What is ICAM? Basic Information, Facts, & Figures

INTRODUCTION TO INTEGRATIVE, COMPLEMENTARY & ALTERNATIVE MEDICINE
This page provides background information regarding integrative, complementary and alternative medicine (ICAM) and outlines some basic issues surrounding it. The contents may be copied and used by project planners for educational handouts or advertisements.

1. Basic Definitions
2. Brief Overview of CAM Modalities
3. ICAM Fast Facts
4. CAM Figures: Issues and Considerations in Medical Practice

BASIC DEFINITIONS

The following ICAM definitions correspond with definitions used by the National Institutes of Health Center for Complementary and Alternative Medicines (NCCAM).

• Complementary Medicine: The use of unconventional medicine secondary, or as an adjunct, to biomedicine.
  
  
• Alternative Medicine: The use of unconventional therapies in place of biomedicine.
  
  
• Integrative Medicine: Medical practice combining conventional treatments and CAM therapies where there is some quality scientific evidence of safety and effectiveness. Intregrative medical practice seeks to provide the most comprehensive medical care to its patients and shares some characteristics with holistic medicine in that it affirms the importance of relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches to achieve optimal health and healing.

Note: The term "biomedicine" is synonymous with conventional, allopathic, mainstream, orthodox, and western medicine. The term "unconventional" refers to therapies not widely used or accepted by biomedicine.

BRIEF OVERVIEW OF CAM MODALITIES

The following information and resource materials were developed and reviewed by the AMSA Foundation's EDCAM Grant Team and Advisory Panel along with expert consultants in the field of CAM and medical education. Originally compiled to serve as curriculum guide for medical schools, the information has been condensed to provide a brief overview of CAM modalities. If you are interested in the complete guide please refer to the Course Modules.

Learn About CAM Modalities:

1. Nutrition and Lifestyle: Diet, Exercise, Sleep, and Stress Management
2. Mind-Body Medicines
3. Alternative Systems of Medical Thought: Traditional Chinese Medicine, Kampo, Tibetan Medicine, and Acupuncture
4. Alternative Systems of Medical Thought: Yoga, Ayurveda, Native American and Yoruba Based Medicines
5. Alternative Systems of Medical Thought: Homeopathy and Flower Essences
6. Bioenergetic Medicines
7. Herbal Medicines
8. Nutrition, Dietary Supplements, and Vitamins
9. Manipulative Therapies: Chiropractic and Osteopathy
10. Manipulative Therapies: Therapeutic Massage

ICAM FAST FACTS: DID YOU KNOW...?

• 40% of respondants in a recent, random, large study of CAM reported using CAM in the past year. ¹
• From this 40%, only 4.4% relied primarily on CAM.1 (Patients are still going to conventional doctors!)
• In 1990, patients paid $11.7 billion for unconventional therapies and made more visits to CAM practitioners than to conventional doctors (425 million visits vs. 388 million visits.) ²
• In 1990, seven out of 10 patients did not tell their doctors that they were using CAM. ²
• According to a 1997 survey, 29.7% of all institutions (schools and residencies) were teaching CAM and another 12% were starting CAM instruction soon or thinking of starting it. ³
• Today, more than 25 insurance companies offer CAM coverage, compared with four in 1993. ⁴
• 80% of first-time homeopathic patients planned to continue homeopathic treatment after the first four months of therapy. ⁵
• From 575 patients surveyed at Chinese medicine clinics, 91.5% reported that their presenting symptoms or complaints had disappeared or improved with Chinese Medicine care. ⁶
• According to the FDA: ⁷
  • $500 million a year is spent on acupuncture treatments
  • Americans make 9-12 million visits to acupuncture practitioners each year.
  • Of 13,000 acupuncturists in the U.S., 3,000 are practicing physicians
  • More than 1 million Americans are thought to use acupuncture
  • About 10% of U.S. health plans pay for acupuncture; Medicare doesn't cover it at all
  • 36 states license or regulate the practice of acupuncture by nonphysicians and have training standards for certification. Interestingly, many states don't regulate physicians practicing acupuncture. ⁷

REFERENCES

1. Astin JA. Why patients use alternative medicine: results of a national study. JAMA. 1998;279:1548-1554.
2. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco RL. Unconventional Medicine in the United States: Prevalence, Costs, and Patterns of Use. N Engl J Med. 1993;328:246-252.
3. Carlston M, Stuart MR, Jonas W. Alternative Medicine Instruction in Medical Schools and Family Practice Residency Programs. Fam Med. 1997;29:559-562.
4. Laino C. Paying for holistic health. Article in MSNBC, 15 July 1998.
5. Goldstein MS, Glik D. Use of and Satisfaction with Homeopathy in a Patient Population. Alt Ther Health Med. 1998;2:60-65.
6. Cassidy CM. Chinese Medicine Users in the United States Parts 1&2: Utilization, Satisfaction, Medical Plurality. J Alt Comp Med. 1998;4:17-27, 189-202.
7. Chinese acupuncture gets nod from the West. Harvard Health Letter. 1998;23:4-12.

CAM FIGURES: ISSUES AND CONSIDERATIONS IN MEDICAL PRACTICE

In the past, anecdotes provided the sole support for the efficacy of complementary and alternative medicine (CAM). However, today's medical world necessitates a search for scientific evidence to validate the effects of these therapies. To a large extent, health care consumers forced this trend. Patients noticed therapeutic benefits before CAM treatments were tested by the scientific method. A recent survey indicates that 40% of Americans surveyed had used CAM in the past year. ¹ Consumers now demand insurance coverage for CAM treatments. In a time of dissatisfaction with the health care system, it may be CAM practitioners' holistic approach that appeals to patients.

• What is complementary and alternative medicine and should it fit into the conventional primary care setting?
• How much "scientific evidence" is necessary to incorporate complementary and alternative medicine into everyday primary care practice?
• Would insurance coverage benefit the practice of complementary and alternative medicine or would it add unwanted restrictions?
• Who uses complementary and alternative medicine and why?

The conventional medical community represents the scientific voice of reason regarding CAM therapies. The creation in 1992 of the Office of Alternative Medicine at the National Institutes for Health reflects this push for hard evidence. In addition, several journals report only studies about CAM treatments. Such studies require critical evaluation and hold the key to the eventual acceptance or dismissal of CAM treatments.

Aside from the quest for studies verifying the effects of CAM treatments, the most important aspect of CAM is that people are using it now. In addition, a 1990 study indicated that 7 out of 10 people using CAM do not tell their doctor about unconventional treatments. ² This poses a serious problem for primary care physicians trying to coordinate their patients' care effectively. Ideally, conventional medicine and thoroughly tested CAM therapies will blend to create a new type of primary care that combines the latest technology with a holistic, patient-centered approach and provides patients with a broad choice of therapies.

Figure 1. Key CAM Questions for Primary Care Doctors

• What therapies or treatments do you and/or your patients consider to be CAM?
• What percentage of your patients use CAM?
• Do you ask all patients about their CAM use?
• Do you refer patients to CAM practitioners?
• How do you think conventional and unconventional medicine should combine to provide the safest and most productive health care possible?
• Are many primary care doctors going back for training in CAM?
• Is there much resistance to CAM and its practitioners among primary care doctors?
• Do you feel qualified to counsel patients about combining conventional medicine and CAM?
• What has your experience been with CAM and insurance coverage?
• Do you think insurance companies should/will cover CAM treatments?
• Would you be willing to join an integrated practice to work closely with CAM practitioners?
• Why do you think so many patients are turning to CAM?
• How do you suggest finding the most unbiased research on CAM?
• Do you think popular CAM advocates (for example, Dr. Andrew Weil or Dr. Deepak Chopra) have helped or hurt CAM?

What is complementary and alternative medicine?

In a frequently cited 1990 study by Dr. David Eisenberg, unconventional therapy was defined as "medical interventions not taught widely at U.S. medical schools or generally available at U.S. hospitals." ² Common examples of such therapies include acupuncture, herbal therapy, massage and chiropractic therapy, and homeopathy (see Figures 2-4).

A 1997 survey reported that 29.7% of all medical schools and family practice residency programs were teaching CAM and another 12% were either adding CAM to the curriculum soon or considering the addition. ³ However, these programs are usually overview courses and do not involve instruction in specific techniques. In another survey of Australian medical students, no significant difference was found in CAM knowledge between first- and fifth-year students. ⁴ Such a survey on American medical students does not exist, but it seems likely that CAM education generally remains outside of conventional medical instruction.

A distinction may be made between complementary and alternative medicine, even though they are frequently grouped together in one category. Sometimes "alternative" and "complementary" are used interchangeably. Complementary therapies generally do not focus on curing a disease but can be used simultaneously with conventional medicine to reduce side effects and stress and to increase well-being. ⁵ However, alternative therapies are used in place of conventional medicine with the goal of curing a disease. In two different studies, only about 4% of those surveyed reported using unconventional medicine without also seeing a conventional medical doctor. ^1,2 Therefore, patients use complementary treatments often and use alternative therapies rarely. The important point is that unconventional therapies are widely being incorporated into conventional medicine (by the patients, with or without their physicians' assistance), but they are not generally substituted for conventional treatments.

Who is using CAM, what for and why?

A 1998 study found that predictors of CAM use include: more education; poorer health status; a holistic orientation to health; having had a transformational experience that changed the person's world view; and classification in a cultural group identifiable by their commitment to environmentalism, to feminism, and interest in spirituality and personal growth psychology. ¹ Also, patients with the following health problems used CAM more than others: anxiety, back problems, chronic pain and urinary tract problems. Interestingly, dissatisfaction with conventional medicine, racial/ethnic differences, sex, income or age did not predict who used CAM. Another study examining why people seek out Chinese medicine indicated that mood care and preventive care were goals equal in importance to symptom relief. ⁹

The second part of the Chinese medicine study explored why patients use Chinese medicine. Reasons included: relief of symptoms and improved functioning; reduced reliance on prescription drugs; minimized side effects; increased self efficacy and self awareness; a new sense of wholeness and balance; and focus on the whole body/mind/spirit/social person. ⁹ In addition, people appreciated the close patient-practitioner relationship. In short-answer responses, participants did not use traditional Chinese medicine language (such as yin, yang, liver and kidney imbalance, ch'i or qi). Therefore, researchers suggested that the holistic approach of Chinese medicine--not the intricacies and theories of Chinese medicine-attracts patients.

Homeopathy also focuses on treating the whole person. Four months after initiating treatment, a group of first-time homeopathic patients reported generally better health and physical ability and less pain. ¹⁰ This was despite the fact that only 18.4% reported complete healing of their primary complaint. Because most of the patients presented with chronic problems (such as GI disorders, respiratory and female reproductive problems), these results suggest that chronically ill patients are also concerned with their ability to function and their overall well-being, not simply with the relief of their primary complaint.

Another study illustrates how complementary medicine may truly "complement" conventional medicine. Columbia-Presbyterian Medical Center offers a complementary medicine program to cardiac care patients to help them deal with the neurologic and psychiatric changes accompanying open heart surgery. ¹¹ Therapies include music therapy, hypnotherapy, nutrition, massage and reflexology, yoga, aromatherapy and therapeutic touch. In addition to providing this program, the center monitors patients for autonomic nervous system function, cognitive function, immune function and quality of life both short- and long-term after the surgery and complementary treatment. Results so far indicate that hypnosis perioperatively significantly reduces anxiety and decreases the amount of pain medication required by patients. Other studies are currently under way.

The above examples suggest that CAM fills a hole in conventional medicine. Michael Cohen describes the biomedical vs. holistic paradigms. ¹² Conventional medicine has almost perfected the biomedical approach. This system views the body as a machine and reduces the body to its components. The biomedical paradigm works well for emergency problems or diseases with one specific cause. The holistic paradigm, embraced by many CAM practitioners, sees the body as more than the sum of all of its parts. It emphasizes lifestyle changes, stress reduction and nutrition to enhance the patient's healing process. Biomedicine often falls short in treating chronic problems, while many patients with chronic problems find some relief with the holistic approach of CAM therapies.

Figure 2. Beware of common herbal therapies/dietary supplements and drug interactions:6

• Herbal Therapy/Dietary Supplement Drug Interactions
• Garlic (CV effects) Anticoagulants
• Ginkgo (Circulatory stimulant) Antithrombotic drugs (possibly)
• Echinacea (Immunostimulant) No known interactions
• Melatonin (Sleep aid) Sex hormones, CNS depressants, NSAIDs, calcium channel blockers, beta blockers, MAO inhibitors, SRIs

Where's the evidence?

Patients are using CAM. In 1990, patients made more visits to CAM practitioners than to conventional doctors and paid more than $11.7 billion out-of-pocket for CAM.1 However, medical doctors, many insurance companies and legislators are waiting for scientific evidence that validates the effectiveness of CAM therapies. First, the issue of what constitutes a scientific study must be resolved.

Proponents of CAM therapies argue that unconventional treatments often cannot be tested effectively by the traditional, double-blind, controlled format that is the hallmark of conventional scientific studies. According to Manuel J. Avancena, L.Ac., an acupuncturist in Reston, Virginia, acupuncture points are different for every patient. If five patients present with the same primary complaint, the treatment will be different for each patient depending on coexisting symptoms or problems. This holistic component of the treatment would not be effectively measured by a study that demands that each patient have the same points treated in order to control variability.

People more skeptical of CAM demand nothing less than the double-blind, controlled study with objective results before they consider CAM. To some, the very argument that CAM cannot be evaluated using the controlled, double-blind study indicates that CAM is equivalent to quackery. In addition, scientists and physicians often remain doubtful if a therapy works but little evidence is available regarding the mechanism of its effects. According to the Harvard Health Letter, "Acupuncture has been slow to gain acceptance by Western physicians, mainly because it is unclear why stimulating certain points alleviates pain or relieves some medical conditions." ¹³

The Scientific Review of Alternative Medicine, a new biannual journal, claims to provide the first nonbiased, scientific evaluations of unconventional therapies. The first issue (fall/winter 1997) included analyses of therapeutic touch, hydrazine sulfate (the alleged anticancer agent), chelation therapy and homeopathy. ¹⁴ According to the editors, other CAM journals use non-scientific methods to evaluate CAM; they use patient satisfaction as a measure of success, not traditional clinical methods. Dr. Barry Beyerstein, Ph.D., a biopsychologist at Simon Fraser University in Burnaby, British Columbia, Canada, argues that many reasons other than the efficacy of the treatment can explain why unconventional therapies seem to work (see Figure 5). Again, the type of study necessary and appropriate for CAM therapies needs to be addressed before significant advances will be made in the area of scientific evidence for CAM.

Recently, small strides have been made towards establishing scientific evidence to the satisfaction of the conventional medical community, but many issues remain debatable. In 1997, the NIH issued a consensus statement on acupuncture. They concluded that "promising results have emerged, for example, efficacy of acupuncture in adult post-operative and chemotherapy nausea and vomiting and in post-operative dental pain." ¹⁵ In addition, acupuncture was approved as appropriate complementary therapy for addiction, stroke rehabilitation, headache, menstrual cramps, many musculoskeletal problems and asthma. The NIH recognized issues such as the training and credentialing of acupuncturists and areas for future research that still need to be addressed. To incorporate acupuncture into the primary care setting, the NIH suggested increasing the communication between acupuncturists and physicians because most acupuncture clients will see both.

Such a statement appears to suggest the existence of some scientific evidence for acupuncture. However, even these conclusions from the NIH were met with some criticism. Editors (physicians and scientists) of The Scientific Review of Alternative Medicine issued a statement claiming that the NIH's Office of Alternative Medicine is frequently criticized for its biases. Likewise, they attributed the success of acupuncture to human psychology--a combination of expectation, suggestion, counterirritation and conditioning. ¹⁶ To this group of editors, this psychological explanation pre-empts accepting the effects of acupuncture as scientifically sound. Again, the type of study necessary to evaluate CAM is unclear.

In order to provide competent care to patients who combine CAM with Western medicine, physicians and medical students should read as much as possible about CAM from many different sources (see the resources list at the end of this box). Articles should be read critically (see Figure 6) but with an open mind. Students and doctors must form their own opinions regarding treatments and make personal decisions about referrals and recommendations to patients. In an article titled "Complementary Medicine: Finding a Balance," Deborah Shattuck writes, "It will be challenging-- challenging to keep your own feet firmly planted in conventional medicine and the scientific method and yet reach out to people with very different perspectives form your own, and challenging to convey your opinions and yet remain compassionate and open-minded." ¹⁷

Figure 3. What is homeopathy?

Homeopathic remedies are chosen through a process called the Law of Similars. The basic idea is that "like cures like." If a substance causes certain symptoms, very small doses of that substance will cure the same symptoms. The Law of the Infinitesimal Dose states that as a substance is diluted (with water or alcohol) and shaken, its potency increases. In fact, some homeopathic remedies contain no trace of the original substance, but apparently the essence of the substance remains. Homeopathy has three basic tenets: 1) individualization, including drug selection using the principle of similars; 2) the promotion of self healing using the minimum dose of a drug; and 3) the use of the totality of symptoms for assessing patterns of healing. ⁷

Figure 4. What is acupuncture?

According to Chinese tradition, acupuncture served to restore the balance of yin and yang and the flow of ch'i (pronounced "chee") in the body. Yin and yang are opposing but complementary forces within the body that must be balanced before ch'i, a life force, can cause vital functions (spiritual, mental, physical and emotional) to work correctly. Ch'i flows along 14 invisible meridians that surface at 360 different points in the body, which are acupuncture points (acupoints). According to Sandy Camper, an acupuncturist in Frederick, Maryland, constitutional strengths and weaknesses, lifestyle or trauma can alter the flow of ch'i and the balance of yin and yang, leading to disease. Stimulating the correct acupoints restores the yin-yang balance and the flow of ch'i.

Western scientists believe that stimulating acupoints releases opiates, or endorphins, in the brain. These reduce one's perception of pain like a natural narcotic. This theory is supported by the fact that when animals are given a drug to block endorphins, they do not respond to acupuncture. ⁸

CAM: to Cover or Not to Cover?

The Capitation Management Report from June 1998 concludes, "The problem is that consumer demand for CAM has overtaken the availability of utilization data, and providers are loathe to accept risk for member populations without historical experience." ¹⁹ Traditionally, consumers receive reimbursement for treatments that cure, not those that heal. Curing refers to eliminating a disease physiologically while healing focuses on moving towards wholeness, growth and a greater balance at the physical, mental, social and emotional levels. Studies guiding insurance companies emphasize the physiological or biochemical responses to treatments, not the emotional, psychological or spiritual effects. ¹² However, some studies show that while reliance on conventional medicine does not disappear when patients turn to CAM, trips to allopathic physicians may decrease. ⁹ Additionally, members who have access to alternative therapies may become more concerned with prevention and may not use as many expensive traditional treatments. ¹⁹ Therefore, CAM therapies may have the potential to decrease overall health care costs. Data supporting this speculation do not yet exist.

On the surface, CAM insurance coverage sounds like a positive step for CAM practitioners, patients and supporters. However, the legal system defines the extent of CAM practitioners' areas of expertise and certifications. ¹⁹ Insurance coverage will follow legal definitions. Therefore, a patient may be covered to have a chiropractor manipulate her back but not to give her nutritional advice. The patient would have to see a medical doctor for nutritional advice. This scenario is not one of holistic care. Likewise, insurance companies may make decisions regarding CAM treatments without understanding the background or complete purpose of the treatments. CAM practitioners would have to hire more staff to handle insurance paperwork and phone calls. They may have to see more patients and have less time with each patient in order to pay overhead and employees.

What type of change will open the doors for the integration of conventional and unconventional medicine? Will something have to change with insurance companies and coverage before CAM therapies will be successfully insured? What could spark such a change? Would this change increase patient satisfaction with conventional health care and reduce the demand for CAM? Who is responsible for initiating this change?

The only guarantee is that present and future primary care physicians need to educate themselves about CAM. New evidence for or against certain treatments appears daily. Doctors and students need to read studies and reports on CAM with a critical but open mind. Medical doctors need to know what their patients are using and how CAM therapies may interact with conventional treatments. Dr. Rosenfeld, in his Guide to Alternative Medicine, offers the following advice to patients: "Your objective should be both to live longer and to enjoy the best possible quality of life. However, don't jump from the frying pan into the fire. Before trying any alternative, you and your doctor should investigate its track record as thoroughly as you can to make sure it won't make matters worse." ⁸ Primary care physicians and their patients should share the responsibility of making wise CAM choices. However, because physicians may be more critical of reports and have access to more scientific information than the general public, they need to initiate discussions on CAM.

Medical students can advocate for CAM education. It needs to be easier for physicians and medical students to obtain scientific, current and nonbiased information on CAM.

For most CAM therapies, the final word is not yet in on their effectiveness. But the medical community cannot wait for the final word; they need to know what patients are using now and if it is effective. Many primary care doctors are opening clinics with CAM practitioners. These integrated medical centers provide one of the best learning tools for current physicians and may be the most efficient and effective way to blend conventional and unconventional medicine.

Figure 5. Seven reasons why people mistakenly attribute "getting better" to an ineffective therapy: ²⁰

1. The disease may have run its natural course.
2. Many diseases are cyclical.
3. The placebo effect may be responsible: through suggestion, belief, expectancy, cognitive reinterpretation and diversion of attention, patients given a placebo often experience measurable relief.
4. People who hedge their bets credit the wrong thing: someone may use both alternative and conventional therapies and credit the alternative one if they improve.
5. The original diagnosis or prognosis may have been incorrect.
6. Temporary mood improvement can be confused with cure.
7. Psychological needs can distort what people perceive and do.

Figure 6. Tips for evaluating studies: ¹⁷

1. Is the study published in a recognized, respected, peer-reviewed journal?
2. How were the subjects selected?
3. Was the number of subjects adequate to evaluate the proposed treatment? Was there a control group?
4. Was the research question clearly stated?
5. Was the study appropriately designed to address the research question?
6. To what people (considering their age, gender and health conditions) can the data be generalized?
7. Is there any information regarding sources of funding for the authors/researchers?
8. Was the appropriate statistical analysis performed?

REFERENCES

1. Astin JA. Why patients use alternative medicine: results of a national study. JAMA. 1998;279:1548-1554.
2. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional Medicine in the United States: Prevalence, Costs, and Patterns of Use. N Engl J Med. 1993;328:246-252.
3. Carlston M, Stuart MR, Jonas W. Alternative Medicine Instruction in Medical Schools and Family Practice Residency Programs. Fam Med. 1997;29:559-562.
4. Hopper I, Cohen M. Complementary Therapies and the Medical Profession: A Study of Medical Students' Attitudes. Alt Ther. 1998;4:68-73.
5. La Voie A. Learning to live with Alternative Medicine. Medical Tribune. March 5, 1998.
6. Roberts JC. Herbal Medicines and Dietary Supplements: "The Good, the Bad, and the Ugly." Presented at the GPIT Leadership Training Program; June 19, 1998; Salt Lake City, UT.
7. Jonas WB, Jacobs J. Healing with Homeopathy. New York, NY: Warner Books, Inc.; 1996:15.
8. Rosenfeld I. Dr. Rosenfeld's Guide to Alternative Medicine. New York, NY: Random House, Inc.; 1996:32-34.
9. Cassidy CM. Chinese Medicine Users in the United States Part 1: Utilization, Satisfaction, Medical Plurality. J Alt Comp Med. 1998;4:17-27, 189-202.
10. Goldstein MS, Glik D. Use of and Satisfaction with Homeopathy in a Patient Population. Alt Ther Health Med. 1998;2:60-65.
11. Oz MC, Whitworth GC, Liu EH. Complementary medicine in the surgical wards. JAMA. 1998;279:710-712.
12. Cohen MH. Complementary and Alternative Medicine: Legal Boundaries and Regulatory Perspectives. Baltimore, MD: The Johns Hopkins University Press; 1998.
13. Chinese acupuncture gets nod from the West. Harvard Health Letter. 1998;23:4-12.
14. First issue of new journal examining alternative medicine published. Skeptical Inquirer. Jan-Feb 1998;22:9-11.
15. NIH Consensus Statement Online 1997 November 3-5 [cited 1998, July 13]; 15(5): in press.
16. Two views on acupuncture: NIH and SRAM dispute validity, efficacy. Skeptical Inquirer. March-April 1998;22:5-7.
17. Shattuck D. Complementary medicine: finding a balance. J Am Diet Assoc. 1997; 97:1367-1370.
18. Daschle T. Floor Statement on the Access to Medical Treatment Act. Congressional Record. April 15, 1997:S3208.
19. Capitation Management Report. 1998;5:81-86.
20. Beyerstein BL. Why Bogus Therapies Often Seem to Work. http://www.quackwatch.com/01Quackery Related Topics/altbelief.html. Accessed 25 June 1998.

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