| Category | Cars |
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| Created | 2020-04-27 | ||||
| Owner | freemexy | ||||
| Title | Herbal medicine research and global health: an ethical analysis | ||||
| Description | Herbal medicine research and global health: an ethical analysis Traditional herbal medicines are naturally occurring, plant-derived substances with minimal or no industrial processing that have been used to treat illness within local or regional healing practices. Traditional herbal medicines are getting significant attention in global health debates. In China, traditional herbal medicine played a prominent role in the strategy to contain and treat severe acute respiratory syndrome (SARS).1 Eighty per cent of African populations use some form of traditional herbal medicine,2,3 and the worldwide annual market for these products approaches US$ 60 billion.2 Many hope traditional herbal medicine research will play a critical role in global health. China, India, Nigeria, the United States of America (USA) and WHO have all made substantial research investments in traditional herbal medicines.2 Industry has also invested millions of US dollars looking for promising medicinal herbs and novel chemical compounds.4,5 This is still a relatively modest investment compared to the overall pharmaceutical industry; however, it raises interesting ethical questions, some of which are not faced in more conventional drug development.To get more news about herbal medicine, you can visit shine news official website. As attention and public funding for international traditional herbal medicine research collaborations grows, more detailed analysis of ethical issues in this research is warranted. Scant literature has addressed selected issues such as informed consent and independent review related to traditional herbal medicine research.6,7 Here we apply a practical, comprehensive and widely accepted ethical framework to international traditional herbal medicine research.8 We examine in detail difficult questions related to social value, scientific validity and favourable risk–benefit ratio. We conclude with implications for future research in this area, focusing on the importance of collaborative partnership. Case A government agency from a developed country is conducting an HIV-treatment trial in Africa. A traditional herbal medicine, Africa Flower, has been used for decades to treat wasting symptoms associated with HIV. Local traditional medicine healers believe Africa Flower is an effective antiviral. It is already widely used for immune boosting in AIDS. In vitro pharmacokinetic studies suggest potential interference with vaccines, and animal models show liver toxicity at very high doses. There are no systemic side-effects reported for humans in the literature. A few case series have shown mixed results. Local leaders are requesting the government agency conduct a large, randomized controlled trial (RCT) of Africa Flower to test its efficacy as a novel adjunctive therapy to slow progression to AIDS. Ethical framework Cases like these present challenging questions related to the role of traditional herbal medicines in public health. In general, international research on traditional herbal medicines should be subject to the same ethical requirements as all research related to human subjects.9 An ethical framework previously outlined by Emanuel et al. and revised for international research8 offers a useful starting point for thinking about the ethics of international traditional herbal medicine research. This framework includes eight ethical requirements for clinical research (Table 1).8 These ethical requirements are universal and comprehensive but must be adapted to the particular social context in which the research is implemented.8 Of these, fair subject selection, independent review, informed consent, and respect for enrolled subjects have been discussed previously in the literature on the ethics of global health research and raise few issues unique to international traditional herbal medicine research.8 However, social value, scientific validity, and favourable risk–benefit ratio raise specific challenges in international herbal medicine research that have not been adequately discussed. Social value All research should hold the potential to achieve social value. Different entities may view the social value of traditional medicine research differently. Public-health officials are often eager to define the safety and effectiveness of herbal medicines for conditions such as malaria.3 Conversely, harm can arise with the unscrupulous use of herbs such as Africa potato (various Hypoxis species).7 While some claim that such medicines have “stood the test of time”, they nonetheless pose serious challenges to investigators and regulators from developed countries, in which standards of proof are closely linked to proven efficacy in RCTs. Accordingly, there has been a serious investment in herbal medicine research by public-health bodies in many countries. China recently launched a safety research programme focusing on herbal medicine injections from traditional Chinese medicine.10 South Africa recently included the need for investigating traditional medicines within its national drug policy.11 In the USA, the National Center for Complementary and Alternative Medicine at the National Institutes of Health spent approximately US$ 33 million on herbal medicines in fiscal year 2005; in 2004 the National Cancer Institute committed nearly US$ 89 million to studying a range of traditional therapies.12 While this scale of investment pales in comparison to the total research and development expenses of the pharmaceutical industry, it nevertheless reflects genuine public, industry and governmental interest in this area. While public-health entities may be concerned with defining the risks and benefits of herbal medicines already in use, entrepreneurs and corporations hope herbal medicines may yield immediate returns from herbal medicine sales, or yield clues to promising chemical compounds for future pharmaceutical development. They test individual herbs, or their components, analysed in state-of-the-art high-throughput screening systems, hoping to isolate therapeutic phytochemicals or biologically active functional components. In 2006, Novartis reported that it would invest over US$ 100 million to investigate traditional medicine in Shanghai alone.4,5 Nongovernmental organizations may be primarily interested in preserving indigenous medical knowledge. One such organization, the Association for the Promotion of Traditional Medicine (PROMETRA), based in Dakar, Senegal, is “dedicated to preserving and restoring African traditional medicine and indigenous science”.13 Governments in developing countries may want to use traditional herbal medicine research to expand the influence of their culture’s indigenous herbal practices in the global health-care market. For instance, Nigeria’s president recently established a national committee on traditional medicine with the expressed desire to boost Nigeria’s market share of traditional medicine.14 In developed countries, the “need” for this research may be to protect the public. The perceived need for the research may justifiably differ across countries, but without some basic agreement on the primary source of social value for the research it may be difficult to judge its ultimate impact. In the Africa Flower case above, before agreements to study a herbal medicine are decided, partners must fully discuss potential differences about the perceived “need” for the research through public forums or structured debates. Based on these frank discussions, partners can assess whether the social values of partner countries are sufficiently compatible to warrant a research partnership. | ||||
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| Broken | No | ||||
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| Promotion level | None | ||||
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