Global Review of the Use of Traditional Medicine and WHO Traditional Medicine Strategy

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Global Review of the Use of Traditional
MedicineandWHO Traditional Medicine Strategy
Dr Xiaorui ZhangCoordinator Traditional
Medicine Department of Essential Drugs and
Medicines PolicyWorld Health Organization
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Characteristics of traditional and
complementary/alternative medicine
Traditional medicine systems

• Include traditional Chinese medicine, Indian
  ayurveda and Unani medicine
• Influenced by culture, history, personal
  attitudes and philosophy
• Practice may vary from country to country and
  from region to region

Complementary/alternative or non-conventional
medicine

• Refers to a broad set of health care practices
  that are not part of a countrys own tradition,
  or not integrated into its dominant health care
  system

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Definition of traditional and complementary/alter
native medicine (TM/CAM)
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Populations using TM/CAM worldwide
Sources Eisenberg DM et al. 1998 Fisher P
Ward A, 1994 Health Canada, 2001 World Health
Organization, 1998 and government reports
submitted to WHO.
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Herbal medicines are rapidly increasing in
economic importance
US 60 000 million world market sales for herbal
medicines (including raw materials)
Other Countries
China
Japan
Western Europe
Canada
USA
Source Secretariats of the Convention on
Biological Diversity (CBD) 2000
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Acupuncture
Countries where the practice of acupuncture is
allowed either only by medical doctors or by both
doctors and acupuncturists
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Chiropractic Laws Worldwide
Prepared for the World Health Organization by the
World Chiropractic Alliance
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TM/CAM use for various diseases and conditions

• 49 for minor diseases
• 54 for chronic diseases
• 3 for serious illnesses
• 17 to maintain health and to prevent diseases

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Role of TM/CAM

• In Africa, North America and Europe, over 75 of
  AIDS patients use some form of TM/CAM treatment
  for various symptoms and conditions

• In Ghana, Mali, Nigeria and Zambia, 60 of
  children with fever are treated with herbal
  medicines at home

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Safety and efficacy of TM/CAM treatment

• Acupuncture relieving pain has been proved by
  clinical studies and laboratory experiment which
  showed needle increases like morphine substance
  
• In 1998, USA national expert panel made consensus
  conclusion there is clear evidence that needle
  acupuncture treatment is effective for
  postoperative, pregnancy and chemotherapy nausea
  vomiting and dental pain with extremely low side
  effects than conventional treatment

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Good evidence of efficacy exists for some herbal
medicines - but too often evaluation is inadequate
of randomized clinical trials (RTCs) showing
benefit of herbal medicines (based on 50 RTCs
with 10 herbal medicines for 18 therapeutic
indications)
Report benefit unlikely - because of design or
analytic flaw 48
Source Based on data in Herbal Medicines An
Evidence Based Look. Therapeutics Letter, Issue
25, June-July, 1998.
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Challenges faced by alternative medicine

• Lack of national policies and regulations on
  TM/CAM
• Lack of sound scientific evidence concerning
  safety and efficacy
• Difficulties in ensuring rational use and quality
  control of TM/CAM
• Need to ensure the sustainable use and the
  protection of knowledge of TM/CAM

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Many challenges need to be met for potential of
traditional medicine to be fully realized
Policy and regulation
Government policy and national regulations vary

• Only 25 of 191 WHO Member States have a national
  policy for TM/CAM
• Only 70 of 191 WHO Member States regulate herbal
  medicines

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Safety and quality control issues

• In 1996, 50 people, in Belgium, had kidney
  failure by a herbal preparation which contain
  Aristolochia fangchi instead of Stephania
  tetrandra or Magnolia officinalis

In USA, some young people dead in using high dose
of ephedra as narcotic drugs or psychotropic
substances

• In some European countries, traditional used form
  of Kava-kava was changed into new form which
  contain concerted Kava-kava which caused several
  people liver damage

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Procedure for developing a new chemical drug
Duration at least 13 years Cost at least US
100 million
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Many challenges need to be met for potential of
traditional medicine to be fully realized

• Research methodology
• Traditional medicine with a holistic view
• Each different system has its own theory
• There is a lack of international standards for
  evaluation of safety and efficacy of traditional
  medicine

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Evaluation of efficacy of herbal medicines
The combination of 4 plants creates a powerful
synergy for maximum anti-tumour effect
Removing any one of the 4 plants weakens the
effectiveness of the formula

• Reported by Prof Yeeng -chi Cheng, Yale Medical
  School 2001

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Many challenges need to be met for potential of
traditional medicine to be fully realized

• There is a lack of sound education and training
  programmes on traditional medicine for health
  care providers
• There is a lack of education for consumers in the
  proper use of traditional therapies and herbal
  medicines

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Many challenges need to be met for potential of
traditional medicine to be fully realized

• A growing herbal market and its great commercial
  benefit - need to ensure sustainable use of
  medicinal plant resources

• Difficulties relating to the protection of
  knowledge on traditional medicine

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WHO Traditional Medicine Strategy 2002-2005
Policy

• integrate TM/CAM with national health care systems

Safety, efficacy and quality
provide evaluation, guidance and support for
effective regulation
Access
ensure availability and affordability of TM/CAM,
including essential herbal medicines
Rational use
promote therapeutically-sound use of TM/CAM by
providers and consumers
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Policy

• Updated document, Regulatory Situation on Herbal
  Medicines Worldwide Review
• Survey on the National Policy on TM/CAM and
  Regulation of Herbal Medicines

• Protection and preservation of traditional
  medicine knowledge
• Recording the knowledge for sustainable use
• Recording the knowledge for safety and efficacy
• Recording the knowledge for equity sharing of the
  benefit

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Safety, efficacy and quality

• Supporting clinical research focus on AIDS and
  malaria, as well as on common diseases

• Collecting existing research data and setting up
  evidence-based global database network to promote
  the proper use of TRM/CAM

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Safety, efficacy and quality
National capacity-building

• A series of workshops on national
  capacity-building on regulation and
  pharmacovigilance of herbal medicines

• Developing Good Sourcing Practices Good
  Agricultural Practice and Good Control
  Practice for medicinal plants
• Developing Guidelines for quality control of
  finished herbal products

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Access

• Study on cost-effectiveness of TRM/CAM

• Support sustainable use of the resources of
  medicinal plants
• Support countries to develop their monographs on
  medicinal plants

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Rational use

• Strengthen the education and training programme
  for qualified practice of traditional medicine by
  health care providers

• Develop educational guidelines for consumers in
  the proper use of traditional therapies and
  herbal medicines

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Conclusion

• Traditional Medicine will contribute to human
  health care in the 21st century.
• There are many challenges to the safety and
  effective use of traditional medicine.
• The WHO Strategy will meet the gaps and
  challenges, but...

it is a long way to go...