Setting a dangerous precedent, the WHO has declared that traditional medicine ‘should be considered alongside other scientific forms of knowledge’.
The World Health Organisation, the UN’s primary technical advisory body on healthcare, from which many countries take their policy cues, is awkwardly trying to ride two horses with one saddle.
On one hand, it wants to promote evidence-based medicine founded on rigorous scientific research. On the other, it is trying to pander to all kinds of hucksters promoting traditional, indigenous, complementary, alternative, and integrative ‘medicine’ (hereafter referred to merely as alternative medicine).
It recently held a Traditional Medicine Global Summit, to ‘look anew at the vast potential and applications of traditional medicine amidst important challenges and opportunities to achieve universal health coverage and well-being for people and the planet.’
From the outset, it strays well beyond its mandate into the political arena with references to ‘universal health coverage’ and ‘well-being for people and the planet’.
The Gujarat Declaration that this summit produced goes even further into the weeds, undertaking to ‘[s]upport and promote the implementation of the United Nations Convention on Biological Diversity,’ which has a tenuous connection only to the source of ingredients for some traditional medicine (like tiger and lion bones, rhino horns, pangolin scales, baboon paws and rare plants).
It also commits to ‘[f]ully recognize, respect and protect the rights of Indigenous Peoples, as provided in the UN Declaration on the Rights of Indigenous Peoples, including the right to self-determination; right to lands, territories, and resources; the right to maintain, control, protect and develop their lands, territories, and resources …’.
What the self-determination and territorial claims of indigenous peoples have to do with medicine is a mystery to me.
Janus-faced
At the heart of the matter, however, is the WHO’s Janus-faced approach to alternative medicine.
At first, it looks quite reasonable: ‘A key barrier to enabling access to safe and quality traditional and complementary medicine (T&CM) services, including through integration into national health systems, is insufficient scientific knowledge on the safety and efficacy of T&CM products and practices.’
So far, so good. As we’ve established before, alternative medicine is medicine that has either not been proven to work, or been proven not to work. Alternative medicine that has been proven to work is called medicine.
Expecting sound scientific evidence for the efficacy and safety of alternative medicines is in the best interests of patients.
‘A stronger evidence base will enable countries to develop appropriate mechanisms and policy guidance for regulation, quality control and monitoring of T&CM practices, practitioners and products, in accordance with national contexts and priorities.’
That alternative medicine ought to be regulated for safety and efficacy in the same manner as real medicine should also not be a controversial take. ‘Natural’ does not mean ‘harmless’. There are good reasons to believe that neither the dosage nor the purity of alternative remedies are well-controlled, which increases the risk of unwanted side-effects.
(A strictly libertarian view would be that no medicine of any kind ought to be regulated by the government, but I have never been convinced that it is reasonable to promote unrestricted self-prescription of complex and powerful drugs in a modern society.)
Epistemology
‘At the Summit, WHO and the partners will present, among others, evidence maps on the clinical effectiveness of T&CM, epistemology and research methods, use of AI to generate evidence, and a country’s journey on establishing a T&CM research framework.’
Wait a minute. They want to use artificial intelligence to ‘generate evidence’? That is absurd. If I used AI to generate an essay, and handed it to my professor, and it was detected, they would fail me, and rightly so.
AI is for generating plagiarised text, or cheapskate images, or uncanny-valley porn.
Evidence about the efficacy and safety of medicine should be obtained from double-blind randomised controlled clinical trials, and ideally from many of them with increasingly large sample sizes. You don’t just ‘generate evidence’ using AI.
If the WHO has such a lax attitude to ‘evidence’, their reference to ‘epistemology’ also becomes suspect.
Epistemology is a branch of philosophy that is concerned with the nature and foundations of justified knowledge. If the WHO is unhappy with epistemology in the context of medicines, they can only mean that they consider the scientific method insufficient, and are allowing space for what critical theorists refer to as ‘other ways of knowing’.
That opens the door to every kind of chicanery, fraud and grift.
Pseudoscience
In pursuit of this alternative medicine campaign, the WHO helpfully tweeted (or Xcreted, or whatever the verb for posting to X is now) a list of traditional medicines it views as a ‘first stop’ for health and well-being for millions of people: acupuncture, ayurveda, herbal medicine, homeopathy, naturopathy, osteopathy, traditional Chinese medicine, unani medicine.
A ‘community note’ helpfully observes that half of those – homeopathy, osteopathy, naturopathy and the modern use of acupuncture – are not at all ‘traditional’, but are modern pseudoscience.
Several of those, like homeopathy, acupuncture and osteopathy, have also been entirely discredited by scientists. They lack even a plausible mechanism of action, and there is no evidence that their perceived benefits, if any, derive from anything other than the placebo effect.
All of the other schools of alternative medicine the WHO mentioned can best be described as follows. Most of it is unproven, and merits the status of folk belief, not scientific medicine. Some of it is known to be actively harmful or counter-productive. Some of it may work, but if so, that can, and should, be proven in clinical trials, with active ingredients identified and isolated for use in modern, dose-controlled and quality-controlled medicine.
In the latter case, private pharmaceutical companies would have a great interest in adopting and developing these medicines. As the WHO itself points out, albeit in an attempt to give blanket cover to all alternative medicine, some 40% of modern medicine derives from natural sources, from aspirin for pain and fever, artemisinim and quinine for malaria, and norethindrone for contraception.
Cautionary tale
The danger of the WHO’s approach is that it gives credence to unproven, or demonstrably false, therapies. And the danger of such alternative therapies, provided they are not harmful in and of themselves, is that people might forgo conventional medicine, of which the efficacy and safety has been scientifically established, in favour of an unproven alternative remedy, which essentially means their illness remains untreated.
In many cases, this doesn’t matter much. A cold or a tummy bug will, usually, clear up all by itself (a fact which is often experienced as ‘evidence’ that the quack remedy worked). In the case of serious illness, however, such as cancer, this matters a great deal. The cautionary tale of Steve Jobs is a case in point.
Off the rails
The Gujarat Declaration itself also tries to put one foot in each camp. It starts off promisingly: ‘The role of the World Health Organization (WHO), as the lead United Nations (UN) technical agency on health, is to apply rigorous scientific methods to support Member States in ensuring effectiveness, safety, and equity in the use of Indigenous knowledges, resources and methods, and TCIM [traditional, complementary and integrative medicine] systems, and at the same time to be rigorous in evolving scientific methods to better understand, assess and, where appropriate, apply more holistic, context-specific, complex and personalized approaches for health and well-being.’
That does indeed sound great, although reference to epistemology earlier makes one suspicious about what exactly they consider to be ‘rigorous scientific methods’.
In the very next paragraph, however, they go off the rails: ‘Diverse Indigenous knowledges and TCIM systems of healing, well-being and sustainability are a valuable resource for humanity. They take into account holistic dimensions of health and well-being of people and the planet – individual, physical, mental, social and spiritual – that have been used for centuries. These should be considered alongside other scientific forms of knowledge, to exchange learning and evolve scientific validation of different approaches to improving health and well-being.’
They are not ‘other scientific forms of knowledge’. Knowledge is either scientific, or it isn’t. It is either evidence-based, or it isn’t. If it is, it is medicine. If it isn’t, the WHO has no business recommending it, pushing to have it introduced into tertiary academic curricula, or advocating its integration with national health systems – all of which it does in the declaration.
Referring to ‘knowledges’, as the declaration does, is both patronising and misleading. It attributes to unscientific beliefs a status equal to scientific knowledge. That is a transparent attempt to curry favour with people who cling to those unscientific beliefs as well as the critical theorists among the academic elite who romanticise ancient or folk beliefs. It also misleads the general public into thinking that it doesn’t matter whether knowledge is produced by scientific rigour, or not.
The declaration mentions ‘holistic dimensions of health and well-being’, which is a common marketing claim for alternative therapies, and is meant to impugn conventional doctors by caricaturing them as mere pushers of drugs and surgery, indifferent to and uninterested in the whole person and their circumstances.
This is false. Every doctor I’ve ever met has ‘prescribed’ exercise, spending time in nature, a healthy diet, good sleeping habits, and sound mental health practices, in addition to, or sometimes instead of, treating ailments with medication only.
The declaration talks about ‘science, technology, innovation and knowledge’ in the same breath as ‘contextual, equitable, and culturally appropriate methods,’ which are not part of the scientific method and can, in fact, contradict it.
Four humours
The declaration commits the WHO to ‘[p]rioritize well-being for societies and economies aligned with the time-tested wisdom and values of Indigenous knowledges and TCIM systems, and as also recommended in the WHO global framework for achieving well-being and by the WHO Council on Economics of Health for All, shifting political and economic models beyond profits to promote health and well-being, equity of access, shared benefits, and financial protection, and incentivising adoption of evidence-informed TCIM approaches, making this a driving force in achieving the health-related SDGs towards health and well-being for all.’
Just because a belief has been held for a long time doesn’t mean it is correct.
The humoural theory of disease, which posited that illness is caused by imbalances in the four humours of phlegm, blood, yellow bile and black bile, has roots in ancient Egyptian beliefs.
It became a systematic foundation for medicine around 500BCE, and was ‘time-tested wisdom’ for at least the next 2300 years. It was finally disproven in the 1850s, with the advent of the germ theory of disease, which has held up to the scrutiny of the scientific method ever since.
(Ayurveda, another of the WHO’s pet schools of traditional medicine, still believes that disease is caused by the four humours.)
Left-wing
Another observation to make is that the WHO slyly slipped in a reference to ‘economic models beyond profits’. Its left-wing, anti-capitalist slip is showing.
Much of the progress and prosperity in the developed world in the last several centuries can be attributed to the scientific method, the profit motive, or both. Denigrating profits is a dangerous rejection of the economic system in which modern medicine developed in the first place.
Furthermore, while mining traditional knowledge for medicines that can stand up to scientific scrutiny is admirable, this does not make traditional medicine worthy of being ‘a driving force’ in achieving public health objectives. That’s putting the cart before the horse.
By trying to straddle both the scientific method and ‘traditional knowledges’, the WHO merely creates confusion and legitimises beliefs in unproven remedies and outright fraudulent therapies that it ought to strongly discourage.
If any medicine needs a qualifier, be it ‘traditional’, ‘indigenous’, ‘alternative’, ‘complementary’ or ‘integrative’, it is almost certainly quackery. If it had been scientifically proven to be safe and effective, it would be called medicine.
Even though it kowtows performatively to scientific rigour and evidence-based medicine, for the WHO to uncritically elevate quackery like this does the general public a great disservice.
[Image: A selection of European folk remedies from the Wellcome Collection at the Science Museum, London. Used under the Attribution 4.0 International (CC BY 4.0) licence]
The views of the writer are not necessarily the views of the Daily Friend or the IRR
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