30.1 Terminology
The Cochrane Collaboration defines ‘complemen-
tary medicine’ as:
‘Complementary and alternative medicine
(CAM) is a broad domain of healing resources
that encompass all health systems, practices,
accompanying theories and beliefs, other than
those intrinsic to the politically dominant health
system of a particular society or culture, within a
defined historical period. CAM includes all such
practices and ideas self-defined by their users for
prevention or treatment of disease, or promotion of
health and well being. Boundaries withinCAMand
between the CAM domain and that of the dominant
system are not always sharp or fixed’.
The term ‘alternative medicine’ is often now
avoided in western developed countries, because
it (often erroneously) suggested a mutual exclusiv-
ity between these therapies and conventional or
‘allopathic’ approaches. However, most of the
diverse disciplines now prefer ‘complementary
medicine’, so as to emphasize that the patient can
benefit from a combination of orthodox and alter-
native approaches. There is no reason why com-
plementary therapies may not be subject to
evidence-based analysis, although there are very
few such published examples, in comparison to
orthodox medicine (see Critchleyet al., 2000).
The factor in common to all complementary
therapies is that they are prescribed or recom-
mended by practitioners who approach the patient
as a whole (holistic practitioners). It might be said
that so does any good general practitioner. How-
ever, the clinical variables used by complementary
therapists are often unquantitated, may lack an
orthodox clinical correlate or, occasionally, even
defy translation into English, for example the clin-
ical variable ‘slipperiness’ that is used in oriental
medicine. Zollman and Vickers (1999) have
pointed out that the same patient may be described
with deficient liver Qi by an acupuncturist, as hav-
ing a pulsatilla constitution by a homeopath or
having a peptic ulcer by a western physician. It
might also be noted that, in the United Kingdom,
the General Medical Council has begun to disci-
pline practitioners who prescribe complementary
therapies wrongly (Ernst, 2004).
Complementary therapists may or may not be
graduates of orthodox medical schools. Other com-
plementary therapistsare organized professionally,
if separate from orthodox medicine (the United
Kingdom operates aGeneral Chiropractic Council
that regulates chiropractors in a manner exactly
analogous to the General Medical Council).
Other complementary therapists are trained pri-
vately, or in more informal ways, such as by experi-
enced older relatives. Chinese traditional medicine
is codified and relies on the cumulated experience
of both ancient and modern practitioners (Cheng,
2000).
The complementary therapies themselves also
vary in their degree of characterization. Less well-
characterized therapies include some forms of
over-the-counter products (especially in the United
States), aromatherapies, crystal therapies and var-
ious forms of psychotherapy. This is a book about
drugs, and non-pharmacological therapies (e.g. the
well-regulated areas of acupuncture and phy-
siotherapy) are beyond the scope here. ‘Herbal
medicines’ (a term widely used in the United
States) are basically unregulated pharmaceuticals;
confusingly, materials that are not of vegetable
origin (e.g. shark cartilage, oyster calcium or sele-
nates) are often included under the category of
herbal medicines. ‘Alkaloid’ is an older term refer-
ring to any drug with a plant origin (e.g. digoxin,
aspirin and warfarin), including both orthodox and
complementary therapies. Incidentally,opiatesare
alkaloids (e.g. morphine, codeine) andopioidsare
semisynthetic or synthetic drugs such as diacetyl-
morphine or pentazocine. ‘Pharmacognosy’ is the
science of plant-related, pharmacologically active
materials.
Homeopathyis the art and science of the treatment
of disease using microscopical drug doses.Homeo-
pathsbelieve that the most potent homeopathic
products are those that have been most extremely
diluted: in many cases, calculations based on
Avagadro’s number and the number of sequential
dilutions suggest there may not be a single alkaloid
molecule left in the administered dose. However,
it is believed that the pharmaceutical method,
which is at least as rigorous as for the manufacture
of allopathic drugs, creates an emergent property
in the administered vehicle that still has the388 CH30 COMPLEMENTARY MEDICINES