Comparison between Traditional Medicine and Modern Medicine
1. Based on belief and empirical evidence for cure; safety, efficacy, and quality of drugs often not well known
2. Highly accessible to individuals and communities
3. Highly acceptable and understood by the communities and individuals in both rural and urban places
4. Highly affordable even if it is often more costly than modern medicine
5. Reputation and credibility spread by way of mouth and individual/community experience
6. Holistic and psychologically more effective
7. Uses understandable language and explanations and takes time with patient
8. Prescription not specified or restricted and can be provided by anybody at any level, including household
1. Based on scientific proof and clearly demonstrated safety, efficacy, and quality of drugs
2. Has limited access to individuals and communities, especially those in rural areas
3. Only highly acceptable and understood by urban populations and those with basic education
4. Depends on money and highly unaffordable by many rural populations
5. Reputation based on scientific fact and spread by advertisement and education
6. Often focuses on physical illness only
7. Often uses a foreign language and doctors have little time with patient
8. Prescription specified and has restrictions depending on the type of drug development of new antimalarial drugs from traditional medicine is the selection of the lead having the highest probability to yield safe and efficacious antimalarial drugs or phytomedicines.
The currently available traditional remedies (phytomedicines) for malaria, according to the guidelines of WHO, the rules of the European Community, the Food and Drug Administration (FDA) in the U.S., and any other licensing body, must have evidence of the product's safety, efficacy, and quality to be registered for human use. However, long-term traditional use is indicative of lack of immediate and acute toxicity, but this does not rule out unforeseeable long-term or latent toxicity (WHO, 2000).
1.2.8 Issues of Ethics, Patents, and Intellectual Property Rights
Issues concerning ethics, patent, intellectual property rights, compensation for loss of finance-rich traditional resources, and the acquisition and safeguarding of traditional health care knowledge need to be addressed in any program that aims to use traditional medicine as a basis for new drug development. The issues of concern are the relationship between the community/traditional healer possessing the healing knowledge and researchers, and the relationship between researchers and pharmaceutical firms. Bioprospecting of new antimalarial drugs from traditional medicinal plants and the exploitation of unprotected traditional knowledge should now be the focus of monitoring measures. Similar concerns that call for closer observation of cultural and intellectual property rights have been addressed in the Chiang-Mai and Kari-Oca Declarations. The first countries to seriously address these issues were China and India. Programs dealing with traditional medicinal plant conservation, cultivation, community involvement, and sustainable development being initiated elsewhere could benefit greatly from the Chinese and Indian experiences (World Bank, 1997).
Recently the case of the Hoodia cactus in South Africa is important evidence of how indigenous knowledge may be exploited and put to better care; however, approaches to share profits emanating from the use of indigenous knowledge still pose ethical problems. From time immemorial, South African Kung bushmen who live around the Kalahari desert have eaten the Hoodia cactus to stave off hunger and thirst on long hunting trips. They used to cut off a stem of the cactus about the size of a cucumber and munch on it over a couple of days, and according to their tradition, they must eat together what they caught, so they brought it back and did not eat while hunting. Now the Hoodia cactus is at the center of a biopiracy row, as it is the source of the patented P57, the appetite-suppressing drug. P57 is an appetite suppressant with novel pharmacological properties that has no effects on behaviour. Pfizer, the U.S. pharmaceutical giant, bought the right to license the drug for $21 million from Phytopharm. However, it appears that the drug companies had forgotten to inform the bushmen, whose traditional knowledge they had used and patented. In addition to that, Phytopharm has six other patents in progress covering the use of the plant and its active molecules, derivatives, and mode of action. Hoodia cactus has been successfully planted in greenhouses, and today plantations have been established worldwide in collaboration with South Africa's Council for Scientific and Industrial Research (CSIR) and Pfizer, and a clinical supplies unit dedicated to the manufacture of the material has been opened in South Africa.
Currently, Phytopharm and CSIR are facing demands for compensation. The Kung tribe claims that their traditional knowledge has been stolen. The Kung people also assert that they were never consulted on the matter, and have accused Phytopharm and Pfizer of biopiracy of their ancient medicinal knowledge of the plant. However, surprisingly, Phytopharm claims that it never consulted the Kung, as it believed the tribe was extinct (Barnett, 2001).
The genetic biodiversity of traditional medicinal plants is continuously under the looming threat of extinction due to ever-growing exploitation, environmental degradation, unsustainable plant harvesting techniques, loss of plant growth habitats, and uncontrolled trade in medicinal plants. Currently, the industrial uses of traditional medicinal plants are many. These range from traditional remedies, herbal teas, nutraceuticals, galenicals, phytopharmaceuticals, and industrially produced pharmaceuticals. In addition, traditional medicinal plants constitute a valuable source of valuable foreign exchange for most developing countries, as they are a dependable source of drugs such as quinine and artemisinin. The traditional medicinal plants market in the U.S. is estimated at U.S. $1.6 billion per year. China is leading with exports of over 120,000 tonnes per year, followed by India with some 32,000 tonnes per year and Madagascar with 8198 tonnes per year. It is estimated that Europe imports about 400,000 tonnes annually of traditional medicinal plants from Africa and Asia with an average market value of U.S. $1 billion (Hoareau and DaSilva, 1999).
The production and commercialisation of traditional medicinal plant-based products in developing countries are dependent upon the availability of resources and information concerning the downstream bioprocessing, phytochemical extraction, and marketing of the phytopharmaceutical products.
1.2.9 The Position of Traditional Medicine in the Multilateral Initiative ON MALARIA
The Multilateral Initiative on Malaria (MIM) is a global alliance of organisations and individuals concerned with malaria in Africa, created in January 1997, aimed at maximising the impact of scientific research on malaria in Africa through the promotion of capacity building and facilitation of global collaboration and coordination. The initiative creates a forum for exchange of resources, information, and ideas between African malaria researchers and those working in developed countries, and thus fosters global collaboration among experts researching malaria to focus on common problems and reinforces the need to collaborate more closely.
188.8.131.52 The Objectives of MIM
• To raise awareness of the problem of malaria and identify key research priorities with a view to mobilising necessary resources and actions
• To develop research capacity in Africa through facilitating a global scientific partnership
• To promote communication, coordination, and collaboration between individuals and organisations involved in malaria research activities in order to maximise the impact of these activities
• To strengthen bridges between the research and implementation communities to ensure that research leads to practical benefit
The role of MIM in traditional medicines falls under three categories in accordance with the above objectives. MIM must recognise that the majority of the high-risk groups for malaria in Africa reside in rural areas that are difficult to access and where the distribution of modern health services is poor or nonexistent. In such communities, the availability of modern health services is a dream, and where they may exist, they are too expensive for poor populations.
These communities, which may account for between 60 and 80% of African populations, rely heavily on traditional medicine for malaria because of the reasons given above.
Within such communities one can find well-established traditional practices and practitioners whose network and expertise range from household and village herbalists to highly reputable healers whose services extend beyond one single community to as vast an area as a district or region.
In Tanzania, a recent study has established that there are five or six healers per village (district), and this is far above the number of modern doctors and health workers available per district (Mhame, 2001).
MIM must also recognise that this situation is necessary because without the presence of providers of alternative medicine and medical practices, the majority of these communities would be left to succumb to the undesirable effects and high death rates due to tropical infectious diseases. For this reason, there is credibility that their medicines and medical practices do work; otherwise, individuals and communities would not use their services at the rate they currently do.
Many African governments, knowing too well that they are unable to provide sufficient efficacious and affordable medicines and medical services to their populations, have either given blanket permission for use of traditional medicines or turned a blind eye to what is happening, hoping that it is all well and good.
It is difficult and will be unethical to stop any of the existing traditional medical practices in the absence of a better substitute, and yet it is equally unethical to let practitioners administer to individuals and populations medicines and medical practices for which there is no scientific evidence of efficacy and safety. It is even more difficult to deal with the innumerable claims of practitioners of alternative medicine in Africa and those of the outer world wishing to sell their products in Africa because of nonspecificity of the claimed efficacy.
Recently, there is an increasing tendency for importers of traditional medicines from China, South Africa, and elsewhere to claim that they are food additives and therefore may not require proof of efficacy. Many of these are making lucrative businesses by advertising that they heal more than 100 diseases, and others claim that they have a cure for HIV/AIDS and many other diseases. Ngoka and Ngetwa are herbal medicines currently circulating in Tanzania that are claimed to cure 120 diseases, including malaria, hypertension, and diabetes. However, the definition of disease is often confused with symptoms like fever, headaches, and feeling weak
Countries must therefore have competence to confirm or deny medical claims and safeguard the health of needy populations, and it is unethical not to have such capacities and to do nothing to help the poor people.
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