Introduction

Alternative medicine is so named because it may be used instead of conventional medicine. It may also be used with conventional medicine and thus is sometimes called complementary medicine. Much of complementary and alternative medicine is rooted in ancient cultures, such as Chinese, Indian, Tibetan, African, and Native American cultures.

Alternative medicine differs from conventional Western medicine in its basic approach. Conventional Western medicine generally defines health as the absence of disease. The focus is on treating disease and its symptoms. As a result, only one part of the person (the affected part) is treated. In contrast, many alternative therapies define health as balance within the body. Imbalance is thought to cause disease. The focus is on treating the whole person (physically, emotionally, mentally, and spiritually), so that balance can be restored. When balance is restored, the body can heal itself.

In alternative medicine, health is also thought to be influenced by a person's experiences, environment, diet, and relationships with other people. This type of approach is called holistic. Consequently, many alternative medicine practitioners find out as much as they can about a person before they make a diagnosis or propose a treatment for a health problem.

The Appeal

Alternative medicine is becoming more popular, especially with older people. Between 2 and 4 out of 10 older people use alternative therapies. Popular therapies include dietary supplements, chiropractic, acupuncture, and homeopathy. Most commonly, older people use alternative therapies to prevent or treat back problems, to treat arthritis, or to relieve pain (especially chronic pain). Another common use is to improve general health. Sometimes older people use alternative therapies to treat specific problems, such as coronary artery disease, memory loss, problems with vision, osteoporosis, wrinkles, prostate enlargement, depression, or anxiety.

Why do so many older people use alternative therapies? Many older people turn to alternative therapies when conventional therapies cannot cure or even relieve a chronic disorder, such as arthritis, cancer, or low back pain. Some older people think conventional therapy has too many side effects or is too expensive. Some use an alternative therapy because they do not have to go to a doctor or hospital to get it. Thus, they may feel they have more control over their health. Also, some people prefer the longer appointment times and extra attention given by some alternative medicine practitioners.

Some older people may like the emphasis on the whole person and on health rather than disease. Or they may believe that alternative therapies are more natural, safer, or healthier than conventional therapies. Some people come from cultural and religious traditions that discourage the use of conventional therapies. Other people use an alternative therapy because friends and caregivers who have tried it recommend it. Still others use an alternative therapy because they hear about it on television or the radio or read about it in advertisements.

The Problems

In spite of the increasing acceptance and use of alternative therapies, there are reasons for caution. Most important, there is little information about effectiveness and safety. Unlike drugs, most alternative therapies are just beginning to be studied scientifically. Even less is known about their use in older people.

For a few alternative therapies, evidence supports their effectiveness. For other therapies, evidence suggests that they are not effective. However, for most alternative therapies that have been studied, the evidence is inconclusive. That is, the evidence is conflicting, or the studies were not designed well enough to provide the needed information.

The safety of alternative therapies is also a concern. An alternative therapy, especially when used for a long time, may have side effects. An alternative therapy used for one disorder may worsen another disorder. Because older people tend to have more than one disorder, the risk of such problems is even higher.

An alternative therapy, especially a dietary supplement, may interact with a conventional drug (prescription or nonprescription). An interaction occurs when a drug and a supplement are taken about the same time, and one of them interferes with how the other works. A supplement may increase or decrease the effect of a conventional drug. Sometimes serious problems result. For example, ginkgo biloba can increase the effect of certain drugs taken to prevent blood clots (anticoagulants, or so-called blood thinners), such as warfarin. As a result, bleeding is more likely to occur. Ginkgo can make anticonvulsants (taken to prevent seizures) less effective. As a result, seizures may be more likely to occur. Interactions between drugs and dietary supplements have been studied, but more study is needed. Supplements may also interact with foods.

More than 50% of older people who use alternative therapies do not tell their doctor. Discussing an alternative therapy with a doctor before using it is best. But people who are already using one should tell their doctor. Doing so may help prevent interactions between a prescribed drug and a dietary supplement. It may also prevent older people from using a therapy that is unsafe. Older people should be cautious when using an alternative therapy because their response may be different from that of younger people. As the body ages, it processes substances, such as drugs, differently.

Dietary supplements are of particular concern. No government agency checks to make sure that a product contains what it says it contains and nothing else. No agency checks that all products with the same name contain the same ingredients in the same amounts. Thus, people have no way of knowing exactly how much of a substance they are taking. A person may get less, more, or, in some cases, none of the active ingredient supposed to be in a product. Products that differ in content may differ in effectiveness. Also, an alternative product may contain substances not listed on the package. Thus, people do not know all of the substances they are taking. A product may contain a potentially harmful substance, such as one that can cause an allergic reaction.

See the sidebar What Makes Medicine "Alternative?"