Article: Globalizing Chinese Medicine

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I figured I'd pass this along .. some interesting reading

 

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Chris (list mom)

http://www.alittleolfactory.com

 

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http://www.tcgreens.org/gl/articles/20030417052720828.html

 

 

Globalizing

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Thursday, April 17 2003

Contributed By: Institute for Science in Society

 

 

by Dr. Mae-Wan Ho

 

 

The drug is China's best-selling cancer treatment. There are perhaps a

dozen others, but this is the first made from a staple.

 

 

The success of Kanglaite has spurred scientists in China, Hong Kong and

Taiwan to screen the 10 000 or so plants described in the Chinese herbal

medicine literature for new drugs, as well as investigating the herbal

remedies themselves.

 

 

Traditional (TCM) has entered the political agenda.

Hong Kong's Chief Executive Tung Chee Hwa has laid out a ten year plan

for making the city an " international centre for Chinese medicine " . His

government is currently funding 18 TCM research projects including

clinical trials, developing quality standards and basic pharmacological

studies. The Hong Kong Jockey Club Charities Trust is equipping research

labs and donating US $64 million to get research started at a new

Institute of .

 

 

Last year, Taiwan's President Chen Shui-bian proposed spending US$1.5

billion over 5 years to develop the country's Chinese medicinal herb

industry, pending a detailed plan.

 

 

China's Ministry of Science and Technology has made the modernisation of

TCM one of the 12 focal points in its current Five-Year Plan, and $3.6

million has been allocated to screening both conventional chemical

compounds and medicinal herbs for potential drugs. " Screening [herbal

remedies] is a way for China to try to catch up with Western countries

in developing new drugs, " said chemist Yang Xiuwei, director of the

National Research Lab of Natural and Biomimetic Drugs at Beijing

University of Medical Sciences

 

 

Biochemist S.D. Kung, who is coordinating herbal medicine research at

Hong Kong University of Science and Technology, says the timing is

right. A new generation of Western-trained scientists is taking up the

challenge to demonstrate the efficacy of traditional remedies to the US

food and Drug Administration and the rest of the world.

 

 

But like many traditional healthcare systems, TCM has suffered from

decades, if not centuries of cultural imperialism from the dominant

mechanistic model of the West and its powerful propaganda machine. As a

result, people in many Asian countries have been increasingly turning

away from their traditional medical systems to embrace modern

biomedicine even as all kinds of 'complementary and alternative

medicine' are gaining in popularity in the West. A 1999 survey by the

Hong Kong government found only 22% of outpatient medical consultations

provided by Chinese practitioners.

 

 

One obstacle to improving the popularity of TCM is the lack of

regulation over the quality of the medications and the qualifications of

practitioners. Hong Kong is addressing that. " Once the regulatory system

is in place and we upgrade professional standards, " says microbiologist

Edmund Lee, who heads the Hong Kong Jockey Club Institute of Chinese

Medicine, " I'm sure the usage rate [for TCM] will increase. "

 

 

Another obstacle to the general acceptance of Chinese herbal remedies is

undoubtedly the traditional practice of using mixtures of many herbs in

formulations, which goes against the grain of the dominant medical model

based on using single pure chemical compounds. Faced with a typical

mixture of 10 or more herbs, the average Western scientist can only

respond with utter disbelief, if not utter despair in ever succeeding in

isolating the active principle. Nevertheless, there have been a few

transfers from Chinese to Western medicine.

 

 

The first chemical originating from Chinese herbal remedies to enter the

Western pharmacopoeia was ephedrine, an amphetamine-like stimulant. A

Japanese scientist isolated it in the 1880s from the Chinese herb,

mahuang (Ephedra sinica), traditionally used to treat congestion, and is

a common ingredient in over-the-counter decongestants and prescription

medications for bronchial asthma. But the abuse of mahuang in 'dieting

aids' and as a legal way to get high in 'herbal ecstasy' has resulted in

a growing list of adverse effects, and several countries have banned

non-prescription uses. I hasten to add that this abuse has never

occurred within TCM itself.

 

 

The next drug originating from a Chinese medicinal herb came a century

later in the 1970s. Chinese scientists isolated a compound called

artemisinin from qinghao, or Artemisia annua, a relative of the sweet

wormwood found in North America. Qinghao is traditionally used to treat

fever; but the researchers found that artemisinin killed even

chloroquine-resistant strains of Plasmodium the malaria parasite

transmitted by mosquitoes. Recent research in US and Europe suggests

that artemisinin may also have anticancer properties. Zhou Weishan,

chemist at the shanghai Institute of Organic Chemistry, who led the

efforts to synthesize artemisinin, says they never patented any part of

the work.

 

 

Chinese researchers are determined not to repeat the mistake when

developing the next drug, which is why Li Dapeng has got a " very

capable " patent lawyer to protect Kanglaite before taking it to the rest

of the world. The company he set up in Hangzhou China, the Zhejian

Kanglaite Pharmaceutical Company Ltd, already owns a subsidiary in the

United States, Kanglaite USA Inc., located in Salt Lake City.

 

 

Another US biopharmaceutical company, Oncoherb, Inc. is collaborating

with " a well-known US cancer centre in New York " on the phase II

clinical trials. This was announced at a symposium on " Modernizing

Traditional " held in July 2001, which featured a talk

by Ren Dequan, deputy director-general of China's State Drug

Adminstration. Ren commented on the challenges for TCM after China has

joined the World Trade Organisation.

 

 

The principle competitive advantage of Kanglaite is its low toxicity,

which is unusual among current conventional cancer therapies available

in the West. Oncoherb is studying Kanglaite's other formulations, such

as edible capsule, or inhalable mist.

 

 

But will Kanglaite be made generally available at affordable prices, as

it should be; or will it fall victim to corporate monopoly, to put it

out of reach of all but the rich? That's the real challenge of

globalising Chinese medicine. The other is the danger of overharvesting

that can cause medicinal plants to become extinct in the wild (see

Herbalert to the rescue, ISIS report).

 

 

Kanglaite is by no means the only candidate to be marketed globally as

an anti-cancer agent. There are others already marketed as food

supplements, often at greatly inflated prices. A typical one-month

supply of one such food supplement costs more than US$500.

 

 

Other similar drugs are also on the way. A compound derived from

huangchi, or yellow root (Astragalus membranaceus), isolated by

Taiwanese biochemist T.S. Jiang, is in the pipelines. Like Kanglaite, it

ameliorates the side-effects of cancer chemotherapy. Jiang had started

screening fractions of yellow root more than ten years ago after

observing its traditional use in patients said to be deficient in the

vital energy 'qi' (see Traditional and Chinese culture,

this series). Jiang thought that sounded just like the lethargy and

weight loss that often accompany chemotherapy. Yellow root is also a

widely used, widely available Chinese herb.

 

 

Scientists in Hong Kong, China and Taiwan hope that modern screening

efforts will turn the previous trickle of drugs into a veritable flood.

The most ambitious effort is Hong Kong University of Science and

Technology's Biotechnology Research Institute, which set up a $1.6

million High-Throughput Drug Screening Centre for Traditional Chinese

Medicine in 1999, supported by the Hong Kong Jockey Club Charities Trust

and other local charities and private companies. The Centre is targeting

neurological diseases, including Alzheimer's, Parkinson's, amyotrophic

lateral sclerosis, and diabetic neuropathy. But the Centre is not

revealing the details of promising hits, so far, for fear of being

scooped.

 

 

Not all herbal enthusiasts are in favour of fractionating and screening,

however. Some think that's missing the point, for traditional remedies

often depend on the joint action of up to 20 herbs. " Extracting only

some of the ingredients from the herbs might impair the original

effectiveness and cause more serious side effects, " says Bian Baolin,

director of research and development at the Institute of Herbal

Medicine, China Academy of Traditional , in Beijing.

 

 

Unfortunately, from the Western perspective, traditional Chinese

remedies fail to inspire confidence. The claims rely on anecdotal

evidence instead of the requisite 'randomised, double-blind,

placebo-controlled trials' that's considered the gold standard for

Western medicine. Edzard Ernst, professor of alternative medicine at the

University of Exeter, UK, and colleagues at the Chinese University of

Hong Kong (CUHK) reviewed more than 2000 clinical trials reported in

mainland Chinese journals and found them almost universally flawed.

 

 

But Tony Mok, a clinical onocologist at CUHK, pointed out that the track

record for Western clinical trials is not much better. Although hundreds

of trials have been conducted in the United States and Europe in recent

years, " only one or two have been worthy of publication in high quality,

peer-review journals, " he says. Mok and his colleagues at CUHK are

conducting 20 randomised, double-blind, placebo-controlled trials of

traditional herbal remedies and acupuncture, with another dozen planned.

 

 

 

But is the randomised, double-blind, placebo-controlled trial another

contradiction to the philosophy of traditional Chinese medicine, which

concentrates on treatments tailored to the individual rather than to the

fictional average of a population? Yet more objections could be levied

at the statistical methods of analysing the data, which are based on an

outmoded mechanistic biology totally inadequate to capture the

predominantly non-linear behaviour of the human organism (see The

excluded biology, SiS 17). The randomised, double-blind,

placebo-controlled trial also excludes the interpersonal relationships

between practitioner and patient that's crucial in all holistic health

systems.

 

 

Irrespective of the many conceptual contradictions with the dominant

Western model, TCM has more than 300 000 practitioners in over 140

countries. The first hospital for Chinese medicine in Europe was opened

in Germany in 1990. British GPs are increasingly contracting out for

acupuncture. Public health-insurance companies in Germany routinely

refund part of the costs of acupuncture treatment provided by trained

doctors, and in France, acupuncture is a widely accepted part of the

health-care provision. Degree programmes in Chinese medicine are now

offered at several British universities, and courses in TCM are

established at European medical schools.

 

 

Dr. Volker Scheid, a scholar of Chinese medicine, predicts three

possible outcomes with regard to the effect of the globalisation of TCM,

both in terms of its widespread adoption in countries across the world

and in its entry into the global drugs market. TCM may be destroyed as

an independent medical tradition by the western biomedical

establishment, which assimilates some of the tools, such as acupuncture,

massage and pharmaceuticals, but discards the core concepts and

practices, such as the notions of yin and yang, and qi. Alternatively,

TCM may be institutionalised along the Chinese model, or TCM may

" develop into a heterogeneous vibrant tradition that eschews political

and economic power for the sake of clinical efficacy, grounded in

personal experience and in modern research " .

 

 

There's a deep cultural and conceptual divide between traditional

healthcare systems and the mechanistic mainstream model, not a

credibility gap. Rather than trying to fit traditional health systems

into the procrustean bed of the mainstream model, it is the mainstream

model that's more in need of change and development as it is proving

itself outmoded and inadequate in many respects. There's a lot to be

gained by the two sides learning from one another and growing together.

 

 

 

http://www.tcgreens.org/gl/articles/20030417052720828.html