THE MEDICAL PROFESSION AND TRADITIONAL / COMPLEMENTARY MEDICINE
اسلاید 1: www.tabaye.ir
اسلاید 2: THE MEDICAL PROFESSION AND TRADITIONAL / COMPLEMENTARY MEDICINEMilton Lum FRCOG, FAMM
اسلاید 3: TRADITIONAL / COMPLEMENTARY MEDICINEAmorphousCodified, regulated,taught with defined curriculum and practised widely and systematicallyMystical, secretive and localized with its knowledge passed down by word of mouth
اسلاید 4: 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.”
اسلاید 5: T/CM Ministry of Health “…practice other than the practice of medicine and surgery by registered medical practitioners as defined by the Medical Act 1971.”
اسلاید 6: USES OF T/CM IN ALLOPATHIC MEDICINEDrugsAcupunctureManipulative therapyHypnosisReflexologyMassageHomeopathy
اسلاید 7: Uninformed scepticism versus Uncritical acceptance
اسلاید 8: INTERACTIONS BETWEEN MEDICAL PROFESSION & T/CMPatients may seek advice, request referral, discuss T/CM treatment or advice, or develop complications from drug interactionsDoctors may practise some aspects of T/CM
اسلاید 9: CONCERNS OF MEDICAL PROFESSIONMacro concernsIndividual doctor’s concerns
اسلاید 10: CONCERNS FROM A MACRO PERSPECTIVESafety, efficacy and qualityResearchTraining, education and regulation
اسلاید 11: 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)
اسلاید 12: Safety, efficacy and quality 2Governments 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
اسلاید 13: ResearchVery little high quality researchHowever, quality of applied research growing rapidlyUse of certain aspects of T/CM supported by conventional medical organizationsIncreased awareness of importance of research into T/CM
اسلاید 14: Training, education and regulationAt best inconsistentPatients not guaranteed of competence of T/CM practitioner No accountability of T/CM practitionerDoctors often sort out problems created by T/CM practicesStatutory regulation of T/CM increasingT/CM training in academic settings
اسلاید 15: INDIVIDUAL DOCTOR’S CONCERNSIdentifying T/CM usersPatients consulting unqualified T/CM practitionersMinimizing potential risks of T/CM to patients - delayed or missed diagnosis - contradictory advice from T/CM practitioner - drug interactions with T/CMEnsuring treatment is in best interests of patient
اسلاید 16: HERB-DRUG INTERACTIONS Fugh-Berman A (2000). Lancet 355: 134-138Betel 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)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)
اسلاید 17: MEDICO-LEGAL CONSIDERATIONSDoctors who practise T/CMReferral to other doctorsDelegation or referral to non-medically qualified practitioner
اسلاید 18: Doctors who practise T/CMBolam 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.”
اسلاید 19: Referral to other doctors for T/CMSame legal situation as when referring to another doctor for any other serviceAs long as decision to refer is appropriate, all responsibility is taken over by the doctor to whom referral is made
اسلاید 20: Delegation or referral to non-medically qualified practitionersIs 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?
اسلاید 21: INCORPORATION OF T/CM INTO HEALTHCARE SYSTEM 1WHO 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 regulationTolerant system – National health care system is based entirely on allopathic medicine but some T/CM is tolerated by law
اسلاید 22: INCORPORATION OF T/CM INTO HEALTHCARE SYSTEM 2Where are we ?Where do we want to go ?Road mapEvidence for decisionsIn most inclusive systems, development of T/CM services have been demand rather than evidence led
اسلاید 23: INCORPORATION OF T/CM INTO HEALTHCARE SYSTEM 3Framework of evidence based medicine, resource allocation and current healthcare systemRaises concerns for - policymakers,managers and medical profession - patients - T/CM practitioners
اسلاید 24: INTEGRATED MEDICINEMedicine is a science and an artDependent on technological solutions to health problemsInsufficient attention to holism and simple effective interventionsGap filled by some T/CM practitionersIntegrated medicine is not synonymous with teaching doctors to use herbs instead of drugsRestoring the soul of medicineIntegrated medicine is good medicine
اسلاید 25: CONCLUSIONSSubstantive shifts in scientific base and organizational structure of T/CMConvergence of clinical, scientific and regulatory standards applied across all forms of health careIf 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
اسلاید 26: Thank you
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