Is Alternative Medicine Compatible with Science?

Why ask the question?
The question implies a conflict, a potential incompatibility. If this doesn’t actually exist, then the subject is moot and we can all go home early. 

Proponents of complementary and alternative veterinary medicine (CAVM- also labeled “holistic,” “integrative,” “natural,” and many other terms we will explore shortly) typically claim that science and evidence support their practices. They recognize the marketing value of science, and they often assert that the conflict is a mere misunderstanding, or the result of ignorance, prejudice, or avarice rather than a true conflict between their approach and that of science-based medicine.

For example, the online College of Integrative Veterinary Therapies advertises its curriculum as “a wide range of evidence-based courses…bridging cutting edge science and tradition.”¹ A prominent proponent of so-called Traditional Chinese Medicine claims that integrative medicine “provide[s] comprehensive, evidence-based care that integrates the best of conventional and complementary approaches for the well-being of animal patients.”² You can read journals like Evidence-based Complementary and Alternative Medicine, or articles reporting clinical trials evaluating Reiki, “a biofield therapy currently used in hospitals worldwide [with] scientific evidence [that] supports its effectiveness in addressing many physical and emotional conditions.”³ Even the World Health Organization states that “Evidence-based complementary medicine has the potential to support mainstream medicine and more comprehensively support people’s health and well-being needs.”⁴

So what’s the problem? Why ask the question at all? Well, the problem is that despite both honest and disingenuous efforts to coopt the language of science and EBM, most of what we typically label CAVM is founded in beliefs and models of nature incompatible with a scientific understanding, and these practices are validated almost entirely by faith, personal experience, cultural tradition, and poor-quality efforts to mimic rigorous scientific investigation. EBM is more than a collection of jargon; it is an approach to knowledge that conflicts directly and forcefully with the philosophy underlying much of CAVM. 

Sometimes this divide can be bridged and truly scientific evaluation of CAVM methods can be undertaken. When this happens, the results mostly show these methods don’t work. In the rare cases where they do, they can, and should, simply become part of medicine, stripped of their mystical folk belief systems. In the words of two former editors of the New England Journal of Medicine, 

“There cannot be two kinds of medicine—conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted.”⁵

It is instructive to note, though, that proponents of CAVM often object to this type of deep acceptance, arguing it strips away the very core of what make their methods valuable. This illustrates the depth of philosophical incompatibility between science and most of CAVM. As these defenders put it: 

“Any CAM practiced its original way cannot be the same as its biomedical version.…If the biomedical paradigm is adopted, the system will have the characteristics of that paradigm- materialistic, mechanistic, reductionistic, linear-causal, and deterministic.”⁶

“Scientifically constructed ‘evidence’ for an alternative therapy only works when the therapy has mutated into a medicalized version and divested itself of its alternative philosophy. The very publication of trials can act as a reformulation of the very nature of a therapy, generally in the direction of medicalization.”⁷

The only reason CAVM exists as a category, then, is to highlight the special origins of certain practices as different from those accepted in science-based medicine. This serves both a marketing purpose (selling treatment that is “special” and “different” from conventional medicine) and also as an excuse for utilizing treatments without the type and level of evidence expected for mainstream medicine. 

Doctors who would never prescribe a new antibiotic with undisclosed ingredients and no clinical trial data showing safety or efficacy, one that is purported to kill bacteria by targeting its “energy signature,” will happily prescribe herbal or homeopathic remedies with no better evidence. The labels of “natural” or “traditional” are used as excuses to imply safety and effectiveness and evade the normal standards of evidence.

“By definition…complementary and alternative medicine…has either not been proved to work or been proved not to work. Do you know what they call alternative medicine that’s been proved to work? Medicine.
Tim Minchin”⁸

What is CAVM?
Before I go further, I should try to define CAVM. This is harder than it sounds because the term encompasses a variety of approaches that conflict with science-based medicine in different ways, to different degrees, and that often conflict just as much with each other. The unity, such as it is, lies not in any shared understanding of nature or of how medical therapies should be validated, though there is some broad agreement on elements of these. The real bond that connects CAVM approaches is their status as “other,” defined in opposition to science-based medicine. 

This opposition may be based on conflicting views of nature, competing cultural traditions, or simple part of a promotional strategy to distinguish oneself and one’s practices from other vets and what they offer. The “alternative” in CAVM was the original term for this loose collection of approaches, and it was meant to designate a replacement for conventional, science-based medicine. That proved too much for most human patients, and for most animal owners, who were mostly unwilling to abandon the obviously successful approach that brought us vaccination, antibiotics, and emergency rooms. 

This led to the adoption of the term “complementary,” suggesting it was beneficial to use unscientific or unproven practices alongside science-based medicine. This has been more successful, but proponents of CAVM dislike the implication that what they offer is an afterthought or second-rate compared with conventional medicine. This has led to the most successful label; “integrative medicine.”

The idea behind this label is that scientific and alternative therapies are different but equally useful tools available to veterinarians, and each should be used when appropriate without any distinctions based on their underlying theoretical rationales or history. The term suggests we can seamlessly blend alternative and conventional therapies, that they are equally useful and reliable tools we can select from for the medical job at hand. 

However, this obscures the reality that there are important practical and philosophical differences between how alternative and conventional therapies are developed, tested, and employed, and these differences matter. Integrative implausible, unproven, or demonstrably ineffective therapies with scientifically validated treatments adds no benefit for the patient, and it can even do harm. 

As infectious disease specialist Mark Crislip has put it, somewhat scatologically, “If you mix cow pie with apple pie, it does not make the cow pie taste better; it makes the apple pie worse.” (for those not familiar with the English idiom “cow pie,” it refers to bovine feces)

The Conflict: Philosophy
The core conflict here is philosophical. In terms of epistemology (the science of how we know things), proponents of CAVM largely reject the diagnosis of the disease EBM, and science generally, exists to treat. Forms of evidence viewed as weak and unreliable by EBM are privileged in CAVM, and those types of evidence higher on the pyramid are seen, at best, as nice to have but fundamentally unnecessary to support a given clinical practice. At worst, they reject the very idea that such evidence is more accurate or reliable than personal observation, anecdote, tradition, or pure faith. Science often serves only a marketing function in CAVM, not a meaningful role in choosing and rejecting ideas and practices.

Philosophically, CAVM relies predominantly on trust in personal belief and observation, and in the historical beliefs of individuals or previous generations of folk medicine practitioners. The most extreme proponents reject the hierarchy of evidence behind EBM entirely:

“[EBM] buttresses the idea that there is a legitimate hierarchy of knowledge and method with the [randomized control trial] as the gold standard and the clinician’s notes, observations, and judgments right down there in status with ethnography, sociology and anecdote…there are practitioners of naturopathic modalities who do not subscribe to this hierarchy at all”⁹

“For ancient and traditional healing modalities, one could argue that history provides the evidence on which to base clinical practice…One cannot conclude that, because a healing system cannot be measured conventionally, it is ineffective or unsafe.”¹⁰

“Users of homeopathy did not see a need for scientific testing and were happy with their own judgment of whether the treatment was working for them…[Randomized clinical trials] came at the bottom of their hierarchy of evidence.”⁷

“The invocation of a saint can cure intractable cancer; a voodoo curse can kill.… A shaman applying a curse does not consider it to be a placebo, nor does his victim. To them, real magic is involved…We can never prove the shaman wrong, only offer an alternative explanation.”⁶

“As a veterinarian now practicing homeopathy and chiropractic almost exclusively, I have all the proof I need every day in my practice to justify these modalities.”¹¹

Another key source of the incompatibility of CAVM and EBM is the problem of vitalism. At the heart of most alternative approaches, whether explicit or hidden, is a belief that living entities are defined by nonphysical energetic or spiritual forces, and health cannot be maintained or restored by any system that does not account for these forces. Homeopathy, chiropractic, Reiki and other “energy” therapies, traditional Chinese medicine (from which derive most of the forms of acupuncture practiced today), and many other CAVM approaches were born from this pre-scientific belief in spiritual forces as the cause of disease. 

While proponents of many of these methods have tried to paint over this idea with more modern scientific language (referencing quantum physics or bioelectricity, for example), the concepts often remain central to their practices. 

“Acupuncture reconnects and balances Life energy.… Energy medicines such as homeopathy, homotoxicology, Reiki, craniosacral therapy, and others align the physical, mental, and spiritual portions of the organism. Yes, I did say spiritual and that is a big part of holistic medicine—recognizing the spiritual nature of Life.”¹²

“pharmacological and surgical approaches appear incomplete…because they ignore the Vital Force which animates and breathes life into the biomachinery of living systems”¹³

“Because medical science has defined itself on a strictly physical basis, it is true that vitalism is unscientific. By definition, vitalism embraces a concept about a nonphysical force that can never be understood within the current scientific, medical paradigm.”¹⁴

“The belief that spiritual, emotional, psychological, or other non-measurable aspects of the individual patient’s presentation are important for healing does not require one to reject evidence obtained from clinical trials, but it does require the recognition that knowledge gained from such methods will be insufficient to guide optimal clinical practice…The importance of Qi in traditional Chinese medicine means that research that cannot and does not account for the force will never be compelling for a practitioner.”¹⁵

Even when disavowed, these mysterious forces leave gaps in causal reasoning left unfilled by scientifically legitimate concepts. Chiropractors have largely replace Palmer’s “innate intelligence” with the “vertebral subluxation complex,” but this has not been convincingly shown to exist.¹⁶ The “energy” behind Reiki and other supposed energy therapies cannot be detected except by those who already believe in it.¹⁷ And for all the thousands of pages devoted to finding a consistent, predictable reason why acupuncture should have beneficial clinical effects, no clear and compelling mechanism has been demonstrated.¹⁶ All of these methods, and even some more plausible CAVM practices such as herbal medicine and laser therapy, use scientific language to cover the core principle, which is some undetectable magical force inconsistent with a scientific understanding of physics and biology.

The Conflict: Practice
The most unfortunate aspect of CAVM is that it is largely defined and marketed in opposition to science-based medicine. Using it requires at least some level of acceptance of principles and forms of evidence not compatible with an evidence-based approach; and all too often it requires an outright rejection of mainstream medicine.

Use of alternative therapies is associated with less confidence in science-based medicine and less effective use of conventional tests and treatments.^18–20 This, in turn, is associated with poorer outcomes, such as shorter survival in cancer patients and greater risk of preventable infectious disease with vaccine refusal. While there is scant evidence to support claims that integrating alternative therapies with scientific medicine improves outcomes, it is clear that it can sometimes worsen them. 

Both the growing popularity of alternative treatments and the growing suspicion of science and science-based medicine stem from the same cultural and political factors, issues that have little to do with what is actually best for patients.

Ideally, every idea for assessment and treatment of our patients would go through the necessary steps of scientific evaluation: 

• development of a biologically plausible theoretical foundation compatible with established knowledge
• validation of this foundation and demonstration of possible benefits and risks in pre-clinical research
• testing in real-world patients through properly designed, conducted, reported, and replicated clinical trials

Not every step is always possible, and the evidence we have is often flawed and incomplete, for both science-based and alternative medicine. But this path is at least the aspiration of EBM, while is generally not seen as necessary or even desirable for CAVM. While EBM looks forward, developing new interventions and abandoning those that deserve to be left behind, CAVM looks backwards, mining the pre-scientific past for ideas and then setting out to create the impression of modern, scientific legitimacy without a genuine willingness to reject them if the data says we should.

Individual therapies may begin in the CAVM domain and pass into truly evidence-based practice. And some apparently science-based practices may drift into CAVM if evidence develops suggesting they should be abandoned but practitioners are unwilling to do so. However, for the most part CAVM and EBM will remain incompatible, oil and water, interacting but separated by incompatible philosophies, epistemologies, culture and politics, and fundamentally different views of how we should judge our practices.

References

1.         College of Integrative Veterinary Therapies. College of Integrative Veterinary Therapies. Accessed October 14, 2025. https://civtedu.org

2.         Marsden S. The New Era of Evidence-Based Medicine: Can We Survive It? American College of Veterinary Botanical Medicine Blog. May 11, 2025. Accessed October 14, 2025. https://acvbm.blog/2025/05/11/the-new-era-of-evidence-based-medicine-can-we-survive-it/

3.         Barbieri CR. Impact of Distant Reiki on Owner Assessment of Health and Wellbeing of Adult Dogs: A Blinded, Placebo-controlled, Randomized Trial. J Am Holist Vet Med Assoc. 78(Summer):11-19.

4.         Traditional, Complementary and Integrative Medicine. Accessed October 14, 2025. https://www.who.int/health-topics/traditional-complementary-and-integrative-medicine

5.         Angell M, Kassirer JP. Alternative medicine–the risks of untested and unregulated remedies. N Engl J Med. 1998;339(12):839-841. doi:10.1056/NEJM199809173391210

6.         Churchill W. Implications of evidence-based medicine for complementary and alternative medicine. J Chin Med. 1999;59:32-35.

7.         Barry CA. The role of evidence in alternative medicine: contrasting biomedical and anthropological approaches. Soc Sci Med 1982. 2006;62(11):2646-2657. doi:10.1016/j.socscimed.2005.11.025

8.         Minchin T. Storm. Orion Publishing; 2014.

9.         Jagtenberg T, Evans S, Grant A, Howden I, Lewis M, Singer J. Evidence-based medicine and naturopathy. J Altern Complement Med N Y N. 2006;12(3):323-328. doi:10.1089/acm.2006.12.323

10.       Curtis P. Evidence-Based Medicine & Complementary & Alternative Therapies. In: Curtis P, Gaylord S, Norton S, eds. The Convergence of Complementary, Alternative, and Conventional Health Care: Educational Resources for Health Professionals. UNC School of Medicine, Program on Integrative Medicine; 2004:Chapel Hill, NC. Accessed October 16, 2025. https://www.med.unc.edu/phyrehab/pim/wp-content/uploads/sites/615/2018/03/Evidence-Based-Med.pdf

11.       Jewell G. Comments on practising complementary and alternative modalities. Can Vet J. 2000;41(5):351.

12.       Kerns N. Alternative views on canine holistic dog care. Whole Dogs Journal. September 13, 2007. Accessed October 16, 2025. https://www.whole-dog-journal.com/care/alternative-views-on-holistic-dog-care/

13.       Stefanatos J. Introduction to bioenergetic medicine. In: Schoen A, Wynn S, eds. Complementary and Alternative Veterinary Medicine: Principles and Practice. Mosby; 1998:227-245.

14.       Knueven D. An introduction to holistic medicine. In: The Holistic Health Guide: Natural Care for the Whole Dog.TFH Publications; 2008:9-13.

15.       Tonelli MR, Callahan TC. Why alternative medicine cannot be evidence-based. Acad Med J Assoc Am Med Coll. 2001;76(12):1213-1220. doi:10.1097/00001888-200112000-00011

16.       McKenzie BA. Placebos for Pets?: The Truth About Alternative Medicine in Animals. Ockham Publishing; 2019.

17.       Rosa L, Rosa E, Sarner L, Barrett S. A Close Look at Therapeutic Touch. JAMA. 1998;279(13):1005-1010. doi:10.1001/jama.279.13.1005

18.       Johnson SB, Park HS, Gross CP, Yu JB. Complementary Medicine, Refusal of Conventional Cancer Therapy, and Survival Among Patients With Curable Cancers. JAMA Oncol. 2018;4(10). doi:10.1001/jamaoncol.2018.2487

19.       Cordonier L, Cafiero F. ?The link between interest in alternative medicine and vaccination coverage?. Rev Eur Sci Soc. 2023;611(1):175-197.

20.       Cramer H, Bilc M. Use of complementary medicine and uptake of COVID-19 vaccination among US adults. Front Med. 2025;12:1474914. doi:10.3389/fmed.2025.1474914