Traditional, Complementary and Alternative Medicine

1
Traditional, Complementary and Alternative
Medicine
Barry Kistnasamy
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Emerging Technologies
Tomorrow
Today
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I think that TCAM

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

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0.4 Africa

• 2,56 trillion is spent on health globally
• 0.4 of this is spent in Africa
• Close on 80 of the worlds HIV people live in
  Africa

5
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

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Financing

• Mainly out of pocket
• In kind
• Few Medical Aids

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South Africas Quadruple Burden

• Natural Non-natural disasters
• Residual of Infectious Diseases
• Emerging New Epidemics
• Epidemiological Transition

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The Economist Dec 13th-19th 2003
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Trends

• International migration
• Urbanisation
• Industrialisation
• bacteria move just as fast as capital

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The Human Balance

• 35000 doctors
• 150 000 nurses
• 200 000 traditional healers
• co-existence versus integration

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The Supply Chain
planning
production
management
Health
Health
Education
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The Regulatory Framework
? SAMMDRA
Allied HPC
SAQA /CHE
Traditional HC
Health
Health
Education
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TCAM Research

• Institute for Traditional Medicines (CSIR, MRC
  WHO)
• Indigenous Knowledge Systems
• National Research Foundation
• Universities
• Useful Plants Garden - Kirstenbosch
• Ethno veterinary practice

Ref Moorman Pick, 1998
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Distribution

• "Ezinyangeni" - the place of healers -

Mai Mai muti capital of Jo'burg
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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

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Prescription

• 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).

BMJ 2001322164-167 ( 20 January )
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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)

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Zimbabwe healer moots magic chastity potion
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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.

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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

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Traditional Chinese Systems of Medicine
BMJ 1997315115-117 (12 July)
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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
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(No Transcript)
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Blue Ribbon Panel USA - 1996

• 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

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World Health Organisation

• adopted a number of resolutions
• has a Traditional Medicine programme
• 19 collaborating centres in 10 countries
• 1996 28 monographs of 28 plants

South Africa

• political support
• NRF / MRC support
• various educational initiatives (UKZN, Limpopo,
  UCT, UWC, Zululand)
• Traditional Healers legislation

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Is the grass greener?
MinnesotaMedicine Published monthly by the
Minnesota Medical AssociationJuly 2000/Volume
83 Error in Medicine What Have We Learned?
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Integrated Medicine Initiative

• integration
• complementarities
• rivalry
• co-existence

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Review of TCAM major domains

• traditional alternative systems
• mind body interventions
• biological based therapies
• manipulative body movement methods
• energy therapies

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What are we doing?

• enhance curriculum
• development of service sites
• resource mobilisation (local international)
• documentation
• academic exchange research support

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Learning Opportunities

• Alternative Complementary
• African systems
• Indian systems
• Chinese systems

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Research agenda

• 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

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Operational Research agenda

• develop adverse effects registry
• credentialing practice numbers
• coding
• billing system
• record keeping
• values

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Conceptual Contextual Issues

• Diagnostic classification
• Adequacy of treatment
• Placebo vs non-placebo
• Outcome measures
• Assumptions about randomisation

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Program mix
Academic development

• certificate
• diploma
• degree

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Together
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(No Transcript)
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Thank You!
barryk_at_ebucksmail.com
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I suggest that BHFs interventions in TCAM should
be

• to form a BHF TCAM task group
• to sponsor research
• have nothing to do with TCAM initiatives