Anecdotal evidence is not evidence, researchers urge — and there is little real evidence to back up China’s push of traditional medicine.

China seems to have surpassed the first coronavirus hump. The draconic measures have seemingly stopped the spread of COVID-19 throughout the country for the time being. While there are major concerns about a second wave caused by re-imported cases, there’s no denying that China’s efforts have had remarkable results — there’s a separate discussion to be had about whether the end justifies the means and how China’s early inaction cost the world, but at least for now, it seems the infection is contained.

Chinese officials are now claiming that much of that success is owed in part to traditional Chinese medicine, which President Xi Jinping has praised it as a ‘treasure’ of Chinese civilization.

According to reports, over 90% of coronavirus patients in China have been given some form of traditional medicine, either by itself or in conjunction with medical treatments, and Beijing is now reportedly promoting traditional Chinese medicine as a solution for COVID-19.

“We are willing to share the ‘Chinese experience’ and ‘Chinese solution’ of treating Covid-19, and let more countries get to know Chinese medicine, understand Chinese medicine and use Chinese medicine,” Yu Yanhong, deputy head of China’s National Administration of Traditional Chinese Medicine, said at a press conference last week.

No standard, no verification

Let’s ignore COVID-19 for a moment.

We use science for a reason: it works. In essence, there’s nothing fundamentally different about scientific research, it’s all about ensuring the validity of science through observation and testing. But the lengths to which we go to ensure this validity is absolutely enormous.

Every single factor must be analyzed, every parameter that can interfere with the data, eliminated. In medical trials, that is particularly difficult. It requires systematic observation of a large number of people (because our bodies are different), of different socioeconomic and cultural parameters (that can affect medical treatments), pre-existing medical conditions, and a long line of other parameters. Then there’s also the placebo effect, the consultation effect, unassisted healing — the list of things that can affect a clinical trial is long and complex.

This is, in part, why it takes so long to long to develop new treatments: simply giving them to a few people and seeing if they get better or not isn’t compelling evidence.

Traditional medicine, including Chinese traditional medicine, has not proven its worth through this scientific rigor. It’s unclear what effect (if any) this medicine has.

At first glance, the evidence might seem convincing. In a clinical trial of 102 patients with mild symptoms in Wuhan, patients that combined medicine with traditional medicine reportedly had a recovery rate of 33% higher. In another Chinese study, patients who received traditional medicine in addition to treatment left hospitals sooner than the control group and had greater levels of oxygen in their blood.

But the underlying data for these studies has not been shared, and little has been done to subject the data to scrutiny. Simply put, the comparison is not scientifically rigorous.

Du Bin, director of the intensive care unit of the Peking Union Medical College Hospital, says that given the lack of scrutiny, comparisons are “impossible or meaningless”.

Even Lao Lixing, former director of the school of Chinese medicine at the University of Hong Kong, acknowledged we cannot put any trust in these figures at this point. He told SMCP:

“We do not have statistics as evidence to show which of those should be credited to Chinese medicine,” said Lao, now president of the Virginia University of Integrative Medicine in the US.

Of course, there is nothing to say that traditional medicine can’t form the basis of valuable treatment. Tu Youyou, the first Chinese Nobel laureate in physiology or medicine, saved millions of lives when she found compounds that are effective in treating malaria — and she did so by sampling compounds found in plants used in traditional medicine. But this doesn’t mean that the traditional medicine worked — it was just a basis for the development of new treatments, under a scientific, controlled environment.

Science?

Despite all these things, however, Chinese authorities continue their push for traditional medicine — both inside the country and out.

When the World Health Organization removed a warning about using herbal remedies (listed in the “what not to do section” of their website), many highlighted this as an example of bowing to pressure from the Chinese government.

The local government in Lancang county in Yunnan province earlier this month forced students and teachers to take a traditional remedy called “big pot soup” — a dish that includes indigowoad root and loquat leaves. The move prompted a backlash which ultimately forced the government to drop the measure and apologize. Most provinces, however, maintain guidelines that focus on Chinese medicine.

In the makeshift COVID-19 pavilions and hospitals, over 90% of all patients were given ephedra soup, which mixes the plant ephedra with blackberry lily, apricot kernel, and gypsum, and is said to alleviate respiratory symptoms, according to official guidelines from the Chinese National Health Commission. Most patients complied, on the rationale that it at least can’t hurt, but some didn’t.

In addition to unproven efficacy, there’s also another concern: traditional Chinese medicine often relies on animal parts and wildlife trading. This wildlife trade is likely to have played a key role in the emergence of the COVID-19 pandemic and has been repeatedly shown to favor the emergence of zoonotic diseases — with recent examples such as SARS and MERS (also coronaviruses).

The world is racing to find drugs that work against the novel coronavirus, and it’s understandable that we want to use every bit of available information. All sorts of trials are accelerated around the world, focusing either on treatment or vaccines, and working on the problem from a multitude of angles, with unprecedented impetus. If there is merit to any type of traditional medicine, that needs to be put to the test — rigorously. Until that happens, there is little reason to emphasize unproven treatments.