Strengthening the scientific base of traditional medicine through international collaboration and partnerships

1. Introduction

Chronic illnesses, also known as non-communicable diseases, account for around 74% of all deaths globally with most of these premature deaths (86%) occurring in low- and middle-income countries as per the recent report of the World Health Organization (WHO) [1]. According to the Global Burden of Disease Collaborative Network, 42 million people died of chronic illnesses including cardiovascular diseases, cancer, and diabetes in 2019 [2]. Rapid unplanned urbanisation, unhealthy lifestyles and the ageing population are some of the key drivers of chronic diseases [1]. Socioeconomic factors such as poverty and rapid increase in healthcare costs, especially in low-income countries also contribute significantly to the global burden of chronic diseases [1]. Therefore, low-cost, and effective intervention strategies are vital for preventing and managing chronic illnesses.

Traditional medicine has been an integral part of people's health and well-being across the world for centuries due to its relative affordability and easy availability. It has been extensively used to treat chronic illnesses as well as to maintain well-being both as stand-alone and complementary therapies to Western medicine. According to the WHO, 88% of all countries use some form of traditional medicine and 40% of pharmaceutical drugs such as aspirin and artemisinin were initially derived from traditional medicinal plants [3].

Despite their widespread popularity, several challenges including the lack of a strong scientific base, and strict regulatory framework need to be addressed to ensure the quality, safety and efficacy of traditional medicine [4]. Traditional medicine must be evaluated using the same rigorous scientific standards applied to other forms of medicine. Methodological flaws and inconsistencies in research, limited facilities, resources and government funding support, the scarcity of collaborative research, and the lack of intellectual property protection have been identified as the key barriers to the generation of scientific evidence in traditional medicine [4]. With the prolific growth of traditional medicine globally, increased demand for the integration of evidence-based traditional and complementary medicine into healthcare education has also been reported [4]. In addition, recent reports have highlighted the importance of a uniform statutory regulatory framework that needs to be frequently reviewed and updated to ensure a high standard of traditional medicine practice and consistency in the efficacy and quality of traditional medicine products across the globe [4]. Furthermore, a robust pharmacovigilant system to monitor the adverse effects of traditional medicine and their interactions with pharmaceutical drugs is urgently needed to ensure its safety. These efficacy and safety issues can only be addressed through more rigorous scientific research to gain a comprehensive understanding of the modes of action, quality, and efficacy of traditional medicine against various diseases.

2. International collaboration in traditional medicine research

International collaborations and partnerships between traditional medicine researchers and research concentrations are critical to the generation of scientific evidence and their integration with conventional healthcare systems. The increase of research partnerships and networks internationally can enable researchers to bring together diverse perspectives, expertise, and resources to address complex research questions and challenges associated with traditional medicine.

The WHO traditional medicine strategy 2014–2023 addresses various challenges in traditional medicine by supporting Member States to develop practical policies and implement action plans [5]. It prioritises the safe and effective use of traditional medicine through regulation, research, and integration with conventional healthcare. Its key focus is on traditional and complementary medicine products, practices, and practitioners for improving and integrating traditional medicine into national health systems in order to keep the populations healthy [5]. In 2022, the WHO and the Government of India signed an agreement to establish the WHO Global Centre for Traditional Medicine in India for ensuring the appropriate use of traditional medicine through optimisation with modern science and technology [3,6]. The WHO Global Centre for Traditional Medicine will concentrate on developing reliable scientific evidence and data and promoting research innovation and collaboration to facilitate the optimal use of traditional medicine [3,6].

In 2023, the WHO launched a project on research synthesis of traditional Chinese medicine, which was successfully awarded to the Korean Institute of Oriental Medicine in collaboration with the National Center in Complementary and Alternative Medicine from Norway and the Center for Evidence-Based Chinese Medicine in Beijing University of Chinese Medicine. This project intends to provide comprehensive and systematic evidence on traditional medicine for decision-making and policy development. Additionally, the Center for Evidence-Based Chinese Medicine commissioned an evidence report on traditional Chinese medicine for smoking cessation, which was submitted to the WHO for guideline development for smoking cessation. In response to the COVID-19 pandemic and the wide use of traditional Chinese medicine in China, the WHO held an expert meeting to evaluate the evidence of using Chinese medicine for COVID-19 between 27th February and 2nd March 2022 (the WHO Expert Meeting on Evaluation of Traditional Chinese Medicine in the Treatment of COVID-19) [7]. In March 2022, the WHO also issued its international standard terminologies on Traditional Chinese Medicine [8].

NICM Health Research Institute (NICM HRI) at Western Sydney University is one of the largest research concentrations in integrative, traditional and complementary medicine research in Western countries, and Australia's leader in complementary medicine research and policy development [9]. Since its inception in 2007, NICM HRI created a broad network of significant research partnerships with international organisations in government and industry including a number of prestigious universities, hospitals and other agencies in China, India, Europe and the United States. For example, NICM HRI has established a strong collaborative research centre with the China Academy of Chinese Medical Sciences (CACMS), the peak Chinese medicine research body in China. To date, this partnership has resulted in a significant joint R&D project to develop a novel, standardised herbal formulation for vascular dementia, which is currently under Phase III clinical development. NICM HRI is also the first institute outside of North America to become a member of the Academic Consortium for Integrative Medicine and Health. In 2022, NICM HRI established the Western Sydney Integrative Health (WSIH) clinic - Australia's first university-based integrative healthcare centre to promote the integration of evidence-based complementary medicine into conventional healthcare [10].

3. Future directions

A patient-focused approach is imperative in traditional medicine research and practice. A strong scientific evidence base is required to ascertain the quality, safety, and therapeutic efficacy of traditional medicine which can be achieved through collaborative and high-quality research among universities, research institutes, hospitals, and industry. Rigorous research methodologies should be implemented to rectify the current methodological flaws in traditional medicine research. The use of artificial intelligence and machine learning might be particularly valuable in tackling complex research questions and collecting real-world data to unpack the benefits of traditional medicine interventions. Furthermore, more government support and policy reform are needed to promote research efforts in traditional medicine and to incentivise the industry to invest in research and innovation. The uniform and strict regulatory framework will enable the safe and optimal use of traditional medicine in the management of chronic illnesses. Integration of evidence-based traditional medicine interventions into conventional healthcare is also crucial. Overall, international collaboration and partnership is the key to developing strong evidence-based traditional medicine, globally.