Integrating complementary medicine?

Contributions from Mexican Flora for the Treatment of Diabetes Mellitus: Molecules of Psacalium decompositum (A. Gray) H. Rob & Brettell

Diabetes mellitus (DM) is cited as a serious worldwide health problem that occupies second place in causes of annual mortality in Mexico. Among Mexican flora, nearly 300 plant species have been employed as hypoglycemic in popular use. Thus, their study entertains great relevance In this context, this work contributes a clear and timely review of the plant species utilized in Traditional Mexican Medicine and experimental biological models in which not only have the hypoglycemic properties of the extracts and the isolated compounds been considered, but also the anti-inflammatory and antioxidant properties, taking into account an integral focus based on the complex mechanisms involved in the pathogenesis and physiopathology of DM. Among the species reviewed, we highlight Psacalium decompositum (Asteraceae), due to the potent hypoglycemic, anti-inflammatory, and antioxidant activity of the sesquiterpenes identified as majority compounds isolated from the root, such as cacalol and cacalone that also possess the capacity of increasing insulin levels. In this manner, the present manuscript attempts to contribute necessary information for the future study of bioactive molecules that are useful in the treatment of DM, as well as also being a contribution to the knowledge and diffusion of Mexican Traditional Medicine.

Medical pluralism in action? A case study of community pharmacies in Johannesburg, South Africa

OBJECTIVES

The main aim of this study was to examine whether, and to what extent, community pharmacies have become sites for the practice of complementary and alternative medicine (CAM) as an example of "medical pluralism."

METHODS

Qualitative as well as quantitative methods such as a telephone survey of all pharmacies in Johannesburg, observations, and in-depth interviews with pharmacists and CAM healers were used.

RESULTS

The evidence presented in this paper, although based on a study of community pharmacies in Johannesburg only, can be interpreted as an indication of a general trend in urban areas in South Africa, that of involvement with CAM in the form of dispensing and sales of CAM products, provision of advice, and, in a few cases, employment of CAM practitioners to consult on their premises. Thus the two systems of CAM and allopathic medicine are being practiced within the same premises. However, the manner in which they operate, as portrayed in this study, is that of two separate systems existing in relative harmony side-by-side.

CONCLUSION

Because of the constraints of the study, it is difficult to ascertain to what extent this is a first step toward the development of a more meaningful integration between the systems. It is much easier to demonstrate that this growth is driven by the pharmacists' response to the growing demand from the public and their readiness to seize the opportunity to expand their responsibilities and increase their profits. This is supported by the willingness of CAM healers to participate in the endeavor.

Themes of holism, empowerment, access, and legitimacy define complementary, alternative, and integrative medicine in relation to conventional biomedicine

Complementary and alternative medicine (CAM) has been defined largely in relation to conventional biomedicine. CAM therapies that are used instead of conventional medicine are termed "alternative." CAM therapies used alongside conventional medicine are said to be "complementary." "Integrative medicine" results from the thoughtful incorporation of concepts, values, and practices from alternative, complementary, and conventional medicines. The evolving process of integration between CAM and conventional medicine evokes new conceptual frameworks, as well as new terminology. Interview-based qualitative research at the University of Wisconsin-Madison seeks to probe and develop this theoretical structure. Interviews with users and practitioners of CAM therapies have revealed four primary themes: holism, empowerment, access, and legitimacy (HEAL). These themes characterize CAM and contrast it with conventional medicine. CAM is said to be more holistic and empowering yet less legitimate than conventional medicine. CAM is more intuitive; conventional is more deductive. While CAM is perhaps more psychologically accessible to many patients in that it better reflects commonly held values, it is often less financially and institutionally accessible, at least for those with conventional health insurance and limited income. Substantive barriers--including economic, organizational and scientific differences, as well as an apparent widespread lack of understanding--continue to thwart attempts at integration. More and better evidence is needed if CAM therapies are to be accepted by mainstream medicine. State-of-the-art research methods developed by conventional science will be needed to test CAM therapies. Conventional medicine, however, has much to learn from CAM. By incorporating a more holistic, empowering and accessible therapeutic approach, conventional medicine could build on its present legitimacy, and thereby enhance its power to "HEAL."

Alternative, complementary, and conventional medicine: is integration upon us?

In attempts to improve their health and/or combat illness, approximately 4 in 10 Americans will use a complementary and alternative medicine (CAM) therapy this year. CAM therapies vary widely, with acupuncture, chiropractic, herbal medicine, and homeopathy among the more prominent modalities. CAM therapies are used in addition to and/or instead of the more conventional forms of medical care available in U.S. hospitals or licensed physicians' offices. A rapidly increasing interest in CAM has led to a nascent movement aimed at integrating various CAM therapies with the conventional health care system. In Washington State, for example, health insurance coverage for CAM therapies has been mandated, and a number of "integrated" delivery systems have been born. Although the political and economic forces leading to adoption and integration of CAM therapies vary widely by geographic locale, it is likely that some degree of integration will occur throughout much of the United States. Similar processes are occurring in Canada, Europe, and Australia, and indeed within middle and upper level socioeconomic strata worldwide. This paper identifies potential barriers and facilitators to potential integration, of medical disciplines and argues for an accessible, multidisciplinary and evidence-based, yet humanistic and patient-oriented approach.

Developing a measure of attitudes: the holistic complementary and alternative medicine questionnaire

We have developed an 11-item scale, the Holistic Complementary and Alternative Medicine Questionnaire (HCAMQ). Six of the HCAMQ items relate to beliefs about the scientific validity of complementary and alternative medicine (CAM), and five to beliefs about holistic health (HH). The HCAMQ was completed by 50 patients attending a CAM clinic and 50 attending rheumatology outpatients; the former completed it twice. Factor analysis (oblique rotation) showed that the CAM and HH items measured distinct but related constructs. The HCAMQ has good test retest reliability (r=0.86, 0.82 and 0.77 for the total, CAM subscale and HH subscale, respectively). The individuals attending CAM clinics were significantly more positive on the CAM but not the HH subscale of the HCAMQ and also used less antibiotics than those attending rheumatology outpatients. Positivity towards CAM on the total HCAMQ and subscales was significantly associated with lower age, increased vitamin use, reduced painkiller use, and, other than on the HH subscale, less antibiotic use. The reason why the HH subscale failed to distinguish between the two patient groups or predict less antibiotic use is unknown. The HCAMQ appears to have good internal validity, but its external validity remains to be established.

Building complementary and alternative health care research capacity: workshop report

Lack of research into the safety and efficacy of CAM has been identified as a barrier to collaboration between conventional and CAM practitioners. As an initial step to address this issue, Health Canada held an invitational roundtable discussion with researchers, practitioners and policy makers to explore specific issues related to CAM research capacity and literacy. The objectives of this workshop were to identify and prioritize CAM research infrastructure and training needs; and to identify strategies for meeting high priority needs. Eleven individuals representing three CAM groups, university-based researchers with experience in CAM research, and policy makers attended. Discussion focussed around research literacy, capacity, funding and leadership. Several recommendations were made including an advisory group, a needs assessment, support for research networks, development of learning modules, a review of existing research programmes, support for centres of excellence in CAM research, and funding for research meetings.

Complementary therapy: complement or threat to modern medicine?

Some believe that medicine has lost its holistic perspective as a result of which many people now seek help from 'alternative' practitioners who seem able to devote time to their patients and listen to their concerns. Such practitioners also treat the 'whole person' rather than only their symptoms, a feature which seems to be valued by patients. The use of complementary therapies is, therefore, increasing world-wide. This paper explores this increase, questioning whether this truly reflects dissatisfaction with 'traditional' (allopathic) medicine or rather represents an increased satisfaction with 'alternative' therapies. It also investigates the use of such therapies in mainstream medicine revealing considerable variation in attitudes towards and use of such therapies in current medical practice questioning whether this should be seen as a threat to modern medicine or their use may enhance patient well-being and quality of life.