alternative medicine

health care and treatment practices, including traditional Chinese medicine, chiropractic, folk medicine, and naturopathy, that minimize or eschew the use of surgery and drugs.

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or complementary medicine

Any of a broad range of healing approaches not used in conventional Western medicine.

Many are holistic (see holistic medicine); many also emphasize prevention and education. Alternative therapies include acupuncture, aromatherapy, Ayurveda medicine, Chinese medicine, chiropractic, herbal medicine, homeopathy, massage, meditation, naturopathy, therapeutic touch, and Yoga. Though considered alternative in the West, such medicine is the main source of health care for up to 80% of people in less-developed countries. Some alternative-medicine practices are useless or harmful; others are effective and may offer treatments in areas where conventional approaches have not succeeded (e.g., chronic disorders).

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▪ 1998

Introduction

by Hari M. Sharma and Gerard C. Bodeker

      Alternative and complementary medicine covers a broad range of healing philosophies, approaches, and therapies. The Office of Alternative Medicine (OAM) at the U.S. National Institutes of Health (NIH) defines alternative and complementary medicine as "those treatments and health care practices not taught widely in medical schools, not generally used in hospitals, and not usually reimbursed by medical insurance companies." Many of these therapies are holistic, which means that the health care practitioner considers the whole person, including his or her physical, mental, emotional, and spiritual characteristics. Many treatments are also preventive, the practitioner educating and treating the person to prevent health problems from arising rather than treating the patient after disease has already occurred. Some of the commonly used alternative and complementary therapies are acupuncture, Ayurveda, chiropractic, herbal medicine, homeopathy, massage, meditation, naturopathy, prayer, shamanism, therapeutic touch, and yoga.

      It is important to note that for large portions of the world's population, nonmainstream approaches to medicine are neither alternative nor complementary. Traditional health care systems constitute the main source of everyday health care for up to 80% of the population of most of the less-developed countries, according to the World Health Organization (WHO). They are also used by ethnic and indigenous populations in industrial countries, such as the U.S., Canada, and Australia. The ratio of traditional health practitioners to population in many places is substantially higher than the ratio of medical personnel trained in mainstream medicine to population and thus represents an irreplaceable health care infrastructure.

International.

      WHO recently produced reports on training for traditional birth attendants and on evaluating herbal medicines. Its Collaborating Centre for Drug Monitoring announced a new technology for patenting, testing, and approving medicinal plants. While maintaining an official interest in traditional medicine, WHO, however, progressively reduced funding for this sector, and other agencies assumed increased responsibility for work in this field. In 1996 and 1997, for example, the World Bank issued reports on medicinal plants, drawing attention to the need to conserve and cultivate these plants in order to ensure a supply for the $800 billion-per-year medicinal plant market.

      In 1996 the Global Initiative for Traditional Systems (GIFTS) of Health, a nongovernment network of traditional medicine research-and-development programs, produced a report on policy in traditional health care. Headquartered in Oxford, Eng., GIFTS recommended formal collaboration between modern and traditional medical sectors. It called for a framework (and adequate budgetary support) for legal recognition of traditional health practitioners and for officially supported training in traditional medicine.

Asia.

      In India the government became involved in traditional drug production when the Central Drug Research Institute patented two new drugs from ancient Ayurvedic formulas. One, a mixture of black pepper, long pepper, and ginger, allows for the dosage of the antibiotic rifampicin to be halved in the treatment of tuberculosis and other mycobacterial infections. The other is a memory tonic produced from the traditional plant called brahmi. Overseas patenting of turmeric and products of the neem tree caused controversy in India and other nations. In August the U.S. Patent and Trademark Office canceled a U.S. patent on the wound-healing properties of turmeric when the Indian government proved that records had existed for this use for centuries.

      Researchers in Thailand and Vietnam reported in the medical journal The Lancet in 1996 that artemether, a plant extract from Artemisia annua used in Chinese medicine, is effective in treating cerebral malaria. Vietnamese researchers, working in collaboration with colleagues at the University of Oxford, found that traditional Vietnamese treatments for burns and wounds are effective in stimulating tissue growth and reducing scar tissue.

      In China, where there is full state support for traditional medicine, almost half of the population uses it on a regular basis. Chinese methods of preventing and treating cardiovascular conditions, cancer, burns, and psoriasis have all been found to be effective in recent studies conducted in China and internationally.

Africa.

      In many countries of Africa, 80-90% of the people use traditional medicine, often as their only method of health care. A recent study by the African Development Bank and UNICEF found that economic factors, such as devaluation of currencies, result in a substantial shift from modern to traditional medicine, even in urban populations.

      In Uganda the government introduced a policy in support of traditional medicine. A group of modern and traditional health practitioners began working together to combat the AIDS epidemic by using herbal remedies to treat opportunistic infections associated with AIDS and by providing culturally relevant emotional support to people with AIDS. In Zambia and Mozambique training courses for traditional healers increased the effectiveness of the AIDS-prevention message being delivered to local communities. Also during the year the new University of the Health Sciences in Tanzania introduced a course in traditional medicine.

      Studies in both Ethiopia and Uganda of the plant Phytolacca dodecandra found it effective against the snails and larvae that carry schistosomiasis, as well as in controlling larvae of the black fly that carries onchocerciasis. A 1997 issue of the Royal Society of Medicine journal Tropical Doctor presented evidence from Uganda of clearance of parasitemia with a local herbal antimalarial mixture.

South and Central America.

      The Pan-American Health Organization, in a set of guidelines for research with indigenous populations, emphasized the importance of developing research into traditional medicine. A study of the understanding and treatment of gastrointestinal disorders among the Maya of Chiapas state, Mex., presented evidence of the scientific bases of the Maya's large pharmacopeia of local herbal medicines. Faced with a severe malaria epidemic, the Yanomami Indians of northern Brazil identified 82 genera of plants in different parts of their region useful for combating the disease. Antimalarial activity was shown to be linked to a range of compounds, and the plants used by the Yanomami were demonstrated to contain these compounds.

Industrialized Countries.

      The growth of alternative medicine in the industrialized countries has resulted almost entirely from the efforts of consumers. The Lannoye Report to the European Parliament (1997) revealed that in countries where statistics are available, 20-50% of the population of European countries uses alternative forms of health care.

      Current legislation within the European Union is varied. In France a tolerant attitude exists; acupuncture has been recognized by the Académie de Médicine since 1950, and homeopathic remedies are reimbursed by social security when medically prescribed. The northern countries—Great Britain, Ireland, The Netherlands, Germany, Denmark, and Sweden—have taken a more restrictive position. Although most allow the practice of health care by complementary practitioners, certain activities are reserved for doctors, and policy and supervision of complementary medicine rest in the hands of the biomedical profession.

      Clinical research in London revealed that Chinese herbal medicine is an effective means of controlling atopic eczema. The National Health Service programs in Great Britain offer some forms of complementary medicine, such as homeopathy and acupuncture. The Glasgow (Scot.) Homœopathic Hospital established an international data collection network that began collecting information from general practitioners who are using homeopathic remedies. Based on a sample of more than 1,000 cases, the International Data Collection Centres for Integrative Medicine network found that 7 out of 10 patients using homeopathic remedies reported moderate improvement in their condition.

      U.S. funding for research on alternative/complementary therapies is increasingly being supplied by the OAM at the NIH. Established by a mandate of Congress in 1992, the OAM awarded grants to six U.S. universities for the study of complementary medicine in relation to cancer, heart disease, women's health, AIDS, pain control, and general medicine. In 1997 Congress allocated $12 million to the OAM, as compared with $7.4 million in 1996.

      Because health care in the U.S. is overwhelmingly centred on employer-provided health plans or insurance, it is significant that medical insurance companies in the U.S. have begun to offer coverage for complementary medicine. In January Oxford Health Plans, Inc., of Norwalk, Conn., announced an alternative medicine program that offers patients a network of qualified providers for chiropractic, acupuncture, yoga, massage therapy, and nutrition information. Since 1995 more than one-third of Oxford's 1.8 million members have chosen alternative medical services either alone or in conjunction with conventional medical treatments. Another major American insurer, Mutual of Omaha Companies, began offering coverage for a cardiovascular program that combines a low-fat vegetarian diet; mild exercise, including yoga; and a regime of stress reduction that employs a form of meditation.

      U.S. researchers have investigated traditional herbal antioxidants. Studies on an herbal mixture called Maharishi Amrit Kalash from the Maharishi Vedic Approach to Health found it to be an exceptionally potent antioxidant. Other research on this mixture revealed it to have marked anticancer effects and to decrease experimental atherosclerosis.

      In a study on Canadians using a stress-reduction program, transcendental meditation (TM), it was found that in a period of up to seven years, government payments to physicians for those patients declined significantly, at a rate of 5-7% annually, as compared with their pre-TM rates. Another study found TM to be efficacious in treating hypertension.

      Medical education in the U.S. is beginning to reflect changes in patients' choices of health care. By 1997 more than 30 American medical schools were offering courses in complementary medicine.

Conclusion.

      Although doubts and opposition remain, it seems inevitable that the momentum of research into traditional, alternative, and complementary health care will continue. While some approaches will likely be found useless or even harmful, others will no doubt be proved effective. They may offer advantages to mainstream medicine by providing treatments in areas where conventional medical approaches have not been successful (such as treatment of chronic disorders), by offering therapies that are cost-effective and free of toxic side effects, and by suggesting new directions for an integrated approach to health care.

Hari M. Sharma is Professor Emeritus and former director, Cancer Prevention and Natural Products Research, Department of Pathology, College of Medicine, Ohio State University; and Fellow, National Academy of Ayurveda, Ministry of Health and Family Welfare, India. He is the author of Freedom from Disease and Contemporary Ayurveda: Medicine and Research in Maharishi Ayur-Veda. Gerard C. Bodeker is a member of the Health Service Research Unit at the University of Oxford, England.

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