Talk:Alternative medicine/Archive 14

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Patient empowerment

The second paragraph in the Efficacy section states: "Advocates of alternative medicine hold that alternative medicine may provide health benefits through patient empowerment, by offering more choices to the public, including treatments that are simply not available in conventional medicine. However, a choice by the patient about which treatment to use can only be made if the patient is properly informed about the pros and cons. The field of medicine is complicated and not even medical doctors are knowledgeable in every topic and need to rely on specialists for many things. A patient does not have the time to study everything before making a decision. Patients need to be able to trust their doctor's advice and should be told if a treatment has no scientific basis." In these five sentence, only the first applies specifically to alternative medicine; the other four are about patient empowerment which applies to any field of health care. Although I am going to remove the last four, I'm preserving them here in the event someone can make that information specifically applicable to this article. Edwardian 04:09, 7 October 2005 (UTC)

Gastrointestinal Origin of Mental Illness?

15/10/2005, Based on the writings of Nutritional Psychiatrist Dr C.M. Reading http://www.gutandmind.cjb.net/

(This article is not intended as replacement for medical treatment.)

Often overlooked in the development of many illnesses, especially mental illness and neurological disorders is the role of the gastrointestinal system. It is known that both our gut and brain originate early in embryogenesis from a clump of tissue called the neurcast, which appears and divides during foetal development. While one section turns into the central nervous system another piece migrates to become the enteric nervous system and thus form both thinking machines. Later the two nervous systems are connected via a cable called the vagus nerve. This nerve meanders from the brain stem through the organs in the neck and thoric and finally ends up in the abdomen. This establishes the brain gut connection. So it is from a correctly functioning gut that we enjoy neurological, psychological and immunological health.

It is currently known among gastroenterologists that children with neurological problems often exhibit gastrointestinal upset. Most medical practitioners associate that the function of the gut is reactive to the mind and not vice versa. This understanding is based of current neuro-gastroeneterology. The guts brain, the enteric nervous system (located in sheaths of tissue lining the esophageus, stomach and colon) is packed with nerves with neurotransmitters, neurons and proteins and support cells like those found in the brain. So when we feel emotional, the enteric nervous system in the gut likely responds to the mind in a certain manner. For example vomiting before an interview.

But contrary to what most people think, latest research indicates that the gut itself may affect the mind and hence how we feel. It is possible that problems with the guts brain - the 'enteric nervous system' and its immunological interactions may indirectly effect the human brain and central nervous system. In this way the gut may be in fact more responsible than we have imagined for our mental well-being...

Gastrointestinal causes of mental illness:

The human body, is an organism of 100 trillion (1014) cells and of this 90 trillion are prokaryotic (bacterial) and 10 trillion are eukaryotic ('human'). Each human cell supports 50-100 bacteria or bacterial descendants. The human gastrointestinal tract is the focal point for this maintaining this balance of bacteria in the body. An advanced array of immunological interactions and defenses constantly interplay between the body and gut to maintain the health of the individual. Infact, the human intestine is the largest organ of the immune system and comprises of millions of bacteria in symbiotic balance with the host. Specialised defences, not fully understood, are in place for the protection of the gut from infectious pathogens and therefore maintain the integrity of the gut mucosa.

Overuse of antibiotics, poor diet, stress, infection and inherited gut disorders such as celiac disease are known to contribute to weakened gastrointestinal health. When the balance of the gut is compromised there is increased risk of gut infection and possible breakdown of the immunological health of the body. So important is this balance, it is noted that 'The brain and body state' is achieved as a reward for looking after our micro flora - according to Evgeny Rothschild, (Science Spectra 6, 1996).

Recurrent gastrointestinal infection, gastritis, post antibiotic infection (colonization of bad bacteria), tropical sprue and inherited gastro-immunological disorders such as celiac sprue, non-celiac sprue and food intolerances may lead to the development of mental illness and disease. For example, current research into autism has postulated that a certain subset of children who had MMR vaccine may have developed a persistent gastrointestinal infection with the measles virus. This has been confirmed through colonoscopies of these children who exhibit inflammation in the small bowel. As a consequence, the poor health of their small bowel has caused these children to deteriorate neurologically.

When the gut can not eradicate a pathogen or suspected antigen correctly a cycle of deterioration occurs in the gut. Normally when a pathogen is acquired by the gastrointestinal tract an auto-immune response is triggered to eliminate this infection. Often diarrhoea, fever and vomiting occur and usually the infection is self limiting and the individual recovers. However, in a subset of people with weakened gastrointestinal systems either inherited or due to environmental factors, the immune response may be inadequate. This leads to persistent gastrointestinal illness. Often a long term immune response to a pathogen not eliminated correctly will trigger persistent inflammation. For example, often seen in cases of inflammatory bowel disease such as Ulcerative colitis, the immune system over-responds and the colon become chronically inflamed due to infection. Repeated inflammation sets in a cycle of deterioration of gut mucosa.

In the case of mental illness it is mostly likely that an insufficient gastro-immunological response occurs in the small bowel. No symptoms of gastrointestinal upset may occur except for mental illness. Repeated immune response due to infection or allergy may result in inflammation, particularly in the area of the small bowel and over time this may lead to damage of the mucosal villi and in turn increase mucosal permeability. With partial-atrophy (flattening) of the villi there is less absorption of food and less immune secretory factors from the villi (IgA, IgM, IgG) cells to prevent further infection. These villi are also responsible in secreting of digestive enzymes, but with greater pathogenic load and poor motility due to infection there is less enzyme release and hence digestion of ingested substances deteriorates. Due to this a cycle of malabsorption can set in, and with malabsorption there is less chance of epithelial repair. This is because epithelial cells are constantly replacing themselves and to do so require a constant nutrient supply. Without adequate and dense nutrition they can not replicate and this worseness mucosal integrity.

In this way, a vicious circle of inflammation, infection, allergy, permeability and malabsorption continues. Overtime, the immunological response of the small bowel may deteriorate, possibly due to autoimmune tendency to the bowel from the body. This may lead to small bowel bacterial overgrowth or candidiasis which in turn increase the leaky ness of the gut.

Once depleted and inflamed, the villi fail to protect the mucosal integrity and allow the intestine to become permeable to more substances. In this way, the small bowel may allow the undigested contents to 'leak' into the blood stream. As enzyme secretion diminishes, due to pathogenic and pancreatic overload there is an accumulation of absorbed undigested materials in the body. These easily cross through a more permeable gut and overload the liver and kidneys with greater than normal toxin levels. In particular, the phase one to phase two detoxification pathways of toxins in the liver can become insufficient for this load and chemical sensitivities may then develop. Without adequate detoxification the poorly digested toxins accumulate in the body.

Allergies to certain foods are often acquired from incomplete digestion and elimination. Allergies in turn also create nutrient deficiencies. In many gut related mental illnesses malabsorption develops both from allergies and poor enzyme release possibly due to pathogenic overload. Malabsorption creates severe disturbances in the body. Many mental patients are known to often exhibit low serum levels of B vitamins and minerals, especially vitamin B12 and B6 and zinc which are vital for normal the function of the brain and stability of mood. Recent studies have shown the many schizophrenics have poor taste and sense of smell - indicative of zinc deficiency.

In addition, the correct break down and digestion foods are required to produce the vitamins needed to create the hormone cortisol. Cortisol and related steroids can only be manufactured with adequate B vitamins, esp. B5, B1, B2, B3, Mg, ZN, and vitamin C.Hence, malabsoption prevents cortisol production in the body. Cortisol is an anti-inflammatory compound and is very important for the homeostasis of the body. With low cortisol the body can not fight allergies, infection or inflammation as well. Cortisol is also is important in mood regulation, stamina levels and blood sugar regulation. Low cortisol can result in mood swings, depression, paranoid and psychotic behaviour. Hypoglycemia results from food allergies, malabsorbtion, low cortisol, Candida, pancreatic overload - all which derive from digestive problems. Hypoglycemia can cause many mental problems such as anxiety, shaking, crying, panic and mood changes.

Insufficient break-down of the hardest to digest (and most commonly consumed) foods leads to incompletely digested fractions or peptides. With stressed detoxification systems these peptides can accumulate in the body. Certain peptides readily cross the blood brain barrier and interfere with brain functioning. Milk and bread exhibit peptides called exorphins from gluten and casein which act as opoids in the human brain and have psychoactive effects. Many psychotic patients have specific IgA antibodies to such peptides indicating that these fractions have accumulated in their brains. It is also possible that poorly digested food fractions may trigger an autoimmune response in the brain due to repeated cerebral allergy. It is postulated that the constant accumulation of such toxins as well as bacterial endotoxins overtime may deteriorate the blood brain barrier itself allowing for greater permeability of the brain to further toxins.

In children and young adults, opoids inhibit the normal maturation of the central nervous system. As the human brain, especially the frontal lobe, does not complete development until the age of 25, permanent damage to the brain often results from these opoids. This explains the rapid onset of autism in healthy children who suddenly deteriorate with severe developmental and learning disorders. Whilst with schizophrenia, this correlates with onset and worsening of symptoms seen in the late teens and early twenties of growing adults. It is likely that the developing brain is damaged from the build up of poorly digested food fractions. These once healthy individuals may have in fact acquired their mental illness through a poorly functioning gastrointestinal-immune system rather than inheriting mental illness. Further examples are of this are seen in Western Ireland which has a high incidence of both celiac sprue and schizophrenia. This also indirectly highlights the mechanism for the inheritance of schizophrenia, whereby inheritance of poor gut function is passed on (not necessarily the gene for dopamine excess) which slowly erodes the developing brain eventually causing mental symptoms.

The combination of the malabsorption of essential nutrients, allergies, low cortisol and accumulation brain opoids and insufficient detoxication to eliminate these toxins may overwhelm the ability of any individual to function normally. By initiating a chain of 'health breakdowns'(See the Gut and Mental illness flow chart diagram), a poorly functioning gastro-immunological system and its cumulative effects, ultimately result in mental illness. The path to recovery or prevention of such illness therefore lies in restoring the immunological balance of the gut. Below are treatment strategies that have helped others recover:

The below treatment strategies are effective for any form of gastro-immune induced illness. Good gut management and gut repair can modify and manage many immune disorders outside the gut. Without gut repair and good gut ecology return of health is unlikely. The Below complementary treatments have assisted people with mental illness, learning disorders, hypoglycemia, autism, memory problems, chronic fatigue, bowel disease, auto-immune disease, arthritis and coeliac and latent cealiac disease. For treatment strategies see http://www.gutandmind.cjb.net/

Based on the writings of Psychiatrist Dr C.M. Reading (This article is not intended as replacement for medical treatment.)

Total pseudoscientific BS. Tokakeke 19:30, 4 March 2006 (UTC)

Definition of alternative medicine

That definition is dire. Alternative medicine is any medicine that is not allopathic. It is alternative to allopathic. Eg Naturopathy, homeopathy, herbalism, nutritional medicine. They can all exist without allopathy apart from the drugs used in trauma medicine, which is not really 'medicine'. 'Complementary medicine is some alternative medicine people who want to work alongside allopaths, with the allopaths as the chief doctor. john 09:48, 3 January 2006 (UTC)

Not sure why I am bothering, but I am struck by the number of errors and pejorative insinuations you can pack into such a short paragraph. Nearly one per sentence. Allopathy is a misnomer used mainly by the ignorant or those who deliberately intend to mislead. All of the definitions of alt med in the article are more accurate than this. Trauma medicine is fully integrated scientific medicine and separating it is unsupportable by facts and definitions. The definition of complementary medicine does not specify who is the "chief doctor". alteripse 01:23, 12 February 2006 (UTC)

"Allopath" is a term used by homeopaths to describe conventional medicine, and it has a precise meaning. I avoid it, since its use is hijacking the premise on the controversy. But saying that it is "used mainly by the ignorant or those who deliberately intend to mislead" is uncharitable, to put it kindly. One can argue with the Whaleto expresses his points, but deliberately misinterpreting the way Alterelipse does is a far graver sin. --Leifern 03:30, 12 February 2006 (UTC)

Utter crap. Allopathy was Hahnemann's caricature mischaracterization of the theoretical basis of the medicine practiced by his critics. It has zero descriptive applicability to current medical practice and is indeed used mainly by the ignorant or those intentionally looking for a pejorative term. You complained that quackery was a misleading term, yet you defend this. Is there any quackery, medical fraud, or intellectual dishonesty you won't defend? alteripse 20:02, 12 February 2006 (UTC)

Alteripse is quite correct. It was Hahnemann's term used to describe what he saw as the opposite of homeopathy - like treating like. Medical practice cannot be categorized so simply, as obviously not all drugs have "effects opposite to the symptoms." In fact modern medicine is quite unconcerned with the origin of a healing method. It is quite eclectic, using any and all methods that are proven to be effective, and for which a relatively good risk-benefit ratio can be established.

Anything else is "alternative," untested, experimental, etc., and often deserving of the acronym sCAM (so-Called "Alternative" Medicine).

Complementary and Alternative Medicine?

Some parts of this article refer to complimentary medicine while other parts refer to alternative medicine and still others refer to CAM (Complimentary and Alternative Medicine).

Stricly speaking, there is a difference between Complimentary and Alternative medicine: the first is in conjuction with traditional Western medicine, while the second is an alternative to it.

It seems that it would make sense to rename this article Complimentary and Alernative Medicine to encompass the two phrases. (There is no Wikipedia article for Complimentary Medicine, and adding one would seem redundant.

Any objections to changing the title?

Mark Fourman

Well......you'll never find it if you keep spelling it wrong.....;-)

Here it is: complementary and alternative medicine

Maybe a merge would be more appropriate, but it's probably been suggested and rejected many times by now. (I haven't checked.) Basically it's the same methods, the difference being the degree of cooperation or lack of cooperation between alt. medders and MDs. -- Fyslee 22:20, 12 February 2006 (UTC)

I think that the CAM and alt med articles should remain separate. (1) The alt med article is more hag ridden with overgeneralized negative POV - since alt med simply means used elsewhere but not accepted in conventional med, a *very broad range* in terms of technical merit and support. One may not see the differences between CAM & alt med so well in a forest of arrows. (2) CAM is being openly used in at least a number of US states so I think that it should be described in a manner with less cruft and confusion than just blended back with the "alt med" maelstrom. (3) related CAM version treatments are often quite different than what will usually be classed as "alt med" e.g. in cancer treatment consider conventional medicine's current coexistence (some places, anyway), say with Abram Hoffer's oral supplementary regimens [1], versus a primary treatment based on all out IV ascorbate treatment (e.g. 60-200+ gm iv C/day)[2], perhaps with adjuvants like massive vitamin K (e.g. 1000+ x RDA K2 as menaquinone-4) Aug'03 Alternative Medical Review, and bindweed extract[3], plus Hoffer's regimen and more. Even "more alternative"[4]. These certainly look to me like substantial differences that the readers might prefer seeing separate discussions between CAM and alt med therapies. --69.178.31.177 13:34, 19 February 2006 (UTC)

What difference is there between an alternative method or medicine that is used outside of traditional medical practice, or within it? The method is the same, it's only a matter of whether it's being used together with ("complementary") accepted methods, or alone ("alternative"). In either case, the methods are identical, it's only the setting that is different. It doesn't even have anything to do with who is doing it, layman or MD. Complementary is alternative medicine that is being used with normal methods. That's all. It's still the same method. Regardless of the setting, if you take it and examine it, it will be identical.

The alternative medicine is more concentrated by nature. This mean also the therapy, where you don`t get (so much) chemical pills. Also it is by the other hand so, that the a. see more the whole person, including the mind/psyche of a human beeing. Last but not least it is not an apparatus medicine. --84.176.75.238 11:08, 1 June 2006 (UTC)

Proponents claim that using these methods in a complementary manner should increase safety and efficacy. So far, in the case of cancer, this has proven to be far from the case, in fact the opposite, since the danger can be increased when used as a complement to conventional medicine. A Norwegian multicentre study examined the association between the use of alternative medicines (AM) and cancer survival. 515 patients using standard medical care for cancer were followed for eight years. 22% of those patients used AM concurrently with their standard care.

The study revealed that death rates were 30% higher in AM users than in those who did not use AM: "The use of AM seems to predict a shorter survival from cancer." -- Does use of alternative medicine predict survival from cancer? Eur J Cancer 2003 Feb;39(3):372-7

"Complementary and alternative medicine" ("CAM") is an imprecise marketing term that is inherently misleading. "Alternative" methods are loosely described as practices outside of mainstream health care. They lack evidence of safety and effectiveness and are generally not covered by insurance plans. "Complementary medicine" is loosely described as a synthesis of standard and alternative methods that uses the best of both. In truth, there are no "alternatives" to objective evidence of effectiveness and safety." -- NCAHF

An increasingly common method for critics to express their skepticism about the terminology, is their use of the acronym sCAM, which stands for so-Called "Alternative" Medicine (always spelled with a small "s" and capitalized "CAM").

The acronym has been very deliberately designed by skeptics to expose what they see as "the deceptiveness and inaccuracy inherent in the popular jargon that is being used to describe and market unproven and disproven healing methods." [5]

These critics consider the commonly used expression "evidence-based alternative medicine", to be an oxymoron. They assert that if a method has become evidence-based, then it should no longer be considered or classified as "alternative medicine". Their use of the term sCAM is an attempt to combat this misuse, and to prevent what they see as a "dumbing down" of modern medicine.

Critics of alternative therapies assert that they are not effective and consequently are not a legitimate alternative to conventional medicine. Richard Dawkins, professor of the Public Understanding of Science at Oxford University, has this to say about the matter:

"...scientific medicine is defined as the set of practices which submit themselves to the ordeal of being tested. Alternative medicine is defined as that set of practices which cannot be tested, refuse to be tested, or consistently fail tests. If a healing technique is demonstrated to have curative properties in properly controlled double-blind trials, it ceases to be alternative. It simply.....becomes medicine. Conversely, if a technique devised by the President of the Royal College of Physicians consistently fails in double-blind trials, it will cease to be a part of "orthodox" medicine. Whether it will then become "alternative" will depend upon whether it is adopted by a sufficiently ambitious quack (there are always sufficiently gullible patients).

"But isn't it still an arrogance to demand that our method of testing should be the scientific method? By all means use scientific tests for scientific medicine, it may be said. But isn't it only fair that "alternative" medicine should be tested by "alternative" tests? No. There is no such thing as an alternative test....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. If a therapy or treatment is anything more than a placebo, properly conducted double-blind trials, statistically analysed, will eventually bring it through with flying colours. Many candidates for recognition as "orthodox" medicines fail the test and are summarily dropped. The "alternative" label should not (though, alas, it does) provide immunity from the same fate." - Richard Dawkins, Foreword to the posthumous book "Snake Oil, and Other Preoccupations" by John Diamond [6]

"There is no alternative medicine. There is only medicine that works and medicine that doesn't works." - Richard Dawkins, A Devil's Chaplain : Reflections on Hope, Lies, Science, and Love

Many on both sides believe that alternative therapies can become accepted as conventional medicine if they are scientifically proven to be effective.

"Evidence-based methods are effective, and effective methods should be evidence-based. If a method appears to be effective, then it should be possible to prove it. If the research has not been done yet, it should be. We must remember that "Absence of proof is not the same as the absence of fact; it simply demonstrates the lack of adequate research. (Robert Sydenham) "Lack of evidence in the literature is not evidence of lack of effectiveness." [7]

Conclusion: Since the methods are identical, there is no reason to deal with the same methods in separate articles. There should simply be a paragraph or two that explain how they are sometimes used together with established methods in a complementary setting. -- Fyslee 20:52, 4 March 2006 (UTC)

Agree with Fyslee...the differences put forth between complementary and alternative medicine are quite subtle and not worth keeping as separate articles; this could only be potentially confusing. Andrew73 21:08, 4 March 2006 (UTC)

Conclusion: strong POV for Andrew73 and Fyslee ("sCAM") for typical "allopathic" (merge+delete)^3 -> 0 pattern, totally ignoring the direct counterexample: 60 - 200 gm/day intravenous C + 1000*RDA K2-MK4 + bindweed/glycans + Hoffer's oral regime (Alt) = Hoffer's oral regime (CAM) + conventional oncology trtmts ??!! Subtle? Andrew, surely as an oncology/hematology fellow you can see a substantial difference whether you agree/disagree. I believe the vit K2 regimen started in Japan for liver cancer, interesting results. And Andrew in a broke America, capitated $/mo patients, it may not be you & pharma$ vs CAM/Alt, it's your $ against the pharma $ esp if the pts could live longer. Well, at least the pharmas know who is going to get the last $$$$ ;> --66.58.130.26 15:34, 7 March 2006 (UTC)

No one is suggesting a deletion of the material. The information in both articles is valuable and should be preserved. There is some unnecessary duplication, and merging would simply combine it where it belongs. It should result in a larger and better article. -- Fyslee 20:03, 7 March 2006 (UTC)

Uh, thanks but no thanks. The alt med article & history is a rat's nest of contentious back and forth at length. CAM deserves a cleaner and more concise article without the obfuscation. Also I think specific articles that link CAM or reference it would be degraded and become less accurate by one big auto de fe. --66.58.130.26 03:10, 21 March 2006 (UTC)

I vote for merge, agreeing with Andrew and Fyslee. There is no reason why info 66.58etc suggests should not be in a merged article.Mccready 08:28, 23 April 2006 (UTC)

The redirect from Complementary medicine should be to CAM, not this article.

Please sign your posts. The Complementary and alternative medicine article has been merged into this one, so the redirect should point here. Like it or not, that's the way things have worked out. -- Fyslee 16:24, 23 November 2006 (UTC)

weasel words

Critics contend that this entire article is written in weasel words.Loodog 01:45, 17 May 2006 (UTC)

Advocates of alternative medicine hold that it is, too. -AED 03:25, 17 May 2006 (UTC)

Yes, evidence-based medicine! Alas, the problem that "evidence" costs money

One poster above says: "It is one thing to say: "I believe it's effective, but have no proof as yet." It's quite another to say: "I believe it's effective, and my experience with it is enough proof for me and my customers."

To which my answer is indeed so, but the same can be said just as fairly of my stock-picking method. And while the wrong stock-picking method won't kill you, at the same it's also pretty fair to say that most of the alternative medical strategies out there won't either. And a bad investment strategy can certainly screw up your life more terribly than the wrong herb. Spare me the stories of people dying after spinal manipulation. You're probably in bigger danger staying in a hospital; the bugs there are nastier. And the medication errors, when they occur, are more likely to be serious.

Besides, this whole argument needlessly conflates a scientific problem with a legal problem. Are we not really to be allowed to pick our own cosmetics, our own religions, our own investment advisors and guidance councilors and chefs and diving and skiing and rock-climbing instructors, without having to consult with some government agency about whether or not their methods and advice have been scientifically scrutinized to the government's satisfaction? Come, now. We are adults. The “nanny-fication” of medical law has more to do with really irrational fears of poisoning than it does good sense. If you ever tried to eat a food again which you had thrown up after a bout of gastroenteritis, you will recognize that we're all wired with some pretty unscientific prejudices when it comes to our foods and medicines. And if you know anything about how the FDA historically came about, and how it gained in power, you'll understand that these prejudices operated at every step.

Recommended is the following article: Is Complementary & Alternative Medicine a UFO?

This is not a bad article, and I don't want to leave the impression that I disagree with most of it. However, it does contain a few howlers that need attention: Speaking of the idea that pharm companies run conspiracies against natural remedies:

"These claims lack credibility for several reasons. While pharmaceutical companies do have commercial motives, which have often led to unethical and illegal practices, they are still interested in finding and marketing new, effective products. They continually research CAM methods. When they find an herb or medicament that can be used, they develop it and market it. They care not where the method comes from. If it can be proven to be effective and relatively safe, they'll find a way to make money off of it, and it will be used. They have a direct interest in marketing effective methods, not in burying them."

To which my answer is "poppycock"! May I have some evidence, please? The only drug I know of which came from a completely natural source, but which a drug company actually made much profit from, is lovastatin--- and that only happened BECAUSE the way the company found to make money "off of it," was to hide its origin, and pretend you couldn't get the same stuff from red rice yeast. Following which they sued the red rice yeast sellers for being "unscientific" until the patent ran out. Although in theory "use patents" are possible, in PRACTICE I've never seen one used to make a drug company much money on any molecule. In theory they could find tomorrow that melatonin is a wonderful adjunct for breast cancer and that curumin from turmeric prevents Alzheimer's disease. But no drug company would fund that research.

I certainly agree with Dawkins that one scientific standard needs to apply to all. My problem with Dawkins is that he seems to have forgotten that science costs money, and we live in a capitalistic society where research follows profit motive. Without good IP protection, we have information-socialism. And information-socialism causes bare shelves at the "good idea store," in the same way that agricultural-socialism caused bare shelves in the grocery stores of the old USSR. Except in our case, the bare "good idea" shelves relate to how to use old drugs and unpatentable molecules.

Case in point: there's some pretty good evidence that fish eating lowers total mortality and extends life, and even a good randomized placebo controlled study in heart patients which found the same. But you won't see fish oil advertised on TV. You'll see Crestor. Crestor endlessly. Is Crestor the "best" statin? Or the best researched one? Not by a long shot. The best data for mortality reduction by a statin comes from gigantic trials like 4S and HPS, which used simvastatin (Zocor). But you won't see Zocor commercials on TV because the Zocor patent has ended. Science and evidence-based medicine is NOT driving this system, folks. The alternative folks are not all just doctor-hating nuts. They do actually have a point about the bias here. In articles like the one quoted above, this needs to be acknowledged. Steve 19:29, 24 June 2006 (UTC)

Complementary and Alternative Medicine are not the same. CAM deserves it's own page.

Definition from NCCAM, National Institutes of Health http://nccam.nih.gov/health/whatiscam/

Q: Are complementary medicine and alternative medicine different from each other?

A: Yes, they are different.

Complementary medicine is used together with conventional medicine. An example of a complementary therapy is using aromatherapy to help lessen a patient's discomfort following surgery.
Alternative medicine is used in place of conventional medicine. An example of an alternative therapy is using a special diet to treat cancer instead of undergoing surgery, radiation, or chemotherapy that has been recommended by a conventional doctor.

The information structure is important

For all of these related articles, the Complementary and alternative medicine article needs to be the highest level, with a link to Alternative Medicine and a redirect from Alternative Medicine to Complementary and alternative medicine. - a medical journal editor Healtheditor 16:48, 30 June 2006 (UTC)healtheditor

Merged CAM to this article

I bit the bullet, as the CAM article entirely overlaps with this article. Here's the remaining material from the CAM article still to merge:

Contemporary use of alternative medicine

The popularity of CAM therapies is great. A survey released in May 2004 by the National Center for Complementary and Alternative Medicine focused on who used complementary and alternative medicine, what was used, and why it was used in the United States during 2002.

According to this new survey, 36 percent of U.S. adults age 18 years and over use some form of complementary and alternative medicine (CAM). When prayer specifically for health reasons is included in the definition of CAM, the number of adults using some form of CAM in 2002 rose to 62 percent (See CDC Advance Data Report #343 below, abstract on page 1).

Consistent with previous studies the present study found that the majority of individuals (i.e., 54.9%) used CAM in conjunction with conventional medicine ( page 6). "The data confirm most earlier observations that most people use CAM to treat and/or prevent musculoskeletal conditions or other conditions associated with chronic or recurring pain" (page 5). "The fact that only 14.8% of adults sought care from a licensed or certified CAM practitioner suggests that most individuals who use CAM" prefer to treat themselves (page 6). "Women were more likely than men to use CAM. The largest sex differential is seen in the use of mind-body therapies including prayer specifically for health reasons" (page 4). "Except for the groups of therapies that included prayer specifically for health reasons, use of CAM increased as education levels increased" (page 4).

Osteopathy, a medical system developed in the United States that employes the use of manipulative techniques in their treatment programmes, is considered by some to be a mix of conventional and alternative medicine. Doctors of Osteopathy (DO) in the USA are trained as medical doctors and surgeons with some different philosophical underpinings.

Alternative therapies are frequently used in veterinary medicine [8].

The top ten CAM therapies

The 10 most commonly used CAM therapies in the United States during 2002 (See CDC Advance Data Report #343 below, table 1 on page 8) when use of prayer is excluded:

Of these 10 most commonly used CAM therapies, 6 are relaxation techniques.

NCCAM classification of CAM categories, grouped by popularity (See CDC Advance Data Report #343 below, table 4 on page 9 and table 1 on page 8) when the use of prayer is excluded:

Biologically Based Therapy (20.6%)
Mind-Body Interventions (16.9%)
1. Herbal therapy (18.9%)
2. Diet-based therapy (3.5%)
3. Exercise-based therapy (not rated)
Manipulative therapy (10.9%)
Alternative Medical Systems (2.7%)
Energy Therapy (0.5%)

In the United Kingdom, the biggest complementary / alternative healthcare professions are:

In the UK, there is an organisation that monitors CAM practitioners known as British Register Of Complementary Practitioners. On their site,[9], they say "The British Register of Complementary Practitioners (BRCP) is a professional register of practitioners who have proved their competence to practise by either completing an approved course or through an assessment made by the Registration Panel. They also agree to abide by a Code of Ethics and Practice and have full practitioner insurance." This helps monitor the quality of CAM in the UK and reduces the risk of quackery.

195.173.23.111 10:07, 11 July 2006 (UTC)

I merged the survey results. I didn't include the second list (categorising the results) as it's original research. Still to go is to mention the BRCP and the line on osteopathy. I'd suggest that some kind of "licensing of practitioners" section is created and the myriad sentences on it in this article are corralled. 195.173.23.111 10:46, 11 July 2006 (UTC)

Merged Integrative Medicine into this article

I merged integrative medicine to this article, as the integrative medicine article was little more than a stub, padded out with information about alternative medicine in general. 195.173.23.111 10:24, 11 July 2006 (UTC)

Spamming for integrative medicine?

I don't know what you all think but there seem to me to be a disproportionate number of mentions of Andrew Weil and Integrative Medicine.

Incidentally the subject is far too big, diverse and fragmented to be squeezed into one article and this article should be a very short umbrella. I don't go along with the placing of generalised often hotly argued comments about efficacy in anything other than a therapy specific context. And even then it should be therapy/condition related. However.....

You're probably right regarding Andrew Weil, but then again it's almost always his hairy face I see whenever the MSM cover alternative health topics.--Herbjunkie 15:59, 24 July 2006 (UTC)

Modern, mainstream, conventional

Hi Fyslee -- I changed "modern" to "mainstream" in the section mentioning Dawkins (diff), hoping for a less POVish term (compare the subtle connotations of "not modern medicine" with "not mainstream medicine"). It is somewhat challenging coming up with an appropriate term to contrast the body of knowledge and practice commonly known simply as "medicine" with that which is called "alternative medicine". The lead section does use "conventional" and Ernst and others use "mainstream", so perhaps that it suitable. That seems a minor nitpick next to your recent set of edits, which otherwise I thought quite improved the article. It's especially good to start an EBM section; well-done! All CAM articles should have this, IMO. regards, Jim Butler^(talk) 01:41, 6 August 2006 (UTC)

I think your choice - mainstream - is a good one. The EBM section wasn't my addition. In fact it and the one following it should simply be in a "See also" section, like in other articles, unless you want to discuss the relationship of AM to EBM, which will probably start edit wars. The relationship is already touched on several times in the article, and I doubt that advocates of AM would want to have those controversies emphasized too much by giving them their own section......;-) Actually those controversies could be the subject of their own article - Controversies between Alternative and Mainstream medicine. Such an article could present both sides of the controversies. -- Fyslee 09:30, 6 August 2006 (UTC)

I bet the editing would get pretty rowdy on that one, but yes, it would be good! cheers, Jim Butler^(talk) 05:22, 8 August 2006 (UTC)

Death Toll

Do we have any facts / figures from direct and indirect deaths from the current faddish belief in alternative medicines? It would be interesting to know how many hundreds of thousands die each year due to belief in the use of various anachronistic medicines to scientifically proven methods. If possible, if anyone has such information, is there any reference to those who are from countries where medical technology is primative to the degree where western 'alternative medicine' is the best they've got to work with? (Ie: Very low socio-economic countries, isolated locales, et cetera.)

Whilst it would be nice to sniff an oil and cure brain cancer, unfortunately I've known three out of seven people in my life who've passed away to be directly related to believing in quacks instead of using proper medicines, now those are some damn high statistics, so I'm hoping it's an uncommon instance and significantly higher than standard deviation. 211.30.80.121 07:45, 19 August 2006 (UTC)

Unfortunately that would be impossible based on the nature of sCAM. They don't do research, keep statistics, or do follow-ups. There is absolutely no form of quality control. That would reflect very badly on the quacks' track records!

There are some frightening figures here from very good research:

Cancer Survival & Alternative Medicine: "The use of AM seems to predict a shorter survival from cancer."

A 30% increased death toll for cancer is pretty awsome, and should get anyone with cancer to reconsider. I have also lost family members because of their belief in sCAM, including my own mother. -- Fyslee 11:19, 21 August 2006 (UTC)

Very sorry about your mother, Fyslee. Mine died from leukemia caused by chemotherapy. (I bear no grudge against the medicine that caused this, because it also very likely spared her suffering a grueling, metastatic, cachechtic death.) Notwithstanding anecdotes near and dear to us, the page above doesn't say anything whatsoever about a causal link. It's like saying crime goes up when people eat more ice cream. best, Jim Butler^(talk) 21:38, 23 August 2006 (UTC)

Yes, wouldn't it be good to compare those figures with iatrogenic deaths, especially from those killed by chemotherapy. Unfortunately it is this kind of fundamental attribution error that leads to people feel justified in shooting the messenger in ranting about how terrible all aspects of CAM must be. Here are some links to recent studies on an alternative medicine approach to cancer treatment:

PMID 16484711 PMID 16450726 PMID 16334146 PMID 15947582 PMID 15727163 PMID 15547686 --apers0n 22:23, 21 August 2006 (UTC)

Of those 6 papers, 3 are not "studies" but speculative review articles along the "this seems like it might work" line. In what sense are the 3 that are studies alternative medicine? These are scientific tests of biological compounds or extracts. Plants have been sources of useful therapeutic substances for centuries and their use has never been precluded by scientific study. You are defending alt med by citing science, not alt med. The essence of alt med is claims before evidence. Typical intellectual dishonesty. alteripse 12:05, 22 August 2006 (UTC)

Use of the word study was not deliberate dishonesty, but intended to refer to the therapeutic benefits of a traditional medicine mentioned in abstracts of published scientific papers (and used as "the most frequently prescribed unconventional cancer therapies in Germany, as in some other European countries"). Mistletoe has been used for a long time in alternative medical approaches to treatment of people with cancer, having few side-effects, but until the scientific method was applied to quantify the beneficial effects it would have been classed as above along with all other "various anachronistic medicines" as Alternative medicine.

From abstract #1 (Review): Many natural health products that inhibit angiogenesis also manifest other anticancer activities. refers to mistletoe amongst others, and is not a speculative statement.

From abstract #2 (Review): Today, mistletoe extracts are the most frequently prescribed unconventional cancer therapies in Germany, as in some other European countries. Is a statement of fact.

From abstract #3 (Randomized Controlled Trial): The results of this study indicate that perioperative use of the mistletoe drug Isorel can improve immune competence and the overall health status of cancer patients undergoing surgery. A significant statement in favour of a traditional medicine from a RCT.

From abstract #4 (Clinical Trial): From these results it is concluded that standardized mistletoe extract could be a potential alternative adjuvant therapy for superficial bladder cancer. Adds to the weight of evidence in favour of mistletoe as an anti-cancer treatment in general.

From abstract #5 (Multicenter Study): When compared with an untreated parallel control group from the same cohort, the results of the FME treatment suggested a significant survival benefit in primary stage II-III MM patients (Malignant Melanoma) A significant statement in favour of a traditional medicine from a multicenter study.

From abstract #6 (Unspecified): In sensitive cell lines, including tumor and endothelial cell cultures, IscadorQu (Oak mistletoe extract) caused early cell cycle inhibition followed by apoptosis in a dose-dependent manner. Adds to the weight of evidence in favour of mistletoe as an anti-cancer treatment in general.

The dishonesty is unqualified generalisations that claim superiority of conventional medicine over unconventional medicine from personal experience. --apers0n 13:05, 22 August 2006 (UTC)

It is hard to communicate if you use words in nonstandard ways. A study is a description of a research trial. Three of those citations were not studies, but reviews. At least one was not even a description of other studies but simply speculation that a treatment might be promising. Reviews can certainly be factual and true, but they are not studies. That was my first point. You completely dodged the accusation of intellectual dishonesty. How are you intellectually dishonest? You described these studies as examples of alt med and they are not. They are examples of scientific considerations and investigations of plant substances for therapeutic use. This is scientific medicine. The claims are not exaggerated beyond the evidence. The methods are those that others can reproduce. The standards of evaluation are those of science, not quackery. There is no underlying theory that contradicts our scientific understanding of the material world. In no sense were any of those not scientific medicine. And you finish your irrelevancies with a typical strawman argument where you accuse me of arguing something I didn't say at all. Your understanding of medical research and journal articles is as poor as your understanding of English and rhetoric, but certainly typical of most defenders of alt med. alteripse 16:19, 22 August 2006 (UTC)

Perhaps the above sentence should be rephrased as follows for clarification:

The "dishonesty" is not so much an accidental use of the word "study" (as admittedly applied erroneously in place of more accurate wording such as: "published results of empirical investigation or enquiry") in my first comment (referring to the fact that some traditional treatment approaches are considered effective in scientific peer-reviewed publications), but even more dishonest is the deliberate use of unqualified generalisations such as that of Fyslee quoting "sCAM" (so-Called "Alternative" Medicine), saying ("They don't do research, keep statistics, or do follow-ups. There is absolutely no form of quality control.") with the insinuation that this should apply to Alternative medicine practitioners. The statement then appears to be justified by use of personal experience as further evidence to support the personal experience of 211.30.80.121.

To explain further, the links to published articles above were given not to claim that Alternative medicine is science, but to demonstrate that some traditional treatment approaches are considered effective, as evidenced by the statements in peer-reviewed scientific publications such as those referring to the use of mistletoe (quoted above).

This article is not about Quacks, it is about Alternative medicine. To argue that approaches in alternative medicine do not stand up to scientific scrutiny and are deserving of the title "various anachronistic medicines" as opposed to "proper medicines" from "scientifically proven methods" is ridiculous. Taking the approach: "If a method has become evidence-based, then it should no longer be considered or classified as CAM. Period." is not a majority viewpoint, or if it were, this meta-analysis (for example) is mistaken (PMID 12458989 Advising patients who seek complementary and alternative medical therapies for cancer.): Table 1. (Criteria Used To Determine Whether a Complementary and Alternative Medical Therapy May Reasonably Be Recommended, Accepted, or Discouraged by Physicians) suggests that if a CAM therapy has had 3 or more adequate RCTs to evaluate the therapy, if 75% or more of trials support efficacy or a meta-analysis of trials supports efficacy, the CAM therapy should be recommended. Using the sCAM definition these "CAM therapies" are no longer Alternative medicine as they have passed the test of evidence-based medicine. --apers0n 22:02, 22 August 2006 (UTC)

Sorry but your definition of alt med is bizarre and makes no coherent sense. No proponent of scientific medicine thinks testing plants for therapeutic potential is alt med-- alt med is the claiming of therapeutic efficacy without proof or against available evidence. The essence of alt med is a rejection of scientific methods to demonstrate efficacy. alteripse 00:11, 23 August 2006 (UTC)

Again I will clarify my point as it was perhaps not expressed clearly enough above. What you are referring to as a definition of Alternative medicine appears to be Dawkins' less accepted definition of "Bad medicine", as stated in the "Alternative definition" section of this article. I was using the perspective of the majority viewpoint, and the dictionary definition — since when was use of mistletoe extract a part of the traditional medical curricula? It is however used extensively in Europe, as mentioned above, and is historically one of: "the most frequently prescribed unconventional cancer therapies in Germany, as in some other European countries". The fact that this stands up to some scientific investigation and speculative review in peer-reviewed journals means by your definition that use of mistletoe is no longer alt med and the alt med practitioners using it are no longer practising alt med but have become practitioners of evidence-based medicine rather than "good CAM". --apers0n 05:29, 23 August 2006 (UTC)

Agree, Apers0n, regarding definition of alternative medicine. The attempt by Dawkins et. al. to redefine it is an example of the No True Scotsman fallacy. thx, Jim Butler^(talk) 06:21, 23 August 2006 (UTC)

No you are both profoundly and completely wrong. Alternative medicine is not scientific medicine. The pharmaceutical companies for 60 years have researched plant compound after plant compound for therapeutic potential. That is exactly what you gave 6 examples of. That is how penicillin was discovered. The only people who criticize this approach are the alt med practitioners like the chiropractors and homeopaths and faith healers and energy practitioners. There is no controversy over alt med if you define it your way, but then what term do you use for all the quacks? alteripse 10:37, 23 August 2006 (UTC)

Alteripse, please read the lead section and "Alternative definition" section of the article, both of which are well-referenced. Or look up CAM in any dictionary, e.g. wiktionary: "any of various medical methods and practices used in place of, or as well as, conventional medicine"[10]. Alt-med is most commonly defined in terms of sphere of usage, not efficacy or idealogy. It is "medicine outside the mainstream". As such, it refers to a broad range of practices, some efficacious and compatible with scientific investigation, some not. While some alt-med practitioners are no doubt anti-scientific, not all are, unless you try to redefine the field by fiat a la Dawkins and No true Scotsman. Thanks, Jim Butler^(talk) 16:47, 23 August 2006 (UTC)

1. Would scientists be researching mistletoe, for example, if it did not have a history of successful use in treatment of people with cancer by practitioners of traditional medicine?

2. I would use the term Quacks for quacks. --apers0n 13:53, 23 August 2006 (UTC)

So what about mistletoe? Our ancestors were quite good at science, and didn't have many scruples about human testing, so they were bound to find something useful. Trouble come when people think that they were better than modern doctors. Jefffire 14:13, 23 August 2006 (UTC)

Simply defining alternative medicine as anything an ordinary MD isn't doing is asinine. It means all new treatments, all new research, are automatically "alternative" until they become standard. That is not what most people mean when they talk about alt med, and it is simply a shield for the quacks. Alternative medicine is practices which are offered by practitioners who use other standards of evidence for efficacy, reject scientific standards of efficacy, reject current scientific medical knowledge, and are usually based on theoretical systems that are logically and empirically incompatible with scientific knowledge. This definition is accurate and useful. It includes all the nonsense, fraud, quackery, and pretend science ranging from untested herbal remedies to aromatherapy, chiropractic subluxations, homeopathy, energy medicine, faith healing, blood type diet, crystal healing, color therapy, therapeutic touch, reflexology, voodoo, remote healing, psychic surgery, reflexology, kinesiology, Clarke zappers, magnets, megavitamin therapy, and naturopathy because those characteristics are what those practices have in common. Those are the typical dimensions of alternative medicine to most people. Scientific investigation of plant substances because has always been part of mainstream medicinal chemistry and is in no way "alternative". Your definition is so vague as to be useless, as well as intellectually dishonest. alteripse 20:39, 23 August 2006 (UTC)

It's not my or Apers0n's definition. It's the one in common usage, the dictionary definition, as the WP article cites. What is intellectually dishonest is the attempt to redefine the term, as Dawkins does. He knows full well that Cochrane, Ernst and other EBM types accept the usage as given in WP, and believe (rightly) that alt-med practices such as chiropractic, acupuncture, herbs and homeopathy should be just as much subject to scientific research as mainstream medicine.

I do agree that whether one defines alt-med as "outside the mainstream" or "non-evidence-based", there are still going to be areas in the grey zone, and that includes certain plants. St. John's Wort started out "alternative" both in the dictionary sense and the Dawkins sense. It now has some evidence supporting it, but in many people's minds it's still "alternative", because it's not generally taught in med schools or Rx'd by docs. So why waste time arguing over the label? Evidence is much more interesting. thx, Jim Butler^(talk) 21:30, 23 August 2006 (UTC)

(edit conflict with Jim Butler):I agree with you now, alteripse, when you say "Simply defining alternative medicine as anything an ordinary MD isn't doing is asinine" (as in this statement you now reject the Dawkins definition of Alt med). You do however contradict yourself in the inclusion of "untested herbal remedies" in "pretend science", as it follows logically from your most recent definition of Alt med above that when a herbal remedy becomes "tested" it therefore ceases to be "pretend science" and must therefore become "current scientific medical knowledge", which makes the quacks who were previously using it into real scientists... etc. --apers0n 21:34, 23 August 2006 (UTC)

It is certainly possible for some alt med therapies to be scientifically demonstrated to be effective, thereby becoming no longer alt med. Acupuncture seems to dance back and forth across the line, depending on the latest trial. Others in the list above have never even been in the same space-time continuum as that line. Again, the essence of alt med is the refusal to subject the therapy to scientific testing or to reject the evidence if it has been tested. An untested herbal remedy may become tested and demonstrated effective or ineffective. However, if the quacks who previously used the treatment did not support the testing and would not have abandoned the treatment if the results had been negative, they are arguably still quacks: it is the refusal to accept the methods and epistemologic philosophy of scientific medicine that defines alt med practitioners, not whether their treatment is preferred by the majority of MDs. Standard medical care changes gradually or quickly all the time-- what doesnt change much is the underlying epistemology of what constitutes evidence of efficacy and meaningful explanation. alteripse 23:58, 23 August 2006 (UTC)

Agree with you, Alteripse, about how quacks operate. I don't think we have much disagreement over the nature of scientific evidence. What you say above about "the essence of alt med" is basically a definition of pseudoscience, and is consistent with Dawkins' proposed redefinition of alt-med. Much of medicine outside the mainstream, aka alt-med in the generally-understood sense, is pseudoscientific (or has elements of pseudoscience), but not all. If we do a Venn diagram of "dic-def alt-med" and "Dawkins alt-med", we'll see significant overlap, and there will also be grey areas depending on evidence and the nature of claims made (e.g., acu'ists who relate to qi as clinically relevant metaphor rather than literal vitalistic force). This is why Dawkins is disingenuous: he knows that people will confuse the two definitions, and he's made up his mind that for practical purposes they're close enough, even though a practice's social sphere of usage is not at all the same as its evidentiary base. As you say, the former will (hopefully) evolve over time to match the latter.

In the meantime, Dawkins' semantic game is about advancing a political agenda, not a scientific one. Don't get me wrong; of course advocates of various alt-med fields play politics and twist commonly-understood terms all the time. But why should a respected scientist stoop to that level? Either cynically to advance an agenda, or because his beliefs really err on the pseudoskeptical side, or both, imo. Probably both.

So, for reasons I've stated elsewhere, I wouldn't stick all of alt-med in category:pseudoscience, nor every alt-med topic. But I have no problem citing significant POV's in articles about alt-med and thoroughly covering all sides of the issue. cheers, Jim Butler^(talk) 02:39, 24 August 2006 (UTC)

Hey, with all this agreement it appears that we may be reaching some kind of, erm, consensus here?... --apers0n 07:45, 24 August 2006 (UTC)

Hmmm... wouldn't that be something? But I'm still skeptical. ;-) Here's Philip K Dick: "The basic tool for the manipulation of reality is the manipulation of words. If you can control the meaning of words, you can control the people who must use the words." That applies to all sides. Luckily, it is possible to look beyond labels, or to use them without prejudice (and with a realistic acceptance of common usage), as Ernst does.

Besides, who is Dawkins kidding? "Bright?" Come on. Talk about a tin ear for meme-catchiness. "Brights" have no corner on brightness. cheers, Jim Butler^(talk) 00:43, 26 August 2006 (UTC)

Infobox on Alternative Medicine Article

I was checking out one of my old links to here, and found myself automatically logged on.

I must be missing something, but I happen to see an Infobox on this article, that is a lot bigger than the one that I originally put on this article.

The problem with the National Center for Complementary and Alternative Medicine (NCCAM) classification system is that they made a very big goof. They left off entirely exercise-based therapies, while constantly babbling away about the wide spread use of prayer.

This is an error that has been corrected on my Dictionary of Alternative Medicine http://naturalhealthperspective.com/gnu-dictionary/

A while back one of the original use of Alternative Medicine in the USA researchers commented on why they decided to ignore exercise. And, the dumb academics at NCCAM have continued to this day to ignore Exercise. I could quote the precise the citation, but why bother. You guys seem to be going in circles anyway by the looks of the great big Infobox on this article.

I do NOT suffer with this problem, since I prefer to think for myself. :)

The big blue Infobox looks pretty good, by the way. Of course, there was NEVER anything wrong with the tiny info box that I put up either. -- John Gohde 11:24, 17 September 2006 (UTC)

Thanks, John Gohde, for your comments about the infobox. Exercise-based therapies would be useful to include in such a navigation. The thing about Wikipedia, of which I am sure you are aware, is that information should ideally be verifiable and from reputable published reliable sources. This infobox was based on the NCCAM classifications due to the lack of any other such source. We would welcome your further input on the matter. --apers0n 18:27, 19 September 2006 (UTC)

Well, I would simply add a category called Exercise-based therapies. Reference the Wellness (alternative medicine) article for your support. People engage in physical exercise for the purpose of improving their health. NCCAM explicitly decided to leave exercise out because people engage in exercise for many different reasons. You can say the same thing about prayer. Yet, NCCAM yacks about prayer all the time. Even though people engage in prayer primarily as a part of religious practice. Only the academic mind can rationalize NCCAM's position on exercise. Joseph Pilates was an important pioneer in promoting Exercise-based therapy.

-- John Gohde 02:12, 20 September 2006 (UTC)