A Brief History. Kristen Alley Swain

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1 33 systems can adversely affect the market value of real estate. Higher costs of renewable energy technologies compared with conventional technologies, inadequate workforce training for production, market control of the national grids by centralized power plants, and difficulty introducing commercially viable innovations and numerous small energy sources into the grids also prevent adoption of renewables. Government policy typically favors existing conventional energy over renewables and near term over long term. Fossil fuel subsidies, lack of net-metering policy and utility interconnection, inadequate financing options for renewable energy projects, prohibitive permitting codes, and lack of incentives for consumer adoption of renewables all hinder development of renewable energy. Lowering income taxes, raising taxes on environmentally destructive activities, and creating subsidies for energy innovations could create a more responsive market for renewables. Kristen Alley Swain See also Biofuels; Environmental Defense Fund; Fuel Cell Technology; Solar Energy; Wind Power Further Readings Brown, L. R. (2006). Plan B 2.0: Rescuing a planet under stress and a civilization in trouble. New York: W. W. Norton. Available at International Energy Agency. (2008). Worldwide trends in energy use and efficiency. Paris: Organisation for Economic Co-operation and Development. Available at indicators_2008.pdf Krupp, F., & Horn, M. (2008). Earth: The sequel: The race to reinvent energy and stop global warming. New York: W. W. Norton. Renewable Energy Policy Network for the 21st Century. (2009, May). Renewables 2007 global status report. Paris: Author. Available at globalstatusreport United Nations Environment Programme. (2006, January). Changing climates: The role of renewable energy in a carbon-constrained world. Paper prepared for Renewable Energy Policy Network for the 21st Century. Available at art/2006_120_report.pdf Worldwatch Institute. (2006). American energy: The renewable path to energy security. Washington, DC: Author. Available at AmericanEnergy.pdf Understanding the history, issues, and trends related to alternative medicine has increasing importance for science communicators, as a growing number of adults and children in the United States are regular users of alternative medicine and seek information about these therapies. In this entry, alternative medicine is discussed, particularly its history and present use in the United States. Key differences between conventional medicine and alternative medicine are summarized, areas of ongoing controversy are described, and gaps in communication research are identified. Although alternative medicine has global use and implications, this entry will largely focus on alternative medicine in the United States. A Brief History Strictly speaking, alternative medicine refers to treatments that are used instead of conventional medicine. Complementary and alternative medicine and traditional, complementary, and alternative medicine are terms that are frequently used when discussing alternative medicine. Complementary medicine refers to therapies that are used in conjunction with mainstream treatment, while traditional medicine refers to medical practices that predate Western medicine and are still used in traditional societies in many parts of the world. Integrative medicine and holistic medicine are also terms used to refer to alternative medicine. Both terms imply a fusion of alternative and mainstream approaches that address a patient s total wellness. Conventional medicine is also referred to as allopathic medicine, mainstream medicine, Western medicine, biomedical approaches to medicine, and science-based medicine. Globally, alternative medicine refers to medical practices that fall outside the domain of mainstream Western medical practices as are used in industrialized nations such as in the

2 34 United States, Canada, the United Kingdom, Australia, and Europe. Many of these practices have their origins in developing nations, such as in China or India, or among the indigenous peoples of industrialized nations, and are thus considered traditional medicine rather than alternative medicine. Acknowledging the importance of all of the above differentiations, the term alternative medicine will be used throughout this entry (for consistency) to refer to alternative, complementary, integrative, and traditional medicine as the combined medical counterpart to conventional Western medicine. Alternative medicine as it is largely practiced in the United States today originated in the combative struggles between various natural therapies and schools of thought and conventional medicine taking place from the early 1800s to the early 1900s. These early therapies had emerged as a reaction against ineffective and painful medical practices of the early 1800s. Various alternative medicine approaches, such as homeopathy, water therapy, and hypnotism, gained popularity in the late 1880s and early 1900s, reflecting the political trends of the times, including democratization of medical knowledge and identification with the Romantic period in art and literature, in which nature was highly valued. Despite the popularity of alternative therapies, practitioners and the various schools of thought were not well organized, and by the early 1900s, had largely fallen out of favor, losing public attention to the scientific discoveries of that period. Alternative medicine reemerged in the late 1960s and 1970s as interest in alternatives to conventional medicine arose as part of the larger counterculture distrust of authority and disillusionment with the mainstream that infused the United States during the Vietnam War era, as well as the growing costs of conventional health care that would characterize the 1980s. Although alternative medicine grew in popularity throughout the 1980s, alternative medicine went largely unacknowledged by the conventional medical establishment until the early 1990s when, after two centuries, the field came into its own with federal and scholarly recognition. In 1991, the U.S. Congress passed legislation that allocated $2 million to establish the Office of within the National Institutes of Health. In 1993, results of the first wide-scale survey on alternative medicine use in the United States were published, which showed that 34% of U.S. adults used alternative medicine, a much higher figure than was previously assumed. In 1996, the state of Washington passed the first legislation in the United States that required every health insurance plan in the state to cover services provided by licensed alternative medicine practitioners. The expansion of the Office of Alternative Medicine to the National Center for Complementary and in 1998, and the increase in budget to $50 million, reflected a broader societal trend of placing higher value on alternative medicine and of viewing alternative therapies as complementing mainstream medicine rather than replacing it. This trend has continued with the growing use of the term integrative medicine to refer to alternative medicine. For example, in 1996, Andrew Weil, a medical doctor, established the program in Integrative Medicine in the Department of Medicine at the University of Arizona, creating the first integrative medicine residency program in the nation. Other universities, including Columbia University, followed suit. It appears likely that the model of integrated medicine will continue into the 21st century. Differences Between Alternative Medicine and Mainstream Medicine Some of the key differences between alternative and mainstream medicine include the training of practitioners, the empirical basis, and the choice of medical model. Mainstream medicine is practiced by medical doctors and nurses who have been trained in medical schools or colleges and who have received either a doctorate in medicine (MD), a degree in nursing such as a registered nurse (RN), or another degree such as a PhD in psychiatry. Alternative medicine practitioners do not require specific licensing, and until the early 21st century, there were few schools that provided accredited training for practitioners. Mainstream medicine is based on an empirical tradition of Western scientific principles. Alternative medicine is based on many different traditions, including esoteric and spiritual traditions such as Hinduism and the yin and yang philosophy of Chinese medicine. These approaches are not considered to be scientific in the Western tradition because they have not been empirically tested and proven.

3 35 Mainstream medicine has traditionally relied on a biomedical model of patient care that emphasizes physical treatment of the patient, an authoritarian communication style, and lack of preventive care. In contrast, alternative medicine practitioners employ a biopsychosocial model of patient care that emphasizes consideration of all aspects of a patient s life in addressing his or her health, a patient-centered communication approach, and preventive care. Since the latter part of the 20th century, many mainstream medical practitioners have adopted a biopsychosocial approach to health care as consumer preference for this approach has grown, displacing the earlier patriarchal model of health care. From the outset, the relationship between alternative medicine practitioners and traditionally trained medical doctors has been contentious. However, as a growing body of scientific research supports the effectiveness of popular alternative therapies for specific health conditions (for example, acupuncture has been shown to be successful in treating pain associated with migraines and cancer), more medical doctors and health care professionals are referring their patients to selected alternative therapies. An analysis of survey data between 1982 and 1995 suggested that many medical doctors in the United States refer their patients to popular alternative therapies including acupuncture, chiropractic treatment, and massage. The findings suggested that medical doctors are less likely, however, to refer their patients to alternative therapies for which there is not scientifically based evidence of effectiveness or that take the place of conventional medicine, such as homeopathy or herbal medicine. Among health care professionals, there is some evidence to suggest that medical doctors in the United States and in Canada have more negative attitudes toward alternative medicine than do other health care professionals, such as nurses or pharmacists. Overall, however, conventional medicine health care professionals report that they want more information and education about alternative medicine. Studies on the perceptions of alternative medicine practitioners suggest that they appear to view their field as supporting conventional medicine, not replacing it. Although the relationship between the two sides has improved dramatically from the animosity that characterized much of the previous two centuries, there is still a need for interaction and collaboration between conventional medicine and alternative medicine providers, particularly in ensuring that patients who are being treated by both types of caregivers receive safe and effective treatment. Type and Frequency of Usage Among U.S. Population The most popular forms of alternative medicine in the United States are acupuncture, traditional Chinese medicine, naturopathy, nutritional supplements, chiropractic treatment, massage, meditation, and yoga. The National Center for Complementary and groups alternative medicine into the following broad five categories: whole medical systems (such as naturopathy), mind body medicine (such as meditation), biologically based practices (such as the use of herbs and supplements), manipulative and bodybased practices (such as chiropractic treatment), and energy medicine (such as therapeutic touch). A 2007 National Health Interview Survey found that approximately 38% of adults in the United States used one or more alternative therapies, compared to 36% in The survey found that reported usage was highest among women, those with higher levels of education, and those with higher incomes. All age groups reported using alternative therapies, with the highest reported use in the 40 to 69 combined age ranges. Significant usage was indicated in American Indian/Alaska Native, white, Asian, African American, and Hispanic populations, with the highest use in American Indian/Alaska Native and white populations in which 50.3% and 43.1%, respectively, of these populations reported using alternative therapies. The 10 most frequently used alternative therapies in the United States, in order of use, are nonvitamin, nonmineral natural products (such as herbal supplements), deep breathing, meditation, chiropractic and osteopathic treatment, massage, yoga, diet-based therapies, progressive relaxation, guided imagery, and homeopathic treatment. The three most common supplements used are fish oil/ omega-3, glucosamine, and echinacea. Americans use alternative therapies most commonly to treat back, neck, and joint pain. The 2007 survey included the

4 36 first survey of children s use of alternative medicine in the United States and found that approximately 12% of children under the age of 18 in the United States use alternative medicine, most commonly vitamins and supplements for back and neck pain and head or chest colds. White children are most likely to use alternative medicine, as well as children with multiple health conditions, children whose parents have higher education, children whose parents use alternative medicine, and children whose parents are unable to afford conventional care. While most Americans use alternative medicine in conjunction with conventional medicine, the majority do not talk to their conventional practitioner about their use. In widely cited survey findings from 1990 and 1997, David M. Eisenberg and his colleagues found that less than 40% of patients who use alternative medicine in the United States disclose their use to their conventional medicine physicians. Reasons for not doing so include that people fear receiving a negative response from their physicians or that their physicians did not ask them. This trend, unchanged in a decade of research, poses risk for potential adverse interactions between prescription medication and herbs and supplements. Overall, visits to alternative medicine practitioners increased by 47.3% from 1990 to The increase was related to more people using alternative therapies rather than the same number of people making more visits. Considering that annual out-of-pocket expenses for alternative treatments in the United States are estimated to exceed $27 billion, a figure comparable with expenditures on all other conventional treatments combined, identifying what motivates people to use alternative medicine poses interesting research questions. Historical studies of alternative medicine suggest that as early as the 1800s, patients were drawn to alternative medicine because they enjoyed the personalized and lengthy attention given by the alternative medicine practitioners and because they were dissatisfied with the level of care for their specific condition provided by conventional medicine. These reasons appear to hold true in current times. Social scientists have suggested that people use alternative medicine either because they are dissatisfied with mainstream medicine, they want more control over their health treatment, or they find alternative medicine more in line with their personal beliefs about health. One study found that those who reported using alternative therapies were more likely to identify with environmentalism, feminism, spirituality, and self-growth psychology. Research in the United Kingdom has suggested that U.K. residents are motivated to use alternative medicine because of the positive patient provider relationship, relaxation, empowerment, and self-awareness. Many ethnic communities in the United States and other nations prefer traditional medicine to conventional medicine. Reasons include an emphasis on family, community, and spirituality that is often absent in Western medicine. The heightened use of alternative medicine in the last two decades indicates a changing public view of health and health care that emphasizes a holistic, patient-centered approach. Controversies Ongoing controversies related to alternative medicine include charges that alternative therapies (particularly herbs and supplements) are untested and unsafe, that alternative medicine may be harmless but that alternative therapies are not beneficial to health and that consumers are being duped, and disagreement over whether the government should regulate alternative medicine. When Eisenberg and his associates found in 1990 that less than 40% of alternative medicine users discussed their usage with their conventional doctors, he urged doctors to be more proactive in discussing alternative medicine with their patients, particularly since herbal supplement use may pose a safety risk for potential adverse interactions with prescription medications. However, survey data from 1997 indicated that people still were not disclosing their alternative medicine use to their doctors. Given that herbal supplements are the most commonly used alternative medicine in the United States and that at least 17 dietary supplements have been found to adversely affect kidney function, many critics charge that unregulated alternative medicine products present a health and safety risk to consumers. In 1999, the U.S. Food and Drug Administration banned the sale of colloidal silver as medicine after some users experienced permanent skin and organ discoloration; however, colloidal silver is still sold as a nutritional supplement in health food stores around the nation.

5 37 Other critics charge that alternative medicine is simply medical quackery that has become big business. Between 1990 and 1997, there was a 45.2% increase in estimated expenditures for alternative medicine in the United States, and nutritional supplements alone are a $23 billion industry. Stephen Barrett, a former psychiatrist and founder of the Web site Quackwatch, credits the placebo effect for the seeming effectiveness of alternative medicine and calls for controlled clinical trials to scientifically determine which alternative therapies are effective. There is considerable disagreement over whether the government should regulate alternative medicine. In 1994, Congress passed the Dietary Supplement Health Education Act, which prohibits the Food and Drug Administration from regulating herbs and dietary supplements unless they contain a known hazard to human health. Some critics argue that federal regulation of herbs and dietary supplements is needed to ensure product quality and consumer safety. Some critics of alternative medicine suggest that regulation will imply legitimacy of questionable medical treatments. Some proponents of alternative medicine oppose federal regulation, suggesting that regulation may make products more expensive and less easily available and will interfere with consumer freedom to make health care choices. Current Issues in Communication About Scholarly studies of media representations of, news coverage of, and communication about alternative medicine are virtually absent. Health communication scholars have called for analyses of media representations of alternative medicine, providerto-consumer information, and identification of provider and user understandings of health and health care. Very little research has been conducted on alternative medicine in the area of science communication. This could be a result of the long-held bias in scientific thought against alternative medicine as pseudoscience or a result of researchers fears that their work would be misused in support of questionable therapies. A number of communication-related issues affect the field of alternative medicine. These include lack of communication between alternative medicine practitioners and conventional practitioners and lack of communication to the patient on the health and safety of alternative medicine. There is little research on why or how patients decide to use alternative medicine, how they access information about alternative medicine, their adherence to treatment, and public perception of information about alternative medicine. Very little research concerns the interaction between alternative and conventional medicine practitioners. More collaboration between the two fields is needed to improve research, education, and practice. The widespread access to the Internet in the early 1990s and subsequent availability of health information online helped create patients who are more active in their own treatment than in previous generations. Research indicates that the majority of online health-related information is authored by laypeople rather than by medical professionals and that approximately a third of such information recommends alternative approaches that have not been scientifically verified and may be harmful. Other research suggests that the amount of online information about alternative medicine overwhelms the user with the resultant effect of reinforcing the user s acceptance of mainstream medical advice. Recent research on public attitudes about science and medicine indicates that people gather information from a variety of sources including the Internet, the mass media, and friends and family members. Public understanding of health and health care is influenced by a variety of factors including an individual s cultural and religious beliefs. Theories that the mass media have strong effects on the public have largely been discarded for theories that people seek information to accommodate beliefs they already hold. More research is needed on how people from diverse backgrounds understand health and health care and how health organizations can effectively meet their needs. Conclusion Alternative medicine continues to grow in popularity and use. As health organizations discover ways to incorporate alternative approaches into conventional medicine to better serve diverse populations, alternative medicine will likely become integrative medicine. Rather than dismissing alternative medicine wholesale, medical doctors will need to become knowledgeable about alternative therapies

6 38 American Association for Public Opinion Research to learn how to communicate effectively with their patients, many of whom are using alternative therapies. Research is needed on the various ways in which people understand and make sense of their health and health care for health care professionals to communicate effectively with different populations, particularly in cross-cultural settings. Alternative medicine has global health care and economic implications, including export opportunities for developing nations that grow the herbs that are used in traditional medical formulas, providing health care for poor and rural communities that do not have Western medical treatment facilities or practitioners, and reducing medical expenses by providing preventative and self-treatment for minor health conditions. Additional scientific research on the effectiveness and safety of alternative therapies is needed. Disagreements over the need for U.S. federal regulation of medicinal herbs and supplements and for additional accreditation and licensure opportunities of alternative medicine practitioners will likely continue. Reliable information for the public in the form of news coverage and online information is needed. Health care professionals are increasingly called upon to educate themselves and their patients about alternative medicine, especially herbs and dietary supplements. Deborah R. Bassett See also Health Communication, Overview; Health Communication and the Internet; Physician Patient Communication; Pseudoscience; Science Communication and Indigenous North America Further Readings Astin, J. (1998). Why patients use alternative medicine: Results of a national study. Journal of the American Medical Association, 270(19), Barnes, P., Bloom, B., & Nahin, R. (2008). Complementary and alternative medicine use among adults and children: United States, National Health Statistics Reports, 12, Bodeker, G., & Burford, G. (2007). Traditional, complementary and alternative medicine: Policy and public health perspectives. London: Imperial College Press. Commission for Scientific Medicine and Mental Health: Committee on the Use of Complementary and Alternative Medicine by the American Public & Board on Health Promotion and Disease Prevention. (2005). Complementary and alternative medicine in the United States. Washington, DC: National Academies Press. Du Pré, A. (2000). Communicating about health: Current issues and perspectives. Mountain View, CA: Mayfield. Eisenberg, D. M., Davis, R. B., Ettner, S. L., Appel, S., Wilkey, S., Van Rompay, M., et al. (1998). Trends in alternative medicine use in the United States, Journal of the American Medical Association, 280, National Institutes of Health National Center for Complementary and : nccam.nih.gov Quackwatch, Inc.: Weil Lifestyle, LLC: Whorton, J. C. (2002). Nature cures: The history of alternative medicine in America. New York: Oxford University Press. Am e r i c a n As s o c i a t i o n f o r Public Opinion Research Public sentiment about various issues whether they be social, political, or scientific stands at the heart of any democratic system. Citizens express their opinions and convey their interests to decision makers, who ideally should consider such views when implementing policy. The news media, charged with informing citizens about the world around them, highlight events, issues, and concerns and often report public opinion about these concerns. For science-related issues as for many others, opinion polls are a news staple. In their daily interactions, some citizens seek information and advice from others, while others attempt to persuade their friends and family to adopt particular views or vote for a specific candidate. Indeed, assessing public opinion on a particular issue and identifying the forces that shape such sentiment are critical in understanding society. Despite theoretical and methodological differences in studies of public opinion, individuals interested in this field often turn to the American Association for Public Opinion Research (AAPOR).