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

Quick linksThis Global Integrator feature notes 77 developments in traditional medicine and alternative and integrative health during July 2015. The work from PRO.ME.TRA international includes a fascinating blurb on a project in Senegal. More on that later. Interesting perspectives from the first female president of Mauritius, Ameenah Gurib-Fakim, a scientifically-trained professional who supports better integration of traditional medicine. On the regulatory front, the government of the Philippines acted to accept a list of 10 traditional medicines. And fascinating to see that India prevailed in stopping multinational Colgate-Palmolive from gaining trademark rights for an herb used in teeth care that has ancient traditional use.



Whole System Research: Survey on Naturopathic Practice Studies Published

Erica Oberg, ND, MPHThe peer-reviewed and indexed BMC Open has published “Estimated Effects of Whole-system Naturopathic Medicine in Select Chronic Disease Conditions: A Systematic Review.” The 8-person US and Canadian research team, led by Erica Oberg, ND, MPH, (pictured) and Ryan Bradley, ND, MPH, found 15 studies that “were of goodquality and had low to medium risk of bias.” These met a set of inclusion criteria, one of which was that each of the studies most focus on “chronic diseases of public health significance.”

In most of the studies, “a quality of life metric was included and found statistical significance in some subscales.” On primary medical outcomes ofthese randomized controlled trials, which varied across the studies, they found statistically significant positive outcomes (P<.05) in 10 out of 13 studies. The authors, mainly naturopathic physicians with significant research histories, concluded: “Previous reports about the lack of evidence or benefit of naturopathic medicine are inaccurate.” They add, “A small but compelling body of research exists. Further investigation is warranted into the effectiveness of whole practice NM for arange of health conditions.”

Comment: The study has value beyond the naturopathic field: while with a naturopathic twist, there is much here of use to the whole field of whole-systems, mind-body, integrative practice. One take-home is the mixed methods approach. Given the attacks on naturopathic medicine a sutterly unscientific by academics opposed to integrative medicine, the sober conclusion of the authors can remind one of 19th-century humorist Mark Twain’s reported comment upon seeing his own obituary: “Reports of my death have been greatly exaggerated.”

I am similarly reminded of the statement of RAND researcher Patricia Herman, PhD, ND, on completing her exhaustive cost-effectiveness review of complementary and integrative medicine: “I’m tired of this talk that there is no evidence forcost-effectiveness of complementary and integrative medicine. There is evidence. We need to move onto phase two and look at how transferable these findings are. We can take this evidence and run.” The integrative health community can take pride in this review of the outcomes of whole-person,integrative care.

Unfortunately for the naturopathic research community, one of the rules by which research proposals to the US National Institutes of Health are gauged is the breadth of the usefulness of the outcomes. Thus, without positioning these as exploration of integrative, whole-person care, any proposal by NDs can be declined due to the small size of their profession (5,000). Reviewers need to respect the model that the naturopathic doctors provide for all care relative to integrative treatment. Past review practices need to change. That said, kudos to the naturopathic research team. Now, someone in the MD integrative medicine field needs to undertake a similar piece that surveys the still-limited number of whole-practice studies for the broader IM field.

Carlo Calabrese, ND, MPHFinally, kudos to Carlo Calabrese, ND, MPH, (pictured), one of the authors and a former member of the advisory council tothe NIH National Center for Complementary and Integrative Medicine. Calabrese, the founding executive director of the Naturopathic Physicians Research Institute where he still sits on the board with Oberg and Bradley (and this writer), is the godfather of outcomes and whole-practice research in that field. We like to call it researching the way we practice. Carlo has also been a mentor and influencer of many, including me, for more than 25 years. Here’s hoping this publication is satisfying evidence of your life work moving things forward, Carlo.

Most Significant International Research Congress on Integrative Medicine Expands to Include Policy, Clinical, and Education Tracks in May 2016

ACIMHThe integrative medicine organization with the most clout, globally, is likely the Academic Consortium for Integrative Medicine and Health (ACIMH, or “The Consortium” as the members prefer to call it). Its core membership is more than 60 North American medical schools. In 2006, the organization began hosting a major research meeting, backed by the US National Institutes of Health National Center for Complementary and Integrative Health. In 2012, the sponsors acknowledged their international reach. The meeting drew an interprofessional mix of more than 1000 researchers and clinicians from some 3 dozen nations. In 2012, 2013, and 2014, the organization hosted or co-hosted significant meetings on education, clinical issues, and policy, respectively.

IMH 2016On May 17-20, 2016, the Consortium is rolling content from these 4 domains into one big meeting. The Green Valley Ranch hotel off the Las Vegas, Nevada, strip will be the site of the International Congress for Integrative Medicine and Health. In a break from the past, the Consortium expanded its supporting organization collaborators: Integrative Health Policy Consortium (policy), Academy of Integrative Health and Medicine (clinical) and Academic Consortium for Complementary and Alternative Health Care (education). These joined the historic partner on research content, the International Society for Complementary Medicine Research. Representatives of each are on the Program Committee and the Communications Committee.

In this video, the organizers suggest the potential for significant synergies. A quick glance at the themes for the 6 Plenary Speakers and the 12 Pre-Conference Workshops says it. The microbiome. Interprofessionalism and team care. Measuring cost-effectiveness in integrative medicine. Group visits. Neurophysiology of meditation. Leadership. Policy action to ensure viability. Mixing qualitative and quantitative methods. And these do not yet touch the not yet announced but anticipated 3 dozen workshops and scores of posters.

CongressComment: Alignment of interest note: I serve on the Congress’s Organizing Committee and as chair of its Communications Committee. I have also been to every one of the 7 congresses and meetings since 2006 leading up to this. Each has offered tremendous learning. As many in the ICIMH video bear witness, they also offer extraordinary networking opportunities. When the only focus was on research, the biggest issue with the Congress was already an overabundance of content. In May 2016, with additional pulls to policy, education, and clinical content, the risk for anyone with a whole-systems view about the state of this movement may be to find oneself struck to stone by the overabundance of tempting options. That’s a great sort of problem to have. You will not regret the decision to attend. Heck, for true whole-systems integrators, there is also the opportunity at this Congress to integrate craps, blackjack, dining options, and extravagant entertainment with subtler healing arts.

PROMETRA International: A Collaborative Model for Stimulating Understanding and Optimal Use of Traditional African Medicines and Practices

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PROMETRA International“In all Black Africa, we notice progressive disappearance of traditional healers and the degradation of their knowledge. This is all the more reason to consider as pressing and essential task the study and revalorization of traditional medicine in our countries. This rehabilitation cannot be made without the regulations of their practice in a legal frame work.”

Erick V.A. Gbodossou, MDThe statement was made last August by Erick V.A. Gbodossou, MD (pictured), the founder and president of PROMETRA International. Gbodossou is also a traditional healer from the Hwula tribe in present-day Benin. He was responding to news that the World Health Organization’s 15TH annual African Traditional Medicine Day would be dedicated to the “regulation of traditional practitioners in the African region.” PROMETRA is a non-governmental organization dedicated to the preservation of “African traditional medicine, culture and indigenous science.”

With origins dating back to 1971, the organization presently has chapters in 27 nations led by “bi-world” leaders trained in both systems of western and traditional medicine. Throughout the past decade, PROMETRA International has trained over 18,000 traditional healers as what it calls “Information, Education and Communication (IEC) agents.” The organization does this through a scientifically-based, culturally appropriated train the trainer program, FAPEG. PROMETRA is one of the longest surviving, sustainable NGOs on the continent of Africa. It has been a grantee of the Bill & Melinda Gates Foundation, the Ford Foundation, UNDP, European Union and other international funders.

Virginia Floyd, MD, MPHIn the United States, activity is led by long-time global health leader Virginia Floyd, MD, MPH (pictured, below). A special projects leader for Morehouse School of Medicine, Floyd also sits on the board of the Andrew Young Foundation and the National March of Dimes. The Global Integrator Blog recently connected with Floyd. She’d recently returned from Benin where she’d coordinated an educational exchange and tour on traditional medicine themes and had just helped send off the 20-person group. Included were 3 professionals from the Cleveland Clinic with a particular interest in Sufi wound healing. Another was a second-year resident in the integrative family medicine residency developed through the University of Arizona Center for Integrative Medicine founded by Andrew Weil, MD. The multidisciplinary nature of the work is evident through the backgrounds of the others: 2 engineers, an architect, 2 other medical doctors, a Reiki master, a naturopath, a farmer, a physician’s assistant, and a nurse practitioner. The tour and medical exchange was set to overlap with the day that the system of Voodoo is annually recognized in that nation, January 10.

Floyd has helped facilitate multiple USA relationships for PROMETRA to explore the science of traditional medicines. (See, here in the Global Integrator Blog, Ebola, Ambassador Andrew Young, and the Potential Role of Native African Medicine.) Her own passions run to traditional Voodoo practice and the entire system of traditional knowledge.

Gbodossou provides a flavor here of the reason for reaching back into tradition even as relationships are developed to research natural products: “It is necessary to remind us that the Cartesian system does not know life, and has nothing to measure love, emotion or intuition! This modern system is incapable to individually solve many health problems.” In setting the Morehouse-PROMETRA relationship, the parties chose to create a “basis” for mutual understanding by distinguishing between “knowledge” of Cartesian/Western medicine and the “knowing” of traditional healers. Behind the work is a profound sense of mission. Gbodossou articulates: “If it is recognized by all that HEALTH IS THE BASE AND FOUNDATION OF ANY DEVELOPMENT then it is painful to notice that the development of the Africa region is almost exclusively in exogenous hands.” [capitals in the original]

Comment: Much of the interest of conventional medical stakeholders in traditional medicines—when it exists—is limited to a drug framework. The focus is on the seemingly low-hanging fruit of natural medicines, often with the intent to synthesize them if value is found. They miss the forest for the fruits. The power of PROMETRA’s work, under Gbodossou’s leadership, is in sustaining and reclaiming the broadest value of the traditions—and not just to individuals, one by one, but to the strength of the peoples as a whole.

PAHO Initiates NicaraguaInitiative on Integrative, Traditional, and Complementary Therapies with US,Australian, and Spanish Partner Organizations

Pan American Health Organization (PAHO)In a remarkable first, Pan American Health Organization (PAHO) has announced amajor, multi-party, global initiative to advance the integration of traditional and complementary medicine into a national health system. The nation at stake is the second poorest in the Western Hemisphere, Nicaragua.

The driving force behind the series of December 2015 meetings in Managua is Maria Socorro Gross, MD (on the left in the photo), the representative in Managua of the PAHO and of the World Health Organization (WHO). The parties met in a workshop conducted through the Nicaraguan Institute for Natural Medicine and Complementary Therapies, established in December 2014. The purpose was described as “capacity building in research and access to information to integrate natural medicine into the health system.” The aim is “contributing to the strengthening of the Model of Family and Community Health.” Key health local health officials attended.

The meeting included the signing of Memoranda of Understanding with the National College of Natural Medicine (Portland, Oregon, USA), Australian Research Centre on Complementary and Alternative Medicine at the University of Technology (Sidney, Australia), the Program Philippus del Real Centro Universitario Escorial-María Cristina (Spain), and Natural Doctors International (NDI – Portland,Oregon, USA, and Ometepe, Nicaragua). The representatives of the international organizations included Tabatha Parker, ND (NDI, NCNM) and Jon Wardle, ND (Australia; pictured below). The goal: “strengthen the comprehensive approach to health care, to provide users with access to services natural medicine,respectful, affordable, safe and effective.”

Socorro GrossComment: One of the most remarkable aspects of this activity is the person behind it. Socorro Gross has more than 20 years in significant leadership promoting WHO’s primary care mission. She has served with PAHO/WHO since 1994 in positions in Columbia, the Dominican Republic, and most significantly in Washington, DC, as the subdirector of PAHO. Perhaps the initiative in Nicaragua will prove a precursorto an expansion.

At the founding of Nicaragua’s integrative care Institute a year ago, the nation’s controversial president, Daniel Ortega, and his spouse, Rosario Murillo—who serves the government as Coordinator of the Communication Council—stated that the interest is in a health system that “promotes a comprehensive service.” To them that means “to use natural medicine to supplement Western conventional medicine.” The services of a Vietnamese acupuncturist were highlighted as an example of the new direction.

Finally, quite interesting to see the team that was present. The Global Integrator Blog previously published this Report from Daniel Gallego-Perez, MD, at APHA: Creating a Database on Integrative Research in Colombia.

Gallego-Perez is completing a doctorate in public health at Boston University with his thesis focused on these very developments. Parker is a cofounder of NDI who, with Wardle, is a leader in efforts to gain WHO recognition for the naturopathic profession. This activity is potent for Nicaragua, potentially for the PAHO region, and definitely for the emerging globalization of the naturopathic health field.

Recognition of Traditional Medicine and Practitioners Around the Globe: Recent Advances

Two interrelated media themes relative to traditional world medicines around the globe are, on the one hand, individuals or organizations of traditional healers calling for more recognition and regulation; and on the other, announcements from one country or another of some new formal status. A recent example of the former was in Cameroon when, on African Alternative Medicine Day, practitioners promoted regulation. More rarely, though not infrequently, one sees notice of governmental action.

The World Health Organization (WHO) called for such increased regulation and inclusion of these practices and practitioners in the Traditional Medicine Strategy: 2014-2023 as part of its mission to achieve primary carefor all. On Africa Traditional Medicine Day, Matshidiso Moeti, MD, WHO’s regional director for Africa, pushed the campaign. He issued a letter urging governments to strengthen regulatory bodies for traditional health practitioners: “The benefits of traditional medicine are evident to all, [but] there is no doubt proper regulation is essential to the provision of quality, safe and effective healthcare products and services.”

United Arab EmiratesA highlight of formal regulation in the past 3 months wasthe decision by the UAE (pictured) Ministry of Health to “adopt 90 new complementary medicines as part of a strategy to include herbal and traditional medicines into mainstream healthcare systems. The Zambian cabinet has reportedly approved a bill to regulate traditional medicines that the Traditional Healers and Practitioners Association of Zambia (THPAZ) is backing. At the state level, in Oregon, USA, the Medicaid plan to provide services to those less well-off is now covering integrative pain treatment from licensed acupuncturists, massage therapists,chiropractors, and naturopathic doctors. In the not-quite-there department, regulation of traditional medicine doctorsis said to be near in Botswana according to this article.

On the regulatory, rather than the legislative side, notice went out from Kuala Lampur’s Health Deputy Director-General (Medical) Datuk Dr Jeyaindran Sinnadurai that the Traditional and Complementary Medicine Act 2013 “is expected to be enforced “at the latest” by mid-2016. There are reportedly some 13,000 registered practitioners of traditional and complementary medicine in the country, 8000 of whom are Chinese traditional medicine practitioners.

HerbsOther government action, while neither legislative nor formally regulatory, saw an Indian state health department advisory offering recommendations for use of traditional medicines with cases of Dengue. In Rwanda, the official in charge of prevention of liver diseases at Rwanda Biomedical Centre called for more research on the ability of traditional medicine to cure Hepatitis B and C.” In Upper Pradesh, India, a governmental scientific council approved an Ayurvedic remedy for diabetes (including the herbs pictured) following clinical drug trials that found that “around 67% of patients showed normal blood sugar levels within 3 to 4 days of drug usage.” Also on the therapy side, in Heviz, Hungary, a lake’s healing waters were “accredited.” And notably, the state health department in Kottayam, India, is “planning to open Yoga training centres at Secretariat and Assembly complex for legislators and other staff.” Thes ewill be run by graduates in naturopathy and Yogic science. Another step toward inclusion in the direct involvement of traditional healers in dealing with Ebola in this story about hard-hit Sierra Leone.

On the other side of the ledger, The National Health Service in England is considering banning inclusion of homeopathy prescriptions under the national plan.

Comment: Taken together, these affirmative actions suggest an organic knitting together of forces for global health that have been estranged, mistrusting, and separated. As we in the global north approach the winter solstice, this rapprochement feels like a sign of the coming of the light.

Global Wellness Summit Declares Top 10 Global Wellness Trends

Deepak ChopraGlobal leaders in the wellness and spa fields met in mid-November in Mexico City at the Global Wellness Summit 2015. A key take-away was a set of a Top 10 Future Shifts in Wellness. The subhead of the organization’s media release on the list is, “Experts at Mexico City conference forecast that wellness will become more mandatory in more nations soon—that breakthroughs in epigenetics, stem cells and integrative medicine are near—and that ‘programmatic’ workplace wellness will disappear.”

Among the high-tech shifts is “From Cracking the Genome to Cracking the Epigenome.” Keynoter and author Deepak Chopra (pictured) explained that “the future is decoding the epigenome, that DNA which is ceaselessly modified by lifestyle choices and environment.” On the lower-tech side, Adam Perlman, MD, MPH, the director of the integrative medicine program at Duke University, spoke to a shift “From Medicine vs Wellness to Truly Integrative Healthcare.” Perlman spoke to the coming together of wellness and the complementary/integrative medicine movements: “We’re at an inflection point. If we saw a first wave of integrative medicine in the mid/late 90s, this time it feels different.” Others of the down-to-earth list included “From Diet Trend Hysteria to Sane Eating” and others related to “Wellness Homes/Real-Estate” and “Wellness Traveling.” A longer version of the report is here.

EllisComment: I first wrote on the leadership work the Global Wellness Summit in one of the early posts at the Global Integrator Blog: The Global Wellness Institute: Update with CEO Susie Ellis after Launch of Evidence Site. The industry group is an unusual combination of industry organization and mission-driven advocacy. I suspect some of this stems from the character of Ellis (pictured) herself.

This top 10 is an interesting compilation and definitely worth a read. Of course, in this challenged world in which we live, to think we are headed toward any shifts to wellness can seem a very ostrich-like act. Then again, with its activism, the group acts out the way that hope becomes a verb in this wonderful statement from the former Czech writer and political leader Vaclav Havel: “Hope is definitely not the same thing as optimism. It is not the conviction that something will turn out well, but the certainty that something makes sense, regardless of how it turns out.” Inside these generally hopeful trends, there are a lot of wheels that will need a lot of shoulders at them to bring these shifts to pass.