(MSI40)
Evidence-based medicine vs traditional medicine: The daily challenges on a tropical island
Medical Students International 40
Massiel Mendez, Franz Lopez ODEM Dominican Republic
The Dominican Republic is a tropical island located in the Greater Antilles on the Caribbean Sea. Since the island represents a mixture of European, African, and Taino cultures, it is only natural that we maintain many traditions that have been passed down for generations. These traditions influence every aspect of our daily lives, ranging from gastronomy, religion, and medicine. Evidence-based medicine (EBM) is defined as the interaction between the best research evidence and clinical expertise to make the best decisions according to patients’ values and circumstances (1). As medical students, it is important to realize that daily clinical practice is not strictly following established guidelines. Each situation is unique, and sometimes we have to trust our experience and expertise to make appropriate decisions. Therefore, while it is true that we need to apply EBM in our practice, we cannot stop visualizing it as a tool. Kelly et al state, “As practicing scientists or doctors we must be humble about what we know, acknowledging our (and our tools’) fallibility” (2, p.2). For instance, applying EBM in the Dominican Republic can be challenging because patients’ general views about health care service delivery may prioritize traditional remedies for disease management of the flu, tetanus, and hepatic disease. According to the World Health Organization (WHO), traditional medicine is the accumulation of practices and knowledge, based on the beliefs and experiences of different cultures used in the maintenance of health as well as in the disease prevention, diagnosis, and treatment (3). To start, it is important to examine two examples of local remedies. Locally, musk seeds are considered as a cure for tetanus and epilepsy, and “cadillo de perro” plant branches are assumed as a cure
for hepatic disease (4). Since these popular beliefs can be dangerous to patients’ health, how do physicians-in-training overcome these challenges? In this specific case, we should educate patients in their health care decisionmaking. By describing the benefits and risks of pharmaceutical agents and traditional remedies, patients can learn about the efficacy of pharmacological agents and understand possible adverse reactions and interactions with local remedies. However, what about the remedies that do not represent any specific harm for patients? For example, a mixture of honey, lemon juice, onions, and watercress have been used for generations as a treatment for the flu (4). Its ingestion does not necessarily harm patients. In contrast, it can even supplement the effects of the treatment because it is well known that ingesting an inert substance believing that it is an active one, can generate physiologic effects expected from that active substance (5). In conclusion, as adolescents, we used to believe that doctors treated diseases, but now as medical students, we realize that doctors realistically do not treat diseases but rather individuals. Behind each person, there is a collection of experiences, values, and traditional practices that influence a person’s lifestyle. We tend to disparage them and force their replacement with what we know or what EBM suggests as best practices. As physicians-in-training, we must recognize relevant cultural differences, be able to negotiate common grounds, and accommodate our patients’ beliefs as necessary without risking their health. References