Growing Needs and Potential Populations throughout Africa, Asia, and Latin America use traditional medicine (TM) to help meet their primary health care needs. As well as being accessible and affordable, TM is also often part of a wider belief system and considered integral to everyday life and well-being. Meanwhile, in Australia, Europe, and North America, “complementary and alternative medicine” (CAM) is increasingly used in parallel to allopathic medicine, particularly for treating and managing chronic disease.
Concern about the adverse effects of chemical medicines, a desire for more personalized health care and greater public access to health information, fuel this increased use. But the widespread and growing use of TM has created public health challenges in terms of policy; safety, efficacy and quality; access; and rational use. Policy-makers, health care providers, TM providers2 and nongovernmental organizations (NGOs) can respond to these challenges, however, and help develop the potential of TM as a source of health care.
crucial to extending TM care
Allopathic practitioners emphasize the scientific approach of allopathic medicine and contend that it is free of cultural values. TM therapies have developed rather differently, having been very much influenced by the culture and historical conditions within which they first evolved. Their common basis is a holistic approach to life, equilibrium between the mind, body and their environment, and an emphasis on health rather than on disease. Generally, the provider focuses on the overall condition of the individual patient, rather than on the particular ailment or disease from which the patient is suffering. This more complex approach to health care makes TM very attractive to many. But it also makes scientific evaluation highly difficult since so many factors must be taken into account. Even evaluating TM products, such as herbal medicines, can prove very difficult. This is because herbal medicine quality is influenced by several factors, such as when and where the raw materials were collected, and the accuracy of plant identification. Nevertheless, many TM practices and products have been used for a considerable period of time. And some scientific evidence points to promising potential. Acupuncture’s efficacy in relieving pain and nausea, for instance, has been conclusively demonstrated and is now acknowledged worldwide. For herbal medicines, some of the best-known evidence for the efficacy of a herbal product, besides that for Artemisia annua for managing malaria, concerns St John’s Wort, for treating mild to moderate depression. At the same time, a growing number of reports document the sometimes fatal adverse effects of misuse of traditional therapies and use of therapies for which information on safety is lacking. Optimal use and expanded credibility of TM will, therefore, depend on developing an evidence base for safety and efficacy. This means consolidating existing national and international studies and supporting new research to fill evidence gaps.
Rational use of TM has many aspects, including qualification and licensing of providers; proper use of good-quality products; good communication between TM providers, allopathic practitioners and patients; and provision of scientific information and guidance for the public. Challenges in education and training are at least twofold. Firstly, ensuring that the knowledge, qualifications, and training of TM providers are adequate. Secondly, using training to ensure that TM providers and modern health care professionals understand and appreciate the complementarity of the types of health care they offer. Proper use of good quality products can also do much to reduce risks associated with TM products such as herbal medicines. However, regulation and registration of herbal medicines are not well developed in most countries, and the quality of herbal products sold is generally not guaranteed. Moreover, many are sold as over-the-counter or dietary supplements. Much more stringent control of TM products is needed. More work is also needed to raise awareness of safe and appropriate use of TM. Side-effects following reactions between herbal medicines and chemical drugs can occur. Yet many patients do not inform their allopathic practitioners that they are taking herbal medicines. Information, education and communication strategies could overcome such problems.
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