Integrative Skin Care: Dermatology and Traditional and Complementary Medicine.

Skin problems and diseases are extremely common globally and, due to their visibility, often result in severe distress and stigma for sufferers. Traditional (i.e., indigenous or local) and complementary health systems are widely used and incorporate many treatment modalities suitable for skin care, and a body of evidence for their efficacy and safety has built up over many decades. These approaches are often used as part of a broader "integrative medicine" (IM) approach that may also include, for example, nutrition and mind-body approaches. This article presents an overview of current knowledge about traditional and complementary medicine (T&CM) and IM principles and practices for skin health; reviews published epidemiologic studies, clinical trials, and wider literature; and discusses the challenges of conducting research into T&CM and IM. It also highlights the need for an innovative research agenda-one which is congruent with the principles of IM, as well as taking policy and public health dimensions into consideration.

Intellectual property rights, benefit-sharing and development of "improved traditional medicines": A new approach.

ETHNOPHARMACOLOGICAL RELEVANCE: Protection of intellectual property rights and benefit-sharing are key issues for all ethnopharmacological research. The International Society of Ethnobiology has produced helpful guidelines on access and benefit-sharing which are widely viewed as a "gold standard" but the question remains how best to apply these guidelines in practice. Difficult questions include ownership of traditional knowledge, making appropriate agreements, and how appropriately to share benefits. MATERIALS AND METHODS: We present the case study of the development of an "improved traditional medicine" for malaria in Mali and we report how benefit-sharing was applied in this case. RESULTS: The knowledge about the selected plant came independently from several families and traditional healers. The IPR approach was to recognise that this traditional knowledge belongs to the people of Mali and was used for their benefit in developing a new "improved traditional medicine" (ITM). The traditional healer whose method of preparation was used, and who collaborated in clinical trials, did not request any financial reward but asked for the ITM to be named after him. The most sustainable benefit for the community was sharing the results of which preparation of which medicinal plant seemed to be the most effective for treating malaria. Attempts at providing a health centre and training a health worker for the village did not prove to be sustainable. CONCLUSIONS: Respect for intellectual property rights and benefit-sharing are possible even in a context where the knowledge is not owned by a clearly identified person or group of people. The most sustainable benefits are intangible rather than material: namely recognition, improved knowledge about which traditional treatment is the best and how to prepare and take it.

Prunus africana (Hook.f.) Kalkman: the overexploitation of a medicinal plant species and its legal context.

The linkage between herbal medicines and the sustainability of medical plants from which they are manufactured is increasingly being understood and receiving attention through international accords and trade labeling systems. However, little attention is paid to the fair trade aspects of this sector, including the issue of benefit-sharing agreements with traditional societies whose knowledge and resources are being exploited for commercial herbal medicine development and production. This article examines the case of Prunus africana (Hook.f.) Kalkman, from equatorial Africa. While the conservation and cultivation dimension of the trade in P. africana has been much discussed in literature, no research appears to have focused on the traditional resource rights and related ethical dimensions of this trade in traditional medicine of Africa. Serving as a cautionary tale for the unbridled exploitation of medicinal plants, the history of P. africana extraction is considered here in the context of relevant treaties and agreements existing today. These include the Nagoya Protocol, a supplementary agreement to the Convention on Biological Diversity, the Trade-Related Aspects of Intellectual Property Rights agreement from the World Trade Organization, and two African regional frameworks: the Swakopmund Protocol and the Organisation Africaine de la Propriété Intellectuelle Initiative. In the context of strengthening medicinal plant research in Africa, a novel international capacity-building project on traditional medicines for better public health in Africa will be discussed, illustrating how access and benefit sharing principles might be incorporated in future projects on traditional medicines.

Correlating traditional Ayurvedic and modern medical perspectives on cancer: results of a qualitative study.

OBJECTIVE: To characterize Ayurvedic perspectives on the etiopathogenesis and supportive treatments for a biomedical diagnosis of cancer. METHODS: Hour-long, digitally recorded interviews were conducted with 10 experienced Ayurvedic clinicians, transcribed verbatim, and analyzed using techniques of qualitative thematic analysis. RESULTS: Four major themes were identified. The Ayurvedic description of the pathophysiology of cancer uses traditional concepts translated into a modern context. Although the biomedical treatment of cancer is considered valuable, from an Ayurvedic perspective it results in degeneration and depletion. In cases where biomedical treatment of cancer is not feasible, an Ayurvedic approach focusing on strengthening digestion, eliminating toxins, reducing tumor growth, and improving tissue metabolism is useful. An Ayurvedic approach to cancer supportive care focuses on restoring equilibrium, building strength, and rejuvenation. CONCLUSION: Ayurvedic medicine offers a unique perspective on the biomedical diagnosis of cancer that emphasizes restoring wholeness, uses natural remedies, includes a focus on emotional health, and emphasizes prevention strategies.

Integrative oncology meets immunotherapy: new prospects for combination therapy grounded in Eastern medical knowledge.

As cancer rates rise globally, standard care is being questioned; new approaches involving immune therapies are emerging. With this shift comes a corresponding shift in the use and potential of herbal medicines and extracts. The focus of this article, which has evolved from a presentation at the Second Beijing International Symposium on Integrative Medicine (BISIM May 19-20, 2012), is particularly on Chinese medicine, but is generalizable to Eastern medicine more broadly and to other herbal traditions. Until recently, herbal and related treatments have been used as adjuvants to conventional care - for reducing side-effects, enhancing cytotoxicity, and sometimes, undesirably counteracting the efficacy of chemotherapy and radiation. Now, in the context of a new class of immune-based cancer therapies, herbal and other complementary modalities are looked at as enhancers of the body's immunity.

Ayurvedic genomics: establishing a genetic basis for mind-body typologies.

BACKGROUND: Ayurveda, India's natural health care tradition, has a unique way of classifying human population based on individual constitution or prakriti. Ayurveda's tridosha theory identifies principles of motion (vata), metabolism (pitta), and structure (kapha) as discrete phenotypic groupings. Patwardhan et al. (2005) hypothesized in a paper published in this journal that there is a genetic connotation to prakriti and as proof of this concept showed a correlation between HLA alleles and prakriti type, establishing a rationale and preliminary experimental support for the concept of an association between HLA alleles and the Ayurvedic tridosha theory of individual prakriti types. This work is both part of and a catalyst for a wider revolution in the scientific investigation of Ayurveda in India, referred to as "Ayurvedic biology" and "AyuGenomics." Subsequently, Chen et al. (2007) reported a similar study in this journal using a classification based on Traditional Chinese Medicine (TCM) theory. CONCLUSIONS: The findings of a genetic basis for both Ayurvedic and TCM classifications indicate a commonality between Asia's great medical traditions in their diagnostic typologies and a genetic basis for Asian traditional medicine's theory of discrete and discernable groupings of psycho-physiologic differences. Accordingly, new horizons have opened for collaborative East-East research and for an individualized approach to disease management and activation of the full range of human potential, as articulated in Ayurveda and TCM.

HIV/AIDS: Traditional systems of health care in the management of a global epidemic.

Cultural preference and the high cost and unavailability of anti-HIV drugs for people living with HIV/AIDS in the developing world leads many to turn to traditional (indigenous) medicine to manage HIV-related illness. Traditional health practitioners can play an important role in delivering an AIDS prevention message and some may be able to offer treatment for opportunistic infections. In industrialized countries, approximately half or more of those with AIDS use complementary medicines in conjunction with their antiretroviral therapy. A growing body of research highlights the immunomodulatory and antiviral potential of plant-based medicines. There are also concerns about unsafe practices and a growth in claims of traditional cures for AIDS. Partnerships between the modern and traditional/complementary health sectors in research, policy, and practice are essential in building comprehensive HIV/AIDS control strategies.

Use of osteopathic or chiropractic services among people with back pain: a UK population survey.

Questionnaires covering health and the use of complementary, alternative and conventional health services were mailed to a random sample of 14 868 adults aged 18-64 years living in four counties of England in 1997. The present study examined the use of osteopathy/chiropractic among the 15% (n = 1377) of respondents reporting back pain. Osteopaths/chiropractors were seen by 13.4% (n = 184) of respondents with back pain during the past 3 months compared with 9.8% (n = 135) who consulted physiotherapists. The presence of back pain and non-manual social class were the strongest predictors of consultation with both types of practitioner. Women, older respondents, non-smokers and those who exercised for 30 minutes at least once a week were more likely to use osteopathy/chiropractic. The only other significant predictor of physiotherapy use was desire for more physical exercise. While those reporting back pain had Short-Form 36 (SF-36) scores suggesting very significant levels ofdisability, respondents with back pain who consulted osteopaths/chiropractors reported better health in all dimensions of the SF-36 than those using physiotherapy services. Although they reported worse pain scores than people not consulting any practitioners, their mental health, physical functioning, energy and health perception were better. It is impossible to disentangle cause and effect in this cross-sectional study, but the data suggest that people who can afford to pay are more likely to choose osteopath/chiropractor treatments than physiotherapy. The possibility that osteopath/chiropractor treatment has a generalised positive effect on health, allowing people with back pain to function better than those not receiving such treatment, warrants further investigation.

A public health agenda for traditional, complementary, and alternative medicine.

Traditional medicine (a term used here to denote the indigenous health traditions of the world) and complementary and alternative medicine (T/CAM) have, in the past 10 years, claimed an increasing share of the public's awareness and the agenda of medical researchers. Studies have documented that about half the population of many industrialized countries now use T/CAM, and the proportion is as high as 80% in many developing countries. Most research has focused on clinical and experimental medicine (safety, efficacy, and mechanism of action) and regulatory issues, to the general neglect of public health dimensions. Public health research must consider social, cultural, political, and economic contexts to maximize the contribution of T/CAM to health care systems globally.

Health status of people using complementary and alternative medical practitioner services in 4 English counties.

OBJECTIVES: This study was undertaken to establish the health status of users of complementary and alternative medicine (CAM) services in England. METHODS: A postal questionnaire (response rate: 64%) covering long-standing illness, use of conventional medical and CAM services, and the United Kingdom Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) was sent to more than 14 000 adults in 4 counties. RESULTS: Sixty percent of CAM users reported having a chronic illness or disability; back pain and bowel problems were the conditions most commonly reported. Regardless of whether chronic illness was reported, CAM users reported poorer health than nonusers, particularly in the dimensions of pain and physical disability, and made more visits to general practitioners. CONCLUSIONS: In England, users of CAM services have poorer physical health than nonusers and make more frequent use of conventional medical services.