As the new coronavirus continued its march across China this weekend, Xinhua, the nation’s official news service, advised a worried public to turn to herbal medicine. Shuanghuanglian, an oral remedy, sold out in stores across the country. The impetus for the Xinhua article came from a study supposedly conducted by two institutions, the Shanghai Institute of Materia Medica and the Wuhan Institute of Virology, using the principles of what the state calls traditional Chinese medicine (TCM), a major part of the Chinese medical system. State-backed TCM doesn’t include all traditional medical practices, it’s a very specific, state-backed set of treatments, theories, and drugs, many of which were invented in the 20th century.
Skeptics immediately criticized the advice, and the backlash to the initial Xinhua report led other parts of state media to play down the medicine’s magical properties. The popular medical site dxy.cn, which has become a go-to resource for information about the virus, also debunked the claims. But it’s not the only role TCM is playing in fighting the virus. One hundred and twenty-five practitioners have been dispatched to Wuhan. (Imagine an outbreak in Florida, and the United States responding by sending the nation’s finest homeopaths.) China’s official devotion to nationalist pseudoscience hurts its medical system—and could hamper its handling of the viral crisis.
Shuanghuanglian is a mixture of honeysuckle, Chinese skullcap, and forsythia. Like many so-called traditional Chinese medicines, it was in fact invented in the 1960s, based on a mixture of the fictional humoral theories that underpin pre-modern Chinese medical theories and the herbology accumulated by Chinese medical practitioners over centuries. As with most such practices, the clinical evidence is highly inconclusive; there is some suggestion shuanghuanglian may aid in respiratory tract illnesses, but there is no evidence it can achieve success in the treatment of bacterial and viral infections, especially at scale. (Allergic reactions are also common in traditional medicine, despite regular claims by advocates that they are impossible; shuanghuanglian is no exception.)
TCM is big business. Modern practice is not a matter of herbalists and amateur doctors but industrialized pharmaceuticals—a $45 billion market in China annually just for such drugs. The industry in China is not alternative medicine but a thoroughly conventional and heavily government-backed business. Shuanghuanglian, although a staple for sore throats and produced by four different manufacturers, is not as prevalent as Yunnan Baiyao, an example of 1930s quackery that seemingly every grandmother in the country swears by. But the stamp of approval over the virus might be enough to send it into the stratosphere. Amid the Monday morning stock crash in China, pharmaceutical companies producing TCM soared.
Runs on folk cures are common during health crises all over the world. In India, for example, a government department devoted to traditional medicines issued a notice last week advising the use of homeopathic and Unani herbs to prevent and manage symptoms of coronavirus infections. But TCM occupies a particularly dangerous role in China. The idea of a separate body of study from Western medicine derives from professional and business squabbles between doctors in the 1920s, but it was codified by Mao Zedong in the early years of the People’s Republic of China and institutionalized. It was formulated as a uniquely Chinese form of medicine, an answer to a more technologically advanced West, and an integral part of the medical system. Early practice turned it from an art into a pseudoscience, throwing out some of the more overtly magical elements while retaining a fundamentally imaginary core theory and practices such as poorly measured herbal dosing and premodern diagnostic techniques.
Large portions of the Chinese health care system are still given over to TCM—at least nominally. Roughly 10 percent of all hospitals center around the industry, and such services are provided at almost all institutions. The actual amount of medical care practiced in hospitals labelled as TCM varies wildly—but sometimes such hospitals are seen as the best option available. And the inherently unclear system can encourage graft: for example, the story of a man trying to pay for care for his dying wife in Hubei, the province surrounding Wuhan, and being charged many times the couple’s monthly income for each day of her treatment at the Huanggang TCM hospital. (It’s not clear what techniques were used to treat her; the mixture of vague diagnosis, demands for money, and unexplained treatments is sadly typical of Chinese provincial hospitals of all types.)
The traditional Chinese pharmacopeia, of course, contains plenty of medicines whose value has been clinically proven. Bringing that knowledge into evidence-based medicine is a project that aids everyone as, for instance, the discovery of artemisinin, a powerful antimalarial drug, by the eventual Nobel Prize winner Tu Youyou proved. But these discoveries are easily incorporated into mainstream medical practice—without the irregular doses and spurious diagnoses that TCM encourages.
Clinical standards inside traditional practices, meanwhile, remain appalling, not only in theory but practice; faking of data is common, as is pharmacological fraud. A 1998 study found 99 percent of TCM papers published in China produced positive results—a statistical impossibility and a sure sign of malpractice. Around 30 to 35 percent of TCM drugs, when tested in British laboratories, turned out to contain conventional medicine—often in dangerously unsafe doses. Purported herbal painkillers were packaged with ibuprofen, sexual aids with Viagra, and healing patches with steroids.
The industry has seen a renewed push under Chinese President Xi Jinping, always keen to emphasize historical nationalism. Xi has repeatedly praised TCM in public, calling it a “gem of Chinese culture,” and an ongoing push to institutionalize it in global health care organizations like the World Health Organization has been given more emphasis and funding. Before 2013, Chinese newspapers sometimes hosted vigorous debates over the value of such treatments; those, like other criticism of Xi-backed institutions, have disappeared. Xi’s past praise means that such practices have to be given a place in treating the virus, regardless of their usefulness or practicality, because of their institutional weight. Resources that could be going to effective research or treatment in a dangerously overstretched medical system will instead be diverted to state-backed quackery.
TCM-trained staff may have a role in fighting the epidemic—if only because many are jointly trained in conventional medical practice and can be effectively deployed as nurses or nurse-practitioners as hospitals struggle to keep bodies on the front line. For poor Chinese unable to afford hospital treatment or afraid of being snatched up into quarantine, home remedies may be the only options available. But spurious herbs and imaginary theories can only harm the attempts to battle a virus that needs a scientific answer, not a politicalized pseudoscience.
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February 04, 2020 at 05:40AM
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Wuhan Virus Can't Be Stopped by Traditional Chinese Medicine - Foreign Policy
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