The Nobel Prize against traditional Chinese medicine

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Last week, in response to the awarding of the Nobel Prize in Physiology or Medicine to Chinese scientist Youyou Tu, who isolated artemisinin and validated it as a useful treatment for malaria in the 1970s, I pointed out that the discovery was a triumph of the products of pharmacology, and not of traditional Chinese medicine (TCM). The same goes for Scott Gavura, a pharmacist who blogs at my other favorite blog, Science-Based Medicine, who also pointed out that the path from TCM fever remedy to the pill used to treat malaria was the very model of how pharmacologists isolate drugs from plants. Basically, we both noted that artemisinin is extracted from wormwood, but the process of turning it into a drug involved a lot of trial and error, the elucidation of the wormwood plants contained enough artemisinin to be useful for manufacturing large amounts, and chemical modification of the compound to make it more potent. None of this had anything to do with the basic ideas at the heart of TCM, such as the five elements or the imbalances of heat, humidity, etc. to which TCM attributes the cause of all diseases.

I hadn’t planned on writing about this again unless some charlatan writes some particularly juicy and silly nonsense about how artemisinin proves TCM works and the Nobel Prize award to You are finally a recognition. Turns out I didn’t have to wait because there was a article in the New York Times over the weekend about what I was talking about, the tension in China between TCM advocates who want to claim the Nobel Prize for artemisinin as TCM validation and Chinese scientists who will have none of these affirmations. It is a story about the Chinese Academy of Medical Sciences, where Youyou Tu did his work in the 1960s until the 1980s and changed the course of Chinese science. The article exposes the essential conflict quite strikingly:

Traditionalists say that the award, in the “physiology or medicine” category, shows the value of Chinese medicine, even though it is based on a very narrow part of that tradition.

“I feel happiness and sadness,” said Liu Changhua, a history professor at the academy. “I am happy that the drug has saved lives, but if this is the path Chinese medicine needs to take in the future, I am sad.”

The reason, he said, is that Dr Tu’s methods were little different from those used by Western pharmaceutical companies who are examining traditional pharmacopoeia around the world for new drugs.

Why, I wonder, would Changhua be sad that Youyou Tu helped bring TCM into modern times? The answer is obvious. He believes in the whole system. This includes all of the prescientific concepts upon which TCM is based, including the Five elements, which are considered to be the five aspects of qi, the life force or energy. Much like the case of the four humours in what I like to call traditional European medicine (i.e., humoral theory), it is about a “harmonious” balance between the elements that TCM teaches as being the basis of health. There are also six pernicious influences, the six excesses or the six evils (eg, wind, cold, heat, humidity, drought) which are responsible for disease. There is also the concept that one can unblock blockages in the flow of Qi by using acupuncture needles.

And that’s the problem. TCM is charged with mystical pseudoscience. There is the vitalism behind the concept of qi, four humor-like nonsense of the five elements, and diagnostic nonsense like the tongue diagnosis, which is very similar to tongue reflexology, where specific areas of the tongue are supposed to correspond to specific organs. , how reflexology maps areas of the soles of the feet and palms of the hands to specific organs. Don’t even get me started on the pulse diagnosis. Yes, evaluating the pulse can be of great help in determining whether a patient is dehydrated, possibly septic, or has heart disease resulting in irregular heartbeats, but this is not the purpose of pulse diagnosis. in TCM. There are 29 types of pulses in TCM pulse diagnostics, none of which is really convincingly correlated with any physiological state. There are notations such as how a “wavering” pulse shows “blood and gasoline fail to nourish the meridians.” The blood does not flow regularly ”. Physiologically, it doesn’t make sense. Like Steve novella In other words, the diagnosis of the pulse and other aspects of TCM are great examples of knowledge out of touch.

Now, of all aspects of TCM, the one aspect most likely to produce useful treatments is herbal medicines, for the simple reason that plants can contain chemicals that can be drugs. That’s it. This was the case with artemisinin, but I note that it took Tu to screen over 2,000 TCM herbal remedies for activity against the parasite that causes malaria. She tested different ways of extracting it from the plant. She chemically modified it. She had to figure out how to make pills out of them. This is all very different from this:

But the most sophisticated part of Chinese medicine, Dr Liu said, involves formulas of 10 to 20 herbs or minerals that a practitioner adjusts each week after a consultation with a patient. And yet, almost no research has been done on how these formulas actually interact with the body, he said. Instead, the government invested money in researching another artemisinin – without success.

“Do we really respect this cultural heritage? Dr Liu said. “When we think that Chinese medicine needs to be modernized and the path it needs to follow should be like Tu Youyou’s, I think it’s disrespectful.”

Here is the problem. From a medical point of view, the vast majority of TCMs do not deserve respect. We can respect it culturally and historically, but medically it is a prescientific system of medicine that is not based on science. If anything that is not rooted in science were to be removed from TCM, all that would be left would be herbal medicine – and then only a small part of it, the herbal remedies that science has so far. now shown that they have uses, so far an infinitely small number. It is this small part of TCM that could be of value – if it is ‘modernized’ and removed on the way to Youyou Tu – that TCM advocates point to as proof that TCM as a system of medicine works. .

Indeed, this is what some Chinese scientists say themselves:

But many Chinese think it shouldn’t be respected at all. Scientists like He Zuoxiu, a member of the prestigious Chinese Academy of Sciences, say the ancient pharmacopoeia should be exploited, but the underlying theories that identified these herbs should have been long abandoned.

“I believe that for the future development of Chinese medicine, people should abandon its medical theory and focus more on researching the value of herbs with a modern scientific approach,” Dr. He said in an interview.

These radically different views on Chinese medicine date back at least a century and go to the heart of how modern China sees itself.

It was discussed in detail how Chairman Mao Zedong reconstructed the history of TCM in order to make it more acceptable to its people after its communists took over the country in 1949. What was a mishmash of many different folk medicine traditions that included bloodletting as a precursor to acupuncture has been transformed into one system of medicine, which Mao sought to “integrate” with “Western medicine”. One thing that the NYT article points out that Mao also demanded that TCM “modernize,” which he tried to do by establishing traditional Chinese hospitals, schools and research centers like the Beijing Academy. After Mao’s death, however, China invested much more in “Western” medicine:

But the money has poured heavily into Western medicine. In Mao’s time, rural health workers – “barefoot doctors” – were often traditional practitioners, which raised the profile of Chinese medicine. After Mao’s death and with increasing prosperity, the government doubled down on Western medicine.

Today, China has 1.1 million certified doctors of Western medicine, compared to 186,947 traditional practitioners. It has 23,095 hospitals, of which 2,889 specialize in Chinese medicine.

“It’s part of the nation, but the Chinese nation defines itself as a modern nation, very much tied to science,” said Volker Scheid, an anthropologist at the University of Westminster in London. “So that causes conflict. ”

In China, it appears that TCM is dying. Fewer and fewer aspiring practitioners are becoming TCM practitioners; rather they want to become doctors. The government supports scientific medicine more than TCM. Defenders of TCM know this, which is why they cling to this Nobel Prize to reassure themselves that it is not, that TCM is scientific, that it is now respected and adopted.

What is sad is that China is moving in the right direction. In the “West”, with the rise of “integrative medicine”, which often wholeheartedly embraces TCM, we are heading in the wrong direction.


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