By Benjamin Guan, Alison Li, and Andrea Lin
April 26th, 2020
Introduction
Like the start of a grisly zombie movie (we recommend Train to Busan), the US has found itself mired in an epidemic of apocalyptic proportions. It’s easy to envision Hollywood producers at each other's throats a few years from now, duking it out to cast Dwayne Johnson as the hotshot American scientist who single handedly brought down COVID-19. Unfortunately, reality is far from the silver screen. As of March 27th, the total number of COVID-19 cases in the US has exceeded those in China, the origin of the deadly disease. It is estimated that over 200,000 people worldwide have been killed (Ansari et al.). While both countries have enacted countermeasures since the outbreak started in December 2019, there’s one big difference: the Chinese government actively incorporated Traditional Chinese Medicine (TCM) into its treatment plan while the US government has only used biomedicine. Dr. Fauci, you are a widely respected medical expert and a lead member of the White House Coronavirus Task Force. We have no doubt that your training at Cornell Medical School and your position as Director of the National Institute of Allergy and Infectious Diseases make you a capable leader. You, more so than anyone else, should understand the limits of Western medicine. Unfortunately, it is time to admit that our systems have failed. We urge your Task Force to consider implementing TCM alongside existing biomedical therapies to resolve the COVID-19 pandemic. You’re a busy man, so here’s the tldr version; TCM uses an individualized approach for treatment, in contrast to the strictly standardized procedures of biomedicine, resulting in bespoke outcomes for patients. It is cost-effective, holistic, and combines multiple types of treatments to alleviate multiple symptoms/causes. While TCM has been practiced in China for thousands of years, it has evolved just as any body of knowledge has and is adept for this modern crisis (MacPherson, “Introduction”). We acknowledge that you have spent your entire career within the realm of biomedicine. Adopting TCM into the COVID-19 response plan might sound insane at first. Our goal in the coming pages is to convince you that it is not. We’ll start by summarizing the current state of biomedical research into COVID-19 cures, followed by describing TCM remedies used to treat COVID-19 in China. Once this baseline of knowledge is established, we’ll break down potential reasons for why the US has been reluctant to leverage TCM thus far. Specifically, we will address common criticisms that TCM is not “scientifically proven” and that is a “political tool” by the Chinese. Spoiler alert: both are untrue. By debunking the misconceptions surrounding TCM, we will demonstrate to you, Dr. Fauci, the potential of this underutilized body of knowledge to alleviate the suffering of millions of Americans.
The (biomedical) search for the cure
In times of crisis, when diseases threaten to anNIHilate our centuries-old way of living, WHO do we turn to? Re-read that sentence. So far, the two most preeminent health institutions in Western society haven’t done much to inspire confidence. The World Health Organization (WHO) states that “there is no evidence that current medicine can prevent or cure [COVID-19]” (“Q&A on coronaviruses”). This sentiment is reiterated by the National Institute of Health (NIH), which explains, “There are no specific therapeutics approved by the Food and Drug Administration (FDA) to treat people with COVID-19” (“NIH clinical trial”). In the absence of a clear cure, physicians must focus on managing symptoms until the virus (hopefully) passes. Therapies used may include antiviral or retroviral medications, breathing support such as intubation or ventilation, steroids to reduce lung swelling, and blood plasma transfusions (“Everything You Should Know”). Rest assured, biomedical researchers around the world are frantically testing over 100 off-the-shelf and experimental therapies as we speak (Langreth and Griffin). As physician after physician touts clinical trials as the “scientific gold standard for studying drugs,” does this mean a cure is within sight? (Brown and Griffin). Unlikely. In late February, the US began clinical trials for its first potential treatment for COVID-19, remdesivir (“NIH clinical trial”). Remdesivir is an antiviral drug developed by Gilead Sciences and the results of the randomized, double-blinded, placebo-controlled study are expected at the end of April (Langreth and Griffin). Sounds suspiciously like your Introductory Psychology professor promising to grade essays by the end of the week, only to “finally get to them” two months later. If the results are positive, have they come too late for remdesivir to be mass-produced and distributed? If the results are inconclusive and the lengthy clinical trial process starts anew, where does that leave the even higher number of COVID-19 patients and their caretakers?
How has TCM been used to treat COVID-19 in China?
President Xi Jinping in February remarked that, “Lots of people like to have Chinese medicine because it has little side effects, it’s effective, and relatively cheap...I myself like Chinese medicine a lot.” (Mai and Lo). It’s no surprise that the Chinese Government has actively used TCM to treat not only the COVID-19 pandemics, but also the H1N1 (swine flu) and H7N9 (bird flu) epidemics. Having survived all 3, perhaps there’s something to be said for China’s millenia-worth of herbal remedies. The US, at the tender age of 244, seems more like the rookie med student eager to prove his mettle. While the US braces for another month of lockdown, China tentatively returns to life as usual. The re-opening can be attributed to basic math: an increasing number of recovered cases plus decreasing number of new cases. Notably, 50,000 recovered COVID-19 patients were prescribed TCM in their treatments (Mai and Lo). In general, the Chinese Ministry of Science and Technology reports that over 85% of all COVID-19 patients in China (about 60,000 people) were treated with both TCM and antiviral medications (Gan and Xiong). This highlights the integral role that TCM played in enabling China to recover from COVID-19. Skeptics may argue that it’s impossible to figure out whether it was TCM, biomedicine, or a combination of the two that led to recovery, but even they have to acknowledge there certainly aren’t any downsides observed to using TCM (Mai and Lo). In the same way that there is no universally accepted cure to COVID-19 in biomedicine, the TCM remedies used for COVID-19 are varied. One of the treatments is a soup containing a mixture of herbs and ephedra (ma huang), which is commonly used in TCM to treat asthma and bronchitis (Mai and Lo). Another treatment is shuanghuanglian, a concoction of Japanese honeysuckle (Lonicerae Japonicae Flos), Chinese skullcap (Scutellariae Radix), and forsythia (Fructus Forsythiae) (Gao et al.). Approved by the Chinese Food and Drug Administration, it is traditionally used to treat respiratory infections (Gan and Xiong). Perhaps the most controversial TCM remedy is tan re qing, an injection containing bear bile, goat horn powder, and plant extracts (Fobar, “China promotes bear bile”). Why is it controversial? All it takes are biased headlines such as “After Ban on Eating Wild Animals, China Promotes Injections with Bear Bile to Treat COVID-19” (Fobar, “Bear bile explained”). Even if the article itself mentions that ursodeoxycholic acid, a compound found in high concentrations in bear bile, has been proven to help with certain ailments, how many people actually read beyond the headline? After all, if it’s featured in National Geographic, it must be factual and objective. It’s no wonder that outside of China, TCM is commonly viewed as antiquated, superstitious, or just outright disturbing to delicate Western palates.
Is TCM Effective?
When they’re not being socially awkward at dinner parties, Western biomedical doctors love sneering that TCM doesn’t work. “It hasn’t gone through enough clinical trials!” they cry, refusing to acknowledge that their system for evaluating efficacy was established by Western scientists, for Western science. After all, if something isn’t good by your own standards, it must not be good at all, right? Let’s take a minute to debunk that. First, TCM has proven its efficacy both as a broader system and in treating COVID-19. The standards of evidence for TCM are clearly different from the standards of evidence created by biomedical scientists. Simply because TCM sometimes fails to perform well in clinical trials, it loses all credibility in the eyes of physicians. But, as you can see from the image above, clinical trials themselves are often unsuccessful as well. Biomedicine has a standardized approach for developing medicine and evaluating how effective it is. Drugs go through multiple phases of research and review, each phase more stringent than the last, before they are approved (“The Drug Development Process”). This lengthy process establishes credibility to physicians, who trust that the final product will ultimately keep patients safe. Or, at the very least, keep patients alive enough to avoid a malpractice lawsuit. As such, clinical trials are indoctrinated in biomedicine as the “gold standard.”
Remember in high school when a new kid joined your class and the popular kids scrutinized her with equal parts fascination, equal parts judgment? That’s what’s happening here. TCM was developed in a disparate world, far away from the tightly-knit echelon of Ivy-educated scientists. What happens when an alternative medicine does not meet the gold standards they have been brainwashed into believing? It’s not taken seriously, viewed as a lesser option, and pushed into the shadows. Unlike biomedicine, TCM treats patients as idiosyncratic individuals rather than entries in an Electronic Health Record. A fundamental tenet of TCM is to personalize treatments and prescriptions to not only the patients’ symptoms, but also their lifestyle and family history. In contrast, biomedicine publishes standardized treatment plans for every ailment and injury imaginable. This enables standardized testing in clinical trials, aka credibility. TCM on the other hand provides a more pragmatic approach that actually “answer[s] real-world questions” (MacPherson, “Evidence-Based Acupuncture”). However, due to its personalization, TCM is deemed “untestable.” Patient-specific prescriptions combined with the historic encouragement for TCM practitioners to develop their own individual styles leads to different treatments for patients with similar symptoms (Zhang et al.). It’s challenging to disprove placebo/sham effects with acupuncture and difficult to doubleblind TCM (Ramsay et al.). Lastly, it seems as if the world of Western medicine is unable to understand that complex interactions exist between multiple TCM agents. Isolating the exact biomedical mechanism through which the prescription acts upon the patient is nearly impossible. TCM was not designed with the system of clinical trials in mind as biomedical drugs were. Is this important? To TCM practitioners, not necessarily. After all, TCM has its own system of laws explaining how its prescriptions work. But to Western practitioners, you’d think we just called their baby ugly. Clinical trials serve as the foundation of credibility for the biomedical community, and because there are many complications in testing TCM, doing so for the sake of appeasing them doesn’t necessarily increase TCM’s credibility. Despite TCM’s difficulty in conforming to clinical trials, numerous biomedical studies have shown using TCM results in significant improvements in patient outcomes. Examples include a greater reduction in Irritable Bowel Syndrome (IBS) symptoms when treated with TCM (Bensoussan et al.) as well as increased fetal activity and cephalic presentation after the use of moxibustion (Cardini and Weixin). TCM has even proved effective in solving global health crises where biomedicine could not. Tu Youyou discovered a cure for malaria in a TCM remedy called Artemisinin. Perhaps to the amazement of biomedical scientists, this discovery saved millions of lives and later earned her the Nobel Prize. And she didn’t need an MD to do it (“Tu Youyou”). With clear cases for its efficacy as a broader system, there is no reason beyond xenophobia why TCM should not be incorporated into treatment plans for COVID-19. Even under the West’s process for establishing efficacy, TCM has been shown to improve patient outcomes when incorporated with biomedicine (Ni et al.). In another trial in China, COVID-19 patients were treated with either Western medicine or a combination of Western and TCM remedies. The results concluded that mixed treatment patients had a 33% higher recovery rate, had higher lymphocyte counts, and left the hospital sooner than those treated with only Western medicine (Gan and Xiong). Unless biomedical scientists want to admit that their own system of clinical trials is flawed, the numbers speak for themselves. The United States is in a pandemic. We don’t have time to rely on the slim possibility that biomedicine will find a cure in time. Failure is more common than not in both clinical trials and convincing Western practitioners to give TCM a chance. Even when there is significant evidence in favor of TCM, TCM still faces disproportionate scrutiny compared to Western counterparts. TCM should be treated as an equal to Western pharmaceuticals in the treatment of COVID-19. There is currently no evidence that biomedicine is equipped to tackle COVID-19 on its own. If TCM can lend a helping hand, why not take it? After using hand sanitizer, of course.
Is TCM more than a political tool?
Image Source: www.respectfulinsolence.com/2019/05/29/mao-triumphant
If the 20th century was any indication, unwavering belief in the superiority of capitalism is as American as apple pie. While firmly ignoring any instances of moral questionability in their own government, patriotic Americans are quick to complain that spreading TCM is no more than another cog in China’s grand scheme to rule the world. Let’s take a moment to clarify what spurious journalists will not. TCM has a mixed history with the Chinese government. While once cracked down on by the CCP as antithetical to China’s modernization, it later received immense support as Mao rose to power. Mao saw TCM as an opportunity for China to develop a self-reliant national identity during the turmoil of the Cultural Revolution (Scheid, “The People’s Republic”). Even today, President Xi Jinping describes TCM “as a ‘treasure’ of Chinese civilization that will help in the ‘rejuvenation of the great Chinese nation’” (Mai and Lo). Despite TCM’s historical ties to the CCP as a form of propaganda, it has its merits as a cheaper alternative to Western medicine (Zimmerman). Especially in recent years, TCM has gained popularity in modern Western countries. Ironically, a significant catalyst to TCM’s acceptance was President Nixon’s 1972 visit to China. During this trip, journalist James Reston was fortunate enough to develop a severe case of appendicitis, requiring immediate surgery. In an amazing feat of American bravery, James Reston agreed to be poked with needles under the assurance that yes, these painful-looking spiky things will in fact reduce post-operative pain. To his amazement, it worked. And just like modern day vloggers, Reston absolutely needed to share his brush with death with the public. However, these were the pre-internet days so he had to settle for the New York Times (Reston). Back then, people actually read the paper, so news of TCM spread across the country like an infectious disease. As TCM became more and more widespread, Americans became uneasy with the idea that a foreign invention could work better than their homegrown solutions. They questioned if the 1972 delegation was overly optimistic to improve US sentiment towards China and exaggerated the success of TCM to flatter their new friends. Since then, TCM has never quite lost its reputation as a chess piece in diplomatic relations. Even after TCM gained acceptance by the WHO last year, opponents are still quick to mischaracterize it as Communist hogwash. At this point, it’s basically a competition to see who can come up with the most clickbait-y headline. In third place, “Widespread consumption of Chinese herbals of unknown efficacy and potential toxicity will jeopardize the health of unsuspecting consumers worldwide” by CNN (Hunt). Coming in second, “Madagascar’s president promotes unproven herbal cure [TCM] for COVID-19” by Mongabay (Vyawahare). And taking the trophy is The Economist with “State- sponsored quackery: China is ramping up its promotion of its ancient medical arts.” But no headline can damage TCM’s legitimacy as much as the words of the US Commander-in-Chief. In an incredible display of international diplomacy, Trump has decided to label COVID-19 “the Chinese Virus” (Cillizza). He is seemingly unaware of the fact that the US has quickly overtaken China in confirmed cases. Trump has also been a strong opponent to the wearing of face masks in public, joining hundreds of Americans in abstaining from the practice due to its association with Asia (Smith). What’s wrong with being associated with Asia? The US certainly didn’t have any issues with that when it decided to open a Panda Express in every shopping center as the hallmark of authentic Chinese cuisine. Even before COVID-19, healthy populations in Asia are used to wearing face masks to pre-emptively stifle the spread of disease. However, the West perceives wearing masks as a sign of being sick. Additionally, critics argue there is no scientific proof that face masks are effective, meaning that they are unnecessary (Friedman).
Recently, the US has reversed its negative stance on face masks. Though there has not been sufficient time for new clinical trials to scientifically prove their effectiveness, the government is now encouraging everyone to wear one when in public. Now that public officials and celebrities alike are showing off designer masks on social media, the stigma has been reduced. Finally, the everyday American can wear face masks in public without fear of being judged. At the end of the day, TCM has unfairly suffered from an image of being a political tool by the Chinese government. Whether it’s an inaccurate name by Trump in 2020 or backlash from Tiananmen in 1989, the perception of TCM by Americans has been inextricably linked to the fluctuating relationship between the US and China. But the recent open-mindedness towards wearing face masks demonstrates that lack of “scientific” evidence and association with Asia shouldn’t determine how willing we are to try a solution or judge its efficacy. Let’s learn from the leap of faith we took with face masks and extend TCM the same generosity.
Conclusion
Image Source: www.activeherb.com/blog/origins-of-tcm.html
Dr. Fauci, we implore you to incorporate TCM into the US response to COVID-19. In the midst of a pandemic for which biomedicine has yet to find a cure, it is only right that all options be explored. As the US struggles to supply hospitals with sufficient equipment and medication, it is apparent that a more effective approach is needed. From the perspective of Western scientists, TCM is illegitimate and little more than placebo. Yet, TCM has seen consistently positive results throughout its long lifespan. Volker Scheid addresses this dissonance in his book. During a study on menopause, he found that symptoms have long been treated with TCM, but if TCM is removed from its cultural methods, it becomes less effective (Scheid, “Globalizing Chinese Medical Understandings”). As Chinese medicine comes under increasing pressure to legitimize itself through evidence-based research, he questions if we should disregard TCM-accepted treatments simply because they do not show clinical effectiveness. We have noticed that while TCM’s credibility is constantly questioned, Western scientists never have to ask themselves why their system for evaluating efficacy is more credible than TCM’s. Why are only clinical trials considered scientific? Why do we only believe a drug works if it is developed in a lab and explained by technical jargon? Given the current global pandemic, now is not the time for medicine and politics to clash. Even if TCM was once weaponized by the CCP as political propaganda, it has since proven itself as an effective, affordable, and less harsh form of treatment. And while thousands are dying everyday, who has time to wait for clinical trials when a proven alternative exists? We may not have clinical studies as evidence, but we know adopting face masks has certainly done more good than harm. TCM presents a similar scenario, right down to its early adoption in Asia versus balking protests in the states. At the end of the day, how are they different? If we’re willing to give face masks a try, why not TCM as well?
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