Written by Tony F.
The past few decades have seen an increasing public interest in the use of complementary and alternative medicine (CAM). Despite a generally positive attitude with regards to its use and safety, concerns do remain about the effectiveness of these therapies (Barnes et al., 2004). Despite the expansion of the scientific knowledge base of Western medicine, the global popularity of CAM therapies has seen a dramatic increase over recent times; a steady increase in the lifetime prevalence of these therapies have also been reported in developed countries (Kessler et al., 2001). Research groups have suggested several determinants that may determine this increased CAM usage- these include those of geographical, cultural, socio-economic, and physical contexts (Shaikh & Hatcher, 2007). The geographical determinant has, by far, been the most accepted amongst these- several developing countries have been observed to use CAM therapy as basic treatment line (Tan et al., 2004). However, the prevalence of this does further vary between urban and rural areas within these countries. Nevertheless, even countries with national insurance systems have seen an increase in the public’s use and acceptance of CAM- where these therapies aren’t covered by insurance; thus suggesting that these therapies may have benefits that outweigh their costs (Frass et al., 2012). Despite these increased usage patterns, the clinical effectiveness of these therapies seem debatable- with CAM professionals themselves leaning towards the requirement of a “more scientific” testing prior to the use of these therapies (Raza et al., 2018). This paper aims to assess the effectiveness of alternative medicine in the treatment of common illnesses.
In order to understand the effectiveness of CAM treatments, it may be necessary to have an insight on acceptance and usage patterns among both the general population as well as medical personnel. In their 2012 review, Frass et al obtained a 32.2% prevalence of CAM usage (from 16 original research papers across the globe) among general populations; this study observed sex, age, and education to be the most predictive factors determining CAM usage- most users tended to be better educated and were middle-aged women. The most common form of CAM therapies included chiropractic manipulation, homeopathy, massage, and herbal medicine. With regards to its insight by medical personnel, Frass et al observed several research groups recording a lack of education and knowledge about CAM- one such study indicated that despite the general physician’s (GP) lack of education in CAM (96.5% GPs received no relevant education), nearly half of the GPs (51%) believed that CAM therapies had some form of effectiveness against illnesses (Ozcakir et al., 2007). However, the GPs CAM insight also tend to vary geographically; in Taiwan, statistics had earlier reported close to 72 Western medical hospitals to have set up departments of TCM (traditional Chinese medicine), with these departments allowing the integration of TCM with Western medicine (Liu et al., 2011). Among various diseases, patients with cancer often tend to have the highest prevalence of CAM acceptance and usage- in their 2012 review, Horneber et al observed the “current use of CAM” among cancer patients to be 40% (studies from 18 countries were included); the highest usage prevalence was observed to be in the United States, and the lowest in Italy and the Netherlands. Nevertheless, the authors in this review pointed out that evidence does suggest the considerable increase of CAM use over the past years; especially the proportion of cancer patients using CAM therapy since 2000.
Among cancer patients, the highest rates of CAM usage (~70%) were observed in patients with breast, prostate, or colon cancer (Patterson et al., 2002). Although the use of TCM is most common in patients with Chinese background, this has become increasingly common in patients from other cultural backgrounds as well. In their 2011 paper, Liu et al studied the effectiveness of TCM for liver protection during chemotherapy. The prevalence of hepatotoxicity (chemical-driven liver damage) among cancer patients undergoing chemotherapy range from 33 to 65%- making it the most common side effect of cancer treatment (Law & Fu, 2002). Liu et al observed that in patients undergoing chemotherapy, TCM allowed for a reduction of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels in blood- thereby protecting liver function during chemotherapy. In addition, TCM had also been observed to have a strong antioxidant function- which, with its property of delaying or preventing liver fibrosis, could prevent liver injury during chemotherapy (Chen & Gao, 2003). Liu et al also observed a higher rate of chemotherapy completion in patients who underwent chemotherapy in conjunction with TCM. This study, however, was limited to data collected within hospitals in Taiwan- with most patients being referred to TCM treatment by their oncologists. While the effects of TCM on liver protection was assessed and confirmed by this research group, further studies may be required to examine the underlying mechanisms of TCM action as well as in confirming its long term effectiveness.
TCM therapy is also routinely used to treat chronic neck and shoulder pains (NSP), as well as other forms of lower back pain. In their 2016 study, Chi et al assessed the effectiveness of cupping therapy (CT) in subjects with NSP. Cupping therapy essentially involves the application of suction/ vacuum in various body parts with the use of a cup or jar. This single-blind research study obtained that cupping therapy increased skin surface temperature while significantly reducing neck pain intensity scores. Among various CAM therapies, CT is often recommended as being effective with no adverse effects- nevertheless, despite its potential to perhaps eliminate the use of analgesics, the clinical evidence of this CAM form remains minimal (Chen et al., 2014). CT therapy has also been suggested to be beneficial in reducing lower back and/or pelvic pain (LBPP) during pregnancy; however, their actual use remains low, with pregnant women often preferring other CAM therapies including chiropractic and acupuncture methods (Close et al., 2014). Surveys have obtained CAM therapies to be used by nearly 25-30% of pregnant women to manage LBPP (Wang et al., 2005). In their 2014 review that investigated the CAM efficacy for management of pregnancy-related LBPP, Close et al observed acupuncture techniques to show the most statistically significant and clinically important changes. However, various studies did have conflicting evidence on the number and frequency of these therapies that were required to reduce LBPP (Elden et al., 2005; Wang et al., 2009). While, according to Close et al (2014), other CAM therapies such as osteopathy and chiropractic manipulation had also shown evidence of effectiveness- but scored high for risk of bias thus making it difficult to base recommendations for practice.
In summary, the usage and acceptance of CAM therapies have seen an increasing trend over the past few decades. While the exact reasons for its utilisation and preference is complex, its integration in modern medicine and therapy decisions have been observed to have a synergistic effect. Nevertheless, the regulations surrounding several CAM therapies are poor- and require a strong scientific base before they can be effectively integrated into modern medicine. As mentioned in this report, CAM practitioners themselves lean towards the requirement for a more scientific testing of these therapies. Future studies and trials are warranted to confirm the efficacy of CAM therapies and may allow mainstreaming of the same.
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