I mentioned the other day that what was reported as a hydroxychloroquine trial in China may well have been (or at least begun as) a trial of “traditional Chinese medicine” (TCM). It doesn’t take much digging to turn up a number of registered clinical trials for coronavirus therapy via TCM, actually. Here are a few at Clinicaltrials.gov, and while it’s harder to do a single search for the topic in the Chinese registry, I’ve found this, this, this, this, this, this this, and this. No doubt some of those overlap, but they’re also just a subset of a large number of TCM trials in general. I mentioned this issue in passing here, and have talked about the Chinese government’s attachment to TCM in the past as well.
But perhaps it’s time to talk about it again. I should make my general feelings clear right at the beginning: I have seen very little convincing evidence of efficacy for TCM overall, so the amount of money and effort being thrown at it is rather interesting. To forestall claims of anti-Chinese bias on my part, let me make clear that I have seen very little convincing evidence for Western traditional medicine, either. And by that I mean the herbal preparations that line the shelves of the pharmacies and health-food stores. The NIH has had a whole section devoted to alternative and complementary medicine for nearly twenty years now, and one of their mandates is to produce and review hard clinical evidence for these various therapies. My impression, and I’m happy to be corrected on this, is that there isn’t much. You can scroll through the list of the trials that have been run under the auspices of the agency without finding much to comment on, that’s for sure. And I don’t think the situation is much different on the Chinese side of things.
Now, it’s for sure that there are active compounds from natural sources – it hardly bears saying, since the entire history of medicinal chemistry and drug therapy starts with these. Quinine, morphine, digitalis, penicillin. . .you can go on and on. But note that all of these are active compounds, and the action of the initial natural-extract preparations were due to those active compounds which were then isolated and purified. The same goes for artemisinin, isolated from the Chinese herb qinghao. But that’s not what we’re seeing in all these TCM trials – nope, these are the good old-fashioned herbal preparations (or their modern commercial forms), treated as de facto medicines even if people have looked for active compounds in them without really finding much.
It goes further: this news item from Nature is about the Chinese government not just subsidizing the testing of these remedies, but actively promoting them as part of the country’s response to the epidemic. That earlier blog post has links to the ways that the government has been promoting TCM in other countries and punishing critics of it at home, and there is no sign of either of those efforts easing up. There are, in fact, reports of physicians being punished when speaking about these COVID-19 efforts Apparently the coronavirus can be fit into the TCM category of “diseases caused by noxious dampness”, so off we go. If you can stand China Daily, here’s one of their many articles on the subject. These preparations have the official blessing of the government and the regulatory agencies, and China has been sending them as donations to other countries. But as the Nature article mentions, the clinical evidence for them is very weak.
This isn’t a medical move; it’s a political one – the government is actively promoting a “Chinese response” to the epidemic as a model for other countries (an effort that’s meeting with mixed success). One form this takes is apparently active lobbying and influence within the WHO. As mentioned by Nature, the initial guidance from the WHO warned against herbal remedies for the coronavirus, but that language has since disappeared. It doesn’t take you long to find documents on the WHO web site extolling the stuff, either. As a separate but equally China-centric WHO issue, the agency said yesterday that it has “no mandate” to invite Taiwan as an observer to an upcoming world health summit, citing “divergent views” among member states. Frankly, Taiwan seems to have done an excellent job with the current pandemic and would likely be able to add to the discussion, but it’s not hard to see what’s happening here.
I’m not enjoying writing this blog post. There are a lot of useless and actively harmful things that can come from an overly nationalist approach, and that means not only the Chinese self-promotion, but also taking a public anti-Chinese stance in other countries just for the approval ratings. That is, in fact, one of the things that is worst about the current nationalist moment that we’re having in world politics; I strongly believe that there are far more wrong moves that can be made using that worldview than right ones. But facts remain facts. There is little or no reason to recommend traditional Chinese medicine against the coronavirus, and doing so just adds to the noise and confusion. We have way too much of both already.