Healing that springs from the earth.
Thesis investigates the role of public compounding pharmacies in the herbal medicine market
Healing that springs from the earth.
Thesis investigates the role of public compounding pharmacies in the herbal medicine market
The bronchodilator and expectorant *Mikania glomerata* , the famous guaco, the calming, analgesic, and anxiolytic * Cymbopogon citratus* , known as lemongrass, and the anti-inflammatory and antioxidant * Curcuma longa* , the popular turmeric, offer examples of medicinal plants easily found in open-air markets and municipal markets in any Brazilian state, in their natural form , in bulk, in bottles, or as essential oils. These plants represent unequivocal proof of our plant biodiversity – the largest in the world – and of our traditional knowledge. A wealth that, despite being recognized, is far from having its full potential explored. While holding 15% to 20% of the planet's plant biodiversity, the country accounts for a tiny 0,1% of the global market for phytotherapeutic and medicinal herbs, which moved US$ 230 billion (R$ 1,3 trillion) in 2024.
To understand the contradictions and complexity of the herbal medicine chain in Brazil, Colombian agricultural engineer Nataly Cubides Zuñiga researched Living Pharmacies in her doctoral thesis, as part of the Graduate Program in Science and Technology Policy (PPG-PCT) of the Institute of Geosciences (IG). Established in 2010, these establishments operate as public compounding pharmacies within the Unified Health System (SUS), providing free medicinal plants that they grow and medications that they compound, in addition to providing pharmaceutical social assistance. The activity promotes the meeting between traditional and scientific knowledge. “This is a natural heritage that we need to integrate. We have both technical-scientific and traditional knowledge, but they are dispersed,” argues the agricultural engineer.
By delving deeper into this space of convergence, Cubides Zuñiga concluded that Farmácias Vivas have the potential to articulate this technical-production chain because they are part of the SUS (Brazilian Unified Health System) and because they are capable of creating knowledge ecosystems based on actions of connection and cooperation involving different actors, such as universities, research institutes, non-governmental organizations, farmer cooperatives and communities. The research identified multiple reasons for the low production of herbal medicines in Brazil. One of them is the lack of description and registration of native medicinal species, something that is mandatory for the production of active pharmaceutical ingredients (IFAVs), necessary for the compounding of medicines.
The engineer began studies together with the team of the Technical-Productive Prospecting and Prioritization Project for the Integration of the Amazonian Phytotherapeutic Chain (Profitos Bioam), funded by the São Paulo State Research Support Foundation (Fapesp) and the Amazonas State Research Support Foundation (Fapeam), between 2021 and 2024.
Restricted autonomy
Still little known by the population and often by the government itself – municipal, state and federal –, the current 226 Farmácias Vivas are part of the federal government's National Policy on Medicinal Plants and Phytotherapeutics (PNPMF). “Farmacias Vivas are an instrument of national policy, whose guideline is to encourage the production and use of medicinal plants and phytotherapeutics in the SUS. However, the inconsistency of regulations and the lack of monographs, in many cases, restrict the autonomy of Farmácias Vivas to work with local species”, said Cubides Zuñiga.
According to the research supervisor, Professor Maria Beatriz Machado Bonacelli, having a large sociobiodiversity – a concept that includes the populations responsible for traditional knowledge – is not enough to promote progress. “Brazil has a great diversity and everyone thinks that this is enough. But resources alone are not enough, just as biodiversity alone is not enough, nor are policies or legislation alone. Traditional knowledge cannot be used without knowing the origin of this knowledge or its people. Traditional knowledge is extremely rich and should be added to scientific knowledge and methods. This encounter must be promoted. Traditional knowledge comes from the indigenous heritage, from riverside communities, from quilombolas and from family farming,” stated Bonacelli.
According to the professor, Brazil has around 340 phytotherapeutic products registered with the National Health Surveillance Agency (Anvisa), while Great Britain has around 3, Germany has around 10 and China has around 70. The country, therefore, has the potential to explore its sociobiodiversity, promoting economic growth, the research indicates. Phytotherapeutic medicines currently account for less than 2% of the Brazilian pharmaceutical market, while in Germany this percentage is around 20%.
Rigor of the law
The legislation on herbal medicines in Brazil, which began to be implemented in the 1980s, gained a new regulatory framework in 2014. According to the research, with more complete national legislation that is closer to international standards, many companies that previously explored medicinal plants, as they did not comply with the new guidelines, ceased to exist or focused on the production of phytocosmetics, supplements and essential oils. Today, there are approximately 68 herbal medicine companies in the country, concentrated in the Southeast Region.
Specifically regarding Living Pharmacies, the legislation, created in 2010, outlines the stages of the production chain, encompassing everything from raw materials ( fresh plants and plant derivatives) to herbal medicines. The herbal medicines or raw materials must be produced within the Living Pharmacies themselves or come from certified producers, all under the control of Anvisa (Brazilian Health Regulatory Agency).
Pharmacies are managed by the municipal or state health departments. The employees of these establishments are part of the SUS and partner institutions, in addition to some volunteers. Each location develops its own model according to its specificities, capabilities and needs. Many of these pharmacies become community spaces for exchanging knowledge, offering training activities, seminars and discussion groups. According to the engineer, institutionalizing pharmacies is one of the program's greatest challenges in the country.
The thesis analyzed units of Farmácias Vivas in the Federal District and seven states, including Ceará, where these places were conceived in 1983 by Francisco José de Abreu Matos, from the Federal University of Ceará (UFC). The Farmácia Viva in the city of Jardinópolis (Nature's Pharmacy), in São Paulo, was the most complete that Cubides Zuñiga had seen: it has nurseries, supplies seedlings and has laboratories that produce herbal medicines in capsules, oils, creams, tinctures and syrups. It also has an outpatient clinic for consultations with the population. This clinic is staffed by doctors from the School of Medical Sciences of the University of São Paulo (USP), in Ribeirão Preto. The pharmacy supplies four herbal medicines to the SUS. In Campinas, the researcher visited four Farmácias Vivas, which house flowerbeds or vegetable gardens.