Traditional, Complementary and Alternative Medicine

Barry Kistnasamy

Emerging Technologies

Today Tomorrow

1. belongs to the trash bin

2. has no role or place in health care given its lack of a “scientific base’’

3. has some therapeutic possibilities

I think that TCAM …

2,56 trillion $ is spent on health globally

0.4% of this is spent in Africa

Close on 80% of the world’s HIV+ people

live in Africa

OECD89%

Other11%

0.4% Africa

TCAM spending

• China – 30% to 50% of medicinal

consumption

• Japanese per capita consumption of

herbal medicine highest in world

• 1400 herbal drugs in EU

• ZAR250m on traditional healers

• $27b in USA

Financing

• Mainly out of pocket • In kind

• Few Medical Aids

South Africa’s Quadruple Burden

• Natural & Non-natural disasters

• Residual of Infectious Diseases

• Emerging New Epidemics

• Epidemiological Transition

Trends …

• International migration

• Urbanisation

• Industrialisation

• ‘bacteria move just as fast as

capital’

The Human Balance

• 35000 doctors

• 150 000 nurses

• 200 000 traditional healers

“co-existence versus integration”

The Supply Chain

planning

Health

production

Education

management

Health

The Regulatory Framework

Allied HPC

Health

SAQA /CHE

Education

? SAMMDRA

Health

Traditional HC

TCAM Research

• Institute for Traditional Medicines (CSIR,

MRC & WHO)

• Indigenous Knowledge Systems

• National Research Foundation

• Universities

• Useful Plants Garden - Kirstenbosch

• Ethno veterinary practiceRef: Moorman & Pick, 1998

Distribution

• "Ezinyangeni" - the place of

healers -

Mai Mai: muti capital of Jo'burg

Distribution• Sangomas normally detect two kinds of bad luck

• One is inflicted through witchcraft, usually by a jealous rival, the other is caused by unhappy ancestors. It is here that patients are counseled to slaughter a beast to appease and rekindle relations with the ancestors.

• Sangomas diagnose and prescribe

• Inyangas generally heal, although they can also prescribe, depending on the nature of the problem or whether their ancestors give them the power to help a patient

Prescription

BMJ 2001;322:164-167 ( 20 January )

Once the muti is obtained, it can be taken in various ways, depending on its form and nature. While some muti is just good for washing with, smearing on one's body, or for burning and inhaling, other muti is designed for elaborate uses like ukuphalaza (regurgitating), ukuchatha (applying by means of an enema), or nokugquma (steaming).

Prescription

• "Isende lehashi" (horse penis) "Zamafufunyane" (for nightmares and hysteria), "Owobusoka" (guaranteed to improve the romantic fortunes of a bachelor), "Zikatokoloshe" (to ward off an imaginary evil goblin said to spread terror at night)

Zimbabwe healer moots magic

chastity potion

Ayurvedic Preparations• Bronchial asthma, ischaemic heart disease and

hyperlipidaemia • Curcumin - rheumatoid arthritis• Acute viral hepatitis• Pterocarpus marsupium effective in reducing

levels of blood glucose and glycosylated haemoglobin in patients with non-insulin-dependent diabetes mellitus

• Fistula-in-ano patients were randomised to surgery or application of medicated thread (Ksharsootra). Surgical treatment led to a faster cure but recurrence rates were lower with medicated thread.

Traditional Chinese Systems of Medicine

• Herbal remedies, acupuncture, acupressure, massage and moxibustion

• 40% of all health care delivered in China

• The first documented source of Chinese medical theory, the Huangdi Nei Jing ("Inner Classic of the Yellow Emperor") was written between 300 BC and 100 BC

Traditional Chinese Systems of Medicine

BMJ 1997;315:115-117 (12 July)

Is it a Communist plot?

Norwegian Law Brings Alternative Medicine to the Mainstream

Journal of the National Cancer Institute, Vol. 96, No. 4, 254-255, February 18, 2004

• complementary medicine in medical & nursing education

• philosophical / spiritual paradigm

• scientific foundation

• practice & evidence of efficacy & safety

• develop national centres of excellence

• 30 medical schools involved

Blue Ribbon Panel

USA - 1996

• adopted a number of resolutions

• has a Traditional Medicine programme

• 19 collaborating centres in 10 countries

• 1996 – 28 monographs of 28 plants

World Health Organisation…

South Africa…• political support

• NRF / MRC support

• various educational initiatives (UKZN, Limpopo, UCT, UWC, Zululand)

•Traditional Healers legislation

MinnesotaMedicine

Published monthly by the Minnesota Medical AssociationJuly 2000/Volume 83

Error in Medicine: What Have We Learned?

Is the grass greener?

• integration

• complementarities

• rivalry

• co-existence

Integrated Medicine Initiative

• traditional & alternative systems

• mind – body interventions

• biological – based therapies

• manipulative & body movement methods

• energy therapies

Review of TCAM – major domains

• enhance curriculum

• development of service sites

• resource mobilisation (local & international)

• documentation

• academic exchange & research support

What are we doing?

• Alternative & Complementary

• African systems

• Indian systems

• Chinese systems

Learning Opportunities

• basic principles & assumptions (rigor & relevance)

• strategies for peer review, evaluation & validation research

• priority areas may be paediatrics, cancer, mental health & cardiovascular disease, HIV/AIDS

• horizontal integration with ethno-botanists, chemists, anthropologists

Research agenda…

• develop adverse effects registry

• credentialing & practice numbers

• coding

• billing system

• record keeping

• values

Operational Research agenda…

• Diagnostic classification

• Adequacy of treatment

• Placebo vs non-placebo

• Outcome measures

• Assumptions about randomisation

Conceptual & Contextual Issues

• certificate

• diploma

• degree

Program mix

Academic development

Together…

barryk@ebucksmail.com

Thank You!

1. to form a BHF TCAM task group

2. to sponsor research

3. have nothing to do with TCAM initiatives

I suggest that BHF’s interventions in TCAM should be: …