Definitions And Terminology

"Alternative medicine" is a loosely defined set of products, practices, and theories that are believed or perceived by their users to have the healing effects of medicine, but whose effectiveness has not been clearly established using scientific methods, whose theory and practice is not part of biomedicine or whose theories or practices are directly contradicted by scientific evidence or scientific principles used in biomedicine.

"Biomedicine" is that part of medical science that applies principles of biology, physiology, molecular biology, biophysics, and other natural sciences to clinical practice, using scientific methods to establish the effectiveness of that practice. Alternative medicine is a diverse group of medical and health care systems, practices, and products that originate outside of biomedicine, are not considered part of biomedicine are not widely used by the biomedical healthcare professions and are not taught as skills practiced in biomedicine Unlike biomedicine an alternative medicine product or practice does not originate from the sciences or from using scientific methodology, but may instead be based on testimonials, religion, tradition, superstition, belief in supernatural energies, pseudoscience, errors in reasoning, propaganda, fraud, or other unscientific source. The expression "alternative medicine" refers to a diverse range of related and unrelated products, practices, and theories, originating from widely varying sources, cultures, theories, and belief systems, and ranging from biologically plausible practices and products and practices with some evidence, to practices and theories that are directly contradicted by basic science or clear evidence, and products that have proven to be ineffective or even toxic and harmful.

"Alternative medicine", "complementary medicine", "holistic medicine", "natural medicine", "unorthodox medicine", "fringe medicine", "unconventional medicine", and "new age medicine" may be used interchangeably as having the same meaning (synonyms) in some contexts, but may have different meanings in other contexts, for example, unorthodox medicine may refer to biomedicine that is different from what is commonly practiced, and fringe medicine may refer to biomedicine that is based on fringe science, which may be scientifically valid but is not mainstream.

The meaning of the term "alternative" in the expression "alternative medicine", is not that it is an actual effective alternative to medical science, although some alternative medicine promoters may use the loose terminology to give the appearance of effectiveness. Marcia Angell stated that "alternative medicine" is "a new name for snake oil. There's medicine that works and medicine that doesn't work." Loose terminology may also be used to suggest meaning that a dichotomy exists when it does not, e.g., the use of the expressions "western medicine" and "eastern medicine" to suggest that the difference is a cultural difference between the Asiatic east and the European west, rather than that the difference is between evidence-based medicine and treatments which don't work.

"Complementary medicine" refers to use of alternative medical treatments alongside conventional medicine, in the belief that it increases the effectiveness of the science-based medicine. An example of "complementary medicine" is use of acupuncture (sticking needles in the body to influence the flow of a supernatural energy), along with using science-based medicine, in the belief that the acupuncture increases the effectiveness or "complements" the science-based medicine. "CAM" is an abbreviation for "complementary and alternative medicine".

The expression "Integrative medicine" (or "integrated medicine") is used in two different ways. One use refers to a belief that medicine based on science can be "integrated" with practices that are not. Another use refers only to a combination of alternative medical treatments with conventional treatments that have some scientific proof of efficacy, in which case it is identical with CAM. "holistic medicine" (or holistic health) is an alternative medicine practice which claim to treat the "whole person" and not just the illness itself.

"Traditional medicine" and "folk medicine" refer to prescientific practices of a culture, not to what is traditionally practiced in cultures where medical science dominates. "Eastern medicine" typically refers to prescientific traditional medicines of Asia. "Western medicine", when referring to modern practice, typically refers to medical science, and not to alternative medicines practiced in the west (Europe and the Americas). "Western medicine", "biomedicine", "mainstream medicine", "medical science", "science-based medicine", "evidence-based medicine", "conventional medicine", "standard medicine", "orthodox medicine", "allopathic medicine", "dominant health system", and "medicine", are sometimes used interchangeably as having the same meaning, when contrasted with alternative medicine, but these terms may have different meanings in some contexts, e.g., some practices in medical science are not supported by rigorous scientific testing so "medical science" is not strictly identical with "science-based medicine", and "standard medical care" may refer to "best practice" when contrasted with other biomedicine that is less used or less recommended.

Problems with definition

Prominent members of the science and biomedical science community assert that it is not meaningful to define an alternative medicine that is separate from a conventional medicine, that the expressions "conventional medicine", "alternative medicine", "complementary medicine", "integrative medicine", and "holistic medicine" do not refer to anything at all. Their criticisms of trying to make such artificial definitions include: "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;" "By definition, alternative medicine has either not been proved to work, or been proved not to work. You know what they call alternative medicine that's been proved to work? Medicine;" "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;" and "There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking.”

Others in both the biomedical and CAM communities point out that CAM cannot be precisely defined because of the diversity of theories and practices it includes, and because the boundaries between CAM and biomedicine overlap, are porous, and change. 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. 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. Some alternative therapies, including traditional Chinese medicine (TCM) and Ayurveda, have antique origins in East or South Asia and are entirely alternative medical systems; others, such as homeopathy and chiropractic, have origins in Europe or the United States and emerged in the eighteenth and nineteenth centuries. Some, such as osteopathy and chiropractic, employ manipulative physical methods of treatment; others, such as meditation and prayer, are based on mind-body interventions. Treatments considered alternative in one location may be considered conventional in another. 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.

Different types of definitions

One common feature of all definitions of alternative medicine is its designation as "other than" conventional medicine. For example, the widely referenced descriptive definition of complementary and alternative medicine devised by the US National Center for Complementary and Integrative Health (NCCIH) 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." For conventional medical practitioners, it does not necessarily follow that either it or its practitioners would no longer be considered alternative.

Some definitions seek to specify alternative medicine in terms of its social and political marginality to mainstream healthcare. 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. In 1993, the British Medical Association (BMA), one among many professional organizations who have attempted to define alternative medicine, stated that it 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". In a US context, an influential definition coined in 1993 by the Harvard-based physician, David M. Eisenberg, characterized alternative medicine "as interventions neither taught widely in medical schools nor generally available in US hospitals". 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; 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. In 1999, 7.7% of US hospitals reported using some form of CAM therapy; this proportion had risen to 37.7% by 2008.

An expert panel at a conference hosted in 1995 by the US Office for Alternative Medicine (OAM), 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." This definition has been widely adopted by CAM researchers, cited by official government bodies such as the UK Department of Health, attributed as the definition used by the Cochrane Collaboration, and, with some modification,[dubious – discuss] was preferred in the 2005 consensus report of the US Institute of Medicine, Complementary and Alternative Medicine in the United States.

The 1995 OAM conference definition, an expansion of Eisenberg's 1993 formulation, is silent regarding questions of the medical effectiveness of alternative therapies. 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. 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". 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. 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.

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. 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. 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."

This line of division has been subject to criticism, however, as not all forms of standard medical practice have adequately demonstrated evidence of benefit  and it is also unlikely in most instances that conventional therapies, if proven to be ineffective, would ever be classified as CAM.

Regional definitions

Public information websites maintained by the governments of the US and of the UK make a distinction between "alternative medicine" and "complementary medicine", but mention that these two overlap. The National Center for Complementary and Integrative Health (NCCIH) of the National Institutes of Health (NIH) (a part of the US Department of Health and Human Services) states that "alternative medicine" refers to using a non-mainstream approach in place of conventional medicine and that "complementary medicine" generally refers to using a non-mainstream approach together with conventional medicine, and comments that the boundaries between complementary and conventional medicine overlap and change with time.

The National Health Service (NHS) website NHS Choices (owned by the UK Department of Health), adopting the terminology of NCCIH, states that when a treatment is used alongside conventional treatments, to help a patient cope with a health condition, and not as an alternative to conventional treatment, this use of treatments can be called "complementary medicine"; but when a treatment is used instead of conventional medicine, with the intention of treating or curing a health condition, the use can be called "alternative medicine".

Similarly, the public information website maintained by the National Health and Medical Research Council (NHMRC) of the Commonwealth of Australia uses the acronym "CAM" for a wide range of health care practices, therapies, procedures and devices not within the domain of conventional medicine. In the Australian context this is stated to include acupuncture; aromatherapy; chiropractic; homeopathy; massage; meditation and relaxation therapies; naturopathy; osteopathy; reflexology, traditional Chinese medicine; and the use of vitamin supplements.

The Danish National Board of Health's "Council for Alternative Medicine" (Sundhedsstyrelsens Råd for Alternativ Behandling (SRAB)), an independent institution under the National Board of Health (Danish: Sundhedsstyrelsen), uses the term "alternative medicine" for:

Treatments performed by therapists that are not authorized healthcare professionals.

Treatments performed by authorized healthcare professionals, but those based on methods otherwise used mainly outside the healthcare system. People without a healthcare authorisation are [also] allowed to perform the treatments.

National traditions or dominant practices

In General Guidelines for Methodologies on Research and Evaluation of Traditional Medicine, published in 2000 by the World Health Organization (WHO), complementary and alternative medicine were defined as a broad set of health care practices that are not part of that country's own tradition and are not integrated into the dominant health care system. Some herbal therapies are mainstream in Europe but are alternative in the US.