What is Alternative Medicine?

Dr Galen · 13-07-2010 09:37PM #1

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!

13-07-2010 09:58PM

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 · 13-07-2010 10:01PM

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?

13-07-2010 10:13PM

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 · 13-07-2010 10:14PM

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

Kurtosis · 13-07-2010 10:17PM

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 · 13-07-2010 10:27PM

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 · 13-07-2010 10:55PM

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 · 14-07-2010 12:12AM

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 · 14-07-2010 12:17AM

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 · 14-07-2010 12:29AM

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 · 14-07-2010 12:42AM

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 · 14-07-2010 12:48AM

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 · 14-07-2010 12:53AM

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 · 14-07-2010 01:06AM

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 · 14-07-2010 12:14PM

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

14-07-2010 12:42PM

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? · 14-07-2010 01:48PM

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 · 14-07-2010 07:29PM

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 · 19-07-2010 04:47PM

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? · 19-07-2010 05:40PM

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 · 19-07-2010 06:57PM

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

Vorsprung · 19-07-2010 09:40PM

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

nesf · 19-07-2010 10:11PM

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 · 20-07-2010 12:52AM

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 · 20-07-2010 09:44AM

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

20-07-2010 10:41AM

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 · 20-07-2010 11:42AM

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.

20-07-2010 12:24PM

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 · 20-07-2010 12:29PM

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

N8 · 20-07-2010 12:41PM

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.

What is Alternative Medicine?

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