Global Perspectives on Wellness & Integrative Medicine Symbiosis University, 6 &7 May, 2011

Global Perspectives on Wellness &Integrative MedicineSymbiosis University, 6 &7 May, 2011 Gerard Bodeker Chair,Global Initiative for Traditional Systems (GIFTS) of Health, Oxford, UK (www.giftsofhealth.org) ; Nuffield Dept of Medicine & Dept of Primary Care, University of Oxford; Dept of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.

What is wellness? • According to the US National Wellness Institute (NWI), wellness is: “an active process through which people become aware of, and make choices towards, a more successful existence”. • NWI identifies six dimensions of wellness: Social; Occupational; Spiritual; Physical; Emotional; Intellectual. • LOHAS – Lifestyles of Health And Sustainability – is a framework that focuses on “health & Fitness; the environment; personal development; sustainable living; and social justice.”

A Global Perspective on Natural Healthcare • Wellness is now a $1trillion industry (SRI International 2008). • Within this, Asian healthcare systems and traditions are globalizing (WHO Global Atlas on Traditional, Complementary & Alternative Medicine, 2005)

Global Spa Industry ,

Integrative Medicine -Consortium of Academic Health Centers for Integrative Medicine: (46 leading academic medical centers in North America) Integrative Medicine: • Is the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, • focuses on the whole person, • is informed by evidence, & • makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing.

IM Globalizing • Integrative Medicine, a concept & approach that has gained ground in the first decade of the 21st Century, is now quite global. • A Google search for ‘Integrative Medicine’ yields over 2 million hits. • And the same search for ‘Integrated Medicine’ yields 9.25 million hits.

Use of complementary medicine providers in Britain (Ong, Peterson, Bodeker & Stewart-Brown, 2002) • The Oxford Healthy Life Survey (HLS III) - used UK-SF36 • 8,889: representative of local population for age, sex and social class • Women outnumbered men 2:1 in their use of CP services. • One in four people (25% ) who use CP's do so for lifestyle reasons (under 45 age group) – i.e. Wellness.

UK: 4 counties in England(Ong, Peterson, Bodeker & Stewart-Brown, 2002) Predictors of CAM use were:- long-standing illness- non-manual occupation.- female (2:1) - high levels of GP service use- age over 35 (mean age was 43.2) 60% of CAM users reported chronic illness or disability (mostly back pain & bowel problems) Regardless of whether chronic illness was reported, CAM provider users reported poorer health than nonusers

. • Very much a case of integrated medicine – • Yet integrated largely by the consumer rather than by the healthcare system.

Some Models of IM Practice: • Modern Medical Doctors practice TCAM, e.g. medical acupuncture • Modern Medical Doctors work in same practice with licensed TCAM practitioners: • Joint or integrated case management • Independent or parallel case management • Cross-referral between health professionals

Evidence: Safety & Efficacy .

Cochrane & Complementary Medicine • The CM field has constructed a database on randomized controlled clinical trials & controlled clinical trials in CM. • Over 5,800 trials have been identified and CM Field members regularly hand search over 40 journals. • Chinese language studies? German? Etc..

Safety Databases & physicians handbooks available on safety of: Herbal medicines, Herb-drug interactions; Other TCAM practices • UK: Royal Pharmaceutical Society of Great Britain: ‘MedicinesComplete’ database includes Herbal Medicines and Dietary Supplements: www.medicinescomplete.com • USA: Natural Medicines comprehensive database • Australia: L. Braun & M Cohen (2010): “Herbs & Natural Supplements: An Evidence Based Guide”

Natural Medicines Comprehensive Database • Search - enter any natural product name, disease or condition, or drug name...gives objective product information, Effectiveness Ratings, or potential interactions with drugs, etc. • Natural Product Effectiveness Checker - tells the level of effectiveness for natural products used for various medical conditions. • Natural Product / Drug Interaction Checker - tells potential interactions between any natural product and any drug. Automatically checks for interactions with EACH INGREDIENT of each product. • Disease / Medical Conditions Search - shows medical conditions, and allows the reader to see which natural products might be effective. • Search Colleagues Interact - questions, answers, and comments posted by other health professionals.

MedicinesCompletewww.medicinescomplete.com • The Royal Pharmaceutical Society’s database “MedicinesComplete” includes “Stockley's Herbal Medicines Interactions” • Stockley’s covers herb-drug, herb-food and herb-supplement interactions in over 150 of the most commonly used herbal medicines, dietary supplements and nutraceuticals. • The interactions are rated using three categories. 1)The weight of evidence behind the interaction, 2) the severity of the interaction & 3) action needed to accommodate the interaction.

Regulatory Context • Need licensed TCAM professions for integration of different health professionals into a single available service. • This requires national &/or regional regulation & licensure for practitioners & products

China • In China, there is a Chinese Association of Integrative Medicine, which organizes World Integrative Medicine Congress every 5 years. • The Capital Medicine University, Beijing, has a Dept. of Integrative Medicine. This, in partnership with the Beijing Association of the Integration of Traditional & Western Medicine, co-organized in October 2010, the First Beijing Conference on Integrative Medicine. • China has at least two journals in this field: “The Chinese Journal of Integrative Medicine” (www.cjim.cn). And “The Journal of Chinese Integrative Medicine”www.jcimjournal.com. • The Consortium for The Globalization of Chinese Medicine (http://www.tcmedicine.org) is engaged in active debate about: • educational curriculum for integrated Chinese medicine practitioners, • creating the requisite evidence base for IM practice of Chinese Medicine.

India • India’s Health Secretary was reported by the national media as stating in December 2010 that: “There is a need to bring different systems of medicine under one roof so that the gaps in allopathic medicine can be filled by the Indian systems of medicine”. • India now has an Institute for Ayurveda & Integrative Medicine (www.iaim.edu.in). This has been accredited by the Health Ministry’s Department of AYUSH to offer a two-year full-time course for a Post Graduate degree followed by a Post doctoral certification. The awardees will be known as Fellows of the Institute of Ayurveda and Integrated Medicine (FIAM). • There are now two journals of Ayurveda & Integrative Medicine in India: www.j-aim.co.in, www.jreim.com.

. WHO Global Atlas of Traditional, Complementary & Alternative Medicine (TCAM)

. • WHO Global Atlas of Traditional & Complementary Medicine is designed to record, analyze and map the status of policy in this sector around the world.

Challenges . Challenges to the development of IM include • the availability of an acceptable body of evidence – efficacy & safety & herb-drug; • differing paradigms of health, diagnostics, disease status & progression; • Including a wellness as well as illness focus • traditional concepts and forms of science vs the modern scientific method; • and the impact of professionalization on traditional systems of pedagogy & practice.

Herbal Home Gardens • In India, Healthcare follows food & shelter as the 3rd leading source of expenditure for the poor. • In a programme covering 6,000 rural villages and comprising 150,000 HHG’s, herbal home garden seedlings of a set of 20 medicinal plants from 12-15 species that are useful for common ailments were grown and sold to rural households by Women Self-Help Groups in the I-AIM network. • These groups were trained by I-AIM in raising, distributing and demonstrating the use of the plants for the conditions. Through participatory rural appraisal a list was developed of plants specific to each of the regions in which the project was conducted.

Economics • Health expenditure incurred by non-HHG households was approximately 5 times greater than that of adopters. • HHG adopters spend Rs. 92 on an average in 3 months towards their family’s primary healthcare while the non-adopters spend Rs. 478 in that time. • The cost of an HHG package at Rs 100 (for the plants) and maintenance cost of Rs. 50-60 per year cost a household only Rs. 160 (US$3.5). • The village resource persons earned at least Rs. 500 (US$11.11) per month through the sale of seedlings and training households in growing and using the plants, thereby promoting income generation for local women. • In India’s planning for reduction in national expenditure on pharmaceuticals – especially by the poor – the HHG model is an important direction to be considered.

Some Dimensions of the Wellness Market .

Anti-Ageing • Euromonitor International: "Ageing consumers are looking to do all they can to help avoid age-related illnesses such as arthritis, osteoporosis and prostate problems. • Many see vitamins and dietary supplements as the answer. Therefore, vitamins and dietary supplements remain the bedrock of OTC healthcare sales, accounting for around 40% of global OTC sales. • Products such as calcium (taken to improve bone health), glucosamine (for arthritis) and co-enzyme Q10 (for cardiovascular health) are the main engines for growth, especially among the affluent, older generations.

Wellness & Beauty • Research shows that US consumers are becoming increasingly convinced that beauty starts with "wellness". • Retailers are increasingly linking their beauty lines to non-beauty products, positioning health products, like vitamins, in close proximity to cosmetics. • Manufacturers are introducing cosmetic lines that tout claims often found in OTC products, featuring, for example, featuring anti-wrinkling and acne-fighting ingredients. The World Market for Cosmetics and Toiletries:http://www.euromonitor.com/cosmeticsandtoiletries

Integrative medicine, Wellness & Health Spas • Within the spa industry, medical spas or ‘medispas’ are the fastest growing sector. • They are also a new ‘front line’ of integrative medicine development

Traditional Knowledge & Wellness .

Meditation & Metabolic Syndrome • Randomized, placebo-controlled clinical trial of 16 weeks. • TM or active control treatment (health education), matched for frequency and time, at an academic medical centre, involving 103 subjects with stable Cardiovascular Heart Disease. CHD patients improved the following components of the metabolic syndrome : • blood pressure • insulin resistance • cardiac autonomic nervous system tone (Arch Intern Med. 2006)

YOGA US reviews of studies suggest that yoga may • reduce many insulin-resistant syndrome related risk factors for CVD, • improve clinical outcomes • may aid in the management of CVD (Innes et al 2005).

Yoga - Reduces age related deterioration in cardiovascular functions (Bharshankar et al 2003).

“India: Diabetes Capital of the World”White Rice: Diabetes Risk for 1.2 billion • Research at Harvard’s Department of Nutrition found a highly significant difference in rates of Type 2 diabetes between those who ate a lot of white rice and those who ate more brown rice. • Those who consumed at least five servings (150 grams each) of white rice per week had a 17% higher risk of getting type 2 diabetes than those who hardly ate any white rice at all. • People eating at least two servings of brown rice a week had an 11 % lower chance of getting the disease than those who ate less than one serving of it a month. • The researchers calculated that replacing white with brown rice would lower the chances of type 2 diabetes by 16%. • Polishing rice removes the bran and germ & uncovers the endosperm. This raises rice’s glycaemic index & strips away vitamins (A,B,K,E), fibre, magnesium and essential amino acids that can help prevent diabetes. Sun et al, Arch. Intern. Med. (2010).

Copper & Serious Pathogens • Research at the Institute of Ayurveda & Integrative Medicine, Bangalore, found investigating the ancient Ayurvedic recommendation of leaving water overnight in a copper pot, found that all water borne pathogens, including cholera, e-coli, shigella, typhoid, etc were killed. -------------------------------------------- • A UK study in 2010 found that copper fittings rapidly killed bugs on hospital wards, succeeding where other infection control measures failed. • During the ten-week trial at Selly Oak Hospital, Birmingham, a set of taps, a lavatory seat and a push plate on an entrance door were replaced with copper versions. They were swabbed twice a day for bugs and the results compared with a traditional tap, lavatory seat and push plate elsewhere in the ward. • The copper items had up to 95 per cent fewer pathogens on their surface whenever they were tested. • Lab tests show that copper kills the deadly MRSA and C difficile superbugs. It also kills the flu virus and E coli. -----------------------

TRADITIONAL KNOWLEDGE & SPAS In the evolving spa world, indigenous themes have emerged as a significant trend , especially in destination spas and in rural and regional settings where traditions are strong and local health knowledge is lively. SpaFinder noted in its ‘Ten Spa Trends to Watch for in 2007’: “Spa guests are rewarding a spa's efforts to incorporate authentic indigenous treatments, hire local staff, and contribute to the community. They're also welcoming education about local cultures and healing traditions.”

UNESCO Heritage Listing ‘

. • THANK YOU

Global Perspectives on Wellness & Integrative Medicine Symbiosis University, 6 &7 May, 2011