alternative medicine

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alternative medicine
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{{short description|Form of non-scientific healing}}{{Alternative medical systems|general}}Alternative medicine describes any practice which aims to achieve the healing effects of medicine, but which lacks biological plausibility and is untested or untestable. In some cases AM treatments are proven ineffective. Complementary medicine (CM), complementary and alternative medicine (CAM), integrated medicine or integrative medicine (IM), and holistic medicine are among many rebrandings of the same phenomenon. Alternative therapies share in common that they reside outside medical science, and rely on pseudoscience. Alternative medicine is distinct from experimental medicine, which employs the scientific method to test plausible therapies by way of responsible and ethical clinical trials, producing evidence of either effect or of no effect. Research into alternative treatments often fails to follow proper research protocol and denies calculalaton of prior probability, providing invalid results. Traditional practices become "alternative" when used outside their original settings without proper scientific explanation and evidence. Frequently used derogatory terms for the alternative are new-age or pseudo, with little distinction from quackery.In some cases, the claims of alternative practices violate laws of nature; in others, the practice is plausibly effective but so dangerous to the patient that any use is unethical. Alternative practices often resort to the supernatural or superstitious to explain their effect, and range from ineffective to harmful and toxic.Much of the perceived effect of an alternative practice arises from a belief that it will be effective (the placebo effect), or from the treated condition resolving on its own (the natural course of disease). This is further exacerbated by the tendency to turn to alternative treatments upon the failure of medicine, at which point the condition will be at its worst and most likely to spontaneously improve. In the absence of this bias, especially for diseases that are not expected to get better by themselves such as cancer or HIV infection, multiple studies have shown significantly worse outcomes if patients turn to alternative therapies. While this may be because these patients avoid effective treatment, some alternative treatments actively interfere with effective ones.The alternative sector is a highly profitable industry with a strong lobby, and faces far less regulation over the use and marketing of unproven treatments. Its marketing often advertises the treatments as being "natural" or "(wikt:holistic|holistic)", in comparison to those offered by "big pharma". Billions of dollars have been spent studying alternative medicine, with little to no positive results. Some of the successful practices are only considered alternative under very specific definitions, such as those which include all physical activity under the umbrella of "alternative medicine". {{TOC limit|3}}

Definitions and terminology

{{see also|Terminology of alternative medicine}}The terms alternative medicine, complementary medicine, integrative medicine, holistic medicine, natural medicine, unorthodox medicine, fringe medicine, unconventional medicine, and new age medicine are used interchangeably as having the same meaning, and are almost synonymous in most contexts.BOOK,weblink Suckers: How Alternative Medicine Makes Fools of Us All, Shapiro, Rose, 2010-09-30, Random House, 9781409059165, Terminology has shifted over time, reflecting the preferred branding of practitioners."Integrative medicine": A brand, not a specialty. Science Based Medicine For example, the United States National Institutes of Health department studying alternative medicine, currently named the National Center for Complementary and Integrative Health (NCCIH), was established as the Office of Alternative Medicine (OAM) and was renamed the National Center for Complementary and Alternative Medicine (NCCAM) before obtaining its current name. Therapies are often framed as "natural" or "holistic", implicitly and intentionally suggesting that conventional medicine is "artificial" and "narrow in scope".WEB,weblink Directive 2004/24/EC of the European Parliament and of the Council, 2004-04-30, Official Journal of the European Union, File:Marcia.angell.jpg|thumb|(Marcia Angell]]: "There cannot be two kinds of medicine â€“ conventional and alternative".)The meaning of the term "alternative" in the expression "alternative medicine", is not that it is an effective alternative to medical science, although some alternative medicine promoters may use the loose terminology to give the appearance of effectiveness.{{Citation|last=Kolata|first=Gina|title=On Fringes of Health Care, Untested Therapies Thrive|date=June 17, 1996|url=|author-link=Gina Kolata|publisher=The New York Times|accessdate=December 22, 2015}} Loose terminology may also be used to suggest meaning that a dichotomy exists when it does not, e.g., the use of the expressions "Western medicine" and "Eastern medicine" to suggest that the difference is a cultural difference between the Asiatic east and the European west, rather than that the difference is between evidence-based medicine and treatments that do not work.

Alternative medicine

Alternative medicine is defined loosely as a set of products, practices, and theories that are believed or perceived by their users to have the healing effects of medicine,{{refn|name=NSFquote|group=n|"[A]lternative medicine refers to all treatments that have not been proven effective using scientific methods."}}{{refn|"Complementary and alternative medicine (CAM) is a broad domain of resources that encompasses health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the dominant health system of a particular society or culture in a given historical period. CAM includes such resources perceived by their users as associated with positive health outcomes. Boundaries within CAM and between the CAM domain and the domain of the dominant system are not always sharp or fixed."{{sfn|IOM Report|2005|p=19}}|name=IOMquote|group=n}} but whose effectiveness has not been established using scientific methods,{{refn|name=NSFquote|group=n}}{{refn|name=Angellquote|group=n|"It is time for the scientific community to stop giving alternative medicine a free ride. There cannot be two kinds of medicine â€“ conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work... speculation, and testimonials do not substitute for evidence."}} or whose theory and practice is not part of biomedicine,{{refn|group=n|name=IOMquote}}{{refn|group=n|name=Harrisonquote |"The phrase complementary and alternative medicine is used to describe a group of diverse medical and health care systems, practices, and products that have historic origins outside mainstream medicine. Most of these practices are used together with conventional therapies and therefore have been called complementary to distinguish them from alternative practices, those used as a substitute for standard care. ... Until a decade ago or so, "complementary and alternative medicine" could be defined as practices that are neither taught in medical schools nor reimbursed, but this definition is no longer workable, since medical students increasingly seek and receive some instruction about complementary health practices, and some practices are reimbursed by third-party payers. Another definition, practices that lack an evidence base, is also not useful, since there is a growing body of research on some of these modalities, and some aspects of standard care do not have a strong evidence base."{{sfn|Harrison's Principles of Internal Medicine|2015|loc=chpt. 14-E|p=1}}}}{{refn |name=WebMD2014quote |group=n |"An alternative medical system is a set of practices based on a philosophy different from Western biomedicine."}}{{refn |group=n |name=NCCIH2quote |"CAM is a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine."}} or whose theories or practices are directly contradicted by scientific evidence or scientific principles used in biomedicine. "Biomedicine" or "medicine" is that part of medical science that applies principles of biology, physiology, molecular biology, biophysics, and other natural sciences to clinical practice, using scientific methods to establish the effectiveness of that practice. Unlike medicine,{{refn|name=Harrisonquote|group=n}} an alternative product or practice does not originate from using scientific methods, but may instead be based on hearsay, religion, tradition, superstition, belief in supernatural energies, pseudoscience, errors in reasoning, propaganda, fraud, or other unscientific sources.{{refn|name=Angellquote|group=n}}Some other definitions seek to specify alternative medicine in terms of its social and political marginality to mainstream healthcare. This can refer to the lack of support that alternative therapies receive from medical scientists regarding access to research funding, sympathetic coverage in the medical press, or inclusion in the standard medical curriculum. For example, a widely used{{sfn|IOM Report|2005|p=19}} definition devised by the US NCCIH calls it "a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine". However, these descriptive definitions are inadequate in the present-day when some conventional doctors offer alternative medical treatments and introductory courses or modules can be offered as part of standard undergraduate medical training; alternative medicine is taught in more than half of US medical schools and US health insurers are increasingly willing to provide reimbursement for alternative therapies.{{sfn|IOM Report|2005|pp=17, 196–252}}

Complementary or integrative medicine {{anchor|Complementary medicine|Integrative medicine|Integrated medicine}}

Complementary medicine (CM) or integrative medicine (IM) is when alternative medicine is used together with functional medical treatment, in a belief that it improves the effect of treatments.{{refn|group=n|name=FinalReport|The Final Report (2002) of the White House Commission on Complementary and Alternative Medicine Policy states: "The Commissioners believe and have repeatedly stated in this Report that our response should be to hold all systems of health and healing, including conventional and CAM, to the same rigorous standards of good science and health services research. Although the Commissioners support the provision of the most accurate information about the state of the science of all CAM modalities, they believe that it is premature to advocate the wide implementation and reimbursement of CAM modalities that are yet unproven."}} For example, acupuncture (piercing the body with needles to influence the flow of a supernatural energy) might be believed to increase the effectiveness or "complement" science-based medicine when used at the same time. Instead, significant drug interactions caused by alternative therapies may make treatments less effective, notably in cancer therapy.JOURNAL, Zeller, T., Muenstedt, K., Stoll, C., Schweder, J., Senf, B., Ruckhaeberle, E., Becker, S., Serve, H., Huebner, J., 2013-03-01, Potential interactions of complementary and alternative medicine with cancer therapy in outpatients with gynecological cancer in a comprehensive cancer center, Journal of Cancer Research and Clinical Oncology, 139, 3, 357–65, 10.1007/s00432-012-1336-6, 1432-1335, 23099993, JOURNAL, Ben-Arye, Eran, Polliack, Aaron, Schiff, Elad, Tadmor, Tamar, Samuels, Noah, 2013-12-01, Advising patients on the use of non-herbal nutritional supplements during cancer therapy: a need for doctor-patient communication, Journal of Pain and Symptom Management, 46, 6, 887–96, 10.1016/j.jpainsymman.2013.02.010, 23707384, 1873-6513, Besides the usual issues with alternative medicine, integrative medicine has been described as an attempt to bring pseudoscience into academic science-based medicine, leading to the pejorative term "quackademic medicine". Due to its many names, the field has been criticized for intense rebranding of what are essentially the same practices.CAM is an abbreviation of the phrase complementary and alternative medicine. It has also been called sCAM or SCAM with the addition of "so-called" or "supplements".WEB,weblink The short and irreverent e-dition of The Skeptic's Dictionary â€“ part 1 â€“ sCAM â€“ so-called complementary and alternative medicine,, 2016-10-15, JOURNAL, Tyreman, Stephen, 2011-05-01, Values in complementary and alternative medicine, Medicine, Health Care and Philosophy, 14, 2, 209–17, 10.1007/s11019-010-9297-5, 1572-8633, 21104324,

Other terms

{{see also|Traditional medicine}}Traditional medicine refers to the pre-scientific practices of a certain culture, in contrast to what is typically practiced in cultures where medical science dominates. "Eastern medicine" typically refers to the traditional medicines of Asia where conventional bio-medicine penetrated much later.Holistic medicine is another rebranding of alternative medicine. In this case, the words balance and holism are often used alongside complementary or integrative, claiming to take into account a "whole" person, in contrast to the supposed reductionism of medicine.

Challenges in defining alternative medicine

Prominent members of the science and biomedical science community say that it is not meaningful to define an alternative medicine that is separate from a conventional medicine, because the expressions "conventional medicine", "alternative medicine", "complementary medicine", "integrative medicine", and "holistic medicine" do not refer to any medicine at all. Others say that alternative medicine cannot be precisely defined because of the diversity of theories and practices it includes, and because the boundaries between alternative and conventional medicine overlap, are porous, and change.{{sfn|Harrison's Principles of Internal Medicine|2015|loc=chpt. 14-E|p=1}}{{sfn|IOM Report|2005|pp=14–20}} Healthcare practices categorized as alternative may differ in their historical origin, theoretical basis, diagnostic technique, therapeutic practice and in their relationship to the medical mainstream.{{sfn|Sointu|2012|p=13}} Under a definition of alternative medicine as "non-mainstream", treatments considered alternative in one location may be considered conventional in another.Critics say the expression is deceptive because it implies there is an effective alternative to science-based medicine, and that complementary is deceptive because it implies that the treatment increases the effectiveness of (complements) science-based medicine, while alternative medicines that have been tested nearly always have no measurable positive effect compared to a placebo. It has been said that "there is really no such thing as alternative medicine, just medicine that works and medicine that doesn't", and that the very idea of "alternative" treatments is paradoxical because any treatment proven to work is by definition "medicine."


{{see also|List of forms of alternative medicine}}Alternative medicine consists of a wide range of health care practices, products, and therapies. The shared feature is a claim to heal that is not based on the scientific method. Alternative medicine practices are diverse in their foundations and methodologies. Alternative medicine practices may be classified by their cultural origins or by the types of beliefs upon which they are based. Methods may incorporate or be based on traditional medicinal practices of a particular culture, folk knowledge, superstition,{{sfn|O'Connor|1995|p=2}} spiritual beliefs, belief in supernatural energies (antiscience), pseudoscience, errors in reasoning, propaganda, fraud, new or different concepts of health and disease, and any bases other than being proven by scientific methods. Different cultures may have their own unique traditional or belief based practices developed recently or over thousands of years, and specific practices or entire systems of practices.{{Clear}}

Unscientific belief systems

Alternative medicine, such as using naturopathy or homeopathy in place of conventional medicine, is based on belief systems not grounded in science.{| class="wikitable"!!Proposed mechanism!Issues!Naturopathy
vitalism>vital energy that guides bodily processes.|In conflict with the paradigm of evidence-based medicine. Many naturopaths have opposed vaccination, and "scientific evidence does not support claims that naturopathic medicine can cure cancer or any other disease".
In his book The Homœopathic Medical Doctrine Samuel Hahnemann the creator of homeopathy wrote: "Observation, reflection, and experience have unfolded to me that the best and true method of cure is founded on the principle, similia similibus curentur. To cure in a mild, prompt, safe, and durable manner, it is necessary to choose in each case a medicine that will excite an affection similar () to that against which it is employed."{{sfn1833iii, 48–49}}>name=Hahnemannquote|group=n}}|Developed before knowledge of atoms and molecules, or of basic chemistry, which shows that repeated dilution as practiced in homeopathy produces only water, and that homeopathy is not scientifically valid.
missing image!
- A person discovering that they have been transformed into se Wellcome V0011124.jpg -
"They told me if I took 1000 pills at night I should be quite another thing in the morning", an early 19th-century satire on Morison's Vegetable Pills, an alternative medicine supplement.

Traditional ethnic systems

File:Xi'an traditionnal medecine market (18).JPG|thumb|Ready-to-drink right|200x200pxAlternative medical systems may be based on traditional medicine practices, such as traditional Chinese medicine (TCM), Ayurveda in India, or practices of other cultures around the world. Some useful applications of traditional medicines have been researched and accepted within ordinary medicine, however the underlying belief systems are seldom scientific and are not accepted.Traditional medicine is considered alternative when it is used outside its home region; or when it is used together with or instead of known functional treatment; or when it can be reasonably expected that the patient or practitioner knows or should know that it will not work – such as knowing that the practice is based on superstition.{| class="wikitable"!!Claims!Issues|Traditional Chinese medicine|Traditional practices and beliefs from China, together with modifications made by the Communist party make up TCM. Common practices include herbal medicine, acupuncture (insertion of needles in the body at specified points), massage (Tui na), exercise (qigong), and dietary therapy.
qi, considerations of Chinese astrology>Chinese Astrology and Chinese numerology, traditional use of herbs and other substances found in China â€“ a belief that the tongue contains a map of the body that reflects changes in the body, and an incorrect model of the anatomy and physiology of internal organs.
Ayurveda#Tridosha system>doshas (called Vata, Pitta and Kapha), and states that a balance of the doshas results in health, while imbalance results in disease. Such disease-inducing imbalances can be adjusted and balanced using traditional herbs, minerals and heavy metals. Ayurveda stresses the use of plant-based medicines and treatments, with some animal products, and added minerals, including sulfur, arsenic, lead and copper sulfate{{Clarify|date=October 2017}}.patent medicines contained toxic levels of heavy metals such as lead, Mercury (element)>mercury and arsenic. A 2015 study of users in the United States also found elevated blood lead levels in 40 percent of those tested. Other concerns include the use of herbs containing toxic compounds and the lack of quality control in Ayurvedic facilities. Incidents of heavy metal poisoning have been attributed to the use of these compounds in the United States.{{sfn2003Mishrap=8}}HALL>FIRST1=HARRIETURL=HTTPS://WWW.CSICOP.ORG/SPECIALARTICLES/SHOW/AYURVEDA_ANCIENT_SUPERSTITION_NOT_ANCIENT_WISDOMACCESSDATE=1 FEBRUARY 2018JOURNAL=INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTHVOLUME=21PAGES=303–07PMID=25843124, 4727589,

Supernatural energies

Bases of belief may include belief in existence of supernatural energies undetected by the science of physics, as in biofields, or in belief in properties of the energies of physics that are inconsistent with the laws of physics, as in energy medicine.{| class="wikitable"!!Claims!Issues
Energy medicine>Biofield therapy|Intended to influence energy fields that, it is purported, surround and penetrate the body.Scientific skepticism) Carl Sagan (1934–1996) have described the lack of empirical evidence to support the existence of the putative energy fields on which these therapies are predicated.{{sfn>Sagan|1996}}
Bioelectromagnetism>Bioelectromagnetic therapy|Use verifiable electromagnetic fields, such as pulsed fields, alternating-current, or direct-current fields in an unconventional manner.|Asserts that magnets can be used to defy the laws of physics to influence health and disease.
|Chiropractic|Spinal manipulation aims to treat "vertebral subluxations" which are claimed to put pressure on nerves.|Chiropractic was developed in the belief that manipulating the spine affects the flow of a supernatural vital energy and thereby affects health and disease. Vertebral subluxation is a pseudoscientific concept and has not been proven to exist.
|Reiki|Practitioners place their palms on the patient near Chakras that they believe are centers of supernatural energies in the belief that these supernatural energies can transfer from the practitioner's palms to heal the patient.

Holistic therapy{| class"wikitable"

!!Claims!Issues|Mind-body medicine|The mind can affect "bodily functions and symptoms" and there is an interconnection between the mind, body, and spirit.|

Herbal remedies and other substances

{{See also|Phytotherapy}}Substance based practices use substances found in nature such as herbs, foods, non-vitamin supplements and megavitamins, animal and fungal products, and minerals, including use of these products in traditional medical practices that may also incorporate other methods.JOURNAL, Abdulla, Sara, Phytotherapy – good science or big business?, Nature, May 13, 1999, 10.1038/news990513-8, Science-based medicine, with its emphasis on controlled study, proof, evidence, statistical significance and safety is being rejected in favour of 'alternative medicine' â€“ an atavistic portmanteau of anecdote, hearsay, rumour and hokum.... Probably the most commercially successful and widely used branch of alternative or complementary medicine is 'phytotherapy'. These are the tablets, powders and elixirs, otherwise known as herbal medicine, that are sold in most countries, through health shops and pharmacies as 'nutritional supplements'.... Only a tiny minority of these remedies have been shown to have mild-to moderately beneficial health effects... So why are affluent, otherwise rational, highly educated people (for this is the average user profile) so hungry for phytotherapy?... people still believe that 'natural' equals good and safe despite plenty of evidence to the contrary." ... as far as the human body is concerned, 'natural' is meaningless... Equally, what's so safe about consuming substances that need meet no standards of contents? ..., JOURNAL, De Smet, Peter A.G.M., The Role of Plant-Derived Drugs and Herbal Medicines in Healthcare, Drugs, December 1997, 54, 6, 801–40, 10.2165/00003495-199754060-00003, 9421691, Examples include healing claims for nonvitamin supplements, fish oil, Omega-3 fatty acid, glucosamine, echinacea, flaxseed oil, and ginseng. Herbal medicine, or phytotherapy, includes not just the use of plant products, but may also include the use of animal and mineral products. It is among the most commercially successful branches of alternative medicine, and includes the tablets, powders and elixirs that are sold as "nutritional supplements". Only a very small percentage of these have been shown to have any efficacy, and there is little regulation as to standards and safety of their contents. This may include use of known toxic substances, such as use of the poison lead in traditional Chinese medicine.File:Chiropractic spinal adjustment.jpg|thumb|right|A chiropractor "adjusting" the spine.]]


{{expand section|date=May 2018}}

Religion, faith healing, and prayer{| class"wikitable"

Christianity>Christian faith healing|There is a divine or spiritual intervention in healing.LAST2=SIMPSONTITLE=A PAEDIATRICIAN'S GUIDE TO COMPLEMENTARY MEDICINEDATE=MARCH 1998ISSUE=1DOI=10.1016/S0957-5839(98)80061-4, Unwanted outcomes, such as death and disability, "have occurred when faith healing was elected instead of medical care for serious injuries or illnesses".FAITH HEALING – MAKING TREATMENT DECISIONS>PUBLISHER=AMERICAN CANCER SOCIETYURL=HTTP://WWW.CANCER.ORG/DOCROOT/ETO/CONTENT/ETO_5_3X_FAITH_HEALING.ASP, A 2001 double-blind study of 799 discharged coronary surgery patients found that "intercessory prayer had no significant effect on medical outcomes after hospitalization in a coronary care unit."AVILES>FIRST1=JENNIFER M.FIRST2=SR ELLENFIRST3=DEBRA A.FIRST4=BRENT A.FIRST5=KATHLEEN E.FIRST6=W. MICHAELFIRST7=STEPHEN L.JOURNAL=MAYO CLINIC PROCEEDINGSVOLUME=76PAGES=1192–98PMID=11761499,
altered state of consciousness>altered states of consciousness in order to encounter and interact with the spirit world or channel supernatural energies in the belief that they can heal.|

NCCIH classification

A US agency, National Center on Complementary and Integrative Health (NCCIH), has created a classification system for branches of complementary and alternative medicine that divides them into five major groups. These groups have some overlap, and distinguish two types of energy medicine: veritable which involves scientifically observable energy (including magnet therapy, colorpuncture and light therapy) and putative, which invokes physically undetectable or unverifiable energy. None of these energies have any evidence to support that they effect the body in any positive or health promoting way.
  1. Whole medical systems: Cut across more than one of the other groups; examples include traditional Chinese medicine, naturopathy, homeopathy, and ayurveda.
  2. Mind-body interventions: Explore the interconnection between the mind, body, and spirit, under the premise that they affect "bodily functions and symptoms". A connection between mind and body is conventional medical fact, and this classification does not include therapies with proven function such as cognitive behavioral therapy.
  3. "Biology"-based practices: Use substances found in nature such as herbs, foods, vitamins, and other natural substances. (Note that as used here, "biology" does not refer to the science of biology, but is a usage newly coined by NCCIH in the primary source used for this article. "Biology-based" as coined by NCCIH may refer to chemicals from a nonbiological source, such as use of the poison lead in traditional Chinese medicine, and to other nonbiological substances.)
  4. Manipulative and body-based practices: feature manipulation or movement of body parts, such as is done in bodywork, chiropractic, and osteopathic manipulation.
  5. Energy medicine: is a domain that deals with putative and verifiable energy fields:
    • Biofield therapies are intended to influence energy fields that are purported to surround and penetrate the body. The existence of such energy fields have been disproven.
    • Bioelectromagnetic-based therapies use verifiable electromagnetic fields, such as pulsed fields, alternating-current, or direct-current fields in an non-scientific manner.


The history of alternative medicine may refer to the history of a group of diverse medical practices that were collectively promoted as "alternative medicine" beginning in the 1970s, to the collection of individual histories of members of that group, or to the history of western medical practices that were labeled "irregular practices" by the western medical establishment.Countercultural Healing: A brief History of Alternavie Medicine in America, James Whorton, PBS, November 4, 2003, weblinkNature Cures  â€“ The History of Alternative Medicine in America, James C. Whorton, Oxford University Press, 2002, WEB,weblink Archived copy, 2015-06-08, yes,weblink" title="">weblink 2015-06-08, The Rise and Rise of Complementary and Alternative Medicine: a Sociological Perspective, Ian D Coulter and Evan M Willis, Medical Journal of Australia, 2004; 180 (11): 587–89 It includes the histories of complementary medicine and of integrative medicine. Before the 1970s, western practitioners that were not part of the increasingly science-based medical establishment were referred to "irregular practitioners", and were dismissed by the medical establishment as unscientific and as practicing quackery. Until the 1970s, irregular practice became increasingly marginalized as quackery and fraud, as western medicine increasingly incorporated scientific methods and discoveries, and had a corresponding increase in success of its treatments. In the 1970s, irregular practices were grouped with traditional practices of nonwestern cultures and with other unproven or disproven practices that were not part of biomedicine, with the entire group collectively marketed and promoted under the single expression "alternative medicine".Quack Medicine: A History of Combating Health Fraud in Twentieth-Century America, Eric W. Boyle, weblinkWEB,weblink The Alternative Fix – Introduction, Frontline – PBS,, Use of alternative medicine in the west began to rise following the counterculture movement of the 1960s, as part of the rising new age movement of the 1970s.The New Age of Alternative Medicine, Why New Age Medicine Is Catching On, Claudia Wallis, Time Magazine, 11-4-1991, weblinkNew Age Medicine, Encyclopedia of New Age Beliefs; John Ankerberg, John Weldon, 1996, pp. 470–508, weblink This was due to misleading mass marketing of "alternative medicine" being an effective "alternative" to biomedicine, changing social attitudes about not using chemicals and challenging the establishment and authority of any kind, sensitivity to giving equal measure to beliefs and practices of other cultures (cultural relativism), and growing frustration and desperation by patients about limitations and side effects of science-based medicine. At the same time, in 1975, the American Medical Association, which played the central role in fighting quackery in the United States, abolished its quackery committee and closed down its Department of Investigation.{{rp|xxi}}JOURNAL, One of the few growth industries in contemporary Britain is alternative medicine. An apparently endless stream of books, articles, and radio and television programmes urge on the public the virtues of treatments ranging from meditation to drilling a hole in the skull to let in more oxygen., 1548588, 1983, Smith, T, Alternative medicine, British Medical Journal (Clinical Research Ed.), 287, 6388, 307–08, 6307462, 10.1136/bmj.287.6388.307, By the early to mid 1970s the expression "alternative medicine" came into widespread use, and the expression became mass marketed as a collection of "natural" and effective treatment "alternatives" to science-based biomedicine.Other healers, other cures: A guide to alternative medicine, Helen Kruger, 1974, weblinkWEB,weblink A Guide to Alternative Medicine, Law, Donald, 18 May 1975, Hippocrene Books, New York, Amazon, By 1983, mass marketing of "alternative medicine" was so pervasive that the British Medical Journal (BMJ) pointed to "an apparently endless stream of books, articles, and radio and television programmes urge on the public the virtues of (alternative medicine) treatments ranging from meditation to drilling a hole in the skull to let in more oxygen".An analysis of trends in the criticism of complementary and alternative medicine (CAM) in five prestigious American medical journals during the period of reorganization within medicine (1965–1999) was reported as showing that the medical profession had responded to the growth of CAM in three phases, and that in each phase, changes in the medical marketplace had influenced the type of response in the journals. Changes included relaxed medical licensing, the development of managed care, rising consumerism, and the establishment of the USA Office of Alternative Medicine (later National Center for Complementary and Alternative Medicine, currently National Center for Complementary and Integrative Health).{{refn|group=n|According to the medical historian James Harvey Young:}}}}

Medical education

Mainly as a result of reforms following the Flexner Report of 1910 medical education in established medical schools in the US has generally not included alternative medicine as a teaching topic.{{refn|group=n|As the medical professor Kenneth M. Ludmerer noted in 2010: "Flexner pointed out that the scientific method of thinking applied to medical practice. By scientific method, he meant testing ideas with well-planned experiments to establish accurate facts. The clinician's diagnosis was equivalent to the scientist's hypothesis: both medical diagnosis and hypothesis required the test of an experiment. Flexner argued that mastery of the scientific method of problem solving was the key for physicians to manage medical uncertainty and to practice in the most cost-effective way."}} Typically, their teaching is based on current practice and scientific knowledge about: anatomy, physiology, histology, embryology, neuroanatomy, pathology, pharmacology, microbiology and immunology. Medical schools' teaching includes such topics as doctor-patient communication, ethics, the art of medicine, and engaging in complex clinical reasoning (medical decision-making). Writing in 2002, Snyderman and Weil remarked that by the early twentieth century the Flexner model had helped to create the 20th-century academic health center, in which education, research, and practice were inseparable. While this had much improved medical practice by defining with increasing certainty the pathophysiological basis of disease, a single-minded focus on the pathophysiological had diverted much of mainstream American medicine from clinical conditions that were not well understood in mechanistic terms, and were not effectively treated by conventional therapies.By 2001 some form of CAM training was being offered by at least 75 out of 125 medical schools in the US. Exceptionally, the School of Medicine of the University of Maryland, Baltimore includes a research institute for integrative medicine (a member entity of the Cochrane Collaboration). Medical schools are responsible for conferring medical degrees, but a physician typically may not legally practice medicine until licensed by the local government authority. Licensed physicians in the US who have attended one of the established medical schools there have usually graduated Doctor of Medicine (MD). All states require that applicants for MD licensure be graduates of an approved medical school and complete the United States Medical Licensing Exam (USMLE).


There is a general scientific consensus that alternative therapies lack the requisite scientific validation, and their effectiveness is either unproved or disproved. Many of the claims regarding the efficacy of alternative medicines are controversial, since research on them is frequently of low quality and methodologically flawed.{{sfn|IOM Report|2005}} Selective publication bias, marked differences in product quality and standardisation, and some companies making unsubstantiated claims call into question the claims of efficacy of isolated examples where there is evidence for alternative therapies.The Scientific Review of Alternative Medicine points to confusions in the general population â€“ a person may attribute symptomatic relief to an otherwise-ineffective therapy just because they are taking something (the placebo effect); the natural recovery from or the cyclical nature of an illness (the regression fallacy) gets misattributed to an alternative medicine being taken; a person not diagnosed with science-based medicine may never originally have had a true illness diagnosed as an alternative disease category.Edzard Ernst characterized the evidence for many alternative techniques as weak, nonexistent, or negative and in 2011 published his estimate that about 7.4% were based on "sound evidence", although he believes that may be an overestimate. Ernst has concluded that 95% of the alternative treatments he and his team studied, including acupuncture, herbal medicine, homeopathy, and reflexology, are "statistically indistinguishable from placebo treatments", but he also believes there is something that conventional doctors can usefully learn from the chiropractors and homeopath: this is the therapeutic value of the placebo effect, one of the strangest phenomena in medicine.In 2003, a project funded by the CDC identified 208 condition-treatment pairs, of which 58% had been studied by at least one randomized controlled trial (RCT), and 23% had been assessed with a meta-analysis. According to a 2005 book by a US Institute of Medicine panel, the number of RCTs focused on CAM has risen dramatically.{{as of|2005}}, the Cochrane Library had 145 CAM-related Cochrane systematic reviews and 340 non-Cochrane systematic reviews. An analysis of the conclusions of only the 145 Cochrane reviews was done by two readers. In 83% of the cases, the readers agreed. In the 17% in which they disagreed, a third reader agreed with one of the initial readers to set a rating. These studies found that, for CAM, 38.4% concluded positive effect or possibly positive (12.4%), 4.8% concluded no effect, 0.7% concluded harmful effect, and 56.6% concluded insufficient evidence. An assessment of conventional treatments found that 41.3% concluded positive or possibly positive effect, 20% concluded no effect, 8.1% concluded net harmful effects, and 21.3% concluded insufficient evidence. However, the CAM review used the more developed 2004 Cochrane database, while the conventional review used the initial 1998 Cochrane database.{{sfn|IOM Report|2005|pp=135–36}}Alternative therapies do not "complement" (improve the effect of, or mitigate the side effects of) functional medical treatment.{{refn|group=n|name=FinalReport}} Significant drug interactions caused by alternative therapies may instead negatively impact functional treatment by making prescription drugs less effective, such as interference by herbal preparations with warfarin.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. 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.Cancer researcher Andrew J. Vickers has stated:

Mechanism of action

missing image!
- Altmed function 2.svg|thumb|right|350px|How alternative treatments "work":a) Misinterpreted natural course – the individual gets better without treatment.b) Placebo effect or false treatment effect – an individual receives "alternative therapy" and is convinced it will help. The conviction makes them more likely to get better.c) Nocebo effect – an individual is convinced that standard treatment will not work, and that alternative treatment will work. This decreases the likelihood standard treatment will work, while the placebo effect of the "alternative" remains. d) No adverse effects – Standard treatment is replaced with "alternative" treatment, getting rid of adverse effects, but also of improvement.e) Interference – Standard treatment is "complemented" with something that interferes with its effect. This can both cause worse effect, but also decreased (or even increased) side effects, which may be interpreted as "helping".Researchers such as epidemiologists, clinical statisticians and pharmacologists use clinical trialclinical trial

Placebo effect

A placebo is a medical treatment with no intended therapeutic value. An example of a placebo is an inert pill, but it can include more dramatic interventions like sham surgery. The placebo effect is the concept that patients will perceive an improvement after being treated with an inert treatment. The opposite of the placebo effect is the nocebo effect, when patients who expect a treatment to be harmful will perceive harmful effects after taking it.Placebos do not have a physical effect on diseases or improve overall outcomes, but patients may report improvements in subjective outcomes such as pain and nausea.JOURNAL, Hróbjartsson A, Gøtzsche PC, Placebo interventions for all clinical conditions, The Cochrane Database of Systematic Reviews, 106, 1, CD003974, January 2010, 20091554, 10.1002/14651858.CD003974.pub3, Hróbjartsson, Asbjørn, vanc,weblink A 1955 study suggested that a substantial part of a medicine's impact was due to the placebo effect. However, reassessments found the study to have flawed methodology.JOURNAL, Hróbjartsson A, Gøtzsche PC, Is the placebo powerless? An analysis of clinical trials comparing placebo with no treatment, The New England Journal of Medicine, 344, 21, 1594–602, May 2001, 11372012, 10.1056/NEJM200105243442106, This and other modern reviews suggest that other factors like natural recovery and reporting bias should also be considered.All of these are reasons why alternative therapies may be credited for improving a patient's condition even though the objective effect is non-existent, or even harmful. David Gorski argues that alternatives treatments should be treated as a placebo, rather than as medicine. Almost none have performed significantly better than a placebo in clinical trials. Furthermore, distrust of conventional medicine may lead to patients experiencing the nocebo effect when taking effective medication.

Regression to the mean

A patient who receives an inert treatment may report improvements afterwards that it did not cause.JOURNAL, Kienle GS, Kiene H, The powerful placebo effect: fact or fiction?, Journal of Clinical Epidemiology, 50, 12, 1311–8, December 1997, 9449934, 10.1016/s0895-4356(97)00203-5, Assuming it was the cause without evidence is an example of the regression fallacy. This may be due to a natural recovery from the illness, or a fluctuation in the symptoms of a long-term condition. The concept of regression toward the mean implies that an extreme result is more likely to be followed by a less extreme result.

Other factors

There are also reasons why a placebo treatment group may outperform a "no-treatment" group in a test which are not related to a patient's experience. These include patients reporting more favourable results than they really felt due to politeness or "experimental subordination", observer bias, and misleading wording of questions. In their 2010 systematic review of studies into placebos, Asbjørn Hróbjartsson and Peter C. Gøtzsche write that "even if there were no true effect of placebo, one would expect to record differences between placebo and no-treatment groups due to bias associated with lack of blinding." Alternative therapies may also be credited for perceived improvement through decreased use or effect of medical treatment, and therefore either decreased side effects or nocebo effects towards standard treatment.JOURNAL, Zeller, T., Muenstedt, K., Stoll, C., Schweder, J., Senf, B., Ruckhaeberle, E., Becker, S., Serve, H., Huebner, J., 2013-03-01, Potential interactions of complementary and alternative medicine with cancer therapy in outpatients with gynecological cancer in a comprehensive cancer center, Journal of Cancer Research and Clinical Oncology, 139, 3, 357–65, 10.1007/s00432-012-1336-6, 1432-1335, 23099993,

Use and regulation


Practitioners of complementary medicine usually discuss and advise patients as to available alternative therapies. Patients often express interest in mind-body complementary therapies because they offer a non-drug approach to treating some health conditions.In addition to the social-cultural underpinnings of the popularity of alternative medicine, there are several psychological issues that are critical to its growth, notably psychological effects, such as the will to believe, cognitive biases that help maintain self-esteem and promote harmonious social functioning, and the post hoc, ergo propter hoc fallacy.


File:Edzard ernst.jpg
Alternative medicine is a highly profitable industry, with a strong lobby. This fact is often overlooked by media or intentionally kept hidden, with alternative practice being portrayed positively when compared to "big pharma".The popularity of complementary & alternative medicine (CAM) may be related to other factors that Edzard Ernst mentioned in an interview in The Independent:}}Paul Offit proposed that "alternative medicine becomes quackery" in four ways: by recommending against conventional therapies that are helpful, promoting potentially harmful therapies without adequate warning, draining patients' bank accounts, or by promoting "magical thinking." Promoting alternative medicine has been called dangerous and unethical.{{refn|name=Groopmanquote|group=n|"Kessler refers to a lack of efficacy but never pushes back at Hatch by enumerating the dangers that unregulated products pose to the public, the dangers that fill the pages of Offit's book."NEWS, Jerome Groopman, The Quackish Cult of Alternative Medicine. Dr. Paul Offit's battle against charlatanism,weblink The New Republic, October 19, 2013, 2015-02-03, }}JOURNAL, Weisleder, P, Unethical prescriptions: alternative therapies for children with cerebral palsy., Clinical Pediatrics, January 2010, 49, 1, 7–11, 10.1177/0009922809340438, 19628756, (File:Lemon-906141.jpg|thumb|Friendly and colorful images of herbal treatments may look less threatening or dangerous when compared to conventional medicine. This is an intentional marketing strategy.)

Social factors

Authors have speculated on the socio-cultural and psychological reasons for the appeal of alternative medicines among the minority using them in lieu of conventional medicine. There are several socio-cultural reasons for the interest in these treatments centered on the low level of scientific literacy among the public at large and a concomitant increase in antiscientific attitudes and new age mysticism. Related to this are vigorous marketing of extravagant claims by the alternative medical community combined with inadequate media scrutiny and attacks on critics. Alternative medicine is criticized for taking advantage of the least fortunate members of society.There is also an increase in conspiracy theories toward 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. 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. Medical doctors are also aggressively marketing alternative medicine to profit from this market.Patients can be averse to the painful, unpleasant, and sometimes-dangerous side effects of biomedical treatments. Treatments for severe diseases such as cancer and HIV infection have well-known, significant side-effects. Even low-risk medications such as antibiotics can have potential to cause life-threatening anaphylactic reactions in a very few individuals. Many medications may cause minor but bothersome symptoms such as cough or upset stomach. In all of these cases, patients may be seeking out alternative treatments to avoid the adverse effects of conventional treatments.

Prevalence of use

According to recent research, the increasing popularity of the CAM needs to be explained by moral convictions or lifestyle choices rather than by economic reasoning.BOOK, Martin, Hélène, Debons, Jérôme, CAM and conventional medicine in Switzerland : divided in theory, united in practice. In N. K. Gale & J. V. McHale, Routledge Handbook of Complementary and Alternative Medicine. Perspectives from social science and law, 2015, Routledge, London and New York, 271–91, 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 healthcare or be integrated into the healthcare system. In Africa, traditional medicine is used for 80% of primary healthcare, and in developing nations as a whole over one-third of the population lack access to essential medicines.Some have proposed adopting a prize system to reward medical research. However, public funding for research exists. In the US increasing the funding for research on alternative medicine is the purpose of the US National Center for Complementary and Alternative Medicine (NCCAM). NCCAM has spent more than US$2.5 billion on such research since 1992 and this research has not demonstrated the efficacy of alternative treatments.WEB,weblink $142 Million For Quack Medicine Buried Inside The New 2018 Budget, Salzberg, Steven, Forbes, en, 2019-02-14, WEB,weblink NCCIH Strategic Plan 2016-2021, or: Let's try to do some real science for a change, 2016-04-04, Science-Based Medicine, en-US, 2019-02-14, JOURNAL, 2001, Stated goals and grants of the Office of Alternative Medicine/National Center for Complementary and Alternative Medicine, Scientific Review of Alternative Medicine, 5, 4, 205–07, Green S, The NCCAM's sister organization in the NIC Office of Cancer Complementary and Alternative Medicine gives grants of around $105 million every year.JOURNAL, Annual Report on CAM 2011,weblink Testing alternative medicine that has no scientific basis has been called a waste of scarce research resources.JOURNAL, Centre turns away from healing herbs, Nature, 462, 7274, 711, Wadman, Meredith, 7 December 2009, Nature Publishing Group, 10.1038/462711a, 20010660, JOURNAL, Gorski, DH, Novella, SP, Clinical trials of integrative medicine: testing whether magic works?, Trends in Molecular Medicine, September 2014, 20, 9, 473–76, 10.1016/j.molmed.2014.06.007, 25150944, That alternative medicine has been on the rise "in countries where Western science and scientific method generally are accepted as the major foundations for healthcare, and 'evidence-based' practice is the dominant paradigm" was described as an "enigma" in the Medical Journal of Australia.

In the US

In the United States, the 1974 Child Abuse Prevention and Treatment Act (CAPTA) required that for states to receive federal money, they had to grant religious exemptions to child neglect and abuse laws regarding religion-based healing practices.JOURNAL, Merrick, Janna, June 2003, Spiritual Healing, Sick Kids and the Law: Inequities in the American Healthcare System, American Journal of Law & Medicine, 29, 2, 269–99, Thirty-one states have child-abuse religious exemptions.WEB,weblink Definitions of Child Abuse and Neglect, 2009-02-27, Child Welfare Information Gateway, 2007, yes,weblink" title="">weblink 11 October 2007, The use of alternative medicine in the US has increased,JOURNAL, Eisenberg, D.M., Davis, R.B., Ettner, S.L., Appel, S., Wilkey, S., Van Rompay, M., Kessler, R.C., 1, 1998, Trends in alternative medicine use in the United States, 1990–1997: Results of a follow-up national survey, JAMA, 280, 18, 1569–75, 10.1001/jama.280.18.1569, 9820257, {{harvid, Eisenberg et al., 1998, }} with a 50 percent increase in expenditures and a 25 percent increase in the use of alternative therapies between 1990 and 1997 in America. Americans spend many billions on the therapies annually. Most Americans used CAM to treat and/or prevent musculoskeletal conditions or other conditions associated with chronic or recurring pain. In America, women were more likely than men to use CAM, with the biggest difference in use of mind-body therapies including prayer specifically for health reasons". In 2008, more than 37% of American hospitals offered alternative therapies, up from 27 percent in 2005, and 25% in 2004. More than 70% of the hospitals offering CAM were in urban areas.A survey of Americans found that 88 percent thought that "there are some good ways of treating sickness that medical science does not recognize". Use of magnets was the most common tool in energy medicine in America, and among users of it, 58 percent described it as at least "sort of scientific", when it is not at all scientific. In 2002, at least 60 percent of US medical schools have at least some class time spent teaching alternative therapies. "Therapeutic touch" was taught at more than 100 colleges and universities in 75 countries before the practice was debunked by a nine-year-old child for a school science project.

Prevalence of use of specific therapies

The most common CAM therapies used in the US in 2002 were prayer (45%), herbalism (19%), breathing meditation (12%), meditation (8%), chiropractic medicine (8%), yoga (5–6%), body work (5%), diet-based therapy (4%), progressive relaxation (3%), mega-vitamin therapy (3%) and Visualization (2%)In Britain, the most often used alternative therapies were Alexander technique, Aromatherapy, Bach and other flower remedies, Body work therapies including massage, Counseling stress therapies, hypnotherapy, Meditation, Reflexology, Shiatsu, Ayurvedic medicine, Nutritional medicine, and Yoga.{{sfn|Sir Walton: Science and Technology Committee|2000}} Ayurvedic medicine remedies are mainly plant based with some use of animal materials.{{sfn|Wujastyk|2003}} Safety concerns include the use of herbs containing toxic compounds and the lack of quality control in Ayurvedic facilities.According to the National Health Service (England), the most commonly used complementary and alternative medicines (CAM) supported by the NHS in the UK are: acupuncture, aromatherapy, chiropractic, homeopathy, massage, osteopathy and clinical hypnotherapy.

In palliative care

Complementary therapies are often used in palliative care or by practitioners attempting to manage chronic pain in patients. Integrative medicine is considered more acceptable in the interdisciplinary approach used in palliative care than in other areas of medicine. "From its early experiences of care for the dying, palliative care took for granted the necessity of placing patient values and lifestyle habits at the core of any design and delivery of quality care at the end of life. If the patient desired complementary therapies, and as long as such treatments provided additional support and did not endanger the patient, they were considered acceptable." The non-pharmacologic interventions of complementary medicine can employ mind-body interventions designed to "reduce pain and concomitant mood disturbance and increase quality of life."


{{Further|Regulation of alternative medicine | Regulation and prevalence of homeopathy}}{{Expand section|date=May 2018}}File:Use Caution With Ayurvedic Products (FDA October 16, 2008).djvu|thumb|Health campaign flyers, as in this example from the Food and Drug AdministrationFood and Drug AdministrationThe alternative medicine lobby has successfully pushed for alternative therapies to be subject to far less regulation than conventional medicine. Some professions of complementary/traditional/alternative medicine, such as chiropractic, have achieved full regulation in North America and other parts of the world{{sfn|WHO|2005}} and are regulated in a manner similar to that governing science-based medicine. In contrast, other approaches may be partially recognized and others have no regulation at all.{{sfn|WHO|2005}} In some cases, promotion of alternative therapies is allowed when there is demonstrably no effect, only a tradition of use. Despite laws making it illegal to market or promote alternative therapies for use in cancer treatment, many practitioners promote them.WEB,weblink Complementary and alternative therapies – Cancer in general, Cancer Research UK,, WEB,weblink Complementary cancer care service,, Regulation and licensing of alternative medicine ranges widely from country to country, and state to state.{{sfn|WHO|2005}} In Austria and Germany complementary and alternative medicine is mainly in the hands of doctors with MDs, and half or more of the American alternative practitioners are licensed MDs. In Germany herbs are tightly regulated: half are prescribed by doctors and covered by health insurance.Government bodies in the US and elsewhere have published information or guidance about alternative medicine. The U.S. Food and Drug Administration (FDA), has issued online warnings for consumers about medication health fraud.WEB,weblink Medication Health Fraud,, 2019-02-09, This includes a section on Alternative Medicine Fraud,WEB,weblink Alternative Medicine Fraud,, such as a warning that Ayurvedic products generally have not been approved by the FDA before marketing.FDA, Use Caution With Ayurvedic Products

Risks and problems

Negative outcomes

{{See also|List of herbs with known adverse effects}}

Adequacy of regulation and CAM safety

Many of the claims regarding the safety and efficacy of alternative medicine are controversial. Some alternative treatments have been associated with unexpected side effects, which can be fatal.JOURNAL, Niggemann, B., Grüber, C., Side-effects of complementary and alternative medicine, Allergy, 22 February 2003, 58, 8, 707–16, 10.1034/j.1398-9995.2003.00219.x, 12859546, A commonly voiced concerns about complementary alternative medicine (CAM) is the way it's regulated. There have been significant developments in how CAMs should be assessed prior to re-sale in the United Kingdom and the European Union (EU) in the last 2 years. Despite this, it has been suggested that current regulatory bodies have been ineffective in preventing deception of patients as many companies have re-labelled their drugs to avoid the new laws. There is no general consensus about how to balance consumer protection (from false claims, toxicity, and advertising) with freedom to choose remedies.Advocates of CAM suggest that regulation of the industry will adversely affect patients looking for alternative ways to manage their symptoms, even if many of the benefits may represent the placebo affect. Some contend that alternative medicines should not require any more regulation than over-the-counter medicines that can also be toxic in overdose (such as paracetamol).

Interactions with conventional pharmaceuticals

Forms of alternative medicine that are biologically active can be dangerous even when used in conjunction with conventional medicine. Examples include immuno-augmentation therapy, shark cartilage, bioresonance therapy, oxygen and ozone therapies, and insulin potentiation therapy. Some herbal remedies can cause dangerous interactions with chemotherapy drugs, radiation therapy, or anesthetics during surgery, among other problems. An example of these dangers was reported by Associate Professor Alastair MacLennan of Adelaide University, Australia regarding a patient who almost bled to death on the operating table after neglecting to mention that she had been taking "natural" potions to "build up her strength" before the operation, including a powerful anticoagulant that nearly caused her death.To ABC Online, MacLennan also gives another possible mechanism:


Conventional treatments are subjected to testing for undesired side-effects, whereas alternative treatments, in general, are not subjected to such testing at all. Any treatment â€“ whether conventional or alternative â€“ that has a biological or psychological effect on a patient may also have potential to possess 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." Specific groups of patients such as patients with impaired hepatic or renal function are more susceptible to side effects of alternative remedies.JOURNAL, Use of herbal remedies among patients undergoing hemodialysis, Iran J Kidney Dis, 24241097,weblink 7, 6, Nov 2013, 492–95, Roozbeh, J, Hashempur, M. H., Heydari, M, JOURNAL, Herbal products: benefits, limits, and applications in chronic liver disease, Evid Based Complement Alternat Med, 22991573, 3443820, 10.1155/2012/837939, 2012, 2012, 1–19, Del Prete, A, Scalera, A, Iadevaia, M. D., Miranda, A, Zulli, C, Gaeta, L, Tuccillo, C, Federico, A, Loguercio, C, An exception to the normal thinking regarding side-effects is Homeopathy. Since 1938, the U.S. Food and Drug Administration (FDA) has regulated homeopathic products in "several significantly different ways from other drugs." Homeopathic preparations, termed "remedies", are extremely dilute, often far beyond the point where a single molecule of the original active (and possibly toxic) ingredient is likely to remain. They are, thus, considered safe on that count, but "their products are exempt from good manufacturing practice requirements related to expiration dating and from finished product testing for identity and strength", and their alcohol concentration may be much higher than allowed in conventional drugs.

Treatment delay

Alternative medicine may discourage people from getting the best possible treatment. Those having experienced or perceived success with one alternative therapy for a minor ailment may be convinced of its efficacy and persuaded to extrapolate that success to some other alternative therapy for a more serious, possibly life-threatening illness. For this reason, critics argue that therapies that rely on the placebo effect to define success are very dangerous. According to mental health journalist Scott Lilienfeld in 2002, "unvalidated or scientifically unsupported mental health practices can lead individuals to forgo effective treatments" and refers to this as opportunity cost. Individuals who spend large amounts of time and money on ineffective treatments may be left with precious little of either, and may forfeit the opportunity to obtain treatments that could be more helpful. In short, even innocuous treatments can indirectly produce negative outcomes. Between 2001 and 2003, four children died in Australia because their parents chose ineffective naturopathic, homeopathic, or other alternative medicines and diets rather than conventional therapies.

Unconventional cancer "cures"

There have always been "many therapies offered outside of conventional cancer treatment centers and based on theories not found in biomedicine. These alternative cancer cures have often been described as 'unproven,' suggesting that appropriate clinical trials have not been conducted and that the therapeutic value of the treatment is unknown." However, "many alternative cancer treatments have been investigated in good-quality clinical trials, and they have been shown to be ineffective....The label 'unproven' is inappropriate for such therapies; it is time to assert that many alternative cancer therapies have been 'disproven'."Edzard Ernst has stated:}}

Rejection of science

{{Reduced pull quote|1=right|2=There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking.4=Journal of the American Medical Association (1998)}}"CAM", meaning "complementary and alternative medicine", is not as well researched as conventional medicine, which undergoes intense research before release to the public. Practitioners of science-based medicine also discard practices and treatments when they are shown ineffective, while alternative practitioners do not.BOOK, Consumer health: a guide to intelligent decisions, Barrett, Stephen, London, William M., Kroger, Manfred, Hall, Harriet, Baratz, Robert S., McGraw-Hill, 2013, 9780078028489, 9th, New York, 34–35, 134, 137, 758098687, Funding for research is also sparse making it difficult to do further research for effectiveness of CAM. Most funding for CAM is funded by government agencies. Proposed research for CAM are rejected by most private funding agencies because the results of research are not reliable. The research for CAM has to meet certain standards from research ethics committees, which most CAM researchers find almost impossible to meet. Even with the little research done on it, CAM has not been proven to be effective.Alternative medicine may lead to a false understanding of the body and of the process of science.BOOK, More harm than good? : the moral maze of complementary and alternative medicine, (Edzard), Ernst, E., Smith, Kevin, 9783319699417, Cham, Switzerland, 18, 1019807158, 2018-01-11, JOURNAL, Fisken, Roger A., 2014-05-19, Teach evidence based, not alternative, medicine,weblink BMJ, en, 348, g3218, 10.1136/bmj.g3218, 24839973, 1756-1833, Steven Novella, a neurologist at Yale School of Medicine, wrote that government-funded studies of integrating alternative medicine techniques into the mainstream are "used to lend an appearance of legitimacy to treatments that are not legitimate." Marcia Angell considered that critics felt that healthcare practices should be classified based solely on scientific evidence, and if a treatment had been rigorously tested and found safe and effective, science-based medicine will adopt it regardless of whether it was considered "alternative" to begin with. It is possible for a method to change categories (proven vs. unproven), based on increased knowledge of its effectiveness or lack thereof. A prominent supporter of this position is George D. Lundberg, former editor of the Journal of the American Medical Association (JAMA).Writing in 1999 in CA: A Cancer Journal for Clinicians Barrie R. Cassileth mentioned a 1997 letter to the US Senate Subcommittee on Public Health and Safety, which had deplored the lack of critical thinking and scientific rigor in OAM-supported research, had been signed by four Nobel Laureates and other prominent scientists. (This was supported by the National Institutes of Health (NIH).)In March 2009, a staff writer for the Washington Post reported that the impending national discussion about broadening access to health care, improving medical practice and saving money was giving a group of scientists an opening to propose shutting down the National Center for Complementary and Alternative Medicine. They quoted one of these scientists, Steven Salzberg, a genome researcher and computational biologist at the University of Maryland, as saying "One of our concerns is that NIH is funding pseudoscience." They noted that the vast majority of studies were based on fundamental misunderstandings of physiology and disease, and had shown little or no effect.Writers such as Carl Sagan, a noted astrophysicist, advocate of scientific skepticism and the author of (The Demon-Haunted World|The Demon-Haunted World: Science as a Candle in the Dark) (1996), have lambasted the lack of empirical evidence to support the existence of the putative energy fields on which these therapies are predicated.{{sfn|Sagan|1996}}Sampson has also pointed out that CAM tolerated contradiction without thorough reason and experiment. Barrett has pointed out that there is a policy at the NIH of never saying something doesn't work, only that a different version or dose might give different results. Barrett also expressed concern that, just because some "alternatives" have merit, there is the impression that the rest deserve equal consideration and respect even though most are worthless, since they are all classified under the one heading of alternative medicine.Some critics of alternative medicine are focused upon health fraud, misinformation, and quackery as public health problems, notably Wallace Sampson and Paul Kurtz founders of Scientific Review of Alternative Medicine and Stephen Barrett, co-founder of The National Council Against Health Fraud and webmaster of Quackwatch. Grounds for opposing alternative medicine include that:
  • It is usually based on religion, tradition, superstition, belief in supernatural energies, pseudoscience, errors in reasoning, propaganda, or fraud.
  • Alternative therapies typically lack any scientific validation, and their effectiveness is either unproved or disproved.{{dubious|date=January 2013}}
  • Treatments are not part of the conventional, science-based healthcare system.{{sfn|IOM Report|2005|pp=17–19}}
  • Research on alternative medicine is frequently of low quality and methodologically flawed.{{sfn|IOM Report|2005|p=146}}
  • Where alternative treatments have replaced conventional science-based medicine, even with the safest alternative medicines, failure to use or delay in using conventional science-based medicine has caused deaths.
  • Methods may incorporate or base themselves on traditional medicine, folk knowledge, spiritual beliefs, ignorance or misunderstanding of scientific principles, errors in reasoning, or newly conceived approaches claiming to heal.
Many alternative medical treatments are not patentable,JOURNAL, Fonfa, Anne E., September 1, 2017, Patient Perspectives: Barriers to Complementary and Alternative Medicine Therapies Create Problems for Patients and Survivors, Integrative Cancer Therapies, 6, September 2007, 297–300, 10.1177/1534735407306598, 17761643, which may lead to less research funding from the private sector. In addition, in most countries, alternative treatments (in contrast to pharmaceuticals) can be marketed without any proof of efficacy â€“ also a disincentive for manufacturers to fund scientific research.English evolutionary biologist Richard Dawkins, in his 2003 book A Devil's Chaplain, defined alternative medicine as a "set of practices that cannot be tested, refuse to be tested, or consistently fail tests." Dawkins argued that if a technique is demonstrated effective in properly performed trials then it ceases to be alternative and simply becomes medicine.CAM is also often less regulated than conventional medicine. There are ethical concerns about whether people who perform CAM have the proper knowledge to treat patients. CAM is often done by non-physicians who do not operate with the same medical licensing laws which govern conventional medicine, and it is often described as an issue of non-maleficence.According to two writers, Wallace Sampson and K. Butler, marketing is part of the training required in alternative medicine, and propaganda methods in alternative medicine have been traced back to those used by Hitler and Goebels in their promotion of pseudoscience in medicine.In November 2011 Edzard Ernst stated that the "level of misinformation about alternative medicine has now reached the point where it has become dangerous and unethical. So far, alternative medicine has remained an ethics-free zone. It is time to change this."

Conflicts of interest

Some commentators have said that special consideration must be given to the issue of conflicts of interest in alternative medicine. Edzard Ernst has said that most researchers into alternative medicine are at risk of "unidirectional bias" because of a generally uncritical belief in their chosen subject.JOURNAL, Ernst E, Edzard Ernst, 2011, Conflicts of Interest in Alternative Medicine,weblink Skeptical Inquirer, 35, 4, Ernst cites as evidence the phenomenon whereby 100% of a sample of acupuncture trials originating in China had positive conclusions. David Gorski contrasts evidence-based medicine, in which researchers try to disprove hyphotheses, with what he says is the frequent practice in pseudoscience-based research, of striving to confirm pre-existing notions.WEB,weblink Conflicts of interest in science-based medicine, Gorski D, David Gorski, 16 November 2009, Science-Based Medicine, Harriet Hall writes that there is a contrast between the circumstances of alternative medicine practitioners and disinterested scientists: in the case of acupuncture, for example, an acupuncturist would have "a great deal to lose" if acupuncture were rejected by research; but the disinterested skeptic would not lose anything if its effects were confirmed; rather their change of mind would enhance their skeptical credentials.WEB,weblink Conflicts of interest, Hall HA, Harriet A. Hall, 27 April 2011, Science-Based Medicine,

Use of health and research resources

Research into alternative treatments has been criticized for "...diverting research time, money, and other resources from more fruitful lines of investigation in order to pursue a theory that has no basis in biology." Research methods expert and author of Snake Oil Science, R. Barker Bausell, has stated that "it's become politically correct to investigate nonsense." A commonly cited statistic is that the US National Institute of Health had spent $2.5 billion on investigating alternative treatments prior to 2009, with none being found to be effective.


File:Fallerjfa.JPG|Christian laying on of hands, prayer intervention, and faith healingFile:Dhanvantari-at-Ayurveda-expo.jpg|Indian Ayurvedic medicine includes a belief that the spiritual balance of mind influences disease.File:Hierbas medicinales mercado medieval.jpg|Medicinal herbs in a traditional Spanish marketFile:Market Pharmacy Tana MS5179.jpg|Traditional medicines in MadagascarFile:Traditional Chinese medicine in Xi'an market.jpg|Assorted dried plant and animal parts used in traditional Chinese medicineFile:Doña ramona.jpg|Shaman healer in Sonora, Mexico.File:American medical botany, being a collection of the native medicinal plants of the United States, containing their botanical history and chemical analysis, and properties and uses in medicine, diet and (14764623455).jpg|Phytotherapy (herbal medicine): an engraving of magnolia glauca in Jacob Bigelow's American Medical Botany

See also

{{Wikipedia books|Alternative medicine}}




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Comparative study of placebo-controlled trials of homoeopathy and allopathy |journal=The Lancet |volume=366 |pages=726–32 |year=2005 |doi=10.1016/S0140-6736(05)67177-2 |pmid=16125589 |issue=9487}}JOURNAL, Complementary and Alternative Healthcare in Israel, Judith T., Shuval, Emma, Averbuch, Israel Journal of Health Policy Research, 2012, 1, 7, 7, 3424827, 10.1186/2045-4015-1-7, 22913721, BOOK, The Skeptics Dictionary, Carroll, R.T., Robert Todd Carroll, complementary medicine,weblink 2011-05-14, Online,weblink" title="">weblink The Skeptics Dictionary, 2013-09-27.JOURNAL, Integrative medicine: Bringing medicine back to its roots, Snyderman, R., Weil, A.T., Ralph Snyderman, JAMA Internal Medicine, 162, 4, 395–97, 2002, 11863470, 10.1001/archinte.162.4.395, harv, 1, BOOK, Sobel, D.S., Chapter 28: The Cost-effectiveness of Mind-body Medicine Interventions, Progress in Brain Research, Progress in Brain Research, Volume 122, 393–412, 2000, 10737073, 10.1016/S0079-6123(08)62153-6, 9780444500496, Mayer, E.A., Saper, C.B., WEB, Stanford's medical curriculum,weblink Stanford University School of Medicine, Stanford University website,weblink" title="">weblink 2013-05-09, no, JOURNAL, I., Stehlin,weblink" title="">weblinkweblink Homeopathy: Real medicine or empty promises?, FDA Consumer Magazine, December 1996, 2007-10-12, harv, EPISODE, N., Swan, Alternative Medicine – Part Three, 2000-10-02, Australian Broadcasting Corporation, Radio National,weblink The Health Report, 2008-03-06,weblink" title="">weblink 2008-03-06, yes, WEB, Cochrane CAM Field, Center for Integrative Medicine, School of Medicine, University of Maryland, University of Maryland website,weblinkweblink" title="">weblink 2013-09-28, yes, WEB, Center for Integrative Medicine,weblink University of Maryland website, University of Maryland School of Medicine,weblink" title="">weblink 2010-03-23, yes, JOURNAL,weblink Ayurveda: Putting the house in order, Guest Editorial, Valiathan, M.S., Current Science, 2006, 90, 1, 5–6, harv, JOURNAL, Vickers, A., Alternative cancer cures: 'Unproven' or 'disproven'?, CA – A Cancer Journal for Clinicians, 54, 2, 110–18, 2004, 15061600, 10.3322/canjclin.54.2.110, harv,, WEB, Warner, J.,weblink Alternative Medicine Goes Mainstream, CBS News, WebMD, 2006-07-20, 2013-03-11,weblink" title="">weblink 2013-09-28, no, JOURNAL, Weber, D.O., Complementary and alternative medicine considering the alternatives, Physician Executive, 24, 6, 6–14, 1998, 10351720, harv, WEB,weblink WebMD, Complementary Medicine – Alternative Medical Systems,weblink" title="">weblink 2015-06-04, 2015-06-01, 2014-01-14, no, WEB,weblink What is Complementary and Alternative Medicine (CAM)?, 2006-07-11, NCCAM, National Center for Complementary and Alternative Medicine,weblink 2005-12-08, no, BOOK, Final Report, White House Commission on Complementary and Alternative Medicine Policy, Chapter 2: Overview of CAM in the United States: Recent History, Current Status, And Prospects for the Future, 978-0160514760, National Institutes of Health, NIH Pub. 03-5411, US Government Printing Office,weblink 2002,weblink yes,weblink" title="">weblink 2013-02-15, Chapter 2 archived 2011-08-25.WEB,weblink Traditional medicine, 2008-03-06, 2003, Fact sheet 134, WHO,weblink 2008-07-28, yes, JOURNAL, Traditional Medicines: Definitions,weblink WHO Website, Medicines, 2012-11-11,weblink" title="">weblink 2013-09-27, no, Xiaorui Zhang, harv, Extracted from {{harvnb|WHO|2000}}.JOURNAL, 10.1525/sp.2005.52.1.38, 52, 1, 38–61, Winnick, T.A., From quackery to "complementary" medicine: The American medical profession confronts alternative therapies, Social Problems (journal), Social Problems, 2005, 10.1525/sp.2005.52.1.38, harv, BOOK, T.A., Winnick, 2009, From Quackery to "Complementary" Medicine: The American Medical Profession Confronts Alternative Therapies, The Sociology of Health and Illness, 8th, P., Conrad, New York, Worth, 261–77, 9781429205580, WEB, Medical Student Education Program: Curriculum Overview,weblink Yale University website, Yale School of Medicine,weblink" title="">weblink 2013-10-04, yes, JOURNAL, Zollman, C., Vickers, A., What is complementary medicine?, ABC of complementary medicine, 10.1136/bmj.319.7211.693, 10480829, 1116545, BMJ, 319, 7211, 693–96, 1999, {{harvid, Zollman et al., 1999, |displayauthors= 1 }}}}


  • BOOK, Bivins, R., Alternative Medicine? A History, Oxford University Press, 9780199218875, 2007, harv,
  • BOOK, Board of Science and Education, British Medical Association, Complementary Medicine: New Approaches to Good Practice, 1993, Oxford University Press, 9780192861665, {{harvid, BMA, 1993, }}
  • BOOK, Callahan, D., 2004, The Role of Complementary and Alternative Medicine: Accommodating Pluralism, Georgetown University Press, Washington, D.C., 9781589014640, {{harvid, Callahan, 2004, }}
  • BOOK, Complementary & Alternative Medicine: Legal Boundaries and Regulatory Perspectives, Michael H., Cohen, Michael H. Cohen, Baltimore, Johns Hopkins University Press, 1998, 9780801856891, {{Harvid, Cohen, 1998, }}
  • BOOK, Committee on the Use of Complementary and Alternative Medicine by the American Public, Board on Health Promotion and Disease Prevention, Institute of Medicine, United States National Academies, US National Academies, Complementary and Alternative Medicine in the United States,weblink 2005, National Academy Press, Washington, D.C., 978-0309092708, {{harvid, IOM Report, 2005, }}
  • BOOK, Gevitz, N., Norman Gevitz, Bynum, W.F., Porter, R.S., Companion Encyclopedia of the History of Medicine, Vol. 1, Chapter 28: Unorthodox Medical Theories, 1997, 1993, 9780415164191, Routledge, New York & London, Roy Porter, harv,
  • BOOK, The HomÅ“opathic Medical Doctrine, or "Organon of the Healing Art", W.F. Wakeman, Hahnemann, S., Samuel Hahnemann, 1833, Dublin, Translation by Devrient, C.H. Annotated by Stratten, S., harv,
  • BOOK, Dennis L, Kasper, Anthony S., Fauci, Stephen L., Hauser, Dan L., Longo, J. Larry, Jameson, Joseph, Loscalzo, Harrison's Principles of Internal Medicine, McGraw Hill Education, 2015, New York, 9780071802154, 19th, {{harvid, Harrison's Principles of Internal Medicine, 2015, }}
  • BOOK, Scientific Basis for Ayurvedic Therapies, Lakshmi Chandra, Mishra, CRC Press, Boca Raton, 2004, 978-0849313660, harv,
  • BOOK, O'Connor, Bonnie Blair, Healing Traditions: Alternative Medicine and the Health Professions, Philadelphia, University of Pennsylvania Press, 1995, 9780812213980, {{harvid, O'Connor, 1995, }}
  • BOOK, Ruggie, M., Marginal to Mainstream: Alternative Medicine in America, 2004, Cambridge University Press, 9780521834292, harv,
  • BOOK, Sagan, C., Carl Sagan, The Demon-Haunted World: Science As a Candle in the Dark, 1996, Random House, New York, 9780394535128, {{harvid, Sagan, 1996, |title-link= The Demon-Haunted World }}
  • BOOK, Saks, M., Orthodox and Alternative Medicine: Politics, Professionalization and Health Care, 2003, Sage Publications, 9781446265369, harv,
  • BOOK, Sointu, E., Theorizing Complementary and Alternative Medicines: Wellbeing, Self, Gender, Class, 2012, Palgrave Macmillan, Basingstoke, England, 9780230309319, harv,
  • BOOK, Sixth Report: Complementary and Alternative Medicine,weblink Walton J., Sir, Science and Technology Committee, House of Lords, Parliament of the United Kingdom, 2000, 9780104831007, Session 1999–2000, HL 123, London, The Stationery Office, {{harvid, Sir Walton: Science and Technology Committee, 2000, }}
  • BOOK, Taylor, Kim, Chinese Medicine in Early Communist China, 1945–63: a Medicine of Revolution, 2005, 978-0415345125, London and New York, Needham Research Institute Studies, RoutledgeCurzon, harv,
  • BOOK, The Roots of Ayurveda: Selections from Sanskrit Medical Writings, Wujastyk, D., Translated by D. Wujastyk, 2003, London and New York, Penguin Books, 978-0140448245, harv,

Further reading

  • BOOK, Bausell, R.B, 2007, Snake oil science : the truth about complementary and alternative medicine, Oxford University Press, 9780195313680,
  • JOURNAL, Benedetti, F., Maggi, G., Lopiano, L., Lanotte, M., Rainero, I., Vighetti, S., Pollo, A., Open versus hidden medical treatments: The patient's knowledge about a therapy affects the therapy outcome, Prevention & Treatment, 2003, 6, 1, 10.1037/1522-3736.6.1.61a, harv, 1,
  • BOOK, John Diamond (journalist), Diamond, J., Snake Oil and Other Preoccupations, 2001, 9780099428336, Foreword, R., Dawkins, Richard Dawkins, Vintage, London, Reprinted in {{harvnb|Dawkins|2003}}.
  • JOURNAL, Downing AM, Hunter DG, Validating clinical reasoning: A question of perspective, but whose perspective?, Manual Therapy, 8, 2, 117–19, 2003, 12890440, 10.1016/S1356-689X(02)00077-2, harv,
  • JOURNAL, Eisenberg DM, Advising patients who seek alternative medical therapies, Annals of Internal Medicine, 127, 1, 61–69, July 1997, 9214254, 10.7326/0003-4819-127-1-199707010-00010, harv,
  • JOURNAL, Gunn IP, A critique of Michael L. Millenson's book, Demanding Medical Excellence: Doctors and Accountability in the Information Age, and its Relevance to CRNAs and Nursing, AANA Journal, 0094-6354, 66, 6, 575–82, December 1998, 10488264, harv,
  • BOOK, Hand, W.D., 1980, Folk Magical Medicine and Symbolism in the West, Magical Medicine, Berkeley, University of California Press, 305–19, 9780520041295, 6420468,
  • BOOK, Ivan Illich, Illich, I., Limits to Medicine: Medical Nemesis: The Expropriation of Health, Penguin, 1976, 9780140220094, 4134656,
  • BOOK, Mayo Clinic, Mayo Clinic Book of Alternative Medicine: The New Approach to Using the Best of Natural Therapies and Conventional Medicine, Parsippany, New Jersey, Time Inc, Time Home Entertainment, 2007, 9781933405926, Mayo Clinic,
  • JOURNAL, P., Jr., Stevens, November–December 2001, Magical thinking in complementary and alternative medicine, Skeptical Inquirer,weblink harv,
  • BOOK, Planer, F.E., 1988, Superstition, Rev., Buffalo, New York, Prometheus Books, 9780879754945, 18616238,
  • WEB,weblink Rosenfeld, A., Where Do Americans Go for Healthcare?, Case Western Reserve University, Cleveland, Ohio, c. 2000, 2010-09-23,
  • JOURNAL, Snyder, Mariah, Lindquist, Ruth, Issues in Complementary Therapies: How We Got to Where We Are, Online Journal of Issues in Nursing, May 2001, 6, 2,weblink
  • JOURNAL, Tonelli MR, The limits of evidence-based medicine, Respiratory Care, 46, 12, 1435–40; discussion 1440–1, 2001, 11728302, harv,
  • BOOK, Trivieri, L. Jr., Anderson, J.W., Alternative Medicine: The Definitive Guide, Berkeley, Ten Speed Press, 2002, 9781587611414,
  • BOOK, Wisneski, L.A., Anderson, L., The scientific basis of integrative medicine, CRC Press, 2005, 9780849320811, 1,
  • JOURNAL, Zalewski, Z., Importance of philosophy of science to the history of medical thinking, CMJ, 1999, 40, 1, 8–13,weblinkweblink" title="">weblink 2004-02-06, harv,

World Health Organization

  • BOOK, General Guidelines for Methodologies on Research and Evaluation of Traditional Medicine,weblink WHO/EDM/TRM/2001.1, World Health Organization, 0, 2000, Geneva, World Health Organization (WHO), This document is not a formal publication of the WHO. The views expressed in documents by named authors are solely the responsibility of those authors., {{harvid, WHO, 2000, }}
  • BOOK, WHO Guidelines on Basic Training and Safety in Chiropractic,weblink World Health Organization, 0, 2005, Geneva, WHO, 978-9241593717, {{harvid, WHO, 2005, }}
  • BOOK, WHO Global Atlas of Traditional, Complementary and Alternative Medicine, WHO Kobe Centre, Bodeker, G., Ong, C.K., Grundy, C., Burford, G., Shein, K., 2005, WHO, 9789241562867, 2, Summary.


External links

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