and alternative medicine
A wealth of information on the
many types of Complementary and Alternative Medicine (CAM) is offered in
the United States. Find out what is hype, which types are based on
sciences, how to find an appropriately credentialed CAM provider and what
to expect. Look into the evolving world of Integrative Medicine using the
best of all practices based on scientific evidence.
Learn why people seek out alternative medicine practitioners, spending
three times as much in out of pocket expenses on CAM ($10.3 billion) as on
traditional Western medicine ($3.5 billion) and have more visits to
alternative medicine practitioners than primary care physicians.
"Complementary", "alternative", "traditional", and "integrative" medicine
are frequently used terms to describe a variety of healthcare treatments.
There are no universally accepted definitions for these terms. Medical
practice that is considered "alternative" in one country may be
"traditional" in another country. Definitions below will be used in this
Non-traditional forms of Western medicine have always been practiced in
the United States. These practices of medicine were rarely discussed in
traditional physicians' offices, either by the doctor or the patient. A
landmark article in the New England Journal of Medicine by Harvard
University's Dr. David Eisenberg in January 1993 brought the debate about
the use of "non-traditional" medical treatments to the forefront of
medical literature. Dr. David Eisenberg is Director of the Centre for
Alternative Medicine and Research, Beth Israel Deaconess Medical Centre
associated with Harvard University.
In his article, Dr. Eisenberg and his researchers estimated that one-third
of the US population used alternative healthcare practices and physicians
in 1990. Approximately 10% more Americans sought treatment with
alternative medicine practitioners than sought care with conventional
primary care physicians. These consumers spent over 10 billion dollars in
alternative healthcare treatments compared with the approximately three
billion dollars out-of-pocket expenses with traditional Western medical
In his follow-up article in the Nov. 11, 1998 issue of The Journal of the
American Medical Association (dedicated solely to complementary and
alternative medicine), Dr. Eisenberg notes that, as of 1997, that over 42%
of American survey responders indicated that they had tried alternative
medical treatment in the previous year. Nearly all of these had also seen
a physician practicing traditional medicine during the same period of
time. However, very few of these individuals report their alternative
medicine treatment to their physician and nearly 20% of those taking
prescription medicine also used herbal products and nutritional
supplements during the same period of time.
The debate regarding the role of each of these types of medicine is very
active. Although many practitioners of a specific type of medical system
are convinced they have the only answer, a growing number of both
conventional and alternative medicine practitioners are attempting to
integrate the best components of several types of medical practice into
their healthcare delivery system.
A 1997 issue of The American Journal of Health Promotion lists reasons
given by American consumers of healthcare for seeking alternative medicine
treatments. These reasons include dissatisfaction with conventional
medicine capabilities and delivery systems, cost of traditional medicine
and the numerous medications used and side effects. From a Western
medicine perspective, more disturbing reasons include traditional
physicians' tendency to treat disease rather than emphasize wellness and
preventive healthcare, depersonalization of the treatment of patients and
a lack of knowledge regarding the increasingly apparent role of lifestyle
decisions, emotional issues and nutritional factors in disease. A study
from Stanford University found that may users of alternative medicine are
not necessarily dissatisfied with traditional medicine practices, but find
alternative medicine fits well with their lifestyle and philosophy about
Finally, the American consumer has more access to information and
increased awareness of potentially successful alternative medical
practices which are being acknowledged by practicing Western medicine
physicians and institutions. Examples include the establishment of the
National Institutes of Health Office of Alternative Medicine in 1992 (now
called the National Center for Complementary and Alternative Medicine),
the increased course offerings in alternative medical practices in
American medical schools, certification and credentialling by government
bodies of alternative medicine practitioners and emerging studies by
Western researchers on the effectiveness of alternative medical
Many traditional Western medical practitioners are cautious about
accepting CAM practices because of the scant amount of rigorous research
studies published in scientific literature. This view is clearly
articulated by the editors of the New England Journal of Medicine in 1998.
Proponents of CAM argue that scant funding is available for research,
there are no financial incentives for investigating treatments that can
not be published and traditional medicine journals are reluctant to
publish CAM studies. They also argue that there is greater harm in not
using many of the therapies used over the centuries without extensive
The harm, counters traditional medicine advocates, is twofold. First, some
patients avoid using effective medical treatments while searching for
alternative medicine answers and allowing the disease to progress.
Secondly, some treatments may actually be harmful. Although there is no
single answer for this concern, certainly each side is correct in its view
when the great number of CAM therapies is considered.
Another issue with traditional physicians is malpractice liability for
referrals to CAM practitioners. For two excellent articles on the subject,
the the November 11, 1998 issue of JAMA on Medical Malpractice
Implications of Alternative Medicine and the Integrative Medicine Consult
article on Liability for Referral to Complementary and Alternative
Providers by attorney Michael Cohen.
For additional information on the debate from a western medicine
perspective, see an editorial from American Family Physician January 1,
2003,"Complementary and Alternative Medicine: Examining the Evidence,"
Traditional medicine in this article is defined as those practices
generally taught in American medical schools and schools of osteopathy.
Practitioners of this type of medicine are usually designated as M.D. or
D.O. Most hospitals and insurance companies in the United States use
traditional medicine as the allowable and reimbursable form of healthcare.
Practitioners in Eastern countries such as India and China would not
consider this practice of medicine "traditional." Much of the scientific
literature available to English readers is based on research on this type
of medicine and using drugs manufactured by pharmaceutical companies to
provide this type of treatment.
Traditional Western medicine is designed to suppress symptoms, surgically
correct injuries, remove diseased organs or tissue and eliminate
disease-causing organisms. Recent interest in preventive medicine has
increased use of wellness practices emphasized long ago by alternative
medical systems. Osteopathic medicine incorporates all of these treatment
techniques and adds manipulation of the joints and assessment of each
individual's health status.
Interestingly, two thirds of US allopathic medical schools now offer
classes in alternative medicine subjects. One third of the courses offered
are required courses. Obviously, there is considerable overlap between all
of the medical systems and approaches. Many types of traditional Western
medicine incorporate elements from other medical systems. This is
particularly true with primary care specialists, rehabilitation medicine
and with preventive medicine physicians.
Many traditional Western medicine practitioners are reluctant to prescribe
alternative treatments, not only because of a lack of knowledge and
understanding, but also for a fear of malpractice liability.
Credentialling and licensure of alternative medical practitioners varies
widely across the nation and medical practice types. In general,
malpractice claims against alternative medicine providers are less
frequent and less severe than those against traditional practitioners,
according to a recent article in JAMA. Traditional physicians do have
responsibilities and liabilities in referring patients to alternative
Alternative medical practitioners are frequently limited in access to
diagnostic testing equipment and their ability to write for prescription
medication. For many of the CAM systems, diagnosis of illness or disease
is not based on traditional laboratory testing nor is treatment dependent
upon prescription medication. In fact, in many of the CAM systems, use of
invasive testing and medications with potential side effects is contrary
to that systems' philosophy. The overlapping areas of nutrition, physical
manipulation, pain relief techniques, psychological support, avoidance of
environmental toxins and personal lifestyle decisions cross into both
traditional and CAM healthcare delivery philosophies.
Alternative medicine practices incorporate a wide variety of healthcare
methods. These methods generally use "natural" techniques and healing
powers of the body to return to a state of health. The term "alternative
medicine" is frequently used to describe techniques not generally
practiced by traditionally trained Western physicians. Many people use
this term when an individual participates in non-traditional medical
practices without the knowledge of their traditional medicine physician.
Traditionally trained Western physicians generally do not practice these
techniques. A brief overview of many of the types of alternative medicine
is found below.
Complementary medicine combines the practices of both alternative medicine
and traditional medical practices and looks at the spectrum of medical
treatment options available for any particular condition. Complementary
medicine uses basic principles of traditional Western medicine with
treatments for some conditions being "complemented" by "alternative
system." Medical practitioners tend to use the synergistic effect of two
separate healthcare systems to the good of the patient. To a limited
extent, nearly every person in the US has participated in some form of
complementary medicine. For example, many people modify their diet to
reduce the risk of particular diseases, ice or massaged an injury, take a
vitamin or allocate time for spiritual contemplation. Often, individuals
are practicing complementary medicine without notifying their traditional
physician of their use of other therapies. This reluctance to mention it
may be based on the patient's embarrassment to admit such use or the
physician's lack of knowledge and acceptance alternative medicine
Integrative medicine, as we define it, is a scientific assessment of all
reviews of medical practice used individually or in combination. The goal
of integrative medicine is to use evidenced-based healthcare practices
from all types of medicine to provide the optimum healthcare outcome to an
individual. All types of medical practices are options for treating any
particular condition. "Integrative medicine operates on the premise that
prevention is the primary responsibility of the practitioner and
appreciates the influences of nutrition and lifestyle on health and
illness", according to Drs. Caspi, Lutz and Greenfield of the University
of Arizona Health Science Centre. They go on to state "The concept of
integrative medicine represents universal values of health care.
Integrative medicine shifts the orientation from curing disease to healing
illness. It is based on a partnership between patient and practitioner
that addresses well-being as well as seeking remediesÖ.. It teaches health
care providers to honour the subtle, yet complex, interactions of mind,
body, spirit, community, and environment. Integrative medicine is the
foundation of the practice of good medicine, whether its origins are
conventional or alternative, and good medicine is based on open-minded,
inquiry-driven good science."
Many "wellness clinics" are practicing integrative medicine. As research
in the "alternative" medical fields evolves, more evidence supporting the
effectiveness of these treatment styles will grow. Integrative
practitioners will use the technique or combination of techniques which
provide the best results based on research. For an excellent discussion of
the validity of difference types of scientific study and the degree of
necessity of scientific proof. The JAMA editorial, "Alternative Medicine
Meets Science", argues that there should be no distinction between types
of medicine, just effective medical practices proven by scientific study.
This is the premise of integrative medicine or evidence-based medical
practice. As both interest and funding grow in "alternative" medical
practices, some therapies will move to the mainstream of medical practice,
while others will be eliminated if shown to be ineffective or even
Throughout the remainder of this article, the term "CAM (Complementary and
Alternative Medicine)" will be used to describe medical practices not
routinely taught in American medical schools or schools of osteopathy. We
recognize that there is considerable overlap in all of these techniques.
What is at one time considered alternative or complementary, may progress
into an integrative system or even be accepted as "traditional" at
sometime in the future. The examples include the use of vitamins and
minerals to prevent diseases such as osteoporosis, birth defects, cancers
and cardiovascular disease. Other examples include use of acupuncture for
pain relief and biofeedback for anxiety control.
Alternative Medical Systems
Complementary and alternative medicines can be divided into several areas.
Alternative medical systems include a comprehensive philosophy of
wellness, treatment of illness and attempts to cure disease. Physical
Medicine uses actual physical hands-on contact by the provider with the
patient as part of the treatment program. Mind Body Medicine instructs the
patient on techniques to use their own mental powers to relieve physical
conditions. Nutritional Medicine Systems use vitamins, minerals, herbs and
other botanical (plant) products to restore health or optimize wellness.
Energy Medicine uses light, sound, electromagnetic fields or other forms
of energy to treat conditions. Environmental medicine seeks avoidance of
toxins the patient is exposed to avoid disease or combat illness. A host
of other symptoms are also briefly described.
The alternative medical systems include Traditional Chinese Medicine (TCM),
Ayurveda, naturopathy and homeopathy. Although some people consider
osteopathy a form of an alternative medicine system, most of its
practitioners have very similar training and identical privileges and
credentialling to conventional Western allopathic medical doctors. The
alternative medical systems of Traditional Chinese Medicine and Ayurveda
involve elements of many of the other subsets of "alternative" medical
Alternative Medical Systems- Traditional Chinese Medicine
Traditional Chinese Medicine (TCM) is a comprehensive health philosophy
based on physical, emotional and spiritual healing. The essential belief
in Chinese medicine is that the "qi" is the vital energy or life force in
all living objects. This qi can be transferred between living beings. Also
essential is the concept that "tao" or "way of life" is the ideal way to
conduct one's life. People who live according to the tao enjoy good
health, where disease results from a lack of balance in the tao. This
balance in all aspects of life is described as opposite forces, called
"yin" and "yang." The diagnosis of disease of these conditions involves an
assessment of the balancing forces acting on qi. Some disease states,
often evaluated by the appearance of the tongue, can be corrected by
avoiding or using specific foods. A disease that is characterized as "hot"
may include treatment with the use of more "cold" foods or the avoidance
of other foods that will produce heat in the body. The TCM treatments for
most conditions involve the use of five principle modalities: Chinese
herbal medicines, acupuncture, dietary changes, massage, exercise and
Chinese Herbal Medicine
Although Chinese medicines are called herbs, they may be derived from
plants, animals or minerals. Herbs are often given in complex formulations
based on an assessment of the organ system that is out of balance. Using
the philosophy of yin and yang, the herbs attempt to restore balance and,
therefore, health to the organ system. The oldest medical textbook known
to man, Nei Jing (The Yellow Emperorís Classic of Internal Medicine)
discusses many of he TCM herbs as well as the philosophy of wellness.
Acupuncture is the art of restoring qi, the vital force, by the insertion
of very thin needles into certain points in the body. These points are
mapped along fourteen meridians that control the qi. Sometimes,
acupuncturists will warm the needles with a burning herb, called
moxibustion. At other times, key points along the meridian may be
stimulated to restore qi by pressure with the fingertips, called
acupressure or shiatsu. See Acupuncture Helps in Treating Medical Problems
in Flight Safety Foundation's Human Factors & Aviation Medicine Sep-Oct
Qi gong and Tíai Chi
Exercise and stress reduction often combined in TCM in a manner similar to
physical therapy and medication in the West. "Qi gong" incorporates
movement, with focus on breathing to restore qi and cleanse the body. "T'ai
chi" is practiced more and more in the US. It involves slow, deliberate
movements performed with a certain rhythm and is designed to a certain
rhythm with meditation and is designed to restore qi to the body.
Diet and Nutrition
A TCM practitioner will evaluate a personís pulse in a completely
different way than Western physicians do. In TCM, the pulse gives an
indication of the balance of Qi. Some conditions are associated with "Hot"
and other are considered "Cold". Specific foods also have Hot and Cold
properties and can be effective in restoring the Qi. Ironically, Western
medicine also uses certain foods to prevent or treat conditions, such as
red meats and green vegetables for iron deficiency anemia and dairy
products to prevent bone loss. Many other examples exist.
The use of massage techniques (An-mo and Tui Na) releases toxins from the
body while relaxing and healing the individual. As with other therapies,
TCM practitioners use massage for inner peace and to restore the balance
Accrediting bodies in traditional Chinese medicine include the National
Certification Commission for Acupuncture and Oriental Medicine, which
conducts national board examinations for acupuncture, oriental bodywork
and Chinese herbology. Acupuncturists are licensed in 29 states in the US.
Another source is the American Association of Oriental Medicine.
Alternative Medical Systems- Ayurvedic Medicine (India)
Prana, Dosha and Prakiti
Ayurveda is the practice of traditional medicine in the country of India
and is over 5,000 years old. It emphasizes that true health results from a
balance between body, mind and spirit and the interrelationship of each.
Like the Chinese qi, the life spirit in Ayurveda is called Prana. Srotas
or channels (similar to Chinese meridians) help balance the five forces of
life and the five organ systems called Vayus. The principles of Ayurveda
state that we are each born with a unique personal physical and mental
constitution , known as Prakruti. Throughout life, illness results from a
deviation form this constitution. This state of imbalance is termed
All living organisms have a constitutional makeup or personality called
Dosha. There are three dosha types, Vada, Pitta and Kapha. The Vada type
is an energetic and enthusiastic, though somewhat restless type. The Pitta
dosha is very intense, inpatient and regimented. This resembles the type A
personality in Western medicine. Kapha doshas are more relaxed, tranquil
and easygoing. Each of the doshas is associated with certain body type,
specific health concerns and mental functions. All people have elements of
each dosha, although one tends to be dominant. Their unique combination
given to them at birth is their Prakruti. By understanding the Prakruti,
one can select a diet and lifestyle that will support health and optimal
functioning of the mind, body and spirit.
Ayurvedic Schools of Practice
Ayurvedic medicine has two main schools of practice. 1) Maharishi Mahesh
Yogi founded one school that emphasizes transcendental meditation. The
Beatles made this form of Ayurveda famous in the 1970's. It is still
taught and practiced throughout the world. 2) Deepak Chopra, M.D., who is
also a famous motivational speaker throughout the US, incorporates the
second branch. He is also the author of the best selling books, "Perfect
Health: Complete Mind/Body Guide" and "Ageless Mind, Timeless Body". It
incorporates meditation, but also uses other therapies, which are
Ayurvedic Healing Methods
Ayurvedic therapeutics focuses on personal diet and lifestyle regimes that
work with the individual constitution to prevent illness and promote
health. Ayurveda is becoming recognized today through the related practice
of Yoga. Yoga is a set of exercises and postures combined with meditation
to reunify mind and body. Yoga postures are called Asanas and breathing
practices are known as Pranayama. Yoga is becoming popular for its proven
ability to relieve stress, promote fitness and aid a variety of disorders.
Other healing methods include herbal therapy, a form of acupressure known
as Marma Chikitsa, and rejuvenative medicines known as Rasayana and
Panchakarma. The latter of these is a cleansing program that utilizes
Abhyanga (oil massage), a specialized diet, Nasya (the administration of
oils to the nostrils), Shirodhara (a warm stream of oil poured on the
forehead), herbal therapy, yoga and other methods to gently balance the
dosha and aid the body in returning to the prakruti.
Research in Ayurveda is only just beginning in the Western world.
Meditation and the integration of mind, body and spirit certainly are
gaining respect in Western medicine, however. The NIH Office of
Alternative Medicine and the National Cancer Institute are currently
studying several Ayurvedic techniques for potential benefits. See the
American Cancer Society' detailed description of Ayurveda and its
potential benefits. The Health Education Alliance for Life and Longevity
also has extensive information on Ayurveda. Currently, there is little
regulated standard for Ayurvedic education in the United States and no
licensing process for Ayurvedic practitioners.
Alternative Medical Systems- Naturopathy
Naturopathy or naturopathic medicine emphasizes Vis medicatrix nataurae
(the healing power of nature). Benedict Lust formed the first American
School of Naturopathy in 1902. This type of medicine is increasingly
popular in the US, and in particular, the Pacific Northwest. Its'
practitioners are primary care providers who have gone through four years
of college and a four year graduate school in naturopathy. The most
prominent school is Baystyr University and the National College of
Naturopathic Medicine. Baystyr University is one of the National
Institutes of Health Office of Alternative Medicine's eleven research
Graduates from naturopathic schools have the initials "N.D." after their
names and are called doctors of naturopathic medicine. There are
tremendous similarities between traditional teaching of M.D.ís D.O.'s and
N.D.'s. Naturopaths study the biological and physical origins of disease.
Evaluations include diagnostic studies using laboratory work, physical
examination and pathology in the same way that Western physicians and
osteopaths do. The major distinction is that, rather than using
artificially produced pharmaceutical medications and surgery, N.D.'s use
natural sources for healing properties, including dietary, herbal and
Guiding Principles of Naturopathy
There are six guiding principles in naturopathy:
1. Primum non nocere ("First, do no harm"). Practitioners of conventional
Western medicine share this philosophy, which is included in the
2. Tolle causam ("Find the cause"). N.D.'s seek not to eliminate symptoms
of disease, but to treat the underlying cause, which they believe is based
on environmental, dietary or lifestyle issues. Correcting the cause of
disease is the key, not treating the symptoms.
3. Vis medicatrix naturae ("the healing power of nature"). This recognizes
the body's ability to heal itself by using its own powers and natural
resources of the environment and diet.
4. Holism. Treat the whole person, not just the diseased organ. This is
often called holistic approach. Examples of this approach in Western
medicine are to combine traditional, surgical and pharmacological
treatments for heart disease with dietary recommendations, exercise,
prescriptions and lifestyle modifications.
5. All doctors should be teachers. Any patients seeking the assistance of
an N.D. should expect to have a careful explanation of the diagnosis and
treatment and to incorporate the patient into the recovery plan. A
frequent criticism of the Western healthcare systems is that treating
physicians do not spend enough time explaining conditions and treatments
to their patients.
6. The sixth principle is that prevention is the best medicine. Healthy
lifestyle habits do far more to prevent disease than medicine can do to
Naturopaths are trained in clinical, physical and laboratory sciences in a
similar fashion to M.D.'s. While lacking in surgical training, N.D.'s
often have a strong background in clinical nutrition, herbal medication
and other forms of alternative medicine. N.D.'s should be a graduate of
one of these institutions and be listed by the American Association of
Naturopathic Physicians. Just as many M.D.'s are not qualified to practice
all elements of naturopathic medicine, N.D.'s are trained in many, but
not, all elements of allopathic medicine.
Alternative Medical Systems- Homeopathy
Homeopathy is based on the philosophy of Samuel Hahnemann, a German
physician who espoused the philosophy that "like cures like" or the law of
similars. The law of infinitesimals states that small amounts of a
compound or dilutions of a compound are much more powerful than larger
amounts in curing disease. Hahnemann's law of chronic disease states that
any treatment for a disease will worsen it unless it's taken in
increasingly dilute amounts.
Homeopathy is relatively well accepted in Europe, but generally dismissed
as non-scientific in the US. Many of the homeopathic "cures" are thought
to be to the placebo effect or the power of suggestion. Only Connecticut
and Arizona license M.D.'s and D.O.'s to practice homeopathic medication.
The National Center for Homeopathy in Virginia provides additional
training to physicians interested in this medical art. Homeopathy is
generally safe. The major danger exists if a full evaluation of serious
medical conditions and definitive treatment is delayed while awaiting the
benefits of homeopathic medication. Recent articles in The Lancet
(9-20-97,pg. 134) indicates there may be some benefits beyond the placebo
affect for homeopathic medicine.
Physical Medical Systems- Chiropractic Care
Chiropractic medicine is the most widely practiced form of "alternative"
medicine in the US. Nearly 15% of the US population has been treated by a
chiropractor within the last year. Chiropractic medicine focuses on the
effect of misalignment of the bones of the spine that affects the nerves
arising from the spine. These affected nerves then produce illness or
discomfort in various body tissues and organs. By properly aligning the
bones of the spine (vertebrae) the proper relationship between the spine
and nervous system can be restored an illness treated.
Diagnosis of disease is made by obtaining a careful history of the
patient's illness, evaluating the posture, reflexes and alignment of the
vertebrae to determine possible treatments. Often the evaluation included
a series of x-rays. Spinal manipulation is then used to correct the
alignment and treat the condition. In some cases, other joints and bones
are manipulated to relieve disease. Rarely, spine or joint manipulation
may cause further problems. Traditional medicine uses some chiropractic
techniques, usually administered by a physical therapist, who work under
the direction of a physician. The National Association for Chiropractic
Medicine is an organization dedicated to moving legitimately trained and
properly licensed chiropractors in to mainstream medical care.
Chiropractic training involves five years of study and clinical experience
at one of the 17 accredited chiropractic schools in the US. The Council of
Chiropractic Education accredits one of the 17 chiropractic colleges in
the US. Chiropractors are licensed in all 50 states. The American
Chiropractic Association provides a listing of the licensed chiropractors
in the United States. Although some work through a regular relationship
with a traditional physician, many chiropractors work independently.
Insurance coverage for chiropractic care is slowly becoming available.
Physical Medical Systems- Massage and Bodywork
There are many types of massage therapy available. Different techniques
have evolved from European traditions, Asian techniques and contemporary
Western massage. Massage is essentially manipulation of the soft tissues
of the body, including muscle, fascia or connective tissue. Massage is
widely used in sports medicine by many world-class athletes. Several
studies have shown that simple physical contact may have beneficial
effects in healing of the body.
European massage techniques include the gentle Swedish massage of the
superficial layers of the muscle and lymphatic massage to improve lymph
flow through the body. Deeper forms of massage include deep tissue massage
which focuses on a specific injured area, neuromuscular or trigger point
massage that focuses on points on the body that trigger pain and Rolfing
which involves manipulation of the fascia or (tissue that covers the
Asian bodywork incorporates several basic techniques with numerous
variations. Often included in traditional Chinese medicine, acupressure
treats medical conditions using the same principles as acupuncture, but
uses pressure applied with the fingers, rather than needles to stimulate
the flow of qi through the meridians of the body. The Japanese equivalent
of acupressure is shiatsu and may involve pressure applied not only with
the fingers, but also with the elbows, knees, feet and hands. Other
variations that include a combination of acupressure and massage include
Tui Na, An-Mo, Jin shindo and Jin shin jutsu. Self-application of
acupressure includes Acu-yoga and Do-In. There are many forms of Oriental
and Ayurvedic massage also. As mentioned above, one form of Ayurvedic
massage is also called Marma therapy, which involves rubbing specific
areas of the body. Another form called Abhyanga involves rubbing the skin
with sesame oil to aid in removal of toxins.
Western bodywork also includes a variety of techniques. These techniques
tend to combine massage movement and posture exercises designed to improve
mental relaxation, relieve physical discomfort and improve movement and
balance. These types of bodywork include the Alexander technique, the
Feldencrais method, the Trager method, the Pilates/Physical Mind method,
Hellerwork and Rolfing.
Physical Medical Systems- Therapeutic Touch
The technique developed by a professor of nursing in New York involves
passing the hands of the practitioner near the patient for the purpose of
changing a patient's "energy field" without any true physical contact. A
study in The Journal of the American Medical Association called in to
question the value of this technique, although some patients report
dramatic results. Very similar techniques include polarity therapy and the
Although most forms of bodywork are generally safe, there are numerous
"practitioners" without formal training. The National Certification Board
for Therapeutic Massage and Bodywork gives a list of therapists who have
passed a national certifying exam, have met requirements for ongoing
education and have been certified by their state if required. The term "LMT"
or licensed massage therapist does not imply specific training or
In general, the goal of mind/bodywork is to create a state of relaxation
or focused concentration to use the healing abilities of one's own mind to
address physical conditions. Although it may be very difficult to see a
direct relationship between the mind and physical illness, a growing field
of study called psychoneuroimmunology is evaluating the relationship
between the mind, the nervous system and the immune system. Not fully
accepted by many medical practitioners and patients because of a lack of
concrete scientific studies, many people intuitively accept the concept
that stress, anxiety and other negative mental states may have an adverse
effect on health. The relationship of a Type A personality with coronary
artery disease, stress with ulcers, improved cancer outcomes with positive
mental attitudes and avoidance of colds with rest and relaxation are
commonly talked about in a casual manner among traditional Western
physicians. Increasing numbers of scientific studies are demonstrating a
direct relationship between mental states and the immune system of the
body, which fights a variety of diseases and infections. In some cases,
direct, measurable physical responses show an improvement with some forms
of mind/body medicine. Many types of mind/body medicine exist. They
include the Relaxation Response, meditation types, yoga, hypnosis, guided
imagery and biofeedback.
Mind/Body Medicine- The
Dr. Herbert Benson of Harvard University's Mind/Body Medical Institute
developed the theory of the relaxation response in the early 1970's. The
goal is to provide people with a self-taught method of finding a peaceful
mental state to improve conditions that may be aggravated by stress. This
is achieved in a relatively brief period of time using relaxed breathing,
visual imaging and repeating a work or phrase that allows the individual
to block out stressful inputs. The repeating of a word or "mantra" is
similar to techniques used in Eastern healing systems.
Mind/Body Medicine- Meditation
Several forms of meditation or relaxation techniques are also used. They
include autogenic training with visual imagery, all focusing on particular
parts of the body. Progressive muscle relaxation involves systematically
contracting a muscle and slowly relaxing it and then moving to another
muscle. Other techniques include mindfulness (vipassana) and body
Two forms of meditation adopted from Eastern Medical Systems and religions
are commonly practiced. Like vipassana, which also comes from Buddhism,
Zen involves focusing on breathing and reading the mind of any intrusive
thoughts to induce a state or relaxation. Zen is an essential part of the
Buddhist religion where an individual seeks enlightenment through
Transcendental medication is the Indian equivalent practice to Zen in
Ayurvedic medicine. Very similar to the relaxation response, this
technique uses the repetition of a simple mantra to allow the mind to
easily wonder to a state of increased consciousness and awareness.
Mind/Body Medicine- Yoga
Also from Ayurvedic medicine comes the technique of yoga which involves
particular postures with focused breathing. There are numerous types of
yoga practiced. Classes in each type, as with many of the mind/body
techniques, are found throughout the US.
Mind/Body Medicine- Spiritual
Prayer is another form of medication producing mental relaxation. Some
Western religions report that faith healing through individual prayer or
the collective power of prayer focused through a spiritual healer as
having cured some medical conditions. The Bible contains many examples of
spiritual healing and miraculous recoveries from disease have been
reported many times over the century.
There is little, if any, concrete evidence at this time that any of the
mind/body techniques will actually cure an illness. However, the field of
psychoneuroimmunology raises the possibility that many conditions may have
a more favourable response when combined with a positive mental attitude.
The cancer treatment centres of America certainly use this relationship
between the mind and the immune system as a key component in their
comprehensive program to address patients with cancer.
Other mind/body techniques that have more Western scientific research
behind them include biofeedback, hypnosis and guided imagery.
Mind/Body Medicine- Hypnosis
Although hypnosis has been used since ancient Greece, Franz Anton Mesmer
formalized the term in the later 1700's. The word "mesmerized" is derived
from his name and technique. Hypnosis can be used with the assistance of a
person trained in hypnotism or can be self-induced.
A common misconception is that hypnotized individuals can be induced to do
a task against their will. In contrast, hypnosis requires a willing
subject and hypnotic suggestions are only carried out if the individual is
willing to do so. Not all individuals are susceptible to hypnosis. Those
who tend to be more creative seem to be better candidates.
Hypnosis has been accepted as a legitimate medical therapy in Western
medicine since the 1950's. Many anaesthesiologists, dentists and
psychologists use hypnosis as an essential part of their treatment.
Hypnosis is particularly useful in behaviour modification and pain
control. Examples include dental work, weight reduction, smoking
cessation, addictive behaviours, anxiety conditions and social phobias.
Some individuals who have a fear of flying have also used hypnosis
successfully to overcome this incapacitating phobia. Many people have
learned the art of self-hypnosis with the assistance of a trained
hypnotherapist. Hypnosis is generally safe, with the possible exception of
individuals with severe psychiatric conditions practicing self-hypnosis.
The American Board of Hypnosis or the American Council of Hypnotists
Examiners certifies hypnotherapists. Many physicians are also licensed
Mind/Body Medicine- Guided Imagery
Guided imagery involves the concept of imagining yourself performing in a
certain way to achieve desired results. Guided imagery may also be looked
at in terms of positive visualization through the use of imagination. Many
collegiate and professional athletes use guided imagery, with the help of
sports psychologists, to improve their performance. Baseball, for example,
baseball players visualized the ball prior to hitting their bat and
following the ball over the fence, while gymnasts and divers mentally
rehearse their performance prior to execution. Sports enthusiasts have
seen golfers, downhill skiers, figure skaters and many other athletes
"walking through" their events prior to starting.
The physical responses to guided images were well demonstrated by Pavlov
who repeatedly rang bells prior to presenting dogs with food. Soon the
sound of the bell triggered images of food and elicited a response of
anticipation and salivation in the dogs even when not presented with food.
Humans are very familiar with the response to guided imagery when
discussing a good meal when hungry or a cold beverage when thirsty,
although the direct connection with healing properties is not established.
Certainly, the ability of the mind to trigger specific physical responses
is well accepted.
Mind/Body Medicine- Biofeedback
Perhaps the best scientifically studied example of the ability of the mind
to affect the body is biofeedback. Certain body functions that are termed
"autonomic" or beyond conscious control, such as pulse, blood pressure and
body temperature have been conclusively shown to be affected by the mind
through biofeedback. Even brain activity measured by an
electroencephalogram can be changed through biofeedback.
The principle of this therapy involves monitoring the desired physiologic
outcome, such as pulse, blood pressure or temperature, in a direct way
while the individual mentally attempts to change that body function.
Feedback is provided through sound, gauges, graphs or lights, for example,
when the physical function moves in the desired direction. The individual
soon learns what mental states will cause movement in the appropriate
direction and soon learns to be able to cause these movements without any
The phenomenon known as "white coat hypertension" where an individual,
such as a pilot, notes an increase in the blood pressure when visiting a
physician for a medical examination. This unconscious physical response
may be easily controlled through biofeedback techniques. Other conditions
that have shown positive responses to biofeedback include anxiety,
irregular heartbeats, migraine headaches, asthma, excessive sweating,
insomnia, and cravings for addictive substances, including tobacco and
food hunger. Many of these conditions may be treated with traditional
prescription medications to control the autonomic nervous system. The
effectiveness of biofeedback clearly demonstrates in a scientifically
proven manner, the ability of the mind to produce physical results
comparable to those of medications.
Mind/Body Medicine- Social Support and Positive Mental Attitude
Many studies have shown improved life span and quality of life in
individuals who have a system of social support, loving relationships and
a positive mental attitude. Elderly, married individuals tend to live
longer than their single counterparts. Nursing homes and hospitals have
even found that the presence of a pet may improve quality of live and
medical conditions. Many organizations for specific diseases effectively
use support groups to improve not only education about the disease, but
attitudes and outcomes of those afflicted.
One well-known business productivity speaker, Peter McLaughlin, addresses
the positive effects on productivity and performance in his book Catch
Fire. In addition to excellent descriptions of the benefits of nutrition,
exercise and rest, he points out that a sense of personal control through
a positive attitude, favorable environment in stress reduction is key to
improved performance. He points out that the Chinese art of placement and
design "Feng Shui" has long been used as a way to improve peoples' health
and vitality. This is closely related to medical theories of
psychoneurobiology associated with a positive response and a sense of
Those individuals who can avoid the "victim" mentality or have the
survivor personality do well, not only in business, but also in survival
situations and in conditions of chronic and progressive disease. The
direct scientific relationship is not yet defined, but common sense and an
infinite number of examples demonstrate a definite relationship between
positive mental images, personal performance and health.
Energy Medicine- Introduction
The term energy medicine is used to describe therapeutic techniques using
electromagnetic (including light) and sound energy to promote healing.
Many of the techniques used in energy medicine are considered standard in
traditional Western medical systems. Western Medical Systems also make
extensive use of energy systems in diagnostic therapy, such as EKG's,
electroencephalograms (EEG's), CAT scans, MRI's, x-rays and ultrasound
procedures. The body cells all have electrical charges and many cells
function by a change in the electrical charge. Muscles contract with an
influx of positively charged anions, such as calcium. The heartís rate and
rhythm are determined by changes in electrical activity. The conduction of
impulses to nerves and muscles is controlled both by electrical and
chemical changes. These inter-relationships of energy forces and health
are the rationale behind Energy Medicine.
Energy Medicine- Electric Energy
Electricity is used in several therapeutic methods. Severe psychiatric
disorders were treated with electroconvulsive therapy (ECT) fairly
routinely in the past. This therapy is still used, though less frequently
now, to treat disease that does not respond to medication. This therapy
probably worked by changing the chemical transmitters in the brain or
electrical activity in certain areas of the brain. ECT is generally
considered part of traditional Western medicine, rather than being used in
any Alternative Medicine System.
Another use of electricity that is common in traditional Western medicine
is Transcutaneous Electrical Nerve Stimulation (TENS). TENS units supply
electrical stimulus to certain nerves to prevent them from conducting pain
signals to the brain. Chronic pain syndromes are treated with TENS units
routinely in Western medicine. Frequently, physical therapists, orthopedic
surgeons, anesthesiologists or rehabilitation medicine physicians use
One form of alternative medicine uses electroacupuncture biofeedback,
which measures the electrical energy at certain biofeedback points in the
body. The energy at certain points is monitored and the individual with a
medical condition attempts to alter the energy to improve the condition, a
technique very similar to biofeedback.
Energy Medicine- Electromagnetic Energy
The other part of electromagnetic energy is the use of magnetic fields to
treat disease. Although orthopaedic surgeons have long used electromagnets
to help bones heal faster and straighter, some alternative medicine
practitioners advocate the use of small, low intensity magnets to relieve
chronic nerve pain. Although not proven to be effective, the magnets are
relatively harmless unless placed near a pacemaker. Western medicine
relies heavily on magnetic energy for diagnostic purposes through he use
of the MRI or Magnetic Resonance Imagery.
Energy Medicine- Light Energy
A difference range of the electromagnetic spectrum is that of light
energy. Treatment with various spectrums of light is termed phototherapy.
Again, some forms of phototherapy are routinely accepted in traditional
Western medicine. One common use of bright light therapy is for a
condition called seasonal affective disorder or SAD. In this condition,
people who live in northern latitudes experience prolonged periods of
darkness during the winter months. Because of a relationship with the
pineal gland located in the brain, which is sensitive to the light, this
reduced exposure to bright light during the daylight hours seems to affect
eating, sleeping, energy levels and moods of affected people. Regular
exposure to the light is effective in improving mood and other
disturbances in many people affected by SAD.
Bright light therapy is also used in some instances to adjust to jet lag
conditions or night shift work. NASA used bright light therapy in
astronauts prior to launches, which would occur during low periods of
circadian rhythm (2:00 A.M. - 6:00 A.M. body clock time).
Practitioners of traditional medicine in treating various skin conditions
effectively use ultraviolet light therapy using the UV-A spectrum. At
times, combining photo UV-A (PUVA) light therapy with coal tar
applications results in dramatic improvements in the skin changes of
psoriasis. Ultraviolet light in the UV-B spectrum tends to be the
dangerous form that can cause sunburn skin cancers and premature skin
Alternative medicine practitioners will recommend full spectrum light
therapy to correct a variety of conditions. Full spectrum light therapy
included the entire range of visible light, plus infrared and ultraviolet
light. Conditions treated include depression, insomnia, headaches,
menstrual disorders and other conditions.
Energy Medicine- Lasers
Lasers use a very narrow wavelength of light with all waves oriented in a
single direction. Traditional medicine physicians have used lasers very
effectively for treating bleeding spots on the retina of the eye in
diabetics, changing the shape of the cornea to improve vision in
procedures known as PRK and LASIK, treating skin conditions and in doing
surgery. Cold laser therapy has been used in alternative medicine by
acupuncturists who use lasers instead of needles. Like acupuncture,
another use has included control of pain.
Energy Medicine- Colour Therapy
Another alternative medicine practice is to use colour therapy. There are
many types of colour therapy. One type which involved surrounding yourself
with painted walls, pictures or lights of a particular colour that is
pleasing to you is closely related to the Chinese Feng Shui which arranges
a person's environment to improve mood and health.
Energy Medicine- Sound and
Though not in the electromagnetic spectrum, the pressure waves generated
by sound are also used for healing. Many of the Eastern medical systems
will use sound and vibration to correct imbalances in the body and improve
a host of medical conditions. Though not considered strict medical
treatment, music has been shown to relieve stress in many individuals. The
soothing psychological effect of pleasing music is relatively well known,
with the use of music to treat chronic degenerative diseases, neurologic
conditions and some mental disabilities is also used.
A recent study from 5 universities evaluating the effect of music therapy
in the form of keyboard lessons for seniors. The 20 week case control
study found lower levels of stress, depression and anxiety in the group
participating in music therapy with no change in the non-participating
Traditional Western medicine uses ultrasound to diagnose many conditions
in a non-invasive fashion. Traditional Western medicine physicians and
physical therapists also use ultrasound to treat muscular injuries.
Nutritional Medicine- Introduction
The idea that nutrition to be used to treat disease through vitamins,
minerals and herbal supplements is common to all forms of Western medicine
and alternative medical practices. Naturopathy, as discussed above, uses
nutrition as the prime means of treating a whole host of diseases. The
American Heart Association and American Cancer Society have very specific
nutritional recommendations to control and minimize the risk of a host of
diseases. At least one quarter of the medicines commonly used by Western
physicians and osteopaths are derived from plants and herbs. Prevention of
specific diseases, such as scurvy, beriberi, rickets, osteoporosis and
some birth defects have been conclusively shown to be prevented by
adequate intake of vitamins and minerals.
The question is not can nutrition help to prevent disease and increase
health, but how much of certain products are required and to what extent
are various medical conditions prevented or treated through adequate
A second question revolves around the concept of adequacy. When the
recommended daily allowances for certain vitamins and minerals were
created for American consumers in the 1940's and 1950's, these levels were
designed as the minimum amount to prevent overt disease. A growing body of
thought in Western medicine (already commonly accepted in most alternative
medical systems) is the increased amounts of nutrients may optimize health
and reduce the risk of certain chronic diseases, infections, cancer and
Approximately two-thirds of over 700 cardiologists indicate that they take
dietary supplements of antioxidants to lower their risk of heart disease.
A slightly lower percentage of family physicians have used or recommended
nutritional supplements for themselves or their patients.
Nearly all practitioners are in agreement that nutrition is ideally
obtained from natural food products. Unfortunately, several factors have
led to current diets not providing adequate nutrition without
supplementation. Our fast paced lifestyle frequently does not allow enough
time for preparation and eating of a nutritionally balanced diet. The
advent of numerous processed foods of questionable nutrient value and
possible harm has diminished the nutrition we receive from our diet.
Depletion of essential nutrients from the soil has led to lower amounts of
the same nutrients in the fruits, vegetables, grains and meats we consume.
The decreased amount of physical activity have our current society
compared to that of a century ago leads to a reduced need for calories to
maintain weight. Some nutrients would be available in adequate amounts
only by the daily consumption of tremendous amounts of calories that would
cause a rapid weight gain.
For these reasons, many alternative medicine practitioners and some
traditional Western practitioners feel that nutritional supplementation is
necessary for optimum health. Taking this concept one step further, many
alternative medicine advocates seek to treat specific medical conditions
with specific plant products and herbs. This type of treatment has been
routine in traditional Chinese medicine and Ayurvedic medicine.
From a Western medicine perspective, the dangers of this philosophy lie in
two areas. First, herbs are potentially very powerful substances that
could have serious interactions with traditional Western medications,
particularly if used simultaneously without the knowledge of the treating
physician. Secondly, many traditional Western medicine physicians feel
that the use of herbs with self-diagnosis and treatment delays the
diagnosis and treatment of potentially serious medical conditions.
Alternative medicine practitioners would counter that many of traditional
Western medications have significant side effects and toxicity and may be
less effective than their treatments. As mentioned in the beginning of
this article, integrative medicine practitioners seek to find the best
evidenced-based treatment or prevention for any condition, regardless of
the medical system from which it is derived. For a full discussion of
vitamins and minerals, herbs and other nutritional supplements, please see
the VFS articles on these specific subjects.
Nutritional Medicine- Orthomolecular Medicine
Orthomolecular medicine advocates that megadoses of certain nutrients will
protect against a variety of disease states. Its most famous proponent and
originator, Linus Pauling, Ph.D., gained attention by recommending huge
doses of vitamin C to prevent and treat the common cold. Most Western
physicians do not accept this theory as valid. Other nutrients recommended
in high amounts include vitamins D and E, beta-carotene, niacin, calcium,
magnesium and folate. Some studies indicate potential benefits from large
doses of some of these nutrients. See the VFS article on Vitamins and
Minerals for information on possible benefits and observed toxic levels of
many vitamins and minerals.
Other Alternative Medical
There are numerous other alternative medicine therapies of using a host of
techniques and philosophies. VFS has not attempted to provide a
comprehensive list. We have briefly discussed several of the current
popular therapies below.
Other Alternative Medical
Reflexologists use pressure on certain mapped portions of the foot to
balance energy in certain organ systems. They may also use massage points
on the palms to seek desired effects. Although similar to acupressure, but
confined to the palms and soles, its roots are Western. There is little
danger in reflexology, but studies have yet to substantiate any claims.
Other Alternative Medical Treatments- Aroma Therapy
In this form of alternative therapy, the scent of oils is used to heal.
Certain scents may trigger strong emotions, reactions or memories, but
whether they can heal is yet to be shown. Aroma therapy is popular in many
Other Alternative Medical Treatments- Chelation Therapy
Chelation is the chemical binding and elimination of minerals from the
body. Western physicians occasionally use chelation to treat overdoses of
certain heavy metals, such as iron or lead. Most forms of chelation use
the chemical EDTA to bind minerals. Advocates suggest chelation is useful
in reversing cardiovascular disease by binding calcium in plaque in the
arteries. Evidence to support this is lacking. The treatment is prolonged,
expensive and possibly harmful, but is not as invasive as some other
interventions for heart disease.
Other Alternative Medical Treatments- Oxygen-Ozone Therapies
Most people naturally think oxygen is good for them. Certainly we need it
for cellular respiration. Unfortunately, the natural form of oxygen with
two attached molecules (O2) and its triplet form (O3) called ozone, are
potentially harmful to the body. Oxygen in increased amounts helps heal
conditions in which there is not enough blood flow to an area, such as
gangrene, decompression sickness and respiratory conditions. Too much
oxygen can be toxic however. Both oxygen and ozone increase oxidation in
the body releasing damaging free radicals. Proponents feel it can improve
AIDS, arthritis, cancer, hepatitis and cardiovascular disease. Studies to
support these claims are lacking.
Other Alternative Medical Treatments- Summary
The field of complementary and alternative medicine practices is receiving
significant consumer use and increasing scientific attention in the West.
The strengths of CAM lie in the primary care arena focusing on the patient
as a whole individual and in preventing and treating chronic disease
states. Traditional medicine strengths include well-funded scientific
studies of treatments and superiority in interventional medicine, critical
care and emergency situations, technologic advances in medical devices and
uniform certification and training of providers. Several limitations on
large scale, robust scientific studies of CAM practices lead to reluctance
to incorporate them into widespread traditional western medicine. Many CAM
therapies have been used for centuries in other cultures, with mixed
results. A closer look at Western medicine reveals elements of CAM in many
therapies considered "traditional". Certification and credentialling of
CAM providers is not uniform and the consumer needs to exercise caution in
using these forms of medical treatment. Consumers of both traditional and
CAM need to inform all of their providers about other forms of practice to
avoid dangers of adverse therapeutic interactions. A prudent approach for
medical consumers is to use the best evidence based medical therapies
available provided by certified and reputable practitioners. Prudent
traditional Western physicians and osteopaths should become familiar with
available CAM therapies and science in their field and develop a network
of reliable CAM providers for coordinated medical therapy for the benefit
of their shared patients.
FAA Standards and Reporting
While use of nutritional supplements is not specifically regulated by the
FAA, the underlying condition can often be of aeromedical significance. It
is also often difficult to determine whether a particular complementary or
alternative medical treatment would be considered a visit to "healthcare
professional" and therefore reportable on a FAA medical application.