes hundreds of M.D.s, chiefly in Europe and North America, and which has its own clinics, hospitals, and medical schools. This is a pedagogical movement with over 1000 Steiner or Waldorf schools (the latter name stems from the first such school, founded in Stuttgart in 1919) located in some 60 countries; the great majority of these are independent (private) schools. Sixteen of the schools have been affiliated with the United Nations’ UNESCO Associated Schools Project Network, a program that sponsors education projects that foster improved quality of education throughout the world, in particular in terms of its ethical, cultural and international dimensions. Waldorf schools receive full or partial governmental funding in some European nations, Australia and in parts of the
Ecole Steiner-Waldorf Verrieres le Buisson (France) via Wikmediai Common
United States (as Waldorf method public or charter schools). Though most of the early Waldorf schools were teacher-founded, the schools today are usually initiated and later supported by an active parent community. Waldorf education is one of the most visible practical applications of an anthroposophical view and understanding of the human being and has been characterized as “the leader of the international movement for a New Education,”
Out of 195 studies of anthroposophic medicine published through 2006, 186 found positive outcomes, defined as comparable or better results than with conventional treatment with respect to at least one clinically-relevant outcome measure, or a clinically-relevant improvement resulting from the treatment (Barrett, 2004). Eight studies found no advantage and one study showed a negative trend. The criteria used in the studies range from subjective judgments of quality-of-life improvements to objectively measured reductions in symptoms. A number of the studies were found to have clear methodological weaknesses (Barrett, 2004).
Anthroposophy’s methodology is to employ a scientific way of thinking, but to apply this methodology, which normally excludes our inner experience from consideration, instead to the human being proper. Whether this is a sufficient basis for anthroposophy to be considered a spiritual science has been a matter of controversy. As Freda Easton explained in her study of Waldorf schools, “Whether one accepts anthroposophy as a science depends upon whether one accepts Steiner’s interpretation of a science that extends the consciousness and capacity of human beings to experience their inner spiritual world.” Sven Ove Hansson has disputed anthroposophy’s claim to a scientific basis, stating that its ideas are not empirically derived and neither reproducible nor testable. Carlo Willmann points out that as, on its own terms, anthroposophical methodology offers no possibility of being falsified except through its own procedures of spiritual investigation, no intersubjective validation is possible by conventional scientific methods; it thus cannot stand up to positivistic science's criticism. Peter Schneider calls such objections untenable on the grounds that if a non-sensory, non-physical realm exists, then according to Steiner the experiences of pure thinking possible within the normal realm of consciousness would already be experiences of that, and it would be impossible to exclude the possibility of empirically grounded experiences of other supersensory content. Olav Hammer suggests that anthroposophy carries scientism “to lengths unparalleled in any other Esoteric position” due to its dependence upon claims of clairvoyant experience, its subsuming natural science under “spiritual science”, and its development of what Hammer calls “fringe” sciences such as anthroposophical medicine and biodynamic agriculture justifiedpartly on the basis of the ethical and ecological values they promote, rather than purely on a scientific basis.
(India Subcontinent, 1500 BC)
In Hindu mythology, the origin of Ayurveda medicine is attributed to the physician of the gods, Dhanvantari. Ayurvedic medicine is a system of traditional medicine native to the Indian subcontinent and practiced in other of the world as a form of alternative medicine. In Sanskrit, the word ayurveda consists of the words āyus, meaning “longevity”, and veda, meaning “related to knowledge” or “science”. Evolving throughout its history, ayurveda remains an influential system of medicine in South Asia.
Lord of Ayurveda,Dhanvantari via Wikimedia Commons
The earliest literature on Indian medical practice appeared during the Vedic period in India. The Susruta Samhita and the Charaka Samhita were influential works on traditional medicine during this era. Over the following centuries, Ayurvedic practitioners developed a number of medicinal preparations and surgical procedures for the treatment of various ailments and diseases.
Around 1500 BC, ayurveda’s fundamental and applied principles got organized and enunciated. Ayurveda traces its origins to the Vedas, Atharvaveda (one of the four most ancient books of Indian knowledge, wisdom and culture) in particular, and is connected to Hindu religion. Ayurveda is considered by some to have divine origin. Indian medicine has a long history, and is one of the oldest organized systems of medicine. Its earliest concepts are set out in the Vedas, which may possibly date as far back as the 2nd millennium BC. According to a later writer, the system of medicine was received by a man named Dhanvantari from Brahma, who was deified as the god of medicine.
The most authentic compilation of Dhanvantari’s teachings and work is presently available in a treatise called Sushruta Samhita. This contains 184 chapters and description of 1,120 illnesses, 700 medicinal plants, 64 preparations from mineral sources and 57 preparations based on animal sources. Other early works of ayurveda include the Charaka Samhita, attributed to Charaka. The earliest surviving excavated written material, which contains the works of Sushruta, is the Bower Manuscript, dated to the 4th century AD. The Bower manuscript quotes directly from Sushruta and is of special interest to historians due to the presence of Indian medicine and its concepts in Central Asia. Early ayurveda had a school of physicians and a school of surgeons.
Ayurveda is grounded in a metaphysics of the “five great elements” (Prithvi- earth, Aap-water, Tej-fire, Vaayu-air and Akash-ether)—all of which compose the Universe, including the human body. Chyle or plasma (called rasa dhatu), blood (rakta dhatu), flesh (mamsa dhatu), fat (medha dhatu), bone (asthi dhatu), marrow (majja dhatu), and semen or female reproductive tissue (shukra dhatu) are held to be the seven primary constituent elements—saptadhatu of the body. Ayurveda deals elaborately with measures of healthful living during the entire span of life and its various phases. Ayurveda stresses a balance of three elemental energies or humors: vata (air & space – “wind”), pitta (fire & water – “bile”) and kapha (water & earth – “phlegm”). According to ayurveda, these three regulatory principles— Doshas are important for health, because when they are in a more balanced state, the body will function to its fullest, and when imbalanced, the body will be affected negatively in certain ways. Ayurveda holds that each human possesses a unique combination of Doshas. In ayurveda, the human body perceives attributes of experiences as 20 Guna (Devanāgarī: meaning qualities). Surgery and surgical instruments are employed. It is believed that building a healthy metabolic system, attaining good digestion, and proper excretion leads to vitality. Ayurveda also focuses on exercise, yoga, meditation, and massage. Thus, body, mind, and spirit/consciousness need to be addressed both individually and in unison for health to ensue.
Ayurveda Yoga via Wikimedia Commons
There are eight disciplines of ayurveda treatment, called ashtangas including internal medicine (Kaaya-chikitsa), pediatrics (Kaumarabhrtyam), surgery (Shalya-chikitsa), eye and ENT (Shalakya tantra), demonic possession (Bhuta vidya), toxicology (Agadatantram), prevention diseases and improving immunity and rejuvenation (rasayana), and aphrodisiacs and improving health of progeny (Vajikaranam). Hinduism and Buddism have been an influence on the development of many of ayurveda’s central ideas particularly its fascination with balance, known in Buddhism as Mahyamaka. Balance is emphasized; suppressing natural urges is seen to be unhealthy, and doing so may almost certainly lead to illness. However, people are cautioned to stay within the limits of reasonable balance and measure.
Ayurveda stresses the use of plant-based medicines and treatments. Hundreds of plant-based medicines are employed, including cardamom and cinnamon. Some animal products may also be used, for example milk, bones, and gallstones. In addition, fats are used both for consumption and for external use. The practice of adding minerals to herbal medicine is known as rasa shastra. Ensuring the proper functions of channels (shrotas) that transport fluids from one point to another is a vital goal of Ayurvedic medicine, the lack of healthy shrotas is thought to cause rheumatism, epilepsy, paralysis, convulsions, and insanity. Practitioners induce sweating and prescribe steam-based treatments as a means to open up the channels and dilute the Doshas that cause the blockages and lead to disease.
Cinnamon Fern via Wikimedia commons
Ayurvedic practitioners approach diagnosis by using all five senses: Hearing is used to observe the condition of breathing and speech. Hygienic living involves regular bathing, cleansing of teeth, skin care, and eye washing. Occasional anointing of the body with oil is also prescribed. The Charaka Samhita recommends a tenfold examination of the patient. The qualities to be judged are: constitution, abnormality, essence, stability, body measurements, diet suitability, psychic strength, digestive capacity, physical fitness and age. In addition, Chopra (2003) identifies five influential criteria for diagnosis: origin of the disease, prodrominal (precursory) symptoms, typical symptoms of the fully developed disease, observing the effect of therapeutic procedures and the pathological process.
In 1970, the Indian Medical Central Council Act aimed to standardize qualifications for ayurveda and provide accredited institutions for its study and research was passed by the Parliament of India. In India, over 100 colleges offer degrees in traditional ayurvedic medicine. The Indian government supports research and teaching in ayurveda through many channels at both the national and state levels, and helps institutionalize traditional medicine so that it can be studied in major towns and cities. The state-sponsored Central Council for Research in Ayurveda and Siddha (CCRAS) is the premier institution for promotion of traditional medicine in India. The studies conducted by this institution encompass clinical, drug, literary, and family welfare research. To fight biopiracy and unethical patents, the Government of India, in 2001, set up the Traditional Knowledge Digital Library as repository of 1200 formulations of various systems of Indian medicine, such as Ayurveda, Unani and Siddha. The library also has 50 traditional Ayurveda books digitized and available online.
Central Council of Indian Medicine (CCIM) a statutory body established in 1971, under Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homepathy (AYUSH), Ministry of Health and Family Welfare, Government of India, monitors higher education in Ayurveda. The Bachelor of Ayurveda, Medicine and Surgery (BAMS) degree is the basic five-and-a-half year course of graduation. It includes eighteen different subjects comprising courses on anatomy with cadaver dissections, physiology, pharmacology, pathology, modern clinical medicine & clinical surgery, pediatrics, along with subjects on ayurveda like Charaka Samhita, history and evolution of ayurveda, identification and usage of herbs (dravyaguna), and ayurvedic philosophy in diagnostics and treatment. Academic institutions related to traditional medicine in India have contributed to ayurveda’s international visibility. The first subspecialty journal for the field of Ayurvedic medicine was launched in July 2010 with the focus in rheumatology and titled the Journal of Clinical Rheumatology in Ayurveda.
Several international and national initiatives have been formed to legitimize the practice of Ayurvedic medicine as CAM in countries outside India including, WHO policy of traditional medicine practice, the US National Center for Complementary and Alternative Medicine, the National Ayurvedic Medical Association, the European Federation for Complementary and Alternative Medicine and the European Ayurveda Association. In 2009, the United States of America National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health expended $1.2 million of its $123 million annual budget on ayurvedic medicine-related research (Brown, 2009).
As a traditional medicine, many ayurveda products have not been tested in rigorous scientific studies and clinical trials. A systematic review of ayurveda treatments for rheumatoid arthritis concluded that there was insufficient evidence, as most of the trials were not done properly, and the one high-quality trial showed no benefits (Fontanarosa, 1998). A review of ayurveda and cardiovascular disease concluded that while the herbal evidence is not yet convincing, the spices are appropriate, some herbs are promising, and yoga is also a promising complementary treatment (Fontanarosa, 1998). A 2004 study found toxic metals in 20% of ayurvedic preparations that were made in South Asia for sale around Boston and extrapolated the data to the United States more broadly. It concluded that excess consumption of these products could cause health risks. A 2008 study of more than 230 products found that approximately 20% of remedies purchased over the Internet from both US and Indian suppliers contained lead, mercury or arsenic.
(Egypt, 1000 B.C.)
In the written record, the study of herbs dates back over 5,000 years to the Sumerians, who described well-established medicinal uses for such plants as laurel, caraway, and thyme. Ancient Egyptian medicines of 1000 B.C. are known to have used garlic, opium, and other herbs for medicine (Acharya & Shrivastava, 2008). Indian Ayurveda medicine has used herbs such as turmeric possibly as early as 1900 B.C. The first Chinese herbal book, the Shennong Bencao Jing, compiled during the Han Dynasty but dating back to a much earlier date, possibly 2700 B.C., lists 365 medicinal plants and their uses (Acharya & Shrivastava, 2008). Succeeding generations augmented on the Shennong Bencao Jing, as in the Yaoxing Lun (Treatise on the Nature of Medicinal Herbs), a 7th century Tang Dynasty treatise on herbal medicine.
Arabic Herb Guide Book via Wikimedia Commons
Greek and Roman medicinal practices, as preserved in the writings of Hippocrates and Galen, provided the pattern for later western medicine. Hippocrates advocated the use of a few simple herbal drugs (Acharya & Shrivastava, 2008). The Greek physician compiled the first European treatise on the properties and uses of medicinal plants, De Materia Medica. In the first century AD, Dioscorides wrote a compendium of more than 500 plants that remained an authoritative reference into the 17th century (Acharya & Shrivastava, 2008). Similarly important for herbalists and botanists of later centuries was the Greek book that founded the science of botany, Theophrastus' Historia Plantarum, written in the fourth century B.C.
Many Greek and Roman writings on medicine, as on other subjects, were preserved by hand copying of manuscripts in monasteries (Acharya & Shrivastava, 2008). The monasteries tended to become local centers of medical knowledge and their herb gardens provided the raw materials for simple treatment of common disorders. At the same time, folk medicine in the home and village continued uninterrupted, supporting numerous wandering and settled herbalists. Among these were the “wise-women,” who prescribed herbal remedies often along with spells and enchantments (Acharya & Shrivastava, 2008). It was not until the late Middle Ages that women who were knowledgeable in herb lore became the targets of the witch hysteria. One of the most famous women in the herbal tradition was Hildegard of Bingen. A twelfth century Benedictine nun, she wrote a medical text called Causes and Cures.
Medical schools known as Bimaristan began to appear from the 9th century in the medieval Islamic world among Persians and Arabs, which was generally more advanced than medieval Europe at the time (Acharya & Shrivastava, 2008). The experimental scientific method was introduced into the field of materia medica in the 13th century by the Andalusian-Arab botanist Abu al-Abbas al-Nabati, the teacher of Ibn al-Baitar. Al-Nabati introduced empirical techniques in the testing, description and identification of numerous materia medica, and he separated unverified reports from those supported by actual tests and observations (Acharya & Shrivastava, 2008). This allowed the study of materia medica to evolve into the science of pharmacology.
In America, early settlers relied on plants imported from Europe, and also from local Indian knowledge. One particularly successful practitioner, Samuel Thomson developed a hugely popular system of medicine (Acharya & Shrivastava, 2008). This approach was subsequently broadened to include concepts introduced from modern physiology, a discipline called Phyiomedicalism. Another group, the Eclectics, were a later offshoot from the orthodox medical profession, who were looking to avoid the then current medical treatments of mercury and bleeding, and introduced herbal medicine into their practices (Acharya & Shrivastava, 2008). Both groups were eventually overcome by the actions of the American Medical Association, which was formed for this purpose. Cherokee medicine tends to divide herbs into foods, medicines and toxins and to use seven plants in the treatment of disease, which is defined with both spiritual and physiological aspects, according to Cherokee herbalist David Winston (Acharya & Shrivastava, 2008).
Herbalism is a traditional medicinal or folk medicine practice based on the use of plants and plant extracts (Marty, 1999). Herbalism is also known as botanical medicine, medical herbalism, herbal medicine, herbology, and phytotherapy. The scope of herbal medicine is sometimes extended to include fungal and bee products, as well as minerals, shells and certain animal parts. The exact composition of a herbal product is influenced by the method of extraction (Marty, 1999). A tisane will be rich in polar components because water is a polar solvent. Oil on the other hand is a non-polar solvent and it will absorb non-polar compounds. Alcohol lies somewhere in between. There are many forms in which herbs can be administered (Marty, 1999).
Sapindus saponaria and the extraction process via Wikimedia commons
Four approaches to the use of plants as medicine include: the magical/shamanic, the energetic, the functional dynamic, and the chemical. The magical/shamanic is used by almost all non-modern societies (Marty, 1999). The practitioner is regarded as endowed with gifts or powers that allow him/her to use herbs in a way that is hidden from the average person, and the herbs are said to affect the spirit or soul of the person. Herbs are regarded as having actions in terms of their energies and affecting the energies of the body (Marty, 1999). The practitioner may have extensive training, and ideally be sensitive to energy, but need not have supernatural powers. Early physiomedical practitioners, whose doctrine forms the basis of contemporary practice in the UK, used the functional dynamic approach (Marty, 1999). Herbs have a functional action, which is not necessarily linked to a physical compound, although often to a physiological function, but there is no explicit recourse to concepts involving energy (Fontanarosa, 1998).
Herbalists tend to use extracts from parts of plants, such as the roots or leaves but not isolate particular phytochemicals (Marty, 1999). Pharmaceutical medicine prefers single ingredients on the grounds that dosage can be more easily quantified. It is also possible to patent single compounds, and therefore generate income. Herbalists often reject the notion of a single active ingredient, arguing that the different phytochemicals present in many herbs will interact to enhance the therapeutic effects of the herb and dilute toxicity (Marty, 1999). Furthermore, they argue that a single ingredient may contribute to multiple effects. Herbalists deny that herbal synergism can be duplicated with synthetic chemicals. They argue that phytochemical interactions and trace components may alter the drug response in ways that cannot currently be replicated with a combination of a few putative active ingredients (Marty, 1999). Pharmaceutical researchers recognize the concept of drug synergism but note that clinical trials may be used to investigate the efficacy of a particular herbal preparation, provided the formulation of that herb is consistent.
In specific cases the claims of synergy and multifunctionality have been supported by science (Marty, 1999). The open question is how widely both can be generalized. Herbalists would argue that cases of synergy could be widely generalized, on the basis of their interpretation of evolutionary history, not necessarily shared by the pharmaceutical community (Aratani, 2009). Herbalists view their field as the study of a web of relationships rather than a quest for single cause and a single cure for a single condition. In selecting herbal treatments herbalists may use forms of information that are not applicable to pharmacists (Aratani, 2009). Because herbs can moonlight as vegetables, teas or spices they have a huge consumer base and large-scale epidemiological studies become feasible (Marty, 1999). Herbalists contend that historical medical records and herbals are underutilized resources. They favor the use of convergent information in assessing the medical value of plants (Ernst, 2005).
Medical schools known as Bimaristan began to appear from the 9th century in the medieval Islamic world among Persians and Arabs, which was generally more advanced than medieval Europe at the time (Acharya & Shrivastava, 2008). The Arabs venerated Greco-Roman culture and learning, and translated tens of thousands of texts into Arabic for further study. As a trading culture, the Arab travelers had access to plant material from distant places such as China and India (Acharya & Shrivastava, 2008). Herbals, medical texts and translations of the classics of antiquity filtered in from east and west. Muslim botanists and Muslim physicians significantly expanded on the earlier knowledge of materia medica (Acharya & Shrivastava, 2008).
Some professional herbalist organizations have made statements calling for a category of regulation for herbal products (Aratani, 2009). Yet others agree with the need for more quality testing but believe it can be managed through reputation without government intervention (Aratani, 2009). The legal status of herbal ingredients varies by country. In the United States, the Food and Drug Administration (FDA) regulates most herbal remedies. Manufacturers of products falling into this category are not required to prove the safety or efficacy of their product, though the FDA may withdraw a product from sale should it prove harmful. The National Nutritional Foods Association, the industry’s largest trade association, has run a program since 2002, examining the products and factory conditions of member companies, giving them the right to display the Good Manufacturing Practices (GMP).
Herbals are often not standardized from one pill to the next, or from one brand to the next, and can be reformulated, remixed, or otherwise altered by any company. Empirical studies are improving processing of herbals, and supporting better regulations regarding the growing, processing, and prescription of various herbals (Aratani, 2009). A medicine called Fufang Luhui Jiaonang was taken off UK shelves in July 2004 when found to contain 11-13% mercury. In the United States, the herb Ephedra was banned in 2004 by the FDA, although the FDA’s final ruling exempted traditional Asian preparations of Ephedra from the ban. The ban was meant to combat the use of this herb in Western weight loss products, a phenomenon well removed from traditional Asian uses.
Use of medicinal plants can be as informal as, for example, culinary use or consumption of an herbal tea or supplement, although the sale of some herbs considered dangerous is often restricted to the public (Acharya & Shrivastava, 2008). Sometimes specialist companies provide such herbs to professional herbalists. Many herbalists, both professional and amateur, often grow or “wildcraft” their own herbs. Some researchers trained in both western and traditional Chinese medicine have attempted to deconstruct ancient medical texts in the light of modern science. One idea is that the yin-yang balance, at least with regard to herbs, corresponds to the pro-oxidant and anti-oxidant balance (Acharya & Shrivastava, 2008). This interpretation is supported by several investigations of the ORAC ratings of various yin and yang herbs. Similarly to prescription drugs, a number of herbs are thought to be likely to cause adverse effects. Furthermore, “adulteration, inappropriate formulation, or lack of understanding of plant and drug interactions have led to adverse reactions that are sometimes life threatening or lethal (Acharya & Shrivastava, 2008).
Hand of Pills via Wikimedia commons
Herbalists criticize mainstream studies on the grounds that they make insufficient use of historical usage, which has been shown useful in drug discovery and development in the past and present (Aratani, 2009). They maintain that tradition can guide the selection of factors such as optimal dose, species, time of harvesting and target population (Acharya & Shrivastava, 2008). Dosage is in general an outstanding issue for herbal treatments: while most medicines are heavily tested to determine the most effective and safest dosages (especially in relation to things like body weight, drug interactions, etc.), there are fewer varieties of dosages for various herbal treatments on the market (Acharya & Shrivastava, 2008). Furthermore, from a conventional pharmacological perspective, herbal medicines taken in whole form cannot generally guarantee a consistent dosage or drug quality, since certain samples may contain more or less of a given active ingredient.
Although initially keeping chiropractic a family secret, in 1898 Palmer began teaching it to a few students at his new Palmer School of Chiropatic. One student, his son Bartlett Joshua Palmer, became committed to promoting chiropractic, took over the Palmer School in 1906, and rapidly expanded its enrollment. There are several schools of chiropractic adjustive techniques, although most chiropractors mix techniques from several schools.
Daniel David Palmer via Wikimedia Commons
Chiropractors emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery, with special emphasis on the spine. The practice of chiropractic medicine involves a range of diagnostic methods including skeletal imaging, observational and tactile assessments, and orthopedic and neurological evaluation. A chiropractor may also refer a patient to an appropriate specialist, or co-manage with another health care provider. Common patient management involves spinal manipulation (SM) and other manual therapies to the joints and soft tissues, rehabilitative exercises, health promotion, electrical modalities, complementary procedures, and lifestyle counseling.
Chiropractic overlaps with several other manual-therapy professions, including massage therapy, osteopathy, physical therapy, and sports medicine. Chiropractic is autonomous and competitive with mainstream medicine, and osteopathy outside the U.S. remains primarily a manual medical system; physical therapists work alongside and cooperate with mainstream medicine, and osteopathic medicine in the U.S. has merged with the medical profession. Members distinguish these competing professions with rhetorical strategies that include claims that, compared to other professions, chiropractors heavily emphasize spinal manipulation, tend to use firmer manipulative techniques, and promote maintenance care; that osteopaths use a wider variety of treatment procedures; and that physical therapists emphasize machinery and exercise.
Chiropractic philosophy includes the following perspectives: Holism assumes that health is affected by everything in an individual’s environment; some sources also include a spiritual or existential dimension. In contrast, reductionism in chiropractic reduces causes and cures of health problems to a single factor, vertebral subluxation. Conservatism considers the risks of clinical interventions when balancing them against their benefits. It emphasizes noninvasive treatment to minimize risk, and avoids surgery and medication. Homeostasis emphasizes the body’s inherent self-healing abilities. Chiropractic’s early notion of innate intelligence can be thought of as a metaphor for homeostasis. Straights tend to use an approach that focuses on the chiropractor’s perspective and the treatment model, whereas mixers tend to focus on the patient and the patient’s situation.
Chiropractic is a health care discipline and profession that emphasizes diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially the spine, under the hypothesis that these disorders affect general health via the nervous system. It is generally categorized as CAM, a characterization that many chiropractors reject. Although chiropractors have many attributes of primary care providers, chiropractic has more of the attributes of a medical specialty like dentistry or podiatry. The main chiropractic treatment technique involves manual therapy, including manipulation of the spine, other joints, and soft tissues; treatment also includes exercises and health and lifestyle counseling. Traditional chiropractic assumes that a vertebral subluxation or spinal joint dysfunction interferes with the body’s function and its innate intelligence, a vitalisic notion that brings ridicule from mainstream science and medicine.
Spinal manipulation is the most common treatment used in chiropractic care in the U.S., chiropractors perform over 90% of all manipulative treatments. Spinal manipulation is a passive manual maneuver during which a three-joint complex is taken past the normal range of movement, but not so far as to dislocate or damage the joint; its defining factor is a dynamic thrust, which is a sudden force that causes an audible release and attempts to increase a joint’s range of motion. Neck manipulations are high-velocity, short-lever thrusts with rotation beyond the physiological range of motion. High-velocity, low-amplitude spinal manipulation (HVLA-SM) thrusts have physiological effects that signal neural discharge from paraspinal muscle tissues, depending on duration and amplitude of the thrust are factors of the degree in paraspinal muscle spindles activation. Clinical skill in employing HVLA-SM thrusts depends on the ability of the practitioner to handle the duration and mangitude of the load. More generally, spinal manipulative therapy (SMT) describes techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues.
Human Spine via Wikimedia Commons
Chiropractors obtain a first professional degree in the field of chiropractic. Although chiropractors often argue that this education is as good as or better than medical physicians’, most chiropractic training is confined to classrooms with much time spent learning theory, adjustment, and marketing. Accredited chiropractic programs require that applicants have 90 semester hours of undergraduate education with a grade point average of at least 2.5; many programs require at least three years of undergraduate education, and more are requiring a bachelor’s degree. Canada requires a minimum three years of undergraduate education for applicants, and at least 4200 instructional hours (or the equivalent) of full time chiropractic education for matriculation through an accredited chiropractic program. The World Health Organization (WHO) guidelines suggest three major full-time educational paths culminating in either a DC, DCM, BSc, or MSc degree. Besides the full-time paths, they also suggest a conversion program for people with other health care education and limited training programs for regions where no legislation governs chiropractic.
Upon graduation, there may be a requirement to pass national, state, or provincial board examinations before being licensed to practice in a particular jurisdiction. Depending on the location, continuing education may be required to renew these licenses. Specialty training is available through part-time postgraduate education programs such as chiropractic orthopedics and sports chiropractic, and through full-time residency programs such as radiology or orthopedics. Chiropractic is established in the U.S., Canada and Australia, and is present to a lesser extent in many other countries.
In the U.S., chiropractic schools are accredited through the Council on Chiropractic Education (CCE). The CCE requires a mixing curriculum, which means a straight-educated chiropractor may not be eligible for licensing in states requiring CCE accreditation. CCEs in the U.S., Canada, Australia and Europe have joined to form CCE-International (CCE-I) as a model of accreditation standards with the goal of having credentials portable internationally. Today, there are 18 accredited Doctor of Chiropractic programs in the U.S. All but one of the chiropractic colleges in the U.S. are privately funded, but in several other countries they are in government-sponsored universities and colleges. Chiropractic curricula in the U.S. have been criticized for failing to meet generally accepted standards of evidence-based medicine. Regulatory colleges and chiropractic boards in the U.S., Canada, and Australia are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency. There are an estimated 53,000 chiropractors in the U.S. (2006).
A 2008 commentary proposed that the chiropractic profession actively regulate itself to combat abuse, fraud, and quackery, which are more prevalent in chiropractic than in other health care professions, violating the social contract between patients and physicians. A study of California disciplinary statistics during 1997–2000 reported 4.5 disciplinary actions per 1000 chiropractors per year, compared to 2.27 for MDs; the incident rate for fraud was 9 times greater among chiropractors (1.99 per 1000 chiropractors per year) than among MDs (0.20). Chiropractors are not licensed to write medical prescriptions or perform major surgery in the U.S., but that recently changed when New Mexico became the first state to allow “advanced practice” trained chiropractors the ability to prescribe certain medications. Their scope of practice varies by state, based on inconsistent views of chiropractic care: some states, such as Iowa, broadly allow treatment of “human ailments”; some, such as Delaware, use vague concepts such as “transition of nerve energy” to define scope of practice; others, such as New Jersey, specify a severely narrowed scope. States also differ over whether chiropractors may conduct laboratory tests or diagnostic procedures, dispense dietary supplements, or use other therapies such as homeopathy and acupuncture; in Oregon they can become certified to perform minor surgery and to deliver children via natural childbirth. A 2003 survey of North American chiropractors found that a slight majority favored allowing them to write prescriptions for over-the-counter drugs. A related field, veterinary chiropractic, applies manual therapies to animals and is recognized in a few U.S. states, but is not recognized by the American Chiropractic Association as being chiropractic.
Chiropractic has seen considerable controversy and criticism. In 1910 endorsement of X-rays as necessary for diagnosis resulted in a significant exodus from the Palmer School of the more conservative faculty and students. In 1924, the invention and promotion of the neurocalometer, a temperature-sensing device, was highly controversial. By the 1930s chiropractic was the largest alternative healing profession in the U.S. Serious research to test chiropractic theories did not begin until the 1970s, and is continuing to be hampered by what are characterized as antiscientific and pseudoscientific ideas that sustained the profession in its long battle with organized medicine. By the mid 1990s there was a growing scholarly interest in chiropractic, which helped efforts to improve service quality and establish clinical guidelines that recommended manual therapies for acute low back pain. However, its future seemed uncertain: as the number of practitioners grew, evidence-based medicine insisted on treatments with demonstrated value, managed care restricted payment, and competition grew from massage therapists and other health professions. The profession responded by marketing natural products and devices more aggressively, and by reaching deeper into alternative medicine and primary care.
Many controlled clinical studies of spinal manipulation (SM) are available, but their results disagree, and they are typically of low methodological quality. Only low levels of scientific evidence that does not demonstrate clinically relevant benefits support health claims made by chiropractors regarding use of manipulation for pediatric health conditions. A 2010 Cochrane review determined the effects of combined chiropractic interventions for low back pain were “slightly improved pain and disability in the short-term and pain in the medium-term for acute and subacute LBP. There is currently no evidence that supports or refutes that these interventions provide a clinically meaningful difference for pain or disability in people with LBP when compared to other interventions.” A 2008 critical review found that with the possible exception of back pain, chiropractic SM has not been shown to be effective for any medical condition, and suggested that many guidelines recommend chiropractic care for low back pain because no therapy has been shown to make a real difference; a 2008 supportive review found serious flaws in the critical approach and found that SM and mobilization are at least as effective for chronic low back pain as other efficacious and commonly used treatments. A 2010 systematic review found that there is no good evidence to assume that chiropractic neck manipulation is effective for any medical condition. The efficacy of maintenance care in chiropractic is unknown (Fontanarosa, 1998).
In the 16th century the pioneer of pharmacology Paracelsus declared that small doses of “what makes a man ill also cures him”, anticipating homeopathy, but it was German physician Samuel Hahnemann in 1796, who gave it a name and laid out its principles in the late 18th century. At that time, mainstream medicine employed such measures as bloodletting and purging, used laxatives and enemas, and administered complex mixtures, such as Venice treacle, which was made from 64 substances including opium, myrrh, and viper’s flesh. Such measures often worsened symptoms and sometimes proved fatal. While the virtues of these treatments had been extolled for centuries, Hahnemann rejected such methods as irrational and inadvisable. Instead, he favored the use of single drugs at lower doses and promoted an immaterial, vitalistic view of how living organisms function, believing that diseases have , as well as physical causes. Hahnemann also advocated various lifestyle improvements to his patients, including exercise, diet, and cleanliness. Hahnemann came to believe that all effective drugs produce symptoms in healthy individuals similar to those of the diseases that they treat. This later became known as the “law of similars”, the most important concept of homeopathy. The term “homeopathy” was coined by Hahnemann and first appeared in print in 1807, although he began outlining his theories of “medical similars” or the “doctrine of specifics” in a series of articles and monographs in 1796.
Hahnemann began to test what effects substances produced in humans. The first collection of evidence was published in 1805 and a second collection of 65 remedies appeared in his book, Materia Medica Pura, in 1810. believed that large doses of drugs that caused similar symptoms would only aggravate illness, so he advocated extreme dilutions of the substances; he devised a technique for making dilutions that he believed would preserve a substance’s therapeutic properties while removing its harmful effects, proposing that this process aroused and enhanced “spirit-like medicinal powers held within a drug”. He gathered and published a complete overview of his new medical system in his 1810 book, The Organon of the Healing Art, whose 6th edition, published in 1921, is still used by homeopaths today.
Bottle of Homeopathic pills via Wikimedia commons
Homeopathic remedies are prepared by serial dilution with shaking by forceful striking, which homeopaths term succussion, after each dilution under the assumption that this increases the effect. Homeopaths call this process potentization. Dilution often continues until none of the original substance remains. Apart from the symptoms, homeopaths use aspects of the patient’s physical and psychological state in recommending remedies. Homeopathic reference books known as repertories are then consulted, and a remedy is selected based on the totality of symptoms.
Homeopathy is a vitalist philosophy that interprets diseases and sickness as caused by disturbances in a hypothetical vital force or life force. It sees these disturbances as manifesting themselves as unique symptoms. Homeopathy maintains that the vital force has the ability to react and adapt to internal and external causes, which homeopaths refer to as the law of susceptibility. The law of susceptibility implies that a negative state of mind can attract hypothetical disease entities called miasms to invade the body and produce symptoms of diseases. However, Hahnemann rejected the notion of a disease as a separate thing or invading entity and insisted that it was always part of the “living whole”.
A miasm is often defined by homeopaths as an imputed “peculiar morbid derangement of the vital force”. Hahnemann associated each miasm with specific diseases, with each miasm seen as the root cause of several diseases. According to Hahnemann, initial exposure to miasms causes local symptoms, such as skin or venereal diseases, but if these symptoms are suppressed by medication, the cause goes deeper and begins to manifest itself as diseases of the internal organs. Homeopathy maintains that treating diseases by directly opposing their symptoms, as is sometimes done in conventional medicine, is ineffective because all “disease can generally be traced to some latent, deep-seated, underlying chronic, or inherited tendency”. The underlying imputed miasm still remains, and deep-seated ailments can only be corrected by removing the deeper disturbance of the vital force.
Originally Hahnemann presented only three miasms, of which the most important was “psora” (Greek for itch), described as being related to any itching diseases of the skin, supposed to be derived from suppressed scabies, and claimed to be the foundation of many further disease conditions. Hahnemann believed psora to be the cause of such diseases as epilepsy, cancer, jaundice, deafness, and cataracts. Since Hahnemann’s time, other miasms have been proposed, some replacing one or more of psora’s proposed functions, including tubercular miasms and cancer miasms.
Remedy is a technical term in homeopathy that refers to a substance prepared with a particular procedure and intended for treating patients; it is not to be confused with the generally-accepted use of the word, which means “a medicine or therapy that cures disease or relieves pain”. Homeopathic practitioners rely on two types of reference when prescribing remedies: Materia medica and repertories. A homeopathic Materia medica is a collection of “drug pictures”, organized alphabetically by remedy that describes the symptom patterns associated with individual remedies. A homeopathic repertory is an index of disease symptoms that lists remedies associated with specific symptoms.
Homeopathy uses many animal, plant, mineral, and synthetic substances in its remedies. Examples include arsenic oxide, sodium chloride or table salt, the venom of the bushmaster snake, Opium, and thyroid hormone. Homeopaths also use treatments called nosodes made from diseased or pathological products such as fecal, urinary, and respiratory discharges, blood, and tissue. Homeopathic remedies prepared from healthy specimens are called sarcodes. Some modern homeopaths have considered more esoteric bases for remedies, known as imponderables because they do not originate from a material but from electromagnetic energy presumed that is “captured” by alcohol or lactose. Recent ventures by homeopaths into even more esoteric substances include thunderstorms (prepared from collected rainwater). There are about 3,000 different remedies commonly used in homeopathy.
Homeopaths generally begin with detailed examinations of their patients’ histories, including questions regarding their physical, mental and emotional states, their life circumstances and any physical or emotional illnesses. The homeopath then attempts to translate this information into a complex formula of mental and physical symptoms, including likes, dislikes, innate predispositions and even body type. From these symptoms, the homeopath chooses how to treat the patient. A compilation of reports of many homeopathic provings, supplemented with clinical data, is known as a homeopathic materia medica. But because a practitioner first needs to explore the remedies for a particular symptom rather than looking up the symptoms for a particular remedy, the homeopathic repertory, which is an index of, lists after each symptom those remedies that are associated with it. Repertories are often very extensive and may include data extracted from multiple sources of materia medica. There is often lively debate among compilers of repertories and practitioners over the veracity of a particular inclusion. Some diversity in approaches to treatments exists among homeopaths. Classical homeopathy generally involves detailed examinations of a patient’s history and infrequent doses of a single remedy as the patient is monitored for improvements in symptoms, while clinical homeopathy involves combinations of remedies to address the various symptoms of an illness.
Bloodletting via Wikimedia Commons
Three logarithmic potency scales are in regular use in homeopathy. Hahnemann created the centesimal or C scale, diluting a substance by a factor of 100 at each stage. A 2C dilution requires a substance to be diluted to one part in one hundred, and then some of that diluted solution diluted by a further factor of one hundred. This works out to one part of the original substance in 10,000 parts of the solution. A 6C dilution repeats this process six times, ending up with the original material diluted by a factor of 100−6=10−12 (one part in one trillion)(1/1,000,000,000,000). Higher dilutions follow the same pattern. In homeopathy, a solution that is more dilute is described as having a higher potency, and more dilute substances are considered by homeopaths to be stronger and deeper-acting remedies. The end product is often so diluted that it is indistinguishable from the dilutant (pure water, sugar or alcohol).
Hahnemann advocated 30C dilutions for most purposes (that is, dilution by a factor of 1060). In Hahnemann’s time it was reasonable to assume that remedies could be diluted indefinitely, as the concept of the atom or molecule as the smallest possible unit of a chemical substance was just beginning to be recognized. The greatest dilution that is reasonably likely to contain one molecule of the original substance is 12C.
Some homeopaths developed a decimal scale (D or X), diluting the substance to ten times its original volume each stage. The D or X scale dilution is therefore half that of the same value of the C scale; for example, “12X” is the same level of dilution as “6C”. Hahnemann never used this scale but it was very popular throughout the 19th century and still is in Europe. This potency scale appears to have been introduced in the 1830s by the American homeopath, Constantine Hering. In the last ten years of his life, Hahnemann also developed a quintamillesimal (Q) or LM scale diluting the drug 1 part in 50,000 parts of diluent. A given dilution on the Q scale is roughly 2.35 times its designation on the C scale. For example a remedy described as “20Q” has about the same concentration as a “47C” remedy.
Homeopathy achieved its greatest popularity in the 19th century. Dr. John Franklin Gray (1804–1882) was the first practitioner of Homeopathy in the United States, beginning in 1828 in New York City. The first homeopathic schools opened in 1830, and throughout the 19th century dozens of homeopathic institutions appeared in Europe and the United States. By 1900, there were 22 homeopathic colleges and 15,000 practitioners in the United States. Because medical practice of the time relied on ineffective and often dangerous treatments, patients of homeopaths often had better outcomes than those of the doctors of the time. Homeopathic remedies, even if ineffective, would almost surely cause no harm, making the users of homeopathic remedies less likely to be killed by the treatment that was supposed to be helping them. The relative success of homeopathy in the 19th century may have led to the abandonment of the ineffective and harmful treatments of bloodletting and purging and to have begun the move towards more effective, science based medicine. One reason for the growing popularity of homeopathy was its apparent success in treating people suffering from infectious disease epidemics. During 19th century epidemics of diseases such as cholera, death rates in homeopathic hospitals were often lower than in conventional hospitals, where the treatments used at the time were often harmful and did little or nothing to combat the diseases.
Water Droplet via Wikimedia Commons
Homeopathy is fairly common in some countries while being uncommon in others; is highly regulated in some countries and mostly unregulated in others (Beyerstein, 1999). It is practiced worldwide and professional qualifications and licenses are needed in most countries. The regulation and prevalence of homeopathy is highly variable from country to country. There are no specific legal regulations concerning its use in some countries, while in others, licenses or degrees in conventional medicine from accredited universities are required (Bodeker, & Kronenberg, 2002). In several countries, homeopathy is covered by the national insurance coverage to different extents, while in some it is fully integrated into the national health care system (Bodeker, & Kronenberg, 2002). In many countries, the laws that govern the regulation and testing of conventional drugs do not apply to homeopathic remedies.
Homeopathy’s efficacy beyond the placebo effect is unsupported by the collective weight of scientific and clinical evidence (Beyerstein, 2001). While some individual studies have positive results, systematic review of published trials fail to demonstrate efficacy conclusively. Furthermore, higher quality trials tend to report less positive results, and most positive studies have not been replicated or show methodological problems that prevent them from being considered unambiguous evidence of homeopathy’s efficacy. An inquiry into the evidence base for homeopathy conducted by the United Kingdom’s House of Commons Science and Technology Committee concluded that homeopathy is no more effective than placebo (Deventer, 2008). Depending on the dilution, homeopathic remedies may not contain any pharmacologically active molecules, and for such remedies to have pharmacological effect would violate fundamental principles of science. Modern homeopaths have proposed that water has a memory that allows homeopathic preparations to work without any of the original substance; however, there are neither verified observations nor scientifically plausible physical mechanisms for such a phenomenon (Beyerstein, 1999). The lack of convincing scientific evidence supporting homeopathy’s efficacy and its use of remedies lacking active ingredients have caused homeopathy to be described as pseudoscience, quackery, and a “cruel deception” (Deventer, 2008).
VII. Naturopathic Medicine
The term naturopathy was coined in 1895 by John Scheel, and purchased by Benedict Lust, the “father of U.S. naturopathy”. Lust had been schooled in hydrotherapy and other natural health practices in Germany by Father Sebastian Kneipp. Kneipp sent Lust to the United States to spread his drugless methods. Lust defined naturopathy as a broad discipline rather than a particular method, and included such techniques as hydrotherapy, herbal medicine, and homeopathy, as well as eliminating overeating, tea, coffee, and alcohol. He described the body in spiritual and vitalistic terms with “absolute reliance upon the cosmic forces of man’s nature.”
In 1901, Lust founded the American School of Naturopathy in New York. In 1902, the original North American Kneipp Societies were discontinued and renamed “NATUROPATHIC Societies”. In September 1919 the Naturopathic Society of America was dissolved and Dr. Benedict Lust founded the “American Naturopathic Association” to supplant it. Naturopaths became licensed under naturopathic or drugless practitioner laws in 25 states in the first three decades of the twentieth century. Naturopathy was adopted by many chiropractors, and several schools offered both Doctor of Naturopathy (ND) and Doctor of Chiropractic (DC) degrees. Estimates of the number of naturopathic schools active in the United States during this period vary from about one to two dozen.
Naturopathic ideology focuses on naturally-occurring and minimally-invasive methods, trusting to the “healing power of nature.” Such treatments as “synthetic” drugs, radiation, and major surgery are avoided, and rejection of biomedicine and modern science in favor of an intuitive and vitalistic conception of the body and nature is common. Prevention through stress reduction and a healthy diet and lifestyle is emphasized. The philosophy of naturopathic practice is self-described by six core values. First, do no harm; provide the most effective health care available with the least risk to patients at all times. Recognize, respect and promote the self-healing power of nature inherent in each individual human being. Identify and remove the causes of illness, rather than eliminate or suppress symptoms. Educate, inspire rational hope and encourage self-responsibility for health. Treat each person by considering all individual health factors and influences. Emphasize the condition of health to promote well-being and to prevent diseases for the individual, each community and our world.
The focus of Naturopathy is on its philosophy of natural self-healing rather than specific methods, and practitioners use a wide variety of treatment modalities. Some methods rely on immaterial “vital energy fields”, the existence of which has not been proven. A consultation typically begins with a lengthy patient interview focusing on lifestyle, medical history, emotional tone, and physical features, as well as physical examination. The traditional naturopath focuses on lifestyle changes and approaches that support the body’s innate healing potential. Traditional naturopaths do not undertake to diagnose or treat diseases but concentrates on whole body wellness and facilitating the body healing itself. Traditional Naturopaths neither prescribe nor undertake to engage in the use of drugs, serums, potions, surgery or disease specific treatments or otherwise practice conventional medicine. Practitioners of naturopathic medicine hold themselves to be primary care providers and in addition to various natural approaches seek to prescribe legend drugs, perform minor surgery and apply other conventional medical approaches to their practice. Naturopaths do not necessarily recommend vaccines and antibiotics, and may provide inappropriate alternative remedies even in cases where evidence-based medicine has been shown effective (Fontanarosa, 1998).
All forms of naturopathic education include concepts incompatible with basic science, and do not necessarily prepare a practitioner to make appropriate diagnosis or referrals (Fontanarosa, 1998). Traditional naturopaths are represented in the US by two National Organizations, The American Naturopathic Association (ANA) founded in 1919 by Benedict Lust, representing about 5000 certified practitioners, and the American Naturopathic Medical Association (ANMA) founded in 1981 and representing about 4500 practitioners with several levels of certification. The ANMA also recognizes MDs, DOs and other conventional medical professionals who have integrated naturopathy into their practices (Barberis, Schiavone, Zicca, & Ghio, 2001).
ANA Certificate via Wikimedia Commons
The level of naturopathic training varies among traditional naturopaths in the United States. Traditional naturopaths may complete non-degree certificate programs or undergraduate degree programs and can certify at a practitioner level with the American Naturopathic Medical Certification Board (ANMCB) and generally refer to themselves as Naturopathic Consultants. There are also postgraduate doctoral degrees for traditional naturopaths. Those completing a Doctor of Naturopathy (ND) degree from an ANMCAB approved school can become a Board Certified Naturopathic Doctor with the ANMCAB traditional naturopaths completing a Doctor of Naturopathy (ND) degree at an National Board of Naturopathic Examiners of the ANA (NBNE) approved school can obtain certification becoming a delegate of the ANA. Medical Doctors (allopathic—MD or osteopathic—DO) with supplemental training in Naturopathy can become National Board Certified Naturopathic Physicians through the ANMCAB.
Traditional naturopathy, as defined by the profession and the US Congress in the early twentieth century does not require a license. Because naturopathic medicine undertakes to engage in activities generally requiring a medical license, its practice is only legal in those 15 states that regulate the profession; however practitioners of naturopathic medicine may practice traditional naturopathy throughout the United States. The American Association of Naturopathic Physicians (AANP) founded in 1985 and representing 2000 student, physicians, supporting and corporate members represent naturopathic Medicine in the US.
Naturopathy is practiced in many countries, especially the United States and Canada, and is subject to different standards of regulation and levels of acceptance. Naturopathic medicine is a modern manifestation of the field of naturopathy, a 19th-century health movement espousing “the healing power of nature.” Naturopathic physicians are now licensed in many states as primary care physicians proficient in the practice of both conventional and natural medicine (Barberis, Schiavone, Zicca, & Ghio, 2001). Pre-naturopathic education training varies depending on the institution, followed by at least four years of naturopathic medical education, including pharmacology and minor surgery. In the United States and Canada, the designation of Naturopathic Doctor (ND) or naturopathic medical doctor (NMD) may be awarded after completion of a four year program of study at an accredited Naturopathic medical school that includes the study of basic medical sciences as well as natural remedies and medical care (Barberis, Schiavone, Zicca, & Ghio, 2001). The scope of practice varies widely between jurisdictions, and naturopaths in unregulated jurisdictions may use the Naturopathic Doctor designation or other titles regardless of level of education.
Naturopathic Clinic via Wikimedia Commons
Naturopathy medicine is criticized for its reliance on and its association with unproven, disproven, and other controversial alternative medical treatments, and for its vitalistic underpinnings. As with any alternative care, there is a risk of misdiagnosis; this risk may be lower depending on level of training. There is also a risk that ailments that cannot be diagnosed by naturopaths will go untreated while a patient attempts treatment programs designed by their naturopath (Beyerstein, 1999). Certain naturopathic treatments, such as homeopathy and iridology, are widely considered pseudoscience (Barrett, 2004). Natural methods and chemicals are not necessarily safer or more effective than artificial or synthetic ones; any treatment capable of eliciting an effect may also have deleterious side effects.
VIII. Orthomolecular Medicine
(North America, 1948)
In the early 20th century, some doctors hypothesized that vitamins could cure disease, and supplements were prescribed in megadoses by the 1930s. Their effects on health were disappointing, though, and in the 1950s and 60s, nutrition was de-emphasized in standard medical curricula. Orthomolecularists claim several figures from these early days of enthusiasm about nutrition as founders of their movement, although Nobel laureate and chemist Linus Pauling coined the word “orthomolecular” only in 1967. The term “orthomolecular” means “the right molecules in the right amounts”. Pauling theorized that “substances that are normally present in the human body” are necessarily good and can be used at high doses to treat disease.
Linus Pauling via Wikimedia Commons
Amongst the individuals claimed posthumously as orthomolecularists are Max Gerson, who developed a diet that he claimed could treat diseases, which the American Medical Association’s 1949 Council on Pharmacy and Chemistry found ineffective; and the Shute brothers, who attempted to treat heart disease with vitamin E. Several concepts now claimed by orthomolecularists, including individual biochemical variation and inborn errors of metabolism, debuted in scientific papers early in the 20th century.
In 1948, William McCormick theorized that vitamin C deficiency played an important role in many diseases and began to use large doses in patients. In the 1950s, Fred R. Klenner also used vitamin C megadosage as a therapy for a wide range of illnesses, including polio. Irwin Stone claimed organisms that do not synthesize their own vitamin C due to a loss-of-function mutation have a disease he called “hypoascorbemia”. The medical community does not use this term, and Stone’s contemporaries did not endorse the idea of an organism-wide lack of a biosynthetic pathway as a disease.
In the 1950s, some individuals believed that vitamin deficiencies caused mental illness. Psychiatrists Humphry Osmond and Abram Hoffer gave people having acute schizophrenic episodes high doses of niacin, while William Kaufman used niacinamide. While niacin has no known efficacy in psychiatric disease, the use of niacin in combination with statins and other medical therapies has become one of several medical treatments for cardiovascular disease.
In the late 1960s, Linus Pauling introduced the expression “orthomolecular” to express the idea of the right molecules in the right amounts. Since the first claims of medical breakthroughs with vitamin C by Pauling and others, findings on the health effects of vitamin C have been controversial and contradictory. Pauling has been criticized for making overbroad claims. Later research branched out into nutrients besides niacin and vitamin C, including essential fatty acids.
Orthomolecular medicine focuses on what it sees as the right nutritional molecules in the right amounts for the individual. Proponents believe that low levels of these substances can cause chronic problems beyond vitamin deficiency. It often recommends megavitamin doses much larger than those recommended by medical authorities. Proponents state that nutrient treatments are based on patients’ personal biochemistries. Supplements are prescribed at high levels or “megadoses” beyond the Dietary Reference Intake. According to Abram Hoffer, “primitive” peoples do not consume processed foods and do not have “degenerative” diseases. In contrast, typical “Western” diets are said to be insufficient for long-term health, necessitating the use of megadose supplements of vitamins, dietary minerals, proteins, antioxidants, amino acids, omega-3 fatty acids, omega-6 fatty acids, medium chain triglycerides, dietary fiber, short and long chain fatty acids, lipotropes, systemic and digestive enzymes, other digestive factors, and prohormones to ward off hypothetical metabolism anomalies at an early stage, before they cause disease.
The first self-identified college of Osteopathy in Canada opened in 1981 (Barberis, Schiavone, Zicca, & Ghio, 2001). Non-physician osteopaths in Canada are currently represented by the Canadian Federation of Osteopaths, a group that advocates for the standardization of training requirements and more legal recognition for the non-medical osteopathic profession. This organization and the schools from which its membership have graduated are not recognized or accredited by any Canadian federal or provincial regulatory authority (Barberis, Schiavone, Zicca, & Ghio, 2001). Council on Manual Osteopathy Education (CMOE) accredits certain schools in Canada to ensure they adhere to certain standards as applicable to manual osteopathy education. The following manual osteopathy schools are currently accredited by CMOE to offer manual osteopathy education in Canada: The Canadian College of Osteopathy in Toronto, National Academy of Osteopathy in Toronto, the Canadian Academy of Osteopathy and Holistic Health Sciences in Hamilton, Ontario, and the Collège d’Études Ostéopathiques in Montreal, Quebec. Osteopathy is not yet a regulated profession in Ontario; however, practitioners, designated as Osteopathic Manual Practitioners to differentiate themselves from physician osteopaths from the United States, follow best practice guidelines set by the Ontario Association of Osteopathic Manual Practitioners (Barberis, Schiavone, Zicca, & Ghio, 2001). The Ontario Federation of Osteopathic Professionals is the association representing Osteopathic Therapists in Ontario, Canada. The goals of OFOP are to promote Osteopathy in Ontario and Canada, to maintain a high level of professional knowledge and conduct among Osteopaths.
Doctors of Osteopathic Medicine (DO) educated in the United States should not be confused with non-physician osteopaths (Barberis, Schiavone, Zicca, & Ghio, 2001). DOs are educated and trained in the United States and may practice in Canada as fully licensed physicians (Barberis, Schiavone, Zicca, & Ghio, 2001). There are no colleges of osteopathic medicine in Canada. Only those graduates of American Colleges of Osteopathic Medicine are eligible for licensure to practice Osteopathic Medicine in Canada. The authority for licensure of American osteopathic graduates lays with the provincial Colleges of Physicians and Surgeons (Barberis, Schiavone, Zicca, & Ghio, 2001). The Canadian Osteopathic Association has been representing osteopathic physicians in Canada for more than 80 years and has enabled near uniform licensure across Canada for American osteopathic graduates.
In the 20th century, osteopathy in the United States moved closer to mainstream medicine in its philosophy and scope of practice. Although manipulation and other principles of traditional osteopathy are still taught in some form in U.S. osteopathic medical schools, a small minority of graduates in actual practice uses them. The profession adopted the name “osteopathic medicine” to reflect its distinction from osteopathy. Since all former schools of “osteopathy” now refer to themselves as colleges of “osteopathic medicine”, there are currently no schools of osteopathy in the United States.
In the United States, pharmaceuticals must be proven safe and effective to the satisfaction of the FDA before they can be marketed, whereas dietary supplements must be proven unsafe before regulatory action can be taken (Bodeker, & Kronenberg, 2002). A number of orthomolecular supplements are available in the US in pharmaceutical versions that are sometimes quite similar in strength and general content, or in other countries are regulated as pharmaceuticals. The US regulations also have provisions to recognize a general level of safety for established nutrients that can forgo new drug safety tests (Bodeker, & Kronenberg, 2002). Proponents of orthomolecular medicine argue that supplements are less likely to cause dangerous side-effects or harm, since they are normally present in the body (Bodeker, & Kronenberg, 2002). Some vitamins are toxic in high doses and nearly all will cause adverse effects given high levels of overdosing for prolonged periods as recommended by orthomolecular practitioners.
Orthomolecular practitioners will often use dubious diagnostic methods to define what substances are “correct”; one example is hair analysis, which produces spurious results when used in this fashion. Proponents of orthomolecular medicine contend that, unlike some other forms of alternative medicine such as homeopathy, their ideas are at least biologically based, do not involve magical thinking, and are capable of generating testable hypotheses. Orthomolecular is not a standard medical term, and clinical use of specific nutrients is considered a form of chemoprevention (to prevent or delay development of disease) or chemotherapy (to treat an existing condition). Orthomolecularists say that they provide prescriptions for optimal amounts of micronutrients after individual diagnoses based on blood tests and personal histories. Lifestyle and diet changes may also be recommended. The battery of tests ordered includes many that are not considered useful by medicine.
Orthomolecular therapies have been criticized as lacking a sufficient evidence base for clinical use: their scientific foundations are too weak, the studies that have been performed are too few and too open to interpretation, and reported positive findings in observational studies are contradicted by the results of more rigorous clinical trials (Bodeker, & Kronenberg, 2002). Accordingly, “there is no evidence that orthomolecular medicine is effective”. Proponents of orthomolecular medicine strongly dispute this statement by citing studies demonstrating the effectiveness of treatments involving vitamins, though this ignores the belief that a normal diet will provide adequate nutrients to avoid deficiencies, and that orthomolecular treatments are not actually related to vitamin deficiency (Beyerstein, 2001). The lack of scientifically rigorous testing of orthomolecular medicine has led to its practices being classed with other forms of alternative medicine and regarded as unscientific (Joyce, 1994). It has been described as food faddism, with critics arguing that it is based upon an “exaggerated belief in the effects of nutrition upon health and disease” (Bodeker, & Kronenberg, 2002).
A 2002 survey found that around one in twenty-five US adults uses megadose therapy, a practice particularly common among cancer patients. Nutrients may be useful in preventing and treating some illnesses, but the broad claims made by advocates of megavitamin therapy are considered unsubstantiated by available medical evidence. Critics have described some aspects of orthomolecular medicine as food faddism. Research suggests that some nutritional supplements might be harmful; several specific vitamin therapies are associated with an increased risk of cancer, heart disease, or death.
IX. Traditional Chinese Medicine
(China, 2698 BCE)
The same philosophy that informs Taoist and Buddhist thought informs the philosophy of traditional Chinese medicine, which reflects the classical Chinese belief that the life and activity of individual human beings have an intimate relationship with the environment on all levels. Traditional Chinese medicine, also known as TCM, includes a range of traditional medicine practices originating in China. Although well accepted in the mainstream of medical care throughout East Asia, it is considered an alternative medical system in much of the Western world.
TCM practices include such treatments as Chinese herbal medicine, acupuncture, dietary therapy, and both Tui na and Shiatsu massage. Qigong and Taijiquan are also closely associated with TCM. Major theories include: Yin-yang, the Five Phases, the human body Meridian/Channel system, Zang Fu organ theory, six confirmations, four levels, etc. In legend, as a result of a dialogue with his minister Qibo, the Yellow Emperor (2698 - 2596 BCE) is supposed by Chinese tradition to have composed his Neijing: Suwen or Inner Canon: Basic Questions. The book Huangdi Neijing, Yellow Emperor’s Inner Canon’s title is often mistranslated as Yellow Emperor’s Classic of Internal Medicine.
Statue of Hua Tuo via Wikimedia Commons
During the Han Dynasty (202 BC–220 AD), Zhang Zhongjing, China’s Hippocrates, who was mayor of Chang-sha toward the end of the 2nd century AD, wrote a Treatise on Cold Damage, which contains the earliest known reference to Neijing Suwen. Another prominent Eastern Han physician was Hua Tuo (c. 140–c. 208 AD), who anesthetized patients during surgery with a formula of wine and powdered cannabis. Hua’s physical, surgical, and herbal treatments were also used to cure headaches, dizziness, worms, fevers, coughing, blocked throat, and even a diagnosis for one lady that she had a dead fetus within her that needed to be taken out. The Jin dynasty practitioner and advocate of acupuncture and moxibustion, Huang-fu Mi (215 - 282 AD), also quoted the Yellow Emperor in his Jia Yi Jing ca. 265 AD. During the Tang dynasty, Wang Bing claimed to have located a copy of the originals of the Neijing Suwen, which he expanded and edited substantially. An imperial commission during the 11th century AD revisited this work.
TCM is largely based on the philosophical concept that the universe is made of an energy called qi. This energy can be any state of matter or energy in existence. TCM believes that the body is a small universe unto itself that is a complex of subsystems of energy and matter, and that these systems work together to maintain a healthy mind andbody. The characteristics of the operation of the mind/body are described in terms of the five elements (metal, water, wood, fire, and earth), Yin/Yang organs, deficiency/excess, emptiness/fullness, hot/cold, wind, dampness, pathogens, internal/external, meridian channels, qi (several different types), essences, body fluids, vessels and more. TCM posits that illness is caused by external and/or internal factors that disrupt the body’s natural processes. The body concept is based on a functional description, as opposed to discrete tissues or specific organic compounds. An additional difference from modern science is a functional description of the mind and emotions as a result of various internal organs ratherthan the brain. This functional approach makes it possible to treat the entire mind and body not just the mind or just the body, through the therapies available in this system.
The most prominent branches of Chinese medicine are the Jingfang and Wenbing schools. The Jingfang school relies on the principles contained in the Chinese medicine classics of the Han and Tang dynasty, such as Huangdi Neijing and Shennong. The more recent Wenbing school’s practice is largely based on more recent books including Compendium of Materia Medica from the Ming and Qing Dynastys, although in theory the school follows the teachings of the earlier classics as well. Intense debates between these two schools lasted until the Cultural Revolution in China, when Wenbing used political power to suppress the opposing school.
Yin and Yang Symbol via Wikimedia Commons
TCM consists of various forms of observation including visual, auditory, olfactory, touch, and questioning. These observations take the form of descriptions of color, moisture and heat, among many others to ultimately identify a pattern that can be subsequently treated. Methods for diagnostic pattern recognition include the following: The Yin/Yang and five element theories may be applied to a variety of systems other than the body, whereas Zang Fu theory, meridian theory and three-jiao (Triple warmer) theories are more specific. Separate models apply to specific pathological influences, such as the Four stages theory of the progression of warm diseases, the Six levels theory of the penetration of cold diseases, and the Eight principles system of disease classification.
Traditional Chinese medicine requires considerable diagnostic skill. A training period of years or decades is necessary for TCMpractitioners to understand the full complexity of symptoms and dynamic balances. According to one Chinese saying, a good doctor is also qualified to be a good prime minister in a country. Modern practitioners in China often combine a traditional system with Western methods (Aratani, 2009). Techniques include palpation of the patient’s radial artery pulse in six positions, observations of patient’s tongue, voice, hair, face, posture, gait, eyes, ears, vein on index finger of small children, palpation of the patient’s body for tenderness or comparison of relative warmth or coolness of different parts of the body and observation of the patient’s various odors. The treatment methods that are part of Chinese medicine include, acupuncture, auriculotherapy, chinese food therapy, chinese herbal medicine, cupping etc. Some TCM doctors may also use esoteric methods that incorporate or reflect personal beliefs or specializations such as Fengshui or Bazi.
Much of the scientific research on TCM has focused on acupuncture. The effectiveness of acupuncture remains controversial in the scientific community (Aratani, 2009). Researchers using evidence-based medicine have found good evidence that acupuncture is moderately effective in preventing nausea (Aratani, 2009). There is conflicting evidence that it can treat chronic low back pain, and moderate evidence of efficacy for neck painand headache. For most other conditions reviewers have found either a lack of efficacy or have concluded that there is insufficient evidence to determine if acupuncture is effective (Aratani, 2009). Several cases of pneumothorax, nerve damage and infection have been reported as resulting from acupuncture treatments. These adverse events are extremely rare especially when compared to other medical interventions, and were found to be due to practitioner negligence. Dizziness and bruising sometimes result from acupuncture (Aratani, 2009).
Acupuncture via Wikimedia Commons
While little is known about the mechanisms by which acupuncture may act, a review of neuroimaging research suggests that specific acupuncture points have distinct effects on cerebral activity in specific areas that are not otherwise predictable anatomically (Aratani, 2009). The World Health Organization (WHO), the National Institutes of Health (NIH), and the American Medical Association (AMA) have also commented on acupuncture. Though these groups disagree on the standards and interpretation of the evidence for acupuncture, there is general agreement that it is relatively safe, and that further investigation is warranted.
Alternative medicine is any healing practice that does not fall within the realm of conventional medicine, or that has not been shown consistently to be effective (Eisenberg, Kessler, Foster, Norlock, Calkins, & Delbanco, 1993). It is opposed to evidence based medicine and encompasses therapies with a historical or cultural, rather than a scientific, basis. Characteristics of alternative medicine include a focus on individualizing treatments, treating the whole person, promoting self-care and self-healing, and recognizing the spiritual nature of each individual but lacks or has only limited experimental and clinical study (Eisenberg, Kessler, Foster, Norlock, Calkins, & Delbanco, 1993).
Practices may incorporate or base themselves on traditional medicine, folk knowledge, spiritual beliefs, or newly conceived approaches to healing (Barrett, 2004). Because alternative techniques tend to lack evidence, or may even have repeatedly failed to work in tests, some have advocated defining it as non-evidence based medicine, or not medicine at all. Mind-body medicine takes a holistic approach to health that explores the interconnection between the mind, body, and spirit. It works under the premise that the mind can affect “bodily functions and symptoms”. There is a debate among medical researchers over whether any therapy may be properly classified as ‘alternative medicine’ (Barrett, 2004).
Some claim that there is only medicine which has been adequately tested and that which has not. They feel that health care practices should be classified based solely on scientific evidence (Dawkins, 2003). If a treatment has been rigorously tested and found safe and effective traditional medicine will adopt it regardless of if it was considered alternative to begin with. It is thus possible for a method to change categories (proven vs. unproven), based on increased knowledge of its effectiveness or lack thereof. Richard Dawkins defines alternative medicine as a “set of practices which cannot be tested, refuse to be tested, or consistently fail tests” (Dawkins, 2003). He says that if a technique is demonstrated effective in properly performed trials, it ceases to be alternative and simply becomes medicine (Dawkins, 2003).
A letter by four Nobel Laureates and other prominent scientists deplored the lack of critical thinking and scientific rigor in National Institutes of Health supported alternative medicine research. In 2009 a group of scientists made a proposal to shut down the National Center for Complementary and Alternative Medicine. They argued that the vast majority of studies were based on unconventional understandings of physiology and disease and have shown little or no effect (Atwood, 2009). Further, they argue that the field’s more-plausible interventions such as diet, relaxation, yoga and botanical remedies can be studied just as well in other parts of NIH, where they would need to compete with conventional research projects. These concerns are supported by negative results in almost all studies conducted over ten years at a cost of $2.5 billion by the NCCAM. R. Barker Bausell states, “it’s become politically correct to investigate nonsense” (Atwood, 2009). There are concerns that just having NIH support is being used to give unfounded “legitimacy to treatments that are not legitimate” (Atwood, 2009).
Most alternative medical treatments are not patentable, which may lead to less research funded by the private sector (Brown, 2009). Additionally, in most countries alternative treatments can be marketed without any proof of efficacy—also a disincentive for manufacturers to fund scientific research (Atwood, 2009). Some have proposed adopting a prize system to reward medical research. However, public funding for research exists (Brown, 2009). Increasing the funding for research of alternative medicine techniques was the purpose of the US National Center for Complementary and Alternative Medicine. NCCAM and its predecessor, the Office of Alternative Medicine, have spent more than $1 billion on such research since 1992 (Atwood, 2009).
Some skeptics of alternative practices say that a person may attribute symptomatic relief to an otherwise ineffective therapy due to the placebo effect, the natural recovery from or the cyclical nature of an illness (the regression fallacy), or the possibility that the person never originally had a true illness (Atwood, 2009). In the same way as for conventional therapies, drugs, and interventions, it can be difficult to test the efficacy of alternative medicine in clinical trials (Angell, & Kassirer, 1998). In instances where an established, effective, treatment for a condition is already available, the Helsinki Declaration states that withholding such treatment is unethical in most circumstances. Use of standard-of-care treatment in addition to an alternative technique being tested may produce confounded or difficult-to-interpret results.
Conventional treatments are subjected to testing for undesired side-effects, whereas alternative treatments generally are not subjected to such testing at all (Angell, & Kassirer, 1998). Any treatment — whether conventional or alternative — that has a biological or psychological effect on a patient may also have potentially dangerous biological or psychological side-effects. Attempts to refute this fact with regard to alternative treatments sometimes use the appeal to nature fallacy, i.e. “that which is natural cannot be harmful” (Angell, & Kassirer, 1998).
Danger can be increased when used as a complement to standard medical care (Angell, & Kassirer, 1998). A Norwegian multicentre study examined the association between the use of alternative medicine and cancer survival. 515 patients using standard medical care for cancer were followed for eight years. 22% of those patients used alternative medicine concurrently with their standard care (Atwood, 2009). The study revealed that death rates were 30% higher in alternative medicine users than in those who did not use alternative medicine (AM): “Death rates were higher in AM users (79%) than in those who did not use AM (65%).... The use of AM seems to predict a shorter survival from cancer” (Atwood, 2009).
Jurisdictions where alternative medical practices are sufficiently widespread may license and regulate them (Atwood, 2009). The claims made by alternative medicine practitioners are generally not accepted by the medical community because evidence-based assessment of safety and efficacy is either not available or has not been performed for these practices. If scientific investigation establishes the safety and effectiveness of an alternative medical practice, it then becomes mainstream medicine and is no longer “alternative”, and may therefore become widely adopted by conventional practitioners (Atwood, 2009). Some researchers state that the evidence-based approach to defining CAM is problematic because some CAM is tested, and research suggests that many mainstream medical techniques lack solid evidence (Atwood, 2009).
A 1998 systematic review of studies assessing its prevalence in 13 countries concluded that about 31% of cancer patients use some form of complementary and alternative medicine (Cassileth, 1999). Alternative medicine varies from country to country. Edzard Ernst says that in Austria and Germany CAM is mainly in the hands of physicians, while some estimates suggest that at least half of American alternative practitioners are physicians (Ernst, 1995). In Germany, herbs are tightly regulated, with half prescribed by doctors and covered by health insurance based on their Commission E legislation (Ernst, 2003).
A number of alternative medicine advocates disagree with the restrictions of government agencies that approve medical treatments (Angell, & Kassirer, 1998). In the United States, for example, critics say that the Food and Drug Administration's criteria for experimental evaluation methods impedes those seeking to bring useful and effective treatments and approaches to the public, and that their contributions and discoveries are unfairly dismissed, overlooked or suppressed (Angell, & Kassirer, 1998). Alternative medicine providers recognize that health fraud occurs, and argue that it should be dealt with appropriately when it does, but that these restrictions should not extend to what they view as legitimate health care products (Atwood, 2009).
The production of modern pharmaceuticals is strictly regulated to ensure that medicines contain a standardized quantity of active ingredients and are free from contamination. Alternative medicine products are not subject to the same governmental quality control standards, and consistency between doses can vary (Angell, & Kassirer, 1998). This leads to uncertainty in the chemical content and biological activity of individual doses. This lack of oversight means that alternative health products are vulnerable to adulteration and contamination (Angell, & Kassirer, 1998). This problem is magnified by international commerce, since different countries have different types and degrees of regulation (Atwood, 2009). This can make it difficult for consumers to properly evaluate the risks and qualities of given products (Atwood, 2009).
Despite all of this, in the United States, increasing numbers of medical colleges have started offering courses in alternative medicine. 60% of the standard medical schools, 95% of osteopathic medical schools and 84.8% of the nursing schools teach some form of CAM (Barberis, Schiavone, Zicca, & Ghio, 2001). The University of Arizona College of Medicine offers a program in Integrative Medicine under the leadership of Andrew Weil that trains physicians in various branches of alternative medicine which “...neither rejects conventional medicine, nor embraces alternative practices uncritically” (Barberis, Schiavone, Zicca, & Ghio, 2001).
Accredited Naturopathic colleges and universities are also increasing in number and popularity in Canada and the USA. In Connecticut, the University of Connecticut Medical School sponsors exposure to Ayurveda in periodic seminars and courses, for example, on mental health by a Yale affiliated medical doctor and psychiatrist (Barberis, Schiavone, Zicca, & Ghio, 2001). Similarly unconventional medicine courses are widely represented at European universities. They cover a wide range of therapies. Many of them are used clinically. Research work is underway at several faculties, but only 40% of the responding European universities were offering some form of CAM training (Atwood, 2009).
After reading this chapter, one should have a detailed understanding of what each medicine is, it’s history, the characteristics of each medicine, it’s educational progress and how it does not work. Each medicine is growing in popularity and education taking resources away from beneficial research. None of these medicines are recent, nor have they been effective within the time they have existed. Through evolution the unbeneficial traits are eliminated or replaced with useful traits, so why are these unbeneficial medicines taking resources after all this time?
A study published in 1999 indicates that a majority of alternative medicine use was in conjunction with standard medical treatments (Alcock, 1999). Approximately 4.4 percent of those studied used alternative medicine as a replacement for conventional medicine (Alcock, 1999). The research found that those who used alternative medicine tended to have higher education or report poorer health status. Dissatisfaction with conventional medicine was not a meaningful factor in the choice, but rather the majority of alternative medicine users appear to be doing so largely because “they find these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life” (Alcock, 1999). In particular, subjects reported a holistic orientation to health, a transformational experience that changed their worldview, identification with a number of groups committed to environmentalism, feminism, psychology, and/or spirituality and personal growth, or that they were suffering from a variety of common and minor ailments - notably anxiety, back problems, and chronic pain (Alcock, 1999).
There is also an increase in conspiracy theories towards conventional medicine and pharmaceutical companies, mistrust of traditional authority figures, such as the physician, and a dislike of the current delivery methods of scientific biomedicine, all of which have led patients to seek out alternative medicine to treat a variety of ailments (Astin, 1998). Many patients lack access to contemporary medicine, due to a lack of private or public health insurance, which leads them to seek out lower-cost alternative medicine (Astin, 1998). Medical doctors are also aggressively marketing alternative medicine to profit from this market.
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