The challenges represented by popular health reform movements and medical sects were among the factors that eventually forced regular practitioners to explore the therapeutic systems of their competitors. Even though late nineteenth-century science led to improved means of diagnosing and explaining the mechanism of disease through germ theory, cellular pathology, and physiology, the scope of therapeutic medicine remained limited. Physicians gradually abandoned calomel, bleeding, and purging, and turned to laboratory research, controlled clinical trials, and more rigorous medical education to validate the superiority of orthodox medicine. As the medical profession improved its image and power, as well as the efficacy of its therapeutics and the safety of surgical operations, physicians were confidant that the challenge of unorthodox practitioners and their systems would disappear.
Until the last decades of the twentieth century, historians and social scientists of medicine, as well as medical policy analysts, generally assumed that medical sectarianism, unorthodox healers, and traditional or folk practices were disappearing as modern, scientific medicine became increasingly effective and powerful. Unorthodox practitioners, whether advocates of antiquated medical theories or leaders of novel cults, seemed to have little relevance to the medical marketplace, except as sources of colorful anecdotes. It came as a surprise to the medical community when surveys conducted during the 1990s revealed that more than 30 percent of all Americans had utilized some form of alternative medicine, creating a multibillion dollar market. Further studies demonstrated that public interest in and usage of alternative medicine was increasing rather than decreasing.
A major survey conducted in the early twenty-first century indicated that over 40 percent of Americans had used or were using some form of alternative medicine; about 75 percent believed in the healing power of prayer and 85 percent believed that certain foods could cure disease or enhance health. The survey included questions on 27 types of alternative or unconventional therapies. Unconventional healing approaches included acupuncture, aromatherapy, Ayurvedic medicine, herbs, botanical products, enzymes, deep breathing exercises, meditation, energy healing, yoga, homeopathy, medical magnets, chiropractic, massage, reflexology, naturopathy, special diets, megavitamin therapy, prayer, and even the ancient practice of dowsing. Moreover, polls indicate that educated people in search of optimum health are the most likely to seek out holistic or alternative medicine. Seventy percent of Canadians have used alternative medicine and one-third of the population uses it on a regular basis. In France, where homeopathic medicine is popular, 75 percent say they have tried alternative medicines. In China, 95 percent of hospitals have folk medicine wards.
Popular demand for choices in approaches to wellness, healing, and medical care, transformed the relationship between orthodox medicine and forms of healing once denounced as sectarianism, superstition, and quackery. As physicians attempted to incorporate rather than eradicate competing healing approaches, unorthodox medicine was subsumed into complementary, alternative, or integrative medicine. From the perspective of mainstream medicine, alternative medicine included osteopaths and chiropractors, as well as folk and religious healers, natu-ropaths, homeopaths, acupuncturists, diet and fitness programs, reflex-ology, therapeutic massage, magnetic devices, self-help systems promising natural healing, and herbalism.
Proponents of complementary or integrative medicine tend to be interested in herbal remedies, vitamins, and other so-called dietary supplements. When Congress passed the Dietary Supplement and Health Education Act of 1994, it allowed significant differences between the marketing of prescription medicines and dietary supplements. Prescription drugs must provide proof of safety and efficacy to secure Food and Drug Administration (FDA) approval, but the agency cannot recall products sold as dietary supplements from the market unless the FDA can prove that they are harmful. Supplement manufacturers are permitted to use advertisements and testimonials claiming that their products are ''all natural'' and ''completely safe.'' Stores specializing in dietary supplements, herbs, and vitamins sell products that purportedly boost metabolism, improve cardiovascular health, prevent health attacks, and so forth. Food and beverage companies have experimented with ''functional'' or ''nutraceutical products'' containing ingredients more commonly associated with dietary supplements and traditional herbal medicines. Skeptics have noted that such supplements are present in such low doses that they probably pose no risk at all, but it might be appropriate to market them as homeopathic rather than functional foods. Some of the most popular herbal remedies include ephedra for energy and weight loss, echinacea for colds, black cohosh for hot flashes, kava for nerves, saw palmetto for benign prostate enlargement, St. John's wort for depression, and ginkgo biloba for memory loss. Pharmacologists, however, emphasize the potentially toxic effect of various herbs, such as ephedra, comfrey, germander, Indian snakeroot, lobelia, pennyroyal, wormwood, yohimbe, and even chamomile. Even though these herbs have been used for many centuries, a low incidence of adverse reactions, or toxic effects on the liver or fetus, may go unnoticed among the small numbers of patients seen by a traditional healer.
Critics of attempts to integrate alternative medicine and mainstream medicine warn that this amalgamation would undermine the foundations of modern medicine and obstruct the progress of biomedical science. Defenders of integrative medicine argue that throughout the world patients are turning to alternative healers because of dissatisfaction with conventional medicine. Patients are particularly interested in nutritional influences on health and skeptical about the excessive use of drugs and surgery. Critics of conventional medicine note that prescription drugs and medical errors directly cause many thousands of deaths in hospitals. Moreover, many practices and beliefs associated with conventional medicine are not necessarily based on randomized clinical trials.
In 1998, under pressure from Congress, the National Institutes of Health upgraded the Office of Alternative Medicine, which had been funded by Congress in 1991, and established the National Center for Complementary and Alternative Medicine (NCCAM). The new institute was charged with evaluating alternative medicine, supporting clinical trials, and providing information and advice to the public. In 2002, the White House Commission on Complementary and Alternative Medicine Policy released a report on alternative therapies calling for increased research spending, more coverage by insurance companies and more Medicare coverage of such treatments. In response to popular and government attention to alternative therapies, medical schools and prestigious university hospitals developed programs for research on alternative therapies and programs in integrative medicine. Even the American Veterinary Medical Association has accommodated forms of alternative medicine. Members of the American Holistic Veterinary Medical Association recommend herbal remedies, acupuncture, acu-therapy, homeopathy, and chiropractic treatments for animals.
Attempts to subject traditional and alternative remedies to rigorous testing have often produced ambiguous results that fail to satisfy critics or proponents. In 1996, for example, Emily Rosa designed an experimental test of a widely used alternative technique known as ''therapeutic touch.'' Her fourth grade Science Fair project was published in the Journal of the American Medical Association in 1998. Proponents of therapeutic touch claim that by passing their hands over a patient's body, without actual physical contact, healers can relieve the symptoms of disease by manipulating and rebalancing defective energy fields. However, when separated from the investigator by a screen, the 21 practitioners who participated in Rosa's study were unable to identify the investigator's energy field any better than by chance. Practitioners objected to the conclusion and pointed out that the study's authors included skeptics from the National Therapeutic Touch Study Group and Quackwatch.
Leaders of Quackwatch warn that the growing acceptance of integrative medicine epitomized by the establishment of NCCAM might not co-opt alternative medicine as the mainstream hopes. Perhaps, skeptics warn, accommodation might encourage the resurgence of unregulated, uncontrolled medical diversity, and quackery. Nevertheless, hospitals, academic medical centers, and medical schools are attempting to attract new patients and consumers by offering programs for wellness, stress reduction, yoga, meditation, massage, biofeedback, Shirodhara (warm herbalized sesame oil dripped onto the forehead), acupressure, aromatherapy, and so forth. The American Hospital Association found that more than 15 percent of all hospitals were offering alternative therapies, including walk-in complementary medicine centers.
In response to a rapid increase in the use of alternative medicine, in 2002 the World Health Organization (WHO) created the first global strategy to analyze traditional and alternative therapies and help integrate them into healthcare services. It was also noted by WHO that it was important to ensure that traditional remedies would not be appropriated and patented by pharmaceutical companies and that medicinal plants would not be eradicated by overharvesting. In many parts of the world, the vast majority of people depend on traditional therapies. In Mozambique, for example, there was 1 medical doctor for every 50,000 people as compared to 1 traditional healer for every 200. Officials of WHO plan to advise nations on how to ensure the quality of traditional remedies and practices through the regulation of drugs and the training and licensing of healers. Unless traditional healers practice nontraditional antiseptic techniques, they can spread diseases by using dirty syringes, knives, razor blades, glass shards, or porcupine quills.
Skeptics warn that the growing interest in alternative medicine encouraged by WHO might allow insidious and dangerous forms of quackery to emerge and flourish within a more welcoming, less skeptical environment that awards ''equal time'' to any and all ideas. When diseases are serious, chronic, and incurable, people are very vulnerable to quackery. Those who have waged war against cancer quackery and AIDS quackery warn against social and legislative changes that make unconventional medicine more acceptable and may make it possible for a global ''army of quacks'' to thrive and prosper.
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