MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Muscular dystrophies are a rare, severe, and genetically inherited disorders characterized by progressive loss of muscle fibers, leading to muscle weakness. The current treatment includes the use of steroids to slow muscle deterioration by dampening the inflammatory response. Chinese herbal medicine (CHM) has been offered as adjunctive therapy in Taiwan’s medical healthcare plan, making it possible to track CHM usage in patients with muscular dystrophies. This investigation explored the long-term effects of CHM use on the overall mortality of patients with muscular dystrophies.

A total of 581 patients with muscular dystrophies were identified from the database of Registry for Catastrophic Illness Patients in Taiwan. Among them, 80 and 201 patients were CHM users and non-CHM users, respectively. Compared to non-CHM users, there were more female patients, more comorbidities, including chronic pulmonary disease and peptic ulcer disease in the CHM user group. After adjusting for age, sex, use of CHM, and comorbidities, patients with prednisolone usage exhibited a lower risk of overall mortality than those who did not use prednisolone. CHM users showed a lower risk of overall mortality after adjusting for age, sex, prednisolone use, and comorbidities. The cumulative incidence of the overall survival was significantly higher in CHM users. One main CHM cluster was commonly used to treat patients with muscular dystrophies; it included Yin-Qiao-San, Ban-Xia-Bai-Zhu-Tian-Ma-Tang, Zhi-Ke (Citrus aurantium L.), Yu-Xing-Cao (Houttuynia cordata Thunb.), Che-Qian-Zi (Plantago asiatica L.), and Da-Huang (Rheum palmatum L.).

The authors concluded that the data suggest that adjunctive therapy with CHM may help to reduce the overall mortality among patients with muscular dystrophies. The identification of the CHM cluster allows us to narrow down the key active compounds and may enable future therapeutic developments and clinical trial designs to improve overall survival in these patients.

I disagree!

What the authors have shown is a CORRELATION, and from that, they draw conclusions implying CAUSATION. This is such a fundamental error that one has to wonder why a respected journal let it go past.

A likely causative explanation of the findings is that the CHM group of patients differed in respect to features that the statistical evaluations could not control for. Statisticians can never control for factors that have not been measured and are thus unknown. A possibility in the present case is that these patients had adopted a different lifestyle together with employing CHM which, in turn, resulted in a longer survival.

6 Responses to Effect of Chinese herbal medicines on the overall survival of patients with muscular dystrophies

  • Obligatory. I think I’m correct in saying this is a case-control study, which is better than YouTube video but still well below RCT. Plus: complex medical conditions, possibly adulterated products, small sample size, extremely dirty data, random chance, likelihood of post hoc bias/Texas sharpshooter fallacy, most initially promising avenues ultimately don’t pan out when rigorously tested anyway, etc, etc.

    To their credit, the authors do couch their observations in “suggest” and “may”. But then rather spoil it by leaping straight to “[identify] the key active compounds”, which implies there are useful compounds present, as opposed to just the possibility of discovering one or more useful compounds in amongst a very large amount of garbage. Pharmacognosy is a thing, after all, but so is being wrong… and no prizes for guessing which proves by far the most common. An occasion when the familiar altie cry of “more research is needed” may be appropriate, but definitely far too early to be calling the Nobel committee and no-one should be surprised if it does ultimately fizzle out, as most leads do.

  • So a poor paper. But…. Do you feel here though that CHM wasn’t harmful as standard non-SCAM treatments were also undertake and (sharp intake of breath) possibly helpful if, as per your hypothesis, the use of CHM resulted in beneficial life style changes increasing survival. Whilst the correlation- causation statement is wrong do you not feel the correlation shown merits further investigation of any compounds used- could they not contain important new biologically active compounds?

    • ” the use of CHM resulted in beneficial life style changes increasing survival”
      NO!!!
      the use of CHM might have been associated with beneficial lifestyle changes that increased survival independently of CHM.

  • Certainly the possibility of adulteration is an issue.

    In the late 1990s various Chinese ‘herbal creams’ for eczema appeared. Invariably, when one was found to work dramatically, it was found to contain corticsteroids, often Potent ones.

    Topical corticosteroids are of course a mainstay in managing atopic eczema, but to use them safely and effectively you have to know what you’re getting.

  • Do the people who submit these papers have a clue about what constitutes a proper study? Have they never heard of the mantra, “correlation does not imply causation”? And just who is editing “respectable” journals these days. This sort of thing is way too common. Finally, what is going on in Asian medical schools? (I realize one could ask the same of the Western world, but I’d guess that it’s a bit less in the West.)

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