Column / Health Matters
The yin and yang of Chinese medicine
Malta, the current holder of the EU council presidency, has signed an agreement with China that would increase the provision of traditional Chinese medicine (TCM) to its citizens.
On 17 January, Malta’s health minister Chris Fearne and his Chinese counterpart Li Bin signed an agreement in Valletta to increase cooperation. This agreement will see the opening of a new TCM clinic at St Luke’s Hospital in Pieta, Malta, and further cooperation between China and Malta to promote medical tourism and conduct joint research.
Minister Fearne noted that 10,000 patients made use of government clinics providing TCM services in 2016. The Maltese government clearly sees the value of using TCM in healthcare practices.
But many in the healthcare community do not share the same enthusiasm. In the treatment of specific diseases and disorders, critics assert that the available data does not support claims made by the TCM community.
Conventional versus traditional
Widely practiced in China for over 2500 years, TCM uses herbal medicines and various mind and body practices, such as acupuncture, massage (tui na), and exercise (qigong), to treat or prevent health problems.
In the West, TCM is largely seen as complementary or alternative medicine.
Practitioners of conventional medicine assessing the value of TCM have, on the whole, been highly sceptical.
Effectiveness in conventional medicine is usually tested with double-blind randomised trials of a specific medicine on a specific disease, and compared to existing approved medicines.
Very few TCM studies meet the accepted standards, often due to flawed research designs. Much of the data on TCMs is done in China, and not usually included in systematic reviews in Western literature.
In the case of physical therapies such as medical qigong - a form of exercise that incorporates movement, breathing and meditation that TCM practitioners claim is effective in treating fibromyalgia and arthritis, as well as improving respiratory and cardiovascular functions - it is notoriously difficult to implement a placebo, which is crucial in assessing effectiveness in trials.
The practice, however, continues to grow across Europe, with Belgium’s Saint-Pierre Hospital being one of the latest to add qigong courses for patients.
The nature of TCM dictates that there can be a lack of consensus among practitioners on diagnosing a patient’s condition and on what treatments to use. The Chinese government and TCM practitioner organisations have sought to standardise aspects of the training curriculum and qualifications to respond to this challenge.
But Western medical consensus is that global health would improve further with a greater uptake of conventional medicine in Asia, rather than TCM being more widely used outside.
On the other hand, there is more of an open mind about research into the thousands of chemical compounds estimated to be found in TCM - a potential pharmacological goldmine.
The EU research framework programme has provided funding in this field. A programme called TCMCANCER, for instance, aims to identify compounds from herbal traditional Chinese medicine for cancer treatments.
A number of TCMs are derived from animals and some practices are considered unacceptable in Europe for animal welfare and environmental reasons.
Shark fin soup, for example, has traditionally been considered both a delicacy and a means to improve health and vitality. Tens of millions of sharks are killed each year for their fins. Until recently, the EU was the biggest supplier until a ban on shark finning was strengthened to protect various threatened European shark species.
A steady growth in the use of TCMs has been seen in the EU, North America and Australasia in recent decades, especially with a view to maintaining health and well-being in later life.
A number of doctors are strong advocates for TCM and some countries, such as Malta and Belgium, even reimburse treatments.
The EU is responsible for setting the laws for the EU single market in herbal medicinal products, and the assessment of specific products is undertaken by the European Medicines Agency and national regulators.
Products are approved for quality and safety which is important, given that a number of regulators have expressed concerns on standards in the supply of traditional herbal medicines. But regulation of herbal products and its practitioners has also been handled sensitively, in view of cultural beliefs of some European citizens and migrants.
TCM is predominantly seen as complementary medicine. Patients are encouraged not to forego the conventional approach and use herbal or complementary approaches as an additional option, if they wish. Ultimately, this interaction comes down to the individual doctor and patient relationship.
The European Medicines Agency has a list of diseases that require a more thorough, centralised assessment if there are claims that herbal medicine can treat it. This assessment procedure is more in line with conventional medicine. Not surprisingly, this list only contains some of the most serious and potentially fatal diseases, such as cancer, diabetes and dementia.
Healthcare policy for governments is increasingly about patient satisfaction and encouraging engagement in our own health as a form of prevention.
Non-compulsory exposure for both patients and doctors to TCM for wellness, and as complementary medicine, fits with such a strategy.
TCM claims of treating specific diseases require more data, with a more rigorous methodology to penetrate the world of conventional medicine in the EU.
The agreement between Malta and China demonstrates an open-minded approach to the delivery of healthcare, addressing the major criticism of TCM by providing research data to back up its claims.
For a relatively small investment, the Maltese government can build on its positive experiences with TCM in recent years. As such, Malta is to be commended, so long as its use is complementary to conventional medicine and optional on the part of the patient.
However, TCMs should be held to the same standards as conventional treatments - where anecdotal support is insufficient and credible data is demanded.
Steve Bridges is an independent health policy adviser in Brussels. His Health Matters column takes a closer look at health-related policies, issues and trends in the EU.