From herbalists in Africa gathering plants to use as poultices to acupuncturists in China using needles to cure migraines, or Indian yogis practising meditation, traditional remedies have increasingly being shown to work, and deserve more attention and research, according to a World Health Organization official.
A historical lack of evidence, which has seen traditional practices dismissed by many, could change with more investment and the use of modern technology, according to Dr Shyama Kuruvilla, who leads the WHO Global Traditional Medicine Centre.
Earlier this year, countries agreed the WHO should adopt a new global traditional medicines strategy for the next decade that “seeks to harness the potential contribution of TCIM [traditional, complementary and integrative medicine] to health and wellbeing based on evidence”.
It includes plans to establish a robust evidence base for traditional medicine practices, develop regulation of treatments and practitioners and, where appropriate, integrate the practices into mainstream biomedical healthcare.
“It’s super-exciting,” says Kuruvilla. “I’m not saying we know what works and what doesn’t work at scale – but I think there’s this opportunity [to find out] right now.”
Traditional medicine, defined as systems for health and wellbeing that predate “biomedicine”, comes in many guises ranging from herbal tea to India’s Ayurvedic medical system.
Many of these centuries-old practices have “huge potential”, says Kuruvilla, and can now be explored in new ways by technologies including artificial intelligence, genomics and brain scans.
Kuruvilla says Thailand is a good example of a country embracing traditional medicine, with researchers observing and documenting traditional practice, and performing randomised trials to get herbal treatments on to the country’s essential medicines list. In May, Thailand’s health ministry recommended doctors switch from some biomedicines to traditional remedies for certain conditions including muscle pain and constipation.
There have been some concerns that the WHO strategy could create a backdoor for unscientific systems such as homeopathy to enter the mainstream but Kuruvilla points out that homeopathy does not fit the WHO’s definition of traditional medicine – it was only created in the late 18th century – and that there is not strong enough evidence for the practice.
But, she says: “With all of these – with biomedicine, homeopathy, traditional medicine – if the evidence changes, I think it’s our responsibility to be open to that.”
In some countries homeopathy is used as a complementary medicine “and that’s up to the countries”, Kuruvilla says. “We have to, as WHO, just stick to the evidence.
“So I think that’s our bottom line: is this supported by robust reliable evidence, especially on safety and efficacy? And if it’s not, WHO is not supporting it, whether it is biomedicine or traditional medicine.”
WHO surveys suggest that in most countries, the majority of traditional, complementary and integrative medicine services are not part of the formal health system and are paid for by patients. They are less likely to be subject to official quality checks but are hugely popular.
“Not engaging wasn’t an option, because that would mean everything goes on without any safeguards,” Kuruvilla says, pointing to a burgeoning trillion-dollar wellness industry ranging from yoga studios to “nutraceuticals”.
New methods let scientists study traditional medicine “in a way that wasn’t possible before”, Kuruvilla says. Genomics might prompt new understanding of the properties of a plant, while modern scanning equipment can pick up changes in the brains of people meditating.
“Meditation was all this ‘woo-woo stuff’ but now, seeing all these advances in neuroscience and showing changes in brain waves from functional magnetic resonance imaging, which we couldn’t do before – actually being able to trace the pathways that lead to changes in health measurements – I think this is really, really exciting,” she says.
A new WHO strategic technical advisory group for traditional medicine was launched this week at a global summit in India. “This is a pivotal moment for traditional medicine. It embodies cultural heritage and national health identities, and increasingly, it constitutes a vital component of primary health care strategies,” Dr Yukiko Nakatani, WHO’s assistant director-general for health system, access and data, told the summit.
The idea, Kuruvilla suggests, is to “build a bridge” between traditional medicine and biomedicine. It is important to “find commonalities”, she says. “Showing that the science can be robust is really, really important, and especially on the patient safety aspect.”
Traditional medicine has the potential to be a “treasure trove”, Kuruvilla says. The vast numbers of people working in the field – including university-educated professionals accredited to work in clinics in China and India – could ease global workforce shortages and make a “huge contribution” to universal health coverage, she says.
In the context of aid cuts forcing countries to rethink health provision, traditional medicine could be “a way for countries also to be more self-reliant and then share those resources with each other”.
The risk of failing to invest, she says, is leaving people unable to access their preferred type of healthcare in a safe way and “the world not being able to use our shared heritage here in a way that allows us to find new holistic solutions for health and wellbeing of people and planet”.
