by Matt Boyce
After our lecture from traditional
medicine experts Dr. Boyd and Dr. Stanifer last Thursday there were two points
that really resonated with me:
(1) That traditional medicine
places a special emphasis on the difference between being cured and being ill.
(2) That traditional medicine
should be viewed as a tool in a multi-disciplinary health arsenal, not an
alternative to modern medicine.
Keeping these things in mind, it
seems, to me at least, that there is a very clear and practical role for
traditional medicine in current treatment practices. And after spending some
time trying to wrap my head around an example of where I saw an application of
traditional medicine in this way, I finally settled on a current event...
Does the name Martin Shkreli ring
any bells? Yes, of course it does. Just last month he raised the price of
Daraprim, a 62 year old medication commonly used to treat parasitic infections
in immunocomprimised patients, from $13.50 a pill to $750 a pill. And in doing
so became the Scrooge of the pharmaceutical industry by hoarding wealth and
exploiting the poor, drawing condemnation of humanitarians, politicians, and
pretty much anyone with a moral compass and internet access.
Meanwhile, another pharmaceutical
competitor has stepped up to challenge him, announcing that it will now offer a
version of Daraprim for as little as $1 per tablet. But what if there were
other alternatives? Enter traditional medicine.
Ok, before I lose you, I do
recognize that’s a bit dramatic. I’m not about to argue that traditional
medicine should replace a highly effective drug. The development of modern
medicine, that is the development of antibiotics and vaccines, is one of the
most important scientific developments ever. However, I do feel that
“Traditional Medicine: Novel Treatment for AIDS and Cancer Patients” would make
one hell of a newspaper headline, and that there is a place for traditional
medicine in our current Daraprim predicament.
Let’s begin with focusing on
turmeric, one of the first few examples of traditional medicine that was
presented to us. As alluded to in our lecture, turmeric may be one of the most
beneficial spices in the world, owing largely to the fact that it contains a compound
called curcumin. Curcumin has many health benefits, including promoting brain
function, protecting against depression, and delaying aging (all of which I
hope we can all agree would promote a “sense of overall wellness”). But quite
possibly the most important benefit is it’s potent natural anti-inflammatory
attributes. While acute inflammation is great and all, as it helps fight
pathogens and helps repairs damage, chronic inflammation has been shown to be
really bad for our bodies. So bad that some researchers believe it may play a
role in heart
disease, cancer, metabolic diseases, and a
handful of other chronic, Western diseases. As such, any compound that can
suppress chronic inflammation, including turmeric, may be viewed as a potential
therapy or even prevention of disease, which also happens to be what cancer
researchers have to say about the spice.
To shift our attention to another
example of traditional medicine, let’s focus on mushrooms. Mushrooms,
especially shitake and button varieties, are excellent sources of vitamin D.
And why exactly is consuming vitamin D so great? Because while our bodies naturally
produce it when exposed to sunlight, many of us are still deficient in vitamin
D levels. This could pose a problem, or at least warrant concern, as vitamin D
has been shown to help prevent chronic illness, and also helps regulate
cellular growth, reduce systemic inflammation, and fight a whole slew of infectious diseases.
The micronutrient’s therapeutic
properties have long been recognized, and some recent studies even go as far as
to allude to antibiotic
like properties being associated with it. In fact, in the pre-antibiotic era,
physicians realized that both sun exposure and cod oil could play a protective
and therapeutic role against TB. And while the two treatments have their
obvious differences they have one thing in common: active forms of vitamin D.
So I’ll propose the following question: is it really that far of a stretch of
the imagination to think that vitamin D could also help prevent or treat
illness in these immunocompromised individuals?
While I personally do not believe
that making sure to eat mushrooms sprinkled with turmeric is remotely close to
a means to replace treatment by Daraprim in these patients, I don’t think it
could hurt to at least acknowledge the health benefits that may be achieved by
incorporating these traditional medicinal foods into their diets. Especially if
we put the time and resources into understanding the metabolic pathways that
underlie their therapeutic properties.
So, to offer a brief summary of
what we’ve covered here: We first established that Shkreli is a goon who has
put a lot of people in a bad situation. Next, tumeric, in addition to promoting
a general sense of wellness may play a role in decreasing the risk of disease
and decreasing the risk or progression of cancer, one of the immunocompromised
populations that frequently uses Daraprim. We followed that up by covering that
mushrooms containing vitamin D could act as a potential therapy to counter
infection, much as Daraprim is used as a therapy to counter parasitic
infection. Ultimately, combine the two (in the albeit oversimplified scenario I
just presented) and you get a one-two punch that could compliment other
therapies, or help fill the gaps left by the actions of Shkreli.
Matt, I think that you've made an interesting point about traditional medicine. I also agree with you opinion that traditional medicine is in no way a replacement of modern medicine. That being said I think it is important for modern physicians to look at and understand traditional medicine. I think this is important due to the fact that for many people traditional medicine is their primary source of health care. In addition to that traditional medicine is an important aspect of their culture. In Africa it is common for people to consult both western medicine and traditional medicine in order to be cured from a disease. So a physician going in to work anywhere where traditional medicine is prevalent should learn and understand the role that traditional medicine has in the culture. In the past western doctors have gone into areas and tried to uproot traditional medicine completely. You need to look no further than precolonial Africa where doctors regarded traditional medicine as "black magic" and refused to treat people as long as they were consulting witch doctors (Feierman). In conclusion I think that it is important for us as future doctors, policy makers, and program directors not to dismiss traditional medicine as a joke. It is an important aspect of culture and can potentially be used in tandem with modern medicine to treat patients.
ReplyDeleteFeierman, Steven, and John M. Janzen. The Social Basis of Health and Healing in Africa. Berkeley: University of California Press, 1992. Print.
This comment has been removed by the author.
ReplyDeleteSomething I've really enjoyed learning about over the past couple of years is related to the point that Matt brought up about turmeric, and is an issue at least partially separate from the question of how best to integrate both traditional medicine and biomedical practitioners into a holistic view of healthcare. Why does it have to be healthcare practitioners who are wholly responsible for administering treatments and cures? It's amazing that there is a huge body of knowledge related to plants and herbs that people can grow at home and that can have so many benefits for health and well-being. Traditional healers have known about this since long before the herbal medicine trend started in the West. Moringa, for example, is a plant that happens to grows best in climates where there also happen to be high rates of malnutrition; plenty of studies done on the leaves of the plant show that it contains an exceedingly high amount of Vitamins A and C, calcium, potassium, protein, and many essential amino acids. Peppermint, an easily-grown herb, has been shown to relieve nausea and indigestion. While neither is a panacea for all health issues, plants like these are easily grown in a garden and can have a wide variety of health benefits. Programs that encourage people to take partial responsibility for their own healthcare and to invest in growing these high-impact plants have huge potential to positively impact their day-to-day lives, and these programs are leveraging knowledge that already exists in the community. When combined with a healthcare system that acknowledges both cultural context and needs as well as the helpful developments of modern medicine, it may be possible to approach a healthcare outlook that is truly holistic.
ReplyDeleteThank you guys for your comments on traditional medicine. I also think that it is important to recognize the potential benefits that can come form traditional medicine and also think that we must work towards this new system of incorporating beneficial components of both modern medicine and traditional medicine. But the thing that interests me most and I think complicates this dichotomy between traditional and modern medicine, are these components of traditional medicine that are actually very harmful to patients. Dr. Stanifier spoke to his recognition of some of these harmful practices and the difficulty that he had in approaching this culturally touchy subject. It seemed as though Dr. Stanifier believes that complete understanding of traditional medicine in respective cultures is first needed before this modern, traditional blending can occur. But I am curious to see how a conversation about removing certain traditional practices, that have been practiced for centuries, would go, or how a conversation like this even begins. As Dr. Stanifier mentioned it is not worthwhile to promote against certain traditional practices unless an alternative option is also available to communities depending on traditional medicine. I think the ideal mindset that traditional medicine is used to complement modern medicine is only possible if modern medicine is made available. Otherwise a conversation on getting patients away from some harmful traditional practices toward alternate options is mute.
ReplyDeleteThis comment has been removed by the author.
ReplyDeleteThank you for this wonderful discussion and presentation on traditional medicine. I have had the same feeling towards traditional medicine for long about it being so much underrated in place of modern medicine. In Uganda where I come from, access to health services is a real challenge due to inequity, low coverage, poor supply and governance in the public health sector. In rural settings where there is low interaction is with the government formal health system (which by the way is well spread by infrastructure- the lowest unit of government the health system is called a Health Center II and it is at a parish level, a collection of several villages); many folks turn to traditional healers who use local root herbs and wild Savannah vegetation to treat patients. Many people have however been discouraged from traditional medicine by government and the general public is hostile to the tradition healers for applying "unproven medicines" and they are often shut out of any reasonable consideration leaving only the rural folk to flock to their shrines. In many African societies, traditional healers who practice traditional medicine are confused with witch doctors (who deal with spiritual aspects of life); both are passed on through family lineage initiations and the difference is blurred because in some societies same people pursue both professions simultaneously. This is the biggest challenge I see with traditional medicine in Uganda because it has a painted a blurred picture of their roles and activities often in a dark light. It is prudent to invest in developing the former and controlling the activities of the latter. Unlike in China where Tu Youyou, was awarded the 2015 Nobel Price for Medicine for his work extracting the malaria-fighting compound Artemisinin from the plant Artemisia annua, a local Chinese traditional herb used in development of ACTs (WHO's recommended first line treatment for malaria), in Africa traditional healers are vilified and not supported despite having some effective medical solutions like their Chinese counterparts and have treated locals for ages before the modern medicine arrived to the scene and continues to do so. For now, we do not have enough evidence of the contribution of traditional medicine in reducing the health burden but as stock outs persist in government hospitals, many folks continue to flock their shrines for medicines and it would would be worth investing and investigating the contribution of traditional medicine in improving health outcomes using local herbs along side the modern medicine as a synergy.
ReplyDeleteThis talk, this blog post, and all of the above comments highlight so many interesting aspects of traditional medicine and its role in today's clinical world. Something I found most interesting in the talk was the ability or willingness of some cultures to really integrate traditional medicine and modern medicine whether it be separately or together. China was the big example of this during the talk - a place where modern medicine and traditional medicine exist together. As Deena stated above, I too agree - as I'm sure many do - that the ideal mindset is using traditional medicine as a complement to modern medicine, although this can only be done if modern medicine is available. However, I agree with Leah that traditional medicine need not necessarily be "medicine" ...would it not be prudent to educate the masses on the truly health beneficial traditional medicines and learn to think of them as a part of a healthy lifestyle as opposed to "medicine?" In areas where modern medicine has yet to fully establish itself, helping to redefine traditional medicines as supplements to a healthy lifestyle (with some that are especially helpful for particular ailments), could possibly help to ease future tensions as modern medicine makes its way into places it's not been before. However, unfortunately, as traditional medicine holds such an important role in so many places, I'm not confident that this "redefining" would go over so well. I do think, though, that incorporating traditional medicine into areas where modern medicine exists but traditional medicine is not prominent would be an advantageous addition.
ReplyDeleteVery insightful perspectives. Taking China as an example, the government has been trying to effectively integrate traditional medicine into a modern health care system through establishment of traditional medicine education and hospitals. But the training of physicians and practitioners of traditional Chinese medicine is embedded in philosophies of modern medicine. They facilitated more efficient use of domestic medical resources, and enhance self-sufficiency in health development for resource poor countries. They wanted to build an inclusive medical system, which could help expand the available medical resources. And at community levels, traditional medicine resources are integrated with healthy lifestyles promoted by modern medicine, which is also an effective way to conduct intervention towards non-communicable diseases among older adults.
DeleteVery insightful perspectives. Taking China as an example, the government has been trying to effectively integrate traditional medicine into a modern health care system through establishment of traditional medicine education and hospitals. But the training of physicians and practitioners of traditional Chinese medicine is embedded in philosophies of modern medicine. They facilitated more efficient use of domestic medical resources, and enhance self-sufficiency in health development for resource poor countries. They wanted to build an inclusive medical system, which could help expand the available medical resources. And at community levels, traditional medicine resources are integrated with healthy lifestyles promoted by modern medicine, which is also an effective way to conduct intervention towards non-communicable diseases among older adults.
DeleteThanks for the wonderful blog post and comments.
ReplyDeleteBeing from a country that has a rich tradition in the use and belief in traditional herbal medicine, I am very interested approaches that can effectively integrate the use of traditional medicine and modern medicine. Among diverse cultures in Kenya for example, the use of traditional herbal medicine is so rooted that the indigenous knowledge regarding its use and practices is passed on from one generation to another. In this view- just as Deena mentioned- it would be very difficult to convince people to do away with a culture they have practiced for so long despite providing evidence of the harm associated with it. Therefore just as Daniel mentioned it would be very important for health care providers to understand the use and role of traditional medicine in such a setting in order to provide tailored care to the patients in the particular setting. Additionally to promote the effective co-existence of traditional and modern medicine in such a setting emphasis should not only be limited to the harm associated with these “medicines” but an approach that recognizes, educates and provides tools and means by which various cultures can integrate their use of traditional medicines to compliment modern medicine should be sought.
For those interested in a case study of blending "traditional" and "modern" medicine, South Africa is a great example. I spent some time working at a district hospital there, and while I was there I got the chance to meet some traditional healers. At least at that point (not sure what has happened since), the government was attempting to reconcile these two different practice groups through a referral system. Traditional healers could be licensed through the government, and had lists of patients that they cared for. If someone was not responding to their therapy, they could refer them to the local hospital for consultation. They actually had a formalized written referral book where traditional practitioners could write the treatments they had tried and what their assessments were for the consulting "modern" treatment team. It was a very interesting system that was supposed to go both directions. Unfortunately, the traditional healers I spoke with felt like their opinions were not respected, and they never received feedback from their colleagues on what they found and their different treatment strategies for patients they referred, which dampened relationships. They also failed to receive many consultations from modern practitioners to them. But in a few cases, it allowed for the referral of people who were very sick in a faster fashion, before all traditional treatments had been exhausted, for further evaluation and treatment.
ReplyDeleteI spent a large part of my childhood in Taiwan, where traditional medicine and biomedicine are both accessible and well-integrated in the culture. For example, the range of over-the-counter medications to treat bug bites range from the hydrocortisone cream, to Tiger Balm, Kwan Loong Oil, and Mopiko (popular herbal ointments), to “centipede wine,” a topical therapy where the supposed “active ingredient” is the venom extracted from a local species of centipede. I also remember a brief stay in the hospital due to pneumonia. As IV antibiotics were pumped into my bloodstream, I was also taking bowl after bowl of lily bulb soup, which is said to relieve phlegm and cough due to its cold properties. I can point to numerous other instances in the daily life of the Taiwanese where traditional ointments and therapies are used without great thought because it is so infused in the culture of the people. However, as biomedicine has become the standard of medical care in the country, there is growing suspicion of the healing powers of traditional chinese medicine. There is an increasing number of studies detailing people’s use of traditional medicine as well as scientific research on the pharmacological effects of herbals used in traditional chinese medicine. Medical care in Taiwan is a good example of how traditional medicine can coexist with biomedicine. My hope is that biomedicine can also become the standard of care in LMICs, and that eventually traditional medicine will be examined with the same rigorous approach as biomedicine to help clarify the harmful and beneficial effects of traditional remedies.
ReplyDeleteThanks for an educative and entertaining blog post. I would like to know: has there been a more aggressive push for traditional healers and doctors to collaborate more closely in some communities? Perhaps even using traditional healers using remedies provided by doctors and vice versa? Or a mild form of task shifting?
ReplyDeleteI think the cross between traditional and biomedicine is an extremely important combination to explore more, as people above have mentioned. In terms of mushroom consumption however, I think the line between traditional medicine and healthy living habits is also somewhat obscured. Eating healthy foods to obtain the essential micronutrients should not be classified as medicine, but rather a basic standard of eating a balanced diet. Eating a balanced diet and consuming essential nutrients is critical to being healthy, regardless of whether you choose to pursue traditional medicine or biomedicine when you get sick.
ReplyDelete