Complementary and Alternative Medicine: a Japanese Perspective

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Complementary and Alternative Medicine: a Japanese Perspective
2004 September
Nobutaka Suzuki
Evidence-based Complementary and Alternative Medicine (eCAM)
PubMed Central

Copyright © 2004, the authors Evidenced-based Complementary and Alternative Medicine, Vol. 1, Issue 2 © Oxford University Press 2004; all rights reserved. The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated.

13-1 Takaramachi, Kanazawa, Ishikawa 920-8640, Japan

The use of complementary and alternative medicine (CAM) is increasing rapidly. The World Health Organization (WHO) classifies 65Ò80% of the world's health care services as Îtraditional medicineÌ (1). Therefore, from the viewpoint of the population ratio, more people use CAM than modern western medicine.
Although much attention has been focused on CAM not only from physicians but also basic medical researchers, scientific evidence for most CAM is still sparse. Emergence of CAM as a new current of medicine depends on whether or not precise scientific evidence can be accumulated.

Why has CAM become so popular among ÎconsumersÌ? I think that the following factors are responsible:

CAM is easy to understand and familiar
CAM is non-invasive, with few side effects
CAM helps improve quality of life (QOL) or activity of daily life (ADL)
CAM helps one to maintain one's own health
Western modern medicine does not fully correspond to the patients' demands
the trend towards a more holistic medical approach
ballooning medical expenses
In this overview, I will describe and discuss the current status of CAM in Japan.

The situation in Japan should be of much interest, since Japan is unique as a country in which highly advanced modern Western medicine coexists with traditional Asian medicine.

Top
Classification of CAM
Validation of Traditional CAM Modalities: A Proposal
History of CAM: Japan and the USA Compared
CAM in the Japanese Modern Western Medical Society
Attitude of the Japanese Government Toward CAM Domains
Different CAM Modalities Used in Japan and the USA
Dietary Supplements in the USA and Japan
Conclusion
References Classification of CAMCAM, as defined by The National Center for Complementary and Alternative Medicine (NCCAM) in the USA, is a group of diverse medical and health care systems, practices and products that are not presently considered to be part of conventional Western medicine. NCCAM classifies CAM therapies into five categories, or domains (Table 1).

Table 1
Classification of CAM therapies

In Japan, part of anti-aging medicine (growth hormone treatment, etc), lifestyle drugs (remedies for alopecia, obesity, impotence, etc) and Îenvironmental medicineÌ are considered to be included in CAM treatment. For example, developing a functional food which absorbs dioxins and promotes discharge into facilities, or developing a filter to trap the free radicals of automobile exhaust gas or cigarette smoke, etc, are included in the category of Îenvironmental medicineÌ.

The CAM domain in Japan also encompasses some forms of advanced medical treatments, which are not yet widely carried out, such as immunotherapy for cancer using tumor specific antigens, etc. In-vitro fertilization and embryo transfer (IVF/ET), one of the most advanced medical technologies, was regarded as CAM at the very beginning. Now, however, IVF/ET is widely used in conventional hospitals, so it can be said that some CAM modalities have been taken into conventional medical treatment. So, in Japan CAM has some connotations of ÎfrontierÌ medicine.

Unlike Western countries, in Japan, part of Kampo medicine (Japanese herbal medicine) and acupuncture are covered by public health insurance. Therefore, Japanese practitioners of Kampo and acupuncture would object to their inclusion in CAM and would rather regard themselves as belonging to the authentic traditional medicine. However, these treatments are categorized as CAM in Europe and the USA. Thus, the definition of CAM differs slightly from country to country.

Japanese doctors' attitudes to CAM are unique, as found in the study carried out Imanishi et al. (2). Some form of complementary medicine was practiced by 267 of their respondents (73%), the most common being Kampo (70% of the respondents). Surprisingly, almost all doctors practicing complementary medicine were Kampo practitioners (96%). A few doctors (8%) practiced other forms of alternative medicine including chiropractic, aromatherapy, homeopathy, health spa therapy, Ayurveda, hypnosis, flower therapy, thalassotherapy, herb therapy, qigong, yoga, dietary therapy, imagery, meditation, art therapy and prayer. This result is very different from that of doctors in European and North American countries (3). Thus, Kampo is by far the most frequently practiced CAM modality by doctors themselves. I think this situation, namely adoption of Kampo by many doctors educated in Western medicine, is the most characteristic feature of CAM in Japan.

Acupuncture, electroacupuncture and moxibustion are practiced by acupuncturists and specialists in moxibustion rather than by doctors, because they need special training, unlike prescribing Kampo medicine. In Japan, after 3 years of education at a professional school of acupuncture, moxibustion, acupressure or massage, one can obtain a license to practice after passing the national examination. However, medical doctors are permitted to perform any one of the above treatments even if they do not attend one of these schools. However, not many medical doctors would actually be trained in the practice of these modalities. They are usually left to specialists.

Judo has been very popular since ancient times. Because injuries such as fracture or dislocation were frequent among judo wrestlers, unique orthopedic techniques have been developed by Judo practitioners over hundreds of years. The government thus recognizes Judo-Orthopedics as a distinct paramedical profession. To obtain a national license for Judo-Orthopedics, one must be educated for 3 years under licensed Judo orthodedicians. In contrast, chiropractic and osteopathy, which are widely used in the USA, are not authorized by the Japanese government.

Patients using CAM are not exclusively human. Recently, the popularity of pet ownership has risen in Japan. Since a pet is usually considered to be a member of the family, the owner is concerned that the pet receives good medical care, including CAM modalities. In response to owners' strong desires, CAM treatment by veterinarians is on the increase, including acupuncture, aromatherapy and herbal therapy. Of particular note is the widespread use of dietary supplements, thus many companies are researching and developing these specifically for animals.

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