Copyright 2010 SAGE Publications. Not for sale, reproduction, or distribution.
Alternative Medicine 33
systems can adversely affect the market value of
real estate. Higher costs of renewable energy tech-
nologies compared with conventional technolo-
gies, inadequate workforce training for production,
market control of the national grids by centralized
power plants, and difficulty introducing commer-
cially 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 www.earth-policy
.org/Books/PB2/Contents.htm
International Energy Agency. (2008). Worldwide trends
in energy use and efficiency. Paris: Organisation for
Economic Co-operation and Development. Available
at www.iea.org/Textbase/Papers/2008/
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 www.ren21.net/
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 www.risoe.dk/rispubl/
art/2006_120_report.pdf
Worldwatch Institute. (2006). American energy: The
renewable path to energy security. Washington, DC:
Author. Available at www.worldwatch.org/files/pdf/
AmericanEnergy.pdf
Alternative Medicine
Understanding the history, issues, and trends
related to alternative medicine has increasing
importance for science communicators, as a grow-
ing 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, particu-
larly its history and present use in the United
States. Key differences between conventional med-
icine 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 alter-
native 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 medi-
cine and traditional, complementary, and alterna-
tive medicine are terms that are frequently
used when discussing alternative medicine.
Complementary medicine refers to therapies that
are used in conjunction with mainstream treat-
ment, 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 medi-
cine are also terms used to refer to alternative
medicine. Both terms imply a fusion of alternative
and mainstream approaches that address a patients
total wellness.
Conventional medicine is also referred to as allo-
pathic medicine, mainstream medicine, Western
medicine, biomedical approaches to medicine, and
science-based medicine. Globally, alternative medi-
cine refers to medical practices that fall outside the
domain of mainstream Western medical practices
as are used in industrialized nations such as in the
 Copyright 2010 SAGE Publications. Not for sale, reproduction, or distribution.
34 Alternative Medicine
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 tra-
ditional 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 tak-
ing 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 knowl-
edge and identification with the Romantic period in
art and literature, in which nature was highly val-
ued. 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 atten-
tion to the scientific discoveries of that period.
Alternative medicine reemerged in the late
1960s and 1970s as interest in alternatives to con-
ventional medicine arose as part of the larger
counterculture distrust of authority and disillu-
sionment 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 alter-
native medicine grew in popularity throughout the
1980s, alternative medicine went largely unac-
knowledged by the conventional medical establish-
ment 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
Alternative Medicine 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 leg-
islation in the United States that required every
health insurance plan in the state to cover services
provided by licensed alternative medicine practi-
tioners. The expansion of the Office of Alternative
Medicine to the National Center for Complem
entary and Alternative Medicine 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 medi-
cine to refer to alternative medicine. For example,
in 1996, Andrew Weil, a medical doctor, estab-
lished 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 universi-
ties, 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 scien-
tific 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.
 Copyright 2010 SAGE Publications. Not for sale, reproduction, or distribution.
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
patients 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 practitio-
ners have adopted a biopsychosocial approach to
health care as consumer preference for this
approach has grown, displacing the earlier patriar-
chal model of health care.
From the outset, the relationship between alter-
native 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 exam-
ple, acupuncture has been shown to be successful
in treating pain associated with migraines and can-
cer), more medical doctors and health care profes-
sionals 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 alter-
native therapies for which there is not scientifically
based evidence of effectiveness or that take the
place of conventional medicine, such as homeopa-
thy 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 med-
icine health care professionals report that they
want more information and education about alter-
native medicine. Studies on the perceptions of
alternative medicine practitioners suggest that they
appear to view their field as supporting conven-
tional medicine, not replacing it. Although the
relationship between the two sides has improved
dramatically from the animosity that characterized
Alternative Medicine 35
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, tradi-
tional Chinese medicine, naturopathy, nutritional
supplements, chiropractic treatment, massage,
meditation, and yoga. The National Center for
Complementary and Alternative Medicine groups
alternative medicine into the following broad five
categories: whole medical systems (such as natur-
opathy), mindbody medicine (such as meditation),
biologically based practices (such as the use of
herbs and supplements), manipulative and body-
based 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 thera-
pies, compared to 36% in 2002. 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 thera-
pies in the United States, in order of use, are nonvi-
tamin, nonmineral natural products (such as herbal
supplements), deep breathing, meditation, chiro-
practic 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
 Copyright 2010 SAGE Publications. Not for sale, reproduction, or distribution.
36 Alternative Medicine
first survey of childrens 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 par-
ents 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 practi-
tioner about their use. In widely cited survey find-
ings 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 interac-
tions between prescription medication and herbs
and supplements. Overall, visits to alternative
medicine practitioners increased by 47.3% from
1990 to 1997. 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 compa-
rable 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 practi-
tioners 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 dis-
satisfied 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 environmental-
ism, feminism, spirituality, and self-growth psy-
chology. 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 tradi-
tional medicine to conventional medicine. Reasons
include an emphasis on family, community, and
spirituality that is often absent in Western medi-
cine. 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 medi-
cine include charges that alternative therapies (par-
ticularly 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 dis-
closing their alternative medicine use to their doc-
tors. 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 perma-
nent skin and organ discoloration; however, col-
loidal silver is still sold as a nutritional supplement
in health food stores around the nation.
 Copyright 2010 SAGE Publications. Not for sale, reproduction, or distribution.
Other critics charge that alternative medicine is
simply medical quackery that has become big busi-
ness. Between 1990 and 1997, there was a 45.2%
increase in estimated expenditures for alternative
medicine in the United States, and nutritional sup-
plements 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 medi-
cine. In 1994, Congress passed the Dietary
Supplement Health Education Act, which prohib-
its the Food and Drug Administration from regu-
lating 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 alter-
native 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 Alternative Medicine
Scholarly studies of media representations of, news
coverage of, and communication about alternative
medicine are virtually absent. Health communica-
tion scholars have called for analyses of media
representations of alternative medicine, provider-
to-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 com-
munication. This could be a result of the long-held
bias in scientific thought against alternative medi-
cine 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
Alternative Medicine 37
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 con-
cerns the interaction between alternative and
conventional medicine practitioners. More collabo-
ration 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
users acceptance of mainstream medical advice.
Recent research on public attitudes about sci-
ence 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 individuals 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 accom-
modate 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 popular-
ity and use. As health organizations discover ways
to incorporate alternative approaches into conven-
tional medicine to better serve diverse populations,
alternative medicine will likely become integra-
tive medicine. Rather than dismissing alternative
medicine wholesale, medical doctors will need to
become knowledgeable about alternative therapies
 Copyright 2010 SAGE Publications. Not for sale, reproduction, or distribution.
38 American Association for Public Opinion Research
to learn how to communicate effectively with their
patients, many of whom are using alternative thera-
pies. 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 popula-
tions, particularly in cross-cultural settings.
Alternative medicine has global health care and
economic implications, including export opportu-
nities for developing nations that grow the herbs
that are used in traditional medical formulas, pro-
viding health care for poor and rural communities
that do not have Western medical treatment facili-
ties or practitioners, and reducing medical expenses
by providing preventative and self-treatment for
minor health conditions.
Additional scientific research on the effective-
ness and safety of alternative therapies is needed.
Disagreements over the need for U.S. federal regu-
lation of medicinal herbs and supplements and for
additional accreditation and licensure opportuni-
ties 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; PhysicianPatient
Communication; Pseudoscience; Science
Communicationand 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), 15481553.
Barnes, P., Bloom, B., & Nahin, R. (2008).
Complementary and alternative medicine use among
adults and children: United States, 2007. National
Health Statistics Reports, 12, 124.
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:
www.csmmh.org
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 Pr, 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, 1990
1997. Journal of the American Medical Association,
280, 15691575.
National Institutes of Health National Center for
Complementary and Alternative Medicine: http://
nccam.nih.gov
Quackwatch, Inc.: www.quackwatch.org
Weil Lifestyle, LLC: www.drweil.com
Whorton, J. C. (2002). Nature cures: The history of
alternative medicine in America. New York: Oxford
University Press.
American Association for
Public Opinion Research
Public sentiment about various issueswhether
they be social, political, or scientificstands 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 candi-
date. Indeed, assessing public opinion on a particu-
lar 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).