Recently, Xiaorui Zhang, World Health Organization (WHO) coordinator on traditional medicine policy, noted the difficulty in conducting clinical trials of herbal remedies because of two factors: first, participants can detect a difference in taste between the placebo and the herbal therapy; second, quality control is difficult since many of the herbal products contain multiple ingredients, making it tough to determine which chemicals are responsible for any health outcomes. She added: "Western medicine came to China about a hundred years ago. That Chinese people survived for thousands of years without Western medicine shows that it [Chinese medicine] works." With a nearly five thousand year-old recorded history, China is one of the oldest civilizations in the world. However, can we so easily attribute its survival to its medical traditions? Is its survival reason enough to discontinue clinical trials of herbal remedies?
First and foremost, we need to put into context Zhang's usage of the word "survived." If she means simply to imply that Chinese society continued to function, then yes, it has survived for over four thousand years. However, if instead of mere survival we look at longevity, the statistics are not as impressive. In the first part of this century, before Western medicine became prevalent in China, the average life span was just twenty-five years, with large numbers dying from infectious diseases. Traditional Chinese medicine did little to prevent these deaths.
Today, the Chinese are no longer dying of communicable diseases. Rather, more than half will die of modern diseases, such as heart disease, cancer, and stroke, a significant proportion of which can be attributed to the increased incidence of cigarette smoking. The British Medical Journal reported back in 1998 that one-third of all young Chinese men would be killed by tobacco if current smoking patterns continue, and currently smoking kills nearly two thousand people every day in China, increasing to eight thousand by 2050. However, even with the negative health effects caused by the introduction of tobacco, Chinese life expectancy has dramatically increased. One way we can look at how life expectancy has risen, while controlling for smoking, is to look at the life expectancy rates of women. (Surprisingly, smoking rates for women have decreased in the last half-century in China in 1950, 10% of young women became smokers, but today, only 1% do.)
As mentioned earlier, in 1900 (when Western medicine was just beginning to infiltrate China's borders), the average Chinese woman lived to age 25, while in the United States a nation dominated by allopathic or conventional medicine the average woman lived to be 48 years old. By 1949, the average woman's life span in China was 35 years (71 years for American women) and as of 2000, it was 73 years (and around 80 years for American women). Is this nearly 50-year increase in average life expectancy thanks to Ma Huang and acupuncture? On the contrary, it can be attributed to greater access to and the better quality of Western medical care. In 1949, China had 80,000 beds and over 360,000 medical personnel. Today, it has 3.18 million beds and nearly 4.5 million medical personnel available to treat its roughly 1.3 billion population.
We can also take a look at another region that has a strong tradition of folk medicine and see how it is "surviving." The practice of folk medicine is actually more prevalent on the African continent, where it tends to be the only alternative. For example, in Mozambique, where 1.2 million people have HIV and 290,000 have AIDS, 80% of the people use traditional medical practices. Do Mozambique's life expectancy rates reflect the "success" of their traditional medicine? No. It is estimated that the average woman in 2001 will only live to 35 years old, while the average man will live to 37 years old. Traditional medicine is doing little to help the people of this country, where increased access and improved Western medical care could greatly increase their chances of survival to a riper, older age.
It is possible for Western medicine and traditional Chinese to coexist, as is the case in China, where 95% of hospitals have folk medicine wards, with 340,000 doctors and 100,000 beds dedicated to traditional medicine. However, it is wrong to attribute the survival of the Chinese civilization to its traditional medical practices. There are many factors that contribute to a civilization's success or for that matter, collapse war, drought, disease, political struggles but even through the haze of complex data, the statistics show us how Western medicine has greatly benefited the health and well-being of the Chinese population. Eighty percent of all Chinese who have ever lived, lived all or a fraction of their lives in this past century when allopathic medicine was introduced and institutionalized. Western medicine is why life expectancy is increasing around the globe and also largely accounts for China's massive population.
So, should we give up on conducting clinical trials of herbal remedies, citing the Chinese civilization's "survival" as proof enough that it works? Zhang was also quoted as saying: "Only through regulation can we ensure quality, safety, and efficacy." Traditional medicine has something to offer in that it treats the emotional and spiritual needs of people, but how do we know for certain that these herbal remedies didn't actually contribute to the short life spans at the turn of the century? With current reports of death, heart attacks, and strokes associated with herbal remedy use (such as Ma Huang or ephedra), we need not just regulation but clinical trials to prove that it's worth the potential health risk. And we should give credit where credit it's due and thank Western medicine for increasing life expectancy by nearly fifty years.
Karen L. Schneider is a research intern at the American Council on Science and Health.
May 28, 2002
Correct me if I'm wrong, but the 5/21 article on Chinese medicine seems to be confusing the effects of public health measures (and increasing wealth), such as clean water, sanitation, and plenty of food, with what most people think of as "Western medicine," i.e., doctors, drugs, x-rays, etc.
My understanding is that the fifty-year life expectancy increase you get with "Western medicine" is really a dramatic reduction in infant mortality and epidemics rather than any increase in base life expectancy. In other words, 1900 Americans (and current Third-Worlders) were not hobbling around like old ladies at age thirty. They just had a lot of their children die young.
Of that fifty years, something like thirty-five years are due to this improvement in sanitation and diet. Perhaps another ten years is due to childhood vaccinations and better prenatal care. The final five years is due to improved medical treatment. Remember that most people are healthy most of their lives. I know people who have never been inside a hospital and have had nothing but routine checkups from doctors. Medical care is obviously not a factor in their health or longevity.
The article also mentions conditions in Third World countries like Mozambique, as if they were directly comparable. The prevalence of AIDS completely changes the picture, making this a worthless comparison. Life expectancies are dropping all over Africa, and this is not due to any change in the quality of healthcare. It's due to a plague.
A more interesting point to make (one ACSH seems to understand) is that preventative care, better diet, more exercise, and consistent vaccinations make more difference to health than all the rest of high-tech medicine. The Chinese case actually proves this point. China is still a poor country, and rural China never sees something like an MRI machine. Yet their life expectancy of seventy-three is nearly the same as our expectancy of eighty. (In other words, that last seven years probably costs us something like a trillion dollars.)
If we made sure that clean water, good food, and basic, cheap medicine were available worldwide, there would only be a five to ten year disparity between life expectancies of rich and poor countries. People would hardly care.
August 8, 2002
I find the response of Michael Goodfellow to this article a bit odd. Somehow he dismissed the gains made due to vaccination, as well as reductions in infant mortality and in epidemic mortality as not representing medical care, and dismissed about 7,000,000,000 total years of life as insignificant (1 billion Chinese people x 7 years life expectancy). If his cost estimate of $1,000,000,000,000.00 (one trillion dollars) is accurate, it amounts to about $143.00 spent per year of life gained (one trillion dollars divided by 7 billion years), hardly an astronomical or unreasonable cost. Even the impoverished Chinese populace should consider that money well spent.
His response also dismissed much of public health as being non-medical, but:
It was a physician, James Lind, who discovered that citrus prevented scurvy, using a prospective controlled clinical study of that botanical treatment more than 250 years ago. (Scurvy killed more than half of the sailors on some long sea voyages; more sailors died from scurvy than from wounds, infectious diseases, and all other causes combined. This was nearly two hundred years before advances in basic science made it possible to explain the cause of the disease and the reason Lind's treatment was effective).
It was a physician, John Snow, that described the transmission of cholera by contaminated public water supplies more than 150 years ago, convincing those governing to remove the Broad Street pump handle in Soho, London; shortly afterward, deaths from cholera in Soho stopped. His actions stimulated improvements in the water supply and sewage-disposal systems in London and other cities thirty years before Louis Pasteur described the germ theory of infection.
Diseases that killed many thousands of children in 1900, such as diphtheria, measles, and pertussis, were practically eliminated by 2000. Other communicable childhood diseases rubella (German measles), scarlet fever, and mumps have all but disappeared. Acute poliomyelitis ended abruptly in the 1950s.
Infectious diseases that killed thousands can now often be treated with antibiotics.
People are now effectively treated for diabetes (type I diabetes was fatal in childhood before insulin), many cancers, appendicitis, pneumonia, and dozens of other traditionally fatal conditions.
Even the AIDS he dismisses as an unavoidable plague is in fact somewhat treatable, and modern drug treatment adds years to the lives of many.
In contrast, the "Traditional Chinese Medicine" treatment for diabetes was burial.
Another component of evidence-based medicine is the relief of suffering (though that may not always change life expectancy). There are effective treatments for congenital and traumatic deformities and for crippling arthritis, which alleviate great suffering that would otherwise last a lifetime and for which there is no "traditional" substitute. Almost all of the people crippled for their long life expectancy by poliomyelitis are the unvaccinated in the Third World and those who opt out of evidence-based Western medical care. Medical care is more than the extension of life; it is also the alleviation of suffering during that life.
Steve Zeitzew, M.D.
August 26, 2002
I appreciated the comments of Karen Schneider, who pointed out that merely having a long history of prior use is not a substitute for scientific evidence when considering the safety and effectiveness of a treatment. She effectively countered the patently invalid argument of Xiaorui Zhang of the WHO that the simple fact that China has survived for many years is evidence that their traditional methods are effective.
Mr. Goodfellow neglected one key observation in his counterargument: that there is no evidence (either direct or inferred) that any alternative modality or system of healthcare has added even a single day to the life expectancy of any population. Proponents of traditional or alternative modalities cannot rest on the historical evidence (i.e., long use or apparent effect) and must be held to the same standards of scientific evidence for safety and efficacy as standard medicine.
Similarly, no particular Western modality should rest on the historical success of scientific medicine. We must continue to maintain high standards for demonstrating the scientific basis of all healthcare.
Steven Novella, M.D.