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Public Health and Policy
Professor Bodeker presented a framework for a public health research agenda during a keynote address to the 3rd International Conference on Complementary Medicine Research, on 31 March 2008, Sydney, Australia.
GIFTS of Health has published a book with Imperial College Press, London, on Traditional, Complementary and Alternative Medicine: Public Health & Policy Perspectives (G Bodeker & G Burford, Eds., 2007) http://www.icpress.co.uk/books/medsci/p419.html
Positive reviews were received in 2008:
WHO Bulletin review:
http://www.who.int/bulletin/volumes/86/1/07-046458/en/index.html
JACM Review:
http://www.liebertonline.com/doi/abs/10.1089/acm.2007.0723
HerbalGram, Jan 2008:
"This edited volume provides a compelling global overview of traditional, complementary, and alternative medicine."
World Health Organisation Global Atlas on Traditional, Complementary and Alternative Medicine
GIFTS of Health took a leading role in researching and compiling the recently published World Health Organization Global Atlas on Traditional, Complementary and Alternative Medicine (WHO, Geneva, 2005). Professor Gerard Bodeker was Editor-in-Chief for the whole Atlas, with GIFTS research associates Dr. Chi-Keong Ong and Ms. Gemma Burford among the co-editors. Other partners were the WHO Centre for Health Development, Kobe, Japan (WHO Kobe Centre) and a GIS mapping team at the London School of Hygiene and Tropical Medicine.
The WHO Global Atlas consists of a map volume and an accompanying text volume. The former uses maps, charts and tables to provide visual information on policy, legislation and infrastructure relating to traditional, complementary and alternative health care (TCAM), as well as the popularity of different health systems around the world. The text volume includes regional overviews of the status and utilisation of TCAM, case studies of selected countries, and discussion papers.
Commonwealth Working Group on Traditional and Complementary Health Systems
For three years (1999-2001), GIFTS of Health acted as Secretariat of the Commonwealth Working Group (CWG) on Traditional and Complementary Health Systems. This entailed developing guidelines and information on traditional medicine and policy, and reporting to the Health Ministers of the 52 Commonwealth countries. GIFTS Chairman, Professor Gerard Bodeker, was a member of the Technical Advisory Committee to the 12th Commonwealth Health Ministers’ Conference, and prepared a Ministerial briefing on “Health Sector Reform and Traditional Medicine”. The CWG is now helping to establish a global information resource on traditional medicine, hosted by the Government of Malaysia.
Complementary Medicine in the UK
The Oxford Healthy Lifestyle Survey (1997-1999) looked at the use of health services and lifestyle health choices by a sample of almost 9,000 people in the Midlands in
Britain. GIFTS of Health worked with the Oxford Health Services Research Unit on data pertaining to complementary and alternative medicine (CAM) use in the UK.
This work was led by Dr. Chi-Keong (Paul) Ong, then of GIFTS, now a GIFTS partner working at the University of Warwick. See Ong et al, ‘Health status of people using complementary and alternative medical practitioner services in four English counties’. American Journal of Public Health; 2002, 92: 1653-1656.
The study found that users of CAM practitioner services tended to have poorer health than non-users, particularly in the dimensions of pain and physical disability, and
also to make more frequent use of conventional medical services. Back pain and bowel problems were the conditions most frequently reported among CAM users.
Back pain was found to be a significant predictor of the use of osteopathic and chiropractic services. (OR=5.6), while bowel problems, depression, diabetes and skin conditions predicted visits to spiritual and religious healers.
Communicable Diseases and Common Illnesses
Malaria
The Research Initiative on Traditional Antimalarial Methods (RITAM) (www.gifts-ritam.org), was founded by GIFTS of Health in 1998 to bring together researchers, health practitioners and policy-makers with an interest in traditional/herbal methods of combating malaria. The inaugural meeting took place in December 1999 at the Tumaini University of Medical Sciences, Moshi, Tanzania, with funding from the Rockefeller Foundation, the Multilateral Initiative on Malaria (MIM) and the Tropical Disease Research (TDR) Division of the World Health Organization. Targets included producing standardized guidelines for assessment of candidate plant species; raising funds and awareness; and building partnerships for future research.
Many of the participants in the 1999 RITAM meeting, and a subsequent workshop held in November 2002 as a parallel session to the MIM Conference in Arusha, Tanzania, have contributed papers to a book entitled ‘Traditional Medicinal Plants and Malaria’, eds. Merlin Willcox & Gerard Bodeker, and Philippe Rasoanaivo (CRC Press, Boca Raton, FL, 2004). The book includes research guidelines for ethnobotanical, pre-clinical and clinical studies on antimalarial plants, including issues of community access, benefit sharing and intellectual property. There are also a number of case studies of traditional preparations used worldwide in the treatment of malaria. Click here for a full table of contents.
RITAM takes a holistic approach that incorporates the repellence and control of mosquitoes, as well as the use of herbal antimalarials and prophylactics within their local contexts. It encompasses both plants that have direct antiplasmodial effects and those that contribute in other ways to the well-being of malaria patients, such as antipyretics and immunostimulants. Some members are also addressing issues of synergism between different plants in traditional mixtures, and between herbal and conventional antimalarials: for example, a clinical trial of a plant reported to reverse Plasmodium resistance to chloroquine is currently in progress in Madagascar. This is in contrast to the conventional ‘bioprospecting’ approach, in which traditional medicine is used solely as a source of active ingredients for the pharmaceutical industry.
Membership of RITAM is free of charge. To apply, please contact RITAM Secretary, Dr. Merlin Willcox at . RITAM currently has a network of over 300 scientists, organised into four specialist groups:
(a) Pre-clinical assessment of traditional medicinal plants used in preventing or treating malaria (ethnobotanical, pharmacological and toxicological studies)
(b) Clinical assessment (observational studies and clinical trials)
(c) Repellence and vector control
(d) Policy, advocacy and funding
The RITAM Electronic Newsletter is circulated by e-mail to all members. RITAM also maintains a database of several hundred published and unpublished studies on medicinal plants and malaria.
HIV / AIDS
The GIFTS HIV work includes:
1. CONFERENCE ORGANISATION & PRESENTATIONS ON TRADITIONAL MEDICINE & HIV/AIDS
- Articles published in the Journal of Alternative & Complementary Medicine on traditional medicine & HIV, and a chapter in Bodeker & Burford (2007) on this topic.
- Women’s health, traditional medicine & HIV. Conference on Women’s Health & Asian Traditional Medicine, Kuala Lumpur Malaysia, 23-25 August 2005.
- HIV/AIDS & perspectives from Traditional Medicine. Health Worlds Asia conference. Kuala Lumpur, Malaysia, 3 September, 2004.
- Global Holistic Health Summit, Bangalore, India. Co-chair and presenter in symposium on traditional medicine and HIV-related illness. 12-17 January, 2003.
- Organizational Member, International Organizing Committee, First International Conference on Siddha Medicine and HIV/AIDS. Gandeepam, Tamil Nadu, India. December, 2001.
- Co-organiser with Delhi Society for the Promotion of the Rational Use of Drugs: Conference on ‘Traditional Medicine and HIV in India: A journey to dialogue’. Delhi, India, 9-10 November 2000.
- Co-convenor with IDRC and the World Bank of a symposium on traditional medicine and HIV/AIDS. Regional conference on: Medicinal plants, traditional medicines & local communities in Africa: Challenges & opportunities of the new millennium. A Parallel Session to the Conference of Parties (COP-5) to the Convention on Biological Diversity (CBD). United Nations Centre, Nairobi, Kenya. May 2000.
- International Conference on AIDS & STDs in Africa (ICASA). GIFTS Chair, G Bodeker, member of Planning Committee. Convenor and chair of symposium on Traditional Medicine and HIV/AIDS in Africa. Lusaka, Zambia, September 1999.
2. RESEARCH DEVELOPMENT
Partner in East & Southern African Research Partnership on HIV/AIDS, coordinated by THETA, Uganda; established 2000.
Partner with Delhi Society for the Promotion of the Rational Use of Drugs: Conference on developing clinical protocol for evaluation of traditional medicine and HIV. 2000 & 2001.
Partner with Indian Government, national research organisations & NGO’s on clinical trial development for the evaluation of South Indian herbal treatments in the management of HIV/AIDS, 2001-2006.
Graduate student research: two masters theses have been done within the GIFTS-HARITHA ethnomedical research in Gandeepam, South India (www.gandeepam.org). One by Mark Dvorak-Little of Oxford University; one by Priya Lall of Warwick University (2004-2005).
Dermatology and Wound Healing
GIFTS of Health has a long-standing partnership with the International Foundation for Dermatology (IFD), an organization committed to improving skin and wound care services in rural areas of developing countries, with the goal of “Healthy Skin for All”. Several joint symposia have been convened at international dermatology conferences on the subject of the contribution made by traditional health care systems towards the achievement of this goal. This incorporates promotion of healthy skin through the regular use of traditional soaps and emollients, as well as the treatment of skin pathology. GIFTS researchers have also contributed to a number of articles in peer-reviewed journals and edited volumes relating to these topics.
Since its inception, the IFD has focused on establishing Regional Dermatology Training Centres (RDTCs) to address the urgent need for training or re-training of medical workers in Dermatology and Venereology, to serve the needs of rural populations. These centres aim to develop skin care protocols based on low-cost, locally available medicaments wherever possible, through small-scale epidemiological studies and partnerships with traditional health care providers. To date, one major centre has been set up in Tanzania, Africa and a smaller centre in Guatemala, Latin America. The process of establishing another RDTC for Asia in China is now under way, in collaboration with the Institute of Dermatology of the Chinese Academy of Medical Sciences (IDCAMS) in Nanjing. GIFTS of Health will be involved in the project throughout its lifespan, and a major involvement of Traditional Chinese Medicine has been planned.
Special Populations
Refugees
The contribution made by traditional healthcare services to the physical and psychological well-being of refugees, particularly those living in camps, is rarely acknowledged at the international level. GIFTS of Health, in collaboration with the Oxford Refugee Studies Centre, conducted a research and development programme at the Thai-Burma border from 2001-2003, focusing on the utilization of traditional healthcare by Burmese refugees. The project included: training of clinic staff in herbal medicine; research on Mae Tao Clinic outpatients' use of and belief in traditional medicine and spiritual practices; and initial work on the development of networks of herbalists in the Thai-Burma border region. Training programmes stimulated the development of several traditional healthcare initiatives and knowledge exchange networks throughout the border region. Outpatient survey findings revealed that 59 refugee respondents listed 271 traditional remedies used for common health conditions. Research on psychosocial health found that separation from ancestral spiritual practices and shrines in the home country may exacerbate and even prolong mental health conditions. Cooperation between Western clinical services and traditional health practitioners was found to be intimately linked with refugee health and well-being, including cultural continuity and identity.
GIFTS of Health is currently carrying out field research to examine the extent and significance of traditional healthcare use among Burmese refugees living in camps in western Thailand. The Chiang Mai Botanical Garden is assisting with the identification of plants. A herbal handbook has been produced for families in refugee villages by KESAN, a local NGO, building on the initial GIFTS work. GIFTS of Health is assisting with printing costs and for additional copies as the demand is high among families with little or no access to other forms of healthcare. Our research suggests that use of medicinal plants is widespread and that traditional healers provide a valuable service, helping people to maintain a sense of cultural identity while coming to terms with displacement and bereavement. Based on this work, a network of herbal clinics has been established along the Thai-Burma border, bringing herbal health services to populations who were previously not served with any form of health care. Several hundred hectares of forest have been set aside as medicinal plant conservation sites and sources for the sustainable harvesting of medical plants for community use and small scale herbal medicine production.
Women’s Health
GIFTS of Health was an international partner in the International Conference on Women’s Health and Asian Traditional Medicine (WHAT Medicine 2005) held in Kuala Lumpur, Malaysia from 23rd to 25th August 2005. The aim of the conference was to bring into focus the Asian healthcare traditions used by generations of women to care for their families and their own health needs. It was hoped that the conference would stimulate a process of ensuring that the best of these traditions are preserved, promoted, evaluated and used as culturally appropriate strategies for meeting women’s healthcare needs in contemporary society.
Specific themes included theory and practice within leading Asian medical traditions (e.g. Ayurveda, Unani, Siddha, Traditional Chinese Medicine and traditional Malay medicine); women’s reproductive and gynaecological health; menopause and ageing; skin health and beauty; gender-specific perspectives on degenerative diseases and sexually transmitted infections; nutrition and lifestyle; and socio-legal issues, including ownership and intergenerational transfer of traditional health knowledge.
WHAT Medicine 2005 was supported by a high level international team of scientists and traditional medicine practitioners and was co-chaired by Professor Gerard Bodeker, Chair of GIFTS, and Professor Fredi Kronenberg, Director of the Rosenthal Centre for Alternative and Complementary Medicine in the College of Physicians & Surgeons, Columbia University, USA. The conference was accompanied by an exhibition of Asian traditional medicines and therapies (including dietary supplements, natural/functional foods, and skin health and beauty products) as well as companies providing ancillary services related to the field.
Biodiversity
A significant number of the world’s medicinal plant species are defined as globally endangered, and many more are threatened at a local level, as a result of factors such as over-harvesting and habitat destruction. The search for sustainable solutions is complicated by the fact that international agencies working on environmental issues often have little interaction with the organisations and individuals involved in traditional healthcare.
GIFTS has generated several publications during 2005-2008 on this theme and has worked with COMPAS, an international NGO based in the Netherlands and working on sustainable endogenous development . Professor Bodeker represented GIFTS at the Commonwealth Forestry conference in Colombo, Sri Lanka, in 2005, presenting on sustainability issues concerning of forest-based medicinal plant harvesting.
In May 2000, GIFTS of Health convened a parallel meeting to the Fifth Conference of the Parties to the Convention on Biological Diversity (CBD) on the topic of “Medicinal Plants, Traditional Medicine and Local Communities in Africa”. The aim of this conference was to bring together representatives of African NGOs, governmental and inter-governmental institutions from both healthcare and environment fields, with a view to disseminating best practices for the conservation and sustainable use of medicinal plants. It also addressed issues of intellectual property, access and benefit sharing as set out in Article 8(j) of the CBD.
One outcome was the ‘Nairobi Declaration’ on the need for official recognition of traditional medicine by African governments and for measures to conserve medicinal plants. The Organisation of African Unity (now the African Union) officially adopted this declaration in July 2001, together with the recommendation that the decade 2001-2010 should be declared a ‘Decade of African Traditional Medicine’.
GIFTS Research Associate, Gemma Burford, also carried out a scoping project on medicinal plant biodiversity in two villages in Northern Tanzania in 2001, in collaboration with the United Nations Development Program/Global Environment Facility/National Environmental Management Council (UNDP-GEF-NEMC) East African Cross-Borders Biodiversity Project. The findings highlighted indigenous conservation measures, such as taboos on unsustainable harvesting methods and the protection of small areas of forest for traditional medical treatment.
Intellectual Property Rights
GIFTS of Health members are occasionally called on to advise on intellectual property issues, as ownership of traditional medical knowledge is a growing concern of both indigenous groups and governments. For an extensive review of this topic, see: G. Bodeker, Intellectual Property, in Bodeker G & Burford G, Traditional, Complementary and Alternative Medicine: Public Health & Policy Perspectives; Imperial College Press, London (2007); and in Bodeker G, 2003. Traditional Medical Knowledge, Intellectual Property Rights and Benefit Sharing. Cardozo Journal of International and Comparative Law, 11 (2003), 785-814. New York.
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