Can conventional Research and Development methods align
with traditional medicine?
A large number of modern-day therapies have had their documented origins
in natural products. These include the popular antimalarial drugs,
quinine and artemisinin from Cinchona and Artemisiaspecies respectively; the heart failure treatment, digoxin fromDigitalis species ; the important pain relief agents codeine and
morphine from Paperver species; anticancer drugs vincristine and
vinblastine from Catharanthus roseus and the pre-surgery
medication, atropine from Atropa belladona 7.
At first blush, the conventional science-based approach to identifying
new therapies seems incongruent with the process by which traditional
medicine is practiced. African traditional medicine provides holistic
treatment. The techniques often derive from the understanding of the
aetiology of disease, as conceived by the practitioners: herbalists,
traditional birth attendants, bone setters, diviners, faith healers and
spiritualists. Their belief that diseases may be caused by spiritual and
esoteric causes as well as physical and psychological
causes8. Following diagnosis, a treatment usually
consisting of a polyherbal remedy is prescribed. In some cases,
individual compounds are responsible for the reputed pharmacological
effect. However, in many cases, the observed pharmacological effects is
due to a mixture of different compounds as well as the holistic approach
of the practitioner.
As scientists, we recognize the benefit of traditional medicine but have
been trained to seek standards, procedures and investigations that would
provide confidence in short and long-term safety and efficacy claims
that align with our own preconceptions of specific safety and efficacy
metrics. This raises a number of questions to be considered:-
Can claims of efficacy be described with the scientific methods that are
already available for conventional R&D?
Could safety claims be under-written by the tests that are already
available for new chemical entities?
What could be the social, economic and political readiness if there is a
need to strictly follow the procedures required by conventional science?
What would be the impact on the established trust and usage by the
communities who depend primarily on traditional medicine?
How could orthodox and traditional healthcare practitioners mutually
learn from each other to benefit their common patient base?
The integration of African natural products into the modern drug
discovery process will require enhanced collaboration among different
stakeholders including the pharmaceutical industry, academic research
units, regulatory bodies, ethics review committees, local, regional,
continental and international organizations. This aligns with the
compromise process that some experts have promoted to facilitate the
integration of traditional and orthodox medicine by recognizing claims
of efficacy, and then attempting to collect as much clinical experience
data as possible, while moving backwards through laboratory evaluations,
preclinical experiments, and targeted clinical studies based on the
learnings (see Table 1). We realize that these are big asks and suggest
that assessments might be prioritized for those traditional therapies
that are widely used or have popular support, and that the goal should
be to support evaluation in clinical trials.
{INSERT TABLE 1 HERE}
We conducted an informal assessment of the COVID-19 clinical trials
registered on https://www.covid-trials.org/ and noted that several
traditional medicines are being examined in clinical trial settings
across the world. The therapies under investigation comprised a diverse
slate ranging from honey, plant products formulated into dosage forms
through to a large number of Chinese Traditional Medicines. We were
especially encouraged to note a trend towards study designs that would
increase confidence in the study outcomes such as blinding processes and
randomisation of participants to the interventions. However, we
acknowledge that the rigour and requirements of clinical trials are
likely to be unaffordable for most investigators and countries, but
suggest that the approach outlined in Table 1, while expediting the
process, might inform future research and future pandemic preparedness.