Lessons on integration from the developing world's experienceTraditional medicine
BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7279.164 (Published 20 January 2001) Cite this as: BMJ 2001;322:164
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Dr. Bodeker's and Professor Chaudhury's articles raise several very important and valid points which require attention if traditional/complementary/alternative medicine is to be practiced effectively, to the maxium benefit of the poorest populations.
One of the major deterrents, as well as the most significant criticism, in the practice of traditional therapies, is the lack of appropriate evaluation of their effectiveness. As Prof. Chaudhury suggests, clinical randomised controlled trials, as defined today, are not always appropriate for the testing of traditional remedies' efficacy, since at the very basis of traditional treatment lies recognition of fundamental uniqueness of each patient's physiology and psychology, a fact with which biomedicine deals through percentages and statistics. Traditional therapies are individually tailored to suit each clinical case, making standardized testing of traditional remedies problematic and even inappropriate.
Here, I propose a method to deal with this dilemma, very much in line with the concept of integrated medicine explored in this issue of BMJ. Namely, traditional and allopathic approaches to treatment of specific categories of diseases should be evaluated and compared based on only two pieces of information: patient satisfaction with the treatment and the number of work days/productivity lost due to illness AND due to the treatment itself. Assessing effectiveness of a treatment based simply on the alleviation of physiological symptoms does not always correspond to a patient's subjective perception of the change in his or her state of health and well-being. Needless to say, patients would also benefit from such evaluation of many allopathic therapies. The final result of such clinical trials would be the selection of the optimal treatment modality for a particular disease, whether it be traditional, allopathic, or a hybrid of both.
The author declares no competing interests.
Competing interests: No competing interests
only after understanding history, the real lessons on integration learned.
Dear Sir
In his article, Bodeker has ignored the difference in sociopolitical
backgrounds and oversimplified the analysis of integration of traditional
medicine into modern medical health systems. 1 Therefore, I believe, his
resulting categories are misleading. He needs to take account of
sociopolitical differences between communist and capitalist countries, and
aspects of integration in other areas such as education and practice.
Even though Bodeker calls the Chinese system "integrated", in fact
there are many different training systems and qualifications. Each
healthcare professional in China is highly specialized with specific
boundaries. For example, acupuncturists cannot prescribe Chinese medicine,
and medical middle school graduates cannot practice in higher clinics. The
system in communist countries appears integrated, but actually it is the
opposite; it is fragmented, because of the degree of control over every
aspect of the medical system.
On the other hand, in South Korea, (which he calls a "parallel
approach"), traditional Korean medicine and western medicine adhere to the
same educational and licensing system. So, Korean students of traditional
medicine are taught courses such as biology, anatomy, physiology, and
pathology by the same faculty as the students of western medicine.
Students take the same classes and are examined together.
China, Vietnam, Korea, and India have all suffered from colonization
or its equivalent, during which time most of their traditional systems
including medicine were taken over by western versions. The revival of
traditional medicine in these countries is recent and represents not just
a process of integration but one of restoration. This approach is
radically different from that of integrated medicine advocated by some in
western developed countries. It is only after understanding of the complex
and diverse history of these developing countries that the real lessons on
integration will be learned.
References
1. Bodeker G. Lessons on integration from the developing world's
experience. BMJ 2001;322:164-6
Competing interests: No competing interests