Asian Medicine Bridging the Validation Gap…?

Mark J. Langweiler, DC, DAAPM

Welsh Institute of Chiropractic

University of South Wales

Treforest

…To Integration.

The Problems

Is it possible to integrate traditional Asian medical practices with modern Western

medical systems without loss of authenticity?

Are traditional ‘best practices’ possible?

Given the wide array of traditional Asian medical systems, is it possible (or desirable)

to develop a regulatory framework?

Are traditional medicine ‘professionals’ a real option?

Globalization Is validation a real option?

Can cultures merge?

Rise of Professionals A 'professional' group has the legitimate authority

(usually delegated from government) to set its own standards for entrance, to admit new

members, to establish a code of conduct, to discipline members and it claims to have a body

of knowledge (achieved through education) which legitimizes its autonomy and

distinctiveness.

The regulation of the production of producers and the regulation of the production by

producer.

How are professions created? Practitioners who through their professional association

seek to identify, carve-out and protect an area of exclusive competence so to maximize financial and status rewards.

Users of professional services who, through their demands

and expectations, determine the way the professions practice and organize themselves.

States who either grant autonomy and self-regulation to

professionals and their associations (Anglo-American context) or actively license them and regulate them as a ‘quasi’ civil service (Continental European context).

Universities which produce the knowledge-base of the

professions and provide the credentials (an approved degree) that support professional closure regimes.

Striving for Professionalism The Glenarthur Criteria

1. Profession is mature

2. A single governing body

3. Based on a systematic body of knowledge

4. Recognised courses of training

5. Demonstrate efficacy

6. Legislative proposals based on independent criteria which safeguard the public*

*Added later by Lord Skelmersdale

The Glenarthur Criteria and Chiropractic:

The UK Example

Chiropractic- Brief History

Developed in US Midwest by Daniel David Palmer 1895.

Medicine in Chaos--response to treatment often

being worse than care!

Early theories based on magnetic healing and vitalism

Entered UK 1908.

Educational standards minimal

Until opening of Anglo-European

Chiropractic College, 1965

Limited research and funding

Chiropractic Act, 1994

As professions mature

Epistemological autonomy

Code of practice

Professional qualifications

Control over own affairs

Self-regulating

Single Governing Body

Regulatory Body- General Chiropractic Council

Professional Bodies British Chiropractic Association(BCA)

United Chiropractic Association(UCA)

Scottish Chiropractic Society(SCA)

Systemic Body of Knowledge

Issues in dispute.

BCA (largest organization) is building on the biomedical model

UCA relies on original philosophy of D.D. Palmer-

vitalism, innate nature of healing

SCA is a catch all organization for a geographic area.

Recognized Courses of Training

Within the United Kingdom there are three schools for the training of doctors of chiropractic.

Anglo-European Chiropractic College(independent)

Welsh Institute of Chiropractic)division of the University of South Wales)

McTimoney College of Chiropractic(independent)

Current Chiropractic Education Curriculum

Year Courses

1 Clinical Anatomy, Physiology, Behaviour Science, Chiropractic Technique, Biomechanics, Normal Radiology, Embryology

2 Neuroanatomy, Neurophysiology, Pathology, Histology, Chiropractic Technique, Clinical Imaging, Clinical Nutrition, Mental Health

3 General Diagnosis, Clinical Imaging II, Chiropractic Technique, Neuro-orthopedics, Functional Management

4 Evidenced Based Diagnosis and Clinical Subspecialties, Research, Clinical Practice

Demonstrate Efficacy Research

Meta-Analysis Systematic Review Evidence Table

Evidence Summary

Practice Guideline Recommendation

Review Criteria Clinical Audit

Protocol

Standard

Legislative Regulatory Environments

Legislative Regulations 1. Illegal practice

2. Common law

3. Regulation without protection of title

4. Regulation with protection of title

5. Regulation with protection of title and function

Legislative

USA- Only registered health professional have any business ministering to the public (5)

Canada-Provincial and Federal responsible with differing requirements from province to province

Australia-Bridged the gap between food and medicine with the ‘therapeutic goods legislation.

UK Legislation Chiropractic Act, 1994

What does this mean?

Recognition?

Incorporation into NHS?

Prestige?

Altered public perception?

Increasing medicalization?

Loss of a tradition or advancement of a profession?

Barriers to inclusion?

Mistrust of lack of evidence

Levels of training

Lack of knowledge about conditions treated

Not paid for by NHS or health insurance

Differing philosophical foundations

Cultural differences

No clear outcomes

Economic considerations uncertain

Organisational constraints

Colleagues resistance

Misguided policies

What to do

Open dialogue with all parties involved

Develop educational standards

Speak with one voice

Research that emphasizes efficacy and outcomes

Build trust and public confidence

Thank you

References Adams J. Editorial: Examining sites of interface between CAM and conventional health care: extending

the sociological gaze. Complementary Therapies in Medicine, 2004; 12:69-70.

Bodekerr G. Lessons on integration from the developing world’s experience. Regulation of complementary/alternative medicine: a Canadian perspective. Complementary Therapies in Medicine, 2002;10:14-19.

Breen A. Evidenced-based practice: friend or foe. British Journal of Chiropractic, 2002; 1(1):2-3.

Burrage, M. and Torstendahl, R. (eds.), 2004 Professions in Theory and History: Rethinking the Study of the Professions. London: Sage.

Butler K, Cunliffe C, Hunnisett A. Barriers between General Practitioners and Chiropractors. Chiropractic Evidence, 2012: 6.

Cardini F, Wade C, Regalia AL et al. Clinical research in traditional medicine: Priorities and methods. Complementary Therapies in Medicine, 2006; 14: 282-287.

Carlton AL, Bensoussan A. Regulation of complementary medicine practitioners in Australia: Chinese medicine as a case example. Complementary Therapies in Medicine, 2002; 10:20-26.

Chen RQ, Wong CM Cao KJ, Lam TH. An evidence-based validation of traditional Chinese medicine syndromes. Complementary Therapies in Medicine, 2010; 18:199-205.

Chua SA, Furnham A. Attitudes and beliefs towards complementary and alternative medicine (CAM): A cross-cultural approach comparing Singapore and the United Kingdom. Complementary Therapies in Medicine, 2008; 16:247-253.

Chung VCH, Ma PXX, Lau CH, Griffiths SM. Developing Policy for Integration Biomedicine and Traditional Chinese Medical Practice Using Focus Groups and the Delphi Technique. Evidence-Based Complementary and Alternative Medicine, 2012; doi:10.1155/2012/149512. Downloaded August 15, 2013.

Cohen MH. CAM regulation in the United States. Complementary Therapies in Medicine, 2002; 10:3-7.

Conboy L, Kaptchuk TJ, Eisenberg DM, et al. The relationship between social factors and attitudes toward conventional and CAM practitioners. Complementary Therapies in Medicine, 2007;13:146-157.

References Copland-Griffiths M. Statutory Regulation: The Chiropractic Experience. British Journal of Chiropractic, 1999;

3(3): 68-73.

Department of Health. The regulation of the non-medical healthcare professions. July 2006. Downloaded August 20, 2013.

Di Sarsina PR. The Social Demand for a Medicine Focused on the Person: The Contribution of CAM to Healthcare and Healthgenesis. eCAM, 2007; 4 (S1): 45-51.

Evetts, J. Short Note: The Sociology of Professional Groups. New Directions. Current Sociology, 2006; 54(1):133-143.

Fennell D, Liberato, ASQ, Zsembik B. Definitions and patterns of CAM use by the lay public. Complementary Therapies in Medicine, 2009; 17:71-77.007; 10: 59-60.

Finch R. Trust, assurance and safety: The regulation of health professional in the 21st century- Revalidation for all. Clinical Chiropractic, 2007; 10: 59-60.

Kelner M, Wellman B, Boon H, Welsh S. The role of the state in the social inclusion of complementary and alternative medical occupations. Complementary Therapies in Medicine, 2004; 12: 79-89.

Lam TP, Sun KS. Dilemma of integration with Western medicine-Views of Traditional Chinese Medicine practitioners in a predominant Western medical setting. Complementary Therapies in Medicine, 2013;21:300-305.

Lewith GT, Jonas WB, Walach H. Clinical Research in Complementary Therapies: Principles, Problems and Solutions, 2nd ed. 2011. Churchill Livingstone, London.

Mills SY. Regulation in complementary and alternative medicine. BMJ, 2001; 322158-160.

Mills S. CAM Regulation, Complementary Therapies in Medicine, 2002;10:2.

Mills SY. The House of Lords report on complementary medicine: a summary. Complementary Therapies in Medicine, 2001;9:34-39.

Noble D. Commentary: Could there be a Synthesis between Western and Oriental Medicine, and with Sasang Constitutional Medicine in Particular?. eCAM, 2009;6(S1) 5-10.

Owen DK, Lewith G, Stephens, CR. Can Doctors respond to patients’ increasing interest in complementary and alternative medicine? BMJ, 2001;322:154-158.

Park CM. Diversity, the individual, and proof of Efficacy: Complementary and Alternative Medicine in Medical Education. American Journal of Public Health, 202; 92(10): 1568-1572.

Rees L, Weil A. Editorial: Integrated medicine. BMJ 2001;322:119-120.

References Scheid V. Editorial: Authenticity, best practice, and the evidence mosaic. The challenge of

integrating traditional East Asian medicines into Western Health Care. Complementary Therapies in Medicine, 2008;16: 107-108.

Scheid V, MacPherson H. 2012. Integrating East Asian Medicine into Contemporary Healthcare. Churchill Livingstone, London.

Schepers RMJ, Hermans HEGM. The medical profession and alternative medicine in the Netherlands: its history and recent development. Social Science and Medicine, 1999; 49:343-351.

Shirwaiker A, Govindarajan R, Rawat AKS. Integrating Complementary and Alternative Medicine with Primary Health care. Evidence-Based Complementary and Alternative Medicine, 2013; doi.org/10.1155/2013/948308. Downloaded August 15, 2013.

Templeman K, Robinson A. Integrative medicine models in contemporary primary health care. Complementary Therapies in Medicine, 2011; 19:84-92.

Thomas KJ, Nicholl JP, Coleman P. Use and expenditure on complementary medicine in England: a population based survey. Complementary Therapies in Medicine, 2001;9:2-11.

Wahner-Roedler DL, Vincent A, Elkin PL, et al. Physicians’ Attitudes Toward Complementary and Alternative Medicine and Their Knowledge of Specific Therapies: A survey at an Academic Medical Center. eCAM 2006; 3 (4): 495-501.

Walker LA, Budd S. UK: the current state of regulation of complementary and alternative medicine. Complementary Therapies in Medicine, 2002: 10: 8-13.

Wilson FJH. PhD Thesis: The Origins and Professional Development of Chiropractic in Britain University of Southampton, 2012.

Wong LY, Toh MPHS, Kong KE. Barriers to patient referral for Complementary and Alternative Medicines and its implications on interventions. Complementary Therapies in Medicine, 2010; 18: 135-142.

World Health Organization. Traditional Medicine, 62nd World Health Assembly, Beijing, May, 2009.