Alternative medicine is the term given for medicinal products or services that are not a part of a standard medical care. It means nonstandard treatments that can be used along with the standard treatment. Some examples of alternative medicine are herbal medicines, acupuncture, chiropractic medicine, energy therapies, magnetic field therapy, hypnosis, Reiki, Ayurveda, Chinese Medicine, Traditional Medicine, and healing touch therapies (National Institute of Health, n.d.). These have been around for many years, but in literature, there is a support as well as controversy surrounding it. In some cases, there has been considerable research done while in some other cases, there has been no research at all (National Institute of Health, n.d.). When used along with standard care, researchers claim that alternative therapies have the potential to transform the physical, emotional, and spiritual lives of people living with chronic illnesses (National Cancer Institute, 2011). Most of the therapies cannot be substitutes for mainstream standard medical care, but when used along with standard care, they reduce stress, anxiety, pain, and other physical and emotional symptoms; and improve the health related quality of life (National Cancer Institute, 2011).
Let us see briefly what each type of alternative medicine therapy is all about and we will also read about some research that has been done till date to test the safety and efficacy of some of the alternative medicine treatment approaches on some medical conditions of which some are common illnesses like low back pain or headaches, while some are deadly diseases like cancer and HIV/AIDS.
Acupuncture is a traditional Chinese medicine that makes use of thin needles to stimulate various points around the body with an aim to restore energy. It helps ease certain chronic pain conditions like headache, low back pain, and osteoarthritis. In chiropractic medicine, the spine is manipulated to better align the body (Martin, 2011). It helps provide relief in low back pain, shoulders, and neck. Energy therapies make use of magnets and healing touch to improve health. Reiki accesses the body’s natural energy to heal the body. The Reiki practitioner hovers his hand on the patient’s body to bring about a state of calmness. Herbal medicine is medicine extracted from plants. Ayurveda, Chinese medicine, and traditional medicine all offer herbal remedies (Martin, 2011).
In an observational study by Jones and colleagues, patients in fatiguing illness take more help of alternative therapies than those who have non-fatiguing illnesses. The alternative medicine therapies commonly used by them are chiropractic and massage therapies and mind-body therapies. It was also seen that those who have a poor physical and mental health appear to use them more often (Jones, 2007).
In recent years, there have been many systematic reviews of trials, reviews of reviews, and meta-analyses published on the relative efficacy of different alternative medicine approaches to fibromyalgia, a condition in which the pharmacological efficacy (standard medical care) is limited. Therefore, patients often seek treatment from alternative medicine providers. Surveys have shown that 60% - 90% of patients in USA report using alternative therapies for fibromyalgia (Bennet, 2007). A recent survey in 29 centers of integrative medicine showed the most promise, most success with conditions like chronic pain, gastrointestinal disorders, depression/anxiety, cancer, and stress. The centers also treated patients with fatigue, sleep problems, and anxiety/depression (Horrigan, 2012). Through yoga and meditation, a somatically focused technique was found to be helpful for depressive symptoms (Baranowsky, 2009). A systematic review by Langhorst confirmed that beneficial effects for the condition of fibromyalgia syndrome were found in hydrotherapy and massage. Homeopathy and acupuncture too were found to have promise, but need further research (Langhorst, 2012). Chinese techniques that incorporated body movements with breathing and attention training improved symptoms of fibromyalgia. Yoga had a significant effect on pain, fatigue, depression, and quality of life. Certain Chinese techniques were effective for sleep. The review also showed traditional Chinese medicine to be an emerging approach to the management of the symptoms of fibromyalgia syndrome (Langhorst, 2012).
Another deadly disease, cancer, has rising incidence in both developed and developing nations. According to National Cancer Institute, cancer patients take the help of alternative medicine to help them cope with the side effects of cancer treatments, such as nausea, pain, and fatigue. Alternative medicines help them comfort themselves and ease the worries of cancer treatment and related stress. Importantly, patients feel that they are doing something more to help with their own care (National Cancer Institute, n.d.).
Alternative medicines are widely used by 50% - 90% of patients with chronic painful, debilitating, or fatal conditions, such as HIV/AIDS and cancer (Richardson and Straus, 2002). Importantly, there is little correlation between the use of alternative medicines and a scientific evidence that they are safe or effective. The only evidence is of their safety and efficacy is embodied in folklore. Herbals like comfrey and kava have been associated with liver failure, aristolochia with genitourinary cancer (De Smet, 2002), and ephedra with heart attacks and strokes (Shekelle, 2003). A lot of data also suggests that patients discuss the use of their supplements with knowledgeable practitioners before initiating any treatment.
Several randomized control trials have been conducted on the safety and efficacy of the alternative medicine treatment approaches and many have positive reviews (Debas and others, n.d.). Treating drug-resistant malaria with Artemisia annua, preventing urinary tract infections with cranberries, lowering blood pressure with garlic, relieving osteoarthritis with Glucosamine, improving liver function with milk thistle, treating mild depression with St. John’s wort, relieving symptoms of benign prostatic hyperplasia (BPH) with saw palmetto and relieving arthritis pain with acupuncture all these trials have had positive study outcome. Decreasing anxiety with meditation, preventing migraine with biofeedback, and treating lower back pain with chiropractic therapy have also shown to have positive study outcomes (Debas and others, n.d.).
Alternative medicines can provide a rationale for conserving species, but a concern could be overharvesting of endangered species. According to WHO, 85% of the world’s population (principally those in developing countries) depends on plants for medicine, and 25% of prescription drugs have an active ingredient derived from a flowering plant (Debas and others, n.d.)
Below, we will discuss a few of the alternative therapy approaches in detail that have really been promising.
Artemisinin is an herbal extract that has been used in China for centuries to treat fever. The active ingredient was discovered in 1970s, and some western pharmaceutical companies have developed several derivatives of the herbal extract as treatments against resistant Plasmodium malaria (Li, 2000). Another such drug, dihydroartemisinin-piperaquine, is effective against drug resistant Plasmodium falciparum malaria. Another derivative of artemisinin known as artesunate, has shown to increase parasite clearance and reduce the gametocyte count when added to existing drugs to combat malaria (Adjuik and others 2004). Rigorous clinical trials have demonstrated positive efficacy in two areas, managing postoperative nausea and emesis (Shen, 2000) and amelioration of the pain of chronic osteoarthritis (Ezzo, 2001).
Chiropractic medicine uses spinal manipulation to treat an array of conditions thought to arise because of abnormal alignment of or stresses on vertebrae, most often in patients with musculoskeletal complaints (Debas and others, n.d.). Even though conventional medicine professionals ostracized practitioners of chiropractic medicine in earlier times, it has gradually evolved into a viable healing discipline that is increasingly accepted by the conventional medicine community. Secondly, the evolution of chiropractic can be compared with that of osteopathy. Osteopathy was developed in the USA in parallel with chiropractic, but the field elected to accommodate rather than reject allopathic techniques (Debas and others, n.d.).
David Spiegel at Stanford University, while working on group support for breast cancer patients, observed that appropriate psychotherapy (both group and individual) not only reduced depression and anxiety and improved coping skills, but also saved money by reducing the number of office visits, diagnostic tests, medical procedures, and hospital admittances (Spiegel, 1994).
In spite of some promising data, the alternative approach presents major challenges and often poses difficulties for opportunities on research. Alternative medicine practitioners need to understand the strengths, limitations, and contributions of their particular approach towards individual and public heath, so that they can work together to ensure the best possible care for everyone.
References
Complementary and Alternative Medicine. N.d. Medline Plus. National Institute of Health. Retrieved from: http://www.nlm.nih.gov/medlineplus/complementaryandalternativemedicine.html; Accessed: 15th March 2013.
The Medline Plus, created by the National Institute of Health provides trusted health information and assists its readers in locating authorative health information.
Do Complementary Therapies Work? – Ask the expert about herbs, acupuncture, and other complementary therapies. (2011) National Cancer Institute. Retrieved from: https://researchtoreality.cancer.gov/node/522 Accessed: 15th March 2013
Researchtoreality.cancer.gov was developed by the National Cancer Institute, which among other many functions, also provides trusted information on health.
Martin, L. (2011) Complementary and Alternative Medicine (CAM). WebMD. Retrieved from: http://www.webmd.com/balance/what-is-alternative-medicine?page=2; Accessed: 15th March 2013.
WebMD is the Health on the Net Code certified website. A HON Code means the website can be trusted for its information. The complementary and alternative medicine overview mentions most of the alternative medicine practices around the world with a brief summary of what every therapy is and how does it benefit patients.
Jones, J. F., Maloney, E., Roumiana, B., Ann-Britt, J., William, R. (2007) Complementary and alternative medical therapy utilization by people with chrobnic fatiguing illnesses in the United States. BMC Complmentary and Alternative Medicine 7, 12. Retrieved from: http://stacks.cdc.gov/view/cdc/3467/
The information is provided by authors James Jones and colleagues on the CDC website, the main aim of CDC being saving lives and protecting people. The abstract provides information on the utilisation of alternative treatment approaches by patients with fatiguing illnesses and also by those suffering with non-fatiguing illnesses. It concludes with an aim to state the requirement of development of intervention strategies for alternative medicine practices.
Greene, A. M., Walsh, E. G., Sirois, F. M., McCaffrey, A. (2009) Perceived Benefits of Complementary and Alternative Medicine: A Whole Systems Research Perspective. The Open Complementary Medical Journal. 1, 35 - 45. Retrieved from: http://www.benthamscience.com/open/toaltmedj/articles/V001/35TOALTMEDJ.pdf
The study examined the benefits of alternative medicine therapies from a patients’ perspective. The findings have provided insights and directions for its use.
Bennett RM, Jones J, Turk DC, Russell IJ, Matallana L. (2007) An internet survey of 2,596 people with fibromyalgia. BMC Musculoskelet Disord, 8:27.
An internet survey by National Fibromyalgia Association provided information on many factors many factors of fibromyalgia like symptoms, aggravating factors, medications used, and the use of alternative therapies for assisting in treating fibromyalgia or stleast controlling the symptoms of fibromyalgia.
Horrigan B, Lewis S, Abrams D, Pechura C. (2012) Integrative Medicine in America. Minneapolis, Minn: The Bravewell Collaborative. Retrieved from: http://www.bravewell.org/current_projects/mapping_field.
The content provides current data on the patient populations and health conditions most commonly treated with integrative strategies.
Baranowsky J, Klose P, Musial F, Häuser W, Dobos G, Langhorst J. (2009) Qualitative systemic review of randomized controlled trials on complementary and alternative medicine treatments in fibromyalgia. Rheumatol Int, 30, 1-21.
The systematic review provides a summary of randomized control trials on alternative medicine as defined by NIH.
Langhorst J, Klose P, Dobos G, Bernardy K, Häuser W. (2012) Efficacy and safety of meditative movement therapies in fibromyalgia syndrome: a systematic review and meta-analysis of randomized controlled trials. Rheumatol Int. [Epub ahead of print]
This systematic review and meta analysis collected data from quality randomized trials that compared a few alternative therapy approaches. The review shows yoga and some Chinese techniques to have a significant effect on quality of life. The review is also in favour of hydrotherapy and massage for fibromyalgia.
Reasons People with Cancer Choose CAM. n.d. National Cancer Institute. http://www.cancer.gov/cancertopics/cam/thinking-about-CAM/page2
The national cancer institute, along with other aims, also aims to provide trusted health information to its readers.
Richardson, M. A., and S. E. Straus. (2002). “Complementary and Alternative Medicine: Opportunities and Challenges for Cancer Management and Research.” Seminars in Oncology 29, 531–45.
This is a work by the US government. The report summarizes the challenges facing the alternative medicine researchers, the most fruitful areas for exploration, and existing information resources.
De Smet, P. A. (2002). “Herbal Remedies.” New England Journal of Medicine, 347, 2046–56.
De Smet’s review summarizes the safety and efficacy of herbal medicines, focusing mainly on four herbs – Ginkgo biloba, hawthorn, saw palmetto, and St. John's wort. These herbs have been evaluated in a sufficient number of randomized, controlled trials.
Shekelle, P. G., M. L. Hardy, S. Morton, M. Maglione,W. A. Mojica, M. J. Suttorp, and others. (2003). “Efficacy and Safety of Ephedra and Ephedrine for Weight Loss and Athletic Performance: A Meta- Analysis.” Journal of the American Medical Association, 289, 1537–45.
The meta analysis has reviewed the efficacy and safety of ephedra and ephedrine in weight loss and enhanced athletic performance.
Debas, H. T., Laxminarayan, R., Straus, S. E. Complementary and Alternative Medicine. Disease Control Priorities in Developing Countries. Retrieved from: http://files.dcp2.org/pdf/DCP/DCP69.pdf; Accessed: 15th March, 2013.
This chapter on alternative and complementary medicine by Debas and colleagues is part of a book that considers the formidable challenges to advancing human health. The chapter reviews certain alternative medicine practices to understand their current and potential place in the overall practice of medicine.
Li, Y., Y.M. Zhu, H. J. Jiang, J. P. Pan, G. S.Wu, J.M.Wu, and others. (2000). “Synthesis of Antimalarial Activity of Artemisinin Derivatives Containing an Amino Group.” Journal of Medical Chemistry 43 (8): 1635–40.
The study is a preclinical trial on water-soluble artemisinin derivative to determine their efficacies.
Adjuik, M., A. Babiker, P. Garner, P. Olliaro,W. Taylor, and N.White. (2004). “Artesunate Combinations for Treatment of Malaria: Meta-Analysis.” Lancet, 363 (9402): 9–17.
The study assessed the evidence that addition of artemisinin derivatives to existing drug regimens could reduce treatment failure. The interpretation was there was a reduction in treatment failure when artesunate was added to the regimen.
Shen, J., N. Wenger, J. Glaspy, R. D. Hays, P. S. Albert, C. Choi, and P. G. Shekelle. (2000). “Electroacupuncture for Control of Myeloablative Chemotherapy-Induced Emesis: A Randomized Controlled Trial.” Journal of the American Medical Association, 284: 2755–61.
The RCT was performed on cancer patients undergoing chemotherapy. The study compared the efficacy of electropuncture vs. minimal needling and mock electrical stimulation or antiemetic drugs alone in controlling episodes of nausea and vomiting among patients undergoing chemotherapy regimen, to show that adjunct electroacupuncture was more effective in controlling emesis.
Ezzo, J., V. Hadhazi, H. Birch, L. Lao, G. Kaplan, and M. Hochberg. (2001). “Acupuncture for Osteoarthritis of the Knee: A Systematic Review.” Arthritis and Rheumatism, 44 (4): 819–825.
The study is a systematic review evaluating trials of acupuncture for osteoarthritis of knee. It assessed the methodologic quality of trials and determined if low quality trials were associated with positive outcomes.
Spiegel, D. (1994). “Health Caring, Psychosocial Support for Patients with Cancer.” Cancer 74 (4): 1453–56.
Spiegel, in this paper, has reviewed four issues regarding psychosocial treatments and concludes that appropriate and timely psychotherapeutic interventions are cost beneficial by reducing unnecessary office visits, diagnostic tests, medical procedures, and hospital admissions.
