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New WHO Guidelines To Promote Proper Use of Alternative Medicines
Up to 80% of developing country populations rely on traditional medicine for their primary health care, due to cultural tradition or lack of alternatives. In wealthy countries, many people seek out various types of natural remedies on the assumption that natural means safe.
However, as the use of traditional or alternative medicines increases, so do reports of adverse reactions. In China, a country where traditional therapies and products are widely used in parallel with conventional medicine, there were 9 854 known reported cases of adverse drug reactions in 2002 alone, up from 4 000 between 1990 and 1999.
Many traditional/alternative medicine products are sold over the counter. In a WHO survey of 142 countries, 99 responded that most of these products could be bought without prescription. In 39 countries, many traditional remedies were used for self-medication, bought or prepared by friends, acquaintances or the patient. These trends raise concerns over the quality of the products used, their therapeutic appropriateness for a given condition, and the lack of medical follow-up.
"WHO supports traditional and alternative medicines when these have demonstrated benefits for the patient and minimal risks," said Dr Lee Jong- wook, Director-General of WHO. "But as more people use these medicines, governments should have the tools to ensure all stakeholders have the best information about their benefits and their risks."
Accessible, easy to understand information is key to guiding consumers in their choices. The guidelines provide simple, easy to follow tips on issues to look out for and a brief checklist of basic questions which may be used to help facilitate proper use of traditional and alternative medicine.
Advice is provided to government authorities on preparing easy-to-access information and on working with the mass media to sensitize and educate the population. In addition, suggestions are given for several health system structures and processes needed to promote proper use of traditional and alternative medicines.
While the guidelines cannot compensate for poor products or inappropriate practices, they can help governments educate consumers on how to maximize the benefits and minimize the risks of traditional medicines.
Alternative therapies -- documented benefits and risks
Empirical and scientific evidence exists to support the benefits of acupuncture, manual therapies and several medicinal plants for chronic or mild conditions. For instance, the effectiveness of acupuncture, a popular treatment for relieving pain, has been demonstrated both through numerous clinical trials and laboratory experiments. As a result, 90% of pain clinics in the United Kingdom and 70% in Germany include acupuncture as a form of treatment. Equally, some medicinal plants have shown efficacy for life- threatening conditions; medicine combinations containing the Chinese herb Artemisia annua are now considered amongst the most effective remedies against malaria.
However, there have been many cases of consumers unknowingly using suspect or counterfeit products; choosing inappropriate therapies in self-care; as well as several reports of unintentional overdose.
Similarly, there have been reports of consumers being injured by unqualified practitioners. For example, a study performed by the National Research Institute on Complementary and Alternative Medicine in Norway reported cases of pneumothorax caused by unqualified acupuncturists. In addition, there have been reports of paralysis caused by unqualified manual therapists.
Another potential risk is that patients do not inform their doctors about their use of traditional and complementary medicines. For instance, Ginkgo biloba is a popularly used herbal medicine worldwide whose main function is to prevent vascular disease and to increase blood circulation. The WHO Uppsala Monitoring Centre reported some cases of excess bleeding during a surgical operation. If the patient had informed the doctor about the use of the medicine this could have been avoided.
The development of the guidelines was carried out with the financial and technical support of the Regional Government of Lombardy, in collaboration with the State University of Milan. The guidelines are based on evidence and experiences collected from 102 countries representing all WHO regions.
WHO Guidelines: Developing Information on Proper Use of Traditional, Complementary and Alternative Medicine can be found on the WHO web site.
All WHO Press Releases, Fact Sheets and Features as well as other information on this subject can be obtained on the Internet on the WHO web site.
WHO Guidelines on Developing Consumer Information on Proper Use Of Traditional, Complementary and Alternative Medicines
Summary Of Highlights
-- Policies Governments Could Put in Place
-- Make sure that sufficient information is provided to consumers on the efficacy and safety of products as well as contraindications
-- Set up the right channels for consumers to report adverse drug reactions and make those channels known
-- Organize communication campaigns to equip consumers with the ability to discern the quality of the service they receive
-- Ensure that practitioners are appropriately qualified and registered -- Encourage interaction between traditional and conventional practitioners
-- Provide insurance for non-conventional therapies and products whose evidence base is sound.
Health System Structures and Processes that Would Help Promote Better Quality and Safety
-- Development of quality standards and treatment guidelines to ensure
uniformity within a particular health system
-- Standardization of training and knowledge requirements for practitioners to promote the credibility of traditional or alternative practices and enhance consumer trust
-- Collaboration between conventional and traditional or complementary care providers to improve results of treatment but also promote health sector reform
-- Organization of traditional or alternative medicine practitioners to provide better structures for self-control mechanisms
Questions Consumers Should Ask
-- Is the therapy suitable for his/her disease or condition?
-- Does the therapy have the potential to prevent, alleviate and/or cure symptoms or in other ways contribute to improved health and well-being for the consumer?
-- Is the therapy or herbal medicines provided by a qualified traditional medicine/ complementary and alternative medicine practitioner (TM/CAM) or health care practitioner with adequate training background, good skills and knowledge, preferably registered and certified?
-- Are the herbal medicinal products or materials of assured quality and what are the contraindications and precautions of the products or materials?
-- Are the therapies or herbal medicinal products available at a competitive price?
Source: World Health Organization