Most of the medicine practiced the United States is Western, or to us, traditional medicine. Non-Western, nontraditional medicine is usually called alternative medicine. Some alternative medicine—acupuncture, meditation, herbology—has its roots in the thousand-year heritage of Eastern philosophy. Some alternative medicine—psychoneuroimmunology, visualization, homeopathy—is more recent and is sometimes connected to traditional medicine. Most physicians who practice traditional medicine do not understand alternative medicine. What they do not understand, they cannot advocate.     Most physicians practicing traditional medicine do not understand alternative medicine for two reasons: unfamiliarity and skepticism. Physicians are unfamiliar with alternative medicine, despite the fact that the principles of some forms of alternative medicine have preceded traditional medicine by several centuries, because those principles are not taught in medical school, are rarely taught in postgraduate education, and are not published in most medical journals.   Physicians are also skeptical of alternative medicine because alternative medicines have not had to pass the rigorous tests of validity imposed by the FDA when it approves drugs, or by medical journals when they approve publication. These traditional tests have to their credit most of the medical achievements of the twentieth century.     Physicians practicing traditional medicine have several concerns about alternative medicine. One is that alternative medicine might cause harm. Another is that alternative medicine might be used instead of traditional medicine. A third is that some forms of alternative medicine have an entrepreneurial element: that is, in some cases, someone is getting rich by selling treatments of doubtful benefit to people who are desperate.     Another concern is that claims are commonly made that some treatment has a specific and measurable benefit, but the benefit is not adequately documented. For example, one frequent claim is that some alternative treatment inhibits HIV in the test tube. The problem with that claim is that a drug that works in a test tube may not work in the body. There are several reasons for this: the concentration of the drug might be wrong; the drug may never get to the site of infection; or the conditions in the body are too different from those in the test tube.     Even more common are claims that some alternative treatment strengthens the immune system. Most such claims falter when scrutinized carefully. The problem is that the immune system has been studied extensively, but much of that study is relatively recent and the immune system turns out to be extremely complicated, to have many interacting parts. Many studies seem to show that almost any treatment—be it vitamins, diet, drug, or a change in behavior—has some measurable effect on some part of the immune system. HIV infection disturbs a certain specific part of this complicated immune system, and boosting a different part of the immune system may be as naive as putting oil in a car that is out of gas. In other words, claims that the functioning of the immune system has improved are true for almost any kind of treatment if you measure enough of the parts of the immune system. But no one knows how a change in one part of the immune system affects the other parts, or whether such changes in the immune system have any important effect on someone’s general health.     The final concern that physicians have about alternative medicine is that people often claim that alternative treatments have been responsible for someone with HIV remaining well for prolonged periods. But, in medicine, exceptions are the rule. Studies have shown that even without medical treatment at all, 5-10 percent of the people with AIDS survive for five years. Be careful about the anecdote, the exceptional case. Remember that the history of medicine is replete with miracles that have happened in spite of treatment, not because of it. This is the reason for the strictness of the controls on a clinical trial: sufficient numbers of cases assure that differences in the results are not due to chance alone.     There are also arguments in favor of alternative medicine. First, it is presumptuous to conclude that because alternative medicine lacks scientific validity, it does not work. Alternative medicines have rarely even been tested for scientific validity. Second, people who use alternative medicine have profound faith in its benefits; such faith seems to allow people with HIV infection to gain the sense of control that is crucial not only to psychological health but possibly to physical health as well. A new field in traditional medicine, called psychoneuroimmunology, has preliminary evidence that physical health and immune function are partially affected by psychological health. In other words, your mental health can affect your physical health, including the strength of your immune system. Psychoneuroimmunology is a new field, and no one yet knows its relevance to HIV infection. But it would be as presumptuous at this point to conclude it does not work as it would be to argue that it certainly does.     A third argument in favor of alternative medicine is that, in many cases, the drug causes no harm, the people supplying the drug are often driven by a sincere interest in the welfare of people with HIV infection, and some people with HIV infection have exhausted the approved drugs and understandably need to do -something about their medical treatment.     Because of these arguments, most physicians practicing traditional medicine are willing to accept—if they cannot advocate—alternative medicine. Their acceptance has two caveats: that alternative medicine not be harmful, and that it not be used instead of traditional medicine.          Regardless of their physicians’ opinions, up to a third of the people with HIV infection are using some form of alternative medicine. The forms of alternative medicine that seem to be used most frequently are underground drugs, acupuncture, macrobiotic diets, megavitamin treatment, and mind work. Most people with HIV infection who use alternative medicine also use traditional medicine. Many of these people are reluctant to share this information with their physicians, and as a result, are operating without medical advice about this part of their health care.      With this in mind, the following section lists some of the most common forms of alternative medicine—treatment is a better word, since some of these alternatives are not medicines—outlines what the treatments claim to do, lists the side effects, and assesses whether the treatment is likely to be harmful.*190\191\2*