For Mr Hunt, it seems, could be seen to be quietly endorsing TCM: fellow Tory MP David Tredinnick, chairman of the all-party group for integrated healthcare, obviously thinks he is: “He has clearly looked at it,” he says, “and thinks that where it is safe, it should be used in conjunction with Western medicine, which is what they do in China.
“Herbal medicine is not quackery – it has been used for thousands of years in China. In my experience, and I have used it, it can be really effective and reduce the amount of conventional medicine needed.”
Of course, Mr Tredinnick isn’t offering Cochrane Collaboration-level evidence – just hearsay and an anecdotal report – but is he right? Are we ignoring a wealth of medicine for no good reason? After all, our medicine doesn’t go back millennia.
“Nor does TCM,” says Professor David Colquhoun, pharmacologist, Fellow of the Royal Society, and scourge of evidence-lite medicine on his award-winning blog DC: Improbable Science.
“Traditional herbal medicine was banned in China in 1822 for being superstitious nonsense by the then emperor,” he adds. “TCM, as we know it, was reintroduced by Chairman Mao as part of the great proletarian revolution and to stir up nationalism.” (Although Mao’s own doctor practised Western medicine after studying in Australia.)
Today, Prof Colquhoun says, there are plenty of excellent Western-style doctors in China. “If you can afford it, you go for real medicine there, not the traditional way,” he adds.
He claims this is because traditional Chinese medicines – even if they are safe to take – have not been shown to be efficacious. “Even where there has been a placebo effect shown, that has mostly been too minor to be noticeable,” he says.
Prof Colquhoun is frustrated to hear talk of TCM coming into the NHS when there is a likelihood that its close cousin – acupuncture – may be on the way out. Acupuncture is based on the belief that a “life force”, called qi, flows through the body. “Like TCM, there have been thousands of studies into the use of acupuncture, but none show any real effect,” he says.
Colquhoun continues: “It is baffling that Nice [the National Institute for Health and Care Excellence] currently recommends acupuncture for some lower back pain, though that guidance is likely to change. Nice made a bit of a cock-up on that one.”
Nice hasn’t shown any interest in approving TCM. Not that this will comfort our hard-pressed GPs, who will be the ones fielding requests from patients for the Secretary of State’s alternative medicine.
“We are in the middle of one of the biggest funding crises ever,” says Dr Thomas Round, a GP in Tower Hamlets, east London. “Millions have been cut from budgets – so we have to focus on where to get best value on everything we spend. Given that there is a complete lack of evidence for TCM, it really wasn’t a helpful thing for the Secretary of State to say. And it’s not just the lack of evidence. Most GPs would have no training in TCM, so it would be outside our competency to offer it.”
Jeremy Hunt, with his Chinese wife Lucia, faces opposition from medical experts
Nor are any of the TCM products licensed or listed with the British National Formulary, the publication that provides doctors with up-to-date information about all prescription drugs. “We would have no idea about contraindications or possible interactions,” says Dr Round.
The doctor insists he is speaking not with a closed mind, just a sensible one: “If the evidence came out, then of course I’d revisit it. And if someone wants to explore TCM privately, I wouldn’t stop them, although I would point out that we don’t know what active ingredients are used in Chinese medicine. For example, a recent report that looked at TCM herbal skin creams found they contained steroids.” Side-effects of using steroid cream unchecked can include skin thinning, allergies, bruising, and it can suppress the adrenal glands.
Concerns about TCM don’t end with effectiveness, cost or side-effects. The Medicines and Healthcare Regulatory Authority (MHRA) warns that some products pose a “direct risk to public health”.
It is an ongoing concern for the teams of MHRA investigators who examine and test every product or device that has alleged health claims. Last summer, it reported finding heavy metals, including mercury, which can cause tremors, memory loss, kidney and even brain damage, in TCM products. It also flagged up advice from the Swedish National Food Agency (SNFA) of “extremely high” levels of arsenic in various products used to treat mumps, sore throat, tonsillitis, toothache, skin infections, anorexia and fever in infants. The items may not be on sale in the UK but can be found online, the MHRA warns.
Last April, the authority also highlighted the fact that a herbal product for migraine called Zheng tian wan contained aconite – a herb known as “the queen of poisons”, which can cause potentially fatal adverse reactions if consumed. And in February 2013, it warned against traditional headache tablets that had been found to contain lead – the toxic effects include abdominal pain, anaemia, changes in blood pressure, miscarriage, insomnia, dizziness and kidney damage.
Side-effects are not merely theoretical, however. Between November 2003 and June 2004, doctors at the Queen Elizabeth Hospital Birmingham treated four patients who had developed severe acute liver injury within two months of starting to take a TCM slimming aid called Shubao.
The lack of labelling in English, the unregulated ingredients, the additional illegal ingredients, the paucity of trials, the absence of evidence of efficacy: isn’t it astonishing to think that anyone in the NHS might think TCM could be useful in the GP’s surgery any day soon?
It certainly won’t happen in Dr Round’s practice. “I am the gatekeeper to finite resources and I wouldn’t feel comfortable using something with dubious clinical evidence,” he says.
If the Secretary of State for Health wants to explore TCM, he may have to go private this time.