One of the interesting contributions to science made by countries in regions that are considered “developing”, is what is labeled as “Alternative” or “Complementary” medicine (CAM) which stems from practices carried through thousands of years into modern times. Methods of healing using local herbs and plants or physical and spiritual elements penetrated Western medicine through the years, becoming an integral part of medical procedures in many countries around the world.

In this article, we sought to find out the extent to which CAM has penetrated modern practices by means of a bibliometric study that looks at journals, articles and citations of alternative medicine in mainstream medical research.

The diversity and sheer number of journals dedicated to Alternative or Complimentary Medicine (CAM) and the countries from which they originate is an interesting phenomenon. According to Ulrich’s Global Serials Directory (http://ulrichsweb.serialssolutions.com/) there are 358 active scientific journals categorized as CAM journals. Figure 1 visualizes the top publishing countries in the area of CAM. Perhaps not surprisingly, China is a leader in CAM journal publications. Many popular alternative medicine methods originated from China and carried through thousands of years making their way into Western medicine and culture. The same goes for India. It is interesting, though, to see leading Western countries such as the United States and Canada in North America and the United Kingdom, Germany, and France in Europe taking a leading role in the publication of CAM journals. This could be interpreted as an indicator of the high penetration rate of alternative medicine in the Western world.

Figure 1 - CAM journals publication by country. Source: Ulrich’s Global Serial Directory

 （上图是根据《乌利希报刊指南》，拥有CAM期刊最多的国家或地区，前三名是中国、美国、印度）

The number of new CAM journals launched in the past few decades tells a lot about the increasing scientific interest in Alternative Medicine. The largest growth in the number of journals published on the topic is seen from the 1960s to the 1980s and from the 1990s to the 2000s (see Figure 2).

The growth of scientific journals focusing on CAM can be attributed to the direct funding of CAM research received in the 1990s. In 1998, for example, the United States congress established the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health. The NCCAM funds university-based centres for research on CAM. This funding stimulated researchers to apply for grants and conduct research in this area, the results of which are published in an ever growing number of dedicated scientific journals. There is similar funding in Europe, where research funded nationally and by the European Commission is conducted by over 50 different foundations, universities and research centers (1). The availability of monetary means to support such research has a direct impact on publication growth.

Figure 2 - Growth in the number of CAM journals launched. Source: Ulrich’s Global Serial Directory

（上图是不同年代创刊的CAM期刊的数量，三、四十年代创刊的不到10种，进入21世纪后新创刊的已经接近100种！）

Based on Ulrich’s Global Serial Directory, English is the leading publication language in CAM journals publications as can be seen in Figure 3. As such, CAM can be seen as a part of the global scientific discourse, as English is no doubt the most common language published in science.

Figure 3 - Publication languages of CAM journals. Source: Ulrich’s Global Serial Directory

（CAM期刊的语种分布，前4名是英文、中文、日文和法文）

In addition to the trends in growth of journals published in this area, we also examined the citations characteristics of this topic and especially the growth of cited references to CAM journals, the top cited CAM journals and the top citing journals from disciplines other than CAM. The purpose of this analysis was to try and establish how this topic evolved in terms of its scientific activity and the manner of exchange between CAM research and other disciplines.

In the first step in our analysis we conducted a Scopus search of all CAM journals indexed by Ulrich’s Global Serial Directory. We then retrieved all the cited references to the CAM journals found. The cited references analyzed here include all publications regardless of their coverage in Scopus. Since Scopus displays all references listed in each publication it indexes, whether their source is indexed in the database or not, it is possible to analyze them in a complete manner. It is important to note here that this analysis depends on database coverage and might result in different numbers of references if a different database is used.

As can be seen in Figure 4, there is an evident and significant growth in the number of cited references to CAM journals and articles through the years. This could indicate a growing research agenda and scientific network around topics and issues related to CAM. Although these numbers do not differentiate between cited references appearing in articles in journals focusing on CAM to those appearing in other disciplines, the mere growth of cited references exchange points to the increased activity in this area of research.

Figure 4 - Cited References to CAM journals and articles. Source: Scopus

 （SCOPUS数据库建立以来，CAM期刊的被引用次数走势）

In addition, we examined the most cited CAM journals. Figure 5 shows the top 10 most cited journals in this area which include Evidence Based Complementary and Alternative Medicine, Journal of Alternative and Complementary Medicine and the American Journal of Chinese Medicine as leading journals.

Figure 5 - Top cited CAM journals. Source: Scopus

 （被引次数最高的CAM期刊，第一名是《循证补充替代医学》杂志，第四名是《中国结合医学杂志》（英文版）。

Finally we examined the top 50 most cited articles in CAM journals and looked at the top journals that cite them. As can be seen from Figure 6, PLOS One has the most citations to CAM articles. However, it must be noted here that PLOS One is an exception as it publishes thousands of articles every year compared to other journals that have more moderate rates of publications. This by itself could be a factor in its prominent place in the top citing journals. The inclusion of PLOS One in our analysis stems from the fact that it is a mainstream Medical journal and thus fits the criteria of our analysis. CAM articles cited in PLOS One were mainly in the areas of Agricultural and Biological Biochemistry, Genetics and Molecular Biology and general Medicine. Other journals citing CAM articles include journals focusing on Chemistry and Pharmacology such as the Journal of Ethnopharmacology and the Journal of Agricultural and Food Chemistry. In addition, journals focusing on internal medicine, pain management and cardiology are also seen to be citing CAM articles.

Figure 6 - Journals most frequently citing CAM periodicals. Source: Scopus

（引用CASM期刊最多的期刊，第一名是PLoS One。由此图可见CAM以外的学科对CAM的兴趣。）

According to the 2009 “National Health Statistics Report” published by the the US Department of Health and Human Services, the American public spent over 33 billion dollars on CAM practitioners and purchases of CAM products, classes, and materials (2). As awareness of nutrition and general well-being as well as a holistic approach to health is gaining more momentum, more and more people seek self-care CAM therapies such as homeopathic products, yoga, and natural products. Moreover, Alternative Medicine and complimentary health services are becoming an integral part of mainstream medical practices and are in many countries sponsored by governments’ health systems. Practices that could have been considered esoteric or exotic a couple of decades ago, are now to be found almost everywhere in the world. These originated from regions and countries that are or were considered ‘developing’ and managed to penetrate and influence science, medicine and human well-being for years to come.