By Adam Minter
For decades, practitioners of traditional Chinese medicine (or TCM) have disputed accusations that their craft is a pseudo-science, a placebo, exploitative of endangered species, poisonous and ineffective. Now China’s government is fighting on their behalf. On Christmas Day, it passed the country’s first law regulating TCM, with the aim of placing it on an equal footing with science-based Western medicine.
It’s an expressly political goal, designed to “give a boost to China’s soft power,” as one spokesperson put it. Unfortunately, it’s also misguided. China’s health-care system is already burdened by fraud, a shortage of doctors, counterfeit medicine and rank profiteering. Whatever the merits of TCM, raising it to the status of science-based medicine will only provide a distraction from the more urgent task of improving standard medical care.
The practices that constitute traditional medicine—herbal remedies, dietary treatments, acupuncture—date back centuries. But TCM as a unified practice only emerged in the 1960s, when China’s government institutionalized it to counterbalance ideologically suspect practitioners of Western medicine. As a favored state industry, TCM has prospered: In 2015, total revenue for the traditional pharmaceutical industry reached $114 billion. Those drugs were dispensed by 452,000 practitioners working out of tens of thousands of clinics — some no more than single-room storefronts.
As with other state-backed industries, the protective hand of government has benefited the industry far more than consumers. The problems start with a lack of oversight over who can practice TCM. Earlier this week, the director of the State Administration of Traditional Chinese Medicine conceded that it’s difficult to judge the qualification level of most practitioners. That’s a nice way of saying that anybody can claim to be a TCM master. To be fair, China has a network of schools designed to professionalize homeopathic care. But amateurism (or charlatanism) remains alarmingly common, especially in the countryside.
This lack of oversight extends to the thriving industry of traditional pharmaceuticals. Last year, a team of scientists found that nearly 90 percent of TCM remedies marketed in Australia contained undeclared ingredients, including antibiotics and decongestants, heavy metals such as lead and arsenic, and a range of plant and animal matter—not least, the DNA of endangered snow leopards. The situation is almost certainly worse in China, which lacks Australia’s (clearly inadequate) screening procedures. A 2013 Greenpeace study found pesticides in 51 of 65 popular herbal remedies marketed in TCM shops in China and Hong Kong. In one case, contamination levels were 500 times the European Union’s accepted safety limit.
It’s impossible to calculate the human toll of shady TCM practices, but there are hints. Several recent studies have found that herbal remedies are the leading cause of drug-induced liver failure in China, accounting for as much as 43 percent of all cases. The problem is equally severe in other countries where TCM is rapidly expanding: Herbal remedies may account for up to 40 percent of drug-induced liver injuries in South Korea and 55 percent in Singapore.
Yet the real toll is likely even higher. Despite a dearth of credible evidence that TCM is effective, it still sucks up millions of dollars in public funds that would be better spent on China’s regular health-care system, which is badly lagging. The new law, for instance, calls for establishing TCM centers in public hospitals, as well as in pediatric and maternal-care units. This might be justifiable if China was already providing adequate science-based care. But it’s not: Chinese hospitals are dangerously overburdened and underfunded, pediatricians are in such short supply that even state media is calling the situation “urgent,” and maternal health care—especially in rural areas—is notable for its lack of cleanliness and pain relief.
Although the new law’s emphasis on criminal penalties for adulterating TCM drugs is laudable, it’s far less important than stamping out rampant counterfeiting and fraud in China’s science-based pharmaceutical industry. That will require heavy investments in regulation and technology, and will need to go well beyond the criminal penalties that have failed to achieve much so far.
China’s traditional medicine business is bound to persist, and the government should regulate it for safety. But promoting it to unwitting patients who believe it’s as effective as science-based medicine isn’t just a bad idea. It’s malpractice.