Choosing between Traditional and Modern Medicine

Choosing between Traditional and Modern Medicine!

A pragmatic and realistic view has to be taken of the place and position of TMs for the healthcare of the community by drawing a proper balance between the use of traditional medicines vs the modern drugs in specific situations. What is im­portant is the interest of the patient and not the promotion of a system of medicine.

In life-threat­ening infectious diseases well proven modern drugs must be used while for life-style diseases, degenerative disorders or primary healthcare much greater use should be made of traditional medicine, with highly favorable pharmacoecomomics. It would be useful for each country to have a Standing Committee on Essential Drugs to draw guidelines for the use of Traditional Medi­cines vs. Modern Drugs.

While many conventional drugs or their precursors are derived from plants, there is a fundamental difference between admin­istering a pure chemical and the same chemical in a plant matrix. It is this issue of advantage of chemical complexity which is both rejected by orthodoxy as having no basis in fact and avoided by most researchers as introducing too many vari­ables for comfortable research (Simon and Kerry, 2000).

The identification of crude herbs based on geographical origins is crucial in order to ensure authenticity, quality, safety and efficacy of the raw material before it is converted to the filial prod­uct. Among all the quality control systems, finger­print has gained more and more attention due to its ability to identify a particular herb and, more­over, to distinguish it from closely related species.

Chromatographic fingerprints sometimes exhibit variations in peak height and retention time of a given sample running through identical columns under the same separation conditions. Because of this, appropriate consideration must be given to proper normalization of chromatographic finger­prints.

One of the major difficulties for undertaking medicinal plants cultivation in large scale i.e. the lack of scientific and appropriate agro technology for different climate zones. Experimental cultiva­tion has been carried out nor in several places, but the recommended commercial practices have been neither worked out nor tested on industrial scale.

Moreover, even if the cultivation is likely to yield economic returns, the dominant sector of cultivators in the country are conservative and are reluctant to abandon their time tested crops and turn to medicinal crops than modern drugs are preferred for pro-motive and preventive health care and for minor chronic ailments requiring long use.

Traditional medicines have been of great value for modern drug research too by providing leads for the discovery of new single molecule medi­cines.

In-fact modern drug discovery started with the leads provided by traditional medicines and continues to this day. Many of the drugs thus dis­covered are still used in the modern system and many more carry the structural imprint of the par­ent molecular prototype which had led to their discovery.

Herbals of course form the main stay of the material Medica of traditional medicine and are thus attracting much attention. In addition there are some societal concerns which add to the grow­ing interest in plant drugs; their raw environment. There is thus now a global interest in the plant drugs.

Quality control of herbal medicines is com­plicated and difficult, and high-technology could be of valuable support. However, when country capacity is limited, continued use of dependable basic technical methods and tests is recommended.

1. Governments should provide adequate sup­port for clinical studies, since there are few clinical studies and appropriate approaches for the assessment of efficacy. WHO should provide technical guidance of appropriate approaches for clinical studies and assessment of efficacy of herbal medicines.

2. Traditional medicine plays an important role in primary health care in many developing countries and countries should consider cat­egorizing herbal medicines based on avail­able knowledge and the literature.

Relevant appropriate requirements should be estab­lished for the assessment of safety and effi­cacy for different categorized herbal medi­cines to reduce cost and expenditure and meet demands of accessibility and affordability.

3. A challenge for national health authorities is the lack of research information and data on herbal medicines. Sharing national informa­tion and experience, as well as setting up com­mon accepted standards through bilateral rec­ognition and through international.

4. Regional regulatory cooperation for herbal medicines should be considered. WHO should continue to provide support to inter­national and regional regulatory cooperative initiatives for herbal medicines.

5. In order to ensure safe and effective use of traditional medicine, integration of traditional medicine into national health systems should be considered where appropriate.

Controlled clinical studies are needed to clarify and determine the clinical importance of drug herb interactions. Patients taking drugs with a narrow therapeutic index (cyclosporine, digoxin, hypoglycemic agents, lithium, phenytoin, procainamide, theophylline, tricyclic antidepres­sants, and warfarin) should be discouraged from using herbal products. 

All drugs with a narrow therapeutic index may either have increased adverse effects or be less effective when used in conjunction with herbal products. More research is required to define the interactions.

When adverse reactions are experi­enced with drug therapy, patients must always be queried as to their intake of herbal products: what they are taking in pills and tincture form, what they are drinking as teas, and what they are eat­ing from their garden.

The safety of herbal products may be re­lated to the mixtures of active chemicals that they contain; their interactions with other herbs and drugs, contaminants, or adulterants; or their inher­ent toxicity.

Plants have complex mixtures of terpenes, alkaloids, saponins, and other chemicals, increasing the risk of adverse reactions to any one of them or to the additive or synergistic effects of chemical interactions. For example, more than 100 chemicals have been identified in tea tree oil.

Active ingredients in herbs and dietary supple­ments can cause unexpected reactions when used with other herbs or medications. Effects on the dis­tribution, metabolism, or excretion of drugs may be pronounced and may lead to drug toxicity. For example, sassafras reportedly inhibits microsomal enzymes and can increase the half-life of drugs metabolized by the liver.

Contaminants and adul­terants of herbal products can be pharmacologi­cally active and responsible for unexpected toxic­ity Ayurvedic medica­tions have been known to cause lead poisoning in children because of their contamination with this heavy metal and others, such as arsenic and mer­cury.

Many Chinese patent medicines contain drugs such as phenylbutazone and barbiturates, warfarin-like chemicals, and contaminants such as lead or arsenic.

Herbal products or folk remedies may be un­safe for example, aconite, a widely used Asian remedy, can produce life-threatening cardiac and neurologic toxicity so stringent quality control measures are to be initiated to test such toxicity as per the recommendations of the pharmacopoeial standards.

Modern phytomedicine emerging with the development of the latest techniques with sophisticated instruments to test the quality of the phytomedicines. eg. Gingerol and taxol in diabetes and cancer.