44 Traditional Medicine FINAL

1radluonal Medlclne
!"#$%&''("# *+ !,-., Mu MP uP(CanLab)

!/-0"-1 2+ 3#-4516, Mu MP
!ohns Popklns 8loomberg School of ubllc PealLh
uecember 2007
repared as parL of an educauonal pro[ecL of Lhe
Clobal PealLh Lducauon Consoruum
and collaboraung parLners
2
Learnlng ob[ecuves
1. AruculaLe denluons of Lradluonal medlclne (1M)
2. LnumeraLe Lhe level of global use of 1M
3. ulscuss reasons for Lhe popularlLy of 1M
4. AruculaLe a classlcauon of 1M
3. ulscuss safeLy, emcacy, and quallLy lssues
6. ulscuss pollcy & regulaLory framework lssues
7. ulscuss some case sLudles on Lhe use of 1M
8. ulscuss posslble fuLure developmenLs
Page 2
3
Module ouLllne
uenluons
Level of global 1M usage
8easons for 1M popularlLy
Classlcauon of 1M
SafeLy, Lmcacy, and CuallLy
Page 3
4
Module ouLllne (conunued)
8auonal use of 1M
ollcy and regulaLory frameworks
Case sLudy on Lhe use of 1M ln rural
8angladesh
1radluonal healers and severe menLal lllness
Ceneraung evldence on lnformal care
Page 4
3
uenluons: WhaL ls Lradluonal medlclne?
1he World PealLh Crganlzauon sLaLes:
1radluonal medlclne refers Lo healLh pracuces,
approaches, knowledge and bellefs lncorporaung
planL, anlmal and mlneral based medlclnes, splrlLual
Lheraples, manual Lechnlques and exerclses, applled
slngularly or ln comblnauon Lo LreaL, dlagnose and
prevenL lllnesses or malnLaln well-belng."
Page 5
See Notes
6
uenluons: 1en core Lerms
1. 1radluonal medlclne (1M)
2. ComplemenLary/
alLernauve medlclne
(CAM)
3. Perbal medlclnes
4. Perbs
3. Perbal maLerlals
6. Perbal preparauons
7. llnlshed herbal
producLs
8. 1radluonal use of herbal
medlclnes
9. 1herapeuuc acuvlLy
10. Acuve lngredlenL
Page 6
See Notes
7
Clobal 1M usage ls wldespread and growlng
Plgh usage ln varlous parLs of Lhe developlng world:
ln Afrlca up Lo 80 use 1M
ln Chlna, 40 of dellvered healLh care ls 1M
ln lndla, 63 of Lhe populauon ln rural areas use Lradluonal
medlclne Lo help meeL Lhelr prlmary healLh care needs
ln many oLher Aslan counLrles 1M wldely used
60-70 of allopaLhlc docLors ln !apan prescrlbe 1M
Laun Amerlca also reporLs hlgh levels of 1M usage
71 ln Chlle, 40 ln Columbla
Page 7
Use of TM is high in many countries in the developing world. Data presented in slides from:
1. WHO Traditional Medicine Strategy 2002-2005. Geneva. 2002. Publication number WHO/EDM/TRM/
2002.1. Available at: http://whqlibdoc.who.int/hq/2002/WHO_EDM_TRM_2002.1.pdf
2. WHO Report by the Secretariat on Traditional Medicine. Executive Board 111th Session. December
2002. Publication number EB111/9. Available at: http://www.who.int/gb/ebwha/pdf_files/EB111/eeb1119.pdf
8
Page 8
Figure source: WHO Traditional Medicine Strategy 2002-2005. Geneva. 2002.
Publication number WHO/EDM/TRM/2002.1. Available at:
http://whqlibdoc.who.int/hq/2002/WHO_EDM_TRM_2002.1.pdf
9
Page 9
usage ln Lhe developed world ls also hlgh and lncreaslng
ercenLages of populauons who have used CAM aL leasL once:
AusLralla 46, Canada 70, uSA 48, 8elglum 31, and lrance 49
ln Lhe uk 40 of all Cs oer some form of CAM referral or access
ln Lhe uSA one sLudy concluded LhaL use of aL leasL 1 of 16 alLernauve
Lheraples durlng Lhe prevlous year was 42 ln 1997 - vlslLs Lo CAM
provlders now exceeds by far Lhe number of vlslLs Lo all prlmary care
physlclans ln Lhe uS
A [olnL nlP/CuC sLudy of 2004 provlded deLalled lnformauon on CAM
usage ln Lhe uSA
See Notes
10
Page 10
Figure source:
WHO Traditional Medicine Strategy 2002-2005. Geneva. 2002.
Publication number WHO/EDM/TRM/2002.1. Available at: http://whqlibdoc.who.int/hq/2002/WHO_EDM_TRM_2002.1.pdf
11
Page 11
8easons for 1M popularlLy: ueveloplng counLrles
AvallablllLy.
Access lssues.
AordablllLy.
Condence ln Lhe ablllLy of 1M Lo manage
deblllLaung/lncurable dlseases.
lamlllarlLy wlLh pracuuoners.
lnLegrauon wlLh communlLy bellef sysLems.
Availability data in Africa in Tanzania, Uganda and Zambia, researchers have found a ratio of TM
practitioners to population of 1:200-1:400 (this contrast with the availability of allopathic practitioners,
where the ratio is typically 1:20,000 or less.
USAID data indicates that traditional practitioners outnumber allopathic practitioners by 100 to 1.
Allopathic practitioners in Africa are often located primarily in cities or other urban areas.
TM is often the only affordable source of health care especially for the poorest patients. Traditional
practitioners can often be paid in kind and/or according to the wealth of the client.
Often, the principals of TM are embedded within the community and traditional practitioners are well
known and respected in their communities
12
Page 12
8easons for 1M popularlLy: ueveloped counLrles
Concern regardlng adverse eecLs of chemlcals
Cuesuonlng Lhe assumpuons of allopaLhlc medlclne
lncreased access Lo healLh lnformauon
Changlng values and reduced Lolerance of paLernallsm
Chronlc dlseases requlre hollsuc approach
ercelved low rlsks of 1M
Consumer sausfacuon wlLh Lhe level of lnLer-personal care
provlded
The fact that CAM usage is high and increasing in developing countries indicates that cost and tradition are
not the only reasons for the use of traditional medicine. Many inter-related factors are contributing to the
high levels of CAM use some of these factors are mentioned in the slide.
Health systems in many developing countries are struggling to maintain continuity of care for the
populations they serve this fragmentation of care is occurring at the same time as high levels of chronic
diseases that necessitate such continuity. CAM has been reported to provide a high level of quality in terms
of inter-personal care. This can be postulated as one of the reasons for the popularity of CAM.
13
Page 13
Classlcauon of 1M/CAM
Any attempt to classify traditional medicine is hazardous, as the field is continuously emerging and many traditional practitioners resist
formalized classification. A good starting point is provided by the WHO, as outlined in the table in the slide. One should note, however,
the absence of multiple traditional healing practices in Africa and South America. Each slide that follows will provide some brief
information on the therapies mentioned in the WHO table. Table source: WHO Traditional Medicine Strategy 2002-2005. Geneva. 2002.
Publication number WHO/EDM/TRM/2002.1. Available at: http://whqlibdoc.who.int/hq/2002/WHO_EDM_TRM_2002.1.pdf
14
Page 14
Classlcauon of 1M/CAM: Chlnese Medlclne
1radluonal Chlnese medlclne (1CM) ls an anclenL
medlcal sysLem LhaL Lakes a deep undersLandlng of
Lhe laws and pauerns of naLure and applles Lhem
Lo Lhe human body. 1CM ls noL "new Age," nor ls lL
a paLchwork of dlerenL heallng modallues. 1CM ls
a compleLe medlcal sysLem LhaL has been pracuced
for more Lhan ve Lhousand years."
(1radluonal Chlnese Medlclne - World loundauon)
See Notes
13
Page 15
Classlcauon of 1M/CAM: Ayurveda
Llfe ln Ayurveda ls concelved as Lhe unlon of body, senses, mlnd and soul.
1he llvlng man ls a conglomerauon of Lhree humours (!"#"$ &'(" &)"*+"),
seven baslc ussues (,"-"$ ,".#"$ /"0-"$ /12"$ 3-#+'$ /"44" & 5+6.7") and
Lhe wasLe producLs of Lhe body such as faeces, urlne and sweaL. 1hus Lhe
LoLal body maLrlx comprlses of Lhe humours, Lhe ussues and Lhe wasLe
producLs of Lhe body. 1he growLh and decay of Lhls body maLrlx and lLs
consuLuenLs revolve around food whlch geLs processed lnLo humours, ussues
and wasLes. lngesuon, dlgesuon, absorpuon, asslmllauon and meLabollsm of
food have an lnLerplay ln healLh and dlsease whlch are slgnlcanLly aecLed
by psychologlcal mechanlsms as well as by blo-re (380')."
(Source - A?uSP, MlnlsLry of PealLh & lamlly Welfare, lndla)
See Notes
16
Page 16
Classlcauon of 1M/CAM unanl
CrlglnaLed ln Creece, based on Leachlngs of PlppocraLes and Calen.
ueveloped lnLo an elaboraLe Medlcal SysLem by Lhe Arabs (8hazes , Avlcenna, Al-
Zahravl , lbne-nas and oLhers).
unanl LreaLmenL ls based on naLural dlagnosls meLhods.
Malnly dependenL on Lhe LemperamenL (Mlza[) of Lhe pauenL, heredlLary condluon and
eecLs, dlerenL complalnLs, slgns and sympLoms of Lhe body, exLernal observauon,
examlnauon of Lhe pulse (nubz), urlne and sLool eLc.
unlque and speclal LreaLmenL meLhods llke uleLo Lherapy (lla[-bll-Chlza), Cllmauc
Lherapy (lla[-bll-Pawa), 8eglmenLal Lherapy (lla[-blL-1adblr), make lL a remarkable and
popular sysLem.
(Source - A?uSP)
The Department of Ayerveda, Yoga & Naturoptahy, Unani, Siddha and Homeopathy (AYUSH) of the Ministry of Health and
Family Welfare of India has a section on Unani at: http://indianmedicine.nic.in/unani.asp
The American Institute of Unani Medicine provides a wide range of further information on Unani at http://www.unani.com
17
Page 17
Classlcauon of 1M/CAM: naLuropaLhy
naLuropaLhy ls a sysLem of heallng sclence sumulaung Lhe body's
lnherenL power Lo regaln healLh wlLh Lhe help of ve greaL elemenLs of
naLure - LarLh, WaLer, Alr, llre and LLher. naLuropaLhy ls a call Lo "8eLurn
Lo naLure" and Lo resorL Lo slmple way of llvlng ln harmony wlLh Lhe self,
socleLy and envlronmenL. naLuropaLhy provldes noL only a slmple pracucal
approach Lo Lhe managemenL of dlseases, buL a rm Lheoreucal basls
whlch ls appllcable Lo all Lhe hollsuc medlcal care and by glvlng auenuon
Lo Lhe foundauons of healLh."
(Source - A?uSP)
The Department of Ayurveda, Yoga & Naturoptahy, Unani, Siddha and Homeopathy (AYUSH)
of the Ministry of Health and Family Welfare of India has a section on Naturopathy at:
http://indianmedicine.nic.in/naturopathy.asp
18
Page 18
Classlcauon of 1M/CAM: CsLeopaLhy
ueveloped 130 years ago by physlclan A.1. Sull, osLeopaLhlc
medlclne ls one of Lhe fasLesL growlng healLhcare professlons ln Lhe
u.S. and brlngs a unlque phllosophy Lo Lradluonal medlclne. WlLh a
sLrong emphasls on Lhe lnLer-relauonshlp of Lhe body's nerves,
muscles, bones and organs, docLors of osLeopaLhlc medlclne, or
u.C.s, apply Lhe phllosophy of Lreaung Lhe whole person Lo Lhe
prevenuon, dlagnosls and LreaLmenL of lllness, dlsease and ln[ury."
(Amerlcan CsLeopaLhlc Assoclauon)
The American Osteopathic Association website provides a wealth of information:
http://www.osteopathic.org/index.cfm
19
Page 19
Classlcauon of 1M/CAM: PomeopaLhy
PomeopaLhy seeks Lo sumulaLe Lhe body's defense mechanlsms and
processes so as Lo prevenL or LreaL lllness.
1reaLmenL lnvolves glvlng very small doses of subsLances called remedles
LhaL, accordlng Lo homeopaLhy, would produce Lhe same or slmllar sympLoms
of lllness ln healLhy people lf Lhey were glven ln larger doses.
1reaLmenL ln homeopaLhy ls lndlvlduallzed (Lallored Lo each person).
PomeopaLhlc pracuuoners selecL remedles accordlng Lo a LoLal plcLure of Lhe
pauenL, lncludlng noL only sympLoms buL llfesLyle, emouonal and menLal
sLaLes, and oLher facLors.
(Source - nauonal CenLer for ComplemenLary and AlLernauve Medlclne, nauonal
lnsuLuLes of PealLh, unlLed SLaLes).
See Notes
20
Page 20
Classlcauon of 1M/CAM: Chlropracuc
locuses on dlsorders of Lhe musculoskeleLal sysLem and Lhe nervous sysLem,
and eecLs of Lhese dlsorders on general healLh.
Chlropracuc care ls used mosL oen Lo LreaL neuromusculoskeleLal
complalnLs, lncludlng buL noL llmlLed Lo back paln, neck paln, paln ln Lhe
[olnLs of Lhe arms or legs, and headaches.
ChlropracLors or chlropracuc physlclans - pracuce a drug-free, hands-
on approach Lo healLh care.
ChlropracLors have broad dlagnosuc skllls and are also Lralned Lo recommend
Lherapeuuc and rehablllLauve exerclses, as well as Lo provlde nuLrluonal,
dleLary and llfesLyle counselllng.
(Source - Amerlcan Chlropracuc Assoclauon)
The American Chiropractic Association provides a large amount of information at:
http://www.amerchiro.org/index.cfm
21
Page 21
Classlcauon of 1M/CAM: 1herapeuuc Lechnlques
Many Lheraples and Lherapeuuc Lechnlques are
common Lo more Lhan one 1M sysLem.
1hese lnclude:
Perbal medlclnes
AcupuncLure and acupressure
Manual Lheraples
SplrlLual Lheraples
Lxerclses
Source: WHO Traditional Medicine Strategy 2002-2005. Geneva. 2002.
22
Page 22
Classlcauon of 1M/CAM
An alLernauve nlP classlcauon
lour domalns:
1. Mlnd-8ody Medlclne
2. 8lologlcally 8ased racuces
3. Manlpulauve and 8ody-8ased racuces
4. Lnergy Medlclne
8loeld Lheraples
8loelecLromagneuc-based Lheraples
Whole medlcal sysLems, cuL across all four
domalns.
See Notes
23
Page 23
key lssues: SafeLy - emcacy and quallLy
1he WPC aruculaLes 6 challenges ln conslderlng Lhese lssues:
1. Lack of research meLhodology
2. lnadequaLe evldence-base for 1M/CAM Lheraples and producLs
3. Lack of lnLernauonal and nauonal sLandards for ensurlng safeLy, emcacy,
and quallLy conLrol
4. Lack of adequaLe regulauon and reglsLrauon of herbal medlclnes
3. Lack of reglsLrauon of 1M/CAM provlders
6. lnadequaLe supporL for research
A discussion of these issues is found on page 21 of the report.
24
Page 24
Sclenuc evldence from randomlzed cllnlcal Lrlals ls sLrong for many uses of
acupuncLure, some herbal medlclnes and some manual Lheraples.
lurLher research ls needed Lo ascerLaln emcacy and safeLy of several oLher pracuces
and medlclnal planLs.
unregulaLed or lnapproprlaLe use of Lradluonal medlclnes and pracuces can have
negauve or dangerous eecLs.
lor lnsLance, Lhe herb Ma Puang" (Lphedra) ls Lradluonally used ln Chlna Lo LreaL
resplraLory congesuon. ln Lhe unlLed SLaLes, Lhe herb was markeLed as a dleLary ald,
whose over dosage led Lo aL leasL a dozen deaLhs, hearL auacks and sLrokes.
(Source - WPC)
Source: WHO Traditional Medicine fact sheet available at
http://www.who.int/mediacentre/factsheets/fs134/en
23
Page 25
1he evldence base for 1M ls expandlng
now able Lo search ub Med wlLh a focus on 1M:
A search on safeLy" reLrleves 7,034 arucles
A search on emcacy" reLrleves 19,884 arucles
A search on quallLy" reLrleves 13,372 arucles
(numbers as of uecember 2007)
Powever, Lhere ls sull an urgenL need Lo expand Lhls pool of global knowledge
8esearch meLhodologles also need Lo adapL Lo Lhe unlque aurlbuLes of
Lradluonal medlclne
NCCAM and the National Library of Medicine (NLM) have partnered to create CAM on PubMed, a subset of
NLM's PubMed. This is available at http://nccam.nih.gov/camonpubmed
The Cochrane Complementary Medicine Field was established in 1996 to produce, maintain and
disseminate systematic reviews on TM/CAM topics.
26
Page 26
1he WPC has ldenued global & nauonal key needs ln ensurlng Lhe
safeLy, emcacy and quallLy of 1M/CAM
AL Lhe global level, Lhere are 3 key needs:
1. Access Lo exlsung knowledge of 1M/CAM Lhrough exchange of
accuraLe lnformauon and neLworklng
2. Shared resulLs of research lnLo use of 1M/CAM for Lreaung common
dlseases and healLh condluons
3. Lvldence-base on safeLy, emcacy and quallLy of 1M/CAM producLs
and Lheraples
27
Page 27
AL Lhe nauonal level Lhere are 3 key needs:
1. 8egulauon & reglsLrauon of herbal medlclnes
2. SafeLy monlLorlng for herbal medlclnes & oLher 1M/CAM
3. SupporL for cllnlcal research lnLo use of 1M/CAM for Lreaung
counLry's common healLh problems
4. nauonal sLandard, Lechnlcal guldellnes and meLhodology, for
evaluaung safeLy, emcacy and quallLy
3. nauonal pharmacopoela and monographs of medlclnal
planLs
28
Page 28
8auonale use of 1M
1he WPC advocaLes Lhe rauonale use of 1M. llve key needs aL Lhe nauonal
level are hlghllghLed:
1. 1ralnlng guldellnes for mosL commonly used 1M/CAM Lheraples
2. SLrengLhened & lncreased organlzauon of 1M/CAM provlders
3. SLrengLhened cooperauon beLween 1M/CAM medlclne & allopaLhlc
medlclne pracuuoners
4. 8ellable lnformauon for consumers on proper use of 1M/CAM Lheraples
and producLs
3. lmproved communlcauon beLween allopaLhlc medlclne pracuuoners &
Lhelr pauenLs concernlng use of 1M/CAM
29
Page 29
8auonale use of 1M
lmporLanL progress ln addresslng needs ldenued on sllde 28 lnclude:
1M Lralnlng ls hlghly developed ln developlng counLrles e.g. Afrlcan counLrles,
Chlna and lndla
AuempLs are belng made Lo dene Lhe Lralnlng needs for healLh pracuuoners
ln developed counLrles
1M/CAM provlders are becomlng lncreaslngly organlzed LhroughouL Lhe world
- Lhe lnLerneL ls revoluuonlzlng organlzauonal capaclLy across borders
Cooperauon beLween 1M and allopaLhlc pracuuoners ls slowly lncreaslng
lnformauon on 1M ls lncreaslngly avallable
See Notes
30
Page 30
8auonale use of 1M
WPC Monographs on selecLed medlclnal planLs ls an example of how sclenuc
lnformauon ls percolaung Lhe pracuce of 1M.
1he Monographs lnclude:
8oLanlcal feaLures of Lhe medlclnal planLs
1he planLs ma[or chemlcal consuLuenLs
lnsLrucuons on quallLy conLrol of planL derlved herbs
harmacology
osology
ConLralndlcauons
Adverse reacuons
The monographs are mentioned on page 33 of the WHO Traditional Medicine Strategy 2002-2005. Geneva. 2002.
The monographs are a key reference for national health authorities, scientists and pharmaceutical companies and
are also used by lay persons to guide them in rational use of herbal medicines.
Posology = study of the dosages of medicines and drugs.
31
Page 31
ollcy & regulaLory frameworks
1he WPC aruculaLes 3 challenges ln Lhls area:
1. Lack of omclal recognluon of 1M/CAM and 1M/CAM provlders
2. 1M/CAM noL lnLegraLed lnLo nauonal healLh care sysLems
3. Lack of regulaLory and legal mechanlsms
4. LqulLable dlsLrlbuuon of beneLs of lndlgenous 1M knowledge and
producLs
3. lnadequaLe allocauon of resources for 1M/CAM developmenL and
capaclLy bulldlng
32
Page 32
WHO defines nine key elements of a national TM/CAM policy:
1. Definition of TM/CAM
2. Definition of governments role in developing TM/CAM
3. Provision for safety and quality assurance of TM/CAM therapies
and products
4. Provision for creation or expansion of legislation relating to TM/
CAM providers & regulation of herbal medicines
5. Provision of education & training of TM/CAM providers
(Continued)
33
Page 33
WHO key elements of a national TM/CAM policy (cont.):
6. Provision for promotion of proper use of TM/CAM
7. Provision for capacity building of TM/CAM human
resources, including allocation of financial resources
8. Provision for coverage by state health insurance
9. Consideration of intellectual property issues
34
Page 34
Chlna - An lnLegraLed approach Lo 1M
nauonal pollcy on 1M ls parL of Lhe 1949 consuLuuon
LxlsLence of SLaLe AdmlnlsLrauon of 1radluonal and ComplemenLary Medlclne
(1CM)
Perbal lndusLry regulaLed, pharmacopela lncludes herbs & essenual drugs llsL
lncludes herbal medlclnes
Plgh level of human 1M resources
ubllc hosplLals lnclude 1M pracuce
PealLh lnsurance covers 1M
Plgh level of research capaclLy
lnLegraLed 1M/AllopaLhlc educauon aL unlverslues
Numerical data on TM capacity in China: 600 manufacturers of herbal medicines; 340, 000 herbal farmers:
Human TM resources (525,000 TCM doctors, 10,000 TCM/AM doctors, 83,000 TCM pharmacists, 72,000 TCM
associate doctors)
Hospital resources (2,500 TCM hospitals, 39 TCM/AM hospitals, 35,000 total beds, 127 TM hospitals for
minority groups).
170 national and state TM research institutions.
Educational resources (30 TCM universities, 3 TM colleges for minority groups, 51 medical technology schools
of TCM).
33
Page 35
Case sLudy on Lhe use of 1M
1radluonal medlclne and menLal lllness ln 8angladesh
1he prevalence of a severe menLal lllness such as schlzophrenla ls 1 across
Lhe globe - Lhls LranslaLes Lo 1.3 mllllon 8angladeshls wlLh schlzophrenla
1radluonal medlclne ls oen Lhe only LreaLmenL avallable for severe menLal
lllness ln rural 8angladesh
An array of Lradluonal pracuuoners oer servlces ln rural 8angladesh
abna PosplLal ls Lhe only hosplLal dedlcaLed Lo Lhe care of Lhose wlLh severe
menLal lllness
The case studies are real, from personal experience in Pabna Mental Hospital, Bangladesh.
The names of the cases are fictitious.
36
Page 36
Mehrun nessa ls a 24 year old lady who auends Lhe ouLpauenL cenLer
aL abna PosplLal ln chalns
She has been dlsLurbed" and possessed" for many years accordlng
Lo Lhe relauves LhaL accompany her
She has been seen by numerous Lradluonal pracuuoners and has
recelved varlous forms of LreaLmenL, oen aL greaL nanclal cosL Lo
Lhe famlly
1aklng a full hlsLory reveals Lhe laLesL LreaLmenL she recelved was Lhe
pourlng of hoL oll lnLo her ears - Mehrun nessa ls now deaf as well as
conunulng Lo be aecLed by audlLory halluclnauons
37
Page 37
Sa[eeda khaLum ls a 18 year old glrl who has recenLly been wlLhdrawn from her famlly
and frlends, and has been acung ln a blzarre fashlon
Per faLher Look her Lo a Lradluonal pracuuoner who lmmedlaLely recognlzed she was
aecLed by severe menLal lllness
1he Lradluonal pracuuoner and her faLher are wlLh Sa[eeda aL Lhe ouLpauenL cenLre aL
abna
lollowlng an assessmenL by Lhe physlclan, a LreaLmenL plan ls dlscussed wlLh
Sa[eeda's famlly and Lradluonal pracuuoner
1he Lradluonal pracuuoner has prevlously supporLed Lhe care of pauenLs aecLed by
schlzophrenla ln Lhe communlLy, and ls condenL he wlll be able Lo supporL Sa[eeda
and her famlly
38
Page 38
1he Lwo case sLudles demonsLraLe marked varlauon ln Lhe pracuce of
Lradluonal medlclne ln rural 8angladesh
1radluonal pracuuoners can provlde an lnvaluable resource for Lhe
recognluon of severe menLal lllness
1radluonal pracuuoners can poLenually be parL of lnLegraLed care paLhways
wlLh allopaLhlc pracuuoners, as lllusLraLed by Lhe case of Sa[eeda khaLum
uangerous Lradluonal pracuces are prevalenL ln rural 8angladesh - Lhese
pracuces need Lo be challenged uslng communlLy based approaches
To learn more about traditional medicine in Bangladesh see the entry in Banglapedia at
http://banglapedia.search.com.bd/HT/T_0207.htm
39
Page 39
8esearch ls requlred Lo undersLand Lhe pracuce of 1M ln rural 8angladesh
Such research ls belng conducLed ln 8angladesh by luLure PealLh SysLems:
lnnovauons for LqulLy
1hls research consoruum ls conducung healLh sysLems research ln 6
counLrles
1he research ln 8angladesh alms Lo undersLand how lnformal rural healLh
care sysLems work and lnLeracL wlLh Lhe formal healLh care sysLems & local
governance
Calnlng such an undersLandlng ls Lhe rsL sLep Lowards sLraLeglzlng
lnLervenuons LhaL ensure safe and hlgh quallLy lnLegrauon of Lradluonal &
allopaLhlc medlclne
See Notes
Culz
Now we invite you to take the module quiz and test your
recent learning.
This module quiz includes ten questions to test whether
you have internalized the key concepts presented in the
module. The last question focuses on the case study
Note your letter answers (A,B,etc.) on a piece of paper.
After completing the quiz you can check the following slides
for the correct answers and additional feedback.
After the quiz a short summary is provided for this module
presentation
41
1. Which component is not included in The World Health Organization definition of
traditional medicine?
A Plant, animal and mineral based medicines.
B Spiritual therapies
C Allopathic medicines
D Manual therapies
E Exercises
2. Which of the following countries uses the term complementary and alternative
medicine when referring to traditional medicine?
A Tanzania
B Bangladesh
C United Kingdom
D Botswana
E Bhutan
42
3. Which of the following statements is not true on the level of usage of traditional
medicine in the developing world?

A In Africa up to 80% use TM
B In China, 40% of delivered health care is TM
C In India, 65% of the population in rural areas use traditional medicine to
help meet their primary health care needs.
D Traditional medicine is used by only a minority in Bangladesh.
E In Chile 71% of the population report having used traditional medicine.
medicine/CAM in the developed world?
A In the USA, about half of the population have used CAM at least once.
B In France, about half of the population have used CAM at least once.
C In Canada, 70% of the population have used CAM at least once.
D In the UK the formal health care system does not encourage use of CAM.
E In Belgium, about a third of the population have used CAM at least once.
43
5. Which of the following systems of traditional medicine are not mentioned in the
WHO classification system?
A Chinese Medicine
B Ayurveda
C Unani
D Homeopathy
E African indigenous medicine
6. The National Center for Complementary and Alternative Medicine (NCCAM) at
the National Institutes of Health groups CAM practices into four domains. Which of
the following is not one of the NIH domains?
A Mind-Body Medicine
B Biologically Based Practices
C Homeopathy
D Manipulative and Body-Based Practices
E Energy Medicine
44
7. The WHO has identified five key needs at national level to ensure the safety,
efficacy and quality of TM/CAM. Which of the following is not one of the five key
needs that have been identified?
A Regulation & registration of herbal medicines..
B Safety monitoring for herbal medicines & other TM/CAM.
C Increased funding for ensuring safety, efficacy and quality of TM/CAM.
D Support for clinical research into use of TM/CAM for treating countrys
common health problems
E National standard, technical guidelines and methodology, for evaluating
safety, efficacy and quality
43
8. The WHO has articulated five key needs at the national level for the rationale
use of TM. Which of the following is not one of the five key needs that have been
identified?
A A national salary and remuneration scale for those practising TM/CAM
B Strengthened & increased organization of TM/CAM providers
C Strengthened cooperation between TM/CAM medicine & allopathic
medicine practitioners
D Reliable information for consumers on proper use of TM/CAM therapies
and products
E Improved communication between allopathic medicine practitioners & their
patients concerning use of TM/CAM.
46
9. The WHO defines key elements of a national TM/CAM policy. Which of the
following is not one of the key elements?
A Definition of TM/CAM.
B Definition of governments role in developing TM/CAM.
C Provision for creation or expansion of legislation relating to TM/CAM
providers & regulation of herbal medicines.
D Defining a desired population to practitioner ratio for each of the types of
TM practised in the country
E Provision of education & training of TM/CAM providers
47
10. Reflect on the case study from Bangladesh. Which of the following statements,
in your opinion, is true?
A The practice of pouring of hot oil in Mehrun Nessas ears should not be
challenged as it is part of a traditional practice
B Traditional practitioners can never be integrated into the care of patients
with severe mental illness.
C Traditional medicine needs to be understood prior to strategizing
interventions to integrate TM and allopathic medicine
D The opinion of the community should be ignored as global medical
knowledge increases
48
And now, check out the correct answers
49
1. Which component is not included in The World Health Organization definition of traditional medicine?
A Plant, animal and mineral based medicines. Incorrect -- 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.
B Spiritual therapies Incorrect -- 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.
C Allopathic medicines -- Correct -- This is not included in the WHO definition if traditional
medicine as this is the type of medicine prescribed by allopathic physicians. The WHO definition of
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.
D Manual therapies Incorrect -- 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.
E Exercises Incorrect -- 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.
30
2. Which of the following countries uses the term complementary and alternative medicine when referring to
traditional medicine?
A Tanzania Incorrect -- The terms "complementary medicine" or "alternative medicine" are used
inter-changeably with traditional medicine in some countries. They refer to a broad set of health care practices
that are not part of that country's own tradition and are not integrated into the dominant health care system.
The term is often used in the United Kingdom and other developed countries.
B Bangladesh -- Incorrect -- The terms "complementary medicine" or "alternative medicine" are
used inter-changeably with traditional medicine in some countries. They refer to a broad set of health care
practices that are not part of that country's own tradition and are not integrated into the dominant health care
system. The term is often used in the United Kingdom and other developed countries.
C United Kingdom Correct -- The terms "complementary medicine" or "alternative
medicine" are used inter-changeably with traditional medicine in some countries. They refer to a
broad set of health care practices that are not part of that country's own tradition and are not
integrated into the dominant health care system. The term is often used in the United Kingdom and
other developed countries.
D Botswana -- Incorrect -- The terms "complementary medicine" or "alternative medicine" are used
E Bhutan -- Incorrect -- The terms "complementary medicine" or "alternative medicine" are used
31
medicine in the developing world?

A In Africa up to 80% use TM -- Incorrect -- This statement is true.
B In China, 40% of delivered health care is TM -- Incorrect -- This statement
is true.
C In India, 65% of the population in rural areas use traditional medicine to
help meet their primary health care needs. -- Incorrect -- statement is true.
D Traditional medicine is used by only a minority in Bangladesh. --
Correct -- This statement is not true. TM is widely used in
Bangladesh exact latest data on the level of use is currently being
explored by researchers.
E In Chile 71% of the population report having used traditional medicine.
Incorrect -- This statement is true.
32
medicine/CAM in the developed world?
A In the USA, about half of the population have used CAM at least once. --
Incorrect]. -- This statement is true.
B In France, about half of the population have used CAM at least once.
Incorrect]. -- This statement is true.
C In Canada, 70% of the population have used CAM at least once.
Incorrect. -- This statement is true.
D In the UK the formal health care system does not encourage the use
of CAM. -- Correct -- This statement is not true. In the UK 40% of all
General Practioners offer some form of CAM referral or access.
E In Belgium, about a third of the population have used CAM at least once.
Incorrect. -- This statement is true.
33
5. Which of the following systems of traditional medicine are not mentioned in the WHO
classification system?
A Chinese Medicine -- Incorrect -- The WHO Traditional Medicine Strategy
2002-2005, displays a Table on the commonly used TM/CAM therapies and therapeutic
techniques. Chinese medicine is included in this table.
B Ayurveda Incorrect -- The WHO Traditional Medicine Strategy 2002-2005, displays a
Table on the commonly used TM/CAM therapies and therapeutic techniques. Ayurveda is
included in this table.
C Unani -- Incorrect -- The WHO Traditional Medicine Strategy 2002-2005, displays a
Table on the commonly used TM/CAM therapies and therapeutic techniques. Unani is included
in this table.
D Homeopathy -- Incorrect -- The WHO Traditional Medicine Strategy 2002-2005,
displays a Table on the commonly used TM/CAM therapies and therapeutic techniques.
Homeoptahy is included in this table.
E African indigenous medicine -- Correct -- The WHO Traditional Medicine
Strategy 2002-2005, displays a Table on the commonly used TM/CAM therapies and
therapeutic techniques. Surprisingly, African indigenous medicine is not included in this
table.
34
6. The National Center for Complementary and Alternative Medicine (NCCAM) at the National
Institutes of Health groups CAM practices into four domains. Which of the following is not one
of the NIH domains?
A Mind-Body Medicine -- Incorrect. -- This is one of the four NCCAM domains.
B Biologically Based Practices -- Incorrect. -- This is one of the four NCCAM domains.
C Homeopathy -- Correct -- This is not one of the four NCCAM domains.
Homeopathy is considered a whole medical system, which cuts across all four
domains. Whole medical systems are built upon complete systems of theory and
practice. Often, these systems have evolved apart from and earlier than the
conventional medical approach used in the United States. Examples of whole medical
systems that have developed in Western cultures include homeopathic medicine, a
whole medical system that originated in Europe. Homeopathy seeks to stimulate the
body's ability to heal itself by giving very small doses of highly diluted substances that
in larger doses would produce illness or symptoms (an approach called "like cures
like").
D Manipulative and Body-Based Practices -- Incorrect. -- This is one of the four
NCCAM domains.
E Energy Medicine -- Incorrect. -- This is one of the four NCCAM domains.
33
7. The WHO has identified five key needs at national level to ensure the safety, efficacy and
quality of TM/CAM. Which of the following is not one of the five key needs that have been
identified?
A Regulation & registration of herbal medicines. -- Incorrect -- This is one of the five
key needs identified by the WHO.
B Safety monitoring for herbal medicines & other TM/CAM. -- Incorrect -- This is one of
the five key needs identified by the WHO.
C Increased funding for ensuring safety, efficacy and quality of TM/CAM. --
Correct -- Although increased funding is certainly needed, this is not one of the five key
needs identified by the WHO.
D Support for clinical research into use of TM/CAM for treating countrys common
health problems. -- Incorrect -- This is one of five key needs identified by the WHO.
E National standard, technical guidelines and methodology, for evaluating safety,
efficacy and quality. -- Incorrect -- This is one of five key needs identified by the
WHO.
36
8. The WHO has articulated five key needs at the national level for the rationale
use of TM. Which of the following is not one of the five key needs that have been
identified?
A A national salary and remuneration scale for those practising TM/
CAM -- Correct -- This is not one of the five key needs identified by the WHO
for the rationale use of TM.
B Strengthened & increased organization of TM/CAM providers. Incorrect
This is one of the five key needs identified by the WHO for the rationale
use of TM.
C Strengthened cooperation between TM/CAM medicine & allopathic
medicine practitioners. -- Incorrect -- This is one of the five key needs
identified by the WHO for the rationale use of TM.
D Reliable information for consumers on proper use of TM/CAM therapies
and products. -- Incorrect -- This is one of the five key needs identified by
the WHO for the rationale use of TM.
E Improved communication between allopathic medicine practitioners & their
patients concerning use of TM/CAM -- Incorrect -- This is one of the five
key needs identified by the WHO for the rationale use of TM.
37
9. The WHO defines key elements of a national TM/CAM policy. Which of the
following is not one of the key elements?
A Definition of TM/CAM. -- Incorrect -- This is one of the key elements of a
national TM/CAM policy defined by the WHO.
B Definition of governments role in developing TM/CAM. -- Incorrect -- This is
one of the key elements of a national TM/CAM policy defined by the WHO.
C Provision for creation or expansion of legislation relating to TM/CAM
providers & regulation of herbal medicines. -- Incorrect -- This is one of the
key elements of a national TM/CAM policy defined by the WHO.
D Defining a desired population to practitioner ratio for each of the
types of TM practised in the country. -- Correct -- This is not one of the key
elements of a national TM/CAM policy defined by the WHO.
E Provision of education & training of TM/CAM providers. -- Incorrect -- This is
one of the key elements of a national TM/CAM policy defined by the WHO.
38
10. Reflect on the case study from Bangladesh. Which of the following statements, in your
opinion, is true?
A The practice of pouring of hot oil in Mehrun Nessas ears should not be challenged
as it is part of a traditional practice. -- Incorrect -- This is a harmful practice that
infringes on the human rights of Mehrun Nessa.
B Traditional practitioners can never be integrated into the care of patients with severe
mental illness. -- Incorrect -- The supportive role provided by traditional practitioners
can be invaluable in the integrated care in the community for persons affected by
severe mental illness.
C Traditional medicine needs to be understood prior to strategizing
interventions to integrate TM and allopathic medicine. -- Correct -- There is an urgent
need to gain an understanding of TM in Bangladesh. Research conducted by Future
Health Systems: Innovations for Equity is contributing to this increased understanding
in rural Bangaldesh.
D The opinion of the community should be ignored as global medical knowledge
increases, -- Incorrect -- Community ideas, concerns, and expectations related to
health and health care need to be understood when designing health systems for
the future.
39
Page 59
Summary
1radluonal medlclne ls an lnLegral parL of Lhe healLh
seeklng behavlor of people LhroughouL Lhe globe
Calnlng an undersLandlng of 1M/CAM ls essenual
for deslgnlng lncluslve healLh sysLems
MaLerlal presenLed ln Lhls module wlll allow
paruclpanLs Lo appreclaLe Lhe complexlLy of Lhls
area of work
8esources provlded ln Lhls module can gulde
paruclpanLs ln Lhelr addluonal learnlng ln 1M/CAM
60
Ceneral 8eferences
1. WHO Traditional Medicine Strategy 2002-2005. Geneva. 2002 Publication number WHO/EDM/TRM/
2002.1. Available at: http://whqlibdoc.who.int/hq/2002/WHO_EDM_TRM_2002.1.pdf
2. WHO Report by the Secretariat on Traditional Medicine. Executive Board 111th Session. December 2002.
Publication number EB111/9. Available at: http://www.who.int/gb/ebwha/pdf_files/EB111/eeb1119.pdf
3. House of Lords Report on complementary and alternative medicine. Great Britain Parliament House of
Lords Select Committee on Science and Technology. Author: Lord Walton of Detchant (chairman, Sub-
committee I). House of Lords papers 123 1999-00. Publisher: TSO (The Stationery Office).
4. Complementary medicine: information pack for primary care groups. Department of Health of the United
Kingdom. June 2000. Available at: http://www.dh.gov.uk/prod_consum_dh/idcplg?
IdcService=GET_FILE&dID=6166&Rendition=Web
This document aims to provide primary care groups (PCGs) with a reference source on forms of
complementary and alternative medicine (CAM). It begins by defining terms and giving an overview of
current CAM provision in primary care. The main body of the document deals with six individual therapies,
namely acupuncture, aromatherapy, chiropractic, homeopathy, hypnotherapy, and osteopathy. In each case
information is provided on conditions which are likely to benefit from treatment, practitioner qualifications, and
registering bodies. The document cites numerous references.
5. The roots of ancient medicine: an historical outline. Subbarayappa BV.
J Biosci. 2001 Jun;26(2):135-43. Full text available at: http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?
PrId=3169&itool=AbstractPlus-def&uid=11426049&db=pubmed&url=http://www.ias.ac.in/jbiosci/
jun2001/135.pdf
This article provides an excellent historical perspective on the development of different systems of medicine.
It covers: Egyptian medicine; Greek medicine; Greco-Arabic medicine; Chinese medicine; Indian medicine;
Ayurveda; Unani; and Siddha.
61
8ooks
6. Traditional medicine. Edited by Biswapati Mukherjee and Amerendra Patra.
Published by International Science Publisher, New York. 1993. ISBN 1881570320.
Web Links
7. World Health Organization, Traditional Medicine. http://www.who.int/topics/
traditional_medicine/en/
This page provides links to descriptions of activities, reports, news and events, as
well as contacts and cooperating partners in the various WHO programmes and
offices working on this topic. Also shown are links to related web sites and topics.
8. The Department of Health of the United Kingdom, Complementary and
Alternative Medicine. http://www.dh.gov.uk/en/Policyandguidance/
Healthandsocialcaretopics/Complementaryandalternativemedicine/index.htm
This page provides information on Complementary and Alternative Medicine,
including British policy, summary documents on different types of complementary
medicine, links with primary care, as well as the regulation of the field.
CredlLs
1hls sllde show was prepared as parL of
an educauonal pro[ecL of Lhe Clobal PealLh
Lducauon Consoruum and Lhe followlng
collaboraung parLners:
7 !"#$%&''("# *+ !,-.
7 !/-0"-1 2+ 3#-4516
Sponsors
The Global Health Education Consortium gratefully acknowledges the
support provided for developing these teaching modules from:
Margaret Kendrick Blodgett Foundation
The Josiah Macy, Jr. Foundation
Arnold P. Gold Foundation
This work is licensed under a
Creative Commons Attribution-Noncommercial-No Derivative Works 3.0
United States License.
nC1L: Sllde 3
!"#$%$&$'%() +,-& $( ./-0$&$'%-1 2"0$3$%"4

1he WPC quoLe on LradlLlonal medlclnes presenLed on Lhe sllde can be accessed aL:
hLLp://www.who.lnL/medlacenLre/facLsheeLs/fs134/en/

1he WPC 1radlLlonal Medlclne SLraLegy aper sLaLes Lhe followlng ln answerlng Lhe quesLlon of WhaL ls
LradlLlonal medlclne?"

1radlLlonal medlclne ls a comprehenslve Lerm used Lo refer boLh Lo 1M sysLems such as LradlLlonal
Chlnese medlclne, lndlan ayurveda and Arablc unanl medlclne, and Lo varlous forms of lndlgenous
medlclne. 1M Lheraples lnclude medlcaLlon Lheraples - lf Lhey lnvolve use of herbal medlclnes, anlmal
parLs and/or mlnerals - and non-medlcaLlon Lheraples - lf Lhey are carrled ouL prlmarlly wlLhouL Lhe use
of medlcaLlon, as ln Lhe case of acupuncLure, manual Lheraples and splrlLual Lheraples. ln counLrles
where Lhe domlnanL healLh care sysLem ls based on allopaLhlc medlclne, or where 1M has noL been
lncorporaLed lnLo Lhe naLlonal healLh care sysLem, 1M ls ofLen Lermed 'compllmenLary', 'alLernaLlve' or
'non-convenLlonal' medlclne."

1he same paper also sLaLes: 1here are many 1M sysLems, lncludlng LradlLlonal Chlnese medlclne, lndlan
ayurveda and Arablc unanl medlclne. A varleLy of lndlgenous 1M sysLems have also been developed
LhroughouL hlsLory by Aslan, Afrlcan, Arablc, naLlve Amerlcan, Cceanlc, CenLral and SouLh Amerlcan and
oLher culLures. lnfluenced by facLors such as hlsLory, personal aLLlLudes and phllosophy, Lhelr pracLlce
may vary greaLly from counLry Lo counLry and from reglon Lo reglon. needless Lo say, Lhelr Lheory and
appllcaLlon ofLen dlffer slgnlflcanLly from Lhose of allopaLhlc medlclne."

1radlLlonal medlclne wlll be referred Lo as 1M wlLhln slldes ln Lhls module.

5"&6/% &' 71$0" 8

==============================

nC1L: Sllde 6
!"#$%$&$'%() 9: ;'/" ."/<(

lmporLanL deflnlLlons are presenLed below - source World PealLh CrganlzaLlon avallable aL
hLLp://www.who.lnL/medlclnes/areas/LradlLlonal/deflnlLlons/en/lndex.hLml

1radlLlonal medlclne refers Lo healLh pracLlces, approaches, knowledge and bellefs lncorporaLlng planL,
anlmal and mlneral based medlclnes, splrlLual Lheraples, manual Lechnlques and exerclses, applled
slngularly or ln comblnaLlon Lo LreaL, dlagnose and prevenL lllnesses or malnLaln well-belng.

1radlLlonal medlclne ls Lhe sum LoLal of Lhe knowledge, skllls, and pracLlces based on Lhe Lheorles,
bellefs, and experlences lndlgenous Lo dlfferenL culLures, wheLher expllcable or noL, used ln Lhe
malnLenance of healLh as well as ln Lhe prevenLlon, dlagnosls, lmprovemenL or LreaLmenL of physlcal
and menLal lllness. 1he Lerms "complemenLary medlclne" or "alLernaLlve medlclne" are used lnLer-
changeably wlLh LradlLlonal medlclne ln some counLrles. 1hey refer Lo a broad seL of healLh care
pracLlces LhaL are noL parL of LhaL counLry's own LradlLlon and are noL lnLegraLed lnLo Lhe domlnanL
healLh care sysLem.

1he Cochrane CollaboraLlon deflnes complemenLary and alLernaLlve medlclne (CAM) as a broad domaln
of heallng resources LhaL encompasses all healLh sysLems, modallLles, and pracLlces and Lhelr
accompanylng Lheorles and bellefs, oLher Lhan Lhose lnLrlnslc Lo Lhe pollLlcally domlnanL healLh sysLems
of a parLlcular socleLy or culLure ln a glven hlsLorlcal perlod.

1he naLlonal lnsLlLuLe of PealLh ln Lhe uS sLaLes LhaL CAM ls a group of dlverse medlcal and healLh care
sysLems, pracLlces, and producLs LhaL are noL presenLly consldered Lo be parL of convenLlonal medlclne.
ConvenLlonal medlclne ls medlclne as pracLlced by holders of M.u. (medlcal docLor) or u.C. (docLor of
osLeopaLhy) degrees and by Lhelr allled healLh professlonals, such as physlcal LheraplsLs, psychologlsLs,
and reglsLered nurses. Some healLh care provlders pracLlce boLh CAM and convenLlonal medlclne. 1he
llsL of whaL ls consldered Lo be CAM changes conLlnually, as Lhose Lheraples LhaL are proven Lo be safe
and effecLlve become adopLed lnLo convenLlonal healLh care and as new approaches Lo healLh care
emerge.

Perbal medlclnes lnclude herbs, herbal maLerlals, herbal preparaLlons and flnlshed herbal producLs LhaL
conLaln as acLlve lngredlenLs parLs of planLs, or oLher planL maLerlals, or comblnaLlons.

Perbs: crude planL maLerlal such as leaves, flowers, frulL, seed, sLems, wood, bark, rooLs, rhlzomes or
oLher planL parLs, whlch may be enLlre, fragmenLed or powdered.

Perbal maLerlals: ln addlLlon Lo herbs, fresh [ulces, gums, flxed olls, essenLlal olls, reslns and dry
powders of herbs. ln some counLrles, Lhese maLerlals may be processed by varlous local procedures,
such as sLeamlng, roasLlng, or sLlr-baklng wlLh honey, alcohollc beverages or oLher maLerlals.

Perbal preparaLlons: Lhe basls for flnlshed herbal producLs and may lnclude commlnuLed or powdered
herbal maLerlals, or exLracLs, LlncLures and faLLy olls of herbal maLerlals. 1hey are produced by
exLracLlon, fracLlonaLlon, purlflcaLlon, concenLraLlon, or oLher physlcal or blologlcal processes. 1hey also
lnclude preparaLlons made by sLeeplng or heaLlng herbal maLerlals ln alcohollc beverages and/or honey,
or ln oLher maLerlals.

llnlshed herbal producLs: herbal preparaLlons made from one or more herbs. lf more Lhan one herb ls
used, Lhe Lerm mlxLure herbal producL can also be used. llnlshed herbal producLs and mlxLure herbal
producLs may conLaln exclplenLs ln addlLlon Lo Lhe acLlve lngredlenLs. Powever, flnlshed producLs or
mlxLure producLs Lo whlch chemlcally deflned acLlve subsLances have been added, lncludlng synLheLlc
compounds and/or lsolaLed consLlLuenLs from herbal maLerlals, are noL consldered Lo be herbal.

1radlLlonal use of herbal medlclnes refers Lo Lhe long hlsLorlcal use of Lhese medlclnes. 1helr use ls well
esLabllshed and wldely acknowledged Lo be safe and effecLlve, and may be accepLed by naLlonal
auLhorlLles.

1herapeuLlc acLlvlLy refers Lo Lhe successful prevenLlon, dlagnosls and LreaLmenL of physlcal and menLal
lllnesses, lmprovemenL of sympLoms of lllnesses, as well as beneflclal alLeraLlon or regulaLlon of Lhe
physlcal and menLal sLaLus of Lhe body.

AcLlve lngredlenLs refer Lo lngredlenLs of herbal medlclnes wlLh LherapeuLlc acLlvlLy. ln herbal medlclnes
where Lhe acLlve lngredlenLs have been ldenLlfled, Lhe preparaLlon of Lhese medlclnes should be
sLandardlzed Lo conLaln a deflned amounL of Lhe acLlve lngredlenLs, lf adequaLe analyLlcal meLhods are
avallable. ln cases where lL ls noL posslble Lo ldenLlfy Lhe acLlve lngredlenLs, Lhe whole herbal medlclne
may be consldered as one acLlve lngredlenL.

5"&6/% &' 71$0" =

==============================

nC1L: Sllde 9
>"?"1 '# @1'A-1 .2 B(-C"

Source of uS sLudy of 1997 - Llsenberg uM, uavls 88, LLLner SL, eL al. 1rends ln alLernaLlve medlclne use
ln Lhe unlLed SLaLes, 1990-1997: resulLs of a follow-up naLlonal survey. !AMA. 1998,280(18):1369-1373.

1he mosL comprehenslve and rellable flndlngs Lo daLe on Amerlcans' use of CAM were released ln May
2004 by Lhe naLlonal CenLer for ComplemenLary and AlLernaLlve Medlclne (nCCAM) and Lhe naLlonal
CenLer for PealLh SLaLlsLlcs (nCPS, parL of Lhe CenLers for ulsease ConLrol and revenLlon). A survey was
compleLed by 31,044 adulLs aged 18 years or older from Lhe u.S. clvlllan nonlnsLlLuLlonallzed populaLlon.
1he survey lncluded quesLlons on varlous Lypes of CAM Lheraples commonly used ln Lhe unlLed SLaLes.
ueLalls can be found aL: hLLp://nccam.nlh.gov/news/camsurvey_fs1.hLm

1he sLudy found LhaL ln Lhe unlLed SLaLes, 36 of adulLs used some form of CAM. When megavlLamln
Lherapy and prayer speclflcally for healLh reasons are lncluded ln Lhe deflnlLlon of CAM, LhaL number
rlses Lo 62. erhaps mosL lmporLanLly Lhe survey found LhaL mosL people use CAM along wlLh
convenLlonal medlclne raLher Lhan ln place of convenLlonal medlclne.

CAM 1heraples lncluded ln Lhe survey: AcupuncLure*, Ayurveda*, 8lofeedback*, ChelaLlon Lherapy*,
ChlropracLlc care*, ueep breaLhlng exerclses, uleL-based Lheraples (vegeLarlan dleL, MacrobloLlc dleL,
ALklns dleL, rlLlkln dleL, Crnlsh dleL, Zone dleL), Lnergy heallng Lherapy*, lolk medlclne*, Culded
lmagery, PomeopaLhlc LreaLmenL, Pypnosls*, Massage*, MedlLaLlon, MegavlLamln Lherapy, naLural
producLs (nonvlLamln and nonmlneral, such as herbs and oLher producLs from planLs, enzymes, eLc.),
naLuropaLhy*, rayer for healLh reasons (rayed for own healLh, CLhers ever prayed for your healLh,
arLlclpaLe ln prayer group, Peallng rlLual for self), rogresslve relaxaLlon, Cl gong, 8elkl*, 1al chl, ?oga.
An asLerlsk (*) lndlcaLes a pracLlLloner-based Lherapy.

5"&6/% &' 71$0" D

==============================

nC1L: Sllde 14
;1-(($#$3-&$'%( '# .2E;F2 ;,$%"(" 2"0$3$%"

1he World loundaLlon for 1radlLlonal Chlnese Medlclne ls an excellenL resource Lo galn an
undersLandlng of 1CM. 1he webslLe for Lhe loundaLlon ls: hLLp://www.Lcmworld.org/ 1he loundaLlon
webslLe explalns: AL Lhe hearL of 1CM ls Lhe LeneL LhaL Lhe rooL cause of lllnesses, noL Lhelr sympLoms,
musL be LreaLed. ln modern-day Lerms, 1CM ls hollsLlc ln lLs approach, lL vlews every aspecL of a
person-body, mlnd, splrlL, and emoLlons-as parL of one compleLe clrcle raLher Lhan loosely connecLed
pleces Lo be LreaLed lndlvldually." lurLher, Lhe webslLe provldes an lnLroducLlon Lo some of Lhe key
Lerms and concepLs ln LradlLlonal Chlnese medlclne.

A secLlon of Lhe webslLe explalns Lhe ma[or 1CM LreaLmenL modallLles
hLLp://www.Lcmworld.org/whaL_ls_Lcm/:

CfLen WesLern CAM pracLlLloners and Lhelr paLlenLs or cllenLs derlve Lhelr undersLandlng of 1CM from
acupuncLure. Powever, acupuncLure ls only one of Lhe ma[or LreaLmenL modallLles of Lhls
comprehenslve medlcal sysLem based on Lhe undersLandlng of Cl or vlLal energy. 1hese ma[or LreaLmenL
modallLles are:

Clgong: an energy pracLlce, generally encompasslng slmple movemenLs and posLures. Some Clgong
sysLems also emphaslze breaLhlng Lechnlques.

Perbal 1herapy: Lhe use of herbal comblnaLlons or formulas Lo sLrengLhen and supporL organ sysLem
funcLlon AcupuncLure: Lhe lnserLlon of needles ln acupolnLs Lo help Cl flow smooLhly.

Acupressure: Lhe use of speclflc hand Lechnlques Lo help Cl flow smooLhly.

loods for Peallng: Lhe prescrlpLlon of cerLaln foods for heallng based on Lhelr energy essences or energy
slgnaLures, noL nuLrlLlonal value.

Chlnese sychology: Lhe undersLandlng of emoLlons and Lhelr relaLlonshlp Lo Lhe lnLernal organ sysLems
and Lhelr lnfluence on healLh."

AnoLher paper resource ls a revlew arLlcle LlLled, 1radlLlonal Chlnese medlclne and kampo: a revlew
from Lhe dlsLanL pasL for Lhe fuLure. 1he auLhors are ?u l, 1akahashl 1, Morlya !, kawaura k, ?amakawa
!, kusaka k, lLoh 1, MorlmoLo S, ?amaguchl n, kanda 1. ueparLmenL of Ceneral Medlclne, kanazawa
Medlcal unlverslLy, lshlkawa, !apan. ! lnL Med 8es. 2006 May-!un,34(3):231-9.

1he absLracL ls reproduced below:
1radlLlonal Chlnese medlclne (1CM) ls a compleLe sysLem of heallng LhaL developed ln Chlna abouL
3000 years ago, and lncludes herbal medlclne, acupuncLure, moxlbusLlon and massage, eLc. ln recenL
decades Lhe use of 1CM has become more popular ln Chlna and LhroughouL Lhe world. 1radlLlonal
!apanese medlclne has been used for 1300 years and lncludes kampo-yaku (herbal medlclne),
acupuncLure and acupressure. kampo ls now wldely pracLlsed ln !apan and ls fully lnLegraLed lnLo Lhe
modern healLh-care sysLem. kampo ls based on 1CM buL has been adapLed Lo !apanese culLure. ln Lhls
paper we revlew Lhe hlsLory and characLerlsLlcs of 1CM and LradlLlonal !apanese medlclne, l.e. Lhe
selecLlon of LradlLlonal Chlnese herbal medlclne LreaLmenLs based on dlfferenLlal dlagnosls, and
LreaLmenL formulaLlons speclflc for Lhe 'Sho' (Lhe paLlenL's sympLoms aL a glven momenL) of !apanese
kampo--and look aL Lhe prospecLs for Lhese forms of medlclne."

5"&6/% &' 71$0" 9G

==============================

nC1L: Sllde 13
;1-(($#$3-&$'% '# .2E;F2 FH6/?"/0-

1he ueparLmenL of Ayurveda, ?oga & naLuropLahy, unanl, Slddha and PomeopaLhy (A?uSP) of Lhe
MlnlsLry of PealLh and lamlly Welfare of lndla has an excellenL webslLe coverlng lndlan medlclne:
hLLp://lndlanmedlclne.nlc.ln/lndex.asp

1he secLlon on Ayurveda can be found aL: hLLp://lndlanmedlclne.nlc.ln/ayurveda.asp

An explanaLlon of Lhe body maLrlx ln Ayurveda ls explalned ln Lhe sllde - Lhls ls aL Lhe core of Ayurveda.
lurLher deLalls on mulLlple dlmenslons of Ayurveda are provlded aL Lhe webslLe. 1hese lnclude: (1)
anchamahabhuLas" (2) PealLh and slckness concepLs ln Ayurveda, (3) ulagnosls ln Ayurveda (4)
1reaLmenL Lypes ln Ayurveda (3) revenLlve 1reaLmenL & Lhe concepLs of AeLlo-aLhogenesls (6) uleL
and Ayurvedlc LreaLmenL.

AnoLher paper resource ls a revlew arLlcle LlLled, uLlllzaLlon of ayurveda ln healLh care: an approach for
prevenLlon, healLh promoLlon, and LreaLmenL of dlsease. arL 1-ayurveda, Lhe sclence of llfe." 1he
auLhors are Sharma P, Chandola PM, Slngh C, 8aslshL C. 1he Chlo SLaLe unlverslLy CenLer for lnLegraLlve
Medlclne, College of Medlclne, 1he Chlo SLaLe unlverslLy, Columbus, Chlo, unlLed SLaLes. ! AlLern
ComplemenL Med. 2007 nov,13(9):1011-20.

Ayurveda ls a naLural healLh care sysLem LhaL orlglnaLed ln lndla more Lhan 3000 years ago. lLs maln
ob[ecLlve ls Lo achleve opLlmal healLh and well-belng Lhrough a comprehenslve approach LhaL addresses
mlnd, body, behavlor, and envlronmenL. Ayurveda emphaslzes prevenLlon and healLh promoLlon, and
provldes LreaLmenL for dlsease. lL conslders Lhe developmenL of consclousness Lo be essenLlal for
opLlmal healLh and medlLaLlon as Lhe maln Lechnlque for achlevlng Lhls. 1reaLmenL of dlsease ls hlghly
lndlvlduallzed and depends on Lhe psychophyslologlc consLlLuLlon of Lhe paLlenL. 1here are dlfferenL
dleLary and llfesLyle recommendaLlons for each season of Lhe year. Common splces are uLlllzed ln
LreaLmenL, as well as herbs and herbal mlxLures, and speclal preparaLlons known as 8asayanas are used
for re[uvenaLlon, promoLlon of longevlLy, and slowlng of Lhe aglng process. A group of purlflcaLlon
procedures known as anchakarma removes Loxlns from Lhe physlology. Whereas WesLern allopaLhlc
medlclne ls excellenL ln handllng acuLe medlcal crlses, Ayurveda demonsLraLes an ablllLy Lo manage
chronlc dlsorders LhaL WesLern medlclne has been unable Lo. lL may be pro[ecLed from Ayurveda's
comprehenslve approach, emphasls on prevenLlon, and ablllLy Lo manage chronlc dlsorders LhaL lLs
wldespread use would lmprove Lhe healLh sLaLus of Lhe world's populaLlon."

5"&6/% &' 71$0" 98

==============================

nC1L: Sllde 19
;1-(($#$3-&$'%( '# .2E;F2 I'<"'J-&,H

1he naLlonal CenLer for ComplemenLary and AlLernaLlve Medlclne aL Lhe naLlonal lnsLlLuLes of PealLh
provldes a large amounL of lnformaLlon on homeopaLhy aL: hLLp://nccam.nlh.gov/healLh/homeopaLhy
Sub[ecLs covered lnclude: (1) WhaL ls homeopaLhy?, (2) WhaL ls Lhe hlsLory of Lhe dlscovery and use of
homeopaLhy? (3) WhaL klnd of Lralnlng do homeopaLhlc pracLlLloners recelve? (4) WhaL do homeopaLhlc
pracLlLloners do ln LreaLlng paLlenLs? (3) WhaL are homeopaLhlc remedles? (6) Pow does Lhe u.S. lood
and urug AdmlnlsLraLlon (luA) regulaLe homeopaLhlc remedles? (7) Pave any slde effecLs or
compllcaLlons been reporLed from Lhe use of homeopaLhy? (8) WhaL has sclenLlflc research found ouL
abouL wheLher homeopaLhy works? (9) Are Lhere sclenLlflc conLroversles assoclaLed wlLh homeopaLhy?
(10) ls nCCAM fundlng research on homeopaLhy? Also, furLher lnformaLlon sources and references are
provlded.

AnoLher paper resource ls an arLlcle LlLled, Where does homeopaLhy flL ln pharmacy pracLlce?. 1he
auLhors are !ohnson 1, 8oon P from Lhe
unlverslLy of 1oronLo, Leslle uan laculLy of harmacy, Cn, Canada. Am ! harm Lduc. 2007 leb
13,71(1):7. lull LexL avallable aL:
hLLp://www.pubmedcenLral.nlh.gov/arLlclerender.fcgl?Lool=pubmed&pubmedld=17429307

PomeopaLhy has been Lhe cause of much debaLe ln Lhe sclenLlflc llLeraLure wlLh respecL Lo Lhe
plauslblllLy and efflcacy of homeopaLhlc preparaLlons and pracLlce. noneLheless, many consumers,
pharmaclsLs, physlclans, and oLher healLh care provlders conLlnue Lo use or pracLlce homeopaLhlc
medlclne and advocaLe lLs safeLy and efflcacy. As drug experLs, pharmaclsLs are expecLed Lo be able Lo
counsel Lhelr paLlenLs on how Lo safely and effecLlvely use medlcaLlons, whlch Lechnlcally lncludes
homeopaLhlc producLs. ?eL many pharmaclsLs feel LhaL Lhe homeopaLhlc sysLem of medlclne ls based on
unsclenLlflc Lheorles LhaL lack supporLlng evldence. Slnce consumers conLlnue Lo use homeopaLhlc
producLs, lL ls necessary for pharmaclsLs Lo have a baslc knowledge of homeopaLhy and Lo be able Lo
counsel paLlenLs abouL lLs general use, Lhe currenL sLaLe of Lhe evldence and lLs use ln con[uncLlon wlLh
oLher medlcaLlons.

5"&6/% &' 71$0" 9D

==============================

nC1L: Sllde 22
;1-(($#$3-&$'% '# .2E ;F2

An AlLernaLlve nlP ClasslflcaLlon
1he naLlonal CenLer for ComplemenLary and AlLernaLlve Medlclne aL Lhe naLlonal lnsLlLuLes of PealLh
groups CAM pracLlces lnLo four domalns, recognlzlng Lhere can be some overlap. 1he exLracLs below are
avallable aL: hLLp://nccam.nlh.gov/healLh/whaLlscam

1. Mlnd-8ody Medlclne - Mlnd-body medlclne uses a varleLy of Lechnlques deslgned Lo enhance Lhe
mlnd's capaclLy Lo affecL bodlly funcLlon and sympLoms. Some Lechnlques LhaL were consldered CAM ln
Lhe pasL have become malnsLream (for example, paLlenL supporL groups and cognlLlve-behavloral
Lherapy). CLher mlnd-body Lechnlques are sLlll consldered CAM, lncludlng medlLaLlon, prayer, menLal
heallng, and Lheraples LhaL use creaLlve ouLleLs such as arL, muslc, or dance.

2. 8lologlcally 8ased racLlces - 8lologlcally based pracLlces ln CAM use subsLances found ln naLure,
such as herbs, foods, and vlLamlns. Some examples lnclude dleLary supplemenLs, herbal producLs, and
Lhe use of oLher so-called naLural buL as yeL sclenLlflcally unproven Lheraples (for example, uslng shark
carLllage Lo LreaL cancer).

3. ManlpulaLlve and 8ody-8ased racLlces - ManlpulaLlve and body-based pracLlces ln CAM are based
on manlpulaLlon (Lhe appllcaLlon of conLrolled force Lo a [olnL, movlng lL beyond Lhe normal range of
moLlon ln an efforL Lo ald ln resLorlng healLh). ManlpulaLlon may be performed as a parL of oLher
Lheraples or whole medlcal sysLems, lncludlng chlropracLlc medlclne, massage, and naLuropaLhy. and/or
movemenL of one or more parLs of Lhe body.

4. Lnergy Medlclne - Lnergy Lheraples lnvolve Lhe use of energy flelds. 1hey are of Lwo Lypes:
a) 8lofleld Lheraples are lnLended Lo affecL energy flelds LhaL purporLedly surround and peneLraLe Lhe
human body. 1he exlsLence of such flelds has noL yeL been sclenLlflcally proven. Some forms of energy
Lherapy manlpulaLe bloflelds by applylng pressure and/or manlpulaLlng Lhe body by placlng Lhe hands
ln, or Lhrough, Lhese flelds.

b) 8loelecLromagneLlc-based Lheraples lnvolve Lhe unconvenLlonal use of elecLromagneLlc flelds, such as
pulsed flelds, magneLlc flelds, or alLernaLlng-currenL or dlrecL-currenL flelds.

ln addlLlon, nCCAM sLudles CAM whole medlcal sysLems, whlch cuL across all domalns. Whole medlcal
sysLems are bullL upon compleLe sysLems of Lheory and pracLlce. CfLen, Lhese sysLems have evolved
aparL from and earller Lhan Lhe convenLlonal medlcal approach used ln Lhe unlLed SLaLes. Lxamples of
whole medlcal sysLems LhaL have developed ln WesLern culLures lnclude homeopaLhlc medlclne, a
whole medlcal sysLem LhaL orlglnaLed ln Lurope. PomeopaLhy seeks Lo sLlmulaLe Lhe body's ablllLy Lo
heal lLself by glvlng very small doses of hlghly dlluLed subsLances LhaL ln larger doses would produce
lllness or sympLoms (an approach called "llke cures llke"). naLuropaLhlc medlclne, a whole medlcal
sysLem LhaL also orlglnaLed ln Lurope, alms Lo supporL Lhe body's ablllLy Lo heal lLself Lhrough Lhe use of
dleLary and llfesLyle changes LogeLher wlLh CAM Lheraples such as herbs, massage, and [olnL
manlpulaLlon. Lxamples of sysLems LhaL have developed ln non-WesLern culLures lnclude 1radlLlonal
Chlnese Medlclne, a whole medlcal sysLem LhaL orlglnaLed ln Chlna. lL ls based on Lhe concepL LhaL
dlsease resulLs from dlsrupLlon ln Lhe flow of ql and lmbalance ln Lhe forces of yln and yang. racLlces
such as herbs, medlLaLlon, massage, and acupuncLure seek Lo ald heallng by resLorlng Lhe yln-yang
balance and Lhe flow of ql. AnoLher example of a sysLem LhaL developed ln non-WesLern culLures ls
Ayurveda, a whole medlcal sysLem LhaL orlglnaLed ln lndla. lL alms Lo lnLegraLe Lhe body, mlnd, and splrlL
Lo prevenL and LreaL dlsease. 1heraples used lnclude herbs, massage, and yoga.

5"&6/% &' 71$0" KK

==============================

nC1L: Sllde 29
5-&$'%-1" B(" '# .2

aper resource: WhaL should sLudenLs learn abouL complemenLary and alLernaLlve medlclne? CasLer 8,
unLerborn !n, ScoLL 88, Schneewelss 8. unlverslLy of WashlngLon School of Medlclne, SeaLLle,
WashlngLon 98103, uSA. Acad Med. 2007 CcL,82(10):934-8. barakg[u.washlngLon.edu

AbsLracL: WlLh Lhousands of complemenLary and alLernaLlve medlclne (CAM) LreaLmenLs currenLly belng
used ln Lhe unlLed SLaLes Loday, lL ls challenglng Lo deslgn a conclse body of CAM conLenL whlch wlll flL
lnLo already overly full currlcula for healLh care sLudenLs. 1he purpose of Lhls arLlcle ls Lo ouLllne key
prlnclples whlch 13 naLlonal CenLer for ComplemenLary and AlLernaLlve Medlclne-funded educaLlon
programs found useful when developlng CAM course-work and selecLlng CAM conLenL. 1hree key
guldlng prlnclples are dlscussed: Leach foundaLlonal CAM compeLencles Lo glve sLudenLs a framework
for learnlng abouL CAM, choose speclflc conLenL on Lhe basls of evldence, demographlcs and condlLlon
(whaL condlLlons are mosL approprlaLe for CAM Lheraples?), and flnally, provlde sLudenLs wlLh skllls for
fuLure learnlng, lncludlng where Lo flnd rellable lnformaLlon abouL CAM and how Lo search Lhe sclenLlflc
llLeraLure and assess Lhe resulLs of CAM research. MosL of Lhe programs developed evldence-based
guldes Lo help sLudenLs flnd rellable CAM resources. 1he cumulaLlve experlences of Lhe 13 programs
have been complled, and an annoLaLed Lable ouLllnlng Lhe mosL hlghly recommended resources abouL
CAM ls presenLed.

AssoclaLlons of LradlLlonal pracLlLloners exlsL ln Lhe ma[orlLy of Afrlcan counLrles and many Afrlcan
counLrles have esLabllshed 1M research lnsLlLuLlons.

An example of an organlzaLlon of 1M/CAM provlders: 1he Luropean Perbal & 1radlLlonal Medlclne
racLlLloners AssoclaLlon (LPA). WebslLe: hLLp://www.ehpa.eu/

1he LP1A was founded ln 1993 when lL became clear LhaL wlLh Lhe developmenL of Lhe Luropean
unlon, Lhe leglslaLlve framework under whlch herbal medlclne was pracLlsed was llkely Lo undergo
radlcal change. 1he maln professlonal herbal pracLlLloner assoclaLlons ln Lhe uk formed a uk naLlonal
organlsaLlon called Lhe 8rlLlsh Perbal racLlLloners AssoclaLlon (8PA). ln Lurope, Lhe 8PA afflllaLed
wlLh lrlsh and uanlsh herbal assoclaLlons Lo form Lhe Luropean Perbal & 1radlLlonal Medlclne
racLlLloners AssoclaLlon (LP1A).

ln laLe 1994, Lhe basls of herbal pracLlce ln Lhe uk was LhreaLened by Lhe sudden announcemenL by Lhe
Medlclnes ConLrol Agency (now Lhe Medlclnes and PealLhcare producLs 8egulaLory Agency) LhaL exlsLlng
Luropean medlclnes leglslaLlon had swepL away all Lhose sLaLuLes ln Lhe Medlclnes AcL 1968 LhaL gave
8rlLlsh herbal pracLlLloners Lhelr legal rlghL Lo obLaln herbal medlclnes. 1he LP1A found lLself Lhrown
headlong lnLo Lhe campalgn Lo rescue Lhe rlghL of uk pracLlLloners Lo obLaln herbal medlclnes wlLhouL
Lhe need for full medlclnes llcences. 1hls hlghly successful campalgn dld much Lo creaLe flrm bonds
beLween lLs member organlsaLlons.

1oday our work focuses on Lhe developmenL of sLandards of Lralnlng and educaLlon, accredlLaLlon of
Lralnlng lnsLlLuLlons, sLrengLhenlng Lhe ldenLlLy of Lhe professlon and worklng closely wlLh key
sLakeholders on speclflc pro[ecLs. lor example, we are a key sLakeholder, worklng closely wlLh Lhe
ueparLmenL of PealLh, ln developlng Lhe paLh Lowards sLaLuLory regulaLlon of herbal pracLlLloners ln Lhe
uk. We work wlLh Lhe MP8A on revlewlng Lhe sLandards of safeLy and quallLy of unllcensed herbal
remedles and wlLh Lhe resL of Lhe herbal secLor on lmplemenLlng Lhe ulrecLlve of 1radlLlonal Perbal
Medlclnal roducLs."

5"&6/% &' 71$0" KD

==============================
nC1L: Sllde 39
;-(" 7&60H '% &," 6(" '# .2L ./-0$&$'%-1 2"0$3$%" -%0 2"%&-1 M11%"(( $% N-%C1-0"(,

ueLalls on Lhe acLlvlLles of luLure PealLh SysLems: lnnovaLlons for LqulLy can be found aL
hLLp://www.fuLurehealLhsysLems.org/lndex.hLm

1he work belng carrled ouL ln 8angladesh ls descrlbed ln a paper presenLed aL lorum 10 of Lhe Clobal
lorum for PealLh 8esearch. Llnkages beLween evldence and pollcy: research prlorlLles for fuLure healLh
sysLems. Syed S8, Pyder AA, 8loom C, lPS: lnnovaLlons for LqulLy (Lheme 3 group). Avallable aL:
hLLp://www.globalforumhealLh.org/fllesupld/forum10/l10_flnaldocumenLs/posLers/Syed_Shamsuzzoha
.pdf

1he paper emphaslzes Lhe lmporLance of conslderlng Lhe lnLerface beLween evldence generaLlon and
declslon maklng. A secLlon of Lhe paper on Lhe work ln 8angladesh ls reproduced below:

A slgnlflcanL proporLlon of Lhe poor ln 8angladesh use lnformal healLh care provlders as Lhelr flrsL llne
of care. 1he general ob[ecLlve of Lhe work ls Lo undersLand Lhls lnformal care sysLem and lLs lnLeracLlon
wlLh Lhe formal healLh sysLem and local governance ln Chakarla, a rural area of 8angladesh. 1he pro[ecL
alms Lo answer research quesLlons focused on Lhe: role of lnformal healLh care sysLem ln Lhe healLh
sLaLus of Lhe poor ln rural 8angladesh, Lhe relaLlonshlp beLween lnformal and formal healLh secLors,
healLh care uLlllzaLlon paLLerns and Lhelr deLermlnanLs, uLlllzaLlon cosLs of formal and lnformal healLh
care servlces, servlce quallLy provlded by lnformal healLh care provlders, and Lhe role of elecLed local
governmenL represenLaLlves ln healLh lssues, parLlcularly ln relaLlon Lo Lhe poor. SLudy flndlngs wlll Lhen
be used Lo develop, lmplemenL, and evaluaLe approprlaLe lnLervenLlons Lo lmprove Lhe healLh of Lhe
poor beLween 2007 and 2010.

1he proposed work lncorporaLes evldence-pollcy lnLerface conslderaLlons ln a number of ways. As
sLaLed above, Lhe poor ln 8angladesh depend on Lhe lnformal secLor, Lhe chosen sub[ecL area as well as
Lhe research approach ls flrmly embedded wlLhln a developmenL conLexL. 1he lnLer-relaLlonshlp of Lhe
lnformal healLh secLor wlLh lndlvldual and communlLy vulnerablllLles and capablllLles can be elucldaLed
from Lhe proposed research. 1he effecLs of healLh shocks on care-seeklng from elLher Lhe formal or
lnformal healLh secLor can also be expllcaLed by Lhe proposed work. 1he proposed research ls
operaLlonal ln naLure and ls acLlon focused. llndlngs wlll help deslgn fuLure lnLervenLlons for worklng
wlLh Lhe lnformal healLh secLor ln 8angladesh - Lhus Lhe process of lnfluenclng pollcy maklng wlLh
research flndlngs can be explored prospecLlvely. CosLs and quallLy of care are lnLegral Lo Lhe research
proposal, whlch creaLes a furLher 'real world' focus of Lhe research. ConslderaLlon of how Lhe lnformal
healLh secLor can be lncorporaLed lnLo Lhe healLh sysLem represenLs an lnnovaLlve approach Lo fuLure
healLh sysLem developmenL.

ro[ecL flndlngs on key lnformal healLh provlders may slgnlflcanLly affecL pollcy maklng. 1hls declslon
maklng process, embedded ln a pollLlcal conLexL, can be examlned. lor example, a cohorL of vlllage
docLors" (non-Mus) was a resulL of governmenL sponsored Lralnlng schemes ln Lhe pasL. SLudy flndlngs
on Lhelr currenL role may lnfluence declslon-maklng ln relaLlon Lo Lhese lnformal healLh provlders.
llndlngs from all local elecLed represenLaLlves (162 elecLed members of 18 unlon counclls) wlll provlde
valuable lnformaLlon on local declslon maker perspecLlves on Lhe healLh secLor. Whlle mulLlple levels of
pollcy maklng are recognlzed ln Lhe llLeraLure, Lhe more local levels are ofLen lgnored - Lhls work
aLLempLs Lo flll Lhls key knowledge gap. ln addlLlon, a wlde array of local sLakeholders ls lncluded wlLhln
Lhe research proposal. Many of Lhese sLakeholders, for example LradlLlonal healers, are non-lnLulLlve
sLakeholders ln formal healLh sysLem developmenL."

lurLher deLalls on Lhe work ln 8angladesh can also be found ln a recenL publlcaLlon. Lxplorlng healLh
sysLems research and lLs lnfluence on pollcy processes ln low lncome counLrles. Pyder AA, 8loom C,
Leach M, Syed S8, eLers uP, lPS: lnnovaLlons for LqulLy. 8MC ubllc PealLh 2007 CcL 31,7(1):309. lull
LexL avallable aL: hLLp://www.ncbl.nlm.nlh.gov/enLrez/uLlls/fref.fcgl?rld=3196&lLool=ClLaLlon-
def&uld=17974000&db=pubmed&url=hLLp://www.blomedcenLral.com/1471-2438/7/309

5"&6/% &' 71$0" OD

44 Traditional Medicine FINAL

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

44 Traditional Medicine FINAL

Uploaded by

Copyright:

Available Formats

1radluonal Medlclne

!"#$%&''("# *+ !,-., Mu MP uP(CanLab)

You might also like