Why China’s traditional medicine boom is dangerous

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Source: economist.com

FANG YUAN gazes around his crowded shop and says happily that business is booming. He has a reliable supplier in Russia and hospitals and pharmaceutical companies are queuing up to buy what he sells: antlers. Tangles of them lie in huge meshes on the floor. Thousands more, sliced into discs, fill glass boxes. They are used to treat breast disease in traditional Chinese medicine (TCM). The shop looks a bit like a Scottish baronial hall. Deer-head trophies gaze down from the walls, as does a red-fronted gazelle with black horns like scimitars. “I don’t sell those,” he says hastily. “Endangered list.”

Mr Fang is a trader at the world’s largest market for TCM, a system of diagnosis and treatment that goes back 2,500 years. The scale of the business is staggering. The small town where the market is located, Bozhou, is three hours drive from the nearest railway station. Yet the main market (pictured) is the size of a football stadium. Mr Fang is one of almost 10,000 traders—four times as many as there are shops in the colossal Mall of America in Bloomington, Minnesota.

They sell every medicinal ingredient imaginable. There are chips of agarwood, smoke from which is said to clean the lungs. There are dried frogs, gekkos and deer penis which, dissolved in alcohol, supposedly aids recovery from athletic injuries. And there are boxes of Tibetan caterpillar fungus or “the Viagra of the Himalayas”, a gram of which can sell for more than the same weight of gold. This is the market that sets prices for Chinese herbal medicine throughout the country. Before 9am its sampling room is overflowing with wholesale buyers.

The market in Bozhou is both a symbol of an extraordinary boom in TCM, and a consequence of it. The number of hospitals offering TCM in the country of its birth (either by itself or in combination with regular medicine) grew from roughly 2,500 in 2003 to 4,000 at the end of 2015. Since 2011 the number of licensed practitioners has increased almost 50% to 452,000. Around 60,000 TCM medicines have been approved by the government’s food and drug regulator. These account for almost a third of China’s pharmaceutical market, the world’s second largest. In 2015 patients made 910m visits to TCM hospitals and doctors, which, the government said, accounted for 16% of total medical care, up from 14% in 2011.

It has been a stunning resurgence for a practice that was rejected as superstitious after the fall of the Qing dynasty in 1911. TCM is still regarded with deep suspicion by Western-trained doctors and scientists. It has developed partly because of huge demand for preventive medicines that people believe will help avoid the need for more expensive treatment in hospital. And for some, acquiring the costliest TCM products such as caterpillar fungus has become a status symbol. “In the past few years,” says Li Ning of Kang Mei Medicine, a large health-care company, “there has been wider recognition [of TCM] because people have more money in their pocket and care more about their well-being.”

TCM has also benefited from the attention paid to it by Xi Jinping, China’s president. Mr Xi calls it “the gem of Chinese traditional science” and says he uses it. “TCM is in its golden age,” he claims. He urges practitioners to “push for TCM to step onto the world stage”. Since 2012, the year Mr Xi came to power, the Communist Party has been insisting that traditional medicine be made equal in status to what China calls “Western medicine” (ie, the modern form). Since then, the government has issued a stream of plans, policies and instructions aiming to make it readily available to everyone in China by 2020.

More doses of one’s own medicine
Early in 2016 the government published a blueprint for developing TCM over the next 15 years. Traditional medicine, it said, should have equal status in law with modern medicine; it should also be regulated like other types. A “white paper” issued at the end of last year said TCM would play a big role in reforming the health-care system because of its relatively low cost.

Then, in July, came China’s first TCM law, which lays down safety standards for TCM drugs and the ingredients that go into them. It imposes controls on farms which grow medicinal herbs (banning certain fertilisers, for instance) and on medical manufacturers which produce TCM pills. It also loosens some professional requirements. In the past, TCM doctors had to qualify as conventional doctors first and then be licensed for traditional medicine. The new law makes it possible to become a licensed TCM doctor by passing local exams in practical skills and getting recommendations from two others with licences. Some health professionals worry that this opens the door to more quackery.

Its proponents respond that TCM can improve both public health and the health-care system. Traditional medicine relies on herbal and other natural remedies, not expensive diagnostic machines. According to the white paper, average inpatient expenses per visit at public TCM hospitals were 24% lower than at general public hospitals; outpatient expenses were 12% lower. If TCM is as effective as Western medicine—a big if—then it would appear to be an efficient means of improving health.

If only there were proof
But evidence that TCM works is scanty. Clinical trials in scientific journals have reported some examples of effective TCM treatments, for example against migraines and obesity. They have found some cases where TCM works well in combination with Western medicine, for example, in treating schizophrenia. However, the overall record is poor.

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.

One aspect of TCM that may be of some help is its focus on prevention rather than cure, says Martin Taylor of the World Health Organisation’s mission in Beijing. TCM doctors aim to see their patients often, partly because the remedies they offer are supposed to be tailored to the individual and need fine-tuning. An axiom of TCM is that good doctors cure diseases before they appear.

As a result, more attention to traditional medicine implies more attention to primary health care, which is best able to monitor the progress of patients with lifestyle-related ailments (such as obesity) and the diseases of ageing. Though a middle-income country, China has the disease burden of a rich one: non-communicable diseases such as heart disease and diabetes cause 85% of all deaths. If TCM doctors can suggest better diets or persuade the half of adult men who smoke to give up, then they could make a big difference.

A government document called Healthy China 2030 says that without better primary services, the health-care system will not be able to keep up with the demands of the ageing population. But an acute shortage of general practitioners is a huge impediment. Even a patient with a minor ailment usually goes to see a specialist. This adds both to costs, since consultations with such doctors are expensive, and to horrible overcrowding in hospitals. The government would like more people to visit local clinics instead. But many people are reluctant to see GPs, regarding them as inferior to specialists. They might, however, be willing to go to a TCM clinic. Opening more of them could offer some relief to the hospital system.

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