Traditional medicine ( TM ) deserves a revival. For millennia , all over the world has healed the sick with remedies derived from plants or animals , knowledge that has passed from generation to generation. In Africa and Asia , 80 % of the population uses traditional medicine and modern medicine for primary health care .
In industrialized countries, the MT is increasingly attracting more people. Some estimates suggest that up to 80 % of the population has proven therapies such as acupuncture or homeopathy, and a survey earlier this year revealed that 74 % of medical students in the U.S. believe that Western medicine would benefit from the therapies and integration of traditional or alternative practices .
The industry has high economic value. In 2005 , sales of traditional medicines in China amounted to 14,000 million dollars. In 2007 , Brazil generated revenues of 160 million dollars from traditional therapies , part of a global market valued at more than 60,000 million dollars.
The truth is that modern medicine has a critical need for new drugs. To make a new substance beyond the stages of research and development and get to market takes years and the investment is enormous. Moreover, the growing resistance to drugs, partly caused by the misuse of drugs, has become ineffective to antibiotics and other drugs that save lives.
Both trends mean that scientists and pharmaceutical companies urgently seek new sources of drugs and devote increasing attention to traditional medicine. A few achievements have revived interest in traditional medicine as a source of profitable and highly successful drugs . The best known is the artemisinin to treat malaria ( see Box 1).
Artemisinin : the economic success of traditional medicine
Artemisinin , extracted from the wormwood plant Artemisia annua , or Chinese, is the basis of more effective antimalarial drugs the world has ever known . Western researchers learned of the compound for the first time in the eighties , but has been in use in China for a long time to treat malaria. However, only until 2004, WHO approved for use internationally . To a large extent, this delay was due to skepticism surrounding the drug and therefore, different research groups took years to validate the claims of Chinese healers .
Artemisinin is also effective to combat other diseases and has demonstrated significant potential for the treatment of cancer and schistosomiasis. But this wonder drug is already showing signs of weakness: Southeast Asian reports some people argue that the malaria parasite has become resistant to treatment with artemisinin . Worldwide , researchers , policy makers , pharmaceutical companies and healers are joining forces to introduce MT in the XXI century .
Somehow, it is already succeeding. Almost a quarter of modern medicines are derived from natural products, many of which were used before in traditional remedies.
But true integration of traditional medicine – the incorporation of their knowledge in modern health care with the assurance that complies with current safety and efficacy – not an easy task and is far from achieved.
In addition , there is growing concern among environmentalists about the possibility that the market growth of traditional medicine as a threat to biodiversity due to overexploitation of medicinal plants or the use of animal parts at risk of species such as tigers , rhinos and elephants.
Beyond the sustainability of natural resources , linking the traditional and modern medicine involves many challenges that result from key differences in their exercise , evaluation and management ( see Table 2).
Protection and Piracy
One of the main differences between traditional and modern medicine is the legal protection accorded to knowledge. Historically, the healers who shared their knowledge and experience without restrictions , defining the ‘open access ‘ even before the term existed . However , modern medicine is subject to stringent laws protecting intellectual property and has a highly developed patent system that is used to protect the knowledge of the drugs or medical techniques .
As Western researchers discover the treasured wealth of knowledge in traditional medicine systems and the need for new drugs becomes more pressing , many scientists have begun to search for new drugs from indigenous sources , what has been called ‘ bioprospecting ‘(see Bioprospecting).
In some cases , researchers have applied for patents to protect medicinal compounds that had been used for centuries to treat diseases. An example is the patent granted in 1995 to an antifungal derived from the Indian lilac , commonly used in traditional Indian remedies . The European Patent Office (EPO ) granted a patent to the Department of Agriculture United States into a multinational.
The Indian government persuaded the EPO to revoke the patent because of prior use , a process that took five years and cost millions of dollars. This exploitation of indigenous resources open access has been termed ‘ biopiracy ‘ and is a striking example of the challenges faced by initiatives to integrate traditional medicine into the modern .
Some regions have attempted to address the problem by enacting laws to protect indigenous knowledge. For example , Cusco (Peru ) prohibits the exploitation of endemic species for profit , including the patenting of genes and other resources found in trees (See Region of Peru prohibits biopiracy).
The Council of Scientific and Industrial Research of India ( CSIR ) has adopted a more pragmatic approach to reduce the gap. In 2001 , he launched a traditional knowledge digital library (TKDL , for its acronym in English ). Since last year, the EPO has consulted this multilingual database on traditional medicine and medicinal plants , comprising 24 million pages , before granting patents (see BioMed Analysis: Open Knowledge But Keep traditional safe).
Many other countries such as China , Ghana , Malaysia , Nigeria , South Africa , Tanzania , Thailand and some Middle East nations already have or intend to create similar databases to protect local resources.
Beyond the differences between indigenous knowledge systems and Western efforts to integrate traditional medicine into modern also have to contend with significant differences in the regulation .
All countries have some form of national authority in the field of drugs , responsible for administering and managing the modern medicines and pharmaceutical policymakers .
The problem is that traditional medicine is not the same for everyone . A particular herb can be classified as food, dietary supplement or herbal drug , depending on location .
A survey conducted in 2005 between WHO member states showed that between 84 and 90 countries (approximately 60 percent ) had no policies, laws or national regulatory standards for traditional medicine , although more than half thought their development [ 5]. For the most part , are the nations where the use of traditional remedies is more widespread (see Figure 1).
And those countries that have laws take different approaches to MT in authorizing , preparing , producing and marketing traditional remedies.
The lack of regulation means that there are many remedies and professional treatments false as genuine, which can have disastrous consequences . For example , last year two people died and nine were hospitalized in the Xinjiang Uygur Autonomous Region in China, with consumption of a traditional medicine against diabetes used to reduce blood sugar and had been falsified .
For much of the last decade , WHO has worked to develop international guidelines and technical standards to assist countries in formulating policies and regulations to control traditional medicines.
If the regulation of traditional and Western medicine differ , so with the methods for evaluation and testing. Modern drugs undergo a series of laboratory tests and rigorous clinical trials before going to market. Modern medicine has developed robust methods to demonstrate the efficacy , safety test and standardize best practices in production.
Instead, it made little scientific evidence to evaluate products and practices of traditional medicine. The tests of quality and production standards tend to be reduced or controlled and in many cases, have no professional credentials or authorizations.
Of course , some researchers believe that it should not submit to a drug that has been tested in thousands of people over decades or centuries to the same restrictions of a new chemical compound .
However, many believe that before entering a part of traditional medicine into conventional pharmaceuticals , we need a reassessment .
In some cases this involves adapting standard methods to address ethical considerations are not presented in conventional drug development . For example, American researchers Kaptchuk Ted Jon Tilburt and have suggested that clinical trials of traditional medicines must follow different rules regarding the ethics of research ( see Box 2). [7 ] p
Ethical standards for research to clinical trials with traditional medicines
1. Social need to justify research
The argument to prove a folk remedy in a clinical trial can not be the simple fact that it exists as a treatment. There must be both a social necessity and some preliminary evidence that the medicine will not counteract the effect of others used to treat the same disease. Different stakeholders will differ in the definition of social need : for example, a government may want to prevent any actor involved in the processing market , while health advocates want to generate more clinical trial drugs.
2. Appropriate definitions of inclusion / exclusion and resulting actions
The concepts of health and disease differ in traditional and modern medicine . For example, Western researchers tend to categorize heart failure as classified by the New Yorker Heart Association . But those involved in traditional Chinese medicine ( TCM) will see it as a deficiency of yang chi of heart or kidney yang deficiency , categorizing patients based on observation of pulse or tongue . Researchers tested a herbal medicine against heart failure should consider both biomedical criteria such as the MTC for the results to be valid from two perspectives.
3. Innovative design of protocols
The drugs derived from traditional remedies that are released after overcoming clinical trials must pass stringent tests , but researchers have to think carefully about how to design protocols. The conventional methods may not be appropriate for a drug that contains a mixture of active ingredients or in the case of therapies that vary by practitioner. Still, the adaptation of standard protocols could see many of these issues . For example, group randomized controlled trials could be strict at the same time allow the variation of professionals.
4. Establish safety standards and evidence
The familiarity of traditional medicines, and its widespread use, some researchers may bias toward a favorable safety profile , but you need to be cautious from the outset to determine the safety requirements . Leaving aside ethical issues , it is extremely difficult to apply modern methods ( developed for standardized testing drugs ) the inherently broad spectrum of traditional remedies .
Many traditional medicines are produced by crushing the leaves or bark of plants and trees, and the resulting mixture can contain hundreds of potentially active molecules . is already quite laborious to identify , verify the effectiveness and safety of all , virtually impossible. And unlike many modern drugs , the quality of the material that serves as a source of traditional medicines varies widely, even within each country. This happens because of differences in the genetic material used or other factors such as environmental conditions , harvesting , transport and storage.
The dosage also varies. Modern medicine requires standardized dosages that only have slight variations depending on the weight of the patient or the severity of the disease. However , healers tend to offer their patients a single dose or a combination of drugs to be prepared in the course of the query itself in response to the patient’s symptoms .
Thus, a negative evaluation may result from many factors, from errors in the selection of plant species through contamination with toxic substances during storage, to an overdose. These situations do not necessarily indicate that medicine is an inappropriate candidate for the development of modern drugs .
Similarly, a traditional remedy does not pass the test of clinical efficacy according to modern standards , does not mean that therapy is to be successful . Homeopathy , for example , seems to work , despite hundreds of clinical trials suggest that no biological effects . Many scientists believe that a placebo effect is generated because homeopaths take much longer to listen to the patient than conventional practitioners .
However, while the placebo effect can definitely be beneficial to many would seem unethical to prescribe treatments without inducing clinical efficacy for this benefit.
Another difficult issue is the combination of traditional medicines and modern drugs . The belief system surrounding traditional medicine can sometimes interfere with modern treatments. In 2009, Kumanan Wilson of the University of Toronto in Ontario (Canada ) and colleagues outlined the obstacles to the treatment of malaria in Africa magazine BMC International Health and Human Rights.
It is estimated that in Africa only one million people die because of malaria , over 90 percent children under five years. Wilson ‘s team concluded that one of the main obstacles to effective malaria treatment was the reliance on traditional remedies and associated cultural beliefs as the idea that a child with seizures is possessed or bewitched and dies if it leads to the hospital.
In many of the studies the team reviewed , respondents expressed that traditional therapies such as herbal medicines were the first-line treatment , above modern drugs .
New techniques for old treatments
In search of modern drugs , traditional medicine is also applying new scientific techniques . These innovative approaches are developed at a dizzying pace . ( See Table 3).
In India, the CSIR has joined several public and private partners to conduct clinical trials with herbal products generated by reverse pharmacology . According to the entity, the initiative has been growing acceptance of traditional remedies and Ayurvedic medicine promises more affordable drugs , effective and efficient. [10 ]
And in the Medical Research Institute in Kenya, in Africa , scientists at the Research Center for Traditional Medicine and Drug being tested thousands of plants in the hope of finding new antimalarial (See Turning Into plants pills in Kenya.) The team has obtained a few promising prototypes , but none have proved effective enough to become a drug candidate .
Integrating traditional medicine into modern health care is undoubtedly an initiative is being taken seriously by major research centers in the world. In 2007 , 62 countries had national institutes for traditional medicine , compared with the 12 it had in 1970. [11 ]
As part of the National Institutes of Health in the United States, for example, runs an organization called the National Center for Complementary and Alternative Medicine (NCCAM , for its acronym in English ) , which this year has a budget of 128.8 million.
NCCAM funds research on how they can help acupuncture, herbal supplements , meditation or osteopathy to treat conditions such as cancer , cardiovascular diseases and neurological disorders .
Developing countries with a long history in traditional medicine also seek ways to modernize their legacy provider. In China, modern and traditional medicine are carried at par at all levels of the health system. The government gives equal importance to the development of both and there is a large and active community of researchers around the ‘ integrative medicine ‘.
Also in Latin America, several countries are working to provide modern and traditional health care in parallel ( See End medical dominance over the developing world).
African governments , including Ghana and Nigeria, broadcast technologies and launch educational campaigns to combat counterfeiting to improve control of drug procurement. E initiatives such as the African Network for Innovation in pharmaceuticals and diagnostics encourage the pursuit of drugs from the products of traditional medicine .
Therefore, traditional medicine has much to offer global health, particularly in view of the urgent need for new drugs. If developed and developing countries pool their research capacities in equal partnerships , new scientific techniques could stimulate its rebirth in the research and development of global health.
Table 1: Some modern drugs derived from traditional medicine
|Artemisinin||Antimalarial||Chinese Plant qing hao or sweet wormwood||Chinese traditional remedy for fevers and colds|
|Cromolyn||Antiasthmatic||Synthetic compound based on the khellin , the active ingredient of the plant khella||Middle Eastern traditional medicine for asthma , also used in Egypt for kidney stones|
|Etoposide||Antitumor||Synthesized from podophyllotoxin produced by mandrake||Various folk medicine remedies Chinese, Japanese and East|
|Hirudin||Anticoagulant||salivary glands of leeches , now produced by genetic engineering||Traditional remedies from around the world, from the zhi shui in China to European medicine in the eighteenth and nineteenth centuries.|
|Lovastatin||It is used to lower cholesterol||girgolas and foods such as red yeast rice . Used to synthesize other compounds such as mevastatin and pravastatin||Fungi are used to treat a broad spectrum of diseases in traditional Chinese medicine , Japanese , Eastern Europe and Russia.|
|Traditional remedies Arabic, Chinese , Europeans, Indians and North Africans , used to relieve pain and treat a range of conditions such as diarrhea, cough and asthma|
|Quinine||Antimalarial||Cinchona bark||Traditional remedies for fever and cramps in South America|
|vinca alkaloids (vincristine , vinblastine )||Antitumor||Rosehip||Various folk remedies around the world , including its use as antidiabetic Jamaica, to treat wasp stings in traditional Indian medicine , eye drops, Cuba and the love potion in medieval Europe .|
Table 2: Key differences between traditional medicine and modern medicine
|Traditional medicine||Modern Medicine|
|Protection of knowledge||Free access||Restricted , protected by patents|
|Formulation||Ad hoc, In consultation with the patient||Default and once proven in clinical trials can not be changed without prior duplicative testing|
|Regulation||Almost non-existent, although some countries attempt to introduce norms and standards||Very strict to the point of cost billions of dollars to introduce a drug to market|
|Trials||No formal trials , because knowledge about the effectiveness passed from generation to generation||Rigorous trials , divided into distinct stages, first to evaluate safety and efficacy after|
|Dosage||Not established : the prescribed amount may be similar, but the active ingredient ( the actual dose) can vary enormously||Target dose , with minor variations according to age , weight or severity of the condition|
|Consultation||Extensive. The patient is asked about a variety of issues beyond their symptoms||Both primary and secondary care tends to be brief and specific, especially for the overload of national health systems|
|Training||Both require training many years , but in traditional medicine knowledge is transmitted person to person in the family and occupation often ” inherited . “||In general , vocational : health professionals continue formal studies at colleges and universities|
Table 3: How to create modern drugs with traditional compounds
|Reverse Pharmacology||The researchers split the final product , such as a compound with therapeutic properties, and break the road to see what it contains and how it works , which may give clues on the activity of certain medicines and body sites where they work.|
|High Efficiency Monitoring||This check uses advanced automated data processing and high-precision sensors for biochemical assays million , genetic or pharmacological in minutes. The process can quickly identify active compounds that affect specific biological targets .|
|Ethnopharmacology||Systematic study of medicinal plant use by specific ethnic groups .|
Abbott , R. B. et al. Medical Student Attitudes Toward complementary , alternative and integrative medicine Evidence-based Complementary and Alternative Medicine (2010)
WHO factsheet on traditional medicine. WHO ( 2008)
WHO Country Cooperation Strategy 2006-2011, India: Supplement on traditional medicine WHO Country Office for India , New Delhi (2007)
Ghalib , H. The hunt for the next Artemisinin TDR News (2007)
Deadly diabetes drug counterfeit Found Outside China ‘s XinjiangXinhua News (2009)
Tilburt , J.C. and Kaptchuk , T.J. Herbal medicine research and global health: an ethical analysis Bulletin of the World Health Organization 86 577–656 (2008).
Ernst , E. Homeopathy : what does the “best “evidence tell us ? The Medical Journal of Australia 192 458–60 (2010).
Maslov , D.M. et al. Barriers to the Effective Treatment and Prevention of malaria in Africa: A systematic review of qualitative studies BMC International Health and Human Rights 9 26 (2009)
Patwardhan , B. Drug discovery and development: perspectives Ethnopharmacology and Traditional medcine SciTopics (2009)
Potential of traditional medicine should be fostered , Economic and Social Council President tells panel on attaining Millennium Development Goals in public health. UN Economic and Social Council ( 2009)
|Category: Agricultural Science||Tags: acupuncture, drugs, homeopathy, wormwood plant|