Integration of Alternative Medicine into Evidence-Based Medicine: Fruitful or Futile?

By-

Nikhita Kalra 

(Final Year MBBS Student, Maulana Azad Medical College, New Delhi) & 

 Dr. Krittika Bhatia 

(House Medical Officer, Dept. of Cardiology | Sir HN Reliance Foundation Hospital, Mumbai)

“What we know is a drop, what we don’t know is an ocean.”- Isaac Newton

The aim of each and every healthcare facility is to provide care in the best interest of the patient. For the healthcare providers to do so, one must possess a sound understanding of medicine but more importantly, demonstrate skills of decision making. Evidence-Based Medicine (EBM) elucidates the importance of making clinical judgments backed by the available evidence with due emphasis on the patient’s preferences. The term ‘Evidence-Based Medicine’ was first coined in 1990 by Gordon Guyatt of McMaster University2. With advancements in the practice of medicine over the decades, the implementation of EBM has shown to increase the competence of the health service decision-makers.

In earlier days, the knowledge about the various available treatment methods was limited but as medicine evolved, it has given people the choice to choose. From the plethora of therapies to choose from, it is important to analyze which would be the best choice in a given situation based on the outcome or results of that particular form of treatment. Evidence-based medicine and literature guide the professional to make the right decision based on how successful that treatment modality has been.

As we all know, the history of medicine can be traced back to thousands of years. Though man has advanced into modern times, the belief in the treatment remedies that have been passed on from generations continues to exist in the modern era. Complementary medicine describes the use of therapies in conjunction with conventional (allopathic) medicine. Alternative medicine includes interventions that are used in place of conventional medicine. Various categories like Traditional Alternative Medicine (Acupuncture, Ayurveda, Homeopathy, Naturopathy, Chinese or Oriental Medicine) | Body Touch (Chiropractic & Osteopathic medicine, Massage, Body Movement therapies, Tai Chi and Yoga), External Energy (Electromagnetic Therapy, Reiki and Qigong) | Mind (Meditation, Biofeedback, Hypnosis) | Senses (Art, Dance, Music, Visualization and Guided imagery) fall under the practice of Alternative Medicine used in our daily lives that today’s population is still unaware about.

As the world takes a step towards EBM, a pertinent question is whether alternative medicine is simply equivalent to a placebo, or science not yet explained by our skill set?

Benefits of Alternative MedicineAll the above modes of treatments have continued to be practiced and have shown benefits in the maintenance of physical and mental well-being One of the principles behind practices like yoga and tai chi is to maintain the balance of chi i.e. the vital force that flows through us. A strong chi is supposed to have a protective effect on mental and physical health.

Multiple studies have reported the benefits of tai chi, an ancient Chinese practice of slow controlled movements, in preventing falls and improving cardiopulmonary fitness4. Yoga has been effective in improving flexibility, reducing anxiety, and promoting recovery from addiction5.

Acupressure has been found to reduce labor pain, low back pain, and chronic headaches6. Ayurvedic formulations like Yashada bhasma (made from zinc metal and aloe vera juice) have proven to be effective anti-aging modalities by improving wound healing. 

It is said that formulations of alternative medicine can cure chronic diseases like asthma, unlike conventional medicine. But currently, there is inadequate evidence to back the same. While many research studies do show a positive impact of alternative medicine, yet the adverse effects are still under-reported as patients don’t always disclose the other forms of therapies they use. 

Adverse Effects of Alternative Medicine

Ayurvedic preparations contain heavy metals like arsenic, zinc, lead which can cause toxicity when permissible limits are exceeded. Herbalism can cause adverse effects due to plant alkaloids since these remedies are not subject to stringent monitoring. In India, AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy) is an approved system of medicine despite the paucity of supportive evidence. 

Should Alternative Medicine be integrated into Evidence-Based Medicine?

There are different schools of thought about a bridge course that could potentially allow AYUSH doctors to practice allopathy in India. 

For this integration to be fruitful, unbiased research studies must be done to back the therapies of alternative medicine. Similar to allopathic treatments that are available in the market only after stringent trials and studies, every modality offered by alternative medicine should also conform to a similar strategy to ensure the safety of the public. An important element is an accountability- a person who practices alternative medicine should be as accountable for the adverse effects of the therapy as an allopathic doctor is for theirs. The concept of integration should not materialize without fulfilling such standards.

The need of the hour is to widen our horizons by delving deeper into the working of alternative medicine. The above modalities can be used hand in hand to provide holistic care to the patient by addressing the patient’s mind, spirit, and emotions and not just focusing on the pathology. Implementing an integrated approach will also develop a sense of respect and understanding among the practitioners of traditional and alternative medicine. This might be able to bridge the gap between the two parallel practices of medicine along with a wider array of treatment options for the patients.

References:

  1. Let’s support evidence based medicine, Global Alliance for Infections in Surgery. Accessed 21 August 2021 <https://infectionsinsurgery.org/lets-support-evidence-based-medicine/> 
  2. Guyatt GH. Evidence-Based Medicine [editorial]. ACP Journal Club 1991:A-16. (Annals of Internal Medicine; vol. 114, suppl. 2).
  3. Complementary and Alternative Medicine: Integration into Primary Care, Musculoskeletal Key, Fastest Musculoskeletal Insight Engine. Accessed 1 September 2021 <https://musculoskeletalkey.com/complementary-and-alternative-medicine-integration-into-primary-care/>
  4. Jahnke R, Larkey L, Rogers C, Etnier J, Lin F. A comprehensive review of health benefits of qigong and tai chi. Am J Health Promot. 2010;24(6):e1–25
  5. Woodyard C. Exploring the therapeutic effects of yoga and its ability to increase quality of life. Int J Yoga. 2011;4(2):49–54.
  6. Chen Y-W, Wang H-H. The effectiveness of acupressure on relieving pain: A systematic review. Pain Manag Nurs. 2014;15(2):539–50.
  7. What is Integrative Medicine; Integrative Medicine. Accessed 1 September 2021. <https://www.suzannegazdamd.com/integrative-medicine.html>

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