Although TM/CAM is widely used in the prevention, diagnosis, treatment and management of disease, very few countries have developed a national TM/CAM policy.
"Without critical assessment of what should be integrated and what should not, we risk developing a health care system that costs more, is less safe, and fails to address the management of chronic disease in a publicly responsible manner."32
Yet such policies are needed in order to define the role of TM/CAM in national health care delivery systems and how it can contribute to health sector reform. They can also ensure that the necessary regulatory and legal mechanisms are in place for promoting and maintaining good practice, that access to TM/CAM is equitable, and that the authenticity, safety and efficacy of any therapies used are assured. Without such policies, TM/CAM is practised without government oversight and without patient/consumer protection.
TM/CAM policies should therefore cover a range of issues, including: legislation and regulation for herbal products and practice of therapies; education, training and licensing of providers; research and development; and allocation of financial and other resources (Table 7.) In brief, sound TM/CAM policies can increase the types of safe and effective health care available to patients and consumers. To date, only 25 of WHO's 191 Member States have developed a national TM/CAM policy.
Attention should also be paid to intellectual property issues if the country concerned has a wealth of indigenous TM knowledge and/or natural resources that are used in TM/CAM products. Some groups recommend protecting TM under existing or new forms of intellectual property rights. Others object to this suggestion for ethical or economic reasons. Nevertheless, "biopiracy" - the unauthorized appropriation of TM knowledge and materials - is largely condemned. Clearly, when drafting national TM/CAM policies, the objectives and implications of intellectual property right protection should be thoroughly considered.48
Table 7. Key elements to include in a national policy on TM/CAM
• Definition of TM/CAM.
• Definition of government's role in developing TM/CAM.
• Provision for safety and quality assurance of TM/CAM therapies and products.
• Provision for creation or expansion of legislation relating to TM/CAM providers and regulation of herbal medicines.
• Provision for education and training of TM/CAM providers.
• Provision for promotion of proper use of TM/CAM.
• Provision for capacity building of TM/CAM human resources, including allocation of financial resources.
• Provision for coverage by state health insurance.
• Consideration of intellectual property issues.
Indeed, great caution generally should be exercised when developing TM/CAM policies. Careful assessment has first to be made of the use and practice of TM/CAM in the relevant country and the most appropriate means of using TM/CAM to help meet its health care goals. National policies should benefit patients using TM/CAM therapies. They fail to provide this benefit if they are: unable to ensure the safety, efficacy and quality of TM/CAM products and practices; unduly restrict the practice of TM/CAM; lead to higher health care costs; unjustifiably hinder patient treatment options; or reduce the ability of allopathic medicine practitioners to cross-refer patients.