Looking for ALTERNATIVE EVIDENCE
Asian, African scholars want global atlas for traditional medicine made, standards adopted to ensure safety and efficacy
By Hiroshi Hiyama
Agence France-Presse
KOBE, Japan
Often underutilized traditional medicine, the only form of health care for millions of people, can save lives in rural areas and can diversify the choices of medical treatment in industrialized nations. But to ensure the safety and effectiveness of the treatments, standardized training and quality control for traditional medicine must be established, especially in Africa and Asia.
This much health experts, doctors, and academics agreed on at the International Meeting on the Global Atlas of Traditional Medicine sponsored by the World Health Organization in this western Japanese city last June. The three-day meet attracted 64 participants from 32 nations.
"If we only promote Western medicine, we limit choices of effective [traditional] medical remedies that are less expensive than mainstream medications," said Yuji Kawaguchi, director of the Kobe-based WHO Center for Health Development. "We must study what is effective and what is not. We have to increase the safety of those practices," he said, noting, however, that a big problem is that "we do not know what is available and where."
Which is why the Kobe center has a multilateral effort to map the global availability of traditional medicine to make it more accessible and to raise awareness of the treatment. They hope to finish and publish the atlas of traditional medicine next year, said Kawaguchi.
The Kobe center started the atlas project in 1999 and hopes that the two-volume reference book, which will contain 70 maps, will be used to improve health-care systems, clinical research, training, and the quality of traditional medicine around the world.
Two Pillars
Xiaorui Zhang, Geneva-based WHO coordinator of traditional medicine, essential drugs, and medicines policy, said traditional medicine is used widely throughout the world and is generally the primary source of medical care in poor nations.
She said, for example, that nearly 90 percent of people in Ethiopia rely only on traditional medicine in part because of lack of access to modern medicine. In China, most people look to traditional treatments like acupuncture, and herbs like ginseng.
Pyong-Ui Roh, professor of health science at the Kyungsan University in South Korea, said Western and traditional medicine are two pillars supporting the whole medical system. "We need to learn and research more about it (traditional medicine)," he said, stressing that policy makers must ensure such care is effective and safe. He said the atlas should raise awareness among political leaders of the need to set guidelines for the use of traditional medicine in their countries.
"We need to standardize training for practitioners. We need science-based, evidence-based traditional medicine," Roh stressed.
Most nations in the Western Pacific, including China, Fiji, and Japan, have traditional healers, who can range from highly trained acupuncturists to religion-based medicine men. However, only 10 regional nations are known to have official policies regulating practices of traditional medicine, he noted.
In Ghana, Mali, Nigeria, and Zambia, 60 percent of children with high fever, presumably due to malaria, are treated with various locally available herbal medications, according to delegates to the conference. For many patients, traditional medicine, such as herbs, can be mixed with modern treatments to achieve the best outcome, they said.
It is important to make the atlas a tool for policy making among health-care officials around the world, commented Gerard C. Bodeker, a medical researcher at the University of Oxford. The atlas should help policy makers discern how dependent people in rural and poor areas are on traditional medicine, and hopefully, it will prompt them to take action to expand health insurance coverage to pay for traditional care, he said. Traditional treatments are less expensive than modern medicine, but the cost can still be prohibitive for some, he said.
The atlas will also help preserve the traditional knowledge of medicine, which in some areas is not passed on to younger generations as modern medicine becomes available, Kawaguchi said. The atlas will allow physicians and traditional healers to learn about one another and exchange information.
"We must coordinate [among countries] to share experiences and information" to ensure safe practice with herbal medications, some of which can be strong enough to injure or kill patients, Roh said.
In Africa, about 80 percent of the population depends on traditional medicine for their primary health-care needs, said Ossy Kasilo, regional advisor on traditional medicine for WHO in Africa. But the region also lacks adequate regulations to ensure safe practices, he said.
"The WHO is urging governments [to monitor] evidence of quality, safety, and efficacy of traditional medicine," Kasilo said.
Nongovernment groups can help educate traditional healers, said D. Nhlavana Maseko, president of the Traditional Healers Organization for Africa. The group, with 800,000 member healers, was considering starting training programs for traditional healers, he said. "They are not familiar with modern illnesses, like AIDS. We can help upgrade their skills," to deal with a wider range of illnesses with available resources, Maseko said.
Uncontrolled Use
But while alternatives or complements to modern medicine can successfully treat illnesses, their uncontrolled use can also cause strong side effects.
Said Zhang: "Many Asians, many in Japan, China, Korea ... like using traditional medicine because they believe in it. But unless you really know how to use it, it may cause you some discomfort, even if it may not have serious side effects. Many people think 'Oh, traditional medicine, it's natural. It must be safe.' But that's not true. We need regulations, we need to educate consumers and practitioners."
For instance, Zhang said kava kava plants, used traditionally among Pacific islanders for a calming tea, were sold in concentrated forms in Europe and caused liver damage to users. Ginseng, used widely in China and other Asian nations, can also cause sleep problems and nosebleeds, among other conditions. Official control can also help preserve traditional medical lore and ingredients.
The African potato, which grew wild, was often used in the belief that it boosted immune systems. It was widely used in treatment of people with HIV/AIDS during the 1990s, though there was no concrete scientific evidence that it was effective, Zhang said.
"Everybody went to harvest it and now we have no more of it," she said. "We cannot even research if it was effective."
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