صفحه 1:
الم
www.tabaye.ir
صفحه 2:
THE MEDICAL PROFESSION
AND TRADITIONAL /
COMPLEMENTARY MEDICINE
Milton Lum FRCOG, FAMM
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TRADITIONAL /
COMPLEMENTARY MEDICINE
* Amorphous
! Codified, regulated,taught with
defined curriculum and practised
widely and systematically
“ Mystical, secretive and localized
with its knowledge passed down
by word of mouth
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TRADITIONAL MEDICINE
World Health Organization
‘«“" including diverse health practices,
approaches,knowledge and beliefs
incorporating plant, animal, and/or
mineral based medicines, spiritual
therapies, manual techniques and
exercises applied singularly or in
combination to maintain well being, as
well as treat, diagnose or prevent
illness.”
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T/CM
Ministry of Health
J “\,.practice other than the practice
of medicine and surgery by
registered medical practitioners
as defined by the Medical Act
9
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USES OF T/CM IN
ALLOPATHIC MEDICINE
“Drugs
" Acupuncture
| Manipulative therapy
| Hypnosis
J Reflexology
| Massage
" Homeopathy
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Uninformed scepticism
versus
Uncritical acceptance
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INTERACTIONS BETWEEN
MEDICAL PROFESSION &
T/CM
| Patients may seek advice, request
referral, discuss T/CM treatment
or advice, or develop
complications from drug
interactions
Doctors may practise some
aspects of T/CM
a,
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CONCERNS OF MEDICAL
PROFESSION
| Macro concerns
! Individual doctor’s concerns
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CONCERNS FROM A MACRO
PERSBEC TIVE
| Safety, efficacy and quality
| Research
| Training, education and regulation
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Safety, efficacy and quality 1
“The quality and quantity of the safety
and quality data on traditional
medicine are far from sufficient to
meet the criteria to support its use
worldwide”
WHO (2000). General Guidelines for
Methodologies on Research & Evaluation
of Traditional Medicine
(WHO/EDM/TRM/2000. 1)
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Safety, efficacy and quality 2
Governments addressing issue by:
- regulation and registration of
T/CM - publishing national
monographs and pharmacopoeia of
medicinal plants - safety
monitoring -
support for clinical research
- establishment of national
standards and methodology for evaluating
safety, efficacy and quality of T/CM
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Research
Very little high quality research
1 However, quality of applied research
growing rapidly
| Use of certain aspects of T/CM
supported by conventional medical
organizations
7 Increased awareness of importance
of research into T/CM
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Training, education and
regulation
‘At best inconsistent
' Patients not guaranteed of competence
of T/CM practitioner
No accountability of T/CM practitioner
" Doctors often sort out problems created
by T/CM practices
" Statutory regulation of T/CM increasing
" T/CM training in academic settings
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INDIVIDUAL DOCTOR’S
CONCERNS
* Identifying T/CM users
‘ Patients consulting unqualified T/CM
practitioners
‘ Minimizing potential risks of T/CM to
patients - delayed or missed diagnosis
- contradictory advice
from T/CM practitioner - drug
interactions with T/CM
“ Ensuring treatment is in best interests of
patient
صفحه 16:
HERB-DRUG INTERACTIONS
Fugh-Berman A (2000). Lancet 355; 134-
138
Liquorice (Glycyrrhiza glabra)
Papaya (Plantago ovata)
St John’s wort (Hypericum
perforatum)
Salboku-to (Asian herbal
mixture)
Shankhapushpl (Ayurvedic
mixed herb syrup)
Sho salko to or Xiao chai hu
tang (Asian herb mixture)
Tamarind (Tamarindus indica)
Valerian (Valeriana officinalia)
Yohimbine (Pausinyatalai
yohimba)
* Betel nut (Areca catechu)
Chili pepper (Capaicum spp)
Danshen (Salvia millttiorhiza)
Devil’s claw (Harpagophytum
procumbens)
Dong quai (Angelica sinensis)
Eleuthero or Siberian ginseng
(Eleutherococcus senticocus)
Garlic (Allium sativum)
Gingko (Gingko biloba)
Ginseng (Panax spp)
Guar gum (Cyamopala
tetragonolobus)
Karela or bitter lemon
(Momordica charantia)
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MEDICO-LEGAL
CONSIDERATIONS
| Doctors who practise T/CM
" Referral to other doctors
! Delegation or referral to non-
medically qualified practitioner
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Doctors who practise T/CM
| Bolam test: “A doctor is not guilty of
negligence if he has acted in
accordance with a practice accepted
as proper by a responsible body of
medical men skilled in that particular
art...Putting it the other way round, a
doctor is not negligent, if he is acting
in accordance with such a practice,
merely because there is a body of
opinion that takes a contrary view.”
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Referral to other doctors for
T/CM
| Same legal situation as when
referring to another doctor for any
other service
| As long as decision to refer is
appropriate, all responsibility is
taken over by the doctor to whom
referral is made
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Delegation or referral to non-
medically qualified practitioners
“Ts the decision to delegate or refer to
the particular T/CM appropriate?
' Have I taken reasonable steps to
ensure that the T/CM practitioner
concerned is qualified and insured?
| Has my medical follow up been
adequate?
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INCORPORATION OF T/CM
INTO HEALTHCARE SYSTEM 1
“WHO classification
\ Integrative system - T/CM is officially
recognized and incorporated into the
national health care system
" Inclusive system - T/CM is recognized but is
not fully integrated into all aspects of health
care delivery, education and regulation
Tolerant system - National health care
system is based entirely on allopathic
medicine but some T/CM is tolerated by law
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INCORPORATION OF T/CM
INTO HEALTHCARE SYSTEM 2
| Where are we ?
| Where do we want to go ?
" Road map
| Evidence for decisions
|
In most inclusive systems,
development of T/CM services have
been demand rather than evidence
led
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INCORPORATION OF T/CM
INTO HEALTHCARE SYSTEM 3
«Framework of evidence based
medicine, resource allocation and
current healthcare system
| Raises concerns for
- policymakers,managers and
medical profession
- patients
T/CM practitioners
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INTEGRATED MEDICINE
* Medicine is a science and an art
“ Dependent on technological solutions to
health problems
Insufficient attention to holism and simple
effective interventions
“ Gap filled by some T/CM practitioners
۲ Integrated medicine is not synonymous with
teaching doctors to use herbs instead of drugs
“ Restoring the soul of medicine
| Integrated medicine is good medicine
Ss
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CONCLUSIONS
“ Substantive shifts in scientific base and
organizational structure of T/CM
“ Convergence of clinical, scientific and
regulatory standards applied across all forms
of health care
If the soul of Medicine is restored and a list is
drawn up of what patients want, what doctors
value, what is important to researchers and
what matters to payers, there would probably
be no reference to historical and political
concepts of conventional medicine and T/CM
(a
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