Personal and professional influences on practitioners’ attitudes to traditional and complementary approaches to health in the UK

Objective:To explore primary care practitioners’personal and professional beliefs about traditional and complementary approaches(TCA)to health and the influence of professional socialization in the UK.Methods:As part of a larger study on child TCA use in a multi ethnic community,semi-structured,one on one,face-to-face interviewswith 30 primary care practitioners(GPs,nurses and health visitors)explored experience,knowledge and attitudes regarding TCA.Framework analysiswas used.This paper explores the key emergent issues of personal and professional beliefs and professional socialization resulting from the qualitative data obtained during the interviews.Results:Personal factors(ethnicity and personal use)influence attitudes,but professional factors appear to dominate,including biomedical theory,evidence basedmedicine,safety and treatment choice.Curbing of personal views and experience may be due to caution and conformity from increasing regulatory power.Inter-and intra-professional group differences also emerged,likely due to variation in training,status and professional role.Conclusions:Practitioners need to understand patients’diverse health beliefs and practices and discuss TCAwith families,despite regulatory and organizational constraints,to fulfil their professional duty to patients,particularly regarding safety.Further research is needed to verify the professional socialization process and the influence of specific regulation on training.

The Importance of Evidence for the Integration of Traditional and Complementary Medicine into Western Healthcare?

Policy makers should consider improving access to treatments normally considered outside of healthcare in the west, particularly given the recent WHO strategy. However, research on integrating traditional and complementary medicines(T&CM) into conventional health care is lacking. T& CM approaches, may provide a cost effective option given the increase in chronic diseases with evidence of effectiveness of T& CM being key if such approaches are to be offered as part of integrative patient care, in most countries, an integrated healthcare approach is unavailable to patients. Evidence based clinical guidelines on T& CM should influence care provision. However evidence that is available may not even be cited. Poor use of evidence may possibly be a reflection of lack of knowledge and/or biases of guideline developers but additionally stakeholders vary in their perceived need for evidence to implement health policy change. Journal editors should focus on publishing high quality manuscripts, with clear rationales, design and reporting frameworks. Researchers should consider carrying out careful feasibility studies prior to conducting trials taking into account the UK Medical Research Council's framework on complex interventions. Examples of feasibility studies highlighting their importance for trial design are given in this paper. If preparation for more definitive studies is conducted this will in turn improve the quality of research being designed, executed and published and subsequently encourage the inclusion of evidence by guideline developers. Robust evidence is necessary in order to inform governments' health policies providing appropriate T&CM interventions which can ultimately help to provide best patient care.

Review of the Regulations for Clinical Research in Herbal Medicines in USA

In 2012,USA Food and Drug Administration（FDA） approved 39 new drugs,however,there are only two botanical drugs（one topical and one oral）approved by FDA since the publication of the FDA＇s industry guidelines for the botanical drug product in June 2004.The approval shows the Western guideline can be used for herbal medicines,authors investigate current regulation on herbal medicine clinical research,identify challenges conducting clinical trials,and seek to produce some guidance for potential investigators and sponsors considering a clinical trial in this area.Key words were formulated for searching on Medline and FDA website to locate relevant regulations for clinical research in herbal medicines to understand current environment for herbal medicine usage and examine the barriers affecting herbal medicine in clinical trials.Authors critically explore case study of the 1st FDA approved botanical drugs,Veregen（sinecatechins）,green tea leaves extract,a topical cream for perianal and genital condyloma.In consideration of current regulation environment in USA,based on the findings and analysis through the literature review and Veregen case study,authors produce and propose a Checklist for New Drug Application of Herbal Medicines for potential investigators and sponsors considerina in a herbal medicine clinical trial.

Integrative Oncology in Australia

The use of alternative medicine（AM） in Australia dates back to its earliest times,with the indigenous medicine of the aboriginal peoples and the folk medicine of the early English settlers.AM has until recently existed quite separately from Western biomedicine（WB） and there has been little integration of the two systems.Now,referred to as complementary medicine（CM）,there has been a movement over the last 20 years to include CM in WB mainstream practices.Varying degrees of success have been reported but for the discipline of oncology.Medical oncology（MO） in Australia is demanding CM provide high levels of evidence for any inclusion in cancer protocols.There are just now the beginnings of this integration, particularly as CM is now being taught in the public university system to a PhD level as well as the public demand for their medical doctors to communicate with their CM practitioners.MO specialists are now open to a dialogue with their CM counterparts.