Volume 7, Issue 1, February 2015, Pages 5–12
A Special Issue: Traditional and Integrative Approaches for Global Health
Review article
The state of the integrative medicine in Latin America: The long road to include complementary, natural, and traditional practices in formal health systems ☆
Abstract
Introduction
Integrative
medicine is not an entirely new concept in Latin America. With a deeply
rooted tradition in medical practices by ancient indigenous peoples,
two milestones are part of the road towards integration. Álvarez Chanca
wrote the first records on medicinal plants in Latin America (1493),
when accompanying Columbus on his first voyage to the New World.
Subsequently, de la Cruz and Badiano wrote a detailed document on
autochthonous medicinal plants (Badianus Manuscript, 1552: “First
American Pharmacopeia”).
Methods
Searching
in MEDLINE, LILACS, Google Scholar/Books. MESH: complementary,
alternative, traditional, natural, health system, intercultural,
ethnomedicine, phytotherapy, and herbs, among others.
Results
It
has been estimated that more than 400 million people in Latin America
use traditional/natural and/or complementary/alternative medicine
(TN-CAM). The yearly expenditure on TN-CAM products of around 3 billion
dollars illustrates that these practices have grown exponentially in
this region as well. The quantity and quality of scientific studies on
TN-CAM, although relatively scarce, has steadily increased. Cuba and
Brazil, where formal health systems for different reasons accept
inclusion of TN-CAM, are in the forefront of this movement. Considerable
advances are also being made in other countries, such as Mexico, Peru,
Chile, Argentina and Colombia.
Conclusions
Immediate
challenges are how to improve multidisciplinary management, research,
professional training, address legal/policy issues and a scientific
approach to the extents and limitations of TN-CAM both in conventional
health care and in the society as a whole. To ignore or fight the
existence of TN-CAM therapies, practiced in a scientific approach, may
harm health-care systems. This article belongs to the Special Issue: T
& G Health Issue.
Keywords
- Integrative medicine;
- Latin America;
- Health system;
- Complementary;
- Traditional
“Latin America is a too poor region to allow itself the luxury of not investing in research”
Inspired by a similar statement about Argentina by Bernardo Houssay (1887–1971)—Nobel Prize in Physiology or Medicine 1947.
Introduction
The
philosophy that health is based on a balance of the mind, body, and
spirit is neither new nor exclusive to integrative medicine. The idea
already existed in the times of ancient Greece. Pioneers in the concepts
of integrative medicine, such as Aristotle and Hippocrates of Kos,
moved from spirituality or religion to experimentation to better
understand ailments of the human being [1].
Today,
integrative medicine has begun to show to be an important means of new
resources in the management of disease and especially in the presence of
chronic severe, and sometimes life-threatening, health problems [2]. Currently worldwide different health centers have started to develop programs for its study, research, and use.
As
such, even though the integrative view of medicine, as a sum of
non-conventional, traditional, natural, complementary and/or alternative
medicines/practices (from now on called TN-CAM) based on evidence of
safety and efficacy, seems quite modern, but probably is not.
Pre-Columbian
Latin America had a strong tradition in the use of different types of
medical practice related to its ancient cultures.
We
may distinguish two historical milestones at the beginning of this long
road that health-care systems still have to travel to integrate much of
this traditional medical heritage [3].
The
first milestone are the notes Diego Álvarez Chanca wrote about certain
medicinal plants in America at the end of the XV century, even though
they were not his only or even most important aim. Accompanying
Christopher Columbus on his second voyage to America, this physician was
the first to record data on medicinal plants of the “New World”, among
many other issues. Although he may have been more motivated by political
rather than scientific reasons, his 1493 notes were the initial step
for the integration of knowledge between two geographically and
culturally very distant civilizations [3] and [4].
Subsequently,
towards the mid XVI century, the first relevant scientific document
appeared. A pupil of the Colegio Mayor of Santa Cruz of Tlatelolco
(today part of Mexico city), an Indian physician called Martín de la
Cruz, passed on his knowledge on autochthonous medicinal plants to a
professor from the school, Juan Badiano, who was also a native. Together
they wrote the document entitled Libellus de Medicinalibus Indorum Herbis,
the existence of which was ignored for centuries before it was
rediscovered at the Library of the Vatican in 1929, translated into
English, and published in America as the Badianus Manuscript. Currently,
the “Códice de Medicina Azteca de la Cruz–Badiano” is considered as the
“First American Pharmacopeia” based on autochthonous knowledge [5].
Nevertheless,
these documents do not fully capture the magical-religious concept, the
main characteristic of pre-Columbian medicine. People with qualitative
and quantitatively important cultural heritages such as the Mayas,
Aztecs, and Incas, as well as other somewhat less developed indigenous
peoples, such as the Guaranies, Mapuches, Tehuelches, and Selk’nam-Ona,
believed in good and bad gods who provided well-being or caused
cataclysms, and had faith-healers and witches [6].
European
conquerors, mainly the Spanish, met with notable ideological resistance
by the native American people when trying to impose themselves. This
resistance, sustained along the centuries, prevented the destruction of
habits and traditions typical of the Latin-American region [6].
The
more recent history of traditional medicine in these societies has
developed through local experience of each population or town based on
empirical practice and related to the environment. Traditional medicine
has lasted due to its easy accessibility and low cost, but typically
without systematically being considered in public health-care policies [6].
Currently,
in the context of an increased life expectancy, that almost reaches 75
years of age, and growing health-care costs, it has been estimated that
more than 400 million people in Latin America use TN-CAM, especially in
primary care [8] and [9].
Recently,
a WHO strategy document aims to address new challenges. It requires
that responsible professional staff determine their own national
situations in relation to traditional and complementary medicine, and
then to develop and enforce policies, regulations and guidelines that
reflect these realities [10].
The
goal of this review is to analyze the history of the integration of
natural and traditional practices inside formal health systems, to
describe different levels of integration of types of countries, to
outline emblematic examples through the analysis of notable experiences
and to explore diverse strategies of integration and to understand
difficulties, barriers, challenges and perspectives of use of TN-CAM in
the context of official health systems in Latin American countries.
Methods
We
conducted a search for articles (English and Spanish languages) in
MEDLINE (via PubMed), LILACS, Google Scholar and Google Books, with
publication dates from January 1960 to May 2014. The search included the
following medical subject heading (MESH), independently and in
combinations: CAM, complementary, alternative, traditional, natural,
medicine, health system, history, intercultural, cancer, oncology,
ethnomedicine, ethnopharmacology, phytotherapy, phytomedicine and
herbs/herbal. We excluded case reports, comments, news, editorials,
letters and “grey literature”. This search was made for every Latin
American country separately or as a region, adding a new MESH: Latin America.
We also consulted the following websites: clinicaltrials.gov, worldbank.org, who.int, paho.org and who-umc.org.
Finally
we added personal/professional bibliography (including data of several
sort of documents, congresses, books and courses), qualified contacts,
and experiences of individual and group works.
Results
Biological, socio-political, and cultural context
Latin
America is an important cultural region in the world. It is
distinguished from other world regions by a set of common cultural
traits that include language, religion, social values, and civic
institutions deriving principally from the Iberian Peninsula. Spanish
and Portuguese are the main languages. Catholicism is practiced by a
vast majority of the region's inhabitants. Nevertheless, the region is
not entirely culturally monolithic. Indigenous peoples and cultures have
influenced national and subnational cultures within regions, affecting
language, music, religion, social customs, food habits, and civic
institutions [11].
Today,
the health-care team lives and works in a multicultural world.
Practically in all countries great ethnic, cultural, and economic
diversity is found and the world population has become mobile and
migrating. The medical profession has changed as well. Similar to other
cultural groups, physicians share a common history, admiring the same
role models, sharing the same studies in their professional training for
homogeneous knowledge and “competence” in medical practice. They learn a
new way of describing health and disease, which requires a new
vocabulary and an established pattern of narrative history, which is not
shared by those outside the medical field. The term “evidence-based
medicine” implies it to be synonymous with truth or actual knowledge [12].
In
this part of America, indigenous peoples have been able to cultivate an
integrative view on health. According to the Health Initiative of
Indigenous Peoples (SAPIA), health is a dynamic combination of
inseparable individual (physical, mental, spiritual, and emotional),
collective (political, economic, cultural, and social), and natural
components. Much of the strength and capacity of survival of the
indigenous peoples is owed to the efficacy of their traditional health
systems, based on balance, harmony, and integrity.
Nature
has been the source of medicinal agents for thousands of years, and an
impressive number of modern drugs have been isolated from natural
sources, many based on their use in traditional medicine [11].
In
modern times, particularly since the 1980s, similar to most of the
western world, Latin America has witnessed the emergence of a strong
social demand for different clinical therapeutic models which we here
identify as TN-CAM [7].
At the same time, over the past years growth of the market of traditional medicines has been exponential throughout world.
Based
on ample studies on the increase of use of this type of medication in
Latin America, it may be estimated that around 3 billion dollars are
spent yearly on these products in the region, making it an economically
highly interesting sector in health care [9] and [13].
Nevertheless,
lack of research and academic sustainability of TN-CAM practices, as
well as the lack of regulatory mechanisms has become evident. This is
why persons without official recognition or a recognized formal training
are able to call themselves physicians or alternative therapists,
misleading a population in need. Procedures that may be harmful to
health are used, negatively affecting the good name of formal
practitioners and the recognition and genuine interest in these
therapies [7].
In
the context of a relatively small but growing number of high-quality
scientific studies, some of the clinical therapeutic models have started
to be validated according to criteria of proven efficacy, safety, and
cost-effectiveness, adherence to ethical and professional norms, and
social acceptability according to guidelines of the World Health
Organization (WHO) [7], [10] and [14].
For
this reason, already in 2002 the WHO has proposed a program to take
advantage of it contributions while at the same time limiting its risks [7].
As
a result of the increased regional awareness on the use of these TN-CAM
therapies, in 2009 in the Latin-American Parliament, an international
political organism that brings together the countries of the region, a
Framework for Traditional Medicine in Latin America and the Caribbean
was proposed [7].
It
is important to point out that this type of initiative is not binding,
i.e. it expresses an agreement on the issue, but does not oblige the
member countries to meet the proposed aims.
The
WHO as well as its regional office the Pan-American Health Organization
(PAHO) have created frameworks for cooperation that, among their
priorities, have included the identification and the development of
intercultural health-care systems incorporating knowledge and practices
of traditional indigenous medicine [15].
Increasingly,
well-known for-profit academic organizations are considering
traditional medicine-related topics in their public health-care
evaluations [16],
added to an increased necessity for quantitative and qualitatively
better information by different health professionals. This conclusion is
not only the result of specific survey analysis, but is also shown by
the creation of new academic units that try to satisfy the need to
complete voids in the initial university as well as post-graduate
training of health-care professionals in issues of complementary and
traditional medicine [17], [18], [19] and [20].
Models for the integration of TN-CAM into Latin-American health-care systems
In
the world, the prominence and definition of
nonconventional/unorthodox/traditional/natural practices varies from
generation to generation. With the development of modern medicine and
advances in treatment of acute, infectious, and other severe diseases in
the XX century, the importance of alternatives largely subsided. As the
limitations of conventional medicine have become more obvious, interest
in alternative medicine has risen. The medical and scientific response
to claims of efficacy outside official medicine has a distinct pattern.
Orthodox
groups have either ignored these practices or attempted to undermine
and suppress them by making them hard to access, by labeling them as
quackery or pseudo-scientific, and by disciplining those that use them.
Additionally, when the mainstream community (politicians, professionals,
and groups of patients) examines them, similarities with what they
already do are found, and practices that easily fit are selectively
adopted into conventional medicine. Once these concepts are integrated,
the groups that originally held them are then considered mainstream [21].
Currently,
none of the Latin-American countries have been able to adequately
integrate TN-CAM treatment into conventional medicine in their
health-care systems. Through the “Figure 1” we want to chart the steps
that a nation/country has to walk, normally, in the historical process
of integration of TN-CAM with a formal health system. That also intend
to show in what stage can be positioned each country in a certain
historic period (category/ranking). (Fig. 1: CAM's Stairs of Six Steps = “3S Process”).
- Fig. 1.Historical process of integration of nonconventional/traditional/natural/complementary/alternative medicines/practices (TN-CAM) in formal/public health systems in Latin America.
Based on the “3S Process” outline (Fig. 1),
the majority of countries in the region may be placed between phases
(steps) 3 and 5. Legislation often exists, particularly as to medicinal
plants, but also as to other issues, such as acupuncture and homeopathy.
Argentina, Chile, Colombia, Bolivia, Mexico, and Venezuela are found
within this group of countries. Uruguay, Costa Rica, Ecuador y Paraguay
are in an earlier phase [22].
Nevertheless,
there is an ongoing process of integrating these practices both into
health-care systems and into the academic field. In the latter case,
integration does not only consist of research (medicinal plants) but
also of the development of new subjects, especially in the form of
post-graduate courses [23].
In
many Latin-American countries, high-level scientific professional
associations are studying TN-CAM, especially in the field of
phytotherapy, with an ongoing debate and advances since the mid XX
century [24], [25], [26] and [27].
Resources
for traditional medicine in Latin America are variable, and often much
less than in other countries, especially in the east, such as China,
Japan, and India.
Additionally,
in this part of America, there is no policy of resource distribution
that allows to invest as in developed countries, according to
well-established criteria in the medical and scientific community in the
research of TN-CAM-related topics [14].
In
Cuba, a special model of integration has been developed since the
1960s, motivated by both cultural and political reasons, to rescue
native traditional knowledge as well as that of other geographic regions
on the planet [28].
The
Cuban public health system has a tendency toward incorporating natural
and traditional medical practices that were marginalized or labeled as
being pseudo- or non-scientific into conventional medicine [28].
In
1991, the Program of Medicinal Plants of Cuba was initiated, including
the use of known plants and their elaboration for the pharmaceutical
industry, determining their phytotherapeutic components, possible
therapeutic effects, advances in clinical trials, and publishing partial
relevant clinical results. Through this program, traditional medicine
was introduced, especially in the field of primary health care [28].
The study culminated in the broader initiative of implementing a
National Program for the Development and Dissemination of Traditional
and Natural Medicine in 1999.
Currently,
in Cuba more than 50 million units containing natural or homeopathic
medications are produced and simultaneously close attention is being
paid to the application of natural and traditional medicine [29].
Scientific
study of many of these therapies is important in Cuba, but due to
political restrictions in the reporting of results some caution should
be taken in the evaluation of the actual potential of some of them.
On
the other hand, one of the most important regional initiatives on the
integration of TN-CAM into health-care systems has been taken by Brazil
as a state policy by the end of the XX century.
Although
in Brazil the first efforts of integration date back to the 1980s,
relevant political decisions in this field were taken in the decade of
the 1990s, in scientific-technological meetings on different TN-CAM
issues [30].
For
the coordination of a Unified Health System (SUS) in Brazil and to
establish policies to ensure integrality of health care, the Ministry of
Health presented a National Policy on Integrative and Complementary
Practices (PNPIC), which was implemented for political, technical,
economic, social, and cultural reasons. This policy, basically addressed
the need for knowledge, support, incorporation, and implementation of
experiences that had been developed in a public network of
municipalities and states, especially in the fields of traditional
Chinese medicine,—acupuncture, homeopathy, phytotherapy,
anthroposophical Medicine, and hydrotherapy/crenotherapy [30].
Another
example is Peru's National Program in Complementary Medicine, which is
working with Pan American Health Organization in clinics and hospitals
operating within the Peruvian Social Security System. They treat
osteoarthritis, back pain, neurosis, asthma, peptic acid disease,
tension and migraine headache and obesity using TN-CAM [22] and [31].
It
is worth mentioning that some traditions, in Latin American medicine,
are exclusively local. A popular and highlight ritual within the Andean
medicine is the “Soba con Cuy” (in Spanish) or “to Clean with Cuy”.
“Sobar” is the verb that suggest the idea of knead, paw or handle. The
cuy (Cavia porcellus) is known as the guinea pig in most parts
of the world and is used in this ritual as a medium for diagnosis and
healing. This practice is still very popular in Peru, but also in
Ecuador and other close regions [32].
Other
countries have advanced in the process of integrating traditional
medicine with conventional medicine from a legal point of view,
particularly as to the political recognition of the therapeutic
potential of medicinal plants. In countries such as Mexico, Argentina,
Chile, and Colombia, there has also been political interest in
initiatives in the field of traditional and non-conventional medicine in
general. This interest mainly focuses on traditional Chinese medicine
(especially acupuncture), energy medicine and its variants, and
homeopathy. Attention has also been paid to therapies that are
increasingly used, such as chiropraxy, yoga, mindfulness, and tai-chi.
Initiatives on the road to formal acceptation
Some
initiatives, with several years of professional and responsible work,
are good examples of efforts that, in the future, can be the basis of
practices integrated to formal health systems. Some of them are detailed
below.
Oncology
There
are outstanding achievements in specific health areas, such as the
Latin American Oncology Group (LACOG), which shortly after its
foundation was able to launch a multinational randomized clinical trial.
Another example is the South American Office for Research and Treatment
of Cancer (SOAD), which was created in 1993 in southern Brazil with the
support of the US National Cancer Institute (NCI) and the European
Organization for Research and Treatment of Cancer. For several years,
semi-purified plant extracts identified by the SOAD in-vitro screening
program were submitted to an in-vitro screening program at the NCI. This
collaboration screened compounds isolated from South-American medicinal
plants for potential use as anticancer treatments [33].
In
certain diseases, such as cancer, there are projects that try
integrative management, especially in palliative care and psychological
and psychosocial support, coordinated by specially trained
professionals. Many of these groups have difficulties to subsist in time
without financial support, although their activities are clearly
beneficial [34].
Ethnobotanic and ethnomedical research
Traditional
medicine has long been marginalized, and only at the end of the XX
century this situation has started to change, especially due to the
advancements in ethnobotanic and ethnomedical research, contributing
important knowledge on traditional medicine, that is thus slowly being
integrated into the clinical field.
In
the production of phytotherapeutic medicines in Latin America foreign
plants are often used, with active principles and pharmacological
effects that have been extensively studied and are known world-wide and
have been included in the most important pharmacopeias, such as those
from Europe and the United States. In some cases, local sources (plants)
are also used, although scientific evidence may not be sufficient or
available.
Different
medicinal plants of Latin-American have been a valuable contribution to
the scientific and cultural heritage, among many others Solanum lycopersicum (tomato), Serenoa repens (saw palmeto), Cinchona ledgeriana (quina), Solanum tuberosum (potato), Passiflora incarnata (passion flower) [35].
The
world demand of medicinal plants has seen an exponential growth. There
has been an increasing flow of medicinal plants from the southern
hemisphere to developed countries, growing from 100 million dollars in
1979 to 35 billion dollars in 2003. This increased interest in medicinal
plants has put a dangerous pressure on the habitat of indigenous
peoples [34].
Different
academic initiatives have focused on this problem. One of the most
important is TRAMIL, a research program on popular medicine in the
Caribbean, whose mission is to scientifically validate the traditional
use of medicinal plants in primary health care. An online collection of
medicinal plants has been published, together with photographs,
drawings, and information on their use in medicine based on popular
knowledge, with the aim to differentiate between simple belief and
useful and efficacious data supported by scientific studies. As such,
the program proves to be an interesting tool providing information for
physicians, pharmacists, and other health-care professionals. (www.tramil.net)
Additionally,
it is possible develop strategies to use plants to elaborate
phytotherapeutic medications. This implies not only a safe economic
strategy for the treatment of certain pathologies, especially of those
treated in primary care, but also the development of regional partners
that may help in solving complex economic problems at a regional level.
In such cases, all sectors involved (agronomy, pharmaceutical and
research laboratories, health-care and public health professionals,
universities, and regulatory/political entities, among others) should
work together to optimize the final product, generate new models, and
allow for the necessary feedback [36].
It
is to be expected that these individual or joint state policies,
although emerging, lead to an awareness in the community on the rational
use of medicinal plants allowing for their adequate preservation,
production, and use [37].
Academic incorporation, research, and other cases
The
generation of knowledge and adequate interpretation and application
allows to avoid false expectations as to the possible results of a “new”
TN-CAM practice. This is especially important when the therapy, even
when meeting other scientific-technological requirements, comes (in its
origins) from a field that is more rooted in traditions.
Additionally,
systematic studies, for example through adequately performed surveys,
may clarify medical anthropologic views that have been hidden and that,
doubtlessly, will contribute to better care of the patients and their
families [38].
Another
important issue is the use of animal products, which as components of
bioprospecting has implications for medicine, the environment, economy,
public health, and culture. Although widely diffused, zootherapeutic
practices remain virtually unstudied, and so far there has been neither a
demonstration of the clinical efficacy of the popularly used remedies
nor an evaluation of the health implications of the prescription of
animal products for the treatment of diseases in the Latin America. New
studies of the medicinal fauna, which seek a better understanding of
this form of therapy—including ecological, cultural, and pharmacological
aspects, are necessary [11].
In
the long term, other strategies are necessary to achieve integration of
TN-CAM into formal medical care in centers that typically are reticent
to these practices. In these cases, political vision and decision-making
are a key factor. Subsequently, a clear and efficacious organization of
the members of the integrative health-care team may sustain clinical
and scientific activities through time.
This
may be especially recommendable, not only in primary-care centers, but
also in tertiary care centers that manage complex pathologies, where
integrative medicine may be a particularly useful tool in the care of
these difficult patients and their families. The Group of Integrative
Medicine from the Garrahan Pediatric Hospital, Buenos Aires (Argentina),
working with neonates and children is an example. Integrative medicine
may also be applied in other physiopathological settings, such as severe
infections, old age, severe undernourishment, congenital malformations,
transplantations, genetic syndromes. Integrative medicine is of
essential importance for patients who, referred from their home towns
that are far from large urban centers, require treatment in which
traditions of their place of origin may be considered [39].
In
any of the aforementioned cases, it is possible to imagine that
multiple personal, economic, and cultural difficulties, often caused by
natural or deliberately installed prejudice, would be inconveniences
encountered when management based on TN-CAM, from a serious, scientific,
and innovative view, is tried.
Even
if all these complications are overcome, the applicability of certain
types of therapy would need to be carefully managed by different members
of the health care team.
Discussion and conclusions
National
governments have recognized the contribution of indigenous knowledge,
practices, resources, and therapies to public health, as well as the
need to find strategies and adequate areas to strengthen them and create
a respectful and complementary relation within official health-care
systems.
As such, an
intercultural focus on health is one of the strategies to improve access
to better health care, and to provide the necessary means for the
people to improve their health and better control their lives. The topic
of intercultural relationships has gone beyond the limits of education
and has taken roots in health-care [40].
The role of traditional medicine in public health is controversial and full of dogmatic conflict and long-standing interests [40].
TN-CAM
has many positive features, such as diversity, flexibility,
acceptation, attainability, and in general, low cost. Additionally, some
characteristics may be considered as challenges. Examples would be the
different degrees to which governments recognize TN-CAM, the lack of
scientific evidence, and difficulties related to the protection of
indigenous knowledge of traditional medicine and how to warrant its
adequate use [13].
High-quality,
safe, and efficacious traditional medicine contributes to improved
access to health care for all people. Many countries currently recognize
the need to establish a coherent and integral approach that facilitates
governments, health-care workers, and especially health-care users
access to safe, respectful, attainable, and effective TN-CAM. A world
strategy designed to encourage integration, regulation, and appropriate
supervision of these practices would be useful for countries who wish to
develop dynamic policies in this important, and often vigorous and
expansive, health-care area.
In
many parts of the world, regulating entities, health-care
professionals, and the general public are facing issues related to the
safety, efficacy, quality, availability, preservation, and regulation of
TN-CAM.
Although some
national policies that have achieve an adequate formalization of TN-CAM
in the more conventional fields exist, this is generally not common in
Latin-American countries.
Maybe
Brazil and Cuba are the most outstanding examples of integration of
traditional practices (non-conventional) into formal medical systems,
albeit for different reasons and with a different development. In both
cases, establishment of solid, predictable, and relatively reliable
systems is being achieved (step 4—“3S Process”: Fig. 1).
In the case of Peru, Colombia, Argentina, Chile, and Mexico first steps
are taken in the framework of a political decision to consider
tendencies in the population showing a preference for TN-CAM in health
care (step 3—“3S Process”: Fig. 1).
Other countries, such as Venezuela, Bolivia, and Ecuador do not seem to
have gathered the “critical mass” necessary to make a change, in spite
of certain initiatives of interest that may be the basis for the
development of policies at a national level in the near future. (step
2—“3S Process”: Fig. 1).
Currently
there are more than 8 million reports in VigiBase, a database which
records adverse drugs reactions of the whole world, depending on the WHO
Collaborating Centre for International Drug Monitoring (also called the
Uppsala Monitoring Centre, UMC), and registering those reactions since
1978 [40].
This
large number of reports is the result only of voluntary communications,
in their majority related to “allopathic medications”. Definitely, the
real incidence of adverse events, although unknown, is much higher. The
reports are mainly considered as a healthy source to increase the
knowledge on these medications.
The
reports do not only shed a light on the toxicology related to the
conventional treatment, but also show that it is desirable to make
TN-CAM medications an official part of these control (pharmacovigilance
and technovigilance), without disarticulating a possible improvement in
patient care. Contrary to what many TN-CAM practitioners believe, these
controls may provide support to those who really want to offer
high-quality health-care services.
A
serious vision on the integration of traditional knowledge and cultures
requires acceptance of several changes of paradigm. In the medical
model currently in force in this region, the criterion of “modern
scientific and neutral” imposes itself on “belief and superstition”
lacking serious support [41].
With
the advent of high-level formal educational structures in the XVI
century, Latin America also went on the road of regulation of medical
knowledge, with positive consequences, but also a process of
hegemonization of medical-scientific practices [41].
In
conformation of an international health paradigm, international health
organisms, continue legitimization of the hegemonic biomedical model as
the only model that “leads to development” at the expense of one of the
most important underlying thoughts of integrative medicine, which
considers intercultural and multidisciplinary management in health care [41].
Many
of the discoveries reported in scientific studies are not translated to
clinical practices, as researchers often work independently from those
who work in patient care.
Similarly,
health-care professionals often do not consult scientific-theoretical
data that are the basic work of local researchers. This lack of
communication may lead to a situation in which valuable
scientific-medical information end up in a journal read only by the
specialists in a particular field.
Some possibly useful recommendations for adequate use of knowledge that has not been included in formal medicine may be [42] and [43]:
- 1-
- To adequately assess the negative impact in the implementation of an intercultural strategy (which at times may exist and have undesirable consequences).
- 2-
- To investigate different interactions between official medicine and traditional medicine at different levels of care, centrally as well as locally.
- 3-
- To recover the strategies and methodologies that resulted in successful intercultural/integrative health management developed throughout the world, allowing for a constructive dialogue.
- 4-
- To preserve traditional knowledge and provide sustainable alternatives for conservation, through collection, preparation, publication, and diffusion of information on different cultures and resource management through adequate programs.
Following
these and other recommendations, the concept of Integrative Medicine,
which is new in Latin America, may start to be considered more
extensively in the field of formal regional health care.
Traditional
medicine as well as non-conventional practices should be studied in the
framework of symmetrical epistemological interaction, always open to
new processes of construction and interpretation. Anthropologic
knowledge may be very useful in this process, opening the way for
denaturalization of the concept of subordination, evaluating this
“different-knowledge” from its full political potential, wealth, and
prospective for creation [43].
New
WHO strategy about traditional and complementary medicines encourage,
among others points, the building of scientific knowledge base to
strengthen the quality assurance, safety, proper use and effectiveness
of these practices. Regulations of practices and practitioners are as
important as education and training to integrate TN-CAM services into
health service [10].
In
this context, the necessary effort to seriously and scientifically
assess the wide and complex range of health issues related to
non-conventional therapies requires a strong public health-care policy.
This policy should be centered both on the application of criteria of
prevention in primary care and the development of guidelines and
normalization based on existing knowledge, as well as research efforts
in coordination with relevant clinical aims.
This way, the so-called Integrative Medicine will simply be good medical practice in the future.
Finally,
the road to Integrative Medicine in Latin America follows the defining
principle that to ignore or fight the existence of natural,
complementary, and traditional therapies, practiced in a professional,
scientific, and multidisciplinary approach, is a strategic error that
may seriously harm health-care systems.
Acknowledgements
We
want to express our deep thanks to the other member of the Integrative
Medicine Group (Garrahan Pediatric Hospital) for their hard and
enthusiastic daily work: Norma Barraza, Silvia Villanueva, Beatriz
Jimenez, Ziomara Balbarrey, Marta Dell’Orso, Claudia Iachino, Claudia
Masseroni and María del Carmen Rocha.
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