SQU Med J, May 2011, Vol. 11, Iss. 2, pp. 161-164, Epub. 15th May 11
Submitted - 25th April 11
Accepted - 27th April 11

In this issue of SQUMJ, Dr. Deepali Jaju and her colleagues have shown the effects of a yoga technique known as Pranayam breathing 
(PB) on the pulmonary system.1 These authors 
have demonstrated that PB has different effects on 
healthy controls compared to those with chronic 
obstructive pulmonary disease (COPD). PB invoked 
clear improvement in maximum inspiratory 
pressure (MIP) in normal controls; however, PB was 
not able to produce MIP changes in subjects with 
COPD. There was however, a significant increase in 
the visual analogue score (VAS) in COPD patients, 
which suggested reduction in respiratory distress. 
While the improvements were limited, and perhaps 
variable in different people, it does indicate that 
there is indeed some validity in yogic intervention. 
In modern parlance, health care systems outside the 
realm of modern biomedical sciences, also termed 
‘allopathic medicine’, are often labelled ‘traditional 
medicine’. The increasing acceptance of ‘non-
allopathic’ health care systems, has led to some 
of them have being accepted as ‘complementary 
and alternative medicine’ (CAM). The term 
‘integrative medicine’ has also emerged to describe 
the concurrent use of different healing systems to 
increase vitality, cure disease, or as integral part of 
a regimen for a healthy lifestyle or prevention of 
diseases.

In the SQUMJ February 2011 issue, Dr. Rahma 
Al-Kindi and her colleagues studied the use of 
alternative medicine among adult diabetics.2 The 
study population was 146 patients, attending 
diabetic clinics at four primary health centres in the 

Muscat area of Oman. This study demonstrated that 
52% of the subjects had used alternative medicine 
at some time in the past. Most importantly, 42% of 
the cohort had used herbs and food supplements 
specifically to manage their diabetes. As half of the 
patients were satisfied with such interventions, the 
study sends a clear message: alternative medicine is 
widely used in the Muscat area for conditions such 
as diabetes. Such findings imply that physicians 
should be better prepared to discuss the use of 
CAM with patients, with all the implications this 
may have including the consideration of potential 
side effects and drug interactions.

It is no surprise that SQUMJ has attracted 
manuscripts on CAM in its recent issues since 
this is consonant with international trends. There 
is evidence in the literature to suggest that there 
is widespread increased use of CAM even in 
developed countries like the United States.3,4,5,6 

In addition to the widespread general increase in 
use, CAM is also being increasingly used to treat 
some specific diseases of major concern to society, 
such as arthritis and cancer in developed countries, 
and malaria in Africa.7,8,9 In developing countries, 
where modern health care systems have remained 
rudimentary, traditional medicine continues to 
meet a significant proportion of health care needs.

Many healing systems owe their origin to 
ancient civilizations. In the Middle East, numerous 
records show the existence of pre-Islamic healing 
systems. This healing system bloomed in ancient 
Mesopotamia, which encompassed the area around 
the Tigris and Euphrates rivers, corresponding to 

Editor-in-Chief, SQU Medical Journal, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman; 
*Email: mjournal@squ.edu.om

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EDITORIAL

Complementary and Alternative Medicine
Where do we stand in the 21st century?

Lamk Al-Lamki



Complementary and Alternative Medicine 
Where do we stand in the 21st century?

162 | SQU Medical Journal, May 2011, Volume 11, Issue 2

present-day Iraq, Syria, Turkey, and part of Iran. 
This cradle of civilization competes with historic 
Egypt in the development and application of such 
healing systems.10 During the heyday of the Islamic 
civilization, various healing systems came into 
prominence and some of them were employed 
in early experimental studies, the precursors of 
modern clinical trials.

Historically, India is one of the countries that has 
given humanity a unique healing system known as 
Ayurvedic medicine which originated at least 4,000 
years ago. The term Ayurveda is a combination of 
Ayu (life) and Veda (science). Ayurvedic medicine 
is based on a humoral interpretation of disease and 
health with the idea of balancing the three humours 
“Vata”, “Pitta” and “Kapha”.11 Ill health results when 
these three are out of balance. Just like India, China 
developed its own unique health care system that 
eventually spread to Japan, Korea and some other 
parts of the Far East. The cardinal idea of the 
Chinese health system was symmetry or balance, as 
in Ayurvedic medicine, and echoed the philosophy 
of ‘Galen’s medicine’ in ancient Greece. In Chinese 
medicine, illness is due to an imbalance in the flow of 
energy through established channels or meridians. 
A normal flow is essential for good health and self-
healing; bamboo sticks, fish bones and now needles 
are used to stimulate points along the energy 
meridians and referred to as acupuncture. Healing 
systems in Europe were strongly influenced by 
Galen and Arab/Islamic medicine until the end of 
medieval period. With the emergence of science and 
experimentation during the European Renaissance, 
scientific medicine started to take root. This, in 
turn, led to the current domination of the modern 
allopathic biomedical health care system in Europe 
and North America. Nonetheless, even in these 
regions, there is still wide popular use of various 
CAM healing practices such as hydrotherapy, 
naturopathy, and herbalism, as well as chiropractic 
therapy, breathing, meditation and the use of mega-
vitamins.  The National Center for Complementary 
and Alternative Medicine (NCCAM) of the 
National Institute of Health (NIH) in the USA has 
instituted scientific studies to explore the efficacy 
of both the remaining traditional medicine systems 
and newly emerged healing systems.12 

With respect to Oman, the health system is 
a hybrid of of allopathic medicine and traditional 
healing practices, the latter being deeply rooted 

in society. It is thus not surprising that Dr. Rahma 
Al-Kindi found a high use of herbal treatments 
for the self-management of diabetes.2 Oman also 
has other types of CAM including the well known 
‘physical treatments’ such as “Al Wasam” (الوسم) 
cauterization and “Al Hujama” (احلجامة) vacuum cup 
suction of the body surface.13 Traditional Omani 
‘orthopaedic’ interventions include the use of “Al 
Jabirah” (اجلبيرة), a homemade equivalent of plaster 
of Paris) used by a traditionally trained person 
(a “Mugabbir” – مجّبر) for fractures and sprains. 
There are also various ‘spiritual’ interventions often 
employed for combatting what would in Western 
medicine be deemed to be psychological disorders; 
these include “Al Bassar” (الباصر), and “Zar” (زار), 
both exorcism practices.14 In addition, like other 
countries round the world, Oman also uses a 
variety of herbs (“Marameiah” –  املرمرية) for different 
medical conditions. There is also a specific type of 
deep massage which is used for the treatment of 
infertility in Oman (“Al Maasah” – املسح). Other 
CAM physical treatments used in Oman include 
using a twin to treat migraine by massaging the 
affected side of the person’s forehead with his/her 
foot. 

Despite the wide current use of non-allopathic 
treatment, there are still highly polarized views 
on the topic among modern practitioners of 
biomedical health care system. Many doctors who 
practice conventional allopathic medicine do not 
‘believe’ in the efficacy of CAM at all—“it neither 
works nor does it have any basis on which it can 
possibly work”. Then, there are those doctors who 
practise both allopathic medicine and CAM, but 
unfortunately, some of these are doing it only for 
profit.

There is however, a glimmer of hope as 
evidenced in the American NCCAM Center, 
where millions of dollars are spent on studying 
various forms of CAM including naturopathy, 
chiropractice, herbalism, traditional Chinese 
medicine, Ayurveda, meditation, yoga, biofeedback, 
hypnosis, homeopathy, acupuncture and nutrition-
based therapies among other therapies.12 NCCAM 
aspires to establish the evidence-based efficacy of 
CAM. More recently, some clinical research has 
been employed to shed light on the efficacy of 
CAM, employing vigorous research methodology 
such as controlled clinical trials.4 To understand 
CAM better, NCCAM has classified CAM into 5 



Lamk Al-Lamki

editorial | 163

major groups:12 1) Whole medical systems such 
as Ayurvedic medicine, Chinese medicine and 
homeopathy; 2) Mind-body medicine which 
include yoga and meditation; 3) Biological-based 
substances such as herbs, foods and vitamins; 4) 
Manipulative and body based practices such as 
chiropractic and osteopathy manipulations; 5) 
Energy medicine including biofield therapists and 
bioelectromagnetic-based therapies. The Cochrane 
Center has also reviewed some scientific studies on 
CAM and published them on website of the Danish 
Knowledge and Research Center for Alternate 
Medicine (ViFABS).15

Those of us who practise conventional allopathic 
medicine need to have a better understanding of 
CAM, how it works, and what the potential benefits 
and side effects are. We need to be more willing to 
discuss the use of CAM with our patients. There is 
indeed potentially great danger in combining the 
two without proper knowledge of both. This is of 
particular concern when a serious illness threatens 
the confidence of patients in modern allopathic 
medicine and they resort to CAM as adjunctive 
therapy, and, at times, as the sole treatment. It is 
not clear why people use CAM, but their reasons 
are related to social and cultural issues, as well as 
the nature and severity of their disease. Somehow, 
CAM has a major persuasive appeal to patients.16,17 
In developed countries, wide usage of CAM 
among patients with chronic and debilitating 
disease may be due to a culturally-based wish to 
“leave no stone unturned” and  a patient’s ‘loss of 
hope’ of regaining their pre-morbid self as in the 
case of people with aggressive types of cancers 
or other progressive debilitating diseases that are 
impervious to conventional medical treatment. 
There is no evidence to suggest that oncologists are 
fully aware of the trend for cancer patients to use 
CAM concomitantly with their chemotherapy. This, 
needless to say, is potentially dangerous as major 
toxicities may arise. Ernst et al. reviewed several 
publications and out of the 21 studies on adult 
cancers, 50% reported that 27% of respondents used 
CAM while the average percentage of adults using 
CAM was 31.4%.8  

Why patients use alternative medicine and which 
patients do this has yet to be empirically charted. 
John Astin, from Stanford Center for Disease 
Prevention, has studied the socio-demographic 
characteristics of people who use CAM and found 

that those who used CAM were likely to be well 
educated, but have poor health status.18 It was found 
in this study that people utilised CAM not because 
they were dissatisfied with conventional medicine, 
but because they found it “more congruent with 
their valued beliefs and philosophical orientations 
towards health and life”.14 It is not known how widely 
CAM is used in different communities or clinical 
conditions. Most of the available studies are marred 
by poor design and methodological limitations. 
Harris and Rees have reviewed 12 studies and could 
not come to a clear conclusion.3 

However, there is hope for humanity as a whole 
because it is gradually getting clearer that there is 
a lot of potential benefit from CAM, even though 
currently there is some misuse or improper use. 
As more and more clinical and basic scientific 
studies are carried out, it becomes clearer that 
the boundaries between CAM and conventional 
Western medicine are becoming blurred. On 
the whole, what is considered complementary 
and alternative practice in one country maybe 
considered conventional practice in another, 
e.g. some herbs in standard use in Europe are 
considered CAM therapy in the United States.12 An 
increasing number of robust studies are appearing 
in the literature showing the potential benefits of 
using CAM alone or as part of integrative medical 
therapy. One of these is a recent Norwegian study 
from the Norwegian University of Life Sciences 
(UMB). It is a scientific study of the plants extracts 
derived from the bark of Cinchona tree and the 
Sweet Wormwood plant (Artemisia Annua) that 
have been used since dawn of history in African 
traditional medicine against malaria. Interestingly, 
contrary to the case with some of the conventional 
drugs available to treat malaria today, the malaria 
parasite has not yet developed resistance to the 
formula employed in African traditional medicine.9 
Another recent clinical research study has studied 
the effects of omega-3 fatty acid and fish intake on 
development of age-related macular degeneration 
(AMD) amongst the 38,022 women who were 
followed up by questionnaire.19 The results showed 
a significant decrease of the incidence of AMD 
over 10 years follow-up. It is postulated that the 
fatty acid in fish and omega-3 fatty acid helped 
improved choroidal blood flow in the eye. AMD 
and cardiovascular disease have been hypothesised 
to share similar mechanisms and risk factors. Intake 



Complementary and Alternative Medicine 
Where do we stand in the 21st century?

164 | SQU Medical Journal, May 2011, Volume 11, Issue 2

of fish and omega-3 fatty acid has been linked to 
reduced cardiovascular events possibly related to 
the anti-inflammatory and anti-atherosclerotic 
effects of these products.

Where do we go from here? We, as modern 
allopathic medicine practitioners, need to take a 
long and good look at our attitude towards CAM. 
We need to be well-versed in this subject so that we 
are able to discuss it intelligently with the ‘e-patients’ 
of the 21st century. We need to understand the role 
of CAM when used alone or in conjunction with 
other treatment protocols that are an integral 
part of biomedical care.  We need more scientific 
research devoted to understanding how and which 
CAM treatment has benefit to those who use it. 
The future of health care would be best served if 
an enlightened and amicable merger of the two 
branches of medical treatments were contemplated. 
More studies are therefore imperative. This means 
physicians need to open their eyes and apply their 
minds to this endeavour.

References
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Al Rawas O. Effects of Pranayam breathing on 
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2. Al-Kindi RM, Al-Mushrafi M, Al-Rabaani M, Al-
Zakwani I. Complementary and alternative medicine 
use among adults with diabetes in Muscat region, 
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3. Harris P, Rees R. The prevalence of complementary 
and alternative medicine use among the  
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5. Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey 
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6. Barnes PM, Powell-Griner E, McFann K, Nahin 
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19. Christen WG, Schaumberg DA, Glynn RJ, Buring JE. 
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