Dr Rajiv Desai

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COMPLEMENTARY AND ALTERNATIVE MEDICINE

COMPLEMENTARY AND ALTERNATIVE MEDICINE:

 

Prologue:

A well educated and qualified doctor from western country practiced in an underdeveloped tribal area of an African country full of quacks and god-men but became very popular. When asked how such a scientific and rational doctor became popular among tribal, he gave a simple answer. He said that one third of patients are psychic, another one third have self limited illnesses and the remaining one third have illnesses which need his attention. The quacks and the god-men can cure psychic & self limiting illnesses but only he could cure the rest and that is why he became popular. This is the difference between the conventional scientific medicine and traditional unscientific medicine. Thousands of years ago everybody believed that the sun revolves around the earth & the earth is stationary but today, everybody believes that the earth revolves around the sun & rotates on its axis. This is the difference between traditional belief and scientific fact.

 

Abbreviations & synonyms:                                                                                                              

CAM = complementary and alternative medicine

MD = doctor of medicine

MSM = mainstream scientific medicine = allopathy = modern medicine = western medicine = conventional medicine

ADR = adverse drug reaction

RCT = randomized clinical trial

Traditional medicine is a part of CAM and not MSM.

 

In 1948, the World Health Organization (WHO) defined health as a complete state of physical, mental, and social well-being and not merely the absence of disease or infirmity. Medicine is the science and art of healing. It encompasses a range of health care practices evolved to maintain and restore health by prevention and treatment of illness. Before scientific medicine, healing arts were practiced in accordance with alchemical treatments and ritual practices that developed out of religious and cultural traditions. The term “Western medicine” was until recently used to refer to scientific and science-based practices to distinguish it from “Eastern medicine” which are typically based in traditional, anecdotal, or otherwise non-scientific practices. There is no such thing as alternative medicine. There is medicine that is either good (effective & safe) or bad (ineffective & unsafe). So called alternative therapies need to be assessed and then classified as good medicines or bad medicines. Hopefully, in the future, the good medicines will be embraced within conventional medicine and the bad medicines will be abandoned. To most of the world’s population, over 80 per cent to be precise, alternative medicine is not “alternative” at all, but rather the basis of the health care system. To western trained physicians alternative medicine is “something not taught in medical schools” and something that allopathic doctors don’t do and generally know nothing about.

 

Allopathy:

Allopathy is a term coined in the early 19th century by Samuel Hahnemann the founder of homeopathy as a synonym for mainstream medicine. Hahnemann felt had it has nothing to do with the disharmony produced by disease but merely addressing symptoms. The term derives from the Greek állos, (other/different) + páthos (suffering). It is a system of medical practice which treats disease by the use of remedies which produce effects different (antagonist) from those produced by the disease itself. Generally, allopathic medicine refers to “the broad category of medical practice that is sometimes called Western medicine, biomedicine, scientific medicine, mainstream medicine, conventional medicine or modern medicine” with varying degrees of acceptance by medical professionals in different locales. In the United States, allopathic medicine can sometimes refer to the medical training that leads to the degree of Doctor of Medicine. I am an allopathic ‘Doctor of Medicine’ from Mumbai University. Of course, on hindsight, Samuel Hahnemann was deadly wrong because his infamous law of similars is absurd. In fact the term allopathy is a misnomer and the correct terminology would be mainstream scientific medicine (MSM).

 

The term “alternative medicine” is generally used to describe practices used independently or in place of conventional medicine. Alternative medicine can be defined as any form of therapy, practice or treatment which is outside the mainstream or beyond the realm of the conventional. An example of an alternative therapy is using a special diet to treat cancer instead of undergoing surgery, radiation, or chemotherapy that has been recommended by a physician. Generally alternative therapies are closer to nature, cheaper and less invasive than conventional therapies, although there are exceptions. Some alternative therapies are scientifically validated, some are not. Complementary medicine is different from alternative medicine. Whereas complementary medicine is used together with conventional medicine, alternative medicine is used in place of conventional medicine. Example of complementary medicine is using ginger syrup to prevent nausea during chemotherapy. Together, complementary and alternative medicines are often referred to by the acronym CAM. The terms “integrative” or “integrated medicine” indicate combinations of conventional and alternative medical treatments which have some scientific proof of efficacy.

 

WHO defines traditional medicine as the sum total of knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures that are used to maintain health, as well as to prevent, diagnose, improve or treat physical and mental illnesses. Practices known as traditional medicines include herbal, Ayurveda, Siddha medicine, Unani, ancient Iranian medicine, Islamic medicine, traditional Chinese medicine, acupuncture, Muti, Ifá, traditional African medicine, and other medical knowledge and practices all over the globe. However, when traditional medicine is adopted by population outside its indigenous culture, it becomes CAM for that population. For example, ayurveda is traditional medicine for India but becomes CAM for America.

 

In Western culture, complementary and alternative medicine (CAM) is any healing practice that does not fall within the realm of conventional medicine or that which has not been shown consistently to be effective. It is often opposed to evidence based medicine and encompasses therapies with historical or cultural, rather than a scientific basis. CAM practices may incorporate or base themselves on traditional medicine, folk knowledge, spiritual beliefs, or newly conceived approaches to healing. CAM is the term for medical products and practices that are not part of standard care. Standard care is what medical doctors, doctors of osteopathy and allied health professionals, such as registered nurses and physical therapists practice. The American National Center for Complementary and Alternative Medicine (NCCAM) cites examples of CAM including naturopathy, chiropractic medicine, herbalism, traditional Chinese medicine, Ayurveda, meditation, yoga, biofeedback, hypnosis, homeopathy, acupuncture, and nutritional-based therapies, in addition to a range of other practices. The claims made by CAM practitioners are generally not accepted by the medical community because evidence-based assessment of safety and efficacy is either not available or has not been performed for these practices. If scientific investigation establishes the safety and effectiveness of CAM practice, then it becomes mainstream medicine and is no longer “alternative”, and may therefore become widely adopted by conventional practitioners. Some researchers state that the evidence-based approach to defining CAM is problematic because some of the CAM is tested, and research suggests that many mainstream medical techniques lack solid evidence.

 

The National Center for Complementary and Alternative Medicine (NCCAM) is the American Federal Government’s lead agency for scientific research on complementary and alternative medicine (CAM) which is a part of the National Institutes of Health (NIH) within the U.S. Department of Health and Human Service. The NCCAM defines CAM as a group of diverse medical and health care systems, practices, and products that are not currently part of conventional medicine. Conventional medicine (also called Western or allopathic medicine) is medicine as practiced by holders of M.D. (medical doctor) and D.O. (doctor of osteopathy) degrees and by allied health professionals, such as physical therapists, psychologists, and registered nurses. The American Medical Association defines alternative medicine as any diagnostic method, treatment, or therapy that is “neither taught widely in U.S. medical schools nor generally available in U.S. hospitals.”  The boundaries between CAM and MSM are not absolute, and specific CAM practices may, over time, become widely accepted. Also, it is possible that a particular therapy or intervention is conventional treatment in one country but becomes alternative in another country.

 

Placebo effect:

A placebo has been defined as a substance or procedure that objectively does not have specific activity for the condition being treated. In other words, a placebo (Latin for “I shall please”) is a pharmacologically inert substance (a starch tablet) that is expected to produce an effect similar to a pharmacologically active substance (such as an antibiotic). Colloquially, Placebo means a “sugar pill” or any dummy medication or treatment. For example, in a controlled clinical trial, one group may be given a real medication while another group is given a placebo that looks just like it in order to learn if the differences observed are due to the medication or to the power of suggestion.The phenomenon of an inert substance resulting in a patient’s medical improvement is called the placebo effect.

Placebos are widely used in drug trials. Various studies have shown that placebos are effective in 50 or 60 percent of subjects with certain conditions, e.g. pain, depression, some heart ailments, gastric ulcers and other stomach complaints and as effective as the new psychotropic drugs. However, meta-analysis of 114 studies found that compared with no treatment, placebo had no significant effect on binary outcomes, regardless of whether these outcomes were subjective or objective. For the trials with continuous outcomes, placebo had a beneficial effect, but the effect decreased with increasing sample size, indicating a possible bias related to the effects of small trials. Also, natural history of many illnesses is regression of illness over time and coincidental use of placebo may give credit to placebo for resolution of illness and therefore if the placebo group shows better results than the group getting no treatment, only then surely the placebo is effective. Also, to study placebo effect, improvement in objective measurement like blood pressure is more reliable than subjective measurement like pain relief. Also, in certain settings placebo interventions can influence patient-reported outcomes, especially pain and nausea, though it is difficult to distinguish patient-reported effects of placebo from biased reporting. Variations in the effect of placebo were partly explained by variations in how trials were conducted and how patients were informed. In other words – for any objective outcome, there is no important placebo effect. For outcomes that are subjectively reported by patients, there is a highly variable placebo effect.

 

Analysis of 19 clinical trials of antidepressants showed that the expectation of improvement, not adjustments in brain chemistry, accounted for 75 percent of the drugs’ effectiveness. A person’s beliefs and hopes about a treatment, combined with their suggestibility, may have a significant biochemical effect. The psychological explanation for placebo effect seems to be the one most commonly believed. Perhaps this is why many people are dismayed when they are told that the effective drug they are taking is a placebo. This makes them think that their problem is “all in their mind” and that there is really nothing wrong with them. The physiological basis for the placebo effect is could be due to release such chemical substances as endorphins, catecholamines and cortisol. One reason, therefore, that people report pain relief from both acupuncture and sham acupuncture is that both are placebos that stimulate endogenous opioid system to release endorphins which relieve pain. The use of placebo to relieve pain without patient’s knowledge amounts to deception and therefore ethical issues do arise. The placebo can be an open door to quackery. Since CAM practitioners’ greatest asset is their nourishment of hope, such therapies may be creating nothing more than the expectation that they will reduce pain by elaborate explanations, promises, and ceremonies which are basically placebo effect.

 

In a double-blind, placebo-controlled randomized clinical trial, neither the patients nor the researchers know who is getting a placebo and who is getting the treatment. Because patients don’t know what they’re getting, their belief about what will happen doesn’t taint the results. Because the researchers don’t know either, they can’t hint to patients about what they’re getting, and they also won’t taint results through their own biased expectations about what the results will be. This is the gold standard of determining efficacy of any medicine. Most of CAM therapies never underwent such randomized clinical trials (RCT).  

 

Classification of CAM:

NCCAM classifies complementary and alternative therapies into five major groups which have some overlap.

1)  Whole medical systems: These are complete systems of theory and practice that have evolved over time in different cultures and are apart from conventional or Western medicine as practiced by medical doctor. Examples include Traditional Chinese medicine, Homeopathy and Ayurveda, native American, Unani medicine, traditional African, South American, Naturopathy etc.

2)  Mind-body medicine: Takes a holistic approach to health that explores the interconnection between the mind, body, and spirit. It works under the premise that the mind can affect “bodily functions and symptoms”. Examples include Meditation, Yoga, Acupuncture, Hypnotherapy, deep breathing exercises, Prayer, mental healing, art, music, dance, humor therapy, biofeedback etc.

3)  Biologically based practices: Use substances found in nature such as herbs, foods, vitamins, and other natural substances; specific diet therapy, dietary supplements, aromatherapy etc. Some uses of dietary supplements- e.g. taking a multivitamin to meet minimum daily nutritional requirements or taking calcium to promote bone health or taking folic acid to prevent birth defects etc are not thought of as CAM. The most commonly used natural product is fish oil/omega 3s consumed by 37.4 percent of all American adults.

4)  Manipulative and body-based practices: Focus primarily on manipulation and/or movement of the structures and systems of the body, including the bones and joints, soft tissues, and circulatory and lymphatic systems, such as are done in chiropractic, osteopathic manipulation, reflexology and body massaging.

5)  Energy medicine: It is a domain that deals with putative and verifiable energy fields including bio-field therapies and bio-electromagnetic based therapies. Bio-field therapies are intended to affect energy fields that purportedly surround and penetrate the human body. The existence of such fields has not yet been scientifically proven. Examples include: Qi gong, Reiki, Therapeutic Touch, Healing touch etc. Bio-electromagnetic-based therapies involve the unconventional use of electromagnetic fields, such as: Pulsed fields, Magnetic fields and alternating-current or direct-current fields.

Many CAM practices fall in more than one category. For example, Acupuncture is considered to be a part of mind-body medicine, but it is also a component of energy medicine, manipulative and body-based practices, and traditional Chinese medicine. Also, ‘Overlapping Practices’ are those that can be either CAM or conventional medicine, depending on their application; for example: hypnotherapy, psychotherapy, placebo and Orthomolecular Medicine (which refers to products used as nutritional and food supplements for preventive or therapeutic purpose at high doses like niacinamide for arthritis and melatonin to prevent breast cancer). Some therapies that were considered alternative in the past have become mainstream in present. For example: patient support groups, cognitive-behavioral therapy and NLP (Neuro Linguistic Programming).    

 

The perceived advantages of CAM over MSM:

1)  There are no side effects. This is because alternative medicine works with the body, not in suppressing symptoms, as modern medicine does.

2)  Medicines are cost effective. This means they are generally affordable by even the most financially compromised families.

3)  Alternative medicines are generally natural substances and no high tech manufacturing processes which use hazardous and polluting chemicals or carbon polluting energy.

4)  No secrecy or patents here and substances are readily available.

5)  Alternative medicines don’t just heal ailments but they allow for growth.

6)  Alternative medicine recognizes the true nature of disease and believes that physical symptoms only develop when you ignore the mental and emotional signs and symptoms.

7)  Herbal remedies have been around for thousands of years and have stood the test of time.

8)  Alternative medicine improves not only a specific ailment but also the other aspects of a person’s life by advocating proper diet, a better lifestyle, and the ways of achieving mental health.

9)  In most of cases of CAM, it’s totally non-invasive, so there’s no need to be afraid of scalpels, drills or syringes.

10)  Alternative medicine, without exception, considers each person as a unique individual and uses a holistic approach in treatment rather than piece-meal pathology of heart or kidneys etc.

11)  Almost all CAM emphasize need on prevention rather than treatment of illness with maximizing body’s inherent healing ability.

 

Herbal medicine:

A herb is a plant or plant part (such as leaves, flowers, or seeds) that is used for its flavor, scent, and/or therapeutic properties. Herbal supplements are one type of dietary supplement.

Herbs and Dietary supplements:

A dietary supplement is a product that:

1) Is intended to supplement the diet

2) Contains one or more dietary ingredients including vitamins, minerals, herbs or other botanicals-A plant or part of a plant used for its flavor, scent, or potential therapeutic properties and includes flowers, leaves, bark, fruit, seeds, stems, and roots, amino acids, and certain other substances or their constituents

3) Is intended to be taken by mouth, in forms such as tablet, capsule, powder, softgel, gelcap, or liquid

4) Is labeled as being a dietary supplement.

The regulations for dietary supplements are not the same as those for drugs and in fact less strict. A manufacturer does not have to prove the safety and effectiveness of a dietary supplement before it is marketed. People must keep in mind that although many dietary supplements (and some prescription drugs) come from natural sources, “natural” does not always mean “safe.” For example, the herbs comfrey and kava can cause serious harm to the liver. Some dietary supplements contain lead and arsenic, and some obstruct other medicines from working like birth control pills.  Be aware that an herbal supplement may contain dozens of compounds and that its active ingredients may not be known and it may be contaminated with other herbs, pesticides, or metals, or even adulterated with unlabeled ingredients such as prescription drugs.

 

How MSM differs from CAM herbal therapy?

Artemisinin-combination therapies (ACT) are now standard treatment worldwide for falciparum malaria. The starting compound, artemisinin (a sesquiterpene lactone) is isolated from the plant Artemisia annua, a herb described in Chinese traditional medicine. Over a third of all drugs routinely used in MSM were derived from herbal sources, including many of the most widely used drugs in cancer chemotherapy. The difference of course is that the active ingredients in these products, even though originally from nature, are now known and have passed rigorous tests of safety and efficacy. This allows their purity and dosages to be accurately controlled, something than cannot be said of  CAM herbal products, whose active ingredients have been shown in lab assays to vary, in different samples, by a factor of as much as 10,000. Majority of CAM herbal medicines have been found to be unproven, disproven and downright dangerous. However, if active ingredient of CAM herbal therapy is identified, purified & quantified, and passes rigorous tests of efficacy & safety in double-blind clinical trial, it automatically becomes MSM. For example, chemical curcumin from turmeric can be useful in cancer & inflammation (vide infra).

 

It is beyond the scope of this article to discuss each herb in detail but I will mention a few common herbs.

St John’s wort:

St. John’s wort (goat weed/ Hypericum perforatum) is a plant with yellow flowers whose medicinal uses were first recorded in ancient Greece. St. John’s wort has been used for centuries to treat mental disorders. Two large studies showed that the herb was no more effective than placebo in treating major depression of moderate severity. St. John’s wort may cause increased sensitivity to sunlight, anxiety, dry mouth, dizziness, gastrointestinal symptoms, fatigue, headache, or sexual dysfunction as well as interact with other medicines like antidepressants, birth control pills, Cyclosporine, Digoxin, Indinavir and Warfarin. St. John’s wort is classified as dietary supplements by the U.S. FDA. There is a possibility that if this herb is used to treat major depression, patient may worsen and commit suicide.

 

Turmeric:

When I was 11 years old, I developed infection in a toe and my allopathic GP tried everything from daily dressing to antibiotics for weeks but no improvement. When I visited village, my grandmother applied turmeric over the wound and dressed the wound. The wound completely healed in one week. On hindsight, I suspect, may be turmeric having anti-microbial properties. However, personal experience should not be used to validate herbal therapy.

Turmeric (Curcuma longa) is grown throughout India, other parts of Asia, and Africa and known for its warm, bitter taste and golden color and used in fabric dyes and foods such as curry powders, mustards, and cheeses. Turmeric has been applied directly to the skin for eczema and wound healing and also used for conditions such as heartburn, stomach ulcers, and gallstones. Laboratory studies suggest that a chemical found in turmeric—called curcumin—may have anti-inflammatory and anti-oxidant properties. There are an estimated three to five grams of curcumin in 100 grams of turmeric. For use in cooking, choose a pure turmeric powder, rather than a curry powder. At least one study has found that curry powders tend to contain very little curcumin, compared to turmeric powder. Curcumin has been shown to influence more than 700 genes, and it can inhibit both the activity and the synthesis of cyclooxygenase-2 (COX2) and 5-lipooxygenase (5-LOX), as well as other enzymes that have been implicated in inflammation. In India where turmeric is widely used, the prevalence of four common U.S. cancers -colon, breast, prostate and lung- is 10 times lower. A research study found that Curcumin acts against transcription factors, which regulate all the genes needed for tumors to form. When these genes are turned off, it shuts down some genes that are involved in the growth and invasion of cancer cells. So scientific studies have found turmeric useful in cancer and inflammation. Turmeric is considered safe for most adults. 

 

Ginger:

Ginger (Zingiber officinale) is a tropical plant that has green-purple flowers and an aromatic underground stem and is commonly used for cooking and medicinal purposes. The underground stems of the ginger plant are used in cooking, baking, and for health purposes. Many digestive, anti-nausea, and cold and flu dietary supplements contain ginger extract as an ingredient. Few side effects are linked to ginger when it is taken in small doses.

 

Garlic:

Garlic (Allium sativum) is the edible bulb from a plant in the lily family. It has been used as both a medicine and a spice for thousands of years. Garlic is commonly used to treat high cholesterol, heart disease, and high blood pressure. An NCCAM-funded study on the safety and effectiveness of various garlic preparations for lowering blood cholesterol levels found no effect but meta-analysis of other controlled trials of garlic to reduce hypercholesterolemia showed a significant reduction in total cholesterol levels. The best available evidence suggests that garlic, in an amount approximating one half to one clove per day, decreased total serum cholesterol levels by about 9% in the groups of patients studied. Preliminary research suggests that taking garlic may slow the development of atherosclerosis and evidence is mixed on whether taking garlic can slightly lower blood pressure. Garlic appears to be safe for most adults.

 

Aromatherapy:

Aromatherapy is the therapeutic practice of using essential oils extracted from plants, trees, flowers and organic herbs. The practice of Aromatherapy has long been observed in places like Asia and the Middle East and is vastly known for its healing capabilities for both mind and body. Aromatherapy is a term originating from the Greek root-word aroma which meant distinctive scent that is sweet and pleasant in nature. With the use of essential oils, scents from specific plants and herbs are combined to form different concoctions designed for therapeutic healing. Among the well-known essential oils in Aromatherapy include Lavender, Eucalyptus and Peppermint. Lavender is administered to relieve stress, headaches, skin irritations, insect bites, and burns and is also used to promote sleep and reduce insomnia; Eucalyptus is common for treatments of colds and coughs and; Peppermint is widely used for stimulant against nausea and dizziness. These essential oils may be administered through soothing massages, warm baths, and calming inhalations and even taken orally. Fragrance oils or perfumes should be treated entirely differently from that of essential oils, as the former provide no therapeutic effects.

 

Ayurveda:

Ayurvedic medicine is a system of traditional medicine native to the India and practiced in other parts of the world as a form of alternative medicine. In Sanskrit language, the word ayurveda consists of the words ?yus, meaning “longevity”, and veda, meaning “related to knowledge” or “science. Ayurvedic medicine has more than 4,000 years of history and is described in the great medical encyclopedias associated with the names Charaka, Sushruta, and Bhe?a, compiled and re-edited over several centuries from about 200 BC and written in Sanskrit language. Ayurvedic medicine uses diet, exercise, yoga, meditation, massage, herbs & medication, and despite its long lineage, is as applicable today as it was 5000 years ago. For example, the seeds of the Mucuna pruriens plant have long been used to treat Parkinson’s disease in India; it is now receiving attention in conventional circles as it is more effective than L-dopa and has fewer side effects. Ayurveda is considered to be a form of CAM in the western world includes the use of herbs, massage, and yoga. Ayurveda is grounded in metaphysics of the five great elements namely; the earth, the water, the fire, the air and the space-all of which compose the Universe, including the human body. In Ayurvedic philosophy, these five elements combine in pairs to form three dynamic forces or interactions called doshas (that which deteriorates). These 3 doshas are vata (air & space – “wind”), pitta (fire & water – “bile”) and kapha (water & earth – “phlegm”). Ayurveda holds that each human possesses a unique combination of Doshas and its imbalance leads to diseases of the body. The ancient Vedic knowledge exemplifies that every individual is composed of a body, a mind and a spirit. Ayurveda deals mainly with the physical body; Yoga deals mainly with spirit; and Tantra, is mainly concerned with the mind. Hinduism and Buddhism have been an influence on the development of many of Ayurveda’s central ideas. Ayurveda places an emphasis on moderation in food intake, sleep, sexual intercourse, and the intake of medicine. Ayurveda stresses the use of vegetable drugs including cardamom and cinnamon. It also uses animal products like milk & bones; and minerals including sulfur, arsenic, lead, copper sulfate and gold. The Indian government supports research and teaching in ayurveda through many channels at both the national and state levels, and helps institutionalize traditional medicine so that it can be studied in major towns and cities. Many ayurveda products have not been tested in rigorous scientific studies and clinical trials. Some ayurvedic herbs like turmeric, neem, cardamom and cinnamon have been found to be useful. The use of toxic herbs and of toxic metals & minerals as ingredients in traditional ayurvedic treatments is a major safety concern but ayurvedic practitioners are reluctant to admit that herbs could be toxic and the reliable information on herbal toxicity is not readily available. A year 2008 study of more than 230 ayurvedic products found that approximately 20% of remedies purchased over the Internet from both US and Indian suppliers contained lead, mercury or arsenic. Following concerns about metal toxicity, Government of India ruled that ayurvedic products must specify its metallic content directly on the labels of the product. 

 

Unani medicine:

The Unani system of medicine originated in Greece and the term Unani is derived from ‘Unan’, Arabic and Urdu for ‘Greece’. The theoretical framework of Unani medicine is based on the work of Hippocrates (460-377 BC). A number of Greek scholars after Hippocrates such as Galen (131-200 AD) followed by Arab physicians like Rhazes (850-932 AD) and Avicenna (980-1037 AD), enriched the system considerably. It refers to a tradition of Graeco-Arabic medicine. Most of the practicing Unani physicians in India are Muslims and therefore people think of Unani as solely a Muslim system of medicine which is not true. Unani system follows the humoural theory which postulates the presence of four humours in the body: dam (blood), balgham (phlegm), safra (yellow bile) and sauda (black bile), a parallel to kapha, vata and pitta, the three doshas in ayurveda. The body has the power of self preservation to maintain a correct balance of these humors, which is called as Quwwat-e-Mudabbira (Medicatrix natura). Unani medicines help the body to regain this balance. Some Unani physicians also examine the blood pressure and use stethoscopes to study the breathing and heart sounds. Unani claims to treat various chronic diseases like arthritis, asthma, mental, cardiac and digestive disorders, urinal infections, and of course sexual diseases. Unani has lagged far behind ayurveda in popularity. 

 

Naturopathy:

Naturopathic medicine strongly believes in the body’s inherent ability to heal itself. Naturopathy is built upon the dictum of Hippocrates, the father of medicine, who declared “Nature cures; not the physicians”. Naturopathy favors holistic approach and focuses on natural remedies and the body’s vital ability to heal and maintain itself. Naturopathy emphasizes the need for seeking and treating the causes of a disease rather than simply suppressing its symptoms. Naturopaths use dietary modifications, herbal medicines, homeopathy, acupuncture, hydrotherapy, massage, yoga and lifestyle counseling to achieve healing. Naturopaths do not recommend vaccines and antibiotics, and may provide inappropriate alternative remedies even in cases where MSM has been shown to be effective.

 

Traditional Chinese medicine:

Traditional Chinese medicine (TCM) has more than 4,000 years of history as a system of medicine that is based on a philosophical concept of balance (yin and yang, Qi, Blood, Jing, Bodily fluids, the Five Elements, the emotions, and the spirit) approach to health that is rooted in Chinese culture. TCM includes a range of traditional medicine practices originating in China and which is well accepted in the mainstream of medical care throughout East Asia but considered an alternative medical system in much of the Western world. TCM practices include such treatments as Chinese herbal medicine, acupuncture, dietary therapy, and massage. The Shen Nong’s Herbal Classic, a 2000-year old medicinal Chinese book considered today as the oldest book on oriental herbal medicine, classifies 365 species of roots, grass, woods, furs, animals and stones. Tai chi is the slow, meditative exercise regimen, originally developed as a martial art in China more than 2,500 years ago and practiced widely across Asia today, improves sleep quality in adults with moderate insomnia. Traditional Chinese medicine is largely based on the philosophical concept that the human body is a small universe with a set of complete and sophisticated interconnected systems, and that those systems usually work in balance to maintain the healthy function of the human body. TCM containing potentially toxic and carcinogenic compounds such as arsenic trioxide and cinnabar are sometimes prescribed as part of a medicinal mixture, in a sense “using poison to cure poison” which is dangerous. A medicine called Fufang Luhui Jiaonang was taken off shelves in UK in July 2004 when it found to contain 11-13% mercury.   

 

Acupuncture:

In traditional Chinese medicine (TCM), the body is seen as a delicate balance of two opposing and inseparable forces: yin and yang. Yin represents cold, slow, or passive aspects of the person, while yang represents hot, excited, or active aspects. A major theory is that health is achieved through balancing yin & yang, and disease is caused by an imbalance between yin & yang leading to a blockage in the flow of qi which is the vital energy or life force proposed to regulate a person’s spiritual, emotional, mental, and physical health and to be influenced by the opposing forces of yin and yang. This vital energy qi flows along 12 primary and 8 secondary meridians. Qi can be unblocked, according to TCM, by using acupuncture at certain points on the body that connect with these meridians which are “connecting the body in a web-like interconnecting matrix”. Acupuncture is a stimulation of specific points of body by inserting fine needles through the skin to remove blockages of qi to restore & maintain health. Acupuncture has been shown to induce the release of endogenous opioids in brain stem, subcortical, and limbic structures. Acupuncture also causes effects on local tissues, including mechanical stimulation of connective tissue, release of adenosine at the site of needle stimulation, and increases in local blood flow. Acupuncture has been used to relieve back pain, joint pain, neck pain, severe headache/migraine, and recurring pain.  

According to the 2007 National Health Interview Survey, which included a comprehensive survey of CAM use by Americans, an estimated 3.1 million U.S. adults and 150,000 children had used acupuncture in the previous year. Even though side effects of acupuncture are rare, when not delivered properly, acupuncture can cause serious adverse effects including infections and punctured organs. A year 2009 systematic review of research on the pain-relieving effects of acupuncture compared with placebo (simulated) or no acupuncture was inconclusive. The World Health Organization (WHO), the National Institutes of Health (NIH), and the American Medical Association (AMA) have commented on acupuncture and agreed that it is relatively safe, and that further investigation is warranted.

 

Homeopathy:

Samuel Hahnemann, a German physician developed a theory in the year 1796, based on three principles: the law of similars, the minimum dose, and the single remedy. The word homeopathy is derived from the Greek words for like (homoios) and suffering (pathos). The law of similars states that if a large amount of a substance causes certain symptoms in a healthy person, smaller amounts of the same substance can treat those symptoms in someone who is ill. Hahnemann believed that a substance’s strength and effectiveness is increased the more it was diluted. Higher is the dilution, greater is the effect and dilution often continues until none of the original substance remains. The homeopathic belief is that the substance has left its imprint or a spirit-like essence that stimulates the body to heal itself. Homeopathic practitioners believe that illness is specific to an individual. In other words, two people with severe headaches may not receive the same remedies. Even in allopathy, two people with severe headaches may receive different medicine provided they have different diagnosis like migraine versus sub-arachnoid hemorrhage but the logic in homeopathy is different. Homeopathy is particularly popular in South America and the British Royal Family has had a homeopathic physician for the last four generations. Homeopathy’s efficacy beyond the placebo effect is unsupported by the collective weight of scientific and clinical evidence. Homeopathy has been criticized for putting patients at risk due to advice against conventional medicine such as vaccinations, anti-malarial drugs, and antibiotics. Depending on the dilution, homeopathic remedies may not contain any pharmacologically active molecules and for such remedies to have pharmacological effect would violate fundamental principles of science. If homeopathy is correct, then, much of physics, chemistry, and pharmacology must be incorrect. It is chemistry and Avagadro’s number that tell us that a 30C homeopathic dilution almost certainly has not a single molecule of original remedy left. It is basic physics and chemistry that tell us that water doesn’t have “memory,” at least not the way that homeopaths tell us. It is basic chemistry that tells us that, even if water did have “memory,” there is no known mechanism by which such “memory” could be transmitted to cells for therapeutic effect.  

I will give a classical example. Substance diazepam (calmpose) causes sedation in all healthy humans and therefore homeopathically, when diazepam in dilution is given to a patient complaining of drowsiness, it should awaken the patient. The truth is that if diazepam in dilution is given to a drowsy patient, he will worsen. The fundamental principle of homeopathy is overwhelmingly illogical & irrational, and yet millions of people take homeopathic medicine and claim to get cured due to placebo effect and psychotherapy given by homeopathic practitioner. The British medical association has called homeopathy as ‘witchcraft’.

 

Chiropractic:

Chiropractic is a health care discipline that emphasizes management of mechanical disorders of the musculoskeletal system, especially the spine, under the hypothesis that these disorders affect general health via the nervous system. Chiropractors emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery with special emphasis on the spine. Traditional chiropractic assumes that a vertebral subluxation or spinal joint dysfunction interferes with the body’s function and its innate intelligence is exerted via the human nervous system. Chiropractic is rooted in mystical concepts. Chiropractic spinal manipulation (SM) is a passive manual maneuver during which a three-joint complex is taken past the normal range of movement, but not so far as to dislocate or damage the joint; with a sudden force that causes an audible release and attempts to increase a joint’s range of motion. The American Medical Association called chiropractic an unscientific cult. A 2008 critical review found that with the possible exception of back pain, chiropractic SM has not been shown to be effective for any medical condition. Even for backache, it is suggested that Chiropractic care benefits from the placebo response. Chiropractic practitioners claim that chiropractic care in general is safe when employed skillfully and appropriately. However, a year 2010 systematic review concluded that numerous deaths have occurred after chiropractic manipulations and the risks of this treatment by far outweigh its benefit.

 

Osteopathy:

Osteopathy or osteopathic medicine is an approach to healthcare that emphasizes the role of the musculoskeletal system in health and disease. Osteopathic principles teach that treatment of the musculoskeletal system (bones, muscles and joints) aids the recuperative powers of the body. In practice, this most commonly relates to musculoskeletal problems such as back and neck pain. Osteopathic manual treatment of the musculoskeletal system attempts to aid the body’s own recuperative faculties by resolution of what many osteopaths call somatic dysfunction. In a year 2005 the systematic review of six randomized controlled trials of osteopathic manipulative treatment (OMT) concluded that OMT significantly reduces lower back pain, and that the level of pain reduction is greater than expected from placebo effects alone. A study suggested that fibroblast proliferation and expression/secretion of pro-inflammatory and anti-inflammatory interleukins may contribute to the clinical efficacy of osteopathic manipulative techniques. Safety concerns have been raised in relation to manipulative techniques used by some osteopaths especially neck cracking; i.e. cervical high-velocity low-amplitude thrusting, has received particular attention owing to a possible risk of cervical arterial occlusion and consequently of stroke.

 

Massage therapy:

Massage therapists press, rub, and otherwise manipulate the muscles and other soft tissues of the body. They most often use their hands and fingers, but may use their forearms, elbows, or feet. Typically, the patient lies on a table, either in loose-fitting clothing or undressed (covered with a sheet, except for the area being massaged). The therapist may use oil or lotion to reduce friction on the skin and therapy may be fairly brief or may last an hour or even longer. Research supports the general conclusion that massage therapy is effective. The studies included in the analysis suggest that a single session of massage therapy can reduce “state anxiety” (a reaction to a particular situation), blood pressure, and heart rate, and multiple sessions can reduce “trait anxiety” (general anxiety-proneness), depression, and pain. A year 2008 review of 13 clinical trials found evidence that massage might be useful for chronic low-back pain. Another study found it useful in chronic neck pain. Massage may provide stimulation that helps to block pain signals sent to the brain. Other examples include theories suggesting that massage might stimulate the release of certain chemicals in the body, such as serotonin or endorphins, or cause beneficial mechanical changes in the body.  Side effects of massage therapy may include temporary pain or discomfort, bruising, swelling, and a sensitivity or allergy to massage oils. Vigorous massage should be avoided by people with bleeding disorders or low blood platelet counts, and by people taking blood-thinning medications such as warfarin. Also, massage should not be done in any area of the body with blood clots, fractures, open or healing wounds, skin infections, or weakened bones (such as from osteoporosis or cancer), or where there has been a recent surgery. Pregnant women should consult their health care provider before using massage therapy.

 

Yoga:

Yoga is a mind-body practice in complementary and alternative medicine (CAM) with origins in ancient Indian philosophy. Yoga refers to traditional physical and mental disciplines originating in India. The word is associated with meditative practices in Hinduism, Buddhism and Jainism. The various styles of yoga that people use for health purposes typically combine physical postures, breathing techniques, and meditation or relaxation.  Hatha yoga, the most commonly practiced in the United States and Europe, emphasizes postures (asanas) and breathing exercises (pranayama).  People use yoga for a variety of conditions and to achieve fitness and relaxation. 7 % American adults are using yoga. You should be cautious and you ought to do yoga under supervision of a teacher if you are suffering from hypertension, asthma, cancer, schizophrenia etc and also if you are pregnant. Gastric disturbances are very common side effects associated with yoga and some may feel flatulence, changes in stool content, passing out of more gases, feeling acidic while practicing yoga. Also, the other negative side effect from practicing yoga is physical injury including wrist pain, neck pain, back pain, tearing of ligaments and tendons, pulling muscles, ankle pain, knee pain, and vertigo.

 

Meditation:

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. Today, many people use meditation outside of its traditional religious or cultural settings as a form of mind-body medicine. Meditation has entered the mainstream of health care as a method of stress and pain reduction. Meditation induces a host of biochemical and physical changes in the body collectively referred to as the relaxation response. The relaxation response includes changes in metabolism, heart rate, respiration, blood pressure and brain chemistry. Studies done by Yale, Harvard, Massachusetts General Hospital have shown that meditation increases gray matter in the brain and slows down certain brain deterioration. Also, meditation decreases the stress that comes in through the brain into the vessels in the heart, slow the heart rate, cause the vessels to relax, to dilate, and result in the blood pressure going down. Research shows patients practicing Transcendental Meditation had a 25% decrease in cardiovascular mortality.  Meditation may produce adverse effects in certain circumstances including uncomfortable kinaesthetic sensations, mild dissociation, feelings of guilt, anxiety-provoking phenomena, psychosis-like symptoms, grandiosity, elation, destructive behaviour &  suicidal feelings, relaxation-induced anxiety and panic, paradoxical increases in tension, less motivation in life, boredom pain, impaired reality testing, confusion and disorientation, feeling ‘spaced out’, depression, increased negativity, being more judgmental, and ironically feeling addicted to meditation.

 

Prayer and spirituality:

Often considered “alternative” by conventional medical standards, prayer and spirituality help patients maintain a sense of purpose, meaning, and hope in the face of pain, suffering, and uncertainty through relationship with one’s own God or Supreme Being.

 

Prevalence of CAM:

Surveys indicate that those with the most serious and debilitating medical conditions, such as cancer, chronic pain, and HIV, tend to be the most frequent users of CAM practices. An American survey of almost 2,000 tumor registry patients selected at random found that 75 percent had used at least one CAM modality. The most frequently used therapies among this group of cancer patients were nutritional approaches (63 percent), massage (53 percent), and herbs (44 percent). The most common reason patients gave for using CAM was to “stimulate an immune response” (73 percent).   A year 1998 systematic review of studies assessing its prevalence in 13 countries concluded that about 31% of cancer patients use some form of complementary and alternative medicine. In Austria and Germany CAM is mainly in the hands of physicians, while some estimates suggest that at least half of American alternative practitioners are physicians. In the year 1997, Americans made 627 million visits to practitioners of alternative medicine but in contrast, Americans made only 386 million visits to their family doctor. Latest American statistics show that 74.6% of adult Americans  have had used some form CAM  in their life time and 54.9% used CAM in conjunction with conventional medicine and except for the groups of therapies that included prayer specifically for health reasons, use of CAM increased as education levels increased. A year 2008 survey of US hospitals found that more than 37 percent of responding hospitals indicated they offer one or more alternative medicine therapies. 1 in 4 hospitals in America offer Services such as Acupuncture, Yoga and Homeopathy. As of year 2006, United States citizens spent $27 billion annually on alternative and complementary treatments. In Australia 57 percent of the population now use some form of alternative medicine, in Germany 46 percent do, and in France 49 percent do. Latest British statistics show that Alternative therapists now outnumber GPs in the UK. According to WHO, in some Asian and African countries, 80% of the population depend on traditional medicine for primary health care. Krauss and colleagues found that CAM practitioners and products were chosen more often than conventional physicians and therapies by those persons with chronic pain (52 versus 34 percent) and headaches (51 versus 19 percent), as well as by persons suffering from other associated maladies, including depression (34 versus 25 percent), anxiety (42 versus 13 percent), and insomnia (32 versus 16 percent).

A recent study of 1,675 HIV-positive men and women using CAM (usually in addition to conventional medication) found that the most frequently reported CAM substances were high doses of vitamin C (63 percent), multiple vitamin and mineral supplements (54 percent), vitamin E (53 percent), and garlic (53 percent). The health practitioners most commonly consulted were massage therapists (49 percent), acupuncturists (45 percent), and nutritionists (37 percent). The CAM activities most commonly used were aerobic exercise (63 percent), prayer (58 percent), massage (53 percent), and meditation (46 percent).

 

Efficacy of CAM:

Let us discuss efficacy of selected complementary and alternative medicine interventions for chronic pain because most people use CAM to relieve chronic pain either unrelieved by MSM or adverse effects of MSM drugs.

What are the criteria for evaluation of efficacy?

 

 

Efficacy of selected complementary and alternative medicine (CAM) interventions for chronic pain. Efficacy levels based on American Psychological Association guidelines (see above figure).
Modality Level of
Efficacy
Explanation
Biologically Based Medicine    
Herbal Remedies/Dietary Supplements 2-3 Level 3: Glucosamine/chondroitin sulfate for arthritis conditions.
Level 2: Other dietary supplements. Studies show mixed findings; pain conditions studied were extremely diverse.
Energy Medicine    
Pulsed Electromagnetic Fields 2-3 Level 3: Migraines & knee osteoarthritis.Level 2: Osteoarthritis of cervical spine.
Therapeutic Touch 2 Promising for chronic musculoskeletal pain & pain related to knee osteoarthritis; less support for fibromyalgia or degenerative arthritis. Studies have several methodological weaknesses.
Reiki 1 Only 1 controlled study showed modest reductions in cancer pain.
Qigong 2-3 Level 3: Mixed chronic pain; findings need replication in independent research group.
Level 2: Complex Regional Pain Syndrome Type I.
Cranial Electrotherapy Stimulation 2 Level 2: Dental anesthesia, spinal cord injury, & fibromyalgia pain.
Mind-Body Medicine    
Meditation 3 Meditation demonstrated improvement from baseline in numerous studies & reviews, including randomized controlled trials. Samples were small & restricted.
Hypnosis 4-5 Hypnotic analgesia treatments are more effective than no treatment. However, hypnosis is not more effective than other treatments that include hypnotic like suggestions, e.g., relaxation training.
Yoga 3 Randomized controlled trials showed benefit for low back pain. Studies in carpal tunnel & osteoarthritis used within-group comparisons. All samples predominately female.
Biofeedback 2-4 Level 4: Migraine, tension headaches, & muscle-related orofacial pain.
Level 3: Stress & muscle tension-related incontinence, cramping & burning phantom pain, irritable bowel syndrome, Reynaud’s, posture-related pain, stress-induced chest pain.
Level 2: Premenstrual syndrome & dysmenorrhea, pain from spastic muscles & muscle spasms, pelvic-floor pain, carpel tunnel syndrome, myofascial/trigger point-related pain,
fibromyalgia.
Manipulative Body-Based Medicine    
Chiropractic 3 Spinal manipulation therapy had beneficial effects in multiple studies. However, higher quality studies needed before concluding that it is more efficacious that placebo, routine medical care, or exercise.
Massage Therapy 2-4 Different ratings designated depending on pain condition because quality of studies varied widely.
Level 4: Low back pain.
Level 3: Shoulder pain.
Level 2: Fibromyalgia, neck pain, headache, carpel tunnel
syndrome.
Modality Level of Efficacy Explanation
Whole or Professionalized CAM Practices
Homeopathy 2 Only 1 in 5 studies found significant pain decreases with homeopathic remedies compared with placebo. This 1 study was lower in quality relative to other studies.
Acupuncture 2-4 Acupuncture effectively treats dental, chemotherapy-related, & chronic low-back pain; probably effective for premenstrual syndrome-related pain. Data too sparse to evaluate efficacy for other chronic or acute pain conditions.

 

People can see that only hypnosis, biofeedback, massage and acupuncture therapy could reach level 4 or level 5 efficacy for chronic pain. Another study revealed that self-hypnosis, relaxation and guided imagery are the only efficacious therapy for recurrent headaches in children.

 

When someone feels better after having used a product or procedure, it is natural to credit whatever was done. This is unwise however because most ailments resolve by themselves and those that persist can have variable symptoms. Even serious conditions can have sufficient day-to-day variation to enable useless methods to gain large followings. In addition, taking action often produces temporary relief of symptoms due to a placebo effect. This effect is a beneficial change in a person’s condition that occurs in response to a treatment which is not due to the pharmacologic or physical aspects of the treatment. Belief in the treatment is not essential, but the placebo effect may be enhanced by such factors as faith, sympathetic attention, sensational claims, testimonials, and the use of scientific-looking charts, devices, and terminology. Another drawback of individual success stories is that they don’t indicate how many failures might occur for each success. People who are not aware of these facts tend to give undeserved credit to “alternative” methods. The fact that an “alternative” method may exert a placebo effect that relieves symptoms is not sufficient reason to justify its use. Therapy should be based on the ability to alter abnormal physiology and not on the ability to elicit a less predictable placebo effect. Placebo therapy is inherently misleading and can make patients believe something is effective when it is not. Without controlled clinical trials, any treatment that is used could receive credit for the body’s natural recuperative ability.

More than 4,000 randomized trials for various CAM therapies worldwide have identified the potential benefits of CAM and related approaches and products for a small number of chronic conditions, including:

1)  Low-fat or modified fat diets for preventing cardiovascular disease.

2)  Acupuncture in the management of low back pain and recurrent headaches.

3)  St John’s Wort for treating mild to moderate depression.

4)  Herbal therapy for treating osteoarthritis.

5)  Nutritional supplements for several neurological conditions.

6)  Ginger capsules may help chemotherapy nausea.

7)  Yoga, massage, meditation and other relaxation methods may relieve symptoms like pain, anxiety and fatigue.

8)  Bromelain is a medicinal compound (today taken in a pill) extracted from the stem and juice of the pineapple plant speeds healing of acute injuries such as cuts and bruises by stopping the production of prostaglandins.

 

After spending 2.5 billion dollars of tax payer’s money over 10 years on various studies, NCCAM came to the conclusion that ‘Echinacea for colds, Ginkgo biloba for memory, Glucosamine and chondroitin for arthritis, Black cohosh for menopausal hot flashes, Saw palmetto for prostate problems, Shark cartilage for cancer, etc…’ proved no better than placebo (dummy pills). When it comes to incurable diseases such as HIV/AIDS, CAM therapies are rampant and have been present since the earliest days of the pandemic. These therapies have only served to worsen suffering, waste money and, in some cases, hasten death.   

 

Scientists and researchers say that it’s become politically correct to investigate nonsense. The most important point is that CAM is directly or indirectly preventing (future) patients from receiving the best available healthcare by incorporating dishonesty, neglect of medical ethics, exploitation of vulnerable patients and political interventions based on vote-bank. According to an article recently published in the European Journal of Cancer, cancer patients using complementary and alternative medicine appear to have higher mortality rates than cancer patients using only conventional medicine. Ayurvedic medicine Guggul-extract has been used in India to decrease cholesterol synthesis in liver. However, several studies have been published that indicate no overall reduction in total cholesterol occurs after consumption of Guggul-extract and in fact levels of low-density lipoprotein (“bad cholesterol”) increased in many people and yet such products are freely marketed in India. Most CAM therapies have never passed the gold standard of placebo-controlled, double-blind trial. A major problem with CAM is the lack of truthful claims. Most of natural remedies are abused by making genuinely bogus cure claim for a product. This kind of Quackery not only harms people, it undermines the ability to conduct scientific research and should be opposed by scientists. It is replete with pseudoscientific, ineffective, unethical, and potentially dangerous practices. The most important feature of CAM therapy is that how a patient does or does not respond to CAM depends entirely on the individual and cannot be predicted. On the other hand, I am witness to many herbal remedies for asthma having corticosteroids in it and many natural therapies for epilepsy having phenytoin in it, proving the point that many so called herbal/natural treatments contain allopathic medicines.

 

Interesting to note that many forms of CAM including naturopathy, homeopathy, and chiropractic are based on beliefs opposed to vaccination and their practitioners have voiced their opposition to vaccination. People must understand that vaccination has made world safer by eradicating small pox and limiting the spread of polio, tetanus, hepatitis B etc and had CAM had its way, then without vaccination, the world would have become potentially unsafe place. Recently, UNICEF has stated that 2 million lives can be saved in 5 years due to vaccination in poor countries. Yes, it is true that good nutrition, improved sanitation, good personal hygiene and clean drinking water also prevent diseases just like vaccination but that does not downplay the importance of vaccination.

 

Safety with CAM use:

It is important not to lose sight that “natural” does not necessarily mean “safe”—think about poison ivy, poisonous mushrooms and rattlesnakes. Despite promising claims that CAM are safe to use, most CAM therapies that are currently being used by consumers have not been studied adequately in regard to safety. Even when evidence indicates that a particular CAM approach or modality is safe and effective for a particular condition, new safety concern may arise when it is used in conjunction with conventional medications, which is the way most consumers use CAM. More than 80 percent of those who use alternative therapies used conventional medicine at the same time, but did not tell their doctors about the alternative treatments. A recent review published in the Journal of the American Medical Association found that some commonly used herbal products can cause serious complications for surgery patient including bleeding, cardiovascular instability, hypoglycemia, and there was evidence that some herbs may increase the strength of anesthetics or the metabolism of many drugs used during and after surgery. A survey found that physicians were unaware of CAM usage by the majority (57 percent) of their patients. Patients did not divulge CAM use to their physicians because they assumed the physicians would not be interested, would respond negatively, would not understand, or would dominate the conversation due to assumed disinterest. The study indicates that physicians and other conventional health professionals must make significant efforts to open the lines of communication with their patients about their use of CAM approaches so that potential adverse effects of inadvertent combination of CAM with conventional therapy can be anticipated. Fortunately, most untested herbal remedies are probably harmless but there are possible health risks when certain herbs are combined with conventional therapies. For example, a popular herb that is promoted as a natural decongestant and weight-loss product can increase blood pressure and heart rate. Garlic supplements interfere with action of anti-HIV chemotherapy.  Some herbs and supplements, such as black cohosh, may interfere with chemotherapy drugs & other medications used in cancer treatment or radiation therapy. Some herb therapies, such as garlic and ginkgo supplements, can also cause excessive bleeding and other complications in a person having surgery. There are also herbs that will increase the rate at which a patient bleeds and if these herbs are used in combination with “blood-thinning” medical drugs, serious problems can result. People with chronic illnesses such as diabetes, high blood pressure, heart disease etc should be careful about using herbal remedies. The dictum remains “if you are considering some form of alternative medicine, you may wish to consult your doctor first”. CAM seem to be used primarily by people who are healthy and believe the remedies will help them stay that way, or by people who have common relatively minor problems such as backache or fatigue. Most such people would probably seek out conventional doctors if they had indications of serious disease, such as crushing chest pain, a mass in the breast, or blood in the urine. Still, uncertainty about whether symptoms are serious could result in a harmful delay in getting treatment that has been proved effective. And some people may embrace alternative medicine exclusively by putting themselves in great danger.

 Please visit the website   http://www.whatstheharm.net/index.html   and find out that 368,379 people are killed, 306,096 people are injured and over $ 2,815,931,000 lost in economic damage by people who used CAM in last 50 years and the website claims that this data is only tip of the iceberg. The website gives details of deaths caused by CAM therapy by giving details of CAM victims and CAM therapy used which harmed the victim.

 

Some of the CAM substances associated with specific side effects or exacerbations of other medical conditions.

Product Alias Toxin(s) Side Effects
Aconite Monkshood
Wolfbane
Aconite,
Hypaconitine
Nausea, vomiting, neuromuscular weakness, seizures, coma
Cardiac effects- bradycardia, arrhythmia, and hypotension
Chaparral Tea     Liver Failure
Chomper     May be contaminated with digitalis
Compfrey Bruisewort,
Knitbone
Pyrrolizidine Veno-occlusive disease, vomiting, hepatomegaly, hepatic necrosis
Jin Bu Huan     Sedative, hepatitis, bradycardia
Lobella     Vomiting, coma, tachycardia, respiratory distress
Ma huang Ephedra Ephedrine,
Pseudoephedrine
Hypertension, heart attack, stroke, arrhythmias
Headaches, seizures, tremors, anxiety, hallucinations
Pennyroyal   Pulegone Liver and renal failure, nausea, vomiting, abdominal pain, shock
Alterations in mental status (delirium, confusion, agitation, seizures)
Plantain Leaf     May be contaminated with digitalis
Yohimbe     Seizures, renal failure

 

Even though CAM like acupuncture and massage are generally (though not always) considered safe when woman is pregnant, CAM therapies are not tested or FDA approved like conventional therapies are for pregnant mothers and therefore, their safety has nor been clinically established. There are no double-blind clinical trials of CAM therapies on pregnant mothers & children, and yet they are so popular with pregnant mothers, midwives and children. One of the most popular alternative therapies during pregnancy is aromatherapy, yet many people are unaware that some oils are far too powerful and should be completely avoided during pregnancy. I am warning people to be cautious in using CAM therapies on pregnant mothers & children as they have no right to cause potential harm to a child unborn/born by experimenting with quackery.   

 

With herbs and other dietary supplements, there’s little guarantee that what is listed on the label of a bottle is what’s actually inside the bottle. This is because the manufacture, distribution and sale of supplements are much less regulated than with conventional drugs. One way to check that a manufacturer follows good practices in preparing supplements is the stamp “USP verified” on the label. This means that the manufacturer of the supplement paid to have its product carefully tested by the U.S. Pharmacopoeia (USP) for integrity, purity and safe manufacturing. Indian CAM products should have ‘IP verified’ label and Indian government must legislate to ensure IP label mandatory for all CAM products manufactured in India.  

 

Why CAM so popular and prevalent:

Research suggests, however, that the public is actually turning to CAM because its doctrines parallel their own personal values and belief systems. For example, patients want physicians who regard them as whole persons—minds and spirits as well as bodies—and who believe in the healing power of nature. CAM satisfies the mystical longings, desire for simpler times, and naive trust in the beneficence of “Nature” during tumultuous times. CAM also resonates with that era’s mix of iconoclasm, reliance on feeling over reason, mistrust of science, and promotion of consumer advocacy.

The most important reason why CAM is so popular is the low level of Scientific Literacy among the public at large. The average citizen of the world is shockingly ignorant when it comes to even the rudiments of science. In a recent survey, only 52 percent of Canadians who were polled could say how long it takes the earth to orbit the sun. Consequently, most people lack the basic knowledge and critical thinking skills to make an informed choice when they must decide whether a highly touted health care product is a sensible buy or not. Sport and movie stars are more popular than Nobel Prize winner. People believe whatever sport & movie stars say in an advertisement promoting CAM product is truth. People believe that the real causes and cures for almost all disease lie in the mind and therefore prayers and meditation will cure illness. Alternative healers are reverting to the pre-scientific notion that health and disease are tied to one’s personal worthiness, rather than to naturalistic causes. It would mean that the patient must have done something despicable to “deserve” his or her affliction and if the treatment fails, as it so often do, sufferers feel worse yet, for they must have been undeserving of a cure. Also, in general, the electronic and print media have tended to give CAM a free ride without criticism. Also, when western scientific doctors criticize acupuncture or ayurveda, they are accused of cultural insensitivity and racism. Personal belief, dogma and experience do matter. ‘I don’t care what your research studies say; I know it worked for me.’ Everybody has heard this statement too often. CAM practitioners often say that they have cured illness with scientifically ‘inert’ drugs because many diseases have spontaneous remissions, many diseases are self limiting and of course, the great placebo effect. Also, many cures of CAM are basically of psycho-somatic disorders to begin with and not genuine serious diseases like tuberculosis, heart attack, strokes, fractures etc. Also, a mistaken diagnosis of serious illness by a scientific doctor can be cured due to a trip to a shrine, alternative healer, or herb counter, which represents a glowing testimonial for having cured a grave condition that never existed in the first place.       

A study found strong associations between CAM usage and

1) An interest in spirituality and personal growth,

2) A commitment to environmentalism,

 3) Feminism.

 In addition, several other studies have found that belief in a holistic approach to health, a strong internal locus of control, and transformational life experiences also are associated with CAM usage. There is some evidence that people used CAM because they believed it to be more effective than conventional medicine. For example, in the survey of rheumatology clinic, 50 percent of respondents reported turning to CAM because they perceived their conventional treatment (drugs) as ineffective. In the year 2001 NSF survey, an overwhelming majority (88 percent) agreed that “there are some good ways of treating sickness that medical science does not recognize.” Probably the most significant contribution to the popularity of non-traditional therapies has been the gnawing dissatisfaction of patients with a health care system that has become increasingly depersonalized and remote. People complain that all too often, after taking expensive pharmacological treatments, they have simply traded symptoms for side-effects. People are drawn to CAM healthcare on the assertion that “natural” remedies are necessarily safer, gentler, and more efficacious than those of technological origin. People believe that conventional therapies are far more harmful than CAM therapies and statistics support this notion. There was a study done in New York in 1991 (The Harvard Medical Practice Study) which found that nearly 4 percent of patients were harmed in the hospital and 14 percent of these died, presumably of their hospital-inflicted injuries. Lucian L. Leape, a Boston physician, extrapolated from this data that as many as 180,000 Americans may be dying each year of medical injuries suffered at the hands of medical care providers. Hospitals are now the third largest killer in Australia. Blood infections acquired in American hospitals cause 62,000 fatalities every year and bypass surgery results in 25,000 strokes a year. A recent Consumers Union study found that medical errors kill nearly 98,000 people in the United States each year and cost $17 billion to $29 billion a year. Two million patients experience adverse drug reactions in hospitals in the United States every year; of these, over 100,000 die making hospital-induced adverse drug reactions the fourth leading cause of death after heart disease, cancer, and stroke. On the other hand, the risks of being positively harmed by a CAM practitioner such as a homeopath, for example, are negligible when compared to the risks of being harmed by a physician dispensing powerful drugs and performing risky surgeries. However people often overlook the fact that MSM practitioner usually deals with emergency and acute illnesses while CAM practitioner usually deals with chronic illnesses and therefore both practices can not be compared for adverse outcome. Also, there is a problem for patients with chronic illnesses especially, who say it is necessary for them to regain control over their disease. It is assumed that with chronic illnesses such as arthritis and allergies, conventional medicine has solutions that help control the symptoms but not cure the illness while CAM can help patients with improvement in health over long period.  People believe there might be something beyond the limits of conventional medicine that could offer a cure or at least a more humane treatment and so search for CAM. Medicine is as much an art as it is a science. People believe that the relationship between the patient and his health care provider is paramount and apparently CAM practitioner is providing much better doctor-patient relationship than conventional practitioner. Alternative healers often have forceful, charismatic personalities to the extent that patients are swept up by the messianic aspects of CAM. Many doctors who use scientific medicine treat the disease first and the person secondly while CAM practitioners are often “holistic,” claiming to treat the mind, the body and the soul of the patient. In many cases, the cure was actually brought about by the scientific medicine taken along with the “alternative” therapy, but the credit is given to the “alternative.” The last point is that many advocates of “alternative” therapies refuse to admit failure.   

 

My personal experience of 23 years as a MSM doctor who treated various patients of various illnesses suggest that one of the most important reason why people go to CAM is that MSM practitioner gives too much medicines which are too expensive, too toxic and often ineffective and many times prescription is based on unholy association with pharmaceutical companies which offer doctors money or gifts or tours as a part of bribe. A recent study on elderly found that the incidence of adverse drug reaction (ADR) is directly proportional to the number of drugs used and using five or more medications approximately doubled the risk, and patients taking eight or more medications could pretty much count on such an event and therefore MSM doctor who is prescribing plenty of medicines for what ever reason is jeopardizing patient’s safety. On the other hand, many patients believe that the doctor’s reputation is directly proportional to number of medicines he prescribes, the more medicines the bigger doctor and greater chance of getting cure. So doctors are tempted to prescribe plenty of medicines to please patient and look bigger which in turn leads to unwanted ADR making patient go for CAM.  Also, many conventional doctors are out of touch with recent advances in medicine, morally corrupt and want to cure illness in one day so that the patient does not abandon him in favour of another rival doctor. I will give example. The patient has fever for 1 day and is being given treatment of typhoid plus malaria on day one without any medical evidence with the hope that he recovers soon. In fact, he may be having viral fever and yet received toxic medicine from so called scientific doctor. This is too common in India. Also in small towns in India, surgeons give treatment of high blood pressure and gynecologists give treatment of malaria which is as good as quackery because these MSM doctors are venturing in therapies for which they received no training. In America where frivolous litigation against doctor is high due to alleged negligence, doctor will ask for too many investigations for minor illness right from blood test to X-rays to MRI scans just to save his skin from missing a serious illness. In India, doctors ask too many unnecessary investigations because they get ‘cut money’ from investigative facility. So MSM doctors are involved in unscientific, immoral and unethical practices. Under such circumstances, what is the option before people? Go to CAM with the hope that less toxic medicines will be given at cheap rate without too many investigations. Allopathic medical doctors must do soul searching instead of blaming CAM practitioners. Interesting to note that in India due to prevalent lawlessness, many Ayurvedic & Homeopathic practitioners give allopathic treatment and people often choose CAM practitioners for allopathic medicine because they are cheap, easily available and have better humane relationship with patients. At the end of the day, it is impossible to please everyone no matter how great the doctor is and no matter how effective & safe his medicines are; some people will always be dissatisfied with MSM and seek CAM therapies.

 

CAM research:

Many conventional healthcare professionals refuse to take CAM seriously – one often-voiced argument is ‘there is no research in CAM’. In most countries, CAM research funding is on a very small scale. For instance, only 0.08% of the British National Health Service research budget goes towards CAM research. Randomized clinical trials (RCT) of CAM can be even more expensive than those of conventional medicine because therapeutic benefits are observed after long time. Also, for most CAM modalities, intellectual property cannot be protected; thus commercial investments are rarely forthcoming. Many CAM practitioners may oppose scientific evaluation of their treatments, further hindering RCT because CAM being emotive issue, patients may not want to take a chance with randomization as required by a clinical trial. Many CAM therapies are based on theories that fly in the face of science. The RCT is specially designed to validate categories of medical interventions that are observable and measurable. CAM practitioners have consistently resisted RCT on the ground of structural incompatibility between the RCT, which was designed for biomedical research, and CAM, which primarily espouses therapeutic philosophies that transcend the biomedical. The very nature of CAM disqualifies the RCT as a suitable research methodology because CAM constitutes a broad range of holistic and integrated etiologies of illnesses and healing that incorporate “complex causal networks” and unconventional concepts such as “bioenergetic homeostatis, repressed memories, spiritual disturbances” amongst others. The practice of CAM is based on “complex” and “personalized” episodes between practitioner and patient, in which the treatment regime is specifically tailored to suit the particular interests of the patient. These regimes can differ considerably from one patient to another, “both in the substance of their contents and in their methods of application”.  This may lead to varying individual responses, “possibly even for the same person,” though at different treatment episodes. MSM rejects such logic of CAM as pseudoscience.

From MSM the chief objection about CAM is that CAM therapies have not been meticulously tested by double-blind, placebo-controlled RCT like the pharmaceutical drugs have been. However, evidence based CAM is on the rise and many CAM journals are supporting & promoting research about CAM in the same way as mainstream medicine. Reflexology is a therapeutic technique from traditional Chinese medicine in which pressure is applied to the feet (and sometimes hands) without using oils or creams. A study published in the medical journal Multiple Sclerosis; few researchers estimated the effects of reflexology on reducing the symptoms of multiple sclerosis. They figured out unbelievable results. Reflexology lessen the patients symptoms with paresthesias (burning, prickling, itching, tingling), urinary symptoms and spasticity (uncontrollable spasms). And this was contrasted to a control group that received a form of fake reflexology. Another study published in the Journal of Clinical Psychiatry in July 2002 that aromatherapy is quite helpful to patients suffering from acute dementia. The effects of this therapy made patients less restless plus more inclined towards the social interaction and participating in constructive activities. And both of these studies were done by the gold standard of double-blind RCT.  Both of these studies are just two of other hundreds of studies that have been conducted globally trying to prove convincingly that alternative medicines do indeed work. However, I have already discussed in my article on ‘The Lie’ that statistics are often used to bolster weak arguments and the nature of the study leaves a margin of error of several percentage points. The most important thing for the people is to check for the sample size and margin of error. Also, I have proved in my article on ‘Dengue’ that normal saline is better than colloid solution for treatment of dengue shock syndrome because scientific logic & rationale can not be hijacked by illusion of statistics.  Most CAM research studies are based on subjective improvement rather than objective improvement on patients and therefore scientific validity of such studies is questionable. For example, study of reflexology on patients of multiple sclerosis should have demonstrated reduction in number and/or size of demyelinating plaques on MRI which is an objective evidence of improvement.   

 

In case you decide to use CAM, what should you do?

Select CAM practitioners with care. Find out about the practitioner’s training and experience. Be aware that some dietary supplements may interact with medications or other supplements, may have side effects of their own, or may contain potentially harmful ingredients not listed on the label. Also keep in mind that most supplements have not been tested in pregnant women, nursing mothers, or children. Tell all your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

 

Media support to CAM:

Media traditionally support CAM. Indian media consistently shows programs of god-men & CAM practitioners who practice therapy & interventions curing everything from asthma to cancer. Obviously TRP counts. Since people like CAM due to religious & cultural reasons, Indian media consistently exploit people’s emotions towards their religion & culture by promoting CAM to enhance TRP rating. Also, many people have incurable illnesses and these god-men give false hopes to these aggrieved people. Most media reports on this topic contain no critical evaluation and feature the views of proponents and their satisfied clients. Interesting to note that most mainstream media talks about sports, movies, soaps, fashion, music & dance but hardly talks about science and this psychology is reflected in promoting CAM. On the other hand, attacks on alternative medicine by some members of the mainstream media would mean that they are telling what pharmaceutical companies are telling them due to media’s vested interest and they are allowing themselves to be used as pawns in a game of billions of dollars. Also, media coverage of clinical trials does not contain the elements readers require to make informed decision and it is rarely possible for the lay public to assess the credibility of the described research in CAM.

 

Alternative veterinary medicine:

Surprised?  Just like human medicine, veterinary medicine has been in a constant flux the past years and decades. With new ideas and perspectives, new ways and means have been found for the treatment and care of our beloved animals. In fact, alternative medicine for dogs has been developed to challenge the conventional veterinary medicine associated with clinics, vaccines and pharmaceutical companies. Vaccines are to be replaced with nosodes which is a homeopathic mixture, chemicals are to be replaced with garlic & yeast to control fleas & ticks, and chondrotin sulfate & glucosamines & Omega fatty acid supplements for allergies & arthritis in dogs. Well, dogs are man’s best friend but are we giving them best medicines by trying alternatives?  Think over it.   

 

Should CAM be taught in MSM schools?

Elements of MSM taught in medical schools are based on evidence and in accordance with scientific knowledge in the functioning of the human body. Many elements of CAM are not supported by scientific evidence. Few may be scientifically correct but majority contradicts what we know how the body works. Instead of encouraging this mode of healing, we must encourage critical thinking about it. So, students must learn to carefully to examine the scientific evidence evaluating the claims of proponents of alternative medicine. Teaching and training should include a critical analysis of research outcomes of various CAM modalities. Curriculum should be a comprehensive model of patient-centered medicine, which emphasizes the centrality of doctor-patient relationship and which includes all methods of healing for which sufficient evidence exists no matter whether from MSM or CAM. The CAM therapy must be evaluated to the same standards of safety and efficacy as MSM.    

 

Discussion:

Pseudoscience is defined here as “claims presented so that they appear to be scientific even though they lack supporting evidence and plausibility”. In contrast, science is “a set of methods designed to describe and interpret observed and inferred phenomena, past or present, and aimed at building a testable body of knowledge open to rejection or confirmation”. Pseudoscience topics include yogi flying, therapeutic touch, astrology, fire walking, voodoo magical thinking, Uri Gellar, alternative medicine including homeopathy & faith healing, channeling, Carlos hoax, psychic hotlines and detectives, near-death experiences, Unidentified Flying Objects (UFOs), the Bermuda Triangle and reincarnation. Scientists and others believe that the media, and in particular the entertainment industry, may be at least partially responsible for the large numbers of people who believe in astrology, ESP, alien abductions, and other forms of pseudoscience. However, CAM as pseudoscience is harmful as seriously ill patient may ignore MSM and lose life. Between homeopathy and herbal therapy lies a bewildering array of untested and unregulated treatments, all labeled alternative by their proponents. Alternative seems to define a culture rather than a field of medicine—a culture that is not scientifically demanding. It is a culture in which ancient traditions are given more weight than biological science, and anecdotes are preferred over clinical trials. Alternative therapies steadfastly resist change, often for centuries or even millennia, unaffected by scientific advances in the understanding of physiology or disease. Incredible explanations invoking modern physics are sometimes offered for how alternative therapies might work, but there seems to be little interest in testing these speculations scientifically. Medical treatments either demonstrably & reproducibly work or they don’t. In CAM, many researchers seem to use science to prove what they believe is correct which not only reveal an unprofessional attitude but it is prone to seriously mislead all. Emotions and strong beliefs can lead to bias and bias leads to bad science which leads to wrong decisions in healthcare that will be detrimental to patients. There is overwhelming evidence to support the fact that there is a double standard in the application or promotion of  CAM as compared to MSM, right from legislation to clinical trials to manufacturing process to government approval to marketing to price control to efficacy to adverse effects.

 

There is a debate among medical researchers over whether any therapy may be properly classified as ‘alternative medicine’. The National Science Foundation has defined alternative medicine as all treatments that have not been proven effective using scientific methods. Some feel that health care practices should be classified based solely on scientific evidence. If a treatment has been rigorously tested and found safe & effective then, mainstream medicine will adopt it regardless whether it was considered alternative to begin with. “Alternative medicine” has become the politically correct term for questionable practices formerly labeled as quack and fraudulent. Loose definitions cause confusion and hence to avoid confusion, “alternative” methods are classified as genuine, experimental, or questionable.

1) Genuine alternatives are comparable methods that have met science-based criteria for safety and effectiveness.

2) Experimental alternatives are unproven but have a plausible rationale and are undergoing responsible investigation. The most noteworthy is use of a 10%-fat diet for treating coronary heart disease.

3) Questionable alternatives are groundless and lack a scientifically plausible rationale. The archetype is homeopathy, which claims that “remedies” so dilute that they contain no active ingredient can exert powerful therapeutic effects.

 

There are concerns that just because some “alternative” have merit, there is the impression that the rest deserve equal consideration and respect even though most are worthless. Enough is known, however, to conclude that most questionable “alternatives” are worthless. Some people characterize the evidence of many alternative techniques as weak, nonexistent, or negative, but states that evidence exists for others, in particular certain herbs and acupuncture. Some people say that alternative medicine is a set of practices which cannot be tested, refuse to be tested, or consistently fail tests. Some people say that CAM is the “propagation of the absurd” based on the example that alternative and complementary have been substituted for quackery, dubious & implausible, and concern that CAM tolerates contradiction without through reason & experiment.

 

A 1998 editorial in the Journal of the American Medical Association notes 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. We recognize that there are vastly different types of practitioners and proponents of the various forms of alternative medicine and conventional medicine, and that there are vast differences in the skills, capabilities, and beliefs of individuals within them and the nature of their actual practices. Moreover, the economic and political forces in these fields are large and increasingly complex and have the capability for being highly contentious. Nonetheless, 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.

 

Integrative medicine is purportedly combining alternative and mainstream approaches to medicine. Scientists believe that it is ridiculous to integrate nonsense with valid scientific knowledge, in the same way of integrating astrology with astronomy. Under the rules of science, people who make the claims bear the burden of proof. It is their responsibility to conduct suitable studies and report them in sufficient detail to permit evaluation and confirmation by others. Instead of subjecting their work to scientific standards, promoters of questionable “alternatives” would like to change the rules by which they are judged and regulated. Instead of conducting scientific studies, they use anecdotes and testimonials to promote their practices and political maneuvering to keep regulatory agencies at bay. Of course, many treatments used in conventional medicine have not been rigorously tested either but the scientific community generally acknowledges that this is a failing that needs to be remedied. On the contrary, many advocates of alternative medicine believe that scientific method is simply not applicable to their remedies. Also, Alternative medicine largely ignores biologic mechanisms, often disparages modern science, and relies on what are purported to be ancient practices and natural remedies which are seen as somehow being simultaneously more potent and less toxic than conventional medicine. Accordingly, herbs or mixtures of herbs are considered superior to the active compounds isolated in the laboratory.  And healing methods such as homeopathy and therapeutic touch are fanatically promoted despite not only the lack of good clinical evidence of effectiveness, but the presence of a rationale that violates fundamental scientific laws. Whereas other fields of healthcare were dependent on their scientific validity for success, alternative medicine thrived despite its lack of academic rigour; aided by an aura of mysticism that put it beyond the realms of science. The crucial difference between scientific medicine and alternative medicine is that the former is institutionally committed to finding empirical support for its treatments and eventually weeds out those that fail to pass muster. And, unlike the alternatives, mainstream medicine does not cling to procedures that contradict well-established principles in the basic sciences. Scientifically-based therapies change because new research accumulates; alternative medicine is mired in the past and changes rarely, if ever. This is because the latter has no serious commitment to testing its rationales and procedures under controlled conditions. Alternative medicine clings to the belief that its procedures must be valid because they have stood the test of time.  

 

Many “alternative” approaches are rooted in vitalism, the concept that bodily functions are due to a vital principle or “life force” distinct from the physical forces explainable by the laws of physics and chemistry and detectable by scientific instrumentation. Practitioners whose methods are based on vitalistic philosophy maintain that diseases should be treated by “stimulating the body’s ability to heal itself” rather than by “treating symptoms.” Homeopaths, for example, claim that illness is due to a disturbance of the body’s “vital force,” which they can correct with special remedies, while many acupuncturists claim that disease is due to imbalance in the flow of “life energy” (Qi), which they can balance by twirling needles in the skin. Many chiropractors claim to assist the body’s “Innate Intelligence” by adjusting the patient’s spine. Naturopaths speak of “Vis Medicatrix Naturae.” Ayurvedic physicians refer to “prana.” And so on. The “energies” postulated by vitalists cannot be measured by scientific methods. Although vitalists often pretend to be scientific, they really reject the scientific method with its basic assumptions of material reality, mechanisms of cause & effect, and testability of hypotheses. They regard personal experience, subjective judgment, and emotional satisfaction as preferable to objectivity and hard evidence.

 

In a book ‘trick or treatment’ written by Simon Singh. PhD. and Edzard Ernst. MD. PhD.; they have concluded that

1) While there is tentative evidence that acupuncture might be effective for some forms of pain relief and nausea, it fails to deliver any medical benefit in any other situations and its underlying concepts are meaningless.

2) With respect to homeopathy, the evidence points towards a bogus industry that offers patients nothing more than a fantasy.

3) Chiropractors, on the other hand, might compete with physiotherapists in terms of treating some back problems, but all their other claims are beyond belief and can carry a range of significant risks.

4) Herbal medicine undoubtedly offers some interesting remedies, but they are significantly outnumbered by the unproven, disproven and downright dangerous herbal medicines on the market.

5) There is no evidence to justify any claim for the specific effectiveness of CAM except a very few specific CAM treatments in specific conditions. Overall the perceived benefits are explained by other dynamics of the therapeutic process particularly the placebo effect; and these benefits, even if substantial in terms of the patient’s experience, should be disallowed because they are unethical, dishonest and they involve lying to patients about the nature of the treatment.

These conclusions are supported by clear discussion of the nature and virtues of evidence-based medicine and the scientific method that underpins it, and an overview of research evidence about CAM that demonstrates the absence of effectiveness. 

 

Scientists have made a proposal to shut down the National Center for Complementary and Alternative Medicine because the vast majority of studies were based on unconventional understandings of physiology & disease and have shown little or no effect. Also, they argue that the field’s more-plausible interventions such as diet, relaxation, yoga and botanical remedies can be studied just as conventional research projects. Scientist’s concerns are supported by negative results in almost all studies conducted over ten years at a cost of $2.5 billion by the NCCAM. So much tax payer’s money wasted to investigate the nonsense due to political agenda. Also in India, government hospitals employ ayurvedic & homeopathic doctors using tax payer’s money when they can not save any life. When people are dying due to tuberculosis, malaria, dengue and HIV infections in India, what is the point of spending tax payer’s money on CAM doctors who have no effective medicines for these rampant diseases. Yes, it is true that politicians want to spend money on CAM because vast segment of population are emotive about CAM and politicians want to please that segment of population. Recently, president Obama stated,  ‘it is pretty well documented by scientific studies showing that acupuncture, for example, can be very helpful in alleviating certain things, such as headaches and other ailments or at least as effective as more intrusive interventions’. Why should president Obama support quackery? Do traditional Obama supporters use acupuncture?  In India, politicians support ayurveda because ayurveda is linked to Hindu religion and speaking against ayurveda would upset large vote-banks and hence successive governments spent money in promoting ayurveda. So politics and CAM are linked. Then why people should hold emotional views on CAM? It seems to me that  when it comes to healthcare, likes and dislikes should matter far less than evidence and it should not be confused with religion in which either one believes or not. Criticism of ayurveda is not criticism of Hindu religion and criticism of Unani medicine is not criticism of Islam and criticism of acupuncture is not criticism of Chinese culture. People must also understand that MSM is a part of scientific revolution which brought about inventions right from light bulb to automobile to refrigerator to computer and so on. Since people have accepted everything else of scientific revolution, why step motherly treatment to MSM? 

 

If I have to market a new drug in America, I have to get it approved by FDA for its safety & efficacy and also by the best peer-reviewed medical journals for the publication of research reports but CAM bypass everything. In India, I see ayurvedic drugs available without approval by any legal authorities, without any evidence of safety & efficacy and without any double-blind clinical trials on humans. Recently, Indian government has issued a guideline that Ayurvedic drugs have to go through the same rigorous process of testing as allopathic drugs and while companies in this traditional medicines business agree that their products need to be tested, they are uncomfortable at having to follow the same process that has been defined with modern medicines in mind. “Alternative therapy” as a marketing term should not be permitted.  People must understand that the best way to preserve their cultural identity and prevent invasion of western culture is not by supporting CAM blindly. All the public ought to demand is safe, effective and efficient treatment. They also ought to demand objective standards of measurement used to determine what is safe, effective and efficient. People who believe that personal experience is the best way to evaluate drugs & therapies should have to identify themselves as spiritualists but not as medical practitioners. They should be forced to admit to themselves and to the world that they reject science and objective standards, and they should never be allowed to sell the drugs they prescribe. However, some techniques referred to as “alternative” may be appropriately used as part of the art of patient care including relaxation techniques and massage which are akin to physiotherapy.

 

According to MSM, human being is a multi-cellular organism with each cell having a nucleus with DNA from both parents. Cancer occurs due to disordered multiplication of abnormal cells and infection occurs due to invasion by non-human cells like bacteria and so on. None of the CAM believes in the concept of multi-cellular organism with DNA from both parents in each cell. In fact, the basis of most of CAM is fiction and not fact. Whatever benefit you are getting from CAM is random benefit. Since randomness and certainty co-exist simultaneously depending on knowledge of all variables, CAM can give benefit with certainty provided you know all variables. Does CAM practitioner know all variables in CAM therapy?  If you want job that requires no constant reevaluation of what you do for patients based on science, then you should be a CAM practitioner. The MSM practitioners are constantly learning, from training all the way to retirement, and that learning occurs because they have a firm background of physiological, biochemical, and anatomical principles involved. The combination of a strong understanding of scientific methods with critical thinking would be a powerful weapon against quackery of CAM.

 

Even when CAM practitioner himself is met with an accident with multiple fractures & blood loss, he rushes to MSM hospital for emergency treatment. MSM has saved millions of lives right from discovery of penicillin to discovery of insulin, treatment of malaria to treatment of tuberculosis, intravenous fluid therapy to blood transfusion, caesarean section to heart transplant and so on. Vaccination has eradicated small pox and controlled paralytic polio. Now to say that all the achievements of MSM are coincidences and CAM is the only way out appears paranoid, bizarre and ludicrous. Even today, with all respect to CAM, MSM is the only therapy available with efficacy for emergency & acute illnesses. I have seen many patients of asthma, diabetes mellitus and jaundice worsening after taking treatment from CAM practitioner and coming to me with life threatening complications and these patients would not have chosen CAM had they been fully informed that delay in seeking MSM treatment would compromise clinical outcome. Media highlights negligence by qualified MSM doctors but ignores morbidity & mortality by quackery of CAM.

 

A benefit-risk approach across a product life cycle is the cornerstone of drug development and should be the foundation of drug regulation as well no matter whether you are using MSM and/or CAM. This is particularly true with regard to drugs for serious and life-threatening diseases like cancer, refractory cardiovascular disease, and neurodegenerative diseases. To focus solely on drug safety without consideration of drug benefit, the severity of the underlying disease, the effectiveness of the product, and the availability of alternative therapies; risks creating a chilling effect on the development of new treatments for patients most in need of innovation. It would be ideal to have a medicine that is both efficacious and safe. However, if any medicine is not efficacious, then safety issue is a non-starter. Most CAM therapies are not efficacious in acute & emergency illnesses and therefore its claim of safety is irrelevant. Also, if a medicine is not safe but life saving in serious illness, it can be used judiciously. For example, chemotherapy given to a patient suffering from cancer causes hair loss & low blood counts but controls cancerous growth and prolongs life. A longer, lengthier review process (including larger clinical trials) will reduce the probability that unsafe drugs enter the market, but at the cost of delaying patient access to potentially useful therapies.  Also, because patient who use drugs often present with other co-morbidities which may lead to death or serious injury, it is often difficult to establish that an unsafe drug was the direct cause of injury. So if you have to choose between efficacy & safety, please choose efficacy first and safety can be dealt with later on. I will give another example. Suppose, you have medicine A with guaranteed efficacy but doubtful safety and you have another medicine B with guaranteed safety but doubtful efficacy for your illness. What will you do?  You have gone to a practitioner to relieve your illness. If you take medicine B, since the efficacy of the medicine B is doubtful, you may worsen depending on the type of illness. However, if you take medicine A, you are sure that your illness will be relieved but you may get side effects depending on type of medicine. So logically, you may worsen anyway but worsening due to type of illness is worse than worsening due to type of medicine because you can not choose type of illness but you can certainly choose type of medicine depending on double-blinded clinical trials. So the dictum goes that ‘in event of clash between the efficacy and the safety of any medicine, efficacy would be primary concern and safety would be secondary concern’. There are only few illnesses like chronic arthritis, chronic pain, chronic skin disorders etc where MSM are less efficacious and therefore CAM role comes into play but otherwise in majority of human illnesses, even today, MSM is efficacious and if MSM fails, CAM will also fail.

 

THE MORAL OF THE STORY:

1)  First the efficacy and second the safety of any medicine is the only gold standard for its use by people no matter whether it is MSM or CAM. Both the efficacy & the safety must be demonstrable and reproducible.

2)  A segment of CAM can become MSM provided it meets the rigorous scientific requirements of its efficacy and safety.

3)  MSM has saved millions of lives despite loss of some lives due to bad doctors & adverse effects of MSM therapies but there is hardly any evidence of CAM saving lives.

4)  MSM got bad name due to some bad doctors but CAM got good name due to ignorance of people.

5)  The day the people of the world become knowledgeable & scientific, unsubstantiated CAM will disappear in oblivion.

 

Dr.Rajiv Desai. MD.

 August 11, 2010

Postscript:

When I was 16 years old, I suffered from tuberculosis of abdomen. I was given lot of herbal medicine in the native village but failed to improve. Ultimately, I took treatment from allopathic doctor who diagnosed the illness and cured me with anti-tubercular medicines. When I was 43 years old, I was diagnosed with otoslerosis which caused deafness in both ears and I had to wear hearing aides in both ears until I underwent an operation stapedectomy with prosthesis implant in both ears. Today, I can hear in both ears without any hearing aide. Had I taken treatment from CAM for my illnesses, either I would have been dead or alive but deaf.

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