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Jin H, Park SB, Yoon JH, Lee JY, Kim EH, Yoon SW. Traditional herbal medicine combined with first-line platinum-based chemotherapy for advanced non-small-cell lung cancer: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e27163. [PMID: 34664842 PMCID: PMC8448030 DOI: 10.1097/md.0000000000027163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Non-small-cell lung cancer (NSCLC) is a major health burden in many countries. This review aimed to evaluate the efficacy of traditional herbal medicine (THM) combined with first-line platinum-based chemotherapy (PBCT) for the treatment of advanced NSCLC. METHODS From inception to April 2021, relevant studies were retrieved from 9 electronic databases. Randomized controlled trials (RCTs) comparing survival outcomes of THM + PBCT treatment with PBCT treatment in patients with advanced NSCLC were reviewed. The risk of bias was evaluated using the Cochrane Risk of Bias Tool. Overall survival, 1-year survival, progression-free survival or time to progression, tumor response rate, and adverse effects were analyzed. RESULTS Sixteen RCTs comprising 1445 patients were included. The meta-analysis indicated that THM + PBCT treatment, compared to PBCT alone, could improve overall survival (median survival ratio = 1.24, 95% confidence intervals [CI] [1.11, 1.39], P < .001), progression-free survival/time to progression (median survival ratio = 1.22, 95% CI [1.09, 1.37], P < .001), and the 1-year survival rate (risk ratio [RR] = 1.56, 95% CI [1.31, 1.86], P < .001). THM + PBCT also led to a higher tumor response rate (RR = 1.39, 95% CI [1.22, 1.59], P < .001) and lower incidence of thrombocytopenia (RR = 0.72, 95% CI [0.56, 0.92], P = .009) and nausea/vomiting (RR = 0.35, 95% CI [0.21, 0.57], P < .001), while there was no significant effect observed on leukopenia (RR = 0.68, 95% CI [0.34, 1.36], P = .27). CONCLUSION THM, when used in combination with PBCT, might increase survival and the tumor response rate while decreasing the side effects caused by chemotherapy in patients with advanced NSCLC. However, considering the limited methodological qualities of the included trials, more rigorous RCTs are needed.
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Affiliation(s)
- Hayun Jin
- College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Su Bin Park
- Korean Medicine Cancer Center, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jee-Hyun Yoon
- Korean Medicine Cancer Center, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jee Young Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Eun Hye Kim
- Korean Medicine Cancer Center, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Seong Woo Yoon
- Korean Medicine Cancer Center, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
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Brinckmann JA, Cunningham AB, Harter DEV. Running out of time to smell the roseroots: Reviewing threats and trade in wild Rhodiola rosea L. J Ethnopharmacol 2021; 269:113710. [PMID: 33358852 DOI: 10.1016/j.jep.2020.113710] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/26/2020] [Accepted: 12/18/2020] [Indexed: 06/12/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Rhodiola rosea L. has a circumpolar distribution and is used in ethnomedicines of Arctic peoples, as well as in national systems of traditional medicine. Since the late 20th century, global demand for R. rosea has increased steadily, in part due to clinical research supporting new uses in modern phytotherapy. Global supply has been largely obtained from wild populations, which face threats from poorly regulated and destructive exploitation of the rootstocks on an industrial scale. AIM OF THE STUDY To evaluate (i) the conservation status, harvesting and trade levels of R. rosea, in order to determine whether international trade should be monitored, (ii) the current state of experimental and commercial farming and whether cultivation may play a role to take pressure off wild stocks, and (iii) evidence of substitution of other Rhodiola species for R. rosea as an indicator of overexploitation and rarity. MATERIALS AND METHODS We reviewed published studies on R. rosea biology and ecology, as well as information on impacts of wild harvest, on management measures at the national and regional levels, and on the current level of cultivation from across the geographic range of this species. Production and trade data were assessed and analysed from published reports and trade databases, consultations with R. rosea farmers, processors of extracts, and trade experts, but also from government and news reports of illegal harvesting and smuggling. RESULTS AND CONCLUSIONS Our assessment of historical and current data from multiple disciplines shows that future monitoring and protection of R. rosea populations is of time-sensitive importance to the fields of ethnobotany, ethnopharmacology, phytochemistry and phytomedicine. We found that the global demand for R. rosea ingredients and products has been increasing in the 21st century, while wild populations in the main commercial harvesting areas continue to decrease, with conservation issues and reduced supply in some cases. The level of illegal harvesting in protected areas and cross border smuggling is increasing annually coupled with increasing incidences of adulteration and substitution of R. rosea with other wild Rhodiola species, potentially negatively impacting the conservation status of their wild populations, but also an indicator of scarcity of the genuine article. The current data suggests that the historical primary reliance on sourcing from wild populations of R. rosea should transition towards increased sourcing of R. rosea from farms that are implementing conservation oriented sustainable agricultural methods, and that sustainable wild collection standards must be implemented for sourcing from wild populations.
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Affiliation(s)
- J A Brinckmann
- Traditional Medicinals, 4515 Ross Road, Sebastopol, CA, 95472, USA.
| | - A B Cunningham
- School of Life Sciences, University of KwaZulu-Natal, King Edward Avenue, Pietermaritzburg, 3209, South Africa; School of Veterinary and Life Sciences, Murdoch University, 90 South St., Murdoch, WA, 6150, Australia
| | - David E V Harter
- Bundesamt für Naturschutz (BfN), Konstantinstr. 110, Bonn, 53179, Germany
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Modak BK, Gorai P, Pandey DK, Dey A, Malik T. An evidence based efficacy and safety assessment of the ethnobiologicals against poisonous and non-poisonous bites used by the tribals of three westernmost districts of West Bengal, India: Anti-phospholipase A2 and genotoxic effects. PLoS One 2020; 15:e0242944. [PMID: 33253320 PMCID: PMC7703885 DOI: 10.1371/journal.pone.0242944] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/12/2020] [Indexed: 12/29/2022] Open
Abstract
Introduction To explore the ethnobiological wisdom of the tribals of three western districts of West Bengal, India against poisonous and non-poisonous bites and stings, a quantitative approach was adopted. These age-old yet unexplored knowledge can be utilized in finding lead-molecules against poisonous and non-poisonous animal-bites. Further, an evidence-based approach is needed to assess the venom-neutralization ability of plants by experimental studies. Materials and methods During 2008–2009 and 2012–2017, 11 ethnomedicinal surveys were carried out to explore the use of medicinal flora and fauna via conducting open semi-structured interviews with 47 traditional healers (THs) or informants. The retrieved dataset was statistically evaluated using seven quantitative-indexes: use-value (UV), informants'-consensus-factor (ICF), fidelity-level (FL), relative-importance (RI), cultural importance-index (CI), index of agreement on remedies (IAR) and cultural agreement-index (CAI). Anti-phospholipaseA2 (PLA2) properties of selected plant extracts were also examined. In addition, the cytotoxicity and genotoxicity of the water extract of the plants showing high FL as well as significant PLA2 inhibitory potential were investigated using Allium cepa root tip assay. Results A total of 41 traditional-formulations (TFs) containing 40 plant species (of 39 genera from 28 families) and 3 animal species were prescribed by the THs. Fabaceae exhibited most number of medicinal plants. Piper nigrum (1.78) and Apis cerana indica and Crossopriza lyoni (both 0.21) exhibited the highest UV among the plants and the animals respectively. Stinging of centipede and dog/cat/hyena bite displayed highest ICF (1.00 each). Among the plants, the maximum RI (0.91) and CI (4.98) values were observed for Aristolochia indica. IAR (1.00) was recorded maximum for Achyranthes aspera, Gloriosa superba, Lycopodium cernuum, Smilax zeylanica and Streblus asper. Maximum CAI value was noted for Piper nigrum (5.5096). Among the animals, Apis cerana indica (0.31) and Crossopriza lyoni (1.52) displayed the highest RI and CI values respectively. Crossopriza lyoni (0.99) and Apis cerana indica (1.3871) exhibited maximum IAR and CAI values respectively. Plants showing higher FL exhibited higher anti-PLA2 activity via selective inhibition of human-group PLA2. In addition, Allium cepa root tip assay has indicated the safety and/or toxicity of the plant parts prescribed by the THs. Root water extracts of Aristolochia indica and Gloriosa superba exhibited significant genotoxicity and cytotoxicity. Conclusions Three western districts of West Bengal is the natural abode for many tribal and non-tribal communities. A noteworthy correlation was established between the plants used against poisonous-bites and their anti-PLA2 activity. A few plant parts used by the THs also exhibited high toxicity. Such alternative medical practices serve as the only option in these underprivileged and backward areas during medical-exigencies.
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Affiliation(s)
- Biplob Kumar Modak
- Department of Zoology, Sidho-Kanho-Birsha University, Lagda, West Bengal, India
| | - Partha Gorai
- Department of Zoology, Sidho-Kanho-Birsha University, Lagda, West Bengal, India
| | - Devendra Kumar Pandey
- Department of Biotechnology, Lovely Faculty of Technology and Sciences, Lovely Professional University, Phagwara, Punjab, India
| | - Abhijit Dey
- Department of Life Sciences, Presidency University, Kolkata, West Bengal, India
- * E-mail: (TM); (AD)
| | - Tabarak Malik
- Department of Medical Biochemistry, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail: (TM); (AD)
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Mohammed HA, Abdel-Aziz MM, Hegazy MM. Anti-Oral Pathogens of Tecoma stans (L.) and Cassia javanica (L.) Flower Volatile Oils in Comparison with Chlorhexidine in Accordance with Their Folk Medicinal Uses. ACTA ACUST UNITED AC 2019; 55:medicina55060301. [PMID: 31238555 PMCID: PMC6631167 DOI: 10.3390/medicina55060301] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/04/2019] [Accepted: 06/18/2019] [Indexed: 01/27/2023]
Abstract
Background and Objectives: Teeth decay and plaque are complicated problems created by oral pathogens. Tecoma stans (L.) and Cassia javanica (L.) are two ornamental evergreen plants widely distributed in Egypt. These plants are traditionally used for oral hygienic purposes. This study aims to elucidate the volatile oil constituents obtained from the flowers of these plants and evaluate the antimicrobial activity of these volatile oils against specific oral pathogens in comparison to chlorhexidine. Materials and Methods: The flowers obtained from both plants were extracted by n-hexane. GC-MS spectrometry was used to identify the constituents. Minimum inhibitory concentrations (MICs) were measured using tetrazolium salt (2,3-bis[2-methyloxy-4-nitro-5-sulfophenyl]-2H-tetrazolium-5-carboxanilide) (XTT). Results: GC-MS analysis revealed the presence of 32 and 29 compounds, representing 100% of the volatile constituents of Tecoma stans and Cassia javanica, respectively. The GC-MS analysis showed more than 60% of the volatile oil constituents are represented in both plants with different proportions. Chlorhexidine exerted stronger activity than tested plants against all microorganisms. Cassia javanica flower extract was more active against all tested microorganisms than Tecoma stans. Of note was the effect on Streptococcus mutans, which was inhibited by 100% at 12.5 and 25 µg/mL of Cassia javanica and Tecoma stans, respectively. The growth of Lactobacillus acidophilus was also completely inhibited by 25 µg/mL of the Cassia javanica extract. MIC90 and MIC were also calculated, which revealed the superiority of Cassia javanica over Tecoma stans against all tested oral pathogens. Conclusion: Cassia javanica flower volatile oils showed a potential anti-oral pathogen activity at relatively low concentrations. Also, Cassia javanica and Tecoma stans demonstrated a strong activity against tooth decay's notorious bacteria Streptococcus mutans. Both plants can be potential substituents to chlorhexidine. Formulating the constituents of these plants in toothpastes and mouthwashes as anti-oral pathogen preparations can be an interesting future plan.
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Affiliation(s)
- Hamdoon A Mohammed
- Pharmacognosy Department, Faculty of Pharmacy, Al-Azhar University, Cairo 11371, Egypt.
- Medicinal Chemistry and Pharmacognosy Department, College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia.
| | - Marwa M Abdel-Aziz
- Regional Centre for Mycology and Biotechnology (RCMB), Al-Azhar University, Cairo 11371, Egypt.
| | - Mostafa M Hegazy
- Pharmacognosy Department, Faculty of Pharmacy, Al-Azhar University, Cairo 11371, Egypt.
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Efferth T, Banerjee M, Abu-Darwish MS, Abdelfatah S, Böckers M, Bhakta-Guha D, Bolzani V, Daak S, Demirezer ÖL, Dawood M, Efferth M, El-Seedi HR, Fischer N, Greten HJ, Hamdoun S, Hong C, Horneber M, Kadioglu O, Khalid HE, Khalid SA, Kuete V, Mahmoud N, Marin J, Mbaveng A, Midiwo J, Nakagawa H, Naß J, Ngassapa O, Ochwang'i D, Omosa LK, Ooko EA, Özenver N, Poornima P, Romero MR, Saeed MEM, Salgueiro L, Seo EJ, Yan G, Yasin Z, Saeed EM, Paul NW. Biopiracy versus One-World Medicine-From colonial relicts to global collaborative concepts. Phytomedicine 2019; 53:319-331. [PMID: 30190231 DOI: 10.1016/j.phymed.2018.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 05/10/2018] [Accepted: 06/07/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Practices of biopiracy to use genetic resources and indigenous knowledge by Western companies without benefit-sharing of those, who generated the traditional knowledge, can be understood as form of neocolonialism. HYPOTHESIS The One-World Medicine concept attempts to merge the best of traditional medicine from developing countries and conventional Western medicine for the sake of patients around the globe. STUDY DESIGN Based on literature searches in several databases, a concept paper has been written. Legislative initiatives of the United Nations culminated in the Nagoya protocol aim to protect traditional knowledge and regulate benefit-sharing with indigenous communities. The European community adopted the Nagoya protocol, and the corresponding regulations will be implemented into national legislation among the member states. Despite pleasing progress, infrastructural problems of the health care systems in developing countries still remain. Current approaches to secure primary health care offer only fragmentary solutions at best. Conventional medicine from industrialized countries cannot be afforded by the impoverished population in the Third World. Confronted with exploding costs, even health systems in Western countries are endangered to burst. Complementary and alternative medicine (CAM) is popular among the general public in industrialized countries, although the efficacy is not sufficiently proven according to the standards of evidence-based medicine. CAM is often available without prescription as over-the-counter products with non-calculated risks concerning erroneous self-medication and safety/toxicity issues. The concept of integrative medicine attempts to combine holistic CAM approaches with evidence-based principles of conventional medicine. CONCLUSION To realize the concept of One-World Medicine, a number of standards have to be set to assure safety, efficacy and applicability of traditional medicine, e.g. sustainable production and quality control of herbal products, performance of placebo-controlled, double-blind, randomized clinical trials, phytovigilance, as well as education of health professionals and patients.
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Affiliation(s)
- Thomas Efferth
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany.
| | - Mita Banerjee
- Department of English and Linguistics, American Studies, Center for Comparative Native and Indigenous Studies, Johannes Gutenberg University, Mainz, Germany
| | - Mohammad Sanad Abu-Darwish
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany; Shoubak University College, Al-Balqa Applied University, Jordan
| | - Sara Abdelfatah
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany
| | - Madeleine Böckers
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany
| | - Dipita Bhakta-Guha
- School of Chemical and Biotechnology, SASTRA University, Thanjavur 613401, TN, India
| | - Vanderlan Bolzani
- Department of Organic Chemistry, Institute of Chemistry, São Paulo State University, Araraquara, Brazil
| | - Salah Daak
- Dr. Salah Wanesi Foundation for Cancer Research and Control, Khartoum, Sudan
| | | | - Mona Dawood
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany
| | - Monika Efferth
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany
| | - Hesham R El-Seedi
- Chemistry Department, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia; Division of Pharmacognosy, Department of Medicinal Chemistry, Uppsala University, Biomedical Center, Uppsala, Sweden
| | - Nicolas Fischer
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany
| | - Henry J Greten
- Biomedical Sciences Institute Abel Salazar, University of Porto, Porto, Portugal; Heidelberg School of Chinese Medicine, Heidelberg, Germany
| | - Sami Hamdoun
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany
| | - Chunlan Hong
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany
| | - Markus Horneber
- Department of Internal Medicine, Division of Oncology and Hematology, Paracelsus Medical University, Klinikum Nürnberg, Germany
| | - Onat Kadioglu
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany
| | - Hassan E Khalid
- Department of Pharmacognosy, University of Khartoum, Khartoum, Sudan
| | - Sami A Khalid
- Faculty of Pharmacy, University of Science and Technology, Omdurman, Sudan; Faculty of Pharmacy, University of Khartoum, Karthoum, Sudan
| | - Victor Kuete
- Department of Biochemistry, Faculty of Science, University of Dschang, Dschang, Cameroon
| | - Nuha Mahmoud
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany
| | - José Marin
- Department of Biochemistry and Molecular Biology, Experimental Hepatology and Drug Targeting (HEVEFARM), CIBERehd, IBSAL, University of Salamanca Campus Miguel de Unamuno, 37007 Salamanca, Spain
| | - Armelle Mbaveng
- Department of Biochemistry, Faculty of Science, University of Dschang, Dschang, Cameroon
| | - Jacob Midiwo
- Department of Chemistry, University of Nairobi, Nairobi, Kenya
| | - Hiroshi Nakagawa
- Department of Applied Biological Chemistry, Graduate School of Bioscience and Biotechnology, Chubu University, Kasugai, Aichi, Japan
| | - Janine Naß
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany
| | - Olipa Ngassapa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Dominic Ochwang'i
- Department of Veterinary Anatomy and Physiology, University of Nairobi, Nairobi, Kenya
| | - Leonida K Omosa
- Department of Chemistry, University of Nairobi, Nairobi, Kenya
| | - Edna A Ooko
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany
| | - Nadire Özenver
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany; Hacettepe University, Faculty of Pharmacy, Department of Pharmacognosy, Ankara, Turkey
| | - Paramasivan Poornima
- Molecular and Cellular Pharmacology Laboratory, School of Science, Engineering and Technology, University of Abertay, Dundee, Scotland, United Kingdom
| | - Marta Rodriguez Romero
- Department of Biochemistry and Molecular Biology, Experimental Hepatology and Drug Targeting (HEVEFARM), CIBERehd, IBSAL, University of Salamanca Campus Miguel de Unamuno, 37007 Salamanca, Spain
| | - Mohamed E M Saeed
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany
| | - Ligia Salgueiro
- Center of Neurosciences and Cell Biology and Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Ean-Jeong Seo
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany
| | - Ge Yan
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany
| | | | | | - Norbert W Paul
- Institute for the History, Philosophy, and Ethics of Medicine, Johannes Gutenberg University Medical Center, Mainz, Germany
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Aramesh K. Science and Pseudoscience in Traditional Iranian Medicine. Arch Iran Med 2018; 21:315-323. [PMID: 30041531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 04/17/2018] [Indexed: 06/08/2023]
Abstract
The recent efforts for revitalizing traditional Iranian medicine (TIM) have shaped two main streams: The quackery traditional iranian medicine (QTIM) and the academic traditional iranian medicine (ATIM). The QTIM encompasses a wide range of practitioners with various backgrounds who work outside the academic arena and mostly address the public. These practitioners have no solid bases or limited boundaries for their claims. Instead, they rely on making misleading references to the Holy Islamic Scriptures, inducing false hope, claiming miraculous results, appealing to the conspiracy theories, and taking advantage of the public resentment toward some groups of unprofessional healthcare providers. The theories and practices of ATIM, however, can be categorized into two major categories: First, valid and scientific TIM that is aimed to conduct well-designed clinical trials and thereby, supply the evidence-based medicine with new treatments originated in or inspired by TIM. Second, a pseudoscientific part of the current TIM that is based on some obsolete medical theories, especially the medieval humoral medicine, and erroneous accounts of human anatomy, physiology, and physiopathology, mostly adopted from the ancient and medieval medical scripts. TIM has recently established some clinical centers for practicing humoral medicine that is partly pseudoscientific and involves significant risks. This paper suggests that the public health sector has a duty to act against the promulgation of medical superstitions by QTIM and the pseudoscientific medical practices of ATIM, and at the same time, support and promote the valid and potentially beneficial research pursued by ATIM aimed to explore the rich recourses of TIM and thereby enrich the evidence-based medicine.
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Affiliation(s)
- Kiarash Aramesh
- Director, James F. Drane Bioethics Institute, Edinboro University of Pennsylvania, Edinboro, PA, USA
- Associate Professor, Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Linger RS. Design and Implementation of an Elective on the Ethnopharmacology of Appalachia for the PharmD Curriculum. Am J Pharm Educ 2017; 81:6100. [PMID: 29367772 PMCID: PMC5774192 DOI: 10.5688/ajpe6100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 03/14/2017] [Indexed: 05/22/2023]
Abstract
Objective. To create and implement a class in ethnopharmacology that would educate student pharmacists on folk medicine, including home remedies and native plants that are used as alternative medicinal sources; active components of medicinal plants including toxicity issues and the mechanism of action of beneficial compounds, such as catechins and other flavonoids; and nutraceuticals and poisonous plants. Methods. In this three-credit hour class, herbal remedies are investigated from the standpoints of medical efficacy, potential toxicities and drug interactions with prescribed medications. Class discussions are conducted on the usefulness of remedies, the attitudes of practitioners toward traditional remedy use and the risks of relying on herbal preparations. Each student prepares a 15-minute presentation on a disease state, which covers modern pharmaceuticals and herbal or folk remedy alternatives used in that disease. Special emphasis is given to drug-herb interactions. Results. The class has gained popularity among students and consistently fills within the first hour of computerized registration. Students agree that being educated in the benefits and potential toxicities of herbal products will better prepare them to counsel their patients who use these remedies. The elective has been offered 10 times since 2007. Anecdotal comments from our alumni indicate that they have found the information to be very useful in their practice environments. Conclusion. Providing our students with a greater understanding of herbal remedies is essential to prepare them for practice. By including both the uses and potential toxicities, the student pharmacist is able to counsel her patients from a standpoint of expertise on these self-administered remedies.
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Affiliation(s)
- Rebecca S Linger
- University of Charleston School of Pharmacy, Charleston, West Virginia
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Elaheebocus N, Mahomoodally MF. Ayurvedic medicine in Mauritius: Profile of Ayurvedic outlet, use, sale, distribution, regulation and importation. J Ethnopharmacol 2017; 197:195-210. [PMID: 27423223 DOI: 10.1016/j.jep.2016.07.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/29/2016] [Accepted: 07/08/2016] [Indexed: 06/06/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Ayurvedic medicine (AM) is a legalised alternative traditional medical system in the multicultural tropical island of Mauritius. A panoply of Ayurvedic specialised shops/centres involved in the provision of Ayurvedic services hereafter termed as 'outlets' operates in different regions of the island and is extensively exploited by a significant number of Mauritians. Nonetheless, there is currently no study geared towards studying the status of AM and profile of Ayurvedic outlets in Mauritius and there is undoubtedly a dearth of standardized regulatory framework governing the practice of AM in Mauritius. The present study attempts to study the profile of Ayurvedic outlets, sale, distribution, regulation and importation of AM in Mauritius. AIM OF STUDY To evaluate the characteristics profile of Ayurvedic shops/clinics/pharmacies/centres, to document common Ayurvedic products used in the treatment and management of diseases, and to analyse existing regulatory control of AM in Mauritius. MATERIAL AND METHODS Ayurvedic outlets were identified using a random approach. Once permission granted, outlets were visited where face-to-face interviews with Ayurvedic practitioners/directors/dispensers were undertaken using a semi-structured questionnaire. The characteristics of the outlets with respect to the type of business registration, procurement and dispensing of products, registration and qualification of personnels employed amongst others were studied. The International Classification of Diseases (ICD) 10 was used to classify common AM dispensed to patients. Additionally, information was sought from local authorities pertaining to existing legislation governing the importation and regulation of AM in Mauritius. RESULTS A total of 16 Ayurvedic outlets ('pharmacies' (n=3), clinics (n=2), shops (n=5) and centres (n=6)) was surveyed. Six outlets dispensed AM strictly on prescription only after consultation with an onsite full-time employed registered Ayurvedic practitioner. Seven outlets offered AM both on prescription and over-the-counter where consultation was not mandatory. The remaining three outlets, where no Ayurvedic practitioner was employed, did not offer consultation at any time and dispensed the medicines over-the-counter most of the time. There is currently no such legal framework that acknowledges the existence of an Ayurvedic pharmacy in Mauritius and no trained Ayurvedic pharmacist was recruited in any of the outlets. It was also found that no specific requirements were in place to establish an Ayurvedic outlet in Mauritius. A wide variety of Ayurvedic formulated and single herb products were recorded to be in use against common diseases. Ayurvedic products were imported from India (n=10), purchased from local suppliers (n=6) or locally manufactured (n=1). The Traditional Medicine Board under the aegis of the pharmacy board is a regulatory body which requires Ayurvedic practitioners to be registered so as to practice AM in Mauritius. Additionally, the government has an Ayurvedic committee, under the aegis of the Pharmacy board in the Ministry of Health and Quality of Life to monitor the importation of AM. However, no legal framework has been enacted to regulate the sale of AM under prescription or under the supervision of an Ayurvedic practitioner. CONCLUSION The current regulatory framework is such that the sale/use/distribution of AM is not strictly controlled unlike its importation. This has led to a certain form of unregulated practice in the private sector whereby the dispensing and sale of AM are being done over-the-counter without professional recommendations. It is recommended that authorities need to regulate the Ayurvedic medical system in Mauritius by amending stringent laws to ensure safety of patients.
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Affiliation(s)
- Naailah Elaheebocus
- Department of Health Sciences, Faculty of Science, University of Mauritius, 230 Réduit, Mauritius
| | - M Fawzi Mahomoodally
- Department of Health Sciences, Faculty of Science, University of Mauritius, 230 Réduit, Mauritius.
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Salari S, Bakhshi T, Sharififar F, Naseri A, Ghasemi Nejad Almani P. Evaluation of antifungal activity of standardized extract of Salvia rhytidea Benth. (Lamiaceae) against various Candida isolates. J Mycol Med 2016; 26:323-330. [PMID: 27499461 DOI: 10.1016/j.mycmed.2016.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 06/25/2016] [Accepted: 06/30/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Salvia species have long been described in traditional medicine for various indications. Owing to the widespread use of this genus by ethnic populations, especially for various infections ranging from skin disease to gastrointestinal disorders, we were encouraged to determine whether Salvia rhytidea could be effective against fungal infections. Given the increased incidence of candidiasis in the past decade, limits on the use of antifungal drugs, emergence of azole-resistant Candida species and increased incidence of treatment failures, it is necessary to identify a novel agent with antifungal properties. Aim of the study was to evaluate the antifungal properties of S. rhytidea against various Candida isolates. MATERIALS AND METHODS In this study, at first rosmarinic acid content of plant extract was determined. A total of 96 Candida isolates were tested, including the following species: Candida albicans (n=42), Candida glabrata (n=16), Candida tropicalis (n=11), Candida krusei (n=9), Candida parapsilosis (n=9), Candida lusitaniae (n=7) and Candida guilliermondii (n=2). The in vitro antifungal activity of methanolic extracts of S. rhytidea Benth. was evaluated against Candida isolates and compared with that of the standard antifungal drug nystatin by using a broth microdilution method, according to CLSI. RESULTS Phytochemical screening results showed that the methanolic extract of S. rhytidea Benth. was rich in flavonoids and tannins. The minimal inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) values of S. rhytidea Benth. ranged from 3.125 to>100μg/ml and 6.25 to>100μg/ml respectively. The growth inhibition value displayed that C. tropicalis, C. krusei and C. albicans isolates were most susceptible to S. rhytidea. CONCLUSIONS Findings show that S. rhytidea possesses an antifungal effect against Candida isolates.
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Affiliation(s)
- S Salari
- Research Center for Tropical and Infectious Diseases, Kerman University of Medical Sciences, Kerman, Iran; Department of Medical Mycology and Parasitology, School of Medicine, Medical University of Kerman, Kerman, Iran.
| | - T Bakhshi
- Department of Medical Mycology and Parasitology, School of Medicine, Medical University of Kerman, Kerman, Iran
| | - F Sharififar
- Department of Pharmacognosy, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - A Naseri
- Department of Medical Mycology and Parasitology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - P Ghasemi Nejad Almani
- Department of Medical Mycology and Parasitology, School of Medicine, Medical University of Kerman, Kerman, Iran
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The problem with unregulated botanicals. Drug Ther Bull 2016; 54:61. [PMID: 27231217 DOI: 10.1136/dtb.2016.6.0403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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11
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Han LW. [Characteristics and innovation in projects of ethnomedicine and ethnopharmacology funded by National Natural Science Foundation of China]. Zhongguo Zhong Yao Za Zhi 2015; 40:3379-3384. [PMID: 26978976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The overall situation of projects of ethnomedicine and ethnopharmacology funded by the National Natural Science Foundation of China (NSFC) since 2008 has been presented in this paper. The main source of characteristics and innovation of the funded projects were summarized, which may come from several aspects, such as the ethnomedical theories, the dominant diseases of ethnomedicine, special diseases in ethnic minorities inhabited areas, unique ethnomedical therapy, special methods for applying medication, endemic medicinal materials in ethnic minorities inhabited areas, same medicinal materials with different applications. Examples have been provided to give references to the applicants in the fields of ethnomedicine and ethnopharmacology.
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12
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Soltani Arabshahi S, Mohammadi Kenari H, Kordafshari G, Shams-Ardakani M, Bigdeli S. Criteria for evidence-based practice in Iranian traditional medicine. Acta Med Iran 2015; 53:419-424. [PMID: 26520629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 10/06/2015] [Indexed: 06/05/2023] Open
Abstract
The major difference between Iranian traditional medicine and allopathic medicine is in the application of evidence and documents. In this study, criteria for evidence-based practice in Iranian traditional medicine and its rules of practice were studied. The experts' views were investigated through in- depth, semi-structured interviews and the results were categorized into four main categories including Designing clinical questions/clinical question-based search, critical appraisal, resource search criteria and clinical prescription appraisal. Although the application of evidence in Iranian traditional medicine follows Evidence Based Medicine (EBM) principles but it benefits from its own rules, regulations, and criteria that are compatible with EBM.
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Affiliation(s)
- SeyyedKamran Soltani Arabshahi
- Department of Medical Education, Center for Educational Research in Medical Sciences (CERMS), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hoorieh Mohammadi Kenari
- Medical Sciences Education and Development Office, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Kordafshari
- Department of Traditional Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - MohammadReza Shams-Ardakani
- Department of Traditional Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shoaleh Bigdeli
- Department of Medical Education, Center for Educational Research in Medical Sciences (CERMS), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Kadetz P. Manufacturing risk: reframing the discourse of safety of commodified potent substances. J Ethnopharmacol 2015; 167:115-122. [PMID: 25557033 DOI: 10.1016/j.jep.2014.12.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 12/16/2014] [Accepted: 12/16/2014] [Indexed: 06/04/2023]
Abstract
ETHNOPHARMALOGICAL RELEVANCE The rapid commodification of plant-based medicines has led to the development of regulatory guidelines and standards by the World Health Organization to ensure the safety of these products. However, these standards have been identified to be selectively implemented, if implemented at all, in many contexts. A primary concern for proving the safety of intrinsic factors of plant-based medicines, may result in less attention paid to the often more problematic extrinsic factors of mass production. This article critically examines the normative global discourse of safety concerning plant-based medicines and problematises many of the assumptions identified in this discourse. MATERIALS AND METHODS This qualitative research was conducted in the Traditional Medicine Unit of the Western Pacific Regional Office of the World Health Organization (WHO) and in field work in the rural Philippines. Data was collected through archival research, analysis of WHO data sets, semi-structured and structured interviews and surveys, participant observation concerning local plant-based medicine use in the Philippines and participant observation in WHO meetings regarding future strategies for traditional Asian medicines. RESULTS Although informants reported concerns of safety for every aspect of the production, marketing and sales of plant-based medicines, this research has identified that the implementation (WHO guidelines) has been uneven and inconsistent over the past ten years in the Western Pacific Region of the WHO. Differences in local contexts that are not consistent with global guidelines and standards were reported by informants. Issues have also been identified in the inconsistent regulation of plant-based medicines as pharmaceuticals within only certain, rather than all, processes of production. CONCLUSIONS It is imperative to understand plant-based medicines as the potent substances they are, whose rapid global commodification may affect both their potency and safety. The WHO discourse of the need for safety in the use of plant-based medicines has justified the need for biomedical oversight through processes of commodification. Yet, it is often through these very processes of commodification and mass production that safety may be compromised. This research suggests that the discourse concerning the safety of the plant-based medicines needs to be reframed from a primary focus on the intrinsic factors of plant-based medicines to a greater focus on the extrinsic factors of global commodification.
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Affiliation(s)
- Paul Kadetz
- Xi׳an Jiaotong-Liverpool University, 111 Ren׳ai Road, Public Building Room 516A, Dushu Lake Higher Education Town, Suzhou Industrial Park Suzhou, Jiangsu, 215123 People׳s Republic of China.
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He JY, Ma N, Zhu S, Komatsu K, Li ZY, Fu WM. The genus Codonopsis (Campanulaceae): a review of phytochemistry, bioactivity and quality control. J Nat Med 2015; 69:1-21. [PMID: 25099952 PMCID: PMC4287686 DOI: 10.1007/s11418-014-0861-9] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 07/18/2014] [Indexed: 11/29/2022]
Abstract
Codonopsis, in the family Campanulaceae, is a genus containing 42 species of dicotyledonous herbaceous perennial plants, predominantly found in Central, East and South Asia. Several Codonopsis species are widely used in traditional medicine and are considered to have multiple medicinal properties. Among the Codonopsis species, Codonopsis pilosula (Franch.) Nannf. and C. lanceolata (Sieb. et Zucc.) Benth. & Hook. f. ex Trautv. are more popular than others according to the findings, especially phytochemical and bioactive studies. Phytochemical research shows that Codonopsis species contain mainly polyacetylenes, phenylpropanoids, alkaloids, triterpenoids and polysaccharides, which contribute to multiple bioactivities. However, the mechanisms of their bioactivities need to be further elucidated. The less popular Codonopsis species remain to be studied and exploited. In addition, although a series of methods for the quality evaluation of Codonopsis species have been developed, a feasible and reliable approach to the efficacious and safe use of various Codonopsis species is still needed, with considering botanical origin, chemical constituents and bioactive effects. This review aims to provide up-to-date and comprehensive information on the phytochemistry, bioactivity and quality control of medicinal plants in the genus Codonopsis and to highlight current gaps in knowledge, which is useful for the wider development of the Codonopsis genus.
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Affiliation(s)
- Jing-Yu He
- />Guangzhou Institute of Advanced Technology, Chinese Academy of Sciences, 1121 Haibin Rd., Nansha Dist., 511-458 Guangzhou, People’s Republic of China
| | - Na Ma
- />Guangzhou Institute of Advanced Technology, Chinese Academy of Sciences, 1121 Haibin Rd., Nansha Dist., 511-458 Guangzhou, People’s Republic of China
| | - Shu Zhu
- />Division of Pharmacognosy, Department of Medicinal Resources, Institute of Natural Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194 Japan
| | - Katsuko Komatsu
- />Division of Pharmacognosy, Department of Medicinal Resources, Institute of Natural Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194 Japan
| | - Zhi-Yuan Li
- />Guangzhou Institute of Advanced Technology, Chinese Academy of Sciences, 1121 Haibin Rd., Nansha Dist., 511-458 Guangzhou, People’s Republic of China
| | - Wei-Ming Fu
- />Guangzhou Institute of Advanced Technology, Chinese Academy of Sciences, 1121 Haibin Rd., Nansha Dist., 511-458 Guangzhou, People’s Republic of China
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Wiesner J, Knöss W. Future visions for traditional and herbal medicinal products--a global practice for evaluation and regulation? J Ethnopharmacol 2014; 158 Pt B:516-518. [PMID: 25152297 DOI: 10.1016/j.jep.2014.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/11/2014] [Accepted: 08/12/2014] [Indexed: 06/03/2023]
Abstract
Medicinal plants and traditional medicines have been used worldwide since ancient times. Currently, there is neither a globally consented terminology nor a harmonized regulatory approach. Nevertheless, it is common sense that quality, efficacy and safety should be assessed following scientific standards, addressing particulars and considering an adequate level of risk management. A global market for traditional medicines is emerging, if not already existing. Therefore, a constructive communication about regulatory systems for herbal and traditional medicinal products should be enforced. Best practice standards might be developed according to current scientific knowledge in order to improve mutual acceptance of data, sets of monographs and assessments. Overall, a convergence of the diverse regulatory systems might save resources and lead to an adequate availability of herbal and traditional medicinal products to the patients without neglecting public health.
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Affiliation(s)
- Jacqueline Wiesner
- Federal Institute for Drugs and Medical Devices, Kurt-Georg-Kiesinger-Allee 3, Bonn 53175, Germany
| | - Werner Knöss
- Federal Institute for Drugs and Medical Devices, Kurt-Georg-Kiesinger-Allee 3, Bonn 53175, Germany.
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Peschel W. The use of community herbal monographs to facilitate registrations and authorisations of herbal medicinal products in the European Union 2004-2012. J Ethnopharmacol 2014; 158 Pt B:471-486. [PMID: 25043780 DOI: 10.1016/j.jep.2014.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 06/11/2014] [Accepted: 07/08/2014] [Indexed: 06/03/2023]
Abstract
The provisions for the simplified registration of traditional herbal medicinal products in the European Union were introduced by Directive 2004/24/EC amending Directive 2001/83/EC (Chapter 2a) in 2004. Since implementation in the European member states until December 2012 a total of 1015 registrations (traditional use) and 514 authorisations (well-established use) have been granted for products containing substances/ preparations from about 200 different herbal drugs. The overall number of received applications with more than one third still under assessment suggests a further increase for the next years. This review summarises the main features of registered and authorised herbal medicinal products in the EU and evaluates available data against provisions of Directive 2004/24/EC and European standards established by the Committee on Herbal Medicinal Products at the European Medicines Agency. The supportive function of Community herbal monographs is described as regards availability and their use in national procedures, which is complemented by an analysis of specific future challenges from experiences made with the implementation of Directive 2004/24/EC so far.
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Affiliation(s)
- Wieland Peschel
- HMPC Secretariat, European Medicines Agency, 7 Westferry Circus, Canary Wharf, London E14 4HB - United Kingdom.
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Cranz H, Anquez-Traxler C. TradReg 2013: regulation of herbal and traditional medicinal products--European and global strategies--international symposium. J Ethnopharmacol 2014; 158 Pt B:495-497. [PMID: 25281419 DOI: 10.1016/j.jep.2014.09.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 08/28/2014] [Accepted: 09/18/2014] [Indexed: 06/03/2023]
Abstract
Plants have always been an important source of treatment. The important contribution of phytotherapy became particularly recognised through European Directive 2004/24/EC (Directive 2004/24/EC, 2004), which set up a new Committee dedicated to herbal medicinal products at the European Medicines Agency (EMA). In addition, it created a new status for traditional herbal medicinal products by making possible their simplified "registration" based on plausible level of efficacy. Nearly 10 years after the creation of this new framework, an impressive number of monographs were established. However, implementation remains a challenge. There is also a critical need to encourage innovation and research and to ensure that new pieces of legislation are applied to herbal medicinal products taking due account of their characteristics. This article reflects the concerns and expectations of the European manufacturers of herbal medicines.
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Affiliation(s)
- Hubertus Cranz
- Association of the European Self-Medication Industry (AESGP), 7 Avenue de Tervuren, B-1040 Brussels, Belgium.
| | - Christelle Anquez-Traxler
- Association of the European Self-Medication Industry (AESGP), 7 Avenue de Tervuren, B-1040 Brussels, Belgium
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van Galen E. Traditional herbal medicines worldwide, from reappraisal to assessment in Europe. J Ethnopharmacol 2014; 158 Pt B:498-502. [PMID: 25043781 DOI: 10.1016/j.jep.2014.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/21/2014] [Accepted: 07/08/2014] [Indexed: 06/03/2023]
Abstract
Since 2004 the regulatory framework within the European Union has a specific assessment procedure for herbal medicinal products, with a medicinal use based on traditional practice. The main requirement concerning the traditional use is focussed on the period of time for medical use: at least 30 years, including 15 years in the EU. In addition to requirements for quality and safety, an evaluation of pharmacological effects or efficacy based on long-standing use, is a main objective. "Traditional Use" however encompasses European, and non-European traditional use. Outside the EU, the medicinal use of herbal substances, preparations, and combinations is well-known, with a long history, which is well-documented in the different systems of medical practice. This has been addressed by WHO, but it has been acknowledged also by European Commission that herbal products from other systems of medicine, can be subject to the procedure for traditional herbal medicinal products. This paper will focus on the possibilities, restraints, and challenges of regulatory practice in the European Union regarding these category of medicinal products.
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Affiliation(s)
- Emiel van Galen
- CBG-MEB Agency Botanicals & Novel Foods, Graadt van Roggenweg 500, PO Box 8275, 3503 RG Utrecht, The Netherlands.
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Abstract
RESULTS According to Directive 2004/24/EC which amended the basic legislation laid down in Directive 2001/83/EC a new European legislation on herbal medicinal products was developed, in order to harmonize the use of herbal medicinal products in Member States of the European Union. CONCLUSIONS The objective of this legislation was to ensure the future existence of such products and to consider particular characteristics during the assessment of their quality, efficacy and safety, having defined two categories for herbal medicines: i) well-established use herbal medicinal products, which can be granted a marketing authorization; and ii) traditional herbal medicinal products which can be granted a registration based on their longstanding safe and efficient use.
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Affiliation(s)
- Ioanna Chinou
- University of Athens, Faculty of Pharmacy, Division of Pharmacognosy and Chemistry of Natural, Products, University Campus of Zografou, Athens 15771, Greece.
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Kroes BH. The legal framework governing the quality of (traditional) herbal medicinal products in the European Union. J Ethnopharmacol 2014; 158 Pt B:449-453. [PMID: 25086408 DOI: 10.1016/j.jep.2014.07.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/25/2014] [Accepted: 07/08/2014] [Indexed: 06/03/2023]
Abstract
In the European Union a complex regulatory framework is in place for the regulation of (traditional) herbal medicinal products. It is based on the principle that a marketing authorisation granted by the competent authorities is required for placing medicinal products on the market. The requirements and procedures for acquiring such a marketing authorisation are laid down in regulations, directives and scientific guidelines. This paper gives an overview of the quality requirements for (traditional) herbal medicinal products that are contained in European pharmaceutical legislation. Pharmaceutical quality of medicinal product is the basis for ensuring safe and effective medicines. The basic principles governing the assurance of the quality of medicinal products in the European Union are primarily defined in the amended Directive 2001/83/EC and Directive 2003/63/EC. Quality requirements of herbal medicinal products are also laid down in scientific guidelines. Scientific guidelines provide a basis for practical harmonisation of how the competent authorities of EU Member States interpret and apply the detailed requirements for the demonstration of quality laid down in regulations and directives. Detailed quality requirements for herbal medicinal products on the European market are contained in European Union (EU) pharmaceutical legislation. They include a system of manufacturing authorisations which ensures that all herbal medicinal products on the European market are manufactured/imported only by authorised manufacturers, whose activities are regularly inspected by the competent authorities. Additionally, as starting materials only active substances are allowed which have been manufactured in accordance with the GMP for starting materials as adopted by the Community. The European regulatory framework encompasses specific requirements for herbal medicinal products. These requirements are independent from the legal status. Thus, the same quality standards equally apply to herbal products based on clinical evidence and traditional herbal medicinal products. The basic principle is that the quality of herbal medicinal products is intrinsically associated with the quality standard of the herbal substances and/or herbal preparations. Furthermore, the herbal substance or herbal preparation in its entirety is regarded as the active substance. Consequently, a mere determination of the content of marker(s) or constituents with known therapeutic activity is not sufficient for the quality control of herbal medicinal products. Specific quality requirements include thorough product characterisation, adherence to the Good Agricultural and Collection Practices, good manufacturing practices and validated manufacturing process, e.g., raw material testing, in-process testing, fingerprint characterisation etc. Quality control of herbal medicinal products is primarily intended to define the quality of the herbal substance/preparation and herbal medicinal product rather than to establish full characterisation.
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Affiliation(s)
- Burt H Kroes
- Medicines Evaluation Board of The Netherlands, Graadt van Roggenweg 500, 3531 AH Utrecht, The Netherlands.
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Carvalho ACB, Ramalho LS, Marques RFDO, Perfeito JPS. Regulation of herbal medicines in Brazil. J Ethnopharmacol 2014; 158 Pt B:503-506. [PMID: 25169216 DOI: 10.1016/j.jep.2014.08.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 07/29/2014] [Accepted: 08/13/2014] [Indexed: 06/03/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Rich Brazilian biodiversity is accompanied by a long acceptance of medicinal plants and traditional knowledge by the Brazilian population. To improve the regulatory framework for herbal medicines in Brazil, ANVISA recently revised its legislations. The aim of this study is to discuss the new Brazilian standards for herbal medicines regulation. MATERIALS AND METHODS The national and international legislation on herbal medicines was revised to prepare new Brazilian standards. This new legislation is discussed. RESULTS This new proposed regulation separates herbal into two categories: herbal medicines (HM) and traditional herbal product (THP). The safety and efficacy of HM must be proven by clinical data. ANVISA recognizes some plants as safe and effective; therefore, the registration of these species can be simplified. ANVISA also recognizes the monographs of the European community as simplified registrations. THP can prove their safety and effectiveness by tradition of use or following a simplified registration. CONCLUSION Brazil has been altering their legal standards for herbal medicines, based on harmonization with internationally practiced requirements and the characteristics of the Brazilian market, facilitating the safe access and rational use of medicinal plants and herbal products to Brazilian population.
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Affiliation(s)
- Ana Cecília Bezerra Carvalho
- Agência Nacional de Vigilância Sanitária, Coordenação de Medicamentos Fitoterápicos e Dinamizados, SIA, Trecho 5, Área especial 57, Bloco A/B, 71.200-980 Brasília-DF, Brazil.
| | - Lívia Santos Ramalho
- Agência Nacional de Vigilância Sanitária, Coordenação de Medicamentos Fitoterápicos e Dinamizados, SIA, Trecho 5, Área especial 57, Bloco A/B, 71.200-980 Brasília-DF, Brazil.
| | - Robelma France de Oliveira Marques
- Agência Nacional de Vigilância Sanitária, Coordenação de Medicamentos Fitoterápicos e Dinamizados, SIA, Trecho 5, Área especial 57, Bloco A/B, 71.200-980 Brasília-DF, Brazil.
| | - João Paulo Silvério Perfeito
- Agência Nacional de Vigilância Sanitária, Coordenação de Medicamentos Fitoterápicos e Dinamizados, SIA, Trecho 5, Área especial 57, Bloco A/B, 71.200-980 Brasília-DF, Brazil.
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Claeson P. Requirements on efficacy of herbal medicinal products. J Ethnopharmacol 2014; 158 Pt B:463-466. [PMID: 25043782 DOI: 10.1016/j.jep.2014.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 05/21/2014] [Accepted: 07/09/2014] [Indexed: 06/03/2023]
Abstract
Based on the regulatory requirements on efficacy documentation in the European Union, the herbal medicinal products have been grouped into the following sections: (i) Herbal medicinal products for which the efficacy is demonstrated by results of a "full" set of clinical trials that are in conformity with the relevant guidelines of the therapeutic area in question. This regulatory pathway to obtain a marketing authorisation for a new medicinal product (new chemical entity) is open to herbal medicinal products, but the examples are in reality few. (ii) Herbal medicinal products which have a "well-established medicinal use with a recognised efficacy and an acceptable level of safety" in the European Union. Results of new and product specific clinical trials are not required to obtain a marketing authorisation for products that fulfil these criteria, but a substantial clinical experience must be documented and sufficient scientific data on efficacy must be publicly available. (iii) "Traditional" herbal medicinal products, that do not fulfil the efficacy requirements for a marketing authorisation, but for which a medicinal use of at least 30 years including 15 years in the European Union can be documented. Traditional herbal medicinal products can only be registered with therapeutic indications that are considered safe for use without the supervision of a physician. After briefly reviewing the regulatory requirements on efficacy documentation of herbal medicinal products in the European Union, some concluding remarks on the past and future developments in the area are made.
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Affiliation(s)
- Per Claeson
- Medical Products Agency, P.O. Box 26, 751 03 Uppsala, Sweden.
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23
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Abstract
Each application for authorisation of a medicinal product must be accompanied by the particulars and documents referred to in Directive 2001/83/EC on the Community code relating to medicinal products for human use. Details on the documentation needed for traditional herbal medicinal products (THMP) are given in article 16c of the above mentioned Directive. It is pointed out that a bibliographic review of safety data together with an expert report and additional data, if necessary, are required. The Committee on Herbal Medicinal Products (HMPC) provides in its "Guideline on the use of the CTD format in the preparation of a registration application for traditional herbal medicinal products" (EMA/HMPC/71049/2007 Rev. 1) guidance on how to present the information and the dossier needed for an application. There, in agreement with the Directive 2001/83/EC, a bibliographical review of safety data is required within the "Non-clinical Overview". However, it is assumable that for such products, with a long tradition of usage bibliographical information relating to non-clinical safety are available, even if incomplete or not in accordance with today׳s state of the art. In the "Guideline on non-clinical documentation for herbal medicinal products in applications for marketing authorisation (bibliographical and mixed applications) and in applications for simplified registration" (EMEA/HMPC/32116/2005) it is reflected how to deal with such an incomplete set of data for traditional herbal medicinal products and crucial information are highlighted. This article will focus on the explanation of the requirements needed for the non-clinical safety evaluation of THMPs and some detailed explanations of the performance and interpretation of the mutagenicity studies.
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Affiliation(s)
- Jacqueline Wiesner
- Federal Institute for Drugs and Medical Devices, K.-G.-Kiesinger-Allee 3, 53175 Bonn, Germany.
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Gruca M, Cámara-Leret R, Macía MJ, Balslev H. New categories for traditional medicine in the Economic Botany Data Collection Standard. J Ethnopharmacol 2014; 155:1388-1392. [PMID: 24971798 DOI: 10.1016/j.jep.2014.06.047] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 06/13/2014] [Accepted: 06/16/2014] [Indexed: 06/03/2023]
Abstract
The Economic Botany Data Collection Standard (EBDCS) has been successfully followed by ethnobotanists investigating plant uses in many parts of the world. However, we have encountered some cases in our study of traditional medicine where the standard seems incomplete and inaccurate when it is applied to plant uses of rural or indigenous societies in developing countries. We propose two categories to be added to the EBDCS: Cultural Diseases and Disorders, and Ritual/Magical Uses. Adding these categories, we believe will give a more accurate insight into traditional medicine and will contribute to developing an integrative ethnomedicinal data collection protocol, which will make ethnomedicinal studies more comparable.
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Affiliation(s)
- Marta Gruca
- Department of Bioscience - Research Group Ecoinformatics and Biodiversity, Aarhus University, Build. 1540, Ny Munkegade 114, DK-8000 Aarhus C, Denmark
| | - Rodrigo Cámara-Leret
- Departamento de Biología, Área de Botánica, Universidad Autónoma de Madrid, Calle Darwin 2, ES- 28049 Madrid, Spain
| | - Manuel J Macía
- Departamento de Biología, Área de Botánica, Universidad Autónoma de Madrid, Calle Darwin 2, ES- 28049 Madrid, Spain
| | - Henrik Balslev
- Department of Bioscience - Research Group Ecoinformatics and Biodiversity, Aarhus University, Build. 1540, Ny Munkegade 114, DK-8000 Aarhus C, Denmark.
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Bamfarahnak H, Azizi A, Noorafshan A, Mohagheghzadeh A. A Tale of Persian Cupping Therapy: 1001 Potential Applications and Avenues for Research. Forsch Komplementmed 2014; 21:42-7. [PMID: 24603629 DOI: 10.1159/000358571] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Hossein Bamfarahnak
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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26
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Abstract
Cancer is emerging as a key disease in India, but there has been virtually no research exploring understandings of cancer and practices of communication within oncology settings. This is despite the fact that the Indian context presents clinicians, patients, and family members with a range of unique challenges, including those related to disease awareness, interpersonal dynamics, and the use of traditional, complementary, and alternative medicines (TCAM). Drawing on a series of qualitative interviews with 22 Delhi-based oncology clinicians, in this article we examine clinicians' accounts of communication with their cancer patients. The interviews reveal the challenges of communication given cancer's relative novelty, cultural practices around collective negotiation, and rhetorical practices evident in advice-giving regarding TCAM. We conclude that with cancer set to become a major burden in India, research exploring competing forms of expertise, the politics of representation, and the nexus between traditional beliefs and techno-scientific development is urgently needed.
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Affiliation(s)
- Alex F Broom
- The University of Queensland, Brisbane, Queensland, Australia.
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27
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Chotchoungchatchai S, Saralamp P, Jenjittikul T, Pornsiripongse S, Prathanturarug S. Medicinal plants used with Thai Traditional Medicine in modern healthcare services: a case study in Kabchoeng Hospital, Surin Province, Thailand. J Ethnopharmacol 2012; 141:193-205. [PMID: 22366679 DOI: 10.1016/j.jep.2012.02.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 01/06/2012] [Accepted: 02/03/2012] [Indexed: 05/10/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Thai Traditional Medicine (TTM) is available in many modern hospitals in Thailand. However, there have been difficulties in integrating TTM, particularly the practices of the use of herbal medicines, into modern healthcare services. Kabchoeng Hospital is one hospital that has been able to overcome these difficulties. Thus, this study aimed to document the successful utilization of herbal medicine at Kabchoeng Hospital. The documentation focused on both the knowledge of medicinal plants and the success factors that facilitated the utilization of herbal medicine in the context of a modern hospital in Thailand. MATERIALS AND METHODS Kabchoeng Hospital was intentionally selected for this case study. Participatory observation was used for the data collection. There were six groups of key informants: three applied Thai Traditional Medicine practitioners (ATTMPs), a pharmacist, two physicians, two folk healers, the head of an herbal cultivation and collection group, and 190 patients. The plant specimens were collected and identified based on the botanical literature and a comparison with authentic specimens; these identifications were assisted by microscopic and thin layer chromatography (TLC) techniques. RESULTS Eighty-nine medicinal plants were used for the herbal preparations. The ATTMPs used these plants to prepare 29 standard herbal preparations and occasional extemporaneous preparations. Moreover, in this hospital, seven herbal preparations were purchased from herbal medicine manufacturers. In total, 36 preparations were used for 10 groups of symptoms, such as the treatment of respiratory system disorders, musculo-skeletal system disorders, and digestive system disorders. Four success factors that facilitated the utilization of herbal medicine at Kabchoeng Hospital were determined. These factors included a proper understanding of the uses of herbal medicines, the successful integration of the modern and TTM healthcare teams, the support of an herbal cultivation and collection group, and the acceptance of the local people. CONCLUSIONS The practices that support the use of herbal medicine at Kabchoeng Hospital illustrated the successful application of TTM and also represented a model for the integration of TTM, and particularly the use of herbal medicine, into modern hospitals. This integration will be beneficial for sustainable healthcare systems in Thailand and in other countries where modern medicine is the mainstream medical system.
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Affiliation(s)
- Somtanuek Chotchoungchatchai
- Department of Pharmaceutical Botany, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayudthaya Road, Bangkok 10400, Thailand
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28
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Abstract
Recent studies on traditional medicine (TM) have begun to change perspectives on TM effects and its role in the health of various populations. The safety and effectiveness of some TMs have been studied, paving the way to better collaboration between modern and traditional systems. Traditional medicines still remain a largely untapped health resource: they are not only sources of new leads for drug discoveries, but can also provide lessons and novel approaches that may have direct public-health and economic impact. To optimize such impact, several interventions have been suggested, including recognition of TM's economic and medical worth at academic and health policy levels; establishing working relationships with those prescribing TM; providing evidence for safety and effectiveness of local TM through appropriate studies with malaria patients; spreading results for clinical recommendations and health policy development; implementing and evaluating results of new health policies that officially integrate TM.
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Affiliation(s)
- Bertrand Graz
- Geneva University, IMSP/CMU, 1, rue Michel Servet, CH-1211 Geneva 4, Switzerland
| | - Andrew Y Kitua
- Special Programme for Research and Training in Tropical Diseases (WHO/TDR), 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Hamisi M Malebo
- National Institute for Medical Research, Ocean Road/Luthuli Street, P.O. Box 9653, Dar es Salaam, Tanzania
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29
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Kmietowicz Z. Diploma in old wives' tales medicine anyone? BMJ 2010; 341:c4953. [PMID: 20833745 DOI: 10.1136/bmj.c4953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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30
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Roberts G. Western epistemology: a stranger in a strange land? Pac Health Dialog 2010; 16:112-118. [PMID: 21714348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Westernization in the Pacific, as in the world, brought with it many old truths and new ideas. It brought new belief systems that were widely accepted and technologies that mostly proved useful. But it also brought something that it never fully put into words, although the brightest of students attending the best of schools may have had a glimpse of it. It's not a secret but, somehow, it's rarely discussed. When Westerners came they claimed to know an awful lot of things. But how did they know what they claimed to know? What was their way of knowing things? This paper discusses the various ways of knowing, with special reference to scientific knowledge and its epistemological basis, and to the nature of the body of knowledge it generates and protects. The objective is to provide a short history of western thought and a foundation for young scientist who need more than the successes of technology to understand how they know the things they claim to know.
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Affiliation(s)
- Graham Roberts
- Fiji School of Medicine, College of Medicine, Nursing and Health Sciences, Fiji National University.
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