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Traditional Complementary and Alternative Medicine: Policy and Public Health
Traditional Complementary and Alternative Medicine: Policy and Public Health Perspectives by Gerard Bodeker and Gemma Burford, eds. Covent Garden, London: Imperial College Press; 2007. Hardcover; 453 pages. ISBN13: 978-1-86094-616-5. $87.00.

This edited volume provides a compelling global overview of traditional, complementary, and alternative medicine (TCAM). While the concerns of western societies center on evidence for efficacy—safety, standardization and reliability of natural products—as well as regulatory and enforcement issues, in developing countries the primary concerns are more urgent. Such concerns include delivery of costeffective treatments—potentially including TCAM—for serious and debilitating epidemics, development of workable models of healthcare delivery to reach remote rural communities, and efficient communication of information on prevention and healthy lifestyles.

Most TCAM research to date has centered on biomedical/scientific research and reviews, or on socio-cultural perspectives. Bodeker and Burford present a novel angle by addressing the topic from a public health perspective, specifically by highlighting the diseases that have had a disproportionately devastating effect in poor, developing countries: malaria, HIV/AIDS, and other priority conditions involving skin and wound care, as well as musculoskeletal diseases and damage.

The 5 chapters in the Public Health section of the book review the research to date in these main areas of concern and discuss the commitments required to alleviate health problems in the developing world. The general consensus is that there is a need for more research into local indigenous treatments to identify safe and effective TCAM therapies that might have a role in treating serious diseases, alleviating complications, and mitigating side effects of conventional treatments. Several chapters emphasize that such research needs to be pragmatic and sensitive to the needs of the local area. It may be that good results from cohort studies afford a sufficient level of evidence for proceeding with indigenous herbal and other remedies where the needs of a local population are dire and immediate.

A recurring conclusion in this section is that western delivery systems are unsuitable. Burford et al argue that the large urban hospital model of care is inappropriate for the orthopedic needs of scattered rural communities and call for simple and appropriate technologies delivered by a range of community practitioners. In Chapter 10, Wilcox and Bodeker similarly call for decentralization of malaria care and collaboration with the existing traditional healers to provide more cost-effective solutions.

Bodeker et al, in Chapter 11 on HIV/ AIDS, summarize the critical factors for future directions that apply generally to the notion of global health: a research agenda for the biomedical evaluation of TCAM; a social science agenda to identify existing choices, recognized practitioners, knowledge frameworks, utilization and cost factors, gender issues, and support systems; a policy framework that includes such issues as protection of indigenous intellectual property rights and medicinal plant sustainability; and the need for partnerships between the different stakeholder groups.

As Bodeker and Burford point out in the Introduction, there is now consumer-led demand for TCAM products in westernized countries, a burgeoning marketplace for herbal and dietary supplements, and pressure for novel product development. The obverse for the developing world is that traditional medical knowledge is quickly disappearing along with the plants and other materials on which the indigenous traditions are based. The authors appeal for all aspects of these traditional systems— mental, social, emotional, spiritual, physical, and ecological—be taken into account when devising policy. Development that neglects these fundamental factors risks trivializing rich traditions and converting them into a mechanistic biomedical framework.

One is reminded of the salutary work of Ernst Friedrich Schumacher who, in his collection of essays originally published in 1973, along with his call for human-scale, appropriate technology that honors the traditions and answers the needs of local communities, pointed out that non-renewable resources should be treated as capital, not income.1

Future policy agenda will vary in accordance with national regulations and legislation. This is the theme of the first section on policy of this book. The editors draw partly from republication of sections of the World Health Organization’s Global Atlas of Traditional, Complementary, and Alternative Medicine, which painted a broad overview of trends in utilization and regulatory and policy development for TCAM.2,3 The atlas illustrated the diverse range of levels of policy development and, consequently, the general lack of comparative data on which policy can at present be based.

The editors have brought in 20 contributors for the 17 chapters of the book, all of whom have long been involved in research into various aspects of TCAM and have published widely. Yet for all but 5 of the chapters, one or both of the books general editors are also authors. This creates an uneasy concern about the high degree of concord on analysis, future objectives, and policy recommendations. It also makes one wonder whether the editors’ high level of involvement in most of the chapters has had the effect of tidying up divergent discussions into an overly coherent thread. It is almost too neat.

Nonetheless, there are some lovely cameo chapters, such as Chapter 7 on “Home Herbal Gardens: A novel health security strategy based on local knowledge and resources,” written by 4 authors from India. They describe a small-scale movement of Local Health Traditions (LHT), “embedded in the lifestyle, customs, diet and health practices of thousands of local communities all over India.” LHT is working to preserve the culture, traditional medicinal knowledge, and the plants on which they are based, in a network of home and community herbal gardens. Such a simple program is sustainable, provides primary healthcare, as well as social and economic benefits, and relies on traditional knowledge and technology.

—Jacqueline C. Wootton, MEd Alternative Medicine Foundation, Potomac, MD

  1. Schumacher EF. Small is Beautiful: Economics as if People Mattered: 25 Years Later...With Commentaries. Point Roberts, WA: Hartley & Marks Publishers; 1999.

  2. Bodeker G, Ong CK, Grundy C, Burford G, Shein K. WHO Global Atlas of Traditional, Complementary and Alternative Medicine: Text Volume. Kobe, Japan: WHO Centre for Health Development; 2005.

  3. Cavaliere C. WHO Atlas Provides Global Perspective on Traditional and CAM Trends. HerbalGram. 2006; No. 70:26-27. http:// content.herbalgram.orgarticleview.asp?a=2960; Accessed July 3, 2007.