A January 21, 2015 news item in the Kalej Times focused on the the growth of complementary and alternative medicine practitioners in the United Arab Emirates. The story, “Alternative medicine growing in UAE with over 200 licensed professionals,” notes that 21 new practitioners have been licensed in the past year “including six homeopathy specialists, two ayurveda practitioners, two hijama, and three chiropractic specialists.” The licensing of Traditional Complementary and Alternative Medicine (TCAM) practitioners is aligned with the World Health Organization strategic plan according to Sassan Behjat, BHMS,MPH,MPA the chair of the January 28 Complementary, Alternative and Integrative Medicine Conference that is part of the huge Arab Healthcare Congress January 26-29, 2015 in Dubai. The day is January 28. Behjat is founder of the Medblend Homeopathy Consultancy in California, USA.
Comment: Interesting to see the directly-referenced influence of the W.H.O. work in this area. While the UAE are said to have been aligning initiatives with the W.H.O. strategies for 20 years, the practitioner regulation is particularly responsive to the 2014-2013 plan which focused in the role of traditional medicine in primary health care. Interesting to see the international line-up in Dubai, including GAHMJ’s associate editor Gunver Kienle, MD of the University of Witten-Herdecke in Germany. GAHMJ founding editor David Riley, MD kicking off the conference which has a case reports focus.
Three colleagues independently sent notes sharing that Edzard Ernst, MD is in the news again. The anti-CAM author grabbed headlines with old news about what he presents as a vendetta to “silence” him that Prince Charles had against him. This headline-grabbing gambit for Ernst’s newest book, A Scientist in Wonderland appears to be working. The book reportedly details, in a chapter entitled “Off with His Head,” Ernst’s perspective on the 2007-2011 dispute. According to The Guardian, the battle erupted after Ernst was given the opportunity to review a draft form of a planned government document on complementary and alternative medicine. Ernst violated professional confidentiality by disclosing the contents. The article links Ernst’s trials to the fact that he “was himself strongly criticised for disclosing the report’s contents before they had been fully reviewed and published.”
The article notes that Prince Charles has been a strong supporter of the potential value of complementary and alternative medicine in assisting people to health and in potentially lowering health costs. A particularly acrimonious theme in the dispute has been the Prince’s support for, and Ernst’s antagonism toward, homeopathy. Following the hoopla over the report, Ernst was sanctioned. Funds subsequently dried up for Ernst’s department at the University of Exeter which at one time included a group of 20 co-workers. He eventually retired to a countryside retreat where he continues to write.
Comment: When colleagues shared this news with me, I wondered about the ethics of writing anything. Why give Ernst and his polarizing more visibility? I have chosen to do so to raise this general question: what do we do with professionals from any perspective who polarize the evidence discussion in integrative health? Ernst kept himself and his work visible and supported, at least until recently, through an oeuvre that hardly admits to the value in integrative practices and practitioners. Meantime, the likes of the conservative accrediting agency for health care organizations, The Joint Commission, has re-shaped guidelines based on evidence. A RAND Corporation researcher marches our 28 high quality studies and concludes that it’s time to stop arguing that we have no data on cost-effectiveness. Mirror imagine to Ernst is the medical doctor author who traffics in over-claims about petri-dish studies of natural agents as though they were large human trials while lambasting shortcomings and biases in pharmaceutical trials.
A colleague Ben Kilgler, MD, MPH, and I recently suggested some ways out of this polarization in Finding a Common Language: Resolving the Town and Gown Tension in Moving Toward Evidence-Informed Practice. In short, we urge evidence-based humility on all sides. Ernst shows little humility regarding how little high-level evidence we actually have on interventions of any kind. “Silencing” and “vendetta” are claims from an individual who silences a good deal of research in his personal vendetta against entire complementary and integrative fields and disciplines. Ernst’s protest rings hollow. Still, his book might be a stimulating – as in infuriating – read. Anyone need an ire injection?
This monthly Global Integrator feature is a quick capture of selected highlights on developments in traditional medicine and alternative and integrative health. Here are 21 selections from India, Turkey, Qatar, Pakistan, Malaysia, England, Australia, Russia and elsewhere for December 2014.
In late November, to mark the European Union’s 2014 “Antibiotics Awareness Day,” EUROCAM published a draft position paper entitled: “The role of Complementary and Alternative Medicine (CAM) in reducing the problem of antimicrobial resistance.” This policy document calls out “the potential of CAM in reducing the problem of AMR [antimicrobial resistance] to be given serious consideration and for further research to be carried out in this area to determine in which conditions, both in human and veterinary healthcare, specific CAM modalities are particularly effective.”
The 33-page paper by this umbrella group introduces policy makers to the historic dialogue about the important role of the host in development of infections of all kinds. The paper’s first segment then speaks to how integrative strategies can build resilience in people so they will have less need for antibiotics of any kind. It then touches such topics as the positive interactions between herbs and antibiotics, and the potential use of homeopathic medicines. The authors cite evidence that the incidence of AMR is lower in an anthroposophical hospital using more integrative therapies than it is in regular settings. The authors also note the importance of integrative practices in veterinary medicine to diminish over use of antibiotics in farming. They conclude: “Complementary and Alternative Medicine can support the EU strategy to conserve and steward the effectiveness of existing antimicrobial treatments and offer an avenue for the development of novel future therapies.
Comment: This is a terrific example of the kind of white papers the integrative health and medicine communities need on a wide array of topics. The EUROCAM strategy of linking the publication to a mainstream event — in this case the annual Antibiotics Awareness Day — is also noteworthy. The authors are correct to assert that the severity of the problem means than no stone should be unturned in exploring options. They clearly urge even those with a prejudice against natural remedies to explore the potential of herbs and homeopathic medicines. If fail, despite suggestive evidence, to make what is after all a relatively limited research investment, policy-makers risk a categorization that is parallel to the Cold War’s term of rebuke: “Better dead than red.” Too many decision-makers would seem to think that they are better dead than CAM. Here’s hoping the EUROCAM policy paper opens eyes, minds, and doors.
The Turkish Health Ministry has chosen to open the doors of its hospitals and medical facilities through a new regulation that took effect in late October 2014 that now allows the legal practice of 14 different “alternative medicine” therapies. Each is listed with descriptors in this article. Among these are many widely known: acupuncture, phytotherapy, chiropractic and osteopathy. Others less so: apitherapy, leeches, wet cupping, larval therapy, prolotherapy, reflexology and ozone therapy. The nation’s social security system will not cover the costs of such care, leading already to a debate about whether there is justice in a nation legalizing practices that may only be available to a financially better-off subsection of citizens. States one attorney: “The regulation creates inequalities. Only those with deep pockets can benefit from [those treatments in] hospitals. The ministry wants to regulate those ancient treatments, but poor citizens are again left in the hands of incompetent people who have little knowledge of alternative medicine.” This is Turkey’s first systematic legal treatment of “traditional and complementary medicine.”
Comment: The Global Integrator contacted Kaleem Ullah Rajput, MD, an associate professor for “CAM and Integrated Medicine” at Medipol University Hospital in Bagcilar, Istanbul. Rajput, who also serves as the general secretary of the British Cupping Society, shares that the work in Turkey preceding the 14 separate recognitions was engaged in each care through a distinct medical society. Rajput was a leader in the cupping society’s work. He notes that the decisions of these societies regarding training standards and certification are “rarely contradicted by the Health Ministry.” He believes that in “8-9 areas quality programs of education are in place.” In response to a question, Rajput stated that while historically such practices have only been open to medical doctors and dentists, the new rules create opportunities for other practitioners.
The proposal reportedly came from Indian Prime Minister Narendra Modi in September 2014. He urged the United Nations’ to promote yoga’s value in helping people “discover the sense of oneness with yourself, the world and the nature.” Three months later, on December 11, 2014, with 175 co-sponsors, the 193 member United Nations General Assembly declared June 21, the solstice, as International Day of Yoga. The U.N. secretary general Ban Ki-moon said the celebration would bring attention to yoga’s holistic benefits: “Yoga can contribute to resilience against non-communicable diseases. Yoga can bring communities together in an inclusive manner that generates respect.” He added: “Yoga is a sport that can contribute to development and peace. Yoga can even help people in emergency situations to find relief from stress.” This is the first time “any such initiative has been proposed and implemented” in less than 90 days. The U.N has declared 118 other such commemorative days.
Comment: The quotes wonderfully capture the many faces of yoga – from sport to stress relief to medical intervention to a multi-leveled “sense of oneness.” The phenomenally rapid uptake of yoga internationally over the past two decades is clearly a chord that hits on all those notes. Fascinating to see this international consensus emerging for advancing health through yoga. Notably, the number of co-sponsors is also a record for any resolution of this sort.
One characteristic of movements for change is that they are in themselves mind-body efforts. There is the body of the work on the ground by thousands of people, often working alone or in semi-isolation. Then there is the connective mind and spirit energy in discovering and learning from others who are similarly engaged. The metaphor may be of other shoulders at the wheel. Or it may be shared nourishment from “stone soup” in which everyone contributes what they can. What one engages in microcosm is multiplied, energized, magnified and refracted by similar activities of others. One engages one’s part, and celebrates or worries the whole.
The movement to enhance the appropriate application of the values, practices and disciplines associated with integrative health and medicine in creating health exemplifies this interplay. Work on the ground can be quite challenging. One confronts perverse incentives, reductive models, and past individual and system patterns that are obstacles to optimal integration. At the same time, many if not most see their work as part of a transformative campaign from disease-centric to a health focus, from reactivity to pro-activity. One may primarily work on change manifestation in one’s practice, one’s hospital or medical unit, one’s profession or one’s community. Yet the work is necessarily global. By definition, integrative medicine draws on multiple traditions. By philosophy, integrative health errs on the side of inclusion. By the mere fact of living in 2015, our lives are daily woven of myriad threads of cultures, peoples and practices. Our nature is global.
The opportunity to develop a Global Integrator Blog for Global Advances in Health and Medicine was offered to me following over 20 years of writing, in various formats and publications, typically more geographically limited content that became known as The Integrator Blog. The focus here as there will continue be on the policy, business and organizational news rather than specific clinical notes. These may be drawn, for example, from: the Hong Kong Jockey Club’s decision to start an Institute of Integrative Medicine; the continuing battle over the government’s relationship to homeopathy in Australia; the international aspirations of the new Academy of Integrative Health and Medicine (with which I am involved); or the work in multiple nations toward the direction set by the World Health Organization in its 2014-2023 Traditional Medicines Strategy. Some news may be immediately useful. Others will be of passing interest. Others will merely connect. My practice is to report, then comment on what I report. From time to time I add the commentary of others. The blog is meant to be in service.
I view this as an opportunity to “develop” this service as I am not sure where the routine writing of 8-10 pieces a month will take us. I know for certain that the Global Integrator Blog will benefit from connecting to your news, and ideas. Contact me with information and queries at email@example.com. Together we can knit a fabric that enriches and serves the global movement of which we are all part.