Ending medical dominance over the developing world
Traditional medical cultures need a true partnership with modern medicine, say Bhushan Patwardhan, Gerard Bodeker and Darshan Shankar.
Despite the huge advances in modern medicine, most people in the developing world still rely on traditional — and effective — knowledge to treat illness and disease.
Its value in providing affordable healthcare has been recognised by the WHO, and now national and international policymakers are calling for partnerships between modern and traditional medicine to help bridge the equity gap in global public health.
But the two are fundamentally different: whereas traditional knowledge tends to be freely accessible (if culturally specific), modern knowledge is fiercely guarded by a rigid patent system, and dominates thinking in the developed world.
In the face of these differences, how can, or should, we build partnerships?
Urge to protect knowledge
Too often, past interactions have been marked by exploitation. Western biomedical scientists frequently see traditional knowledge as nothing more than an underexploited resource waiting to be systematically prospected and improved.
Such 'biopiracy' has led many developing countries to focus on ways of protecting, rather than promoting, their traditional knowledge.
For example, some South American regions have tried legislating against biopiracy but have struggled to implement laws at a national or international level (see Peruvian region outlaws biopiracy).
Several countries have reorganised their traditional knowledge into systems that Western patent offices can reference for 'prior art' — existing inventions already in the public domain. India's Traditional Knowledge Digital Library (TKDL), for example, is one of the most sophisticated protective responses to the concerns of biopiracy (see BioMed Analysis: Keep traditional knowledge open but safe).
Still others use an approach known as access and benefit sharing (ABS). This provides convenient access to traditional knowledge but demands, in return, a fair share of benefits arising from the modified use of traditional products.
For example, the Kani tribal community in Kerala receives funds from an Indian pharmaceutical manufacturer for its contribution to commercialising an anti-stress drug known as Jeevani.
But the Kani case is an exception rather than the rule andthe truth is that many operational and conceptual issues concerning ABS remain unresolved.
We need a better way of balancing the interests of researchers wanting to develop traditional knowledge for modern medicine and the indigenous custodians of that knowledge, who are entitled to a fair share of any rewards.
In essence, we need an integrative knowledge system that acknowledges the epistemological differences between traditional knowledge and modern science.
And the real challenge will be to establish norms for cross-cultural interactions.
For example, it is ethically and legally important that scientists acquire informed consent from custodians of traditional knowledge — but what else? When is it appropriate for custodians to deny their consent? In some cases, denial may not be simply related to unfair commerce or trade but might also be based on epistemological incompatibility.
Take, for example, the case of Indian long pepper. It is used in several formulations in the Indian Ayurvedic tradition to enhance bioavailability and assimilation of another drug, and a commercial formulation of the plant's active ingredient, piperine, is now being used to reduce dosages of the drug rifampicin in tuberculosis treatments.
According to traditional knowledge, to avoid side effects the plant should not be used for more than 40 consecutive days. But tuberculosis treatments must be taken for much longer than this. Should Ayurvedic physicians permit such misuse of their traditional knowledge?
A holistic approach
For integrated knowledge systems to work, they will also have to include the full range of traditional treatments, including yoga, detoxification therapies and therapeutic diets.
These have largely been excluded from existing ABS debates, yet they play an increasing role in global public health. The global spa industry, for example, draws heavily on Asia's healing traditions, with Ayurvedic and Chinese therapies often incorporated into spa regimens across the world.
The value of the global spa industry was put at US$255 billion in 2007 — so if companies are profiting from indigenous traditions, they should give something back to the cultures that held the knowledge.
This need not necessarily mean only money. For example, corporate social responsibility programmes could support the revival of local traditions, encourage the development of micro-enterprises related to traditional knowledge, and promote fair trade practices for the purchase and export of traditional health products and ingredients.
Ending Western domination
Creating an integrative knowledge system has the further challenge of the developed world's domination, especially over Asian knowledge bases. Why is modern biomedicine so frequently considered superior to traditional medicine?
In fact, research from one of our groups has shown that the Ayurvedic concept of 'prakriti' — seeing the individual as a whole — has greatly helped biomedical researchers understand new disciplines such as pharmacogenomics (how an individual's genetic makeup influences response to a drug).
There is greater appreciation now among scientists for the concept of traditional knowledge guiding biomedicine, rather than scientific methods being used as a tool to prove or disprove traditional concepts and practices.
An integrative knowledge system that builds on such appreciation could drastically improve public health. It could even reverse the direction of knowledge flow in the world of modern science.
Instead of science mining natural resources for new ingredients, traditional knowledge could reshape the scientific world by offering novel paradigms and solutions that will broaden outlooks and offer holistic solutions.
Bhushan Patwardhan is director designate of the Institute of Ayurveda and Integrative Medicine (IAIM) in Bangalore, India.
Gerard Bodeker is adjunct professor of epidemiology at Columbia University, New York, and a senior clinical lecturer in public health at the University of Oxford, United Kingdom.
Darshan Shankar is founder director of the Foundation for Revitalisation of Local Health Traditions (FRLHT), Bangalore.