WHO to Promote Alternative Medicine

In response to a rapid increase in the use of alternative and complementary medicine over the last decade, the World Health Organization (WHO) has created the first global strategy for traditional or complementary/alternative medicine (TM/CAM).

The United Nations’ health agency aims to bring traditional, or alternative, therapies out of the shadows by intensifying research into their effectiveness and safety, by promoting their proper use and regulation and by helping countries integrate them into their health care services.

Traditional medicine - called complementary or alternative medicine in countries where conventional Western, or modern, medicine dominates - includes remedies, such as ginger root or shark cartilage, and diverse practices, such as acupuncture, yoga, shiatsu massage and aromatherapy, and would by default include chiropractic and osteopathy.

In Western countries, growing numbers of patients rely on CAM for preventive or palliative care. In France, 75% of the population has used CAM at least once; in Germany, 77% of pain clinics provide acupuncture; and in the United Kingdom, expenditure on complementary or alternative medicine stands at US$2,300 million per year.

Traditional medicine has been used for millennia in parts of the developing world and remains widespread there. More than one-third of the population lacks access to essential medicines, and the provision of safe and effective TM/CAM therapies could become a critical tool to increase access to health care. But while TM has been fully integrated into the health systems of China, North and South Korea and Vietnam, many countries have not collected and standardised evidence on this type of health care.

Problems may arise out of incorrect use of traditional therapies. For instance, the herb Ma Huang (ephedra) is traditionally used in China to treat short-term respiratory congestion. In the United States, 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 transplant or dialysis for interstitial fibrosis of the kidney after taking the wrong herb from the Aristolochiaceae family, again as a dietary aid.

Like conventional drugs, alternative treatments must be used correctly, and as with conventional medications, tragedies have occurred. However, unlike with Western medicine, consumers are mostly deciding for themselves what they use.

“There seems to be a growing gap between what you might call the ‘uncritical enthusiasts’ and the ‘uninformed sceptics’,” said Dr. Jonathan Quick, director of WHO’s essential drugs and medicines policy unit. “The enthusiasts rave that all of these methods work and don’t want to recognize that herbal remedies that are used the wrong way can kill.”

“On the other hand you’ve got the uninformed sceptics who don’t believe that there’s any evidence for any of these and would prefer that they not be around,” Quick said.

“There is now an urgent need to establish through rigorous scientific testing what works and what doesn’t,” said Forkel Falkenberg, a professor of international health at Sweden’s Karolinska Institute in Stockholm. “This is a very important step for modern science, to engage in understanding the complexity of complementary medicine. One cannot any more marginalize this area. One needs to bring it into the light, to understand what to do with it, how to take away the unsafe practices.”

He said the WHO’s decision to create a strategy for alternative medicine is a clear signal that the field is now being taken seriously.

Studies have shown success in treating conditions ranging from malaria and HIV to high blood pressure and lower back pain. The WHO intends to help countries trying to evaluate therapies by providing guidance on how to conduct the studies.

It will also provide countries with expert advice on setting up consumer education programs to help people select the right therapies for the right conditions and remind people that just because something is natural, it doesn’t mean that it is safe.

The strategy, a working document for adaptation and regional implementation, and more information on TM/CAM can be accessed on: http://www.who.int/medicines/organization/trm/orgtrmmain.shtml