Alternative

When the term entered medical writing

A 2023 review in Integrative Medicine Research traced the vocabulary through a textual analysis of literature published between 1975 and 2013. It reports the first instances of "alternative medicine" in 1975, "unconventional medicine" in 1980, "complementary medicine" in 1984, "complementary and alternative medicine" in 1994 and "integrated" or "integrative medicine" in 1995. The review says "alternative medicine" dominated the literature until about 1990, after which "complementary medicine" rose and the combined phrase became the most common term from the 2000s.

The same review notes that adjectives such as complementary, alternative and integrative are Westernized terms. In many non-Western cultures, it says, traditional practices are not separated from conventional medicine in the same way, so a system such as Ayurveda or traditional Chinese medicine may be mainstream in its home country and labeled alternative elsewhere.

The 1993 national survey

In January 1993 the New England Journal of Medicine published a national telephone survey by David Eisenberg and colleagues. Interviewers reached 1,539 US adults in 1990 and asked about 16 interventions that the authors described as neither taught widely in US medical schools nor generally available in US hospitals. About one in three respondents (34 percent) reported using at least one of them in the past year.

The authors estimated 425 million visits to providers of unconventional therapy in 1990 and about $13.7 billion in expenditures, $10.3 billion of it paid out of pocket. They also reported that 72 percent of respondents who used such therapy had not told their medical doctor. The survey measured use in 1990, so it does not describe later periods.

A federal office, then a center

The NCCIH timeline dates the institutional history. In October 1991 Congress provided funding to establish an office within the National Institutes of Health to study unconventional medical practices, and in October 1992 Joseph J. Jacobs was appointed the first director of the Office of Alternative Medicine. The NIH Revitalization Act of June 1993 placed the office within the NIH Office of the Director.

In October 1998 Congress authorized an independent center, and in February 1999 the Secretary of Health and Human Services signed the memo creating the National Center for Complementary and Alternative Medicine as the 25th independent component of NIH. In December 2014 Congress renamed it the National Center for Complementary and Integrative Health. The 2023 review gives 1991 for the office and 1998 for the center, so secondary sources vary by a year on the first date.

International policy attention

The World Health Organization's traditional medicine strategy for 2014 to 2023 was developed in response to World Health Assembly resolution WHA62.13 and builds on a 2002 to 2005 strategy. Its overview says the updated strategy gives more attention than its predecessor to health services and systems, including traditional and complementary medicine products, practices and practitioners.

The NCCIH definition

NCCIH states that people often use "alternative" and "complementary" interchangeably but that the terms refer to different concepts. If a non-mainstream approach is used together with conventional medicine it is considered complementary, and if it is used in place of conventional medicine it is considered alternative. NCCIH adds that most people who use non-mainstream approaches also use conventional health care, and that the terms are continually evolving.

Under this definition the label describes how a practice is used and not what the practice is. The same practice can be complementary in one person's care and alternative in another's. NCCIH separately defines integrative health as bringing conventional and complementary approaches together in a coordinated way, with attention to the whole person.

Definitions used by other bodies

The World Health Organization does not separate the two words. Its glossary says "complementary medicine" or "alternative medicine" refers to a broad set of health care practices that are not part of a country's own tradition or conventional medicine and are not fully integrated into the dominant health care system, and that the terms are used interchangeably with traditional medicine in some countries.

The US National Cancer Institute uses "complementary and alternative medicine" as the term for medical products and practices that are not part of standard medical care. In the 1993 survey, Eisenberg and colleagues used an operational definition instead: interventions not taught widely at US medical schools or generally available at US hospitals.

Criticism of the term

The most quoted criticism came in a 1998 JAMA editorial by Phil Fontanarosa and George Lundberg. Its published abstract argues that there is no alternative medicine, only medicine supported by solid scientific data or medicine for which scientific evidence is lacking, and that whether a practice is Eastern or Western, unconventional or mainstream is largely irrelevant except for historical and cultural interest.

The 2023 terminology review raises a related point from a different angle. It says that what counts as conventional has changed over time and by region, that practices can move into conventional use when evidence supports them, and that some are dropped when judged ineffective or unsafe. On that view the boundary of the label is not fixed, and its membership changes as evidence and practice change.

How this label relates to the other three

Machipedia uses four editorial labels: Metaphysical, Alternative, Complementary and Holistic. They are applied by the site's editors to describe how a practice is usually positioned, and a label is not a finding about evidence. The Alternative label here follows the NCCIH idea of use in place of conventional care, whereas Complementary marks practices used alongside it. Integrative Medicine and Holistic Health have their own pages, and several practices carry more than one label.

How the label is applied

Because the NCCIH definition turns on use in place of conventional care, no practice is alternative by nature. The 2023 terminology review built a list of 604 therapies for its operational definition of complementary, alternative and integrative medicine, and the National Cancer Institute groups such practices into mind-body therapies, biologically based practices, manipulative and body-based practices, energy healing and whole medical systems.

Systems and plant-based practices on this site

Machipedia's page on Homeopathy describes a medical system founded by Samuel Hahnemann that uses serially diluted, shaken preparations. Naturopathy is described as a system of care built on diet, lifestyle, herbs, water treatments and other non-drug methods, and Herbal Medicine as the use of plants and plant extracts such as teas, tinctures and capsules. Acupuncture, described as the insertion of fine needles at selected points, carries both the Alternative and Complementary labels.

Assessment and device-based practices on this site

Iridology is described on its page as a practice that claims to assess health by examining the iris. Applied Kinesiology is a chiropractic-derived system that uses manual muscle testing. Bioresonance is a device-based method said to detect and alter weak electromagnetic signals of the body, and Magnet Therapy is the use of static magnets worn or placed against the body. Energy Healing is an umbrella term for practices in which practitioners aim to influence a person's energy field.

Procedures on this site

Ear Candling is described as placing a lit, hollow, wax-coated cone near the outer ear, and Colonic Hydrotherapy as flushing the colon with water through the rectum, offered as cleansing. Chelation Therapy is the use of drugs that bind metals in the body, and its page separates established medical uses from alternative ones. Each of these pages sets out its own history and evidence separately from this category page.

Reasons people give for use

In the 1993 survey, most respondents used unconventional therapy for chronic rather than life-threatening conditions. Among those who used it for serious conditions, 83 percent also sought treatment from a medical doctor for the same condition. The 2023 review says users cited wanting to control side effects, dissatisfaction with physicians' attitudes or with the results of conventional medicine, and wanting care that includes a spiritual component.

The National Cancer Institute lists reasons people with cancer may use complementary and alternative medicine: coping with side effects such as nausea, pain and fatigue, comfort and stress relief, feeling that they are doing something for their own care, and trying to treat the cancer itself. These are reasons people report, and the institute does not endorse them.

Who chooses it in place of conventional care

Choosing a non-mainstream approach in place of all conventional treatment is uncommon. A National Center for Health Statistics report states that in the United States most people who use complementary health approaches do so to complement conventional care, and cites an analysis of the 2002 National Health Interview Survey finding that fewer than 5 percent of adults used complementary approaches without conventional care.

In a cancer registry study of patients who used alternative medicine as their only anticancer treatment, such patients were more likely to be younger, female, have higher income and education, and have higher cancer stage than patients who received conventional treatment. The authors describe this use as rare.

How common use is

NCCIH cites the 2012 National Health Interview Survey in reporting that more than 30 percent of US adults and about 12 percent of children used health care approaches that are not typically part of conventional medical care. The figure covers complementary as well as alternative use.

A National Center for Health Statistics report analyzed 88,962 adults across the 2002, 2007 and 2012 surveys. Non-vitamin, non-mineral dietary supplements were the most used approach each time (18.9 percent in 2002, 17.7 percent in 2012).

Evidence differs by practice

No source reviewed here assesses the label as a whole, and the label groups practices that have very different evidence. NCCIH says large, rigorous studies of a few dietary supplements often showed that the products did not work for the conditions studied, while research on others is continuing. For cancer, NCCIH reports that acupuncture, mindfulness-based stress reduction and yoga may help manage symptoms and treatment side effects.

The same NCCIH page states that no complementary health approach has been shown to prevent or eliminate cancer. Evidence on one practice does not transfer to another, so the individual practice pages are the place to look for a specific practice.

Alternative medicine alone for curable cancer

Skyler Johnson and colleagues analyzed the US National Cancer Database for 2004 to 2013 and identified 281 patients with nonmetastatic breast, prostate, lung or colorectal cancer whose only treatment was coded as administered by nonmedical personnel, with no conventional treatment. After matching 280 of them to 560 patients who received conventional treatment, median follow-up was 66 months. Five-year survival was 54.7 percent with alternative medicine and 78.3 percent with conventional treatment.

After adjustment, alternative medicine use was associated with a hazard ratio for death of 2.50 (95 percent confidence interval 1.88 to 3.27). The hazard ratios were 5.68 for breast, 2.17 for lung and 4.57 for colorectal cancer, and not statistically significant for prostate cancer (1.68, interval 0.68 to 4.17). The authors attribute this to the long natural history of prostate cancer and short follow-up.

The authors note that the study is observational, that the data do not say which therapies patients received, and that unmeasured confounding or selection bias may remain. They state that complementary and integrative medicine differ from the alternative medicine studied.

Complementary use alongside treatment

A later JAMA Oncology cohort study by the same group used 1,901,815 National Cancer Database patients, 258 of whom received complementary medicine in addition to at least one conventional treatment. Those patients refused chemotherapy more often than matched controls (34.1 percent versus 3.2 percent) and had lower five-year survival (82.2 percent versus 86.6 percent). The association with death (hazard ratio 2.08) was no longer statistically significant once treatment delay or refusal was included (1.39, interval 0.83 to 2.33), and the authors concluded that the risk was mediated by refusal.

Replacing or delaying necessary care

The best-documented risk attached to the label as a whole is substitution. NCCIH advises people not to use untested products or practices to replace or delay medical treatment for cancer, and says some fraudulent cancer products marketed online are dangerous in themselves while others can be harmful if used instead of effective medical treatment. It reports that Society for Integrative Oncology guidelines warn against replacing conventional treatment because delay reduces the likelihood of remission.

The registry studies described above are consistent with this guidance for cancer, but they are observational, cover four cancer types in one country, and do not test any specific therapy. The sources reviewed do not quantify substitution risk for other conditions.

Product quality, interactions and health claims

The US Food and Drug Administration states that a health product is fraudulent if it is deceptively promoted as effective against a disease but has not been shown scientifically to be safe and effective for that purpose. Its consumer guidance lists warning signs: one product claimed to treat many diseases, personal testimonials, quick fixes, "all natural" labeling, "miracle" wording, and conspiracy claims. It adds that natural labeling does not establish safety and that FDA laboratories have found products marketed as all-natural that contained hidden prescription drug ingredients.

A Federal Trade Commission consumer guide produced with FDA says fraudulently marketed health products can interact dangerously with medicines people already take and can keep people from getting a proper diagnosis and treatment. The National Cancer Institute adds that herbal and dietary supplements do not have to be approved by FDA before sale, that kava has been linked in some studies to liver damage, and that St. John's wort may make certain cancer drugs less effective.

Talking with a clinician

NCCIH recommends listing every practice and product on patient history forms, telling providers at each visit, and asking about safety, effectiveness and interactions before starting something new. In the 1993 survey, 72 percent of unconventional therapy users had not told their doctor, so open disclosure is a long-standing gap. Anyone considering stopping, skipping or delaying a diagnosed treatment should discuss it with their treating clinician first.

The sources reviewed do not show that the Alternative label as a whole is either hazardous or harmless. Risk depends on the practice, the product, the condition and whether necessary conventional care continues. This page is educational and is not a substitute for medical advice.