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Efforts to augment accountability through the use of metrics, and especially randomised controlled trial or other statistical methods place an increased burden on small nongovernmental organisations (NGOs) doing global health. In this paper, we

This special issue of the journal Asian Medicine emerged from the VIIth ICTAM conference held in Thimphu, Bhutan, in September 2009. It includes contributions in English, though several of the articles have been translated from Tibetan.

The article reviews the book "Precious Pills: Medicine and Social Change Among Tibetan Refugees in India," by Audrey Post.

Objectives Whether in metropoles or remote mountain communities, the availability and adoption of contraceptive technologies prompt serious and wide-ranging biological, social, and political-economic questions. The potential shifts in women's capacities to create spaces between pregnancies or to prevent future pregnancies have profound and often positive biological, demographic, and socioeconomic implications. Less acknowledged, however, are the ambivalences that women experience around contraception use-vacillations between moral frameworks, generational difference, and gendered forms of labor that have implications well beyond the boundaries of an individual's reproductive biology. This paper hones in on contraceptive use of culturally Tibetan women in two regions of highland Nepal whose reproductive lives occurred from 1943 to 2012. Methods We describe the experiences of the 296 women (out of a study of more than 1000 women's reproductive histories) who used contraception, and under what circumstances, examining socioeconomic, geographic, and age differences as well as points of access and patterns of use. We also provide a longitudinal perspective on fertility. Results Our results relate contraception usage to fertility decline, as well as to differences in access between the two communities of women. Conclusions We argue that despite seemingly similar social ecologies of these two study sites-including stated reasons for the adoption of contraception and expressed ambivalence around its use, some of which are linked to moral and cosmological understandings that emerge from Buddhism-the dynamics of contraception uptake in these two regions are distinct, as are, therefore, patterns of fertility transition.

The article presents information regarding the proceedings of the Seventh International Congress of the International Association for the Study of Traditional Asian Medicine (IASTAM), which was held in Thimphu, Bhutan, during September 7-11, 2009. Under the convention, a multi-day panel titled "Cultivating the Wilds: Considering Potency, Protection, and Profit in the Sustainable Use of Himalayan and Tibetan Materia Medica" was organized.

This article emerges from a workshop titled “Producing Efficacious Medicine: Quality, Potency, Lineage, and Critically Endangered Knowledge,” held in Kathmandu, Nepal, in December 2011. An experiment in collaborative event ethnography (CEE), this

Ethnopharmacological relevanceGeological materials, such as minerals, have a long history of usage as ingredients in multicompound formulations of Himalayan Sowa Rigpa medicine – as well as in its localized form of Bhutanese traditional medicine (BTM) – for treating various disorders for over thousand years. Yet, hardly any scientific research has been done on their ethnopharmacological efficacy and chemistry. Aim of the study This study documents and correlates the rarely explored ethnopharmacological and chemical identification of various minerals and their ethnomedicinal uses in BTM formulations for the first time. Material and methods A five stage cross-disciplinary process was conducted as follows: (1) a review of classical literature of Sowa Rigpa texts (Tibetan medical texts, pharmacopoeias and formularies) that are still in use today; (2) listing of mineral ingredients according to Sowa Rigpa names, followed by identification with common English and chemical names, as well as re-translating their ethnomedical uses; (3) cross-checking the chemical names and chemical composition of identified Sowa Rigpa minerals with various geological mineral databases and mineral handbooks; (4) authentication and standardization of Sowa Rigpa names through open forum discussion with diverse BTM practitioners; (5) further confirmation of the chemical names of identified minerals by consulting different experts and pharmacognosists. Results Our current study lists 120 minerals as described in Sowa Rigpa medical textbooks most of which we were able to chemically identify, and of which 28 are currently used in BTM herbo-mineral formulations. Out of these 28 mineral ingredients, 5 originate from precious metal and stone, 10 stem from earth, mud and rocks, 8 are salts, and 5 concern ‘essences’ and exudates. Conclusions Our study identified 120 mineral ingredients described in Sowa Rigpa medical textbooks, out of which 28 are currently used. They are crucial in formulating 108 multicompound prescription medicines in BTM presently in use for treating more than 135 biomedically defined ailments.

This essay analyzes the impacts of global and national pharmaceutical governance on the production of traditional medicines--specifically the making and marketing of Tibetan medicines in contemporary China. Based on research conducted in Tibetan medical factories and with practitioners, producers, and consumers of Tibetan medicines in the Tibet Autonomous Region (TAR) and Qinghai Province between 2002-2010, this article presents ethnographic evidence for the ways Tibetan knowledge systems and the value of medicines themselves are being transformed through interlinked engagements with science, technology, and the market. I focus on the implementation of Good Manufacturing Practices (GMP) and related regulations: state-mandated standards that govern the conditions under which raw materials are evaluated, medicines are made, and finished products are sold. This article responds to calls for an anthropology of pharmaceutical practice in the context of social transformation. I propose that ethnography of Tibetan pharmaceutical production provides an apt illustration of global governance in action because it shows how shifts in medical production practices are tied to much larger processes of political and economic change within China and beyond. Further, my examination of points of incommensurability and ambivalence with respect to GMP regulations contributes to an anthropological analysis of the constitutive role cultural politics plays in the construction of value and meaning with respect to traditional medicine.

"Tibetan medicine has come to represent multiple and sometimes conflicting agendas. On the one hand it must retain a sense of cultural authenticity and a connection to Tibetan Buddhism; on the other it must be proven efficacious and safe according to biomedical standards, often through clinical research. Recently, Tibetan medicine has found a place within the multibillion-dollar market for complementary, traditional, and herbal medicines as people around the world seek alternative paths to wellness. Healing Elements explores Tibetan medicine within diverse settings, from rural schools and clinics in the Nepal Himalaya to high-tech factories and state-supported colleges in the People's Republic of China. This multi-sited ethnography explores how Tibetan medicines circulate as commercial goods and gifts, as target therapies, and as panacea for biosocial ills. Through an exploration of efficacy - What does it mean to say Tibetan medicine "works"? - this book illustrates a bio-politics of traditional medicine in the twenty-first century. Healing Elements examines the ways traditional medicine interacts with biomedicine: from patient-healer relationships and the cultural meanings ascribed to affliction, to the wider circumstances in which practitioners are trained, healing occurs, and medicines are made, evaluated, and used. As such, it examines the meaningful, if contested, translations of science and healing that occur across distinct social ecologies"--Provided by publisher.

'Healing Elements' explores how Tibetan medicine circulates through diverse settings in Nepal, China, and beyond as commercial goods and gifts, and as target therapies and panacea for biophysical and psychosocial ills.

The article focuses on the study which aims to develop an informed consent process of Tibetan traditional medicine through a randomized placebo-controlled trial in Lhasa, China. The study reveals a process that enables the U.S. and Tibetan research team in meeting their ethical and logistical challenges, and examines the differences between the outcomes. Moreover, a step-by-step process on how participants would react to the research and informed consent process were presented.

Procedures of Informed Consent are considered a high priority for international biomedical research. However, informed consent protocols are not necessarily transferable across cultural, national or ethnic groups. Recent debates identify the need for balancing ethical universals with practical and local conditions and paying attention to questions of cultural competence when it comes to the Informed Consent process for clinical biomedical research. This article reports on the results of a two-year effort to establish a culturally appropriate Informed Consent process for biomedical research in the Tibet Autonomous Region in the People's Republic of China. A team of Tibetan and American researchers, physicians, health professionals and medical anthropologists conducted the research. The Informed Consent was specifically for undertaking a triple-blind, double placebo-controlled randomized clinical trial of a Tibetan medicine compared with Misoprostol for reducing postpartum blood loss. The findings suggest greater need for flexibility and cooperation in establishing Informed Consent protocols across cultures and nations.


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