Environment & Health HKFP Voices

No, this Nobel Prize is NOT for Traditional Chinese Medicine

China has a Nobel Prize in one of the sciences. Tu Youyou’s Nobel Prize for Medicine is wonderful for her and for the global fight against malaria, since Tu was instrumental in developing a viable drug against this terrible disease. The fact that she answered a call from Chairman Mao to become a medical researcher makes her story patriotic and China has broken a psychological barrier with this Nobel win, because China’s leaders have long been frustrated by the nation’s lack of Nobel laureates in the sciences. When Mo Yan won the Nobel Prize for Literature in 2012, the country was celebrating already, but this is a vindication of China’s scientific progress, a more objective reason for nationalist pride.

Nobody mentions the 2010 Nobel Prize for Peace, of course.

According to Prime Minister Li Keqiang, Tu’s Nobel Prize ‘embodies the enormous contributions of Traditional Chinese Medicine (TCM)  to human health’. Tu isolated the active anti-malarial ingredients in the drugs that she developing in a plant called qinghao. Her inspiration to extract the antimalarial substance came from the plant’s mention in a 4th-century medical text, hence Prime Minister Li’s allusions to traditional medicine. In fact the Nobel committee explicitly honored Tu for her sophisticated extraction and development of the antimalarial ingredient, not her discovery of the qinghao plant itself. Her discovery was inspired by ancient writings but the consequential extraction and rigorous scientific testing have nothing to do with TCM. Most importantly, unlike the questionable therapeutic value of nearly all TCM, the antimalarial drugs Tu forged actually work.

mo yan

Mo Yan, winner of Nobel Peace Prize 2012. Photo: Wikicommons.

Nevertheless, Li Keqiang’s allusions are dangerous. At best TCM does not work. At worst TCM does tremendous harm to people and animals. It would be very wrong if people think this Nobel Prize celebrates anything else except Tu’s extraordinary and laudable scientific research.

In modern China, traditional Chinese medicine (TCM) does not have the air of hippies and sandals that alternative medicine in the west has had for a long time. There are those rural herbalists and folk healers that we associate with a less complicated life close to nature, but most of TCM has been institutionalized, incorporated into the government’s approved and state-run medical system. It has universities dedicated to the study of it. In pharmacies there is no clear difference between TCM medicine and drugs developed according to the scientific method. Indeed, doctors often do not tell their patients whether they are receiving TCM or ‘conventional’ medicine. Approximately 12 per cent of national health care services are provided by TCM facilities, but to muddy the waters further, these often also practice scientifically rigorous medicine. According to James Palmer, who made an extensive study of TCM in 2013, it is a 60 billion dollar industry in mainland China and Hong Kong.

The theories behind TCM treatments are philosophical and not, even by the most relaxed standards, scientific. TCM is heavily influenced by Daoism (or Taoism) and, to a lesser extent, Confucianism. These philosophies, though not by definition harmful to the soul, are either disastrous or completely useless when applied to the body. Chinese philosophers have mostly viewed the human body as composed of the interaction of different elements, processes, and fluids: the elements of fire, water, earth, metal, and wood and their interconnectness with each other and the essences of yin, yang, and qi (the life force). Each of these comes with its own correspondences in the body. Indeed, the human body is a smaller mirror-image of the universe. The grand design of the cosmos and the miniature design of a person are in an eternal flow. That sounds great and one a philosophical level I find it greatly appealing. When it comes to medicine it is nothing but quackery.

In TCM illnesses are a result of excesses that disrupt the balance between the elements, similar to the four humors of Greek philosophy that were influential in western medicine before the scientific revolution. In TCM the symbolism of the elements becomes, for the lack of any other words, naively materialistic. Illness is manifested in symptoms of wind, fire, cold, dampness, dryness, and heat and a herb that looks like the heart, the hand or the penis can be used to treat ailments in those body parts respectively. Animals have powers that can be harnessed for use in TCM: the vitality of a tiger can be extracted from its bones; the strength of an ox from its gall stones; the qi of any animal can be found in its testicles and penis or any body part that looks vaguely phallic, making aspects of TCM quite Freudian – and just as unfalsifiable. Moreover, many a Chinese man today can attest to how many stewed pig brains he had been fed as a schoolboy prior to taking the Chinese university entrance examinations, the SAT or the Cambridge Overseas School Certificate.

Traditional Chinese medicine.

Traditional Chinese medicine. Photo: Wikicommons.

Despite a remarkable period of economic growth and scientific progress, TCM ideas suffuse Chinese popular thinking about health and, according to Palmer, there is a fierce defensiveness associated with them. He says that opposition to TCM makes a person stand out, even when the critic is inside Chinese culture. He wrote about several Chinese who were critical of TCM who found it difficult to be accepted socially and scholars who faced expulsion from teaching.

Opposition to TCM within China has not always been so outlandish. During a brief period of engagement and openness to the outside world, in the twilight of the last imperial dynasty, it was common among even the most famous intellectuals. The Qing scholar Yu Yue published On Abolishing Chinese Medicine in 1890, after losing his wife and children to badly treated illness. Lu Xun, China’s greatest modern writer, trained as a Western doctor in Japan in reaction against what he called the ‘unwitting or deliberate charlatans’ of medicine in China. He had seen his father die and his family nearly bankrupted by increasingly rare herbal and animal part treatments. In 1919 he published the story ‘Medicine’ in which a family desperate for a cure is told they can find it in the blood of an executed rebel.

lu xun

Lu Xun. Photo: Wikicommons.

On this wave of modernization and reinvigoration, the Nationalist government of the 1920s took a far greater interest in western-style public health. The movement harbored deep-rooted anger against the west for the humiliation of China, and a turnaround required letting go of the past and embrace those western ideas that would allow China to compete on a more equal basis. The Nationalists even tried to abolish TCM in 1929, but after a few years of struggle against conservative stalwarts they had to accept a resolution called ‘Equal treatment for Western and Chinese medicine.’ It still exists, in altered form, as the law of Taiwan.

Chairman Mao, whose peasant forces replaced the Nationalists in 1949, dismissed TCM practitioners as ‘circus entertainers, snake-oil salesmen or street hawkers’, but it was the Communist government that coined the term TCM, founding the State Administration of Traditional Chinese Medicine, and creating universities and research centers dedicated to the study and reform of it. There was a conscious effort to create an alternative, native theory, to make TCM ‘scientific in form’, so it could exist side by side with ‘Western medicine’, or even integrated into broader medical theory for the new, post-capitalist man. This integration into the Communist education apparatus allowed TCM to survive even the onslaught of the Cultural Revolution.

One of the reasons for the enduring popularity of treatments that clearly do not work beyond the placebo effect and pure randomness, is the alternative. Unless you pay handsome bribes or pull strings, Chinese hospital treatment is a journey through several circles of Hell, those of bureaucracy, disorganized waiting, and competition for the doctors’ attention. In less developed areas the educational level and the knowledge of medical staff is rudimentary at best. There is a good possibility that going to the doctor in China will make you worse off, even if the doctor is not practicing TCM.

tu youyou

Tu Youyou. Photo: Chinanews.com.

However, there are many examples of TCM treatments that are objectively harmful when studied using the most basic of western methods of research. Palmer mentions two TCM medications in his 2013 article: Anshen Bunao Pian pills, used for treating insomnia, contain 55 times the Chinese mainland’s legal limit for mercury. Zheng Tian Wan, a popular migraine treatment, is packed with aconite, causing potentially fatal heart palpitations and kidney failure. In fact, more than 60 per cent of China’s TCM products are blocked from export, according to the World Federation of Chinese Medicine Societies, a government-approved industry group.

The magical ingredients in TCM, if they are not harmful to humans when taking them, are definitely harmful for nature in the way they are extracted. No one is healed, but countless elephants, rhinos, tigers, pangolins, manta rays, and other endangered animals are lost.

Sometimes there is hope and it can come from unexpected developments. The greatest blessing for wildlife protectors has not been harsher punishment for poachers, crackdowns on smugglers or extensive media campaigns by skeptical groups. It has been the introduction of Viagra to the Chinese market. Once the middle-aged or insecure Chinese man had medicine that actually worked, the need for many sorts of animal penises vanished. Indeed, the price for seal penises, a popular TCM remedy for erectile dysfunction, has fallen sharply.

If Tu Youyou were to use her newfound fame and her position of symbolic power in China to unmask TCM for the dangers it represents, she would be my pick for another Nobel Prize in the future. Perhaps even a Peace Prize that the Beijing government will not have represented by an empty chair.

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No, this Nobel Prize is NOT for Traditional Chinese Medicine