Recognising traditional health systems
It's time to consign to history the idea that traditional medical systems have nothing to offer modern medical science, says Antony Taubman of the World Trade Organization.
From a cursory, modernist perspective, traditional medical knowledge might be dismissed as a relic of antiquated cultures, bereft of the intellectual illumination of the Age of Enlightenment.
But as medical research continues to draw insights from traditional medicine, and as the patent system has come methodically to recognise systems of traditional knowledge, it is hard to argue for a fundamental divide between 'modern' and 'traditional' knowledge.
The WHO reports that 80 per cent of people in some countries rely on traditional medicine for their primary healthcare. The organisation has established a strategy for integrating traditional medicine into national healthcare systems. Obviously, so-called 'alternative' medicine is in fact mainstream to many.
Many modern drugs are, of course, rooted in the insights of traditional practitioners. Hippocrates himself — who helped set clinical medicine on an empirical footing and first codified the ethical responsibilities of physicians — prescribed willow bark for pain and fever, paving the way towards aspirin. He was also a progenitor of the Unani school of traditional medicine, widely practiced in South Asia.
Competing or complementary objectives?
The solid empirical basis of much traditional knowledge extends over many generations and provides scientific insights for even the most sceptical of modern researchers. But traditional knowledge should be seen as systems of knowledge — ways of organising and analysing facts, and developing appropriate treatments, not just as veins of raw data to be mined.
Any erosion or loss of traditional knowledge systems will be felt by all. They offer potential pathways to meeting future health challenges which we cannot afford to neglect.
But the loss would be felt more directly by the communities themselves who maintain traditional medical systems, not only for practical health care, but also as part of their cultural identities. The recent UN Declaration on the Rights of Indigenous Peoples recognises the right to maintain, control, protect and develop traditional knowledge, including medicines, and to maintain traditional health practices.
Yet when traditional medicine is documented, and is used in medical research, charges often arise of misappropriation and lack of respect for its roots — risking tension between protecting knowledge in its traditional context and promoting its wider use and dissemination.
Can these objectives — to preserve, protect and promote — be compatible?
It depends on building partnerships based on respect and clarity about the relevant rights. Knowledge is made to be shared — but showing respect for traditional knowledge systems will ensure their sustainable use in research and development.
Protect and preserve…
Put simply, preservation without protection does not work.
Many initiatives are under way to collect, record and document traditional knowledge, and disseminate it through databases and publications. But these preservation efforts can expose knowledge systems to further erosion, as they can fuel concerns about misappropriation. The tools of the information age can unwittingly strip knowledge of its intellectual and legal context.
And traditional custodians will be reluctant to share knowledge with drug developers unless they are confident that their interests and values will be respected.
In any case, an accumulation of raw data will be of limited value unless we also sustain the systems of knowledge that give the data its full meaning.
The bare fact that a plant has an identified medicinal property can be practically useless — positively misleading in fact — unless we also know how and where that plant is cultivated, how an extract is prepared and administered, how it interacts with other treatments and what the lessons are from clinical experience. The glut of uprooted data may unwittingly obscure the fact that we are losing the systems of knowledge that enable us to make sense of it.
…and vice versa
Protection without preservation does not work, either. Focusing exclusively on the legal rights of custodians and the liabilities of knowledge users at a global level will not in itself ensure the continuing vitality of local knowledge systems.
To do that requires a truly global effort — built around respect for tradition and its cultural and intellectual underpinnings — to strengthen communities as the fulcrum of traditional knowledge systems.
The good news is that this is already starting to happen. Many grassroots initiatives have developed practical and legal solutions to the challenge of preserving traditional knowledge, and are increasingly recognised in international policy debate.
These initiatives show that the modern and traditional need not clash. The tools of the information age can reinforce, rather than erode, the local character of knowledge systems.
In fact, the latest information technologies are often the best suited to preserving and transmitting the most ancient of oral cultures — the flexibility of data formats allows the local, cultural and individual context to be preserved along with 'hard' data.
For example, the Tulalip Tribes in the United States have developed a Cultural Stories database, preserving oral narrative traditional practices and ecological context within flexible data structures based on the customary law requirements that govern how knowledge should be maintained and shared. This kind of community experience has informed the work of the World Intellectual Property Organization (WIPO) towards international solutions.
Morals, culture — and science
And a moral instinct that the originators and custodians of traditional medicine deserve respect, recognition and an equitable share of downstream benefits is gradually gaining a concrete legal dimension. The 1992 Convention on Biological Diversity established the objective of equitable sharing of benefits from the use of genetic resources. Negotiators are currently at work on an international regime to advance this objective for genetic resources and associated traditional knowledge, recognising that the value of genetic resources and traditional knowledge are intertwined.
Perhaps it is time to consign to cultural history the notion that traditional knowledge systems are at odds with the ideals of modern science. We cannot afford to overlook the solid empirical basis of much traditional knowledge and its roots in the practical experience of its custodians, just as we cannot dismiss the cultural and intellectual strengths of these traditions.
A strengthened recognition of these systems may indeed help us to a new age of medical enlightenment, in which diverse intellectual heritages build a common basis for promoting the health of all — and not a kind of dark age characterised by the loss of entire ways of working with knowledge.
Antony Taubman is director of the Intellectual Property Division at the World Trade Organization, and previously led WIPO's program on traditional knowledge. This comment is provided in a personal capacity and is not an official view of the WTO, its secretariat or its members.