Dear Amina,
Yes for promoting and integrating good traditional, alternative & complementary medicine (TACM) research and development is actually needed.
- Magnitude: 60-80% of Ugandans use TACM but its support from development partners and government is less than 1% of the national health care budget yet serving a large part of the communities.
Research and Development provides
- A broader population can access TACM as some preparations are only available locally (accessibility), e.g. anti sickle cell medicine produced in Nigeria also accessible in USA and other countries where sickle cell anaemia occurs
- The medicine can keep for longer as some traditional formula getting spoiled quickly (stability) and can be future developed (patient friendliness especially for child formulations)
- Assist in conserving biodiversity by domesticating rare medicinal plants, which need research to speed up the natural evolutionary process conducted by TACM practitioners locally in their farms
- Protecting wild populations and biodiversity by reducing post harvest loss, therefore reducing the demand on the medicinal plants
- Portability (medicines are often water based preparations which are bulky e.g 100ml per does for example) and carry on for treatment can be a challenge.
- Satisfy the demand Traditional health practitioner to find solutions for challenges and can access professionals assistance from scientists (experienced during my work with TACM practitioners in Uganda)
- A high potential for integration in the national health care system to provide holistic and appropriate care therefore TACM needs to be evidence based on repetitive protocols and efficacy
- Provides TACM a opportunity to be developed in to a cost effective and complimentary basic health care options for rural communities by bringing health service near to the people. This takes in to account that the system is already existing and accessible (1 TACM practitioner for every 300-600 inhabitants, whereby a allopathic professional is about 1 to 5000 – 20000 inhabitants in Uganda depends on location where most health care practitioner are in the more attractive urban centres.
- Is needed for TCAM for adjusting to the ever changing preference of health seeking persons - integrating research in to the adoption process to the changing service seeking pattern caused.
Grretings from Mbarara, Uganda
(1 TACM practitioner for every 300-600 inhabitants, whereby a allopathic professional is about 1 to 5000 – 20000 inhabitants in Uganda depends on location where most health care practitioner are in the more attractive urban centres.
this is very true as most of the developing countries are much needed of this ... thanks for the answer .
• Dear Amina, Complementary and alternative medicine for many centuries include intelligent and long sophisticated tradition. CAM has experience from all sources. Work in it is important for us. But there is quite another important aspect. Two things in all kinds of medical science change from time to time. These are 1) positions for research and 2) viewing directions in science. I'll give an example: For decades Europe has chosen the position of ‘pathogenesis’ as a starting point for planning therapy. With the position ‘salutogenesis’ a completely new look at the patient and his recovery has emerged. The physician must now capture life plan, life and lifestyle of patients. He must take into account biological, psychological and social points of view. He on his side can measure and do only if his patients on the other side are trained to find relevance, understandability and ease of use of the powers of self-healing in the medical act. This requires the patient easier comparisons than that of modern biochemistry and pharmacology. The patient finds that understandable in traditional medicine. By the way compliance is easier for him. This sight at the cooperation between the patient and the necessary caring effects point out the importance of Integrative Medicine. And this sight too is worth to be cared by research.
Dear Amina,
thanks for the correspondence. I've now got an information from your institution. I look forward to further discussion and will gladly come to you in early April. Because I'm from 15.3. to 30.3. on the Gulf of Siam, and wait there for research with an Indonesian group. My wife and I myself 1980 have discovered a gallate isolated from tropical plants, and then studied in animals. Today it is used as to be astringent and immuno-stimulating on the mucosa. That is success for internal medicine and rehabilitation too.
Sincerely
Heinz.
I have the impression that there needs to be more research in the fields of classical and traditional medicine, not with a bias, but as a sort of counterpart to modern western medical practices. In the west, medicine tends to be very segrational. The components of the human body are each treated as separate from one another, and the mind, feelings, and (that taboo word) "energy" of the patient are considered even more separate, if not neglected.
Whilst, the most popular traditions of traditional medicine tend to be rather holistic in approach and theory. Though often a little too metaphysical for my liking.
Luke, that's a very good observation. We accept that traditional medicines have previously recognized ‚health’ as a center of practice. Practical Western medicine has grown since 1700 from morphology, pathogenesis and organ specificity. The later arising technocratic medicine has brought many new aspects. The scientific counterpart to the medical scene came when the medical sociologist Antonovsky founded in the 1970s the complementary Salutogenesis (as term coined to pathogenesis). According to this model, research and development, then health is not to be understood as a state but as a process. It is important that this view of medicine now in all conditions of modern Western medicine continues to develop. Furtheron modern medicine has solidified the psychosomatic medicine in it. In 2007, we published the Medical Health Design (ISBN 978-3-934672-21-5) and received global attention. This includes mind, feeling, social consideration and energy. Global chairs of complementary medicine (Israel, US, Germany) have taken this value and represented it. We are inviting to continue to develop.
Amina,
This is a very interesting, and hotly debated, question. I would say that the short answer is: yes. There are several reasons: 1) ethical practitioners what/need to provide the most effective and cost-effective treatment available for their clients; 2) harmful and non-effective modalities should be exposed; 3) acceptance in the larger medical community requires an evidence-based approach to treatment; 4) private pay is difficult in today’s world and insurance will not cover treatments that are not proven through solid research (and sometimes not even then).
The long answer, however, requires a defining of the term ‘research’. The randomized controlled trial is the gold standard in medical research, as well as in other fields. Yet the RCT is not a suitable approach for TACM. There will likely never be a large body of literature supporting TACM via RCTs as there is with allopathic approaches. This is often the type of research that is required to get a therapy accepted in the medical community and approved by insurance companies, thus this lack of compatibility with the research model presents a challenge to the acceptance of TACM.
Why is the RCT or standard quantitative research not a good fit for TACM? Allopathic medicine treats diseases. The patient is diagnosed and the treatment is prescribed based on that diagnosis with limited consideration given to who the patient is – perhaps only taking into account history of allergies or other medications. TACM treats the individual client rather than the disease so five clients with the exact same diagnosis may receive five very different treatments based on lifestyle factors, energy levels or blockages, and even temperament. It would be impossible to conduct an RCT with an experimental group in which all of the participants received different interventions. At the same time, establishing a TACM experimental condition in which all of the participants receive the same intervention would not be truly representative of the TACM approach. Unfortunately qualitative research is often not considered scientific and is rarely sufficient for establishing broad acceptance of a treatment in the medical community.
That said, there is interesting research going on in mind-body medicine and TACM. Beverly Rubik (http://www.healthy.net/scr/bio.aspx?Id=75) has conducted scientific research on the human biofield, which includes what is referred to as chi, qi, life-force, and energy in many ‘energy-based’ holistic treatments. Jeanne Achterberg (http://www.jeanneachterberg.com/bio.html) studied MRI scans of energy healers and shamans as they performed distance healing. The Center for Mind-Body Medicine (www.cmbm.org) has used standardized scales to measure the impact of Mind-Body Skills Groups on traumatized children in war zones. Research on the impact of mindfulness in almost every area of human health is being published daily. The list goes on. The research is being conducted and it is producing very promising results but the question of acceptance remains.
Hello, Alexzandria and Denis,
as to Aminas question I understood that she searches to study CAM in the context of rersearch (TCAM bench mark).
Need for research is definitely important for both, evidence-based-medicine (EBM) of our days and CAM too. CAM is older than the EBM in their approach. Currently it seems to me: Medical and non-medical healthcare professionals strive to act constantly in the state of the art of medicine. Therefore, the CAM key components must involve EBM (with medical history, diagnosis, prognosis and treatment of acute and life-threatening diseases), as well as the degree measurements of EBM. This serves the patient. It will also record the criteria of evidence-based medicine in the CAM to serve the patient. This seems to me to be the future research. We began to differentiate the EBM-research into: evaluated evidence, descriptive evidence and empirical evidence. We plan to list and describe all CAM as specific strategies into these three categories.
Dear Oliver, you are right. But CAM is one of many traditional systems. EBM is an approach. I do think that it could be used for a lot of other medical systems.
Dear Mojtaba, if CAM could make novel hypotheses, one would have to certify the need of the asked therapeutics agents. CAM otherwise is a real good source for theoretical and practical appearances.
Definitely, yes! TAC medicine does need more research. Let me please share with you this: in Latin American we have been working in solid networking on TAC. Centered in Peru, a well organized congress has been going on for already three consecutive years. People from the Americas have been participating actively. Of course, the presence of shamanic medicine and wisdom has been present. As we all know, basically five major centers on traditional medicine stand out in the world: Indian, Chinese, Peruvian (including Amazonian), Mexican, and Russian. A most central concern for us all over here is precisely the need to carry on further and deeper research. For, as it happens, there is much med-babble, pervades serious works on TAC.
Right now, we are organizing the fourth Congress on TAC. The need of a serious dialogue between western mainstream medicine and TAC has been openly acknowledge. (No news here!).
(I' ll continue later on…)
Very briefly, another benefit of doing research in traditional, alternative & complementary medicine is gaining of traditional knowledge from the areas, communities or target groups. These traditional knowledge and practices could be the first stepping stone to new discoveries in research and development.
Yes alternative medicine needs thoroughly and objectively researching for two particular reasons. Some of it is pure nonsense and is duping patients into expensive and possibly dangerous behaviour. Some of it is highly effective and works by pharmacological processes just as proprietary manufactured drugs do. Since pharmaceutical products can be dangerous because of pharmacokinetic and pharmacodynamic mechanisms alternative medicines will also carry risks.
All herbal medications for instance should be subjected to the yellow card adverse reaction reporting scheme so that a better database of the nasty side effects and adverse reactions can be properly catalogued. Many of the herbal medications can interfere with the metabolism of proprietary medicines or have serious toxic interactions. Those dispensing herbal medications need better training on pharmacology and human physiology so they can avoid this serious risk.
Ms. Amina Ather
Research is a continuous activity both in traditional and conventional medicine and in all other fields of science and technology. Though India is known for centuries for its traditional therapies and traditional medicines, several Universities and Institutes are actively engaged in R&D on CAM. Indian government established separate councils for different traditional systems of medicine and each council has research institutes actively researching on the therapies and medicines in their respective systems. WHO has several publications on CAM and recognized the importance of CAM for the health security of human beings. CAM is becoming popular in the west also.
Interesting question and equally fascinating discussions.
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