Terms and definitions

The expression "complementary and alternative medicine" (CAM) resists easy definition because the health systems and practices to which it refers are diffuse and its boundaries are poorly defined.^{[13][14][15][n 2]} Healthcare practices categorized as alternative may differ in their historical origin, theoretical basis, diagnostic technique, therapeutic practice and in their relationship to the medical mainstream.^[17] Some alternative therapies, including traditional Chinese Medicine (TCM) and Ayurveda, have antique, non-Western origins and are entirely alternative medical systems;^[18] others, such as homeopathy and chiropractic, are native to the West and emerged in the eighteenth and nineteenth centuries.^[19] Some, such as osteopathy and chiropractic, employ manipulative physical methods of treatment; others, such as meditation and prayer, are based on mind-body interventions.^[20] Treatments considered alternative in one location may be considered conventional in another.^[21] Thus, chiropractic is not considered alternative in Denmark and likewise osteopathic medicine is no longer thought of as an alternative therapy in the United States.^[21]

One common feature of all definitions of alternative medicine is its designation as "other than" conventional medicine.^[22] For example, the widely referenced ^[23][24] descriptive definition of complementary and alternative medicine devised by the US National Center for Complementary and Altenative Medicine (NCCAM) of the National Institutes of Health (NIH), states that it is "a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine."^[25] This definition has been criticized as, if an alternative therapy, both effective and safe, is adopted by conventional medical practitioners, it does not necessarily follow that either it or its practitioners would no longer be considered alternative.^{[n 3]}

Some definitions seek to specify alternative medicine in terms of its social and political marginality to mainstream healthcare.^[28] This can refer to the lack of support that alternative therapies receive from the medical establishment and related bodies regarding access to research funding, sympathetic coverage in the medical press, or inclusion in the standard medical curriculum.^[28] In 1993, the British Medical Association (BMA), one among many professional organizations who have attempted to define alternative medicine, stated that it^{[n 4]} referred to "those forms of treatment which are not widely used by the conventional healthcare professions, and the skills of which are not taught as part of the undergraduate curriculum of conventional medical and paramedical healthcare courses".^[29] In a US context, an influential definition coined in 1993 by the Harvard-based physician,^[30] David M. Eisenberg,^[31] characterized alternative medicine "as interventions neither taught widely in medical schools nor generally available in US hospitals".^[32] These descriptive definitions are inadequate in the present-day when some conventional doctors offer alternative medical treatments and CAM introductory courses or modules can be offered as part of standard undergraduate medical training;^[33] alternative medicine is taught in more than 50 per cent of US medical schools and increasingly US health insurers are willing to provide reimbursement for CAM therapies.^[34] In 1999, 7.7% of US hospitals reported using some form of CAM therapy; this proportion had risen to 37.7% by 2008.^[35]

An expert panel at a conference hosted in 1995 by the US Office for Alternative Medicine (OAM),^{[n 5]} devised a theoretical definition of alternative medicine as "a broad domain of healing resources ... other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period."^[36] This definition has been widely adopted by CAM researchers,^[37] cited by official government bodies such as the UK Department of Health,^[38] attributed as the definition used by the Cochrane Collaboration,^[39] and, with slight modification, was preferred in the 2005 consensus report of the US Institute of Medicine, Complementary and Alternative Medicine in the United States.^{[n 6]}

The 1995 OAM conference definition, an expansion of Eisenberg's 1993 formulation, is silent regarding questions of the medical effectiveness of alternative therapies.^[41] Its proponents hold that it thus avoids relativism about differing forms of medical knowledge and, while it is an essentially political definition, this should not imply that the dominance of mainstream biomedicine is solely due to political forces.^[41] According to this definition, alternative and mainstream medicine can only be differentiated with reference to what is "intrinsic to the politically dominant health system of a particular society of culture".^[42] However, there is neither a reliable method to distinguish between cultures and subcultures, nor to attribute them as dominant or subordinate, nor any accepted criteria to determine the dominance of a cultural entity.^[42] If the culture of a politically dominant healthcare system is held to be equivalent to the perspectives of those charged with the medical management of leading healthcare institutions and programs, the definition fails to recognize the potential for division either within such an elite or between a healthcare elite and the wider population.^[42]

Normative definitions distinguish alternative medicine from the biomedical mainstream in its provision of therapies that are unproven, unvalidated or ineffective and support of theories which have no recognized scientific basis.^[40] These definitions characterize practices as constituting alternative medicine when, used independently or in place of evidence-based medicine, they are put forward as having the healing effects of medicine, but which are not based on evidence gathered with the scientific method.^{[1][25][44][45][46]} Exemplifying this perspective, a 1998 editorial co-authored by Marcia Angell, a former editor of the New England Journal of Medicine, argued that:

"It is time for the scientific community to stop giving alternative medicine a free ride. 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. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted. But assertions, speculation, and testimonials do not substitute for evidence. Alternative treatments should be subjected to scientific testing no less rigorous than that required for conventional treatments.^[47]

This definition has been described by Robert L. Park as a logical Catch-22 which ensures that any CAM method which is proven to work "would no longer be CAM, it would simply be medicine."^[48]

Paul Offit, while criticizing alternative medicine, has provided a similar type of definition:

"...there's no such thing as conventional or alternative or complementary or integrative or holistic medicine. There's only medicine that works and medicine that doesn't. And the best way to sort it out is by carefully evaluating scientific studies--not by visiting Internet chat rooms, reading magazine articles, or talking to friends."^[49]

Joseph A. Schwarcz has stated: "There's a name for alternative medicines that work. It's called medicine."^[49] Tim Minchin states: "Alternative medicine&_65533; has either not been proved to work, or been proved not to work. You know what they call &_65533;alternative medicine&_65533; that's been proved to work? Medicine."^[50]

"Complementary medicine" refers to use of alternative medicine alongside conventional science based medicine, in the belief that it "may help patients feel better and recover faster."^[44] In Science and Technology: Public Attitudes and Public Understanding, chapter 7 of a report Science and Engineering Indicators – 2002, issued by a US government agency The National Science Foundation, it was stated that the term "alternative medicine" was there being used to refer to all treatments that had not been proven effective using scientific methods.^[1]