Please Don’t Define “Complementary and Alternative Health Practices”!

Since I have a master’s and doctoral degree in health education and since I’m a professor in a department of public health with an undergraduate curriculum that includes substantial attention to health education, I participate in the email discussion group of HEDIR, the Health Education Directory. On August 16th, I received a message to the discussion group from the American Association for Health Education inviting participants to complete an online survey from the Joint Committee on Health Education and Promotion Terminology with results to be analyzed at the Committee’s meeting in September 2011.

The survey items include various terms used by health educators, the currently approved terminology, and three choices followed by a type-in box:

  • This term should remain as defined
  • This term should remain in the report but modified in definition
  • This term is no longer commonly used in health education/health promotion literature

If modify, please provide the suggested wording and reference for that definition if you are citing it from a specific source.

For one of the terms, my preferred response would have be have been a fourth choice that was not offered: The term is commonly used in health education/health promotion and elsewhere, but it should not be used because its use only serves to distort our thought processes and promote quackery.

Here is the term along with the definition presented in the survey:

Complementary and Alternative Health Practices: These practices generally include natural substances, physical manipulations, and self-care modalities. These approaches often incorporate aspects of interventions derived from traditional practices. The approach in Western societies has been to select specific approaches from these systems and apply them to health maintenance, health enhancement, or disease management. Such approaches can be used to compliment[sic] conventional allopathic care (complementary therapy), or as an alternative to conventional approaches (alternative therapy). Many of these complementary and alternative approaches have not been validated through experiential research, but those that have, such as acupuncture for pain, are being integrated into conventional health practices (integrative medicine).

And here are my objections to the term and to the definition given:

“Complementary and alternative health practices” is marketing doublespeak that conceals how promoting (via advertising, publicity, direct selling, word-of-mouth, etc.) non-validated or invalidated practices is unethical. When a practice is science-based, it is simply part of good healthcare or health promotion. “Complementary and alternative” jargon is never necessary to describe validated practices in health promotion or health care delivery. Science-based uses of natural substances, physical manipulations, and self-care modalities are all part of regular medicine.

Science-based natural products medicine is called pharmacognosy. Labels like “complementary and alternative” are used to give the impression of legitimacy, not to pharmacognosy, but to superstitious and often ecologically destructive uses of natural products such as herbalism (particularly paraherbalism), gruesome extractions of bile from living bears, shark cartilage, and rhinoceros horns.

Physical manipulations with a rational basis such as many of those included in personal exercise programs and physical therapy do not require euphemistic labels such as “complementary” or “alternative.” However, the labels “complementary” or “alternative” are often applied to give the appearance of legitimacy to superstition-based or pseudoscience-based physical manipulation treatments such as those used in chiropractic. Many chiropractors falsely claim that the spine requires periodic maintenance “adjustments” of health compromising  “subluxations” that only chiropractors can supposedly detect. Such adjustments don’t complement anything else and they aren’t a viable alternative for health promotion or disease prevention.

Many of the manipulations promoted as “complementary” or “alternative” are actually non-physical; they are rooted in vitalism, which is defined as: “a doctrine that the functions of a living organism are due to a vital principle distinct from physicochemical forces” or “a doctrine that the processes of life are not explicable by the laws of physics and chemistry alone….” Different health cults have different names for the supposed vital principle. In anthroposophy, the names are the divine element in nature, astral body, formative force, or either body. In Ayurvedic medicine, it’s prana. In chiropractic, it’s innate intelligence. In Reichian psychotherapy, it’s orgone energy. In homeopathy, it’s vital energy. In naturopathy, it’s vis medicatrix naturae. In Traditional Chinese Medicine and acupuncture, it’s chi or qi or ki.

The vital principle was popularized in Star Wars as “the force.” But in the real universe, nothing like “the force” is reliably detectable and there are no Jedi-like masters who can manipulate anything akin to it for healing or any other purposes. In the movie Austin Powers: The Spy Who Shagged Me, the vital principle was called mojo. The idea that some people have skills as mojo detectors or mojo manipulators is as absurd as the movie, but “there are some ideas so absurd that only an intellectual could believe them.”

Self-care modalities have been promoted as “complementary” and “alternative,” but what useful distinction is there to be made between supposed “complementary” or “alternative” self-care modalities and those that don’t qualify and are therefore implicitly non-complementary or non-alternative? If the distinction is to be based on validation for safety and efficacy, why introduce euphemistic language like “complementary” or “alternative”? Categories such as validated, non-validated, and invalidated should suffice to give consumers useful information for deciding what modalities of self-care are worth trying out.

It’s true that many tradition-based practices are promoted as “complementary” or “alternative.”  Scholars who attempt to advance “complementary and alternative medicine” often like to emphasize traditional systems of care and ignore other practices marketed as “complementary and alternative.” Since it is often considered rude to be judgmental about traditions associated with particular cultures, fallacious appeals to traditional wisdom are useful in public relations. But numerous practices, products, and services marketed to consumers as “complementary” or “alternative” are promoted as “innovative,” “advanced,” “cutting edge,” “modern,” “scientific,” and the like, not as tradition-based. Examples include such so-called complementary and alternative medicine approaches (sCAMs) as metabolic therapy, chelation therapy, oxygenation treatments, insulin potentiation therapy, clinical ecology, anti-aging medicine, attachment therapy, various other mental health therapies, antineoplastons, cellular therapy, and syncrometers & zappers.

Referring to the selection of specific approaches from traditional systems in Western societies as “complementary” or “alternative” implies an East-West dichotomy that is simply false. Tradition-based systems and supposed whole-system care are not uniquely Eastern. Is it only in Western societies that approaches from traditional systems get used separately from whole-system care?

Medical anthropologists, medical sociologists, educated laypersons, health educators, and even physicians often make the mistake of describing standard medical practices of today and recent decades as “conventional allopathic care.” Allopathy is a term coined by Samuel Hahnemann (formulator of homeopathic treatment principles) as a label for medical practices of his day that were based upon ancient Greek humoral theory of disease such as bleeding and purging and blistering to manipulate the four so-called body humors: blood, phlegm, black bile, and yellow bile. As medicine became more science-based, it discarded treatment based upon the convention of manipulating body humors and progressed by developing healthcare consistent with progress in biological and physical sciences. Nevertheless, approaches to healthcare based upon humoral theory—what Hahnemann called allopathy—persist today in parts of India, Pakistan and elsewhere as Unani medicine, which, ironically, the World Health Organization recognizes as a type of “CAM.” Unani is an Arabic adjective meaning Greek.

Since modern medicine makes progress by relying on science, it is iconoclastic—the antithesis of conventional. By contrast, the real allopathy practiced today as Unani medicine is bound to its ancient conventions. Like much of what gets promoted as “complementary” and “alternative,” Unani medicine reflects conventional wisdom of healing traditions rather than the rigor of scientific testing and the iconoclasm of scientific discovery.

I have previously explained that calling an approach to healthcare “complementary” implies that it adds to the outcome when combined with some other treatment and that calling an approach to healthcare “alternative” implies that it can be successfully used in lieu of some other approach. However, this is misleading labeling. Simply calling an approach “complementary” doesn’t mean it actually complements anything else and calling an approach “alternative” doesn’t make it a viable alternative. The jargon “complementary and alternative” serves to distract attention away from questions of utility based upon scientific merit.

Professor Richard Dawkins has explained: “Either it is true that a medicine works or it isn’t. It cannot be false in the ordinary sense but true in some ‘alternative’ sense.”

Drs. John E. Dodes and Marvin Schissel put it this way: “Erythromycin is an alternative to penicillin, but a pogo stick is not an alternative to an automobile.”

Drs. Marcia Angell and Jerome Kassirer wrote: “There cannot be two kinds of medicine—conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work.”

Dr. George Lundberg explains it this way:

There is no “alternative medicine.” There is only medicine:

  • Medicine that has been tested and found to be safe and effective. Use it; pay for it.
  • And, medicine that has been tested and found to be unsafe or ineffective. Don’t use it; don’t pay for it.
  • And, medicine for which there is some plausible reason to believe that it might be safe and effective. Test it and then place it into one of the other two categories.

Although many people believe that acupuncture for pain is medicine that fits Dr. Lundberg’s first category,  the weight of evidence places it in the second category, especially considering the lack of a plausible rationale for acupuncture as a therapy. Few, if any, health practices that have been promoted as “complementary” and “alternative” also belong in Dr. Lundberg’s first category. More than ten years of research funding by the National Center for Complementary and Alternative Medicine has failed to contribute to medical progress.

The term integrative medicine is superfluous and should not be used by responsible health professionals. Palliative care and adjunctive care are meaningful and useful terms for efforts to provide rational modalities of humane care, comfort, and support addressing the diverse needs of patients. The term “integrative medicine” adds nothing to describe approaches strongly supported by scientific evidence, but serves as an income-generating mechanism for attracting patients to seemingly special modalities that typically lack support beyond cherry-picked evidence or tradition. The term “integrative medicine” is not needed to offer science-based psychological approaches for managing health problems, but it does help in marketing when you are offering modalities based on vitalism. “Integrative medicine” represents branding, not a meaningful medical specialty. It projects a misleading image of academic seriousness that serves only to obscure its hype and help secure funding for clinical research of dubious need.

Terms such as “alternative,” “complementary,” and “integrative” have become popular euphemisms for non-validated and invalidated approaches to health enhancement—especially approaches with farfetched rationales. The use of such euphemisms facilitates quackery: the promotion of health products, services, or practices of questionable safety, effectiveness, or validity for an intended purpose. Today quackery is a far less popular term than the euphemisms. In some circles, it is politically incorrect to refer to quackery. But if we cannot refer to quackery as quackery, we can expect it to persist as a neglected public health scandal. I suggest that there are better alternatives to using currently popular euphemisms of alt-speak.

William M. London is a professor in the Honors College and in the Department of Public Health in the College of Health and Human Services at California State University, Los Angeles. He co-authored the sixth, seventh, eighth, and ninth (in press) editions of the college textbook Consumer Health: A Guide to Intelligent Decisions. Since 2002, he has been associate editor of the free weekly e-newsletter Consumer Health Digest. Since 2005, he has been co-host of the Credential Watch web site. He tweets as @healthgadfly.

Posted in: Medical Academia

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