Alternative,complementary, and conventional medicine: is integration upon us?

In attempts to improve their health and/or combat illness, approximately 4 in 10 Americans will use a complementary and alternative medicine (CAM) therapy this year. CAM therapies vary widely, with acupuncture, chiropractic, herbal medicine, and homeopathy among the more prominent modalities. CAM therapies are used in addition to and/or instead of the more conventional forms of medical care available in U.S. hospitals or licensed physicians' offices. A rapidly increasing interest in CAM has led to a nascent movement aimed at integrating various CAM therapies with the conventional health care system. In Washington State, for example, health insurance coverage for CAM therapies has been mandated, and a number of "integrated" delivery systems have been born. Although the political and economic forces leading to adoption and integration of CAM therapies vary widely by geographic locale, it is likely that some degree of integration will occur throughout much of the United States. Similar processes are occurring in Canada, Europe, and Australia, and indeed within middle and upper level socioeconomic strata worldwide. This paper identifies potential barriers and facilitators to potential integration, of medical disciplines and argues for an accessible, multidisciplinary and evidence-based, yet humanistic and patient-oriented approach.     

Alternative medicine utilization by African Americans and improving life expectancy: is there a correlation?

The life expectancy of African Americans and Caucasians has been increasing in the United States and in many other countries around the world since the late 1800s. However, as long as statistics have been accrued on race and ethnicity, the life expectancy of African Americans and Blacks in general has been significantly lower than that of Caucasians. Basic public health and medical preventive education is needed because higher cardiovascular disease (CVD) rates is one of the primary reasons for the differences between life expectancy between African Americans and Caucasians. It is also of an apparent separate but perhaps related interest that several recent preliminary studies suggest that African Americans, more than any other race, may have some of the lowest uses of alternative medicine due to skepticism, as well as educational efforts and trust in their health care professional. Despite a common belief that African Americans harbor profound distrust of specific areas of the medical profession, it is of interest that this finding has not held validity in the area of alternative medicine. Therefore, since lifestyle changes are considered alternatives in most of these studies, this would suggest that a greater educational emphasis on behavioral modification could establish a foundation or a model of preventive medical education that can be utilized for underserved populations around the world.     

Complementary medicine and genetic medicine: polar disciplines or dynamic partners?

For more than a decade, a powerful movement promoting the integration of complementary and alternative medicine (CAM) and conventional medicine has evolved. Throughout the same period, there has been a monumental shift in the biologic sciences, and in perspectives on disease, resulting from advances in genetics. It is noteworthy, and perhaps not coincidental, that these "movements" have been occurring in parallel. The simultaneous growth of complementary medicine and genetic medicine may be fueled by a deep interest in the development of "personalized" medicine. There is a prevailing view that the metaphysical visions of these two fields are in conflict. To advance discussion of this question, we describe what we believe are the common philosophies and goals of these apparently disparate fields, and why it would be advantageous for them to work together in the service of the public's health.     

Can scientific medicine incorporate alternative medicine?

The authors examine the problem of defining alternative medicine, and after a brief analysis conclude that a satisfactory unifying definition of the different practices is not possible. Scientific knowledge is a function of scientific method. In turn the principle of falsifiability proposed by Karl Popper is used as a demarcation line between science and pseudoscience. They assert that the various alternative modalities do not represent authentic scientific disciplines, as they lack many of the minimum requirements of scientific discourse and, above all, because they violate the principle of falsifiability. Until they overcome these methodological shortcomings, alternative medical practices cannot become authentic scientific disciplines.     

Who uses complementary and alternative medicine in Israel?

OBJECTIVE: To describe the Israeli complementary and alternative medicine users and examine whether they are the same or different from non-users. DESIGN: This analysis was conducted on data collected from the use of health services module (n=2,365) of the Israeli National Health Interview Survey conducted 2003-2004. The questionnaire was based on the European Health Interview Survey and was administered over the telephone by trained interviewers. SUBJECTS: This survey was conducted on a random sample of the Israel general population age 21 years or more. OUTCOME MEASURES: Chi-square tests and logistic regression analyses were conducted. Complementary and alternative medicine was defined as self-reported use of homeopath, acupuncturist, chiropractor/osteopath, naturopath, or other complementary and alternative provider services for the subjects' own health needs in the last 12 months. RESULTS: Almost 6 percent of Israelis reported using complementary and alternative medicine. Use increased with income. Users were more likely to visit any doctor or a specialist in the prior 4 weeks to the survey compared to nonusers. Users self-reported similar use of pain medications compared to nonusers. CONCLUSIONS: These findings inform the international debate regarding if and how complementary and alternative medicine services should be covered by national health insurance.     

Evidence-based practice and emergency medicine: A mismatch?

Evidence-based practice, also known as evidence-based medicine, has been suggested as a more suitable basis for decision making in clinical practice than the traditional ‘expert’ based approach. Central to evidence-based practice is the application of evidence (as found in the published literature) to an individual clinical problem. Evidence-based practice, however, has limitations that may raise questions regarding its applicability to particular types of clinical situations, including many of the problems encountered in emergency medicine.