On December 20, 2002 Dr. Xiaorui Zhang, WHO’s Coordinator of Traditional Medicine had a meeting with committee members of PEFOTS: Mr. Zhilin Dong, Mr.Guoguang Zhu, Dr . Giovanardi and Mr. Jianping Wang. Mr. Dong made a briefing to Dr. Zhang about the work done by PEFOTS over the past year since its establishment and also presented her the work schedule for 2003 with events such as: ‘Symposium on Traditional Chinese Medicine (TCM) Education in Europe’, which will be held March 15-16, 2003 in Lisbon and ‘Forum of TCM Legislation in Europe’, which will be held April 29, 2003 in London. Mr. Dong invited Dr. Zhang as a representative of WHO to attend these two conferences and to present a speech on ‘Development and Problems of TCM in Europe’.

 

 

Dr Zhang gave a presentation on the situation in the use of traditional medicine Worldwide and WHO traditional medicine strategy. During the meeting Dr. Zhang recommended PEFOTS to pay an attention to encourage the clinical research by using appropriate methodology, to publish materials related to the TCM specific knowledge for other health professionals such as doctors, nurses, physiotherapists, and to develop the information and organize the seminars or workshops for consumers on the proper use TCM. These activities could contribute to the better understanding of TCM in the Western world so that people can benefit from a safer and more effective use of Traditional Medicine.
WHO is happy to support PEFOTS to organize the seminars on the consumer education for the proper use of traditional medicine. PEFOTS is intending to organize two seminars on the consumer education of proper use traditional medicine in 2003 and 2004 in Holland and Finland respectively. If other countries also want to set up such events, PEFOTS is willing to cooperate. Mr. Dong hopes for a growing cooperation between PEFOTS and WHO in the future to strengthen the further development of TCM in Europe. Dr. Zhang said she would like to attend the ‘Forum on TCM Legislation in Europe’ on April 29, 2003 in London if her schedule allows her.

 

Global Review of the Use of Traditional Medicine and WHO Strategy Much of what follows is based on material provided to us by Dr. Zhang. As Traditional Chinese Medicine (TCM) is a species of ‘Traditional Medicine’ (TM), we ask our readers to keep that in mind when reading the following lines.

 

Traditional Medicine (TM)
Traditional Medicine (TM ) includes diverse health practices, approaches, knowledge and beliefs incorporating plant, animal and/or mineral based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to maintain well-being, as well as to treat, diagnose or prevent illness. Populations throughout Africa, Asia and Latin America use traditional Medicine (TM). 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.

 

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 providers and nongovernmental organisations NGOs) can respond to these challenges. Many challenges need to be met for the potential of traditional medicine to be fully realised. Challenges such as:

1. Lack of national policies and regulations on TM/CAM: only 25 of 191 WHO Member States have a national policy for TM/CAM and only 70 of 191 WHO Member States regulate herbal medicines.
2. Lack of sound scientific evidence concerning safety and efficacy. There is a lack of international standards for evaluating the safety and efficacy of traditional medicine.
3. Difficulties in ensuring rational use and quality control of TM/CAM. In 1996, 50 people in Belgium had kidney failure due to a herbal preparation which contained Aristolochia fangchi instead of Stephania tetrandra of Magnolia officinalis. In the USA, some young people died when using high doses of ephedra as narcotic drugs of psychotropic substances. In some European countries, change of traditional use of Kava-kava into a new form caused liver damage in several people. Therefore sound education and training programmes on traditional medicine for health care providers and education for consumers in the proper use of traditional therapies and herbal medicines are absolute prerequisites.
4. Need to ensure the sustainable use and the protection of knowledge of TM/CAM. This can be achieved by way of: recording the knowledge for sustainable use; recording the knowledge for safety and efficacy; recording the knowledge for equity sharing of the benefit

 

To meet the growing challenges, WHO has formulated a comprehensive working TM strategy for 2002-2005. The Strategy was developed through broad consultation with WHO Regional Offices and Member States, WHO Expert Committees and Collaborating Centres for Traditional Medicine, as well as through work with a broad range of partners with diverse interest in TM. It incorporates four objectives relating to:

1. Policy: integrate TM/CAM with national health care systems
2. Safety, efficacy and quality: Promote the safety, efficacy and quality of TM/CAM
3. Access: Increase the availability and affordability of TM/CAM
4. Rational use: promote therapeutically sound use of TM/CAM by providers and consumers.

 

National Policy
In 2002, 25 countries reported having a national TM policy. Such a policy provides a sound national health care delivery, ensuring that the necessary regulatory and legal mechanisms are created for promoting and maintaining good practice, that access is equitable, and that the authenticity, safety and efficacy of therapies are assured. To conclude we will present some valuable information on the Utilization and Legal Status of TM/CAM in Selected European Countries. These are useful for overview and comparison.

 

Utilization and Legal Status of TM/CAM in Selected European Countries

 

Country	Use	Practice CAM	Law	Insurance
Netherlands	80% population Herbal	50% GPs practice: Homeopathy Manual Therapy Acupuncture	Legal Register Homeopathy CAM: Homeopath	47 Private companies cover Acupuncture Chiropractic
Belgium	40% population	25% GPs provide CAM 59% MDs Homeopathy 40% MDs Acupuncture 28% Herbs 33% Manual Therapy	Legislation CAM approved by Parliament 1999	Partially covered
France	75% population	30% GPs practice CAM 50,000 non MDs provide CAM	MDs legally practice CAM Chiropractic	Social/private cover Homeopathy Manual Therapy
Germany	30% population	77% pain clinic provide Acupuncture 13,000 Heilpraktikers	Homeopathy legal Licensed Heilpraktikers 1994	Partially covered Herbal Homeopathy Acupuncture
Switzerland	40-50% population Including MDs		Regulatory Homeopathy 1998 Chiropractic 1999 Acupuncture	1999 Cover Homeopathy Chiropractic private cover
UK	70% population provide Acupuncture	50,000 Non-MDs provide CAM 90% pain clinics Osteopathy 1993	Non-MDs practice CAM tolerated by law Homeopathy 1950 free Acupuncture Chiropractic 1994	National health service; hospital provides Osteopathy Chiropractic
Denmark	33% population	Acupuncture Chiropractic	Chiropractic 1992	Fully reimburse Chiropractic
Finland	50% population	200 centres provide Acupuncture	MDs legally practice CAM	Some cases Chiropractic
Norway	30% population	GPs practice: 35% Acupuncture 33% Homeopathy	Chiropractic Legal 1990	Partially Chiropractic
Chinese-Norway		29% Chiropractic	Agreement 1999