WHO traditional medicine strategy

The main objectives of the WHO Traditional medicine activities are:

• To facilitate integration of traditional medicine into the national health care system by assisting Member States to develop their own national policies on traditional medicine.
• To promote the proper use of traditional medicine by developing and providing international standards, technical guidelines and methodologies.
• To act as a clearing-house to facilitate information exchange in the field of traditional medicine.

The objective of the strategy is to discuss the role of traditional medicine in health care systems, current challenges and opportunities and WHO's role and strategy for traditional medicine. Many Member States and many of WHO's partners in traditional medicine (UN agencies, international organizations, nongovernmental organizations, and global and national professional associations) contributed to the Strategy and have expressed their willingness to participate in its implementation. The Strategy was reviewed by the WHO Cabinet in July 2001 and, based on Cabinet comments, has since been revised. The Strategy was printed in January 2002. Since this is at present a working document, the proposed objectives and activities have started to be implemented in early 2002 and the Strategy will be widely disseminated. We understand that the situation in the use of traditional medicine is quite different from country to country and region to region. For example, in AFRO and in WPRO, the Member States consider that traditional medicine is a priority for health care in their regions, but in other regions the role of traditional medicine is treated as complementary or alternative medicine.

For more information contact:

Dr Xiaorui Zhang
Traditional Medicine, Essential Drugs and Medicines Policy (EDM)
WHO/Geneva
Fax: +41 22 791 4730
E-mail: trm@who.int

Source: http://www.who.int/medicines/publications/traditionalpolicy/en/index.html

How safe is traditional medicine?

Q: How safe is traditional medicine?

A: Traditional medicine includes many different practices and remedies, and varies from one country to another. While some practices seem to offer benefits, others remain questionable.

In 2002, WHO launched a strategy on traditional medicine to help countries explore its potential for people’s health and well-being, while minimizing the risks of unproven or misused remedies. The main aim of the strategy is to encourage further research.

There is some evidence that seems to support the use of traditional and complementary medicine – for example, acupuncture in relieving pain, yoga to reduce asthma attacks, and tai ji techniques to help elderly people reduce their fear of falls. WHO does not currently recommend these practices, but is working with countries to promote an evidence-based approach to addressing safety, efficacy and quality issues.

Unfortunately, the misuse of certain herbal remedies can cause harm – even death – in some cases. The herb Ma Huang (ephedra) is traditionally used in China to treat short-term respiratory congestion. In the United States of America, the herb was marketed as a dietary aid, whose long-term use led to at least a dozen deaths, heart attacks and strokes. In Belgium, at least 70 people required renal transplants or dialysis for interstitial fibrosis of the kidney after taking the wrong herb from the Aristolochiaceae family, again as a dietary aid.

In developing countries, where more than one-third of the population lack access to essential medicines, the provision of safe and effective traditional and alternative remedies could become a important way of increasing access to health care. One way to ensure this is to integrate traditional medicine into the formal health system, thus ensuring better safety and adequate follow-up for patients.

Traditional medicine is also becoming more popular in industrialized countries, where many products can be bought over the counter.

In addition to concerns over safety and quality issues, traditional medicine also raises questions of protecting biodiversity (through over harvesting of the raw material for herbal medicines and other products), and protecting the traditional knowledge of communities.

source: http://www.who.int/features/qa/20/en/index.html

What does WHO say about nature/natural herbal medicine?

WHO (World Health Organization) has a research about nature medicine. It's called Collaborating Center for Traditional Medicine. We can see what WHO says below:

Traditional medicine

What is traditional medicine?

Traditional medicine refers to health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being.

Countries in Africa, Asia and Latin America use traditional medicine (TM) to help meet some of their primary health care needs. In Africa, up to 80% of the population uses traditional medicine for primary health care. In industralized countries, adaptations of traditional medicine are termed “Complementary“ or “Alternative” (CAM).

Increasing use and popularity

TM has maintained its popularity in all regions of the developing world and its use is rapidly spreading in industrialized countries.

• In China, traditional herbal preparations account for 30%-50% of the total medicinal consumption.
• In Ghana, Mali, Nigeria and Zambia, the first line of treatment for 60% of children with high fever resulting from malaria is the use of herbal medicines at home.
• WHO estimates that in several African countries traditional birth attendants assist in the majority of births.
• In Europe, North America and other industrialized regions, over 50% of the population have used complementary or alternative medicine at least once.
• In San Francisco, London and South Africa, 75% of people living with HIV/AIDS use TM/CAM.
• 70% of the population in Canada have used complementary medicine at least once.
• In Germany, 90% of the population have used a natural remedy at some point in their life. Between 1995 and 2000, the number of doctors who had undergone special training in natural remedy medicine had almost doubled to 10 800.
• In the United States, 158 million of the adult population use complementary medicines and according to the USA Commission for Alternative and Complementary medicines, US $17 billion was spent on traditional remedies in 2000.
• In the United Kingdom, annual expenditure on alternative medicine is US$ 230 million.
• The global market for herbal medicines currently stands at over US $ 60 billion annually and is growing steadily.

Safety and efficacy issues

Scientific evidence from randomized clinical trials is only strong for many uses of acupuncture, some herbal medicines and for some of the manual therapies. Further research is needed to ascertain the efficacy and safety of several other practices and medicinal plants.

Unregulated or inappropriate use of traditional medicines and practices can have negative or dangerous effects.

For instance, the herb “Ma Huang” (Ephedra) is traditionally used in China to treat respiratory congestion. In the United States, the herb was marketed as a dietary aid, whose over dosage led to at least a dozen deaths, heart attacks and strokes.

In Belgium, at least 70 people required renal transplant or dialysis for interstitial fibrosis of the kidney after taking a herbal preparation made from the wrong species of plant as slimming treatment.

Biodiversity and sustainability

In addition to patient safety issues, there is the risk that a growing herbal market and its great commercial benefit might pose a threat to biodiversity through the over harvesting of the raw material for herbal medicines and other natural health care products. These practices, if not controlled, may lead to the extinction of endangered species and the destruction of natural habitats and resources.

Another related issue is that at present, the requirements for protection provided under international standards for patent law and by most national conventional patent laws are inadequate to protect traditional knowledge and biodiversity.

Tried and tested methods and products

• 25% of modern medicines are made from plants first used traditionally.
• Acupuncture has been proven effective in relieving postoperative pain, nausea during pregnancy, nausea and vomiting resulting from chemotherapy, and dental pain with extremely low side effects. It can also alleviate anxiety, panic disorders and insomnia.
• Yoga can reduce asthma attacks while Tai Ji techniques can help the elderly reduce their fear of falls.
• TM can also have impact on infectious diseases. For example, the Chinese herbal remedy Artemisia annua, used in China for almost 2000 years has been found to be effective against resistant malaria and could create a breakthrough in preventing almost one million deaths annually, most of them children, from severe malaria.
• In South Africa, the Medical Research Council is conducting studies on the efficacy of the plant Sutherlandia Microphylla in treating AIDS patients. Traditionally used as a tonic, this plant may increase energy, appetite and body mass in people living with HIV.

WHO efforts in promoting safe, effective and affordable traditional medicine

The World Health Organization launched its first ever comprehensive traditional medicine strategy in 2002. The strategy is designed to assist countries to:

• Develop national policies on the evaluation and regulation of TM/CAM practices;
• Create a stronger evidence base on the safety, efficacy and quality of the TAM/CAM products and practices;
• Ensure availability and affordability of TM/CAM including essential herbal medicines;
• Promote therapeutically sound use of TM/CAM by providers and consumers;
• Document traditional medicines and remedies.

At present, WHO is supporting clinical studies on antimalarials in three African countries; the studies are revealing good potential for herbal antimalarials.

Other collaboration is taking place with Burkina Faso, the Democratic Republic of the Congo, Ghana, Mali, Nigeria, Kenya, Uganda, and Zimbabwe in the research and evaluation of herbal treatments for HIV/ AIDS, malaria, sickle cell anaemia and Diabetes Mellitus.

In Tanzania, WHO, in collaboration with China, is providing technical support to the government for the production of antimalarials derived from the Chinese herb Artemisia annua. Local production of the medicine will bring the price of one dose down from US $6 or $7 to a more affordable $2.

In 2003, WHO support has so far facilitated the development and introduction of traditional and alternative health care curricula in seven tertiary education institutions in the Philippines.

Training workshops on the use of traditional medicines for selected diseases and disorders have also been organized in China, Mongolia and Vietnam.

Priorities for promoting the use of traditional medicines

Over one-third of the population in developing countries lack access to essential medicines. The provision of safe and effective TM/CAM therapies could become a critical tool to increase access to health care.

While China, the Democratic People’s Republic of Korea, the Republic of Korea and Vietnam have fully integrated traditional medicine into their health care systems, many countries are yet to collect and integrate standardized evidence on this type of health care.

70 countries have a national regulation on herbal medicines but the legislative control of medicinal plants has not evolved around a structured model. This is because medicinal products or herbs are defined differently in different countries and diverse approaches have been adopted with regard to licensing, dispensing, manufacturing and trading.

The limited scientific evidence about TM/CAM’s safety and efficacy as well as other considerations make it important for governments to:

• Formulate national policy and regulation for the proper use of TM/CAM and its integration into national health care systems in line with the provisions of the WHO strategies on Traditional Medicines;
• Establish regulatory mechanisms to control the safety and quality of products and of TM/CAM practice;
• Create awareness about safe and effective TM/CAM therapies among the public and consumers;
• Cultivate and conserve medicinal plants to ensure their sustainable use.

For more information contact:

Ms Daniela Bagozzi
Telephone: +41 22 791 4544
Mobile phone: +41 79 475 5490
E-mail: bagozzid@who.int

WHO Media centre
Telephone: +41 22 791 2222
E-mail: mediainquiries@who.int

Source: http://www.who.int/mediacentre/factsheets/fs134/en/

A lifestyle

Oh, Your Aching Back!

By Bill Gottlieb

Peter Gulke, a screenwriter from Hollywood, was a guy who really used—and abused—his back. In high school and college he competed as a gymnast. After graduation, he picked up cliff diving and surfing. But it wasn’t the sports that did him in, at least not directly. One day in his late twenties, while raking the lawn, he reached for some leaves and felt an ominous twinge in his lower back. In that swift moment, he became one of the millions of people in this country who suffer from lower back pain.

He had to stop surfing, then jogging, then golfing. The pain would plague him for a few weeks, go away, then come back again. He tried chiropractic, acupuncture, herbs, muscle-relaxing drugs, mind-body techniques. Everything helped a little, but not for long.

Gulke’s story is so typical as to be almost a cliché. No doubt you’ve heard the statistics. Eighty percent of Americans will suffer a bout of debilitating back pain at some point in their lives, with a full 80 percent having one or more recurrences. Back pain sends more people to the doctor than any other illness except colds. For Americans between the ages of 30 and 50, medical costs to treat back pain are higher than they are for any other health problem.

And how is that money spent? On thousands of operations—even though some studies show that four years after back surgery, patients fared no better than those who hadn’t gone under the knife— and on millions of prescription drugs, like anti-inflammatories and narcotics, that only temporarily ease pain. Of course, some of the alternative remedies that didn’t help Gulke, like acupuncture and chiropractic, do have good track records. But the moral of the back story seems to be that no single treatment works for all people all the time.

That’s why alternative and conventional healers alike have been hard at work seeking new solutions. Some are based on a new understanding of how the back works and why it starts hurting; others involve new approaches to pain relief. The following treatments are three of the most promising to gain credibility in recent years.

Exercises
to stabilize your spine
Until two years ago, Anne-Marie Howard*, a 32-year-old laboratory technician in Halifax, Nova Scotia, considered herself lucky. She had spondylolisthesis, a congenital condition in which the front half of a vertebra separates from the back half, but she never experienced any pain.

Then her luck changed. By the time she walked into the office of Rick Jemmett, a physical therapist in Halifax and author of Spinal Stabilization: The New Science of Back Pain, she hurt every day. At work she spent most of her time standing. By noon she was usually in pain. By quitting time, she was in agony.

Jemmett didn’t give Howard the standard exercises prescribed by most physical therapists. Instead, he instructed her in highly specific but subtle move- ments involving the transversus abdominis muscle of her abdomen and the multifidus muscles of her lower back; he calls these “spinal stabilization” exercises. After two weeks of daily practice, Howard’s symptoms improved. After a month, she was pain free—and remains so, as long as she sticks with her exercise program.

Spinal stabilization is the first regimen to show an actual decrease in recurrence rates among sufferers of back pain, according to a study published recently in the journal Spine. The study compared a group of back patients whose treatment consisted of counseling and medication with a second group who received instruction in spinal stabilization.

After one year, 80 percent of the people receiving conventional methods had a recurrence of back pain compared to 30 percent of the spinal stablization group. After three years, the recurrence rate was 75 percent among the conventional group and 35 percent among the group taught the spine-stabilizing exercises.

What’s the secret to this unusual approach? Nothing less than a new understanding of what causes a back to start hurting in the first place. Traditionally, experts thought that strained ligaments and degenerating disks were the main problem, so they prescribed exercises to strengthen the muscles supporting those structures, which are the big muscles close to the skin.

But in 1992, Manohar Panjabi, professor and director of the biomechanics laboratory of the department of orthopedics and rehabilitation at Yale University School of Medicine, challenged this notion.

Based on research with cadavers, he concluded that the spinal column alone isn’t strong enough to support the body’s weight. Other researchers later demonstrated that most of the back’s stabilizing force is, in fact, provided by the small, deep muscles of the lower back and abdomen—the multifidus and the transversus abdominis.

Since then, experts have built on Panjabi’s research and discovered that regardless of the cause of spinal damage—whether it’s trauma, arthritis, or congenital problems like Howard’s—the underlying effect is the same. The signals between the central nervous system and these deep stabilizing muscles become impaired. As a result, it takes longer for the nervous system to activate the muscles, and at times it may do so in the wrong order.

Researchers have also found that the multifidus muscles tend to atrophy after an injury; believe it or not, they can shrink by as much as 25 percent within 24 hours of a back injury—and stay that way for years. Once these small muscles are damaged, the central nervous system compensates by relying on the larger ones to stabilize the spine. But they don’t quite get the job done, so back pain recurs.

The only way to really cure back pain, according to this theory, is to help the central nervous system regain control of the transversus abdominus and multifidus muscles. That’s where the spinal stabilization program—originally created by Carolyn Richardson of the University of Queensland in Brisbane, Australia—comes in. When a patient learns to control the small stabilizing muscles, he or she can then proceed to the standard strengthening exercises taught by most physical therapists.

Unfortunately, the techniques to stimulate the muscles are difficult to learn by yourself, says Jemmett, and they’re not yet well known by many physical therapists. You can get a general list of therapists in your area from the American Physical Therapy Association at 800.999.2782; check with those on the list to see if any have been trained in spinal stabilization.

Supplements
to nourish your disks
What baby boomer hasn’t heard of glucosamine and chondroitin, the wonder-workers for aging knees? But did you know that these popular supplements, which nourish and rebuild cartilage, can also help with a certain kind of back pain? Many back sufferers have the same kind of osteoarthritis that people more commonly associate with knees and hands, only this time it’s in their disks. (Cartilage is the main material of the spongy disks that cushion the vertebrae.)

“When the disks are damaged, either by injury or the wear and tear of age, they lose their ability to hold water and absorb shock,” says Luke Bucci, a clinical nutritionist and adjunct faculty member in the department of nutrition at the University of Utah and author of Healing Arthritis the Natural Way.

To compensate, vertebrae grow new bone, which rubs against pain receptors, squeezes nerves, and can make life close to unbearable for some sufferers. The key to treating this condition, also known as degenerative joint disease, is to rebuild the cartilage of a damaged disk. That’s where glucosamine and chondroitin can help.

Many studies show that these supplements relieve arthritis, but one in particular looked at their power to ease back pain. Reporting in the journal Military Medicine, scientists gave 1,500 milligrams (mg) of glucosamine and 1,200 mg of chondroitin to Navy SEALs with low back pain; another group got a placebo, or fake pill. Those who took the two-nutrient combination had a 41 percent reduction in the level of back pain; the placebo group had a 19 percent reduction. The dose they got is considered standard. But you could safely take two to three times that amount for faster relief, Bucci says.

“You should get substantial pain relief in a week or two, and then you can start the more standard dosage,” he says. He also recommends looking for a product that contains both substances in a single supplement and taking it once a day rather than in divided doses. “You need to get blood levels of the substances to the highest possible level, so they get into the disk,” he says.

Natural Injections
to rebuild ligaments
“The fact that modern medicine attempts to relieve back pain by reducing inflammation is absolutely wrong.” That’s the strongly held opinion—which might strike some as rather inflammatory itself—of Marc Darrow, an assistant clinical professor at the University of California at Los Angeles School of Medicine and director of the Joint Rehabilitation and Sports Medical Center, also in Los Angeles.

“Anti-inflammatories are antihealing,” he says. When the body is injured, he explains, the injury triggers an immune response, starting with inflammation, which sends white blood cells to the site to clean up the damage. Other cells called fibroblasts also travel to the affected area, where they help create new collagen, the connective tissue necessary for healing. The standard anti-inflammatory medications—like aspirin, ibuprofen, and Celebrex—interrupt this process.

“When inflammation is reduced, a person does get temporary pain relief. But because healing is blocked, the person can end up with a long-term injury that causes chronic pain,” Darrow says. “True healing of back pain means working with inflammation, not against it.”

He and several hundred other physicians in the United States today are working with a technique, called prolotherapy, that follows this rationale. The “prolo” in prolotherapy is short for proliferation, because the idea is to use the inflammation to produce collagen and strengthen ligaments in areas where they have become weak.

In a typical treatment, says Darrow, whose clinic specializes in prolotherapy, the therapist first numbs the sore area with lidocaine. He or she then injects it with a dextrose solution. (Some prolotherapists use other solutions, such as sodium morrhuate, a cod liver oil extract.) The dextrose draws water from the cells, damaging a small layer in the area.

This sparks an inflammatory response at the site, calling in fibroblasts, which produce collagen to strengthen the ligaments. Studies show that after eight sessions of prolotherapy, ligaments are 50 percent thicker and two to four times stronger. These stronger ligaments stabilize the spine, reducing or even eliminating back pain.

Prolotherapy may also have a neurological effect, says Jeff Patterson, an osteopath and professor in the department of family medicine at the University of Wisconsin Medical School in Madison. He thinks the injections may quiet pain by altering nerve function in the area. In this respect, the technique is similar to a widely accepted approach to pain relief called trigger point therapy, in which a therapist uses finger pressure to release knots of tension and constricted nerves.

Studies show that on average, 90 percent of prolotherapy patients with back pain get significant relief, Darrow says. Prolotherapy may briefly make the pain worse before it gets better, since it’s creating more inflammation. But according to Darrow, it’s gentler than surgery and many of the pharmaceuticals commonly used in treating back pain.

Some orthopedic surgeons aren’t convinced. They say prolotherapy works by creating scar tissue, not inflammation, and that the results are only temporary. But Darrow disagrees. “A study of post-prolotherapy tissue of a spinal ligament shows fresh layers of collagen and no scar tissue,” he says.

Usually a prolotherapy session consists of four to six injections, with one to two weeks between sessions to allow time for the growth of new tissue. Some patients may need more treatments. Costs range from $100 to $500 a visit. If prolotherapy is billed as trigger point therapy, insurance may cover it, and worker’s compensation will usually pay if it’s a work-related accident.

For Peter Gulke, the money was well spent. “I can surf again,” he says. “I can play golf again. Prolotherapy makes more sense than any other therapy I’ve had. I feel like I have a new back.”

How to Get Over a Back Injury:
Don’t be afraid to move

If you hurt your back and you’re not getting any better, your back may not be the problem: It could be your psyche.

That’s the conclusion of a recent study in the medical journal Pain. Surprisingly, researchers found that the best predictor of whether a person returns to work within one month of a back injury is whether or not the person suffers from “fear-avoidance behavior.” The notion is pretty self-explanatory. It means you fear your back pain, so you avoid any movement you think might make it worse. But this behavior pattern itself, by keeping your muscles tense and tight, might keep you on the couch.

“The spine and back are not frail structures you need to coddle during your recovery,” says Steven George, one of the authors of the study and a fellow at the Brooks Center for Rehabilitation Studies at the University of Florida in Gainesville. In fact, for most people who are under 55 and whose backs have generally been in good shape, he says, the best way to get better after an injury is keep moving and confront the pain.

No, this isn’t about telling your back to back off. It’s about knowing what it takes to recover. First, understand that you must stretch and strengthen your muscles to heal a back injury and that pain is an expected and normal part of the process. “With your doctor’s okay, start your recovery program two to three days after the injury,” says George. “Exercise or stretch about 10 percent beyond your pain threshold,” he adds, “and don’t take off from exercise more than two days in a row.”

Deep breathing can also help you overcome anxiety and relieve muscle tension, says Bruce Kodish, a physical therapist in Pasadena, California, and author of Back Pain Solutions. Any time you feel anxious about reinjuring yourself, take five deep breaths, holding the inhale to a count of five and exhaling as slowly as possible.

In some instances, though, confronting pain is not a good idea. If you’ve tried it and your aching is worse 24 to 48 hours later, if your pain moves from your back into your buttocks or leg, or if your symptoms change—from pain to numbness or weakness, for example—stop exercising and see your doctor

Fact from research

Science Sees the Light

Alternative medicine practitioners have long held that with a little help, the human immune system possesses the power to heal itself of even the gravest conditions. Now, in its lab-based way, traditional science is reporting its own success on the immunotherapy front.

Researchers at the National Cancer Institute have announced new progress in using a patient’s rebuilt immune system to treat melanoma, a potentially fatal form of skin cancer that afflicts more than 50,000 Americans each year.

Adoptive transfer, as the therapy is known, involves rebuilding a patient’s immune system with disease-fighting T cells extracted directly from the patient’s tumors. T cells are the body’s primary defense against foreign bacteria and infection. Having been exposed to the deadly tumors, the T cells are already programmed for the fight. Without reinforcements, however, they are apparently doomed to failure. And so in the Bethesda, Maryland labs, researchers cloned new cells from the originals.

Meanwhile, doctors used chemotherapy to destroy each patient’s immune system, which otherwise tends to reject adoptive transfer cells. Finally, the reinforced T cells were reintroduced in combination with the protein interleukin-2, which stimulates T cell growth.

By the end of the study, 6 of 13 patients whom chemotherapy, radiation therapy, and/or surgery had largely failed saw their malignant tumors shrink up to 50 percent. Researchers are unsure how long the benefits of the new therapy will hold—or if it will be effective with other forms of cancer—but after about four months, the shrunken tumors had yet to grow back. No one would deny this is a promising development, but alternative practitioners believe they can achieve similar results with less invasive, less grueling methods.

“We’ve had the same kind of success without destroying a patient’s immune system first,” says Arthur D. Alexander, vice president of the Livingston Foundation Medical Center in San Diego. The Livingston method includes a mainly organic diet, vitamin-rich nutritional supplements, specialized vaccines, detoxifying enemas, and psychotherapy.

For now, the traditional and alternative worlds remain divided. But hopefully they’ll converge in the future to offer cancer patients their best possible shot at recovery.

—James O’Brien