The use of complementary and traditional medicine (CAM) must follow evidence of efficacy and safety, say a group of global experts, who are concerned about the potential for patient harm and health and are urging more scientific evidence amid the growing use of some treatments and medicines that they say have not been sufficiently researched or proven.
Cyriac Philips, Timothy Caulfield, Catherine de Jong, Xingshun Qi, and Dileep Chethipadath Narayan write in an editorial in The BMJ that the BRICS economies had committed to further collaboration to integrate traditional medicine in healthcare at a meeting in May 2026. The meeting was held by India’s Ministry of Ayush (ayurveda, yoga and naturopathy, unani, siddha and homeopathy).
Globally, interest in complementary and alternative medicine (CAM) – that is, unproved, non-standard interventions – is surging, with the market projected to reach $359bn by 2032.
In December 2025, a multilateral declaration endorsed the World Health Organisation’s Global Traditional Medicine Strategy 2025-2034, aiming for “universal access to safe, effective” traditional medicine.
This proposes integrating CAM into national health systems and universal health coverage through strengthening evidence, tightening safety regulation, expanding workforce, and building a global library of traditional knowledge.
Lower standards of evidence
Yet despite claiming evidence must precede integration, the strategy also allows member states to fund and integrate CAM before standard efficacy and public safety data exist, which is ethically and methodologically indefensible. WHO contradicts its promise of universal scientific rigour by lowering evidentiary standards: the strategy endorses observational and “real world data” designs “appropriate to the unique characteristics” of CAM instead of the standard randomised controlled trials.
In a WHO survey, 95% of responding member states cited lack of research data as the key barrier to integrating CAM. Robust evidence supporting CAM is lacking, despite increased research funding and thousands of studies. After millennia of using traditional Chinese medicine, for example, major evidence gaps on efficacy and safety remain, and patients experience unpredictable effects.
As global interest in CAM grows, so does an “infodemic” of health misinformation and the exploitative sale of unproved interventions. The stakes are enormous: patient harm, displacement of effective care, and eroded trust in health institutions.
Patient harm
In the US, liver injuries from the use of herbal preparations rose from 7% to 20% in 2004-13, and the number of people requiring a liver transplant because of taking herbal supplements rose eightfold during 1995-2020.
Globally, herbal remedies are a more common cause of liver failure leading to liver transplant or death than prescription drugs. In India, more than one-third of 386 traditional products tested contained toxic botanicals and 28% contained adulterants. India’s promotion of unvalidated CAM for Covid-19 led to liver injury.
In China, traditional medicines cause more than 20% of drug-induced liver injuries. Additionally, herb-drug interactions can render standard care ineffective or toxic, and five year survival was significantly reduced among people using CAM in a study of more than 2m US breast cancer patients.
Acceptance of some CAM interventions owes more to political invention, nationalism, or decolonial movements than to evidence in many places, including in some African countries, China, India and Burma.
Additionally, WHO’s strategy was shaped by Rudolf Steiner’s unscientific philosophies of “anthroposophic medicine” and was funded by India and China, which have economic and political interests in promoting CAM. Integration of CAM into standard healthcare is already outpacing evidence generation.
Major Indian Government institutes have CAM departments treating patients based largely on unblinded, uncontrolled, observational research, despite some CAM practitioners’ criticism.
India’s annual CAM budget has grown fivefold since 2014 to more than $530m, without evidence of improved outcomes, increasing the financial burden for patients already facing high out-of-pocket healthcare costs.
WHO’s definitions risk legitimising unproved practices from the prescientific era. The strategy defines integrative medicine as an “evidence based” combination of biomedical and traditional or complementary practices without specifying the standard of evidence needed, and it characterises traditional medicine as aiming to “restore balance of mind, body and environment” and “evolving with science … from an experience-based origin”.
The strategy claims that an “increasing research base demonstrates [CAM’s] promise” without characterising the quality of evidence. Imprecise language risks commercial exploitation of CAM.
Public trust in CAM is consistently linked to susceptibility to misinformation and vaccine scepticism. WHO-endorsed language could be used by CAM practitioners and health influencers for “scienceploitation” – marketing unproved interventions – deepening distrust in science.
Colonisation and epistemicide
Some proponents of CAM correctly identify ongoing power asymmetries from historical colonisation; “epistemicide” describes colonisers’ destruction and devaluing of traditional healthcare knowledge.
CAM in healthcare might improve patient experience but not necessarily objective outcomes. The randomised control trial is not colonial oppression: it distinguishes interventions that work from those that do not. Traditionally used artemisinin became standard malaria treatment through scientific evaluation, not deference to tradition.
WHO’s strategy insufficiently distinguishes CAM as traditional knowledge for hypothesis generation from validated knowledge that is ready for integration. An ideal CAM strategy should mandate efficacy and pharmacovigilance, including adverse event reporting.
Existing large CAM workforces worldwide should be retrained in evidence based priorities for primary care, including screening, vaccination, identifying chronic disease, and maternal health. Research funding should prioritise independent trials, with negative results published.
WHO’s CAM library should document harms alongside claims of benefit, while disclosing commercial conflicts of interest. And WHO’s messaging must remain unequivocally aligned with scientific consensus – a proved tool against misinformation that mixed messaging undermines.
Globally, CAM is the predominant healthcare option for billions of indigenous, rural, and underserved people,23 likely reflecting constrained access to evidence based care instead of informed choices. The ethical response is not uncritical endorsement of CAM but to expand access only to interventions that withstand standard scientific scrutiny as effective and safe.
Patients everywhere deserve nothing less.
Cyriac Abby Philips – senior consultant, Liver Institute, Centre of Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Kerala, India;
Timothy Caulfield, Professor – Faculty of Law and School of Public Health; Health Law Institute, University of Alberta, Canada;
Catherine de Jong – consultant anaesthesiologist, Kindertand, Amsterdam, The Netherlands;
Xingshun Qi – Clinical Director Gastroenterology and Hepatology, General Hospital of Northern Theatre Command, Shenyang, China;
Dileep Chethipadath Narayan – Ppatient partner, Patient representative, Chalakkudy, Kerala, India.
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