Evidence for the efficacy of Traditional Chinese Medicine is scanty, unconvincing, and often fraudulent. China is seeing a resurgence of TCM, even teaching it to children. But in Australia, restrictions are being placed on misleading advertising.
What is traditional Chinese medicine (TCM)? And if it works, why aren’t we all using it? Here’s one explanation:
With rich experience accumulating for thousands of years, Chinese medicine (CM) is a treasure for human healthcare. It is a patient-oriented medical system which takes a holistic approach in treating the subjects instead of the diseases. CM possesses a broad spectrum of treatment modalities, including herbal, proprietary CM, acupuncture, moxibustion, and qigong. Selection of therapy is tailor-made on which pattern of disharmony can be identified.
However, the scientific validity of CM due to the lack of scientific evidence is being challenged. Thus, there is a great demand in the knowledge gap to explore the scientific and evidence-based knowledge of CM…we need to provide more efficacies and safety evidence to demonstrate its effectiveness in the modern era.
That statement is wrong-headed in so many ways:
- Experience, even “rich experience,” can be misleading; it is no substitute for controlled scientific studies.
- Age is not a reliable guide to truth. Astrology is ancient, but it is ancient nonsense, not ancient wisdom.
- Misleading alternative medicine buzzwords: patient-oriented, holistic, treating people instead of diseases. Ideas that alternative medicine has co-opted from the goals of the best mainstream clinical practice.
- Acupuncture is theatrical placebo.
- Proprietary? Doesn’t that mean they’re not revealing what’s in it?
- Tailor-made on patterns of disharmony? What does that even mean?
- “Scientific validity is being challenged because of lack of scientific evidence.” Of course it is, because we can’t know if a treatment works if there is no scientific evidence.
- “We need to… demonstrate its effectiveness.” Scientists don’t set out to “demonstrate” effectiveness. They try to find out “if” something is effective.
The basis of TCM
The concepts underlying TCM are fanciful ideas that originated in a pre-scientific era; they have no basis in reality. They posit a vitalistic energy (qi) that circulates through meridians that connect to body organs. They think in terms of yin/yang and the five elements (wood, fire, earth, metal, and water). Therapy is based on patterns of disharmony, and different practitioners identify different patterns and prescribe different remedies. They examine things like the color and shape of the tongue, the smell of the breath, the sound of the voice. They claim to be able to palpate 12 different pulses and find qualities like “floating, slippery, bolstering-like, thread and quick.” The remedies they prescribe include animal parts (sometimes from endangered species), plant extracts, and mineral products.
Problems with research
At best, the evidence for the effectiveness of TCM is scanty:
America’s National Institutes of Health looked at 70 systematic reviews of TCM treatments. In 41 of them, the trials were too small or badly designed to be of use. In 29, the studies showed possible benefits but problems with sample sizes and other flaws meant the results were inconclusive. Shu-chuen Li of Newcastle University in Australia found that only a quarter of the studies he looked at showed some benefits, but most of these were marginal.
Nearly 100% of TCM studies from China report that TCM is effective. If studies get negative results, they aren’t published. This is not just publication bias. A survey of Chinese clinical trials revealed fraudulent practice on a massive scale; it found that 80% of the data was fabricated. Guangdong-based rights activist Mai Ke said there is an all-pervasive culture of fakery across all products made in the country.
A study from the Centre for Evidence-Based Chinese Medicine at Beijing University of Chinese Medicine found strong evidence of publication bias, manipulation, positive conclusions based on data that showed no significant difference, and other problems.
Proponents of TCM like to claim that its research was good enough to be awarded a Nobel Prize. Tu Youyou won a Nobel Prize for the discovery of artemisinin, a malaria drug derived from a plant that had been used for other purposes in TCM. But this was in no way a victory for TCM or herbalism. It was a victory for pure, standard, “Western” scientific pharmacognosy.
Chinese Medical Board of Australia urges caution in advertising claims
Our colleagues in Australia are making some progress in combatting misinformation about TCM. The Friends of Science in Medicine (FSM) submitted over 1,000 images from TCM/acupuncture websites to AHPRA, the Australian Health Practitioner Regulation Agency. And as a result, the Chinese Medicine Board of Australia issued this statement in their Newsletter:
Because of the higher standard of evidence required for public advertising, acceptable evidence to support advertising claims needs to be based on findings obtained from quantitative methodology such as systematic reviews of randomised, and high quality controlled trials…All advertisers must ensure that any statements and claims made about Chinese medicine practice are not false, misleading or deceptive or create an unreasonable expectation of benefits from such services.
If your advertising includes therapeutic claims about the treatment of heath conditions, you must be able to substantiate each claim with acceptable evidence to support such claims. The Board is particularly concerned about claims that acupuncture is a safe and effective treatment for turning breech babies.
They go on to say that practitioners should not cite the WHO document about conditions acupuncture can effectively treat, because it has not been updated for five years and it does not meet the requirements to be acceptable evidence. They still think “traditional use evidence” is sufficient for treating patients, but it should not be used in advertising.
FSM’s Loretta Marron has said that in her opinion, this “means that practitioner websites can’t make ANY claims because there is no ‘robust’ evidence for any TCM intervention!”
Indoctrinating the young
In a disturbing development that has sparked controversy in China, children as young as 12 are being taught how to administer acupuncture. TCM has been added to the curriculum in Zhejiang province, 100,000 textbooks have been distributed, more are on the way, and there are plans to extend the program throughout the country. It is seen as “a way to get Chinese medicine’s scientific [sic] values and spirit into every household. Instilling a love of our country’s traditional culture in primary and secondary school students will be good for the health of the whole society.” Not everyone approves; comments have included “Poisoning yet another generation,” and “Let’s also start courses in fortune telling and palm reading.”
In February 2016, the State Council released a “Strategic Development Plan for Chinese Medicine (2016-2030)”that seeks to spread knowledge of TCM into campuses and homes and also promote TCM abroad.
TCM is big business
An article in The Economist describes a TCM boom in China. It features Fang Yuan, who sells antlers (to treat breast disease!) in the world’s largest market for TCM with 10,000 traders in the town of Bozhou in China. Tibetan caterpillar fungus, the “Viagra of the Himalayas” sells for more than the same weight of gold. The number of hospitals offering TCM grew from 2,500 in 2003 to 4,000 at the end of 2015. Since 2011 the number of licensed practitioners increased 50%. 60,000 TCM medicines have been approved by the government, accounting for almost a third of the pharmaceutical market. TCM now accounts for 16% of total medical care, up from 14% in 2011.
The president of China has said that TCM is in its golden age; the Communist Party insists that it be made equal in status to “Western” medicine. Safety laws have been passed to regulate the production of TCM medicines, but professional requirements have been relaxed for TCM practitioners. Costs for TCM are estimated to be 24% lower than for conventional medicine. But that is likely to be false economy, since the Economist article points out that the evidence that TCM works is scanty.
Loretta Marron wrote in an e-mail that:
China is protecting its $40Bn Chinese medicine export and sales industry and attempting to grow it and is influencing our country [Australia, but probably many other countries too] through the back door, by giving millions of dollars to our Universities for so called ‘collaborative’ research which may translate into building TCM ‘research’ hospitals – here and abroad.
(Yiling Pharmaceutical, a company that makes herbal remedies based on traditional recipes has a market capitalisation of ($3bn)! )
Quality control issues
A large percentage of TCM remedies are contaminated or adulterated with pharmaceuticals. One survey found some form of undeclared substance in 9 out of 10 medicines tested. They found plant or animal DNA from species not listed on the label. Significant levels of toxic heavy metals were found in over half of the medicines.
According to Edzard Ernst, Chinese officials have tried to ignore or suppress the information about contaminants, fearing that “their profits might be endangered by being open about the dubious quality of their TCM-exports.”
Conclusion: Buyer beware
There is little evidence that TCM remedies are safe and effective. Acupuncture has been exhaustively studied and found to be theatrical placebo. Some remedies have never been properly studied, and many of the studies that have been done are poor quality and may even be fraudulent. And you can’t be sure what you’re getting: many of the products are mislabeled, contaminated, or adulterated. Using TCM is a gamble. Mainstream science-based medicine isn’t perfect, but it’s a much better bet.
This article was originally published in the Science-Based Medicine Blog.