mechanisms or private insurance programmes exist for traditional healthcare
services, the costs of which are paid out of pocket by the patient.
Efficacy/safety/quality
Efficacy – an adequate evidence base for traditional medical practice
therapies and products
Considerable research effort on the part of the multinational pharmaceutical
industry was devoted during the period 1985–2000 to bioprospecting, guided
by ethnobotanical ‘leads’.^45 This effort for the most part targeted biodiver-
sity-rich countries in Africa, South America and south-east Asia, where tradi-
tional medicines were widely used but had been little investigated as a source
of new therapeutic agents. The purpose was new drug discovery for the treat-
ment of essentially first-world health problems, e.g. lifestyle diseases and
neurodegenerative disorders. The generally adopted approach was that of
bioassay-guided fractionation in order to isolate one or more ‘actives’ that
might lend themselves to laboratory synthesis and/or subsequent structural
modification. An example is the isolation of the alkaloid galanthamine from
BalkanGalanthus(snowdrop) spp. (Amaryllidaceae) and its successful intro-
duction as a treatment for early stage Alzheimer’s disease,^46 following reports
of its use as a traditional remedy for muscular weakness.
Since the year 2000, the main thrust of ethnomedical screening of
African plants appears to have shifted from the domain of the multinational
pharmaceutical industry^47 to that of public research institutions or private
enterprises within individual African states. The focus of this research has
also shifted, with less emphasis on first-world diseases and more on the
major causes of mortality/morbidity in Africa, e.g. malaria, tuberculosis
(TB) and HIV/AIDS. The research approach has, however, remained essen-
tially the same, i.e. one of bioassay-guided fractionation and a search for
individual molecules with therapeutic activity.
An example of a national initiative is the current South African research
and development programme for novel drug development from indigenous
medicinal plants (see http://www.sahealthinfo.org/noveldrug/novelpamphlet.htm)..)
The aim of this programme, which brings together a consortium of three
government agencies (medical, environmental and agricultural) and four local
universities, is the discovery and industrial development of novel therapeutic
agents for the treatment of TB, malaria and diabetes mellitus, as well as the
identification of new immune modulators and tonics. Initially destined to run
over 3 years (2004–6), the programme is on-going and has published some of
its preliminary findings.48,49
A recent example emanating from African private enterprise is the devel-
opment of preparations derived from South African Sceletium(Figure 5.8)
Traditional medical practice in Africa | 103