Montreal: McGill Queens Press, 1994. Nevertheless many ceremonies are primarily
indigenous, e.g. ‘The way the peyote ceremony is practiced, I would say about 99 percent
of whatever is taking place in there is basically Navajo. Prayers are all in Navajo; many
Navajo traditional prayers have been integrated and incorporated into the ceremonies.’
(Davies W. Healing Ways. Navajo health care in the twentieth century. Albuquerque:
University of New Mexico Press, 2001: 181.)- It is appropriate to notice that the current promotion of ‘old’ medicines and practices
often fails to consider new safety information, a consideration as in the example given
next, namely the issue of pyrrolizidine alkaloids in coltsfoot. Under the internet heading
‘Cold and flu formulas. Make your own herbal medicine for your families cold and flu
symptoms’: ‘Garlic Honey Cough and Cold Syrup (Peel garlic cloves, put into a jar. cover
with honey. Set in warm place for 2 weeks or more until the garlic turns opaque. Take 1
teaspoonful as needed. Dilute with a little water or lemon juice for children. Or, Cough
Combo (‘Equal parts of Coltsfoot, Mullein and Licorice. Combine all herbs and use 1–2
tsp. per cup of boiling water. Steep for 10 minutes.)’ Available from: http://www.taoherbfarm.
com/herbs/resources/coldflurecipes.htm (accessed October 2008). - Inadequacies in history taking, at least with respect to CAM, have been documented,
often in the context that patients, fearing ridicule, do not volunteer information to physi-
cians. Compare Cockayne NL, Duguid M, Shenfield GM. Health professionals rarely
record history of complementary and alternative medicine. Br J Clin Pharmacol2005;
59 :254–8. Published advice and guidelines exist although these – intended either to elicit
specific usage during routine history-taking, or to give advice on how to talk to patients
(sometimes referred to as holistic interviewing) – tend to be overly detailed for the busy
physician. Eisenberg DM. Advising patients who seek alternative medical therapies. Ann
Intern Med1997; 127 :61–9. At least one ‘decision tree’, useful but complex, has also been
published to assist doctors who need to search for information on behalf of a patient
and/or to decide whether integrated care is appropriate. For the decision tree:
http://www.amsa.org/ICAM/decisiontree.cfm (accessed October 2008). Taken from Frenkel
MA, Borkan JM. An approach for integrating complementary–alternative medicine into
primary care. Fam Pract2003; 20 :324–32. - For example, Health Canada’s note on work with the Cree of Eeyou Istchee, Quebec,
Canada. The project investigates use of medicinal plants for diabetes in Cree. Available
at: http://www.hc-sc.gc.ca/sr-sr/activ/consprod/cree-cries-eng.php (accessed October 2008). - For example, Sacket DL, Straus SE, Richardson WS et al. Evidence-based Medicine: How
to practice and teach EBM. Edinburgh: Churchill Livingstone, 2000: 1. - Various lists of hierarchies, differing in detail and terminology, have been published. Just
to mention some, from the Bandolier group, in descending order of validity: 1. Strong
evidence from at least one published systematic review of multiple well-designed RCTs. - Strong evidence from at least one published properly designed RCT of appropriate size
and in an appropriate clinical setting. 3. Evidence from published well-designed trials
without randomisation, single group pre–post, cohort, time series or matched case-
controlled studies. 4. Evidence from well-designed non-experimental studies from more
than one centre or research group. 5. Opinions of respected authorities, based on clinical
evidence, descriptive studies or reports of expert consensus committees. Available at:
http://www.jr2.ox.ac.uk/bandolier/band6/b6–5.html (accessed October 2008). Level 5, the
lowest level, is not to be confused with simple expert opinion and personal experience
that is sometimes called eminence-based medicine. - For an indication of this pattern of thinking in conventional medicine, most obvious
before the rise of protoclinical trials and animal experiments in the eighteenth century,
see Crellin JK. Theory and clinical experience in eighteenth-century extemporaneous
prescriptions – a reciprocal relationship? Pharm Hist2006; 48 :3–13. The importance of
anecdotal knowledge in other fields of endeavour (e.g. in the fishery) is often recognised. - See Montgomery K. How Doctors Think. Clinical judgement and the practice of medi-
cine.Oxford: Oxford University Press, 2006: 8 for comments about science and clinical
practice, although the theme runs throughout the book.
62 |Traditional medicine