Balancing the Modern and Traditional – Regulation of Traditional Medicine in Canada

When you feel an itch in your throat, do you reach for the medicine cabinet, or do you gravitate towards natural remedies like a hot ginger tea with lemon? The latter might be a more common approach than you would think. In a 2023 survey conducted on behalf of Health Canada, around 73% of responding Canadians reported using natural health products (NHPs), including traditional medicine. In fact, the NHP industry is a booming market, with annual sales of $13.2 billion in 2021. Given the increasing interest and acceptance towards traditional medicine, it is important to consider how these products are regulated and how these regulations are evolving to suit our population’s growing needs.

Health Canada defines traditional medicine as “medicine based on the sum total of knowledge, skills and practices based on theories, beliefs and experiences indigenous to different cultures, used in the maintenance of health, as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness”. They are classified as natural health products (NHPs) along with vitamins and minerals, herbal remedies, homeopathic medicines, probiotics, and other dietary supplements. NHPs fall under the purview of the Natural Health Products Regulations established in 2004, and the Protecting Canadians from Unsafe Drugs Act since 2023. Within these frameworks, Health Canada is responsible for setting and enforcing standards related to NHP safety and efficacy, manufacturing, and post-market monitoring of adverse events. While not subject to the same stringent regulatory hurdles as prescription drugs, traditional medicines nonetheless must present evidence demonstrating a history of safe and efficacious use within their associated system of traditional medicine such as pharmacopoeias (reference manuals detailing the identification, preparation, and usage guidelines for compounds), reputable written references, observational studies, and/or clinical trial data if available.

However, the Western scientific and medical communities remain skeptical of the various schools of traditional medicine. For example, scathing editorials published in Nature have questioned the recognition of traditional medicine by the World Health Organization, stating that it “risks legitimizing an unfounded underlying philosophy and some unscientific practice” and that “hundreds of years of use in clinics that don’t standardize or analyse the clinical data are no match for blinded, controlled studies”. In particular, the lax regulations around traditional medicine have drawn heavy criticism. A 2017 editorial in the Canadian Medical Association Journal writes, “alternative medicines with claims based on alternative facts do not deserve an alternative, easy regulatory road to market”, arguing that if traditional medicine is to be used for therapeutic benefit, they should be held to the same rigorous standards as modern drugs. On the other hand, proponents of traditional medicine stress that the reductionist framework of the modern biomedical system does not reflect the integrative and holistic approach of traditional medicine, and thus it is not appropriate to assess both schools of medicine with the same metrics.

Clearly there is a need to ensure that the claims of safety made by different medicines, whether modern or traditional, are backed by evidence. However, it is important to evaluate this evidence in a manner reflective of the appropriate knowledge system of health. This requires open and continuous dialogue between Western and traditional medical practitioners and policymakers to allow Canadians access to the fullest range of healthcare options possible. In this way, medical practices from both schools of thought may be harnessed in tandem to better advance health and wellbeing in Canada.