The document discusses complementary and alternative medicine (CAM) and its relevance to family physicians. It provides definitions of CAM, conventional medicine, and integrative medicine. CAM modalities discussed include biologically based practices like herbalism and aromatherapy, mind-body medicine techniques, manipulative body-based practices, energy medicine, and whole medical systems. Standards and guidelines for CAM by WHO are outlined, along with Nigeria's situation regarding CAM regulation and integration. The family physician's role in utilizing CAM is also mentioned.

1. THE FAMILY PHYSICIAN AND
COMPLEMENTARY & ALTERNATIVE
MEDICINE (CAM)
Dr Maimuna, Mang & Awala
Supervisor – Dr Udo

2. PRE-TEST
1. Attributes of a good Family Physician
a) First contact doctor
b) Holistic approach to care
c) Member of care team
d) Sees undifferentiated patients
e) Uses CAM

3. PRE-TEST
2. CAM practitioners respond to their
considered ‘inferior status’ by :
a) Allowing scientific investigation of products
b) Lobby of relevant organs
c) Registration of products as drugs
d) Repackaging their products
e) Vigorous advertisement and marketing

4. PRE-TEST
3. Challenges of integrative medicine
include:
a) Absent scientific investigational tool
b) Cannot be all inclusive
c) Fight for superiority in care team
d) Mutual distrust
e) Refusal to copy the right model

5. PRE-TEST
4. The dichotomy into conventional/CAM practices
negatively impacts CAM practitioners by:
a) Loss of association
b) Loss of clientele
c) Loss of fame
d) Loss of income
e) Loss of opportunity to benefit humanity

6. LEARNING OBJECTIVE
• To Understand who is a family Physician
• To Understand what is CAM
• To understand the domains of CAM
• To understand the classes of CAM approved by the
Medical and Dental Council of Nigeria (MDCN)
• To understand the factors influencing the use of
CAM, and the potential herbal- orthodox medicine
interaction
• Appreciate the relevance and challenges of CAM to
the practice of Family Medicine

7. OUTLINE
• Case presentation
• Introduction
• Ethical basis of CAM
• Standards and guidelines for CAM
• The Nigerian situation with CAM
• Classification of CAM
• The Family Physician and CAM

8. INTRODUCTION
• Conventional medicine (also called Western or
allopathic medicine) is a medicine as practiced
by holders of M.D.(Medical Doctor) and
D.O.(Doctor of Osteopathic Medicine) degrees
and by allied health professionals, such as
physical therapists, psychologists, and
registered nurses.
(Sanadhya et al, 2015)

9. INTRODUCTION
• Alternative medicine is the sum total of
knowledge, skills and practices based on the
theories, beliefs and experiences indigenous
to different cultures that are used to maintain
health as well as to prevent, diagnose,
improve or treat physical and mental illnesses

10. WHAT IS CAM?
• Complementary and Alternative medicine (CAM) is
a broad domain of healing resources that
encompasses all health system, modalities, and
practices and their accompanying theories and
beliefs, other than intrinsic to the politically
dominant health systems of a particular society or
culture in a given historical period.
(Cochrane collaboration operational
definition by Wieland et al, 2011)

11. WHAT IS CAM?
• CAM refers to diverse health practices,
approaches, knowledge and beliefs incorporating
plant, animal, and/or mineral based medicines,
spiritual therapies, manual techniques and
exercises applied singularly or in combination to
maintain well-being, and to treat, diagnose or to
prevent illness.
(WHO 2018)

12. CAM
• When used independently of conventional medicine,
the practice is referred to as Alternative Medicine.
• When used in conjunction with or complementing
conventional medicine, the practice is referred to as
Complementary Medicine.
• Combination of conventional and alternative
medicine with some scientific proof of safety and
effectiveness is called Integrative Medicine.

13. INTEGRATIVE MEDICINE
• Is healing-oriented medicine that takes into
account of the whole person (body, mind, and
spirit), including all aspects of lifestyle.
• It emphasizes the therapeutic relationship and
makes use of all appropriate therapies, both
conventional and alternative.

14. Prevalence of use of CAM
• CAM is used widely around the world, cutting
across developing and developed countries
• The average worldwide prevalence of
alternative medicine use in systematic review
of studies that looked at cancer patient
cohorts was put at 31%
(Casileth et al. 2001)

16. Prevalence of use of CAM
• Prevalence of CAM use within the general
population in sub-Saharan Africa range
between 4.6% (urban settlement in Ethiopia)
to 94% (semi-urban settlements in Nigeria and
Ethiopia), with an estimated average of 58.2%
(Systematic literature review by Bai et al, 2018)

17. Prevalence of use of CAM
• Several studies in Nigeria looking at prevalence of
CAM use in subgroup populations are given below:
• 96.9% in farmers for musculoskeletal pain in South-
West Nigeria (Mbada et al, 2015)
• 88.5% among sickle cell disease patients attending
haematology clinic in Lagos University Teaching
Hospital. (Busari and Mufutau 2017)
• 31% in children with chronic health conditions in
Lagos (Oshikoya et al. 2008)

22. DOMAINS OF CAM
• CAM is classified into five main domains
according to the United States National Centre
for Complementary and Alternative Medicine
(NCCAM) These are:
1. Whole medical systems
2. Mind-Body medicine
3. Biologically based practices
4. Manipulative and body based practices
5. Energy medicine

23. DOMAINS OF CAM
Source: https://basicmedicalkey.com/integrative-health-practices-complementary-and-
alternative-therapies/

24. BIOLOGICALLY BASED PRACTICES

25. BIOLOGICALLY BASED PRACTICES
• Use substances found in nature such as herbs,
foods and vitamins
• Subdivided into;
Herbalism
Aromatherapy

26. BIOLOGICALLY BASED PRACTICES
Herbalism
• Natural plants or plant-based substances are
used to treat illnesses or enhance body healing
systems
• Most of these herbs are claimed to target
various diseases
• Biological-based therapies, particularly herbal
therapy ranked the most commonly used in
Sub-Saharan Africa (Bai et al, 2018)

27. COMMON MEDICINAL HERBS IN WEST AFRICA
Neem tree popularly known as
“Dogonyaro” in Hausa land is said
to have antimalarial, antibiotic,
antifungal and antioxidant
properties
A concoction of Cochorious olitorius,
known as ‘Ewedu’ in yoruba land,
and honey, is used twice daily as a
concoction to prevent acute
asthmatic episodes

28. COMMON MEDICINAL HERBS IN WEST AFRICA
Moringa tree/ leave and
seeds have been shown to
have various benefits
including; anti-
inflammatory properties,
reduction of blood sugar,
treatment of rheumatoid
arthritis and insomnia etc.

29. 29
OTHER HERBAL MEDICINES IN COMMON USE
Herb Common Uses
- Ginseng
(Panaxginseng/Panax
quinque folius)
Adaptogen; antioxidant; antihepatotoxic;
immunostimulant
- Goldenseal
(Hydrostis Canadensis)
Immunostimulant; antimicrobial (against
bacteria, protozoa and fungi)
- Milk thistle
(Silybum maryanum)
Prevention, treatment of liver disorders
- Saint-John’s-wort
(Hypericum perforatum)
Treatment of depression; sleep aid;
externally speeds wound-healing; anti-
inflammatory.
- Garlic
(Allium sativum)
Prevention and treatment of viral, bacterial
infections and flu.
Anti-hypertensive and cholesterol lowering

30. BIOLOGICALLY BASED PRACTICES
Aromatherapy
• Involves use of essential oils from plants to
improve physical, mental and spiritual
wellbeing
• Connection between the olfactory and limbic/
other systems leading to systemic stimulation
of various organs

31. BIOLOGICALLY BASED PRACTICES
Aromatherapy
• Flowers (rose, lavender), twigs (pines), leaves
(bay leaf), roots(ginger), bark (cinnamon),
seeds, (cumin), fruit (Grapes).
• Use in cancer patient to reduce nausea, anxiety
and pain from disease or its treatment
• Lemon and lavender scents has been used to
improve mood and reduce stress etc.

32. • Safety
• Efficacy
• Quality assurance
• Pharmacovigilance
• Control of advertisement of herbal medicines
MINIMUM REQUIREMENTS FOR ASSESSMENT
OF HERBAL MEDICINES BY WHO

33. MIND-BODY MEDICINE

34. MIND-BODY MEDICINE
Uses a variety of techniques to enhance the minds
capacity to enhance bodily function and symptoms
System Principle Uses
Biofeedback Monitors minute
metabolic changes in
ones own body using
sensitive machines
Stress related
conditions e.g
asthma, migraine,
insomnia,
incontinence high
blood pressure.
Meditations Power of the spirit
over the body
Modifying markers of
stress like heart rate,
breath cycles etc

35. MIND-BODY MEDICINE
System Principle Uses
Hypnotherapy The conscious mind
is bye- passed. The
subconscious level is
accessed to reach
suppressed
memories,
repressed emotions,
forgotten but
recorded events.
Effecting behavioral
attitudinal or
emotional changes
in cases of weight
loss, smoking
cessation or in
addressing patients’
illness experience
Mindful exercises Integrating body and
mind
Mental and physical
problems e.g
reducing frailties
and fall especially

36. MANIPULATIVE BODY BASED PRACTICES
Based on manipulation
and/ or movement of one
or more parts of the body

37. MANIPULATIVE BODY BASED PRACTICES
System Philosophy/ Principles Uses
Chiropractic • Correction of
structural
distortions that
cause functional
abnormalities
mostly by
manual
manipulations
• Also stimulates
the body’s innate
healing power.
• Low back pain,
• Neck pain
• Headaches.
• To relieve
muscle tension.
• Reduce BP
• Infant colic,
• vertigo
• relieves TMJ
syndrome

38. MANIPULATIVE BODY BASED PRACTICES
System Principle Uses
Therapeutic
massage
Based on eastern and
western cultures;
• It involves
manipulating a
person’s muscles and
other soft tissues to
cause better health/
well being
Health promotion
Reflexology • Specific points on
hands and feet are
believed to
correspond with
internal organs and
tissues
Treating wide –
range of stress related
disorders

41. MANIPULATIVE BODY BASED PRACTICES
System Principle Uses
Acupuncture Chinese – fine needles inserted
at specific points to stimulate,
disperse and regulate flow of
vital energy and restore healthy
energy balance
• Relief of pain
• Treating acute,
chronic and
degenerative
conditions
Others e.g
Therapeutic
Touch / Reike
Light hand placements to
channel healing energies to
recipient. Practitioners vary in
philosophy and technique
• Treating emotional
and mental
distress; acute and
chronic problems
• Helps patient
achieve spiritual
focus

42. ACUPUNCTURE

43. WHOLE MEDICAL SYSTEMS
• This involve systems of theory and practice that have
evolved independently from or parallel to allopathic
(Conventional) medicine
• Many are traditional systems of medicine practiced by
individual cultures throughout the world. Examples
include:
– Traditional Chinese medicine (TCM)
– Japanese Kampo medicine
– Ayurvedic medicine (of India)
– Homeopathy and Naturopathy – based of Western
cultures

44. WHOLE MEDICAL SYSTEMS
Principles Procedures
• TCM
• Japanese Kampo
Medicine
• Others –Korea,
Vietnam
Achieving and maintaining
the body in a balanced
state.
The delicate balance
between ‘yin’ forces (cold,
slow, passive) and ‘Yan’
(Hot, excited, or active)
• Acupuncture
• Materia medica –
natural products, herbs
etc
• Massage therapies
• Ayurvedic medicine Restoring innate harmony
between the body, mind
and spirit and maintains
emphasis on each of the
components
• Herbs
• Meditation
• Diet
• Exercise,
• Massage,
• Exposure to sunlight,
• Controlled breathing
etc.

45. WHOLE MEDICAL SYSTEMS
Principles Procedures
• Naturopathy Using the body’s own
healing abilities to
restore and support
health
Disease seen as an
alteration of this
process
• Diet modification
• Nutritional
supplements
• Hydrotherapy
• Massage and joint
manipulation
• Lifestyle
counselling
• Homeopathy Selecting therapies on
the basis of how
closely symptoms
produced by a remedy
match that of the
symptoms of the
patients disease.
• Uses infinitesimal
doses of natural
substances or
‘remedies’, to
stimulate a person’s
immune and
defense systems.

46. ENERGY MEDICINE

47. ENERGY MEDICINE
• Involves use of energy fields
• Biofield therapies
– Intended to affect energy fields that purportedly
surround and penetrate the human body
– Some for of this therapy manipulate biofields by
applying pressure and/ or Manipulating the body, by
placing hands in or through those fields
– Examples qi gong, Reiki, therapeutic touch
• Bioelectromagnetic based therapies
– involves unconventional use of electromagnetic fields
such as pulsed fields, magnetic, alternating or direct
current fields

48. • Qi is the vital life force, and Gong means
effort. Qigong is the cultivation or gathering,
and the utilization of the life force energy.
• In general, this is a type of energy healing with
roots in ancient Chinese medicine.
• The goal is for you to rebalance your chi/qi, to
remove emotional, physical, and mental
blockages, and to achieve an optimal state of
health and well-being.

49. Qi-GONG ENERGY HEALING

52. STANDARD GUIDELINES FOR CAM
• The WHO set policies and guidelines regarding
traditional and CAM practices at the world
stage
• The latest guideline is captured in the WHO
traditional medicine strategy 2014 – 2023
• The strategic objectives are as follows:
– To build the knowledge base for active
management of T&CM through appropriate
national policies.

53. STANDARD GUIDELINES FOR CAM
– To strengthen the quality assurance, safety, proper
use and effectiveness of T&CM by regulating
products, practices and practitioners.
– To promote universal health coverage by
integrating T&CM services into health care service
delivery and self-health care.

54. STANDARD GUIDELINES FOR CAM
• By 2007, 48 countries had a national policy on
traditional medicine and over 110 countries
have mechanisms in place to regulate
traditional medicines.
• The World Health Organization encourages
and supports Member States to integrate
TCAM into national health care systems and to
ensure their rational use.

55. NIGERIAN SITUATION WITH CAM
 In 2007, a division of Traditional Medicine Development
(TMDD) was established in the Department of Food and
Drug Services (FDS)with the following mandate;
 To accelerate the integration of Traditional Medicine into
the conventional healthcare system of the country and;
 To promote herbal medicine product development and
commercialization.
 This led to the formulation of NANTMP association and the
presentation of the TMC bill to the National Assembly.

56. NIGERIAN SITUATION WITH CAM
 2013- Inauguration of three Committees on Herbal,
Complementary and Alternative Medicines development with the
mandate to develop;
 A curriculum for the training of Herbal Medicine Practitioners at the
Medical Schools in Nigeria,
 Modules for the development of TM into medical students training
curriculum,
 TM modules into nursing students training curriculum; and
 Expansion of TM modules in the pharmacy students curriculum

57. NIGERIAN SITUATION WITH CAM
• Review of the Code of Ethics & Practice for
Traditional Medicine Practitioners (TMPs) with
the support of the WHO and;
• Development of Strategic Plan for the
Implementation of Traditional Medicine Policy
(2007) For Nigeria also with the support of the
WHO.(Dec. 2013).

58. • Development of the Curriculum for the
Training of Herbal Medical Practitioners at the
Medical Schools in Nigeria.(Dec. 2013).
• Submission of the report of the Committee on
Herbal Products Promotion and Export to the
Honorable Minister of Health.(March 2014).

59. 2008–Establishment of the Artemisia
Development Company(ADC) which later
changed to the Nigeria Medicinal Plants
Development Company(NMPDC).
30th May, 2006 – Inauguration of Presidential
Initiative Committee headed by late Prof.
Sofowora on Development, Promotion and
Commercialisation of Nigerian Medicinal Plants
which produced a blueprint for setting up an
Institute.

60. • The TMD division was upgraded to a status of
a full-fledged Department of Traditional,
Complementary & Alternative Medicines
following the approval by the Head of Service
in a letter OHCSF /MSO/72/IV/132 dated 4th
April, 2018.

61. Complementary & Alternative Medicines(CAM)
Division - Functions
 Development, review and implementation of
National policies on complementary & Alternative
Medicines healthcare services.
 Regular evaluation and monitoring of standardized
TCAM hospitals in both private and public facilities.
 Liaise with TCAMCN, State Boards and Committees
and Local Governments.
61

62. Complementary & Alternative Medicines(CAM)
Division – Functions (cont’d)
 Strengthen co-operation between CAM providers
and other healthcare providers.
 Develop proper mechanism for registration of CAM
therapeutic products in collaboration with TCAMCN.
 Development of National Essential List of
Complementary & Alternative Medicines.
 Collaborations with relevant MDA’s, international
and local organizations
62

63. Current Activities
National Herbal Pharmacopoeia Review to
include more medicinal plants to serve as a
reference for production of herbal products in
Nigeria for knowledge and revenue
generation.
African Traditional Medicine(ATM) Day
celebration in line with earlier declaration by
African Heads of States.
63

64. Current Activities (cont’d)
 Traditional, Complementary & Alternative Medicine
Council of Nigeria(TCAMCN) Bill – currently at the
Federal Ministry of Justice.
 Federal College of Complementary & Alternative
Medicine(FEDCAM)- repositioning of FEDCAM.
 Collaborators(local & International)e.g India,
China, Thailand, Ghana, WAHO, WHO etc
 Reconstitution of the Presidential Initiative
Committee(PIC) on production, commercialization
and export of Herbal Medicine products
64

65. Proposed Activities
Review of the Traditional Medicine Policy 2007
Proposal for the production of the first nutritional
supplement in Nigeria for Moringa for integration
into the healthcare delivery system.
Utilization of the former NMPDC structure for
cultivation of Artemisia annua, training, contract
packaging and internally generated revenue(IGR).
Collaborating with NIPRD for analysis of herbal
products which will increase NAFDAC’s IGR.
65

66. Proposed Activities .
(cont’d)
 Collaboration with Pharmacists Council of Nigeria (PCN) for training on
processing, packaging and quality standardization of herbal products for
commercialization.(IGR)
 Collaboration with Nigerian Export & Promotion Council(NEPC) for
exhibition of herbal medicinal products by producers both nationally and
internationally.(IGR)
 Collaboration with China and India for the establishment of state-of-the-
art herbal hospital/clinic/training institutes in the country. (IGR)
 Collaboration with relevant Ministries and Agencies. E.g Raw Materials
Development Agency, Federal Ministry of Agriculture and Rural
Development etc.
 Collaboration with the Federal Ministry of Trade, Investment and Industry
for the establishment of SME’s on manufacturing/processing of medicinal
plant products.
66

67. Challenges
• Office accommodation and general working equipment such as
computers, office stationery, furniture, display shelves for medicinal
plants products etc. for the newly established department.
• Poor advocacy on acceptability of TCAM.
• Inadequate funding.
• Inadequate awareness/advocacy to the populace.
• Non-passage of the Traditional Medicine Council Bill for regulation of
practice and products.
• Lack of cooperation and coordination amongst Practitioners.
• Lack of strong political will
67

68. MDCN AND CAM
• Alternative Practitioners’ Registration
• CAM practices currently approved by MDCN:
Herbal Medicine
Homeopathy
Naturopathy
Acupuncture
Osteopathy
Chiropractic

69. • In Nigeria, the regulatory body concerned with
herbal medicines is National Agency for Food
and Drug Administration and Control(NAFDAC).
• The Drugs and Related Products Act, Decree 15
in 1993 empowered NAFDAC to make
regulations concerning herbal medicines and
related products.
NAFDAC and CAM

70. NAFDAC REGULATES THESE PRODUCTS WITH REGARDS
TO:
• Adequate and clear labelling information
• Name and address of manufacturer, packer or
distributor
• Declaration of ingredients
• Trade mark
• NAFDAC identification number
• Adequate information on insert
• Warning statement concerning use in pregnancy and
warning for children
• Expiration date
NAFDAC and CAM

71. FACTORS INFLUENCING THE USE OF
CAM
• Relative low cost and flexibility of payment of CAM
products and services
• Perception of CAM being natural and therefore safe as
well as effective compared with conventional healthcare.
• Desire to be more active in one’s own health care.
• Patient’s sociocultural, religious and spiritual values with
regard to health and disease

72. FACTORS INFLUENCING THE USE OF CAM
• Dissatisfaction with or loss of trust in conventional
medicine especially with regards to chronic illnesses.
• Decrease the feelings of hopelessness and
helplessness.
• Improve the immune system.
• Improve the quality of life
• Poor prognosis with Orthodox therapies.

73. FACTORS INFLUENCING THE USE OF
CAM
• Perceived psychosocial care and support provided by TCAM
providers compared with orthodox healthcare providers.
• Lower socioeconomic status
• Rural residence
• Recommendation by respected and trusted peers such as
CAM providers, elders, relatives and friends
• Aggressive advertisement of CAM products and services

75. CHALLENGES WITH CAM USE
• Limited scientific evidence.
• Confusing marketing.
• Potentially dangerous interactions.
• knowledge is shrouded.
• questionable research methodology.
• little or no funding for in depth research.

77. POTENTIAL HERBAL- ORTHODOX MEDICINE
INTERACTION
Herbal Medicine Prescribed drug Clinical result of
Interraction
Cranberry Warfarin Increased anticoagulant
response including fatal
haemorrhage

78. THE FAMILY PHYSICIAN AND
CAM
• WHO IS A FAMILY PHYSICIAN?
• First contact doctor
• Care from cradle to grave
• Sees undifferentiated patients
• Holistic approach(biopsychosocial medicine)
• Advocates for patients
• A member of a care team

79. THE FAMILY PHYSICIAN AND
CAM
• Considers patient’s family, community and
environment
• Considers patient’s faith, culture and values
• Individualize patients
• Practice evidence based medicine
• Coordinates care
• A researcher

80. RELEVANCE OF CAM TO FAMILY PRACTICE
• Many people who use CAM therapies are not
comfortable discussing them with their
doctors, and many physicians are
uncomfortable with the topic as well.
• This communication gap between patients
and their doctors represents an important
opportunity for family physicians.

81. RELEVANCE OF CAM TO FAMILY PRACTICE
• It is essential for physicians to understand what
patients are doing to seek health, as this under-
standing is important to harness potential benefits
and to help patients avoid harm
• Discussing CAM can lead not only to new insights
into illness and health, but also to enhanced patient
communication, satisfaction and quality of care.
• It also enhances the FP practice of holistic care by
incorporating the systems and biopsychosocial
philosophy in the care of the patient.

82. RELEVANCE OF CAM TO FAMILY MEDICINE
• Family Physicians should be knowledgeable about
CAM for three reasons.
– First, patients, families, physicians, and institutions are
increasingly expecting their doctors to be knowledgeable
about CAM.
– Secondly, many healthcare providers are expanding their
clinical practice by incorporating CAM services.
– Finally, although CAM may seem totally safe, there are
some potentially harmful interactions that could occur
with used in combination with some orthodox therapies.

83. FAMILY PHYSICIAN APPROACH TO
CAM
• Objectivity (open mindedness and a heart
devoid of personal gain)
• Crave for knowledge and understanding of
CAM
• Willingness to study and investigate CAM
and its practices(development of
investigational strategies, advocacy, lobby
and persuasion of all stake holders to get
involved)

84. FAMILY PHYSICIAN APPROACH TO
CAM
Acceptance of evidence based, scientifically proven, safe and
efficacious CAM
• This does not mean the PF should practice CAM except
he decides to study and acquire relevant skills for CAM
practice
• But it does mean that he accepts such CAM, and ready
to collaborate with CAM practitioners in the care of his
patients in the best interest of the patients.
• ? It enhances the ultimate goal which is integrative medicine
(good medicine).

85. • Ask every patient about use of cam therapy at each
visit
• Avoid using the word alternative therapy at least
initially
• Don’t dismiss any therapy as placebo.
• Discuss providers as well as therapies.
• By not educating ourselves about cam therapies or
by avoiding the subject during patient visits, we risk
poor outcomes.
FAMILY PHYSICIAN APPROACH TO CAM

86. FAMILY PHYSICIAN APPROACH TO CAM
• Emphasize to patient that all herbs have pharmacologic
properties just as do conventional pharmaceuticals.
• Explain that there is the possibility of adverse
interaction between herbs and any pharmaceutical.
• Review each herb with the patient in detail and ask
him not to take any herb that needs more time to
review.
• Try to reach a joint decision with the patient regarding
what would be safe for him to take.
• Read CAM-related journals and attend CAM-oriented
conferences.

87. CONCLUSION
• There is increasing use of CAM despite its
controversies.
• Patients may expect their family physician(s)
to be more knowledgeable, skillful, and have a
balanced approach regarding CAM use.
• Practitioners should learn how to
communicate effectively and better
collaborate with CAM practitioners to the
benefit of their patients.

88. REFERENCES
• Sanadhya, S., Aapaliya, P., Jain, S. and Choudhary, G., 2015. Complementary and
alternative medicine: A buzz for medical and health care systems. Journal of research
in pharmacy practice, 4(1), pp.42-43. https://europepmc.org/articles/pmc4326972
• Wieland, L.S., Manheimer, E. and Berman, B.M., 2011. Development and classification
of an operational definition of complementary and alternative medicine for the
Cochrane collaboration. Alternative therapies in health and medicine, 17(2), p.50.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3196853/
• World Health Organisation, 2018. 1.1 What is traditional medicine? Towards a working
definition. Available from: http://apps.who.int/medicinedocs/en/d/Js2297e/4.1.html
•
• James, P.B., Wardle, J., Steel, A. and Adams, J., 2018. Traditional, complementary and
alternative medicine use in Sub-Saharan Africa: a systematic review. BMJ global health,
3(5), p.e000895. https://gh.bmj.com/content/3/5/e000895#request-permissions
•
• Cassileth, B.R., Schraub, S., Robinson, E. and Vickers, A., 2001. Alternative medicine use
worldwide: the International Union Against Cancer survey. Cancer, 91(7), pp.1390-
1393. https://onlinelibrary.wiley.com/doi/full/10.1002/1097-
0142%2820010401%2991%3A7%3C1390%3A%3AAID-CNCR1143%3E3.0.CO%3B2-C

89. REFERENCES
• James, P.B., Wardle, J., Steel, A. and Adams, J., 2018.
Traditional, complementary and alternative medicine
use in Sub-Saharan Africa: a systematic review. BMJ
global health, 3(5), p.e000895.
https://gh.bmj.com/content/3/5/e000895#request-
permissions
• Cassileth, B.R., Schraub, S., Robinson, E. and Vickers, A.,
2001. Alternative medicine use worldwide: the
International Union Against Cancer survey. Cancer,
91(7), pp.1390-1393.
https://onlinelibrary.wiley.com/doi/full/10.1002/1097-
0142%2820010401%2991%3A7%3C1390%3A%3AAID-
CNCR1143%3E3.0.CO%3B2-C