What is Alternative Medicine?

Dr Galen

As happens from time to time we have a spate of threads in the forum regarding alt health, or all things complimentary.

A simple question I ask is posed above. What makes something alt or complimentary? Is it a lack of scientific proof? Is it because its not common in the mainstream of medicine that we all mostly work in or around? IS it something else completely?

I'll pose an example based on my own experience and area of most knowledge, that of wound care. Years ago, it was suggested that sticking some silver into wound dressings would be a good idea. That it would help deal with infected wounds, lowering bioburden and generally creating a much healthier wound healing environment. Nowadays, all the mainstream dressing manufacturers have a range of silver based dressings and such. There is oodles of work done on the area, some supportive, some not quite so, but mainly its not seen as an "alternative" treatment for an infected wound. Silver as an antimicrobial has been around for donkeys though, going back to the ancient Egyptians, and thus in the modern debates around alt/CAM would be seen as having its roots in that sphere.

Anyway, i think people should get what I'm asking here, if not, ask me to clarify!

The question gets even more complex when you add in the fact that some quacks use real medical techniques for different proposes altogether.

For example some people put thier autistic children through chelation therapy, cause you know, mercury and toxins and stuff.

http://en.wikipedia.org/wiki/Chelation_therapy#Autism

Dr Galen

Ok so leaving aside the kinda out-there ones, what constitutes an alt treatment say that one can buy over the counter in a pharmacy or Boots for example? What makes something alt?

Dr Galen

Dr Galen wrote: »

Ok so leaving aside the kinda out-there ones, what constitutes an alt treatment say that one can buy over the counter in a pharmacy or Boots for example? What makes something alt?

Well most alternative medicines are proud of that fact and will display it on the box etc.

But I suppose if you exclude the magic stuff it gets a bit fuzzy.

Then again if it refers to "detoxing" or "toxins" it's probably on the woo side.

bleg

I find a good rule of thumb is if it mentions the word "science" on the box it is "alternative medicine" and bollox.

Kurtosis

Very good question/post, I'm sure it will stimulate plenty of healthy debate

While I'm not going to try to answer the question at the moment (I don't have a big post in me at this time of the day!) I would like to add, or perhaps complicate matters, with a couple of points.

Firstly, I've done it myself many times I'm sure, but there is a tendency to cover a whole host of therapies under the heading of CAM, complementary and alternative therapy. However there is an important distinction to be made between what is complementary and what is alternative which is often forgotten. The former is intended for use in combination with other therapies ("conventional" medicine for instance), while the latter is a substitute or replacement for other therapies. The danger of adding a benign complementary therapy to medicine is very minimal, while replacing medicine with an alternative therapy has large potential for harm.

Secondly, while many alternative therapies have their roots in ancient times (and like silver in the OP) and in nature, some of these natural remedies of times gone by have been found to actually be effective. Many are now widely used in medicinal products, for example aspirin being derived from salicylic acid in willow bark, digoxin from Digitalis lanata (Foxglove) for heart failure and the taxol alkaloids from yew trees used in cancer. Ethnopharmacology is another big area looking at folk remedies used by ethnic groups and has given us the vinca alkaloids as anti-cancer agents. So all I would say is some natural or primitive therapies can yield useful medicines.

locum-motion

Dr Galen wrote: »

...What makes something alt?

I could spend an hour typing an answer to that question, but I won't. Here's a brief answer.

For me the defining characteristics of an 'alt' therapy are twofold; the claims made in favour of the therapy and the explanations proposed for how they are supposed to work. Homeopathy is of course one, and its claims and explanations have been covered in the other thread.

Another one of my personal 'favourites' is Bach Flower Remedies. For those that don't know, these are a collection of about 20-30 flower essences sold in a solution in brandy that are claimed to treat various negative emotions. All very nice and fluffy and nebulous and therefore difficult to measure. As regards the claims made for how it works, their literature talks about Dr. Bach conducting experiments to see which flowers were useful for which emotions. So far, all very Hahneman-like, with the provings and so on, but then it starts to get really far out; apparently, Dr. Bach became over time so 'in tune' with flowers, that he could tell which flowers would treat which emotions simply by holding his hands over the flower.

Now, that's Alt!

Dr Galen

penguin88 wrote: »

Very good question/post, I'm sure it will stimulate plenty of healthy debate

While I'm not going to try to answer the question at the moment (I don't have a big post in me at this time of the day!) I would like to add, or perhaps complicate matters, with a couple of points.

Firstly, I've done it myself many times I'm sure, but there is a tendency to cover a whole host of therapies under the heading of CAM, complementary and alternative therapy. However there is an important distinction to be made between what is complementary and what is alternative which is often forgotten. The former is intended for use in combination with other therapies ("conventional" medicine for instance), while the latter is a substitute or replacement for other therapies. The danger of adding a benign complementary therapy to medicine is very minimal, while replacing medicine with an alternative therapy has large potential for harm.

Secondly, while many alternative therapies have their roots in ancient times (and like silver in the OP) and in nature, some of these natural remedies of times gone by have been found to actually be effective. Many are now widely used in medicinal products, for example aspirin being derived from salicylic acid in willow bark, digoxin from Digitalis lanata (Foxglove) for heart failure and the taxol alkaloids from yew trees used in cancer. Ethnopharmacology is another big area looking at folk remedies used by ethnic groups and has given us the vinca alkaloids as anti-cancer agents. So all I would say is some natural or primitive therapies can yield useful medicines.

I think this is a very interesting post and you make a good point regarding the difference between complimentary and alternative.

I think maybe a good example of complimentary would be the common usage of pro-biotics etc as a dietary addon. Aoriund the time I was training, this was something that caught on in many hospitals in Dublin. Many patients who were were on mostly antibx were also supplemented with those drinks etc. I noticed a while back that the local pharmacy had started selling products in this ilk. All claimed to be natural and good and wholesome. Had a gander at the pricing though and was shocked. The product was over €20. Not sure how long you would get out of the box of stuff, but seeing as a few Yakult in the supermarket across the road were 4.50, i think that might be better value tbh.

Have no real grounding in nutrition though, apart from were it links into tissue repair, so I really can't comment on effectiveness of such things, still though i think it shows again how what maybe once was considered "alternative" can cross the bridge and become complimentary or even standard of care

nesf

locum-motion wrote: »

I could spend an hour typing an answer to that question, but I won't. Here's a brief answer.

For me the defining characteristics of an 'alt' therapy are twofold; the claims made in favour of the therapy and the explanations proposed for how they are supposed to work. Homeopathy is of course one, and its claims and explanations have been covered in the other thread.

Another one of my personal 'favourites' is Bach Flower Remedies. For those that don't know, these are a collection of about 20-30 flower essences sold in a solution in brandy that are claimed to treat various negative emotions. All very nice and fluffy and nebulous and therefore difficult to measure. As regards the claims made for how it works, their literature talks about Dr. Bach conducting experiments to see which flowers were useful for which emotions. So far, all very Hahneman-like, with the provings and so on, but then it starts to get really far out; apparently, Dr. Bach became over time so 'in tune' with flowers, that he could tell which flowers would treat which emotions simply by holding his hands over the flower.

Now, that's Alt!

A side example I have is some Passionflower extract in tincture form. It makes no direct claims of effect on the box or the literature. None. Not even a suggested use! This is despite there being some evidence (early, not great human studies with some animal studies) for it being useful as a sedative and for congestive heart failure.

I find this fascinating, they could justifiably claim these uses on the box and refer to studies as back-up. Not enough evidence for things to be clear-cut sure but enough to make an advertising claim. Yet they don't, which I find weird.

El_Dangeroso

nesf wrote: »

I find this fascinating, they could justifiably claim these uses on the box and refer to studies as back-up. Not enough evidence for things to be clear-cut sure but enough to make an advertising claim. Yet they don't, which I find weird.

They don't want to be sued bottom line. If someone takes that instead of their prescibed medicine and dies then they will get the pants sued off them.

What's the evidence for it btw?

lonestargirl

nesf wrote: »

A side example I have is some Passionflower extract in tincture form. It makes no direct claims of effect on the box or the literature. None. Not even a suggested use! This is despite there being some evidence (early, not great human studies with some animal studies) for it being useful as a sedative and for congestive heart failure.

I find this fascinating, they could justifiably claim these uses on the box and refer to studies as back-up. Not enough evidence for things to be clear-cut sure but enough to make an advertising claim. Yet they don't, which I find weird.

There's a very fine line between advertising and a medical claim, presumably they don't want it classed as a medication and thus needing to be licensed by IMB.

nesf

Temple_Grandin wrote: »

They don't want to be sued bottom line. If someone takes that instead of their prescibed medicine and dies then they will get the pants sued off them.

What's the evidence for it btw?

Some papers in the bibliography here: http://www.healthline.com/natstandardcontent/passion-flower?brand=#H1

It's graded as C by Natural Standard: i.e.

Evidence of benefit from >1 small RCT(s) without adequate size, power, statistical significance, or quality of design by objective criteria,* OR conflicting evidence from multiple RCTs without a clear majority of the properly conducted trials showing evidence of benefit or ineffectiveness, OR evidence of benefit from >1 cohort/case-control/non-randomized trials AND without supporting evidence in basic science, animal studies, or theory, OR evidence of efficacy only from basic science, animal studies, or theory.

So some small bit of evidence but nothing major or compelling.

From HealthLine about sedation which is what I'm most interested in:

Passion flower has a long history of use for symptoms of restlessness, anxiety, and agitation. Early evidence from animal studies and weak human trials supports these uses. Better research is needed before a firm conclusion can be drawn.

So again, some evidence, nothing compelling.

Capt'n Midnight

I love Dara O'Brein's answer where he says they looked all the old stuff and took the bits that worked and called it medicine.



TBH anything that doesn't do statistically better than the placebo effect shouldn't really be offered as a treatment.

Actually I'd nearly say that we should be careful of expensive treatments that while are better than placebo aren't much better than the current treatments, without offering some other benefits.

nesf

Capt'n Midnight wrote: »

I love Dara O'Brein's answer where he says they looked all the old stuff and took the bits that worked and called it medicine.



TBH anything that doesn't do statistically better than the placebo effect shouldn't really be offered as a treatment.

Actually I'd nearly say that we should be careful of expensive treatments that while are better than placebo aren't much better than the current treatments, without offering some other benefits.

Does higher expense increase the placebo effect? Ditto with it being the latest or traditional therapy etc.

El_Dangeroso

nesf wrote: »

Does higher expense increase the placebo effect? Ditto with it being the latest or traditional therapy etc.

Well it works for wine..:pac:

http://news.cnet.com/8301-13580_3-9849949-39.html

Capt'n Midnight

nesf wrote: »

Does higher expense increase the placebo effect? Ditto with it being the latest or traditional therapy etc.

Aspirin is a good painkiller, it is generic and ridiculously cheap, it's just a tad dangerous for some people ( children ) and those who don't need their blood thinned. Because it's so cheap and available people forget that it's actually quite good. If it was discovered tomorrow you would probably need a prescription for it too and that would placebo it a lot.

just look at the numbers of people who want pills and prescriptions

Almost any new painkiller will be patented and will be far more profitable than aspirin, and yes if it has fewer side effects it's worth using in those cases that warrant it. But if it only mimics the effect of a generic then it's just marketing.


Confidence tricksters can be good at making you feel relaxed and better about your self. Well at least until you realise you've lost a lot of money
I'm not saying alternative medicine is a con, it's just that personnel interaction is huge part of feeling well.

I'm sure there are plenty of doctors who recognise that they need more people skills but it's a lot harder to walk away from 7 years of training than a few weeks of XYZ alternative medicine course. Not sure what the failure rate is for medicine but I'd be very sure that there are a lot more people who have done alternative medicine courses than than are practicing it, so the filtering of those who don't please their target audience is higher. Also doctors tend to upset people more by telling them stuff like "the tests came back and I'm afraid it's not good news" . And people tend to go to doctors for stuff that is immediately life threatening even if it involves a crowded ER and a zombified* junior doctor, by comparison alternative medicine gets the easier stuff.

*sleep deprivation does strange and unpleasant things

nesf

nesf wrote: »

Does higher expense increase the placebo effect? Ditto with it being the latest or traditional therapy etc.

Absolutely. More expensive pills are much better placebos.

Also the more dramatic the placebo the better it works. An injection works better than a pill.

ORLY?

Capt'n Midnight wrote: »

it's just a tad dangerous for some people ( children ) and those who don't need their blood thinned.

Aspirin is more than a tad dangerous really for quite a lot of people. I hate that it's not prescription.

Capt'n Midnight

ORLY? wrote: »

Aspirin is more than a tad dangerous really for quite a lot of people. I hate that it's not prescription.

Passenger: "Stewardess, what exactly is a 'tad'?"
Elaine: "In space terms, that's half a million miles."

N8

Dr Galen wrote: »

As happens from time to time we have a spate of threads in the forum regarding alt health, or all things complimentary.

A simple question I ask is posed above. What makes something alt or complimentary?

Medicine involves the diagnosis and treatment of disease with the use of drugs, radiation and surgery.

Complimentary medicine involves those therapies that compliment medicine: massage, nutritional advice, are but to name two.

Alternative (to) medicine involves the treatment of disease with everything but drugs, radiation and surgery.

ORLY?

N8 wrote: »

Medicine involves the diagnosis and treatment of disease with the use of drugs, radiation and surgery.

Complimentary medicine involves those therapies that compliment medicine: massage, nutritional advice, are but to name two.

Alternative (to) medicine involves the treatment of disease with everything but drugs, radiation and surgery.

Not really.

For example, the primary intervention for non insulin dependent diabetes is a change in diet and increase in exercise. Look in any clinical medicine book and you'll find it there.

sam34

or the first intervention for treatment of hypertension is lifestyle changes - diet, exercise, stopping smoking etc

Vorsprung

And among those working in hospitals are physiotherapists, occupational therapists and speech and language therapists.

nesf

Vorsprung wrote: »

And among those working in hospitals are physiotherapists, occupational therapists and speech and language therapists.

Actually you'll find it's all part of Big Pharma's conspiracy and these people secretly apply drugs and/or radiation to people while pretending to offer non-drug/radiation treatment..

YFlyer

nesf wrote: »

Actually you'll find it's all part of Big Pharma's conspiracy and these people secretly apply drugs and/or radiation to people while pretending to offer non-drug/radiation treatment..

Eh I don't understand what you are saying here

N8

ORLY? wrote: »

Not really.

For example, the primary intervention for non insulin dependent diabetes is a change in diet and increase in exercise. Look in any clinical medicine book and you'll find it there.

sam34 wrote: »

or the first intervention for treatment of hypertension is lifestyle changes - diet, exercise, stopping smoking etc

whilst I have no doubt of your sincerity and this would be ideal it rarely happens in either recommendation or follow through

Vorsprung wrote: »

And among those working in hospitals are physiotherapists, occupational therapists and speech and language therapists.

and as therapists are complimentary to the medical profession

N8

N8 wrote: »

whilst I have no doubt of your sincerity and this would be ideal it rarely happens in either recommendation or follow through

Can you please explain how you know this rarely happens?
Or is it only because they refute you silly point?

N8 wrote: »

and as therapists are complimentary to the medical profession

But none of those are considered Complimentary medicines either by themselves or by medical professionals.
Again seems the only reason you have to claim these are "complimentary" is because otherwise would refute your point.

N8

King Mob wrote: »

Can you please explain how you know this rarely happens?
Or is it only because they refute you silly point?

Because it rarely happens in practice. There is the cursory mention of lifestyle changes / interruptions that accompany the prescription, more often than not due to known patient intransigence based upon prior interaction, rather than any incompetence or ineptitude on that doctor's behalf.

Hardly silly rather an observation of real life.

King Mob wrote: »

But none of those are considered Complimentary medicines either by themselves or by medical professionals.

None are considered alternative therapies but they are complimentary to medical practice - are they not?

King Mob wrote: »

Again seems the only reason you have to claim these are "complimentary" is because otherwise would refute your point.

Yawn - in any discussion I am entitled to my opinion unless of course challenged by a skepdick cynic then I must bow.

N8

N8 wrote: »

Because it rarely happens in practice. There is the cursory mention of lifestyle changes / interruptions that accompany the prescription, more often than not due to known patient intransigence based upon prior interaction, rather than any incompetence or ineptitude on that doctor's behalf.

Hardly silly rather an observation of real life.

Again, how do you know this is the case?
Are you challenging the idea that the treatments listed are valid and used?

N8 wrote: »

None are considered alternative therapies but they are complimentary to medical practice - are they not?

No because they are medical practices.

Can you please point to a physiotherapy/speech therapy organisation that considers the practices complimentary medicine?

N8 wrote: »

Yawn - in any discussion I am entitled to my opinion unless of course challenged by a skepdick cynic then I must bow.

You're entitled to you opinion.
However opinion does not equal fact.
Facts are the ones you have to back up.

But it's often easier to accuse people of cynicism or trying to silence you than to back up claims...

Alun

[Grammar Nazi Mode]
It's complementary medicine.
[/Grammar Nazi Mode]

N8

Alun wrote: »

[Grammar Nazi Mode]
It's complementary medicine.
[/Grammar Nazi Mode]

thanks

com·ple·men·ta·ry (pron. kämpləˈment(ə)rē)
Adjective
1. Completing; forming a complement.
2. (of two or more different things) Combining in such a way as to enhance or emphasize each other's qualities.

as opposed to

com·pli·men·ta·ry (pron. kämpləˈmentərē)
Adjective
1. Expressing a compliment; praising or approving.
2. Given or supplied free of charge.

Vorsprung

nesf wrote: »

Actually you'll find it's all part of Big Pharma's conspiracy and these people secretly apply drugs and/or radiation to people while pretending to offer non-drug/radiation treatment..

People working in these professionals also tend to be pretty tasty, resulting in less time looking up doses and more time looking at other figures, thus rendering my work, and that of my male medical colleagues, less complete. Bastards.

N8 wrote:

and as therapists are complimentary to the medical profession

They are referred to as Allied Health Professionals. They have journals (peer reviewed) in which papers are published, leading to evidence based treatment. They also have a number of (proven and useful) roles in treatment. 2 examples for you:

- Take a person whose had a stroke. Any medical management that's prescribed is aimed at preventing a second stroke. The treatment effectively is physio, OT and SALT.

- Vertigo (random example) - Treatment is Epley manoeuvre - performed by physios.

ORLY?

N8 wrote: »

None are considered alternative therapies but they are complimentary to medical practice - are they not?

NO. They are an integral part of medical practice

N8

Vorsprung wrote: »

They are referred to as Allied Health Professionals. They have journals (peer reviewed) in which papers are published, leading to evidence based treatment. They also have a number of (proven and useful) roles in treatment.

Far point - allied rather than complementary - fine line I suppose but one that defines them closer to and within medical confidences I presume.

Treatment proven and evidence based? Is it 100%?

ORLY? wrote: »

NO. They are an integral part of medical practice

"Allied health professions are clinical and administrative health care professions distinct from medicine, dentistry, and nursing."

No they work with medical practitioners but are seperate from. And as per my post above I am accepting this point but I find 'complementary' and 'allied' a fine line, but one that sets them clearly within a medical paradigm.

King Mob wrote: »

Again, how do you know this is the case?
Are you challenging the idea that the treatments listed are valid and used?

How do you know they are not? Perhaps you would liketo back up your claim first?

No I am not challenging those ideas at all. One chap I spoke with at christmas has successfully lost almost five stone and given up a 40 a day habit but he is one of a very very select lot that are willing to listen and would rather medicate themselves and make their deterioration comfortable.

King Mob wrote: »

No because they are medical practices.

NO they are not they are side by side therapists either known as complementary staff or preferred it appears as allied health professionals.

"Allied health professions are clinical and administrative health care professions distinct from medicine, dentistry, and nursing."

King Mob wrote: »

But it's often easier to accuse people of cynicism or trying to silence you than to back up claims...

No not quite cynicism is easily recognisable. Cynics blindly accept any information that confirms their lack of faith in something (here alternative health care thinking). Skeptics question everything, even the the main stream view (here main stream medicine).

You are a cynic skepdick not a skeptic in any true sense of the word or character.

N8

N8 wrote: »

How do you know they are not?

FFS. Is this seriously your evidence?
Can you back up your claim on not.

N8 wrote: »

Perhaps you would liketo back up your claim first?

So the various health care people here on the boards detailing several conditions for which the primary treatment is something other than "drugs surgery and radiation" doesn't count?

Did you look into these claims before you dismissed them?
Do you feel no hypocrisy demanding evidence while offering none of yours?

Here's two examples that Vorsprung mentioned.
http://en.wikipedia.org/wiki/Epley_maneuver

http://en.wikipedia.org/wiki/Stroke#Treatment

Maybe the others would like to provide references for the other treatments mentioned, but I wouldn't blame them if they didn't.
Why bother looking them up when you have no intention of reading them.

N8 wrote: »

No I am not challenging those ideas at all.

Then why ask for references other than to be pedantic?
Do you argue that they are the primary treatments for some conditions?

N8 wrote: »

One chap I spoke with at christmas has successfully lost almost five stone and given up a 40 a day habit but he is one of a very very select lot that are willing to listen and would rather medicate themselves and make their deterioration comfortable.

What's your point exactly?

How do you know that he is the rare case exactly?
Have you any data on this?

N8 wrote: »

NO they are not they are side by side therapists either known as complementary staff or preferred it appears as allied health professionals.

"Allied health professions are clinical and administrative health care professions distinct from medicine, dentistry, and nursing."

So then no you can't find a single regulatory body that describes itself as a complementary medicine?
Shocker.

Now I did look up a regulatory body (with a loose definition of the term regulatory) and found this:
http://nccam.nih.gov/health/whatiscam/#definingcam

No where at all in there do they mention proper physiotherapy or proper nutritional therapy.

Lots of chiropractic and other quackery though.

N8 wrote: »

No not quite cynicism is easily recognisable. Cynics blindly accept any information that confirms their lack of faith in something (here alternative health care thinking). Skeptics question everything, even the the main stream view (here main stream medicine).

You are a cynic skepdick not a skeptic in any true sense of the word or character.

Are you serious?

Can you please tell me that since I'm such a "cynic skepdick" why am I asking you for evidence to back up your claims?

And why when you are such a "True skeptic" you have no problem dodging these requests and other points?

A skeptic doesn't just question everything ad nausem, we base our positions on the best evidence and reasoning available.
You are providing neither good evidence for you claims or good reasoning.
But if you would prefer to accuse me of being close minded because I dare to question you....

lonestargirl

N8 wrote: »

Far point - allied rather than complementary - fine line I suppose but one that defines them closer to and within medical confidences I presume.

Treatment proven and evidence based? Is it 100%?

I'm a medical physicist/dosimetrist, this is considered an allied health professional. The use of radiation therapy is 100% evidence based, the doctor may decide what treatment he/she wants buts it's not going to happen without me and my collegues (+ radiation therapists who operate the linacs - another allied health professional). Our involvement is central to the treatment of the patient.

lonestargirl

lonestargirl wrote: »

I'm a medical physicist/domsimetrist,

Adding this to my list of awesome sounding disciplines.
Up there with archeo-astronomer.

bleg

N8 wrote: »

F
NO they are not they are side by side therapists either known as complementary staff or preferred it appears as allied health professionals.

"Allied health professions are clinical and administrative health care professions distinct from medicine, dentistry, and nursing."

So, you would see pharmacists as complementary therapists?

lonestargirl

What would you think of ECG techs? or respiratory techs? or perfusionists? or radiographers?

I would consider allied health professionals as those that perform a designated specialist role within the medical care of the patient. The doctor will have a good understanding of the work the allied health professional does but might not be able to fully perform the role themselves (you can't possibly have a enough time to fully train in each of these roles).

ORLY?

N8 wrote: »

No they work with medical practitioners but are seperate from. And as per my post above I am accepting this point but I find 'complementary' and 'allied' a fine line, but one that sets them clearly within a medical paradigm.

I didn't say they were the same as people in the medical profession, I said they were an integral part of medical practice. Some one from the medical profession is a doctor, someone from the nursing profession a nurse etc. None is the same as the other but all are integral to the implementation of conventional medical practice.

Often a doctor's job is to decide on what treatment a person needs and often this involves something like PT or OT that a doctor is not trained in but knows would be helpful. So in that case, the physio or OT is the person that implements the treatment decided upon by the doctor. The process is in no way complementary to conventional medical practice but part of the process, just a part that is not implemented by a medical profession, just like the way many ultrasounds, x-rays, radiotherapy sessions, vaccinations etc. etc. are performed by people who are not members of the medical profession.

N8

ORLY? wrote: »

For example, the primary intervention for non insulin dependent diabetes is a change in diet and increase in exercise. Look in any clinical medicine book and you'll find it there.

sam34 wrote: »

or the first intervention for treatment of hypertension is lifestyle changes - diet, exercise, stopping smoking etc

N8 wrote: »

whilst I have no doubt of your sincerity and this would be ideal it rarely happens in either recommendation or follow through

King Mob wrote: »

Can you please explain how you know this rarely happens?
Or is it only because they refute you silly point?

N8 wrote: »

Because it rarely happens in practice. There is the cursory mention of lifestyle changes / interruptions that accompany the prescription, more often than not due to known patient intransigence based upon prior interaction, rather than any incompetence or ineptitude on that doctor's behalf.

Hardly silly rather an observation of real life.

kings mob I never challenged a primary treatment being other than drugs, radiation or surgery. I descibed a day to day challenge for those advising clients of their first choice of care - lifestyle change - meeting those who want a quick fix and medication.

I think I can now add manic and hysterical to cynical in my description of your postings and opinion.

lonestargirl wrote: »

I'm a medical physicist/dosimetrist, this is considered an allied health professional. The use of radiation therapy is 100% evidence based

I am not an expert in the field by no means lonestargirl but is the use of radiation therapy 100% evidence based? I am not saying it isn't but I understood that quite alot of practice is not.

A while back David Eddy's in the BMJ stated the evidence base for medical care was somethin like 15% iirc

bleg wrote: »

So, you would see pharmacists as complementary therapists?

not paricularly and as such my position has changed or this as I stated previously but they are not medical professionals, they are professions allied to the medical profession and practicing under the medical paradigm which is where the division I believe is.

So we have those professionals, therapists and practitioners either working under a medical paradigm, and as Orly describes integral of (unable to exist without) and those working alternate to all this.

What practice does the description complementary describe?

N8

N8 wrote: »

kings mob I never challenged a primary treatment being other than drugs, radiation or surgery. I descibed a day to day challenge for those advising clients of their first choice of care - lifestyle change - meeting those who want a quick fix and medication.

I think I can now add manic and hysterical to cynical in my description of your postings and opinion.

Actually you said:

N8 wrote: »

Medicine involves the diagnosis and treatment of disease with the use of drugs, radiation and surgery.

Complimentary medicine involves those therapies that compliment medicine: massage, nutritional advice, are but to name two.

It's been shown to you that actual medicine involves massage/physiotherapy and nutritional advice as primary treatments in many conditions.

Now you're saying that doctors don't use these because patients don't follow through with them.
Now leaving aside the fact that this is blatantly moving the goalposts, you've not provided a scrap of evidence to suggest that doctors aren't using these treatments.

N8 wrote: »

What practice does the description complementary describe?

http://nccam.nih.gov/health/whatiscam/#definingcam

Now any chance you're going to address the rest of my points or does being a "true skeptic" involve ignoring questions you can't answer?

lonestargirl

N8 wrote: »

I am not an expert in the field by no means lonestargirl but is the use of radiation therapy 100% evidence based? I am not saying it isn't but I understood that quite alot of practice is not.

Yes.

N8

King Mob wrote: »

Actually you said:

sorry kings mob you are deliberately misquoting me.

Although it would be fair to say (repeat) I would not describe those professions I described earlier as complementary having been brought round to the fact they are not such - they are allied health professionals.

King Mob wrote: »

you've not provided a scrap of evidence to suggest that doctors aren't using these treatments.

nor have you that they are.

Dr Galen wrote: »

A simple question I ask is posed above. What makes something alt or complimentary? Is it a lack of scientific proof? Is it because its not common in the mainstream of medicine that we all mostly work in or around? IS it something else completely?

N8 wrote: »

What practice does the description complementary describe?

King Mob wrote: »

http://nccam.nih.gov/health/whatiscam/#definingcam

why didn't you just give your answer backed up by your usual one stop source of research, declared your answer to be fully correct, without any need for further discussion and request that as such, the thread be locked.

King Mob wrote: »

Now any chance you're going to address the rest of my points or does being a "true skeptic" involve ignoring questions you can't answer?

I am afraid in answering you I never described myself as a skeptic true or otherwise I merely made the observation that your position was not one of skepticism but one of cynicism that was deteriorating toward manic hysteria.

lonestargirl wrote: »

Yes.

I don't mean to be rude Lonestar but this quite interests me - do you have a paper or metaanalysis that you can point me in the direction of this please?

N8

N8 wrote: »

sorry kings mob you are deliberately misquoting me.

I fail to see how I can misquote you when I'm reposting your exact words...

N8 wrote: »

Although it would be fair to say (repeat) I would not describe those professions I described earlier as complementary having been brought round to the fact they are not such - they are allied health professionals.

So then you would describe the treatments they provide, as prescribed by doctors as being part of medicine?

N8 wrote: »

nor have you that they are.

I have actually, you've just ignored that post.

King Mob wrote: »

Here's two examples that Vorsprung mentioned.
http://en.wikipedia.org/wiki/Epley_maneuver

http://en.wikipedia.org/wiki/Stroke#Treatment

Maybe the others would like to provide references for the other treatments mentioned, but I wouldn't blame them if they didn't.
Why bother looking them up when you have no intention of reading them.

Now are you still standing behind your claim that doctors don't use these treatments?
Despite the fact that physiotherapists, dietitians (not nutritionists) etc are still in business? And despite the fact that you yourself don't contest that these treatments are the recommended primary treatments?

You also do realise you've been moving the goal posts quite a bit on this too.
You started off by saying "treatments such as diet, change of lifestyle and physiotherapy where not considered to be real medicine", to "they are,but doctors never use them."

So again I have to ask you, how do you know these treatments are not used?

N8 wrote: »

why didn't you just give your answer backed up by your usual one stop source of research, declared your answer to be fully correct, without any need for further discussion and request that as such, the thread be locked.

Again, it's funny that you're whinging about discussion...

You ever going to get round to those questions and points you're ignoring?

N8 wrote: »

I am afraid in answering you I never described myself as a skeptic true or otherwise I merely made the observation that your position was not one of skepticism but one of cynicism that was deteriorating toward manic hysteria.

Ah ok, so dispute me asking you to back up your claims so as to change my mind about this issue as well as the fact that you aren't even reading what ever reasoning or evidence you are presented with, I'm a cynic...?

Somehow I don't think you're using the right definitions here....

lonestargirl

N8 wrote: »

I don't mean to be rude Lonestar but this quite interests me - do you have a paper or metaanalysis that you can point me in the direction of this please?

It's a whole treatment area, the evidence is specific to a given disease site/histology. This a really useful book that summarises all the major evidence with a chapter per site: Handbook of Evidence Based Radiation Oncology, you can flick through the first few pages on Amazon. If you have a question about a particular use of radiotherapy I'd be happy to answer it.

N8

lonestargirl wrote: »

It's a whole treatment area, the evidence is specific to a given disease site/histology. This a really useful book that summarises all the major evidence with a chapter per site: Handbook of Evidence Based Radiation Oncology, you can flick through the first few pages on Amazon. If you have a question about a particular use of radiotherapy I'd be happy to answer it.

Thanks - appreciated.

locum-motion

Guys (specifically, N8 & KingMob),
You're dragging this thread off topic; the topic is "What is Alternative Medicine?" not "Are allied health professionals part of medicine or not?" What you're both arguing is essentially semantics, IMO.
For the purposes of this thread, I propose that we stipulate the following:
Medical doctors don't practice alternative medicine.*
Pharmacy, Dietetics, Physiotherapy, Occupational Therapy, Medical Physics etc are not alternative medicine, nor complementary medicine, but are professions that are allied to the medical profession and are a part of medical treatment.

The core question of the thread is more to do with things like Accupuncture, Herbalism, Ayurveda, Homeopathy etc, and how we define them; as complementary/alternative etc.

"Nutritionists" is a tricky one: the term "Nutritionist" isn't legally protected. Some nutritionists have a BSc degree in Human Nutrition and Dietetics, and the only difference (educationally speaking) between them and dieticians is that they didn't do the 6 month clinical practice rotation necessary for state registration as a dietician. Such people tend to work in the food industry rather than with patients.
Then, on the other hand, you've got people like "Dr." Gillian McKeith who call themselves Nutritionists but don't have any real, properly recognised qualifications.


* That said, there are some medical doctors, pharmacists, dieticians etc who do include alternative treatments in their practice.

Capt'n Midnight

what is the politically correct term for "medicine that isn't evidence based"

bleg

I cal it bull****.

goingpostal

I always think that mainstream medicine/alternative 'medicine' is a false, or at best, a very poor dichotomy. A much better dichotomy that works for me is evidence-based medicine vs faith-based 'medicine'. And remember folks: The best possible outcome to having an argument with a quack is to be able to say that you won an argument with a quack.