Updated Edition!
Siddha medicine is based on a combination of ancient medicinal practices and spiritual disciplines as well as alchemy and mysticism. It is thought to be one of the oldest system of healthcare of India that developed during the Indus civilization, which flourished between 2500 and 1700 BCE.
It has been reported that the Indian ‘National Institute of Siddha’ (NIS) claim to have successfully treated 160 COVID-19 positive patients. Subsequently, they have requested the government to hand over all COVID-19 Care Centres in Chennai and let Siddha doctors treat all COVID-patients. They say they are confident of flattening the curve in Chennai and convert it into a safe zone in just matter of days.
The NIS claim to have three potent combinations of Siddha drugs. “Depending upon the availability and quantity required for treating Coronavirus positive patients, we have after thorough research, come out with three different effective combinations of the Siddha preparations,” Dr R Meenakumari, Director of NIS, said. The treatment low-cost compared to the prohibitive cost in corporate hospitals and all the Siddha medicines are locally available, she added. “We have requested the state government to hand over all the COVID-19 Care Centres to us and allow us to treat all the patients. Our Siddha drug combination is potent enough to convert a positive patient into Coronavirus negative in three days’ time,” she claimed.
Her confidence stems from the fact that the Siddha doctors here have “successfully” treated 160 patients besides
23 inmates of the Puzhal Central Prison. “Initially, we treated 85 patients with SRM Medical College and Hospital and another 75 at the Greater Chennai Corporation… They all recovered and tested negative after five days of successful treatment,” she claimed. “The combination that we have prepared will help to cure the infected patient within three days… Siddha medicine has huge potential to treat the patients and there are possibilities to use the medicine to save precious human lives”.
The combination drug in question seems to be similar to or identical with Kabasura Kudineer. Also termed ‘Nilavembu Kudineer‘, this drug is a powder form of medicine mainly used in the treatment of respiratory problems such as fever, cold, severe phlegm and flu. This polyherbal Siddha medicine is also widely used as a prophylactic during times of viral epidemics. To get the proper benefits, it should be made into a decoction and then consumed.
Kabasura Kudineer is made up of 15 different ingredients:
- ginger,
- cloves,
- aakarkara,
- harad,
- oregano,
- giloy,
- chiretta,
- nagarmotha,
- kali mirch
- tragiainvolucrata,
- vajradanti,
- malabar nut,
- kuth,
- ajwain,
- leghupatha.
In 2009, it allegedly helped containing the spread of swine flu and, in 2012, the then Chief Minister Jayalalithaa had requested public to use Nilavembu Kudineer prepared by the Institute to prevent dengue.
Meanwhile, the ‘Central Council for Research in Siddha’ has sent a proposal to the state government to include the
traditional medicine in the treatment protocols at the state-run CCCs. “We have also urged the state government to include the Brahmananda Bhairava Mathirai a herbo-mineral preparation, which has already been approved by the AYUSH ministry to treat persons with COVID-19 related fever, at all the COVID-19 wards,” a senior doctor at the CCRS said.
Of course, we all wish that an effective treatment against COVID-19 will be found soon. However, what the NIS calls THOROUGH RESEARCH looks like a flimsy bit of pseudo-research. And their assertion that their herbal mixture turns positive into negative patients within three days is a claim that sounds far too good to be true.
I have no reason to doubt that the NIS is full of good intentions. But I am reminded of Bert Brecht’s bon mot: ‘the opposite of good is not evil, but good intentions’.
I recently came across a short article from 2009 in the BMJ reporting that: “The World Health Organization has said that homoeopathy should not be used to treat several serious diseases such as HIV, tuberculosis, and malaria...”
At the time most people (including myself) were rather pleased that the WHO took what was considered a clear stance, I remember. Reading the short paragraph again today, I must say I am underwhelmed. In fact, if I analyse it carefully, I have to admit that the statement is nonsense.
This would be inconsequential or trivial, were it not for the hundreds of similar statements warning people that HOMEOPATHY SHOULD NOT BE USED FOR SERIOUS CONDITIONS.
Have I confused you?
No, I am not claiming the homeopathy SHOULD be used for serious conditions! I am saying that the statement is misleading and can easily be misunderstood. Some people might interpret it as meaning that, alright homeopathy must not be used for serious diseases, but can be used for all other conditions. Come to think of it, the WHO has often been seen promoting so-called alternative medicine (SCAM), and therefore I cannot be sure that this is not the message they wanted to send out.
Highly diluted homeopathic remedies contain nothing; they are therefore biologically implausible. Crucially, the best evidence fails to show that they work beyond a placebo effect. Therefore, employing it for a serious condition might hasten the patient’s death. But using it for a less serious condition is surely not much better.
Imagine someone takes it for asthma, or psoriasis, or coronary heart disease, or rheumatoid arthritis, or flu, or food poisoning, or the common cold, etc, etc. If he uses it as a sole treatment, he will suffer needlessly. If he uses it as a complementary treatment (Hahnemann did expressly forbid such combinations), he might not be affected negatively except for the time and money invested. But his health would not benefit, and therefore the WHO (or anyone else for that matter) should not imply that this is fine.
It follows that the warning HOMEOPATHY SHOULD NOT BE USED FOR SERIOUS CONDITIONS is nonsense. The only sound advice is this:
HOMEOPATHY SHOULD NOT BE USED FOR ANY CONDITIONS.
In a recent 3-part series of posts, I have demonstrated how very unconvincing the evidence for acupuncture really is. But new studies emerge all the time and many of them suggest that acupuncture does work. Take this one, for instance.
This new study compared the effects and safety of acupuncture for the treatment of irritable bowel syndrome (IBS) with those of polyethylene glycol (PEG) 4000 and pinaverium bromide.
This multicentre randomized clinical trial was conducted in 7 hospitals in China. The researchers enrolled participants who met the Rome III diagnostic criteria for IBS between May 3, 2015, and June 29, 2018. Participants were first stratified into constipation-predominant or diarrhoea-predominant IBS groups. Patients from each group were randomly assigned in a 2:1 ratio to receive acupuncture (18 sessions) or PEG 4000 (20 g/d, for IBS-C)/pinaverium bromide (150 mg/d, for IBS-D) over a 6-week period, followed by a 12-week follow-up. The primary outcome was the change in total IBS-Symptom Severity Score from baseline to week 6.
531 patients were randomized and 519 (344 in the acupuncture group and 175 in the PEG 4000/ pinaverium bromide group) were included in the full analysis set. From baseline to 6 weeks, the total IBS-Symptom Severity Score decreased by 123.51 (95% CI, 116.61 to 130.42) in the acupuncture group and by 94.73 (95% CI, 85.03 to 104.43) in the PEG 4000/pinaverium bromide group. The between-group difference was 28.78 (95% CI, 16.84 to 40.72; P<.001). No participant experienced severe adverse effects.
The authors concluded that acupuncture may be more effective than PEG 4000 or pinaverium bromide for the treatment of IBS, with effects lasting up to 12 weeks.
I am not impressed by this study.
Here are a few reasons why:
- There was no attempt to control for placebo effects or to blind patients. The placebo response rate varies in randomized controlled trials of IBS from 20 to 70% and can persist for up to 1 year based and does not wane after 1 or 2 months.
- The design of the study is odd. I suspect that, as an equivalence trial with 175 patients in the control group which was split up into two sub-groups, it may have been under-powered.
- The control treatments might not be as effective as the authors try to make us believe. This could be particularly true, if the allocation to the two sub-groups within the control group was suboptimal.
- According to previous studies, acupuncture does not seem to have specific effects in IBS. The current Cochrane review concluded that sham-controlled RCTs have found no benefits of acupuncture relative to a credible sham acupuncture control for IBS symptom severity or IBS-related quality of life.
I think that this study shows just one very unsurprising phenomenon: spending a total of 9 extra hours with empathetic therapists (who must have been highly motivated to encourage patients to experience less symptoms) has a positive effect on IBS patients – no matter what treatment the therapist might apply. I find it regrettable that supposedly decent journals publish such papers without even the slightest attempt of a critical discussion of its findings.
Am I the only one who is tired of hearing that, in India, homeopathy is doing wonders for the current pandemic? All of the reports that I have seen are based on little more than hearsay, anecdotes or pseudo-science. If anyone really wanted to find out whether homeopathy works, they would need more than that; in fact, they would need to conduct a clinical trial.
But wait!
As it happens, there are already ~500 clinical trials of homeopathy. Many show positive effects, but the reliable ones usually don’t. Crucially, the totality of the evidence fails to be positive. So, running further studies is hardly a promising exercise. In fact, considering how utterly implausible homeopathy is, it even seems like an unethical waste of resources.
But many homeopaths disagree, particularly those in India. And it has been reported that several trials have been given the go-ahead in India and are now up and running. This regrettable fact is being heavily exploited for swaying public opinion in favour of homeopathy. The way I see it, the situation is roughly this:
- a few trials of homeopathy are being set up;
- they are designed by enthusiasts of homeopathy who lack research expertise;
- therefore their methodology is weak and biased towards generating a false-positive result;
- while this is going on, the homeopathic propaganda machine is running overtime;
- when the results will finally emerge, they will get published in a 3rd rate journal;
- homeopaths worldwide will celebrate them as a triumph for homeopathy;
- critical thinkers will be dismayed at their quality and will declare that the conclusions drawn by over-enthusiastic homeopaths are not valid;
- in the end, we will be exactly where we were before: quasi-religious believers in homeopathy will feel vexed because their findings are not accepted in science, and everyone else will be baffled by the waste of time, opportunity and resources as well as by the tenacity of homeopaths to make fools of themselves.
But criticising is easy; doing it properly is often more difficult.
So, how should it be done?
The way I see it, one should do the following:
- carefully consider the implausibility of homeopathy;
- thoroughly study the existing evidence on homeopathy;
- abandon all plans to study homeopathy in the light of the above.
But this hardly is inconceivable considering the current situation in India. If further studies of homeopathy are unavoidable, the following procedure might therefore be reasonable:
- assemble a team of experts including trial methodologists, statisticians, epidemiologists and homeopaths;
- ask them to design a rigorous protocol of one or two studies that would provide a definitive answer to the research question posed;
- make sure that, once everyone is happy with the protocol, all parties commit to abiding by the findings that will emerge from these trials;
- conduct the studies under adequately strict supervision;
- evaluate the results according to the protocol;
- publish them in a top journal;
- do the usual press-releases, interviews etc.
In India, it seems that the last point in this agenda came far too early. This is because, in this and several other countries, homeopathy has become more a belief system than a medicine. And because it is about belief, the believers will avert any truly meaningful and rigorous test of homeopathy’s efficacy.
Sorry, but (exceptionally) this post is not about so-called alternative medicine (SCAM).
During the last weekend, I had the displeasure watching video clips of Donald Trump being unable to lift a glass of water one-handedly and being unable to walk normally down a ramp. Many observers agree that his health has been in steady decline ever since he was taken to the hospital late last year. Now Trump seems to have deteriorated to the point where he sounds and acts like a zombie, loses his temper, acts irrationally, etc. To me, there is no question: this man is seriously ill, physically and mentally.
Why is that any of my business?
The answer is simple: because he is rapidly destroying not just the US but, with it, much of the world as I know it. Therefore, I feel that Trump’s health should be all our business.
So, what disease might he be suffering from?
There is very little to go by for answering this question. His medical check-ups have apparently attested him perfect health, but they seem as trustworthy as a 4 £ note. Even when he was rushed to hospital, we learnt nothing about his condition. This means, we merely have little more than what we see of his behaviour to suggest a diagnosis which inevitably must remain guesswork.
Watching Trump, I often asked myself: could he be suffering from neurosyphilis? It would certainly fit in with his past life-style.
Neurosyphilis is a syphilis infection of the spinal cord or brain of people who had syphilis that has not been adequately treated. It can occur many years after they had their first infection. The physical symptoms are highly variable and can include:
- Having abnormal gait
- Loss of balance
- Not being able to walk normally
- Visual disturbances
- Headaches
- Incontinence
- Numbness in legs, toes, or feet
- Seizures
- Tremors
- Stiff neck
- Muscular weakness
- Abdominal pain
Most of these have been displayed by Trump. In addition, there are mental symptoms that are also highly variable and can include:
- Irritability
- Loss of ability to concentrate
- Delusional thinking
- Grandiosity
- Problems with memory
- Lack of insight
- Impaired judgment
- Emotional instability
Patchy hair loss can also be a sign of the later stages of syphilis, and is something that I find hard to miss when observing Trump.
I know that neurosyphilis is highly speculative as a diagnosis of Trump’s condition. What is not speculative, however, is that he is gravely ill. As such, he should not be in the Oval Office making decisions that affect us all.
Whatever disease Trump has, he is a serious danger to mankind.
This was essentially the question raised in a correspondence with a sceptic friend. His suspicion was that statistical methods might produce false-positive overall findings, if the research is done by enthusiasts of the so-called alternative medicine (SCAM) in question (or other areas of inquiry which I will omit because they are outside my area of expertise). Consciously or inadvertently, such researchers might introduce a pro-SCAM bias into their work. As the research is done mostly by such enthusiasts; the totality of the evidence would turn out to be heavily skewed in favour of the SCAM under investigation. The end-result would then be a false-positive overall impression about the SCAM which is less based on reality than on the wishful thinking of the investigators.
How can one deal with this problem?
How to minimise the risk of being overwhelmed by false-positive research?
Today, we have several mechanisms and initiatives that are at least partly aimed at achieving just this. For instance, there are guidelines on how to conduct the primary research so that bias is minimised. The CONSORT statements are an example. As many studies pre-date CONSORT, we need a different approach for reviews of clinical trials. The PRISMA guideline or the COCHRANE handbook are attempts to make sure systematic reviews are transparent and rigorous. These methods can work quite well in finding the truth, but one needs to be aware, of course, that some researchers do their very best to obscure it. I have also tried to go one step further and shown that the direction of the conclusion correlates with the rigour of the study (btw: this was the paper that prompted Prof Hahn’s criticism and slander of my work and person).
So, problem sorted?
Not quite!
The trouble is that over-enthusiastic researchers may not always adhere to these guidelines, they may pretend to adhere but cut corners, or they may be dishonest and cheat. And what makes this even more tricky is the possibility that they do all this inadvertently; their enthusiasm could get the better of them, and they are doing research not to TEST WHETHER a treatment works but to PROVE THAT it works.
In the realm of SCAM we have a lot of this – trust me, I have seen it often with my own eyes, regrettably sometimes even within my own team of co-workers. The reason for this is that SCAM is loaded with emotion and quasi-religious beliefs; and these provide a much stronger conflict of interest than money could ever do, in my experience.
And how might we tackle this thorny issue?
After thinking long and hard about it, I came up in 2012 with my TRUSTWORTHYNESS INDEX:
If we calculated the percentage of a researcher’s papers arriving at positive conclusions and divided this by the percentage of his papers drawing negative conclusions, we might have a useful measure. A realistic example might be the case of a clinical researcher who has published a total of 100 original articles. If 50% had positive and 50% negative conclusions about the efficacy of the therapy tested, his TI would be 1.
Depending on what area of clinical medicine this person is working in, 1 might be a figure that is just about acceptable in terms of the trustworthiness of the author. If the TI goes beyond 1, we might get concerned; if it reaches 4 or more, we should get worried.
An example would be a researcher who has published 100 papers of which 80 are positive and 20 arrive at negative conclusions. His TI would consequently amount to 4. Most of us equipped with a healthy scepticism would consider this figure highly suspect.
Of course, this is all a bit simplistic, and, like all other citation metrics, my TI provides us not with any level of proof; it merely is a vague indicator that something might be amiss. And, as stressed already, the cut-off point for any scientist’s TI very much depends on the area of clinical research we are dealing with. The lower the plausibility and the higher the uncertainty associated with the efficacy of the experimental treatments, the lower the point where the TI might suggest something to be fishy.
Based on this concept, I later created the ALTERNATIVE MEDICINE HALL OF FAME. This is a list of researchers who manage to go through life researching their particular SCAM without ever publishing a negative conclusion about it. In terms of TI, these people have astronomically high values. The current list is not yet long, but it is growing:
John Weeks (editor of JCAM)
Deepak Chopra (US entrepreneur)
Cheryl Hawk (US chiropractor)
David Peters (osteopathy, homeopathy, UK)
Nicola Robinson (TCM, UK)
Peter Fisher (homeopathy, UK)
Simon Mills (herbal medicine, UK)
Gustav Dobos (various, Germany)
Claudia Witt (homeopathy, Germany and Switzerland)
George Lewith (acupuncture, UK)
John Licciardone (osteopathy, US)
The logical consequence of a high TI would be that researchers of that nature are banned from obtaining research funds and publishing papers, because their contribution is merely to confuse us and make science less reliable.
I am sure there are other ways of addressing the problem of being mislead by false-positive research. If you can think of one, I’d be pleased to hear about it.
The objective of this study was to identify adverse drug reactions (ADR) associated with the use of so-called alternative medicine (SCAM) in Malaysia and to define factors which are associated with the more serious reactions. For this purpose, all ADR associated with the use of SCAM products (including health supplements) submitted to the Malaysian Centre for ADR Monitoring, National Pharmaceutical Regulatory Agency over a 15-year period were reviewed and analysed. Multivariate logistic regression analysis was performed to identify predictors of serious ADR.
From a total of 74 997 reports in the database, 930 (1.2%) involved SCAM products. From a total of 930 reports, 242 (26%) were serious ADR with 36 deaths. Six people died as a result of taking the SCAM, while another 30 cases were possibly associated with the SCAM products. Among the 36 mortality cases, adulterants were detected in 30% of cases. Examples of adulterants were dexamethasone, avanafil, nortadalafil and banned drugs such as phenylbutazone and sibutramine
About a third of the reports involved used SCAM products for health maintenance. Most (78.1%) of the ADR reports implicated unregistered products with 16.7% confirmed to contain adulterants which were mainly dexamethasone. Of the 930 reports, the ADR involved skin and appendages disorders (18.4%) followed by liver and biliary system disorders (13.7%). The odds of someone experiencing serious ADR increased if the SCAM products were used for chronic illnesses (odds ratio [OR] 1.99, confidence interval [CI] 1.46-2.71), having concurrent diseases (OR 1.51, CI 1.04-2.19) and taking concurrent drugs (OR 1.44, CI 1.03-2.02).
The authors concluded that the prevalence of serious ADR associated with SCAM products is high. Factors identified with serious ADR included ethnicity, SCAM users with pre-existing diseases, use of SCAM for chronic illnesses and concomitant use of SCAM products with other drugs. The findings could be useful for planning strategies to institute measures to ensure safe use of SCAM products.
The authors also point out that underreporting of ADRs remains a major ongoing issue in pharmacovigilance. Many SCAM consumers may not be vigilant or may be unaware of ADR they experience due to misconceptions on the
safety of SCAM products. Most doctors rarely ask their patients about the use of SCAM.
To this, I would add that SCAM providers do their utmost to give the impression that their products are natural and therefore safe. Furthermore the press is far too often perpetuating the myth, and the regulators tend to turn a blind eye.
I expect that some readers of this post will now point out that the rate of SCAM-related ADRs is very small compared to that of conventional drugs. They would be correct, of course. But they would also miss the point that the value of a treatment is not determined by its risk alone. It is determined by the risk/benefit balance. Where there is no effectiveness, this balance is negative, even if the risk is tiny.
So, now let me challenge the defenders of SCAM to name a few SCAMs that are demonstrably associated with a positive risk/benefit balance.
Yesterday, it was announced that UK universities are not doing well according to international league tables. Of the UK’s 84 ranked universities, 66 saw their staff to student ratio decline while 59 had a drop in research citations. International student numbers at 51 universities also fell.
No reason to despair; help is on the way!
The University of Exeter reported that “as International Education Champion, Sir Steve will have a leading role in a 10-year strategy to both increase the number of international students choosing to study in the UK higher education system to 600,000 and increase the value of education exports to £35 billion per year by 2030. The University of Exeter is delighted and proud with this appointment…
The role of International Education Champion will be to work with organisations across the breadth of the education sector, including universities, schools, the EdTech industry, vocational training, and early years schooling providers. Steve will also help target priority regions worldwide to build networks and promote the UK as the international education partner of choice. The role will additionally help to boost the numbers of international students in the UK.
The appointment of Sir Steve Smith fulfils a priority action from the International Education Strategy, published by the Department for Education and the Department for International Trade. Sir Steve will spearhead overseas activity and address a number of market access barriers on behalf of the whole education sector, including concerns over the global recognition of UK degrees and other qualifications. Sir Steve’s experience, knowledge and global connections will help to develop long-term relationships with international governments and overseas stakeholders…”
Shortly after becoming VC at Exeter, Prof Smith closed two Departments: Music and Chemistry. Apparently, they were not bringing in enough cash. Several years later, he had a key role in closing my unit. It had attracted a complaint from Prince Charles’ 1st private secretary (full story here, in case you are interested).
I hope Sir Steve is more productive in boosting international education. One thing seems certain to me: post-Brexit/post-COVID academia in the UK will need a boost after what our current government has done to it.
In the wake of both the NEJM and the LANCET withdrawing two potentially influential papers due unanswered questions about the source and reliability of the data, one has to ask how good or bad the process of peer review is.
Peer review is the evaluation of work by one or more people with similar competences as the producers of the work (peers). It functions as a form of self-regulation by qualified members of a profession within the relevant field. It normally involves multiple steps:
- Authors send their manuscript to a journal of their choice for publication.
- The journal editor has a look at it and decides whether to reject it straight away (for instance, because the subject area is not of interest) or whether to send it out to referees for examination (often to experts suggested by the authors of the submission).
- The referees (usually 2 or 3) have the opportunity to reject or accept the invitation to review the submission.
- If they accept, they review the paper and send their report to the editor (usually following a deadline).
- The editor tries to come to a decision about publication; often the referees are not in agreement, and a further referee has to be recruited.
- Even if the submission is potentially publishable, the referees will have raised several points that need addressing. In such cases, the editor sends the submission back to the original authors asking them to revise the article.
- The authors do their revision (often following a deadline) and re-submit their paper.
- Now the editor can decide to either publish it or send it back to the referees asking them whether they feel their criticisms have been adequately addressed.
- Depending on the referees’ verdicts, the editor makes the final decision and informs all the involved parties accordingly.
- If the paper was accepted, it then goes into production.
- When this process is finished, the authors receive the proofs for final a check.
- Eventually, the paper is published and the readers of the journal may scrutinise it.
- Often this prompts comment which may get published.
- In this case, the authors of the original paper may get invited to write a reply.
- Finally the comments and the reply are published in the journal side by side.
The whole process takes time, sometimes lots of time. I have had papers that took almost two years from submissions to publications. This delay seems tedious and, if the paper is important, unacceptable (if it is not important, it should arguably not be published at all). Equally unacceptable is the fact that referees are expected to do their reviewing for free. The consequence is that many referees do their reviewing less than well.
When I was still at Exeter, I had plenty of opportunity to see the problems of peer review from the reviewers perspective. At a time, I accepted about 5 reviews per week, and in total I surely have reviewed over 1000 papers. I often recommended inviting a statistician to do a specialist review of the stats. Only rarely were such suggestions accepted by the journal editors. Very often I recommended rejecting a submission because it was rubbish, and occasionally, I told the editor that there was a strong suspicion of the paper being fraudulent. The editors very often (I estimate in about 50% of cases) ignored my suggestions and comments and published the papers nonetheless. If the editor did follow my advice to reject a paper, I regularly saw it published elsewhere later (usually in a less well-respected journal). Several times, an author of a submission contacted me directly after seeing my criticism of his paper. Occasionally this resulted in unpleasantness, once or twice even in threats. Eventually I realised that improving the publications in the realm of SCAM was a Sisyphean task, became quite disenchanted with all this and accepted less and less reviews. Today, I do only very few.
I had even more opportunity to see the peer review process from the author’s perspective. All authors must have suffered from unfair or incompetent reviews and most will have experienced the frustrations of the endless delays. Once (before my time in alternative medicine) a reviewer rejected my paper and soon after published results that were uncannily similar to mine. In alternative medicine, researchers tend to be rather emotional about their subject. Imagine, for instance, the review you might get from Dana Ullmann of a trial of homeopathy that fails to show what he believes in.
Finally, since 40 years, I have also had the displeasure of experiencing peer review as an editor. This often seemed like trying to sail between the devil and the deep blue sea. Editors want to fill their journals with the best science they can find. But all too often, they receive the worst science they can imagine. They are constantly torn by tensions pulling them in opposite directions. And they have to cope not just with poor quality submissions but also with reviewers who miss deadlines and do their work badly.
So, peer review is fraught with problems! The trouble is that there are few solutions that would keep a better check on the reliability of science. Peer review, it often seemed to me, is the worst idea, except for all others. If peer review is to survive (and I think it probably will), there are a few things that could, from my point of view, be done to improve it:
- Make it much more attractive for the referees. Payment would be the obvious thing – and by Jove, the big journals like the LANCET and NEJM could afford it. But recognising refereeing academically would be even more important. At present, academic careers depend largely of publications; if they also depended on reviewing, experts would queue up to do it.
- The reports of the referees should get independently evaluated according to sensible criteria. These data could be conflated an published as a criterion of academic standing. Referees who fail to to a good job would spoil their chances to get re-invited for this task.
- Speed up the entire process. Waiting months on months is hugely counter-productive for all concerned.
- Today many journals ask authors for the details of experts who are potential reviewers of their submission and then send the paper in question to them for review. I find this ridiculous! No author I know of has ever resisted the temptation to name people who are friends or owe a favour. Journals should afford the extra work to find who the best independent experts on any particular subject are.
None of this is simple or fool-proof or even sure to work well, of course. But surely it is worth trying to get peer-review right. The quality of future science depends on it.
By guest blogger Loretta Marron
Although assumed to be traditional, what we know today as ‘Traditional Chinese Medicine’ (TCM) was invented in the 1950s for political reasons by then Chairman Mao. It has since been proclaimed by Xi Jinping, now life-President of the People’s Republic of China, as the “jewel” in the millennia of Chinese civilization.
In May this year, Xi “announced plans to criminalise criticism of traditional Chinese medicine”. Speaking out against TCM could land you years in prison, prosecuted for “picking fights to disturb public order” and “defaming” the practice.
With the industry expected to earn $420 billion by the end of 2020, covid-19 has provided Xi with a platform to promote unproven, potentially harmful TCM. To keep these profits filling Chinese coffers, the World Health Organization (WHO) remains silent and those challenging TCM are silenced.
In January, the late Dr Li Wenliang was arrested and gaoled for warning China about covid-19. Li was one of up to nine people who were disciplined for spreading rumours about it. As the virus silently spread around the world, Beijing told the WHO that there was ‘no clear evidence’ of spread between humans.
As their death toll passed 1,000, Beijing’s response was to remove senior officials and to sack hundreds over their handling of the outbreak. With the support of the WHO, claims continue to be made that TCM “has been proved effective in improving the cure rate”, denying the simple fact that “patients would have recovered even if they hadn’t taken the Chinese medicine”.
With cases now heading for 8 million, and over four hundred thousand people confirmed dead world-wide and with economies in free-fall, Beijing continues, “to protect its interests and people overseas; to gain leadership of international governance”,for financial gain, to aggressively use its national power. Under the guise of ‘International Aid’, during the pandemic, Beijing promoted treatments based on unproven traditional medicine, sending TCM practitioners to countries including Italy, France and Iran.
Countries challenging Beijing can expect claims of racism and financial retaliation.
Back in 2016, the Chinese State Council released a “Strategic Development Plan for Chinese Medicine (2016-2030)”, seeking to spread ‘knowledge’ into campuses, homes and abroad.
In July 2017, a law promising equal status for TCM and western medicine came into effect. Provisions included encouragement to China’s hospitals to set up TCM centres. “The new law on traditional Chinese medicine will improve global TCM influence, and give a boost to China’s soft power”.
In 2019, after strong lobbying by the Chinese Communist Party (CCP), WHO added a chapter on TCM to their official International Classification of Diseases (ICD-11). In China, doctors are now instructed to prescribe traditional medicine to most patients.
While Chinese herbs might have exotic names, they are, once translated, often the same as western herbs, many of which might have significant interactions. WHO fails to acknowledge any drug interactions.
In 1967, Mao launched Project 523 to find a cure for chloroquine-resistant malaria. Over 240,000 compounds had already been tested and none had worked. Trained in pharmacology and modern western methods, Tu Youyou used the scientific method to test sweet wormwood, a herb traditionally used in China for fever, where she developed a useful artemisinin derivative for resistant malaria. The drug has saved millions of lives. In 2015 she won the Nobel Prize for her work. However, Tu’s work is not a blanket endorsement of TCM: without the years of research, she would not have been successful.
TCM is commercially driven. Criticism of remedies is often blocked on the Internet in China, and critics have been jailed. The majority of TCM’s are not tested for efficacy in randomized clinical trials. Clinical trials are usually of poor quality and serious side effects are underreported. China has even rolled back regulations as Beijing forcefully promotes TCM’s as an alternative to proven western medicine. An increasing number of prestigious research hospitals now prescribe and dispense herbs that may cause drug interactions alongside western medicine for major illness patients.
TCM’s are not safe. Most systematic reviews suggest that there is no good or consistent evidence for effectiveness, negative results aren’t published, research data are fabricated and TCM-exports are of dubious quality.
If the benefits of herbal remedies are to be realised, good clinical studies must be encouraged.
TCM is not medicine. It’s little more than a philosophy or a set of traditional beliefs, about various concoctions and interventions and their alleged effect on health and diseases.
To stop misleading the world with what Mao himself saw as nonsense, and to mitigate future pandemics, WHO can and should remove all mention of TCM other than to state that it is unproven and could be dangerous.
