Ill at ease with Chinese medicine

Symposium on Eastern medicine meets with criticism

In Hongkong, dried geckos are sold in pairs, male and female. They apparently work against all kind of ailments.

by Bart Braun

Should you take Chinese herbal potions or not? A symposium centred on this issue in an attempt to remove both charlatanism and mistakes.

Alternative medicine, as Australian comedian Tim Minchin once said, by definition, has either not been proved to work, or been proved not to work. Alternative medicine that has been proved to work is called "medicine". Nevertheless, this has not stopped a good many people from spending an awful lot of money on the first two kinds of medicine, which is rather a waste, and can even be unhealthy: an exotic herbal preparation could cause permanent liver damage, for example. And it seems ungrateful towards all the people, governments and companies who invest whole life times and huge amounts of cash in the third kind of medicine.
Consequently, in the Netherlands in 1880, an organisation, the Dutch Society against Quackery, was founded to submit complaints about misleading advertisements, to call in the Health Care Inspectorate to check on all too imposturous therapists and to rail against things like healing crystals, homeopathic anti-flu granules and anyone who styles him or herself "pH-technician". And last winter, the Society was displeased with Leiden University, due to a conference on traditional Chinese medicine that was to be held in the Gorlaeus Building last week. "That kind of medicine is an atavism (a reversal to an ancestral type). People believe in meridians and vital energy influenced by Yin and Yang. None of the traditional Chinese herbal preparations has been able meet any of the customary standards and quality requirements necessary for European registration and no one expects this ever to change. Besides, these preparations may be harmful," Catherine de Jongh, a doctor and the Society's Chair, wrote to Rector Paul van der Heijden. "I am appealing to you to stop the conference or to dissociate your university from it. If you do not, the Chinese medicine community will compromise Leiden University's good reputation and make the medical faculty look foolish." In response, the Rector invoked the university's Praesidium Libertatis principle, arguing in favour of an open-minded but scientific attitude towards other ideas and opinions.
The conference went ahead anyway. In his office at the Gorlaeus, organiser Professor Rob Verpoorte listens resignedly to the Society's accusations. "I wrote to De Jongh to say that we are pursuing the same goal: Evidence-Based Medicine. And if research proves that a Chinese therapy doesn't work, that's fine by me."
The conference's title is Good Practice in Traditional Chinese Medicine research in the post-genomic era. "For the past three years, my group was part of a network funded with European money to determine how to prove whether Chinese medicine worked or not, and we discussed the results at the conference," he explains.
In March, Verpoorte and his colleagues published an article under the same title in the Journal of Ethnopharmacology. "The Society against Quackery is partly right in claiming that there is no evidence – although a number of Chinese herbal concoction trials are currently being held in America. After all, there is a lot wrong with very many articles, although that doesn't just apply to this field of science." In the article, Verpoorte and his fellow researchers clarify the minimum requirements to which a study must comply. For instance, it is not always clear which plant is to be researched. "It sounds silly, but it's not. We classify the plants according Mr Linnaeus' method, which dates from the eighteenth century, but five thousand years ago, Chinese physicians had never heard of Linnaeus. Consequently, sometimes an article might discuss a specific plant with a Chinese name while we know two varieties of it."
And that can cause problems. In the nineties, Belgian users of a certain diet pill suddenly developed cancer. It emerged that the Chinese name Fang Ji indicated several plants, most of which make you need to pee more, but this particular variety was carcinogenic. By the same token, Western buyers might make a similar mistake: the difference between Japanese and Chinese star anise is not always easy to see, but the second kind is not fit for human consumption, although the plant was still marketed.
Verpoorte wants to find a reliable way of proving the effect of the first, unproven, field of medicine. "We have to be practical. What do we really need? Where does the effect of a placebo end? Where does the effect of food end and where does medicine begin? You can't simply claim that something is wrong because its effect hasn't been proved. I just want to see it proved, to see whether it works or whether it doesn't work."
Nevertheless, things seem to be working out between the Society against Quackery and Verpoorte: a member of the Society gave a talk at the conference.

“They must read the literature first”

Leiden Professor of Analytical Biochemistry Jan van der Greef was the only Dutch speaker at the conference. 

“Ninety per cent of Western medicine only works on forty per cent of the patients”, says Professor Jan van der Greef. “If you and I were to have the same illness, we would react differently to a drug, which is why the pharmaceutical industry is currently working on personalized medicine, medicine that is modified to suit the patient. And we are working closely with China to do just that.” Besides being a professor in Leiden and doing research at TNO, Van Der Greef is also the Director of the Sino-Dutch Centre for Preventive and Personalized Medicine. “The medicine we have in the West is designed to work very effectively for one complaint: one disease, one target, one medicine. However, that actually only works when you are completely affected by the disease, and even then it doesn’t always cure you. But if you discover that the organisation is running into trouble at an earlier stage, you can work on health promotion instead of disease management.”He has an example of what he means by organisation: Western doctors are accustomed to look out for one, or a few, substances, called biomarkers. Your blood sugar level tells us something about diabetes, the relationship between LDL and HDL cholesterol in your blood tells us something about the risks of cardiovascular disease.If, using powerful technology, you could see not how one or two biomarkers react but how many or all genes, proteins and metabolic products respond, you would have a far better picture of the self-organisation and dynamics of a system. Perhaps your cholesterol is only constant because somewhere in your body the factor that keeps it constant is working overtime. The design and use of this kind of technology is called, depending on whom you ask, system biology or –omics, with “omics” denoting an accumulation of genomics, transcriptomics, metabolomics and other similar terms that refer to a whole collection of biological data. Van der Greef prefers to use the term “system biology”: “Omics means a lot measuring and trying to construct a system, while system biology concentrates on measuring regulatory processes.” Van der Greef adds: “Last year, we published an article with the Leiden Analytical Bioscience group in Plos One on a group of patients with a Western diagnosis: rheumatism. A Chinese doctor divided the group into two, and gave them different treatments. Using metabolomics (studying the metabolic products, ed.), we could distinguish these two groups in biochemical terms too. If you can diagnose things more precisely, you are step closer to personalized medicine.’The Leiden conference was criticised by the Society against Quackery, but Van der Greef is used to flak, because as well as doing this study on Chinese medicine, he also conducts research into controversial topics such as biophotons. In 2006, the Society nominated Van der Greef for its “Meester Kackadoris Award for the advancement of quackery”. “However, they did not substantiate it with any scientific arguments against my papers,” says Van der Greef.The Professor says that he would rather discuss the issues with them than fight them. “But they must read the literature first, and find out what it’s all about. There’s no proof that it works, so my opponents say, but should I only research things that have already been proved?” BB

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