Wednesday, February 13, 2008

Use of alternative medicine alongside conventional medicine

conventional medicine

A major objection to alternative medicine is that it is done in place of conventional medical treatments. As long as alternative treatments are used alongside conventional treatments, the majority of medical doctors find most forms of complementary medicine acceptable. A recent study of US adults indicated that a majority (54.9%) of CAM users cited belief that it would help when combined with conventional medical treatments as a factor in their use.

It is advisable for patients to inform their medical doctor when they are using alternative medicine, because some alternative treatments may interact with orthodox medical treatments, and such potential conflicts should be explored in the interest of the patient. However, many fear that conventional practitioners may be biased or uninformed about alternative care and worry that disclosure of use may damage their doctor-patient relationship.

The issue of alternative medicine interfering with conventional medical practices is minimized when it is turned to only after conventional treatments have been exhausted. Many patients feel that alternative medicine may help in coping with chronic illnesses for which conventional medicine offers no cure, only management. Over time, it has become more common for a patient's own MD to suggest alternatives when they cannot offer effective treatment.

Support for alternative medicine

Support for alternative medicine

Alternative therapies provide some services not available from conventional medicine. Examples are patient empowerment and treatment methods that follow the biopsychosocial model of health.

Advocates of alternative medicine hold that the various alternative treatment methods are effective in treating a wide range of major and minor medical conditions, and contend that recently published research (such as Michalsen, 2003, Gonsalkorale 2003, and Berga 2003) proves the effectiveness of specific alternative treatments. They assert that a PubMed search revealed over 370,000 research papers classified as alternative medicine published in Medline-recognized journals since 1966 in the National Library of Medicine database. See also Kleijnen 1991, and Linde 1997.

Evidence-based medicine (EBM) applies the scientific method to medical practice, and aims for the ideal that healthcare professionals should make "conscientious, explicit, and judicious use of current best evidence" in their everyday practice. Prof. Edzard Ernst is a notable proponent of applying EBM to CAM.

Although advocates of alternative medicine acknowledge that the placebo effect may play a role in the benefits that some receive from alternative therapies, they point out that this does not diminish their validity. Researchers who judge treatments using the scientific method are concerned by this viewpoint, since it fails to address the possible inefficacy of alternative treatments.

Medical education

Medical education

Increasing numbers of medical colleges have started offering courses in alternative medicine. For example, the University of Arizona College of Medicine offers a program in Integrative Medicine under the leadership of Dr. Andrew Weil which trains physicians in various branches of alternative medicine which "...neither rejects conventional medicine, nor embraces alternative practices uncritically." In three separate research surveys that surveyed 729 schools in the United States (125 medical schools offering an MD degree, 25 medical schools offering a Doctor of Osteopathy degree, and 585 schools offering a nursing degree), 60% of the standard medical schools, 95% of osteopathic medical schools and 84.8% of the nursing schools teach some form of CAM. Accredited Naturopathic colleges and universities are increasing in number and popularity in the U.S.A. They offer the most complete medical training in complimentary medicines that is available today. See Naturopathic medicine.

In Britain, no conventional medical schools offer courses that teach the clinical practice of alternative medicine. However, alternative medicine is taught in several unconventional schools as part of their curriculum. Teaching is based mostly on theory and understanding of alternative medicine, with emphasis on being able to communicate with alternative medicine specialists. To obtain competence in practicing clinical alternative medicine, qualifications must be obtained from individual medical societies. The student must have graduated and be a qualified doctor. The British Medical Acupuncture Society, which offers medical acupuncture certificates to doctors, is one such example, as is the College of Naturopathic Medicine UK and Ireland.

Because some of the alternative practices of natural medicine was considered illegal in the U.S., especially concerning alternative therapies for cancer, many doctors went into hiding. Some of their discoveries and remedies were documented and recorded by Jon Barron and can be found in his book "Lessons From The Miracle Doctors."

Contemporary use of alternative medicine

Contemporary use of alternative medicine

Many people utilize mainstream medicine for diagnosis and basic information, while turning to alternatives for what they believe to be health-enhancing measures. However, studies indicate that a majority of people use alternative approaches in conjunction with conventional medicine.

Edzard Ernst wrote in the Medical Journal of Australia that "about half the general population in developed countries use complementary and alternative medicine (CAM)." A survey released in May 2004 by the National Center for Complementary and Alternative Medicine, part of the National Institutes of Health in the United States, found that in 2002, 36% of Americans used some form of alternative therapy in the past 12 months, 50% in a lifetime — a category that included yoga, meditation, herbal treatments and the Atkins diet. If prayer was counted as an alternative therapy, the figure rose to 62.1%. 25% of people who use CAM do so because a medical professional suggested it. Another study suggests a similar figure of 40%. A British telephone survey by the BBC of 1209 adults in 1998 shows that around 20% of adults in Britain had used alternative medicine in the past 12 months.

The use of alternative medicine appears to be increasing. A 1998 study showed that the use of alternative medicine had risen from 33.8% in 1990 to 42.1% in 1997. In the United Kingdom, a 2000 report ordered by the House of Lords suggested that " data seem to support the idea that CAM use in the United Kingdom is high and is increasing."

Alternative medicine

Alternative medicine
Alternative medicine includes practices that differ from conventional medicine. Some alternative medicine practices are homeopathy, naturopathy, chiropractic, and herbal medicine. A typical definition is "every available approach to healing that does not fall within the realm of conventional medicine".

Alternative medicine practices may be based on non-traditional belief systems or philosophies, and some may not follow the scientific method. They may incorporate spiritual, metaphysical, or religious underpinnings, untested practices, pre-modern medical traditions, or newly developed approaches to healing. If an initially untested alternative medical approach is subsequently shown to be safe and effective, it may then be adopted by conventional practitioners and no longer considered "alternative".

"Alternative medicine" is often categorized together with complementary medicine using the umbrella term Complementary and alternative medicine or CAM.

Regulation / Alternative medicine

Jurisdiction differs concerning which branches of alternative medicine are legal, which are regulated, and which (if any) are provided by a government-controlled health service or reimbursed by a private health medical insurance company.

A number of alternative medicine advocates disagree with the restrictions of government agencies that approve medical treatments (such as the American Food and Drug Administration) and the agencies' adherence to experimental evaluation methods. They claim that this impedes those seeking to bring useful and effective treatments and approaches to the public, and protest that their contributions and discoveries are unfairly dismissed, overlooked or suppressed. Alternative medicine providers often argue that health fraud should be dealt with appropriately when it occurs.

Monday, February 11, 2008

Principles of diagnosis

Principles of medical diagnosis

The main tools of the doctors are the medical history and the physical examination, but this holds particularly true for internal medicine. Subtle descriptions of disease (e.g. cyclic shallow and deep breathing, as in Cheyne-Stokes's respiration, or persistently deep breathing as in Kussmaul's) or physical signs (e.g. clubbing in many internal diseases) are important tools in guiding the diagnostic process. In the medical history, the "Review of Systems" serves to pick up symptoms of disease that a patient might not normally have mentioned, and the physical examination typically follows a structured fashion.

At this stage, a doctor is generally able to generate a differential diagnosis, or a list of possible diagnoses that can explain the constellation of signs and symptoms. Occam's razor dictates that, when possible, all symptoms should be presumed to be manifestations of the same disease process, but often multiple problems are identified.

In order to "narrow down" the differential diagnosis, blood tests and medical imaging are used. They can also serve screening purposes, e.g. to identify anemia in patients with unrelated complaints. Commonly performed screening tests, especially in older patients, are an X-ray of the chest, a full blood count, basic electrolytes, renal function and blood urea nitrogen.

At this stage, the physician will often have already arrived at a diagnosis, or maximally a list of a few items. Specific tests for the presumed disease are often required, such as a biopsy for cancer, microbiological culture etc.

ABIM additional qualifications

The ABIM also recognizes additional qualifications in the following areas:

* Adolescent medicine;
* Clinical cardiac electrophysiology;
* Critical care medicine;
* Geriatric medicine;
* Interventional cardiology;
* Sports medicine;
* Transplant hepatology.

Internists may also specialize in allergy and immunology. The American Board of Allergy, Asthma, and Immunology is a conjoint board between internal medicine and pediatrics.

The American College of Osteopathic Internists recognizes the following subspecialties:

* Allergy/Immunology;
* Cardiology;
* Critical care medicine;
* Endocrinology;
* Gastroenterology;
* Geriatric medicine;
* Hematology/Oncology;
* Infectious diseases;
* Nuclear medicine;
* Nephrology;
* Pulmonology;
* Rheumatology.