Traditional medicine merits rigorous evaluation, not wholesale dismissal

Agreement: I Agree Body: Dear Editor, Philips and colleagues are correct that traditional or complementary medicine should not be incorporated into routine clinical care without robust evidence of safety and net clinical benefit. Their concerns regarding adulteration, hepatotoxicity, herb–drug interactions, and the replacement of effective treatment with unproven remedies are serious and demand rigorous regulatory oversight. [1,2] However, the broader conclusion that traditional medicine is largely "unproven," and therefore unworthy of integration, risks overlooking important scientific and public-health considerations. Three points temper that conclusion. First, traditional knowledge is a productive source of therapeutic hypotheses, and natural products more broadly remain a major source of medicines. In Newman and Cragg's analysis of 1394 small-molecule drugs approved worldwide between 1981 and 2019, 32% were natural products, botanical drugs, or direct natural-product derivatives, rising to roughly half once synthetic drugs modelled on natural-product structures are included.[3] The WHO likewise notes that many modern medicines from aspirin to treatments for childhood cancer derive from nature and traditional knowledge.[4] Artemisinin, the editorial's own example, illustrates the pathway: Tu's team reviewed some 2000 traditional formulations and prepared around 380 extracts, and a classical reference to qinghao supplied the decisive lead, though the drug entered practice only after isolation, pharmacological work, and clinical testing.[5] Historical use generates leads; validation makes medicines. Dismissing the source knowledge as merely "prescientific" discards a fertile starting point. Second, the clean dichotomy of "unproven tradition" versus "proven medicine" does not hold, particularly in prevention. Tai chi, a traditional Chinese mind–body practice, reduces falls in older adults across several meta-analyses of randomised trials (pooled risk ratios around 0.8) and features in falls-prevention guidance.[6] Yoga produces modest reductions in blood pressure. Where large populations already use such approaches as in India and China, which incorporate them into preventive and primary care the pragmatic public-health priority is to strengthen quality, safety, and evidence, rather than to withhold low-cost, accessible interventions with a reasonable safety profile. Third, some effects of complex, multi-component interventions may simply not have been measurable with earlier tools. The human gut microbiome scarcely existed as a research field 15 years ago; a purgative procedure such as Virechana would then have been easy to dismiss. A controlled clinical trial now reports that a Panchakarma-based intervention produces statistically significant changes in plasma phosphatidylcholines and sphingomyelins within six days [7] biological effects that were previously difficult to capture. Whether these are mediated by the microbiome or by diet and other components is unresolved, and the evidence is preliminary; that argues for continued study, not a "pseudoscience" verdict that forecloses it. Reductionist single-target assays are ill-suited to such interventions, and network-pharmacology and multi-omics methods are expanding what can be investigated. None of this lowers the evidentiary bar: clinical recommendations still require reliable evidence that benefits outweigh harms, and different designs suit different stages of evaluation. Harms from intrinsic toxicity, contamination, adulteration, or herb–drug interactions are real and demand pharmacovigilance, quality control, and transparent adverse-event reporting, standards that should apply equally across all therapeutic modalities. The relevant question is not whether an intervention is traditional or modern, but whether it withstands transparent, reproducible evaluation. Judged that way, traditional medicine is neither vindicated nor safely dismissed as a whole: it is an under-examined source of leads, a provider of some already-validated tools, and an evidence base that modern methods are only beginning to interrogate. Patients are best served by investment and safeguards, not by closing the question prematurely. References 1. Philips CA, Caulfield T, de Jong C, Qi X, Chethipadath Narayan D. WHO's misguided push for complementary and alternative medicine. BMJ 2026;393:e100062. 2. World Health Organization. WHO global traditional medicine strategy 2025–2034. Geneva: World Health Organization; 2025 accessed on 11 July 2026 3. Newman DJ, Cragg GM. Natural products as sources of new drugs over the nearly four decades from 01/1981 to 09/2019. J Nat Prod 2020;83:770–803. 4. World Health Organization. Traditional medicine has a long history of contributing to conventional medicine and continues to hold promise [feature story]. Geneva: WHO; 2023. Accessed on 10 July 2026 5. Tu Y. The discovery of artemisinin (qinghaosu) and gifts from Chinese medicine. Nat Med 2011;17:1217–20. 6. Lomas-Vega R, Obrero-Gaitán E, Molina-Ortega FJ, Del-Pino-Casado R. Tai Chi for risk of falls: a meta-analysis. J Am Geriatr Soc 2017;65:2037–43. 7. Peterson CT, Lucas J, St John-Williams L, Thompson JW, Moseley MA, Patel S, et al. Identification of altered metabolomic profiles following a Panchakarma-based Ayurvedic intervention in healthy subjects: the Self-Directed Biological Transformation Initiative (SBTI). Sci Rep 2016;6:32609. No competing Interests: Yes The following competing Interests: Electronic Publication Date: Saturday, July 11, 2026 - 03:28 AI use: No, I have not used AI Highwire Comment Subject: WHO’s misguided push for complementary and alternative medicine Workflow State: Released Full Title: Traditional medicine merits rigorous evaluation, not wholesale dismissal Highwire Comment Response to: WHO’s misguided push for complementary and alternative medicine Check this box if you would like your letter to appear anonymously:: Last Name: Goel First name and middle initial: Sumeet Email: drsumeet.goel@aiia.gov.in Address: North Goa, India Occupation: Associate Professor Other Authors: Devesh Tewari, Assistant Professor, Delhi Pharmaceutical Sciences and Research University Affiliation: All India Institute of Ayurveda BMJ: Additional Article Info: Rapid response

Agreement: I Agree Body: Dear Editor, Philips and colleagues are correct that traditional or complementary medicine should not be incorporated into routine clinical care without robust evidence of safety and net clinical benefit. Their concerns regarding adulteration, hepatotoxicity, herb–drug interactions, and the replacement of effective treatment with unproven remedies are serious and demand rigorous regulatory oversight.

[1,2] However, the broader conclusion that traditional medicine is largely "unproven," and therefore unworthy of integration, risks overlooking important scientific and public-health considerations. Three points temper that conclusion. First, traditional knowledge is a productive