With Folk Medicine on Rise, Health Group Is Monitoring

By DONALD G. McNEIL Jr.
The New York Times
May 17, 2002 

ENEVA, May 16 -- Assigning itself a Herculean task, the World Health Organization took the first step today toward becoming the global watchdog over unconventional medicine.

The organization, a branch of the United Nations, has long focused on Western medicine, but it is looking closely at non-Western treatments, because at least 80 percent of the people in the world's poorest countries use them. Few of those countries can regulate their folk healers or share their plant lore, which may be a miracle cure or a poison.

The group's mission to catalog and give information about such treatments begins as they grow more popular in the West, and as the danger of some folk remedies increases the numbers potentially at risk.

The treatments can be fatal. For example, the Chinese ma huang herb, which contains ephedrine and helps breathing problems, caused heart attacks and strokes among some Americans using it as a diet aid. Kavakava, a Pacific Island anxiety-relieving tea, has poisoned the livers of those drinking a concentrated form. Ginkgo biloba, which stimulates circulation, also stimulates bleeding during surgery.

"We must act quickly to evaluate safety, efficacy, quality and standardization," said Dr. Ebrahim Samba, the W.H.O.'s regional director for Africa. Not only do patients need protecting, Dr. Samba said, but some native medicinal plants with potentially lucrative new applications might, too.

For example, artemisinin, a compound in a wormwood plant that has been used as a fever remedy in China for 2,000 years, has become the world's most effective new antimalaria drug. Sutherlandia frutescens, a South African herbal tonic called cancerbush in English, is being tested on AIDS patients to see if it helps them gain weight.

As defined by the W.H.O., folk medicine —sometimes called traditional and alternative/complementary medicine —includes things from chiropractic care and fad diets in Manhattan to porcupine quill injections in South Africa, shamanistic trances in Siberia, Arabic unani medicine and faith-healing with chicken guts in the Philippines.

Today, the Western-trained doctors who run the health organization acknowledged that they were making a very modest beginning, on a budget of $500,000, less than one-twentieth of 1 percent of the organization's $1.1 billion annual budget.

"We're not pushing to be the global anything —this isn't the black helicopters," said Dr. Jonathan D. Quick, the organization's director of essential medicines, joking about the conspiracy theory that a secret United Nations army patrols the night skies in black helicopters. "There's no W.H.O. policy that says, `You should regulate herbal medicine this way.' We're just trying to get information out there."

But because it is the leading international health agency, its small initiatives tend to grow in importance. A modest effort to identify suppliers of cheap drug cocktails for AIDS and recommend dosages, for instance, has led to substantial gains against the disease in Africa.

The group's ultimate goal is to catalog all folk remedies, making sure the plants are saved in botanical gardens and the products patented country by country. It also envisions writing common codes of ethics and training for folk healers.

But for the moment, Dr. Quick's team is simply surveying the way different countries train their practitioners and control their medicines. It is compiling the existing studies and has published papers on 100 of the roughly 5,000 medicinal plants that experts believe are in use.

Every study is expensive. Private ones now under way on ginkgo and St. John's wort are costing $16 million and $5 million respectively, said Torkel Falkenberg, of the Karolinska Institute in Sweden, who is an author of the agency's strategy. Dr. Ossy Kasilo, the agency's specialist in African remedies, said its first task was "to just undertake an inventory, then do research on what works and what doesn't."

In China, where 95 percent of hospitals have folk medicine wards, treatments are relatively advanced. But the practice is most prevalent in Africa, where at least 80 percent of people use it, sometimes because it is the only alternative. A W.H.O. survey found that while there was only one medical doctor for every 50,000 people in Mozambique, there was a traditional healer for every 200.

Africa is also the least regulated continent. Physicians in South Africa, for example, angrily describe how their AIDS patients die of kidney failure because a sangoma, a Zulu healer, has given them an enema containing an essence made from powerful roots. Diseases are spread by injections done with dirty razor blades or porcupine quills.

On the other hand, there are African remedies that seem to work on malaria, sickle cell anemia, high blood pressure and some AIDS symptoms, Dr. Samba said. "And for mental illness," he added, "traditional practitioners beat psychiatrists hands down."

Most African healers learn their art by apprenticeship, so education is inconsistent. But some African countries are taking the first step toward regulation by creating healers' associations and offering courses on topics like sanitary practices.

Folk practices are still common in the West, as well. For instance, in France, where homeopathic medicine is popular, 75 percent say they have tried alternative medicines, compared with 42 percent of Americans who responded to a 1997 survey.

Dr. Quick of the W.H.O. said the field tended to divide into two poles, "uninformed skeptics who don't believe in anything, and uncritical enthusiasts who don't care about data."

"We want to convince the skeptics that some things work, and make the enthusiasts more cautious because it can kill them."