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Traditional Healers and Evidence-Based Medicine

Ranabir Pal*, Pradip Kumar Mohanta, Gautam Sarker, Neeti Rustagi, Ayan Ghosh

Department of Community Medicine and Family Medicine All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Abstract: Traditional medicine is the oldest primary care with 400 million practitioners across the globe. Many consider traditional medicine to be unsystematic and not based on science, with voluminous apprehensions. Yet, due to reasons better known to them as care-seekers daily patronize traditional healers by accepting them as ‘Friend, Philosopher and Guide’. Otherwise in absence of 'receivers of treatment' these traditional healers would not have survived over years with respect from the community. They are true professionals. Our so-called academic understanding is nothing in front of their generations old practical knowledge stored in their senior members. From the pragmatic and empiricist medicine of 5000 BC, today medicine has put off the robe of ego for the ultimate benefit of mankind amidst profiteering groups. We have to use both individual clinical expertise and the best available evidence for the benefit of mankind. From the age old concept of ‘Doctor’ as ‘healer, preacher and teacher’, we have currently reached the era of evidence based medicine- ‘What is the evidence that what you have just advised, works’. Practicing evidence based medicine will identify and apply the most efficacious interventions with ideas and concepts to think positively to maximise the chances of individuals, groups and communities to attain and sustain, long happy and fulfilled lives. The empiricist traditional healers are truly practicing 'Evidenced Based Medicine' in their own limited way. We have to pass through painstaking process to help them learn how to improve.

Keywords: traditional healers, evidence-based medicine

Citation: Ranabir Pal, Pradip Kumar Mohanta, Gautam Sarker, Neeti Rustagi, Ayan Ghosh, Traditional Healers and Evidence-Based Medicine. American Journal of Public Health Research, 3 (5A). 194-198. January 2015. doi:10.12691/ajphr-3-5A-41

1. Introduction

Evidence-based medicine (EBM) intends to relate the translational evidences achieved from the scientific method to decision making in health care services [1]. This scientific advancement applies to other fields of health care delivery in an additional encompassing term to evaluate the strength of substantiation of the risk and benefit of interventions [2]. Discourses persist on the prediction on desirable outcomes in healthcare evolving updated guidelines, policy, and regulations to form the corpus of the evidence-based healthcare those in the long run will lower the cost of the health care [3]. The philosophical origins of EBM dates back to mid-19th century in Europe rolled on the clinical parlance involving public policy advocacy, stakeholders and, planners. Evidence based medicine is not only restricted merely to randomized trials, systematic review or meta-analyses, but also involves roadmap to finest substantiation to rejoinder our clinical acumen. To optimize the accuracy of a diagnostic investigation, we need to find appropriate studies on clinically suspected individual with the relevant disorder that may or may not be always the randomized trial [4]. Starting from the days of Socrates empathy has been the driving force to strive for healing with the ever growing body of health care statistics [5].

2. The Perpetual Challenge

Modern medicine practitioners and traditional healers have long been at the opposite camps with one another in the community. There are innumerable traditional healers who are conventionally termed as the "local doctors" in different corners of the world. I believe this is the time to take an open mind with broad eyes at ‘what they proclaim to be’, ‘what they are able to do’, ‘how they ensure it’, ‘what they are not able to treat’ and in the downstream ‘how to improve on them’ for the sake of the broader mass of the population. This is very important because people have a lot of confidence in the traditional medicine and they will continue to use them for the days to come. Sometimes, one approach is often paraded in one place as remedial for many ailments and the health seekers accept them for the fact that such a medicine may be very potent. The health professionals should help to document ‘what these are’ - ‘what they can and cannot do’ to be shared by all for the benefit of the world population. But when healer’s decision is only on faith, tradition, or what the patient asks for, without reference to and knowledge of efficacy or risk, does that healer deserve such trust?

3. Global Journey

World Health Organization has globally acknowledged the crucial role of traditional health practitioners based on rich experiences from Asia, Africa (80%) and Latin America in primary heath arena. In Zambia, 60 percent of the population receive medical care from traditional practitioners including the educated urban people because where they have been reinstated from disrespected historical regrettable label of ignorant or uncivilized witchcraft with honor in AIDS care. Against the challenges of poverty, they are deep rooted among disadvantaged masses of people that is more affordable and culturally acceptable than their trained counterparts of modern medicine. In spite of their questionable health literacy and training, they are comprehensively rooted sharing problems of community from womb to tomb in remote areas of the world. The cost-effective poles apart novel idea in Uganda of their capacity building in HIV/AIDS helped early intervention by bridging the gap in case finding [6].

4. Traditional Approach

On equal footings of other important health service providers, traditional health practitioners in the African continent are also acceptable to manage socio-psycho-physical problems in their communities, they are accepted as the trusted, accessible and available friend in need. The traditional healers usually refuse to share knowledge, because this has cultural implications, the knowledge is usually passed by a father to one of his sons and is not just any son, it will be the one who has good character and showed interest whilst young, will go with him as a learner. Most of them take no charge for treatment. They are saving lives of millions of patients since generations without rest. In India, they hold a reputation of quacks and their practice is considered illegal. There are also challenges before the traditional healers to incorporate in the mainstream of health care providers. These are autonomy, limited non-verbal communication, and generating evidence in their concept of holistic approach. More than a hundred healers' associations are active in central and peninsular India. There is a need for the Government to recognize their perennial contribution as a stepping stone is their recognition in an proper way and as a policy action in line with the framework of activities of International and national stakeholders for the survival and growth of health traditions exploiting locally available resources [7].

Traditional health practitioners (THPs) and their role in traditional medicine health care system are increasingly accredited. Traditional medicine (TRM) and Alternative or Complementary medicine is increasing getting footsteps due to uphill trends of HIV/AIDS, malaria, tuberculosis and other diseases like cancer. In this scenario, genuine concern from the public and scientists/biomedical health practitioners (BHP) on efficacy, safety and quality of traditional healthcare has been raised [8].

5. South African Legislation

In South Africa, traditional healers treat about 30 million people with rich indigenous resources that may be misappropriated in the name of patents by vested interest, by protecting their rights of age old knowledge bank with honorable share of downstream paybacks. South African government has created regulatory instruments to safeguard and uphold the indigenous knowledge by legislation, and national initiatives to transform the traditional knowledge and what these outcomes for the stakeholders [9].

6. Charity Begins at Home

In the Indian scenario let us think of recognizing the talents of evidence based medicine among the traditional healer who does not even get recognition from so called erudite masses. National Health Mission (NHM) had accepted some of the mainstream 'alternative medicine' in the terminology of AYUSH (acronym of Ayurveda, Unani, Siddha and Homeopathy together) to promote the dedication of healers of the other systems of medicine practiced in India. Department of AYUSH, Ministry of Health and Family Welfare, launched a number of schemes for restoring the glory of traditional medicine with economic support for documentation, participatory evaluation for the promotion of safe and efficacious eternal conventional health practices under National Health Mission. For centuries, traditional healers are engaged in the health care needs of India as a part of their social accountability with their knowledge on the therapeutic worth of the resources from the neighborhood. These rich traditional systems are perpetuated for the most part in the tribal belt though completely ignored by the modern medicinal system in India with rare chance to integrate best of both worlds. Father of our nation Mahatma Gandhi put considerable effort to promote naturopathy, yoga and vegetarianism through the ashrams across the country. The 'AMCHI' system practiced in the hilly terrains of Himalayas may be considered in AYUSH and needs recognition by mainstream health care policy makers as well as practitioners [11].

7. Traditional Healers are not Killers

Medicine is the `Art of healing'. Indigenous wisdom is rooted in the global cultural and spiritual lives of common people. Millions of traditional practitioners commonly offer much-needed healthcare to billions of people. All the practitioners of traditional medicine use empathy that boosts the `placebo effect' which really heals and not surgery or drugs. On the contrary, usually modern medicine rarely train how to offer empathy.

Traditional health systems are particularly important in countryside where any health care is a basic need. The `goldmine' of plant amalgam of the global rich biodiversity, pooled with age old competency needed to optimally exploit them in the mainstream health care delivery system to hold immense prospect for the innovative interventions. To uphold the value of local knowledge depository, government and non-governmental organizations, teaching and research organizations has to embark on a dialogue of public policy advocacy and capacity building in this direction. To augment the traditional medicine, the ethical and legal issues need to be addressed with targeted programme that will usher a new era in the evidenced based medicine. This will protect the knowledge that distinguishes between procedures to obtain biological property and to learn by practice.

Whether traditional medicine should be considered intellectual property or not is a matter which is open to debate. Indigenous practitioners are ignorant of their rights and responsibilities to protect themselves, from exploitation. The onus of this sensitive issue obviously goes to the department of Health and/or Industry, and Science and Technology. The pharmaceutical companies are trading the traditional knowledge for the own profit motive in the name of research interest in natural resources and immensely damaging the probability of hidden power of traditional medicines instead of rationalizing the database for the safer use in primary healthcare. If we feel that traditional medicine has to be incorporated in the mainstream, we have to deal with the ethical issues together with intellectual property rights and the homogeny of in terms of effectiveness and usefulness.

Biomedical research has to be conserved at any cost in addition to proving efficiency and effectiveness in the light of modern research methodology with sincere commitments from governments and the research society Presently the intellectual property rights are skewed against the shared characteristic of indigenous knowledge; that should been more focused to user driven to guarantee sustainability of local culture.

Traditional medicine uses historically proven naturally available organic substances, and modern pharmaceutical research seeks to isolate active/effective agents within organic substances and chemically reproduce them. Yet, most known traditional treatments are masked in secrecy and lack quantification by the healers. They do not invent or discover their own medicine; only uses knowledge though generations. Still they claim that their therapies cure everything from pin to elephant- even HIV / AIDS, infertility, cancer. Finding the herbs and locally used medications and treatments that has or can be demonstrated to be effective, and differentiating them from those that are either ineffective or harmful is a vital endeavor in our search for the best treatments for the sick and the continued wellbeing of the healthy. But before rejecting any honored treatment, it should be subjected to a randomized trial. There is no disbelief about the power and effectiveness of the herbs. But the only dilemma is the quantity and preparation to cure and the side effects.

In China the doctors who practice western medicine are all trained in Traditional Chinese Medicine and all hospitals offer both the systems. Dealing with traditional African medicine is more challenging and complex as it has the spiritual element so strong and central to the practices that make it far more difficult to compare and document the practice. Tradition medicine practitioners connect with the spiritual world which informs them of the ailment of their clients and the diagnosis. Much as they may know the possible prescription they may give they depend on their connection with the spirit world to confirm the diagnosis and prescription.

8. Easier Said than Done

In the era of commercialization of medicine, series of experimentation in the scientific arena are directed to serve the profit motive of vested interests of different shades. Practitioners of traditional medicines conventionally keep the knowledge secret from outsiders. We have to work with them for long time without much expectation. It could have been better if a part of the talents devoted in the research fields is diverted to explore the positive aspects of the traditional medicine directly which are practiced by the so called 'untrained millions of healers'. Crash training for the capacity building of non-health community members to administer health does not produce the attitudes of empathy, resilience, and emotional support that sick people need unless there is continuous supervisory support from trained health workers. We need to have soul-searching whether there has been sustained long term evaluation of these "task shifting" interventions. There has been considerable effort placed on the training of Traditional Birth Attendants worldwide in the last three decades that have focused on training on optimal care with locally available resources with little attention to their grass-root work environment. Yet integration of traditional healers into the formal health care system, conditions for timely referral, infrastructural support, adequate transportation, and related logistics are needed [12].

9. Every Day We Are Learning

Traditional herbs are getting substantial thoughtfulness in global health debates as their safety profile is proven due to its long use. These are getting substantial thoughtfulness in global health debates as their safety profile is proven due to its long use. Many herbs are used in standard formulations or purified extensively to produce highly potent drug products. Modern establishments like National Center of Complementary and Alternative Medicines (NCCAM), have moved into the formal investigation of herbs. Other countries, especially developing ones, follow this approach. Without engaging ourselves in debates, we believe that the medical professionals will be able to make positive contributions. For example, NCCAM-funded investigators are looking whether ginger interacts with immunosuppressive drugs, and ginger's effects on reducing nausea and vomiting. Clinical Trials supervisory body in the west have listed herbs and other alternative medicines. All cultures have spiritual beliefs concerning healing and health. Even America and Britain has its faith healers. Herbal medicine should be separated from "spiritual medicine" because spiritual medicine has got to do with belief and faith, while the use of herbs is more scientifically measurable. But all these herbal products should pass through ethically sound research for rational global health [13] .

Traditional healers can be optimally utilized in the community based palliative care with necessary capacity building, not only for cheaper financial consequences, but they also share same traditional reliefs of disease and health. Although Traditional Births Attendants are recognized in Primary Health Care, traditional healers who operates in different categories where traditional health technology could meet with modern medicine to improve health care delivery especially palliative care. Palliative care by traditional healers can create lesser bed occupancy in hospitals whose service can be optimally used with due respect to their position in society. Like in music symphony of ‘East meets west’, competency of the traditional healers can be boosted with a tailor-made target oriented capacity building. Then terminally ill patients could be referred to the traditional healers who have been optimally trained or re-oriented for the point-of-care, while monitoring and supervision is conducted by health visitor or a social worker.

10. Where Our Medical Education System Stands

Conventional medical education has missed the profound relationships that traditional healers have with the community. We have utterly failed to realize their potency, knowledge and experience of finding ailments and choices made in treatment. Promotion of traditional medicine will help sustain primary health care in the world. This is also essential for growth of local health traditions tailor-made for each country as all the herbal drugs have gone through thousands of years of observational research in society and survived only because they were good except those dangerous methods practiced in the name of faith. Their role should be re-evaluated and the true traditional healers must get respectable place in society. Most traditional healers do their expertise as service and money does not figure as important. On the contrary, many medical students become a doctor ‘without their heart’ - learn to churn money only and can never be a healer in spirit. Healing is always based on the foundation of trust, and we expect patients to rely on their healers to do the best that they are expected to know. The traditional healers are all time winner on this issue. We have to internalise that traditional knowledge practices need to be incorporated in the researches on 'Evidenced Based Medicine'.

Declaration of Conflicting Interests

The authors declare that there is no potential conflicts of interest with respect to the research, authorship and /or publication of this article.

Funding

The authors received no financial support for the research, authorship and/or publication of this article.

Annexure

[1] Guidelines for the appropriate use of herbal medicines (1998); Guidelines for clinical research in acupuncture (1995); Research guidelines for evaluating the safety and efficacy of herbal medicines (1993); Medicinal plants in China (1989); Medicinal Plants in Papua New Guinea (2009); Medicinal plants in the Republic of Korea (1998); Medicinal plants in the South Pacific (1998); Medicinal plants in Viet Nam (1990); WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region (2007) [online] [cited 13 May 2014] Available from:

http://www.wpro.who.int/publications/publications.htm.

[2] WHO's global publications on Traditional, Complementary and Herbal Medicine [online] [cited 13 May 2014] Available from:

http://apps.who.int/medicinedocs/en/cl/CL1.1.1.3.1/clmd,50.html#hlCL1_1_1_3_1.

[3] WHO Guidelines on Developing Consumer Information on Proper Use of Traditional, Complementary and Alternative Medicine [online] [cited 13 May 2014] Available from:

http://apps.who.int/medicinedocs/en/d/Js5525e/.

[4] The Essential Medicines and Pharmaceutical Policies unit, World Health Organization, Regional Office for the Eastern Mediterranean (EMRO) [online] [cited 13 May 2014] Available from:

http://www.emro.who.int/EMP/medicines_traditional.htm [*].

[5] 'Guidelines on minimum requirements for the registration of herbal medicinal products in the EMR' (2006), in order to develop regional guidelines on the regulation of herbal medicines. [online] [cited 13 May 2014] Available from:

http://www.emro.who.int/publications/Book_Details.asp?ID=375.

[6] 'WHO traditional medicine strategy 2002-2005' is available in Arabic, Chinese, English and Russian languages. [online] [cited 13 May 2014] Available from: http://www.who.int/medicines/publications/traditionalpolicy/en/index.html.

[7] The Eastern Mediterranean Health Journal (EMHJ), Volume 16 issue no. 9, September 2010 published an article titled 'Community pharmacists’ knowledge, attitudes and practices towards herbal remedies in Riyadh, Saudi Arabia'. [online] [cited 13 May 2014] Available from:

http://www.emro.who.int/publications/emhj/1609/article13.htm.

[8] 'Knowledge, attitudes and practice of general practitioners towards complementary and alternative medicine in Doha, Qatar' EMHJ, Volume 16, no. 5[online] [cited 13 May 2010] Available from:

http://www.emro.who.int/publications/emhj/1605/article10.htm.

[9] Traditional, Complementary and Herbal Medicine. [online] [cited 13 May 2014] Available from:

http://www.emro.who.int/Library/Databases/wxis.exe/Library/Databases /iah/?IsisScript=iah/iah.xic&base=imemr&form=B&user=guest〈=i&nextAction=search& indexSearch=^iSU^xSU%25.

[10] Relevant articles published in 483 journals

http://www.emro.who.int/library/imjournals/ within the Eastern Mediterranean Region (IMEMR) site [online] [cited 13 May 2014] Available from: http://www.emro.who.int/lin/imemr.htm free of charge on request.

[11] The Laureates [online] [cited 13 May 2014] Available from: http://rolexawards.com/en/the-laureates/laurentpordie-home.jsp and blog re India http://rolexawards.com/en/the-laureates/laurentpordie-the-project.jsp.

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