Perspective on comprehensive patient care: The experience of the WHO collaborating centre for traditional medicine of Milan University (Italy) in collaboration with the government of Lombardy Region

Traditional/complementary and alternative medicine (TRM/CAM) and conventional medicine (CM) are based on epistemological models often clashing between them. While the holistic point of view of TRM/CAM has led to a comprehensive attitude toward the patient, the mechanistic, determinist, reductionist philosophy of CM has led to an approach deeply characterized by a specialist attitude.

These two epistemological models seem absolutely incompatible between them, but the daily clinical practice shows that each model includes some elements that could be useful for a therapeutic approach, which can be strictly scientific on the one hand and able to collect and improve all the expressions of the human complexity on the other hand.

In this contest of particular value is the document of the WHO, Traditional Medicine Strategy 2002–2005, in which are outlined some criteria to avoid either an acritical and enthusiastic attitude or a sceptic and misinformed attitude for the development of a safe and proper use of the TRM/CAM.

The activity of our Collaborating Centre started in 1997 from four ideas:

In 1998, the University of Milan started some basic training courses for teaching the conventional medical doctors the use of Acupuncture and Traditional Chinese Medicine in some fields of therapy for which there were evidence of efficacy in the international literature. Later, some basic training courses on TRM/CAM, including Homeopathy and Phytotherapy, were added.

But it was almost evident that for producing an implementation of the integration between TRM/CAM and CM a general framework was urgently requested. For this reason, from 2000 our Centre started a cooperation with the Regulatory Authorities of Lombardy Region, which can be resumed in four steps.

First step: 2000–2002—D.G.R. n. VI/48041 04-02-2000: Observation and evaluation of therapeutic treatments of TRM/CAM through observational studies. Objective: To verify if TRM/CAM can work, to assess the operators and the providers of TRM/CAM, to introduce operators and providers to research methodology.

Second step: 2002–2004. The TRM/CAM is included in the Health Regional Plan among the innovative projects. Objective: To rule the process of integration between the CM and TRM/CAM.

Third step: 2003–2006 D.G.R. VII/13235 09-06-2003 Quadrennial Program of collaboration with WHO for evaluation and use of TRM/CAM.

Objective: To promote the safety, efficacy and quality of TRM/CAM by expanding the TRM/CAM basic knowledge for promoting a proper use of TRM/CAM by both providers and consumers.

Fourth step: 2007–2009. Regional Social Health Plan. Objective: Organising a Regional Monitoring Centre for evaluating the integration between TRM/CAM and CM and the impact of the cost-effectiveness on the global health-care system.

Second MOU between the WHO and Lombardy Region on activities relating to TRM/CAM, with an emphasis on interactions between herbal and other medicines and a review of the results of clinical reports of TRM/CAM.

In conclusion, in our opinion, there are not two kinds of medicine—TRM/CAM and CM—but only one medicine that has been adequately tested, correctly ruled and regulated, on which the doctors have been adequately trained. A medicine in which several knowledges and skills can be used for the best advantage of the patient.

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