Complementary and Alternative Medicine and Their Effect on Global Health

By Nathan Douthit

According to the World Health Organization (WHO), the use of complementary and alternative medicine (CAM) is on the rise. The US National Institute of Health defines complementary medicine as non-mainstream, non-western practice used together with conventional medicine, whereas alternative medicine is defined as the same used instead of conventional medicine. The WHO also offers a definition of traditional medicine (TM) as

“the sum total of the knowledge, skill, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness”

Globally, TM and CAM are much more accessible to patients than conventional medicine. Therefore the WHO strategy for TM and CAM revolves around research into these alternative techniques as well as education and training for their practice. However, recent years have seen a surge in popularity for CAM in western countries as well, with many being willing to pay out of pocket for these treatments. Integration of these practices into national health systems can allow them to be regulated and safely practiced along with conventional medicine for the best possible outcomes.

Unfortunately, the case report “Consequences of delivery at home in a woman without prenatal care” by Kumar et al reveals the danger associated with lack of education, training and regulation. We are told,

“The patient denied having any allopathic prenatal care during the current pregnancy. She denied having gestational diabetes testing, blood work or detailed ultrasonography, but she stated that she had undergone regular Doppler and bedside ultrasound scans by her midwife.”

Despite having had three prior caesarean sections, the woman chose a direct entry midwife, defined as follows.

“Direct entry midwives are defined as independent practitioners educated in midwifery through self-study, apprenticeship, a mid- wifery school or a university-based programme…. In the USA, licensure and training varies per state, with ∼50% of states not requiring licensure for direct entry midwives. Most patients are unaware of the difference between [direct entry and certified nurse midwives] and may not receive the necessary guidance to choose the appropriate provider for their needs.”

This patient’s past medical history puts her at increased risk, and her poor outcome is the result of lack of education, regulation and information in this alternative delivery.

BMJ Case Reports invites authors to publish cases regarding the effects both positive and negative of complementary and alternative medicine. Global health case reports can emphasize:

-Successful integration of CAM into national health systems

-Research on CAM that has proved useful in patient care

-Partnerships between practitioners of CAM and practitioners of conventional medicine that have improved patient outcomes

-Use of CAM causing delays in care, inappropriate care or worsening of patient outcomes.

Manuscripts may be submitted by students, physicians, nurses or other medical professionals to BMJ Case Reports. For more information, review the blog on how to write a global health case report.

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