Talk:History of alternative medicine

Initial comments

I disagree with this article's assertion that the term modern only encompasses the last 30 years. ᚣᚷᚷᛞᚱᚫᛋᛁᛚ 20:58, 1 May 2004 (UTC)

The history of alternative medicine in the West reads as if there was a conspiracy to suppress it, perpetrated by the Catholic Church and professional physicians. I very much doubt that this is the case. Although I am not terribly familiar medical history, I would think that alternative medicine declined in the face of professional medicine, because professional medicine tended to move in sync with scientific advancement. Alternative medicine was simply labelled superstitious (with good reason), the more science learned about the human body. --129.173.223.103 01:48, 7 March 2007 (UTC)

I am afraid the above is far from true. The folk healers were the psychics and witches, and they healed with the magical and psychic properties of the herbs; the efforts of the catholic church to stamp them out are well documented. Science also rejects a priori the perceptions of the healers and shamans. Aniksker (talk) 20:19, 10 August 2009 (UTC)

Sourcing and POV problems

1. Except for the last section, this article has NO references! That needs fixing. It is unsourced assertion and all but the last section could be deleted, but let's see if anyone will source it.

2. The article is written in an unencyclopedic style with many fluff words.

3. The last section reads like a copyvio, but I'm not sure about its history here, and I can't find a copy. If it's a copyvio, maybe someone else can find it. If this was written by one or more editors here, kudos for providing sources. If that's the case, then it's not a copyvio and apologies to the author(s).

The article needs tags. I'll add some, and if someone finds more suitable ones, then just use them. -- Brangifer (talk) 04:53, 29 May 2009 (UTC)

This article needs an enema FiachraByrne (talk) 22:48, 2 January 2013 (UTC)

"enema"? Maybe, but could be better said of Alternative medicine, if not something more drastic per "Regain focus"[22]]. I have revised History article to make a link to List of branches of alternative medicine instead, but please would any previous editor revert if not acceptable. Editors will know that the List links to Glossary of alternative medicine which in turn links to Alternative medicine.Qexigator (talk) 14:12, 18 January 2013 (UTC)

No this article was then far worse than the Alternative Medicine article is currently [23]. FiachraByrne (talk) 15:05, 18 January 2013 (UTC)

Yes, and now all the better for the further edits after 22:48, 2 January 2013 (UTC), but the Ayurvedic medicine section is still labelled problematic. Could that not be hived off to another article, as for Chinese culture, where it need not vex those who seem to be so anxious to protect the USA population and professional bodies and healthcare program from all that? Qexigator (talk) 15:31, 18 January 2013 (UTC)

No. Chinese and Ayurvedic medicine are relevant to the History of alternative medicine. The current content is unsourced and inadequate but I'd like to keep it there as a placeholder until I get the opportunity to fix it. It's tagged for neutrality and lack of sources which is fine by me. Same with the material about CAM in the UK (although this is sourced). I've another article to finish before then so it might be a few weeks before I get the opportunity to get down to it and there are quite a few other sections in the article- currently hidden - that I'd like to do first (medical botany, hydropathy, etc). As regards those sections vexing any editors – or even why that should be a concern in the absence of sources and arguments – there's no evidence of that here at the moment so it appears to be a non-issue. FiachraByrne (talk) 17:20, 18 January 2013 (UTC)

Quote from 1784 Commission

collapse offtopic (but interesting) "stashed" quote

Just stashing this here:FiachraByrne (talk) 22:48, 2 January 2013 (UTC) The Commissioners have found that the magnetic fluid is not detectable with any other senses; that this fluid has no action, either on the Commissioners or on the patients subjected to it ... they have demonstrated by decisive experiments that imagination, apart from magnetism, produces convulsions, and that magnetism without imagination produces nothing Conclusion of the 1784 royal appointed commission of inquiry into mesmerism.< ref > Quoted in Schlun 2007, p. 37 < /ref >

Lede

Here is the current lede - [24]

The term alternative medicine refers to systems of medical thought and practice which function as alternatives to or subsist outside of conventional, mainstream medicine. Alternative medicine cannot exist absent an established, authoritative and stable medical orthodoxy to which it can function as an alternative. Such orthodoxy was only established in the West during the nineteenth century through processes of regulation, association, institution building and systematised medical education.[1]

Lede over-reliance on single source

The lead relies on a single source. This is overreliance on a single source. FloraWilde (talk)

Lede POV and vague description of medical science as "orthodoxy", without any mention of the word "science"

The lead describes science-based medicine as "orthodoxy ... established in the West", without ever mentioning the word "science". It is highly POV to describe science as "orthodoxy". It is overly vague to refer science-based medicine in this way. The description is so POV and so vague that a reader cannot possibly know that science-based medicine is what is being talked about. FloraWilde (talk)

Offtopic lede content

The lead says nothing about the history of alternative medicine as a catch-all for non-science based medical practice that grew beginning in the 70's or so, and nothing about the histories of the individual practices. The lead is off-topic and does not summarize the history of alternative medicine. FloraWilde (talk) 21:08, 11 August 2014 (UTC)

On-topic content and three sources added to lead

I this on-topic content to the lead -

The history of alternative medicine (or the history of complimentary and alternative medicine) refers to the histories of a number of different medical practices with different individual histories, which share the common feature of a claim to heal that is not based on the scientific method.[1] It can also refer to the history of the social phenomenon of collecting these non-science-based medical practices under the general expression, "alternative medicine", or to the history of the movement in which popularity of the collection grew, beginning in about the last quarter of the 20th Century.

I added three sources supporting the second sentence -

• "The Rise and Rise of Complementary and Alternative Medicine: a Sociological Perspective, Ian D Coulter and Evan M Willis, Medical Journal of Australia, 2004; 180 (11): 587-589"[25] This source specifically uses the expression "social phenomenon", which has a history, referring not to the individual histories of various alt med practices, but to collecting them under a single umbrella with a name, "alternative medicine". This source says,

"The increasing use of complementary and alternative medicine (CAM) within industrialised, 'advanced' Western nations presents itself as something of an enigma. As a social phenomenon, it is not well understood or indeed much researched. In this article we offer some observations and tentative explanations, some of a speculative nature. It is curious that this growth is occurring in countries where Western science and scientific method generally are accepted as the major foundations for healthcare, and “evidence-based” practice is the dominant paradigm. As medicine experiences an explosion in its knowledge base and genomic medicine opens a whole new approach to medical care, we are witnessing the rapid expansion of a branch of healthcare whose claim to be 'scientific', so far at least, has been widely debated."

I also added these two sources which have content on the history of the rise of the social phenomenon, or "movement", that support the second lead sentence I just added -

• Sampson, W. (1995). "Antiscience Trends in the Rise of the "Alternative Medicine'Movement". Annals of the New York Academy of Sciences 775: 188–197. doi:10.1111/j.1749-6632.1996.tb23138.x. PMID 8678416.
• Ignore Growing Patient Interest in Alternative Medicine at Your Peril - MDs Warned, Heather Kent, Canadian Medical Association Journal, November 15, 1997 vol. 157 no. 10

Hmm. The lead is supposed to summarise the (unfortunately unfinished) body. Can I ask did anyone actually read the source material - that is sources by historians on the history of alternative medicine - before making these entirely unachronistic changes to the lead. What you've done would be okay, perhaps, if this was an article titled 'Alternative medicine'; it's not - it draws on historical sources and perspectives rather than those of biomedicine. FiachraByrne (talk) 00:03, 5 June 2015 (UTC)

Section - "Cross-cultural medical exchange"

Why does this section have this title? FloraWilde (talk) 20:55, 11 August 2014 (UTC)

I retitled the section. FloraWilde (talk) 17:23, 12 August 2014 (UTC)

Use of WP:Fringe word "orthodoxy" to refer to medicine based on the scientific method

This article repeatedly uses the WP:FRINGE and POV word "orthodoxy" to refer to medicine based on science, or to the attitude that medicine should be based on science. This is done without ever saying that what is meant by orthodoxy is medicine based on science. This perspective is WP:Fringe and is highly POV. However, the content has a place at Wikipedia (although not necessarily in a history of alt med article). Per WP:Fring, the content should be moved to a section at the end of the article. FloraWilde (talk) 17:22, 12 August 2014 (UTC)

For much of the period that this article covered medicine, or at least therapeutics, was not particularly based upon 'science' as you use the term.

The use of the term "orthodoxy" and other cognate terms reflects the sources. FiachraByrne (talk) 00:05, 5 June 2015 (UTC)

"based on..."

Noting this edit 22:26, 8 September,[26] is there any exception to the proposition that none of the AM named are based on the scientific method? Those that are traditional, before the age of science based medicine, say later 19c. onwards, are not, and others such as naturopathy, as well as homeopathy, claim to be based on something else. Qexigator (talk) 22:40, 8 September 2014 (UTC)

Chiropractic (for the purpose of realigning muscles and bones, not curing stuff), physiotherapy, for two examples that have/are labelled as pseudoscience, yet recognized for legitimate medical purposes. Pseudoscience and alternative medicine are not synonymous, and it is a rather bold statement to attribute to one source that puts it: "One group considers..." and "As used here, alternative medicine refers to all treatments that have not been proven effective using scientific methods." (emphasis mine) - Floydian ^τ _¢ 22:53, 8 September 2014 (UTC)

User:Floydian, your mention of various wordings which are not the subject in this thread only creates straw men and confusion. We are not talking about the subject of pseudoscience, nor about the "One group..." (which also refers to pseudoscientific subjects). We're talking about that one NSF source and the best wording to use. The National Science Foundation (NSF) is using their own definition of alternative medicine: "As used here, alternative medicine refers to all treatments that have not been proven effective using scientific methods." We have formulated a statement focusing on the "scientific method" terminology. Maybe we could use a better formulation, but it's accurate and is an apt description of alternative medicine, regardless of whether some of them may later achieve acceptance and proof. They did not start that way. BTW, Physical Therapy is not, and never has been, alternative medicine, and when chiropractors use physical therapy methods for legitimate purposes, they are not practicing pseudoscience. It is their reliance on "adjustments" to cure fictive "vertebral subluxations" which is pseudoscientific. That is also part of the "history of alternative medicine". -- Brangifer (talk) 05:48, 9 September 2014 (UTC)

Still, chiropractice in general is labelled alternative medicine. Check our own article. I can also find sources that label physiotherapy as alternative medicine when I return from work this evening. Fact is, you're still using one source that verbatim declares that the definition given is its own to justify a bold claim that this subject refers to just hoaxes, as opposed to any practice that is not considered part of mainstream western medical literature. - Floydian ^τ _¢ 09:48, 9 September 2014 (UTC)

Reply to Floydian ( 09:48, 9 September): ...this subject refers to just hoaxes, as opposed to any practice that is not considered part of mainstream western medical literature. That may be fair comment on certain portions or presentational emphasis of the lead or images in the present version of the AM article, but read more carefully the opening paragraph of this section, and exemplify for us, if you can, something which is named in that article as AM which is, according to its own precepts and principles, based on the scientific method. That would be more helpful and to the point than your comment on the source. Qexigator (talk) 11:46, 9 September 2014 (UTC)

Floydian, again you are using words not appropriate for this discussion. We have not mentioned hoaxes. Stick to the topic. Chiropractic has always been classified as alternative medicine. Physical therapy has never been classified in that manner. You might find some comment, but nothing reliable or official. They have very different origins and very different positions in the health care system. Chiropractic started as a hostile and competitive system, and has never achieved full acceptance. PT was created by physicians within mainstream healthcare, as an adjunct to their own work. PT has never been in competition with, or hostile to, mainstream medicine. -- Brangifer (talk) 15:39, 9 September 2014 (UTC)

Look, you can try to swing the argument to my specific wording, but this isn't thesaurus time. The fact is, you've got a single source, which clearly states that they are using their own definition, to backup a claim that it is fact. So, either find more sources that back that definition, or add the text "According to... the definition is", as required by our verifiability policies. Stonewalling will only result in me taking this issue higher up the ladder, be it posting to a noticeboard regarding this misuse of a source, or an RfC. - Floydian ^τ _¢ 22:01, 9 September 2014 (UTC)

Reply to Floydian (22:01, 9 September): Given that the lead at the top of an article is meant to be a summary of an article as a whole, the concern is whether the lead is properly representing what is more fully expressed in the opening section "Alternative medicine". Is it your contention that the lead is misrepresenting that section and what follows it ('Before the "fringe" ', 'Medical professionalisation', 'Nineteenth-century non-conventional medicine', etc., including the Notes as well as listed sources)? If so, please specify. Qexigator (talk) 22:31, 9 September 2014 (UTC)

As it stands, a source is used in the lede that appears nowhere else in the article; the source in question. The first section is extraordinarily confusing, and reads like a philosophical rant. It essentially takes a simple concept: "The definition of alternative medicine is dependant on that of mainstream medicine. There is a clear delineation between the two, and nothing can be both." - This in of itself strengthens my point: things that were alternative medicine (i.e. spinal and muscle-skeletal manipulations [Chiropractic practise, the actual real world one we see medical doctors participate in today] as a solution to back pain, knee pain, wrist pain, and any pain caused by... well... muscular-skeletal inflammation or dislocation) are today seen as common sense science. Things that were once "common sense science" are now almost-universally regarded as lunatic fringe. By that simple fact, we cannot define alternative medicine as such when discussing the history. What defines alternative medicine may be unchanged, but what is defined AS alternative medicine has changed dramatically over the years. I suppose I've increased the number of issues here, but it still comes down to that one sentence in the lede (although now I want brevity in that confusing blob of a first section). - Floydian ^τ _¢ 23:05, 9 September 2014 (UTC)

Reconsider?

The source in question was introduced by an editor intent on revising the lead by revision of 20:42, 11 August 2014[27] Should this be reconsidered? The earlier version, as at 29 July, was:

The term alternative medicine refers to systems of medical thought and practice which function as alternatives to or subsist outside of conventional, mainstream medicine. Alternative medicine cannot exist absent an established, authoritative and stable medical orthodoxy to which it can function as an alternative. Such orthodoxy was only established in the West during the nineteenth century through processes of regulation, association, institution building and systematised medical education. (Bivins 2007,p. 171)

That text in the present version is placed in section 7 "Relativist perspective".

Qexigator (talk) 23:30, 9 September 2014 (UTC)

I want the old lead back. We can contextualise it by stating that it's a definition from a historical perspective. FiachraByrne (talk) 00:09, 5 June 2015 (UTC)

How is discussing the rise and rise of something since its inception, not relevant to its history?

Re this edit] deleting an RS on a sociological perspective of "The rise and rise of complementary and alternative medicine", not support the history of alt med as a social phenomenon? The history of alt med being a "rise and rise" since the expression was first used in the 1970's, is part of the history of alt med from a sociologist's perspective. The "rise and rise" of a social phenomenon is inherently a statement about at least part of its history. FloraWilde (talk) 18:10, 6 June 2015 (UTC)

Fuck. I really don't care. Make shit of it. By the way, whatever you do, please don't read the actual sources as that might fatally impinge upon your worldview. FiachraByrne (talk) 19:35, 6 June 2015 (UTC)

I read the source. It says the history of alt med is one of growth, which sociologists cannot understand because growth has occurred in countries with scientifically literate populations. It says the reason for this history of growth is a history with major societal change, not because of a history of change in the alt med practices. It cites the history of new age movements becoming mainstream ("green... organic non-chemical solutions to problems... historic trends toward individualism1... postmoderinism"), as reasons for alt meds history of growth. It says it was historically not taught in medical schools or practiced by MDs, but over its history it has increasingly been taught in med schools and practiced by MDs. The source supports the article content. FloraWilde (talk) 20:09, 6 June 2015 (UTC)

Mesmerism history content is good but section is undue too long; Time to start a new history of Mesmerism article?

The history of mesmerism content is good, but the section is too long per [[WP:UNdue]. It's my opinion that there is enough good content for a stand-alone article, "History of mesmerism", and we can lift the lead summary of that article in to this article. (making such a lead admittedly requires more hard work by the article section's author, who I assume is one editor because of the cohesiveness of the section.) FloraWilde (talk) 19:20, 6 June 2015 (UTC)

Orphaned references in History of alternative medicine

I check pages listed in Category:Pages with incorrect ref formatting to try to fix reference errors. One of the things I do is look for content for orphaned references in wikilinked articles. I have found content for some of History of alternative medicine's orphans, the problem is that I found more than one version. I can't determine which (if any) is correct for this article, so I am asking for a sentient editor to look it over and copy the correct ref content into this article.

Reference named "Ernst-eval":

• From Chiropractic: Ernst E (May 2008). "Chiropractic: a critical evaluation". Journal of pain and symptom management. 35 (5): 544–62. doi:10.1016/j.jpainsymman.2007.07.004. ISSN 0885-3924. PMID 18280103.
• From Daniel David Palmer: Ernst, E (May 2008). "Chiropractic: a critical evaluation". Journal of pain and symptom management. 35 (5): 544–62. doi:10.1016/j.jpainsymman.2007.07.004. ISSN 0885-3924. PMID 18280103.

Reference named "Chiro-PH":

• From Quackery: Johnson C; Baird R; Dougherty PE; et al. (2008). "Chiropractic and public health: current state and future vision". J Manipulative Physiol Ther. 31 (6): 397–410. doi:10.1016/j.jmpt.2008.07.001. PMID 18722194. {{cite journal}}: Unknown parameter |author-separator= ignored (help)
• From Chiropractic: Johnson C, Baird R, Dougherty PE, Globe G, Green BN, Haneline M, Hawk C, Injeyan HS, Killinger L, Kopansky-Giles D, Lisi AJ, Mior SA, Smith M (2008). "Chiropractic and public health: current state and future vision". J Manipulative Physiol Ther. 31 (6): 397–410. doi:10.1016/j.jmpt.2008.07.001. PMID 18722194.{{cite journal}}: CS1 maint: multiple names: authors list (link)

I apologize if any of the above are effectively identical; I am just a simple computer program, so I can't determine whether minor differences are significant or not. AnomieBOT⚡ 17:31, 21 June 2015 (UTC)

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Excessive information in Alternative medicine

Much of the following was removed from the article on alternative medicine for being excessive. It should be harmonized with the content here, and some of it may be useful expansion:

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

History

The history of alternative medicine may refer to the history of a group of diverse medical practices that were collectively promoted as "alternative medicine" beginning in the 1970s, to the collection of individual histories of members of that group, or to the history of western medical practices that were labeled "irregular practices" by the western medical establishment. It includes the histories of complementary medicine and of integrative medicine. Before the 1970s, western practitioners that were not part of the increasingly science-based medical establishment were referred to "irregular practitioners", and were dismissed by the medical establishment as unscientific and as practicing quackery. Until the 1970's, irregular practice became increasingly marginalized as quackery and fraud, as western medicine increasingly incorporated scientific methods and discoveries, and had a corresponding increase in success of its treatments. In the 1970s, irregular practices were grouped with traditional practices of nonwestern cultures and with other unproven or disproven practices that were not part of biomedicine, with the entire group collectively marketed and promoted under the single expression "alternative medicine".

Use of alternative medicine in the west began to rise following the counterculture movement of the 1960s, as part of the rising new age movement of the 1970s. This was due to misleading mass marketing of "alternative medicine" being an effective "alternative" to biomedicine, changing social attitudes about not using chemicals and challenging the establishment and authority of any kind, sensitivity to giving equal measure to beliefs and practices of other cultures (cultural relativism), and growing frustration and desperation by patients about limitations and side effects of science-based medicine. At the same time, in 1975, the American Medical Association, which played the central role in fighting quackery in the United States, abolished its quackery committee and closed down its Department of Investigation. By the early to mid 1970s the expression "alternative medicine" came into widespread use, and the expression became mass marketed as a collection of "natural" and effective treatment "alternatives" to science-based biomedicine. By 1983, mass marketing of "alternative medicine" was so pervasive that the British Medical Journal (BMJ) pointed to "an apparently endless stream of books, articles, and radio and television programmes urge on the public the virtues of (alternative medicine) treatments ranging from meditation to drilling a hole in the skull to let in more oxygen". In this 1983 article, the BMJ wrote, "one of the few growth industries in contemporary Britain is alternative medicine", noting that by 1983, "33% of patients with rheumatoid arthritis and 39% of those with backache admitted to having consulted an alternative practitioner".

By about 1990, the USA alternative medicine industry had grown to a US$27 billion per year, with polls showing 30% of Americans were using it. Moreover, polls showed that Americans made more visits for alternative therapies than the total number of visits to primary care doctors, and American out-of-pocket spending (non-insurance spending) on alternative medicine was about equal to spending on biomedical doctors. In 1991, Time magazine ran a cover story, "The New Age of Alternative Medicine: Why New Age Medicine Is Catching On". In 1993, the New England Journal of Medicine reported one in three Americans as using alternative medicine. In 1993, the Public Broadcasting System ran a Bill Moyers special, Healing and the Mind, with Moyers commenting that "...people by the tens of millions are using alternative medicine. If established medicine does not understand that, they are going to lose their clients."

Another explosive growth began in the 1990s, when senior level political figures began promoting alternative medicine, investing large sums of government medical research funds into testing alternative medicine, including testing of scientifically implausible treatments, and relaxing government regulation of alternative medicine products as compared to biomedical products. Beginning with a 1991 appropriation of US$2 million for funding research of alternative medicine research, federal spending grew to a cumulative total of about US$2.5 billion by 2009, with 50% of Americans using alternative medicine by 2013.

In 1993, Britain's Prince Charles, who claimed that homeopathy and other alternative medicine was an effective alternative to biomedicine, established The Prince's Foundation for Integrated Health (FIH), as a charity to explore "how safe, proven complementary therapies can work in conjunction with mainstream medicine". The FIH received government funding through grants from Britain's Department of Health. In 2008, London's The Times published a letter from Edzard Ernst that asked the FIH to recall two guides promoting alternative medicine, saying: "the majority of alternative therapies appear to be clinically ineffective, and many are downright dangerous." In 2010, the FIH closed after allegations of fraud and money laundering led to arrests of its officials.

In 2001, MEDLINE introduced a MeSH term to index scientific publications in alternative medicine.

In 2004, modifications of the European Parliament's 2001 Directive 2001/83/EC, regulating all medicine products, were made with the expectation of influencing development of the European market for alternative medicine products. Regulation of alternative medicine in Europe was loosened with "a simplified registration procedure" for traditional herbal medicinal products. Plausible "efficacy" for traditional medicine was redefined to be based on long term popularity and testimonials ("the pharmacological effects or efficacy of the medicinal product are plausible on the basis of long-standing use and experience."), without scientific testing. The Committee on Herbal Medicinal Products (HMPC) was created within the European Medicines Agency in London (EMEA). A special working group was established for homeopathic remedies under the Heads of Medicines Agencies.

Through 2004, alternative medicine that was traditional to Germany continued to be a regular part of the health care system, including homeopathy and anthroposophic medicine. The German Medicines Act mandated that science-based medical authorities consider the "particular characteristics" of complementary and alternative medicines. By 2004, homeopathy had grown to be the most used alternative therapy in France, growing from 16% of the population using homeopathic medicine in 1982, to 29% by 1987, 36% percent by 1992, and 62% of French mothers using homeopathic medicines by 2004, with 95% of French pharmacists advising pregnant women to use homeopathic remedies. As of 2004, 100 million people in India depended solely on traditional German homeopathic remedies for their medical care. As of 2010, homeopathic remedies continued to be the leading alternative treatment used by European physicians. By 2005, sales of homeopathic remedies and anthroposophical medicine had grown to €930 million, a 60% increase from 1995.

Since 2009, according to Art. 118a of the Swiss Federal Constitution, the Swiss Confederation and the Cantons of Switzerland shall within the scope of their powers ensure that consideration is given to complementary medicine.

By 2013, 50% of Americans were using CAM. As of 2013, CAM medicinal products in Europe continued to be exempted from documented efficacy standards required of other medicinal products.

Individual systems and practices

Much of what is now categorized as alternative medicine was developed as independent, complete medical systems. These were developed long before biomedicine and use of scientific methods. Each system was developed in relatively isolated regions of the world where there was little or no medical contact with pre-scientific western medicine, or with each other's systems. Examples are traditional Chinese medicine and the Ayurvedic medicine of India.

Other alternative medicine practices, such as homeopathy, were developed in western Europe and in opposition to western medicine, at a time when western medicine was based on unscientific theories that were dogmatically imposed by western religious authorities. Homeopathy was developed prior to discovery of the basic principles of chemistry, which proved homeopathic remedies contained nothing but water. But homeopathy, with its remedies made of water, was harmless compared to the unscientific and dangerous orthodox western medicine practiced at that time, which included use of toxins and draining of blood, often resulting in permanent disfigurement or death.

Other alternative practices such as chiropractic and osteopathic manipulative medicine were developed in the United States at a time that western medicine was beginning to incorporate scientific methods and theories, but the biomedical model was not yet totally dominant. Practices such as chiropractic and osteopathy, each considered to be irregular practices by the western medical establishment, also opposed each other, both rhetorically and politically with licensing legislation. Osteopathic practitioners added the courses and training of biomedicine to their licensing, and licensed Doctor of Osteopathic Medicine holders began diminishing use of the unscientific origins of the field.

"Irregular practitioners"

Main article: History of alternative medicine

Further information: History of medicine

Until the 1970s, western practitioners that were not part of the medical establishment were referred to "irregular practitioners", and were dismissed by the medical establishment as unscientific, as practicing quackery. The Irregular practice became increasingly marginalized as quackery and fraud, as western medicine increasingly incorporated scientific methods and discoveries, and had a corresponding increase in success of its treatments.

Dating from the 1970s, medical professionals, sociologists, anthropologists and other commentators noted the increasing visibility of a wide variety of health practices that had neither derived directly from nor been verified by biomedical science. Since that time, those who have analyzed this trend have deliberated over the most apt language with which to describe this emergent health field. A variety of terms have been used, including heterodox, irregular, fringe and alternative medicine while others, particularly medical commentators, have been satisfied to label them as instances of quackery. The most persistent term has been alternative medicine but its use is problematic as it assumes a value-laden dichotomy between a medical fringe, implicitly of borderline acceptability at best, and a privileged medical orthodoxy, associated with validated medico-scientific norms. The use of the category of alternative medicine has also been criticized as it cannot be studied as an independent entity but must be understood in terms of a regionally and temporally specific medical orthodoxy. Its use can also be misleading as it may erroneously imply that a real medical alternative exists. As with near-synonymous expressions, such as unorthodox, complementary, marginal, or quackery, these linguistic devices have served, in the context of processes of professionalisation and market competition, to establish the authority of official medicine and police the boundary between it and its unconventional rivals.

Peking Union Medical College

An early instance of the influence of this modern, or western, scientific medicine outside Europe and North America is Peking Union Medical College.

From a historical perspective, the emergence of alternative medicine, if not the term itself, is typically dated to the 19th century. This is despite the fact that there are variants of Western non-conventional medicine that arose in the late-eighteenth century or earlier and some non-Western medical traditions, currently considered alternative in the West and elsewhere, which boast extended historical pedigrees. Alternative medical systems, however, can only be said to exist when there is an identifiable, regularized and authoritative standard medical practice, such as arose in the West during the nineteenth century, to which they can function as an alternative.

During the late eighteenth and nineteenth centuries regular and irregular medical practitioners became more clearly differentiated throughout much of Europe and, as the nineteenth century progressed, most Western states converged in the creation of legally delimited and semi-protected medical markets. It is at this point that an "official" medicine, created in cooperation with the state and employing a scientific rhetoric of legitimacy, emerges as a recognizable entity and that the concept of alternative medicine as a historical category becomes tenable.

As part of this process, professional adherents of mainstream medicine in countries such as Germany, France, and Britain increasingly invoked the scientific basis of their discipline as a means of engendering internal professional unity and of external differentiation in the face of sustained market competition from homeopaths, naturopaths, mesmerists and other nonconventional medical practitioners, finally achieving a degree of imperfect dominance through alliance with the state and the passage of regulatory legislation. In the US the Johns Hopkins University School of Medicine, based in Baltimore, Maryland, opened in 1893, with William H. Welch and William Osler among the founding physicians, and was the first medical school devoted to teaching "German scientific medicine".

Buttressed by increased authority arising from significant advances in the medical sciences of the late 19th century onwards – including development and application of the germ theory of disease by the chemist Louis Pasteur and the surgeon Joseph Lister, of microbiology co-founded by Robert Koch (in 1885 appointed professor of hygiene at the University of Berlin), and of the use of X-rays (Röntgen rays)—the 1910 Flexner Report called upon American medical schools to follow the model of the Johns Hopkins School of Medicine, and adhere to mainstream science in their teaching and research. This was in a belief, mentioned in the Report's introduction, that the preliminary and professional training then prevailing in medical schools should be reformed, in view of the new means for diagnosing and combating disease made available by the sciences on which medicine depended.

Putative medical practices at the time that later became known as "alternative medicine" included homeopathy (founded in Germany in the early 19th century) and chiropractic (founded in North America in the late 19th century). These conflicted in principle with the developments in medical science upon which the Flexner reforms were based, and they have not become compatible with further advances of medical science such as listed in Timeline of medicine and medical technology, 1900–1999 and 2000–present, nor have Ayurveda, acupuncture or other kinds of alternative medicine.

At the same time "tropical medicine" was being developed as a specialist branch of western medicine in research establishments such as Liverpool School of Tropical Medicine founded in 1898 by Alfred Lewis Jones, London School of Hygiene & Tropical Medicine, founded in 1899 by Patrick Manson, and Tulane University School of Public Health and Tropical Medicine, instituted in 1912. A distinction was being made between western scientific medicine and indigenous systems. An example is given by an official report about indigenous systems of medicine in India, including Ayurveda, submitted by Mohammad Usman of Madras and others in 1923. This stated that the first question the Committee considered was "to decide whether the indigenous systems of medicine were scientific or not".

By the later twentieth century the term "alternative medicine" entered public discourse, but it was not always being used with the same meaning by all parties. Arnold S. Relman remarked in 1998 that in the best kind of medical practice, all proposed treatments must be tested objectively, and that in the end there will only be treatments that pass and those that do not, those that are proven worthwhile and those that are not. He asked "Can there be any reasonable 'alternative'?" But also in 1998 the then Surgeon General of the United States, David Satcher, issued public information about eight common alternative treatments (including acupuncture, holistic and massage), together with information about common diseases and conditions, on nutrition, diet, and lifestyle changes, and about helping consumers to decipher fraud and quackery, and to find healthcare centers and doctors who practiced alternative medicine.

By 1990, approximately 60 million Americans had used one or more complementary or alternative therapies to address health issues, according to a nationwide survey in the US published in 1993 by David Eisenberg. A study published in the November 11, 1998 issue of the Journal of the American Medical Association reported that 42% of Americans had used complementary and alternative therapies, up from 34% in 1990. However, despite the growth in patient demand for complementary medicine, most of the early alternative/complementary medical centers failed.

Medical education

Mainly as a result of reforms following the Flexner Report of 1910 medical education in established medical schools in the US has generally not included alternative medicine as a teaching topic. Typically, their teaching is based on current practice and scientific knowledge about: anatomy, physiology, histology, embryology, neuroanatomy, pathology, pharmacology, microbiology and immunology. Medical schools' teaching includes such topics as doctor-patient communication, ethics, the art of medicine, and engaging in complex clinical reasoning (medical decision-making). Writing in 2002, Snyderman and Weil remarked that by the early twentieth century the Flexner model had helped to create the 20th-century academic health center, in which education, research, and practice were inseparable. While this had much improved medical practice by defining with increasing certainty the pathophysiological basis of disease, a single-minded focus on the pathophysiological had diverted much of mainstream American medicine from clinical conditions that were not well understood in mechanistic terms, and were not effectively treated by conventional therapies.

By 2001 some form of CAM training was being offered by at least 75 out of 125 medical schools in the US. Exceptionally, the School of Medicine of the University of Maryland, Baltimore includes a research institute for integrative medicine (a member entity of the Cochrane Collaboration). Medical schools are responsible for conferring medical degrees, but a physician typically may not legally practice medicine until licensed by the local government authority. Licensed physicians in the US who have attended one of the established medical schools there have usually graduated Doctor of Medicine (MD). All states require that applicants for MD licensure be graduates of an approved medical school and complete the United States Medical Licensing Exam (USMLE).

The British Medical Association, in its publication Complementary Medicine, New Approach to Good Practice (1993), gave as a working definition of non-conventional therapies (including acupuncture, chiropractic and homeopathy): "...those forms of treatment which are not widely used by the orthodox health-care professions, and the skills of which are not part of the undergraduate curriculum of orthodox medical and paramedical health-care courses." By 2000 some medical schools in the UK were offering CAM familiarisation courses to undergraduate medical students while some were also offering modules specifically on CAM.

United States government

Main article: National Center for Complementary and Integrative Health

Sen. Tom Harkin at a press conference.

In 1991, pointing to a need for testing because of the widespread use of alternative medicine without authoritative information on its efficacy, United States Senator Tom Harkin used US$2 million of his discretionary funds to create the Office for the Study of Unconventional Medical Practices (OSUMP), later renamed to be the Office of Alternative Medicine (OAM). The OAM was created to be within the National Institute of Health (NIH), the scientifically prestigious primary agency of the United States government responsible for biomedical and health-related research. The mandate was to investigate, evaluate, and validate effective alternative medicine treatments, and alert the public as the results of testing its efficacy.

Sen. Harkin had become convinced his allergies were cured by taking bee pollen pills, and was urged to make the spending by two of his influential constituents. Bedell, a longtime friend of Sen. Harkin, was a former member of the United States House of Representatives who believed that alternative medicine had twice cured him of diseases after mainstream medicine had failed, claiming that cow's milk colostrum cured his Lyme disease, and an herbal derivative from camphor had prevented post surgical recurrence of his prostate cancer. Wiewel was a promoter of unproven cancer treatments involving a mixture of blood sera that the Food and Drug Administration had banned from being imported. Both Bedell and Wiewel became members of the advisory panel for the OAM. The company that sold the bee pollen was later fined by the Federal Trade Commission for making false health claims about their bee-pollen products reversing the aging process, curing allergies, and helping with weight loss.

In 1994, Sen. Harkin (D) and Senator Orrin Hatch (R) introduced the Dietary Supplement Health and Education Act (DSHEA). The act reduced authority of the FDA to monitor products sold as "natural" treatments. Labeling standards were reduced to allow health claims for supplements based only on unconfirmed preliminary studies that were not subjected to scientific peer review, and the act made it more difficult for the FDA to promptly seize products or demand proof of safety where there was evidence of a product being dangerous. The Act became known as "The 1993 Snake Oil Protection Act" following a New York Times editorial under that name.

Senator Harkin complained about the "unbendable rules of randomized clinical trials", citing his use of bee pollen to treat his allergies, which he claimed to be effective even though it was biologically implausible and efficacy was not established using scientific methods. Sen. Harkin asserted that claims for alternative medicine efficacy be allowed not only without conventional scientific testing, even when they are biologically implausible, "It is not necessary for the scientific community to understand the process before the American public can benefit from these therapies." Following passage of the act, sales rose from about US$4 billion in 1994, to US$20 billion by the end of 2000, at the same time as evidence of their lack of efficacy or harmful effects grew. Senator Harkin came into open public conflict with the first OAM Director Joseph M. Jacobs and OAM board members from the scientific and biomedical community. Jacobs' insistence on rigorous scientific methodology caused friction with Senator Harkin. Increasing political resistance to the use of scientific methodology was publicly criticized by Jacobs and another OAM board member complained that "nonsense has trickled down to every aspect of this office...It's the only place where opinions are counted as equal to data." In 1994, Senator Harkin appeared on television with cancer patients who blamed Jacobs for blocking their access to untested cancer treatment, leading Jacobs to resign in frustration.

In 1995, Wayne Jonas, a promoter of homeopathy and political ally of Senator Harkin, became the director of the OAM, and continued in that role until 1999. In 1997, the NCCAM budget was increased from US$12 million to US$20 million annually. From 1990 to 1997, use of alternative medicine in the US increased by 25%, with a corresponding 50% increase in expenditures. The OAM drew increasing criticism from eminent members of the scientific community with letters to the Senate Appropriations Committee when discussion of renewal of funding OAM came up. Nobel laureate Paul Berg wrote that prestigious NIH should not be degraded to act as a cover for quackery, calling the OAM "an embarrassment to serious scientists." The president of the American Physical Society wrote complaining that the government was spending money on testing products and practices that "violate basic laws of physics and more clearly resemble witchcraft". In 1998, the President of the North Carolina Medical Association publicly called for shutting down the OAM.

In 1998, NIH director and Nobel laureate Harold Varmus came into conflict with Senator Harkin by pushing to have more NIH control of alternative medicine research. The NIH Director placed the OAM under more strict scientific NIH control. Senator Harkin responded by elevating OAM into an independent NIH "center", just short of being its own "institute", and renamed to be the National Center for Complementary and Alternative Medicine (NCCAM). NCCAM had a mandate to promote a more rigorous and scientific approach to the study of alternative medicine, research training and career development, outreach, and "integration". In 1999, the NCCAM budget was increased from US$20 million to US$50 million. The United States Congress approved the appropriations without dissent. In 2000, the budget was increased to about US$68 million, in 2001 to US$90 million, in 2002 to US$104 million, and in 2003, to US$113 million.

In 2009, after a history of 17 years of government testing and spending of nearly US$2.5 billion on research had produced almost no clearly proven efficacy of alternative therapies, Senator Harkin complained, "One of the purposes of this center was to investigate and validate alternative approaches. Quite frankly, I must say publicly that it has fallen short. It think quite frankly that in this center and in the office previously before it, most of its focus has been on disproving things rather than seeking out and approving." Members of the scientific community criticized this comment as showing Senator Harkin did not understand the basics of scientific inquiry, which tests hypotheses, but never intentionally attempts to "validate approaches". Members of the scientific and biomedical communities complained that after a history of 17 years of being tested, at a cost of over US$2.5 Billion on testing scientifically and biologically implausible practices, almost no alternative therapy showed clear efficacy. In 2009, the NCCAM's budget was increased to about US$122 million. Overall NIH funding for CAM research increased to US$300 Million by 2009. By 2009, in the USA US$34 billion was spent annually on CAM.

In 2012, the Journal of the American Medical Association (JAMA) published a criticism that study after study had been funded by NCCAM, but "failed to prove that complementary or alternative therapies are anything more than placebos". The JAMA criticism pointed to large wasting of research money on testing scientifically implausible treatments, citing "NCCAM officials spending US$374,000 to find that inhaling lemon and lavender scents does not promote wound healing; US$750,000 to find that prayer does not cure AIDS or hasten recovery from breast-reconstruction surgery; US$390,000 to find that ancient Indian remedies do not control type 2 diabetes; US$700,000 to find that magnets do not treat arthritis, carpal tunnel syndrome, or migraine headaches; and US$406,000 to find that coffee enemas do not cure pancreatic cancer." It was pointed out that negative results from testing were generally ignored by the public, that people continue to "believe what they want to believe, arguing that it does not matter what the data show: They know what works for them". Continued increasing use of CAM products was also blamed on the lack of FDA ability to regulate alternative products, where negative studies do not result in FDA warnings or FDA-mandated changes on labeling, whereby few consumers are aware that many claims of many supplements were found not to have not to be supported.

In 2014 the NCCAM was renamed to the National Center for Complementary and Integrative Health (NCCIH) with a new charter requiring that 12 of the 18 council members shall be selected with a preference to selecting leading representatives of complementary and alternative medicine, 9 of the members must be licensed practitioners of alternative medicine, six members must be general public leaders in the fields of public policy, law, health policy, economics, and management, and 3 members must represent the interests of individual consumers of complementary and alternative medicine.

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References

Thanks, Carl Fredrik ^talk 10:55, 10 May 2018 (UTC)