Recently the World Health Organization published their guidelines on traditional medicine, actually referring to the category of “traditional, complementary and integrative medicine (TCIM) practices.” As has long been the case, there are some good parts to their approach, but also some concerning aspects, and at times it feels self-contradictory.
The problems begin with their definition. I dislike lumping traditional, complementary, and integrative into one category. I understand the concept of “traditional” medicine – beliefs, philosophies, and practices of medicine in traditional uses in a culture prior to the advent of scientific medicine. Traditional practices are still in wide use in many parts of the world, and understanding them can be very beneficial. They should be studied and hopefully regulated.
“Complementary” medicine, however, is a marketing slogan. It assumes the practices in question complement (implying in a helpful way) scientific medicine. The same it true for “integrative” medicine, as if there is utility to integrating the practices in question. Also, both terms imply that the methods are not being used instead of scientific medicine, but in practice this is often not the case.
What this framing does is allow the peddlers of fantastical, unscientific, and even disproven therapies to ride the coattails of traditional methods, which they do for marketing purposes. Here is how the WHO defines traditional methods – “Traditional medicine emphasizes nature-based remedies and holistic, personalized approaches to restore balance of mind, body and environment.”
This definition is, in my opinion, mostly propaganda. First, what does “nature-based” mean? There is no meaningful operational definition of “natural”, and such appeals are often little more than the appeal to nature fallacy. I also challenge the notion that they are “holistic”, which means that they address all aspects of health and illness. The opposite is often the case – they are based on narrow philosophies that ignore vast swaths of biology, mechanisms of illness, and possible interventions. Modern medicine is far more holistic than any TCIM approach.
Often, prescientific philosophies of medicine and TCIM methods take an overly simplistic view of health. They often are based one “the one cause of all disease” approach, or boil down the complexities of biology into a simple (and incorrect) system. Acupuncture is all based on manipulating chi, for example. Pulse diagnosis thinks that all health conditions are reflected in patterns in the pulse. Many are variations of the life force or the four humors. This is not holistic.
The part about personalized approaches may be true sometimes (not universally), but as implemented by TCIM methods can be a double-edged sword. First, individual treatment is only helpful if the factors on which you are individualizing the treatment are real. Homeopathic treatments can be “individualized” but based entirely on fantasy. Often the individualization is a bug not a feature – the traditional approach does not recognize the basic concept of disease, that there are specific mechanisms of illness that can be shared across individuals. Rather, everyone has their own particular “illness”. This may be individualized, but it is contrary to science and not helpful.
Similarly, restoring balance may be a good thing, but what, exactly, are you balances. If you are balancing things that don’t actually exist, like ying and yang (like the humors), it’s not helpful. “Balance” is an ancient concept, and is overly relied upon in pre-scientific philosophies. If you think the only thing that can possibly be wrong with someone’s health is that they are out of balance, that is likely not to be effective or holistic.
But all these terms are great marketing terms, which is why modern alternative medicine promoters like them, and tying them to ancient traditional methods is just more good marketing. So the WHO, whether intentionally or not (I guess it depends on who was involved in creating these statements) is promoting modern snake oil in the guise of studying traditional medicine.
Elsewhere, the WHO statement gets it right. They state:
“Integration of TCIM within national health systems must be done appropriately, effectively, and safely, based on the latest scientific evidence. WHO supports countries that want to embrace traditional medicine practices to do so in a science-based manner to avoid patient harm and ensure safe, effective, and quality health care. An evidence-based approach to traditional medicine, establishing efficacy and safety through rigorous scientific validation, is crucial, even if they have been used for a long period. This not only guarantees that treatment is effective and safe, but provides the rigorous evidence needed for the recommendation of traditional medicine in WHO guidelines.”
It’s hard to disagree with any of this. If this were truly their focus, that would be great. And I agree – we should rigorously study widely used traditional methods. But then what do we do with the results? Are there any cases of the WHO condemning and working for stopping traditional methods that are shown to lack efficacy? If evidence can only be used to support methods, that is not sufficient. It’s even counterproductive, acting like a ratchet to promote questionable methods.
Later in the same statement they write: “Therapies like acupuncture, herbal medicine, and yoga are increasingly used alongside biomedical interventions to ease pain, reduce side effects, and improve quality of life for chronic conditions.”
I understand that the WHO is trying to leverage existing traditional medicine infrastructure to get effective treatments to people who lack access to modern biomedicine. I also get that they are trying to be respectful to local cultures and traditions. They do need to take a global perspective. And I applaud their stated dedication to a scientific approach. In the past they have even taken hard stances against things like homeopathy (although under pressure from scientists).
Unfortunately at times they fall victim to pro-CAM propaganda and the clever marketing of shoddy research.
