Substitutes or Complements? Diagnosis and Treatment with non-Conventional and Conventional Medicine

Document Type : Original Article

Author

Center of Study and Research in Health/Centro de Estudos e Investigação em Saúde (CEISUC), University of Coimbra, Coimbra, Portugal

Abstract

Background
Portugal has a strong tradition of conventional western healthcare. So it provides a natural case study for the relationship between Complementary/Alternative Medicine (CAM) and Western Medicine (WM). This work aims to test the relationship between CAM and WM users in the diagnosis and treatment stages and to estimate the determinants of CAM choice.
 
Methods
The forth Portuguese National Health Survey is employed to estimate two single probit models and obtain the correlation between the consumption of CAM and WM medicines in the diagnosis and treatment stages.
 
Results
Firstly, both in the diagnosis and the treatment stage, CAM and WM are seen to be complementary choices for individuals. Secondly, self-medication also shows complementarity with the choice of CAM treatment. Thirdly, education has a non-linear relationship with the choice of CAM. Finally, working status, age, smoking and chronic disease are determinant factors in the decision to use CAM.
 
Conclusion
The results of this work are relevant to health policy-makers and for insurance companies. Patients need freedom of choice and, for the sake of safety and efficacy of treatment, WM and CAM healthcare ought to be provided in a joint and integrated health system.

Highlights

Commentaries Published on this Paper

  • New Scope for Research in Traditional and Non-conventional Medicine; Comment on “Substitutes or Complements? Diagnosis and Treatment with Non-conventional and Conventional Medicine”

            Abstract | PDF

  • Middle Age Like Fight or Modern Symbiosis?; Comment on “Substitutes or Complements? Diagnosis and Treatment With Non-conventional and Conventional Medicine”

            Abstract | PDF

 

Author's Response to the Commentaries

  • The Challenge of Complementary and Alternative Medicine After Austerity: A Response to Recent Commentaries

            Abstract | PDF

 

 

Watch the Video Summary here

 

Keywords

Main Subjects


 

 

 

  1. World Health Organization (WHO). Traditional medicines: definitions [internet]. [cited 30 January 2014]. Available from: http://www.who.int/medicines/areas/traditional/definitions/en/
  1. European Information Centre for Complementary and Alternative Medicine (EICAM). 2008. [cited 30 June 2013]. Available from: http://www.eiccam.eu/portal.html
  2. CAMbrella Project. CAMbrella project funded by the 7th Framework Programme of the European Commission (FP7-HEALTH-2009-3.1-3) [internet]. [cited 31 January 2015]. Available from: http://www.cambrella.eu/home.php
  3. Fisher P, Ward A. Complementary Medicine in Europe. BMJ 1994; 309: 107-11. doi: 10.1136/bmj.309.6947.107
  4. Harris P, Rees R. The prevalence of complementary and alternative medicine use among the general population: a systematic review of the literature. Complement Ther Med 2000; 8: 88-96. doi: 10.1054/ctim.2000.0353
  5. Pagán JA, Pauly MV. Access to conventional medical care and the use of complementary and alternative medicine. Health Affairs 2005; 24: 255-62. doi: 10.1377/hlthaff.24.1.255
  6. Astin JA.Why patients use alternative medicine: results of a national study. JAMA 1998; 20: 279: 1548-53. doi: 10.1001/jama.279.19.1548
  7. Silva BA. Optar pelo uso de terapias alternativas e complementares: representações sociais da Medicina Alternativa e/ou Complementar e da Medicina Oficial/Convencional  [master thesis in Social Psicology]. Oporto, Portugal: Faculty of Psychology and Educational Sciences, University of Oporto; 2008.
  8. Akinci AC, Zengin N, Yildiz H, Sener E, Gunaydin B. The complementary and alternative medicine use among asthma and chronic obstructive pulmonary disease patients in the southern region of Turkey. Int J Nurs Pract 2011; 17: 571-82. doi: 10.1111/j.1440-172x.2011.01976.x
  9. Houssen ME, Ragab A, Mesbah A, El-Samanoudy AZ, Othman G, Moustafa AF, et al. Natural anti-inflammatory products and leukotriene inhibitors as complementary therapy for bronchial asthma.Clin Biochem 2010; 43: 887-90. doi: 10.1016/j.clinbiochem.2010.04.061
  10. Beuth J, van Leendert R, Schneider B, Uhlenbruck G. Reduced side-effects of adjuvant hormone therapy in breast cancer patients by complementary medicine. In Vivo 2010; 24: 799-802.
  11. Nahas R, Moher M. Complementary and alternative medicine for the treatment of type 2 diabetes. Can Fam Physician 2009; 55: 591-96.
  12. Langhorst J, Wulfert H, Lauche R, Klose P, Cramer H, Dobos GJ, et al. Systematic Review of Complementary and Alternative Medicine Treatments in Inflammatory Bowel Diseases. J Crohns Colitis 2015; 9: 86-106. doi: 10.1093/ecco-jcc/jju007
  13. De Silva V, El-Metwally A, Ernst E, Lewith G, Macfarlane GJ. Evidence for the efficacy of complementary and alternative medicines in the management of fibromyalgia: a systematic review. Rheumatology (Oxford) 2010; 49: 1063-8. doi: 10.1093/rheumatology/keq025
  14. Furlan AD, Yazdi F, Tsertsvadze A, Gross A, Van Tulder M, Santaguida L, et al. Complementary and alternative therapies for back pain II. AHRQ Publication No. 10(11)-E007, Agency for Healthcare Research and Quality U.S. Department of Health and Human Services. Evid Rep Technol Assess (Full Rep) 2010; 194: 1-764.
  15. Zhou S, Chan E, Pan SQ, Huang M, Lee EJ. Pharmacokinetic of interactions of drugs with St.John’s wort. J Psychopharmacol 2004; 18: 262-76. doi: 10.1177/0269881104042632
  16. Rispler DT, Sara J. Impact of complementary and alternative treatment modalities on the care of orthopaedic patients. J Am Acad Orthop Surg  2011; 19: 634-43.
  17. Woodward KN. The potential impact of the use of homeopathic and herbal remedies on monitoring the safety of prescription products. Hum Exp Toxicol 2005; 24: 219-33. doi: 10.1191/0960327105ht529oa
  18. Hu Z, Yang X, Ho PC, Chan SY, Heng PW, Chan E, et al.  Herb-drug interactions: a literature review. Drugs 2005; 65: 1239-82. doi: 10.2165/00003495-200565090-00005
  19. Ulbricht C, Chao W, Costa D, Rusie-Seamon E, Weissner W, Woods J. Clinical evidence of herb-drug interactions: a systematic review by the natural standard research collaboration. Curr Drug Metab 2008; 9: 1063-120. doi: 10.2165/00003495-200565090-00005
  20. Fugh-Berman A. Herb-drug interactions. Lancet 2000; 355: 134-8. doi: 10.1016/s0140-6736(99)06457-0
  21. Chan E, Tan M, Xin J, Sudarsanam S, Johnson DE. Interactions between traditional Chinese medicines and Western therapeutics. Curr Opin Drug Discov Devel 2010; 13: 50-65.
  22. Barros PP, Simoes J. Portugal: Health system review. Health Syst Transit 2011; 13: 1-156.
  23. Simões J. Essay Series: Healthcare system in Portugal [internet]. Medical Solutions. [cited 20th August 2012]. Available from: http://www.siemens.com/healthcare-magazine
  24. Miranda, AS. Terapêuticas não convencionais: Perspectivas dos médicos de medicina geral e familiar [master thesis in Medicine]. Covilha, Portugal; Faculty of Health Sciences, University of Beira Interior; 2010.
  25. Antunes JL. A Profissão de Médico. Análise Social 2003; XXXVIII: 77-99.
  26. Grossman M. On the concept of health capital and the demand for health. J Polit Econ 1972; 80: 403-20. doi: 10.1086/259880
  27. Belloc NB, Breslow L. Relationship of physical health status and health practices. Prev Med 1972; 1: 409-21. doi: 10.1016/0091-7435(72)90014-x
  28. Breslow L, Enstrom J. Persistence of health habits and their relationship to mortality. Prev Med 1980; 9: 469-83. doi: 10.1016/0091-7435(80)90042-0
  29. Schoenborn CA. Health habits of US adults, 1985: the Alameda Seven revisited. Public Health Reports 1986; 101: 571-80.
  30. Kenkel D. Should we eat breakfast. Health Econ 1995; 4: 15-29. doi: 10.1002/hec.4730040103
  31. Zhao XF, Du Y, Liu PG, Wang S. Acupuncture for stroke: evidence of effectiveness, safety, and cost from systematic reviews. Top Stroke Rehabil 2012; 19: 226-33. doi: 10.1310/tsr1903-226
  32. Marchisio P, Bianchini S, Galeone C, Baggi E, Rossi E, Albertario G, et al. Use of complementary and alternative medicine in children with recurrent acute otitis media in Italy. Int J Immunopathol Pharmacol 2011; 24: 441-9.
  33. Kooreman P, Baars EW. Patients whose GP knows complementary medicine tend to have lower costs and live longer. European Journal Health Economics 2012; 13: 769-76. doi: 10.1007/s10198-011-0330-2
  34. Shuval JT, Gross R, Ashkenazi Y, Schachter L. Integrating CAM and Biomedicine in Primary care settings, physicians perspectives on boundaries and boundary work. Qual Health Res 2012; 22: 1317-29. doi: 10.1177/1049732312450326
  35. Das T, Choudhury D. Are complementary and alternative medicines alternative to conventional medical system? An economic evaluation. Applied Economic Letters 2007; 14: 697-700. doi: 10.1080/13504850600592580
  36. van Gameren E. Health insurance and use of alternative medicine in Mexico. Health Policy 2010; 98: 50-7. doi: 10.1016/j.healthpol.2010.04.006
  37. Wolsko PM, Eisenberg DM, Davis RB, Ettner SL, Phillips RS. Insurance coverage, medical conditions, and visits to alternative medicine providers, results of a national survey. Arch Intern Med 2002; 162: 281-7. doi: 10.1001/archinte.162.3.281
  38. Tom Xu K, Farrell TW. The Complementarity and substitution between unconventional and mainstream medicine among racial and ethnic groups in the United States. Health Serv Res2007; 42: 811-26. doi: 10.1111/j.1475-6773.2006.00628.x
  39. Chan YM, Huang H, Mei H. Socioeconomic status, attitudes on use of health information, preventive behaviours, and complementary and alternative medical therapies: using a US national representative sample. Natural and Applied Sciences Part I 2012; 3: 15-23.
  40. Eardley S, Bishop FL, Prescott P, Cardini F, Brinkhaus B, Santos-Rey K, et al. Final Report of CAMbrella Work Package 4 CAM use in Europe – The patients’ perspective. Part I: A systematic literature review of CAM prevalence in the EU [internet]. CAMbrella project funded by the 7th Framework Programme of the European Commission (FP7-HEALTH-2009-3.1-3), 2012. [cited 31 January 2015]. Available from:  http://phaidra.univie.ac.at/
  41. Nissen N, Johannessen H, Schunder-Tatzber S, Lazarus A, Weidenhammer W. Final Report of CAMbrella Work Package 3 Citizens’ needs and attitudes towards CAM [internet]. CAMbrella project funded by the 7th Framework Programme of the European Commission (FP7-HEALTH-2009-3.1-3), 2012. [cited 31 January 2015]. Available from: http://phaidra.univie.ac.at/
  42. Eardley S, Bishop FL, Prescott P, Cardini F, Brinkhaus B, Santos-Rey K, et al. A Systematic Literature Review of Complementary and Alternative Medicine Prevalence in EU. Forsch Komplementmed 2012; 19: 18-28. doi: 10.1159/000342708
  43. von Ammon K, Frei-Erb M, Cardini F, Daig U, Dragan S, Hegyi G, et al. Complementary and alternative medicine provision in Europe – first results approaching reality in an unclear field of practices. Forsch Komplementmed 2012; 19: 37-43. doi: 10.1159/000343129
  44. Hämeen-Anttila KP, Niskala UR, Siponen SM, Ahonen RS. The use of complementary and alternative medicine products in preceding two days among Finnish parents – a population survey. BMC Complement Altern Med 2011; 11: 107-14. doi: 10.1186/1472-6882-11-107
  45. Giannelli M, Cuttini M, Arniani S, Baldi P, Buiatti E. Non-conventional medicine in Tuscany: attitudes and use in the population. Epidemiology Prevenzione 2004; 28: 27-33.
  46. Barbadoro P, D’Errico MM, Minelli A, Pennacchietti L, Ponzio E. Complementary and alternative medicine (CAM) among adults in Italy: use and related satisfaction. Eur J Integr Med 2011; 3: e325-32. doi: 10.1016/j.eujim.2011.09.001
  47. Bücker B, Groenewold M, Schoefer Y, Schäfer T. The use of complementary alternative medicine (CAM in 1001 German adults: results of a population based telephone survey. Gesundheitswesen 2008; 70: e29-36. doi: 10.1055/s-2008-1081505
  48. Al-Windi A, Elmfeldt D, Svärdsudd K. The relationship between age, gender, well-being and symptom and the use of pharmaceuticals, herbal medicines and self-care products in a Swedish municipality. Eur J Clin Pharmacol 2000; 56: 311-7. doi: 10.1055/s-2008-1081505
  49. Al-Windi A. Determinants of complementary and alternative medicine (CAM) use. Complement Ther Med 2004; 12: 99-111. doi: 10.1016/j.ctim.2004.09.007
  50. Thomas K, Coleman P. Use of complementary and alternative medicine in general population in Great Britain. Results from the National Omnibus survey. J Public Health (Oxf) 2004; 26: 152-7. doi: 10.1093/pubmed/fdh139
  51. Adams J, Easthope G, Sibbritt D. Exploring the relationship between women’s health and the use of complementary and alternative medicine. Complement Ther Med 2003; 11: 156-8. doi: 10.1016/s0965-2299(03)00062-1
  52. Colebunders R, Dreezen C, Florence E, Pelgrom Y, Schrooten W; Eurosupport Study Group. The use of complementary and alternative medicine by persons with HIV infection in Europe. Int J STD AIDS 2003; 14: 672-4. doi: 10.1258/095646203322387929
  53. Molassiotis A, Scott JA, Kearney N, Pud D, Magri M, Selvekerova S, et al. Complementary and alternative medicine use in breast cancer patients in Europe. Support. Care Cancer 2006; 14: 260-7. doi: 10.1258/095646203322387929
  54. Decker SL. Cigarettes and alcohol: substitutes or complements? NBER Working Paper, WP/7535, Cambridge; 2000.
  55. Ganz ML. Family Health effects: complements or substitutes. Health Econ 2001; 10: 699-714. doi: 10.1002/hec.612
  56. Rask K, Rask K. Delivering public health care services: substitutes, complements or both? Contemp Econ Policy 2005; 23: 28-39. doi: 10.1093/cep/byi003
  57. Atella V, Deb P. Are primary care physicians, public and private sector specialists substitutes or complements? Evidence from a simultaneous equations model for count data. J Health Econ 2008; 27: 770-85. doi: 10.1016/j.jhealeco.2007.10.006