Commentary on Political Economy

Friday, 12 June 2020


Will Beijing Silence 

Critics of Folk Medicine?

A new regulation might criminalize skepticism of Traditional Chinese Medicine. It’s highly likely to backfire.
No complaints.
No complaints.
Photographer: Adam Dean/Bloomberg
If you mock an acupuncturist in Beijing, you might soon find yourself in trouble with the authorities. That, at least, seems to be the intent of a draft city regulation that would criminalize the slander of Traditional Chinese Medicine, or TCM. Minor infractions could result in two weeks’ detention; more serious cases could mean prison time.

It might sound outlandish, but the point of such regulation is fairly straightforward. Under President Xi Jinping, China has promoted TCM as an equal to “Western” evidence-based medicine in an effort to increase its national soft power. As with other heavy-handed attempts at advancing its long-term goals, however, this one will very likely backfire for China, and undermine its aspirations to be a global public-health leader in the process.

For most of Chinese history, folk medicine was idiosyncratic, local and entirely decentralized. That started to change thanks to Mao Zedong. In the 1950s, with the country desperately short of doctors, Mao tried to fill the gap by promoting a unified and institutionalized vision of Chinese medicine (although he was dismissive of traditional practices). Within a decade, Traditional Chinese Medicine had emerged fully formed (and with capital letters), backed by a Communist Party keen to present an ideological alternative to Western medicine.

Official support of the practice has been solid ever since. Over the years, various levels of government have supported TCM schools, standards and exports. Under Xi, that backing has only grown stronger. In speeches he has referred to TCM as a "treasure of Chinese civilization," and he has sought to bolster the practice with policy papers, subsidies and propaganda.

In the government’s view, these efforts have been a spectacular success. In 2019, the domestic TCM market was worth about $45 billion, up nearly 10% over the previous year. That kind of revenue doesn’t come from small, artisanal pharmacists crafting custom herbal concoctions from a wooden cabinet. Rather, the bulk of the industry’s income comes from about 1,500 large companies, most of which are engaged in the manufacture of pills.

To be fair, TCM isn’t necessarily harmful. The Chinese pharmacopeia has produced science-based treatments for malaria and leukemia, and hundreds of millions of people rely on it without any obvious population-wide problems. But there are also serious deficiencies, starting with a near total lack of clinical trials to ensure that TCM practices are effective and safe. And while China has attempted to regulate both medicines and practitioners, enforcement is often weak. In 2015, researchers found that nearly 90% of the TCM remedies marketed in Australia included undeclared ingredients such as antibiotics, painkillers, lead and cadmium.

Despite its boosterism, China has long been relatively tolerant of TCM criticism. But in recent years, evidence has accumulated that local governments, especially those home to large TCM businesses, are becoming less patient with the skeptics. In 2018, a physician in Guangzhou blogged that Hongmao Medicinal Wine, a TCM product popular in hundreds of Chinese cities, is "poison from heaven" that has no medical benefits. In response, police arrested the doctor and detained him for months.

More ominously, another doctor — who had nearly a million followers on Weibo — was recently demoted after he criticized China's response to the coronavirus pandemic, including its promotion of TCM as a treatment. This was a particularly touchy subject. For months, China has advertised folk medicine as a remedy for the new virus, and included TCM in its national diagnosis and treatment guidelines. It has even promoted TCM treatments for Covid-19 patients overseas, and deployed high-ranking officials to dispute suggestions that politics and mercantilism were its real motivations for doing so.

It's possible that these efforts are only about patient welfare. Certainly, many TCM practitioners feel that way. But the growing effort to silence skeptics of the practice — or even to classify their criticism as "slander," as Beijing is considering — doesn't instill confidence in China’s motives. To the contrary, it will very likely undermine efforts to export TCM globally. After all, if scientists are fearful that a clinical trial could produce slanderous results, why would they even pursue it?

China has made great strides in public health over the past half-century. It shouldn't silence those who want to see it do even better.

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