Alternative (integrative, complementary, natural, holistic) medicine is composed of a broad range of treatments that are often preventive in nature and commonly directed at treating the whole person rather than a specific disease. Substances used in alternative therapies are most often derived from natural sources. Many of these—particularly herbal medicines—have been used for more than 2000 years and are relied on by approximately 80% of the world’s population in developing countries. Most people who use alternative care modalities do so because they are following traditions handed down from one generation to the next. What Western culture calls alternative treatments are in most cultures often the only available options for health care. Most such treatments have lacked rigorous scientific evidence of efficacy; however, there is a growing body of clinical research documenting the activity and utility of some of these regimens. The National Institutes of Health have designated such therapies as complementary and alternative medicine (CAM). In contrast, Western medicine (sometimes referred to as allopathic) includes a diverse array of scientific, mostly evidence-based pharmacologic and surgical technologies, which, although described as “mainstream,” “conventional,” “orthodox,” or “traditional,” have been practiced for little more than a century. These treatments focus almost exclusively on eliminating disease.

The term alternative medicine is used in this chapter to indicate “interventions neither taught widely in medical schools nor generally available in hospitals.”¹⁰ This selection is not meant to exclude other terms. The increasingly popular term integrative medicine may be preferable because it stresses that these treatment protocols often can be effectively integrated with conventional medicine to optimize the health of the patient.

For decades in the United States and in some European countries, alternative medicine—and alternative (or holistic) dentistry—has implied care at the “fringe” of accepted medical (or dental) practice. There is an increasing trend now to incorporate many of these forms of care into the mainstream and include them as covered benefits in health insurance plans. Alternative medical therapies, depending on how they are defined (e.g., whether prayer is included as a CAM therapy) are used by an estimated 25% to 42% of the U.S. population.^4,10,18 About 20% use natural products, including vitamins, minerals, herbs, and other dietary supplements. Table 56-1 lists the reasons why patients pursue CAM therapies. Visits to alternative care practitioners exceed visits to allopathic primary care physicians by more than 200 million annually, and Americans spend an estimated $30 billion a year on these services plus $18.8 billion on dietary supplements; most of these expenses are not reimbursed.¹⁰ In response to these trends, most medical and some dental schools in the United States now provide at least introductory coursework in CAM.

TABLE 56-1 Reasons for Using Complementary and Alternative Medicine Therapies*

CAM, Complementary and alternative medicine.

* Based on survey of 31,044 adults ≥18 years old from the U.S. civilian noninstitutionalized population.

From Reference 4.

A survey of 46,000 subscribers to Consumer Reports magazine found that 60% of individuals who used alternative therapies told their physicians they were doing so, and most physicians approved of (55%) or were neutral to (40%) their actions.¹⁶ One in four patients tried alternative therapies at the recommendation of a physician or nurse. Another national survey concluded that individuals who use alternative therapies are better educated but often less healthy than individuals who do not use them.³ These individuals are not dissatisfied with conventional medicine, but they find alternative therapies “more congruent with their own values, beliefs, and philosophical orientations toward health and life.”³ Although most people using herbal medicines do so in a manner consistent with evidence-based medicine, there is concern that “evidence-based information is not reaching the consumer” and that “health care professionals should proactively educate consumers.”⁵ This conclusion presumes that health care professionals themselves are first educated on the scientifically established benefits of botanicals. The health benefits of an increasing number of CAM treatments are being supported by published peer-reviewed research. One such study documented that healthy individuals who regularly consume one or more dietary supplements (e.g., vitamin C) may have superior health, increased longevity, or both compared with their peers.²⁰ Chiropractic and acupuncture for certain chronic and acute conditions have been accepted by the American Medical Association (AMA), which often is reserved in accepting new or unconventional treatment modalities. Most CAM therapies are not so endorsed because the AMA considers scientific evidence regarding their efficacy lacking or insufficient. The AMA does not endorse the sale of dietary supplements from physicians’ offices based on concerns that the inventorying and sale of such products may inappropriately affect physicians’ clinical judgments.

Although some authors claim that alternative medicine differs from allopathic medicine by virtue of treating the patient as a whole person rather than for the specific disease or collection of diseases, alternative therapies do offer disease-specific methods of care. CAM treatment modalities also constitute a more self-determined form of health care, especially because they are frequently integrated with nutritional and lifestyle modifications. This chapter focuses on natural pharmacologic and therapeutic agents—principally botanical (herbal) remedies—that constitute one of the alternative or integrative means of health maintenance and disease treatment.