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The Globalization of Traditional Medicine in Northern Peru: from Shamanism to Molecules

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The Globalization of Traditional Medicine in Northern Peru: from Shamanism to Molecules Hindawi Publishing Corporation Evidence-Based Complementary and Alternative Medicine Volume 2013, Article ID 291903, 46 pages http://dx.doi.org/10.1155/2013/291903 Review Article The Globalization of Traditional Medicine in Northern Peru: From Shamanism to Molecules Rainer W. Bussmann WilliamL.BrownCenter,MissouriBotanicalGarden,P.O.Box299,St.Louis,MO63166-0299,USA Correspondence should be addressed to Rainer W. Bussmann; [email protected] Received 30 August 2013; Accepted 22 October 2013 Academic Editor: Narel Paniagua Copyright © 2013 Rainer W. Bussmann. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Northern Peru represents the center of the Andean “health axis,”with roots going back to traditional practices of Cupisnique culture (1000 BC). For more than a decade of research, semistructured interviews were conducted with healers, collectors, and sellers of medicinal plants. In addition, bioassays were carried out to evaluate the efficacy and toxicity of plants found. Most of the 510 species encountered were native to Peru (83%). Fifty percent of the plants used in colonial times have disappeared from the pharmacopoeia. Market vendors specialized either on common and exotic plants, plants for common ailments, and plants only used by healers or on plants with magical purposes. Over 974 preparations with up to 29 different ingredients were used to treat 164 health conditions. Almost 65% of the medicinal plants were applied in these mixtures. Antibacterial activity was confirmed in most plants used for infections. Twenty-four percent of the aqueous extracts and 76% of the ethanolic extracts showed toxicity. Traditional preparation methods take this into account when choosing the appropriate solvent for the preparation of a remedy. The increasing demand for medicinal species did not increase the cultivation of medicinal plants. Most species are wild collected, causing doubts about the sustainability of trade. 1. Introduction of visits to providers of complementary-alternative medicine (CAM)nowexceedsbyfarthenumberofvisitstoallprimary Traditional medicine is used globally and has a rapidly care physicians in the US [1–3]. growing economic importance. In developing countries, tra- Complementary-Alternative Medicine is becoming more ditional medicine is often the only accessible and affordable and more popular in many developed countries. Forty-eight treatment available. In Uganda, for instance, the ratio of tra- percent of the population in Australia, 70% in Canada, 42% ditional practitioners to the population is between 1 : 200 and in the US, 38% in Belgium, and 75% in France have used 1:400,whiletheavailabilityofWesterndoctorsistypically Complementary-Alternative Medicine at least once [4–6]. A 1 : 20,000 or less. Moreover, doctors are mostly located in surveyof610Swissdoctorsshowedthat46%hadusedsome cities and other urban areas and are therefore inaccessible to rural populations. In Africa, up to 80% of the population form of CAM, mainly homeopathy and acupuncture [7]. In uses Traditional Medicine as the primary healthcare system. the United Kingdom, almost 40% of all general allopathic In Latin America, the WHO Regional Office for the Americas practitioners offer some form of CAM referral or access [8]. (AMRO/PAHO) reports that 71% of the population in Chile In the US, a national survey reported the use of at least 1 of and40%ofthepopulationinColombiahaveusedTraditional 16 alternative therapies increased from 34% in 1990 to 42% in Medicine. In many Asian countries, Traditional Medicine is 1997 [9, 10]. widely used, even though Western medicine is often readily The expenses for the use of Traditional and Comple- available. In Japan, 60–70% of allopathic doctors prescribe mentary-Alternative Medicine are exponentially growing in traditional medicines for their patients. In China, Traditional many parts of the world. In Malaysia, an estimated US $500 Medicine accounts for about 40% of all healthcare and is used million is spent annually on Traditional Medicine, compared to treat roughly 200 million patients annually. The number to about US $300 million on allopathic medicine. The 1997 2 Evidence-Based Complementary and Alternative Medicine out-of-pocket Complementary-Alternative Medicine expen- the 90s delineates problems related to the production of diture was estimated at US $2,700 million in the USA. phytopharmaceuticals in Peru. In Australia, Canada, and the United Kingdom, annual Complementary-Alternative Medicine expenditure is esti- (i) Lack of national policies. mated at US $80 million, US $2,400 million, and US $2300 (ii) Absence of state and local policies that include medic- million, respectively. The world market for herbal medicines inal plants. based on traditional knowledge was estimated at US $60,000 (iii) Lack of support by the state. million in the late 1990s [11]. A decade later, it was around (iv) Lack of support from the medical establishment. US $60 billion [12]withestimatesfor2015atUS$90billion [13]. The sales of herbs and herbal nutritional supplements in (v) Ignorance of the benefits of the phytopharmaceutical the US increased to 101% between May 1996 and May 1998. industry. The most popular herbal products included Ginseng (Ginkgo (vi) Limited human and technical resources. biloba), Garlic (Allium sativum), Echinacea spp., and St. John’s (vii) Lack of technical knowledge for the production of wort (Hypericum perforatum)[11]. herbal products. Traditional and complementary-alternative medicine are gaining more and more respect by national governments and (viii) Ignorance of methods and processes of quality control health providers. Peru’s National Program in Complemen- and standardization. tary Medicine and the Pan American Health Organization (ix) Problems in obtaining quality materia prima in ade- recently compared Complementary Medicine to allopathic quate quantities and predatory collecting. Medicine in clinics and hospitals operating within the Peru- (x) Absence of conservation policies implementing culti- vian Social Security System. A total of 339 patients—170 being vation of herbals under best conditions. treated with Complementary-Alternative Medicine and 169 with allopathic medicine—were followed for one year. Treat- (xi) Limited research in ethnobotany, agrotechnology, ments for osteoarthritis; back pain; neurosis; asthma; peptic pharmacy, and therapeutic validation. acid disease; tension and migraine headache; and obesity (xii) Lack of legal parameters for sanitary controls and wereanalyzed.Theresults,with95%significance,showed commercialization of herbal products. that the cost of using Complementary-Alternative Medicine (xiii) Vested interests of the pharmaceutical industry min- was less than the cost of using Western therapy. In addition, imizing the importance of herbs which are not the for each of the criteria evaluated—clinical efficacy, user product of their own research and development. satisfaction, and future risk reduction—Complementary- Alternative Medicine’s efficacy was higher than that of con- Dr. Fernandez´ also discusses a decreasing trend in Latin ventional treatments, including fewer side effects, higher American consumption of medicinal products from 8% of perception of efficacy by both the patients and the clinics, globalconsumptionin1980to5%in1990.Heattributes and a 53–63% higher cost efficiency of Complementary- this reduction to decreased government distribution of free Alternative Medicine over that of conventional treatments for medicines to the poor, concentrated wealth in a few hands, the selected conditions [14]. and increased poverty. Another factor is the fact that devel- According to WHO [3], the most important chal- opednationsspendamuchhigherpercentageofGDPon lenges for Traditional Medicine/Complementary-Alternative medicines (6–8%) than developing nations (1-2%) where it Medicine for the next years are as follows. is estimated that 2/3s of medicines purchased are paid for by the patients. And per capita spending is much higher (i) Research into safe and effective Traditional Medicine in developed nations compared with developing countries, and Complementary Alternative Medicine treat- for example, Japan: US $276; Germany: US $148; USA: US ments for diseases that represent the greatest burden, $128; Argentina: US $42; Uruguay US $40; Paraguay: US $18; particularly among poorer populations. Brazil:US$10.5;andBoliviaUS$4.Therearenofiguresfor (ii) Recognition of the role of Traditional Medicine Peru,butitisestimatedtobeslightlyabovetheamountfor practitioners in providing healthcare in developing Bolivia. Overall, it is estimated that 50% of the population of countries. Latin America has little or no access to medicines and that a (iii) Optimized and upgraded skills of Traditional large portion of these people use medicinal plants. Medicine practitioners in developing countries. An innovative response to the challenges listed above has been developed by the Centro de Medicina Andina (CMA) (iv) Protection and preservation of the knowledge of founded in Cuzco in 1984 as an autonomous branch of the indigenous Traditional Medicine. Instituto Pastoral Andina (IPA). Started by Catholic health- (v) Sustainable cultivation of medicinal plants. care workers with extensive experience in Quechua commu- (vi) Reliable information for consumers on the proper nities, CMA’s pragmatic methodology involves
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