When I think about medical practices outside the conventional healthcare system, it is impossible not to reflect on the seemingly modern concept of body and mind equilibrium.
I say seemingly modern because this is the concept that guides most traditional practices that originated way before conventional Western medicine practice.
Traditional Chinese medicine is, perhaps, the best-known example, but there are also others such as African traditional medicine and Indian traditional medicine1. According to the World Health Organization (WHO), traditional medicine is defined as “the sum of knowledge, skills, and practices based on theories, beliefs, and experiences from different cultures.”
Complementary and alternative medicine, on the other hand, comprise a set of health care practices that are not part of conventional medicine and, therefore, are not integrated into the health system2.
While complementary medicine can be understood as an unconventional approach used in conjunction with conventional medicine, alternative medicine is used to replace conventional medicine3.
Traditional, alternative, and complementary medicine include practices such as the use of herbs and probiotics, vitamin supplements, herbal medicines, meditation, music therapy, psychotherapy, acupuncture, massage, and yoga, among others.
The combined use of complementary and conventional medicine make up what we call integrative medicine. It aims to treat the patient as a whole and not just a specific organ or system. Integrative medicine seeks health and well-being together. The integrative approach considers the body and mind axis to treat any condition.
Hence, we return to the starting point of the body and mind equilibrium and the fact that being healthy is not just the absence of illness or injury. Indeed, we do know that health is much more than that: it comprises physical, mental, and social well-being. Therefore, we can imagine that the approaches that different people use to achieve a “healthy state” can vary enormously.
Nevertheless, some questions on the use of complementary approaches are still unanswered. For example, are they effective? Are they safe for the users? How are they regulated in the health system?
Publication trend over the years
In the past 20 years, there was an increase in the number of publications related to complementary therapies. In the PubMed database, a search for the term “Complementary Therapies”[MAJR] retrieves more than 145,000 scientific papers. From 2000 to 2020, the number of publications more than doubled, going from 2,441 to 6,365.
Considering two practices of complementary medicine, acupuncture, and yoga, the same growing tendency is observed. In 2000, PubMed listed only five papers related to acupuncture and tweety-four on yoga. Twenty years later, this number increased to 75 publications related to acupuncture (an increase of 500%) and 319 related to yoga (an increase of 329%).
This may illustrate the growing interest in studying and generating scientific evidence about these practices to support their use. In addition, this can be understood as possible growth of the body of evidence related to safety and efficacy. However, when taking a closer look, this is not always the case.
History of use but limited evidence
I risk saying that, nowadays, the most used practices of complementary medicine are herbal and dietary supplements, yoga, and acupuncture. It is not by chance that these are the practices with more studies seeking to validate their benefits with scientific evidence and to show for which conditions they can be used.
Mental disorders are one of the most common conditions treated with alternative approaches4. For instance, a recent literature review analyzed the use of complementary and alternative therapies to treat psychological symptoms of menopause, especially anxiety and depression5. According to the analysis, the use of some herbal and dietary supplements, namely, evening primrose oil, St. John’s wort (Hypericum perforatum), and bitter orange showed evidence of benefits in combating anxiety and/or depression. On the other hand, curcumin and vitamin E failed to improve anxiety symptoms in menopausal women. Other approaches such as yoga, acupuncture, and aromatherapy with lavender essential oil or geranium in almond oil also reduced the psychological symptoms of menopause.
However, the common bottom line for all mentioned treatments is the low number of studies and the need for more robust evidence with methodology of better quality as well as evaluation of long-term use. Therefore, the efficacy and safety data remain limited compromising the reliable adoption of these practices in evidence-based medical approaches.
The regulation issue and use in the conventional healthcare system
The use of traditional and complementary medicine in the public healthcare system depends not only on the scientific evidence about these practices but also on the creation of laws, regulations, and national policies.
According to the WHO, since 2005, many countries have put in place a registration system and regulation for herbal medicines. As expected, South-East Asia has the most organized system in terms of national policies, regulation, and registration of herbal medicines. Many countries in the American continent are following these steps, while Europe is still behind the global average6.
A review that analyzed the regulatory landscape for traditional and complementary medicine in South-East Asia concluded that it is urgent to determine the technical requirements of quality control and market surveillance studies7.
In this region, many herbs used in traditional medicine are granted a simplified regulatory process to be approved based on their long history of use. In general, tests for hazardous contaminants, clear descriptions of manufacturing methods, and stability reports are required in the application, while most product efficacy documents such as the clinical trial report, pharmacological tests, pharmacodynamic studies, and some safety documents regarding toxicity are exempted. However, the safety, toxicity, and interactions of these herbs must be taken into account to ensure herbs with potential adverse effects do not pass this simplified process.
The WHO report data also shows that most member states feel the need for more technical guidance provided by the organization, specifically concerning safety, quality, and efficacy. This highlights the need for more structured requirements for both clinical trials and regulatory applications.
Therefore, despite the growing body of scientific evidence related to traditional and complementary practices, the lack of data, financial support for research, and regulatory guidelines are impairing some of these approaches to be fully implemented in healthcare systems worldwide.
References
1. Che, C.-T., George, V., Ijinu, T. P., Pushpangadan, P. & Andrae-Marobela, K. Traditional Medicine. in Pharmacognosy 15–30 (Elsevier, 2017). doi:10.1016/B978-0-12-802104-0.00002-0.
2. WHO website. Traditional, Complementary and Integrative Medicine. https://www.who.int/health-topics/traditional-complementary-and-integrative-medicine#tab=tab_1.
3. NIH website. Complementary, Alternative, or Integrative Health: What’s In a Name? https://www.nccih.nih.gov/health/complementary-alternative-or-integrative-health-whats-in-a-name.
4. Maria Helha, F.-N. & Wang, Y.-P. (2022). Trends in complementary and alternative medicine for the treatment of common mental disorders: A bibliometric analysis of two decades. Complement. Ther. Clin. Pract. 46, 101531.
5. Mehrnoush, V., Darsareh, F., Roozbeh, N. & Ziraeie, A. Efficacy of the Complementary and Alternative Therapies for the Management of Psychological Symptoms of Menopause: A Systematic Review of Randomized Controlled Trials. J. Menopausal Med. 27, 115 (2021).
6. World Health Organization. (2019). WHO GLOBAL REPORT ON TRADITIONAL AND COMPLEMENTARY MEDICINE 2019. https://apps.who.int/iris/handle/10665/340838.
7. Liang, Z. et al. (2021). Advancing the Regulation of Traditional and Complementary Medicine Products: A Comparison of Five Regulatory Systems on Traditional Medicines with a Long History of Use. Evid. Based Complement. Alternat. Med. 2021, 1–16.
Featured Image by Luiza Erthal
