Chinese medicine should not be available on the NHS

In April this year, the Health Secretary Jeremy Hunt suggested that Traditional Chinese Medicine could be made available through the NHS, provided there was "good evidence" that it works.

At one level, the answer to this is simple. When TCM has been tested, it doesn’t work. There’s nothing unusual about that. Almost all of Western medicine from 100 years ago was equally ineffective.

TCM isn’t really traditional. In 1822 Emperor Dao Guang banned acupuncture and moxibustion from the Imperial Medical Academy. As practised now in the West, it’s essentially a product of Chairman Mao Zedong’s Great Proletarian Cultural Revolution of 1966 (Atwood, 2009), though Chairman Mao didn’t use it himself. It started as a device to encourage Chinese nationalism, and now it is a mixture of nationalism and big business.

In fact TCM isn’t even unique to China. It has much in common with early Western and Islamic medicine, for example therapeutic tattooing, astrology and lancing: “lancing was also believed to affect the flow of a numinous force that is called ‘qi’ in Chinese, ‘prāna’ in Sanskrit, ‘pneuma’ in Greek, etc“(Kavoussi, 2009).

Acupuncture scarcely existed in the West before 1970. Along with other sorts of alternative medicine, it was thought to be history; a strange hangover from a pre-scientific age. But then a gullible journalist wrote about it in the New York Times, and, strangely, acupuncture gained more acceptance than any other sort of alternative medicine. It is, after all, pretty implausible that being impaled with pins should be good for pain, or any other affliction. It has been part of the zeitgeist for a generation, but people are no longer fooled so easily.

There are two branches of TCM: Chinese herbal medicine, which has hardly been tested at all, and acupuncture, which has been the subject of over 3,000 clinical trials.

The outcome after these trials is clear. Acupuncture is no more than a theatrical placebo (Ingraham, 2009), (Colquhoun & Novella, 2013). There is little or no difference between the effects of acupuncture and sham acupuncture in a wide range of conditions. This alone is sufficient to show that all the talk about meridians and qi is baseless. It isn’t even a very effective placebo: in non-blind comparisons of acupuncture with no acupuncture, the acupuncture usually does a bit better, but barely enough for the patient to notice (Madsen et al., 2009). Similar small effects were observed in a later meta-analysis by (Vickers et al., 2012), but the spin put on the results by the authors (who are sympathetic to acupuncture) was very different. This sort of spin is a very common problem, especially in anything to do with alternative medicine.

An extreme example of spin occurred in a paper published in the British Journal of General Practice (Paterson et al., 2011). This paper showed that acupuncture showed essentially no effect, not even a placebo effect, in “frequent attenders” with medically unexplained symptoms. Bu the authors concluded exactly the opposite. And what’s worse, the journal’s press release seemed to have been copied from the paper’s abstract. After a flood of critical letters to the journal, a half-hearted apology was issued by the journal, but the authors were unrepentent (Colquhoun, 2011a).

There is no area in which it is more important to read the paper, not just the abstract. And as always, it’s as well to look at the authors’ conflicts of interest. The senior author of (Paterson et al., 2011) runs an expensive acupuncture clinic. In the words of Upton Sinclair, “It is difficult to get a man to understand something, when his salary depends upon his not understanding it.”

Like most papers on alternative medicine, papers with indecisive results always end with the mantra “more research is needed”. If 3,000 trials have not produced any convincing evidence of effectiveness, I see no point in doing more.

In stark contrast with acupuncture, next to nothing is known about the effectiveness of Chinese herbs. Not a single Chinese herb is registered under the Medicines and Healthcare Products Regulatory Agency’s (MHRA) Traditional Herbal Medicine scheme, despite the fact that that scheme requires absolutely no evidence that the herb is effective, and permits labelling which is deceptive (Colquhoun, 2011b).

But the MHRA has issued no fewer than 96 warnings about Chinese and Ayurvedic herbs between 2004 and 2014 (MHRA, 2014a). The warnings concern a whole range of toxic effects from either the herb itself, or from the all too common contaminants. Contamination of herbs with lead, mercury and arsenic is not uncommon, as is contamination with regular drugs like corticosteroids and Sildenafil (Viagra) (MHRA, 2014b). You’d have to be a bit crazy to take products like these.

In the light of all this, it’s surprising that four UK universities still offer Bachelor of Science degrees in acupuncture and/or TCM (Westminster, Middlesex, London South Bank and Glyndwr). Most universities have now stopped such degrees (Colquhoun, 2012).

How about the NHS? Acupuncture is available, but at present, the (unusually poor) guidance from NICE that allowed acupuncture to be prescribed for low back pain is being revised (Colquhoun, 2009). It would be surprising if the recommendation of acupuncture were to survive the revision. From time to time, Health Secretary Jeremy Hunt seems to show sympathy for Chinese Medicine, and even for the barmiest of all quackery, homeopathy. I doubt if he’s given the matter much thought, and his reaction has been to say that these things would be provided on the NHS only if there was good evidence that they worked.

Let’s hope that he doesn’t ask David Tredinnick MP (Cons, Bosworth) for advice about the evidence (Colquhoun, 2013).

References

Atwood, K. "Acupuncture Anesthesia": a Proclamation from Chairman Mao (Part IV) (Access date: 2-9-2102)

Colquhoun, D. "NICE fiasco, part 2. Rawlins should withdraw guidance and start again" (Access date: 14-6-2014)

Colquhoun, D. "More quackedemia. Dangerous Chinese medicine taught at Middlesex University". (Access date: 14-6-2014)

Colquhoun, D. "Acupuncturists show that acupuncture doesn't work, but conclude the opposite: journal fails" (Access date: 2-10-2012a)

Colquhoun, D. "Why does the MHRA refuse to label herbal products honestly? Kent Woods and Richard Woodfield tell me" (Access date: 22-7-2013b)

Colquhoun, D. "The demise of quackademia. Progress in the last 5 years leaves Michael Driscoll and Geoffrey Petts isolated" (Access date: 22-7-2013)

Colquhoun, D. A curious letter from David Tredinnick MP, the government's resident medical loon.

Colquhoun D & Novella SP (2013). "Acupuncture is theatrical placebo", Anesth Analg 116, pp. 1360-1363.

Ingraham, P. "Does Acupuncture Work for Pain?" (Access date: 13-6-2014)

Kavoussi B (2009). "The untold story of acupuncture", Focus on Alternative and Complementary Therapies 14[3], pp. 276-286.

Madsen MV, Gotzsche PC, & Hrobjartsson A (2009). "Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups". BMJ 338, a. 3115.

MHRA, "All herbal safety warnings and alerts" (Access date: 12-6-2014a)

MHRA, "Warnings about unlicensed traditional Chinese medicines containing undeclared pharmaceuticals and heavy metals" (Access date: 14-6-2014b)

Paterson C, Taylor RS, Griffiths P, Britten N, Rugg S, Bridges J, McCallum B, & Kite G (2011). "Acupuncture for 'frequent attenders' with medically unexplained symptoms: a randomised controlled trial (CACTUS study)". Br J Gen Pract 61, e. 295-e305.

Vickers AJ, Cronin AM, Maschino AC, Lewith G, Macpherson H, Foster NE, Sherman KJ, Witt CM, & Linde K (2012). "Acupuncture for Chronic Pain: Individual Patient Data Meta-analysis". Arch Intern Med, pp. 1-10.