6 Scientific American, April 2019SCIENCE AGENDA
OPINION AND ANALYSIS FROM
SCIENTIFIC AMERICAN’S BOARD OF EDITORSIllustration by Christina UngThe WHO Takes
a Reckless Step
The World Health Organization
is now promoting unproved
traditional Chinese medicine
By the EditorsFor more than 2,000 years Chinese healers have used herbal
powders and tinctures, dust made from various animal parts
and strategically placed needles to treat a host of human ail-
ments. These are used in hundreds of nations globally, but the
practice in China is perhaps the most extensive, documented
and catalogued. Traditional Chinese medicine (TCM) is based on
the concept of qi, a system of energy that flows along meridians
in the body to maintain health.
Over the past decade proponents of TCM have worked hard to
move it into the mainstream of global health care—and it appears
those efforts are coming to fruition. The latest (11th) version of
the World Health Organization’s list known as the International
Statistical Classification of Diseases and Related Health Problems
( ICD ) will include these remedies for the first time.
According to its own mandate, the WHO sets the norms and
standards for medical treatment around the globe and articulates
“ethical and evidence-based policy options.” It categorizes thou-
sands of diseases and influences how doctors treat them; how
insurers cover those treatments; and what kind of research is
done on which ailments. More than 100 countries rely on the doc-
ument to determine their medical agendas.
To include TCM in the ICD is an egregious lapse in evidence-
based thinking and practice. Data supporting the effectiveness of
most traditional remedies are scant, at best. An extensive assess-
ment was done in 2009 by researchers at the University of Mary-
land: they looked at 70 review papers evaluating TCM, including
acupuncture. None of the studies proved conclusive because the
data were either too paltry or did not meet testing standards.
To be sure, many widely used and experimentally validated
pharmaceuticals, including aspirin, decongestants and some anti-
cancer chemotherapies, were originally derived from plants or
other natural sources. Those drugs have all gone through exten-
sive clinical testing of safety and efficacy, however. Giving cre-
dence to treatments that have not met those standards will
advance their use but will also diminish the WHO’s credibility.
China has been pushing for wider global acceptance of tradi-
tional medicines, which brings in some $50 billion in annual rev-
enue for the nation’s economy. And in 2016 Margaret Chan, then
the WHO director, praised China’s plans to do so. But while it’s a
good idea to catalogue TCM and make health workers aware of
treatments used by millions, their inclusion in the ICD recklessly
equates them with medicines that have undergone clinical trials.
In China, traditional medicines are unregulated, and they fre-
quently make people sick rather than curing them. One particu-
larly troublesome ingredient, aristolo chic acid, is commonly used
in traditional remedies and has been linked to fatal kidney dam-
age and cancers of the urinary tract.
A 2018 study in the British Journal of Clinical Pharmacology
tested 487 Chinese products taken by sick patients and discov-
ered 1,234 hidden ingredients, including approved and banned
Western drugs, drug analogues and animal thyroid tissue. And in
2012 a team led by Megan Coghlan, then at Murdoch University
of Australia, identified the DNA sequences in 15 samples of tradi-
tional medicines in the form of powders, tablets, capsules, bile
flakes and herbal teas. The samples also contained plants that
produce toxic chemicals and animal DNA from vulnerable or
endangered species (the Asiatic black bear and saiga antelope, for
example) and other creatures protected by international laws.
Thus, the proliferation of traditional medicines would have sig-
nificant environmental impacts on top of the negative health
effects. It would contribute to the destruction of ecosystems and
increase the illegal trade of wildlife. China an nounced last Octo-
ber that it was legalizing the controlled trade of rhinoceros horn
and tiger bone. (The move was postponed in November, following
a global outcry.) Both are believed by practitioners to have the
power to cure a range of ailments, from fever to impotence—
although no study has found any beneficial outcome of ingesting
either. Allowing even the controlled harvest of otherwise endan-
gered creatures will boost illegal poaching, critics say.
Until they undergo rigorous testing for purity, efficacy, dosage
and safety, the WHO should remove traditional medicines from
its list. These remedies should be given the same scrutiny as oth-
er treatments before being in cluded in standard care practices.JOIN THE CONVERSATION ONLINE
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