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'''Complementary and Alternative Medicine'''</th></tr> |
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<tr><td align="center">This article is part of the ] series of articles.</td></tr> |
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{{Alternative medical systems}} |
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'''Complementary and alternative medicine''' (CAM) is an ] for ] and ]. The term also incorporates ]. Typical examples of CAM approaches are ], ], ], ], body work and diet-based therapies. Definitions of CAM vary with culture and time and can change with scientific evidence. CAM therapies have been criticized by scientific researchers. |
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==Definitions== |
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According to the ] (IOM), "A lack of consistency in the definition of what is included in CAM is found throughout the literature."<ref name =IOM_CAM_p17>{{cite web| url = http://books.nap.edu/openbook.php?record_id=11182&page=17| title = Complementary and Alternative Medicine in the United States, p. 17| accessdate = 2008-01-08| author= Board on Health Promotion and Disease Prevention of the ] |date= 2005 | publisher= ]}}</ref> For the purposes of their report, entitled "Complementary and Alternative Medicine in the United States" (2005),<ref name=IOM_CAM>{{cite web| url = http://www.nap.edu/catalog.php?record_id=11182| title = Complementary and Alternative Medicine in the United States | accessdate = 2008-01-08| author= Board on Health Promotion and Disease Prevention of the ] |date= 2005 | publisher= ]}}</ref> the IOM adopted this definition: "Complementary and alternative medicine (CAM) is a broad domain of resources that encompasses health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the dominant health system of a particular society or culture in a given historical period. CAM includes such resources perceived by their users as associated with positive health outcomes. Boundaries within CAM and between the CAM domain and the domain of the dominant system are not always sharp or fixed."<ref name =IOM_CAM_p19>{{cite web| url = http://books.nap.edu/openbook.php?record_id=11182&page=17| title = Complementary and Alternative Medicine in the United States, p. 19| accessdate = 2008-01-08| author= Board on Health Promotion and Disease Prevention of the ] |date= 2005 | publisher= ]}}</ref> |
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Other groups and individuals have offered various definitions and distinguishing characteristics of CAM. The ] defines CAM as "a group of diverse medical and health care systems, practices, and products, that are not currently part of ] medicine."<ref name=NCCAM_CAM>{{cite web| url = http://nccam.nih.gov/health/whatiscam/| title = What is Complementary and Alternative Medicine (CAM)?| accessdate = 2006-07-11|publisher=] at the ]}}</ref> NCCAM has developed what the ] calls "ne of the most widely used classification structures"<ref name =IOM_CAM_p18>{{cite web| url = http://books.nap.edu/openbook.php?record_id=11182&page=18| title = Complementary and Alternative Medicine in the United States, p. 18| accessdate = 2008-01-08| author= Board on Health Promotion and Disease Prevention of the ] |date= 2005 | publisher= ]}}</ref> for the branches of complementary and alternative medicine.<ref name=NCCAM_CAM/> David M. Eisenberg defines CAM as "medical interventions not taught widely at U.S. medical schools or generally available at U.S. hospitals."<ref name="Eisenberg"> Eisenberg D, et al. ''N Engl J Med'' 1993; 328:246-252.</ref> ] defines CAM as a "set of practices which cannot be tested, refuse to be tested, or consistently fail tests."<ref name=Dawkins>] {{cite book | last = Dawkins | first = Richard | author = Richard Dawkins | year = 2003 | title = A Devil's Chaplain | publisher = Weidenfeld & Nicolson}}</ref> ] and J. P. Kassirer state that "There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work."<ref name="Angell"/> Fontanarosa and Lundberg also deny that such a thing as "alternative medicine" exists, saying there is only "evidence-based medicine supported by solid data or unproven medicine."<ref name="Fontanarosa">Fontanarosa P.B., and Lundberg G.D. '']''. 1998; 280: 1618-1619.</ref> |
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The term "alternative medicine" is used to describe these practices when they are used in place of conventional medicine. Used in conjunction and cooperation with conventional medicine they are termed "complementary medicine". "Integrative" or "integrated medicine" combines conventional medical treatments with CAM treatments which have some high-quality scientific evidence. It is viewed by its advocates as the best of complementary medicine.<ref name=NCCAM_CAM/> ] and ] considered "integrative medicine is not synonymous with complementary and alternative medicine (CAM). It has a far larger meaning and mission in that it calls for restoration of the focus of medicine on health and healing and emphasizes the centrality of the patient-physician relationship."<ref name=Snyderman>{{cite paper | author = Snyderman, R.; Weil, A. T.| url = http://www.bravewell.org/news_resources/bravewell_news/bringing_medicine_back_to_its_roots/| title = Integrative Medicine: Bringing Medicine Back To Its Roots| publisher = Archives of Internal Medicine| date= 2002-02-25| accessdate = 2006-07-11}} </ref> <!-- WE CAN'T USE PROJECTIONS SEVERAL YEARS AFTER THE FACT; ALSO, THE ESTIMATE IS UNCITED In 2002, the growth estimate during the years 1995 to 2005 in the USA and other developed countries for the number of chiropractors, acupuncturists, naturopaths, and other nonphysician clinicians was double that of physicians.<ref name=Cassileth>{{cite journal | author = Cassileth, Barrie R. | title = The Role of Complementary & Alternative Medicine: Accommodating Pluralism. | journal = NEJM | volume = 347 | pages = 860-861 | year = 2002}}</ref>--> The combination of orthodox and complementary medicine with an emphasis on prevention and lifestyle changes is known as ]. |
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== Relationship between conventional medicine and CAM== |
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According to the NCCAM formerly unproven remedies may be incorporated into conventional medicine if they are shown to be safe and effective.<ref>. ].</ref> |
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According to Angell and Kassirer, "What most sets alternative medicine apart, in our view, is that it has not been scientifically tested and its advocates largely deny the need for such testing." They also state "many treatments used in conventional medicine have not been rigorously tested, either, but the scientific community generally acknowledges that this is a failing that needs to be remedied."<ref name="Angell"/> They state: "Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted."<ref name="Angell">{{cite journal |author=Angell M, Kassirer JP |title=''Alternative medicine--the risks of untested and unregulated remedies'' |journal=N. Engl. J. Med. |volume=339 |issue=12 |pages=839–41 |year=1998 |pmid=9738094 |doi= |url=http://kitsrus.com/pdf/nejm_998.pdf |accessdate=2007-12-28 |doi=10.1056/NEJM199809173391210}}</ref>According to Dawkins, disproven practices remain in the realm of CAM.<ref name=Dawkins/> |
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], Professor of Complementary Medicine at the University of Exeter, believes that CAM can and should be subjected to scientific testing. In his view, there can be "good CAM" or "bad CAM" based on evidentiary support.<ref>The Cochrane Collaboration Complementary Medicine Field, . Retrieved 5 August 2006.</ref><ref>The HealthWatch Award 2005: Prof. Edzard Ernst |
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Complementary medicine: the good the bad and the ugly. , retrieved 5 August 2006</ref><ref>"Complementary medicine is diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy or by diversifying the conceptual frameworks of medicine." Ernst et al British General Practitioner 1995; 45:506</ref> |
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M.R. Tonelli argues that CAM cannot be ] unless the definition of evidence is changed. He states that "the methods of developing knowledge within CAM currently have limitations and are subject to bias and varied interpretation. CAM must develop and defend a rational and coherent method for assessing causality and efficacy, though not necessarily one based on the results of controlled clinical trials."<ref name="pmid11739043">{{cite journal |author=Tonelli MR, Callahan TC |title=Why alternative medicine cannot be evidence-based |journal=Academic medicine : journal of the Association of American Medical Colleges |volume=76 |issue=12 |pages=1213-20 |year=2001 |pmid=11739043 |doi=}}</ref> |
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A review of Michael L. Millenson's book ''Demanding Medical Excellence: Doctors and Accountability in the Information Age'' described it as "a wake up call to both medicine and nursing" due to what Millenson calls a "lack of scientific-based medical practice". According to the review, the book states that "85% of current practice has not been scientifically validated" and that it suggests that users of the research presented by Medline should question research articles rather than assuming they are accurate simply because the are published. The review states that Millenson's thesis and conclusion call for all health researchers and policy makers do a better job in assuring valid methodology and avoidance of bias in published research.<ref>Gunn IP. "A critique of Michael L. Millenson's book, Demanding medical excellence: doctors and accountability in the information age, and its relevance to CRNAs and nursing." ''AANA J'', 1998 '''66'''(6):575-82. Review. PMID 10488264</ref> Michael Dixon, the Director of the NHS Alliance stated that “People argue against complementary therapies on the basis of a lack of evidence. But I’d say only 10 per cent of what doctors do in primary care is evidence-based."<ref>Simon Crompton, "," Times Online, Times Newspapers Ltd., January 17, 2004.</ref> Many CAMs are criticized by the activist non-profit organization ].<ref name="Quackwatch-Homepage"> |
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{{cite news |
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|first=Stephen |
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|last=Barrett |
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|title=Quackwatch |
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|url=http://www.quackwatch.org/ |
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|work=Your Guide to Quackery, Health Fraud, and Intelligent Decisions |
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|publisher=] |
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|date= |
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|accessdate=2008-03-04 |
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|quote=}}</ref> |
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A survey of websites providing information about ] found that about one in twenty such sites contained inaccurate information, and that CAM websites were 15 more likely to contain inaccuracies.<ref></ref><ref>{{cite journal|author=Elmer V. Bernstam, Muhammad F. Walji, Smitha Sagaram, Deepak Sagaram, Craig W. Johnson, Funda Meric-Bernstam |
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|title=Commonly cited website quality criteria are not effective at identifying inaccurate online information about breast cancer |
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|journal=Cancer |
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|volume=In press |
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|issue= |
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|pages= |
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|year=2008 |
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|doi=10.1002/cncr.23308 |
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|url=http://www3.interscience.wiley.com/cgi-bin/abstract/117908535/ABSTRACT?CRETRY=1&SRETRY=0 |
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|accessdate=2008-02-12|pages=1206}}</ref> |
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== NCCAM classifications of CAM == |
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NCCAM classifies CAM therapies into five major groups. The classification are rather loose, and there can be some overlap.<ref name=whatiscam> ]</ref> |
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=== Whole medical systems === |
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Whole medical systems or "alternative medical systems" (such as ] and ]) cut across more than one of the other groups.<ref name=wholemed> ]</ref> |
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=== Mind-body medicine === |
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Mind-body medicine take an holistic approach to health that explores the interconnection between the mind, body, and spirit. They work under the premise that the mind can affect "bodily functions and symptoms".<ref name=mindbody> ]</ref> |
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=== Biologically based practices === |
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Biologically based practices use substances found in nature such as herbs, foods, vitamins, and other natural substances.<ref name=biobasedprac> ]</ref> |
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=== Manipulative and body-based practices === |
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Manipulative and body-based practices are based on the manipulation or movement of body parts, such as is done in ] and ] manipulation.<ref name=manipulative> ]</ref> |
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=== Energy medicine === |
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Energy medicine is a domain that deals with putative and veritable energy fields.<ref></ref> - |
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*] therapies are intended to influence energy fields that purportedly surround and penetrate the body. No empirical evidence has been found to support the existence of such fields. |
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*]-based therapies use electromagnetic fields, such as pulsed fields, alternating-current or direct-current fields in an unconventional manner. <ref name=energymed></ref> |
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== Contemporary use of CAM == |
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] wrote in the Medical Journal of Australia that ''"about half the general population in developed countries use complementary and alternative medicine (CAM)''."<ref name=Ernst>] "Obstacles to research in complementary and alternative medicine." ''Medical Journal of Australia'', 2003; 179 (6): 279-80. PMID 12964907 </ref> A survey released in May 2004 by the ], part of the ] 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 ].<ref name=Barnes>{{cite paper | url = http://nccam.nih.gov/news/report.pdf | author = Barnes, P. M.; Powell-Griner, E.; McFann, K.; Nahin, R. L. | title = Complementary and Alternative Medicine Use Among Adults: United States, 2002 | date= 2004 | publisher = ]}}</ref> If ] was counted as an alternative therapy, the figure rose to 62.1%. 25% of people who use CAM do so because medical professional suggested it.<ref name=CAM_reason> ]</ref> Another study suggests a similar figure of 40%.<ref name=Astin>Astin JA "Why patients use alternative medicine: results of a national study" ''JAMA'' 1998; '''279'''(19): 1548-1553</ref> 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.<ref>Thomas KJ, Nicholl JP, Coleman P. Use and expenditure on complementary medicine in England: a population based survey. |
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Complement Ther Med. 2001 Mar;9(1):2-11. </ref> |
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The use of alternative medicine appears to be increasing, as a 1998 study showed that the use of alternative medicine had risen from 33.8% in 1990 to 42.1% in 1997.<ref name=Eisenberg_trends>Eisenberg, DM, Davis RB, Ettner SL "Trends in alternative medicine use in the United States 1990-1997." ''JAMA'', 1998; '''280''':1569-1575. PMID 9820257</ref> In the United Kingdom, a ] report ordered by the ] suggested that "...limited data seem to support the idea that CAM use in the United Kingdom is high and is increasing."<ref name=HOL></ref> |
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In April 2008 ] published a letter from Edzard Ernst, Professor of Complementary Medicine asking ] and his Foundation for Integrated Health to recall two guides that promote "alternative medicine." The letter said "The majority of alternative therapies appear to be clinically ineffective, and many are downright dangerous." |
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=== Medical education === |
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Increasing numbers of medical colleges have begun offering courses in alternative medicine. For example, the ] College of Medicine offers a program in ] under the leadership of ] which trains physicians in various branches of alternative medicine which "...neither rejects conventional medicine, nor embraces alternative practices uncritically."<ref name=UofA></ref> In three separate research surveys that surveyed 729 schools in the United States (125 medical schools offering an MD degree, 19 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.<ref name=Wetzel>Wetzel MS, Eisenberg DM, Kaptchuk TJ. "Courses involving complementary and alternative medicine at US medical schools." ''JAMA'' 1998; 280 (9):784 -787. PMID 9729989 </ref><ref>Saxon DW, Tunnicliff G, Brokaw JJ, Raess BU. "Status of complementary and alternative medicine in the osteopathic medical school curriculum." ''J Am Osteopath Assoc'' 2004; 104 (3):121-6. PMID 15083987</ref><ref name=Fenton>Fenton MV, Morris DL. "The integration of holistic nursing practices and complementary and alternative modalities into curricula of schools of nursing." ''Altern Ther Health Med,'' 2003; 9 (4):62-7. PMID 12868254</ref> Accredited Naturopathic colleges and universities are increasing in number and popularity in the U.S.A. See ]. |
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Similarly "unconventional medicine courses are widely represented at European universities. They cover a wide range of therapies. Many of them are used clinically. Research work is underway at several faculties."<ref>Barberis L, de Toni E, Schiavone M, Zicca A, Ghio R. Unconventional medicine teaching at the Universities of the European Union. J Altern Complement Med. 2001 Aug;7(4):337-43. PMID: 11558776 </ref> But, "only 40% of the responding universities were offering some form of CAM training."<ref>Varga O, Márton S, Molnár P. Status of complementary and alternative medicine in European medical schools. Forsch Komplement Med (2006). 2006 Feb;13(1):41-5. Epub 2006 Jan 3. PMID: 16582550 </ref> |
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In the UK, no medical schools offer courses that teach the clinical practice of alternative medicine. {{Fact|date=December 2007}}. |
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== See also == |
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* ] |
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* ] |
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* ] |
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* ] |
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* ] |
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* ] |
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* ] (see also ]) |
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* ] |
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* ] |
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* ] |
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== Further reading == |
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* Pharmaceutical Press |
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* . London : BioMed Central, 2001- NLM ID: |
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* |
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* |
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* |
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* New York, NY : Mary Ann Liebert, Inc., c1995-] |
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* {{citation |
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| last = Bausell | first = R. Barker |
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| year = 2007 |
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| title = Snake Oil Science: The Truth About Complementary and Alternative Medicine |
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|publisher = ] |
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|ID = ISBN 978-0-19-531368-0 |
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}} |
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== Notes == |
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* Benedetti F, Maggi G, Lopiano L. "Open Versus Hidden Medical Treatments: The Patient's Knowledge About a Therapy Affects the Therapy Outcome." ''Prevention & Treatment'', 2003; '''6'''(1), |
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* Downing AM, Hunter DG. "Validating clinical reasoning: a question of perspective, but whose perspective?" ''Man Ther'', 2003; '''8'''(2): 117-9. PMID 12890440 |
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* Eisenberg DM. "Advising patients who seek alternative medical therapies." ''Ann Intern Med'' 1997; '''127''':61-69. PMID 9214254 |
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* Tonelli MR. "The limits of evidence-based medicine." ''Respir Care'', 2001; '''46'''(12): 1435-40; discussion 1440-1. Review. PMID 11728302 |
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* Zalewski Z. "Importance of Philosophy of Science to the History of Medical Thinking." ''CMJ'' 1999; '''40''': 8-13. |
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== References == |
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{{reflist|2}} |
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==External links== |
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* - US National Institutes of Health |
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* - Alternative Medicine Research Database |
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* (from the ] Medical Center) - Comprehensive guide covering conditions and treatments |
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