Knowledge, Attitude and Practice of Complementary and Alternative Medicine (CAM) among Medical Practitioners

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1 Original Reserch Paper Knowledge, Attitude and Practice of Complementary and Alternative Medicine (CAM) among Medical Practitioners Kong FH, Man LK, Shetty RS, Kamath VG ABSTRACT Background: Complementary and Alternative Medicine (CAM) is gaining popularity worldwide recently. Aim: The ever-increasing popularity of CAM in the world warrants an in-depth study to evaluate the knowledge, attitude, and the use of CAM among allopathic doctors. Methods: A questionnaire based cross-sectional survey was carried out among the medical practitioners of an academic medical center in southern India during April Consenting participants were requested to complete a semi-structured questionnaire. Results: Most (92%) of the doctors were aware of the term CAM, but only half have heard of AYUSH. Twothirds of them believed in CAM. Nearly all doctors were aware of Yoga therapy, of which 71% regarded it to be effective. Half of the doctors opined that CAM is better than allopathy in treating certain cases; is cost effective and carries fewer side effects. Sixty-two percent of doctors would recommend CAM to peers; 39% had recommended to patients. Less than one-third has used CAM on themselves. Majority thought that integrated treatment would be more effective than allopathic treatment alone and there is a need to introduce Integrative Medicine into the medical curriculum. Conclusions: Most doctors were aware of the commonly practiced CAM in the region; believed in CAM; had welcoming attitudes towards CAM. However, only a small proportion have ever sought CAM and recommended CAM along with allopathic treatment to their patients. INTRODUCTION Keywords: AYUSH, allopathic treatment, integrative medicine, CAM Complementary and Alternative Medicine (CAM) has gained its popularity worldwide in recent years, as evidenced by the widespread practice of Yoga, Ayurveda, Acupuncture, Herbology and many 1,2 others across the globe. India harbours a vast diversity of CAM practices, which can be traced back to as early as past 5000 years when Ayurveda has been practiced. Ayurveda, the most commonly practiced form of CAM in India fulfills 80% of the 3,4 medical needs of the population. Nonetheless, the Indian System of Traditional Medicine is not being integrated into the conventional medical system. With a rural population of 68.8%, affordable and effective health care is still beyond 5 the reach of vast sections of the Indians. Integrating CAM into primary health care may be a solution as CAM practices could be the only healthcare services available in some remote areas 6,7 of India. CAM is defined by the National Center for CAM (NCCAM), United States as a group of diverse medical and health care systems, practices, and products that are not generally considered part of Conventional Medicine. "Complementary Medicine" refers to use of CAM together with conventional medicine. "Alternative Medicine" refers to use of CAM in place of conventional medicine. "Integrative medicine" combines treatments from conventional medicine and CAM for which there is some high-quality evidence of 8 safety and effectiveness. Most CAM practices emphasize on disease prevention and health 1,2 promotion rather than treating the disease itself. CAM may enhance the disease outcome if appropriately used along with allopathic 9 medicine. Low-cost intervention offered by CAM practices such as Yoga, meditation, herbal medicines, supplement therapy and behavioral medicine could be delivered as substitutes for high cost drugs and technological interventions for the 5

2 Kong FH et al. Knowledge, Attitude and Practice of Complementary and Alternative Medicine (CAM) among Medical Practitioners 6,9 management of chronic conditions. In Nov 2009, the Government of India has taken a step to promote 'Indian Systems of Medicine' on the promotion of AYUSH (Ayurveda, Yoga and 6,10 Naturopathy, Unani, Siddha and Homeopathy). It illustrated the willingness of the government in embracing CAM as part of an effort to implement the ideology of holistic approach in patient care. 3 Despite it being a common practice in this region, there is dearth of data regarding the usage and acceptance of CAM by allopathic healthcare professionals. Hence, the present study was undertaken to evaluate the knowledge, attitudes, and practice towards CAM among allopathic doctors and to correlate these findings with their demographic and professional characteristics. MATERIALS AND METHODS This cross sectional study was carried out during the month of April, 2011 among the consenting allopathic healthcare professionals (MBBS qualified doctors) working in a medical college and its hospital in southern India. The study protocol was approved by the Institutional Ethical Committee. The initial questionnaire was developed based on a review of literature, input from authors, colleagues and peers, and also from CAM practitioners. It is designed to be appropriate for the local context. The initial framework was then expanded by incorporating new aspects encountered during literature search. The draft so prepared was then pre-tested on 10 respondents and necessary changes were made based on pre-testing. The questionnaire was divided into 5 sections. Section 1 comprised of demographic information essential for data stratification during data analysis. Designation, field of practice and years of experience since MBBS graduation were included. Section 2 incorporated the questions to assess the 'knowledge' of respondents regarding CAM. Section 3 included questions to study their 'attitude' towards CAM. Section 4 was designed to assess their 'practice' such as using CAM for themselves, recommendation of CAM to friends, family and their patients. Section 5 was meant to obtain their opinion on the need to integrate CAM into current medical curriculum in India. Of these 330 participants, 238 (62.3%) responded the questionnaires. The data were analyzed using SPSS (Version 16.0) and results are presented in proportions and percentages. T-test was used wherever required and the level of significance was set at RESULTS Among the 238 respondents, 218 (92%) were aware of the term CAM, but only 121 (51%) of them have heard of the term AYUSH. Among those who have heard of AYUSH, 69% of them were able to expand the term correctly. A statistically significant association was observed between increasing year of practice and awareness of the term CAM (p<0.05). About 45% of the respondents from para-clinical field were able to expand the term AYUSH compared to those from pre-clinical field (15%) and clinical field (34%). Sixty-six percent of respondents stated that they believed in CAM. A significant proportion of those who believed CAM considered it better than allopathic treatment (p=0.0001) in diseases like psychological/psychiatric disorders (27%), chronic illnesses (23%), joint problems (14%), bronchial asthma (12%), allergic disorders (11%) and skin conditions (11%). They felt that integrative medicine is more effective than allopathic treatment alone (p=0.0001). They also opined that CAM is more cost effective (p=0.003) and carries less side effects (p=0.0001) compared to allopathic treatments. 6

3 Kong FH et al. Knowledge, Attitude and Practice of Complementary and Alternative Medicine (CAM) among Medical Practitioners Doctors' awareness and perceptions on the effectiveness of various CAM practices are shown in Table 1. Yoga was recorded as the most responded CAM modality (93%) followed by Ayurveda (91%) and Meditation (87%). A substantial number of participants were not aware of Unani (46%), Siddha and Reflexology (45%) and Chiropractics (44%). The majority of respondents perceived Yoga therapy to be effective (70.7%). Meditation and Diet-based therapy were also perceived as effective modalities by the surveyed doctors group. Ayurveda, the second most responded modality had been reported as Somewhat Effective by half of the respondents. Reflexology, Siddha and Energy therapy were p e rc e i v e d a s t h e l e a st e f fe c t i v e C A M modalities.more than half of the respondents had the perception that CAM modalities are most effective in psychological/psychiatric conditions (66%), pain relief (65%) and its placebo effect (61%). Only 11% of respondents felt that CAM is effective in treating malignancies. Table 1. Perceptions on various among doctors CAM Practices Yoga Ayurveda Meditation Homeopathy Diet Based Therapy Prayer Massage Therapy Acupuncture Dietary and herbal supplement Naturopathy Aromatherapy Energy therapy Unani Reflexology Siddha Chiropractic Nos Percentage (%) Effective Somewhat Not effective effective Only 4.6% of the participants believed that CAM is better than allopathic treatment. Sixty-two percent stated that CAM carries fewer side effects. 7

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5 Kong FH et al. Knowledge, Attitude and Practice of Complementary and Alternative Medicine (CAM) among Medical Practitioners REFERENCES 1. National Center for Complementary and Alternative Medicine. What is Complementary and Alternative Medicine? Available at Accessed on 2 April Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and Alternative Medicine Use Among Adults: US, Adv Data. 2004;343: Eisenberg DM, Davis RB, Ettner SL, Et al. Trends in alternative medicine use in the United States, : results of a follow-up national survey. JAMA. 1998;280: Verma U, Sharma R, Gupta P, Gupta S, Kapoor B. Allopathic vs. Ayurvedic practices in tertiary care institutes of urban North India. Indian J Pharmacol.2007;39: Gogtay NJ, Bhatt HA, Dalvi SS, Kshirsagar NA. The use and safety of non-allopathic Indian medicines. Drug Saf. 2002;25(14): Government of Kerala, India. Census of India 2011-Provisional Population Totals-Rural and Urban Distribution. Available at kerala.pdf Accessed on 6 April Government of India. Mainstreaming AYUSH under NRHM. Available at pdf.accessed on 4 April