Traditional Medicine and international standards

November 11, 2006 at 8:00 am (Sarah's Posts)

I just spent the day at the 2006 World Ayurveda Congress (www.ayurworld.org/) that was held at the University of Pune, where I am studying. It was a huge event that brought together more than 4000 people who practice or are interested in Ayurveda, traditional Indian medicine. Ayurveda, which translates to the “science of life” has had a lot of bad press in international journals like JAMA and NEJM because of some problems with heavy metals in some of the herbal medicines are regularly prescribed.

Despite the fact that many traditional medical systems are quite old and well established, it seems to me that it falls into the scope of public health to evaluate these systems for their efficacy and ability to promote health. So, the question is where we begin if we want to look at traditional medicine in a culturally appropriate way.

One of the first things that I come up against is how garbled ideas, philosophies and approaches get in the process of language translation. For better or worse, English has become an international standard, which prevents many people from being able to voice their thoughts and knowledge. In addition, many traditional medical practices are based on concepts whose translations in English are, at best, imprecise. The dominance of scientific language relegates people who do not have mastery over English to the back burners of international discourse.

I read the Dali Lama’s new book a while back, The World in a Single Atom. One of his points was that the scientific method is not an adequate tool for evaluating some disciplines because some meaning is lost in taking a third person observer perspective. So, how do we incorporate first person experiences (like the experience of meditation, the feeling of wellness, or the connection between the mind and the body) into a rational objective model for analysis?

There seems to me to be a lot of understandable resistance in traditional medical communities to the perceived arrogance of outsiders coming in to evaluate practices that have been used in communities for hundreds of years. But, I think it is imperative to look at ways to measure the safety and efficacy of these treatments because most people are not empowered or knowledgable enough to evaluate the health services available to them. Nor would we necessarily be in the US without relying on extensive health regulations and a functional judicial system to hold practitioners accountable for high standards of care.

In many communities, traditional medicine is the standard of care. Care providers know their communities and they are entrusted with the health of the people there. The question that I keep rolling around is how we can use and improve these systems to provide better care to people.

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2 Comments

  1. msoule said,

    I think that anthropologists have a way of documenting those first person experiences, don’t they? I’m not one so I don’t really know, but I would think they do.
    As someone who grew up using “alternative”/”complementary” medicine to make my sickness back into wellness, I’d agree with the concern that Sarah is raising. There is not really a good way to describe my experience with these things in Western terms.
    It is here that I’d like to break into a little philosophy. Eastern philosophy differs from Western in that Eastern is often based on cycles. It does have a sense of Cartesian “True or false” to it sometimes when it needs to. But usually, it is more qualitative than quantitative. Symptoms are not Ruled Out as in Yes or No. They are documented by their levels and qualities and are connected to greater systemic imbalances. Thus, each patient has their own set of balance issues and it is hard to break them down into objective models. First person experience is fundamentally not rational or objective and so I think that it’s not worth suggesting that we could somehow make absolute models for the comparison of them. Rather, I would suggest modifying the Western model to include more of these personal experiences. Quite often, I talk to people who say that they hate doctors because they don’t feel connected to them. How can we, as future health care professionals, be sure that our patients don’t say that about us?
    Also, we in the US are often at the whim of Big Pharma to accept what they deem a reasonable level of risk. I was talking to a mom last night whose daughter was crosseyed for months as a direct result of getting an MMR vaccination that had been deemed safe by the FDA. Her son also had “a bad trip” on Benadryl. Didn’t remember a thing the next day. She was talking about medications and vaccinations in terms of blind trust in the system. She just has to hope it doesn’t let her down. Talk about not being empowered or knowledgeable enough to evaluate health services.
    Also, and this is a personal subject for me so forgive me if I sound touchy, these systems are not hundreds of years old. They’re thousands of years old. Compared to our system which is roughly 250 (according to Michel Foucault whose “Birth of the Clinic” I am reading). Which is more worthy of trust?
    I think the real question is how can we incorporate these systems into our own in order to draw on the strengths of each? Certainly there are weaknesses in traditional systems, but there are also weaknesses in our own system. A combination of the two is the best course of action, I think.

  2. aebeacon said,

    Sarah,
    I agree on most aspects of your posts. Traditional medicines have played a role (for thousands of years) in improving the health of people around the world. However, I would suggest caution when extolling the benefits of these remedies.
    First, “medicines” like female genital mutilation, the bleedings of the 17th and 18th century, olive oil and garlic for HIV/AIDS and a variety of other supposed cures fall under the auspices of “traditional medicines”. While these malevolent treatments are certainly NOT the majority of treatments, they are striking examples of how certain ancient medical practices have no acceptable place in modern times. Again, while not the majority of cures, we must be vigilant in distinguishing which treatments we should be actively incorporating into medical care and which we shouldn’t.
    That said, a huge percentage of modern medicines, acetaminophen for example, come from the plants that have long played an integral role in traditional medicines. We would be remiss as current or future medical professionals to dismiss a host of ways to make our patients better simply because the cures don’t come from Pfizer. I think that practically it would be useful to know a lot more about many traditional medicines not only so we can understand what parts of them make people better but also so that we can better know how to discriminate the good and bad.
    Fundamentally, a health worker should want their patients to get better while not making them worse. Whether that’s through traditional medicine or pharma doesn’t matter to me so long as they can make informed decisions. Right now, many people practicing medicine (I have no idea if people who fall under the title of “medical practitioners” even make up the majority of people practicing medicine but I suspect they don’t) have no basis by which to say that a given cure outside of the Western cannon is good or bad. From a medical practitioner perspective, not prescribing a traditional cure is appropriate if you have no idea if it will work. That said, its clear we need to better document which work and which don’t so that these approaches can be better incorporated into our form of medicine.
    Finally, a quick note on medical imperialism. We must be careful to suggest that western medicine is going out and destroying traditional medicine. First, every country in the world has groups of people who are neither American or nor British stooges who genuinely believe that traditional cures no longer have a place in their society. There are just as many Indian, Chinese, Nigerian and Thai doctors who think these practices are not appropriate as there are American. Second, medicine, like all other aspects of life, evolves. Pharma is a force of evolution and those medicines which stand the test of time, which produce cures for people successfully and repeatedly, will survive (see acupuncture). I once sat with a traditional healer who got up in the middle of mixing together some bones and sand to take a cell phone call. That said we must definitely work to combat the ignorance that insists all traditional medicines are poor, there are certainly many which work and, as we move forward, we must bring those with us.

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