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msJAMA
March 4, 1998

Evaluating the Alternatives

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JAMA. 1998;279(9):706. doi:10.1001/jama.279.9.706-JMS0304-2-1

The term alternative medicine has been used interchangeably with complementary medicine, integrative medicine, and unconventional medicine. While these names encompass many healing practices outside the realm of allopathic medicine, they are not necessarily equivalent and are often inaccurate in describing the practice and use of alternative medicine in the United States.

For example, not all alternative therapies complement allopathic medicine. As Megan Johnson illustrates in her essay, homeopaths might treat a runny nose by prescribing herbs that enhance the nasal discharge, while allopathic physicians would probably provide medications to suppress the symptoms. Combining both approaches to restoring health may not work synergistically, and it is unclear to what degree treatment compatibility exists. Physicians must identify the parameters within which alternative practices can be best used.

Another term that inadequately describes alternative medicine is unconventional. While most allopathic physicians may not recommend the use of energy healing to their ill patients, they might recommend other practices, such as the use of vitamins. Alternative practices may even be essential for the total health of the individual, given that the training of allopathic physicians has traditionally focused on intervention. Perhaps the prevention or palliation of certain chronic conditions are areas where alternative medicine could provide effects that are synergistic with allopathic interventions.

If alternative practices are not entirely complementary or unconventional, they are undeniably popular.1 Despite their common use, physicians are often uninformed regarding alternative techniques. In the absence of organized oversight lies the potential for harm. As Mehmet Oz and colleagues state in their report, engaging in yoga subsequent to open heart surgery can be dangerous. By working together, surgeons and yoga instructors have modified these exercises to alleviate pressure on the thoracic cavity. Acknowledging the prevalence of alternative therapies might allow physicians to incorporate those that are beneficial in the regimen toward complete recovery.

Can alternative therapies be integrated with allopathic practices to produce improved patient outcomes? Without rigorous research, it is impossible to identify those therapies that reproducibly benefit patients' health. Fortunately, the Office of Alternative Medicine at the National Institutes of Health is tackling these problems. After careful study, some alternative practices may prove to be useful. Indeed, experimental evidence already suggests that surprising benefits can be found for certain alternative therapies. For example, gingko biloba extract has recently been documented to slow the progression of dementia in some patients.2 The possible benefits should be justification enough for continued rational evaluation.

If an accurate, comprehensive definition of alternative medicine remains elusive, perhaps a more restrictive definition can be applied. From the perspective of medical students, alternative medicine consists of those traditions and practices of healing not taught in medical schools.1 Given the prevalence and potential of these practices, it is the responsibility of medical students to rectify this situation and educate themselves about the field.

References
1.
Eisenberg  DMKessler  RCFoster  CNorlock  FECalkins  DRDelbanco  TL Unconventional medicine in the United States—prevalence, cost and patterns of use. N Engl J Med. 1993;328246- 252Article
2.
LeBars  PLKatz  MMBerman  NItil  TMFreedman  AMSchatzberg  AF A placebo-controlled, double-blind, randomized trial of an extract of gingko biloba for dementia. JAMA. 1997;2781327- 1332Article
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