In the traditional context, herbs are often used as herbal whole system therapies, however, most clinical trials included highly selected patients and applied standardized treatment protocols with the aim to exclude as much bias as possible. These studies have contributed important information on the efficacy of herbal medicine extracts; however, their results are only marginally helpful to understand the value of herbal medicine and food items in a more traditional usual care context.
The new development of comparative effectiveness research (CER) will be introduced and synergies with ethnopharmacology will be outlined.
CER provides great opportunities for guiding researchers and clinicians in improving management of disease. CER compares two or more health interventions in order to determine which of these options works best for which types of patients in settings that are similar to those in which the intervention will be used in practice. CER uses a broad spectrum of methodologies including randomized pragmatic trials that can also be applied to herbal whole system therapies. Ethnopharmacological research can provide highly relevant information for CER including data on characteristics of typical patients as well as traditional usage including methods of collection, extraction, and preparation. Recommendations for future research on traditional herbal medicine and food items are (1) a systematic cooperation between ethnopharmacology and clinical researchers and (2) a call for more CER on traditional herbal medicines and food items.
Multiple stakeholders, including ethnopharmacologists, should cooperate to identify relevant study questions as well share their knowledge to determine the optimal placement of a clinical trial in the efficacy-effectiveness-continuum.
[Show abstract][Hide abstract] ABSTRACT: The ethnopharmacological approach toward the understanding and appraisal of traditional and herbal medicines is characterized by the inclusions of the social as well as the natural sciences. Anthropological field-observations describing the local use of nature-derived medicines are the basis for ethnopharmacological enquiries. The multidisciplinary scientific validation of indigenous drugs is of relevance to modern societies at large and helps to sustain local health care practices. Especially with respect to therapies related to aging related, chronic and infectious diseases traditional medicines offer promising alternatives to biomedicine. Bioassays applied in ethnopharmacology represent the molecular characteristics and complexities of the disease or symptoms for which an indigenous drug is used in "traditional" medicine to variable depth and extent. One-dimensional in vitro approaches rarely cope with the complexity of human diseases and ignore the concept of polypharmacological synergies. The recent focus on holistic approaches and systems biology in medicinal plant research represents the trend toward the description and the understanding of complex multi-parameter systems. Ethnopharmacopoeias are non-static cultural constructs shaped by belief and knowledge systems. Intensified globalization and economic liberalism currently accelerates the interchange between local and global pharmacopoeias via international trade, television, the World Wide Web and print media. The increased infiltration of newly generated biomedical knowledge and introduction of "foreign" medicines into local pharmacopoeias leads to syncretic developments and generates a feedback loop. While modern and post-modern cultures and knowledge systems adapt and transform the global impact, they become more relevant for ethnopharmacology. Moreover, what is traditional, alternative or complementary medicine depends on the adopted historic-cultural perspective.
Frontiers in Pharmacology 07/2013; 4:92. DOI:10.3389/fphar.2013.00092 · 3.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The world's cultures can be conceived as a cultural landscape that may be described in terms of a geographical map showing abysses, foul grounds, ditches, plateaus, hills and peaks of cultural consensus, variation, dissension and vacancies. This dynamic cultural topography can be described, compared and analysed to find local and universal patterns. Ethnopharmacology focuses on a specific cultural realm, the materia medica (also called ethnopharmacopoeia) and its use by different peoples. It investigates the local use of pharmaceutical agents, the mode of preparation, application, and associated therapeutical believes and knowledge. Usually, the focus is on plants, generally the most numerous part of any materia medica. The term 'medicinal flora' is thus used to subsume the medicinal plants of a specific area or community. A local materia medica is the product of a consensus among the local community and its local and/or traditional healthcare practitioners on what to use to prevent, diagnose and cure diseases and illnesses, and how to sustain and promote emotional and spiritual well-being. Local materia medica is shaped by community-internal as well as external factors, such as local and cross-cultural knowledge exchange, globalization and resulting syncretism. A generally accepted theory is that among humans the search for food and edible greens, especially after the transition from a nomadic to a sedentary agriculturalist lifestyle, promoted the exchange and consensus on the physiological and therapeutical properties of plants (Johns, 1990; Logan and Dixon, 1994). People continuously modify their medicinal flora to adapt to new diseases and epidemics, and also to socioeconomic changes. Belief systems related to medicine may be adapted to new social hegemonies or the materia medica may be abandoned and/or Ethnopharmacology, First Edition. Edited by Michael Heinrich and Anna K. Jäger.
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