Alternative medicine comprises practices that aim to achieve the healing effects of medicine, but that lack biological plausibility, testability, repeatability, or supporting evidence of effectiveness. Such practices are not part of mainstream evidence-based medicine. Unlike modern medicine, which employs the scientific method to test plausible therapies by way of responsible and ethical clinical trials, producing repeatable evidence of either effect or of no effect, alternative therapies are not products of the scientific method, but instead rely on testimonials, anecdotes, religion, tradition, superstition, belief in supernatural "energies", pseudoscience, errors in reasoning, propaganda, fraud, or other unscientific sources. Alternative medicine practices are also called New Age medicine, pseudo-medicine, unorthodox medicine, holistic medicine, fringe medicine, functional medicine, and unconventional medicine, with little distinction from quackery.
Some alternative practices are based on theories that contradict the established science of how the human body works; others appeal to the supernatural or superstitions to explain their effect or lack thereof. In others, the practice has plausibility but lacks a positive risk–benefit outcome probability. Research into alternative therapies often fails to follow proper research protocols (such as placebo-controlled trials, blind experiments and calculation of prior probability), providing invalid results. History has shown that if a method is proven to work, it eventually ceases to be alternative and becomes mainstream medicine.
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 therapies 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 therapies are actively harmful (such as cyanide poisoning from amygdalin, or the intentional ingestion of hydrogen peroxide) or actively interfere with effective treatments.
The alternative medicine sector is a highly profitable industry with a strong lobby, and faces far less regulation over the use and marketing of unproven treatments. Complementary medicine (CM), complementary and alternative medicine (CAM), functional medicine (FM), integrated medicine or integrative medicine (IM), and holistic medicine attempt to combine alternative practices with those of mainstream medicine. Traditional medicine practices become "alternative" when used outside their original settings and without proper scientific explanation and evidence. Alternative methods are often marketed as more "natural" or "holistic" than methods offered by medical science, that is sometimes derogatorily called "Big Pharma" by supporters of alternative medicine. Billions of dollars have been spent studying alternative medicine, with few or no positive results and many methods thoroughly disproven.
Definitions and terminology
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. Terminology has shifted over time, reflecting the preferred branding of practitioners. For example, the department of the United States National Institutes of Health studying alternative medicine is currently named the National Center for Complementary and Integrative Health (NCCIH), but it was established as the Office of Alternative Medicine (OAM) and then renamed the National Center for Complementary and Alternative Medicine (NCCAM) before now. Therapies are often framed as "natural" or "holistic", implicitly and intentionally suggesting that conventional medicine is "artificial" and "narrow in scope".
The meaning of the term "alternative" in the expression "alternative medicine", is not that it is an effective alternative to medical science (though some alternative medicine promoters may use the loose terminology to give the appearance of effectiveness). Loose terminology may also be used to suggest meaning that a dichotomy exists when it does not (such as the use of the expressions Western medicine and Eastern medicine to suggest a cultural difference between the Asian 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, but whose effectiveness has not been established using scientific methods, or whose theory and practice is not part of biomedicine, 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, 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.
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 definition devised by the National Center for Complementary and Alternative Medicine (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.
Complementary or integrative medicine
Complementary medicine (CM) or integrative medicine (IM) is when alternative medicine is used together with mainstream medical treatment in a belief that it improves the effect of treatments. Several medical organizations differentiate between complementary and alternative medicine including the UK National Health Service (NHS), Cancer Research UK, and the US Center for Disease Control and Prevention (CDC), the latter of which states that "Complementary medicine is used in addition to standard treatments" whereas "Alternative medicine is used instead of standard treatments." For example, acupuncture (piercing the body with needles to influence the flow of energy) might be believed to increase the effectiveness or "complement" science-based medicine when used at the same time. Significant drug interactions caused by alternative therapies may make treatments less effective, notably in cancer therapy.
Some mainstream academic medical centers have integrative or functional medicine departments, including the Cleveland Clinic, the Mayo Clinic, Stanford University, UCLA, UC San Francisco and Northwestern University. In contrast, other medical practitioners are unconvinced by these practices. For example, surgical oncologist, David Gorski has described integrative medicine as an attempt to bring pseudoscience into academic science-based medicine with skeptics such as Gorski and David Colquhoun referring to this with the pejorative term "quackademia". Robert Todd Carroll described integrative medicine as "a synonym for 'alternative' medicine that, at its worst, integrates sense with nonsense. At its best, integrative medicine supports both consensus treatments of science-based medicine and treatments that the science, while promising perhaps, does not justify." Rose Shapiro has criticized the field of alternative medicine for rebranding the same practices as integrative medicine.
CAM is an acronym for complementary and alternative medicine. The 2019 World Health Organization (WHO) Global Report on Traditional and Complementary Medicine states that the terms complementary and alternative medicine "refer to a broad set of health care practices that are not part of that country's own traditional or conventional medicine and are not fully integrated into the dominant health care system. They are used interchangeably with traditional medicine in some countries."
The Integrative Medicine Exam by the American Board of Physician Specialties includes the following subjects: manual therapies, biofield therapies, acupuncture, movement therapies, expressive arts, traditional Chinese medicine, ayurveda, Indigenous medical systems, homeopathic medicine, naturopathic medicine, osteopathic medicine, chiropractic, and functional medicine.
Functional medicine Functional medicine (FM) is a form of alternative medicine that encompasses many unproven and disproven methods and treatments. It is a rebranding of complementary and alternative medicine (CAM), and as such is pseudoscientific, and has been described as a form of quackery. In the US, FM practices have been ruled ineligible for course credits by the American Academy of Family Physicians because of concerns they may be harmful. Functional medicine was created by Jeffrey Bland, who founded The Institute for Functional Medicine (IFM), which is based in the US state of Washington, in the early 1990s as part of one of his companies, HealthComm. IFM, which promotes functional medicine, became a registered non-profit in 2001. Mark Hyman became an IFM board member and prominent promoter.