Spiritualised Medicine?

A Bibliometric Study of Complementary and

Alternative Medicine (CAM)

Jenny-Ann Brodin & Rickard Danell
Department of Sociology, Ume University, Sweden

Introduction
Several studies, both American and European, indicate that complementary and alternative
medicine (CAM) is increasingly popular and frequently used by the general population. For
example, Eisenberg et. al. (1993; 1998) has shown that the use of 16 CAM-therapies, such as
homeopathy, massage and energy healing, has increased from 34% in 1993 to 42% seven
years later, in the USA. Similar changes have also been identified in European countries
(INSERT REF). From the historical and sociological research of CAM we can also conclude
that many CAM-therapies, over time, has gained increased societal recognition and
acceptance and that many therapies has gone from the fringe to become integrated into
conventional medicine and public health sectors (for overviews, see Eklf [ed.] 2003; Jtte,
Eklf & Nelson [ed.] 2001).

However, integration is far from a simple process and can be identified at many levels and
from different perspectives. In most countries there are both symbolic and institutional
divisions between conventional/regular/scientific/bio-medicine and unconventional/fringe/
alternative/holistic medicine. An important aspect is that most CAM therapies, at least to
some extent, relies on spiritual, religious, or magic assumptions often at odds with western
scientific traditions. It is far from given that CAM actors strive for integration neither is it
given that establishment (medical professionals, researcher etc.) want to let them in. From
our perspective, the line of division is not naturally given or stable over time but socially
constructed, contested and fought over (cf. Gieryn 200x).

Purpose, method, and data
The general purpose of this paper is to study the development of CAM as a scientific field.
With help from the Medline database, we will show how the general publication activity has
developed during the period 1966-2003. We will take a closer look at the academic journals
where the publication activity can be found. We will also analyze if and how the content of
CAM research, in these publications, has changed over time.

The study is restricted to published items, classified as journal articles, during the period
1966-2003, in Medline database. We selected the CAM-articles as defined by the MESH
(Medical Subject Headings) category Complementary Therapies. However, in this category
we excluded traditional medicines, such as African medicine and Chinese medicine, since
these are not complementary in their own cultural context. They are neither therapies in a
restricted sense, but general traditions. It should be noted that traditional medicines only are
excluded in the search profile. As we will see later on in this paper, they will appear in other
categories.

General development of publication activity
Let us begin with a simple overview of the publication activity. Figure 1 shows the number of
CAM articles in Medline during the period 1966 to 2003. The articles grow at a steady rate,
with exception from a small increase in the middle of the 1970
th
(which we will come back to
later?), from 1966 to 1996, with an average growth rate of 44 articles per years. However, in
1996 something seems to happen. During the rest of the period, the growth rate increases to
an average of 424 articles per year.

<INSERT FIGURE 1 ABOUT HERE>

How is it possible to explain this change in publication activity? One answer could be that the
numbers not are reflecting a real change, but an increase in the number of journals indexed in
Medline. Another answer could be that the increase in publication activity reflects an increase
in research activity.

Figure 2 shows the percentage of CAM articles in Medline as a whole. The share of CAM
articles is relatively constant from 1966 to 1996 (again; with an exception for a peak in the
beginning of the 1970
th)
. After 1996 the share of CAM articles increases rapidly, i.e. faster
than Medline as a whole. We can therefore conclude that the changing growth rate of CAM is
not due to an expansion of Medline.


<INSERT FIGURE 2 ABOUT HERE>

Establishment of CAM Journals
In Figure 1 we display all articles in Medline, indexed as CAM. However, in 1975 CAM as a
journal category appears in Medline. This can imply that this is the point of time when CAM
in general, or CAM research and journals in particular, is enough recognized and/or accepted
to be included in Medline. This can also imply that some journals are re-indexed, and/or that
the journals in this category are fairly new (and therefore not included in Medline before). To
find answer, we have compared when the journals appear in the CAM journal category, if
they were indexed in another Medline category before, and when the journal originally was
founded.
1


<INSERT TABLE ONE>

The first journal indexed as CAM in Medline was Chinese Medical Journal, founded as early
as 1887 but not indexed in Medline until 1975. However, most journals in this category
follow another pattern; they were founded during the 1970
th
to the 1990
th
and got included in
Medline with a few years, or in some cases about a decade, delay. Two American journals
are, exceptionally, indexed in Medline from their first issue. Two other journals, one
homeopathic and one fitotherapeutic, are, in similarity with Chinese Medical Journal, old
journals, not included in Medline until they got included in the CAM-category. In other
words, there are no re-indexations, and most of the journals in the CAM category are
relatively new.

In order to get a clearer picture of the assumed increase in publication activity, we use Figure
3. Is the observed change in growth rate, after 1996, due to the increase in the number of
CAM journals?


<INSERT FIGURE 3 ABOUT HERE>

1
Since year of foundation not is included in Medline, this information has been taken from the official webpages
of the journals. In some cases, as for the Chinese journals, the year has been estimated from the number of
volumes.

In this figure we subtract articles published in CAM journals and journals classified as
Medicine. It can be observed that the steady increase in CAM articles between 1975 and 1996
in great part is due to the increase in CAM journals. However, after 1996 the field displays a
rapid growth both within and outside this journal category. The expansion within the CAM
category evolves from 2,7% in 1975 (when just is one journal indexed in this catgeory) to
36,4% in 2003. (We can also see that the number of articles published in journals classified a
Medicine is relatively stable, although the share is decreasing.) These results are very much in
line with Table 1, where we can see that as many as 12 of the 18 journals, in the CAM
category, are included in Medline after 1996 i.e. during the period of dramatic expansion of
CAM as a scientific field.

The few number of CAM journals in Medline, can probably be explained by the fact that there
are few multiple classifications in the database (in this specific category, there are none). If
we look at other journal categories, such as Nursing, with a great share of CAM articles, we
find many journals that also could be classified as CAM (such as Complementary Therapies
in Nursing and Midwifery, Holistic Nursing Practice, Journal of Holistic Nursing). Measures
of expansion within and outside journal categories, such as CAM, therefore seem relatively
rough. We can expect an underestimation of the number of CAM journals and the volume of
articles published in these.

Content and development of CAM research
What is the content of CAM publications and has it changed over time? In Figure 4 we can
see that the character of CAM articles changes, especially at the beginning of the 1990
th
,
towards more clinical oriented research. A similar development can be identified in Medline
as a whole. The clinical trials expands from about 3% of the published articles in the early
1990
th
up to 6% at the end of the decade. However, the change is much more dramatic among
the CAM articles; from 7% in 1993 up to the double in a few years. From Figure 4 we can
also conclude that the expansion of clinical trials takes place both within and outside the
CAM journal category.

<INSERT FIGURE 4 ABOUT HERE>


The fact that the share of clinical trails in CAM journals increases rapidly in the early 90
th

might indicate that new types of journals are established. It can also reflect a general strive for
scientific proofs (or from a antagonistic perspective; falsification) and acceptance from the
scientific establishment (cf. Hess?) in order receive integration of CAM therapies in public
health.

But is there a general increase in clinical trials among CAM-therapies or just among a few
(for example, among those therapies that already are relatively integrated such as
acupuncture)? In Figure 5, with help from the hierarchical categories in MESH, we separate
four dominating sub fields (Mind Body therapies, Spiritual therapies, Musculoskeletal
manipulations, and Acupuncture) in the overall CAM category. Interestingly, we can see that
there is a substantial increase in all four sub fields. However, the increase is, as suspected,
most dramatic among Musculoskeletal manipulations and Acupuncture.


















References

Eisenberg et. al.

Eisenberg, et. al.

Eklf, M. [ed.] (2004) Perspektiv p komplementr medicin. Lund: Studentlitteratur.

Hess, D. (19xx) Scince in the New Age.

Jtte, R. , Eklf, M. & Nelson, M. C. [ed.] (2001) Historical Aspects of Unconventional
Medicine Approaches, Concepts, Case Studies. Sheffield: European Association for the
History of Medicine and Health Publications.


Skrp?
Establishment of CAM-journals can be interpreted in many ways. First of all, it can be a sign
of greater public interest in CAM in general and in different CAM subfields. It can also be a
sign of greater research activity and a scientific need of specialization. However, it can also be
a sign of work in progress of creating separate scientific fields, governed by, at least in part,
other scientific standards than the conventional medical field (cf. Hess 199x). This, in turn,
can also be the result of exclusion from conventional medical forums. The results presented
above, opens up for several interpretations. Since we both can identify internal and external
expansion

























Figure 1. CAM articles in Medline

0
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Figure 2. Percent CAM articles of Medline articles.
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Figure 3. Subtracting articles published in CAM and medical journals.



0
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Without articles published in CAM journals
All CAM articles
Without articles published in journals classified as Medicin

Name of Journal First year
in
Medline
Year of
foundation
Acupuncture and Electro Therapeutics Research 1981 1975
Acupuncture in Medicine Journal of the British Medical
Acupuncture Society
2001 1981
Advances in Mind Body Medicine 1999 1985
Alternative Therapies in Health and Medicine 1995 1995
The American Journal of Chinese medicine 1979 1972
China Journal of Chinese Material Medica 1989 1976
Chinese Medical Journal 1975 1887
Chinese Medical Sciences Journal 1991 1986
Complementary Therapies in Medicine 1999 1993
Fitoterapia 2000 1929
Forschende Komplementarmedizin und Klassische
Naturheilkunde
2000 1994
Homeopathy the Journal of the Faculty of Homeopathy 2002 1912/1995
Journal of Alternative and Complementary Medicine 1995 1995
Journal of Chinese Medicinal Materials 1997 1978
Journal of Traditional Chinese Medicine 1981 1981
Phytomedicine International Journal of Phytotherapy and
Phytopharmacology
1999 1994
Phytotherapy Research PTR 1999 1987
Chinese Journal of Integrated Traditional and Western Medicine 1992 1981
























Figure 4. Percent articles classified as clinical trails.
0,0
2,0
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Percent CAM articels classified as clinical trails
Percent CAM articles classif ied as clinical trails in CAM journals
Percent articles classified as clinical trails in Medline