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Alternative medicine
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Alternative medicine
NCCAM classifications [2]
1. Alternative Medical Systems
2. Mind-Body Intervention
3. Biologically Based Therapy
4. Manipulative and body-based methods
5. Energy Therapy
Alternative medicine has been described as "any of various systems of
healing or treating disease (as chiropractic, homeopathy, or faith healing)
not included in the traditional medical curricula taught in the United
States and Britain".[1]
Alternative medicine practices are often based in belief systems not derived
from modern science. Alternative medicines may therefore incorporate
spiritual, metaphysical, or religious underpinnings, untested practices,
non-Western medical traditions, or newly developed approaches to healing.
If an alternative medical approach, initially regarded as untested, is
subsequently shown to be safe and effective, it may then be adopted by
conventional practitioners and no longer considered "alternative".
Criticisms of the term
Alternative medicine is commonly categorised together with complementary
medicine under the umbrella term 'complementary and alternative medicine'
(CAM for short). Some scientists reject this and the above classifications
and to varying degrees reject the term "alternative medicine" itself.
The following three commentators argue for classifying treatments based on
the objectively verifiable criteria of the scientific method, not based on
the changing curricula of various medical schools or social sphere of usage.
They advocate a classification based on evidence-based medicine, i.e.,
scientifically proven evidence of efficacy (or lack thereof). According to
them it is possible for a method to change categories (proven vs. nonproven)
in either direction, based on increased knowledge of its effectiveness or
lack thereof:
* Marcia Angell, former editor-in-chief of the New England Journal of
Medicine, states that "...since many alternative remedies have recently
found their way into the medical mainstream [there] cannot be two kinds of
medicine - conventional and alternative. There is only medicine that has
been adequately tested and medicine that has not, medicine that works and
medicine that may or may not work. Once a treatment has been tested
rigorously, it no longer matters whether it was considered alternative at
the outset. If it is found to be reasonably safe and effective, it will be
accepted."[2]
* George D. Lundberg, former editor of the Journal of the American Medical
Association (JAMA), and Phil B. Fontanarosa, Senior Editor of JAMA, state:
"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. 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."[3]
* Richard Dawkins, Professor of the Public Understanding of Science at
Oxford,[4] defines alternative medicine as a "...set of practices which
cannot be tested, refuse to be tested, or consistently fail tests. If a
healing technique is demonstrated to have curative properties in properly
controlled double-blind trials, it ceases to be alternative. It
simply...becomes medicine."[5] He also states that "There is no alternative
medicine. There is only medicine that works and medicine that doesn't
work."[6]
Other well-known proponents of evidence-based medicine, such as the Cochrane
Collaboration and Edzard Ernst, Professor of Complementary Medicine at the
University of Exeter, use the term "alternative medicine" but agree with the
above commentators that all treatments, whether "mainstream" or
"alternative", ought to be held to standards of the scientific
method.[7][8][9] Oxford University Press publishes a peer-reviewed journal
entitled Evidence-based Complementary and Alternative Medicine (eCAM).[10]
Some commentators maintain that some or all fields of alternative medicine
are pseudoscientific, or contain significant pseudoscientific elements. In
the late 20th century systematic investigation of the evidence-base
proceeded, and at least one university department of alternative and
complementary medicine was established, at the University of Exeter under
Professor Edzard Ernst for this purpose.
Regulation
Jurisdiction differs concerning which branches of alternative medicine are
legal, which are regulated, and which (if any) are provided by a
government-controlled health service or reimbursed by a private health
medical insurance company.
In article 34 (Specific legal obligations) of the General Comment No. 14
(2000) on The right to the highest attainable standard of health of the
Committee on Economic, Social and Cultural Rights (United Nations), it is
stated that
Obligations to respect (the right to health) include a State's obligation to
refrain from prohibiting or impeding traditional preventive care, healing
practices and medicines, from marketing unsafe drugs and from applying
coercive medical treatments [11]
A number of alternative medicine advocates disagree with the restrictions of
government agencies that approve medical treatments (such as the American
Food and Drug Administration) and the agencies' adherence to experimental
evaluation methods. They claim that this impedes those seeking to bring
useful and effective treatments and approaches to the public, and protest
that their contributions and discoveries are unfairly dismissed, overlooked
or suppressed. Alternative medicine providers often argue that health fraud
should be dealt with appropriately when it occurs.
In India, which is the home of several alternative systems of medicines,
Ayurveda, Siddha, Unani, and Homeopathy are licenced by the government,
despite lack of reputable scientific evidence. Naturopathy will also be
licensed soon because several Universities now offer bachelors degrees in
it. Other activities connected with AM/CM, such as Panchakarma and massage
therapy related to Ayurveda are also licenced by the government now.
Research into and licensing of these activities is carried out by the
Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH).[12]
Contemporary use of alternative medicine
Many people utilize mainstream medicine for diagnosis and basic information,
while turning to alternatives for what they believe to be health-enhancing
measures. However, studies indicate that a majority of people use
alternative approaches in conjunction with conventional medicine.
Edzard Ernst wrote in the Medical Journal of Australia that "about half the
general population in developed countries use complementary and alternative
medicine (CAM)."[13] A survey released in May 2004 by the National Center
for Complementary and Alternative Medicine, part of the National Institutes
of Health in the United States, found that in 2002, 36% of Americans used
some form of alternative therapy in the past 12 months, 50% in a lifetime —
a category that included yoga, meditation, herbal treatments and the Atkins
diet.[14] If prayer was counted as an alternative therapy, the figure rose
to 62.1%. 25% of people who use CAM do so because medical professional
suggested it.[15] Another study suggests a similar figure of 40%.[16] A
British telephone survey by the BBC of 1209 adults in 1998 shows that around
20% of adults in Britain had used alternative medicine in the past 12
months.
The use of alternative medicine appears to be increasing. A 1998 study
showed that the use of alternative medicine had risen from 33.8% in 1990 to
42.1% in 1997.[17] In the United Kingdom, a 2000 report ordered by the House
of Lords suggested that "...limited data seem to support the idea that CAM
use in the United Kingdom is high and is increasing."[18]
Medical education
Increasing numbers of medical colleges have begun offering courses in
alternative medicine. For example, the University of Arizona College of
Medicine offers a program in Integrative Medicine under the leadership of
Dr. Andrew Weil which trains physicians in various branches of alternative
medicine which "...neither rejects conventional medicine, nor embraces
alternative practices uncritically."[19] In three separate research surveys
that surveyed 729 schools in the United States (125 medical schools offering
an MD degree, 19 medical schools offering a Doctor of Osteopathy degree, and
585 schools offering a nursing degree), 60% of the standard medical schools,
95% of osteopathic medical schools and 84.8% of the nursing schools teach
some form of CAM.[20][21][22] Accredited Naturopathic colleges and
universities are increasing in number and popularity in the U.S.A. They
offer the most complete medical training in complimentary medicines that is
available today. See Naturopathic medicine.
In Britain, no conventional medical schools offer courses that teach the
clinical practice of alternative medicine. However, alternative medicine is
taught in several unconventional schools as part of their curriculum.
Teaching is based mostly on theory and understanding of alternative
medicine, with emphasis on being able to communicate with alternative
medicine specialists. To obtain competence in practicing clinical
alternative medicine, qualifications must be obtained from individual
medical societies. The student must have graduated and be a qualified
doctor. The British Medical Acupuncture Society, which offers medical
acupuncture certificates to doctors, is one such example, as is the College
of Naturopathic Medicine UK and Ireland.
Public use in the US
The NCCAM surveyed the American public on complementary and alternative
medicine use in 2002. According to the survey:[23]
* 50 percent of U.S. adults age 18 years and over used some form of
complementary and alternative medicine (CAM).[24]
* When prayer specifically for health reasons is included in the definition
of CAM, the number of adults using some form of CAM in 2002 rose to 62
percent.
* The majority of individuals (54.9%) used CAM in conjunction with
conventional medicine.
* Most people use CAM to treat and/or prevent musculoskeletal conditions or
other conditions associated with chronic or recurring pain.
* "The fact that only 14.8% of adults sought care from a licensed or
certified CAM practitioner suggests that most individuals who use CAM prefer
to treat themselves."
* "Women were more likely than men to use CAM. The largest sex differential
is seen in the use of mind-body therapies including prayer specifically for
health reasons".
* "Except for the groups of therapies that included prayer specifically for
health reasons, use of CAM increased as education levels increased".
* The most common CAM therapies used in the USA in 2002 were prayer (45.2%),
herbalism (18.9%), breathing meditation (11.6%), meditation (7.6%),
chiropractic medicine (7.5%), yoga (5.1%), body work (5.0%), diet-based
therapy (3.5%), progressive relaxation (3.0%), mega-vitamin therapy (2.8%)
and Visualization (2.1%)
Support for alternative medicine
Alternative therapies provide some services not available from conventional
medicine. Examples are patient empowerment and treatment methods that follow
the biopsychosocial model of health [25].
Efficacy
Advocates of alternative medicine hold that the various alternative
treatment methods are effective in treating a wide range of major and minor
medical conditions, and contend that recently published research (such as
Michalsen, 2003,[26] Gonsalkorale 2003,[27] and Berga 2003[28]) proves the
effectiveness of specific alternative treatments. They assert that a PubMed
search revealed over 370,000 research papers classified as alternative
medicine published in Medline-recognized journals since 1966 in the National
Library of Medicine database. See also Kleijnen 1991,[29] and Linde
1997.[30]
Advocates of alternative medicine hold that alternative medicine may provide
health benefits through patient empowerment, by offering more choices to the
public, including treatments that are simply not available in conventional
medicine:
"Most Americans who consult alternative providers would probably jump at the
chance to consult a physician who is well trained in scientifically based
medicine and who is also open-minded and knowledgeable about the body's
innate mechanisms of healing, the role of lifestyle factors in influencing
health, and the appropriate uses of dietary supplements, herbs, and other
forms of treatment, from osteopathic manipulation to Chinese and Ayurvedic
medicine. In other words, they want competent help in navigating the
confusing maze of therapeutic options that are available today, especially
in those cases in which conventional approaches are relatively ineffective
or harmful."[31]
Evidence-based medicine (EBM) applies the scientific method to medical
practice, and aims for the ideal that healthcare professionals should make
"conscientious, explicit, and judicious use of current best evidence" in
their everyday practice. Prof. Edzard Ernst is a notable proponent of
applying EBM to CAM.
Although advocates of alternative medicine acknowledge that the placebo
effect may play a role in the benefits that some receive from alternative
therapies, they point out that this does not diminish their validity.
Researchers who judge treatments using the scientific method are concerned
by this viewpoint, since it fails to address the possible inefficacy of
alternative treatments.
Use of alternative medicine alongside to conventional medicine
A major objection to alternative medicine is that it is done in place of
conventional medical treatments. As long as alternative treatments are used
alongside conventional treatments, the majority of medical doctors find most
forms of complementary medicine acceptable.[32] Consistent with previous
studies, the CDC recently reported that the majority of individuals in the
United States (i.e., 54.9%) used CAM in conjunction with conventional
medicine.
It is advisable for patients to inform their medical doctor when they are
using alternative medicine, because some alternative treatments may interact
with orthodox medical treatments, and such potential conflicts should be
explored in the interest of the patient. However, many conventional
practitioners are biased or uninformed about alternatives, and patients are
often reluctant to share this information with their medical doctors since
they fear it will hurt their doctor-patient relationship.
The issue of alternative medicine interfering with conventional medical
practices is minimized when it is turned to only after conventional
treatments have been exhausted. Many patients feel that alternative medicine
may help in coping with chronic illnesses for which conventional medicine
offers no cure, only management. Over time, it has become more common for a
patient's own MD to suggest alternatives when they cannot offer effective
treatment.
Criticism of alternative medicine
Due to the wide range of therapies that are considered to be "alternative
medicine" few criticisms apply across the board, except possibly that of not
being scientifically supported or even testable. Proponents of CAM typically
address this basic criticism by arguing that it is a self-fulfilling
prophecy: critics believe that there is no plausibility to CAMs because they
find little or no proofs, while it is plausibility that should inform the
scientific research for proofs.
Proponents of alternative therapy have an obligation to provide grounds for
biological plausibility, such as sound theoretical or preclinical data, or
for clinical plausibility, in the form of authentic, well-prepared case
reports, in order to justify the investment of time and energy in exploring
the merits of a novel anticancer therapy. But plausibility, not proof,
should be sufficient to initiate the process. [33]
In other words, proponents of CAMs argue that skeptics, in saying that
theories or anecdotal and preclinical data do not constitute proof, merely
state the obvious but do not actually engage in the evaluation of CAMs.
Criticisms directed at specific branches of alternative medicine range from
the fairly minor (conventional treatment is believed to be more effective in
a particular area) to incompatibility with the known laws of physics (for
example, in homeopathy). Critics argue that alternative medicine
practitioners may not have an accredited medical degree or be licensed
physicians or general practitioners and make sweeping claims without
demonstrated expertise. This cannot always be considered a serious
criticism, because unless a new system of medicine becomes established, it
does not receive accreditation of any kind, except by its own professional
organizations. This is the route homeopathy, ayurveda, siddha, unani, and
naturopathy had to follow in those countries where it is now offered by
accredited institutions. Proponents of the various forms of alternative
medicine reject criticism as being founded in prejudice, financial
self-interest, or ignorance. Refutations of criticism sometimes take the
form of an appeal to nature.
Efficacy
Lack of proper testing
Although proponents of alternative medicine often cite the large number of
studies which have been performed, critics point out that there are no
statistics on exactly how many of those studies were controlled, double
blind, peer-reviewed experiments, or how many produced results supporting
alternative medicine or parts thereof. They contend that many forms of
alternative medicine are rejected by conventional medicine because the
efficacy of the treatments has not been demonstrated through double-blind
randomized controlled trials; in contrast, conventional drugs reach the
market only after such trials have proved their efficacy.
Some argue that less research is carried out on alternative medicine because
many alternative medicine techniques cannot be patented, and hence there is
little financial incentive to study them. Drug research, by contrast, can be
very lucrative, which has resulted in funding of trials by pharmaceutical
companies. Many people, including conventional and alternative medical
practitioners, contend that this funding has led to corruption of the
scientific process for approval of drug usage, and that ghostwritten work
has appeared in major peer-reviewed medical journals.[34][35] Increasing the
funding for research of alternative medicine techniques was the purpose of
the National Center for Complementary and Alternative Medicine. NCCAM and
its predecessor, the Office of Alternative Medicine, have spent more than
$200 million on such research since 1991. The German Federal Institute for
Drugs and Medical Devices Commission E has studied many herbal remedies for
efficacy.[36]
Some skeptics of alternative practices point out that a person may attribute
symptomatic relief to an otherwise ineffective therapy due to the placebo
effect, the natural recovery from or the cyclical nature of an illness (the
regression fallacy), or the possibility that the person never originally had
a true illness.[37] CAM proponents point out this may also apply in cases
where conventional treatments have been used. To this, CAM critics point out
that this does not account for conventional medical success in double blind
clinical trials. CAM proponents, however, don't typically question
conventional medical successes revealed in double blind clinical trials.
Safety
Critics contend that some people have been hurt or killed directly from the
various practices or indirectly by failed diagnoses or the subsequent
avoidance of conventional medicine which they believe is redundant.
Alternative medicine critics agree with its proponents that people should be
free to choose whatever method of healthcare they want, but stipulate that
people must be informed as to the safety and efficacy of whatever method
they choose. People who choose alternative medicine may think they are
choosing a safe, effective medicine, while they may only be getting quack
remedies. Grapefruit seed extract is an example of quackery when multiple
studies demonstrate its universal antimicrobial effect is due to synthetic
antimicrobial contamination.[38][39][40][41][42]
Delay in seeking conventional medical treatment
Those who have had success with one alternative therapy for a minor ailment
may be convinced of its efficacy and persuaded to extrapolate that success
to some other alternative therapy for a more serious, possibly
life-threatening illness. For this reason, critics contend that therapies
that rely on the placebo effect to define success are very dangerous.
According to Lilienfeld (2002) "unvalidated or scientifically unsupported
mental health practices can lead individuals to forgo effective treatments"
and refers to this as “opportunity cost.” Individuals who spend large
amounts of time and money on ineffective treatments may be left with
precious little of either, and may forfeit the opportunity to obtain
treatments that could be more helpful. In short, even innocuous treatments
can indirectly produce negative consequences[3].
Danger can be increased when used as a complement to conventional medicine
A Norwegian multicentre study examined the association between the use of
alternative medicine and cancer survival. 515 patients using standard
medical care for cancer were followed for eight years. 22% of those patients
used alternative medicine concurrently with their standard care. The study
revealed that death rates were 30% higher in alternative medicine users than
in those who did not use alternative medicine (AM): "The use of AM seems to
predict a shorter survival from cancer."[43]
Associate Professor Alastair MacLennan of the Department of Obstetrics and
Gynaecology in Adelaide University, Australia reports that a patient of his
almost bled to death on the operating table. She had failed to mention she
had been taking "natural" potions to "build up her strength" for the
operation - one of them turned out to be a powerful anticoagulant which
nearly caused her death. [4]
To ABC Online, MacLennan also gives another possible mechanism:
"And lastly there’s the cynicism and disappointment and depression that some
patients get from going on from one alternative medicine to the next, and
they find after three months the placebo effect wears off, and they’re
disappointed and they move on to the next one, and they’re disappointed and
disillusioned, and that can create depression and make the eventual
treatment of the patient with anything effective difficult, because you may
not get compliance, because they’ve seen the failure so often in the past".
[5]
Danger from undesired side-effects
Conventional treatments are subjected to testing for undesired side-effects
(which may not, however, be revealed to the public in a timely manner),
whereas alternative treatments generally are not subjected to such testing
at all. However, any treatment — whether conventional or alternative — that
has a biological or psychological impact on a patient may also have
potentially dangerous biological or psychological side-effects.
Nevertheless, attempts to refute this fact with regard to alternative
treatments sometimes use the appeal to nature fallacy, i.e. "that which is
natural cannot be harmful".
Homeopathy, however, is regarded as being safe in terms of such side effects
since, according to known physics and chemistry, it cannot possibly have
more effect on the patient than simple water does.
Danger related to self-medication
Similar problems as those related to self-medication also apply to parts of
alternative medicine. For example, an alternative medicine may instantly
make symptoms better, but actually worsen problems in the long run. The
result may be addiction and deteriorating health.
Issues of regulation
Critics contend that some branches of alternative medicine are often not
properly regulated in some countries to identify who practices or know what
training or expertise they may possess. Critics argue that the governmental
regulation of any particular alternative therapy does necessitate that the
therapy is effective. The most sensible course in such a case could be to
simply ensure that the sold treatment is not dangerous, but the problem
would then remain to know if it does what its proponents say it does.
Explanations for efficacy of alternative medicine
There are both social/cultural and psychological reasons:
Social or cultural reasons:
* the low level of scientific literacy among the public at large[44]
* an increase in anti-intellectualism and antiscientific attitudes riding on
the coattails of new age mysticism[44]
* vigorous marketing of extravagant claims by the "alternative" medical
community[44]
* inadequate media scrutiny and attacking critics[44]
* increasing social malaise (conspiracy theories) and mistrust of
[44]traditional authority figures - the antidoctor backlash
* dislike of the delivery methods of scientific biomedicine.[44]
Psychological reasons:
* the placebo effect
* the will to believe[44]
* self-serving biases that help maintain self-esteem and promote harmonious
social functioning[44]
* demand characteristics - the obligation to respond in kind when someone
does them a good turn[44]
* post hoc, ergo propter hoc fallacy ("after this, therefore because of
this"; the basis of most superstitious beliefs)[44]
* psychological distortion, such as confirmation bias[44] and Cognitive
dissonance (inability to respond to criticism of alternative medicine in
order to reduce one's cognitive dissonance)
Integrative medicine
Further information: Glossary of alternative medicine terms
Integrative medicine is a branch of alternative medicine which claims to
limit itself to methods with strong scientific evidence of efficacy and
safety. The main proponent of integrative medicine is Andrew T. Weil M.D.,
who founded the Program in Integrative Medicine at the University of Arizona
in 1994 based on a phrase coined by Elson Haas, MD. It is claimed that
responsible alternative health product providers who have had medical
studies conducted on their products often publish these studies online..
Notes
1. ^ Merriam-Webster online. Definition retrieved 16 April 2007
2. ^ Alternative medicine--the risks of untested and unregulated remedies.
Angell M, Kassirer JP. N Engl J Med 1998;339:839.
3. ^ Alternative medicine meets science. Fontanarosa P.B., and Lundberg G.D.
JAMA. 1998; 280: 1618-1619.
4. ^ Simonyi Professorship web site
5. ^ A callous world. Richard Holloway. Book review Richard Dawkins A
Devil's Chaplain. The Guardian, February 15, 2003.
6. ^ Dawkins, Richard (003). A Devil's Chaplain. Weidenfeld & Nicolson.
7. ^ The Cochrane Collaboration Complementary Medicine Field. Retrieved 5
August 2006.
8. ^ The HealthWatch Award 2005: Prof. Edzard Ernst, Complementary medicine:
the good the bad and the ugly. Retrieved 5 August 2006
9. ^ "Complementary medicine is diagnosis, treatment and/or prevention which
complements mainstream medicine by contributing to a common whole, by
satisfying a demand not met by orthodoxy or by diversifying the conceptual
frameworks of medicine." Ernst et al British General Practitioner 1995;
45:506.
10. ^ Evidence-based Complementary and Alternative Medicine
11. ^ COMMITTEE ON ECONOMIC, SOCIAL AND CULTURAL RIGHTS. General Comment No.
14 (2000) The right to the highest attainable standard of health : .
11/08/2000. E/C.12/2000/4. http://www.unhchr.ch/tbs/doc.nsf/(symbol)/E.C.12.2000.4.en
12. ^ Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and
Homoeopathy (AYUSH)
13. ^ Ernst E. "Obstacles to research in complementary and alternative
medicine." Medical Journal of Australia, 2003; 179 (6): 279-80. PMID
12964907 MJA online
14. ^ Barnes, P. M.; Powell-Griner, E.; McFann, K.; Nahin, R. L. (2004).
"Complementary and Alternative Medicine Use Among Adults: United States,
2002". National Center for Health Statistics.
15. ^ Reasons people use CAM
16. ^ Astin JA "Why patients use alternative medicine: results of a national
study" JAMA 1998; 279(19): 1548-1553
17. ^ Eisenberg, DM, Davis RB, Ettner SL "Trends in alternative medicine use
in the United States 1990-1997." JAMA, 1998; 280:1569-1575. PMID 9820257
18. ^ House of Lords report on CAM
19. ^ University of Arizona position on Alternative Medicine
20. ^ Wetzel MS, Eisenberg DM, Kaptchuk TJ. "Courses involving complementary
and alternative medicine at US medical schools." JAMA 1998; 280 (9):784
-787. PMID 9729989
21. ^ Saxon DW, Tunnicliff G, Brokaw JJ, Raess BU. "Status of complementary
and alternative medicine in the osteopathic medical school curriculum." J Am
Osteopath Assoc 2004; 104 (3):121-6. PMID 15083987
22. ^ Fenton MV, Morris DL. "The integration of holistic nursing practices
and complementary and alternative modalities into curricula of schools of
nursing." Altern Ther Health Med, 2003; 9 (4):62-7. PMID 12868254
23. ^ Barnes, P. M.; Powell-Griner, E.; McFann, K.; Nahin, R. L. (2004).
"Complementary and Alternative Medicine Use Among Adults: United States,
2002". National Center for Health Statistics.
24. ^ CAM Use by U.S. Adults
25. ^ Vickers A. "Alternative Cancer Cures: "Unproven" or "Disproven"?" CA
Cancer J Clin 2004; 54: 110-118. Online
26. ^ Michalsen A, Ludtke R, Buhring M. "Thermal hydrotherapy improves
quality of life and hemodynamic function in patients with chronic heart
failure." Am Heart J, 2003; 146 (4):E11. PMID 14564334
27. ^ Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ. "Long term benefits
of hypnotherapy for irritable bowel syndrome." Gut, 2003; 52 (11):1623-9.
PMID 14570733
28. ^ Berga SL, Marcus MD, Loucks TL. "Recovery of ovarian activity in women
with functional hypothalamic amenorrhea who were treated with cognitive
behavior therapy." Fertility and Sterility 2003; 80 (4): 976-981 Abstract
29. ^ Kleijnen J, Knipschild P, ter Riet G. "Clinical trials of
homoeopathy." BMJ, 1991; 302:316-23. Erratum in: BMJ, 1991; 302:818. PMID
1825800
30. ^ Linde K, Clausius N, Ramirez G. "Are the clinical effects of
homeopathy placebo effects? A meta-analysis of placebo-controlled trials."
Lancet, 1997; 350:834-43. Erratum in: Lancet 1998 Jan 17;351(9097):220. PMID
9310601
31. ^ Snyderman R & Weil AT. "Integrative medicine: bringing medicine back
to its roots." Arch Intern Med 2002; 162:395-397.
32. ^
33. ^ Hoffer LJ (2001). "Proof versus plausibility: rules of engagement for
the struggle to evaluate alternative cancer therapies". CMAJ : Canadian
Medical Association journal = journal de l'Association medicale canadienne
164 (3): 351-3. PMID 11232135.
34. ^ Larkin M. "Whose article is it anyway?" Lancet, 1999; 354:136.
Editorial
35. ^ Flanagin A, Carey LA, Fontanarosa PB. "Prevalence of articles with
honorary authors and ghost authors in peer-reviewed medical journals." JAMA,
1998; 280(3):222-4. Full text
36. ^ CSICOP.org article on alternative medicine
37. ^ James Alcock PhD, Alternative Medicine and the Psychology of Belief,
The Scientific Review of Alternative Medicine, Fall/Winter 1999 Volume 3 ~
Number 2. available online
38. ^ Ganzera M, Aberham A, Stuppner H. Development and validation of an
HPLC/UV/MS method for simultaneous determination of 18 preservatives in
grapefruit seed extract. Institute of Pharmacy, University of Innsbruck,
Innrain 52, 6020 Innsbruck, Austria. J Agric Food Chem. 2006 May
31;54(11):3768-72. Abstract
39. ^ Takeoka, G., Dao, L., Wong, R.Y., Lundin, R., Mahoney N.
Identification of benzethonium chloride in commercial grapefruit seed
extracts. J Agric Food Chem. 2001 49(7):3316–20. Abstract
40. ^ von Woedtke, T., Schlüter, B., Pflegel, P., Lindequist, U.; Jülich,
W.-D. Aspects of the antimicrobial efficacy of grapefruit seed extract and
its relation to preservative substances contained. Pharmazie 1999
54:452–456. Abstract
41. ^ Sakamoto, S., Sato, K., Maitani, T., Yamada, T. Analysis of components
in natural food additive “grapefruit seed extract” by HPLC and LC/MS. Bull.
Natl. Inst. Health Sci. 1996, 114:38–42. Abstract
42. ^ Takeoka, G.R., Dao, L.T., Wong, R.Y., Harden L.A. Identification of
benzalkonium chloride in commercial grapefruit seed extracts. J Agric Food
Chem. 2005 53(19):7630–6. Abstract
43. ^ Risberg T, et al. Does use of alternative medicine predict survival
from cancer? Eur J Cancer 2003 Feb;39(3):372-7 [1]
44. ^ a b c d e f g h i j k Beyerstein BL. Psychology and 'Alternative
Medicine' Social and Judgmental Biases That Make Inert Treatments Seem to
Work. The Scientific Review of Alternative Medicine/ Fall/Winter 1999 Volume
3 ~ Number 2
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