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New WHO guidelines to promote proper use of alternative medicines


Adverse drug reactions to alternative medicines have more than doubled in three years

Since traditional, complementary and alternative medicines remain largely unregulated, consumers worldwide need to be informed and given the tools to access appropriate, safe and effective treatment. To help address this issue, the World Health Organization (WHO) today releases a new set of guidelines for national health authorities to develop context specific and reliable information for consumer 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.

Daniela Bagozzi | WHO
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