Alternative and Complementary Medicine ( ACM )

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• Alternative and Complementary Medicine ( ACM )
• Aproposal For Regulation
• In Saudi Arabia

Prof. Adnan Ahmad Albar Dept. of Family
Community medicine King Abdul-Aziz
University Jeddah, K. S. A.
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Introduction

• Definitions
• Extent of Practice
• Types, claimed benefits, and scientific
  evidence.
• Why do patient seek ACM .

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• Who seeks ACM.
• How does it work in view of the Biopsychosocial
  model the concepts of illness and healing.
• Training , education and certification in ACM.
• The criticism against alternative and
  complementary medicine.

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• The place of Evidence in ACM.
• The WHO Expert group review of ACM in 114
  countries.
• Current status and regulation of ACM practice in
  S.A.
• The way forward.

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Terminologies

• Alternative medicine.
• Complementary medicine.
• Natural medicine
• Greek medicine.
• Chinese medicine.
• Herbal medicine

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Terminologies

• Indian medicine.
• Arabic medicine
• Islamic medicine.
• Quranic medicine.
• Prophetic medicine.
• Ancient medicine.

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• Increasing global practice of ancient and new
  modalities
• WHO estimates that 30 of patients seek
  alternative or complementary medicine.
• A U .S estimation revealed that Americans spent
  27 billion dollars On alternative and
  complementary medicine in 1997.

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• In 2000 a German study reveled that 65 of
  health care seekers used herbal medicine.
  Compared to 45, 50, 50.1, 60 in America,
  France, Australia, and Canada respectively.

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In U.S.A.

• More patients seek alternative medicine than
  modern primary health care facilities.
• 90 of self care practices use alternative
  medicine.

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Alternative treatment modalities

• Chinese traditional medicine. (Herbal,
  acupuncture, acupressure, massage,cupping,
  nutritional.)
• Indian Medicine (herbal, relaxation,
  reflexology, Yoga, ..)
• German(homeopathy,herbal,auriculopuncture,cupping)

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• Naturopathy.
• Osteopathy.
• Greek/Unani medicine (herbal, massage, and
  relaxation.)
• The 4 Body mixes theory.
• Arabic(hijama,cauterization,Quranic,herbal).
• Cauterization.
• Odd and unknown modalities.
• Magic and Illegal modalities.

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• Aromatherapy.
• Hijama (Air cups and venapuncture).
• Therapeutic touch (reflexology, Polarity
  therapy)
• Ozone therapy
• Chelation(eddeta)
• Craniosacral massage(CSF movement)
• Herbal Medicine

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Diet and Nutrition treatments

• Supplements
• Folic acid.
• Soya proteins
• Vitamins.
• Niacin-amide
• Food elimination
• Macrobiotics.
• Vegetarians.

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Body-mind interventions

• Prayers.
• Biofeedback
• Yoga
• Relaxation
• Hypnosis.
• Dance and music
• NLP

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Those for Practicing alternative and
complementary medicines

• It cures or alleviates.
• It complements treatment.
• It helps where modern medicine doesnt.
• No or minimal side effects.
• Costs less.
• Simpler and less invasive.
• No complication or serious side effect

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Those against its practice

• Lacks scientific evidence.
• Carries serious side effects.
• Negatively affects patient management.
• Lacks criteria of diagnosis , treatment choice
  and dose.
• No measurable effects.
• costly

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Why do patients seek alternative medicine?

• Not receiving enough care.
• Poor patient doctor relationship.
• Loss of trust in modern medicine esp. in chronic
  and psych cases.
• As a complement.
• Trial
• Believe

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Characteristics of patients seeking alternative
medicine

• More educated.
• Having chronic illness.
• Having pain-full conditions.
• Having disabling condition.

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• Having psychiatric condition.
• Middle aged.
• Women gt men.
• Intolerant.
• More spiritually and or environmentally oriented.

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How does it work?

• The Body-Mind- Spirit set.
• Internal equilibrium reset immunity
  enhancement.
• The Biopsychosocial model of health care.
• Relieves tensions (relaxation and hypnosis).

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• Emphasis on human touch and believe.
• Release of therapeutic substances.
• Pharmacological action.
• Action on body meridians e.g. acupuncture ,
  acupressure , massage, cauterization and Hijama).

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• The place of evidence in the practice of ACM.

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? ??? ?????? ????????? ?????? ???????
1 ????? ?????? Acupuncture ???? ????? ????? ??????? ????? ???????? ???????? ????? ?????? ??? ???? ??????? ?????? ????? ???????? ??? ????? ????? ????? ??? ???????? ????? ??? ???? ??????? ??????? ????? ??????? ???????? ?????? ????? ????????? ??? ????? ????? ??? ??? ???????? ??? ??? ????? ????? , ???? ?????? ??? ??? ?????????
2 ?????? ????? ???????? ???????Aromatherapy ???? ?????? ????? ?????? ???? ?????? ???? ??????? ??? ??????? ?????? ??????? ?? ???? ???? ?????? ?? ???? ????? ???? ?????? ?? ????? ????????? ?? ??????
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? ??? ?????? ????????? ?????? ???????
3 ???????? ???? ???? ???????? ???????? ????????? ??????? ???????? ???????? ????? - ???????? ????? - ????? ????? - ???? ??????? - ???????? - ?????? - ????? - ????? ??????? ???????? ???????? ?????????? ????? ????? ??? ??????? ??? ??? ????? ?? ???? ??? ??????? ?????? ???????? ??? ???????? ????? ??? ???? ???? ??? ?????? ??????? ??? ????? ???????? ?? ???? ????? ???? Blood letting , bowl purging induced vomiting
4 Chelation ?????? ?????? ????? ??? EDETA ???? ???????? ??????? ???????? ????? ???? ????? ?? ??????? ?? ??????? ??????? ??? ???? ?? ???? ???????? ?? ??? ????? ??? ???? ?????? Bone marrow damage ?? ???? ?????
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? ??? ?????? ????????? ?????? ???????
5 Chiropractic ???? ???? ?????? ?????? - ???? ??? ????? - ?????? - ???? ?????? - ?????? ??????? - ??? ????? ??? ????? ??????? ???????? ????? ?????? ?? ???? ?????.????????? ?????? ??? ?????. ???? ?????? ?? ????? ????? ???? ?? ????? ?? ???? ???? ????? ?? ?????? ??? ??????? ?????????
6 Craniosacral therapy ??? ???? ??? ??????? ??????? ?????? ????? ???????? ???? ?????? ?????? - ???? ?????? ????? ?????? - ????? - ?????? - ?????? ??????? - ???????? - ????? ?????? ????????? ??? ????? ????? ??? ??????? ?? ???? ???????
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? ??? ?????? ????????? ?????? ???????
7 DHEA ?????? ?? ????? ???? ????? ?????? ?????????? , ??????????, ???????????? - ???? ????? ????? ????????? - ???? ??????? - ???? ????? ?????? - ????? ????????? ?????? ????? ??? ?????? ??????? ??? ????? Synthetic supplement ???? ????? ?????????? ???? ?????? ????? ????? ??? ??????
8 Glucosamine Synthetic supplement ????? ??? ?????? ??????? ??????? ?? ???????? ??? ?????? ????? ???? ?? ???? ?????? ????? ?? ????
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? ??? ?????? ????????? ?????? ???????
9 ?????? ???????? - ??? ??????? Ginkgo - ???????? - ???? ????????? - ???? ???? ?? ??????? ?????? ???????? ??? ???? ?? ???? ???? ??? ??????? ???? ??? ????? ?????? ????? . - ???? ?? ???? ??? - ?? ???? ???? ????? ?? ?????? ?? ?? ????? ????? - ????? ??????
10 ?????? ?????? Homeopathy - ?????? ??????? - ????? - ?????? - ???????? - ?????? - ??????? - ????? ????? - ??? ??? ??????? - ?? ???? ???? ????? ????? ???? ??? ???? ????? - ?? ???? ??? ???? ???? ?? ??? ????? ?? ??????? ?? ????? ?? ????? ????? - ?? ???? ????? ?? ???????? - ?????? ????? ???? ??????? ??? ????? ?? ?????? ????? ?? ?????? ???? ??????
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? ??? ?????? ????????? ?????? ???????
11 ??????? ??????????Hypnotherapy - ????? - ??????????? - ???????? ?????? ??????? ?????? - ???????? - ???? ?????? - ??????? - ??????? ??????? ??? ???????? ???? ???? ???? ?????. - ????? ??????? ?????? - ??????? - ??? ??????? ?? ?????????
12 ?????? ??????? Naturopathy ??????, ?????, ?????, ???????, ?????? ?????? - ?????? ??????? - ????? - ???????? - ?????? - ?????? ??? ???? - ???????? ?????? ?????? - ????? ????? - ??????? ???? ???? ???? ??? ????? ????? ?????? ??????? ,???????? ????????, ??? ??????? , ?????? ??? ????? - ????? ?? ??????? ??? ???????. - ??????? ???? ??? ??????? ?? ???? ???????? ?????????
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? ??? ?????? ????????? ?????? ???????
13 Osteopathy???? ???? ??????? ??????? ?????? ????? ?????? ?? ??????? ?????? - ??? ????? - ??? ??????? - ????? ??????? - ?????? - ????? - ???????? - ????? - ??? ????? - ???? ???? ????? - ?? ???? ?????? ????? ??? ???? ????????? - ????????? ????? ???????? ????? ??? ?? ???? ???????? ?? ??????
14 ?????? ????????? ??? ???????? ?? ??????? ?? ?????????? ????????? ?? ?? ???? ????? ??? o2 ???? - ??????? - ?????? ??????? - ?????? ?? ???? ???? ???????? ???????? ????????? ????? ???? ??? ???? ??? ??? ??????? ???????
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• The WHO expert group report on ACM in 114
  countries in Africa, Asia, Europe, North and
  South America, and the Middle-east

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• Germany is leading in the practice of homeopathy,
  auriculo-puncture, and herbal medicine.
• In the NHS of the U.K. there are gt50000
  registered alternative medicine practitioners.
• Training, Certification, legislation, and
  registration are more in USA, and Europe.

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• gt50 of the countries have systems of
  registration, licensure and training for
  alternative and complementary medicine.
• In China there are 2500 alternative medicine
  hospitals and thousands of practice centers ,
  525000 practitioners and gt800 factories for
  alternative medicine products.

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• In India 2860 alternative medicine hospitals ,
  22100 practice centers, and 87500 practitioners.
• gt 280000 practitioners in Indonesia and gt 700
  factories of alternative medicine (100 big ones).

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• Herbal medicine is very common in China, India,
  Korea, Australia, USA, Germany, Malaysia,
  Indonesia, Singapore, Pakistan, Bangladesh.

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The Practice of Acupuncture in the USA

• Acupuncture in licensed in 42 states.
• 14000 registered non-physicians acupuncturists .
• 3000 registered physician acupuncturists.
• All practitioner set a unified written
  examination and some states give a practical exam.

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• Training programs for non-physicians lasts 3
  years.
• Training for physician last one year.
• 12 states allow practice through referral from a
  modern medicine practice only.
• CME and CPD are conditional.

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Chiropractic in USA

• gt 70000 registered practitioners.
• gt16 accredited schools.
• Training for 4-5 years.
• A unified written and clinical oral examination

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• The practice of alternative medicine in Saudi
  Arabia
• Common Practices
• Quranic Prophetic recitations.
• Bone healers.
• Herbal shops.
• Herbal healers.
• Hijama.

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• Cauterization
• Acupuncture
• Massage and manipulative therapies.
• Homeopathy.
• Nutritional therapy
• NLP

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• No well set rules and regulations.
• No registration.
• Poor supervision.
• Community pressures for exceptions.
• No clear criteria for required training, and
  accreditation.
• No training centers or programs.h

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• Towards safe practice of alternative medicine In
  The Arab countries

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• Short term measures
• Allow it as complementary and not alternative to
  modern medicine.
• Ensure ethical consideration.
• Autonomy.
• Beneficence.
• Non-maleficience
• Justice.

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• Register all practitioners.
• Register all used herbs and allow useful and harm
  less ones.
• License for practice of specified treatment
  modalities based on training, certification, and
  experience.

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• Encourage shared care and bilateral referral.
• Control advertisement.
• Records, documentation, and statistics.
• Allow its practice in announced places as past of
  modern medicine facilities and based on set
  standerds.

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• Forbid treatment of serious or infectious
  diseases (Malignancies, cardiovascular, Aids,
  etc.)
• Ensure liability.
• Encourage controlled bioethical research work.
• Adhere to countries medical practice by laws.

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• What modalities to be allowed ?
• Classification of the therapeutic effects of
  alternative medicine treatment modalities
• Invalidated treatments Dont allow
• Non validated
• Potentially harmless.
• Potentially useful.
• Potentially harmful.
• Potentially useless
• Validated treatments regulate and allow practice

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Who could be currently licensed ?

• Physician with one year certified training in a
  specific field of ACM. Practitioners with Post
  graduate of bachelor degrees.
• Practitioner with accredited 2-3 years diplomas
  and one year of supervised practice.

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• B)Long term measures
• Establish The Saudi Council for Alternative and
  Complementary Medicine ( SCACM ) either separate
  or under SCHS to
• Review and determine allowed practices and their
  pre-requisites.
• Training, CME, CPD, and certification of
  practitioners.
• Accreditation
• Places
• Persons
• Certificates training.
• Licensure.

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• Practice guideline.
• Quality control measures.
• Health information center.
• Information center.
• Research center.
• Herbal medicine laboratory.
• Alternative medicine industry.

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• Thank You