Integrative Medicine: Global Perspective
Gundu HR Rao and Pratiksha G Gandhi Emeritus Professor, Lilehei Heart Institute, University of Minnesota, USA Chair Person, IPC Heart Care Center, Mumbai, India
*Corresponding author: Gundu HR Rao, Professor, Laboratory Medicine and Pathology, Anesthesiology, Lillehei Heart Institute, University of Minnesota, USA, Tel: 952 594 5248; E-mail: gundurao9@gmail.com
Rec date: Mar 15, 2014, Acc date: Mar 27, 2014, Pub date: Mar 29, 2014
Copyright: © 2014 Gundu HR, et al.
This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Integrative medicine is an approach to care, which can be easily incorporated by all medical specialties and professional disciplines including, Indian Traditional Health Systems, and by all other health care systems worldwide. Its use will not only improve health care for patients, but also enhance the cost effectiveness of health care delivery for providers and payers and facilitate the development of universal health care for all. A practical strategy, integrative medicine puts the patient at the center (patient centric) and addresses the full range of physical, emotional, mental, social, spiritual and environmental influences that affect a person’s health. Important elements of an integrative approach to health care include, engaging the patient as an informed and empowered partner and personalizing the care to best address the individual’s unique conditions, needs and circumstances. This approach is totally lacking in the modern allopathic system worldwide. The integrative approach emphasizes prevention, health maintenance and early intervention, and utilizes all appropriate, evidenced-based and personalized therapeutic approaches, to achieve optimal health and wellbeing across one’s lifespan. Although this is the basic strategy of all Indian traditional health systems, they lack evidence-based or observation-based clinical data, to support the benefits of such an approach. Global Alliance of Traditional Health Systems, a new platform that promotes integrative approach, is developing strategies to collect and collate observation-based clinical data on the safety and efficacy of Traditional Indian System of Medicine. In this presentation, we review some aspects of “Global Perspective” on this subject and suggest ways to develop and promote this method of healthcare delivery.
Introduction
South Asians have the highest incidence of coronary artery disease (CAD), compared to any other ethnic group in the world [1-3]. In addition, they also have a high incidence of cardio-metabolic disorders such as hypertension, central abdominal obesity, type- 2 diabetes (T2D), vascular disorders and stroke [1-4]. Currently we have 65 million type-2 diabetics in the country and an equal number of pre- diabetics [4]. To create awareness develop educational and preventive programs, I started a society, South Asian Society on Atherosclerosis and Thrombosis (SASAT) in the USA in 1993. Since then we have organized over 15 international conferences in India and published several books and scholarly articles on the subject. To promote the concept and practice of Integrative and Alternate Medicine, we are working with AYUSH, IPC Heart Care Center, Mumbai, as well as we are starting two new platforms, a dedicated institution, Institute of Preventive Medicine (IPM), and a professional society, International Society for Prevention of Atherosclerosis and Thrombosis (IPSAT).
During SASAT-2010 conference in Bangalore, we organized a Round Table Discussion on the subject of “How to Provide Affordable Health Care to All”. The experts who were present in these discussions felt an immediate need for the creation of a novel platform that provides accessible, acceptable and affordable health care for all. Since the modern medicine as we know today, cannot be provided to all levels of the community, it was felt desirable to bring all the Indian traditional therapies on a common platform. In view of these observations, it was decided to launch a platform called, Global Alliance of Traditional Health Systems (GATHS: www.GATHS.org), to standardize and promote traditional therapies. We also launched a sister platform called, Mind Body Spirit Society of India, to complement the Integrative Medicine. This concept was presented at the 4th World Ayurveda Conference (December 2010) in Bangalore. Bringing traditional methods of therapies as an alternative or complementary medicine is called “integrative medicine” in other countries [5-7]. In India and other developing countries, these traditional therapies are the mainstream therapeutic modalities available. Integrative medicine by and large, is an approach to health care that can be easily incorporated by all medical specialties and professional disciplines, and by all health care systems. If the integrated platform could be developed well, its use will not only improve health care for patients, but also will enhance the cost effectiveness of health care delivery for providers as well as payers. Since in a country like India, less than 10% of the individuals are covered by health insurance, we will have to find a novel way to empower people to take charge of their own health care. Integrative approach to health care should include engaging the patient as an informed and empowered partner and personalizing the care to best address the individual’s unique conditions, needs and circumstances.
To develop such a system, we need to bring in multiple stakeholders and develop the needed infrastructure, at the level of the community health centers. In view of this need, we have launched an alliance of traditional healers (Global Alliance of Traditional Health Systems: GATHS), so that we can develop a well-harmonized, accessible, acceptable, and affordable health care to all. By bringing traditional therapeutic specialties like Yoga, Ayurveda, Unani, Siddha, Naturopathy and Homeopathy and the science of spiritual healing modalities, we can address the full range of physical, emotional, mental, social, spiritual aspects, which affect a person’s health. By treating the whole person (holistic approach), both the patient’s immediate needs as well as the effects of the long-term and complex interplay between a range of biological, behavioral, psychosocial influences can be addressed. This process enhances the ability of individuals to not only get well, but most importantly, to stay well. The integrative approach emphasizes prevention, health maintenance and early intervention, and utilizes all appropriate, evidenced-based and personalized therapeutic approaches, to achieve optimal health and wellbeing across one’s lifespan. This fits very well with the mission and vision of our professional societies, South Asian Society on Atherosclerosis and Thrombosis (SASAT), International Society For Prevention of Atherosclerosis and Thrombosis (ISPAT), as well as that of the new alliance (GATHS) that we have initiated. Although traditional therapies are well accepted in India and neighboring countries, European countries and USA have not approved these therapies. A British Professor of great authority on Alternate Medicine described Traditional and Alternate Medicine as hocus or quackery in the May 19th issue (2011) of The Economist [8,9]. In view of such observations, we feel strongly, that we need to debate these issues and develop acceptable guidelines, protocols and white paper on this subject, so that these ancient therapies are not ridiculed on international platforms. We also feel that it is time, we establish robust collaboration between AYUSH, India and academic centers in the west, to promote and develop these therapies to the same standard as western medicine. With such ideas in mind, we are planning to organize symposiums and workshops in selected academic centers in India as well as in the USA. The Omics Group recently (December 9-11, 2013) organized an international Conference on “Traditional and Alternate Medicine” in Hyderabad, India. This overview was presented as a Key Note Address in that Conference, to provide a Global Perspective on this very important topic.
In recognition of the growing body of evidence, in February of 2009, Institute of Medicine (IOM), National Institutes of Health (NIH), USA organized a Summit on Integrative Medicine and Health of the Public [7]. More than 600 Health Partners, Scientists, Policy Makers, Academic Leaders and Patient Advocates presented their views on the subject. The IOM Summit Summary States, “quote”, “The disease-driven approach to care has resulted in spiraling costs as well as fragmented health system that is reactive and episodic as well as inefficient and impersonal”. According to IOM, “The first priority for any health care system using an integrative approach is to ensure that the full spectrums of preventive opportunities –clinical, behavioral, social, spiritual and environmental- are included in the care and delivery process”. This is not any new idea, but a collective thought from the US Public Health System, which as early as in 1991 established National Center for Complementary and Alternative Medicine (NCCAM) [5]. This organization of the US Public health service has set aside millions of dollars to promote Complementary and Alternate Medicine (CAM) at US Health Care facilities. A consortium of Academic Health Centers participating in CAM programs has been established.
Over 50 US Academic Institutions have CAM programs funded by NCCAM. One can get the information on the CAM programs that are funded and explored at various educational and research institutes in the US [8]. Therapeutic aspects of Traditional Medicine in which herbal products or herbal preparations are used, have no place in this system, as both the European Union and US-FDA have banned the sales of these products for therapeutic purposes in their respective countries. Added to this restrictions by the international regulatory bodies, Dr Edzard Ernst, Professor of Alternative Medicine at the Peninsula Medical School at South-West England, wrote articles in the May 19th issues of The Economist (2011): “Alternate Medicine: “Think yourself Better”. Alternate medical treatments rarely work. But the placebo effect they induce sometimes does”. He also wrote another article in the same issue. “There is no Alternate Medicine: Virtually all- alternate medicine is bunk, but the placebo effect is rather interesting” [9,10]. Furthermore he wrote to the UK funding agencies, to stop funding to all these therapeutic modalities. We the members of Global Alliance of Traditional Health Systems, Mysore, discussed these issues during our National Conference on Challenges and Opportunities in Traditional Medicine (GATHS-2012, Mysore).
Contrary to the UK approach, in the USA, many prestigious health care organizations such as the Mayo Clinics, Rochester, Minnesota; satellite clinics of Mayo at Arizona, Florida, and Scripps Health in Southern California, operate integrative medicine centers. What does this integrative medicine offer? In most of the centers, it is by and large, Life Style Heart-Health Programs or Cardiac Wellness Programs or Yoga and Meditation (Spirituality). Going to an Integrative Medicine specialist, say integrative oncologist, will not change the diagnosis or prognosis, but it will put your body and mind in a better state of mind to get healthy or to tolerate the rigors of therapy. It is important to realize that it is not a cure but a complementary treatment. In Medanta- Hospital (The Medicity) in New Delhi, India, a young Robotic Surgeon is using Yoga as a complementary therapy before and after surgery. He is collecting data on the overall response of patients. In his presentation at the 5th Ayurveda Conference (2013) in Bhopal, he gave a very impressive talk on his findings. All the patients who received the complementary Yoga therapy felt better and rated this approach better than surgery without such a complementary program. What is so hard about the integrative approach and why the difference in the way the East and West looks at it? Integrative approach is not treatment focused; it is a way of life. Just like the holistic treatment is a way of life compared to the modern medicine, which is disease focused. Traditional Medicine practitioners will accept this philosophy better than the allopathic doctors. The traditional therapists believe in the benefits of holistic approach. Life style programs for example, which focus on nutritional interventions, stress reduction, moderate exercise and the development of emotional wellbeing (mindfulness) can reduce or sometimes-even reverse the progression of chronic diseases. Several clinical studies have demonstrated the benefits of such an approach for people suffering from cardio-metabolic disease such as hypertension, diabetes, heart disease, chronic pulmonary disease and cancer. Global utilization of such holistic health management practices will not only improve patient’s lives, but also drastically reduce health care costs. Data presented at the IOM summit in 2009 revealed, that five chronic conditions, diabetes, heart disease, asthma, high blood pressure, and depression account for half the US health care cost. This is true for the less developed countries also. Indeed, management of these diseases amounts to major health care burden. In view of these observations, there is a great move at the level of United Nations, to forge a Global Alliance for the Prevention of Non-Communicable Diseases (NCDs) [11].
The integrative approach emphasizes prevention, health maintenance and early intervention, and utilizes all appropriate, evidenced-based and personalized therapeutic approaches, to achieve optimal health and wellbeing across one’s lifespan. Although this is the basic strategy of all Indian Traditional Health Systems, they lack evidence based or observation-based clinical data, to support the benefits of such an approach. Global Alliance of Traditional Health Systems, a new platform that promotes integrative approach, is developing strategies to collect and collate observation-based clinical data on the safety and efficacy of Traditional Indian System of Medicine. In the month of October of 2012, National Conference on Medicinal Plants and Herbal Products was held at Maryland, USA. At that time, Indian Ambassador to USA, Ms Anupama Rao expressed confidence; that the conference will provide a unique platform to share information, foster research and development, promotion of safe and effective use of medicinal and herbal products. Professor Krishna Banaudha an expert of CAM at the George Washington University said, that the use of this traditional knowledge of healing in the USA has remained restricted. He pointed out, that severe lack of validating traditional therapies with the rigors of clinical research and support has hampered its promotion in the western countries. He also welcomed the recent announcement by AYUSH, India, to make clinical trials mandatory for all existing and new Ayurvedic medicinal products. In the US, policy makers have suggested following steps: dietary supplements undergo an FDA review of evidence for safety and efficacy prior to approval; dietary supplements display standardized FDA-approved labeling that clearly describes safe use, potential drug interactions, and cautions for special populations; the FDA enforce GMPs for these products; all dietary supplements meet FDA- established standards for identity, strength, purity, and quality; the FDA establish and maintain an adverse-event reporting system specifically for dietary supplements [12-15].
There is lot of concern and debate over this issue. Many Vaidyas (Ayurvedic Doctors) feel that, Ayurveda is an ancient healing art, which has come from the sages and has survived for thousands of years and hence, there is no need for clinical validation. Whereas, if Traditional Medicine as practiced in the East has to reach Global platform, then the development of this ancient healing art with the rigors of clinical research and evidence is essential. It is not my opinion or suggestion, that we should please the west or become Global, but I for one will feel great, if we can demonstrate the true value of this ancient science and art of healing with some evidence based documentation. I have been asking the Vaidyas for years now, that it is time, that we start digitizing our data, collate our data and observations, so that we can develop the needed observation based evidence. Even a minimum documentation as to what was the ailment for which the treatment was given, what was nature of the treatment given and a follow up of the response of diseases to the treatment given, will go a long way, as far as the documentation of the observation based evidence is concerned. One of the major hurdles for the advancement of Traditional Medicine in India is, the lack of a National Platform, to address issues related to this aspect of health care. It is high time we develop postgraduate research and education platforms in this area. Recently, I chaired a debate organized by The Himalaya Drug Company in Mysore, for JSS Ayurveda postgraduate students. The topic was relevant and encouraged the students to speak out about the need for clinical validation and research in Ayurvedic Sciences. The two main topics that were debated included:
1). Clinical Documentation and Evidence Based Medicine: “Need in Ayurveda”.
2). Contemporizing Ayurveda Pharmaceutical Industry “Need Versus Challenges”. We should have more such debates at Regional and National levels for students and the faculty, conducted by Herbal Medicine Industry as well as AYUSH, India, so that the students and faculty start asking questions and think “out of the box” about the relevance of such studies for the overall improvements in the way the traditional medicine is practiced today in the country.
Conclusion
In Conclusion, “Integrative Medicine” is a novel approach to healthcare, which can be easily incorporated by all medical specialties and professional disciplines including, Indian Traditional Health Systems, and by all health care systems worldwide. In brief, it incorporates what is best in Eastern Medicine and Western Medicine. However, from “Global Perspective”, there is a great difference in the way this discipline is perceived and practiced in the West and in the developing countries. In the west, especially in the USA, complementary and alternative medicine (CAM) is used as supplementary to the modern medicine. Whereas, what is CAM, in the west, is the primary health care in majority of the resource poor countries, as well as developing countries. In India for example, people who depend upon the indigenous medicine, use the modern medicine, when all the therapeutic modalities of Indian Medicine fail to provide the relief. In a country like India, where majority of people are deprived of modern health care, a novel integrated approach may be the only way, to provide the much needed health care, to the community at large. A simple diagnostic platform that can identify the common risks and an AYUSH approved, consulting facility with
clinicians from all the various Indian Systems of Medicine can indeed provide a holistic preventive health care for a large section of the society.
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