outside of the medical mainstream presents a real
barrier to good clinical care.”^31
On the other hand, many patients in the AIDS
community, for example, have become quite vocal
about the need for research in alternative medicine
because they think many patients are being
deceived by proponents of untested therapy, and
have appealed to the OAM and others for definitive
answers about unconventional AIDS treatments
being offered.^31
What do physicians think about alternative
medicine? It is likely that most physicians are
unaware of the scope, breadth, and extent of use of
unconventional therapies in the United States.^1
The level of interest among physicians in learning
more about alternative therapy, however, seems to
be high. A regional survey of family physicians in
the Chesapeake Bay area showed that more than
70% were interested in training in such practices as
herbal medicine, prayer therapy, acupressure, veg-
etarian and megavitamin diet therapy, acupunc-
ture, and biofeedback.^32 The results of this study,
however, are curious in that 26% of respondents
claim to have had training in chiropractic methods,
22% in acupuncture, and nearly 10% report train-
ing in traditional Oriental or Native American med-
icine. While informal training courses in these
areas may be available, the scientific basis for such
instruction is weak to nonexistent, and not usually
accredited by specialty societies or traditional orga-
nized medical associations that govern continuing
medical education. It would be most unusual if
over 20% of family physicians in this area actually
use chiropractic in their practice.
In a national survey of referral patterns by
board-certified family physicians and internists,
94% indicated willingness to refer for at least one
alternative therapy, 90% for at least two, 85% at
least three, 77% at least four, and 66% at least five
such modalities. The list of therapies for which
these physicians expressed a willingness to refer
patients included: relaxation techniques—86%,
biofeedback—85%, therapeutic massage—66%,
hypnosis—63%, acupuncture—56%, and medita-
tion—54%. By contrast, 47% said they would refer
for chiropractic, 24% for “spiritual” healing, 15%
for homeopathy, 14% for energy healing, and 6%
would refer for megavitamin or herbal therapy. In
the same survey, 22% of respondents reported per-
sonally providing relaxation therapy, 17% “lifestyle
diet (vegetarian, macrobiotic, etc.),” 5% hypnosis,
3% massage or chiropractic therapy, and 1%
homeopathic or acupuncture therapies.^33
The authors of the Chesapeake Bay study^32 cite
surveys of physicians in Great Britain, Israel, and
New Zealand that show “similar interest” in study-
ing alternative medicine. A more recent meta-
analysis of European physicians and their attitudes
about alternative medicine shows that on average,
physicians view complementary medicine to have
an “effectiveness rating” of 46± 18 on a scale of
0–100. There was no trend among these data to
suggest increasing endorsement of alternative
medicine by conventional practitioners, but the
authors conclude that European physicians give
these therapies a “considerable degree of accep-
tance.”^34 They caution, however, that the per-
ceived usefulness of such therapies by physicians
or the public should not be equated with proven
efficacy.
Many persons who are proponents of alterna-
tive medicine understand and acknowledge the
role of traditional Western medicine for such prob-
lems as surgical intervention for appendicitis and
fractures, or antibiotic therapy for specific infec-
tious diseases. However, many in the alternative
medical community spend a good deal of energy
denigrating the role of allopathic intervention as
dangerous, expensive, and impersonal. In the
“deconstructionist” mode, they often change the
vocabulary to make their methods seem rational
and reasonable. In a critique of alternative medi-
cine, Wallace Sampson, MD, points out that an edi-
torial in Alternative Therapiesposes:
“a non sequitur: present knowledge is adequate
to dismiss the utility of most alternative methods;
but [the editorial claims] there are ineffable quali-
ties that [conventional] methods cannot detect and
alternatives cannot define; therefore, alternative
methods must be accepted, their practitioners
licensed, and their services paid for by public funds
and health insurance.”^35
In an unpublished survey of all 125 US medical
schools, Sampson has found that just over 50
schools offer elective, for-credit courses on alterna-
tive therapy, and 18 other schools offer lecture200 The Encyclopedia of Complementary and Alternative Medicine