Executive Summary
- The UK’s declining healthy life expectancy calls for an outward-looking approach—one that seeks complementary resources, expertise and wisdom from beyond our borders.
- A case study of herbal medicinal products (HMPs) reveals striking heterogeneity across Europe. By the end of 2016, European countries had registered hundreds of HMPs with well-established clinical evidence of efficacy; the UK had registered just one.
- We do not claim a causal link between HMP availability and population health outcomes. Nevertheless, this disparity invites reflection: what accounts for these divergent regulatory and cultural attitudes towards HMPs across otherwise comparable European health systems? Could cross-cultural exchange—including around HMPs—offer an opportunity for better health?
- In line with the WHO’s Global Traditional Medicine Strategy 2025–2034, we propose an NHS task force to review the clinical evidence for HMPs and assess their suitability for NICE guidelines. We also advocate for cross-cultural learning to harness the potential of diverse medical traditions in shaping tomorrow’s medicine.
- We do not claim that HMPs and other products offer a panacea for the UK’s health challenges. Rather, we argue that the regulatory disparity and the growing evidence base warrant serious, systematic evaluation, and that it is time to integrate complementary approaches for innovation.
Introduction
In the lead editorial of the King’s CICM Newsletter from May 2026, we called for action to ‘widen the lens’—to look beyond the UK for resources and expertise in confronting the pressing decline in healthy life expectancy (Figure 1 A & B).1,2
A
B
C
Figure 1. Healthy Life Expectancy and Life Expectancy: The UK vs Selected Countries & Regions.
(A) Healthy life expectancy in the UK declined from 2014 to 2024 (The Health Foundation). 2
(B) By 2021, the UK ranked 20th of 21 comparable countries (The Health Foundation). 2
(C) Life expectancy: the UK and US perform poorly versus top-performers—adapted from the reference.3 Top- and low-performers are highlighted in red and pink rectangles, respectively.
Much of the subsequent discourse, notably in the BMJ, has remained inward-looking. Hiam and McKee’s opinion piece convincingly identifies austerity as a primary driver, arguing that Britain’s low public spending and attenuated welfare state have exacerbated health decline since the early 2010s.4 Meanwhile, Sally Howard’s news analysis scrutinises the reliability of this trajectory and proposes damage mitigation through resource reallocation.5
Yet for all their merit, these internal critiques represent what we might term looking inside—examining our own systems, policies and resources through the very frameworks that generated the present difficulties. This is, in essence, thinking inside the box. The danger is two-fold: such approaches risk creating a self-reinforcing feedback loop of critique and incremental tinkering; they may even precipitate an internal competition for scarce resources when budgets are constrained.
In this editorial, we build on our earlier call by arguing that we must not only look outward for resources and expertise but also adopt fundamentally different modes of thinking, i.e., think outside the box. To reverse our health decline, we call for exchange with our European neighbours who have outperformed us and can offer complementary approaches, as well as learning from Far Eastern exemplars (e.g. Hong Kong, Japan, South Korea and Singapore) that have integrated Western and Eastern wisdom into their systems (Figure 1C). Senior health and care leaders from England and Singapore recently met to explore mutual learning.6 Dialogues should go deeper and broader.
A Case Study on External Resources: HMPs
In the same issue of the King’s CICM Newsletter, we also highlighted a striking difference between the herbal medicine landscape in the UK and Germany, from a pharmacist’s perspective.1,7
We now broaden our lens to compare the UK with more European neighbours. Under the regulatory framework of the European Medicines Agency (EMA), the Committee on Herbal Medicinal Products (HMPC) defines EMA regulatory criteria for HMPs registered under the Traditional Use Registry (TUR) and Well-Established Use Marketing Authorisation (WEU MA). The UK has registered the most HMPs under TUR, which lack robust clinical evidence of efficacy, limiting their applications to minor disorders. In contrast, many other European countries have embraced a more evidence-based and integrated approach, resulting in hundreds of HMPs registered under WEU MA, supported by evidence on clinical efficacy, allowing these products to be used for the prevention and treatment of major diseases. By December 2016, Germany had registered 286 WEU-MA HMPs; the UK, just one. Austria, Slovenia, Sweden, Croatia, Czechia and Spain each had more than 30 WEU-MA HMP registrations, while 14 other European countries had 10 to 29 (Figure 2).8
This disparity reveals a fundamental difference in regulatory philosophy among European neighbours. One legitimate interpretation is that regulators in high-use countries prioritise patient access and autonomy, while the UK adopts a more precautionary stance, viewing its primary duty as avoiding harm. These are defensible positions, but the divergence invites reflection on whether the UK’s approach may now be unduly restrictive.
Amid growing unmet medical needs in the UK, it is worth asking whether the hundreds of WEU MA-authorised HMPs across Europe—products expected to meet established clinical evidence standards for both safety and efficacy—could have value in addressing our health challenges. We are not advocating for deregulation, nor do we assume that these products will prove effective or that the evidence base is uniformly robust. Nevertheless, the regulatory disparity warrants formal evaluation. We propose an NHS task force to assess the quality of their clinical evidence, identify products that meet NICE standards, and flag promising candidates for further validation.
Figure 2. Herbal Medicinal Products in the European Union by the End of 2016.8 (A, left) The landscape of Traditional erbal Medicinal Products (THMPs) registered under the Traditional Use Registry (TUR) scheme in European Union (EU) Member States (MS); (B, right) Herbal Medicinal Products (HMPs) under Well-Established Use Marketing Authorisation (WEU MA). This pre-Brexit European Medicines Agency dataset captures products that meet European standards for quality and safety (both TUR and WEU MA) and efficacy (only WEU MA). It offers a valuable baseline for examining the relative contributions of the United Kingdom (UK) versus other EU MS to the total HMP portfolio. DE, Germany; AT, Austria; SL, Slovenia; SE, Sweden; HR, Croatia; CZ, Czechia; ES, Spain.
This call for a proactive review extends to other medical traditions, including traditional Chinese Medicine (TCM)—the primary research focus of King’s CICM. As a research-led initiative within King’s Health Partners (KHP) and primarily led by King’s College London, the Centre aims to catalyse innovation by delivering patient-centred, evidence-based, safe and effective healthcare to the UK. It does so by integrating the complementary resources, expertise and wisdom of TCM with those of conventional medicine, science and technology.
We recognise that the evidence base for TCM is not yet sufficiently robust. Accordingly, what we seek at King’s CICM is not simply a fusion of two medical systems. Rather, we adopt a research-driven, evidence-based approach to help shape the future of medicine, addressing health challenges through cross-cultural and interdisciplinary collaboration, innovation and rigorous inquiry.9
To this end, we have compiled a summary of promising clinical evidence accumulating in leading medical journals, supporting the safety and efficacy of TCM products and techniques in preventing and treating major diseases and common disorders.10 We do not assume that this evidence is sufficient, nor that it meets the standards required for NICE guideline inclusion. However, it does, in our view, warrant systematic evaluation. We propose that the NHS establish a formal mechanism for this purpose. Such a task force could: (a) assess which HMPs and TCM products or devices already meet NICE standards, (b) identify the most promising candidates for jointly funded validation trials, and (c) help set research priorities to address evidence gaps. This would create a transparent pathway for evidence-based integration, distinct from the current system where lack of engagement perpetuates lack of evidence. Research into HMPs and TCM herbal medicines also offers a promising avenue for discovering novel natural chemical structures that could inform new drug development, as our own research has demonstrated.11-14
Thinking Beyond the Box: The TCM-Inspired Research at King’s CICM
At King’s CICM, we emphasise not only the expertise and resources of TCM,10 but also its distinct modes of reasoning: a holistic view of human–nature harmony; the interconnection of body and mind; dynamic functional equilibrium; intrinsic self-healing capacities; personalised syndrome-based strategies; and an integrated preventive-therapeutic approach.9 This is where thinking outside the box becomes truly transformative.
The Xu Lab exemplifies this approach not by rejecting conventional science, but by using ancient concepts to generate testable modern hypotheses. Guided by TCM concepts of healthy qi (defensive mechanisms) and yang qi (metabolic function), its research does not simply seek to validate TCM remedies. Instead, it leverages these ancient concepts to generate novel biological hypotheses—for example, elucidating kidney defence mechanisms against injury and their dysregulation in disease. This TCM-inspired search for endogenous defenders explores the roles of the collecting duct and glomerular parietal epithelial cells in renal protection, as well as the regulatory role of retinoic acid signalling in these specialised kidney cells.15-18 Meanwhile, proteomic studies of fibrogenesis—mechanisms underlying scarring and chronic failure of kidney and other organs—have pinpointed multiple metabolic pathways and enzymes as potential therapeutic targets, which are regulated by antifibrotic herbal and non-herbal treatments.14,19 Finally, by applying bioimaging, photoplethysmography (measuring blood volume in the peripheral circulation), pulse wave velocity and AI to TCM inspection, tongue and pulse diagnostics, our research promises innovation in cost-effective diagnosis, as well as stratified intervention and prognosis.
An Invitation to Be Inspired
This editorial draws inspiration from three sources: the wisdom of TCM, the heterogeneity of European herbal legacies, and the lecture series of Professor Sir Robert Lechler, a long-standing supporter and enabler of King’s CICM. His lectures—Looking Back (10 advances that changed the world), Looking In (the good, the not so good and the questionable), and Looking Ahead (more of the same will not suffice)—are thought-provoking.20-22 These lectures serve as a powerful reminder that looking ahead requires not just more resources, but fundamentally different thinking. Beyond looking back for historic lessons and looking in to assess our strengths and weaknesses, it is time to transcend conventional paradigms and embrace cross-cultural learning.
In private correspondence, Professor Sir Robert Lechler has insightfully observed that many alternative and traditional therapies may generate benefit through stress reduction, with some of this likely attributable to placebo effects, where belief in the product is itself beneficial. For conditions such as COVID-19 and its sequelae—where, for much of the pandemic, no conventional medicine could offer effective intervention—a holistic, functionally oriented diagnosis and intervention may work through a range of mechanisms, including stress reduction. Stress is a well-established contributor to many of the acute and chronic conditions driving the UK’s declining healthy life expectancy, including some core research programmes of King’s CICM (e.g. cardiovascular, kidney and metabolic disorders, cancer, and mental health conditions).
At King’s CICM, we see this not as a limitation but as an opportunity. TCM’s holistic framework, with its emphasis on mind–body interconnection and dynamic functional equilibrium, offers testable hypotheses about stress pathways that could be investigated through rigorous research. Whether through the physiological effects of specific compounds, the neurobiological mechanisms of acupuncture, or the psychological benefits of mindfulness practices derived from TCM, this is precisely the kind of cross-cultural learning we advocate. We invite collaboration in designing studies that could advance this evidence base.
As Einstein observed, ‘We cannot solve our problems with the same thinking we used when we created them.’ In the context of healthcare, this means questioning not only our resource allocation but also our frameworks for evaluating evidence and our assumptions about what constitutes legitimate therapeutic knowledge. Integrative medicine embodies this principle, exploring innovative solutions for human health through cross-cultural learning and collaboration. We must embrace the substantial opportunities that such an integrative approach affords, not just by looking beyond our shores, but by welcoming the new ways of thinking that other cultures and disciplines can offer.
We invite you to engage with Professor Sir Robert’s lectures, reflect on his comments, and join us in this endeavour. We do not claim that TCM or other traditional systems offer ready-made solutions to the UK’s health challenges. Rather, we argue that their distinct frameworks, the substantial clinical experience they embody, and the growing evidence base for specific interventions warrant serious, rigorous and open-minded investigation. The goal is not to replace conventional medicine but to enrich it through evidence-based integration.
The King’s CICM team is ready for the challenges ahead. We cordially invite you to join our journey.
Acknowledgements
We sincerely thank Professor Sir Robert Lechler (Emeritus Senior Vice President at King’s College London), Professor Andrew George MBE (Chair of the Health Innovation Network South London), Professor Tanya Shaw (Head, Department of Inflammation Biology, King’s College London) and all King’s CICM team members for their insightful comments.
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