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Traditionally in medicine, nearly all prescribing decisions were made by the treating physician. The patient had relatively little input and hardly any access to alternative sources of information bearing on that decision; the cost of the prescription was covered by the patient or by an insurer, and neither was likely to provide any feedback to the physician to shape his or her decision. Now, all that has changed. Beginning with the consumerist movement of recent decades and culminating in the explosion of health-related information on the Internet, patients are increasingly vocal participants in the prescribing decision, on both clinical and economic grounds. Payers have become participants as well, and increasingly seek to influence prescribing decisions in the light of their own economic imperatives. Added to all these cross-currents is an additional wild card: the proliferation of ‘alternative medicines,’ ‘nutraceuticals’ and other nostrums that society has placed beyond the reach of the evidence-based discourse and regulations that govern conventional drug therapy. In a country where patients struggle to cover the cost of prescription therapies proven both safe and effective in rigorous clinical trials, billions of dollars per year are spent on alternative treatments in the US, unencumbered by concerns about whether they actually work or that they might be toxic. While these patterns of communication, education, disinformation and economic influence are much more chaotic than those that prevailed in the ‘good old days,’ this very ferment may also present opportunities for improvement of rational pharmacotherapy and public health. This paper briefly outlines the above changes in patterns of communication and influence as they relate to medication use in today's industrialised world (particularly the US), and suggests both hopeful and terrifying scenarios describing where these trends might lead in the coming decade. [ABSTRACT FROM AUTHOR]

Minnesota has the largest Somali diaspora in the world. Uniquely, the Minnesotan Somali diaspora utilizes traditional healing practices along with Western medicine. Therefore, medical providers who regularly interact with Somali patients must be aware of traditional healing practices. A scoping review inclusive of three databases (Embase Classic + Embase, Ovid MEDLINE, PsychINFO) was conducted. Fifty-eight studies met established criteria. Traditional medicine is performed with conventional medicine. Illnesses are acknowledged to be caused by a malfunctioning body, evil eye, and/or zar (possession). Examples of the utilization of dawo dhaqmeed (traditional practices) included ilko dacowo (dental enucleation), khat (catha edulis), guboow (use of a fire-heated object), cupping, xoq (scraping), xidhayn (female genital mutilation), duugto (massage), baan (nutrition), herbs, caano geel (camel milk), Qur'anic healing, prayer, zam zam (holy water), tahliil liquid (blessed water), and amulets. Practices ranged from benign to harmful. Identifying Somali traditional healing practices is the first step in understanding the health of the Somali community in Minnesota. [ABSTRACT FROM AUTHOR]