Fraud In Chinese Medicine

Chinese Herbal Medicine could be seen as the acceptable side of alternative medicine. It does not suffer from the utter implausibility of homeopathy, nor does it appear to rely on supernatural mechanisms such as with Reiki. Indeed, herbal medicine appears to be nothing but a primitive form of pharmacology with the practitioner diagnosing disease and then prescribing the right chemicals: the Chinese method is through herbs; the ‘western’ method through tablets (which may well be derived from plant sources.) I fear though that this perception might be very far from the truth with levels of fraud and dishonesty well above what is seen in other forms of CAM.
 
Today, the Medicines and Healthcare products Regulatory Agency, the MHRA, issued a warning against a Chinese Herbal product called ‘Jia Yi Jian’, and sold as ‘Herbal Viagra’, through high street Chinese Herbalists. Batches of this product had been seized and examined and they were found to contain exceedingly high levels of undeclared pharmaceutical ingredients. Despite being labelled as being only herbal in origin, the product had actually been adulterated with large quantities of real drugs that were licensed for treating erectile dysfunction and, strangely, obesity.
 
Now, most alternative medicine is largely inert and has no specific effects. For example, homeopathy pills are just plain sugar pills and chiropractic is just a rough massage. Alternative medicine, if it has an effect, just generates a placebo response or waits for the complaint to get better on its own. For this reason, most alternative medicine likes to ‘treat’ self-limiting conditions, diseases that are cyclical, or made up conditions that need ‘detoxing’. However, when you claim to treat a disorder with an obvious, err, end point, such as erectile dysfunction then it is going to be pretty obvious if your potions fails to, what can I say, produce the magic.
 
It then makes perfect sense why the ‘herbal viagra’ was adulterated with tadalafil, but at many times the recommended dosage. This level of unprescribed drug might well have serious health implications. An MHRA spokesperson said,
The pharmaceuticals are deliberately included to make it work. People think they are getting something completely herbal but it contains up to four times the dose of pharmaceuticals found in legally prescribed medicinal products. Often, such marketing claims about the supposed natural ingredients in these unlicensed products are simply an attempt to divert the consumer’s attention away from very low manufacturing and ethical standards.

It might be tempting to dismiss this as an exceptional case where the herbal product required adulteration in order for it to rise to the occasion. However, some independent research has been done into measuring the levels and frequency of adulteration in herbal medicines and the results are rather startling. Bandolier, the Oxford evidence based healthcare information journal, reports that a literature survey would suggest that adulteration was widespread and that “Chinese herbal medicines may work because of the adulterants.” Surveys reported conflicting levels of adulteration, from US reports of 7% to reports showing nearly all samples containing adulterants. Bandolier conclude that  “in the absence of better information, we should assume that Chinese medicines are adulterated.” A review by Edzard Ernst concluded, “that adulteration of CHMs [Chinese herbal medicines] with synthetic drugs is a potentially serious problem which needs to be addressed by adequate regulatory measures.”

Alarming stuff. And of course, if your are lucky enough to have got from your Chinese herbalist some unadulterated herbs, then you are still left with the problem that you are about to take an unquantified amount of probably pharmacological active ingredient, mixed in with many other compounds that may or not be good for you, in a way that has not been tested for safety or efficacy and without any recourse should the herb not work or even harm you. And at the same time, your condition and herb taking is not being monitored by a qualified health worker.

Fraud in Chinese Medicine does not appear to be restricted to herbalism. It is not just adulteration that distorts our view of Chinese Medicine. Claims of efficacy can also be subject to fraud. One interesting review is by Kevin W Chen, Ph.D., M.P.H. of the University of Medicine and Dentistry of New Jersey. The review is into a branch of TCM called QiGong. Qi is the mysterious life-force that binds together so much of so called Traditional Chinese Medicine. QiGong was really invented in the last fifty years, but it has spawned a lot of research in China. Despite Kevin Chen being a True Believer, his review is interesting because it paints a fascinating picture of the nature of research in China into TCM. 

The review (An Analytic Review of Studies on Measuring Effects of External Qi in China) describes the various methods used to research Qi. However, the author notes that there are few randomised controlled studies and the field does not tend to replicate any results. As you might expect, there is complete publication bias with no negative results being considered worthy of publication.  Thus, any spurious results stand without independent confirmation. The reasons for this are interesting. Chen describes the “deliberate deception by qigong healers and in the research conducted by special interest groups that are determined to find positive outcomes”. There is a complete lack of discussion of “potential covariates that may affect the results”: positive results are assumed to be due to Qi.

Rivalry between different research teams drove bias,

Few double-blind randomization methods were used in these exploratory studies, which may greatly discount the results or conclusions, because experimenter effect and measurement bias might all become part of the observed results, especially when the specific qigong schools sponsored the research and tried to prove their own styles of qigong to be most effective.

Ten years ago, a review by Vickers et al looked at the question “Do Certain Countries Produce Only Positive Results? A Systematic Review of Controlled Trials”. They looked specifically at thousands of acupuncture trials and noted that “No trial published in China or Russia/USSR found a test treatment to be ineffective.” Even in England, “75% gave the test treatment as superior to control.” Not publishing negative results massively distorts our view of the efficacy of treatments; it can make ineffective treatments look effective, and that is not good. Pharmaceutical companies are guilty of publication bias too, but not on the scale of Chinese researchers.

Tang, Zhan and Ernst (1999) wrote a paper on “Review of randomised controlled trials of traditional Chinese medicine”. They saw a list of similar problems over all TCM. They concluded that “the quality of trials of traditional Chinese medicine must be improved urgently.”

Misleading people about acupuncture has a long history. Since, the first diplomatic contacts with communist China with Nixon, reports emerged of major operations being undertaken with acupuncture being used as an anaesthetic. What was not reported was the massive levels of patient sedation and local anaesthetic. Even the BBC were fooled and, in turn, fooled their audience when Kathy Sykes broadcast her programme, Alternative Medicine, that claimed to show that “acupuncture was used instead of a general anaesthetic during open heart surgery in China”. After a complaint and an appeal to the BBC, it finally admitted that it had misled the audience over acupuncture.

Why should Chinese Medicine be associated with so much fraud? I find this alarming. For the best part, I believe that most people working in alternative medicine are simply naive and deluded, and only harm people through omission and a negligence in not doing enough due diligence over their own beliefs. The examples I report here go somewhat further than this. China, being a nationalistic and totalitarian regime, will not produce the strongest incentives to produce honest and open research and industrial methods. Accountability will be low and  the rewards for producing ‘success’ high. Examining the research and claims of Chinese medicine in the UK is naturally made more difficult by language.

But what is more alarming is that there are signs we are approaching the regulation of much of Chinese Alternative Medicine in the belief that we simply need to uphold standards of training and ensure that traders are of ‘good character’. This will do little to stop adulterated products arriving in the UK or false and misleading claims being made by practitioners. Even unadulterated products present significant risks to customers. At the heart of the regulatory problem is a double standard. Real medicine is tightly regulated. Only a few qualified people can prescribe and dispense. There are professional regulators with teeth and drug companies are not allowed to advertise to the public and make misleading claims in their literature. Somehow, we allow herbalists to imply all sorts of unproven claims. They do not have to provide proof of efficacy or safety. There is no follow up and monitoring of side effects. We do this under the mistaken belief that Chinese Medicine is “traditional, natural and safe”. None of this is true. It is a business based on fraud, misleading claims and dangerous practices. I rarely say this sort of thing, but there is a strong case to be made to make the dispensing of herbal medicines illegal.

22 comments for “Fraud In Chinese Medicine

  1. SVETLANA PERTSOVICH
    April 8, 2009 at 7:07 am

    Good work.
    Probably,Chineze medicines are not the only remedies, which contain undeclared pharmaceutical ingredients. This method is one of main way of deception of consumers by quacksalvers. It is necessary to test homeopathic remedies with claims of unusually high effectiveness. For example, “Canova Brasil”, which was mentioned by Ullman in previous post.
    Besides, the same sin could be discovered in some new remedies, especially claiming their effectiveness for longevity, treatment of ageing diseases, etc. Story of Q-10 is known. But there are antioxidants of new generation with overstated claims and overblown advertising. It would be all the better to test them for undeclared ingredients.
    But there are antioxidants of new generation with overstated claims and overblown advertising, which – as well as Q10 – “are cooked” in enough worthy research organizations. It would be all the better to test them for undeclared ingredients. These producers use their rights of patent-holders to hide real composition of their remedies.

  2. Claire
    April 8, 2009 at 8:56 am

    “The pharmaceuticals are deliberately included to make it work” [MHRA]

    One for the YCNMIU file. It would be funny if it wasn’t potentially so serious. It seems like most of the towns in my part of the world (Bucks) have at least one TCM shop

  3. John H
    April 8, 2009 at 9:16 am

    Good article Andy.

    I never realised TCM was full of proper pharmaceuticals until I read ToT. I guess that is called covering the bases or hedging your bets.

    It would be nice if some proud member of the TCM community condemned this practice. Not very likely is it.

    Given that the evidence for the pot pourri rubbish is hardly likely to stand up this nonsense does require the application of a rigid code backed up by stiff penalties.

    Part of the problem is apparently the proliferation of knock-off pharmaceuticals in China which quacks can get very easily and cheaply in a rather limp and floppy regulatory regime. Why not add a little something to your litle something just to make sure and get the marks coming back for more overpriced dried leaves.

    Beats me why HY quacks don’t just add their mystical potions to aspirin. (copyright JH)

  4. Rosy
    April 8, 2009 at 2:04 pm

    TCM does not restrict itself to the use of herbs and pharmaceutical drugs in its ‘medicines’ but also uses animal parts. By buying into TCM one is also promoting the poaching of endangered animals such as the Javan Rhino and the Saiga Antelope.
    The time for much stricter regulation of TCM is well overdue.

  5. Le Canard Noir
    April 8, 2009 at 4:48 pm

    If you are interested in some examples of the harm herbal remedies can cause, this is a good site:

    http://whatstheharm.net/herbalremedies.html

  6. Le Canard Noir
    April 8, 2009 at 4:54 pm

    Unbelievable.

    When I try to go to the web site of the manufacturer of the ‘Jia Yi Jian’ Herbal Viagra at http://www.hnamzy.cn, my anti-virus alerts me that the site is trying to install malware on my computer. Scum.

  7. SVETLANA PERTSOVICH
    April 8, 2009 at 7:33 pm

    Oh-oh! And such thing isn’t surprising for me ;) China holds “top rating” in Internet hacking and pirating. Look ahead!

  8. Warhelmet
    April 8, 2009 at 8:51 pm

    Thanks for the tip-off. I’ll do rounds of the local TCM shops, buy up all their stock and sell it all at the local gay bar.

  9. Warhelmet
    April 8, 2009 at 9:52 pm

    BillyJoe – Sorry, should be “them thar stock”.

  10. Claire
    April 9, 2009 at 8:26 am

    Adulteration of Chinese herbal slimming supplements currently a concern in Germany

  11. SVETLANA PERTSOVICH
    April 9, 2009 at 3:05 pm

    Aha!
    And it is some answer of life to my first comment above:
    http://vz.ru/news/2009/4/9/274291.html
    http://www.k2kapital.com/news/fin/576679.html
    (Sorry, text in Russian. But translator in Internet is free and on-line!)
    Sanitary Control of Russian Federation has forbidden to use on the territory of Russia the plant composition for aromatization of air, which contains poisonous, narcotic and psychotropic substances (Salvia divinorum, Argyreia nervosa, Nymphaea caerulea) and is dangerous for human. The composition is being produced in United Kingdom and other European countries and sold under trade names – AM-HI-CO, Dream, Spice (Gold, Diamond), Zoom, Ex-ses, Pep Spice, Yucatan Fire.
    Be careful – the thing came from you.
    And I repeat – all quack remedies require to test for undeclared and illegal ingredients!

  12. Stuart van Onselen
    April 10, 2009 at 12:51 pm

    In fairness to the purveyors of poison, they may not even be aware that their site is trying to infect your machine. A common tactic of malware distributors is to hack someone else’s site, not change it visibly, but add the hidden malware-downloading function. This has happened to several very respectable (yet poorly-secured) sites in the past.

    “Never attribute to malice what can as easily be ascribed to incompetence.” – Anon

    Of course, you certainly can’t discount the possibility of malice in this particular case, given that the site belongs to an organisation which is already known to lack any scruples.

  13. Bob Calder
    April 10, 2009 at 11:00 pm

    Could it be bound up with the lack of affordable health insurance for Chinese citizens?

    For some reason people don’t consider the fact that there is no universal health care in China.

  14. Janet
    April 13, 2009 at 8:48 am

    It’s not just the Chinese who adulterate their medicines. I was mildly amused, in a sad sort of way, by a recent alert issued by the MHRA regarding unlicenced eczema creams containing steroids:
    http://www.mhra.gov.uk/Howweregulate/Medicines/Herbalandhomoeopathicmedicines/Herbalmedicines/HerbalSafetyNews/Currentsafetyissues/CON041331

    The most recent episode was uncovered because some cream worked when a parent obviously didn’t expect it to …

    “The latest case was brought to our attention by a parent who became concerned when the cream, which he was assured only contained natural ingredients from India, cleared his son’s eczema within 3 days.”

  15. John H
    April 13, 2009 at 12:18 pm

    Janet – what a fantastic post.

    “I only realised there was something wrong with the quack herbal medicine when it worked within 3 days. I wasn’t expecting anything to happen (as usual) so it was clearly adulterated. It shouldn’t be allowed”.

    As ever it is becoming increasingly difficult to take the piss out of this stuff.

  16. Anonymous
    May 11, 2009 at 4:49 pm

    Real traditional herbal medicine is best acquired in an unprocessed
    manner. The raw herbs are mixed together in a receptacle in front of you. Instructions for the preparation, i.e. boiling making a tea, etc. should also be provided by a well trained Herbalist.

  17. Le Canard Noir
    May 11, 2009 at 4:56 pm

    Anonymous – how does this ensure you have a safe level of active ingredients and minimum amounts of unwanted ingredients? The chemicals in herbs can vary greatly depending on which bit you use and when they were harvested.

  18. kim
    December 13, 2010 at 7:56 pm

    i’m really disappointed to see this.
    it seems to me that you have been influenced by literature and findings that are largely biased & incomplete.
    it is irresponsible journalism to bite off the crust of an apple pie & declare that what you’ve eaten is only flour, sugar & butter.
    i am really sorry that there are deceptive & unprofessional practitioners/herbal distributors out there, but they should not looked upon as icons for TCM.
    there are honest, credentialed TCM doctors who are able to provide safe & natural herbs that really do address erectile dysfunction.
    the results would be like ‘magic’… only it’s not magic… it’s science.

    • Le Canard Noir
      December 13, 2010 at 8:01 pm

      Kim – if you read my article you will see I reference studies that investigate the high levels of fraud in TCM.

  19. Hillary Step
    March 17, 2012 at 3:00 am

    Most TCM practitioners would not deal with erectile dysfunction solely since it is a symptom that implies a larger problem. It is most likely true that an herbal remedy claiming to treat erectile dysfunction would be ineffective; that is because the symptom may be the result of something larger such as blood deficiency, poor circulation, the result of statin drugs or any other number reasons that are not specified in this article. In any case a legitimate TCM/CCM practitioner would not simply treat the symptom (as western medicine does) but would instead identify the over all pattern and treat the root of the problem. This does mean that the treatment may be extended, but over time it can be effective in resolving the root of the issue and there by resolving the symptom.
    Your article and references do provide a somewhat plausible argument but your characterization of the Chen article seems over simplified and biased. I think you missed the point of the article. In any case you need more references to back up your claims. I think your argument could benefit from a deeper understanding of the medicine. What do you think of the article linked below?

    http://www.health-care-reform.net/causedeath.htm

  20. Besart Zhubi
    November 22, 2014 at 2:47 pm

    This is old article but I am compelled to respond.

    Plants have provided medicine with compounds that have revolutionised people’s health for the better. One example that springs to mind is the Madagascan Periwinkle, which led to the development of vincristine that changed survival (5+ years) rates of some childhood blood cancers from 10% to 90%. It is foolish to discount plant based medicine on the basis of criminality of some sellers.

    Not all herbal medicine is quackery. The reliance on randomised clinical trials (EBM) is relatively new to Western Medicine. Some of the drugs in the BNF predate EBM and some have no evidence of efficacy in the way you’re calling for. Some medicines are used ‘off-license’ and this is perfectly acceptable. I don’t remember seeing any RCTs used to justify the use of penicillin.

    The price of Western Medicine is sky-rocketing because of the insistence of RCTs which only large pharmaceutical companies can afford to a) conduct b) market. This is leading to massive costs which people are unable to meet. So, what’s wrong with looking to cheap, readily available medicines which have been used traditionally, have no history of toxicity and in some instance are just as effective as modern medicines. St. John’s Wort being a prime example. The cost of mental health drugs is extortionate and almost any research (almost always publicly funded) has shown that St. John’s Wort is as effective than (want of a better term) modern medicine for depression.

    Unfortunately doctors have an agenda themselves here. Big Pharma spends big bucks in the marketing of medicines. Many of the doctors who sit on advisory boards are also in the pay of big pharma. Yes, they declare this, but government regulators simply don’t have the money to scrutinise the data and claims made. And doctors are not impervious to the tricks used by pharmaceutical sales people.

    All I’m calling for is some balance here and some humility.

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