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Alternative, Complementary or Orthodox: What is real medicine?

Dave Newell, George Lewith


The division between orthodox and CAM approaches to musculoskeletal (MSK) problems is blurred. Manipulative medicine and acupuncture are recognized treatment options for some MSK conditions. These therapies are increasingly evidence based with well-defined mechanisms and are provided by a number of registered professional practitioners, whose ethics and practice is overseen and ultimately regulated, by the Professional Standards Authority. Some practitioners may be considered historically as CAM providers (Osteopaths, Chiropractors and Acupuncturists) and some orthodox practitioners (Physiotherapists and Doctors). If both CAM and orthodox practitioners are providing the same therapies for the same conditions, we believe that this represents good evidence based medical practice. Consequently in this situation, the historical and artificial boundaries between CAM and orthodox medicine cease to be meaningful either clinically or ethically.  We should reasonably assume that CAM and orthodox practitioners, in this context, are practicing ethically.


Orthodox, CAM, Alternative, Legitimacy

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Dean M. A (2000)homeopathic origin for placebo controls: ‘An invaluable gift of God’. Alternative Therapies in Health and Medicine.; 6:58–66

Pickstone J. (2006) "Medicine, Society and the State", in Roy Porter, The Cambridge History of Medicine. New York: Cambridge University Press, pp. 260–97

Ramsey, M. (1999) Alternative Medicine in Modern France. Medical history. 43 [3]: 286–322,

Wieland LS, Manheimer E, Berman BM. (2011) Development and classification of an operational definition of complementary and alternative medicine for the Cochrane collaboration. Altern Ther Health Med. 17[2]: 50–9.

House of Lords Select Committee on Science and Technology. London: The Stationary Office; (2000) Complementary and Alternative Medicine. Session 1999–2000 6th Report.

Coulter I, Hurwitz E, Adams, Genovese B, Hays R and; Shekelle P. (2002) Patients Using Chiropractors in North America: Who Are They, and Why Are They in Chiropractic Care? Spine. 27[3]: 291-297

Fawkes CA, Leach C, Mathias S, Moore A. (2014) A profile of osteopathic care in private practices in the United Kingdom: A national pilot using standardised data collection. Manual Therapy; Apr 1;19[2]:125–30.

Ong CK, Doll H, Bodeker G, Stewart Brown S. (2004) Use of osteopathic or chiropractic services among people with back pain: a UK population survey. Health & Social Care in the Community. 12[3]: 265–73.

Kuczynski JJ, Schwieterman B. (2012) Effectiveness of physical therapist administered spinal manipulation for the treatment of low back pain: a systematic review of the literature. Physical therapy.

Staal, J, HendriksII E, Heijmans M, Kiers H, Lutgers-Boomsma A, Rutten G, van Tulder M, den Boer J, Ostelo J, Custers J. (2014) KNGF Clinical Practice Guideline for Physical Therapy in patients with low back pain. Royal Dutch Society for Physical Therapy [Koninklijk Nederlands Genootschap voor Fysiotherapie, KNGF]

Ruggie, M. [2004]. Understanding CAM: The Problem of Knowledge and the Power of Words. In: Marginal to Mainstream. pp. 19-42.

McGregor M, Puhl AA, Reinhart C, Injeyan HS, Soave D. (2014) Differentiating intraprofessional attitudes toward paradigms in health care delivery among chiropractic factions: results from a randomly sampled survey. BMC Complement Altern Med. BMC Complementary and Alternative Medicine; 14[1]:1–8.

Puhl A, Reinhart C, Doan J, McGregor M and Injeyan. (2014) Relationship Between Chiropractic Teaching Institutions and Practice Characteristics Among Canadian Doctors of Chiropractic: A Random Sample Survey. Journal of Manipulative and Physiological Therapeutics. National University of Health Sciences; 37[9]: 709–18.

Machado LAC, Kamper SJ, Herbert RD, Maher CG, McAuley JH. (2009) Analgesic effects of treatments for non-specific low back pain: a meta-analysis of placebo-controlled randomized trials. Rheumatology. Oxford University Press; May; 48[5]: 520–7.

Scholten-Peeters GG, Thoomes E, Konings S, Beijer M, Verkerk K, Koes BW, et al. (2013) Is manipulative therapy more effective than sham manipulation in adults?: a systematic review and meta-analysis. Chiropractic & Manual Therapies. Chiropractic & Manual Therapies; 21[1]: 1–1.

Licciardone JC, Brimhall AK, King LN. (2005) Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. BioMed Central Ltd; 6[1]: 43.

Vickers AJ, Cronin AM, Maschino AC, Lewith G, MacPherson H, Foster NE, et al. (2012) Acupuncture for Chronic Pain. Arch Intern Med. American Medical Association; 172[19]: 1444–53.

Millan M, Leboeuf-Yde C, Budgell B, Amorim M-A. (2012) The effect of spinal manipulative therapy on experimentally induced pain: a systematic literature review. Chiropractic & Manual Therapies. Chiropractic & Manual Therapies; 20[1]: 1–1.

Bialosky JE, Bishop MD, Price DD, Robinson ME, George SZ. (2009) The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Manual Therapy. Elsevier; 14[5]: 531–8.

Kawakita K, Okada K. (2014) Acupuncture therapy: mechanism of action, efficacy, and safety: a potential intervention for psychogenic disorders? Biopsychosoc Med. BioMed Central Ltd; 8[1]: 4.

Clinical Evidence Efficacy Categorisations. Clinical Evidence. URL: [Accessed 1st January, 2014].

Mora MS, Nestoriuc Y, Rief W. (2011) Lessons learned from placebo groups in antidepressant trials. Philosophical Transactions of the Royal Society B: Biological Sciences. 366[1572]: 1879–88.

Bialosky JE, Bishop MD, George SZ, Robinson ME. (2011) Placebo response to manual therapy: something out of nothing? J Man Manip Ther. 19[1]: 11–9.

Fässler M, Gnädinger M, Rosemann T, Biller-Andorno N. (2011) Placebo interventions in practice: a questionnaire survey on the attitudes of patients and physicians. br j gen pract. 61[583]:101–7.

Meissner K, Hofner L, Fassler M, Linde K. (2012) Widespread use of pure and impure placebo interventions by GPs in Germany. Family Practice. 29[1]: 79–85.

Howick J, Bishop FL, Heneghan C, Wolstenholme J, Stevens S, Hobbs FDR, et al. (2013) Placebo Use in the United Kingdom: Results from a National Survey of Primary Care Practitioners. Manchikanti L, editor. PLoS ONE. 8[3]: e58247.

Lewith G, Barlow F, Eyles C, Flower A, Hall S, Hopwood V, Walker J. (2009) The Context and Meaning of Placebos for Complementary Medicine. Forsch Komplementmed 16:404-412

Brien S, Lachance L, Prescott P, McDermott C, Lewith G. (2011) Homeopathy has clinical benefits in rheumatoid arthritis patients that are attributable to the consultation process but not the homeopathic remedy: a randomized controlled clinical trial. Rheumatology. Oxford University Press; 50[6]: 1070–82.

Tyreman S. (2011) Values in complementary and alternative medicine. Med Health Care and Philos; 14:209–217

Brien SB, Leydon GM, Lewith G. (2012) Homeopathy enables rheumatoid arthritis patients to cope with their chronic ill health: A qualitative study of patient's perceptions of the homeopathic consultation. Patient Education and Counseling. Elsevier Ireland Ltd; 89[3]: 507–16.

Brien SB, Bishop FL, Riggs K, Stevenson D, Freire V, Lewith G. (2011) Integrated medicine in the management of chronic illness: a qualitative study. br j gen pract. 61[583]: 89–96.



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