Essentials of. Complementary and. Alternative. Medicine eBook-een

explain or do not like. Science is one of the most pow erful tools for mitigating this self-delusionary 

capacity. However, the complexity of disease and the powerful healing capacity of the body often make it 

difficult to apply science to clinical medicine, especially when evaluating chronic disease (55, 56). K. B. 

Thomas demonstrated that nearly 80% of those who seek out medical care get better no matter what hand-

waving or pill-popping is provided (57). This is called the “80 Percent Rule,” meaning that data collected 

on novel therapies delivered in an enthusiastic clinical environment typically yield positive outcomes in 70 

to 80% of patients (58). 

NONSPECIFIC EFFECTS 

Oftentimes our most accepted treatments are shown to be nonspecific in nature (59, 60 and 60a) or even 

harmful (61) when finally studied rigorously. Their apparent effectiveness in practice is due to a variety of 

factors unrelated to the treatment, such as the ability of the body to heal (often enhanced by expectation), 

statistical regression to the mean (a measurement problem), and self-delusion (sometimes called bias) 

(58). It is not surprising that for the majority of physicians and patients, many therapies, both orthodox and 

unorthodox, seem to work. The methods of clinical research–especially blinding and the randomized 

controlled trial–have emerged as powerful approaches for better identifying to what extent the outcome 

can be attributed to the treatment. These methods must be used rigorously, however, if we wish to 

examine both the social and statistical forces that shape our perception of reality. As sophistication in 

clinical trials methods improves in order to better control for these nonspecific effects, however, the 

rigorous evaluation of chronic disease prevention and treatment approaches become more difficult and 

expensive (62). 

METHODS FOR EXAMINING CHRONIC DISEASE TREATMENTS 

For these and a variety of other ethical, economic, and scientific reasons, it is very unlikely that all CAM 

(or conventional) therapies can be examined using large, rigorous, randomized trials (see Chapter 4). 

There are now sophisticated scientific methods for applying basic-science 

 

 

information to clinical practice and highly effect ive approaches for the management of trauma and acute 

and infectious diseases. Current methods for examining chronic disease or practices that have no 

explanatory model in Western terms, however, are not adequately informed by science. CAM offers the 

opportunity to test new approaches for examining these areas as their presence in medicine increases. For 

example, the development of observational and outcome research methods is being explored in CAM as a 

new approach for obtaining acceptable evidence for the use of low-risk therapies for treatment of chronic 

disease (63, 64 and 65). 

SYNERGISTIC EFFECTS 

Most research on plant products is done to identify single active chemicals for drug development. Many 

herbal products, however, contain multiple chemical agents that may operate synergistically, producing 

effects with low amounts of multiple agents and lower risk for adverse effects. Standardization and quality 

production of herbals (necessary for producing safe and reliable products) may allow us to develop low-

cost therapies with reduced risk over pharmaceuticals (16, 18). 

CONSCIOUSNESS 

Another frontier area with potentially profound implications for science and medicine is the area of 

consciousness and its relationship to statistical events and biological outcomes. For example, extensive 

research has documented that intention can have an influence on chance events (75a, 76 and 76a) and 

living systems (77, 78). Traditional and indigenous healing practices from around the world universally 

assume that this is true and claim to use these “forces” in practices such as shamanism, spiritual healing, 

and prayer. Science now has the experimental methodology, sophisticated technology, and statistical 

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expertise to examine this question precisely. If changes in consciousness do have significant effects, what 

potential might this have for diagnosis and treatment (79, 80)? What implications would this have for our 

methods of experimentation and the notion of “objectivity?” Research on unorthodox medical practices 

allows us to begin serious scientific investigation of such areas. 

ANOMALOUS FINDINGS 

The unconventional basic-science assumptions that underlie some CAM practices provide opportunities to 

explore some of the deepest and most difficult enigmas of modern biology and medicine. Acupuncture, for 

example, was largely ignored in the United States until brought to national attention by a prominent 

reporter traveling with President Nixon in 1972. This led to basic science research and the discovery of its 

pain-relieving mechanisms ( 66). Another current enigma is whether biologically active nonmolecular 

information can be stored and transmitted through water  or over wires, as claimed in homeopathy and 

electrodermal diagnosis (40, 67, 68, 69, 70, 71 and 72). Most scientists are unaware of the research in 

this area and claim that the concept is impossible. If some version of this claim were true, however, its 

potential implications for biology, pharmacology, and medical care are enormous. Data from clinical 

research on homeopathy do not support the expected assumption that homeopathy operates entirely like 

placebo (73, 74 and 75). Basic research on homeopathy can help examine the accumulating anomalous 

observations and experiments in this area (40). 

CENTRAL MODELS OF ETIOLOGY AND TREATMENT IN MEDICINE 

What can we make of the diversity of CAM approaches? Are they an unrelated, socially defined, and 

shifting group of disparate practices, or do they have common concepts and central themes that tie them 

together and to conventional medicine? If so, how are these approaches similar to and different from 

modern Western medicine? Historically and cross-culturally, different medical systems have exhibited 

different understandings of disease caus ation and of factors relevant to etiology. Alongside this diversity 

are different approaches to identifying etiological factors and to addressing them in clinical 

 

 

practice. These diverse perspectives can be classified into (a) those that focus on a specific cause, and 

(b) those that emphasize complex systems of causative or antecedent factors. Alongside these two central 

perspectives on disease etiology, most major medical systems emphasize one of three approaches in the 

treatment of disease. These are (a) a hygiene-oriented or health-promotion approach, (b) approaches that 

induce or stimulate endogenous healing responses, and (c ) approaches that oppose, interfere with, or 

eliminate disease causes and biological responses to those causes. 

Figure 1 illustrates these different models of etiology and approaches to treatment. The “specific cause 

model” (1, Figure 1) attempts to identify the most prominent linear etiological pathway of the headache. 

This usually leads to a therapy that interferes with that pathway directly (opposition approach—a, Figure 

1). Thus, in a patient who presents with a headache , an understanding of the pathophysiology of the 

headache is traced to vasospasm, and medication or biofeedback is provided to interfere with that 

pathway. Treatment is offered for only those aspects of the illness that cross a predefined diagnostic 

threshold. The “systems model” (2, Figure 1) attempts to identify the web of etiological influences that 

contribute to the headache and their relationships to other covert problems or risks. Intervention targets 

the most prominent of these factors on multiple levels. Thus, a chronic headache patient who has other 

less prominent problems (fatigue, borderline blood pressure, insomnia, etc.) is treated with lifestyle 

changes and behavioral therapy addressing  diet, exercise, relaxation skills, and drug or medication abuse 

(hygiene approach—b, Figure 1). The “wholistic model” (3, Figure 1) examines the patient's reactions to 

etiological agents and influences. Treatment approache s focus on improving resistance, restoring 

homeostatic “balance,” or stimulating self-healing processes in the patient (induction approach—c, Figure 

1). Thus, the headache patient may be given acupuncture to restore the balance of  chi, a vasospastic 

agent (e.g., caffeine or belladonna alkaloids) to adjust autonomic reactivity, or a specifically selected 

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