Hypertension 1996 : One Medicine, Two Cultures

Research and development
WHO's policy and activities in the field of traditional medicine

Xiaorui Zhang
Medical Officer, Traditional Medicine
World Health Organization

I am greatly honoured and privileged in being invited and in addressing the International Symposium on “Hypertension: One Medicine, Two Cultures".
I would like to take this opportunity to make a brief summary of trend in the use of traditional medicine, and WHO's policy and activities in the field of Traditional Medicine.

Trends in Use of Traditional Medicine

Firstly, I would like to give you a brief idea of the trends in the use of traditional medicine.
A large part of the population in the developing countries still rely on traditional practitioners and local medicinal plants to satisfy their primary health care needs. On the other hand, due to the high cost of health insurance, population ageing and other reasons, the public in many developed countries are seeking for other types of complementary and alternative medicine. Therefore, there has also been a growing interest in herbal medicines, acupuncture and other alternative and complementary systems of medicine.
In 1992, for example, an elaborate national survey report in the New England Journal of Medicine revealed that in the past years, about one third of all American adults used alternative medical treatment.
Consumer surveys consistently showed positive public attitudes to complementary medicine, with about 60% of both the Dutch and Belgian public declaring themselves ready to pay extra health insurance premiums for it, and 74% of the British public favouring its being available on the national health system, as reported at the conference on complementary medicine research in 1994 by Dr Peter Fisher and Dr Adam Ward from the London Royal Homeopathy Hospital.

Acupuncture

Acupuncture-moxibustion is a part of Chinese traditional medicine and its use has also been occurring world wide in the last two decades.
For example, based on a survey of acupuncture-moxibustion in Europe reported by "Proceedings of Forum on Non-Conventional Medicine and Acupuncture, European Workshop" in 1990, the total number of acupuncturists has reached 88,000, 62,000 of which are medical doctors. In 1990, the number of acupuncture users was 20 million in European countries. In Belgium 74% of all acupuncture treatments are carried out by doctors; in the Netherlands 47% of the general physicians use acupuncture and 90% of the pain clinics in the United Kingdom and 77% in Germany use acupuncture.

Herbal Medicines

In Asian countries, the use of herbal medicine has permanently remained popular.
In China, for example, traditional medicines account for 30-50% of the total medicinal consumption. In 1993, the total sales of herbal medicines amounted to more than US$ 2.5 billion.
In Japan, from 1974 to 1989, there was a 154o1d increase in herbal sales in comparison with only a 2.64o1d increase in the sales of pharmaceutical products.
In the Republic of Korea, a breakdown of herbal raw material imports by years is given as follows:

• 1986 US $ 20 million
• 1988 US $ 64 million
• 1990 US $ 103 million
• 1991 US $ 123 million

In the western countries, according to a report in the journal Market of Herbal Medicines in the United States of America and Canada, OTC sales of herbal medicines reached US$860 million with a growth rate of 15% in USA during 1990.
In the European market, OTC sales of herbal medicines amounted to US$1.55 million in Germany in 1990, and the national growth rates in other western European countries were from 5% to 22% as reported by the European Scientific Co-operative on Phytotherapy in 1992.

Other Forms of Natural Medicine

The use of other forms of natural medicines including homeopathy, manipulation and other therapies, is on the increase. The same presentation by Dr Peter Fisher and Dr Adam Ward also mentioned that in countries for which statistics are available, complementary therapies are used by 20% to nearly 50% of the population. The popularity of complementary medicine is growing rapidly. For instance, in 1981 6.4% of the Dutch population visited a therapist or doctor providing complementary medicine; this increased to 9.1% by 1985 and 15.7% in 1990. The proportion of members of the UK Consumers Association who had visited a non-conventional practitioner in the preceding 12 months had risen from I in 7 in 1985 to almost 1 in 4 in 1991. Homeopathy is the most popular form of complementary therapy in France; its use rose from 16% of the population in 1982 to 29% in 1987 and to 36% in 1992.

WHO's Policy and Objectives for Traditional Medicine

Secondly, I would like to give you a brief account of WHO's policy and objectives for traditional medicine.
In response to requests from Member States, a series of resolutions concerning policy, the World Health Assembly has issued objectives and activities for traditional medicine. A summary of them may be made as follows:

Member States are urged:

• to give adequate importance to the utilization of their traditional systems of medicine, with appropriate regulations as suited to their national health systems (1977);
• to make a systematic inventory and assessment (pre-clinical and clinical) of the medical plants used by traditional practitioners and by the population (1989);
• to intensify activities leading to co-operation between those providing traditional medicine and modern health care, respectively, especially as regards the use of scientifically proven, safe and effective traditional remedies to reduce national drug costs (1991);
• to introduce measures for the regulation and control of acupuncture methods (1991).

Based on the resolutions, the objectives of the Traditional Medicine Programme are to:

• facilitate the integration of traditional medicine into the national health care system;
• promote the rational use of traditional medicine through development of technical guidelines and international standards in the field of herbal medicines and acupuncture;
• act as a clearing house for the dissemination of information on various forms of traditional medicine.

WHO's Activities in the Field of Traditional Medicine

In order to facilitate the research and development of traditional medicine, WHO has co-operated with WHO collaborating centres, non-governmental organizations and institutions to develop and prepare, among others, the following technical documents concerning medicinal plants and acupuncture during the last few years:

1. Quality Control Methods for Medicinal Plant Materials (1994)
2. Guidelines for the Assessment of Herbal Medicines (1994)
3. Guidelines on the Conservation of Medicinal Plants (1993)
4. Examples of Model Monographs of Widely Used Medicinal Plants (in preparation)
5. Research Guidelines for Evaluating the Safety and Efficacy of Herbal Medicines

Regional Office for the Western Pacific (1993)

1. Selection of Essential Medicinal Plants

Regional Office for the Eastern Mediterranean (1995)

1. Standard International Acupuncture Nomenclature (1989)
2. Guidelines on basic training in acupuncture (in preparation)
3. Guidelines for safe acupuncture treatment (in preparation)
4. Indications and contraindications of acupuncture (in preparation)
5. Guidelines for clinical research on acupuncture

Regional Office for the Western Pacific (1995).

WHO will continue to fully support research activities in the field of traditional medicine and to strengthen co-operation with countries, research institutes and non-governmental organizations in the collection and dissemination of technical and administrative information. Technical documents and guidelines will continue to be developed.
Finally, I would like to thank the Italian Ministry of Health, the Research Centre of Biotechnology and Natural Medicine, University of Milan and the Department of Cardiology, Hospital of G.B. Grassi-Rome again for organising this significant symposium and giving me this opportunity to meet many friends and obtain up-to-date scientific information and valuable ideas for future activities in the field of integration of traditional and modern medicine.

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Edited by Aldo Campana,