INTRODUCTION

Traditional medicine (TM) refers to the knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures, used in the maintenance of health and in the prevention, diagnosis, improvement or treatment of physical and mental illness.

Traditional medicine covers a wide variety of therapies and practices which vary from country to country and region to region. In some countries, it is referred to as "alternative" or "complementary" medicine (CAM).

Traditional medicine has been used for thousands of years with great contributions made by practitioners to human health, particularly as primary health care providers at the community level. TM/CAM has maintained its popularity worldwide. Since the 1990s its use has surged in many developed and developing countries.

KEY FACTS

- In some Asian and African countries, 80% of the population depend on traditional medicine for primary health care.

- Herbal medicines are the most lucrative form of traditional medicine, generating billions of dollars in revenue.

- Traditional medicine can treat various infectious and chronic conditions: new antimalarial drugs were developed from the discovery and isolation of artemisinin from Artemisia annua L., a plant used in China for almost 2000 years.

- Counterfeit, poor quality, or adulterated herbal products in international markets are serious patient safety threats.

- More than 100 countries have regulations for herbal medicines.

Traditional medicine that has been adopted by other populations (outside its indigenous culture) is often termed alternative or complementary medicine.

Herbal medicines include herbs, herbal materials, herbal preparations, and finished herbal products that contain parts of plants or other plant materials as active ingredients.

TRADITIONAL MEDICINE: WHO USES IT??

In some Asian and African countries, 80% of the population depend on traditional medicine for primary health care.

In many developed countries, 70% to 80% of the population has used some form of alternative or complementary medicine (e.g. acupuncture).

Herbal treatments are the most popular form of traditional medicine, and are highly lucrative in the international marketplace. Annual revenues in Western Europe reached US$ 5 billion in 2003-2004. In China sales of products totaled US$ 14 billion in 2005. Herbal medicine revenue in Brazil was US$ 160 million in 2007.

CHALLANGES

Traditional medicine has been used in some communities for thousands of years. As traditional medicine practices are adopted by new populations there are challenges.

International diversity: Traditional medicine practices have been adopted in different cultures and regions without the parallel advance of international standards and methods for evaluation.

National policy and regulation: Not many countries have national policies for traditional medicine. Regulating traditional medicine products, practices and practitioners is difficult due to variations in definitions and categorizations of traditional medicine therapies. A single herbal product could be defined as either a food, a dietary supplement or an herbal medicine, depending on the country. This disparity in regulations at the national level has implications for international access and distribution of products.

Safety, effectiveness and quality: Scientific evidence from tests done to evaluate the safety and effectiveness of traditional medicine products and practices is limited. While evidence shows that acupuncture, some herbal medicines and some manual therapies (e.g. massage) are effective for specific conditions, further study of products and practices is needed. Requirements and methods for research and evaluation are complex. For example, it can be difficult to assess the quality of finished herbal products. The safety, effectiveness and quality of finished herbal medicine products depend on the quality of their source materials (which can include hundreds of natural constituents), and how elements are handled through production processes.

Knowledge and sustainability: Herbal materials for products are collected from wild plant populations and cultivated medicinal plants. The expanding herbal product market could drive over-harvesting of plants and threaten biodiversity. Poorly managed collection and cultivation practices could lead to the extinction of endangered plant species and the destruction of natural resources. Efforts to preserve both plant populations and knowledge on how to use them for medicinal purposes is needed to sustain traditional medicine.

Patient safety and use: Many people believe that because medicines are herbal (natural) or traditional they are safe (or carry no risk for harm). However, traditional medicines and practices can cause harmful, adverse reactions if the product or therapy is of poor quality, or it is taken inappropriately or in conjunction with other medicines. Increased patient awareness about safe usage is important, as well as more training, collaboration and communication among providers of traditional and other medicines.

TRADITIONAL MEDICINE: HOW SAFE IS IT??

Traditional medicine includes many different practices and remedies, and varies from one country to another. While some practices seem to offer benefits, others remain questionable.

In 2002, WHO launched a strategy on traditional medicine to help countries explore its potential for people’s health and well-being, while minimizing the risks of unproven or misused remedies. The main aim of the strategy is to encourage further research.

There is some evidence that seems to support the use of traditional and complementary medicine – for example, acupuncture in relieving pain, yoga to reduce asthma attacks, and tai ji techniques to help elderly people reduce their fear of falls. WHO does not currently recommend these practices, but is working with countries to promote an evidence-based approach to addressing safety, efficacy and quality issues.

Unfortunately, the misuse of certain herbal remedies can cause harm – even death – in some cases. The herb Ma Huang (ephedra) is traditionally used in China to treat short-term respiratory congestion. In the United States of America, the herb was marketed as a dietary aid, whose long-term use led to at least a dozen deaths, heart attacks and strokes. In Belgium, at least 70 people required renal transplants or dialysis for interstitial fibrosis of the kidney after taking the wrong herb from the Aristolochiaceae family, again as a dietary aid.

In developing countries, where more than one-third of the population lack access to essential medicines, the provision of safe and effective traditional and alternative remedies could become a important way of increasing access to health care. One way to ensure this is to integrate traditional medicine into the formal health system, thus ensuring better safety and adequate follow-up for patients.

Traditional medicine is also becoming more popular in industrialized countries, where many products can be bought over the counter.

In addition to concerns over safety and quality issues, traditional medicine also raises questions of protecting biodiversity (through over harvesting of the raw material for herbal medicines and other products), and protecting the traditional knowledge of communities.

WHO RESPONSE

WHO and its Member States cooperate to promote the use of traditional medicine for health care. The collaboration aims to:

- support and integrate traditional medicine into national health systems in combination with national policy and regulation for products, practices and providers to ensure safety and quality;

- ensure the use of safe, effective and quality products and practices, based on available evidence;

- acknowledge traditional medicine as part of primary health care, to increase access to care and preserve knowledge and resources; and

- ensure patient safety by upgrading the skills and knowledge of traditional medicine providers.

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