Complementary and Alternative Medicine

CASE SCENARIO 1

A known diabetic managed for diabetic foot 4 months prior came to the clinic, saying he would commence the use of quail eggs and "zogali" moringa leaves to control his blood sugar, as recommended by a friend. How should his doctor respond?

CASE SCENARIO 2

H.P., a 28-year-old teacher, was prescribed Addyzoa by his wife's gynecologist for Azoospermia. After six months, his wife conceived, and they now have a baby after three years of delay. Anyone with an experience like this?

WHAT IS COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM)?

Health care can be broadly divided into 2:

1. Modern: Conventional, Orthodox, Western, or Allopathic
2. Traditional: Indigenous, Complementary, Alternative, or Integrative

In modern medicine, knowledge expansion is achieved through scientific research. This is in sharp contrast to the situation with traditional medicine.

CAM is a group of diverse medical and health care systems and practices that are not generally considered to be part of conventional medicine.

Scientific evidence exists regarding some CAM therapies, but for most, key questions are yet to be answered through well-designed scientific studies.

Definitions

ALTERNATIVE MEDICINE: any practice that is perceived by its users to have healing effects of medicine but does not originate from evidence-based scientific methods and is not a part of biomedicine or standard care.

COMPLEMENTARY MEDICINE: used together with conventional medicine.

INTEGRATED/INTEGRATIVE MEDICINE: refers to a practice that combines both conventional and CAM treatments for which there is evidence of safety and effectiveness.

CONVENTIONAL MEDICINE: is medicine practiced by a medical doctor, doctor of osteopathy, and other health professionals (Nurses, Dentists, etc.).

C.A.M- NIGERIAN STORY

• The World Health Organization made a recommendation that each nation should have a national policy on C.A.M as well as national regulation of traditional and herbal medicines.
• In the 1980s, policies were established to accredit and register traditional medicine practitioners and regulate the practice.
• Registration requirements for chiropractors and osteopaths are outlined in the Medical Rehabilitation Therapists Decree of 1988.
• In 1994, state health ministries were mandated to set up boards of traditional medicine to enhance its contribution to the Nation's official health care delivery system.
• In 2000, the Traditional Medicine Council of Nigeria Act was proposed.
• Functions of the Traditional Medicine Council of Nigeria iclude the following-
1. Facilitating the practice and development of traditional medicine.
2. Establishing guidelines for the regulation of traditional medicine practice to protect the population from quackery, fraud, and incompetence.
3. Liaising with state boards of traditional medicine to ensure adherence to policies and guidelines outlined in the Federal Medicine Board Act.
4. Collaborating with organizations with similar objectives within and outside Nigeria.

Epidemiology in the USA

• An estimated out-of-pocket expenditure for complementary health practice in 2007 was $34 Billion.
• It accounted for a total of 1.5% of the total expenditure.
• There are about 30,000 herbs on the market.
• About 600 million visits a year to C.A.M providers.
• The prevalence is 40% of adults using CAM.

Epidemiology in Africa

Ethiopia: Prevalence was 67.8%.

Nigeria:

• Prevalence in Lagos was 88.5%.
• Prevalence in Sokoto was 84%.
• Prevalence in Enugu was 84.7%.
• Prevalence in Ilorin was 68%.

Males to Females ratio = 1:1.7

Commonly used C.A.M included:

• Biological products
• Prayer and faith healing

Reasons for Use

• Up to 80% of developing country populations rely on traditional medicine for their primary health care, due to cultural tradition or lack of alternatives.
• In the developed countries, people seek out CAM on the assumption that natural means safe.
• Affordability and availability.
• Incessant advertisement.
• Health promotion and maintenance.

Classification of CAM	Examples
Whole Body Systems	Ayurveda, Traditional African Medicine, Chinese Acupuncture
Manipulative and Body Based Practices	Chiropractic, Osteopathy, Massage
Biologically Based Principles	Naturopathic Medicine (e.g., ginger, garlic), Homeopathy, Aromatherapy, Dietary Supplement, Herbs
Mind Body Therapies	Biofeedback, Faith and Prayers, Dance, Art, Music, Hypnotherapy, Meditation, Cognitive Behavioral Therapy
Energy Therapies	Biofield Therapies and Biomagnetic-Based Therapies (Pulsed Fields, Magnetic Fields, Alternating/Direct Current Field)

WHOLE BODY SYSTEMS

1. AYURVEDA

   • It evolved from India.
   • It encourages the use of certain lifestyle intervention and natural therapies to regain balance between the body, mind, spirit, and environment.
   • It is based on the idea that disease is caused by an imbalance or stress in a person’s consciousness.
   • It is the major East Indian traditional medicine system; treatment includes meditation, diet, exercise, herbs, and elimination regimens using emetics and diarrheals.

2. TRADITIONAL AFRICAN MEDICINE

   • This is a holistic discipline involving indigenous herbalism and African spirituality, typically involving diviners, midwives, and herbalists.
   • Claims are made for the cure of various conditions such as cancers, psychiatric disorders, high blood pressure, venereal diseases, epilepsy, asthma, eczema, fever, etc.
   • There is increased interest in this form of practice in Africa due to poor access to conventional medicine as well as its high cost.
   • The diagnoses and chosen methods of treatment are based on sociocultural beliefs and rely heavily on spiritual aspects.
   • The African culture believes that "nobody becomes sick without sufficient reason. The search is not for ‘what’ causes the disease but ‘who’."
   • Diseases are believed to stem from a lack of balance between the patient and his or her social environment or the spiritual world, not by natural causes.
   • Sickness is often attributed to guilt by the person, family, or village for a sin or moral infringement. The illness, therefore, would stem from the displeasure of the gods or God, due to an infraction of universal moral law.
   • Incantations are sometimes used for diagnosis and treatment and may require not only medication but sacrifices as well.

3. ACUPUNCTURE

   • This is a practice where the skin is penetrated with thin solid metallic needles.
   • These needles are activated through gentle and specific movements of the practitioner's hands or with electrical stimulation.
   • This stimulates the CNS which, in turn, releases chemicals (endorphins, norepinephrine, and enkephalins, which are said to be more potent than morphine) into the muscles and spinal cord, stimulating the body’s natural healing abilities.

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MANIPULATIVE AND BODY BASED PRACTICES

1. Chiropractic Medicine

   • Manipulation of the spine can improve a person’s health without surgery or medicine.
   • It is based on the link between the alignment of the spine and the function of the body.
   • Used in treating certain lower back pain and muscle pain.

2. Osteopathy

   • Manipulative treatments are applied to the joints, and bones to bring about improved health by releasing endocannabinoids.

3. Therapeutic Massage

   • Manipulation of the muscles is used to achieve balance in health.
   • Helps in the management of stress.

BIOLOGICALLY BASED PRINCIPLES

1. NATUROPATHY

   It is based on the principle that a disease can be successfully treated or prevented without the use of drugs, rather by the use of natural interventions e.g., herbs

2. HOMEOPATHY

   It is a natural form of medicine to treat acute or chronic conditions. Originates from Germany. Works with the principle that substances taken in small amounts will cure the same symptom it causes when taken in a large amount. Stimulating a healing process and strengthening the body’s own healing abilities.

3. HERBAL MEDICINE

   • Herbal medicine or herbalism, the oldest known form of health care, uses plants and plant extracts to treat disease and promote wellness.
   • Either a single herb or a mixture of different herbs can be used.
   • Chinese herbal medicine mixtures can also contain minerals and animal parts.
   • Unlike conventional drugs, in which a single, active chemical may be extracted and isolated, herbal medicine usually makes use of the medicinal plant in its whole form.
   • Many drugs used in conventional medicine were originally derived from plants.
   • Salicylic acid is a precursor of aspirin that was originally derived from white willow bark.
   • Quinine and Artemesinin are antimalarial drugs derived from Cinchona pubescens bark and Artemisia annua plant respectively.
   • Morphine and codeine are derived from the poppy plant.
   • Digitalis is a cardiac glycoside derived from foxglove plant.

MIND-BODY THERAPIES

1. Biofeedback

   • It’s a mind-body technique.
   • Uses various monitoring devices to create conscious control over physical processes normally under automatic control of the body.
   • Helps with blood pressure, heart rate, body temperature control, breathing pattern, and muscle responses.

2. Meditation

   • A form of mind-body technique used to create control over physical processes under automatic control, e.g., blood pressure, heart rate, etc.

ENERGY THERAPIES

1. Biofield Therapy

   • The use of energy fields to restore balance and health by stimulating the healing process. Includes therapeutic touch, healing touch, pranic healing (using colors and crystals), and Reiki (use of hands on the body to align with chakras-spiritual powers).

2. Biomagnetic-Based Therapy

   • Use of specialized magnets to scan, detect, classify, measure, and correct pH imbalances of living organisms. It is believed that when the pH of an organ/system is correctly balanced, it creates a hostile environment for any pathogen to reside, effectively neutralizing it.

• Lack of funding for research
• No scientific basis
• Lack of regulatory bodies
• Difficulty in formulating protocols
• Non-standardization of herbal formulations
• Unknown side effects
• Non-effective / harmful products
• Polypharmacy, Drug interactions

• Build rapport and show patient respect
• Be non-judgmental despite personal opinion
• Understand that CAM can be beneficial when used correctly
• Be aware that CAM can be dangerous if it interacts with conventional treatment
• Educate the public about the positive and negative information regarding CAM
• Be aware that the use of CAM is popular and increasing and must be included as part of the history

• Conventional model of healing need not preclude other approaches to healing.
• Physicians need to know available alternatives – the principles and philosophies guiding them, efficacy, adverse reactions, researched status, etc., of these alternatives.
• Supporting evidences of reliability and accountability – so they can appropriately advise their patients who may wish to use other alternatives.
• Patients’ belief in other alternatives may be therapeutic not just placebo (e.g. faith healing); sometimes patients may just derive a placebo effect, and every opportunity should be given to guide such patients back into conventional medicine to prevent loss of essential timely interventions.