body and their environment, and an emphasis on Optimal use and expanded credibility of TM will there- health rather than on disease. Generally, the provider fore depend on developing an evidence base for focuses on the overall condition of the individual pa- safety and efficacy. This means consolidating existing tient, rather than on the particular ailment or disease national and international studies, and supporting from which the patient is suffering new research to fill evidence gaps This more complex approach to health care makes Access: making Tm evaluation highly difficult since so many factors must available and affordable be taken into account ds poorest countries are most in ven evaluating TM products, such as herbal medi- cines, can prove very difficult. This is because herbal need of inexpensive, effective treatments for diseases WHO estimates that one-third of medicine quality is influenced by several factors, such as when and where the raw materials were collected the global population still lacks regular and accuracy of plant identification access to essential drugs, and that in he poorest parts of Africa and Asia, this figure rises to over 50% In these re- Nevertheless, many TM practices and products have gions, some form of TM is often a more widely avail- been used for a considerable period of time And able and more affordable source of health care some scientific evidence points to promising poten- However, if access to TM is to be increased to help tiaL. Acupuncture's efficacy in relieving pain an improve health status, two issues must be tackle nausea, for instance, has been conclu- They are: development of reliable standard indi sively demonstrated and is now cators to accurately measure levels of access, and acknowledged worldwide. For collection of qualitative data to identify constraints Ks herbal medicines (Figure 2). some to extending access. of the best-known evidence for effi cacy of a herbal product, besides Safe and effective TM therapies must also be identi- that for Artemisia annua for manag- fied, to provide a sound basis for efforts to promote ing malaria, concerns St Johns Wort, for TM. The focus should be on safe and effective trea treating mild to moderate depression ments for diseases which represent the greatest bur- den for poor populations, i.e. for malaria and HIV/AIDS At the same time, a growing number of reports docu- ment the sometimes fatal adverse effects of misuse Cooperation between TM providers and community of traditional therapies and use of therapies for which health workers needs to be increased too. In some information on safety is lacking countries- notably in Africa - links between, for ex ample, traditional birth attendants and primary health are providers are being strengthened. But in many others, these two types of heath care provider work Figure 2 Good evidence of efficacy exists for some in isolation from one another. TM therapies then risk herbal medicines-but evaluation is inadequate being sidelined. Opportunities to deliver health mes- sages are also lost. At the same time, some TM provid- 34% ers lack knowledge of primary health care and per- same as compared placebo benefit as compared form practices that carry health risks. The challenge to placebo is to recognize and ensure that the health skills and knowledge of TM providers are optimized other access issues relate to protection of TM knowl- edge and sustainable use of natural resources. Many methods and regimes can be used for protecting TM knowledge, such as report benefit unlike creating a national inventory of medicinal plants, recording TM of randomized clinical trials(RCTs)showing benefit of herbal medicines knowledge, and creating a (based on 50 RCTs with 10 herbal medicines for 18 therapeutic indications) national policy on protection of TM knowledge. Sustainable use Souce: Based on data in Herbalmedicines an evidence based look thero can also be promoted by several beutics Letter, ssue 25, June-July 1998 means, including adoption of good agricultural practices Page 3: WHO Policy Perspectives on edicines- Traditional medicine -Growing needs and PotentialPage 3: WHO Policy Perspectives on Medicines — Traditional Medicine – Growing Needs and Potential body and their environment, and an emphasis on health rather than on disease. Generally, the provider focuses on the overall condition of the individual pa￾tient, 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 medi￾cines, 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 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 poten￾tial. Acupuncture’s efficacy in relieving pain and nausea, for instance, has been conclu￾sively demonstrated and is now acknowledged worldwide. For herbal medicines (Figure 2), some of the best-known evidence for effi￾cacy of a herbal product, besides that for Artemisia annua for manag￾ing malaria, concerns St John’s Wort, for treating mild to moderate depression. At the same time, a growing number of reports docu￾ment the sometimes fatal adverse effects of misuse of traditional therapies and use of therapies for which information on safety is lacking. 18% same as compared to placebo 34% benefit as compared to placebo 48% report benefit unlikely — due to design or analytic flaw % of randomized clinical trials (RCTs) showing benefit of herbal medicines (based on 50 RCTs with 10 herbal medicines for 18 therapeutic indications) Figure 2 Good evidence of efficacy exists for some herbal medicines – but evaluation is inadequate Optimal use and expanded credibility of TM will there￾fore 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. Access: making TM available and affordable The world’s poorest countries are most in need of inexpensive, effective treatments for diseases. WHO estimates that one-third of the global population still lacks regular access to essential drugs, and that in the poorest parts of Africa and Asia, this figure rises to over 50%. In these re￾gions, some form of TM is often a more widely avail￾able and more affordable source of health care. However, if access to TM is to be increased to help improve health status, two issues must be tackled. They are: development of reliable standard indi￾cators to accurately measure levels of access, and collection of qualitative data to identify constraints to extending access. Safe and effective TM therapies must also be identi￾fied, to provide a sound basis for efforts to promote TM. The focus should be on safe and effective treat￾ments for diseases which represent the greatest bur￾den for poor populations, i.e. for malaria and HIV/AIDS. Cooperation between TM providers and community health workers needs to be increased too. In some countries – notably in Africa – links between, for ex￾ample, traditional birth attendants and primary health care providers are being strengthened. But in many others, these two types of heath care provider work in isolation from one another. TM therapies then risk being sidelined. Opportunities to deliver health mes￾sages are also lost. At the same time, some TM provid￾ers lack knowledge of primary health care and per￾form practices that carry health risks. The challenge is to recognize and ensure that the health skills and knowledge of TM providers are optimized. Other access issues relate to protection of TM knowl￾edge and sustainable use of natural resources. Many methods and regimes can be used for protecting TM knowledge, such as creating a national inventory of medicinal plants, recording TM knowledge, and creating a national policy on protection of TM knowledge. Sustainable use can also be promoted by several means, including adoption of good agricultural practices. Source: Based on data in Herbal medicines: an evidence based look. Thera￾peutics Letter, Issue 25, June–July 1998