TRADITIONAL,COMPLEMENT & ALTERNAT MED..
Policy and
Public Health Perspectives
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CONTENTS
Contributors IX
Foreword xv
POLICY
Introduction
Gerard Bodeker and Gemma Burford
Chapter 1 Policy and Public Health Perspectives on
Traditional, Complementary and Alternative
Medicine: An Overview
Gerard Bodeker, Fredi Kronenberg and
Gemma Burford
Chapter 2 Financing Traditional, Complementary and
Alternative Health Care Services and Research 41
Gemma Burford, Gerard Bodeker and
Chi-Keong Ong
Chapter 3 Training 61
Gerard Bodeker, Cora Neumann, Chi-Keong Ong
and Gemma Burford
Chapter 4 Safety: Issues and Policy 83
Gilbert Shia, Barry Noller and Gemma Burford
vi Contents
Chapter 5 Pharmacovigilance of Herbal Medicines:
A United Kingdom Perspective 101
Joanne Barnes
Chapter 6 Medicinal Plant Biodiversity and Local
Healthcare: Sustainable Use and
Livelihood Development 145
Gerard Bodeker and Gemma Burford
Chapter 7 Home Herbal Gardens — A Novel
Health Security Strategy Based on Local
Knowledge and Resources 167
G. Hariramamurthi, P. Venkatasubramanian,
P. M. Unnikrishnan and D. Shankar
Chapter 8 Humanitarian Responses to Traditional
Medicine for Refugee Care 185
Cora Neumann and Gerard Bodeker
Chapter 9 Public-Private Partnerships: A Case Study
from East Africa 205
Patrick Mbindyo
PUBLIC HEALTH ISSUES: PRIORITY DISEASES
AND HEALTH CONDITIONS
Chapter 10 Malaria 239
Merlin L. Willcox and Gerard Bodeker
Chapter 11 HIV/AIDS: Traditional Systems of Health Care
in the Management of a Global Epidemic 255
Gerard Bodeker, Gemma Burford,
Mark Dvorak-Little and George Carter
Contents vn
Chapter 12 An Overview of Clinical Studies on
Complementary and Alternative Medicine
in HIV Infection and AIDS 295
Jianping Liu
Chapter 13 Skin and Wound Care: Traditional, Complementary
and Alternative Medicine in Public Health
Dermatology 311
Gemma Burford, Gerard Bodeker and
Terence J. Ryan
Chapter 14 Traditional Orthopaedic Practices: Beyond
'Bonesetting' 349
Gemma Burford, Gerard Bodeker and
Jonathan Cohen
RESEARCH
Chapter 15 Clinical Trial Methodology 389
Ranjit Roy Chaudhury, Urmila Thatte
and Jianping Liu
Chapter 16 Ethical Issues in Research 405
Merlin L. Willcox, Gerard Bodeker and
Ranjit Roy Chaudhury
Chapter 17 Intellectual Property Rights 419
Gerard Bodeker
Epilogue 433
Gerard Bodeker and Gemma Burford
Index 437
CONTRIBUTORS
Joanne Barnes
Associate Professor in Herbal Medicines
School of Pharmacy
Faculty of Medical and Health Sciences
University of Auckland
Grafton Campus
Private Bag 92019
Auckland, New Zealand
Gerard Bodeker
University of Oxford Medical School, UK
and Adjunct Professor of Epidemiology,
Mailman School of Public Health
Columbia University, New York, USA
Chair, Global Initiative For Traditional Systems (GIFTS) of Health
Oxford OX2 6HG, UK
Gemma Burford
Senior Associate
Global Initiative For Traditional Systems (GIFTS) of Health
Oxford, UK
and International Programme Manager
Aang Serian (House Of Peace)
P.O. Box 13732, Arusha, Tanzania
IX
X Contributors
George Carter
Director
Foundation for Integrative AIDS Research (FIAR)
62 Sterling Place, Suite 2
Brooklyn, NY 11217, USA
Ranjit Roy Chaudhury
Professor and Chairman, The INCLEN Trust and INCLEN Inc
161-L Hans Mansion
1st Floor, Left Wing
Gautam Nagar
New Delhi 110 048, India
Jonathan Cohen
Specialist Registrar
Department of Paediatric Infectious Diseases
Great Ormond Street Hospital
Great Ormond Street
London WC1N 3JH, UK
Mark Dvorak-Little
Stanford Graduate School of Business
350 Memorial Way
Stanford, CA 94305-5015, USA
Govindaswamy Hariramamurthi
Convenor, Medicinal Plants Conservation Network
Foundation for Revitalization of Local Health Traditions (FRLHT)
74/2 Jarakbande Kaval, Attur. P.O, Yelahanka
Bangalore 560 064, India
Fredi Kronenberg
Director, The Rosenthal Center for Complementary and
Alternative Medicine
Columbia University, College of Physicians and Surgeons
630 W. 168th Street, Box 75
New York, NY 10032, USA
Contributors
Jianping Liu
Professor and Director
Evidence-Based Chinese Medicine Center for Clinical Research
and Evaluation
School of Preclinical Medicine
Beijing University of Chinese Medicine
Bei San Huan Dong Lu 11
Chaoyang District
Beijing 100029, China
Patrick Mbindyo
Newborn and Child Health Group
Kemri-Wellcome Trust-University of Oxford Collaborative Prog
P.O. Box 43640-00100
Nairobi, Kenya
Cora Neumann
Department of International Development
Queen Elizabeth House
University of Oxford
Oxford OX1 3TB, UK
Barry Noller
National Research Center for Environmental Toxicology
The University of Queensland
39 Kessels Road
Coopers Plains, QLD 4108
Australia
Chi-Keong Ong
Head of Service Development and Palliative Care Studies
The Shakespeare Hospice
Church Lane, Shottery
Stratford-upon-Avon, CV37 9UL
and Associate Research Fellow
Centre for Primary Health Care Studies
Warwick Medical School
University of Warwick
Coventry CV4 7AL, UK
Xll Contributors
Allan Rosenfield
Dean, Mailman School of Public Health
Columbia University
722 West 168th Street, Suite 1408
New York, NY 10032, USA
Terence J. Ryan
Emeritus Professor of Dermatology
University of Oxford and Oxford Brookes University
Hill House, Abberbury Avenue
Iffley, Oxon OX44EU, UK
Darshan Shankar
Director
Foundation for Revitalization of Local Health Traditions (FRLHT)
74/2 Jarakbande Kaval, Attur. P.O, Yelahanka
Bangalore 560 064, India
Gilbert Shia
Clinical Fellow
Chinese Medicine Advisory Service
Medical Toxicology Unit
Guy's and St. Thomas' Hospital Trust
Avonley Road
London SE14 5ER, UK
Urmila Thatte
Professor and Head
Department of Clinical Pharmacology
TN Medical College and BYL Nair Hospial
Mumbai Central
Mumbai 400 008, India
Unnikrishnan Pay \ appallimana
Senior Program Officer
Traditional Systems of Medicine Unit
Foundation for Revitalisation of Local Health Traditions (FRLHT)
74/2 Jarakbande Kaval, Attur. P.O, Yelahanka
Bangalore 560 064, India
Contributors xm
Padma Yenkatasubramanian
Joint Director
Foundation for Revitalisation of Local Health Traditions (FRLHT)
74/2, Jarakabande Kaval
Attur Post via Yelahanka
Bangalore 560 064, India
Merlin L. Willcox
Honorary Secretary
Research Initiative for Traditional Antimalarial Methods (RITAM)
36 Hare Close
Buckingham MK18 7EW, UK
FOREWORD
In many parts of the world, where medicines are not readily available
or affordable, the public continue to rely on medicines used tradition-
ally in their cultures. At the same time, affluent consumers in the indus-
trialized world are spending their own money on healthcare approaches
that fall outside what has been considered mainstream medicine. A grow-
ing body of national and international studies highlight the reality that
there is exponential growth of global interest in and use of traditional (i.e.
indigenous), complementary and alternative medicine (TCAM). The scale
of this is so sizeable that it constitutes a public health phenomenon in
itself.
There is considerable use of traditional medicine in many developing
countries: 40% in China and Colombia; 71% in Chile; and up to 80% in
some African countries (World Health Organization Global Atlas on Tradi-
tional, Complementary & Alternative Medicine, Bodeker et al, 2005). In a
number of industrialized countries, almost half of the population now reg-
ularly uses some form of CAM, while the figures for Canada and Germany
are 70% and 71-75% respectively, and Australians spend more on comple-
mentary medicines than on pharmaceutical drugs. In the US, Americans
now make more visits to complementary practitioners than to primary
care physicians and spend more on complementary therapies than on
hospitalizations.
Individuals seek to avoid long-term use of pharmaceuticals, with their
potential for side effects. Thus, chronic conditions including pain condi-
tions are a major reason that people seek the help of CAM practitioners.
Women outnumber men in their use of CAM, often by 2:1. CAM use is also
XV
XVI Foreword
associated with higher education, higher income and strong environmental
values.
Naturally, governments have become increasingly focussed on the
public's need to be assured of safety, reliability and a beneficial thera-
peutic outcome from the healthcare choices that they make. Accordingly,
these societal trends have been matched in the past decade by a growing
momentum in regulation, research, policy development and professional
education.
Drawing on data from policy studies, and in areas of priority in inter-
national health, such as malaria and HIV, as well as in the areas of com-
mon ailments such as skin conditions and fractures, this book provides a
unique and important overview of the major trends of relevance to pub-
lic health and health policy. After almost two decades of international
research into the clinical and experimental dimensions of complementary
and traditional therapies, this newer focus on the public health and policy
dimensions will bring research and policy attention to a new and wider
set of questions. These include: evidence based decision-making, the cost-
effectiveness of TCAM treatments compared with other more mainstream
approaches to managing health and disease; how the health and safety of
populations is impacted by TCAM use; and how TCAM providers can
best partner with mainstream healthcare colleagues to deliver AIDS and
malaria prevention messages and to communicate information on healthy
lifestyles.
The focus on population trends in self-medication, expenditures on
alternative healthcare modalities, healthcare outcomes for TCAM and
chronic disease, and the prospects for low-cost and locally available
methods of disease prevention and management is timely. Indeed, it is
overdue in view of the widespread and long-standing use of TCAM
globally.
By providing a public health and policy perspective, the various chap-
ters in this book illustrate a basis for effective integration of services
for the benefit of the public, and potentially for cost-savings to gov-
ernments through effective means of prevention and affordable meth-
ods of health maintenance and disease control. The book brings together
a global overview of the challenges, promise and professional require-
ments of a vast area of health care practice that is now international
Foreword xvii
in scope and worthy of increased attention and analysis. The single
most important challenge for the future is to provide solid evidence-
based decision making, as has been done recently in the area of malaria
therapy.
Allan Rosenfield, MD, FACOG
DeLamar Professor of Public Health and Ob/Gyn
Dean, Mailman School of Public Health
Columbia University
New York, USA
