MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

The ‘Daily Mail’ is not a paper famed for its objective reporting. In politics, this can influence elections; in medicine, it can endanger public health.

A recent article is a case in point, I think.

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Traditional Chinese medicines could help prevent heart disease and the progression of pre-diabetes, according to research. Some herbal treatments proved as effective in lowering blood pressure as Western drugs and improved heart health by lowering cholesterol, scientists found. Certain alternative medicines could lower blood sugar and insulin levels, too.

Chinese medicines could be used alongside conventional treatments, say researchers from Shandong University Qilu Hospital in China. Or they can be beneficial as an alternative for patients intolerant of Western drugs, they said in their review of medical studies over a ten-year period. Senior review author from the university’s department of traditional Chinese medicine said: ‘The pharmacological effects and the underlying mechanisms of some active ingredients of traditional Chinese medications have been elucidated. Thus, some medications might be used as a complementary and alternative approach for primary and secondary prevention of cardiovascular disease.”

It’s potentially good news for people living with diabetes, which is now a global epidemic and has proved a tricky condition to manage for many people. High blood pressure is very common too, affecting more than one in four adults in the UK,  although many won’t show symptoms and realise it. If untreated, it increases your risk of serious problems including heart disease, the number one killer globally.

The Chinese have used herbs for treating diseases for thousands of years and have become increasingly popular in Europe and North America, mainly as complement to Western medicine. But the researchers also warn that much of the research conducted have limitations and so their long-term effects are not proven.

Key findings  

Herbs for high blood pressure

The blood pressure-lowering effect of herb zhongfujiangya was found to be similar to that of oral anti-hypertension medication benazeprilm, which goes by the brand name Lotensin. Similarly, patients treated for eight weeks with herbal tiankuijiangya had a lower reading than those given a placebo. Herbal Jiangya tablets were found to ‘significantly lower’ systolic blood pressure, that is the amount of pressure in your arteries during contraction of your heart muscle compared to a fake treatment. The herb Jiangyabao also had a significant effect compared to a placebo, but just at night. But overall, compared to the drug Nimodipine, a calcium channel blocker, it worked just as well. Qiqilian capsules also proved more effective compared to a placebo.

Herbs for diabetes

The team report some Chinese medicines medications – such as xiaoke, tangminling, jinlida, and jianyutangkang – have a ‘potent’ effect on lowering blood sugar levels and b-cell function, which controls the release of insulin. Some remedies – such as tangzhiping and tianqi – might prevent the progression of pre-diabetes to diabetes, they note.

Herbs for cholesterol 

The researchers looked at research on dyslipidemia, the term for unbalanced or unhealthy cholesterol levels. They found that jiangzhitongluo, salviamiltiorrhiza and pueraria lobata, and zhibitai capsule all have a ‘potent lipid-lowing effect’.

Herbs for heart disease

Some traditional Chinese medicines such as qiliqiangxin, nuanxin, shencaotongmai, and yangxinkang, might be effective in improving function in patients with chronic heart failure, they wrote.

Limitations with trials

But Western scientists often reject Chinese medicine for specific reasons, warned Dr Zhao’s team. Chinese medicines are frowned upon because they do not go through the same exhaustive approval process as trials conducted domestically, they pointed out. Plus, one treatment can be made of many different ingredients with various chemical compounds, making it hard to pinpoint how their benefits work. ‘One should bear in mind that traditional Chinese medicine medications are usually prescribed as complex formulae, which are often further manipulated by the practitioner on a personalized basis,’ said Dr Zhao.

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Apart from the fact that this article is badly written, it is also misleading to the point of being outright dangerous. Regular readers of my blog will be aware that Chinese research is everything but reliable; there are practically no Chinese TCM-trials that report negative results. Furthermore, the safety of Chinese herbal preparations is as good as unknown and they are often contaminated with toxic substances as well as adulterated with synthetic drugs. Most of these preparations are also unavailable outside China. Moreover, Chinese herbal treatments are usually individualised (mixtures are tailor-made for each individual patient), and there is no good evidence that this approach is effective. Crucially, the trial evidence is often of such poor quality that it would be a dangerous mistake to trust these findings.

None of these important caveats, it seems, are important enough to get a mention in the Daily Mail.

Don’t let the truth get in the way of a sensational story!

Let’s just for a moment imagine what would happen if people took the Mail article seriously (is there anyone out there who does take the Mail seriously?). In a best case scenario, they would take Chinese herbs in addition to their prescribed medication. This might case plenty of unwanted side-effects and herb-drug interactions. In addition, people would lose a lot of their hard-earned cash. In a worst case scenario, they would abandon their prescribed medication for dubious Chinese herbal mixtures. This could cause thousands of premature deaths.

With just a little research, I managed to find the original article on which the Mail’s report was based. Here is its abstract:

Traditional Chinese medicine (TCM) has more than 2,000 years of history and has gained widespread clinical applications. However, the explicit role of TCM in preventing and treating cardiovascular disease remains unclear due to a lack of sound scientific evidence. Currently available randomized controlled trials on TCM are flawed, with small sample sizes and diverse outcomes, making it difficult to draw definite conclusions about the actual benefits and harms of TCM. Here, we systematically assessed the efficacy and safety of TCM for cardiovascular disease, as well as the pharmacological effects of active TCM ingredients on the cardiovascular system and potential mechanisms. Results indicate that TCM might be used as a complementary and alternative approach to the primary and secondary prevention of cardiovascular disease. However, further rigorously designed randomized controlled trials are warranted to assess the effect of TCM on long-term hard endpoints in patients with cardiovascular disease.

In my view, the authors of this review are grossly over-optimistic in their conclusions (but nowhere near as bad as the Mail journalist). If the trials are of poor quality, as the review-authors admit, no firm conclusions should be permissible about the usefulness of the therapies in question.

As the Mail article is obviously based on a press release (several other papers worldwide reported about the review as well), it seems interesting to note what the editor of the Journal of the American College of Cardiology (the journal that published the review) recently had to say about the responsibility of journalists and researchers:

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…I would like to suggest that journalists and researchers must share equally in shouldering the burden of responsibility to improve appropriate communication about basic and clinical research.

First, there is an obligation on the part of the researchers not to inflate the importance of their findings. This has been widely recognized as damaging, especially if bias is introduced in the paper…

Second, researchers should take some responsibility for the creation of the press release about their research, which is written by the media or press relations department at their hospital or society. Press releases are often how members of the media get introduced to a particular study, and these releases can often introduce errors or exaggerations. In fact, British researchers evaluated 462 press releases on biomedical and health-related science issued by 20 leading U.K. universities in 2011, alongside their associated peer-reviewed research papers and the news stories that followed (n = 668). They found that 40% of the press releases contained exaggerated advice, 33% contained exaggerated causal claims, and 36% contained exaggerated inference to humans from animal research. When press releases contained such exaggeration, 58%, 81%, and 86% of news stories, respectively, contained further exaggeration, compared with rates of 17%, 18%, and 10% in the news when the press releases were not exaggerated. Researchers should not be excused from being part of the press release process, as the author(s) should at least review the release before it gets disseminated to the media. I would even encourage researchers to engage in the process at the writing stage and to not allow their hospital’s or society’s public relations department to extrapolate their study’s results. Ultimately, the authors and the journals in which the studies are published will be held accountable for the information that trickles into the headlines, not the public relations departments, so we must make sure that the information is accurate and representative of the study’s actual findings.

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Sound advice indeed.

Now we only need to ALL follow it!!!

9 Responses to Recklessly stupid TCM-promotion by the ‘Daily Mail’

  • http://www.lavanguardia.com/local/barcelona/20160202/301846066786/barcelona-catalunya-hospital-medicina-tradicional-china.html………….

    and then curiously, the University of Barcelona is offering a Masters in TCM….and summer courses open to all. I do not really know what they hope to get out of this generous underwriting, but there it is.

  • I am really concerned about the ‘integration’ of TCM with conventional healthcare, especially when they specifically target something such as oncology. Herb-drug interactions is a big concern, where the herb might be completely harmless but by taking it with a powerful chemotherapeutic the patient might OD – good explanation of this is the ‘grapefruit juice effect’

    https://en.wikipedia.org/wiki/Grapefruit%E2%80%93drug_interactions

    The problem is that the principles (diagnostics and treatment) of TCM is 100% BS, and the fact that some herbs might be beneficial is therefore 100% based on luck. In order to increase their chances of getting lucky they will therefore prescribe a complex mixture of 10-20 different herbs. This improves their chances that there might be some benefit but unfortunately it also dramatically increases the possibility that you will run into a grapefruit juice effect. The latter they tend to ignore.

  • Article states that the herbs might be effective in improving, have a effect, might prevent, more effective compared to a placebo. But I didn’t see any notion if they are better, cheaper, more effective than current medicaments. I don’t understand why someone should change his/her medicament for chinese herb which is slightly more effective than placebo and price is unknown, maybe even pays more and may have unknown side effects.

  • I think in the U.S. the government is mainstreaming and legitimizing cam modalities in response to the opioid epidemic.

    There was a time several years ago when pain clinics and small pharmacies were popping up on every corner. People could see a physician and get a prescription for narcotic analgesics the same day. The ease of access and over prescription of addictive painkillers really got out of hand and has had myriad unintended consequences. Fortunately states have tightened up access to these drugs but a fantastic replacement is lacking. Thus, I feel the NIH and other government agencies are quick to allow / endorse cam modalities despite the lack of evidence of effectiveness or rational reason for support.

    Seems like the only ones who can be relied on at this time to give a “realistic” evaluation of therapies are the insurance companies. As bean counters, they only seem to deal in facts and results rather than the peripheral issues and noise surrounding medicine. Examples of this would be with acupuncture and low level laser. Although studies show no better than placebo, the government has given tacit approval for use in many pain situations (migraine, back pain, ptsd) yet insurance will not pay for these services as no substantial or compelling evidence deems them effective therapies.

    • in Europe, most health insurances pay for alt med; mainly because they want to be ‘competitive’.

      • Edzard are the European health insurance companies part of a “nationalized” medical system or are they private , independent insurance health companies? My guess is that it would be easier for cam to infiltrate a nationalized system that is encumbered by bureaucracy and politics than a small independent business that had to answer bottom line financial questions to a board of directors.

    • US medical schools are legitimizing cam in response to patient demand and money. This is very discouraging when the institutions that should set practice standards are succumbing to fake medicinal practices. It seems we are reversing medical advancement and history to the good old days of quackery, theatrical placebo touch, needle and “spine adjustment therapy and snake oil salesmen.

  • Bah humbug! If these medicines should ever prove themselves in rigorous RCTs then they will qualify as conventional drugs, e.g. Artemisinin.

    If they don’t progress any further than pre-clinical testing or preliminary RCTs, they will remain unfit for any other description than unproven, aka CAM.

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