Post on 26-Dec-2015
Traditional, Complementary and Alternative Medicine
Barry Kistnasamy
Emerging Technologies
Today Tomorrow
1. belongs to the trash bin
2. has no role or place in health care given its lack of a “scientific base’’
3. has some therapeutic possibilities
I think that TCAM …
2,56 trillion $ is spent on health globally
0.4% of this is spent in Africa
Close on 80% of the world’s HIV+ people
live in Africa
OECD89%
Other11%
0.4% Africa
TCAM spending
• China – 30% to 50% of medicinal
consumption
• Japanese per capita consumption of
herbal medicine highest in world
• 1400 herbal drugs in EU
• ZAR250m on traditional healers
• $27b in USA
Financing
• Mainly out of pocket • In kind
• Few Medical Aids
South Africa’s Quadruple Burden
• Natural & Non-natural disasters
• Residual of Infectious Diseases
• Emerging New Epidemics
• Epidemiological Transition
Trends …
• International migration
• Urbanisation
• Industrialisation
• ‘bacteria move just as fast as
capital’
The Human Balance
• 35000 doctors
• 150 000 nurses
• 200 000 traditional healers
“co-existence versus integration”
The Supply Chain
planning
Health
production
Education
management
Health
The Regulatory Framework
Allied HPC
Health
SAQA /CHE
Education
? SAMMDRA
Health
Traditional HC
TCAM Research
• Institute for Traditional Medicines (CSIR,
MRC & WHO)
• Indigenous Knowledge Systems
• National Research Foundation
• Universities
• Useful Plants Garden - Kirstenbosch
• Ethno veterinary practiceRef: Moorman & Pick, 1998
Distribution
• "Ezinyangeni" - the place of
healers -
Mai Mai: muti capital of Jo'burg
Distribution• Sangomas normally detect two kinds of bad luck
• One is inflicted through witchcraft, usually by a jealous rival, the other is caused by unhappy ancestors. It is here that patients are counseled to slaughter a beast to appease and rekindle relations with the ancestors.
• Sangomas diagnose and prescribe
• Inyangas generally heal, although they can also prescribe, depending on the nature of the problem or whether their ancestors give them the power to help a patient
Prescription
BMJ 2001;322:164-167 ( 20 January )
Once the muti is obtained, it can be taken in various ways, depending on its form and nature. While some muti is just good for washing with, smearing on one's body, or for burning and inhaling, other muti is designed for elaborate uses like ukuphalaza (regurgitating), ukuchatha (applying by means of an enema), or nokugquma (steaming).
Prescription
• "Isende lehashi" (horse penis) "Zamafufunyane" (for nightmares and hysteria), "Owobusoka" (guaranteed to improve the romantic fortunes of a bachelor), "Zikatokoloshe" (to ward off an imaginary evil goblin said to spread terror at night)
Zimbabwe healer moots magic
chastity potion
Ayurvedic Preparations• Bronchial asthma, ischaemic heart disease and
hyperlipidaemia • Curcumin - rheumatoid arthritis• Acute viral hepatitis• Pterocarpus marsupium effective in reducing
levels of blood glucose and glycosylated haemoglobin in patients with non-insulin-dependent diabetes mellitus
• Fistula-in-ano patients were randomised to surgery or application of medicated thread (Ksharsootra). Surgical treatment led to a faster cure but recurrence rates were lower with medicated thread.
Traditional Chinese Systems of Medicine
• Herbal remedies, acupuncture, acupressure, massage and moxibustion
• 40% of all health care delivered in China
• The first documented source of Chinese medical theory, the Huangdi Nei Jing ("Inner Classic of the Yellow Emperor") was written between 300 BC and 100 BC
Traditional Chinese Systems of Medicine
BMJ 1997;315:115-117 (12 July)
Is it a Communist plot?
Norwegian Law Brings Alternative Medicine to the Mainstream
Journal of the National Cancer Institute, Vol. 96, No. 4, 254-255, February 18, 2004
• complementary medicine in medical & nursing education
• philosophical / spiritual paradigm
• scientific foundation
• practice & evidence of efficacy & safety
• develop national centres of excellence
• 30 medical schools involved
Blue Ribbon Panel
USA - 1996
• adopted a number of resolutions
• has a Traditional Medicine programme
• 19 collaborating centres in 10 countries
• 1996 – 28 monographs of 28 plants
World Health Organisation…
South Africa…• political support
• NRF / MRC support
• various educational initiatives (UKZN, Limpopo, UCT, UWC, Zululand)
•Traditional Healers legislation
MinnesotaMedicine
Published monthly by the Minnesota Medical AssociationJuly 2000/Volume 83
Error in Medicine: What Have We Learned?
Is the grass greener?
• integration
• complementarities
• rivalry
• co-existence
Integrated Medicine Initiative
• traditional & alternative systems
• mind – body interventions
• biological – based therapies
• manipulative & body movement methods
• energy therapies
Review of TCAM – major domains
• enhance curriculum
• development of service sites
• resource mobilisation (local & international)
• documentation
• academic exchange & research support
What are we doing?
• Alternative & Complementary
• African systems
• Indian systems
• Chinese systems
Learning Opportunities
• basic principles & assumptions (rigor & relevance)
• strategies for peer review, evaluation & validation research
• priority areas may be paediatrics, cancer, mental health & cardiovascular disease, HIV/AIDS
• horizontal integration with ethno-botanists, chemists, anthropologists
Research agenda…
• develop adverse effects registry
• credentialing & practice numbers
• coding
• billing system
• record keeping
• values
Operational Research agenda…
• Diagnostic classification
• Adequacy of treatment
• Placebo vs non-placebo
• Outcome measures
• Assumptions about randomisation
Conceptual & Contextual Issues
• certificate
• diploma
• degree
Program mix
Academic development
Together…
barryk@ebucksmail.com
Thank You!
1. to form a BHF TCAM task group
2. to sponsor research
3. have nothing to do with TCAM initiatives
I suggest that BHF’s interventions in TCAM should be: …