To maximize the potential of TM/CAM as a source of health care, a number of issues must first be tackled. They relate to: policy; safety, efficacy and quality; access; and rational use.
Policy: basis of sound action in TM/CAM
Relatively few countries have developed a policy on TM and/or CAM - only 25 of WHO's 191 Member States. Yet such a policy provides a sound basis for defining the role of TM/CAM in 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. It can also help to ensure sufficient provision of financial resources for research, education and training.
In fact, many developed countries are now seeing that CAM issues concerning safety and quality, licensing of providers and standards of training, and priorities for research, can best be tackled within a national policy framework. The need for a national policy is most urgent, however, in those developing countries where TM has not yet been integrated into the national health care system, even though much of their population depends on TM for health care.
An increased number of national policies would have the added benefit of facilitating work on global issues such as development and implementation of internationally accepted norms and standards for research into safety and efficacy of TM/CAM, sustainable use of medicinal plants, and protection and equitable use of the knowledge of indigenous and traditional medicine.
Safety, efficacy and quality: crucial to extending TM/CAM care
TM/CAM practices have developed within different cultures in different regions. So there has been no parallel development of standards and methods - either national or international - for evaluating them.
Evaluation of TM/CAM products is also problematic. This is especially true of herbal medicines, the effectiveness and quality of which can be influenced by numerous factors. Unsurprisingly, research into TM/CAM has been inadequate, resulting in paucity of data and inadequate development of methodology. This in turn has slowed development of regulation and legislation for TM/CAM.
National surveillance systems to monitor and evaluate adverse events are also rare. So although many TM/CAM therapies have promising potential, and are increasingly used, many of them are untested and their use not monitored. As a result, knowledge of their potential side-effects is limited. This makes identification of the safest and most effective therapies, and promotion of their rational use more difficult. If TM/CAM is to be promoted as a source of health care, efforts to promote its rational use, and identification of the safest and most effective therapies will be crucial.
Access: making TM/CAM available and affordable
Although many populations in developing countries are reported as depending heavily on TM to help meet their health care needs, precise data are lacking. Quantitative research to ascertain levels of existing access (both financial and geographic), and qualitative research to clarify constraints to extending such access, are called for. The focus should be on treatments for those diseases which represent the greatest burden for poor populations.
Also, if access is to be increased substantially, the natural resource base upon which certain products and therapies depends must be protected. Raw materials for herbal medicines, for instance, are sometimes over-harvested from wild plant populations.
Another major challenge concerns intellectual property and patent rights. The economic benefits that can accrue from large-scale application of TM knowledge can be substantial. Questions about how best these benefits can be shared between innovators and the holders of TM knowledge have not yet been resolved though.
Rational use: ensuring appropriateness and cost-effectiveness
Rational use of TM/CAM has many aspects, including: qualification and licensing of providers; proper use of products of assured quality; good communication between TM/CAM providers, allopathic practitioners and patients; and provision of scientific information and guidance for the public.
Challenges in education and training are at least twofold. Firstly, ensuring that the knowledge, qualifications and training of TM/CAM providers are adequate. Secondly, using training to ensure that TM/CAM providers and allopathic practitioners understand and appreciate the complementarity of the types of health care they offer.
Proper use of products of assured quality could also do much to reduce risks associated with TM/CAM products such as herbal medicines. However, regulation and registration of herbal medicines are not well developed in most countries, and the quality of herbal products sold is generally not guaranteed.
More work is also needed to raise awareness of when use of TM/CAM is appropriate (and cost-effective) and when it is not advised, and why care should be taken when using TM/CAM products.