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
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
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
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
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
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
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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