Dava, Daktar, and Dua: anthropology of practiced medicine in India.

The paper explicates "practiced medicine" as an operative cross-cultural analytic concept by locating it within previous major developments and directions of study within anthropological studies of medicine in India, and medical anthropology more generally. Practiced medicine in India, for example, allows us to see better how India manages not only multiple traditional and modern medical approaches, languages, therapeutic regimens, and materia medica, but it also leads us to a sustained moral, social and material criticism from within. The study of such diversity leads to a loosely shared, and ethnographically attestable, cultural reasoning, practice and practical ethos across the traditional and modern medical worlds. Also appearing before us are the usually hidden cultural assumptions, negotiations and compromises of diverse Indian medical practitioners, and the strengths and weaknesses of modern medicine under "normal" and "disastrous" situations in contemporary India. As India today grapples with issues of availability, affordability, equity, and distributive justice in medical care, its practiced medicine raises issues of "critical consciousness" for modern (and traditional), state supported medicine.

Responses of established healthcare to the professionalization of complementary and alternative medicine in Ontario.

This paper examines the reactions of leaders of established health professions in Ontario, Canada to the efforts of selected complementary and alternative (CAM) occupational groups (chiropractors, naturopaths, acupuncture/traditional Chinese doctors, homeopaths and Reiki practitioners) to professionalize. Stakeholder theory provides the framework for analysis of competing interests among the various groups in the healthcare system. The data are derived from personal interviews with 10 formal leaders from medicine, nursing, physiotherapy, clinical nutrition and public health. We conceived of these leaders as one group of stakeholders, with both common and conflicting interests. The findings demonstrate that these stakeholders are reluctant to endorse the professionalization of CAM. They propose a series of strategies to contain the acceptance of CAM groups, such as insisting on scientific evidence of safety and efficacy, resisting integration of CAM with conventional medicine and opposing government support for research and education. These strategies serve to protect the dominant position of medicine and its allied professions, and to maintain existing jurisdictional boundaries within the healthcare system. The popular support for CAM will require that health professional stakeholders continue to address the challenges this poses, and at the same time protect their position at the apex of the healthcare pyramid.

Spatial pattern of private health care provision in Ujjain, India: a provider survey processed and analysed with a Geographical Information System.

In developing countries like India, official information on private health care providers is scanty. This is an obstacle for effective health care planning and policy development. In this paper, we present a project aimed to enumerate, characterise and digitally map all private providers (PPs) using Geographical Information System (GIS) in a rural district in India. A team of surveyors carried out a census of private providers in the district. This data was combined with official data on geophysical characteristics and infrastructure, demographic situation and location of settlements and public health care providers. This study highlights the need to consider PPs in health policy making in India. The survey identified about 2000 additional PPs over and above those listed with the health authorities. About half practised modern medicine (Allopathy) while the rest practised other types of formal medical systems (Ayurveda or Homeopathy) or informal therapeutic systems. Individuals with no formal health care training constituted the majority of PPs. Formally trained doctors were highly concentrated in urban areas while trained non-doctors and untrained PPs dominated in the rural areas. The study shows how GIS can be used to create an improved basis for health services research. In the future, the digitised map will be used as a sampling frame and point of reference for studies on quality and utilisation of PPs in Ujjain district. However, the utility for health care planning is less clear. GIS has limitations in countries like India due to lack of valid routine data to enter into GIS as well as to competing demand for health care resources.

The role of the state in the social inclusion of complementary and alternative medical occupations.

OBJECTIVE: To examine the views of government spokespersons regarding the efforts of five complementary and alternative medicine (CAM) groups (chiropractic, traditional Chinese medicine/acupuncture, naturopathy, homeopathy and Reiki) to take their place in the formal health care system. DESIGN: In this small scale, exploratory study, we conducted in-depth interviews with 10 key government officials at the federal (5), provincial (4) and municipal (1) levels. We used qualitative techniques such as constant comparison to describe and explain their responses to three main questions: (1) What should be the role of the state in the professionalization of CAM? (2) Is there a legitimate place for CAM groups in the formal health care system? and (3) Should CAM services be integrated with conventional medical care? SETTING: Ontario, Canada. RESULTS: The findings identify a fundamental tension between the various levels of government. Their mandate to protect the public comes into conflict with the obligation to respond to consumer pressure for CAM. Safety, efficacy and cost-containment were the chief explanations given for the government's slowness to catch up to consumers. They also mentioned fears of rising health care costs and the lack of cohesion among and between CAM groups as barriers to legitimacy and integration. CONCLUSION: Realizing the professional aspirations of CAM practitioners will depend on the outcome of a political contest between the public, the state and the established health care professions.

[Knowledge of the municipal health managers about the National Policy on Integrative and Complementary Practices and its influence on the provision of homeopathy in the Local Unified Health System]. / O conhecimento de gestores municipais de saúde sobre a Política Nacional de Prática Integrativa e Complementar e sua influência para a oferta de homeopatia no Sistema Único de Saúde local.

The social determinants of the health-disease process and the challenge of comprehensive care have led the World Health Organization to propose Complementary and Alternative Medicines to be included in health policies. In Brazil in 2006 the National Policy on Integrative and Complementary Practices (PNPIC) was published. It is a tool for the institutionalization of homeopathy in the Unified Health System (SUS). This paper analyzes the knowledge of health managers of municipalities of São Paulo on PNPIC, and its influence on homeopathic care. In 2008, the municipalities that performed homeopathic consultations from 2000 to 2007 were identified in DATASUS, managers were interviewed and the results were analyzed quantitatively and qualitatively: of the 645 municipalities, 47 had offered homeopathy and 42 of them were interviewed. Of these, 26% knew about PNPIC, 31% knew little, 41% were unaware of it. It should be stressed that those aware of it stated that they use PNPIC to: instruct the local government about homeopathy; the construction of specific legislation and the increase in homeopathic services. The conclusion is that PNPIC is unknown by health managers and those that know it use it to make known the homeopathic medical rationale and justify its application in the SUS.

International development of traditional medicine / complementary and alternative medicine research--what can Europe learn?

BACKGROUND: The aim of this study was to analyse global research and development (R&D) strategies for traditional medicine (TM) and complementary and alternative medicine (CAM) across the world to learn from previous and on-going activities. METHODS: 52 representatives within CAMbrella nominated 43 key international stakeholders (individuals and organisations) and 15 of these were prioritised. Information from policy documents including mission statements, R&D strategies and R&D activities were collected in combination with personal interviews. Data were analysed using the principles of content analysis. RESULTS: Key stakeholders vary greatly in terms of capacity, mission and funding source (private/public). They ranged from only providing research funding to having a comprehensive R&D and communication agenda. A common shift in R&D strategy was noted; whereas 10 years ago research focused mainly on exploring efficacy and mechanisms, today the majority of stakeholders emphasise the importance of a broad spectrum of research, including methodologies exploring context, safety and comparative effectiveness. CONCLUSION: The scarce public investment in this field in Europe stands in stark contrast to the large investments found in Australia, Asia and North America. There is an emerging global trend supporting a broad research repertoire, including qualitative and comparative effectiveness research. This trend should be considered by the EU given the experience and the substantial research funding committed by the included stakeholders. To facilitate international collaborative efforts and minimise the risk of investment failure, we recommend the formation of a centralised EU CAM research centre fostering a broad CAM R&D agenda with the responsibility for implementing the relevant findings of CAMbrella.