Introduction to Integrative Medicine and Complementary and Alternative Medicine (CAM)

1. Introduction to Integrative Medicine and Complementary and Alternative Medicine (CAM) Jaime Z. Galvez Tan, MD, MPH Professor, U.P. College of Medicine Head, Traditional and Integrative Medicine Clinic, UP-PGH

2. Outline of Presentation • Historical Developments in CAM • Definitions of CAM • Global Examples of CAM • Concepts of Health, Illness and Wellness • Rationale for Learning Filipino Traditional Medicine and Integrative Medicine • Challenges to Health Institutions and Health Sciences Students

3. Historical Developments: Global • World Health Organization (WHO): 1978 Alma Ata Declaration on Primary Health Care (PHC): Integration of Traditional Medicine in PHC • 1999: US Congress established the National Center for Complementary and Alternative Medicine (NCCAM) in the National Institutes of Health (NIH) Bethesda, Maryland.

4. Philippine Experience in CAM • Mid-70’s: Private physicians started training in acupuncture in China • Early 1980’s: DOH physicians trained acupuncture in China; herbal medicine production started • 1993-95: DOH established the Traditional Medicine Unit which promoted the use of medicinal plants, acupuncture and therapeutic massage

5. CAM Policy and Practice in the Philippines • Republic Act 8433 established the Philippine Institute for Traditional and Complementary Health Care (PITAHC) in 1997 as an attached agency of the DOH. • Filipino physicians have organized the Philippine Association of Medical Acupuncturists Inc (PAMAI) and the Philippine College for the Advancement of Medicine (PCAM) to promote the practice of CAM.

6. What is Complementary and Alternative Medicine (CAM)? 1 • Complementary and alternative medicine is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine (NCCAM-NIH).

7. What is Complementary and Alternative Medicine (CAM)? 2 • CAM is a broad domain of healing resources that encompasses all health systems, modalities and practice and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health systems of a particular society or culture in a given historical period (Cochrane Collaboration).

8. What is Complementary and Alternative Medicine (CAM)? 3 • The scope of alternative health care modalities as other forms of non-allopathic, occasionally non-indigenous or imported healing methods, though not necessarily practiced for centuries nor handed down from one generation to another. (PITAHC R.A. 8433)

9. Examples of CAM 1 • Traditional Chinese Medicine: yin-yang; 5 element law; acupuncture, acupressure, moxibustion, tuina, medicinal plants, chi-gong, tai chi, animal and mineral medicine • Ayurveda: humours (vata-pita-kapha), yoga, meditation, fasting, purification, medicinal plants, aromatic oils, urine therapy • European: homeopathy, iridology, health spa, psychic healing, Swedish massage, orthomolecular, anthroposopy, macrobiotics

10. Examples of CAM 2 • North American: chiropractic, osteopathy, prayer healing, nutraceuticals, music therapy, color therapy, chelation, biofeedback, native American medicine • Asian: reiki, shiatzu, Kampo medicine, reflexology, Zen meditation, Buddhist meditation, Thai massage, Tibetan medicine, kalimasada

11. Examples of CAM 3 • Filipino: herbal medicines, hilot sa pilay, hilot sa panganganak, psychic surgery, biomagnetic healing, pasma, usog, babaylan, mumbaki, spiritual healing, bentosa, tawas, hiyang

12. Classification of CAM Modalities • Biological therapies: herbal medicine, aromatherapy, dietary therapies • Manipulation therapies: acupuncture, massage, reflexology, chiropractic, osteopathy • Mind-Body interventions: meditation, hypnotherapy, prayer, spiritual healing, imaging, visualization • Energy therapy: pranic healing, reiki, crystals, bio-magnetic healing • Alternative systems: traditional Chinese medicine, Ayurveda, Yunani-Tibb, naturopathy, homeopathy

13. Concepts of Health, Well-Being, Wellness and Illness

14. Biomedical or Conventional Medicine Definition circa 1878-1978 • Health is the absence of disease. • Biomedicine is Disease-oriented; Understanding the person physically (anatomy, histology, biochemistry, physiology, pathology etc) • The Medical / Conventional Model –measuring health by counting cases of diseases in populations by incidence, prevalence, morbidity and mortality.

15. W.H.O. Definition 1978 W.H.O. Definition of Health: It is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity

16. Filipino Traditional Medicine Definition Health and wellness is the state of harmony, balance and synergy between humankind and the universe, between humankind and the environment, between and among humankind and within the human body, mind and soul. (J.Z. Galvez Tan from interviews with hundreds of traditional healers)

17. Integrative or Holistic Medicine • Health and wellness is the state of complete physical, mental, social, spiritual, emotional and environmental well-being. • Quality of life and quality of daily living is primordial. • It is the fusion of the best of Asian and Filipino Traditional Medicine with the best of North American and European Medicine

18. Six Dimensions of Health, Wellness and Well-Being Spiritual Emotional Physical Social Mental Environmental

19. Six Dimensions of Health, Wellness and Well-Being Soul Body Heart Hands Mind Feet

20. Six Dimensions of National Health, Wellness and Well-Being Cultural Political Economic Security Social Environmental

21. Why Filipino Traditional Medicine and Integrative Medicine and Complementary Medicine in Medical and Health Sciences Education?

22. Why Study Filipino Traditional Medicine? #1 • Cultural and ethnolinguistic competency of the Filipino Physicians, Nurses, Dentists and other Health Professionals • W.H.O. recommendation of integration of Traditional Medicine in Medical and Health Sciences Education and Primary Health Care since 1978 • World Health Assembly resolutions since 1981 called upon member-states to integrate Traditional Medicine in their health care systems

23. Why Study Filipino Traditional Medicine? #2 • Filipino Physicians and Filipino Health Professionals who manifest the rich heritage, self-respect and uniquely Filipino character and identity of more than thousand year old healing traditions of our country, are truly able to express the genuine Filipino soul in their health care practice • Philippine government policies and laws supportive through the Philippine Institute of Traditional and Alternative Health Care (PITAHC, Republic Act 8433, 1997)

24. Why Integrative and Complementary Medicine in the Medical and Health Sciences Curricula? • Evidence Based Medicine already being applied in Complimentary and Alternative Medicine • NIH Bethesda actively promoting through the National Center for Complementary and Alternative Medicine • North American, European and Asian Medical and Health Sciences Schools already incorporating Integrative Medicine and Complementary and Alternative Medicine • Patients already inquiring if not requesting their physicians and health care professionals for complementary and alternative medicine

25. Global Uses of Medicinal Plants • Phytomedicines and phytochemicals • Nutraceuticals • Personal Care Products and Cosmetics • Spa Health and Spa Medicine • Culinary: Flavors and spices • Fragrance and perfumer • Bio-pesticides

26. Challenges to the Research Community and Business Sector • 1. Majority of Philippine medicinal plants with centuries of ethnomedical history, remain untapped. • 2.The Philippine herbal industry is still in the early developmental stage and its potential has not been fully exploited. • 3. Lack of collaboration among research institutions, private sector and academe

27. More Challenges to the Research Community & Business Sector • 4.Lack of investments in research and development, raw material production, post harvest processing and herbal manufacturing. • 5.Low level of scientific technology in herbal medicine research and manufacture among small and medium enterprises. • 6. No standardized procedures in local manufacture of most herbal products.

28. More Challenges to the Research Community and Business Sector • 7. Need for market and government incentives like the ones given to rice, corn, coconut, sugar, bananas, pineapples and mangoes.

29. Challenges to Expanding the Market • Raw material production • Quality processing and production • Attitude of “Competition is good” versus crab mentality • Investments in research and development • Regulatory framework • Wildlife Act of 2002 • Market and government incentives

30. Most Marketable Medicinal Plants • Lagundi (Vitex negundo) • Sambong (Blumea balsamifera) • Ampalaya (Momordica charantia) • Herba buena (Mentha cordifolia) • Tsaang Gubat (Carmina retusa) • Malunggay (Moringa olifera) • Balbas pusa (Orthosiphon aristatus) • Banaba (Lagerstroema speciosa) • Takip-Kuhol (Centella asiatica) • Saluyot (Corchorus olitorius) • Pansit-pansitan (Peperonia pellucida) • Akapulko (Cassia alata)

31. The Future of Complementary and Alternative Medicine and Integrative Medicine in the Philippines The Future is Good! The Future is Great!

32. Philippines - The Heart of Asia • Philippines - Islands of Wellness and the Center of Health and Wellness in Asia • Philippines - The Global Capital for Tropical Medicinal Plants • The Filipino Hilot Traditional Massage - a brand name in all spas of the world in the next 5 years • Philippine Health Care - the Best of Asia with the Best of Europe and North America

33. Maraming Salamat Po!Thank You Very Much! Jaime Z. Galvez Tan M.D., M.P.H. Mobile: 0928 507 4479 E-mail: jzgalveztan@gmail.com