TM/CAM therapies often develop within a very specific cultural environment. Yet, increasingly, they are transferred to other cultural environments. This raises safety and efficacy issues. For instance, are the transferred therapies applied with the same degree of training, skill and knowledge as in their original environment? Acupuncture is a case in point. Now widely practised in many countries other than China - its country of origin - acupuncture has probably become one of the world's most popular TM/CAM therapies. WHO has accordingly worked with experts in acupuncture to propose a standard international nomenclature. This is now widely accepted. WHO has also developed Guidelines on Basic Training and Safety in Acupuncture and Guidelines for Clinical Research on Acupuncture. These guidelines strongly encourage national health authorities to regulate acupuncture practice and research.
Similarly, TM/CAM products, particularly herbal medicines, are now traded inter-regionally and internationally. Many health authorities are concerned as to whether they are used rationally and safely, particularly if relevant regulations are lacking, and the quality and safety of these products cannot be assured. WHO has responded by producing reference documents such as Quality Control Methods for Medicinal Plant Materials, to not only facilitate the technical work of drug regulatory authorities but also to encourage countries to undertake quality control of herbal medicines.
WHO tools and assistance
In most developing countries, national TM institutes have been established - as in China, the Democratic People's Republic of Korea, Ghana, India, Indonesia, the Lao People's Democratic Republic, Mali, Madagascar, Nigeria, the Republic of Korea, Sri Lanka, Thailand and Viet Nam. WHO provides not only guidelines and scientific information to support their research, but also grants for research into the safety and efficacy of use of TM/CAM. In Africa, WHO is supporting a total of 21 countries in their research into TM therapies. For example, it has provided research grants to support clinical research on herbal antimalarials that is being carried out by Kenya's Medical Research Insitute, Ghana's National Centre for Scientific Research into Plant Medicine, and Nigeria's National Institute for Pharmaceutical Research and Development. The research is following the WHO General Guidelines for Methodologies on Research and Evaluation of Traditional Medicine.
Collaboration with other organizations
WHO's work to promote appropriate, safe and effective use of TM/CAM benefits from technical input from a number of organizations, both national and international. NCCAM in the USA, for example, was designated a WHO Collaborating Centre for Traditional Medicine in 1996. It has provided not only technical comments on developing the WHO Monographs on Selected Medicinal Plants and Guidelines on Basic Training and Safety in Acupuncture, but also financial support for development of documents such as the General Guidelines for Methodologies on Research and Evaluation of Traditional Medicine.
At European level, collaboration has taken place with EMEA's Ad Hoc Working Group on Herbal Medicinal Products. The group has assisted with the preparation of WHO Monographs on Selected Medicinal Plants, General Guidelines for Methodologies on Research and Evaluation of Traditional Medicine, and Guidelines for the Assessment of Herbal Medicines. As a result, European countries are further encouraged to use WHO technical documents on TM/CAM.
WHO also works with its Collaborating Centres for Traditional Medicine to carry out national, regional and global activities. (A full list of these WHO Collaborating Centres is given in Annex 1.) WHO Collaborating Centres for Traditional Medicine agree to promote their national TM through their research and training programmes (Figure 12). They also agree to provide technical comments and information to support development of WHO technical guidelines and documents, and to provide training, at WHO's request, for experts in acupuncture and on research skills for investigating the safety and efficacy of herbal medicines.