Indian Prime Minister Urged to a More “Integrative” Model for AYUSH Strategy

AYUSHIn an opinion piece entitled “Why AYUSH Must Go Mainstream,” a microbiologist describes varying strategies for integration of traditional medicine and Western medicine in his country. He notes that a decade ago, the National Rural Health Mission (NRHM) “attempted to integrate AYUSH systems and facilities with the existing healthcare infrastructure, with the intention of converging different paradigms of practice.” He reports little success. The fall 2014 initiative of Prime Minister Modi takes a different approach in this view: “To simply set up standalone AYUSH clinics alongside other departments of medicine within hospitals and promote a system of ’inclusion’ that enables patients to choose alternative treatments.” The writer questions this potential as well.

Missing in this view is a “clear establishment of the roles of AYUSH practitioners and doctors, and protocol for interactions and referrals, to facilitate a dialogue between ayurveda and allopathic doctors.” More fundamentally: “Practitioners of ayurveda or homoeopathy differ from allopaths in their understanding of anatomy, physiology, and disease and its treatment.” Generating the right evidence is yet another issue. Yet the writer calls “defeatist” the view that these systems cannot interact. One strategy recommended is to overthrow a prohibition on “cross practice” that keeps those from one school from using tools of another. The writer urges “identifying and documenting which illnesses respond best to which systems of medicine, and establishing treatment protocols” that “will enable us to realise the vision of integrative medicine in India.” At the present time, India has slightly more allopathic than AYUSH practitioners. The author concludes, “Adopting an ‘either-or’ approach to healthcare, which forces people to choose between allopathic treatment and AYUSH, is doomed to failure. It’s time for the AYUSH ministry to change its tune.”

According to a recent survey by the National Sample Survey Office (NSSO), “most Indians still seek the services of private, allopathic doctors when they are unwell.”

Comment: Interesting to encounter this legislation that guarantees that the regular and traditional practitioners not step into the others’ line of work. In the United States, the integrative medicine movement advanced as regularly educated medical doctors expanded their toolbox to new natural therapies and, on the other hand, naturopathic physicians increasingly broadened their scopes to include prescriptions of regular drugs. It may be that quality integrative care requires cultivating subsets of professionals who can go both ways. These act as translators. Then we must simply chuck the idea that any form of significant integration can take place via executive action—even if by a Prime Minister—without a strategic policy process to engage the significant cultural and scientific challenges.

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Terrific SciDevNet Review of Issues as Traditional Medicine Meets the Modern World

SciDevNet is an internet portal that announces itself as “the world’s leading source of reliable and authoritative news, views and analysis on information about science and technology for global development.” A mid–July 2015 article,Traditional medicine and modern times: facts and figures, lives up to the name. The piece, by Andrea Rinaldi and Priya Shetty, dips into a series of key themes. Achart on the importance of herbs in medicine shows pharmaceutical drugs derived from plants. A segment looks at conservation issues for both plants and animal sthat are harvested for medicinal use. One table introduces key differences between traditional and modern medicine in such areas as regulation,formulation, dosage, and knowledge protection. They highlight the model, respectful relationship on intellectual property between a products company and the San people in South Africa covered in The Global Integrator Blog as South Africa’s San People Find a Respectful Partner for Marketing a Sacred Herb. Key World Health Organization (WHO) data are reviewed on the level of regulation and education. Controversies are noted. The piece updates the authors’ June 2010 piece entitled “Integrating modern and traditional medicine: facts and figures.”

Comment: The piece is also good in its links to more in-depth dialogues provoked by this rich intersection. One, for instance, jumps to a prior SciDevNet piece entitled “Indigenous knowledge is also a science—don’t ignore it.” The author of that piece argues that for global health development, “The logical approach would be to rely largely on indigenous medicine and include the Western system where needed.” Another link takes one to a WHO-published piece on the ethics of research on traditional medicines coauthored by Harvard’s TCM and placebo expert, Ted Kaptchuk.

For organizations in the integrative health and medicine field that are emerging with an intended global reach and impact—I think of the US-based Academy of Integrative Health and Medicine as well as the mission of Global Advances in Health and Medicine—this is great fodder for reflection. If one seeks, as in the case of Global Advances, to “catalyze whole-person and whole-systems care and healing,” might some of that role be targeted into the dozen areas listed in “Figure 2: Deficit areas that limit effective regulation of T & C medicine, ranked by number of WHO states”? Bringout the whiteboards, please!

Italian Author Team Stakes Ground for Traditional Medicine in “Person-Centered Medicine”

Paolo Roberti di Sarsina, MDItalian integrative medicine leader and GAHMJ editorial board member Paolo Roberti di Sarsina, MD, (pictured) has a passion for shaping the evolving concept of “person-centred” health and medicine. He is particularly interested in ensuring that the concept is inclusive of traditional, complementary and alternative approaches and practices. He is the founder of the Italian non-governmental organization entitled the Association for Person-Centred Medicine. He and his colleagues have published extensively on this theme and related matters. Some of those that are available in English are listed at the bottom of this post.

In his most recent publication, available via open access, “Person-centred healthcare and medicine paradigm: it’s time to clarify,” Roberti di Sarsina and his co-author Mariateresa Tassinari take a stab at defining what “person-centred” is and what it is not. To them, it is beyond a “holistic” view of the person: “To our way of thinking, that is simply the basic premise from which we must set out; it is not an achievement on which to preen ourselves.”

AMCPThe author team offers a figure to define the multiple contributors to the scheme. For instance: “The person-centred medicine and medical paradigm is not only prevention but salutogenesis not prediction through costly genetic testing that could (potentially) contribute to an increased inequality in terms of health but also empowerment to the citizen.” In this care paradigm, “to foster health by a pro-active, pro-resilient health-generating approach marks a point of historic crux and transition.” They add: “From being an object of observation and welfare (to be ‘patched up’ and restored to his/her place of provenance as quickly as possible), the patient becomes an active and responsible subject, the true protagonist in the process of healing.”

Roberti di Sarsina and other colleagues took an earlier look at some of these issues in an article titled “Traditional, complementary and alternative medical systems and their contribution to personalisation, prediction and prevention in medicine—person-centred medicine.”

Comment: Back in the 1980s in the United States, among the ways by which “alternative medicine” practitioners typically distinguished themselves was by their focus on what they called individualized care. To the physicians, the term was sometimes biochemical individuality. A revolt, in those days, from the term “patient” as object and top-down passive recipient of treatment also often figured in. Treating the whole person was the favored phrase. These views are fundamentally aligned with Roberti di Sarsina’s notions of what it means to have the human being in the center of care.

So there was great irony that in regular medicine the notion of “personalized” care finally arrived not via the eyes, bodies, and energetic presences of the human beings that face one in clinic, but rather on the multibillion-dollar back of the genome project. “Patient-centeredness,” likewise, arrived in regular medicine often as marketing initiatives when US hospitals became a more overtly competitive endeavor in the early 1990s. The focus on the patient also came as a response to safety issues rather than a more fundamental view that the best treatment meant engaging the whole person. Meanwhile, it is the cultural, familial, and personal predilections for selfcare and engagement, and for appropriate combinations of regular, traditional, or alternative approaches and practitioners that should be in the center of any method that deserves to be called “person-centered care.” Yet still in most of regular medicine, while we are seeing some excellent movement toward more meaningful integration in some systems, “TCAM,” as the writers put it—traditional, complementary, and alternative medicine—are still often merely tagged on, perhaps via a couple of boxes to check on an intake form. Thus, the importance of what Roberti di Sarsina and Tassinari set out to do is high.

Because the paper is about finding clarity, however, and indeed, in putting a stake in the ground in the broader medical use of the term, the authors would have been served by a more linear and step-wise progression of themes in the paper.  For instance, I like the references to the person-centered intention in the World Health Organization work on traditional medicine and the Declarations of Beijing and Alma Ata. These lend the thesis global backing. Yet the references feel almost like a sort of “declaration-centered medicine” rather than “person-centered.” A lengthy sidebar on the role of the placebo in this form of medicine also increases a rambling quality already in the article. Some of the authors’ clarity may have been lost in the translation. Still, this is a great direction for not only semantic clarification but, more importantly, for re-establishing a claim to prior water rights to this potent paradigm. Person-centeredness begins with the person, not the gene.
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At Roberti di Sarsina’s request, I provide these selected from a list of prior publications from his group linked to the Association for Person-Centred Medicine:

US CDC Head Frieden on Global Health Nightmares: Contributions From Indigenous Systems?

Tom Friedan, MDA recent article in Epoch Times begins with Tom Friedan, MD (pictured), ticking off the top “three nightmare threats” to global health. He lists the following: emerging infectious diseases (such as Ebola), antibiotic resistance, and the potentially disastrous relationship if both converge. Friedan is the administrator of the US Center for Disease Control and Prevention. He was speaking at the 4th Atlanta Summit on Global Health in Latin America and the Caribbean, hosted by the World Affairs Council of Atlanta. Friedan’s prescription: “The way to prepare for the unimaginable is to strengthen global health systems.”

Virginia Davis Floyd, MDThe article, by writer Mary Silver, immediately continues with: “It is also necessary to strengthen indigenous health systems.” The text notes the challenges that can surface if Western non-governmental organizations (NGOs) come into a nation without any significant connection with the local population. She cites the recent reports of the wasteful Red Cross Haitian disaster. During the Summit,a questioner, Virginia Davis Floyd, MD (pictured), a member of the Morehouse School of Medicine faculty and former Ford Foundation official who has studied indigenous systems via a W.K. Kellogg Foundation grant, stirred a conversation regarding whether the NGOs work with “local traditional healers and lay midwives.” Silver synopsized the response: “Some of the doctors said they did work with local healers, and noted how valuable it is to do that. As trusted members of the community, they are ideal conduits for health information.” Silver concludes,“Any surge [in activity to meet a crisis] and any health education program must flow both ways, with respect and compassion.”

Comment: In my first quick read of the article, I thought I was reading that CDC head Frieden was recommending the strengthening of indigenous health systems as a step toward prevention of future disasters. This surprised me. It is rare that a professional as ensconced and empowered in Western medical solutions would reach across the intercultural divide to suggest that global health would be enhanced if indigenous systems are strengthened rather than supplanted. This elevation of indigenous medicine, though, appears to be the writer’s perspective rather than Frieden’s. However, it apparently was raised by Morehouse’s Floyd and apparently some members of one of the Atlanta Summit’s panels agreed. (Efforts to contact Floyd or find Frieden’s full remarks to gain clarity have not yet been successful.)

Silver’s bias raises intriguing questions. Can use of indigenous methods perhaps help us with even something as powerful as Ebola, as Ambassador Andrew Young and other Morehouse personnel have suggested? Can “mainstreaming of traditional medicine” as suggested in this recent piece on Senegal be a significant part of “African solutions to African problems in health”? Might traditional medicines help stem overuse of antibiotics, as the directorof the US National Center for Complementary and Integrative Health Josephine Briggs, MD, has suggested?

Here’s looking forward to a time  when Western leaders speaking of “strengthening global health systems” clearly mean also maximizing the potential from integrating practices that preceded the arrival of NGOs. The value may go far beyond merely serving as “conduits for health information.”

South Africa’s San People Find a Respectful Partner for Marketing a Sacred Herb

San people of South AfricaThe name of the article is an assertion: “Firmsand Indigenous Peoples Can Be Partners.” This begins the remarkable tale ofa relationship between the San people of SouthAfrica (mother and child pictured), the region’s first people, and asupplement company regarding a plant they call “buchu” (boo-koo). The San areknown to many in the West as “Bushmen.” The talk in an 18-minute video on thesite of the article is of integration, specifically of industry, in the form ofa natural-products interest, CapeKingdom, and the interests of the San people—put differently, between the“knowledge holders” and the scientific and business communities. Throughelaborate dialogue with multiple parties including the San Council and the SanInstitute, a plan was created that is backed by the South African governmentand follows the Convention on BiologicalDiversity.

Petrus VaalbooiThe video beginsand ends with comments from a weathered San leader, Petrus Vaalbooi (pictured).He speaks of the plant’s “sacred” value. Vaalbooi and fellow members of hispeople note its use in ceremonies and for such purposes as stomach pain, backache,and bringing down fever. Modern science has found antibacterial,anti-inflammation and antifungal properties associated with the plant. The CapeKingdom products are developed from farmed rather than threatened wild-craftedsources and sold internationally as buchulife. The products, which include a topicalgel, are marketed via the faces and endorsements of world-class athletes andsupermodels. San people, and another tribal group with a claim on theknowledge, receive steady residuals on the sale. The video, entitled “Responsible,Inclusive, Innovative: The Buchu Plant,” ends with Vaalbooi echoing an buchulifeearlierspeaker: “If we work together we can have a better future for our descendants.”The article and video are on the SciDevNetsite that is dedicated to “bringing science and development togetherthrough original news and analysis.”

Comment: Thestory brought to mind the news 2 months ago of a community-based natural-productscompany written up on this Global Integrator Blog site as “The Inspiring Tale of a Nigerian Monk,Sustainable Herbalism, and the African Research Institute.” The two storieshave in common overarching commitments to responsible behavior. Each hasbenefitted its respective Institute. Notably, the respect extends not only to scienceand product quality, but also relationship to peoples and place. Each story hasthe wonderful reek of right livelihood. Good to see such models emerging—evenif, in the case of Cape Kingdom, the conscientiousness becomes a piece of theirmarketing. They would appear to have earned the right to make it so.

Quick Links to Global News in Traditional, Alternative, and Integrative Health and Medicine for June 2015

quick linksThis monthly Global Integrator notes 56 developments in traditional medicine and alternative and integrative health during June 2015. Significant themes include a Milan conference in which the role of TCM in the future of medicine was affirmed by a global group; then, one such emerging example—a Czech-Chinese integrative center, dismaying details on the continuous markets for animal parts for medicinal use, and efforts by homeopaths to regain footing after recent challenges

  • This article focuses on Abhaibhubejhr Hospital, foundedin 1941, which is “the only facility in Thailand where conventional and Thai Traditional Medicine are integrated to ensure as many patients aspossible are cured of their ailments.” A research center is anticipated.
  • On May 16, 2015, after more than 2 years of work, the leaders of Acaté and the Matsés tribes in Brazil met to finalize the 500-page Matsés Traditional Medicine Encyclopedia.
  • In New South Wales, more than 500 Indigenous andnon-Indigenous boys and girls “are learning hygiene, first aid and bush medicine as part of a Young Doctor program tobridge the gap in some of the poorest communities across Australia.”
  • Traditional medicine use is implicated in this piece on the impending extinction of African vultures.
  • More than 200 bear paws were seized in Vancouver, BC.
  • This article estimates that more than 1 million pangolins have been sold for medicinal purposes in the past decade.
  • Meantime, a new Chinese beer will be made from synthesized rhino horn “to save real rhinos.”
  • The lure of the illegal animal market in Bangladesh is detailed here: “A rhino horn fetches up to $60,000 per kg in the grey market. An elephant ivory goes for $2,200 a kg; a tiger’s bones, skin and meat fetch $70,000 while a leopard’s body parts are a tad cheaper. Bears are killed for their paws, a delicacy that comes for $12-15 each, and their “cure-all” bile for $200,000 a pound.”
  • In late June, Thailand’s Deputy Prime Minister andForeign Minister Tanasak Patimapragorn announced “the achievements of the 7th India-Thailand joint committee meeting, which included a memorandum of understanding on India’s traditional medicine between Rangsit University and the ministry responsible for India’s traditional medicine.”
  • The George Family Foundation and James Gordon, MD’s Center for MindBody Medicine figure into this article from the US state of Minnesota about indigenous healers using mind-body practice via the Minnesota Indian Women’s Resource Center.
  • More than 4500 people are anticipated at the September 27-28, 2015 London CAM EXPO of Diversified Communications. The firm has along-running Integrative Practitioner Symposium, formerly styled “CAM EXPO” in NewYork City and will start a Canadian symposium in October 2015.
  • A former national public official in Canada is starting acenter to promote medical marijuana in that country.
  • The Thai government is backing a “healthy city and community lifestyle event aiming to raise the community’s confidence in services of healthcare institutes in Thailand and to increasethe economic value of Thai and integrative medicine.”
  • This article notes that a Belgian traditional medicine producer, Joris Ghyssaert, has opened a branch of its herb business in Liberia with Liberian government backing.
  • Elmonda Chase GrantThe comments of medical herbalist and pharmacist Elmonda Chase-Grant (pictured) in Barbados are the subject of this article.
  • An African ethicist urges more balanced reporting on whathe considers over-claims of African traditional healers.
  • The Indian government has offered 20 scholarships to Malaysian students to study traditional Indian medicine.
  • Joseph Jiya, a pharmacist with the Nigerian Federal Ministry of Health,“has called for enabling laws to regulate and promote the proper practice of herbal medicine in the country.”
  • Medical doctors in Tasmania were not pleased when a Reiki-and crystal-favoring practitioner was appointed to head the state’s hospital network. The backing of the appointment by the health minister is here.
  • A report estimates that the global personalized medicine market, which includes complementary and alternative approaches, will reach $2.4 trillion by 2022, up from just over $1 trillion now.
  • The International Day of Yoga provoked the Wall Street Journal India to ask what is behind Prime Minister Modi’s push for yoga? Modi has reportedly doubled government spending on AYUSH since making it a separate department. The article is entitled “Bend It Like Narendra: Modi Turns to Tradition With Yoga” and subheaded:“International Yoga Day part of Prime Minister Narendra Modi’s push to promote India’s traditions.”
  • An author in Korea suggests that the MERS crisis should take a lead from a report on the SARS crisis that found that “in treating SARS patients, a combination of traditional Chinese (Oriental) medicine and Western medicine was more effective that Western medicine alone.”
  • Harvard research suggesting that the blue evergreen hydrangea root “canblock a type of rogue T-cell” has stimulated interest from Bristol-Myers Squibb.
  • In Pune, India, a book entitled “Integrative Approaches for Health: Modern medicine, Ayurveda and Yoga” was recentlyreleased.
  • A Czech-Chinese Centre for Research into Traditional Chinese Medicine was opened mid–June 2015 in the presence of Chinese Vice-PM Liu Yandong in Hradec Kralove’s hospital (model pictured), whose director Roman Prymula spoke about the plan to build aclinic focusing on traditional Chinese medicine. This is a pilot project and is the first center of traditional Chinese medicine in Central and Eastern Europe.
  • The South African government has been accused of “medical apartheid” due to the Medicines and Related Substances Amendment Bill 2014 that “will provide a regulatory framework and oversight for the use of medicines, including complementary medicines.” Regulated will be the nation’s 200,000 Sangomas under a new South African Health Products Regulatory Authority, despite strong arguments that their practice is very different than, for instance, that of TCM practitioners.
  • Dr Seo Hyo-seok, “who has been taking the initiative to globalize Korean medicine, gave aspecial lecture on traditional medicine and the health of lungs in his capacity as a sponsor for the World Conference of Science Journalists in the afternoon of June 11, 2015.”
  • Over the past 40 years, more than 1,200 medical professionals from China have gone to Morocco “to serve the local [Chinese population] and help promote bilateral understanding between the two countries and their peoples.” In 1986, Chinese acupuncturists first established a center in the city of Mohammedia, 50 km south of capital Rabat.
  • Inclusion of Chinese medicine in a China-Australia free-trade agreement via a side-letter stimulated a backlash from anti-acupuncture people in Australia. Here is a related piece.
  • In mid-June, M  K  C  Nair,vice chancellor of Kerala University of Health Sciences, inaugurated a two- day “all India” seminar and exhibition on “Raw Drugs, Substitutes and Adulterates in Ayurveda” for which eight papers were presented.
  • Traditional medicines were one subject taught to children in a Truth and Reconciliation Day for the Dakota indigenous people of Canada. Another story on a Truth and Reconciliation event in Guelph, Ontario, is here.
  • This PharmaBiz.com article shares that researchers at Savitribai Phule Pune University “have proved that Triphala, one of the most popular and widely used Ayurvedic formulations, can have therapeutic effects against a wide range of complex diseases like cardiovascular diseases, asthma, arthritis, diabetes and cancer.”
  • The Integrative Medical Institute in Hong Kong is looking for new practitioners.
  • This article focuses on the most productive province forginseng, China’s Jilin province. Pictured is a portion of a ginseng plantation.
  • A small Oxford-based company claims it “has become the first European drug maker to bring traditional Chinese medicine to the Western market, launching two EU-certified products this year.”
  • This article entitled “Traditional healers blast vapostori” speaks to the more challenging elements of regulating traditional medicine in Zimbabwe.
  • A “talent training base for traditional medical practice in co-operation with the World Health Organisation (WHO) will be established on the University of Macaucampus by August this year.”
  • Homeopath Dana Ullman, MPH, CCH is among those in a gathering in Mumbai seeking to defend homeopathy against recent attacks.
  • An article clarifies that the ban on sales of alcohol in TCM shops in Pakistan did not mean to include medicines.
  • An EU-Chinese consortium exploring TCM integration is noted here in Yibada.com following a global meeting in Milan, Italy, that Xinhua is touting as evidence that TCM will have significant contributionsto global health. IM leaders from Germany and the United States are cited.
  • Patronage of traditional medicine “quacks” is viewed as a part of why Nigerians do not participate in the country’s healthcare system.
  • The National Chairman of the Ghana Federation of Traditional Medicine Practitioners Association, Kojo Odum Edful, has commended the Ministry of Health “for the steps taken over [15] years, to create an enabling environment for the practice of traditional medicine in Ghana.” He notes that remaining challenges include “quackery, charlatanism and poor intellectual property coverage and the aversion to herbal medicine by some western medicine practitioners due to stigma, reports of toxicity related to bad use of herbal medicines and lack ofinformation.”
  • A Bangladesh writer and lecturer speaks to the potential of herbal medicines.
  • The controversy over Prince Charles’ support of homeopathy and complementary medicine as found in the “black spider memos” was covered widely, including here and here.
  • The controversial move by Blackmores to fund a U Sydney chair in integrative medicine continues to garner coverage.
  • The article looking at changes in the Maasai culture (pictured) touches on sales of herbal medicines.
  • The head of the Central Council on Indian Medicines forecasts that an Indian medicine will replace antibiotics.
  • The head of the US CDC Tom Frieden, MD, argues that “the way to prepare for the unimaginable” in problematic health futures “is to strengthen global health systems.” A Kellogg-funded physician who studied traditional methods supported Frieden’s thesis.
  • A launch ceremony was held “for the International Cancer Centre of Asia in early June as part of the China-EU 2020 Strategic Agenda for Cooperation.” The center will explore TCM for cancer.
  • The Philippines’ National Telecommunications Commission has warned a radio station against misleading herbal ads.
  • The remarkable story of Father Anselmo’s PAX Herbals of Nigeria gets follow-up coverage here.
  • Possible toxic chemical contamination from Ayurvedic medicine products is explored here.
  • A Western Cape University, South Africa, professor shares her views on appropriate uses of traditional medicines.
  • A release notes a substantial new relationship involving Prof Alan Bensoussan (pictured), the director of the National Institute of Complementary Medicine at UWS, and the Institute’s longstanding relationship with the Beijing University of Chinese Medicine.
  • The US Pharmacopeia (USP) is in the process of developing monographs to create a dedicated database for its Herbal Medicines Compendium (HMC) for South Asia and East Asia through separate panels with experts from India and China.