The Economist article detailed the recent growth of TCM within China. According to the article, a hundred years ago TCM had fallen on hard times, denigrated as superstition following the fall of the Qing dynasty. But a 2,500-year-old medicine system doesn’t disappear overnight, and recently, because of official policy, TCM is again on the rise. The number of hospitals within the country that offer TCM has grown from about 2,500 in 2005 to about 4,000 at the end of 2015. The number of licensed practitioners now stands at about 425,000, and about 60,000 TCM preparations have been officially approved as medicines.
TCM has received a hefty boost from the favor of President Xi Jinping, who has called it “the gem of Chinese traditional science.” Since 2012, the year Xi took office, the government has embarked on a plan to raise the system to a status more or less equal to that of Western medicine. A detailed blueprint was released in April 2015, with a goal to make TCM readily available to all patients by 2020. In July of this year, a TCM law was passed that specifies safety standards for TCM formulations and the ingredients that go into them.
Folklore underlies every medical system, even that of the West
TCM encompasses many practices, such as acupuncture and tai chi. The most relevant to the dietary supplement industry are the many herbal formulas and the thousands of ingredients that go into them. Some aspects of TCM might seem ‘folkloric’ in nature to some Western eyes, based as it is on traditional uses. But even the formulation of that sentence belies a prejudice, maintains Roy Upton, founder of the American Herbal Pharmacopoeia. Upton is a practicing herbalist himself and has broad experience and knowledge of traditional herbal medicine systems from many cultures. Folklore, he said, is the foundation of medical knowledge everywhere in the world, regardless of whether scientists ensconced in Western research universities and medical centers are willing to admit it.
“Every medical tradition in the world has a folkloric basis to it, including conventional western medicine. The manner in which the question is posed implies folkloric knowledge is not valuable. Virtually all established drug uses of plants from aspirin, to morphine, to quinine, and digitalis were all based on folkloric uses of those medicines,” Upton told NutraIngredients-USA.
“All medical traditions including western conventional medicine has a certain amount of superstition attached to them. In Western medicine, medical practitioners have exchanged a rattle or feather, for a stethoscope, a bunch of machinery, and state sanctioned (cultural) acceptance of these tools, even when there is no scientific proof they are of clinical value. When a practitioner gives a cancer patient a prognosis of 6 months to live, it is often referred to as a ‘medical hex,’” he said.
MDs don't always apply knowledge from clinical trials
A recent book by two medical doctors bears Upton’s assertion out. In Demand Better! Revive Our Broken Health Care System, authors Dr Sanjaya Kumar, MD, chief medical officer of Quantros, and Dr David B. Nash, MD, dean of the Jefferson School of Population Health at Thomas Jefferson University in Philadelphia argued that despite the claims of scientific rigor, typical accepted medical practice in the West falls far short of that ideal.
“When scientific consensus exists on which clinical practices work effectively, physicians only sporadically follow that evidence correctly. . .The plain fact is that many clinical decisions made by physicians appear to be arbitrary, uncertain and variable. Reams of research point to the same finding: Physicians looking at the same thing will disagree with each other, or even with themselves, from 10 percent to 50 percent of the time during virtually every aspect of the medical-care process,” they wrote.
Numerous examples exist of pharmaceuticals that have been approved by the US Food and Drug Administration when their effects have only narrowly cleared the bar of statistical significance. And some have come to market with significant side effects that are only fully characterized down the line, after a history of usage builds up. Upton said that many, perhaps more than half, of studies on common antidepressant medications show they don’t work better than placebos, yet they have become the standard of care even so. He also said numerous prescriptions are now written for off label uses of pharmaceuticals, indications for which there is little or no clinical evidence of the sort Western medicine claims to revere.
“They are legal as practitioners have the right to use approved drugs for indications that the collective community of medical shamans BELIEVE work for those purposes. But, they often lack any evidence of efficacy and did not pass the scientific rigor of well-controlled clinical trials, which is purported to be the gold standard of evidence,” he said.
China could be looked to as an example, rather than a source of ridicule
The Economist article pointed out that China has taken this tack because the country recognizes that by 2030 the health care system as it is constituted today will be unable to meet the needs of an aging population, so more cost effective solutions must be found. Upton said that rather than trash TCM as mere superstition, which is the overall tone of the article, Western thought leaders should rather look to China’s example for ways in which health care modalities and the ingredients for health support preparations can come from natural sources.
“The determination of whether something is ‘efficacious’ is whether the ingredient or modality is beneficial for the patient. Ultimately, it is the patient who determines what is best for them, and literally tens of millions of consumers of TCM worldwide are choosing TCM over, or in addition to, Western medical practices. Numerous surveys show a relatively high level of satisfaction with natural healing modalities including TCM . . . Honoring the various traditions fosters an openness that all medical traditions and modalities have greater or lesser benefit for some patients and not one model has the answer for all,” Upton said.
Iklhas Khan, PhD, director of the National Center for Natural Products Research at the University of Mississippi, said TCM researchers within China and elsewhere are working hard to assemble a body of data in the Western mode to go with the reams of traditional use information. Khan’s organization hosts a conference each spring at the center in Oxford, MS, that includes botanical researchers from around the world, many from mainland China.
“Modernization of TCM as charged by Chinese government has put a lot of effort on backing traditional usage by science. A world class science is being done and the future is very bright and these products in the future will be based on scientifically valid parameters,” he said.