We’ve all seen the words “complementary,” “alternative,” and “integrative,” but what do they really mean?

History of alternative medicine

The history of alternative medicine refers to the history of a group of diverse medical practices that were collectively promoted as “alternative medicine” beginning in the 1970s, to the collection of individual histories of members of that group, or to the history of western medical practices that were labeled “irregular practices” by the western medical establishment.^[1][2][3][4] It includes the histories of complementary medicine and of integrative medicine. “Alternative medicine” is a loosely defined and very diverse set of products, practices, and theories that are perceived by its users to have the healing effects of medicine, but do not originate from evidence gathered using the scientific method,^{[5]:Ch 14E, p. 1[6][7]} are not part of biomedicine,^{[5][8][9][10]} or are contradicted by scientific evidence or established science.^[4][11][12] “Biomedicine” is that part of medical science that applies principles of anatomy, physics, chemistry, biology, physiology, and other natural sciences to clinical practice, using scientific methods to establish the effectiveness of that practice.

Much of what is now categorized as alternative medicine was developed as independent, complete medical systems, was developed long before biomedicine and use of scientific methods, and was developed in relatively isolated regions of the world where there was little or no medical contact with pre-scientific western medicine, or with each other’s systems. Examples are Traditional Chinese medicine, European humoral theory and the Ayurvedic medicine of India. Other alternative medicine practices, such as homeopathy, were developed in western Europe and in opposition to western medicine, at a time when western medicine was based on unscientific theories that were dogmatically imposed by western religious authorities. Homeopathy was developed prior to discovery of the basic principles of chemistry, which proved homeopathic remedies contained nothing but water. But homeopathy, with its remedies made of water, was harmless compared to the unscientific and dangerous orthodox western medicine practiced at that time, which included use of toxins and draining of blood, often resulting in permanent disfigurement or death.^[1] Other alternative practices such as chiropractic and osteopathic manipulative medicine, were developed in the United States at a time that western medicine was beginning to incorporate scientific methods and theories, but the biomedical model was not yet totally dominant. Practices such as chiropractic and osteopathic, each considered to be irregular by the medical establishment, also opposed each other, both rhetorically and politically with licensing legislation. Osteopathic practitioners added the courses and training of biomedicine to their licensing, and licensed Doctor of Osteopathic Medicine holders began diminishing use of the unscientific origins of the field, and without the original practices and theories, is now considered the same as biomedicine.

Until the 1970s, western practitioners that were not part of the medical establishment were referred to “irregular practitioners”, and were dismissed by the medical establishment as unscientific or quackery.^[1] Irregular practice became increasingly marginalized as quackery and fraud, as western medicine increasingly incorporated scientific methods and discoveries, and had a corresponding increase in success of its treatments. In the 1970s, irregular practices were grouped with traditional practices of nonwestern cultures and with other unproven or disproven practices that were not part of biomedicine, with the group promoted as being “alternative medicine”. Following the counterculture movement of the 1960s, misleading marketing campaigns promoting “alternative medicine” as being an effective “alternative” to biomedicine, and with changing social attitudes about not using chemicals, challenging the establishment and authority of any kind, sensitivity to giving equal measure to values and beliefs of other cultures and their practices through cultural relativism, adding postmodernism and deconstructivism to ways of thinking about science and its deficiencies, and with growing frustration and desperation by patients about limitations and side effects of science-based medicine, use of alternative medicine in the west began to rise, then had explosive growth beginning in the 1990s, when senior level political figures began promoting alternative medicine, and began diverting government medical research funds into research of alternative, complementary, and integrative medicine.^{[1][2][3][4][13][14][15]}

Complementary Versus Alternative

According to a 2012 national survey, many Americans—more than 30 percent of adults and about 12 percent of children—use health care approaches that are not typically part of conventional medical care or that may have origins outside of usual Western practice. When describing these approaches, people often use “alternative” and “complementary” interchangeably, but the two terms refer to different concepts:

• If a non-mainstream practice is used together with conventional medicine, it’s considered “complementary.”
• If a non-mainstream practice is used in place of conventional medicine, it’s considered “alternative.”

Most people who use non-mainstream approaches also use conventional health care.

In additional to complementary and alternative, you may also hear the term “functional medicine.” This term sometimes refers to a concept similar to integrative health (described below), but it may also refer to an approach that more closely resembles naturopathy (a medical system that has evolved from a combination of traditional practices and health care approaches popular in Europe during the 19th century).

Integrative Health

Integrative health care often brings conventional and complementary approaches together in a coordinated way. It emphasizes a holistic, patient-focused approach to health care and wellness—often including mental, emotional, functional, spiritual, social, and community aspects—and treating the whole person rather than, for example, one organ system. It aims for well-coordinated care between different providers and institutions.

The use of integrative approaches to health and wellness has grown within care settings across the United States. Researchers are currently exploring the potential benefits of integrative health in a variety of situations, including pain management for military personnel and veterans, relief of symptoms in cancer patients and survivors, and programs to promote healthy behaviors.

Types of Complementary Health Approaches

Complementary health approaches include natural products and mind and body practices.

Natural Products

This group includes a variety of products, such as herbs (also known as botanicals), vitamins and minerals, and probiotics. They are widely marketed, readily available to consumers, and often sold as dietary supplements.

According to the 2012 National Health Interview Survey (NHIS), which included a comprehensive survey on the use of complementary health approaches by Americans, 17.7 percent of American adults had used a dietary supplement other than vitamins and minerals in the past year. These products were the most popular complementary health approach in the survey. (See chart.) The most commonly used natural product was fish oil.

Researchers have done large, rigorous studies on a few natural products, but the results often showed that the products didn’t work for the conditions studied. Research on others is in progress. While there are indications that some may be helpful, more needs to be learned about the effects of these products in the human body, and about their safety and potential interactions with medicines and other natural products.

Mind and Body Practices

Mind and body practices include a large and diverse group of procedures or techniques administered or taught by a trained practitioner or teacher. The 2012 NHIS showed that yoga, chiropractic and osteopathic manipulation, and meditation are among the most popular mind and body practices used by adults. According to the 2017 NHIS, the popularity of yoga has grown dramatically in recent years, from 9.5 percent of U.S. adults practicing yoga in 2012 to 14.3 percent in 2017. The 2017 NHIS also showed that the use of meditation increased more than threefold from 4.1 percent in 2012 to 14.2 percent in 2017.

Other mind and body practices include acupuncture, relaxation techniques (such as breathing exercises, guided imagery, and progressive muscle relaxation), tai chi, qi gong, hypnotherapy, Feldenkrais method, Alexander technique, Pilates, Rolfing Structural Integration, and Trager psychophysical integration.

The amount of research on mind and body approaches varies widely depending on the practice. For example, researchers have done many studies on acupuncture, yoga, spinal manipulation, and meditation, but there have been fewer studies on some other practices.

Other Complementary Health Approaches

Some complementary approaches may not neatly fit into either of these groups—for example, the practices of traditional healers, Ayurvedic medicine, traditional Chinese medicine, homeopathy, naturopathy, and functional medicine.