Le medicine non convenzionali in Italia: le presentazioni di E. Cooper e A. Bianco   [05.04.2007]

LE MEDICINE NON CONVENZIONALI IN ITALIA.

Storia, problemi e prospettive d’integrazione.

A cura di Guido Giarelli, Paolo Roberti di Sarsina, Bruno Silvestrini

FrancoAngeli, Milano, 2007, (pp. 416, € 25,00)

Prefazione di Edwin L. Cooper (Fondatore e Direttore di eCAM Journal)

Postfazione di Amedeo Bianco (Presidente FNOMCeO)

PREFACE

Present and Future Perspectives of CAM: A Challenge to Biomedicine

Edwin L. Cooper Ph.D., Sc.D., Distinguished Professor, Laboratory of Comparative Neuroimmunology, Department of Neurobiology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA USA

Non-Conventional Medicine In Italy sometimes refereed to as CAM (Complementary and Alternative Medicine; and there are other proposed appellations) elsewhere is universal and by any other term the only seeming strictures are purely cultural and the discipline or practice is thereby tempered by the cultural milieu. Thus one can view similar practices in various regions of the world all aimed at improving the quality of life. Some who adhere to the practices of CAM or non-conventional medicine look forward to cures especially in life threatening situations. Still others are less demanding and look for mild amelioration of chronic problems. As readers will note, this book is focused in the region of Bologna, Italy and the contributors drawn almost exclusively from there. However their expertise is unsurpassed even when viewed critically in the countries where certain therapies were initiated. In keeping with a regional approach, I present examples of supporting works that under gird or confirm the Italian contributions but are drawn almost exclusively from the new journal, eCAM that has received substantial support and encouragement from eight members of the Editorial Board in this region some of whom are contributors to this volume. This book and its mission should be easily comprehended with extensive appeal.


Non-Conventional Medicine In Italy is divided into two logical parts. Part I poses the question and consists of six chapters that lay the firm foundation for the entire book. Some of the pertinent questions include the necessity for examining the development of evidence based medicine a new paradigm and this is addressed by a biomedical researcher an appropriate assignment since this is now the international trend that will remove some of the so called magic or lack of acceptability by practitioners of traditional western medicine. It is of particular interest that the question of education is dealt with and is considered absolutely essential for any discipline whether ancient, new, or emerging. There is a need to educate, to have adherents who will move forward with the skills and information of the emerging discipline. This discipline or concept is in desperate need in order to dispel much of the suspicion that surrounds it and the reluctance to even embrace the simplest of procedures or products. The other subjects that receive attention are acupuncture, homeopathy, homotoxicology, phytotherapy, Ayurvedic medicine, osteopathy, chiropractic, Shiatsu. Of course there are those who would gladly enlarge this list by adding a veritable cornucopia of other remedies, products that contribute to a seemingly unlimited choice of techniques and cures. One, for example, that receives little or no attention are those products derived from animals either those that are terrestrial or aquatic especially those from the sea.

It is often more popular to attribute CAM historically to the Chinese about the 7th Century, but careful analysis, to not be short sighted, partial and non-cosmopolitan, reveals that there are instances of equivalent CAM practices throughout the world and it is as universal as is humanity to cite a few examples (Suzuki, 2004, Yi and Chang, 2004, Shaikh and Hatcher, 2005, Kim, et al., 2005, Saad et al., 2005). Thus the first requirement for integration is not to strip the cultural roots, but to arrive at internationally acceptable nomenclatures and practices common to all regardless of the cultural background. Sometimes this has been achieved by drawing scholarly comparisons (Patwardhan et al, 2005, and Olalde-Rangel, et al., 2005). And there are questions concerning the relevance to one important segment of the world that of the less industrialized where non-conventional medicine is practiced more widely (Chinnock et al., 2005).

Thus it is admirable that attempts are made to seek a merger from within the industrialized world bordering at times on the fashionable. However, it must be remembered that many of these ancient remedies did, after all have their origins in what are, now the developing world or at least their remnants in what are now developed countries. This is in marked contrast to western medicine a very young practice by contrast that is at best aligned with the highly profitable pharmaceutical industry, no more than 200 years old by certain estimates and steps further away from natural products per se. Thus there should be a merger somewhere for the alleviation of certain health problems by simply embracing the “old” remedies and therefore combining them with the newer ones that depend we hope on pure scientific inquiry. Again, this is not to peel away the very root of and essence of non-conventional medicine. On the contrary, it is to be enhanced. Similarly western medicine with all of its technical innovations should be enriched emerging from the persistent quest for what amounts to the more impersonal, reduction of the whole patient. In many views something has been lost and the patient invariably compromised. To create an amalgam of the two, realizing the advantages for the patient through the incorporation of both avenues should be of great importance, in fact the ideal.

With this real and soon to be realized renaissance, there is a struggle and deep probing to define this scientific approach, some times referred to as evidence based confirming the importance on the one hand of the western pre occupation with technology but essential if the claims of CAM or non-conventional medicine can ultimately be believed and trusted, peeling away from its surface what is often perceived as quackery. Of course this assumes that the western approach is fool proof and surely it is not—like other human endeavors. Witness the enormous expense required to develop drugs and to bring them to market only to have some of them removed from the shelves because of threats to human wellbeing. Thus with western medicine and with non-conventional medicine we must realize that the human population is not an inbred one and that variability in population responses to drugs will differ enormously. This however, does not excuse the same from occurring in the case of non-conventional medicine—even more so since some of the remedies and their effectiveness rests almost entirely on the somewhat capricious practices and responses of true believers.

So what is Evidence Based CAM, the supposed answer to this prevailing dilemma? And is it relevant to non-conventional medicine the subject of this book, Non Conventional Medicine in Italy? There is a lot of soul-searching, debate, controversy, political exchanges in the houses of government that erupt into vociferous, polemics, both written and spoken. Perhaps a few citations are worthy of consideration again from the journal with the title that proposes to find the answer. Several examples are worth a brief mention. One covers in very eloquent terms the philosophy of CAM and likens it to a super-system and that it is epimedical—a purely biomedical approach with a strong emphasis on the biological (Tada, 2004). Another proposes to draw from Japanese practices and sets out to present an evidence-based reconstruction of Kampo Medicine (Terasawa, 2004). Still another in two papers actually gives the formula or the process of evidence based research (Chiappelli, et al., 2006). On the other hand, like that of Tada drawn from the thinking of an immunologist here is the following declaration.

The first objective in a serious approach to complementary and alternative medicine (CAM) should be to obtain a broad understanding, with a minimum of detail, of how CAM fits into the pattern of biology—of the way in which the three great regulators, nervous, endocrine, immune systems evolved, their function and coordination with other body systems, and their development from the embryo onwards (Cooper and Brazier, 1982, Cooper, 1984a, Cooper, 1984b, Cooper and Yamaguchi, 2004). Concomitantly, this outline should provide an adequate background for easy application of CAM, (qua non-conventional medicine), ideas and challenges to the detail of practical CAM work in public health, clinical and medical practice. These definitions however, should not deviate significantly from the very biology that supports them. Approaches to human conditions should be viewed in a broad context with respect to all that lives and breathes. What then will emerge is that CAM is organismic, inclusive and not exclusive and contrary to the prevailing paradigm, CAM and of course non-conventional medicine will not be reductionist.

To aid in this quest for merger, a melting pot a cross cultural exchange, the journal, Evidence-based Complementary and Alternative Medicine (eCAM) will seek to awaken medicine from a winter's sleep often imposed by the prevailing traditional western medical approach. In so doing, there should be a mutual rejuvenation (reconstruction, renewal, renovation), a renaissance (rebirth, resurgence, revitalization, revival, reawakening) of both biomedicine and CAM and an enlargement of non-conventional medicine both vertically and horizontally. Many will greet this renaissance with mixed feelings but the open spirit will applaud. And the open spirit will applaud this book (Non-Conventional Medicine in Italy) for taking some of the much needed initiative.


Edwin L. Cooper Complementary and Alternative Medicine, When Rigorous, can be Science eCAM 2004 1: 1-4

Tomio Tada Toward the Philosophy of CAM: Super-system and Epimedical Sciences eCAM 2004 1: 5-8

Katsutoshi Terasawa Evidence-based Reconstruction of Kampo Medicine: Part I—Is Kampo CAM? eCAM 2004 1: 11-16

Nobutaka Suzuki Complementary and Alternative Medicine: a Japanese Perspective eCAM 2004 1: 113-118

Yeong-Deug Yi and Il-Moo Chang An Overview of Traditional Chinese Herbal Formulae and a Proposal of a New Code System for Expressing the Formula Titles eCAM 2004 1: 125-132

Alex Hankey CAM Modalities Can Stimulate Advances in Theoretical Biology eCAM 2005 2: 5-12

Babar T. Shaikh and Juanita Hatcher Complementary and Alternative Medicine in Pakistan: Prospects and Limitations eCAM 2005 2: 139-142

Paul Chinnock, Nandi Siegfried, and Mike Clarke Is Evidence-Based Medicine Relevant to the Developing World? Systematic reviews have yet to achieve their potential as a resource for practitioners in developing countries eCAM 2005 2: 321-324

Yong-Suk Kim, Hyungjoon Jun, Younbyoung Chae, Hi-Joon Park, Bong Hyun Kim, Il-Moo Chang, Sung-keel Kang, and Hye-Jung Lee The Practice of Korean Medicine: An Overview of Clinical Trials in Acupuncture eCAM Advance Access published on August 3, 2005 eCAM 2005 2: 325-352


Bhushan Patwardhan, Dnyaneshwar Warude, P. Pushpangadan, and Narendra Bhatt Ayurveda and Traditional Chinese Medicine: A Comparative Overview eCAM 2005 2: 465-473

Bashar Saad, Hassan Azaizeh, and Omar Said Tradition and Perspectives of Arab Herbal Medicine: A Review eCAM 2005 2: 475-479

José A. Olalde Rangel, Meyer Magarici, Francis Amendola, and Oswaldo del Castillo The Systemic Theory of Living Systems. Part IV: Systemic Medicine—The Praxis eCAM 2005 2: 429-439

Francesco Chiappelli, Paolo Prolo, Monica Rosenblum, Myeshia Edgerton, and Olivia S. Cajulis Evidence-Based Research in Complementary and Alternative Medicine II: The Process of Evidence-Based Research eCAM 2006 3: 3-12

Cooper EL. Immune system: an overview. In Cooper EL. (Ed.) Stress, Immunity and Aging. 1984b; New York, NY Marcel Dekker, Inc. 13-26.

Cooper EL. (Ed.) Stress, Immunity and Aging. 1984a; New York, NY Marcel Dekker, Inc..

Cooper EL and Brazier MAB. (Eds.) Developmental Immunology: Clinical Problems and Aging. UCLA Forum in Medical Sciences, Vol. 25. 1982; New York, NY Academic Press.

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LE MEDICINE NON CONVENZIONALI IN ITALIA.

Storia, problemi e prospettive d’integrazione.

A cura di Guido Giarelli, Paolo Roberti di Sarsina, Bruno Silvestrini

FrancoAngeli, Milano, 2007, (pp. 416, € 25,00)

Prefazione di Edwin L. Cooper (Fondatore e Direttore di eCAM Journal)

Postfazione di Amedeo Bianco (Presidente FNOMCeO)


POSTFAZIONE

Amedeo Bianco


Vorrei innanzitutto complimentarmi con gli editors del volume per aver dato alle stampe una trattazione approfondita ed ampia di un tema di grande attualità, che propone una lettura attenta del fenomeno Medicine Non Convenzionali nel nostro Paese, un terreno sul quale per la FNOMCeO è d’obbligo muoversi con doverosa prudenza e forte responsabilità

In effetti si tratta di una materia che, anche nel nostro paese, da anni va suscitando vasti interessi e non poche polemiche, travalicando gli esclusivi profili medico-sanitari per assumere una spiccata valenza sociale, intercettando gli interessi dei cittadini, degli organismi medico-scientifici, nonché di quelli politici e legislativi.

Le Medicine Non Convenzionali, così come definite dal testo, (altri preferiscono la dizione Complementari), hanno trovato negli ultimi anni un consenso sempre più vasto tra i cittadini e nella pratica di medici non necessariamente dediti in modo esclusivo a tali specifiche pratiche, sollevando nei fatti prima ancora che nei presupposti, una questione di legittimazione sociale, tecnico professionale e giuridica..

La Federazione Nazionale degli Ordini dei Medici Chirurghi e degli Odontoiatri ha ridefinito le proprie posizioni nei confronti di tali medicine e pratiche attraverso un percorso di confronto tecnico professionale e sociale culminato a Terni, nel maggio 2002 in una mozione del Consiglio Nazionale.

Tale documento segna una svolta importante, incentrata su un’assunzione piena delle responsabilità laddove prevede che nove discipline tra le quali l’Omeopatia, in quanto riconosciute atto medico, siano esercitate e gestite esclusivamente da personale medico (chirurgo e/o odontoiatra) l’unico abilitato a formulare diagnosi e, a prescrivere ed eventualmente praticare piani terapeutici.

L’obiettivo di tale forte assunto fu a suo tempo variamente e non sempre benevolmente interpretato ma nella realtà obbediva ed obbedisce all’unico fine di garantire la sicurezza ed appropriatezza delle prestazioni e la corretta informazione al paziente.

Da tale considerazione scaturivano poi le altre indicazioni previste in quel documento che si sperava potessero essere recepite in una legge quadro e cioè i criteri di accreditamento dei provider pubblici e privati di formazione specifica, i contenuti didattici, i titoli da conferire, il controllo professionale sulle attività, la ricerca soprattutto nelle aree di possibile integrazione con la medicina scientifica .

La FNOMCeO, nel rispetto dei suoi compiti di promozione della qualità professionale e quindi della efficacia, appropriatezza e sicurezza delle attività mediche ed odontoiatriche, ribadisce oggi il suo impegno affinché quei principi trovino adeguato riscontro legislativo dopo le delusioni dell’ultima legislatura che, come è noto, si è chiusa in materia con il naufragio del progetto Lucchese.

Del resto non è più possibile, né giusto, che l’Italia si possa ulteriormente sottrarre a quel processo di integrazione tra tali discipline e quelle “ ufficiali “ che ha coinvolto le politiche sanitarie dei diversi paesi europei nei quali, pur con alcune diversità, si è addivenuti all’accoglimento della coesistenza delle diverse forme terapeutiche.

Sono certo di poter affermare che questa opera troverà un sicuro gradimento, soprattutto da parte di quel pubblico che si dichiara cultore delle Medicine Non Convenzionali, e comunque sarà accolta favorevolmente per il contributo notevole che dà alla conoscenza della materia sviluppando, nel succedersi dei capitoli, argomenti di grande rilevanza.

Da parte mia, oltre a trovare appropriata e pertinente la trattazione della materia che, non a caso, è stata affidata a cultori di alto livello delle varie discipline, non posso che valutare positivamente il fatto che nel testo, a più riprese, si faccia riferimento all’importanza del rapporto medico-paziente oggi fondato sia sul rispetto del principio di autodeterminazione e di libertà di scelta, sia sull’esigenza di farsi carico dell’intero universo affettivo ed emozionale del paziente.

E’ dunque mia convinzione che la scelta degli argomenti, la trattazione ampia e approfondita, la vastità delle notizie e la puntualità dei dati riportati, oltre alla fama degli editors, contribuiscono a connotare la presente opera come un sicuro successo editoriale destinato ad incontrare un notevole favore fra i lettori, sia in campo medico che in qualsiasi altro settore che sia, a vario titolo, interessato alla materia.

Non posso al contempo astenermi dall’osservare che la materia, per molti aspetti, necessita ancora di approfondimenti ulteriori, che ne consentano una valutazione obiettiva e una conseguente e coerente condotta che coinvolga i medici, gli Ordini professionali, le Università e le Istituzioni preposte alla tutela del bene salute.

AMEDEO BIANCO

Presidente della Federazione Nazionale degli Ordini dei Medici Chirurghi e degli Odontoiatri

 


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