Alternative medicine: which way forward?

Despite technological advances in Conventional Medicine, globally there is sufficient evidence to suggest an increasing interest in alternative medicine. This is not only by public but also by physicians.1 For example, in 1990, Americans carried 425 million visits to alternative practitioners, 40 million more times than they visited their family physicians. A total of $13.7 billion was spent on this care and it is increasing overtime.23 Variable answers may be elicited for questions such as why is this occurring? Is it of value to physicians? How does it differ from conventional medicine? Interestingly enough, the definition of alternative medicine is not yet generally agreed upon by majority of the people practicing it, i.e. “complementary medicine”, “holistic, “unconventional”,“frontier,” “traditional”,“folk”.

Compared with conventional medicine, alternative medicine tends to concentrate on augmenting health through changes in life style adopting partnership relation with the patient and a comprehensive (holistic) approach.5 In other words, looking at the whole patient in the context of the entire family and social environment. Nowadays, there are more than one hundred centers all over the world that have been recognized by World Health Organization as accredited alternative medicine providers. This is in addition of innumerable number of colleges, clinics, hospitals and organizations teaching, practicing and coordinating activities of this type of medicine. There is substantial evidence in the literature to support that it is naïve to think that the effects of the alternative medicine are no more than a placebo-effect.5–13

Many patients seek out alternative medicine after they have explored the utility of conventional medicine where they found it to be ineffective or resulted in serious side effects and most of those patients are suffering of chronic illnesses. Others use it in combination with conventional modalities, as a way of complementing each other. While some of the patients refer to alternative medicine providers because they believe that their physicians are incapable or willing to listen to them, to understand them or to meet their needs. Physician's attitudes towards alternative medicine practice may be another reason compelling patients to do so.14 Therefore, physicians should better show a degree of openness towards their patients’ concerns and interest including alternative medicine. This was shown to improve doctor-patient relationship.15 For this purpose, physicians may need to acquaint themselves with at least the commonly used non-conventional modalities by their patients. Generally, references and special courses to physicians towards the practice of alternative medicine are made commonly available.4 Currently, most of physicians are not in a position to answer many of the questions raised by their patients towards alternative medicine. Some physicians become defensive, angry and dismissive when the patient considers the use of an alternative medicine modality. As a result, more than 70% of patients were found to use such therapies without telling their doctors that they are doing so.2

In Saudi Arabia, the interest in studying how prevalent is the practice of alternative medicine has already started. For example, Dr. Al-Faris's article in this issue describes the pattern of alternative medicine use in a given Saudi population. That article included a concise review of the literature that was published so far regarding some modalities of alternative medicine practiced in Saudi Arabia, their prevalence and some complications associated with their use. More research work is still needed for open yet critical evaluation of the different modalities used in Saudi Arabia. It should not be forgotten in this regard that healing by the Holy Quran and by the Prophet Mohammad (PBUH), sayings are inseparable parts of Muslims faith. In USA, the Office of Alternative Medicine (OAM) was established on 1992, the National Institute of Health (NIH) for the purpose of investigating the efficacy of alternative therapies with a budget of $ 7.4 million in 1996.5 As a result of this, alternative medicine practiced at USA has already been classified into five categories. In Saudi Arabia at the level of the Ministry of Health, steps have been initiated towards studying this type of medicine. However, it would be of interest to know how much the Ministry of Health in Saudi Arabia allocated of its resources to the study of an area of medicine that is practiced by no less than one-fifth of the Saudi population. Although already started, in Saudi Arabia, physicians need to develop a reliable network of communication with alternative medicine providers. Alternative medicine modalities practiced in Saudi Arabia should be studied, classified so that areas of potency, weaknesses, and dangers are identified and modalities with proven efficacy may be integrated in conventional medical practice. Up till that time when this objective has already been achieved, substantial increasing portion of patients are expected to use alternative medicine modalities. Issues such as banning or at least discouraging the practice of all or some of the modalities of alternative medicine and some other related questions such as, Can we do that? How can we regulate such practice? Who should be permitted (licensed) to practice, etc. will remain to be answered. Consequently, complications due to some of these practices are expected to continue.