Integration of Traditional Medicine and the Modern Clinical Practices - Literature review Example

Integration of Traditional Medicine and the Modern Clinical Practices Name: Institution: Integration of Traditional Medicine Introduction Traditional medicine is mainly used to denote complementary and alternative medicine or indigenous health traditions encompassing many and different types of treatments including religious and magical rituals, the substances of animal, plant, and minerals (Bodeker & Kronenberg, 2002: 1582). There are various ways in which traditional herbal medicine can be amalgamated for application to patient cases in clinical practice, and there are three ways in which this amalgamation can be achieved. Countries can integrate tradition medicine in their formal healthcare system with each of the two medical practices being considered to be a approapriate form of health care and being practiced under single framework that is used for other modern health care system; health care practitioners can individually integrate traditional medicine with clinical practices; traditional medicine and clinical care practices can be integrated as two branches forming one new branch (World Health Organization 2013). Although not widely used especially in developed countries, traditional medicine still plays a significant role in clinical practices worldwide. Traditional medicines have to do with its greater affordability and availability because they are very much accepted and enjoy great popularity, as an alternative or complementary medicine. The World Health Organization (2013) acknowledges traditional medicine as one of the mainstays of the clinical care provision and the one that serves to complement it and to show its support for traditional medicine, it reappraised its Traditional Medicine Strategy, which set out the course for complementary and traditional medicine in the future. This reappraisal is intended to enable health care providers to develop solutions to clinical problems. This appraisal has also enabled WHO to understand how it can integrate traditional and complementary medicine into the clinical practice (WHO, 2013). Bodeker & Kronenberg (2002: 1586) indicate that there is a need for health professionals to increase their effort to lay down a public health agenda and set up policy priorities aimed at addressing the public health dimensions on the use of traditional medicine. Eskinazi (1998: 1622) challenged the definition of complementary and alternative medicine thus laying a new way of perceiving CAM. The differences between obvious and alternative medication and the conventional medicine are not limited to mere therapeutic concerns. Eskinazi (1998) challenges other popular definitions of CAM by calling the whole group ‘alternative medicine’: “I propose that alternative medicine be defined as a broad set of health care practices (already available to the public) that are not readily integrated into the dominant health care model, because they pose challenges to diverse societal beliefs and practices (economic, cultural, scientific, medical, and educational). This definition brings into focus factors that may play a major role in the a priori acceptance or rejection of various alternative health care practices by any society. Unlike criteria of current definitions, those of the proposed definition would not be expected to change significantly without significant societal changes.” (p. 1622). It has been noted that this definition is crucial because it demonstrates the full extent to which traditional medicine poses a threat to prevailing orthodoxies. In highlighting the various challenges traditional medicine poses, Eskinazi clarifies the point that acceptance or rejection by the medical profession is no longer the main or sole issue, because traditional knowledge and medicine are grounded in a wider range of concerns. This represents a significant shift in the debate, as in the past it was assumed that doctors, as the guardians of health, were best placed to comment on CAM. Eskinazi’s definition recognizes that the issues intrinsic to CAM philosophy go beyond what historically has been considered the concern of medicine, for example the impact of the environment on individual health, or the effects of social relationships on health, healing and coping. Current Issues of Integration Most traditional and herbal medicines are used in developed countries including the United States only as dietary supplements. In the United States, the only way that law mandates these medicines is production under cGMP (FDA, 2007). For dietary supplements with the inclusion of traditional medicines, the prescription guidelines only apply to the manufacturers of the final material rather than the dietary ingredient suppliers. This is considered to be one of the main sources of the main problems related to contaminated, substituted, or adulterated traditional dietary supplements. This problem is well illustrated by one study which identified some cases of poor quality, unfinished herbal products. Liva’s (2009: 40-42) study investigated the extracts of hops (Humulus lupulus), wild yam (Dioscorea villosa), Asian red ginseng (Panax ginseng), and milk thistle (Silybrum marianum). This study found each of these extracts to contain some form of illegal substances. For example, milk thistle was found to contain well-known carcinogens including toluene and benzene; wild yam was found to contain an illegal fungicide referred to as quintozone, and hops were found to contain burned maltodextrin. Since cGMP requirements are not mandated neither are they adhered to on the supply side as it is on the manufacturing side, the problems of integrating traditional medicine with the clinical practice will continue to persist because the availability of quality traditional medicine is limited. In many countries, herbal medicines are not regulated. In Europe, traditional herbal medicine is not fully recognized as appropriate cures and are regarded under the term “acceptably safe” (Moreira, Teixeira, Monteiro, De-Oliveira & Paumgartten, 2014: 248). These medicines are not considered to fit into a special category of drugs. Therefore, there use in both clinical and non-clinical uses. This study has also raised a cause of concern regarding clinical interactions. Also, this study indicated that there is not enough demonstration on the safety of herbal medicine. Some other countries in the world such as China have established medical training programs where clinical care practitioners are taken through some training in traditional medicine (Zhang, Xue & Fong, 2008: 1006). China represents one of the countries where traditional medicine is highly emphasized and practiced. Nevertheless, documentation of these traditional medicines is very limited (Giordano, Garcia & Stickland, 2004: 708). In other parts of the world such as United States, Canada and some parts of Europe, herbal medicine trade has become a billion dollar business, some people benefiting from it. Health care providers often fail to recognize the important role played by social, cultural, and economic contexts during integration. When these contexts are put into consideration, the benefits of integration might be significantly realized (Bodeker & Kronenberg, 2002: 1585). Mechanisms of Action of Herbal Medicine: Chemical Constituents There is no enough knowledge to identify the chemical constituents of herbal medicine. Therefore, it has not been possible to elucidate the underlying herbal mechanisms of action. The problem applies to the identification of herbal medicine constituents including phytochemical constituents, bioavailability, and pharmacokinetics (Mukherjee, 2015: 224). The major constraint of herbal medicines is that there are unidentifiable and unknown active chemical constituents. However, there are some researchers who have attempted to identify these chemical constituents. For example, one study on a Chinese herbal medicine formula tried to establish the in vitro effects of this formula on rat macrophage and peritoneal mast cells (Lenon, Xue, Story, Thien & Li, 2009: 2071). Inflammatory mediators were released leading the researchers to conclude that the formular has multiple mechanisms (Benzie & Wachtel-Galor, 2011: 457). However, antiallergic effects seen raise questions regarding the validity of such a postulation. Despite these concerns, TCMs have been used for thousands of years and they fall under the category of traditional medicine (TM) according to the World Health Organization (Koithan, Bell, Niemeyer & Pincus, 2012: 9). Another research study also established that there are risks associated with herbal medicine usage including liver injuries associated with the use of certain herbal medicine (Yun, Nah, Park et al., 2008: 1131). It is also important to distinguish herbal medicine usage among children and adults. Santich & Bone (2008: 471) have stated that the potential benefits and risks of herbal and complementary medicine among the children significantly differ from those of adults; therefore, the principles governing herbal medicine practice among the two groups should also differ. The second issue of concern is the herbal medicine and modern drugs interactions. Most reports on these interactions are mainly documented in case reports which have inadequate documentation or based on vitro studies (Benzie & Wachtel-Galor, 2011: 457). There are only limited clinical interactions between herbal medicines and modern drugs. Therefore, there have major safety concerns among the clinicians because the amalgamation of traditional medicine into clinical practice becomes very difficult to predict. Also, there is unavailability of such integration information. The third issue is the behavioral and cultural contexts and how health care providers are supposed to communicate efficiently about the use of herbal medicine to patients, among herbal medicine practitioners, and practitioners in clinical practice. However, several scientific research data materials have provided a bit of convincing evidence although this evidence has not met the EBM standard (Benzie & Wachtel-Galor, 2011: 457). This has given rise to doubtful perceptions and negative attitudes towards herbal medicine. Clinicians have also raised concerns that most of the users of traditional medicine are combining them with other medicine without first consulting their health care providers. The resulting effect is unhealthy herb-drug interactions that could have been avoided if there was communication between the patients and the clinical doctors. One of the studies that were conducted in Australia found out that around half of the users of herbal medicine used a combination of herbal medicine and other medicine the same day (Zhang, Story, Lin, Vitetta & Xue, 2008: 1008). However, the other half of the study participants indicated that they voluntary inform consult their medical doctors concerning traditional medicine. There were same findings from a different study where half of the study participants indicated that they first consult health care practitioners (Kennedy, Wang & Wu, 2008: 454). In this study, most of the participants who indicated that they do not consult their medical doctors before using tradition medicine were from ethnic and racial minority groups. As a result, there is a need to conduct more research to establish the reasons for non-disclosure. Such research studies can provide findings that can help in safe integration. Factors Encouraging or Discouraging Integration Various interrelated efficacy, safety, and quality issues have a possibility of contributing to the successful amalgamation of traditional medicine into clinical practice. i. Herb Quality Issues Traditional and complementary medicines are very poorly documented and defined (Abbort, 2014: 3). Also, these medicines do not have uniformity in their physical and chemical qualities. Factors such as the ones discussed earlier in this paper have made the quality of traditional medicine questionable and inferior. ii. Herb-Herb Interactions Contraindications are well documented in ancient textbooks on traditional medicine. These documentations have revealed 19 counteracting herbs and 18 incompatible herbs. For instance, incompatibility has been found between Ban Xia (Pinellia ternate rhizome) and Wu Tou (Aconitum rhizome); Bei Mu (Bulbus Fritillariae) has been found to be incompatible with Fu Zi (Radix Aconiti). Although many researchers have attempted to come up with scientific evidence, they have not yet come up with conclusive recommendations (Tang, Wu, Ding, Duan, 2009: 80). iii. Cultural and Social Dimensions, Economic Factor The use of herbal medicine is significantly influenced by cultural, political, and social values (Bodeker & Kronenberg, 2002: 1584). The reason for putting these factors into consideration is because different groups have different perceptions about traditional/herbal medicine. There are other poor people especially from low social status who have been unable to gain access the medicines due to high cost. Therefore, it is important to put these factors into consideration when integrating traditional medicine into the clinical practice. This amalgamation will make these traditional medicines available in clinical settings where they can easily be accessible to people regardless of their social, cultural, and economic status. Bodeker & Kronenberg (2002: 1584) have suggested that policy formulations and research studies should establish ways in which traditional medicines which are preferred by various ethnic groups can be amalgamated into clinical practice for greater consumer friendliness. Policy formulations can also establish the most appropriate amalgamation of traditional medicine into clinical settings. Herbal Medicine Research Needs There is a need to elevate the level of research on herbal medicine because the current level of research is not adequate (Benzie & Wachtel-Galor, 2011: 459). Such elevation of research is necessary to ensure effective herbal-modern medicine. There is also need to have clinical products produced by GMP from the source materials, and these materials have to be produced using good agriculture and collection practices. Also, there is need for botanical validation. As discussed earlier in this paper, only a few herbal products have been documented. Therefore, for herbal medicine research to be adequately reliable, it must begin with acquiring the source materials from good agriculture and processed starting materials (Benzie & Wachtel-Galor, 2011: 457). Towards this end, it is important to state that the major research areas are herbal medicine standardization and quality; action mechanism and preclinical pharmacological assessments; and safety assessments and clinical efficacy. To enable these research studies, WHO has formulated and upraised a guideline for the research methodologies and also published a policy. i. Quality Control and Assurance Currently, there are serious issues associated with quality control and quality assurance of traditional herbal medicine. According to Bodeker & Kronenberg (2002: 1585), even the industrialized countries have only recently established self-regulation practices and standards. The study also found out that only 25 countries out of the 191 countries who are members (WHO) have national policies governing the use of traditional medicine. The foundation for good quality control has to begin by acquiring source materials to be used in clinical formulations. Appropriate plant parts to be used in research must be appropriately acquired through good cultivation means and field collection via GACP. Several countries have established good agricultural practice guidelines and World Health Organization guideline also assists member countries to produce quality herbal plants. To ensure appropriate botanical fitness assurance, it is important to identify herbal plants by their scientific names instead of identifying them by their common names. The next important consideration is to subject each of the herbs to be used in research to purity and contaminant tests to establish whether there is the presence of pesticide residues, foreign matters, microorganisms, mycotoxins, and toxic metals (Benzie & Wachtel-Galor, 2011: 460). By ensuring that source materials are free from these foreign matters, quality of the substance is ensured. ii. Action Mechanisms and Preclinical Pharmacological Assessment There is a high need for quality-certified standardization methods especially for future clinical and laboratory investigations. Kunle, Egharevba & Ahmadu (2012: 104) suggests that herbal medicines must first be undertaken through a preclinical pharmacological assessment to ensure that they are safe for use. Although animal models have been used to make some very good findings, some biological responses are not transferable. That is, while some substances are active in animal models, they may fail to be active in human beings. Therefore, animal models cannot be relied upon when testing whether herbal medicine is safe. Some requirements must be mandatory when testing herbal medicine especially when testing whether heavy metals are present because these substances are readily available in the environment and are thus found in many herbs and sometimes in high concentrations (Kunle, Egharevba & Ahmadu, 2012: 104). iii. Safety Assessment of Traditional Medicine According to Santich & Bone (2008: 473), one of the most important considerations especially when integrating herbal medicine especially in pediatric herbal therapeutics is the question of safety. There is not enough direct information to address the issue of herbal medicine in a pediatric setting. Due to this lack of data, the only option for herbal clinicians serving in pediatric care is to use data from adult studies. This includes only one of the safety concerns among the health care practitioners and patients thus calling for safety assessment and efficacy. The leading database in the medical field, Cochrane provides articles with rich information regarding herbal medicine. Cochrane acknowledges that knowledge on traditional medicine usage is not sufficiently documented or characterized. The World Health Organization required the procedure used to prepare herbal medicine to be described in details (Davidson, Vlachojannis, Cameron & Chrubasic, 2013: 12). There are different worldviews concerning complementary and alternative medicine. According to one previous study, different alternative worldview from different parts of the world can provide very helpful ways of conceptualizing how diseases manifest in human beings and how various interventions can contribute to the facilitation of health care and health promotion (Koithan, Bell, Niemeyer & Pincus, 2012: 10). Correlation to Research Studies Integration can enable WHO (based on its reappraised strategy) to integrate plants such as Pteronia divaricata into the treatment of diseases such as colds, influenza, fever, diarrhea, tuberculosis, high blood pressure, stomach pain, back pain, and chest ailments. Hulley, Viljoen, Tilney, Vuuren, Kamatou & Wyk’s (2011: 65) study has documented nine separate uses of Pteronia divaricate including being used as a cure for the above diseases. Some of these diseases including high blood pressure, influenza, and tuberculosis have proved to be some of the diseases that have posed significant challenges for health care providers. Another previous research has investigated how Virginia plants were used as cures among the Powhatan Indians before English colonization (Morgan & Perry, 2010: 12). This study identified carious medicinal uses of Virginia plants by conducting several literature surveys, conducting interviews with some of the members of Pamunkey tribe, and conducting an assessment of species nativity. Their assessment led them to identify a total of 89 plants which were traditionally used as medicines. Another previous study investigated herbal galactagogues as an augmentation of breast milk (Mortel & Mehta, 2013: 154). Although five trials indicated that this herb increases breast milk, this sample size was found to be very limited; therefore calling for more research studies to be conducted to establish the validity of this herb as an augmentation of breast milk. As a result of lack of sufficient evidence, this study did not recommend the use of herbal galactagogues. Although there is a little evidence explaining the improvement of milk output after the consumption of herbal galactagogues, in the United States, approximately 15 percent of breastfeeding women are using this herb whereas in Norway, approximately 43 percent of breastfeeding women are using this herb (Mortel & Mehta, 2013: 155). Finally, another study investigated whether traditional medicine can adequately heal nasopharyngeal cancer (Kim, Lee, Lee, Min, Lee & Cho, 2015: 215). Although there is little evidence that THM cures this type of cancer, the demonstration that it does indeed effectively heal is not adequate. If more research is conducted to add to the little available evidence, it may be possible that this can be the breakthrough cure for nasopharyngeal cancer and can be used in modern hospitals to help in reducing the high cases on nasopharyngeal cancer. According to WHO estimates, more than 80,043 new cases of nasopharyngeal cancer develop each year with higher incidences being witnessed in areas around Greenland, Alaska, and Southeast Asia (Kim et al., 2015). With enough evidence, traditional herbal medicine can be used as an alternative to radiotherapy and surgery which are the main treatments for nasopharyngeal cancer. Model Validity of the Proposition Koithan, Bell, Niemeyer, & Pincus’s (2012: 12) study has proposed that models are the only ones that provide a working hypothesis and suggests explanatory mechanisms of action. These models as explained by complex systems science are the ones that can provide a way of moving from the more limited and simple causal models. In this case, traditional and complementary medicine may be referred as parts whereas the clinical practice can be referred as the whole. Amalgamation of the parts into the wholes is the ideal model for the real world. Amalgamation of the parts into the wholes will help the conceptualization of disease development and the experience of healing. According to Helmstadter & Staiger (2014: 5), historical research has uncovered traditional knowledge which has been found to identify new therapeutic agents. Traditional knowledge has the capability to produce new clinical practices that could help address many health care problems affecting people. References Abbort, R. (2014). Documenting Traditional Medical Knowledge. World Intellectual Property Organization. Retrieved from http://www.wipo.int/export/sites/www/tk/en/resources/pdf/medical_tk.pdf Benzie, I. & Wachtel-Galor, S. (2011). Herbal Medicine: Biomolecular and Clinical Aspects. Boca Raton, FL: CRC Press. Bodeker, G. & Kronenberg, F. (2002). A Public Health Agenda for Traditional, Complementary, and Alternative Medicine. American Journal of Public Health, 92 (10), 1582-1591. Davidson, E., Vlachojannis, J., Cameron, M. & Chrubasic, S. (2013). 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