There have been a number of mentions in the media lately of an initiative by GlaxoSmithKline (GSK), one of the biggest of Big Pharma companies, setting up a division in China to study Traditional Chinese Medicine (TCM). Here’s one report quoting a company representative:
Pharmaceutical company GlaxoSmithKline will open a new research unit in China to look at traditional Chinese medicine.
According to the company, Innovative TCM will be one of GSK’s R&D programs in China, aiming to transform TCM from an experience-based practice to evidence-based medicines through innovation and differentiation.
“Traditional chinese medicine is a well-established system of medical practice developed through thousands of years of empirical testing and refinement of herbal mixtures, and relies generally on clinical experience,” said Zang Jingwu, senior vice president and head of R&D China.
“Western medicines, on the other hand, are generally target-based small molecules or biologics, and their approvals for clinical use are based on clinical evidence of safety and efficacy by staged clinical trials,” he said.
He said the newly formed unit is working with academic TCM experts in China to develop new TCM products for the benefits of patients in China and the rest of the world.
The strategy is to integrate the existing TCM knowledge of diseases with modern drug discovery technology and clinical trial methodology.
“We are developing novel therapeutic TCM mixtures as prescription medicines through innovative extraction methods and combinations, and we use clinical data/evidence to differentiate from existing TCM products on the market,” he said.
I have to admit a bit I’m not quite sure how to think about the prospect of this integration of an idiosyncratic and unscientific approach to healthcare with a profit-driven, corporate research and marketing machine. I can spot a few potential problems, though the possibility that something good might come of it is there too.
To begin with, it’s important to remember what TCM is. It is a complex system of looking at health and disease that is vitalistic (based on manipulating spiritual energies not detectable by scientific means), idiosyncratic (not really traditional at all but a set of principles cobbled together in the 20th century from a variety of sources and traditions with some modern innovations tacked on), and, as the GSK representative says, founded on trial and error and individual experiences rather than systematic scientific research. (1, 2, 3, 4) Ultimately, the modern incarnation of TCM as a coherent and comprehensive system of healthcare founded in a philosophical and spiritual world view is fundamentally incompatible with science, which is acknowledged by some practitioners of TCM as well as skeptics. (5)
That doesn’t mean, of course, that some TCM remedies might not be effective. Many of the remedies used are combinations of herbal ingredients, and these unquestionably contain active chemicals that have physiologic effects. The problem is that without controlled research, whether these effects are clinically meaningful, and whether they are beneficial or harmful, isn’t known.
The theoretical system of diagnosis and selection of therapies in TCM is not validated by anything other than anecdote and personal faith, and it contradicts established science, so it is highly unlikely to be accurate or worth investigating. And so far extensive scientific evaluation of acupuncture has failed to find a consistent, meaningful benefit beyond placebo effects. (6, 7). However, rigorous evaluation of the ingredients and combinations of herbal preparations used in TCM might turn up some useful compounds. Certainly, this has been the case for many other drugs derived from plants, though the ultimate use of the drug often bears little relationship to the pre-scientific use of the plant.
There are, of course, some problems even with scientific evaluation of herbal remedies employed in TCM. There is little consistency in the ingredients of particular remedies, with undisclosed substitutions being common, and there is a significant problem with contamination of TCM remedies with parts from endangered plants and animals, toxic metals and even pharmaceuticals (8, 9). So to study such products scientifically, one would first have to clear the hurdle of deciding what the accepted constituents for every given remedy tested really are, and one would have to be very conscious of quality control and not extrapolating results for the product tested to variants identified as the same but not scrupulously evaluated to ensure they actually are the same. Quite a challenge, but perhaps ultimately worth pursuing if the resources and the will are available to do the job properly.
On the other hand, it is important to remember what GSK is. It is a multinational private corporation with enormous financial resources and concomitant influence over governments and the media. It unquestionably produces life-saving medical therapies, but its primary purpose is to make money, and there is no shortage of examples in the pharmaceutical industry of how this can distort the ostensibly humanitarian project of developing medicines.
Perhaps GSK intends to make money by identifying, through rigorous and properly conducted scientific investigation, safe and effective therapies amidst the mélange of remedies currently used according to largely mystical principles in TCM. Or, perhaps GSK intends to cash in on the mystique of TCM, the growing popularity of alternative medicine, and the notoriously weak and ineffectual regulation of the herbal supplement industry to produce products it can sell despite inadequate information about safety and efficacy.
The track record of pharmaceutical companies, and of Chinese food and medicine exporters, in safeguarding the public health is not encouraging. It would be wonderful to see the incredible resources of a company like GSK targeted and a truly scientific evaluation of the potential medicines lurking in TCM remedies. However, just as faith and ideology can distort even honest attempts by alternative medicine proponents to bring scientific scrutiny to their practices, so the potential for profit can distort the efforts of corporations to produce safe and effective medical therapies. There is some evidence that the herbal medicine industry is even less trustworthy than the pharmaceutical industry (10), though I suspect the difference is more that herb and supplement manufacturers are not regulated and watched as closely, not that there is any fundamental difference in the motives, cultures, or practices of large corporations in these two similar industries.
So I will be interested to see whether the growing involvement of conventional pharmaceutical and healthcare companies in the domain of alternative medicine brings more reliable, scientific approach to evaluating TCM remedies (with the necessary rejection of those that fail to prove safe and effective), or if it simply leads to bigger, more aggressive marketing of inadequately evaluated therapies.