Summary Note on Public Health Alternative Medicine –PUH 503

INTRODUCTION

National Science Board (2002), defined Alternative medicine as any practice

that is put forward as having the healing effects of medicine, but is not based on

evidence gathered using the scientific method. It consists of a wide range of

health care practices, products and therapies, using alternative medical

diagnoses and treatments which typically are not included in the degree

courses of medical schools or used in conventional medicine. Examples include

homeopathy, naturopathy, chiropractic, energy medicine and acupuncture

(FDA, 2007).

Traditional medicine is used interchangeably with alternative medicine.

WHO (1976) defined traditional medicine as the sum total of the knowledge,

skills, 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.

SCOPE OF ALTERNATIVE MEDICINE

Mind-Body Interventions

Mind-body medicine uses a variety of techniques designed to enhance the

mind’s capacity to affect bodily function and symptoms. This includes:

meditation, prayer, mental healing, and therapies that use creative outlets such

as art, music, or dance (Ernst,2004).

Acupuncture (“AK-yoo-pungk-cher”) is a method of healing developed in

China at least 2,000 years ago. Today, acupuncture describes a family of

procedures involving stimulation of anatomical points on the body by a variety

of techniques. American practices of acupuncture incorporate medical

traditions from China, Japan, Korea, and other countries.

The acupuncture technique that has been most studied scientifically involves

penetrating the skin with thin, solid, metallic needles that are manipulated by

the hands or by electrical stimulation (Ernst, 2004; Barnes et al,

2008;NCCAM,2012).

.Aromatherapy (“ah-roam-uh-THER-ah-py”) involves the use of essential oils

(extracts or essences) from flowers, herbs, and trees to promote health and

well-being(NCCAM,2012).
Ayurveda (“ah-yur-VAY-dah”) is an alternative medical system that has been

practiced primarily in the Indian subcontinent for 5,000 years. Ayurveda

includes diet and herbal remedies and emphasizes the use of body, mind, and

spirit in disease prevention and treatment (Elsenberg, 1993; NCCAM, 2012).

Chiropractic (“kie-roh-PRAC-tic”) is an alternative medical system. It focuses

on the relationship between bodily structure (primarily that of the spine) and

function, and how that relationship affects the preservation and restoration of

health. Chiropractors use manipulative therapy as an integral treatment tool

(Ernst, 2004; Barnes et al, 2008;NCCAM,2012).

Massage (“muh-SAHJ”) therapists manipulate muscle and connective tissue

to enhance function of those tissues and promote relaxation and well-

being(Ernst, 2004; Barnes et al, 2008;NCCAM,2012).

Qi gong (“chee-GUNG”) is a component of traditional Chinese medicine that

combines movement, meditation, and regulation of breathing to enhance the

flow of qi (an ancient term given to what is believed to be vital energy) in the

body, improve blood circulation, and enhance immune function (Ernst,

2004;NCCAM,2012).
Reiki (“RAY-kee”) is a Japanese word representing Universal Life Energy. Reiki

is based on the belief that when spiritual energy is channeled through a Reiki

practitioner, the patient’s spirit is healed, which in turn heals the physical body

(Elsenberg, 1993 ;NCCAM,2012).

Therapeutic Touch is derived from an ancient technique called laying-on of

hands. It is based on the premise that it is the healing force of the therapist that

affects the patient’s recovery; healing is promoted when the body’s energies are

in balance; and, by passing their hands over the patient, healers can identify

energy imbalances (Ernst, 2004).

Traditional Chinese medicine (TCM) is the current name for an ancient

system of health care from China. TCM is based on a concept of balanced qi

(pronounced “chee”), or vital energy, that is believed to flow throughout the

body. Qi is proposed to regulate a person’s spiritual, emotional, mental, and

physical balance and to be influenced by the opposing forces of yin (negative

energy) and yang (positive energy). Disease is proposed to result from the flow

of qi being disrupted and yin and yang becoming imbalanced. Among the

components of TCM are herbal and nutritional therapy, restorative physical

exercises, meditation, acupuncture, and remedial massage (NCCAM, 2012).

Reflexology is a curative science in which healing is effected in parts of the

human body by putting the right amount of pressure on strategic points on any

of the soles of the feet. Sometimes the palm of the hand is also used. The healing

method was discovered and used extensively by the ancient Egyptians before

the Christian era. In this scientific healing, the healer has mastered the specific

locations and functions of various points on the foot or hand.

There is a theory that each healing point on the sole or palm has a

corresponding organ of the body with which it is in ‘sympathy’ or attunement.

If the point of the sole or palm is stimulated by certain pressure to proper

functioning, then its corresponding organ gets healed. It is estimated that there

are over seven thousand reflex points on the sole, each having corresponding

organs in the body(NCCAM,2012; Ernst, 2004) .

Herbal medicines

Herbal medicines include herbs, herbal materials, herbal preparations and

finished herbal products that contains active ingredients found in parts of

plants, or other plant materials, or combinations.

Table: showing common Alternative Therapy used in different parts of the

World

Common Alternative Source

Therapy
United State Herbalism, prayers Barnes et al,2008
breathing meditation,
chiropractic medice,
yoga, body work, diet
based therapy,
progressive relaxation,
mega-vitamin therapy,
visualization
Britain Alexander technique,
Aromatherapy, Bach Walton, 2000.
and other flowers
remedies,
Body work therapy
including massage,
counseling stress
therapies,
hypnotherapy,
meditation, shiatsu,
Reflexology, ayurvedic
medicine, nutritional
medicine and yoga.
United Kingdom Acupuncture, NHS Careers Website:
Aromatherapy, UK Department of
chiropractic, Health. 2013
homeopathy, massage,
Osteopathy and clinical
hypnotherapy.
Africa herbalism, body and (Elujoba et al, 2005)
mind intervention
including meditation,
prayer, mental healing,
and therapies that use
creative outlets such as
art, music, or dance.,
spiritualism, traditional
bone-setting, traditional
surgery, traditional
birth attendance,
massage etc
BRIEF HISTORY OF ALTERNATIVE MEDICINE IN NIGERIA

The practice of alternative medicine is as old as man (Herbert, 2012) . It is

known that between 65% and 80% of the world’s population uses herbal

medicine as their primary form of healthcare (Eisenberg et al.,1998; WHO,

2007). The methods of health care system developed by the indigenous peoples

arose from the interaction with their peculiar environment and belief system.

In spite of the derision suffered by this healing system from western

propaganda who see it as being crude, unscientific and primitive, among others,

it has survived and thrived and has continued to meet the health care needs of

the people.

Nigeria is made up of at least 250 linguistic groups (which some describe as

ethnic groups), of which 3 are major groups comprising over 60% of the total

population. Although all of these groups share common major macro-culture

and macro-traditions, each evolved its own micro-culture and micro-traditions

in response to prevailing environmental circumstances. Traditional medicine

and healing constituted part of the microcultural evolution (Scott-Emuakpor,

2010). In pre-explorers and pre-western trader Nigeria traditional medicine

was the system of health care delivery. Traditional healing and medical

practices in Africa includes herbalists, divine healers, soothsayers, midwives,

spiritualists, bone-setters, surgeons, traditional psychiatrists, traditional

pediatricians, traditional birth attendants (TBA), occult practitioners, herb

sellers, general practitioners, etc (Elujoba et al, 2005).

In spite of more than 150 years of introduction of Western style medicine to

Nigeria, traditional healing and medical practices remain a viable part of the

complex health care system in Nigeria today(Scott-Emuakpor, 2010).

There has been a rapid expansion of allopathic health care in Nigeria over the

last three decades, including an increase in the number of allopathic health care

providers. At the same time, because the majority of Nigerians use traditional

medicine, the Government of Nigeria has shown appreciation for the

importance of traditional medicine in the delivery of health care.

Though informal interaction between the Government and traditional medicine

practitioners can be traced back to the 19th century, formal legislation

promoting traditional medicine dates to 1966 when the Ministry of Health

authorized the University of Ibadan to conduct research into the medicinal

properties of local herbs. Efforts to promote traditional medicine continued

throughout the 1970s in the form of conferences and training programmes. In

the 1980s, policies were established to accredit and register traditional

medicine practitioners and regulate the practice of traditional medicine (Ajai,

1990) . In 1984, the Federal Ministry of Health established the National

Investigative Committee on Traditional and Alternative Medicine. A committee

to research and develop traditional and complementary/alternative medicine

was formed by the Ministry. In 1994, all state health ministries were mandated

to set up boards of traditional medicine in order to enhance the contribution of

traditional medicine to the nation's official health care delivery system (Sule,

2000) .

The National Traditional Medicine Development Programme was established

in 1997. Since then, the Federal Ministry of Health has been instituting

measures to formally recognize and enhance the practice of traditional

medicine. These measures include the constitution and inauguration of the

National Technical Working Group on Traditional Medicine; development of

policy documents on traditional medicine, including the National Policy on

Traditional Medicine, National Code of Ethics for the Practice of Traditional

Medicine, the Federal Traditional Medicine Board Decree, and Minimum

Standards for Traditional Medicine Practice in Nigeria; and advocacy for

traditional medicine at all levels and in relevant forums, such as the National

Council on Health (since 1997), Consultative Meetings of the Honourable

Minister of Health with State Commissioners for Health and Local Government

Chairmen (in 1999), and the Presidential Think Tank Forum (in 1999).

In 2000, the Traditional Medicine Council of Nigeria Act was proposed. The

functions of the Council include facilitating the practice and development of

traditional medicine; establishing guidelines for the regulation of traditional

medical practice to protect the population from quackery, fraud, and

incompetence; liaising with state boards of traditional medicine to ensure

adherence to the policies and guidelines outlined in the Federal Traditional

Medicine Board Act; establishing model traditional medicine clinics, herbal

farms, botanical gardens, and traditional medicine manufacturing units in the

geopolitical zones of the country; and collaborating with organizations with

similar objectives within and outside Nigeria. The Nigeria Medical Council is

contemplating integrating homeopathy into the country's health care delivery

system (WHO, 2001).

AWARENES OF ALTERNATIVE MEDICINES

In the recent past there has been a growing interest in traditional,

complementary and alternative medicine (TCAM) and its relevance in public

health both in developed and developing countries. Diversity, flexibility, easy

accessibility, broad continuing acceptance in developing countries and

increasing popularity in developed countries, relative low cost, low levels of

technological input, relative low side effects and growing economic importance

are some of the positive features of traditional medicine (WHO 2002). More

than 80% of Nigerians are aware of alternative medicine/traditional medicine

and several Nigerian traditional medicine practitioners like Professor Oyebanjo

Dayo Oyekole, Quincy Sumbo Ayodele, Reverend Father Anselm Adodo, Dr. J.J

Abdullahi, High Chief Oladosu Ekunrin , Dr. M. Akinsanya, Alj. Rafiu Owolabi

(Omo, 2014) to mention a few, had tirelessly contributed to the awareness of

traditional medicine majorly in the 21st century in Nigeria. The arrival of

Chinese Traditional Medicines to Nigeria also created so much awareness about

alternative medicine via their multilevel marketing business plan they

introduced to the marketing and distribution of TCM products and services.

Despite all the efforts to create adequate awareness about traditional medicine

in Nigeria, the fact still remains that enough awareness on the dosage,

evaluation, allergy and side effects of some herbal products are yet to be made

known to consumers (Adefolaju,2011; Herbert, 2012; Abodunrin et al, 2011) .

This maybe as a result of low technology input involved or inadequate research

on the products by producers and NAFDAC.

PATRONAGE OF ALTERNATIVE MEDICINE

The importance of traditional medical practices in meeting the health needs of

the Nigerian population has been stressed in different studies (Emmanuel,

1973; Ademuwagun, 1969; Sofowora, 1982; 1973; Akinkugbe, 1979;

Afolaju,2011). The main thrust of these studies is that because of its peculiar

nature and characteristics, traditional medicines provide the bulk of health care

for Nigerian population. For instance it has been found that traditional

medicine enjoys a wider acceptability among the people than modern medicine.

This could be due partly to the inaccessibility of modern medicine. But more

importantly, the major contributing factor is the fact that traditional medicine

blends readily into the socio-cultural life of the people in whose culture it is

deeply rooted (Yusuf, 1994; Elujoba et al, 2005; WHO, 2005). Again, it was the

only form of health care available to the people before the advent of modern

medicine. Instances have been reported where people who are close to modern

hospitals consult traditional healers as a first choice of health care.

According to Essential Drugs (2003), in the past decade, there has been

renewed attention and interest in the use of traditional medicines globally. In

China for instance, traditional medicine is said to account for about 40% of all

healthcare delivered. The percentage is said to be 71 in Chile, 65% in India, 48%

in Australia, 70% in Canada, 49% in France, and 42% in the United States.

Nigeria is not left out of this embrace. Traditional medicine is said to be popular

among 70% of the population (Abubaka, 2003; Maiwada, 2004; Adelaja, 2006;

Herbert, 2012).

Country Traditional Medicine Usage

China 80%

Chile 71%

India 65%

Australia 48%

Canada 70%

USA 42%

France 49%

Nigeria 70%

Abodurin et al (2011) and Oreabga et al, studied Lagos and Ogbomoso

respectively on the use of TM. The result was 67.7% in Lagos and 66.8% in

Ogbomoso. WHO has recently estimated that about 80% of the world’s

population use herbal medicines for some aspects of primary health care and
the worldwide market for these products (between 2002-2004) approaches

$60 billions (Willcox and Bodeker, 2004).

WHO in January, 2004 highlighted three broad types of utilization patterns.

The first is prevalent in countries where TM is used as the primary source of

health care. Typically for these countries, the availability and/or accessibility of

conventional medicine are generally limited and TM is used mainly by poor

populations, as in many African countries and some Asian countries. This

situation is found mainly in countries with either a tolerant or an inclusive

health system structure. The second type of TM utilization, involving a few

countries, entails the use and prescription of TM in conjunction with

conventional medicine due to cultural/historical influence. This dual utilization

pattern is found in integrative systems such as in China, Viet Nam, and the

Republic of Korea or in inclusive systems in many countries in Asia and South

America. The third type involves the use of TM/CAM in a complementary or

alternative role with conventional medicine. This selective utilization is

common in high-income countries where the health system structure is usually

inclusive or tolerant as in North America and many European countries.

IMPLICATION OF ALTERNATIVE MEDICINE FOR NIGERIA HEALTH CARE

SYSTEM.

The present status of health care delivery in Nigeria is far from being capable

of meeting the basic health needs of Nigerians. The existing health care delivery

system does not meet the ever increasing health needs of the Nigerians

population because of the high cost of modern health care, its advanced

technology and high illiterate population.

Alternative medicine constitutes an important source of medical care for

many people in the developing nations of the world, especially among those

living in the rural areas where modern medical services seldom penetrate. An

exposition of the relevance of traditional medicine to Nigeria’s health care

delivery system is therefore considered very important in the light of the above,

especially as the bulk of the population resides in the rural area where they

make frequent use of indigenous health practitioners.

According to Olujoba et al, (2005) Traditional Medicine has

demonstrated its contribution to the reduction of excessive mortality,

morbidity and disability due to diseases such as HIV/AIDS, malaria,

tuberculosis, sickle-cell anaemia, diabetes and mental disorders. Traditional

Medicine reduces poverty by increasing the economic well-being of

communities and developes health systems by increasing the health coverage

to the people.

Listed below are some of the advantages of alternative medicines :

• Traditional medicine blends readily into the socio-cultural life of the

people in whose culture it is deeply rooted.

• Traditional medicine enjoys a wider acceptability among the people than

modern medicine. (Emmanuel, 1973; Ademuwagun, 1969; Sofowora,

1982;1973; Akinkugbe, 1979).

• Reduced risk of side effects: Most herbal medicines are well tolerated by

the patient, with fewer unintended consequences than pharmaceutical

drugs. Herbs typically have fewer side effects than traditional medicine,

and may be safer to use over time.

• Widespread availability: Herbs are available without a prescription. You

can grow some simple herbs, such as peppermint and chamomile, at

home. In some remote parts of the world, herbs may be the only

treatment available to the majority of people.

• Lower cost: Another advantage to herbal medicine is cost. Herbs cost

much less than prescription medications. Research, testing, and

 marketing add considerably to the cost of prescription medicines. Herbs

tend to be inexpensive compared to drugs.

The disadvantages of Alternative Medicine are:

• Inappropriate for many conditions: Modern medicine treats sudden

and serious illnesses and accidents much more effectively than herbal or

alternative treatments. An herbalist would not be able to treat serious

trauma, such as a broken leg, nor would he be able to heal an appendicitis

or a heart attack as effectively as a conventional doctor using modern

diagnostic tests, surgery, and drugs.

• Lack of dosage instructions: traditional medicine is the very real risks

of doing yourself harm through self-dosing with herbs. While you can

argue that the same thing can happen with medications, such as

accidentally overdosing on cold remedies, many herbs do not come with

instructions or package inserts. There's a very real risk of overdose.

• Poison risk associated with wild herbs: Harvesting herbs in the wild is

risky, if not foolhardy, yet some people try to identify and pick wild herbs.

They run a very real risk of poisoning themselves if they don't correctly

identify the herb, or if they use the wrong part of the plant.
 • Medication interactions: Herbal treatments can interact with

medications. Nearly all herbs come with some warning, and many, like

the herbs used for anxiety such as Valerian and St. John's Wort, can

interact with prescription medication like antidepressants.

• Lack of regulation: because traditional medicines are not tightly

regulated, consumers also run the risk of buying inferior quality herbs.

The quality of herbal products may vary among batches, brands or

manufacturers. This can make it much more difficult to prescribe the

proper dose of an herb.

The world health body in 2008 marked WHO’s 60th anniversary and, also

the 30th anniversary of the Alma –Ata Declaration adopted by WHO and

United Nations International Children Educational Funds (UNICEF) in 1978.

The declaration was significant for traditional medicine. Although, it has

been used for thousands of years, and has made great contributions to

human health, the declaration was the first recognition of the role of

traditional medicine and its practitioners in primary health care by W.H.O

and its member states.

The World Health Organization in its Alma Ata declaration recognized

Primary Health Care as a practical approach that can make essential health care
universally accessible to individuals and families in a community in an

acceptable and affordable way and with their full participation (WHO, 1978).

The organization also issued a call for the promotion and development of

traditional medicine. Recognizing that traditional medicine will of necessity, if

not also by desire, remain the major source of health care for most of the world

population, the world health recommends national implementation of an

integration policy wherever feasible(WHO, 1983).

Taking a cue from the WHO recommendation, the Nigerian Government

proposes as its goal the establishment of a comprehensive health care system

based on primary health care that is promotive, protective, preventive,

restorative and rehabilitative to every citizen of the country within the

available resources so that individuals and communities are assured of

productivity, social well-being and enjoyment of living (FMH, 1988, p.34).

Alternative medicine has contributed and is still contributing to the promotion,

protection, prevention, restoration and rehabilitation of health in Nigeria.

If the great impact of alternative medicine is to be felt in Nigeria’s healthcare

system the competition and diversity in Nigeria’s health care system must be

checkmate by introducing a Complimentary Alternative Medicine (CAM) into

the health care system. This will bring a union between the western medicine
and alternative medicine leading to a better healthcare system as seen in China,

India, USA and some other countries (a bill sponsored by HON.GOZIE AGBAKO

in 2009).