The recent news that a panel of experts in traditional Chinese medicine, otherwise known as TCM, have designed a treatment for Covid-19 appears to be good news. According to one of the experts, Lin Zhixiu, studies from the mainland show that TCM is over 90 per cent effective in alleviating Covid symptoms and can reduce the death rate. This is certainly timely news given the rise in cases here and around the world.
Or is it?
Certainly, TCM is well-established here in Hong Kong and on the mainland with plenty of shops selling TCM remedies, testifying to the strong local belief in its efficacy. However, some caution is in order regarding that word “belief” because belief is closely connected to narratives rather than scientific data. And as we all know, the plural of anecdote is not data.
In other words, it would be good if we could have a look at those studies conducted on the mainland showing the effectiveness of TCM on Covid. Specifically, were they randomized, double-blind and placebo driven?
Apologies for raining on the TCM parade regarding Covid. After all, isn’t any good news during this pandemic worth latching on to?
In a word, no.
TCM is thousands of years old and based on a vital energy called qi that flows through meridians throughout the body. Various herbs, and especially the body parts of endangered species of animals, are said to be good for curing all sorts of diseases and ailments as they empower this energy that travels along the meridians. Acupuncture is also a form of TCM that taps into these flows of energy.
TCM has witnessed a huge growth in popularity. In the past couple of decades, the number of hospitals on the mainland offering TCM has almost doubled. The Chinese government, through its Confucius Institutes, has been subsidising courses in TCM in several countries including the United States.
Among mainland pharmaceuticals, about 60,000 TCM “drugs” have been approved by regulators accounting for close to one-third of the entire market. Locally, three universities also offer degree courses in TCM.
This interest in TCM comes as a surprise given that a century ago it was dismissed on the mainland as pseudoscience. However, during Mao’s time, although he personally did not believe in TCM, he knew it was popular among the peasant class and viewed it as a lubricant for his guerrilla war.
Following Mao’s lead, current Chinese leader Xi Jinping has been an ardent promoter of TCM. A recent white paper notes TCM’s “positive impact on the progress of human civilization” and requires all hospitals to establish TCM wards, giving it equivalence to Western medicine. Like Mao, Xi clearly understands the power of tribalism.
Curiously, modern Western medicine has been dismissive of TCM. This may be because there is little evidence that the energy flows and meridians that form the basis of TCM actually exist.
Further, if TCM really were effective, it would have long ago spread beyond China’s borders and be used worldwide. After all, just to give one example, Viagra spread like wildfire around the world upon its introduction, while tiger penis, said by TCM to be a powerful aphrodisiac, is largely consumed only in East Asia.
Research studies have been conducted on TCM. In fact, there have been several dozen systematic reviews of TCM. A systematic review uses methods to identify and critically analyze published studies to assess their rigour and validity. When the American National Institutes of Health looked at these reviews, they found that in the reviewed studies over half used small samples or were poorly designed. And among the remainder, many had other flaws.
We should not, however, completely dismiss TCM. Just for example, I have a friend who swears by acupuncture for his pain. Clearly, when many needles that are puncturing the skin are removed after a half hour of treatment, there is some relief, and this can also reinforce the belief system about the treatment’s effectiveness, otherwise known as the placebo effect.
There is strong evidence that the placebo effect releases endorphins, or pleasure hormones, in the brain, providing a real chemical explanation for the benefits accrued.
On the other hand, although most TCM is harmless, the environmental damage it causes, especially to endangered species, is obviously harmful. For example, pangolin scales, which are made of the same substance as our fingernails, are in great demand, and this is leading to the possible extinction of pangolins. Ivory tells a similar tale of woe for the elephant.
Another issue concerns belief systems. When leaders and institutions espouse certain ideas that are not grounded in reality, often a large portion of the population believes them. And with such beliefs comes a way of thinking that relies on hearsay rather than science. We don’t need to look too far in the current pandemic for examples of this phenomenon.
Returning to TCM and relief from Covid symptoms, the TCM medicine used may in fact provide some marginal benefits, albeit mostly psychological. The larger concern, however, is that the narrative surrounding the belief continues a millennia-old conviction to magical thinking.
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