Sex education may also be described as "sexuality education," which means that it encompasses education about all aspects of sexuality, including information about family planning, reproduction (fertilization, conception and development of the embryo and fetus, through to childbirth), plus information about all aspects of one's sexuality including: body image, sexual orientation, sexual pleasure, values, decision making, communication, dating, relationships, sexually transmitted infections (STIs) and how to avoid them, and birth control methods. Click Here to Advertise on My Blog
Sex education may be taught informally, such as when someone receives information from a conversation with a parent, friend, religious leader, or through the media. It may also be delivered through sex self-help authors, magazine advice columnists, sex columnists, or through sex education web sites. Formal sex education occurs when schools or health care providers offer sex education.
Sometimes formal sex education is taught as a full course as part of the curriculum in junior high school or high school. Other times it is only one unit within a more broad biology class, health class, home economics class, or physical education class. Some schools offer no sex education, since it remains a controversial issue in several countries, particularly the United States (especially with regard to the age at which children should start receiving such education, the amount of detail that is revealed, and topics dealing with human sexual behavior, eg. safe sex practices, masturbation, premarital sex, and sexual ethics).
In 1936, Wilhelm Reich commented that sex education of his time was a work of deception, focusing on biology while concealing excitement-arousal, which is what a pubescent individual is mostly interested in. Reich added that this emphasis obscures what he believed to be a basic psychological principle: that all worries and difficulties originate from unsatisfied sexual impulses.
When sex education is contentiously debated, the chief controversial points are whether covering child sexuality is valuable or detrimental; the use of birth control such as condoms and hormonal contraception; and the impact of such use on pregnancy outside marriage, teenage pregnancy, and the transmission of STIs. Increasing support for abstinence-only sex education by conservative groups has been one of the primary causes of this controversy. Countries with conservative attitudes towards sex education (including the UK and the U.S.) have a higher incidence of STIs and teenage pregnancy.
The existence of AIDS has given a new sense of urgency to the topic of sex education. In many African nations, where AIDS is at epidemic levels (see HIV/AIDS in Africa), sex education is seen by most scientists as a vital public health strategy. Some international organizations such as Planned Parenthood consider that broad sex education programs have global benefits, such as controlling the risk of overpopulation and the advancement of women's rights (see also reproductive rights).
According to SIECUS, the Sexuality Information and Education Council of the United States, 93% of adults they surveyed support sexuality education in high school and 84% support it in junior high school. In fact, 88% of parents of junior high school students and 80% of parents of high school students believe that sex education in school makes it easier for them to talk to their adolescents about sex. Also, 92% of adolescents report that they want both to talk to their parents about sex and to have comprehensive in-school sex education.
Monday, March 2, 2009
Sex education worldwide
Afica
Sex education in Africa has focused on stemming the growing AIDS epidemic. Most governments in the region have established AIDS education programs in partnership with the World Health Organization and international NGOs. These programs were undercut significantly by the Global Gag Order, an initiative put in place by President Reagan, suspended by President Clinton, and re-instated by President Bush. The gag order refused government funding for any efforts that promote condom and contraception use in addition to abstinence and monogamy. The Global Gag Order was again suspended as one of the first official acts by President Barack Obama. The incidences of new HIV transmissions in Uganda decreased dramatically when Clinton supported a comprehensive sex education approach (including information about contraception and abortion). According to Ugandan AIDS activists, the Global Gag Order undermined community efforts to reduce HIV prevalence and HIV transmission.
Egypt teaches knowledge about male and female reproductive systems, sexual organs, contraception and STDs in public schools at the second and third years of the middle-preparatory phase (when students are aged 12–14). A coordinated program between UNDP, UNICEF, and the ministries of health and education promotes sexual education at a larger scale in rural areas and spreads awareness of the dangers of female genital cutting.
Asia
The state of sex education programs in Asia is at various stages of development. Indonesia, Mongolia, South Korea and Sri Lanka have a systematic policy framework for teaching about sex within schools. Malaysia, the Philippines and Thailand have assessed adolescent reproductive health needs with a view to developing adolescent-specific training, messages and materials. India has programs aimed at children aged nine to sixteen years. In India, there is a huge debate on the curriculum of sex education and when should it be increased. Attempts by state governments to introduce sex education as a compulsory part of the curriculum have often been met with harsh criticism by political parties, who claim that sex education "is against Indian culture" and would mislead children. (Bangladesh, Myanmar, Nepal and Pakistan have no coordinated sex education programs.)
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In Japan, sex education is mandatory from age 10 or 11, mainly covering biological topics such as menstruation and ejaculation.
In China, sex education traditionally consists in reading the reproduction section of biology textbooks. However, in 2000 a new five-year project was introduced by the China Family Planning Association to "promote reproductive health education among Chinese teenagers and unmarried youth" in twelve urban districts and three counties. This included discussion about sex within human relationships as well as pregnancy and HIV prevention.
The International Planned Parenthood Federation and the BBC World Service ran a 12-part series known as Sexwise, which discussed sex education, family life education, contraception and parenting. It was first launched in South Asia and then extended worldwide.
Europe
Finland
In Finland, sexual education is usually incorporated into various obligatory courses, mainly as part of biology lessons (in lower grades) and later in a course related to general health issues. The Population and Family Welfare Federation provides all 15-year-olds an introductory sexual package that includes an information brochure, a condom and a cartoon love story.
France
In France, sex education has been part of school curricula since 1973. Schools are expected to provide 30 to 40 hours of sex education, and pass out condoms, to students in grades eight and nine. In January 2000, the French government launched an information campaign on contraception with TV and radio spots and the distribution of five million leaflets on contraception to high school students.
Germany
In Germany, sex education has been part of school curricula since 1970. Since 1992 sex education is by law a governmental duty.
It normally covers all subjects concerning the growing-up process, body changes during puberty, emotions, the biological process of reproduction, sexual activity, partnership, homosexuality, unwanted pregnancies and the complications of abortion, the dangers of sexual violence, child abuse, and sex-transmitted diseases, but sometimes also things like sex positions. Most schools offer courses on the correct usage of contraception.
A sex survey by the World Health Organization concerning the habits of European teenagers in 2006 revealed that German teenagers care about contraception. The birth rate among 15- to 19-year-olds was very low.
The Netherlands
Subsidized by the Dutch government, the “Lang leve de liefde” (“Long Live Love”) package, developed in the late 1980s, aims to give teenagers the skills to make their own decisions regarding health and sexuality. Nearly all secondary schools provide sex education as part of biology classes and over half of primary schools discuss sexuality and contraception. The curriculum focuses on biological aspects of reproduction as well as on values, attitudes, communication and negotiation skills. The media has encouraged open dialogue and the health-care system guarantees confidentiality and a non-judgmental approach. The Netherlands has one of the lowest teenage pregnancy rates in the world, and the Dutch approach is often seen as a model for other countries.
Sweden
In Sweden, sex education has been a mandatory part of school education since 1956. The subject is usually started between ages 7 and 10, and continues up through the grades, incorporated into different subjects such as biology and history.
Switzerland
In Switzerland, the content and amount of sex education is decided at the cantonal level. In Geneva, courses have been given at the secondary level since the 1950s. Interventions in primary schools were started more recently, with the objective of making children conscious of what is and isn't allowed, and able to say "No". In secondary schools (age 13-14), condoms are shown to all pupils, and are demonstrated by unfolding over the teacher's fingers. For this, classes are usually separated into girl-only and boy-only subgroups. Condoms are not distributed, however, except among older adolescents engaged in state-run non-compulsory education (age 16-17).
United Kingdom
In England and Wales, sex education is not compulsory in schools as parents can refuse to let their children take part in the lessons. The curriculum focuses on the reproductive system, fetal development, and the physical and emotional changes of adolescence, while information about contraception and safe sex is discretionary and discussion about relationships is often neglected. Britain has one of the highest teenage pregnancy rates in Europe and sex education is a heated issue in government and media reports. In a 2000 study by the University of Brighton, many 14 to 15 year olds reported disappointment with the content of sex education lessons and felt that lack of confidentiality prevents teenagers from asking teachers about contraception.In a 2008 study conducted by YouGov for Channel 4 it was revealed that almost three in ten teenagers say they need more sex and relationships education.
In Scotland, the main sex education program is Healthy Respect, which focuses not only on the biological aspects of reproduction but also on relationships and emotions. Education about contraception and sexually transmitted diseases are included in the program as a way of encouraging good sexual health. In response to a refusal by Catholic schools to commit to the program, however, a separate sex education program has been developed for use in those schools. Funded by the Scottish Government, the program Called to Love focuses on encouraging children to delay sex until marriage, and does not cover contraception, and as such is a form of abstinence-only sex education.
Sex education in Africa has focused on stemming the growing AIDS epidemic. Most governments in the region have established AIDS education programs in partnership with the World Health Organization and international NGOs. These programs were undercut significantly by the Global Gag Order, an initiative put in place by President Reagan, suspended by President Clinton, and re-instated by President Bush. The gag order refused government funding for any efforts that promote condom and contraception use in addition to abstinence and monogamy. The Global Gag Order was again suspended as one of the first official acts by President Barack Obama. The incidences of new HIV transmissions in Uganda decreased dramatically when Clinton supported a comprehensive sex education approach (including information about contraception and abortion). According to Ugandan AIDS activists, the Global Gag Order undermined community efforts to reduce HIV prevalence and HIV transmission.
Egypt teaches knowledge about male and female reproductive systems, sexual organs, contraception and STDs in public schools at the second and third years of the middle-preparatory phase (when students are aged 12–14). A coordinated program between UNDP, UNICEF, and the ministries of health and education promotes sexual education at a larger scale in rural areas and spreads awareness of the dangers of female genital cutting.
Asia
The state of sex education programs in Asia is at various stages of development. Indonesia, Mongolia, South Korea and Sri Lanka have a systematic policy framework for teaching about sex within schools. Malaysia, the Philippines and Thailand have assessed adolescent reproductive health needs with a view to developing adolescent-specific training, messages and materials. India has programs aimed at children aged nine to sixteen years. In India, there is a huge debate on the curriculum of sex education and when should it be increased. Attempts by state governments to introduce sex education as a compulsory part of the curriculum have often been met with harsh criticism by political parties, who claim that sex education "is against Indian culture" and would mislead children. (Bangladesh, Myanmar, Nepal and Pakistan have no coordinated sex education programs.)
Custom Search
In Japan, sex education is mandatory from age 10 or 11, mainly covering biological topics such as menstruation and ejaculation.
In China, sex education traditionally consists in reading the reproduction section of biology textbooks. However, in 2000 a new five-year project was introduced by the China Family Planning Association to "promote reproductive health education among Chinese teenagers and unmarried youth" in twelve urban districts and three counties. This included discussion about sex within human relationships as well as pregnancy and HIV prevention.
The International Planned Parenthood Federation and the BBC World Service ran a 12-part series known as Sexwise, which discussed sex education, family life education, contraception and parenting. It was first launched in South Asia and then extended worldwide.
Europe
Finland
In Finland, sexual education is usually incorporated into various obligatory courses, mainly as part of biology lessons (in lower grades) and later in a course related to general health issues. The Population and Family Welfare Federation provides all 15-year-olds an introductory sexual package that includes an information brochure, a condom and a cartoon love story.
France
In France, sex education has been part of school curricula since 1973. Schools are expected to provide 30 to 40 hours of sex education, and pass out condoms, to students in grades eight and nine. In January 2000, the French government launched an information campaign on contraception with TV and radio spots and the distribution of five million leaflets on contraception to high school students.
Germany
In Germany, sex education has been part of school curricula since 1970. Since 1992 sex education is by law a governmental duty.
It normally covers all subjects concerning the growing-up process, body changes during puberty, emotions, the biological process of reproduction, sexual activity, partnership, homosexuality, unwanted pregnancies and the complications of abortion, the dangers of sexual violence, child abuse, and sex-transmitted diseases, but sometimes also things like sex positions. Most schools offer courses on the correct usage of contraception.
A sex survey by the World Health Organization concerning the habits of European teenagers in 2006 revealed that German teenagers care about contraception. The birth rate among 15- to 19-year-olds was very low.
The Netherlands
Subsidized by the Dutch government, the “Lang leve de liefde” (“Long Live Love”) package, developed in the late 1980s, aims to give teenagers the skills to make their own decisions regarding health and sexuality. Nearly all secondary schools provide sex education as part of biology classes and over half of primary schools discuss sexuality and contraception. The curriculum focuses on biological aspects of reproduction as well as on values, attitudes, communication and negotiation skills. The media has encouraged open dialogue and the health-care system guarantees confidentiality and a non-judgmental approach. The Netherlands has one of the lowest teenage pregnancy rates in the world, and the Dutch approach is often seen as a model for other countries.
Sweden
In Sweden, sex education has been a mandatory part of school education since 1956. The subject is usually started between ages 7 and 10, and continues up through the grades, incorporated into different subjects such as biology and history.
Switzerland
In Switzerland, the content and amount of sex education is decided at the cantonal level. In Geneva, courses have been given at the secondary level since the 1950s. Interventions in primary schools were started more recently, with the objective of making children conscious of what is and isn't allowed, and able to say "No". In secondary schools (age 13-14), condoms are shown to all pupils, and are demonstrated by unfolding over the teacher's fingers. For this, classes are usually separated into girl-only and boy-only subgroups. Condoms are not distributed, however, except among older adolescents engaged in state-run non-compulsory education (age 16-17).
United Kingdom
In England and Wales, sex education is not compulsory in schools as parents can refuse to let their children take part in the lessons. The curriculum focuses on the reproductive system, fetal development, and the physical and emotional changes of adolescence, while information about contraception and safe sex is discretionary and discussion about relationships is often neglected. Britain has one of the highest teenage pregnancy rates in Europe and sex education is a heated issue in government and media reports. In a 2000 study by the University of Brighton, many 14 to 15 year olds reported disappointment with the content of sex education lessons and felt that lack of confidentiality prevents teenagers from asking teachers about contraception.In a 2008 study conducted by YouGov for Channel 4 it was revealed that almost three in ten teenagers say they need more sex and relationships education.
In Scotland, the main sex education program is Healthy Respect, which focuses not only on the biological aspects of reproduction but also on relationships and emotions. Education about contraception and sexually transmitted diseases are included in the program as a way of encouraging good sexual health. In response to a refusal by Catholic schools to commit to the program, however, a separate sex education program has been developed for use in those schools. Funded by the Scottish Government, the program Called to Love focuses on encouraging children to delay sex until marriage, and does not cover contraception, and as such is a form of abstinence-only sex education.
Sex education in United States
Almost all U.S. students receive some form of sex education at least once between grades 7 and 12; many schools begin addressing some topics as early as grades 5 or 6. However, what students learn varies widely, because curriculum decisions are so decentralized. Many states have laws governing what is taught in sex education classes or allowing parents to opt out. Some state laws leave curriculum decisions to individual school districts.
For example, a 1999 study by the Guttmacher Institute found that most U.S. sex education courses in grades 7 through 12 cover puberty, HIV, STIs, abstinence, implications of teenage pregnancy, and how to resist peer pressure. Other studied topics, such as methods of birth control and infection prevention, sexual orientation, sexual abuse, and factual and ethical information about abortion, varied more widely.
Two main forms of sex education are taught in American schools: comprehensive and abstinence-only. Comprehensive sex education covers abstinence as a positive choice, but also teaches about contraception and avoidance of STIs when sexually active. A 2002 study conducted by the Kaiser Family Foundation found that 58% of secondary school principals describe their sex education curriculum as comprehensive.
Abstinence-only sex education tells teenagers that they should be sexually abstinent until marriage and does not provide information about contraception. In the Kaiser study, 34% of high-school principals said their school's main message was abstinence-only.
The federal government plays a large role in which form of sex education is taught in public schools. In 1996, Congress passed a law to fund abstinence-only sex education. The federal government only funds abstinence-only sex education.
The difference between these two approaches, and their impact on teen behavior, remains a controversial subject. In the U.S., teenage birth rates had been dropping since 1991, but a 2007 report showed 3% increase from 2005 to 2006. From 1991 to 2005, the percentage of teens reporting that they had ever had sex or were currently sexually active showed small declines.[25] However, the U.S. still has the highest teen birth rate and one of the highest rates of STIs among teens in the industrialized world. Public opinion polls conducted over the years have found that the vast majority of Americans favor broader sex education programs over those that teach only abstinence, although abstinence educators recently published poll data with the opposite conclusion.
Proponents of comprehensive sex education, which include the American Psychological Association, the American Medical Association, the National Association of School Psychologists, the American Academy of Pediatrics, the American Public Health Association, the Society for Adolescent Medicine and the American College Health Association, argue that sexual behavior after puberty is a given, and it is therefore crucial to provide information about the risks and how they can be minimized; they also claim that denying teens such factual information leads to unwanted pregnancies and STIs.
On the other hand, proponents of abstinence-only sex education object to curricula that fail to teach their standard of moral behavior; they maintain that a morality based on sex only within the bounds of marriage is "healthy and constructive" and that value-free knowledge of the body may lead to immoral, unhealthy, and harmful practices. Within the last decade, the federal government has encouraged abstinence-only education by steering over a billion dollars to such programs. Some 15 states now decline the funding so that they can continue to teach comprehensive sex education. Funding for one of the federal government's two main abstinency-only funding programs, Title V, was extended only until December 31, 2007; Congress is debating whether to continue it past that date.
The impact of the rise in abstinence-only education remains a question. To date, no published studies of abstinence-only programs have found consistent and significant program effects on delaying the onset of intercourse. In 2007, a study ordered by the U.S. Congress found that middle school students who took part in abstinence-only sex education programs were just as likely to have sex (and use contraception) in their teenage years as those who did not. Abstinence-only advocates claimed that the study was flawed because it was too narrow and began when abstinence-only curricula were in their infancy, and that other studies have demonstrated positive effects.
For example, a 1999 study by the Guttmacher Institute found that most U.S. sex education courses in grades 7 through 12 cover puberty, HIV, STIs, abstinence, implications of teenage pregnancy, and how to resist peer pressure. Other studied topics, such as methods of birth control and infection prevention, sexual orientation, sexual abuse, and factual and ethical information about abortion, varied more widely.
Two main forms of sex education are taught in American schools: comprehensive and abstinence-only. Comprehensive sex education covers abstinence as a positive choice, but also teaches about contraception and avoidance of STIs when sexually active. A 2002 study conducted by the Kaiser Family Foundation found that 58% of secondary school principals describe their sex education curriculum as comprehensive.
Abstinence-only sex education tells teenagers that they should be sexually abstinent until marriage and does not provide information about contraception. In the Kaiser study, 34% of high-school principals said their school's main message was abstinence-only.
The federal government plays a large role in which form of sex education is taught in public schools. In 1996, Congress passed a law to fund abstinence-only sex education. The federal government only funds abstinence-only sex education.
The difference between these two approaches, and their impact on teen behavior, remains a controversial subject. In the U.S., teenage birth rates had been dropping since 1991, but a 2007 report showed 3% increase from 2005 to 2006. From 1991 to 2005, the percentage of teens reporting that they had ever had sex or were currently sexually active showed small declines.[25] However, the U.S. still has the highest teen birth rate and one of the highest rates of STIs among teens in the industrialized world. Public opinion polls conducted over the years have found that the vast majority of Americans favor broader sex education programs over those that teach only abstinence, although abstinence educators recently published poll data with the opposite conclusion.
Proponents of comprehensive sex education, which include the American Psychological Association, the American Medical Association, the National Association of School Psychologists, the American Academy of Pediatrics, the American Public Health Association, the Society for Adolescent Medicine and the American College Health Association, argue that sexual behavior after puberty is a given, and it is therefore crucial to provide information about the risks and how they can be minimized; they also claim that denying teens such factual information leads to unwanted pregnancies and STIs.
On the other hand, proponents of abstinence-only sex education object to curricula that fail to teach their standard of moral behavior; they maintain that a morality based on sex only within the bounds of marriage is "healthy and constructive" and that value-free knowledge of the body may lead to immoral, unhealthy, and harmful practices. Within the last decade, the federal government has encouraged abstinence-only education by steering over a billion dollars to such programs. Some 15 states now decline the funding so that they can continue to teach comprehensive sex education. Funding for one of the federal government's two main abstinency-only funding programs, Title V, was extended only until December 31, 2007; Congress is debating whether to continue it past that date.
The impact of the rise in abstinence-only education remains a question. To date, no published studies of abstinence-only programs have found consistent and significant program effects on delaying the onset of intercourse. In 2007, a study ordered by the U.S. Congress found that middle school students who took part in abstinence-only sex education programs were just as likely to have sex (and use contraception) in their teenage years as those who did not. Abstinence-only advocates claimed that the study was flawed because it was too narrow and began when abstinence-only curricula were in their infancy, and that other studies have demonstrated positive effects.
Alternative medicine
The term alternative medicine, as used in the modern western world, encompasses any healing practice "that does not fall within the realm of conventional medicine". Commonly cited examples include naturopathy, chiropractic, herbalism, traditional Chinese medicine, Unani, Ayurveda, meditation, yoga, biofeedback, hypnosis, homeopathy, acupuncture, and diet-based therapies, in addition to a range of other practices. It is frequently grouped with complementary medicine, which generally refers to the same interventions when used in conjunction with mainstream techniques, under the umbrella term complementary and alternative medicine, or CAM. Some significant researchers in alternative medicine oppose this grouping, preferring to emphasize differences of approach, but nevertheless use the term CAM, which has become standard.
Alternative medicine practices are as diverse in their foundations as in their methodologies. Practices may incorporate or base themselves on traditional medicine, folk knowledge, spiritual beliefs, or newly conceived approaches to healing.Jurisdictions where alternative medical practices are sufficiently widespread may license and regulate them. The claims made by alternative medicine practitioners are generally not accepted by the medical community because evidence-based assessment of safety and efficacy is either not available or has not been performed for many of these practices. If scientific investigation establishes the safety and effectiveness of an alternative medical practice, it may be adopted by conventional practitioners. Because alternative techniques tend to lack evidence, some have advocated defining it as non-evidence based medicine, or not medicine at all. Some researchers have noted that the evidence-based approach to defining CAM is problematic because some CAM is tested, and research suggests that many mainstream medical techniques lack solid evidence.
A 1998 systematic review of studies assessing its prevalence in 13 countries concluded that about 31% of cancer patients use some form of complementary and alternative medicine.Alternative medicine varies from country to country; Dr. Edzard Ernst believes that in Austria and Germany CAM is mainly in the hands of physicians, although some estimates suggest that half of CAM is administered by physicians in the US. In Germany, herbs are tightly regulated, with half prescribed by doctors and covered by health insurance based on their Commission E legislation
Alternative medicine practices are as diverse in their foundations as in their methodologies. Practices may incorporate or base themselves on traditional medicine, folk knowledge, spiritual beliefs, or newly conceived approaches to healing.Jurisdictions where alternative medical practices are sufficiently widespread may license and regulate them. The claims made by alternative medicine practitioners are generally not accepted by the medical community because evidence-based assessment of safety and efficacy is either not available or has not been performed for many of these practices. If scientific investigation establishes the safety and effectiveness of an alternative medical practice, it may be adopted by conventional practitioners. Because alternative techniques tend to lack evidence, some have advocated defining it as non-evidence based medicine, or not medicine at all. Some researchers have noted that the evidence-based approach to defining CAM is problematic because some CAM is tested, and research suggests that many mainstream medical techniques lack solid evidence.
A 1998 systematic review of studies assessing its prevalence in 13 countries concluded that about 31% of cancer patients use some form of complementary and alternative medicine.Alternative medicine varies from country to country; Dr. Edzard Ernst believes that in Austria and Germany CAM is mainly in the hands of physicians, although some estimates suggest that half of CAM is administered by physicians in the US. In Germany, herbs are tightly regulated, with half prescribed by doctors and covered by health insurance based on their Commission E legislation
Alternative and evidence-based medicine
Testing of efficacy
Many alternative therapies have been tested with varying results. In 2003, a project funded by the CDC identified 208 condition-treatment pairs, of which 58% had been studied by at least one randomized controlled trial (RCT), and 23% had been assessed with a meta-analysis. According a 2005 book by a US Institute of Medicine panel, the number of RCTs focused on CAM has risen dramatically. The book cites Vickers (1998), who found that many of the CAM-related RCTs are in the Cochrane register, but 19% of these trials were not in MEDLINE, and 84% were in conventional medical journals.:133
As of 2005 the Cochrane Library had 145 CAM-related Cochrane systematic reviews and 340 non-Cochrane systematic reviews. An analysis of the conclusions of only the 145 Cochrane reviews was done by two readers. In 83% of the cases, the readers agreed. In the 17% in which they disagreed, a third reader agreed with one of the initial readers to set a rating. These studies found that for CAM, 38.4% concluded positive effect or possibly positive (12.4%) effect, 4.8% concluded no effect, 0.69% concluded harmful effect, and 56.6% concluded insufficient evidence. An assessment of conventional treatments found that 41.3% concluded positive or possibly positive effect, 20% concluded no effect, 8.1% concluded net harmful effects, and 21.3% concluded insufficient evidence. However, the CAM review used the 2004 Cochrane database while the conventional review used the 1998 Cochrane database.[15]:135-136
Most alternative medical treatments are not patentable, which may lead to less research funded by the private sector. Additionally, in most countries alternative treatments (in contrast to pharmaceuticals) can be marketed without any proof of efficacy—also a disincentive for manufacturers to fund scientific research. Some have proposed adopting a prize system to reward medical research. However, public funding for research exists. Increasing the funding for research of alternative medicine techniques was the purpose of the US National Center for Complementary and Alternative Medicine. NCCAM and its predecessor, the Office of Alternative Medicine, have spent more than $1 billion on such research since 1992. The German Federal Institute for Drugs and Medical Devices Commission E has studied many herbal remedies for efficacy.
Some skeptics of alternative practices point out that a person may attribute symptomatic relief to an otherwise ineffective therapy due to the placebo effect, the natural recovery from or the cyclical nature of an illness (the regression fallacy), or the possibility that the person never originally had a true illness.
In the same way as for conventional therapies, drugs, and interventions, it can be difficult to test the efficacy of alternative medicine in clinical trials. In instances where an established, effective, treatment for a condition is already available, the Helsinki Declaration states that withholding such treatment is unethical in most circumstances. Use of standard-of-care treatment in addition to an alternative technique being tested may produce confounded or difficult-to-interpret results.
Many alternative therapies have been tested with varying results. In 2003, a project funded by the CDC identified 208 condition-treatment pairs, of which 58% had been studied by at least one randomized controlled trial (RCT), and 23% had been assessed with a meta-analysis. According a 2005 book by a US Institute of Medicine panel, the number of RCTs focused on CAM has risen dramatically. The book cites Vickers (1998), who found that many of the CAM-related RCTs are in the Cochrane register, but 19% of these trials were not in MEDLINE, and 84% were in conventional medical journals.:133
As of 2005 the Cochrane Library had 145 CAM-related Cochrane systematic reviews and 340 non-Cochrane systematic reviews. An analysis of the conclusions of only the 145 Cochrane reviews was done by two readers. In 83% of the cases, the readers agreed. In the 17% in which they disagreed, a third reader agreed with one of the initial readers to set a rating. These studies found that for CAM, 38.4% concluded positive effect or possibly positive (12.4%) effect, 4.8% concluded no effect, 0.69% concluded harmful effect, and 56.6% concluded insufficient evidence. An assessment of conventional treatments found that 41.3% concluded positive or possibly positive effect, 20% concluded no effect, 8.1% concluded net harmful effects, and 21.3% concluded insufficient evidence. However, the CAM review used the 2004 Cochrane database while the conventional review used the 1998 Cochrane database.[15]:135-136
Most alternative medical treatments are not patentable, which may lead to less research funded by the private sector. Additionally, in most countries alternative treatments (in contrast to pharmaceuticals) can be marketed without any proof of efficacy—also a disincentive for manufacturers to fund scientific research. Some have proposed adopting a prize system to reward medical research. However, public funding for research exists. Increasing the funding for research of alternative medicine techniques was the purpose of the US National Center for Complementary and Alternative Medicine. NCCAM and its predecessor, the Office of Alternative Medicine, have spent more than $1 billion on such research since 1992. The German Federal Institute for Drugs and Medical Devices Commission E has studied many herbal remedies for efficacy.
Some skeptics of alternative practices point out that a person may attribute symptomatic relief to an otherwise ineffective therapy due to the placebo effect, the natural recovery from or the cyclical nature of an illness (the regression fallacy), or the possibility that the person never originally had a true illness.
In the same way as for conventional therapies, drugs, and interventions, it can be difficult to test the efficacy of alternative medicine in clinical trials. In instances where an established, effective, treatment for a condition is already available, the Helsinki Declaration states that withholding such treatment is unethical in most circumstances. Use of standard-of-care treatment in addition to an alternative technique being tested may produce confounded or difficult-to-interpret results.
Medical education
In the United States, increasing numbers of medical colleges have started offering courses in alternative medicine. For example, in three separate research surveys that surveyed 729 schools (125 medical schools offering an MD degree, 25 medical schools offering a Doctor of Osteopathic medicine degree, and 585 schools offering a nursing degree), 60% of the standard medical schools, 95% of osteopathic medical schools and 84.8% of the nursing schools teach some form of CAM. The University of Arizona College of Medicine offers a program in Integrative Medicine under the leadership of Dr. Andrew Weil which trains physicians in various branches of alternative medicine which "...neither rejects conventional medicine, nor embraces alternative practices uncritically." Accredited Naturopathic colleges and universities are also increasing in number and popularity in Canada and the USA. (See Naturopathic medical school in North America)
Similarly "unconventional medicine courses are widely represented at European universities. They cover a wide range of therapies. Many of them are used clinically. Research work is underway at several faculties,"[74] but "only 40% of the responding [European] universities were offering some form of CAM training."
In Britain, no conventional medical schools offer courses that teach the clinical practice of alternative medicine.[citation needed] However, alternative medicine is taught in several unconventional schools as part of their curriculum.[citation needed] Teaching is based mostly on theory and understanding of alternative medicine, with emphasis on being able to communicate with alternative medicine specialists.[citation needed] To obtain competence in practicing clinical alternative medicine, qualifications must be obtained from individual medical societies.[citation needed] The student must have graduated and be a qualified doctor.[citation needed] The British Medical Acupuncture Society, which offers medical acupuncture certificates to doctors, is one such example, as is the College of Naturopathic Medicine UK and Ireland.
[edit] Regulation
Due to the uncertain nature of various alternative therapies and the wide variety of claims different practitioners make, alternative medicine has been a source of vigorous debate, even over the definition of alternative medicine. Dietary supplements, their ingredients, safety, and claims, are a continual source of controversy. In some cases, political issues, mainstream medicine and alternative medicine all collide, such as the case where synthetic drugs are legal but the herbal sources of the same active chemical are banned. In other cases, controversy over mainstream medicine causes questions about the nature of a treatment, such as water fluoridation. Alternative medicine and mainstream medicine debates can also spill over into freedom of religion discussions, such as the right to decline lifesaving treatment for one's children because of religious beliefs. Government regulators continue to attempt to find a regulatory balance.
Jurisdiction differs concerning which branches of alternative medicine are legal, which are regulated, and which (if any) are provided by a government-controlled health service or reimbursed by a private health medical insurance company. The United Nations Committee on Economic, Social and Cultural Rights - article 34 (Specific legal obligations) of the General Comment No. 14 (2000) on The right to the highest attainable standard of health - states that
"Furthermore, obligations to respect include a State's obligation to refrain from prohibiting or impeding traditional preventive care, healing practices and medicines, from marketing unsafe drugs and from applying coercive medical treatments, unless on an exceptional basis for the treatment of mental illness or the prevention and control of communicable diseases."
Specific implementations of this article are, of course, left to member states.
A number of alternative medicine advocates disagree with the restrictions of government agencies that approve medical treatments. In the USA, for example, critics claim that the Food and Drug Administration's criteria for experimental evaluation methods impedes those seeking to bring useful and effective treatments and approaches to the public, and protest that their contributions and discoveries are unfairly dismissed, overlooked or suppressed. Alternative medicine providers recognize that health fraud occurs, and argue that it should be dealt with appropriately when it does, but that these restrictions should not extend to what they view as legitimate health care products.
In New Zealand alternative medicine products are classified as food products, so there are no regulations or safety standards in place.
The production of modern pharmaceuticals is strictly regulated to ensure that medicines contain a standardized quantity of active ingredients and are free from contamination. Alternative medicine products are not subject to the same governmental quality control standards, and consistency between doses can vary. This leads to uncertainty in the chemical content and biological activity of individual doses. This lack of oversight means that alternative health products are vulnerable to adulteration and contamination. This problem is magnified by international commerce, since different countries have different types and degrees of regulation. This can make it difficult for consumers to properly evaluate the risks and qualities of given products.
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Similarly "unconventional medicine courses are widely represented at European universities. They cover a wide range of therapies. Many of them are used clinically. Research work is underway at several faculties,"[74] but "only 40% of the responding [European] universities were offering some form of CAM training."
In Britain, no conventional medical schools offer courses that teach the clinical practice of alternative medicine.[citation needed] However, alternative medicine is taught in several unconventional schools as part of their curriculum.[citation needed] Teaching is based mostly on theory and understanding of alternative medicine, with emphasis on being able to communicate with alternative medicine specialists.[citation needed] To obtain competence in practicing clinical alternative medicine, qualifications must be obtained from individual medical societies.[citation needed] The student must have graduated and be a qualified doctor.[citation needed] The British Medical Acupuncture Society, which offers medical acupuncture certificates to doctors, is one such example, as is the College of Naturopathic Medicine UK and Ireland.
[edit] Regulation
Due to the uncertain nature of various alternative therapies and the wide variety of claims different practitioners make, alternative medicine has been a source of vigorous debate, even over the definition of alternative medicine. Dietary supplements, their ingredients, safety, and claims, are a continual source of controversy. In some cases, political issues, mainstream medicine and alternative medicine all collide, such as the case where synthetic drugs are legal but the herbal sources of the same active chemical are banned. In other cases, controversy over mainstream medicine causes questions about the nature of a treatment, such as water fluoridation. Alternative medicine and mainstream medicine debates can also spill over into freedom of religion discussions, such as the right to decline lifesaving treatment for one's children because of religious beliefs. Government regulators continue to attempt to find a regulatory balance.
Jurisdiction differs concerning which branches of alternative medicine are legal, which are regulated, and which (if any) are provided by a government-controlled health service or reimbursed by a private health medical insurance company. The United Nations Committee on Economic, Social and Cultural Rights - article 34 (Specific legal obligations) of the General Comment No. 14 (2000) on The right to the highest attainable standard of health - states that
"Furthermore, obligations to respect include a State's obligation to refrain from prohibiting or impeding traditional preventive care, healing practices and medicines, from marketing unsafe drugs and from applying coercive medical treatments, unless on an exceptional basis for the treatment of mental illness or the prevention and control of communicable diseases."
Specific implementations of this article are, of course, left to member states.
A number of alternative medicine advocates disagree with the restrictions of government agencies that approve medical treatments. In the USA, for example, critics claim that the Food and Drug Administration's criteria for experimental evaluation methods impedes those seeking to bring useful and effective treatments and approaches to the public, and protest that their contributions and discoveries are unfairly dismissed, overlooked or suppressed. Alternative medicine providers recognize that health fraud occurs, and argue that it should be dealt with appropriately when it does, but that these restrictions should not extend to what they view as legitimate health care products.
In New Zealand alternative medicine products are classified as food products, so there are no regulations or safety standards in place.
The production of modern pharmaceuticals is strictly regulated to ensure that medicines contain a standardized quantity of active ingredients and are free from contamination. Alternative medicine products are not subject to the same governmental quality control standards, and consistency between doses can vary. This leads to uncertainty in the chemical content and biological activity of individual doses. This lack of oversight means that alternative health products are vulnerable to adulteration and contamination. This problem is magnified by international commerce, since different countries have different types and degrees of regulation. This can make it difficult for consumers to properly evaluate the risks and qualities of given products.
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Public use in the US
A botánicas, such as this one in Massachusetts, caters to the Latino community and sells folk medicine alongside statues of saints, candles decorated with prayers, and other items.A 2002 survey of US adults 18 years and older conducted by the National Center for Health Statistics (CDC) and the National Center for Complementary and Alternative Medicine indicated:
74.6% had used some form of complementary and alternative medicine (CAM).
62.1% had done so within the preceding twelve months.
When prayer specifically for health reasons is excluded, these figures fall to 49.8% and 36.0%, respectively.
45.2% had in the last twelve months used prayer for health reasons, either through praying for their own health or through others praying for them.
54.9% used CAM in conjunction with conventional medicine.
14.8% "sought care from a licensed or certified" practitioner, suggesting that "most individuals who use CAM prefer to treat themselves."
Most people used CAM to treat and/or prevent musculoskeletal conditions or other conditions associated with chronic or recurring pain.
"Women were more likely than men to use CAM. The largest sex differential is seen in the use of mind-body therapies including prayer specifically for health reasons".
"Except for the groups of therapies that included prayer specifically for health reasons, use of CAM increased as education levels increased".
The most common CAM therapies used in the US in 2002 were prayer (45.2%), herbalism (18.9%), breathing meditation (11.6%), meditation (7.6%), chiropractic medicine (7.5%), yoga (5.1%), body work (5.0%), diet-based therapy (3.5%), progressive relaxation (3.0%), mega-vitamin therapy (2.8%) and Visualization (2.1%)
In the state of Texas, physicians may be partially protected from charges of unprofessional conduct or failure to practice medicine in an acceptable manner, and thus from disciplinary action, when they prescribe alternative medicine in a complementary manner, if board specific practice requirements are satisfied and the therapies utilized do not present "a safety risk for the patient that is unreasonably greater that the conventional treatment for the patient's medical condition."
74.6% had used some form of complementary and alternative medicine (CAM).
62.1% had done so within the preceding twelve months.
When prayer specifically for health reasons is excluded, these figures fall to 49.8% and 36.0%, respectively.
45.2% had in the last twelve months used prayer for health reasons, either through praying for their own health or through others praying for them.
54.9% used CAM in conjunction with conventional medicine.
14.8% "sought care from a licensed or certified" practitioner, suggesting that "most individuals who use CAM prefer to treat themselves."
Most people used CAM to treat and/or prevent musculoskeletal conditions or other conditions associated with chronic or recurring pain.
"Women were more likely than men to use CAM. The largest sex differential is seen in the use of mind-body therapies including prayer specifically for health reasons".
"Except for the groups of therapies that included prayer specifically for health reasons, use of CAM increased as education levels increased".
The most common CAM therapies used in the US in 2002 were prayer (45.2%), herbalism (18.9%), breathing meditation (11.6%), meditation (7.6%), chiropractic medicine (7.5%), yoga (5.1%), body work (5.0%), diet-based therapy (3.5%), progressive relaxation (3.0%), mega-vitamin therapy (2.8%) and Visualization (2.1%)
In the state of Texas, physicians may be partially protected from charges of unprofessional conduct or failure to practice medicine in an acceptable manner, and thus from disciplinary action, when they prescribe alternative medicine in a complementary manner, if board specific practice requirements are satisfied and the therapies utilized do not present "a safety risk for the patient that is unreasonably greater that the conventional treatment for the patient's medical condition."
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