Earlier this month China won its first Nobel Prize for Medicine, prompting Prime Minister Li Keqiang to boldly state that Tu Youyou’s prize ‘embodies the enormous contributions of Traditional Chinese Medicine (TCM) to human health’. For ‘TCM’, this seems like a huge win, years of doubt and scepticism swept under the carpet. In fact the Nobel committee explicitly honoured Tu for her sophisticated extraction and development of the antimalarial ingredient – this process was far removed from TCM practices and completely ‘western’ in method and execution. The discovery of the qinghao plant within a 4th century text, from which Artemisinin is extracted, was indeed inspired, but having an idea does not win you a Nobel Prize.
What is important to remember is that Tu tapped into the most likely part of Chinese medicine to produce results. To some extent, her prize does vindicate TCM’s use of herbal remedies. Even then, some herbal injections in China mixed with antibiotics have proved disastrous in terms of side effects, suggesting that without proper research, herbal remedies still remain dangerous. In any case the use of naturally occurring chemicals that can effectively treat illnesses is a well-established practice worldwide and is by no means exclusive to TCM. This prize is arguably a perfect example of pharmacognosy – ‘the study of the physical, chemical, biochemical and biological properties of drugs, drug substances or potential drugs or drug substances of natural origin as well as the search for new drugs from natural sources’ – importantly this involves the isolation of these useful chemicals from plants.
Despite all this, supporters of TCM are taking it further, and asserting that other aspects of Chinese medicine might also be valid. This includes the wider beliefs of human bodies being made of the five elements, and the idea of ‘qi’ and ‘yin and yang’. This type of pseudoscience benefits from the fact that TCM is an umbrella term for many ancient Chinese medicinal practices. In this case, a vindication in the herbal arm of the ‘science’ represents a vindication of the entire TCM body. Obviously this seems an illogical argument; indeed Tu in a recent interview illustrated this when responding to a question about other efforts during the 1960s in China to find a cure for malaria – “There was a team of acupuncture specialists who were trying to cure patients in quarantine centres. Obviously that didn’t work“.
The idea of applying rigorous evidence-based methods is unacceptable to institutionalised TCM. As Professor Zhang Gongyao has said, ‘researchers have been refusing to conform to the “Western norm of science” in their lab results, for it is thought to be “unsuitable” for TCM’. One example is that the researchers of TCM have no interest in eliminating the placebo effect, which may constitute a large part of TCM’s ‘effectiveness’. There are also claims that standard research methods aren’t applicable to TCM, because treatment must differ for each individual. Not included in this is the alleged frequent doctoring of results in studies, and poor experimental technique (Aeon).
TCM causes so much controversy due to its emotive history. At the turn of the century, China seemed destined for reform. Traditional medicine came in for especially harsh criticism. Its theories were vague, its outcomes dubious, and most of all it was “unscientific”. The Qing dynasty and later the Nationalists would however find it difficult to displace and ran into stiff opposition. Its status was then given a massive boost with the arrival of the Communist party. Mao would adopt it under his brand of ideology despite his own lack of faith. In a conversation with his physician Mao told him, “I personally do not believe in it. I don’t take Chinese medicine.”
Chinese Pharmacy in Singapore
TCM is in fact a relatively new term and was coined in the 1950s under Mao before being institutionalised for practical and propagandistic reasons. China was (and still is) a vast country, with very few trained doctors and a lot more ‘trained’ TCM physicians, it simply made sense to continue TCM to care for the majority of the populace. In terms of propaganda, Mao set about creating academies that aimed to integrate Chinese and Western medicine. In 1952, the president of the Chinese Medical Association said that, “This One Medicine, will possess a basis in modern natural sciences, will have absorbed the ancient and the new, the Chinese and the foreign, all medical achievements—and will be China’s New Medicine!” The idea that TCM could form the basis of an alternative system of medicine was a powerful piece of ideology, and valuable currency in the cold war era. Whilst several other Chinese traditions were cast overboard during the revolutions, TCM was allowed to survive.
It was TCM’s endurance that accounts for its popularity today. Virtually every other aspect of traditional Chinese culture was shattered by Mao, during the convulsions of the 1960s. An entire generation or more was lost, and that hole within society still echoes through contemporary society. Belief in TCM is a comforting national myth, connecting a proud past with new belief in the present. For the Chinese, the West might have invented modern medicine, but they have something just as good, if not better. Such pride is demonstrated in one ethno-graphic illustration of TCM, some believe that ‘the reason Westerners don’t believe in TCM is that it only works on Chinese bodies.’
What’s more TCM’s claims of being ‘natural’ are highly appealing in a country where everything from dumplings to baby milk has proved toxic (Telegraph). What’s more TCM is also popular because of the poor image of its ‘modern’ counterpart. Chinese conventional hospitals are filled with poorly paid doctors who are overworked and resented or attacked by patients (FT). In addition drugs are often more expensive than TCM and the administration is suspect to huge amounts of corruption (TIME). Going to a Chinese hospital with its long queues, several fees and general disregard for comfort can be a fairly traumatic experience (Harvard Blog). With such deficiencies in conventional health care coupled with TCM as a source of national pride, it is not surprising that it still gains such a large amount of traction in modern Chinese society. Its apparent vindication by a western institution in the Nobel Committee might provide it with further encouragement.
Li Keqiang’s statement should thus be taken with a pinch of salt. Tu’s research was, at best, TCM that benefited from western scientific techniques. After all the Artemisinin had to be isolated, and was by no means necessarily effective without extraction and isolation. This demonstrates Chinese Medicine has its obvious merits in its ancient Pharmacopeia. There is no reason why mining ancient texts for clues about plants with real medical value is not a fruitful avenue for research. However the idea that TCM should continue unchallenged is wrong, and ultimately dangerous, both for the animals and people suffering from the industry. Historically, its revival was based on propaganda and politics, not on scientific fact. Thanks to this warped history and failures in China’s conventional hospital administration, TCM has remained stubborn.
Chairman Mao. Photo: Tauno Tõhk / 陶诺. Used under CreativeCommons.
This prize may only serve to reignite debate, but discussion fuels research. The issue has piqued international interest in TCM and perhaps we will see new discoveries soon – especially if the Chinese government throws money at this kind of R&D again. Zhao Haiyu, Assoc. Professor at Chinese Academy of Chinese Medical Sciences has suggested what the future holds for TCM – “Tradition is our source of inspiration, and modern technology takes it further. They don’t go against each other. They go hand in hand with each other.”