News and Analysis • Volume 13 • Number 1 • March 2009

The Beijing Declaration: A Landmark for Traditional Medicine

by Ryan Abbott

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Last November in Beijing, government officials representing member states of the World Health Organisation adopted a declaration that provides a powerful endorsement of traditional medicine and may one day become the foundation for a legally binding resolution.

The WHO Congress on Traditional Medicine was the first time that member state representatives came together solely to discuss traditional medicine and to prepare an advocacy document. In the Beijing Declaration, they recognised the role of traditional medicine in the improvement of public health and supported its integration into national health systems where appropriate. The declaration encourages governments to create or improve national policies on traditional medicine. It also promotes improved education, research and clinical inquiry into traditional medicine, as well as improved communication between health care providers.

Because traditional medicine (TM) may be more affordable and accessible than western medicine, it has played an important role in meeting the demands of primary health care in many developing countries. For example, data indicates that 70 to 80 percent of the population in India and Ethiopia depend on TM for primary health care. Developed nations have also witnessed renewed interest in the use of traditional medicine. Seventy percent of the population in Canada and 80 percent in Germany are reported to have used it as complementary and/or alternative medical treatment. And yet, TM remains largely marginalised from national health services.

From Alma Ata to Beijing

The Alma-Ata Declaration on Primary Health Care adopted 30 years ago set forth the goal of health for all by the year 2000 through the promotion and strengthening of primary health care systems. In order to meet this objective, the declaration called upon WHO member states to include TM in their primary health care systems and to recognise TM practitioners as health care providers. It was at that time that the WHO Traditional Medicine Programme was established.

From this perspective, the Beijing congress represented a significant milestone for the WHO and traditional medicine. The declaration adopted by the participants recognises the importance of traditional medicine and establishes a set of objectives for promoting its use. It states that the “knowledge of traditional medicine, treatments and practices should be respected, preserved, promoted and communicated widely and appropriately based on the circumstances in each country.”

There are good reasons for traditional medicine to be promoted and integrated into mainstream health care. TM encompasses a large group of health care systems, practices and products that are evidence-based and effective. For example, as early as 1998, the US National Institutes of Health released a consensus statement indicating that acupuncture was effective in the treatment of certain conditions such as post-chemotherapy induced nausea and vomiting. TM therapies, such as Tai Chi, for example, may also function as preventative medicine and benefit quality of life. Traditional treatments have also proven effective in the treatment of chronic, disabling and neglected diseases for which adequate western treatments do not yet exist.

TM therapies tend to be lower in cost and less invasive than western therapies. Treatments are typically low-tech, high-touch in nature and rely on inexpensive manual therapies and natural products in the public domain. They help avoid the human and economic costs of adverse effects from medical treatment, as well as the legal and administrative costs that can be associated with western therapies.

However, TM therapies are not always safe and effective, and the use of traditional medicine can present unique challenges to national health authorities. Poor regulation and oversight, as well as a lack of comprehensive national policies on traditional medicine, may result in consumer confusion and the marketing of potentially dangerous or ineffective therapies. High-profile cases of adverse effects from herbal supplements have demonstrated the potential dangers of poorly regulated traditional medicine. Ephedra Sinica, for example, was banned in the United States after deaths occurred from use of this herbal medicine for weight loss and athletic enhancement, with disregard to its traditional dosage and contraindications. A regulatory environment that does not enforce good manufacturing practices and that fails to adequately monitor claims of health benefits can encourage the use of ineffective treatments. Herbal remedies adulterated with heavy metals and pharmaceuticals can represent a genuine threat to public health.

The Beijing Declaration states that governments have “a responsibility for the health of their people and should formulate national policies, regulations and standards, as part of comprehensive national health systems to ensure appropriate, safe and effective use of traditional medicine.”

Although relatively few countries have developed TM policies, the number is rising. According to the first WHO global survey on national policy and regulation of traditional medicine, only five member states had a national policy on traditional medicine prior to 1990. By 2003, that figure had reached 45, while 51 countries reported national policies pending. The same trend is seen with national laws and regulations regarding herbal medicine.

TM and IP Protection

As the economic value of traditional medicine has increased significantly, the issue of TM and intellectual property rights has become a topic of debate. Some countries are concerned about misappropriation of natural resources, preservation of biodiversity and protection of medicinal plant resources for the sustainable development of traditional medicine. In 2005, the World Health Assembly concluded that member states should “take measures to protect, preserve and to improve if necessary traditional medical knowledge and medicinal plant resources for sustainable development of traditional medicine, depending on the circumstances in each country; such measures might include, where appropriate, the intellectual property rights of traditional practitioners over traditional medicine formulas and texts, as provided for under national legislation consistent with international obligations, and the engagement of WIPO in the development of national sui generis protection systems.”

Mirroring ongoing discussions in other fora, including WIPO and the WTO, intellectual property protection for traditional medicine was the most controversial section of the Beijing Declaration.

The final text states that “traditional medicine should be further developed based on research and innovation in line with the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property adopted at the 61st World Health Assembly in 2008. Governments, international organisations and other stakeholders should collaborate in implementing the global strategy and plan of action.” The referenced resolution contains a number of provisions related to the protection of TM and intellectual property rights, and promotion and improvement of research on traditional medicine.

Earlier versions of the declaration had proposed different language: “The knowledge of traditional medicine, treatments and practices must be preserved and protected, along with the natural resources essential for their sustainable use.” This wording was partially excerpted from existing WHO instruments, and some developing nations felt that the declaration should contain the phrase ‘preserve and protect’ to parallel the earlier formulations. However, several developed countries were unwilling to endorse what they saw as further intellectual property protection for traditional medicine. Ultimately, member states reached consensus by agreeing to recognise the already accepted global strategy and action plan without specifically repeating its content.

Countries with a strong history of practicing traditional medicine, or with significant biodiversity resources, have an interest in protecting against misappropriation and securing intellectual property rights that would allow their communities to derive economic benefits from their TM-related resources. The United Nations has estimated that developing nations lose billions of dollars annually in unpaid royalties to foreign pharmaceutical corporations that appropriate traditional medicine.

Nations have struggled with determining how best to achieve intellectual property protection for traditional medicine. India, for example, has established a Traditional Knowledge Digital Library to prevent misappropriation through documenting formulations used in traditional medicine. The database was created following public outrage over the patenting of turmeric in the United States, an herb used in traditional Indian medicine (Ayurveda). Although making this information publically available may protect against misappropriation, it also makes it more difficult for communities to benefit financially from traditional medicine. African and Latin American nations face similar challenges. In some of these countries the majority of traditional medicine may not be publically available, and attempts to obtain patent protection may prove problematic because of disclosure requirements. This is so because traditional knowledge may be a form of ‘trade secret’ for which disclosure is ordinarily detrimental to the trade secret holder, and patent applications require disclosure.

China, which also has substantial interests in the protection of its traditional medicine and biodiversity resources for commercial exploitation, has recently enacted new laws that require disclosure of the source of genetic resources in domestic patent applications. The country not only seeks to shield its large domestic market for pharmaceutical and traditional medicine products based on native biological materials against uncompensated exploitation by foreign companies, it also has an interest in promoting exports of biological resource-based inventions to foreign markets.

Improving Research and Education

As the global strategy and plan of action referenced in the Beijing Declaration notes, it is important that research on traditional medicine be improved. Unfortunately, the widespread increase in TM use has not been accompanied by a corresponding increase in the quantity and quality of clinical inquiry. Even the relatively modest amount of funding devoted to TM research can be a vehemently debated political issue. However, an improved evidence-base for TM would encourage the most effective use of traditional medicine, as well as reduce conventional medical practitioners’ reluctance to treat patients with TM. The most frequent reason given by physicians for not accepting the use of traditional medicine is that they perceive such therapies as lacking rigorous scientific support.

It is equally important to improve education and standards in traditional medicine, not only to provide the most effective health care possible, but also to mitigate any risks associated with the use of traditional medicine. Acupuncture, for example, carries a minimal risk of serious side-effects such as pneumothorax (collapsed lung), but the hazard it is significantly higher in areas where the practice is poorly regulated or where training is sub-standard.

Lack of communication between conventional and traditional practitioners, as well as with health care consumers, may lead to inappropriate use of TM. Western therapies may be more effective than TM in many situations, and there is a danger that serious conditions with effective conventional treatments may be treated exclusively with TM. Rather than operating competitively, western and traditional medicines have the potential to form a complementary partnership.

As an advocacy document, the Beijing Declaration will hopefully encourage governments to create or improve national TM policies, as well provide an incentive for more clinical inquiry, improved communication between health care providers and the integration of traditional medicine into mainstream care across the globe.

Ryan Abbott is Research Scientist at the University of California at Los Angeles Center for East-West Medicine (www.cewm.med.ucla.edu).

One response to “The Beijing Declaration: A Landmark for Traditional Medicine”

ICTSD • 《北京宣言》：传统医药的里程碑 13th May 2009 at 13:18
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