Commercialization of Tibetan medicine in China

Below are two brief articles that were published in Trin-Gyi-Pho-Nya [???????????????]. The first article by Tashi Tsering expresses concerns for the social, environmental and the long-term sustainability implications of the Tibetan medical system due to its commercialization. In response, Tsultrim Gyaltsen provides some thoughtful suggestions on dealing with the situation, including payment of royalty fees for using plants from the Tibetan environment and the necessity of regulation being in the hands of people who possess the knowledge system.

Designing Modernization To Promote Traditional Tibetan Medicine
By Tashi Tsering
Source: Trin-Gyi-Pho-Nya [???????????????], Tibet Justice Center, Vol. 2, No. 6, January 2005.

Tibetan medicine has become a lucrative business yielding million-dollar profits to large pharmaceutical companies in China. Various new policies have been instituted to standardize the production and distribution of Tibetan medicinal products, mainly for commercial and bureaucratic reasons. These new policies are proving to be a debilitating legal framework for the persevering practitioners of the unique Buddhist healing tradition.

According to a study, there are 75 pharmaceutical companies dealing with Tibetan medicine in various corners of the Tibetan Plateau, out of which 30 are run by Tibetans. While the spiritual guidelines of making medicine according to the Buddhist medical texts � Gyushi � are increasingly compromised with the onslaught of industrial production of Tibetan medicine, an interesting issue that comes to point is regarding the efficacy of the healing powers of these medicine. �Amchi (Tibetan doctor) makes medicine to heal the patient but the pharmaceutical companies make medicine to reap profits,� explained a concerned Tibetan doctor from Amdo (now incorporated in Qinghai Province).

New government regulations require all Tibetan doctors to go through a cumbersome registration process. When approved, they are allowed to sell medicine, but only to their private patients. Rinchen-Tsotru-Dashel, a pill that normally costs 20 yuan, is now being sold for 50 yuan by pharmaceutical companies.

�Soon, we will be barred from producing these medicines as Chinese companies are gaining patents over different Tibetan medicines,� said the doctor. To the Tibetan people, the long-term issues involve the survival of this centuries-old healing tradition, as well as the access members of the community have to the tradition. Surely the ultimate subversion of the Tibetan medical tradition would be if the Tibetan people themselves were forced to purchase medicine invented by their own culture and made from their own land, at a higher cost, and from a Chinese company because of a contrived patent system set-up to benefit large industries to the exclusion of local practitioners.

Commercialization of Tibetan medicine also has environmental consequences. Most of Tibetan medicine�s plant ingredients are rare herbs that are endemic to Tibet�s high mountains. Currently, there are no mechanisms in place to check indiscriminate harvesting of these species. The commercialization of Tibetan medicine has dramatically increased demands for these ingredients, resulting in the widespread, unsustainable removal of certain plant species. Utpal Ngonpo (Blue poppy, meconopsis sp.), marketed as a cure for Hepatitis B by Chinese companies, is one such rare plant species that the Tibetan doctor fears might not survive if the current rate of harvesting continues.

The challenge for policy makers in China is not just the integration Tibetan medicine into the mainstream economy and modes of production, but also the preservation and promotion of a unique tradition of medical knowledge and expertise. While greater access to, and availability of, Tibetan medicine is a worthwhile goal, it will mean very little if the tradition which produced it is swallowed up and destroyed in the process.
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Response from Tsultrim Tsering Gyaltsen
Source: Trin-Gyi-Pho-Nya [???????????????], Tibet Justice Center, Vol. 3, No. 1, March 2005.

Regarding your last editorial, "Designing Modernization To Promote Traditional Tibetan Medicine," there are some issues that should be given consideration for all parties involved at the practice or production level in "traditional" Tibetan medicine.

The plants and substances used in Tibetan medicine are also part of the fabric of life particular to Tibet and therefore a part of the heritage of the Tibetan people. The fact is that companies selling Tibetan medicines are not only profiting from the knowledge of Tibetan medicine but are also using the actual plants integral to the wholeness of the land. In consequence, I suggest the following two conditions.

1) There should be strict limits established regarding the sustainable harvest of these plants and that all companies, in some fair way, should share in that supply and those restrictions.
2) Non-Tibetan owned companies should pay a royalty fee for using plants from the Tibetan environment. When companies substitute foreign plants for native Tibetan plants then the resultant production should not be called Tibetan medicine.

Such measures could insure benefit for future generations in three ways.

1) The integrity of the environment would be assured by mitigating potential environmental damage from overuse.
2) They would create an economic basis for the enforcement of those regulations.
3) There would be an ongoing source of funds to support further research and training in all aspects of the tradition of Tibetan medicine.

Furthermore regarding the production of medicines the traditional texts often specify many conditions under which the ingredients for the medicines were to be collected, handled, and prepared. The texts may state, for example, that certain plants are to be collected only in certain months because their medicinal properties are then active, or that some medicines were only collected from north facing slopes, or in a certain season, or at night, or during a certain phase of the moon. These are some of the many subtleties that, in combination, make Tibetan medicine effective. It does not suffice for a manufacturer to have a list of ingredients that can be haphazardly combined to hopefully produce a positive result.

If what is called a "Tibetan medicine" is in the sole judgment of physicians, fully qualified in the Tibetan medical tradition, to be found to be of diminished quality, efficacy, or that it has a negative consequence for the environment as a result of its production, that product and its producer should be made to conform to traditional practice or the production should be discontinued.

Furthermore if the Tibetan medical system is to be regulated it should be done from the bottom up, not the top down. It must be put under the supervision of those who are intimately familiar with the traditional training and all of the prerequisites for the qualification of doctors and the production of the medicines. In such case, there should be assembled a congress of knowledgeable and qualified Tibetan doctors to establish the requirements for the formulation of the compounds used and the practice of the traditional medicine.

Regulation should come only from within the ranks of those who have an intimate understanding of the tradition and not by governmental officials or profit driven companies who know little or nothing of its nuances. The members of that congress should provide certification for a qualifying product that the product has been produced in accord with tradition and is an "authentic Tibetan medicine." This is the only way to insure the continued efficacy of the medicines and to prevent the bastardization of the Tibetan medical tradition for profit.

With this approach the twin goals of establishing standards of practice and production would be accomplished along with the guarantee of the preservation of all of the many nuances of understanding that are critical to the authentic continuation of the tradition.

A final point is that all names traditionally used for medicines should be part of the public domain. They should be available for use to anyone who produces medicines in accord with the above standards. They must not belong to any single company who could disenfranchise other legitimate producers of traditional medicines simply by controlling the rights to the names.