Talk:Complementary and alternative medicine: Difference between revisions

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[[Chelation therapy]] for things like heavy metal poisoning are probably not considered alternative medicine.
==I am archiving this article and its talk page and starting us over==
Is the author thinking of a particular kind, like ETDA with heart diseases? [[User:David E. Volk|David E. Volk]] 14:52, 13 April 2008 (CDT)
Here goes. For future reference only, here is:


== Change article title to Complementary and Alternative Medicine ==
*[[Complementary_and_alternative_medicine/article_archive]]
*[[Talk:Complementary_and_alternative_medicine/Archive 1]].


I believe making such a change would be more consistent with general usage in the broad fields of health. In the terminology of the [[National Center for Complementary and Alternative Medicine]], alternative medicine describes "whole systems" that totally supplant mainstream medicine or different whole systems. Complementary medicine can work with whole systems, including mainstream medicine. [[User:Howard C. Berkowitz|Howard C. Berkowitz]] 21:00, 19 November 2008 (UTC)
--[[User:Pat Palmer|Pat Palmer]]


Agree, with redirects from [[Complementary medicine]] and [[Alternative medicine]]. [[User:D. Matt Innis|D. Matt Innis]] 01:39, 20 November 2008 (UTC)
:I updated the above talk page archive link so that it would show as Archive 1 on the Article Checklist above. [[User:D. Matt Innis|D. Matt Innis]] 03:06, 27 December 2008 (UTC)


== Sorry for the undo... ==
==What I've done==


But I strenuously object to separating complementary and alternative medicine at a high level, although there can indeed be separation within individual disciplines. See the [[National Center for Complementary and Alternative Medicine]] taxonomy, which is not, at all, U.S. specific. If you want language revered, I'd appreciate more of an explanation. Even if it's simply that something is confusing, I'd like to know what is confusing. A confusing aspect may be a term of art that needs explanation or linking.
* I would recommend giving this article a simple name, maybe just "Alternative medicine"
* I would recommend moving debates to specific subtopics, such as representing, on an acupuncture article, the perceived arguments for and against, specifically, acupuncture
* I am moving Howard's comments to my talk page, for now, because he made them before I had finished this archiving action; he may choose to come back here if he wishes, I just want to give others a chance to think first


For example, there are advocates of [[Traditional Chinese medicine]], which include acupuncture, to insist that it is a whole system. As you will see in the main TCM article, the Chinese goverment does not. I am personally quite willing to recommend acupuncture as an complement to pain management and rheumatology, both human and veterinary. It may work, it may not work, but it is also being done in an interdiscipinary way.  Anecdote is not the singular of data, but I've seen people close to me sicken and die because they insisted on alternative medicine only.
--[[User:Pat Palmer|Pat Palmer]]


The broad area of manipulative therapies, including chiropractic, osteopathic medicine and osteopathy, physical therapy, and massage, as well as a few other areas of physical medicine, are searching for new syntheses. For example, I know a few complementary practitioners that have dual-certified in chiropractic and physical therapy. They say chiropractic gives them the best tools for flexibility and pain control, while physical therapy is better for restoring strength. These practitioners routinely work with conventional physicians of many specialties, including rheumatology, pain management, neurology, orthopedics, and physiatry. [[User:Howard C. Berkowitz|Howard C. Berkowitz]] 14:38, 4 December 2008 (UTC)


:I think I see what you are saying.. perhaps that you want the theories explained only on the pages that are titles specifically for each alternative or complementary practice.  I haven't thought that one through; there might be a reason to have a page on Alternative medicine - though I think most that were once alternative are being integrated slowly.  Everyone seems to be crossing lines of what used to be "turf". I have no trouble with the beginning of the sentence that you removed.  Maybe just remove the part about "these are explained on the Alternative medicine (theories) page. [[User:D. Matt Innis|Matt Innis]]
:Countersuggestion: could everyone look at [[integrative medicine]] and see if it already is moving in the right direction?


::Does "alternative" mean only "alternative" to conventional medicine? Certainly, once you start integrating, at least as I understand the concept, you are becoming complementary. I like NCCAM's term "whole system", which clearly identifies "classic" disciplines that do not share paradigms.  
:Also, while it's very early, look at [[phytomedicine]] and see if it has the flavor of specific argument. It may not yet have enough detail; there are, for example, a few plant-derived remedies that show evidence of efficacy. With the particular regulatory and economic structure in the U.S., there's no incentive to do full studies and standardization for indications and warnings. Germany, however, has a system that is much friendlier to a combination of scientific and traditional approaches. China has yet another. [[User:Howard C. Berkowitz|Howard C. Berkowitz]] 00:03, 27 December 2008 (UTC)


::Other than to call it not-biomedicine, or maybe not-other-whole system, I literally don't know how to define alternative medicine. It is not synonymous with complementary.  
::Howard, I will go look soon as I get time. THanks![[User:Pat Palmer|Pat Palmer]] 00:07, 27 December 2008 (UTC)


::I don't have an answer to whether a combination of classic homeopathy ONLY with classic chiropractic is alternative or complementary, but I'd lean toward alternative. To me, alternative means "biomedicine, get lost." Complementary says "we may each have something to contribute." "Basic" complementary might be an internist sending a patient with acute low back pain to a chiropractor. I'm thinking, though, of some chiropractors at an interdisciplinary symposium, who were suggesting that the manipulations might be helping not so much because they reduced subluxations, but the high-velocity movements caused neuromodulator releaseThey were very complementary, especially when the neurologists got together with them and the acupuncturists that added electrical stimulation, all guided by an anesthesiologist who started as a dentist. (Really!) [[User:Howard C. Berkowitz|Howard C. Berkowitz]] 00:23, 5 December 2008 (UTC)
==Complementary==
I find that I am bothered by the term "complementary".  Sorry, it's an OPINION as to whether an unofficial health approach is complementary or not. It is not an opinion as to whether an approach is "alternative" (i.e., "unofficial" or "not necessarily approved")Therefore, I strongly recommend renaming this article back to simply "alternative medicine".


:::Well, I think "alternative" is a word derived by conventionalists (for lack of a better term). It was never meant to really define these different philosophies in any other way but "different than conventional".  It is probably meant to be vague - in an effort not to offend or promote. When "conventionalists" begin to see value (of some sort) in some of these methods, they call them "complementary", and if they really like them, they give it the "integrative" brand. It's marketingNow that "alternative" practices have been able to improve their brand, I would suspect that the name will be changed to something less appealing. Meanwhile, I wouldn't mind seeing someone like Martin work to write something about the evolution of "alternative" approaches to healthcare. It seem that might be part of his expertise, so why not. [[User:D. Matt Innis|D. Matt Innis]] 14:20, 5 December 2008 (UTC)
This article should, in my opinion, describe the idea that there are regulating authorities, and that anything they do not "approve" is "alternative" (even if it is not banned, though some alternatives ARE banned).  The issue of whether patients would be better off pursuing both official therapies and alternative therapies is up for dispute.  I don't think any sensible person would rule out investigation, or at least considering the idea of, alternatives. 
 
But, calling this article "Complementary" (as well as "alternative") implies that alternative therapies and approaches ARE always helpful, and that is open to question in every single case.  Simply renaming this article makes it easier to keep it merely descriptive, and helps us keep separate the philosophical questions such as, 1) who gets to be the police of what's "official", 2) what should be "banned" or downright "illegal", 3) whether unblessed approaches have value or not.  All these are really interesting and important questions, but no one has been able to produce a definitive answer for them in thousands of years, and we are not going to be able to agree on the answer in CZ either.  We can only agree on the questions.
 
:Sorry, no. In the U.S., it varies state-by-state, but there is a concept of "scope of practice". Within broad limits, anything within the discretion of a physician, and consistent with his or her training, is "official". There are exceptions where additional licensing may be required for the use of radioisotopes, certain drugs, etc., and a hospital isn't normally going to let an opthalmologist do high-risk obstetrics.
 
:The usual definition of alternative medicine is that it is offered as a whole system of health care, to the full or partial exclusion of people with conventional medical licenses. Complementary medicine is seen as something that works jointly with conventional medicine. The combination, however, is a set of skills outside the scope of conventional medical training. Again, see the National Center for Complementary and Alternative Medicine; it may be surprising that music therapy is considered complementary. Spiritual healing is complementary when, for example, a hospital chaplain does a religious healing ritual in the ICU, while an alternative spiritual healer would not approve of anything except prayer.
 
:No, there isn't any implication of efficacy for CAM. Calling something "medicine" doesn't mean it is effective; I can give you a long list of drugs and surgical procedures, performed by physicians, that turned out to be useless or actively dangerous. You may be thinking of [[evidence-based medicine]].
 
:For example, acupuncture is outside the scope of the U.S. National Board of Medical Examiners. Nevertheless, in Virginia, one must be a licensed physician to perform it, presumably with additional training. In other states, someone trained only in acupuncture might perform it only on physician orders, or, depending on the state, might be licensed to perform it on self-referred patients.
 
:Nurse practitioners can prescribe all drugs in some states, or prescribe anything but there must be a responsible physician, or might be able to prescribe antibiotics but not "narcotics". Each state defines scope of practice, even though there often are national examinations. [[User:Howard C. Berkowitz|Howard C. Berkowitz]] 02:03, 27 December 2008 (UTC)
 
::First, the American Medical Association doesn't regulate or authorize anything in the U.S., although it may issue position papers. While the majority of physicians once belonged, I think membership is in the 30 percent range.
 
::At the national level in the U.S., there is a National Board of Medical Examiners that supervises examinations after years 2 and 4 of medical school, and first year graduate medical training. See [[medical education]] and [[graduate medical education]]. Beyond that, there are specialty boards. To prescribe certain drugs, you must be licensed by the [[Drug Enforcement Administration]]; to use radioisotopes in diagnosis and therapy, you need a Department of Energy license whether or not you are board-certified in [[nuclear medicine]].
 
::Some states tightly regulate who can perform what, and others are permissive. Insurance reimbursement is yet another issue.
 
::[[Acupuncture]] and [[phytotherapy|herbal medicine]] are often regulated differently, but the scope of recognized [[traditional Chinese medicine]] (often an OMD degree) includes both, as well as some other techniques. I have had two mentors in acupuncture and some related areas; one was a graduate of a U.S. school (Florida) of Oriental medicine, and her scope of practice was quite limited. The other was a board-certified OB/GYN, and, in fact a Washington DC and national authority on gynecological ultrasonography -- but also had acupuncture training from his native Vietnam. He still needed a Virginia acupuncture license on top of his MD and FACOG (OB/GYN board). I vaguely remember that he had to retake a short acupuncture program to have the credential, since the school in Vietnam no longer existed to send a certificate.
 
::The '''safety and efficacy''' of a treatment method is open to dispute, but that doesn't depend on whether it's mainstream or CAM. CM and AM are different by the [[NCCAM]] definition. What would you call, for example, chiropractic, in a state where one is licensed and authorized to practice independently? It's not "medicine". It could be either complementary or alternative, depending on whether it is offered as a "whole system".  Even the whole system idea isn't always clean; some practitioners are perfectly willing for a surgeon to take over for trauma, but they might go back to herbalism or naturopathy for cancer. The World Health Organization recognizes culturally specific traditional forms of treatment.
 
::Culturally specific may involve multiple modalities; China has what it calls the "Three Roads" method that includes both [[traditional Chinese medicine]] and conventional techniques. [[User:Howard C. Berkowitz|Howard C. Berkowitz]] 02:32, 27 December 2008 (UTC)
 
:::Big sigh here.  For most of my 55 years, I've heard mainly "alternative medicine".  If I asked my aging mother about "complementary medicine" or "integrative medicine", she would just look at me and say, "WHAT?But if I said "alternative medicine", she'd probably nod wiselyIn my view, these are terms that people use in a variety of ways; the NIH department you mention has its way, and the normal Joe the Plumber has probably, in my opinion, never heard any of the phrases except "alternative".[[User:Pat Palmer|Pat Palmer]] 03:19, 27 December 2008 (UTC)
 
::::Well, youngster :-), I agree. At both the level of the U.S. and of the World Health Organization, it was realized the terms were confusing, and precision was sought. I gave links in the Forum that I can bring over here, but, as an example, here is the text from ''Medical Subject Headings'', the standard medical indexing reference:<blockquote>
::::Therapeutic practices which are not currently considered an integral part of conventional allopathic medical practice. They may lack biomedical explanations but as they become better researched some ( PHYSICAL THERAPY MODALITIES; DIET; ACUPUNCTURE) become widely accepted whereas others (humors, radium therapy) quietly fade away, yet are important historical footnotes. Therapies are termed as Complementary when used in addition to conventional treatments and as Alternative when used instead of conventional treatment.</blockquote>
 
::::MeSH also defines integrative medicine as "The discipline concerned with using the combination of conventional (allopathic) medicine and ALTERNATIVE MEDICINE to address the biological, psychological, social, and spiritual aspects of health and illness." There will always be the Joe the Plumber problem; the best we can do is explain that the definitions are becoming more specific. Sometimes even with the best intention, integrative medicine can pose challenges: a hospital welcomed a Lakota Sioux healing ritual, but then went into utter confusion when they realized that the ritual used tobacco and they had an absolute no-smoking policy. [[User:Howard C. Berkowitz|Howard C. Berkowitz]] 03:43, 27 December 2008 (UTC)
 
:::::that makes me smile![[User:Pat Palmer|Pat Palmer]] 03:45, 27 December 2008 (UTC)

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I am archiving this article and its talk page and starting us over

Here goes. For future reference only, here is:

--Pat Palmer

I updated the above talk page archive link so that it would show as Archive 1 on the Article Checklist above. D. Matt Innis 03:06, 27 December 2008 (UTC)

What I've done

  • I would recommend giving this article a simple name, maybe just "Alternative medicine"
  • I would recommend moving debates to specific subtopics, such as representing, on an acupuncture article, the perceived arguments for and against, specifically, acupuncture
  • I am moving Howard's comments to my talk page, for now, because he made them before I had finished this archiving action; he may choose to come back here if he wishes, I just want to give others a chance to think first

--Pat Palmer


Countersuggestion: could everyone look at integrative medicine and see if it already is moving in the right direction?
Also, while it's very early, look at phytomedicine and see if it has the flavor of specific argument. It may not yet have enough detail; there are, for example, a few plant-derived remedies that show evidence of efficacy. With the particular regulatory and economic structure in the U.S., there's no incentive to do full studies and standardization for indications and warnings. Germany, however, has a system that is much friendlier to a combination of scientific and traditional approaches. China has yet another. Howard C. Berkowitz 00:03, 27 December 2008 (UTC)
Howard, I will go look soon as I get time. THanks!Pat Palmer 00:07, 27 December 2008 (UTC)

Complementary

I find that I am bothered by the term "complementary". Sorry, it's an OPINION as to whether an unofficial health approach is complementary or not. It is not an opinion as to whether an approach is "alternative" (i.e., "unofficial" or "not necessarily approved"). Therefore, I strongly recommend renaming this article back to simply "alternative medicine".

This article should, in my opinion, describe the idea that there are regulating authorities, and that anything they do not "approve" is "alternative" (even if it is not banned, though some alternatives ARE banned). The issue of whether patients would be better off pursuing both official therapies and alternative therapies is up for dispute. I don't think any sensible person would rule out investigation, or at least considering the idea of, alternatives.

But, calling this article "Complementary" (as well as "alternative") implies that alternative therapies and approaches ARE always helpful, and that is open to question in every single case. Simply renaming this article makes it easier to keep it merely descriptive, and helps us keep separate the philosophical questions such as, 1) who gets to be the police of what's "official", 2) what should be "banned" or downright "illegal", 3) whether unblessed approaches have value or not. All these are really interesting and important questions, but no one has been able to produce a definitive answer for them in thousands of years, and we are not going to be able to agree on the answer in CZ either. We can only agree on the questions.

Sorry, no. In the U.S., it varies state-by-state, but there is a concept of "scope of practice". Within broad limits, anything within the discretion of a physician, and consistent with his or her training, is "official". There are exceptions where additional licensing may be required for the use of radioisotopes, certain drugs, etc., and a hospital isn't normally going to let an opthalmologist do high-risk obstetrics.
The usual definition of alternative medicine is that it is offered as a whole system of health care, to the full or partial exclusion of people with conventional medical licenses. Complementary medicine is seen as something that works jointly with conventional medicine. The combination, however, is a set of skills outside the scope of conventional medical training. Again, see the National Center for Complementary and Alternative Medicine; it may be surprising that music therapy is considered complementary. Spiritual healing is complementary when, for example, a hospital chaplain does a religious healing ritual in the ICU, while an alternative spiritual healer would not approve of anything except prayer.
No, there isn't any implication of efficacy for CAM. Calling something "medicine" doesn't mean it is effective; I can give you a long list of drugs and surgical procedures, performed by physicians, that turned out to be useless or actively dangerous. You may be thinking of evidence-based medicine.
For example, acupuncture is outside the scope of the U.S. National Board of Medical Examiners. Nevertheless, in Virginia, one must be a licensed physician to perform it, presumably with additional training. In other states, someone trained only in acupuncture might perform it only on physician orders, or, depending on the state, might be licensed to perform it on self-referred patients.
Nurse practitioners can prescribe all drugs in some states, or prescribe anything but there must be a responsible physician, or might be able to prescribe antibiotics but not "narcotics". Each state defines scope of practice, even though there often are national examinations. Howard C. Berkowitz 02:03, 27 December 2008 (UTC)
First, the American Medical Association doesn't regulate or authorize anything in the U.S., although it may issue position papers. While the majority of physicians once belonged, I think membership is in the 30 percent range.
At the national level in the U.S., there is a National Board of Medical Examiners that supervises examinations after years 2 and 4 of medical school, and first year graduate medical training. See medical education and graduate medical education. Beyond that, there are specialty boards. To prescribe certain drugs, you must be licensed by the Drug Enforcement Administration; to use radioisotopes in diagnosis and therapy, you need a Department of Energy license whether or not you are board-certified in nuclear medicine.
Some states tightly regulate who can perform what, and others are permissive. Insurance reimbursement is yet another issue.
Acupuncture and herbal medicine are often regulated differently, but the scope of recognized traditional Chinese medicine (often an OMD degree) includes both, as well as some other techniques. I have had two mentors in acupuncture and some related areas; one was a graduate of a U.S. school (Florida) of Oriental medicine, and her scope of practice was quite limited. The other was a board-certified OB/GYN, and, in fact a Washington DC and national authority on gynecological ultrasonography -- but also had acupuncture training from his native Vietnam. He still needed a Virginia acupuncture license on top of his MD and FACOG (OB/GYN board). I vaguely remember that he had to retake a short acupuncture program to have the credential, since the school in Vietnam no longer existed to send a certificate.
The safety and efficacy of a treatment method is open to dispute, but that doesn't depend on whether it's mainstream or CAM. CM and AM are different by the NCCAM definition. What would you call, for example, chiropractic, in a state where one is licensed and authorized to practice independently? It's not "medicine". It could be either complementary or alternative, depending on whether it is offered as a "whole system". Even the whole system idea isn't always clean; some practitioners are perfectly willing for a surgeon to take over for trauma, but they might go back to herbalism or naturopathy for cancer. The World Health Organization recognizes culturally specific traditional forms of treatment.
Culturally specific may involve multiple modalities; China has what it calls the "Three Roads" method that includes both traditional Chinese medicine and conventional techniques. Howard C. Berkowitz 02:32, 27 December 2008 (UTC)
Big sigh here. For most of my 55 years, I've heard mainly "alternative medicine". If I asked my aging mother about "complementary medicine" or "integrative medicine", she would just look at me and say, "WHAT?" But if I said "alternative medicine", she'd probably nod wisely. In my view, these are terms that people use in a variety of ways; the NIH department you mention has its way, and the normal Joe the Plumber has probably, in my opinion, never heard any of the phrases except "alternative".Pat Palmer 03:19, 27 December 2008 (UTC)
Well, youngster :-), I agree. At both the level of the U.S. and of the World Health Organization, it was realized the terms were confusing, and precision was sought. I gave links in the Forum that I can bring over here, but, as an example, here is the text from Medical Subject Headings, the standard medical indexing reference:
Therapeutic practices which are not currently considered an integral part of conventional allopathic medical practice. They may lack biomedical explanations but as they become better researched some ( PHYSICAL THERAPY MODALITIES; DIET; ACUPUNCTURE) become widely accepted whereas others (humors, radium therapy) quietly fade away, yet are important historical footnotes. Therapies are termed as Complementary when used in addition to conventional treatments and as Alternative when used instead of conventional treatment.
MeSH also defines integrative medicine as "The discipline concerned with using the combination of conventional (allopathic) medicine and ALTERNATIVE MEDICINE to address the biological, psychological, social, and spiritual aspects of health and illness." There will always be the Joe the Plumber problem; the best we can do is explain that the definitions are becoming more specific. Sometimes even with the best intention, integrative medicine can pose challenges: a hospital welcomed a Lakota Sioux healing ritual, but then went into utter confusion when they realized that the ritual used tobacco and they had an absolute no-smoking policy. Howard C. Berkowitz 03:43, 27 December 2008 (UTC)
that makes me smile!Pat Palmer 03:45, 27 December 2008 (UTC)