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WHO recognizes Chinese medicine pseudoscience
« on: October 09, 2018, 02:28:17 AM »

NEWS FEATURE 26 September 2018
Why Chinese medicine is heading for clinics around the world
(Print version: The big push for Chinese medicine. Nature 561:448-450)

For the first time, the World Health Organization will recognize traditional medicine in its influential global medical compendium.

David Cyranoski

free full text:


"Choi Seung-hoon thought he had an impossible assignment. On a grey autumn day in Beijing in 2004, he embarked on a marathon effort to get a couple of dozen representatives from Asian nations to boil down thousands of years of knowledge about traditional Chinese medicine into one tidy classification system."

"But over the next few years, they came to agree on a list of 3,106 terms and then adopted English translations — a key tool for expanding the reach of the practices.

"And next year sees the crowning moment for Choi’s committee, when the WHO’s governing body, the World Health Assembly, adopts the 11th version of the organization’s global compendium — known as the International Statistical Classification of Diseases and Related Health Problems (ICD). For the first time, the ICD will include details about traditional medicines.

"The global reach of the reference source is unparalleled. The document categorizes thousands of diseases and diagnoses and sets the medical agenda in more than 100 countries. It influences how physicians make diagnoses, how insurance companies determine coverage, how epidemiologists ground their research and how health officials interpret mortality statistics."

"Choi and others expect that the inclusion of TCM will speed up the already accelerating proliferation of the practices and eventually help them to become an integral part of global health care."

"Whether this is a good thing depends on whom you talk to..."

"Many Western-trained physicians and biomedical scientists are deeply concerned, however. Critics view TCM practices as unscientific, unsupported by clinical trials, and sometimes dangerous: China’s drug regulator gets more than 230,000 reports of adverse effects from TCM each year.

"With so many questions about TCM’s effectiveness and safety, some experts wonder why the WHO is increasing support for such practices. One of them is Donald Marcus, an immunologist and professor emeritus at Baylor College of Medicine in Houston, Texas, and a prominent TCM critic. In his opinion, 'at some point, everyone will ask: why is the WHO letting people get sick?'”

"Chapter 26 is meant to be a standard reference that all practitioners can use to help diagnose disease and assess possible causes. For example, ‘wasting thirst syndrome’ is characterized by excessive hunger and increased urination and explained by 'factors which deplete yin fluids in the lung, spleen or kidney systems and generate fire and heat in the body'. On the basis of those observations, physicians can work out how to treat them. The patient, who would probably be diagnosed as diabetic by a Western doctor, would probably be prescribed acupuncture, various tonics and moxibustion — in which practitioners burn herbs near the skin of the patient. Spinach tea, celery, soya beans and other ‘cooling’ foods would also be recommended."

"Critics argue that there is no physiological evidence that qi or meridians exist, and scant evidence that TCM works. There have been just a handful of cases in which Chinese herbal treatments have proved effective in randomized controlled clinical trials."

"In one of the most comprehensive assessments, researchers at the University of Maryland school of medicine in Baltimore surveyed 70 systematic reviews measuring the effectiveness of traditional medicines, including acupuncture. None of those studies could reach a solid conclusion because the evidence was either too sparse or of poor quality1. The NIH’s National Center for Complementary and Integrative Health in Bethesda, Maryland, concludes that 'for most conditions, there is not enough rigorous scientific evidence to know whether TCM methods work for the conditions for which they are used'."

"...many Western physicians and scientists doubt that the herbal remedies and various other components of TCM or other traditional medicines have much to offer in their current use. They grant that TCM herbs might turn up useful molecules (many Western drugs are derived from plants, after all), but worry that TCM could replace proven drugs or be potentially dangerous.

"Arthur Grollman, a cancer researcher at Stony Brook University in New York, has published work showing how aristolochic acid, an ingredient in many TCM remedies, can cause kidney failure and cancer3. He thinks that WHO documents should pay more attention to the risks of remedies that contain the chemical, which are still widely used.

"For some scientists, the WHO’s embrace of TCM is perplexing. 'I thought the WHO was committed to evidence-based medicine,' says Richard Peto, a statistician and epidemiologist at the University of Oxford, UK."

"Wu Linlin, a WHO representative in the Beijing office, told Nature that the WHO does not endorse particular traditional and complementary medicine procedures or remedies.'

"But that stands in sharp contrast to the WHO’s actions in other areas. The agency gives member countries specific advice on what vaccines and drugs to use and what foods to avoid. With traditional medicines, however, the specifics are mostly omitted. The WHO website carries some warnings and states that aristolochic acid is a carcinogen. But with the repeated emphasis on integrating traditional medicine, the message is clear, says Marcus. In his view, 'the WHO is clearly saying these are safe and effective medicines'."

"For those steeped in Western medicine, the continued spread of traditional treatments is worrisome. TCM practitioners increasingly talk of replacing proven Western medicines with traditional substitutes, where there is a cost advantage. Grollman thinks that ICD-11 is heading in that direction. Seventy per cent of money spent on health care globally is reimbursed or allocated on the basis of ICD information. Now TCM will be part of that system.

“'The thing they want is to make it sound official and be recognized by the insurance companies. Because it’s relatively low cost, insurance companies will accept it,' says Grollman."

Comments: Steven Novella and "Orac" discussed the developments, and were critical of the "false balance" in the Nature article.  Edzard Ernst also commented.
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