Introduction to alternative, Complementary and Integrated Medicine
Any therapeutic procedure or system of treating diseases that falls outside the scope of conventional scientific evidence based system is considered alternative or complementary medicine. We have kept alternative medicine separate from quackery because of the following reasons. All the different alternative forms of medicine generally follow a specific system either traditional or invented recently.
NomenclatureComplementary & Alternative Medicine (CAM)
- All such systems offer a philosophy or theory of healing different from the conventional scientific approach.
- By and large all such alternative forms of medicine till today stand scientifically unproven because once they get the proof they will become the part of mainstream conventional treatment.
- All such systems warrant proper scientific research before clearly labeling them ineffective or useless but letting them continue unmonitored practice till that time is not justifiable.
- Quackery on the other hand is a different issue. The quacks are those self proclaimed experts who have not received training in conventional or any of the alternate systems of medicines. They may adopt any modality of treatment and claim to be the experts in any of the methods. Quacks are frauds and criminals and they need to be dealt with by law with full force.
Generally speaking all the types of therapeutic practices which do not fall under the realm of convention Medical Practice are called alternate or complementary medicine.Traditional Medicine
Traditional medicine is the sum total of knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures that are used to maintain health, as well as to prevent, diagnose, improve or treat physical and mental illnesses.Herbal medicines
These include herbs, herbal materials, herbal preparations, and finished herbal products that contain parts of plants or other plant materials as active ingredients.Integrated Medicine
It is a concept of therapeutic practice in which the therapeutic methods emanating from any one of the complementary or alternative forms are utilized in the conventional practice by the conventional practitioners. In this way certain therapeutic techniques or medicines of alternate system are utilized by the conventional medicine.
In many countries certain traditional or alternate forms of medicine have been authorized to practice alongside the conventional therapeutic systems. Such systems are thus integrated into the health system of such countries. In Pakistan we have Homeopathy, Tib e Yunaani and Ayurvedic systems integrated into our health system and have given them practice authorization through legislations.Beijing Declaration 8 November 2008
In accordance with national capacities, priorities, relevant legislation and circumstances, hereby make the following Declaration:
- I. The knowledge of traditional medicine, treatments and practices should be respected, preserved, promoted and communicated widely and appropriately based on the circumstances in each country.
- II. Governments have a responsibility for the health of their people and should formulate national policies, regulations and standards, as part of comprehensive national health systems to ensure appropriate, safe and effective use of traditional medicine.
- III. Recognizing the progress of many governments to date in integrating traditional medicine into their national health systems, we call on those who have not yet done so to take action.
- IV. Traditional medicine should be further developed based on research and innovation in line with the "Global strategy and plan of action on public health, innovation and intellectual property" adopted at the Sixty-first World Health Assembly in resolution WHA61.21 in 2008. Governments, international organizations and other stakeholders should collaborate in implementing the global strategy and plan of action.
- V. Governments should establish systems for the qualification, accreditation or licensing of traditional medicine practitioners. Traditional medicine practitioners should upgrade their knowledge and skills based on national requirements.
- VI. The communication between conventional and traditional medicine providers should be strengthened and appropriate training programmes be established for health professionals, medical students and relevant researchers.
History of Health Systems
Since ages humans have been using various methods of treating illnesses.
Some of the well defined systems were based upon human understanding of health and disease and those formed complete health systems like Ayurvedic and Traditional Chinese medicine. While other were isolated practices or methods found to be useful for a single disease or a group of disorders. Such practices did not form any comprehensive treatment system.
The Modern conventional therapeutic system has also evolved through the traditional medicine. We can safely assume that The Traditional system followed by dominant nations on the face of earth evolved into the conventional medicine. This system was initially adopted by Greeks and Romans, then it was further studied by Muslims during their golden period and eventually it was polished by western societies in the modern era.
Tib e Yunaani that was practiced in Muslim Era and commonly known as hikmet was also kept alive in a frozen state in Muslim countries and the same is being practiced in Pakistan.
Some traditional medicine systems developed by non dominant Nations of the world include Ayurvedic system of India and Traditional Chinese Medicine.
Homeopathy is not a traditional system as it was proposed by a German doctor about 200 years ago but it forms a complete therapeutic system with its own unique philosophy and a wide range curing propositions for all type of disorders.NCCAM Classification of CAM Practice
NCCAM has developed one of the most widely used classification systems for the branches of complementary and alternative medicine. It classifies complementary and alternative therapies into five major groups, which have some overlap.
Practice Trends of Complementary Medicine in Pakistan
- Whole medical systems: cut across more than one of the other groups; examples include Traditional Chinese medicine, Naturopathy, Homeopathy, and Ayurveda
- Mind-body medicine: takes a holistic approach to health that explores the interconnection between the mind, body, and spirit. It works under the premise that the mind can affect "bodily functions and symptoms"
- Biology-based practices: use substances found in nature such as herbs, foods, vitamins, and other natural substances
- Manipulative and body-based practices: feature manipulation or movement of body parts, such as is done in chiropractic and osteopathic manipulation
- Energy medicine: is a domain that deals with putative and verifiable energy fields:
- Biofield therapies are intended to influence energy fields that, it is purported, surround and penetrate the body. No empirical evidence has been found to support the existence of the putative energy fields on which these therapies are predicated.
- Bioelectromagnetic-based therapies use verifiable electromagnetic fields, such as pulsed fields, alternating-current, or direct-current fields in an unconventional manner.
Out of the list of available forms of alternative medicine only a few are being regularly practiced in Pakistan. These include traditional tib e yunaani or hikmet, homeopathy ayurveda, Chinese traditional medicine and acupuncture.How often these are being practiced?
All the statistical data available shows that several of these alternative systems have significant following and they are being practiced with full fervor in different parts of our country.
According to WHO in some Asian and African countries, 80% of the population depend on traditional medicine for primary health care.
According to one study published in pubmed the percentage utilization of CAM by general public is:
The overall trend in Pakistan shows that 51.7% chose CAM while 48.3% chose biomedicine. Of those who chose CAM, 20% also used biomedicine as well; 16% homeopathy, 12.4% unani medicine, 2.1% mind-body medicine (faith healing), 0.9% biologically based practices (home remedies, diet and nutrition) 0.05% energy medicine (Reiki), 0.05% Traditional Chinese Medicine, and 0.02% aromatherapy.Official Status of CAM in Pakistan.
Several types of CAM practitioners are practicing in Pakistan under Govt Umbrella. Hakeems, Veds and Homeopaths have been licensed to practice and they have also been officially employed at specially designated posts in several govt hospitals and institutions.
CAM practices were first regularized in Pakistan by: Unani, Ayurvedic and Homeopathic Practitioner's Act, 1965
To supplement this act following bill was presented in National Assembly in 2008.Tibb-e-Unani, Ayurvedic, Homeopathic, Herbal and other non-
Allopathic Medicine Act, 2008
(pdf) Why they are still being practiced
Cost of CAM
- People think they are cheaper.
- People believe them to be safer.
- Some people do not want to change the old practices and customs.
- Their advertising strength.
- For some disease, like cancers the conventional medicine does not offer any satisfactory cure so people resort to CAM to try their luck.
It is a misconception that CAM offers cheap treatment to people. Many a times these practitioners charge hefty amounts from their patients. A poor patient reported at my clinic that he paid a homeopathic practitioner Rs 20,000 for a single consultation which included some homeopathic medicines. (We must keep in mind that these homeopathic medicines are pharmaceutically the cheapest because they do not have any chemical other than alcohol or sugar) Future Prospects of CAM practices in Pakistan Benefits of CAM Practices
It is likely that at least some of the therapeutic procedures and medicines being used by the traditional medicine do carry curative prospects for certain disease. As a prototype example we need to remember the antimalarial "artimisinin" which came from traditional Chinese medicine. So it is feared that if we leave the traditional medicines altogether without looking further into them we may lose certain vital therapeutic prospects which people came to know through experience of centuries.
For several chronic case in which the conventional practice does not offer a lot, like certain cancers or certain chronic pain syndromes etc: the CAM practices provide an opportunity to the people for at least trying something different with at least a hope to get better. Need of Serious research in CAM
The current practice trend of CAM in Pakistan or to speak broadly worldwide in not what we should satisfy ourselves with. It needs a serious research into finding the proof for those medicines and procedures which are effective and abandoning those which are useless or harmful.
Letting these systems work as such for an indefinite period is not likely to serve any purpose and is neither justified.
Through gradual research these systems must be integrated or merged with the conventional therapeutic systems. Hazards of CAM Practices
Allowing these CAM practitioners to deal with patients as independent health providers in this modern scientific era seems very illogical. The very basic philosophy of several of these systems is grossly flawed and several of their therapeutic practices are clearly unscientific. Ayurvedic system believes in five elements; water, fire, earth, ether and air. This could be a logical understanding of nature and composition of matter and humans during pre-scientific era, but to base a philosophy of healing today on these fundamental assumptions looks ridiculous.
Letting these people practice independently, knowing that they are totally unaware of the latest developments in medical research is denying the patients an opportunity of the most reliable and proven treatment for many diseases and exposing them to unproven and harmful or useless treatment which is at times equally or more expensive than the conventional treatment.