Alternative Medicine: A Desperate Agenda

I have not been kind to my blog in recent times. I apologize. Many reasons account for this: my doctoral research, travelling - first to the UK as one of the presenters at an international conference on the development of health law and policy in both the United Kingdom and Canada and then to multiple Canadian provinces; I have also been tied up with meetings and consultations... And today, as I read Chikwe Ihekweazu's piece entitled "Are You Sick" available at
http://nigeriahealthwatch.blogspot.com, one of those meetings came to mind. In June I was one of the discussants at a round table conference in British Columbia. The conference was designed to discuss Natural Substances and Methods as Adjuvants to Standard Treatment for Cancer. The conference came to a close with all discussants including prominent researchers, donors and financiers of health research from the University of British Columbia, Simon Fraser University, InspireHealth (Canada's foremost integrative cancer care centre), and the Hecht, Michael Smith, and Canadian Breast Cancer Foundations calling for the establishment of a Centre of Excellence on Complementary and Alternative Medicine Research in British Columbia. Ihekweazu's paper did more than remind me of this important conference. It also reminded me to address some issues raised by a friend and colleague in response to my post titled "Another Imperial Outlook on Health".

Ihekweazu's piece, beautifully written as usual, questions the unregulated practice of alternative medicine. He asks those pertinent questions that need to be asked: a question about regulation, a question about practice and implicitly malpractice standards, and indeed a question about patient safety.

Like Ihekweazu acknowledges, the problem with alternative medicine is the medley of issues, emotional and otherwise, involved in its discussion. However, there is a reason why this has been so. The alternative medicine debate is emotive because of its interconnection with the colonization debate, which scholars are beginning to point out. Post-modern theorists and socio-legal scholars viewing issues through post-colonial lenses are reassessing the historical hierarchy between science and non-western forms of knowledge. Pro-alternative medicine scholars have attempted to show that the present hierarchy of knowledge systems, especially medical knowledge, has everything to do with a colonial heritage in which the medical creativity of peoples of the third world and developing countries have always been rated poorly by the West.

But we are talking about medicine and about life. So, scholastic discussions aside, I believe the most important issue we should be addressing is how to make the best of different medicines - allopathic or alternative - work for the good of health consumers. However, this discussion should in no way start with criticism of alternative medical systems. Ihekweazu's questions, while fundamental to the debate, have to be preceded by the political will to look more closely at the benefits and disadvantages of alternative medicine. We should first ask: how do we create a stronger and more independent Nigerian healthcare system? How do we use alternative medicines to increase access to healthcare in Nigeria? How can we use alternative medical practitioners to fill the gaps created in our healthcare system by migrating Nigerian doctors doing well in the diaspora? In what ways can we use alternative medicines for preventative care so as to reduce the incidence of critical health conditions? How did Cuba achieve the great historical feat of having a strong and functional healthcare system by merely relying on its own (and only its own) home grown medical resources for many years? Cubans invested in healthcare that is holistic and preventative and has created one of the most effective healthcare systems in the world: http://www.yesmagazine.org/article.asp?ID=1733. How come the visit of Americans to alternative practitioners were more common than visits to primary care physicians in recent studies? (425 million visits versus 338 million to registered physicians: D.M. Eisenberg, et al., "Unconventional Medicine in the United States: Prevalence, Costs and Patterns of Use"/National Health Interview Survey (2002)) How is it that American private health insurance companies and some Canadian provinces are providing coverage for some alternative medicines? How come Canadian and American health consumers are suing and invoking the Canadian Charter and the constitution to assert their right to have access to the alternative medicines of their choice? How is it that alternative medicine is being studied in American medical schools, with a research division at Harvard Medical School? Shouldn't we, dear Nigerians, be looking inwards as well in the search for greater access to healthcare?

I say deperate situations require desperate measures. But once we have asked ourselves these important foundation questions, then we can invite the law - indeed Ihekweazu's questions are medico-legal questions - yes, we can invite the law to mandate regulation, to ensure that the appropriate regulatory Agencies are efficient, to protect the citizens... Today, the malpractice rules for alternative medicine are not clear. Scholars are skewed between arguing for the application of scientific standards to alternative medicine or devising a unique set of rules for these medicines. The legal positions are very interesting, but they are a discussion for another day... One thing is sure: rules must be formulated with the co-operation of all the relevant parties to the debate: alternative practitioners, doctors, health policy-makers, and of course, health lawyers. Until a spirited and pro-active debate is underway, it will not be enough to simply criticize the practitioners who are taking advantage (sadly so) of Nigeria's frail healthcare system and regulatory structure to practice their art.

The friend of mine, Idowu Ohioze, who had sent a comment to my inbox about my earlier posting on this issue had asked: "Would alternative and traditional medicines system, once institutionalised, provide cheap alternative channel to Nigerians, in the real sense of the world (sic)? Can it, as presently administered, lend itself to rid us of, say, cancer in all it forms? Wouldn't we still need western medicines? Why then do we advertise traditional medicines as the do-all-be-all of healthcare in Nigeria?" Idowu's very important question was the subject of discussion at the roundtable conference at British Columbia in June. Researchers from both the United States and within Canada are proving this is possible. At Inspirehealth, Canada's foremost integrated cancer care centre, cancer patients are given a longer lease on life through the combined efforts of allopathic and alternative practitioners (http://www.inspirehealth.ca). I had a meeting with the co-founder of the centre last week where I learnt some more about the benefits of integrated medicine. Over 5,000 patients have benefited from the centre's research-informed natural approaches to health. The patients have been guided to integrate these approaches into their cancer treatment and recovery. All at no cost as the services are free and funded by the provincial government. Again, this is an issue of political will. So, while we hope that the government will take up the task, some of us have submerged ourselves in this research, to find answers to the questions posed in this posting and raised in Ihekweazu's Health Watch.

Alternative medicine is a desperate agenda: Like Ihekweazu rightly mentions, people are vulnerable. With the increasing difficulty in accessing and affording conventional medicines, many unqualified alternative (and indeed allopathic practitioners) will continue to prey on unprotected citizens. Detoxifying the Nigerian healthcare system of unqualified practitioners, however, should not be an isolated agenda. We must ask ourselves: how do we use what we have in combination with what Western medicine has offered to increase access to healthcare in Nigeria?

Read Chikwe Ihekweazu's piece at: http://nigeriahealthwatch.blogspot.com