International Journal of Health Sciences

Qassim University

Complementary and Alternative Healthcare: Is it Evidence-

based?
Syed Amin Tabish, FRCP (London), FRCP (Edin), FACP, FAMS, MB
(AIIMS), Editor-in-Chief IJHS
Additional article information

Complementary and alternative healthcare and medical practices (CAM) is a group

of diverse medical and health care systems, practices, and products that are not
presently considered to be part of conventional medicine. The list of practices that
are considered as CAM changes continually as CAM practices and therapies that
are proven safe and effective become accepted as the “mainstream” healthcare
practices. Today, CAM practices may be grouped within five major domains:
alternative medical systems, mind-body interventions, biologically-based
treatments, manipulative and body-based methods and energy therapies.
TCM is a system of healing that dates back to 200 B.C. in written form. China,
Korea, Japan, India and Vietnam have all developed their own unique versions of
traditional medicine. Alternative medicine is commonly categorized together with
complementary medicine under the umbrella term “complementary and alternative
medicine”. Complementary medicine refers to therapies that complement
traditional western (or allopathic) medicine and is used together with conventional
medicine, and alternative medicine is used in place of conventional medicine.
Alternative medicine refers to therapeutic approaches taken in place of traditional
medicine and used to treat or ameliorate disease. Integrative medicine refers to
combining complementary treatments with conventional care. The basic
philosophy of complementary and alternative medicine include holistic care, which
focuses on treating a human being as a whole person.
Examples of complementary and alternative medicine healing systems include
Ayurveda, which originated in India more than 5,000 years ago, emphasizes a
unique cure per individual circumstances. It incorporates treatments including
yoga, meditation, massage, diet and herbs; Homeopathy uses minute doses of a
substance that causes symptoms to stimulate the body’s self-healing response.
Naturopathy focuses on non-invasive treatments to help your body do its own
healing. Ancient medicines (complementary and alternative medicine treatments)
include Chinese, Asian, Pacific Islander, American Indian and Tibetan practices.
Conventional medicine relies on methods proved to be safe and effective with
carefully designed trials and research. But, many complementary and alternative
treatments lack solid research on which to base sound decisions. The dangers and
possible benefits of many complementary and alternative treatments remain
unproved.
While the whole medical systems differ in their philosophical approaches to the
prevention and treatment of disease, they share a number of common elements.
These systems are based on the belief that one’s body has the power to heal itself.
Healing often involves marshalling multiple techniques that involve the mind,
body and spirit. Treatment is often individualized and dependent on the presenting
symptoms.
The use of alternative medicine appears to be increasing. A 1998 study showed
that the use of alternative medicine in the USA had risen from 33.8% in 1990 to
42.1% in 1997 [1]. The most common CAM therapies used in the USA in 2002 were
prayer (45.2%), herbalism (18.9%), breathing meditation (11.6%), meditation
(7.6%), chiropractic medicine (7.5%), yoga (5.1%), body work (5.0%), diet-based
therapy (3.5%), progressive relaxation (3.0%), mega-vitamin therapy (2.8%) and
visualization (2.1%) [2, 3]. In the United Kingdom, limited data seem to support the
idea that CAM use in the United Kingdom is high and is increasing.
Increasing numbers of medical colleges have started offering courses in alternative
medicine. Accredited Naturopathic colleges and universities are increasing in
number and popularity in the USA. They offer the most complete medical training
in complimentary medicines that is available today [4, 5]. In Britain, no conventional
medical schools offer courses that teach the clinical practice of alternative
medicine. However, alternative medicine is taught in several unconventional
schools as part of their curriculum. Teaching is based mostly on theory and
understanding of alternative medicine, with emphasis on being able to
communicate with alternative medicine specialists.
Naturopathy (naturopathic medicine) is a whole medical system that has its roots in
Germany. It was developed further in the late 19th and early 20th centuries in the
United States, where today it is part of CAM. Naturopathy aims to support the
body’s ability to heal itself through the use of dietary and lifestyle changes together
with CAM therapies such as herbs, massage and joint manipulation. Naturopathy is
a whole medical system. It views disease as a manifestation of alterations in the
processes by which the body naturally heals itself and emphasizes health
restoration rather than disease treatment. Naturopathic physicians employ an array
of healing practices, including diet and clinical nutrition, homeopathy,
acupuncture, herbal medicine, hydrotherapy, spinal and soft-tissue manipulation,
physical therapies involving electric currents, ultrasound and light therapy,
therapeutic counseling and pharmacology. Today, naturopathy is practiced in a
number of countries, including the United States, Canada, Great Britain, Australia
and New Zealand.
The acupuncture is being practiced for relief or the prevention of pain and for
various other health conditions. Preclinical studies have documented acupuncture’s
effects, but they have not been able to fully explain how acupuncture works within
the framework of the western system of medicine.
Ayurveda, which literally means “the science of life”, is a natural healing system
developed in India. It is a comprehensive system of medicine that places equal
emphasis on the body, mind and spirit, and strives to restore the innate harmony of
the individual. Some of the primary Ayurvedic treatments include diet, exercise,
meditation, herbs, massage, exposure to sunlight, and controlled breathing,
Ayurvedic medications have the potential to be toxic. Most Ayurvedic medications
consist of combinations of herbs and other medicines, so it can be challenging to
know which ones are having an effect and why.
Other traditional medical systems have been developed by Native American,
Aboriginal, African, Middle-Eastern, Tibetan, Central and South American
cultures.
Homeopathy is a system of medical theory and practice. Its founder, German
physician Samuel Christian Hahnemann (1755–1843), hypothesized that one can
select therapies on the basis of how closely symptoms produced by a remedy
match the symptoms of the patient’s disease. He called this the “principle of
similars”. Since homeopathy is administered in minute or potentially non-existent
material dosages, there is an a priori skepticism in the scientific community about
its efficacy [6–9].
The term meditation refers to a variety of techniques or practices intended to focus
or control attention. Most of them are rooted in Eastern religious or spiritual
traditions. These techniques have been used by many different cultures throughout
the world for thousands of years.
People have used prayer and other spiritual practices for their own and others’
health concerns for thousands of years. Scientific investigation of these practices
has begun quite recently, however, to better understand whether they work; if so,
how; and for what diseases/conditions and populations. Many Americans are using
prayer and other spiritual practices. Prayer is the therapy most commonly used
among all the CAM therapies.
Energy therapies focus either on energy fields originating within the body
(biofields) or those from other sources (electromagnetic fields). Biofield therapies
are intended to affect the energy fields, whose existence is not yet experimentally
proven, that surround and penetrate the human body. Some forms of energy
therapy manipulate biofields by applying pressure and/or manipulating the body by
placing the hands in, or through, these fields. Examples include Qi gong, Reiki,
Prana and Therapeutic Touch. Bioelectromagnetic-based therapies involve the
unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields
or alternating current or direct current fields, to, for example, treat asthma or
cancer, or manage pain and migraine headaches.
In India, which is the home of several alternative systems of medicines, Ayurveda,
Siddha, Unani and Homeopathy are licenced by the government, despite the lack
of reputable scientific evidence. Naturopathy will also be licensed soon because
several universities now offer bachelors degrees in it. Other activities such as
Panchakarma and massage therapy related to Ayurveda are also licensed by the
government now [10].
About half the general population in developed countries uses CAM [10]. A survey
released in May 2004 by the National Center for Complementary and Alternative
Medicine, part of the National Institutes of Health in the United States, found that
in 2002, 36% of Americans used some form of alternative therapy in the past 12
months, 50% in a lifetime—a category that included yoga, meditation, herbal
treatments and the Atkins diet. The majority of individuals (54.9%) used CAM in
conjunction with conventional medicine. Most people use CAM to treat and/or
prevent musculoskeletal conditions or other conditions associated with chronic or
recurring pain. Women were more likely than men to use CAM. The largest sex
differential is seen in the use of mind-body therapies including prayer specifically
for health reasons [2, 3]. If prayer was counted as an alternative therapy, the figure
rose to 62.1%. 25% of people who use CAM do so because a medical professional
suggested it [11]. A British telephone survey by the BBC of 1,209 adults in 1998
shows that around 20% of adults in Britain had used alternative medicine in the
past 12 months.
Evidence-based medicine (EBM) applies the scientific method to medical practice,
and aims for the ideal that healthcare professionals should make “conscientious,
explicit, and judicious use of current best evidence” in their everyday practice.
Although advocates of alternative medicine acknowledge that the placebo effect
may play a role in the benefits that some receive from alternative therapies, they
point out that this does not diminish their validity. They believe that alternative
medicine may provide health benefits through patient empowerment, by offering
more choices to the public. Researchers who judge treatments using the scientific
method are concerned by this viewpoint, since it fails to address the possible
inefficacy of alternative treatments.
As long as alternative treatments are used alongside conventional treatments, the
majority of medical doctors find most forms of complementary medicine
acceptable. Consistent with previous studies, the CDC recently reported that the
majority of individuals in the United States (i.e., 54.9%) used CAM in conjunction
with conventional medicine.
The issue of alternative medicine interfering with conventional medical practices is
minimized when it is turned to only after conventional treatments have been
exhausted. Many patients feel that alternative medicine may help in coping with
chronic illnesses for which conventional medicine offers no cure, only
management. Classifying treatments need to be based on the objectively verifiable
criteria of the scientific method evidence-based medicine, i.e. scientifically proven
evidence of efficacy (or lack thereof), and not on the changing curricula of various
medical schools or social sphere of usage [12].
Since many alternative remedies have recently found their way into the medical
mainstream, there cannot be two kinds of medicine - 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. Once a treatment has
been tested rigorously, it no longer matters whether it was considered alternative at
the outset. If it is found to be reasonably safe and effective, it will be accepted [13].
It is argued that 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. Whether a therapeutic practice is
“Eastern” or “Western”, is unconventional or mainstream, or involves mind-body
techniques or molecular genetics is largely irrelevant except for historical purposes
and cultural interest. As believers in science and evidence, we must focus on
fundamental issues—namely, the patient, the target disease or condition, the
proposed or practiced treatment, and the need for convincing data on safety and
therapeutic efficacy [14]. The Cochrane Collaboration [15] and Edzard Ernst [16]agree
that all treatments, whether “mainstream” or “alternative”, ought to be held to
standards of the scientific method.
Many forms of alternative medicine are rejected by conventional medicine because
the efficacy of the treatments has not been demonstrated through double-blind
randomized controlled trials; in contrast, conventional drugs reach the market only
after such trials have proved their efficacy. A person may attribute symptomatic
relief to an otherwise ineffective therapy due to the placebo effect, the natural
recovery from or the cyclical nature of an illness (the regression fallacy), or the
possibility that the person never originally had a true illness [17]. CAM proponents
point out this may also apply in cases where conventional treatments have been
used. To this, CAM critics point out that this does not account for conventional
medical success in double blind clinical trials.
People should be free to choose whatever method of healthcare they want, but
stipulate that people must be informed as to the safety and efficacy of whatever
method they choose. People who choose alternative medicine may think they are
choosing a safe, effective medicine, while they may only be getting quack
remedies. Grapefruit seed extract is an example of quackery when multiple studies
demonstrate its universal antimicrobial effect is due to synthetic antimicrobial
contamination [18, 19].
Those who have had 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 contend that therapies that rely on the placebo effect to define
success are very dangerous. Scientifically unsupported health practices can lead
individuals to forgo effective treatments and this can be referred to 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. More research must be undertaken
to prove the effectiveness of complimentary therapies before they can be
incorporated in formal medical practice. Sufficient evidence is required for
biological or clinical plausibility in order to justify the investment of time and
energy in exploring the merits of alternative medicine. After all, human life is
precious and no chances can be taken to comprise the health of any individual.

Article information
Int J Health Sci (Qassim). 2008 Jan; 2(1): V–IX.
PMCID: PMC3068720
PMID: 21475465
Syed Amin Tabish, FRCP (London), FRCP (Edin), FACP, FAMS, MB (AIIMS), Editor-in-Chief IJHS
Copyright Qassim Univeristy
This article has been cited by other articles in PMC.
Articles from International Journal of Health Sciences are provided here courtesy of Qassim
University

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