Figure 1.
From an anthropological perspective, ethnomedicine—meaning the folk medicines of specific ethnic groups—depends on location. Preliterate indigenous populations used plants that were available in their local environments to treat illness and promote health. Diverse folk remedies thus evolved that were passed down through oral traditions. Most traditional healers learned their art through apprenticeship. As populations converged, dominant cultures gained ascendancy, and in most places throughout the world today Western medicine is considered preeminent. Indeed, “complementary and alternative medicine” (CAM) refers to a broad set of health care practices that are not integrated into the dominant health care system. Nonetheless, close to 25% of modern medicines are descended from plants that were first used traditionally.
In May 2002, the World Health Organization (WHO) launched the First Global Strategy on Traditional and Alternative Medicine. This strategy provides a framework that policymakers can use to regulate CAM, with the goal of making its use safer, more accessible, and sustainable. It also addresses concerns about the loss of biodiversity and the need to preserve and protect traditional knowledge.
Our motivation for devoting an entire issue of the Journal to CAM is its widespread and growing use. Up to 80% of people in the poorest countries of the world use CAM as part of primary health care. In Mozambique, for example, a WHO survey found that while there was only 1 medical doctor for every 50 000 people, there was 1 traditional healer for every 200 people. Meanwhile, CAM is fully integrated into the health systems of China, North Korea, South Korea, and Vietnam. In the United States, spending on CAM stands at $2.7 million per year, and growing numbers of patients are beginning to rely on CAM for preventive or palliative care (http://www.who.int/inf/en/pr-2002-38.html).
The collaborative effort that pulled this issue together grew out of a research project funded through the Harlem Health Promotion Center by the Centers for Disease Control and Prevention. In Vince Silenzio and Connie Park, we found 2 dedicated guest editors who regularly combine CAM research, practice, and education with healthy doses of sensitivity and good humor (see their contributions on 1562 and 1568).
We issued an open call for papers in fall 2001 to better ensure broad publicity, as critical research on CAM has been neglected to date in the peer reviewed literature. The WHO estimates that there are currently studies and published papers on only 100 of the nearly 5000 medicinal plants discovered so far. We received scores of submissions, largely from authors who had never published in the Journal. As a result, we more than tripled our referee base for CAM research and are now better equipped to review future CAM submissions.
We strove to include papers on a diversity of CAM modalities and populations. While evaluation of safety is essential, we also sought evidence on effectiveness—from controlled clinical trials to the lived experiences of people who use CAM. Because there has been limited financial support for CAM research to date, many of the research reports were on pilot or preliminary studies and were published as briefs.
Jonathan D. Quick, the WHO Director of Essential Medicines, has noted that the CAM field tends to divide into 2 poles: “uninformed skeptics who don’t believe in anything, and uncritical enthusiasts who don’t care about data” (http://www.nytimes.com/2002/05/17/international/12MEDI.html). Through the publication of this landmark issue, the Journal hopes to bridge the gap between these poles and increase the CAM knowledge base.