Understanding the Differences Between Conventional, Alternative,
from Townsend Letter, July 1999
This paper will attempt to delineate the differences between and definitions of, conventional, alternative, traditional, complementary, natural, holistic, and integrative medicine. The author begins with the a priori notion that there are differences between these areas of medicine. Assumptions about and credibility of "a newly emerging field of medicine" is greatly impacted by one's understanding of the term used to describe that field. At least some other medical authors would concur that word meanings can have a significant impact on credibility, application and regulation in the profession of medicine.1,2
Clarification of the terms used to describe different areas of medicine should be based on appropriate word meanings as found in standard dictionaries. To define is to "set forth the meaning of; to determine or identify the essential qualities or meaning of; to fix or mark the limits of; to characterize (or) distinguish (something)."3 Definitions for conventional, alternative, traditional, complementary, natural, holistic, and integrative medicine need to convey the essential qualities and uniqueness of each field of medicine. Suitable definitions will benefit insurance companies, healthcare consumers and practitioners. Whether these definitions become standard appears to be a matter of politics, power and changing healthcare values of the American public.
It is important to understand and eventually agree on the correct terminology that should be used synonymously with conventional medicine, the dominant medical system in the United States and other developed nations. Appropriate identifiers for conventional medicine would include allopathic or orthodox medicine. The term allopathic (in Greek "allo" means other) medicine was coined by Samuel Hahnemann, MD, in the late 18th century in reference to the use of therapeutic modalities which are based on the assumption that symptoms need to be treated, i.e. opposed.4 The focus on treating symptoms appears to have developed as one of the guiding treatment principles in orthodox medicine.
Use of the term conventional or orthodox provides the dominant medical system in the United States an almost automatic credibility. Synonyms for orthodox include accepted, approved, established, sanctioned, and authoritative. Each of these words connotes a high degree of credibility within the American social, economic, and insurance structure. In fact, using the terms conventional or orthodox does not appropriately describe the practice of that form of medicine (as does allopathic), but rather provides it with a sanctioned power. The power of those terms are so great that to some extent they lead to negating the existence of any other system of medicine.
Although "traditional medicine" is often used synonymously for orthodox medicine, Webster's definition of "traditional" would suggest that this term is not an appropriate identifier for conventional medicine. Traditional is defined as the handing down of opinions, doctrines, practices, rites, and customs, especially by oral communication.3 Correct word usage would dictate traditional medicine be reserved for Chinese, Ayurvedic, Tibetan, or other indigenous medical systems.5 All of these have century-old philosophies and practice foundations, which are heavily rooted in the traditions of each society. Cultural, spiritual and societal beliefs have largely formed the basis of traditional systems of medicine. In the sense that allopathic medicine would claim its basis to be scientific, rather than cultural or spiritual, traditional medicine should not be used synonymously with orthodox medicine.
By utilizing the identifier of traditional medicine, allopathic medicine effectively softens the hard, uncaring edge of a medicine "at war" with disease. The emphasis on disease and high technology rather than on health and individualized care, creates a visit to an orthodox physician which is often replete with impersonal attendance to a disease entity. Using the term traditional in fact, helps root allopathic medicine in humanity and removes it from the cold world of technology and systematized economic incentives.
The term biomedical is also often used to refer to conventional medicine.6 This term again conveys credibility and power to conventional medicine. The assumptions that underlie "biomedical" medicine are that it is accurate, scientific and proven. It is a medicine based on the biological understanding of the organism. Given the tremendous advances in our understanding of the physical universe, i.e. quantum physics, it is clear that the biology of living organisms is not as simple as the textbooks would suggest. In fact, the evidence that the mind and body are one and that the human body is more than a structural and biochemical entity is overwhelming.7,8 Recognition that the body has an energetic level is burgeoning and can be partially explained by quantum physics. Therapies which are currently within the vast realm of "alternative medicine," such as acupuncture and homeopathy, may actually be best explained as therapies which impact physiology via the energetic level.9 With a more contemporary, comprehensive understanding of human biology, biomedicine becomes an inappropriate, exclusive identifier for conventional medicine.
To discuss accurate and appropriate definitions of alternative, comple-mentary, natural, and integrated medicine requires clarity regarding the difference between a system of medicine and the practice of medicine. The dictionary defines the practice of medicine as the "scientific study of diagnosing, treating, or preventing disease." Notably this definition does not include any reference to a system of medicine. The American Medical Association (AMA) has stated that for any medical system to be truly credible it needs to have a theoretical basis.10
Despite the apparent absence of allopathic medical philosophy classes in conventional medical schools, the theoretical basis of allopathic medicine appears to have stemmed from Pasteur's findings regarding infectious illness.11 Namely, that a single agent causes a single type of disease and that a specific therapy can be used to treat that disease. This has been called the "doctrine of specific etiology." This simple doctrine along with the quick symptom-relieving effects of synthetic drugs and surgeries, have undoubtedly contributed to the dominance allopathic medicine enjoys today.
Pietroni, a general medical practitioner from the United Kingdom, has written several short articles posing his concerns over clarifying terminology in this vast field of alternative medicine.1,12 He states "Much confusion arises from the belief that holistic medicine and alternative medicine are the same."12 He further suggests that there are four distinct aspects to alternative medical therapies; 1) complete systems, 2) diagnostic methods, 3) therapeutic modalities, and 4) self-care approaches. These various aspects of "alternative medicine" should be understood separately and not under one single definition.
Eisenberg's survey study defined alternative medicine to mean a treatment which is not taught by US medical schools or offered at any US hospital.13 Although this definition was useful for the purpose of Eisenberg's survey, it is somewhat inaccurate. Alternative medical treatments are taught at naturopathic medical schools and alternative medicine is often used to include alternative diagnostic procedures, not just treatment modalities.12 The term "alternative medicine" is used by many to mean any medical therapy which is not a synthetic drug or not surgery. For the purpose of research through the NIH Office of Alternative Medicine, the definition of complementary and alternative medicine (CAM) is "CAM is a broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period."2 In other words, alternative medicine has come to mean a treatment, which is not the standard of care in conventional medicine.
Basing a whole area of medicine on something which it is not, rather than on what it is, suggests that there is no theoretical foundation to the field of alternative medicine. The author suggests that if the term "alternative medicine" is simply used to mean therapies, which can be used to treat ill health, but are not the "standard of care," then the paradigm for practice of alternative medicine is the same as orthodox medicine. This translates to a patient with disease X being given herb Y or nutrient Z to treat their disease. The assumption by the medical community is that herb Y or nutrient Z is just an alternative to drug Q.
Natural medicine could be considered a system of medicine within the field of alternative medicine. It is more than just an alternative approach to treating a specific disease. A comprehensive definition of natural medicine would be the science and art of preventing, curing or alleviating ill health using treatment modalities in harmony with the laws of nature. Natural medicine is a medical system, which cares for and treats individuals, not disease entities. Applying the laws of nature of the physical/energetic universe to human physiology forms the foundation principles for the practice, teaching and research of natural medicine. It is not so much the specific treatment modality, which defines the field of natural medicine, but rather the approach to the patient and the paradigm, which is used by the practitioner to determine a treatment plan. Synonymous with natural medicine is naturopathic medicine.
Naturopathic medicine began in the United States in the early 1900's by a German-born healer, Benedict Lust, and was more formalized and systematized by Henry Lindlahr, MD in his published volumes on natural therapeutics in 1919.14 Lust defined naturopathy as the use of nontoxic healing methods derived from the best traditional healing systems from around the world. The ideas, theories and practices described in Lindlahr's first two volumes are so important to understanding the roots and foundations of natural medicine, that contemporary naturopathic medical schools still use them as textbooks in naturopathic medical philosophy courses.
As a matter of clarification, a short definition of homeopathic medicine is presented. Although naturopathic medical colleges teach the principles and practice of homeopathic medicine, it is in fact a complete system of medicine. Homeopathy has both a systematized theoretical and therapeutic basis.15 This system of medicine was developed by Samuel Hahnemann, MD in the late 1800's. Hahnemann proposed the theoretical framework and researched specific homeopathic remedies. The theoretical foundations for homeopathic medicine are too extensive to be reviewed in this manuscript; interested readers are referred to several good publications.4,15 The practice of homeopathic medicine is conducted using a natural medicine paradigm, with the treatment modality always being a homeopathic remedy. In essence, naturopathic/natural medicine shares the same medical/healing paradigm as homeopathy, but natural medicine is more comprehensive and eclectic in its choice of treatment modalities.
Complementary medicine, like alternative medicine, is best understood, not as a system of medicine, but rather as a practice of medicine. Unlike alternative medicine, complementary medicine is a non-standard treatment given in conjunction with allopathic therapy, as opposed to instead of a standard treatment. The allopathic paradigm of disease still guides the treatment plan. For example, treating hypertension with a synthetic drug like propranolol (§-blocker), may not effectively lower the high blood pressure or may produce unwanted side effects. Complementary medicines could be used in conjunction with propranolol to help alleviate side effects or help lower blood pressure to normal ranges.
It would appear that the term complementary is often used synonymously with alternative medicine.2,6 This does not seem to be appropriate word usage. A dictionary defines complementary as "what completes or necessarily coexists with."3 Whereas alternative is defined as "mutually exclusive" or "a choice between two or more things."3 Clearly, these terms have different definitions and should not be used interchangeably.
Allopathic doctors may have suggested that these terms could be interchanged to help keep alternative medicine in its proper place within the medical system.6 Not surprisingly, allopathic doctors would view the use of "non-standard" treatments skeptically and automatically assume they are less effective than standard treatments. By using complementary as a synonym for alternative medicine, allopathic doctors are comfortable with alternative treatments used in conjunction with, but not instead of allopathic treatments. This inappropriate interchange of terms creates unwarranted assumptions and dilutes the credibility of alternative medicines in the mind of healthcare consumers. It suggests that all non-synthetic agents (i.e. nutrient, herbal, other supplements) are unproven in efficacy and have all been compared to synthetic drugs for their overall safety and effectiveness. Until this type of research has been conducted it would seem that sagacious use of word meanings dictate "alternative" and "complementary" be defined as separate and distinct practices of medicine.
The term holistic medicine used to be a popular term, and now with the interest in "alternative medicine," is not used as much. In fact, this author would suggest that holistic medicine is an archaic and confusing term. Since there is no system of medicine, known as holistic medicine, and the premise of holism fits well within the realm of natural medicine paradigm, natural medicine is probably a more appropriate term.
Finally, integrative medicine has also been used interchangeably with alternative and complementary medicine.16 Integrative medicine is another term without a foundation philosophy. Proper word usage would dictate that integrative medicine be used by a single medical practitioner who is familiar with allopathic therapeutic armamentarian and alternative medicine modalities, such that the patient receives "integrated" treatment. The term "integrative medicine" would also be appropriate for a clinic in which a patient is treated by both allopathic and alternative medicine practitioners. Integrative medicine could be considered synonymous with complementary medicine, as defined here.
In an ideal, non-biased, non-political society, perhaps integrative medicine should be the term applied to the whole healthcare system. A system based on physicians fitting into the scheme of patient care depending on their type of training. For example, naturopathic physicians are trained in the majority of "alternative medicine" modalities, while learning how to deal with patients from a natural medicine paradigm. This training positions naturopathic physicians as experts in prevention and gentle treatment of all common ailments and chronic degenerative diseases which have a dietary and lifestyle, i.e. multifactorial etiology. While allopathic medical training, with its emphasis on disease pathology and technology have expert training in high intervention medicine. When surgery is required, when a potent antibiotic is required, when a strong, potent drug is required, when life support systems are required, conventional medicine practitioners have unparalleled expertise.
In summary, I would propose that accurate use of the terms "alternative," "complementary" and "natural" medicine would benefit the health consumer, insurance companies, biomedical research and the medical community. As the American healthcare system moves to integrate "alternative medicine" practitioners, perhaps that integration will be more systematized and appropriate if the type of medicine that clinicians practice is more clearly understood. Furthermore, terminology clarification will help guide the development of appropriate research models and hypotheses. For example, the effectiveness of natural medicine should be judged based on the accuracy of its theoretical foundations, whereas the effectiveness of alternative medicine cannot be judged as a whole, since it is not a "system of medicine." Only individual, "non-standard" therapies can be studied as part of alternative medicine.
Anna MacIntosh, PhD, ND
P.O. Box 644
Beavercreek, Oregon 97004 USA
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