A Call For Tighter Regulation Of Traditional Chinese Medicine

Europe’s leading doctors are to call for tighter regulation of traditional Chinese medicine, anxious that recent recognition by the World Health Organization (WHO) will encourage the use of unproven therapies that can sometimes be harmful. The Federation of European Academies of Medicine (FEAM) and the European Academies’ Science Advisory Council will issue a joint statement on Thursday urging the WHO to clarify how traditional Chinese medicine and other complementary therapies should be used.

Earlier this year, the WHO decided to add a chapter on traditional Chinese medicine to the International Classification of Diseases, which lists treatments available globally for medical conditions. The ICD is influential with governments, which look at its recommendations when deciding how to spend health budgets. The WHO says this is not an endorsement, but European scientists fear it will be used by manufacturers to promote their herbal and other remedies – and that the public will be misled into thinking there is good evidence that they work and are safe. There is a risk, they say, that some people with a serious medical condition may even avoid or delay going to a conventional doctor.

Doctors stress the importance of evidence-based medicine, said Prof George Griffin, the President of FEAM. “We don’t give drugs and surgical treatments unless there is real evidence that they work and do no damage and basically the feeling is that most of the traditional Chinese medicine drugs are unregulated,” he said. “They are not tested properly for toxicity. They probably vary greatly between batches produced, for example, seaweed, which is the latest, and they may be harmful. The other side of the equation is that they may be deluding patients into thinking they are taking appropriate therapies for serious disease.”

Traditional Chinese medicine includes herbal remedies, tai chi, skin cupping and acupuncture. Its practitioners are interested in the entirety of the mind and body and do not diagnose on the basis of isolated symptoms. They believe that vital energy, called qi, circulates through body channels, connected to organs and functions. While many of the therapies have been in use for hundreds of years, there is little evidence of benefit from scientific trials and some evidence of harm. The doctors behind the statement recognise that traditional Chinese medicine has sometimes produced treatments of real value to the world. The most notable recently is artemisinin therapy, which is the mainstay of malaria treatment in Africa. But, they point out, the original artemisia preparations were chemically modified and rigorously tested to produce the drugs used in combination today. They say they agree with the WHO’s good intention to encourage the rigorous testing of remedies used by so many people. But they think the listing of traditional Chinese medicine will be misconstrued.

“Multiple risks of harm from herbal ingredients have been documented,” they will warn. Sometimes herbal remedies have been adulterated with chemicals. Interaction with conventional drugs can be a serious threat. And acupuncture, they will say, “is not necessarily harmless.” A review in 2017 found many injuries, infections and adverse reactions. Although those who use complementary medicines think of them as originating from small scale enterprises, globally it is big business. “The production and delivery of traditional Chinese medicine have become a large industry with estimates of $60bn [£46.5bn] a year and an annual growth rate above 10%,” says the statement. The doctors “urge the European Commission and member states to do more to ensure that all medical products and procedures are subject to an appropriate level of evaluation for quality, safety and efficacy consistent with standardised testing procedures.”

Credit: Sarah Boseley for The Guardian, 6 November 2019.