China plans to modernize traditional medicine

2. Nature |Vol. 446|5 April 2007 China plans to modernize traditional medicine

3. China has announced: an ambitious attempt to bring the ancient practice of traditional Chinese medicine (TCM) into line with modern standards

4. Government: • Expand basic and clinical research • Improve the testing and developing of TCM remedies for export • Critics: • The research will meet the scientific standards necessary for international recognition?

5. Before: China invested in TCM • 15-year plan: Change of direction Receive significantly more money Back by 16 Chinese ministries (MOST & SATCM & ministry of health)

6. Director of MOST’s health and biotechnology division: government has earmarked 1 billion yuan (US$ 130 million) for TCM research and development + total budget over the next five years increasing to at least 5-6 times as much as the previous total of 740 million yuan

7. Most of population not covered by the public healthcare system and can not afford to go to hospital • Tenfold increase in money for the TCM-related part of the public healthcare system to 8.5 billion yuan

8. Deputy director of SATCM: • Chinese medicine has served the Chinese people since antiquity • still has an important role in today’s healthcare (especially in areas where people do not have access to , or could not afford , treatments based on Western medicine

9. Initiative after heated discussions on TCM throughout China: • 2006 : Publish an article by one university scholar titled “Farewell to Traditional Chinese Medicine” in Chinese journal Medicine and Philosophy • Argued that TCM is a pseudoscience and should not be part of healthcare and research

10. Keenly awaiting the government’s stance • Come down firmly in favour of promoting TCM as a science • Earn regulatory approval for TCM remedies abroad • Hope to globalize TCM by 2020 • Doubled the world market for Chinese herbal medicine over the past decade(E &US :biggest importers)

11. But: • The patchy safety record of TCM from China has led to a steady decline in its exports • Lost market share to neighboring nations (Japan & South Korea)

12. China’s plan specifies strategies to boost standards: 1- conducting clinical research on the safety of TCM remedies 2-encouraging international collaboration 3-improving manufacturing techniques 4-bringing the drug regulatory system into line with international guidelines

13. More controversial: the government’s shift in approach Previous attempt: • isolating active ingredients from the remedies • Screening them one at a time • (+ ) a handful of new treatments (artemisin for malaria / decongestant ephedrine) • (-) no goldrush of approved drugs

14. New plan: • Develop methodologies to test TCM’s more traditional features and principles • A holistic approach to disease treatment • Complex combinations of plant extracts rather than using one drug • Personalized each mixture to the symptoms and characteristics of the patient

15. TCM practitioners and researchers: The government will actually come up with the money? Generally welcomed the plan “It’s a significant step forward” vice-president of TCM University “After thousands of years of practice and development ,TCM is already close to perfect and that modernization will simply distort its essence”

16. A US-trained biochemist: • Website called ‘New threads” that fights pseudoscience and research misconduct in China • Unimpressed by the plan , but for opposite reasons • In favour of scientific research into Chinese herbal remedies • but thinks: the emphasis on testing the theories of TCM is misplaced

17. “The basic concept of Chinese medicine , such as yin and yang, wuxing ( the five elements) and the qi (meridian) theory, are inaccurate descriptions of the human body that verge on imaginative. • The government has already spent a lot of money trying to prove their mechanistic basis,but this hasn’t gone anywhere”

18. Director of the National Centre for Drug Screening at the Shanghai Institute of Materia Medica: “To truly modernize Chinese medicine , we must first demystify these theories”

19. Some critics: • The plan doesn’t set strict enough scientific standards ? • Clinical research : as a priority • But the plan doesn’t specify whether there should be randomized , controlled trials in which neither practitioners nor patients Know who is receiving active remedy and who is getting a placebo

20. No requirement for TCM researchers to publish in internationally recognized journals • “Most research on TCM in the past is of poor quality , and is published only in Chinese medical journals without proper peer-review processes” • “Without a clear position from the government, it is unlikely that the situation will change”

21. Another concern : The government doesn’t specify how it will control the way in which research funding is allocated. Critics: resources are currently being circulated only among certain favoured universities and institutes Reform: to ensure that TCM grants are based on merit (to achieve real progress)

22. associate dean of the pharmacy school at Shanghai university: “The initiative will be just Loud thunder , small raindrops”

23. The government is aware of the controversy and problems surrounding TCM. • The plan, on which it has consulted widely, is set to resolve these issues. • SATCM: The plan outlines overall principles and long-term directions for the development of TCM , rather than going into details , and further strategies will be published to specify exactly how the schemes will be carried out.

24. Whether the government will take critics’ concerns into account while drafting these plans remains to be seen, but many are cautiously optimistic. “ THE WIND IS NOW RIGHT FOR THE DEVELOPMENT OF TCM. LET’S HOPE THIS WILL NOT BE A MISSED OPPORTUNITY.”