The World Health Organization concluded its First WHO Traditional Medicine Global Summit on Friday. The conference was co-hosted by the Indian government and held in Gandhinagar, India, where the WHO had set up a Global Centre for Traditional Medicine, with help from $250 million from the Indian government. Unfortunately, as we have long lamented, the WHO has long had a penchant for promoting “traditional medicine,” particularly Traditional Chinese Medicine but also Ayurveda and others, as “evidence-based” and worthy of being “integrated” with science-based medicine, and this conference is just one more example of how far down that road the WHO has gone. To get an idea of how this meeting is being described and promoted by its stakeholders, I refer you to a statement by the Indian government released on August 17, the first day of the summit:
WHO’s first ever Global Summit on Traditional Medicine inaugurated as part of the G20 Health Minister’s Meeting in Gandhinagar, Gujarat.
By embracing ancient wisdom and modern science, we can collectively work towards achieving the health-related Sustainable Development Goals while fostering a ‘One Earth, One Family, One Future’ ethos: Dr. Mansukh Mandaviya.
“In modern times, the demand for natural and herbal-based pharmaceuticals and cosmetics underscores the enduring significance of traditional healing practices.”
“WHO’s Global Centre for Traditional Medicine headquartered in Jamnagar, Gujarat, accelerates advancements in Traditional Medicine globally.”
Traditional Medicine can play a huge role in honouring cultural diversity, empowering communities, and celebrating our shared heritage: Shri Sarbanand Sonowal.
I hope that the Gujarat Declaration, will integrate use of traditional medicines in national health systems, and help unlock the power of traditional medicine through science: Dr. Tedros Adhanom Ghebreyesus, WHO Director-General.
But what does the WHO itself say? Its statement announcing the summit listed the usual examples of medicines that derive from natural products used in some traditional medicine systems and touted how “evidence-based” the summit would be, before stating:
In response to this increased global interest and demand, WHO, with the support of the Government of India, established in March 2022 the WHO Global Centre for Traditional Medicine as a knowledge hub with a mission to catalyse ancient wisdom and modern science for the health and well-being of people and the planet. The WHO Traditional Medicine Centre scales up WHO’s existing capacity in traditional medicine and supplements the core WHO functions of governance, norms and country support carried out across the six regional Offices and Headquarters.
The Centre focuses on partnership, evidence, data, biodiversity and innovation to optimize the contribution of traditional medicine to global health, universal health coverage, and sustainable development, and is also guided by respect for local heritages, resources and rights.
Elsewhere, the WHO writes about its summit:
“Traditional medicine can play an important and catalytic role in achieving the goal of universal health coverage and meeting global health-related targets that were off-track even before the disruption caused by the COVID-19 pandemic,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Bringing traditional medicine into the mainstream of health care — appropriately, effectively, and above all, safely based on the latest scientific evidence — can help bridge access gaps for millions of people around the world. It would be an important step toward people-centered and holistic approaches to health and well-being.”
Does this language sound familiar, particularly the parts about “ancient wisdom”? It is the language used by “integrative medicine” advocates to justify the “integration” of quackery with science-based medicine. Indeed, I immediately harkened back to an article I wrote for this blog nearly a decade ago about how Chairman Mao and his Communist government undertook a very systematic and intentional effort to retcon the history of Traditional Chinese Medicine. I’ll just drop a couple of quotes that I cited in that post for your edification:
“This One Medicine,” exulted the president of the Chinese Medical Association in 1952, “will possess a basis in modern natural sciences, will have absorbed the ancient and the new, the Chinese and the foreign, all medical achievements—and will be China’s New Medicine!”
Sound familiar? “This One Medicine” is about as simple a statement of what “integrative medicine” intends as I’ve ever encountered, and this one is 71 years old. Indeed, the WHO’s rationale that using “traditional medicine” to “bridge access gaps” is exactly the same as one major rationale that Chairman Mao used to promote traditional Chinese medicine. When he took power in the late 1940s, China did not have enough “Western”-trained doctors, leading to the idea of recruiting “traditional healers” (“barefoot doctors”), giving them some basic training in hygiene and more modern medical practices, and sending them to fill in the massive gaps in China’s healthcare system then.
I’ll cite another quote from Alan Levinovitz, whose writings in part inspired my 2014 article, in which he described how Chairman Mao understood that he needed to address the objections of proponents of scientific medicine:
His [Mao’s] solution was a two-pronged approach. First, inconsistent texts and idiosyncratic practices had to be standardized. Textbooks were written that portrayed Chinese medicine as a theoretical and practical whole, and they were taught in newly founded academies of so-called “traditional Chinese medicine,” a term that first appeared in English, not Chinese. Needless to say, the academies were anything but traditional, striving valiantly to “scientify” the teachings of classics that often contradicted one another and themselves. Terms such as “holism” (zhengtiguan) and “preventative care” (yufangxing) were used to provide the new system with appealing foundational principles, principles that are now standard fare in arguments about the benefits of alternative medicine.
I like to say that there is nothing new under the sun when it comes to antivaccine narratives, but it turns out that this principle also applies to narratives used to promote “ancient wisdom” as co-equal with science-based medicine. In essence, the WHO has been engaged in an effort to “scientify” (which I define as the effort to make practices based in prescientific mysticism and pseudoscience appear scientific) all of “traditional medicine,” as Mao tried (and, unfortunately, largely succeeded) to scientify TCM in the 1950s and as the Chinese government continues to do to this day. It’s an effort that has manifest itself in the WHO’s addition of “traditional medicine” diagnoses to the all-important ICD-11, the successor to the currently used ICD-10, a standardized system of alphanumeric codes for diagnoses maintained by the World Health Organization used throughout the world for billing, epidemiology, research, and cataloging causes of death. (Steve Novella described it as the WHO “endorsing quackery,” and he was correct.)
So let’s take a look at this conference. The entire proceedings can be found on video here.
The WHO’s promotion of traditional medicine vs. reality
Several days before the event, I noticed that the WHO had started promoting its summit on X, the social media platform formerly known as Twitter. I’m going to quote some of these Tweets because they reveal some very important things. Here’s the first part of the WHO’s promotion:
In 1969, Tu Youyou was tasked to search for antimalarial drugs. She turned to ancient Chinese #TraditionalMedicine books & discovered artemisinin. In 2015, Tu Youyou was awarded the Nobel Prize for her work on #malaria, which has saved millions of lives.https://t.co/TrcGF8rdeL pic.twitter.com/hqqn1D2idW
— World Health Organization (WHO) (@WHO) August 10, 2023
These are common rationales used by proponents of “traditional medicine,” namely that the existence of medicines derived from plants and other natural products, some of which were used in traditional medicine practices, validates the whole of traditional medicine. Of course, we’ve already discussed the example of Tu Youyou and why her winning the Nobel Prize for the discovery of artemisinin as an effective treatment for malaria does not somehow validate traditional Chinese medicine. Rather, it represented the triumph of natural products pharmacology, not herbalism or Traditional Chinese medicine. As Scott Gavura put it, alone “artemisinin isn’t effective as a treatment – it is eliminated too quickly from the body,” and added that what “finally turned artemisinin into a useful drug and brought this treatment to patients was in fact Big Pharma.”
The WHO continued:
For millions of people around the world #TraditionalMedicine is their first stop for health and well-being.
Which of these have you used?
🍵 Traditional Chinese medicine
☀️ Unani medicine pic.twitter.com/VY9PUq7TMW
— World Health Organization (WHO) (@WHO) August 12, 2023
Aside from the repetition of Chairman Mao’s rationale for using TCM, I must say that it was definitely news to me that homeopathy, naturopathy, and osteopathy are in any way “traditional medicine.” After all, as longstanding readers of this blog know, homeopathy was “discovered” by a German physician named Samuel Hahnemann in the late 18th century, just 227 years ago, making me wonder if it could even qualify as “traditional” European medicine. Naturopathy, too, is European in origin, which alone doesn’t disqualify it as “traditional.” What does disqualify it as “traditional” is that it is an even more recent development than homeopathy, having arisen from the “natural cure” movement in Europe in the 1800s, and only having been named “naturopathy” in 1895, with the first school of naturopathy founded in 1901. As for osteopathy, it was invented in the US in 1874, founded by Andrew Taylor Still, a 19th-century American physician, Civil War surgeon, and Kansas state and territorial legislator.
As for norethindrone, this is an example that I had never seen advocates point to as validation of traditional medicine before, which is why I did a bit of Googling and PubMed searching. It turns out that this is just another example of the WHO citing a natural product that came to be used as a medicine as if that in itself validated “traditional medicine.” Norethindrone was indeed derived from two species of inedible wile Mexican yams, cabeza de negro (Dioscorea mexicana) and barbasco (D. composita), in the local language, and the use of the drug as birth control came about through nothing more remarkable (or “traditional”) than the application of pharmacognosy, the branch of pharmacology devoted to finding compounds in natural products that have medicinal properties.
The promotion continued:
WHO’s #TraditionalMedicine programme aims to build solid evidence base for policies and standards on traditional medicine practices and products, helping countries integrate it into their health systems & regulate its quality.
— World Health Organization (WHO) (@WHO) August 14, 2023
This represents yet another example of putting the cart before the horse. Note how the WHO doesn’t say that it will study traditional medicine to see if it works or to identify specific practices that might work. Rather, it assumes that traditional medicine works and promises to work to “build solid evidence base for policies and standards on traditional medicine practices and products, helping countries integrate it into their health systems & regulate its quality.”
Only after days of promotion, which began a week before the summit, does the WHO get around to caveats:
Listen to Dr Susan Wieland explain how to safely use #TraditionalMedicine.
Find out more in our FAQs:
— World Health Organization (WHO) (@WHO) August 15, 2023
Out of curiosity, I looked at the FAQ referred to above and found more of the WHO putting the cart before the horse, for example:
A remarkable and rapid modernization of the ways traditional medicine is being studied can help realize the potential and promise of traditional medicine and traditional knowledge, for health and well-being. Taking clues from traditional uses, new clinically effective drugs can be identified through research methods such as ethnopharmacology and reverse pharmacology.
The application of new technologies in health and medicine can open new frontiers of knowledge on traditional medicine. Artificial intelligence (AI) has emerged as a game-changer, revolutionizing the study and practice of traditional healing systems. AI’s advanced algorithms and machine learning capabilities can allow researchers to explore extensive traditional medical knowledge, map evidence and identify once elusive trends.
AI…it had to be…AI. Seriously, just as adding AI to homeopathy doesn’t make it any less pseudoscientific (or ridiculous), adding AI to all of traditional medicine will not make it scientific. Notice the assumption, though. The WHO assumes that there is enormous promise in studying traditional medicine and combining it with science-based medicine. This proposition, as lawyers would say, assumes facts not in evidence, and even the WHO’s caveats about traditional medicine are the weakest of weak sauce. For example, I laughed out loud when the WHO asserted, seemingly reasonably, that natural products and traditional medicine practices “must pass the same level of scrutiny as modern pharmaceuticals.” Notice what precedes this statement:
#TraditionalMedicine practices and products must pass the same level of scrutiny as modern pharmaceuticals.
— World Health Organization (WHO) (@WHO) August 16, 2023
That’s right. Only right after pure boosterism for traditional medicine by an athlete does the WHO suggest that traditional medicine should be subject to the same scientific standards as science-based medicine. Here’s the problem. It already has been, for the most part, and been found wanting. I like to quote Dara ÓBriain on herbal medicine:
I’m sorry, ‘herbal medicine’, “Oh, herbal medicine’s been around for thousands of years!” Indeed it has, and then we tested it all, and the stuff that worked became ‘medicine’. And the rest of it is just a nice bowl of soup and some potpourri, so knock yourselves out.
Indeed. Or, to paraphrase an adage, “alternative medicine” that has been show through science to be effective and safe ceases to be “alternative” and becomes just “medicine.” In fairness, we “haven’t tested it all,” but it’s pretty unlikely that there’s much left untested that’s hiding any sort of amazing new treatments and cures, no matter how much the WHO wants this to be so or how much into a pretzel it has to twist the definition of “traditional medicine” in order to include other popular forms of alternative medicine, like naturopathy, homeopathy, and osteopathy. Moreover, any sort of medicine that includes homeopathy as potentially “science-based” is anything but science-based. I strongly suspect that the WHO included these European and American forms of quackery as being somehow “traditional medicine” in order to get European and American advocates of quackery on board with its summit.
A one-sided summit
But what about the summit itself? Let’s just say that my perusal and sampling of some of the talks showed it to be entirely consistent with the WHO’s promotion of traditional medicine and gauzy propaganda videos like this one:
Again, this video is propaganda, not reality.
It is not entirely unreasonable to hold a conference to examine traditional medicine practices and treatments in light of modern science. However, that is not what this is about. As Edzard Ernst was quoted saying in an article published in Nature, although he included his full statement (of which the Nature article only used a brief excerpt) on his blog:
The WHO has a long history of uncritically promoting alternative therapies. The Indian government has recently advocated irresponsibly dangerous nonsense, such as the use of homeopathy for the prevention and treatment of covid infections. The two together make an ominous initiative when it comes to alternative medicine.
Of course, there is nothing wrong in hosting a constructive dialogue about this subject. What seem ill-conceived, however, is the fact that the conference exclusively includes speakers who are staunch proponents of alternative medicine, a subject that, after all, remains highly controversial. Progress is not created by voicing one-sided, biased opinions. I fear that this meeting will result in the often before voiced platitudes and wishful thinking which no true scientist is then able to take seriously.
The Nature article only quoted the last sentence of this statement. Ernst, however, has nailed exactly the problem with this summit and pretty much every other conference held on “integrative medicine”: They are organized by believers in alternative medicine and include as speakers only believers, suffused with this “cart before the horse” mentality, for example, inadvertently described in the Nature article:
Lisa Susan Wieland, director of Cochrane Complementary Medicine at the University of Maryland School of Medicine in Baltimore, and an external adviser for the summit, says that the participants will discuss ways to gather evidence for traditional healing systems.
Wieland says that the quality and quantity of research for traditional medicine needs to improve before conclusive statements can be made about its safety and efficacy. “A lot has changed over the past 15 years,” she says. “Where there was previously insufficient good-quality research to determine what does and doesn’t work, we are now seeing more and better research on some traditional medicine.”
Cochrane Complementary Medicine? I hadn’t known before reading this that there was a Cochrane Complementary Medicine or that it was coordinated at the University of Maryland, an institution that has featured in this blog many times before since very early on for the uncritical promotion of “integrating” quackery into science-based medicine by its Integrative Medicine program. After having read this, I looked at the list of members of the advisory group for this summit. Every single member, from co-chairs Lisa Susan Weiland and Bhushan Patwardhan on down, holds a high-ranking faculty, advocacy, or government position in “integrative” or “traditional” medicine. You might think that if the WHO were truly interested in a science-based approach to studying “traditional medicine” it might include at least a token skeptic or two on the advisory group and among the speakers. It didn’t. That’s because the conclusions of the summit were foreordained before it was even convened.
Again, this is not about using science to study what does and doesn’t work in “traditional medicine.” It is about assuming that traditional medicine is of immense value on par with that of science-based medicine and then looking for evidence to support that conclusion. Again, it’s about putting the cart before the horse, as evidenced by just the titles and descriptions of some of the sessions, such as “Planetary health and well-being for all: Learning from Indigenous knowledges, and traditional, complementary and integrative health systems,” “Integrative health for well—being at all ages,” and “Contribution of Traditional Medicine to Healthcare Systems.” (Also, note the titles of many WHO press releases on the conference, like WHO summit aims to unlock power of traditional medicine through science. and describing its Global Centre for Traditional Medicine as Catalysing ancient wisdom and modern science for the health of people and the planet.) Again, note the assumptions, namely that traditional medicine is an important part of “planetary health and well-being for all” that we have to learn from and that traditional medicine has already made great contributions to the healthcare systems of many nations, if only we would just recognize that. (And, make no mistake, the purpose of this summit is to promote that idea as justification not just for the $250 million spent to found the WHO’s Global Centre for Traditional Medicine but for the continued promotion of traditional medicine and its “integration”—whether science-based practitioners like it or want it or not—into the global health system through the ICD-11 and other means.
Unsurprisingly, the day after the summit ended, the WHO released a statement, Global partners commit to advance evidence-based traditional, complementary and integrative medicine, which concluded pretty much what I expected the WHO to conclude from the day that I learned about this summit, which now seems to have renamed “traditional medicine” to “traditional, complementary, and integrative medicine” (TCIM):
Preliminary findings from the WHO Global Survey on Traditional Medicine 2023 shared at the Summit indicate that around 100 countries have TCIM related national policies and strategies. In many WHO Member States, TCIM treatments are part of the essential medicine lists, essential health service packages, and are covered by national health insurance schemes. A large majority of people seek traditional, complementary and integrative medicine interventions for treatment, prevention and management of noncommunicable diseases, palliative care and rehabilitation.
Dr Bruce Aylward, Assistant Director-General, Universal Health Coverage, Life Course at WHO, highlighted the need for a “stronger evidence base—a WHO priority—to enable countries to develop appropriate regulations and policies around traditional, complementary, and integrative medicine.”
Tell me something I didn’t know 15 years ago, when this blog was founded. Advocates of unproven and disproven treatments always claim that there is “insufficient evidence” and that we need a “stronger evidence base.” The latter statement is one of those vague generalities that is always true to one degree or another. It is something that believers in prescientific and pseudoscientific traditional medicine approachers were saying 20 years ago, when I first became heavily involved in assessing “nontraditional” health claims, that they continue to argue now, and that they will likely continue to argue long after I have shuffled off this mortal coil.
It is thus utterly unsurprising that the WHO press release after the conference concludes:
In closing the Summit, Dr Hans Kluge, WHO Regional Director for Europe said, “Together, we have gently shaken up the status quo that has, for far too long, separated different approaches to medicine and health. By taking aim at silos, we are saying we will collaborate all the more to find optimal ways to bring traditional, complementary and integrative medicine well under the umbrella of primary health care and universal health coverage.” He further added, “We have reiterated how crucial it is to get better evidence on the effectiveness, safety and quality of traditional and complementary medicine. That means innovative methodologies for assessing and evaluating outcomes.”
Dr Shyama Kuruvilla, Senior Strategic Adviser and lead for the WHO Traditional Medicine Global Centre, who also led the organization of the Summit said, “We learnt much about the existing policies, tools and practices. But it is clear we have a long journey ahead in using science to further understand, develop and deliver the full potential of TCIM approaches to improve people’s health and well-being in harmony with the planet that sustains us.”
The Summit’s summary document included conclusions and commitments from participants on wide-ranging issues, from global policy, leadership, innovation, health workforce, data, evidence, monitoring, regulation, legal frameworks and protecting biodiversity and sustainable development.
The WHO and other believers in traditional medicine are now touting the Gujarat Declaration as the key to “integrating” traditional medicine into medicine going forward. Of note, the Gujarat Declaration was referenced in the opening remarks by WHO Director-General Tedros Adhanom Ghebreyesus:
This summit is an important opportunity to advance the understanding and use of traditional medicine.
The Gujarat Declaration—the main outcome of this Global Summit—if effectively implemented, will enhance the appropriate integration of traditional medicine into national health systems.
Let me leave you with three specific requests.
First, we urge all countries to commit to examining how best to integrate traditional and complementary medicine into their national health systems.
Second, I urge you all to identify specific, evidence-based and actionable recommendations that can inform the next WHO traditional medicine global strategy.
Third, I urge you to use this meeting as the starting point for a global movement to unlock the power of traditional medicine through science and innovation.
Once again, my thanks to India for its hospitality and leadership in this area.
Again, note how the purpose of this summit was not to determine whether traditional medicine has value and to demonstrate what does and doesn’t work. Rather, the purpose was to promote the “integration” of “traditional medicine” into science-based medicine and to go looking for evidence to justify that predetermined goal.
Let me suggest something that might seem a bit heretical to the WHO as it exists now. The $250 million spent on its quackery-promoting Traditional Medicine Global Centre would be much better spent on—dare I say?—more traditional public health programs in areas of the world that desperately need them, programs promoting clean water, vaccination, and better nutrition, as well as providing “on-the-ground” public health workers and medical personnel to bring science-based medicine, rather than unproven woo, to the people who need it most. The WHO has done such good work in these areas over the decades, and it saddens me to see it slipping more and more into a mindset that promotes medicine based on mysticism and prescientific religious belief systems, such as TCM and Ayurveda, as somehow being co-equal with science-based medicine to the point that they should be “integrated” with it. That is not promoting “planetary health and well-being for all.” Rather, it is shunting precious global health care funds away from science-based public health and medicine to promote unproven and disproven “ancient knowledge.”