A Cross-Cultural Dialogue on Health Care Ethics

14. Threats from the Western Biomedical Paradigm: Implications for Chinese Herbology and Traditional Thai Medicine

Chapter 14 Threats from the Western Biomedical Paradigm: Implications for Chinese Herbology and Traditional Thai Medicine Edwin Hui, Sumana Tangkanasingh, and Harold Coward In this chapter, two authors explore some of the threats to traditional and folk medicine posed by contemporary Western biomedical policy. Hui articulates these threats in terms of Canadian attempts to regulate Chinese herbology, while Tangkanasingh warns of the difficulties that traditional Thai medicine will have to transcend if it is to survive into the future. The former represents an effort by immigrant Chinese now living in Canada to retain some of their traditional values in the form of the employment of herbs for health maintenance and therapeutic purposes, whereas the latter may be seen as an attempt to preserve a rich tradition of medical practice which consists of strong religio-moral dimensions. Both reflect the intrusion of Western medicine based on the biomedical model into cultures and lifestyles which embrace vastly different values and worldviews with regard to human nature, health, and illness. Coward adds a concluding commentary. 226 Threats from the Western Biomedical Paradigm 227 Canadian attempts to regulate Chinese herbology In Canada, all ingestible substances sold for human consumption, including herbs and botanical products, are classified either as foods or drugs and are regulated under the Food and Drugs Act and Regulations (FDAR). Herbs as drugs As drugs, herbal products generally fall into two major groups (Health Protection Branch 1990). The first group includes herbs listed in pharmacopoeias and major pharmacological reference works, with their properties, dosage, indications and contraindications for use well established. Products containing such herbal ingredients are reviewed in the same manner as other drug products and they are widely available on the market either as prescription drugs (e.g. digitalis, rauwolfia) or non-prescription drugs (e.g. lobelia, belladonna). The second group includes herbs which are not documented in the scientific literature but are traditionally known to be of medicinal use either on an empirical or anecdotal basis. The government considers that many of these references are useful in supporting the acceptability of herbal drug products, providing that the supporting references have not been superseded by more scientific research and study regarding toxicity (e.g. comfrey). In accepting herbal medicine in this second group, the government expects that they will be used for minor selflimiting conditions and prohibits any claims of their usefulness in the prevention or treatment of serious diseases, such as set out in Schedule A of the FDAR, or diseases which are otherwise inappropriate for self-diagnosis and treatment. These herbal medicinal products are to be designated as "Traditional Medicines" and must be labelled in such a way that the consumer should be able to judge the purpose of the product so as to use it appropriately. Furthermore, the government routinely reviews products intended for use in pregnancy, lactation, and childhood, or for use in circumstances where the ingredients might interfere with other medications or pose a hazard to persons with certain chronic physical disabilities. In 1990, the Health Protection Branch published a mechanism for the registration of these herbal medicinal products as "Traditional Herbal Medicines" (THMs) (Health Protection Branch 1990). As part of the registration process, manufacturers must complete an application for each herb for a Drug Identification Number (DIN), and a proposed label must be submitted. In the application, each herbal ingredient must be identified, giving both its common and botanical name, and specifying the part of the plant used as well as the form in which the plant is present (e.g. powdered extract, tincture, etc.). The quantities of each of the herbal ingredients per dosage unit must also be provided. A clean claim or indication for the use of 228 A Cross-Cultural Dialogue on Health Care Ethics the THMs should be presented on the label, and their identities as medicines should be unequivocal in order to discourage a public attitude that they are foods or that they are innocuous just because of their herbal origin, Herbs as foods As foods, herbal products fall into these groups: (i) generally acceptable as foods; (ii) acceptable as foods under specified conditions; and (iii) unacceptable for use in or as foods. A report (1993) prepared by an Expert Advisory Committee on Herbs and Botanical Preparation commissioned by the Health Protection Branch of the Ministry of Health list 74 herbs commonly sold in the market that have been reviewed and considered safe to be consumed...