Still widely used in many developing countries, they are enjoying a revival in developed countries where, the World Health Organisation estimates, over half the population has used complementary or alternative medicine at least once.
The global market for herbal medicines was estimated at around US$60 billion in 2003.
The industry's growth of between 5 per cent and 15 per cent a year is set to continue as more people seek safe natural alternatives to chemical drugs.
With a history going back thousands of years and more than 7,000 plants in its pharmacopoeia, traditional Chinese medicine (TCM) will snag the lion's share of this growth.
The big boys' attention
THE pharmaceutical industry is feeling the heat.
Western pharmaceutical companies now spend over US$800 million (S$1.2 billion) on average to get a new drug approved.
This cost includes the lengthy and complex clinical development process which sees many potential drugs fall by the wayside, either because they do not work or because they cause unacceptable side effects.
Only around one in 17 candidate drugs identified makes it to market.
If the drug being researched fails in the development process the losses can be considerable.
Pfizer, for example, recently wrote off around US$1 billion and 15 years of research and development after its experimental cholesterol drug failed to make the cut.
The industry is under increased pressure to develop new blockbuster drugs as patents expire, and to cut innovation costs.
Increasingly, companies are looking to TCM as a source of innovation. The economic incentives are clear.
The quality imperative
IN THE past, much publicity has been given to a few quality issues which have arisen in TCM.
Over-dosage of the herb ma huang, traditionally used to treat respiratory congestion in China, led to a dozen deaths, heart attacks and strokes in the United States.
In Belgium, the use of the wrong species of plant, coupled with failure to comply with Good Manufacturing Practices (GMP) and heavy metal limits led to kidney failure in over 70 people taking a slimming treatment.
To take safe medicines to patients and convince mainstream medical doctors and consumers of their benefits, traditional medicines - their efficacy already backed by centuries of usage - now have to establish their quality and safety through accepted, modern evaluation practices.
This requires stringent GMP for manufacturing, systematic testing of the product for quality, recording of side effects in clinical trials, clear labelling and close monitoring of patients reporting adverse effects.
Taking TCM into the future
THERE are two main ways to exploit the business of TCM.
In the first approach, a company takes an established TCM remedy, ensures manufacturing quality, then repackages and rebrands the product before marketing it to appeal to a wider audience.
This is a fast, low-risk model which requires mainly marketing investment. But it presents limited growth potential since it does not go beyond traditional usage.
The second approach is more difficult. It amounts to applying a full-blown Western pharmaceutical development model to TCM.
This is already being implemented by several pharmaceutical companies, including Swiss pharmaceutical giant Novartis, which uses TCM to identify promising active chemical compounds in tried and trusted botanicals.
It next puts in years of investment to develop the drug and subject it to rigorous clinical trials, which can take six to eight years.
Novartis has already taken its TCM-derived malaria drug Coartem to market with this approach.
This approach is Western-medicine focused and does not require any in-depth understanding of TCM, but it requires long-term deep pockets and carries a large element of risk, as with classical drug development.
The returns can be handsome.
The best of both worlds
IT IS possible however, to get the best of both worlds, by focusing on the safety and efficacy of selected traditional Chinese medicines which have already been seen to work in patients across China and address gaps in mainstream medicine.
This is the model Moleac is pioneering in Singapore by consolidating existing safety evidence, and further proving the efficacy of TCMs in the context of Western medicine.
In this way, existing traditional medicines can be taken to more countries - and patients - sooner.
Neuroaid, for example, made from 14 existing extracts from Chinese medicine, helps a stroke patient to achieve fuller neurological function and recovery.
It has already undergone several clinical trials in China to establish its efficacy and safety; strong interest from the international scientific community is now driving additional clinical trials on it, in partnership with academia.
This model of pharmaceutical development has also been adopted by dietary supplement companies such as Himalaya with its Liv.52, Reliant Pharma with Omacor for triglycerides, and Enzymatic Therapy with Remifemin for menopause therapy.
Such products, supported with clinical data, receive stronger recognition from patients and prescribers.
This pragmatic and clinically focused model for developing TCM may be a way forward for younger biomedical companies which want to develop meaningful products in a short time.
This model, however, has its own set of challenges: TCM and Western medicine are poles apart, both in intellectual foundations and ethical viewpoints.
The approach involves TCM doctors and Western clinicians in China, in Singapore and in the West, who need to share the same objectives and be willing to accept one another's differences.
East meets West
THIS is where Singapore - an ideal place to get the best from East and West - comes in.
With its strong intellectual property framework, Singapore can act as a platform for promoting mutual understanding.
There are institutions here which understand TCM and, at the same time, can implement world-class clinical trials and regulatory processes widely recognised in the West.
Western science has much to gain from unlocking the secrets of the East, and more companies will no doubt make use of Singapore's unique advantages to do so here.
The writer is co-founder of Moleac, a biopharmaceutical company based in Singapore.
