Traditional Medicines And all That February 14, 2007 Bernard Sorofman

Learning Objectives

Some Basics Medical Pluralism – the existence of more than one health care system operating in the same cultural space. Exercise: How many health care systems can we list for Iowa City? Midwest USA?

Some Basics Roemer’s Principles: –Integral part of culture –Multi functioning Jobs, promote health, improve society –Curative / preventive –Defined by the culture Exercise: Discuss how these apply to ‘your’ involvement in a health care system.

Medicine – substances having an inherent power to transform a condition (SR Whyte 1988) USA definition of a drug – FDA defines as having a physiological effect. Question: What are the differences between these two?

What gives medicine its power? Belief in Outcomes –Not the outcomes themselves What are indicators of Power? –Source –Color –Size –Dosage form –Others???

David Landy’s Classification (1977) Attenuated healing Role Adapted healing Role Emerging healing Role From your knowledge of health care, how does TM fit into this???

Conventional Medicine Medicine that is practiced by holders of MD or DO Degrees and their allied health professionals, such as nurses. Older or less politically correct –Biomedicine –Western medicine –Developed medicine

Popular Care Health Professional Care Lay Professional Care After A. Kleinman

Traditional Medicine Refers to health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being. –WHO

Traditional Medicine TM is the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness. –WHO

Complementary and Alternative Medicine CAM is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Complementary medicine – used together with conventional medicine Alternative Medicine –used in place of conventional medicine

Adventure (AKA: Homework) Ms Collins; Mr Johnson Products not from dominant HCS List of products Cost of products What did the ‘attendant’ say? Impact? –New Pi, Chain pharmacy, GNC

Risks Poor quality Incorrect usage Delay conventional treatment Lack of information

TM Safety Issues Can have negative effects –Ma Huang (Ephedra). Treat respiratory Problem: health attacks, stroke deaths –Belgium: wrong species of plant Concept of safety is influenced by culture Concept of efficacy is influenced by culture

Complementary and Alternative Medicine CAM is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine.CAM is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Complementary medicine – used together with conventional medicineComplementary medicine – used together with conventional medicine Alternative Medicine –used in place of conventional medicineAlternative Medicine –used in place of conventional medicine

CAM Users (USA 1999) Women > men Increased Education Recently hospitalized (past year) Former smoker (more than smokers or never smoker

Why CAM CAM would improve health – 55% Interesting – 50% Conventional medical treatments would not help – 28% Conventional medical professional suggested – 26% Conventional medical treatments too expensive – 13%

CAM expenses USA Study –$36B - $47B expenses –$12B - $20B out of pocket for CAM healers More than out of pocket for hospitalizations Half of out of pocket paid to physicians –$5B on herbal products

Mind Body Medicine –Patient support group –Cognitive behavioral –Meditation –Prayer –Mental healing –Therapies with art, music, dance –Others??? Biologically Based –Herbs –Dietary supplements –Shark cartilage –Others???

Manipulative & Body –Chiropractic –Osteopathic manipulation –Powwowing –Massage –Others??? Energy / biofield –Qi gong –Reiki –Therapeutic touch Energy / bioelectromagnetic –Pulse fields –Magnetic fields –Electric current

Mostly prayer

Factors influencing the reporting of the use of natural products to community pharmacists Benjaporn Kingroungpet (B. Sorofman) 2005

Integration of TM Tolerant HCS allows TM Inclusive HCS recognizes but not fully Parallel HCS has both, separate Integrated brings TM into training. Promote acceptance Protect Medicinal Plants/animals Protect indigenous knowledge Promote rational use –Consumers –Providers

Treatment Pluralism Disease with multiple approaches to treatment Diseases with only conventional Tx Diseases with only traditional Tx Illnesses without disease with only traditional Tx

WHO Plan National policies on TM Evidence for TM Availability and Affordability of TM Promote sound TM use by healers Document TM

Why TM Accessibility Affordability Perceived safety Potential for treating disease

What does a Pharmacy bring to TM? Accessibility Diversity Relative Cost Proximity of information Other???

What does a pharmacist bring to TM? Local knowledge Skill Other???