Talk:Complementary and alternative medicine

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

Here goes. For future reference only, here is:

• Complementary_and_alternative_medicine/article_archive
• Talk:Complementary_and_alternative_medicine/Archive 1.

--Pat Palmer

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

What I've done

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

--Pat Palmer

Countersuggestion: could everyone look at integrative medicine and see if it already is moving in the right direction?

Also, while it's very early, look at phytomedicine and see if it has the flavor of specific argument. It may not yet have enough detail; there are, for example, a few plant-derived remedies that show evidence of efficacy. With the particular regulatory and economic structure in the U.S., there's no incentive to do full studies and standardization for indications and warnings. Germany, however, has a system that is much friendlier to a combination of scientific and traditional approaches. China has yet another. Howard C. Berkowitz 00:03, 27 December 2008 (UTC)

Howard, I will go look soon as I get time. THanks!Pat Palmer 00:07, 27 December 2008 (UTC)

Complementary

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

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

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

Sorry, no. In the U.S., it varies state-by-state, but there is a concept of "scope of practice". Within broad limits, anything within the discretion of a physician, and consistent with his or her training, is "official". There are exceptions where additional licensing may be required for the use of radioisotopes, certain drugs, etc., and a hospital isn't normally going to let an opthalmologist do high-risk obstetrics.

The usual definition of alternative medicine is that it is offered as a whole system of health care, to the full or partial exclusion of people with conventional medical licenses. Complementary medicine is seen as something that works jointly with conventional medicine. The combination, however, is a set of skills outside the scope of conventional medical training. Again, see the National Center for Complementary and Alternative Medicine; it may be surprising that music therapy is considered complementary. Spiritual healing is complementary when, for example, a hospital chaplain does a religious healing ritual in the ICU, while an alternative spiritual healer would not approve of anything except prayer.

No, there isn't any implication of efficacy for CAM. Calling something "medicine" doesn't mean it is effective; I can give you a long list of drugs and surgical procedures, performed by physicians, that turned out to be useless or actively dangerous. You may be thinking of evidence-based medicine.

For example, acupuncture is outside the scope of the U.S. National Board of Medical Examiners. Nevertheless, in Virginia, one must be a licensed physician to perform it, presumably with additional training. In other states, someone trained only in acupuncture might perform it only on physician orders, or, depending on the state, might be licensed to perform it on self-referred patients.

Nurse practitioners can prescribe all drugs in some states, or prescribe anything but there must be a responsible physician, or might be able to prescribe antibiotics but not "narcotics". Each state defines scope of practice, even though there often are national examinations. Howard C. Berkowitz 02:03, 27 December 2008 (UTC)

First, the American Medical Association doesn't regulate or authorize anything in the U.S., although it may issue position papers. While the majority of physicians once belonged, I think membership is in the 30 percent range.

At the national level in the U.S., there is a National Board of Medical Examiners that supervises examinations after years 2 and 4 of medical school, and first year graduate medical training. See medical education and graduate medical education. Beyond that, there are specialty boards. To prescribe certain drugs, you must be licensed by the Drug Enforcement Administration; to use radioisotopes in diagnosis and therapy, you need a Department of Energy license whether or not you are board-certified in nuclear medicine.

Some states tightly regulate who can perform what, and others are permissive. Insurance reimbursement is yet another issue.

Acupuncture and herbal medicine are often regulated differently, but the scope of recognized traditional Chinese medicine (often an OMD degree) includes both, as well as some other techniques. I have had two mentors in acupuncture and some related areas; one was a graduate of a U.S. school (Florida) of Oriental medicine, and her scope of practice was quite limited. The other was a board-certified OB/GYN, and, in fact a Washington DC and national authority on gynecological ultrasonography -- but also had acupuncture training from his native Vietnam. He still needed a Virginia acupuncture license on top of his MD and FACOG (OB/GYN board). I vaguely remember that he had to retake a short acupuncture program to have the credential, since the school in Vietnam no longer existed to send a certificate.

The safety and efficacy of a treatment method is open to dispute, but that doesn't depend on whether it's mainstream or CAM. CM and AM are different by the NCCAM definition. What would you call, for example, chiropractic, in a state where one is licensed and authorized to practice independently? It's not "medicine". It could be either complementary or alternative, depending on whether it is offered as a "whole system". Even the whole system idea isn't always clean; some practitioners are perfectly willing for a surgeon to take over for trauma, but they might go back to herbalism or naturopathy for cancer. The World Health Organization recognizes culturally specific traditional forms of treatment.

Culturally specific may involve multiple modalities; China has what it calls the "Three Roads" method that includes both traditional Chinese medicine and conventional techniques. Howard C. Berkowitz 02:32, 27 December 2008 (UTC)

Big sigh here. For most of my 55 years, I've heard mainly "alternative medicine". If I asked my aging mother about "complementary medicine" or "integrative medicine", she would just look at me and say, "WHAT?" But if I said "alternative medicine", she'd probably nod wisely. In my view, these are terms that people use in a variety of ways; the NIH department you mention has its way, and the normal Joe the Plumber has probably, in my opinion, never heard any of the phrases except "alternative".Pat Palmer 03:19, 27 December 2008 (UTC)

Well, youngster :-), I agree. At both the level of the U.S. and of the World Health Organization, it was realized the terms were confusing, and precision was sought. I gave links in the Forum that I can bring over here, but, as an example, here is the text from Medical Subject Headings, the standard medical indexing reference:

Therapeutic practices which are not currently considered an integral part of conventional allopathic medical practice. They may lack biomedical explanations but as they become better researched some ( PHYSICAL THERAPY MODALITIES; DIET; ACUPUNCTURE) become widely accepted whereas others (humors, radium therapy) quietly fade away, yet are important historical footnotes. Therapies are termed as Complementary when used in addition to conventional treatments and as Alternative when used instead of conventional treatment.

MeSH also defines integrative medicine as "The discipline concerned with using the combination of conventional (allopathic) medicine and ALTERNATIVE MEDICINE to address the biological, psychological, social, and spiritual aspects of health and illness." There will always be the Joe the Plumber problem; the best we can do is explain that the definitions are becoming more specific. Sometimes even with the best intention, integrative medicine can pose challenges: a hospital welcomed a Lakota Sioux healing ritual, but then went into utter confusion when they realized that the ritual used tobacco and they had an absolute no-smoking policy. Howard C. Berkowitz 03:43, 27 December 2008 (UTC)