Safety strategy for alternative medicine

The World Health Organisation (WHO) has launched a global plan to address the issue of safety in the practice of alternative medicine.

The strategy provides a framework for policy to assist countries to regulate traditional or complementary/alternative medicine (TM/CAM) to make it safer to use and more accessible.

"About 80 per cent of the people in Africa use traditional medicine. It is for this reason that we must act quickly to evaluate its safety, efficacy, quality and standardisation - to protect our heritage and to preserve our traditional knowledge. We must also institutionalise and integrate it into our national health systems,"​ said Ebrahim Samba, WHO's regional director for Africa.

The organisation said that in wealthy countries, growing numbers of patients rely on alternative medicine for preventive or palliative care. In France, 75 per cent of the population has used complementary medicine at least once; in Germany, 77 per cent of pain clinics provide acupuncture; and in the United Kingdom, expenditure on complementary or alternative medicine stands at €2,480 million per year.

However, problems may arise out of incorrect use of traditional therapies. The WHO cited the herb Ma Huang (ephedra), traditionally used in China to treat short-term respiratory congestion. In the US, 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.

"Traditional or complementary medicine is victim of both uncritical enthusiasts and uninformed sceptics,"​ explained Dr Yasuhiro Suzuki, WHO executive director for health technology and pharmaceuticals. "This strategy is intended to tap into its real potential for people's health and well-being, while minimising the risks of unproven or misused remedies."​

In developing countries, where more than one-third of the population lacks access to essential medicines, the provision of safe and effective TM/CAM therapies could become a critical tool to increase access to health care, the WHO said.

But while traditional medicine 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.

The global market for traditional therapies is worth $60 billion annually and is steadily growing, according to the WHO. In addition to the patient safety issue and the threat to knowledge and biodiversity, there is also the risk that further commercialisation through unregulated use will make these therapies unaffordable to many who rely on them as their primary source of health care. For this reason policies on the protection of indigenous or traditional knowledge are necessary, said the WHO.

About 25 per cent of modern medicines are descended from plants first used traditionally. In Africa, North America and Europe, three out of four people living with HIV/AIDS use some form of traditional or complementary treatment for various symptoms and conditions. In South Africa, the Medical Research Council is conducting studies on the plant Sutherlandia microphylla​'s efficacy in treating AIDS patients. Traditionally used as a tonic, this plant may increase energy, appetite and body mass in people living with HIV.

The Chinese herbal remedy Artemisia annua​, used for almost 2000 years, has recently been found to be effective against resistant malaria and could give hope of preventing many of the 800 000 deaths among children from severe malaria each year.

The WHO TM/CAM strategy aims to assist countries to develop national policies on the evaluation and regulation of TM/CAM practices, create a stronger evidence base on the safety, efficacy and quality of the products and ensure availability and affordability of TM/CAM, including essential herbal medicines.

The strategy, a working document for adaptation and regional implementation and more information on TM/CAM can be accessed on the WHO website​.