| Contents | Previous | Next |
Medicine in the United States evolved from a mix of Native American/ Eastern, and European botanical traditions. In the mid-1800s, the medical system called bio-medicine began to dominate. Biomedicine was shaped by the observations that bacteria were responsible for producing disease and characteristic pathological damage and that antitoxins and vaccines could improve a person's ability to ward off the effects of pathogens. With this knowledge, biomedical investigators and clinicians began to conquer devastating infections and to perfect effective surgical procedures.
Thus biomedicine became the "conventional," or mainstream, health care system and began setting the standards for the diagnosis and treatment of every facet of illness. Several decades ago, however, consumer trust in conventional medicine began to falter, and many Americans sought alternative treatments outside conventional medicine. Today, alternative medicine constitutes a significant portion of Americans' health care expenditures.
A number of barriers are preventing promising alternative therapies from being investigated and developed. Structural barriers are caused by problems of classification, definition, culture, and language. Regulatory and economic barriers include legal and cost implications of complying with Federal and State regulations. Belief barriers have been caused by constraining ideologies, misconceptions, and myths.
In late 1992, Congress established the Office of Alternative Medicine (OAM) within the Office of the Director, National Institutes of Health (NIH), to facilitate the fair, scientific evaluation of alternative therapies that could improve many people's health and well-being. OAM, as a de facto intermediary between the alternative medical community and the Federal research and regulatory communities, seeks to reduce barriers that may keep promising alternative therapies from coming to light.
Part I of this report examines six fields of alternative medicine: mind-body interventions, bioelectromagnetics applications in medicine, alternative systems of medical practice, manual healing methods, pharmacological and biological treatments, herbal medicine, and diet and nutrition in the prevention and treatment of chronic disease. Part II deals with a number of cross-cutting issues germane to all six fields, including research infrastructure, research databases, research methodologies, the peer review process, and public information activities. The major recommendations from all chapters are included at the end of this executive summary.
Most traditional medical systems make use of the interconnectedness of mind and body and the power of each to affect the other. During the past 30 years there has been a growing scientific movement to explore the mind's capacity to affect the body. The clinical aspect of this enterprise is called mind-body medicine. Mind and body are so integrally related that it makes little sense to refer to therapies as having impact just on the mind or the body.
Mind-body interventions often help patients experience and express their illness in new, clearer ways. Distinctions between curing and healing have little place in contemporary medical practice but are important to patients. Perceived meaning has direct consequences to health. The placebo response is one of the most widely known examples of mind-body interactions in contemporary, scientific medicine, yet it is also one of the most undervalued, neglected assets in medical practice. That the placebo response relies heavily on the relationship between doctor and patient says a great deal about the importance of the doctor-patient relationship and the need to provide further medical training on understanding and using this relationship. The therapeutic potential of spirituality as well as religion also has been neglected in the teaching and practice of medicine.
Interest in the mind's role in the cause and course of cancer has been substantially stimulated by the discovery of the complex interactions between the mind and the neurological and immune systems/ the subject of the rapidly expanding discipline of psychoneuroimmunology. The profound differences in the psychological stances taken by people who survive cancer suggest that there is extreme variation both among cultures and within cultures.
Specific mind-body interventions include psychotherapy, support groups, meditation, imagery, hypnosis, biofeedback, yoga, dance therapy, music therapy, art therapy, and prayer and mental healing.
Psychotherapy directly addresses a person's emotional and mental health, which is, in turn, closely interwoven with his or her physical health. It encompasses a wide range of specific treatments from combining medication with discussion, to simply listening to the concerns of a patient, to using more active behavioral and emotive approaches. It also should be understood more generally as the matrix of interaction in which all the helping professions operate. Conventional psychotherapy is conducted primarily by means of psychologic methods such as suggestion, persuasion, psychoanalysis, and reeducation. It can be divided into general categories. All of the therapies can be undertaken either individually or in groups.
Research indicates that psychotherapeutic treatment can hasten a recovery from a medical crisis and is in some cases the best treatment for it. Psychotherapy also appears to be valuable in the treatment of somatic illnesses, in which physical symptoms appear to have no medical cause, are often improved markedly with psychotherapy. In addition, psychotherapy has been shown to speed patients' recovery time from illness. This, in turn, leads to smaller medical bills and fewer return visits to medical practitioners.
Support groups, as the research literature demonstrates, can have a powerful positive effect in a wide variety of physical illnesses, from heart disease to cancer, from asthma to strokes. Indeed, one study found that women with breast cancer who took part in a support group lived an average of 18 months longer (a doubling of the survival time following diagnosis) than those who did not participate. In addition, all the long-term survivors belonged to the therapy group.
Support groups have two other major benefits: (1) they help members form bonds with each other, an experience that may empower the rest of their lives; and (2) they are low cost or even "no cost" (e.g.. Alcoholics Anonymous).
Meditation is a self-directed practice for relaxing the body and calming the mind. Most meditative techniques have come to the West from Eastern religious practices, particularly India, China, and Japan, but can be found in all cultures of the world. Until recently, the primary purpose of meditation has been religious, although its health benefits have long been recognized. During the past 15 years, it has been explored as a way of reducing stress on both mind and body. Cardiologists, in particular, often recommend it as a way of reducing high blood pressure.
Some studies have found that regular meditation reduces health care use; increases longevity and quality of life; reduces chronic pain; reduces anxiety; reduces high blood pressure; reduces serum cholesterol level; reduces substance abuse; increases intelligence-related measures; reduces post-traumatic stress syndrome in Vietnam veterans; reduces blood pressure; and lowers blood cortisol levels initially brought on by stress.
Imagery is both a mental process (as in imagining) and a wide variety of procedures used in therapy to encourage changes in attitudes, behavior, or physiological reactions. As a mental process, it is often defined as "any thought representing a sensory quality." It includes, as well as the visual, all the senses—aural, tactile, olfactory, proprioceptive, and kinesthetic.
Imagery has been successfully tested as a strategy for alleviating nausea and vomiting associated with chemotherapy in cancer patients, to relieve stress, and to facilitate weight gain in cancer patients. It has been successfully used and tested for pain control in a variety of settings; as adjunctive therapy for several diseases, including diabetes; and with geriatric patients to enhance immunity.
Imagery is usually combined with other behavioral approaches. It is best known in the treatment of cancer as a means to help patients mobilize their immune systems, but it also is used as part of a multidisciplinary approach to cardiac rehabilitation and in many settings that specialize in treating chronic pain.
Hypnosis and hypnotic suggestion have been a part of healing from ancient times. The induction of trance states and the use of therapeutic suggestion were a central feature of the early Greek healing temples and variations of these techniques were practiced throughout the ancient world.
Modem hypnosis began in the 18th century with Franz Anton Mesmer, who used what he called "magnetic healing" to treat a variety of psychological and psychophysiological disorders, such as hysterical blindness, paralysis, headaches, and joint pains. Since then, the fortunes of hypnosis have ebbed and flowed. Freud, at first, found it extremely effective in treating hysteria and then, troubled by the sudden emergence of powerful emotions in his patients and his own difficulty with its use, abandoned it.
In the past 50 years, however, hypnosis has experienced a resurgence, first with physicians and dentists and more recently with psychologists and other mental health professionals. Today, it is widely used for addictions, such as smoking and drug use, for pain controls, and for phobias, such as the fear of flying.
One of the most dramatic uses of hypnosis is the treatment of congenital ichthyosis (fish skin disease), a genetic skin disorder that covers the surface of the skin with grotesque hard, wart-like, layered crust. Hypnosis is, however, most frequently used in more common ailments, either independently or in concert with other treatment, including the management of pain in a variety of settings, reduction of bleeding in hemophiliacs, stabilization of blood sugar in diabetics, reduction in severity of attacks of hay fever and asthma, increased breast size, the cure of warts, the production of skin blisters and bruises, and control of reaction to allergies such as poison ivy and certain foods.
Biofeedback is a treatment method that uses monitoring instruments to feed back to patients physiological information of which they are normally unaware. By watching the monitoring device, patients can learn by trial and error to adjust their thinking and other mental processes in order to control bodily processes heretofore thought to be involuntary—such as blood pressure, temperature, gastrointestinal functioning, and brain wave activity.
Biofeedback can be used to treat a very wide variety of conditions and diseases, ranging from stress, alcohol and other addictions, sleep disorders, epilepsy, respiratory problems, and fecal and urinary incontinence to muscle spasms, partial paralysis, or muscle dysfunction caused by injury, migraine headaches, hypertension, and a variety of vascular disorders. More applications are being developed yearly.
Yoga is a way of life that includes ethical precepts, dietary prescriptions, and physical exercise. Its practitioners have long known that their discipline has the capacity to alter mental and bodily responses normally thought to be far beyond a person's ability to modulate them. During the past 80 years, health professionals in India and the West have begun to investigate the therapeutic potential of yoga. To date, thousands of research studies have been undertaken and have shown that with the practice of yoga a person can, indeed, lean to control such physiologic parameters as blood pressure, heart rate, respiratory function, metabolic rate, skin resistance, brain waves, body temperature, and many other bodily functions.
Regular yogic meditation also has been shown to reduce anxiety levels; cause the heart to work more efficiently and decrease respiratory rate; lower blood pressure and alter brain waves; increase communication between the right and left brain; reduce cholesterol levels (when used with diet and exercise); help people stop smoking; and successfully treat arthritis.
Dance therapy began formally in the United States in 1942, and in 1956 dance therapists from across the country founded the American Dance Therapy Association, which has now grown to over 1,100 members. It publishes a journal, the American Journal of Dance Therapy, fosters research, monitors standards for professional practice, and develops guidelines for graduate education.
Dance / movement therapy has been demonstrated to be clinically effective in the following: developing body image, improving self-concept and increasing self-esteem; facilitating attention; ameliorating depression, decreasing fears and anxieties, and expressing anger; decreasing isolation, increasing communication skills, and fostering solidarity; decreasing bodily tension, reducing chronic pain, and enhancing circulatory and respiratory functions; reducing suicidal ideas, increasing feelings of well-being, and promoting healing; and increasing verbalization.
Music therapy is used in psychiatric hospitals, rehabilitation facilities, general hospitals, outpatient clinics, day-care treatment centers, residences for people with developmental disabilities, community mental health centers, drug and alcohol programs, senior centers, nursing homes, hospice programs, correctional facilities, halfway houses, schools, and private practice.
Studies have found music therapy effective as an analgesic, as a relaxant and anxiety reducer for infants and children, and as an adjunctive treatment with burn patients, cancer patients, cerebral palsy patients, and stroke, brain injury, or Parkinson's disease patients.
Art therapy is a means for the patient to reconcile emotional conflicts, foster self-awareness, and express unspoken and frequently unconscious concerns about his/her disease. In addition to its use in treatment, it can be used to assess individuals, couples, families, and groups. It is particularly valuable with children who often cannot talk about their real concerns.
Research on art therapy has been conducted in clinical, educational, physiological, forensic, and sociological arenas. Studies on art therapy have been conducted in many areas including with burn recovery in adolescent and young patients, with eating disorders; with emotional impairment in young children, with reading performance, with chemical addiction, and with sexual abuse in adolescents.
Prayer and mental healing techniques fall into two main types. In Type I healing, the healer enters a prayerful, altered state of consciousness in which he views himself and the patient as a single entity. There need be no physical contact and there is no attempt to "do anything" or "give something" to the person in need, only the desire to unite and "become one" with him or her and with the Universe, God, or Cosmos. Type II healers, on the other hand, do touch the healee and describe some "flow of energy" through their hands to the patient's area of pathology. Feelings of heat are common in both healer and healee. These healing techniques are offered only as generalities. Some healers use both methodologies, even in the same healing session, and other healing methods could be described.
There exist many published reports of experiments in which persons were able to influence a variety of cellular and other biological systems through mental means. The target systems for these investigations have included bacteria, yeast, fungi, mobile algae, plants, protozoa, larvae, insects, chicks, mice, rats, gerbils, cats, and dogs, as well as cellular preparations (blood cells, neurons, cancer cells) and enzyme activities. In human "target persons," eye movements, muscular movements, electrodermal activity, plethysmographic activity, respiration, and brain rhythms have been affected through direct mental influence.
These studies in general assess the ability of humans to affect physiological functions of a variety of living systems at a distance, including studies where the "receiver" or "target" is unaware that such an effort is being made. The fact that these studies commonly involve nonhuman targets is important; lower organisms are presumably not subject to suggestion and placebo effects, a frequent criticism when human subjects are involved.
Many of these studies do not describe the psychological strategy of the influencer as actual "prayer," in which one directs entreaties to a Supreme Being, a Universal Power, or God. But almost all of them involve a state of prayerful-ness—a feeling of genuine caring, compassion, love, or empathy with the target system, or a feeling that the influencer is "one" with the target.
In addition to preventing or curing illnesses, these therapies by and large provide people the chance to be involved in their own care, to make vital decisions about their own health, to be touched emotionally, and to be changed psychologically in the process. Many patients today believe their doctor or medical system is impersonal, remote, and uncaring. The mind-body approach is potentially a corrective to this tendency, a reminder of the importance of human connection that opens up the power of patients acting on their own behalf.
More work needs to be done, but there is already a growing amount of evidence that many of the mind-body therapies discussed in this report, if appropriately selected and wisely applied, can be clinically as well as economically cost-effective, that they work, and that they are safe.
Bioelectromagnetics (BEM) is an emerging science that studies how living organisms interact with electromagnetic (EM) fields. Electrical phenomena are found in all living organisms, and electrical currents in the body can produce magnetic fields that extend outside the body. Those that extend outside the body can be influenced by external magnetic and EM fields. Changes in the body's natural fields may produce physical and behavioral changes.
Endogenous (internal) fields are distinguished from exogenous (external) fields. The latter can be natural, such as the earth's geomagnetic field, or artificial, such as power lines, transformers, appliances, radio transmitters, or medical devices. Oscillating nonionizing EM fields in the extremely low frequency (ELF) range can have vigorous biological effects that may be beneficial. Changes in the field configuration and exposure pattern of low-level EM fields can produce specific biological responses, and certain frequencies have specific effects on body tissues.
The mechanism by which EM fields produce biological effects is under increasing study. At the cutting edge of BEM research is the question of how endogenous EM fields change with consciousness. Nonionizing BEM medical applications are classified according to whether they are thermal or non thermal in biological tissue. Thermal applications of nonionizing radiation include radio frequency (RF) hyperthermia, laser and RF surgery, and RF diathermy.
The most important BEM modalities in alternative medicine are non thermal applications of nonionizing radiation. Major new applications of non thermal, nonionizing EM fields are bone repair, nerve stimulation, wound healing, treatment of osteoarthritis, electroacupuncture, tissue regeneration, and immune system stimulation.
In the study of other alternative medical treatments, BEM offers a unified conceptual framework that may help explain how diagnostic and therapeutic techniques such as acupuncture and homeopathy may produce results that are hard to understand from a more conventional viewpoint.
Worldwide, only an estimated 10 percent to 30 percent of human health care is delivered by conventional, biomedically oriented practitioners. The remaining 70 percent to 90 percent ranges from self-care according to folk principles to care given in an organized health care system based on an alternative tradition or practice.
Popular health care is the kind most people practice and receive at home, such as giving herbal tea to someone who has a cold. Community-based health care, which reflects the health needs, beliefs, and natural environments of those who use it, refers to the non professionalized but specialized health care practices of many rural and urban people. Professionalized health care is more formalized; practitioners undergo more standardized training and work in established locations.
Professionalized health care systems. The professionalized health care practitioners often have conducted scientific studies about the causes of illness and explanations and results of treatment. Each of the major professionalized systems has certain characteristics: a theory of health and disease; an educational scheme to teach its concepts; a delivery system involving practitioners; a material support system to produce medicines and therapeutic devices; a legal and economic mandate to regulate its practice; cultural expectations about the medical system's role; and a means to confer professional status on approved providers. These professionalized medical systems include traditional oriental medicine, acupuncture, Ayurvedic medicine, homeopathy, anthroposophy, naturopathy, and environmental medicine
Traditional oriental medicine is a sophisticated set of many systematic techniques and methods, including acupuncture, herbal medicine, acupressure, qigong, and oriental massage. The most striking characteristic of oriental medicine is its emphasis on diagnosing disturbances of qi, or vital energy, in health and disease. Diagnosis in oriental medicine involves the classical procedures of observation, listening, questioning, and palpation, including feeling pulse quality and sensitivity of body parts.
The professionalization of oriental medicine has taken diverse paths in both East Asia and the United States. Currently, the model in the People's Republic of China, which was established after the 1949 revolution, involves the organized training of practitioners in schools of traditional Chinese medicine. The curriculum of these schools includes acupuncture, oriental massage, herbal medicine, and pharmacology, though the clinical style of making a diagnosis and then designing a treatment plan is the one traditionally associated with herbal medicine. The graduates of these colleges are generally certified in one of the four specialty areas at a training level roughly equivalent to that of a Western country's bachelor's degree.
In the United States, the professional practitioner base for oriental medicine is organized around acupuncture and oriental massage. There are about 6,500 acupuncturist practitioners in the United States. The American Oriental Body Work Therapy Association has approximately 1,600 members representing practitioners of tuina, shiatsu, and related techniques. Many American schools of acupuncture are evolving into "colleges of oriental medicine" by adding courses in oriental massage, herbal medicine, and dietary interventions. They also are offering diplomas, master's degrees, and doctor's degrees in oriental medicine. The legal sanctioning of oriental medical practice is most extensive in New Mexico, where the acupuncture community has established an exclusive profession of oriental medicine. Their legal scope of practice is currently similar to that of primary care M.D.s and D.O.s (doctors of osteopathy), and their State statute restricts other licensed New Mexico health professionals' ability to advertise or bill for oriental medicine or acupuncture services.
Extensive research has been done in China through the institutions of traditional Chinese medicine, but only in the past quarter century have biomedical scientists in China characterized and identified active agents in much of traditional medical formulary. The use of traditional oriental herbal medicines and formulas in China and Japan has been studied for therapeutic value in the following areas: chronic hepatitis; rheumatoid arthritis; hypertension; atopic eczema; various immunologic disorders, including acquired immunodeficiency syndrome (AIDS); and certain cancers. It would be useful to repeat these studies in the United States, assessing U.S. clinical populations according to high-quality research criteria.
Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes. Puncturing the skin with a needle is the usual method, but practitioners also use heat, pressure, friction, suction, or impulses of electromagnetic energy to stimulate the points. In the past 40 years acupuncture has become a well-known, reasonably available treatment in developed and developing countries. Acupuncture is used to regulate or correct the flow of qi to restore health.
Modern theories of acupuncture are based on laboratory research conducted in the past 40 years. Acupuncture points have certain electrical properties, and stimulating these points alters chemical neurotransmitters in the body. The physiological effects of acupuncture stimulation in experimental animals have been well documented, and in the past 20 years acupuncture has become an increasingly established health care practice. An estimated 3,000 conventionally trained U.S. physicians have taken courses to incorporate acupuncture in their medical practices.
Acupuncture is one of the most thoroughly researched and documented of the so-called alternative medical practices. A series of controlled studies has shown compelling evidence for the efficacy of acupuncture in the treatment of a variety of conditions, including osteoarthritis, chemotherapy induced nausea, asthma, back pain, painful menstrual cycles, bladder instability, and migraine headaches. Studies on acupuncture also have shown positive results in the areas of chronic pain management and in the management of drug addiction, two areas where conventional Western medicine has had only a modicum of success.
Ayurveda is India's traditional, natural system of medicine that has been practiced for more than 5,000 years. Ayurveda provides an integrated approach to preventing and treating illness through lifestyle interventions and natural therapies. Ayurvedic theory states that all disease begins with an imbalance or stress in the individual's consciousness. Lifestyle interventions are a major Ayurvedic preventive and therapeutic approach. There are 10 Ayurveda clinics in North America, including one hospital based clinic that has served 25,000 patients since 1985.
In India, Ayurvedic practitioners receive state-recognized, institutionalized training in parallel to their physician counterparts in India's state-supported systems for conventional Western biomedicine and homeopathic medicine. The research base is growing concerning the physiological effects of meditative techniques and yoga postures in Indian medical literature and Western psychological literature. Published studies have documented reductions in cardiovascular disease risk factors, including blood pressure, cholesterol, and reaction to stress, in individuals who practice Ayurvedic methods.
Laboratory and clinical studies on Ayurvedic herbal preparations and other therapies have shown them to have a range of potentially beneficial effects for preventing and treating certain cancers, treating infectious disease, promoting health, and treating aging. Mechanisms underlying these effects may include free-radical scavenging effects, immune system modulation, brain neurotransmitter modulation, and hormonal effects.
Homeopathic medicine is practiced worldwide, especially in Europe, Latin America, and Asia. However, even in the United States the homeopathic drug market is a multimillion-dollar industry. Homeopathic remedies, which are made from naturally occurring plant, animal, or mineral substances, are recognized and regulated by the Food and Drug Administration (FDA) and are manufactured by established pharmaceutical companies under strict guidelines. Homeopathy is used to treat acute and chronic health problems as well as for disease prevention and health promotion. Recent clinical trials suggest that homeopathic medicines have a positive effect on allergic rhinitis, fibrositis, and influenza.
Basic research in homeopathy has involved investigations into the chemical and biological activity of highly diluted substances. Some homeopathic medicines are diluted to concentrations as low as 10-30 to 10-20'000. This particular aspect of homeopathic theory and practice has caused many modern scientists to reject homeopathic medicine. Critics of homeopathy contend that such extreme dilutions of the medicines are beyond the point at which any active molecules of the medicine can theoretically still be found in the solution. On the other hand, scientists who accept the potential benefits of homeopathic theory suggest several theories to explain how highly diluted homeopathic medicines may act. Using recent developments in quantum physics, they have proposed that electromagnetic energy in the medicines may interact with the body on some level. Researchers in physical chemistry have proposed the "memory of water" theory, whereby the structure of the water-alcohol solution is altered by the medicine during the process of dilution and retains this structure even after none of the actual substance remains.
Anthroposophically extended medicine is an extension of Western biomedicine and also incorporates approaches and therapeutics from two alternative medicine movements: naturopathy and homeopathy. There are an estimated 30 to 100 M.D.s in the United States who practice anthroposophical medicine. Hundreds of uniquely formulated medications are used in anthroposophical practice, each seeking to match the key dynamic forces in plants, animals, and minerals with disease processes in humans to stimulate healing. Much research in anthroposophically extended medicine has been connected with attempts to understand the nature of disease, assess treatments qualitatively, and understand how the essential properties of the objects under investigation could be applied in therapy.
Naturopathic medicine, as a distinct American health care profession, is almost 100 years old. It was founded as a formal health care system at the turn of the century by medical practitioners from various natural therapeutic disciplines. By the early 1900s, more than 20 naturopathic medical schools existed, and naturopathic physicians were licensed in most States. Today there are more than 1,000 licensed naturopathic doctors in the United States.
As practiced today, naturopathic medicine integrates traditional natural therapeutics—including botanical medicine, clinical nutrition, homeopathy, acupuncture, traditional oriental medicine, hydrotherapy, and naturopathic manipulative therapy—with modern scientific medical diagnostic science and standards of care. The medical research base of naturopathic practice consists of empirical documentation of treatments using case history observations, medical records, and summaries of practitioners' clinical experiences.
At present, the two accredited naturopathic medical schools in the United States have active research departments. Naturopathic researchers have investigated the pharmacology and physiological effects of nutritional and natural therapeutic agents, and naturopathic physicians have been active in the investigation of new homeopathic remedies and in the natural treatment of women's health problems. The most recently completed naturopathic study in women's health tested the clinical and endocrine effects of a botanical formula as an alternative to estrogen replacement therapy. Results of this study showed a clinically significant benefit (measured as reduction in the total number of menopausal symptoms) among the treated women versus the placebo group.
Environmental medicine, like anthroposophically extended medicine, also can be viewed as an extension of modern biomedicine. Environmental medicine traces its roots to the practice of allergy treatment and the work of Dr. Theron Randolph in the 1940s, who identified a variety of common foods and chemicals that were able to trigger the onset of acute and chronic illness even when exposure was at relatively low levels.
Environmental medicine recognizes that illness in individuals can be caused by a broad range of incitant substances, including foods, chemicals found at home and in the workplace, and chemicals in the air, water, and food. Today there are 3,000 physicians worldwide practicing environmental medicine, and there are several environmental control units in the United States and one in Canada, where patients' sensitivities are unmasked through fasting and complete avoidance of potentially incitant chemicals.
Research in this field has been directed at clinical treatment of patients and at evaluation of the diagnostic and treatment techniques used by practitioners. Other studies have supported the use of the approaches of environmental medicine in treating arthritis, asthma, chemical sensitivity, colitis, depression, eczema, fatigue, and hyperactivity.
The belief that humans can get sick from cumulative low-level environmental exposure to certain incitants is not well accepted by the conventional medical community. However, because "sick building syndrome" and other chronic conditions that cannot be explained by other phenomena are being seen with greater frequency, environmental medicine offers a theoretical groundwork for dealing with such phenomena Indeed, environmental medicine is in a position to be a leading force in the investigation of ways to reduce the incidence of these and other disorders.
Community-based health care practices. Community-based health care practices are varied and found throughout the United States. Like other health care specialists, community-based healers may emphasize naturalistic, personalistic, or energetic explanatory models or a combination. Traditional midwives and herbalists and nowadays, pragmatic weight loss specialists are probably the best known of community-based practitioners who follow the naturalistic model. In addition, the Native American medicine man or medicine woman is a community-based traditional healer with primarily naturalistic skills, that is, the skills of an herbalist in particular. Some medicine people are also shamans, in which case they are often distinguished as holy men and women.
In contrast to professionalized practitioners, community-based healers often do not have set locations such as offices or clinics for delivering care but do so in homes, at ceremonial sites, or even right where they stand. Community-based healing of the personalistic variety can also be "distant," that is, it does not require that practitioner and patient be in each other's presence. Prayers or shamanic journeys, for example, can be requested and "administered" at any time, and charm cures are sometimes delivered by telephone.
Meanwhile, community-based systems also thrive in urban areas. These systems include the popular weight loss programs and other 12-step programs. Often the practitioners rent office space and emphasize contact between client and practitioner, and they may charge considerable fees. Since these practitioners depend on their healing practice for their livelihood, they advertise and so may be easier to identify and contact for study purposes.
Native American Indian community-based medical systems all share the following rituals and practices: sweating and purging, usually done in a "sweat lodge"; the use of herbal remedies gathered from the surrounding environment and sometimes traded over long distances; and shamanic healing involving naturalistic or personalistic healing. Tribes such as the Lakota and Dineh (Navajo) also use practices such as the medicine wheel, sacred hoop, and the "sing," which is a healing ceremonial that lasts from 2 to 9 days and nights and is guided by a highly skilled specialist called a "singer."
Formal research into the healing ceremonies and herbal medicines conducted and used by bona fide Native American Indian healers or holy people is almost nonexistent, even though Native American Indians believe they positively cure both the mind and body. Ailments and diseases such as heart disease, diabetes, thyroid conditions, cancer, skin rashes, and asthma reportedly have been cured by Native American Indian doctors who are knowledgeable about the complex ceremonies.
Latin American community-based practices include curanderismo, which is a folk system of medicine that includes two distinct components: a humoral model for classifying activity, food, drugs, and illness; and a series of folk illnesses.
In the humoral component of curanderismo things could be classified as having qualitative (not literal) characteristics of hot or cold, dry or moist. According to this theory, good health is maintained by maintaining a balance of hot and cold. Thus, a good meal will contain both hot and cold foods, and a person with a hot disease must be given cold remedies and vice versa. Again, a person who is exposed to cold when excessively hot may "take cold" and become ill.
The second component, the folk illnesses, is actively in use in much of Mexico and among less educated Hispanic U.S. citizens. Studies have found that as many as 96 percent of Mexican-American households (more frequent in the less Americanized communities) treated members for Hispanic folk illnesses. Similarly high use patterns among Mexican migrant workers has been found in Florida and Mexico.
Although no formal effectiveness studies seem to have been done on this system, its wide popularity and the research suggesting the relevance of the folk diagnoses for biomedical practice indicate the need for further demographic and effectiveness studies.
Alcoholics Anonymous (AA) is an example of an urban community-based healing system for helping people whose lives are damaged by the consumption of alcohol to stop drinking. Founded in 1935 by Bob Smith, M.D., and Bill Wilson, two alcoholics, it is a patient-centered self-help fellowship of men and women. AA has burgeoned and today is widely considered the most successful existing method for supporting sobriety.
In contrast to most community-based systems, a very large literature exists analyzing AA. Several models attempt to explain its success. One popular psychometric model interprets AA as a "cult" and the achievement of sobriety as a "conversion experience." Another model, however, asserts that members recover by integrating their own experiences with alcohol with those of others in the group and by learning and practicing some new ways to behave. Through these new ways, AA members feel as if they are living apart from the urban materialist norm; that the cause of alcoholism is not at issue; that people should share, not compete; and that the individual need not rise above the rest (spiritual anonymity).
Studies have concluded that active AA membership allows up to 68 percent of alcoholics to drink less or not at all for up to a year, and 40 percent to 50 percent to achieve sobriety for many years. More active or dedicated members (those who attend meetings more often) remain sober longer.
Touch and manipulation with the hands have been in use in health and medical practice since the beginning of medical care. Physicians' hands were once their most important diagnostic and therapeutic tool. Today, however, many medical and health practitioners tend to retreat from physical contact with the patient, distanced by diagnostic equipment and legal and time constraints.
The manual healing methods are based on the understanding that dysfunction of a part of the body often affects secondarily the function of other discrete, not necessarily directly connected, body parts. Consequently, theories and processes have been developed for correcting secondary dysfunctions by manipulating soft tissues or realigning body parts. Overcoming misalignments and manipulating soft tissues bring the parts back to optimal function, and the body returns to health.
One of the earliest U.S. health care systems to use manual healing methods was osteopathic medicine. In 1993 more than 32,000 American-educated and -licensed D.O.s were practicing in the United States. More than 60 percent of osteopathic physicians are involved in primary care— family medicine, pediatrics, internal medicine, and obstetrics-gynecology. An extensive body of work supports the use of osteopathic techniques for musculoskeletal and nonmusculoskeletal problems. Nearly all osteopathically oriented research has been funded from the private sector.
Chiropractic science is concerned with investigating the relationship between structure (primarily of the spine) and function (primarily of the nervous system) of the human body to restore and preserve health. Chiropractic medicine applies such knowledge to diagnosing and treating structural dysfunctions that can affect the nervous system. Chiropractic physicians use manual procedures and interventions, not surgical or chemotherapeutic ones. In 1993 more than 45,000 licensed chiropractors were practicing in the United States.
Chiropractic specialty areas are extremely pertinent to other medical specialties, such as radiology, orthopedics, neurology, and sports medicine. Current chiropractic research interests include back and other pain, somatovisceral disorders, and reliability studies.
Massage therapy, one of the oldest methods in health care practice, is the scientific manipulation of the soft body tissues to return those tissues to their normal state. Massage consists of a group of manual techniques that include applying fixed or movable pressure and holding and causing the body to move. Primarily the hands are used, but sometimes forearms, elbows, and feet are used also. These techniques can affect the musculoskeletal, circulatory-lymphatic, and nervous systems. Massage therapy encompasses the concept of vis medicatrix naturae—helping the body heal itself—and is aimed at achieving or increasing health and well-being. Touch is the fundamental medium of massage therapy.
Massage therapists are licensed by 19 States and several localities. Most States require 500 or more hours of education from a recognized school program and a licensing examination. Massage therapy techniques include Swedish massage, deep-tissue massage, sports massage, neuromuscular massage, and manual lymph drainage. Other physical healing methods include reflexology, zone therapy, tuina, acupressure Rolfing, Trager, Feldenkrais method, and Alexander technique.
Biofield therapeutics—laying on of hands—is also a very old form of healing. The earliest Eastern references are in the Huang Ti Nei Ching Su Wen (The Yellow Emperor's Classic of Internal Medicine), dated between 2,500 and 5,000 years ago. The underlying rationales cluster around two views: first, that the healing force comes from a source other than the practitioner—God, the cosmos, or another supernatural entity—and second, that a human biofield directed, modified, or amplified in some way by the practitioner is the operative mechanism.
During biofield treatment, the practitioner places hands directly on or near the patient's body to improve general health or treat a specific dysfunction. Treatment sessions may take from 20 minutes to an hour or more; a series of sessions is often needed to treat some disorders. There is consensus among practitioners that the biofield permeates the physical body and extends outward for several inches. Extension of the external biofield depends on the person's emotional state and health. Biofield practitioners have a holistic focus. About 50,000 practitioners provide 18 million sessions annually in the United States.
At least three forms of biofield therapetutics are used in medical care inpatient and outpatient settings: healing touch, therapeutic touch, and SHEN therapy. No generally accepted theory accounts for the effect of these therapies.
Pharmacological and biological treatments are an assortment of drugs and vaccines not yet accepted by mainstream medicine. A sampling of biological and pharmacological treatments currently being offered by alternative medical practitioners includes the following:
A major impediment to full investigation of alternative pharmacological and biological treatments is the high expense of conducting the trials needed to meet FDA approval. Most alternative treatments lack sponsors and funding for clinical trials of safety and effectiveness. Many potentially useful alternative drugs or vaccines are supported by data indicating they may be useful in treating cancer, AIDS, heart disease, hepatitis, and other major health problems.
All cultures have long folk medicine traditions that include the use of plants and plant products. Even in ancient cultures, people methodically collected information on herbs and developed well-defined herbal pharmacopoeias. Indeed, well into the 20th century much of the pharmacopoeia of scientific medicine was derived from the herbal lore of native peoples. Many drugs commonly used today are of herbal origin. Indeed, about one-quarter of the prescription drugs dispensed by community pharmacies in the United States contain at least one active ingredient derived from plant material.
The World Health Organization (WHO) estimates that 4 billion people, 80 percent of the world population, presently use herbal medicine for some aspect of primary health care. Herbal medicine is a major component in all indigenous peoples' traditional medicine and a common element in Ayurvedic, homeopathic, naturopathic, traditional oriental, and Native American Indian medicine.
Although during the centuries the discovery of useful therapeutics from plants has changed the face of medicine and the course of civilization, many people, especially some in the Federal Government, evaluate herbal remedies as though they were either worthless or dangerous. Today in the United States, herbal products can be marketed only as food supplements. An herb manufacturer or distributor can make no specific health claims without FDA approval. Despite FDA skepticism, a growing number of Americans are interested in herbal preparations.
Two features of European drug regulation make that market more hospitable to natural remedies. First, it costs less and takes less time in Europe to approve medicines as safe and effective. This is especially true of substances that have a long use history and can be approved under the "doctrine of reasonable certainty." European guidelines for the assessment of herbal remedies follow up on WHO'S Guidelines for the Assessment of Herbal Medicines, which state that a substance's historical use is a valid way to document safety and efficacy in the absence of scientific evidence to the contrary.
France, where traditional medicines can be sold with labeling based on traditional use, requires licensing by the French Licensing Committee and approval by the French Pharmacopoeia Committee. Germany considers whole herbal products one active ingredient; this makes it simpler to define and approve the product. The German Federal Health Office regulates products such as ginkgo and milk thistle extracts so that potency and manufacturing processes are standardized. England generally follows the rule of prior use; that is, years of use with apparent positive effects and no evidence of detrimental side effects constitute enough evidence—in lieu of other scientific data—that the product is safe.
In Japan, China, and India, patent herbal remedies composed of dried and powdered whole herbs or herb extracts, often in tablet form, are the rule. Traditional herbals are the backbone of China's medicine. Japan's traditional medicine, kampo, is similar to and historically derived from Chinese medicine but includes traditional medicines from Japanese folklore. Herbal medicines are the staple of medical treatment in many developing countries and are used for many types of ailments.
European phytomedicines are among the world's best studied medicines, researched in leading European universities and hospitals. Some have been in clinical use under medical supervision for more than 10 years, with tens of millions of documented cases. This form of botanical medicine most closely resembles American medicine. In Europe there have been credible research studies reporting positive effects on a variety of chronic illnesses for herbs such as Sily-bum marianum (milk thistle), Ginkgo biloba (ginkgo), Vaccinium myrtillus (bilberry extract), and Ilex guayusa. Many herbs in China have been studied extensively by methods that are acceptable from the Western perspective; among these herbs are ginseng, fresh ginger rhizome, Chinese foxglove root, baical skullcap root, wild chrysanthemum flower, and licorice root. A number of Ayurvedic herbs also have recently been studied in India under modern scientific conditions, including Eclipta alba, Indian gooseberry, neem, turmeric, and trikatu.
Reports of positive effects of herbal preparations in developing countries and Native American Indian herbs are primarily anecdotal. However, since much modern-day medicine is directly or indirectly derived from such folklore sources, it seems illogical to conclude that there are no more significant treatments or cures for major diseases to be found in the world from plant sources.
Throughout evolution, human beings adapted to a wide range of naturally occurring foods, but the types of food and the mix of nutrients (in terms of carbohydrates, fats, and proteins) remained relatively constant. Food supplies were often precarious, and the threat of death from starvation was a constant preoccupation for most early humans.
However, about 10/000 years ago the agricultural revolution began making profound dietary changes in many human populations. The ability to produce and store large quantities of dried foods led to preferential cultivation of some foods, such as grains, which constituted new challenges to the human digestive system. Then about 200 years ago, the Industrial Revolution introduced advances in food production, processing, storage, and distribution. Recent technological innovations, along with increased material well-being and lifestyles that have allowed people more freedom in deciding what and when they wish to eat, have led to even further major dietary changes in developed countries. Because changes in the dietary patterns of the more technologically developed countries, such as the United States, have been so dramatic and rapid, the people consuming these affluent diets have had little time to adapt bio-logically to the types and quantities of food that are available to them today. The longer term adverse health effects of the diet prevailing in these countries—characterized by an excess of energy-dense foods rich in animal fat, partially hydrogenated vegetable oils, and refined carbohydrates but lacking in whole grains, fruits, and vegetables—have become apparent only in recent decades.
Because of the recent, rapid rise in chronic illness related directly or indirectly to diet, the focus of nutrition research has shifted away from eliminating nutritional deficiency to dealing with chronic diseases caused by nutritional excess. Another concern among nutrition researchers is the accumulation of evidence indicating that less-than-adequate intake of some micronutrients over a long period may increase the risks of developing coronary heart disease, cancers, cataracts, and birth defects. In recent decades the data on the relationship between certain dietary habits and nutritional intake have been growing exponentially. Designing interventions based on this wealth of research has become increasingly more difficult and complex.
The Federal Government's approach to dietary intervention, formulated by boards composed of nutrition scientists, generally does not recommend supplementing the typical American diet with vitamins or nutrients beyond the recommended daily allowances (RDAs), nor does it suggest that some foods never be eaten. In contrast, many alternative dietary approaches contend that no amount of manipulation of the typical American diet is enough to promote optimum health or prevent eventual chronic illness. These alternative approaches represent a continuum of philosophies ranging from the concept that supplementing the typical American diet somewhat beyond the RDAs is necessary to promote optimum health, to the idea that supplementation well beyond the RDAs is often required to reverse the effects of long-term deficiencies. Other approaches advocate drastic dietary modification, either eliminating or adding certain types of foods or macronutrients, to treat specific types of conditions such as cancer and cardiovascular disease. Finally, there is the view that certain major staples of the typical American diet, such as meat and dairy products, are basically unhealthy and should be generally avoided.
There is a growing body of data supporting the notion that the RDAs for minerals, such as calcium and magnesium, may be too low and that supplementation may be necessary to prevent the onset of chronic diseases. In addition, the RDAs for a number of vitamins and micronutrients, such as vitamin C, vitamin D, vitamin E, folate, and beta-carotene, may not be adequate to prevent chronic illness. For example, recent studies have found that the RDA for folate may need to be doubled for women as well as men.
Orthomolecular medicine—the therapeutic use of high-dose vitamins to treat chronic disease—promotes improving health and treating disease by using the optimum concentration of substances normally present in the body. Increasing the intake of such nutrients to levels well above those usually associated with preventing overt deficiency disease may have health benefits for some people. There is at least preliminary evidence that orthomolecular remedies may be effective in treating AIDS; bronchial asthma; cancer; cardiovascular disease, heart attacks, and stroke; lymph edema; and mental and neurological disorders.
A variety of alternative diets are offered for treating cancer, cardiovascular disease, and food allergies. Virtually all these interventions focus on eating more fresh and freshly prepared vegetables, fruits, whole grains, and legumes. Allergy to food has become a major area of research. Food intolerance is being studied as a causal or contributing factor in rheumatoid arthritis, and there is evidence that food-elimination diets may help many hyperactive children.
Some alternate dietary lifestyles are believed to offer a greater resistance to illness. These include several variations of the vegetarian diet, such as those consumed by Seventh-Day Adventists and proponents of the macrobiotic diet. Studies have found a significant lowering of risk factors for heart disease and certain forms of cancer in these two groups. Recent studies have also reported that certain cultural eating styles, such as the Asian and Mediterranean diets, appear to lower risk factors for heart disease and certain forms of cancer as well. Although there have been few controlled studies of the benefits of many traditional diets, such as those originally consumed by Native American Indians, diseases such as diabetes and cancer were not a problem for these populations until their diets became more Western, or affluent.
Because dietary and nutritional therapy interventions affect an array of biochemical and physiological processes in the body, evaluating their effectiveness may require equally complex methods. Furthermore, developing a comprehensive health care policy that incorporates diet and nutritional interventions may require taking into account Federal feeding programs and dissemination strategies that might present barriers to the effective propagation of adequate nutritional knowledge.
Like mainstream medicine, alternative medicine needs reasonable, responsible research and validation of safety and effectiveness. However, several issues must first be addressed: lack of dedicated facilities for alternative medical research, inadequate funding for alternative medical research, lack of training for alternative medical researchers, lack of a centrally located research database, difficulty in designing research, and difficulty obtaining NIH peer review of alternative medical grant applications.
Although there are pockets of alternative medical research at some U.S. research institutions, including NIH, most has been conducted outside such institutions. A factor that is structured to promote more conventional research over alternative research at most institutions is the peer review process, intended to limit poorer research from being funded or published.
Several alternative medical colleges have research departments and engage in research. Their approach usually differs from that of conventional medical institutes because of a different focus and, more important, less exposure to methodological training. These researchers are more likely to be interested in determining dosages than in investigating whether or how a treatment works. The interest of conventional researchers in dosages and optimal treatment combinations is likely to occur further along in the research process.
However, funding is both limited and precarious for these institutions. Almost without exception, Federal funding has not been available. Limited funding is available from private sources but is inadequate for current needs. Because of the limited funding, at such institutions, infrastructure and faculty have developed only minimally in their research departments. Further, at present there is little communication between these research facilities, other alternative research facilities, and their conventional counterparts. Increased research and communication are likely to benefit the Nation's health care.
Also, some clinical groups need training to become accomplished alternative medical investigators. Some require training in proper and acceptable research methods, and other researchers need exposure to alternative medical practices to be better prepared to evaluate them properly. Indeed, multidisciplinary teams conducting research in alternative medicine may be more successful if they include participants with some level of dual training in conventional medical research methodology and clinical alternative medical practice. Further, alternative medical practitioners have suggested that research in alternative medicine should be performed by individuals and teams trained in as wide as possible an array of relevant research methodologies.
Existing research centers could be enhanced, and new ones could be installed, at alternative medical institutions throughout the United States. Here also, expert faculty from various disciplines would join to evaluate efficacy, safety, clinical effectiveness, cost-effectiveness, and mechanisms of action of alternative medicine through basic as well as clinical research.
Several mainstream medical institutions recently have begun or are developing basic academic medical courses to introduce medical students and physicians in training to the theory, practice, and research of alternative medical therapies. A few other conventional institutions integrate alternative medicine in at least a limited way into the curriculum.
Properly designed, courses such as these will not only provide information on the utility of specific therapeutic approaches but develop a larger framework for understanding the strengths and limitations of more conventional medicine. These courses also will promote recognition of the contributions that theoretical and research models in alternative medicine may make to enlarging conventional research methodology.
A first step in developing a research strategy is to study previously published research literature on the subject and related subjects. Having a central source of information means investigators can go directly to the best and most current research on a topic instead of trying to collect data from disparate sources. Investigators who have access to a comprehensive research database can focus their efforts on the basis of previous research and obtain the information they need to design their own research.
Unfortunately, research into alternative medicine has been hampered because there is currently no easily accessible comprehensive database. Although a great deal of information can be found in the major medical databases on various aspects of alternative medicine, expert searching skills are needed to locate these materials. In addition, much of the little that has been collected on alternative medicine in the major medical databases has not been sufficiently indexed and catalogued. The problem is compounded if there are few journals available for a particular alternative discipline, if the relevant journals are not indexed and catalogued for inclusion in the databases, or if the data were not collected or reported properly. Other potentially valuable information is available only in non-English languages, such as the substantial bodies of literature on traditional Chinese medicine and Ayurvedic medicine.
No alternative medical system or method should be recommended for inclusion in the medical health system until it has been adequately tested. Evaluating alternative medical systems is no different from studying conventional systems—appropriate methods must be chosen to evaluate the system. Alternative medical researchers face new challenges as they address factors that lie outside the strictly biological realm. Research design, even for conventional medicine, is difficult and challenging. Researchers in alternative medicine are challenged by the need to apply acceptable research design to procedures or techniques that are hard to quantify.
A review of published conventional research over the years indicates that prospective randomized clinical trials are not always possible or preferred. A 1990 report of the Committee on Technological Innovation in Medicine, Institute of Medicine, supports this tacit reality and discusses methodological options:
It has also become clear that randomized controlled clinical trials are not necessarily practical or feasible for answering all clinical questions. Therefore, a variety of other methods, such as nonrandomized trials or observational methods, have been adopted to provide complementary information. Traditionally these methods were regarded as weaker than randomized controlled clinical trials for clinical evaluation. Recent methodological advances, such as the use of non-classical statistics and the ability to link large-scale automated data bases for analysis... are strengthening these approaches.
The first goal of any research investigation into a medical treatment is to determine whether the treatment makes a clinical or cost difference. The second major concern about designing evaluations is the extent of external validity—the ability to generalize evaluation results to other populations and settings. Whatever methodology or methodologies are used to evaluate an alternative treatment, it may have to take into account a number of factors, including how to measure the perspectives of patients; how to evaluate systematic therapeutic learning, such as with biofeedback; or how to evaluate systems of medicine that adhere to paradigms completely different from those of conventional medicine, such as homeopathy. Other factors, such as disbelief in the treatment by reviewers, also should be taken into account to ensure a truly unbiased evaluation of an alternative therapy.
Peer review is the process in which researchers' peers evaluate the research strengths, weaknesses, and potential publishability or value of their work. Peers are chosen to participate in the evaluation process on the basis of their knowledge of or demonstrated expertise in the area of scientific investigation being considered.
This process is widely used in education, publication, State licensing, research publication, and review of clinical outcomes on a case-by-case basis by physician review organizations mandated by Federal law. While these areas all are relevant to alternative medicine, this report focuses on NIH's evaluation process for research grant and research contract applications.
At NIH, the peer review process is administered by the Division of Research Grants. In the review process, grants are reviewed by a primary and a secondary reviewer in the study section, who present findings to the entire study section. Grants are eventually funded after a second level of review of the application by an advisory council or board of NIH centers and institutes that have funding authority.
The peer review process in alternative medicine is not expected to raise methodological issues substantially different from those encountered in other emerging fields. Alternative medicine challenges established scientists and institutions by proposing models and patterns that differ from what is familiar in conventional medicine. Peer review in alternative medicine will aid reviewers in confronting issues of potential bias stemming from differences in basic assumptions about health and disease that may reflect limitations of current scientific knowledge.
As vital as research databases are to the researcher, information libraries are of equal importance to clinician, physician, and patient; without information there is no way a physician or patient can make truly informed choices. An accessible database of alternative medicine information is a vital need for the American public.
Several Institutes at NIH as well as some other Federal agencies include alternative medical practices in some of their information. For example, the National Institute of Neurological Disorders and Stroke includes acupuncture and psychological techniques, the National AIDS Information Clearinghouse provides information on nutrition strategies, the National Institute of Mental Health provides information on biofeedback, and the National Cancer Institute, on chaparral tea and other medicinal herbs. Outside NIH auspices, the Science and Technology Division, Reference Section, of the Library of Congress has reference guides to Acupuncture and Medicinal Plants, among others.
However, a national clearinghouse would provide a clear, concise message for the broader healthcare community, as well as interested members of the lay public, of the benefits of alternative medicine based on a body of scientific information that is current, accurate, and complete. Thus, an OAM-sponsored alternative medicine clearinghouse would provide a gateway for knowledge transfer to several audiences: healthcare practitioners, policymakers, educators, and the public at large.
Information will need to be gathered from a wide range of sources. Furthermore, information will need to be made available to consumers through various means. Electronic access through America On Line, CompuServe, Genie, and Prodigy will likely be very useful. However, since not all consumers have access to home computers, other means will be required to provide information to the general public. This may be through print information, CD-ROM disks at public libraries, and other community outlets.
Some of the medical systems discussed in this report, such as Ayurvedic medicine and traditional oriental medicine, are centuries old and are still in extensive use in other nations and cultures of the world. Others, such as osteopathy and naturopathy, evolved in the United States in the not-too-distant past but were relegated to the fringes of medicine because the concepts of health and illness they embraced were different from those of conventional biomedicine. Still others, such as some of the mind-body and bioelectromagnetics approaches, are on the frontier of scientific knowledge and understanding.
Many alternative medical practitioners face many barriers before their therapies can become part of mainstream medicine or they can be allowed to peacefully coexist with mainstream medical practitioners. However, consumers are already using their services in rapidly growing numbers. Most people who opt to use alternative therapies do so because they believe conventional medicine has nothing to offer them or because they want to supplement their conventional treatment—or, they want cheaper health care alternatives.
Although biomedicine has revolutionized medicine and the way health and illness are viewed, it is becoming increasingly expensive. This means that significant segments of the population—especially the young, the old, and people with chronic or severe diseases—are being left without adequate health care. Many alternative medical systems, with their emphasis on preventive medicine, may have much to offer in further controlling health care costs. Furthermore, regulations for approving potentially valuable drugs, interventions, and technical devices need to be significantly streamlined in order to bring costs down and offer potentially lifesaving treatments to the public in a timely fashion.
Many of the alternative therapies discussed in this report have already received sufficient clinical evaluations to warrant being included in any serious discussions about developing a comprehensive health care system. Others need to be quickly and thoroughly evaluated to determine their potential for improving the health and the health care of the Nation.