Respectful Insolence

Nature is one of the oldest and most respected scientific journals around. It’s been around since 1869 and is said to be the world’s most cited journal. What makes Nature unusual these days is that it’s a general science journal. Astronomy, physics, chemistry, medicine, biology, it publishes it all. The only other journal of its type that I can think of is Science, which also has a similar high impact factor. In any case, getting published in Nature is a big deal, one that can make a career. Believe it or not, I actually have a Nature publication. True, it’s from the 1990s, and, true, I’m the third or fourth author, but it is a Nature publication. Ever since then, I keep telling myself that, one of these days, I’ll manage to find a way to be published again in Nature, although I realize that it’s looking increasingly unlikely that that will happen. Such is the power and cachet of Nature. It’s a name that has provided prestige to some of its spinoff journals, such as Nature Medicine, although of late Nature appears to have diluted the brand name beyond belief.

All of which makes it very, very disappointing to see Nature publish a supplement like this one, which is hot off the presses and entitled Traditional Asian Medicine. It’s a mixture of The Good, The Bad, and The Ugly, with the vast majority falling credulously into the latter two categories, starting with the acknowledgment of the sponsors:

We are grateful for the support of our sponsors, Saishunkan Pharmaceutical Co., ltd. and the Kitasato University Oriental Medicine Research Center. As always, Nature carries sole responsibility for all editorial content.

Yes, you read it right. Nature has apparently sold out to a Japanese supplement manufacturer and a quackademic medical center. The company Saishunkan Pharmaceutical Co., Ltd., is described thusly:

Saishunkan is a herbal medicine manufacturer which aims to help people make the most of their natural powers of healing and self-recovery. Based on the idea from herbal medicine that humans are part of the nature, our dream and joy is to ease the worries and concerns of aging, which comes to everyone. We maximize our capabilities to support lively and happy aging by using the power of nature to enhance human revitalization.

Our business started with a herbal formula “Tsusanto” for easing pains of neuralgia and rheumatism. In 1974, “Domohorn Wrinkle”, a family of basic skincare products intended for mature skin came to being from the same principles of herbal medicine.

The company itself also has a message published in the supplement. It’s basically a lot of self-serving company propaganda with a couple of Western blots and graphs, the better to make it more science-y. Apparently one of its concoctions increases levels of certain heat shock proteins, and this is trumpeted as evidence that they work. I’m not impressed.

Meanwhile the Kitasato University Oriental Medicine Research Center is described thusly:

The Oriental Medicine Research Center provides two types of clinical activities: medical treatment based on Kampo medicine theory, primarily using decoctions, and acupuncture that follows our country’s traditional techniques. To prepare Kampo medicines, we have set up an exclusive pharmacy that is in charge of dispensing and formulating these medications, focusing on crude drugs. Patients come from all over the country in search of treatments based on Oriental medicine, both Kampo medicine and acupuncture/ moxibustion.

Kampo medicine, for those of you not familiar with it, is simply the Japanese study and adaptation of traditional Chinese medicine (TCM). As practiced today, it does seem somewhat different in that the Japanese government regulates Kampo medications as pharmaceutical products, rather than supplements. It is, however, the same TCM woo, just transplanted.

Basically, the approach of the articles in this supplement tend to follow roughly the form and arguments of the very first article by Michelle Grayson, Traditional Asian Medicine. It’s all on display there, claims that TCM is being “integrated” into “Western” medicine, and, most annoying of all to me, the claim that TCM is so “personalized” that randomized clinical trials are very difficult, if not impossible, to do:

Yet a bit of probing revealed what a complex story this is. Not only are big efforts underway to modernize traditional medicine in China and Japan, but Western medicine is adopting some aspects of the Eastern point of view too. In particular, modern medical practitioners are coming around to the idea that certain illnesses cannot be reduced to one isolatable, treatable cause. Rather, a fall from good health often involves many small, subtle effects that create a system-wide imbalance.

But do traditional medicines actually work? Their personalized nature makes randomized controlled trials — the gold standard for testing drugs — extremely difficult. Rarely are two formulations identical. However, as modern medicine becomes more personalized, using biological and genetic markers, it is inadvertently developing the tools to better test traditional medicines.

The other theme that runs through these articles, besides the implication that TCM is just too personalized to be studied easily using randomized clinical trials is the very conscious effort to link this “personalization” with the new era of genomic medicine, whose fruits (if we ever realize them) will one day be considered truly personalized medicine based on a patient’s genomic profile. Honestly, it should be profoundly embarrassing to Nature that one of its own actually wrote this twaddle. Actually, Nature should be profoundly embarrassed at publishing so much twaddle in this supplement. I could, if I so desired, spend several days, one post per day, deconstructing these articles. I’m not sure if I’m really up for the task right now, given the proximity of the holidays, although I might very well change my mind. I’m also likely to have more to say about this supplement issue on my other blog next week.

In the meantime, the next installment in the series is Convergence: Where West meets East starts with a passage that any supporter of SBM will find incredibly irritating. See how many fallacies you can count in just this short snippet of text:

For around 200 years, two very different systems of medicine have been used in Asia to cure diseases and keep people healthy. The local Asian one is based on traditional Chinese medicine (TCM) — herbal mixtures developed though observation and experience accumulated over thousands of years, but with unknown mechanisms of action. On the other hand, modern medicine, imported from the West, consists of chemically purified compounds that have been discovered through scientific investigation and tested in controlled clinical trials.

Yes, there it is, the the false dichotomy of “East” versus “West,” which portrays the “East” as being more spiritual and the “West” as being unfeeling, scientific, and out of touch with nature. Notice the reference to “chemically purified compounds” compared to the “natural” compounds of TCM. Notice the argument from antiquity, which implies that because TCM is ancient (“Observation and experience accumulated over thousands of years”) contrasted with science. Just this brief paragraph is a veritable plethora of woo-speak! It doesn’t get any better from there.

There’s a long section on TCM diagnosis, which in reality is based on a prescientific understanding of disease and how the human body functions. In essence, they boil down to imbalances in the five “elements,” which are basically the Chinese version of the four humors plus one. Remember that a major component of TCM diagnosis is something called “tongue diagnosis,” which the article even dutifully reproduces, complete with woo diagnoses like Yin Deficiency and Yang Deficiency, not to mention Qi Stagnation. This system is described, in all seriousness by the author, as producing diagnoses that are a “finer level of classification than disease groupings in modern medicine.” I kid you not. In support of this, a study published in the American Journal of Chinese Medicine is cited in which the authors used TCM diagnoses to classify rheumatoid arthritis patients. The study concluded that patients with cold-pattern symptoms (diagnosed by TCM, of course) responded better to real medicine, while patients with qi deficiency responded better to TCM. In any case, this entire article is very much woo-omics, like the Ayurogenomics that I discussed a while back; i.e, a total abuse of genomics and systems biology. They even use and abuse poor Leroy Hood, one of the originators of systems biology whom I’ve mentioned before.

The rest of the issue is chock full of similar atrocities against skepticism and science. For example, there’s an article by Felix Chueng entitled TCM: Made in China, which is basically one long appeal to popularity, listing how many people use TCM, how many companies manufacture it, and how this number is growing, as though this were evidence that TCM must be scientifically valid. Chueng even appeals to the one example of how a blind squirrel can find an acorn every so often, namely the example of the antimalaria drug artemisinin, which was isolated from an herb described in TCM. Another article by Chueng extolls the glories of how TCM is practiced in the clinic. It’s nothing more than one long anecdote, in which the author, suffering from a “persistent back problem” that also causes leg pain (which sounds a lot like sciatica) goes to a TCM clinic. There, he’s diagnosed with xinhuo (“heart fire) and then treated with acupuncture, moxibustion, and cupping. He was even treated with–believe it or not–bloodletting to clear the “heart fire.” He concludes:

I walked happily away with my leg feeling much better. As I left the hospital, I saw the women still doing their baduanjin. I began to wonder if maybe I should start practicing baduanjin too.

Baduanjin is a form of Tai Chi.

As I read this account, I wondered: This guy is editor of Nature China in Hong Kong. I couldn’t help but also wonder if Chueng had ever heard of placebo effects, because he was describing a lovely example of them in his anecdote.

Another bit of pure propaganda for TCM can be found in an article by Zhiguo Xu entitled Modernization: One step at a time. Once again, the example of artemisinin is trotted out as an example to imply that all TCM must have something to it. Of course, what’s interesting is that the description of artemisinin provided in this article is nothing more than good, old-fashioned pharmacognosy; i.e., natural products pharmacology. In fact, that, and the other example culled from TCM, arsenic trioxide, are used to imply that the view of TCM that purified compounds aren’t the best way to treat disease, that there is synergy between different compounds in herbs:

For decades, European and US regulatory agencies held the view that a drug must be either a highly purified or synthetic agent. Traditional medicines could not qualify under this definition because a TCM preparation is a concoction rather than a single compound, and the chemical structures of the active ingredients are undefined. Consequently, when it came to assessing a traditional medicine for efficacy, most effort went into identifying the principal agent within a herb or mixture of herbs and purifying it as a single chemical compound. However, “academic scientists and the pharmaceutical industry have not been very successful at isolating the active substances in TCM preparations”, says Bai Lu.

Others share Lu’s dour outlook. “Few active ingredients are extracted from TCM herbs by modern scientific approaches,” says Yi Rao, dean of life sciences at Peking University in Beijing. “Those extracted effectively have not been demonstrated to be clinically successful.” Indeed, he says, “artemisinin and arsenic trioxide are perhaps the only two examples”.

The author seems not to realize that these two examples actually demonstrate the importance of isolating the active compound and purifying it. Yet the entire focus of this particular article is to claim that there is “synergy” between ingredients of herbs and how to capture it. The problem is, there usually isn’t. Herbs can be drugs, but they are impure drugs. Perhaps the reason that so few active substances have been isolated from TCM herbs is because there just aren’t that many.

Even more amusingly, another example is described, something called the Herbalome project. This is nothing more than high throughput screening of herbs from TCM for active ingredients using liquid chromatography and other methods of separation. Analyzing 500 samples a day, the project has thus far identified the active ingredient from only one herb. Inadvertently, the Herbalome project appears to be demonstrating that there probably isn’t much that’s useful in the herbal medicine of TCM that hasn’t already been identified. Of course, that leads to this excuse:

For example, Liang acknowledges that one of the major tools used by his team as part of the Herbalome — high-throughput screening — is not ideally suited to the task. That’s because TCM concoctions are mixtures of multiple active compounds, and a typical Chinese medicine is intended to hit multiple biological targets.

Notice the rebranding. The originators of TCM had no idea what a “biological target” was. They were trying to “rebalance the elements” or “correct the flow of qi.” They weren’t trying to “hit multiple biological targets,” and they used herbs because that was all they had. Substances found in TCM that actually had some activity against real diseases (substances such as artemisinin and arsenic trioxide) were discovered by accident, not because the principles of TCM facilitated their identification. In any case, what the Herbalome project is doing is nothing different than high throughput screening of natural products that just happened to be used in TCM.

Finally, there’s a horrible, horrible article by Jan van der Greef, principal scientist at the Netherlands Organization for Applied Scientific Research (TNO), professor of Analytical Biosciences at Leiden University and chairman of the Sino-Dutch Centre for Preventive and Personalized Medicine, entitled All Systems Go. Practically every paragraph had seriously cringe-worthy sentences in it (to supporters of SBM like me, anyway), passages like this:

The concepts and practices of systems biology align very closely with those of traditional Asian medicine. Consider the very idea of ‘health’. The current World Health Organization definition of the term is based on a 1948 consensus: “A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” However, an emerging concept of health in the scientific literature describes an ability to adapt and self-manage in the face of social, physical and emotional challenges1. This perspective has, of course, long been central to the concept of health in traditional Chinese medicine (TCM), which further includes spiritual fulfilment and a sense of individual well-being.

And:

But there is a growing realization in the West that single biomarkers are not enough. A better approach is to look at patterns of biomarker responses to a challenge. These data will provide insight into the resilience of allostatic mechanisms, and hence into a person’s health, an approach not unlike the tenets of TCM.

Get it? TCM was ahead of its time, and “Western” science is only now catching up! This assertion is, of course, a pair of fetid dingo’s kidneys. What’s really going on is that woo-friendly “Western” scientists like van der Greef are retrofitting new scientific findings into the framework of TCM and declaring that they fit. In reality, what quackademics are doing is taking parts of TCM that sound vaguely as though they fit in with the latest scientific findings in systems biology and grafting them on to create a Frankenstein monster made up of parts of systems biology with a parts from TCM stitched together. Add to that the typical alt-med excuse that “your science can’t study my woo” because it’s “personalized” and randomized clinical trials can’t handle that, and you have the recipe for the infiltration of quackademic medicine into academia.

In all fairness, I will concede that the Nature supplement isn’t entirely bad. For instance, there is a reasonably good article on biodiversity and how TCM threatens it by using body parts of animals belonging to endangered species, a practice that generates a lucrative trade in endangered species. Unfortunately, the article fails to describe just how cruel some of the techniques used to obtain these body parts and fluids can be and just how much they endanger species like tigers. There is, however, a nice debunking of the idea that rhino horn has been used for thousands of years to treat cancer. (It turns out that it was made up less than 100 years ago.) There’s also an article on the dangers of herbal medicine, which can cause side effects, sometimes severe. However, overall the articles in this supplement leave this reader with the inescapable impression of boosterism. This is, of course, not surprising, given that this supplement should be viewed, more than anything else, as an advertising supplement, bought and paid for by its sponsors.

As I read this supplement, I couldn’t help but think of what the reaction would be from CAM practitioners to a supplement bought and paid for by a pharmaceutical company. (Actually, this supplement was bought and paid for by a pharmaceutical company; it’s just that it was bout and paid for by a pharmaceutical company that makes TCM remedies.) The reaction would be unrelentingly hostile, and rightly so. In fact, I highly doubt that Nature would agree to publish a supplement funded by, for example, Merck, Pfizer, or Sanofi-Aventis extolling the virtues of their products. I doubt even more highly that it would hire out its own editors to write articles for such a supplement. Yet that’s exactly what Nature has done in this case for TCM.

I’m left with the conclusion that, to their eternal shame, by publishing this issue, the editors of Nature have become willing shills for the TCM industry. Nature has sold out, and its editors and publisher should be called out for it.

Comments

  1. #1 DevoutCatalyst
    December 22, 2011

    Unbelievable. I saw this last night and worried it might get lost in the holiday shuffle. I needn’t have worried because Orac is on the case. Look forward to more of your flogging of naughty Nature.

  2. #2 LW
    December 22, 2011

    So, I assume that Saishunkan sells its formulations exclusively to trained and licensed practitioners? And the formulation is different each time and is prepared only in response to a proper personalized prescription? Certainly this must be so, for otherwise the “personalized nature” would imply that a patient who picks up the herbal formula “Tsusanto” because it’s touted as good for easing pains of neuralgia and rheumatism is likely to be disappointed since it isn’t personalized for him.

  3. #3 Daniel J. Andrews
    December 22, 2011

    This is worse than I thought then. I saw it online, figured I’d wait till the mail edition came in. Once I’ve read it carefully I’m going to put a comment on their site.

    In fact, I highly doubt that Nature would agree to publish a supplement funded by, for example, Merck, Pfizer, or Sanofi-Aventis extolling the virtues of their products. I doubt even more highly that it would hire out its own editors to write articles for such a supplement.

    They have this year published one of their Outlooks on research into cancer or molecular/cell biology mechanisms (I need to find it again to get the details straight), which was funded by a pharmaceutical company. As far as I recall though they did not seem to be pushing anything to the extent that this latest supplement does. I’ll have to recheck now, and later post the details for anyone interested.

  4. #4 Denice Walter
    December 22, 2011

    *Nature* puts alt med apologists into a quandary: there it is- a highly respected periodical (mostly) praising TCM *however* it is backed by a pharmaceutical company – just like the BMJ is- Oh, wait! it’s the *right kind* of pharmaceutical company, one that doesn’t base its products on SB research and safety testing like those Western polluters of the envrironment and bodily fluids. Problems like that only happen in North America and Western Europe.

    A few years ago, I attended an exhibit called the “Lure of the East” ( Yale’s British Art museum) tracing the influence of Orientalism in pictorial arts in the West: from the brochure, a modern critic ( Edward Said) characterises Western interest in the East as “harmfully imperialist in nature”, rife with stereotypical ideas and prejudices about these cultures.

    Except today, rather than focusing exclusively on these cultures’ ( largely imagined) sensuousity and timelessness, there is instead a lack of criticism about dangerous products that would be heralded as nightmares if they originated from Western companies. The East is stereotyped in an entirely different way: beyond reproach above suspicion, an over-flowing font of wisdom based on ancient knowledge of nature.Which leaves out SB research that originates in Asian countries I guess.

  5. #5 TBruce
    December 22, 2011

    This system is described, in all seriousness by the author, as producing diagnoses that are a “finer level of classification than disease groupings in modern medicine.”

    Really? I wonder what the TCM classification of malignant lymphoma looks like.

    There’s a much overused expression that I think is appropriate here: Nature has jumped the shark.

  6. #6 Wildlife Margrit
    December 22, 2011

    For Shame is right!

  7. #7 Heliantus
    December 22, 2011

    We are grateful for the support of our sponsors, Saishunkan Pharmaceutical Co., ltd. and the Kitasato University Oriental Medicine Research Center.

    Let’s be positive. Next time some altie shouts “Don’t trust what’s published in scientific journals, they are all sold out to Big Pharma”, we can answer “you mean like this?” and point them to this journal issue.

    OTOH, it’s not the first time that Nature’s editors decide to publish something outside of the box. Didn’t they publish some article about water memory’s?

  8. #8 Karl Withakay
    December 22, 2011

    I don’t understand why the practice of individualized formulation can’t be studied scientifically. It’s not even good special pleading. Individualized formulation may be problematic in evaluating any specific, individual formulation, but it wouldn’t be too problematic for the practice itself.

    Randomize the subjects into two groups. Have the witch doctor, I mean herbalist, evaluate each individual and design a formulation specifically for that individual. (While you are at it, note how uniquely individualized the formulations really are when used for the same medical condition. We hear this claim of individualization a lot, but I seriously question how individualized any sCAM practice really is in real world practice: see LW @ #2 above) Subjects in the experimental group get their individualized, recommended formulation while subjects in the other group get a placebo.

    Yes, there will be some blinding/ relative placebo factor strength issues in that it’s possible the various formulations may look, smell, or taste differently from each other and the placebo, but in at least some circumstances, it would be possible to control for this by encapsulating the formulation in a colored coating. An interesting variation of this experiment would be to divide the experimental group into two sub-groups. Group A subjects get their recommended, individualized formulation while the recommended, individualized formulations for Sub group B are put into a pool and randomly assigned to the group B patients.

    Boom, you have an experiment that can compare the practice of individualized formulation to a control. No special pleading required.

  9. #9 JB
    December 22, 2011

    Thank you for directing me to this article. It’s refreshing to see a nuanced (although brief) approach to another medical thought system, rather than the child’s understanding often portrayed in either credulous or skeptical portrayals of a vast and complex body of clinical thought.

    This remark is a good example of how a truly scientific mindset can benefit from an alternative perspective: “Modern medical practitioners are coming around to the idea that certain illnesses cannot be reduced to one isolatable, treatable cause. Rather, a fall from good health often involves many small, subtle effects that create a system-wide imbalance.”

  10. #10 dt
    December 22, 2011

    @TBruce…. and that is just NHL. There is also the Hodgkin’s lymphoma classification.

    I cannot wait to read the TCM classification. What will it be, I wonder…? Possibly:
    1. Hot liver lymphoma
    2. Dragon urine lymphoma
    3. Angry spleen lymphoma

    And all categorized purely on the beat of the pulse and appearance of the tongue. Who needs clinical hemo-oncologists or disgnostic radiologists or histopathologists?

  11. #11 Dianne
    December 22, 2011

    our sponsors, Saishunkan Pharmaceutical Co., ltd.

    Isn’t this a smoking gun level proof that TCM and “naturopathy” are just another part of “big pharma”? Except maybe with even more questionable standards? If you distrust, say, Merck because of vioxx, why not distrust Saishunkan because of kava kava, ephedrin, et al?

  12. #12 Dianne
    December 22, 2011

    OTOH, it’s not the first time that Nature’s editors decide to publish something outside of the box. Didn’t they publish some article about water memory’s?

    Yes, they did. This is one reason why I’m not too worried about having no Nature publications. Well, that and being a clinician. Though I don’t have any NEJM publications either, sigh! (Though given their publication of the death seeking cat article, maybe the same logic should hold…)

  13. #13 dean
    December 22, 2011

    ” Didn’t they publish some article about water memory’s?”

    Yes, but (from Wiki)

    The editor of Nature, John Maddox, stated that, “Our minds were not so much closed as unready to change our whole view of how science is constructed.” Rejecting the paper on any objective grounds was deemed unsupportable, as there were no methodological flaws apparent at the time. In the end, a compromise was reached. it was accompanied with an editorial by Maddox that noted “There are good and particular reasons why prudent people should, for the time being, suspend judgment” and described some of the fundamental laws of chemistry and physics which it would violate, if shown to be true. Additionally, Maddox demanded that the experiments be re-run under the supervision of a hand-picked group of what became known as “ghostbusters”, including Maddox, famed magician-cum-paranormal researcher James Randi, and Walter Stewart, a physicist and freelance debunker at the U.S. National Institutes of Health.

    A slightly different approach.

  14. #14 JB
    December 22, 2011

    The piece on systems biology and TCM is especially interesting. If you can’t see value in this, it belies your stance as objective. (I may be understating the case.)

  15. #15 David Marjanović
    December 22, 2011

    Let’s be positive. Next time some altie shouts “Don’t trust what’s published in scientific journals, they are all sold out to Big Pharma”, we can answer “you mean like this?” and point them to this journal issue.

    …Yeah.

    Isn’t this a smoking gun level proof that TCM and “naturopathy” are just another part of “big pharma”?

    …Yeah.

    Though given their publication of the death seeking cat article, maybe the same logic should hold…

    Do you mean the cat that apparently likes the smell of failing metabolism?

  16. #16 David Marjanović
    December 22, 2011

    The piece on systems biology and TCM is especially interesting. If you can’t see value in this, it belies your stance as objective. (I may be understating the case.)

    Please do explain.

  17. #17 JB
    December 22, 2011

    David: The statement, “TCM is descriptive and phenomenological,” is an accurate characterization of TCM’s approach to diagnosis and pathology. Disparage however you like, but TCM is descriptive of phenomena. This allows for “qualitative subtyping” that may be clinically useful. Why not study these subtypes?

    Also, the paragraph on “multitarget pharmacology” of herbal medicine, introduces a very useful concept into the context of medicine. A study is cited in which an herbal combination decreased triglycerides and cholesterol, while raising HDL. Is there a med that can do that? With little to no side-effects?

    How is the idea that people with symptoms can be described differently, leading to different interventions, so appalling?

    I’m not meaning to troll. But this stuff isn’t black and white.

  18. #18 LW
    December 22, 2011

    This system is described, in all seriousness by the author, as producing diagnoses that are a “finer level of classification than disease groupings in modern medicine.”

    No doubt one could create a “finer level of classification than disease groupings in modern medicine” based on the Chinese zodiac, Sun signs, favorite color, and whether you wear socks with sandals. More categories is not the same as more meaningful categories.

  19. #19 Beamup
    December 22, 2011

    “Descriptive” is irrelevant. I can describe diagnosis and pathology in terms of the Wizard spell level required in D&D to produce the effects, if I want.

    USEFUL is the relevant metric. Does it actually produce improved outcomes, or not.

    Your second paragraph also betrays a profound misconception. Herbs are either “a nice bowl of salad and some potpourri,” or drugs. Which carry all the same risks of side effects as anything produced by Merck. Anything with effects, has side effects. The implication that magic herbs somehow can only be beneficial, is quite simply false.

  20. #20 Dianne
    December 22, 2011

    A study is cited in which an herbal combination decreased triglycerides and cholesterol, while raising HDL.

    Citation, please.

    Is there a med that can do that?

    Dozens.

    With little to no side-effects?

    Dozens. Every medication has side effects, of course, but not every side effect is intolerable or universal. Statins, for example, have virtually no notable side effects in the majority of patients-but cause serious and occasionally fatal side effects (less than 1 case in 1 million).

    While on the subject, what is the evidence that the herbal combination you cite has no side effects? Natural does not mean side effect free. In fact, most medicinal herbs are medicinal because the plant is making something to discourage animals from eating it. Digitalis, opioids, taxanes, vinca alkloids…all derived from plants, all, from the plants’ point of view, there to kill animals that try to eat it, NOT to help them.

  21. #21 JB
    December 22, 2011

    Beamup: These are clinical descriptions refined in clinical practice over many years. That is the basis of their relevance. As to your second point, I did not mean to imply that herbs can only be beneficial. But when properly tailored to an individual, they ARE generally side-effect free.

    Dianne, the citation is in the article. And the point I was trying to make about multi-target pharmacology is better stated in the article as well. On the whole, herbal remedies certainly appear to be more well tolerated than meds. There is, in fact, a vast problem with drug safety, as everyone knows.

  22. #22 warthog
    December 22, 2011

    There, he’s diagnosed with xinhuo (“heart fire) and then treated with acupuncture, moxibustion, and cupping. He was even treated with–believe it or not–bloodletting to clear the “heart fire.”

    That’s interesting. I don’t know what a couple of those are, but I wonder if he didn’t feel a lot better afterwards because he was concentrating on enduring the cure. I know when I’m given a shot or getting blood drawn I watch like a hawk to be sure they’re sterilizing properly and such. I’m sure bloodletting would be more stressful.

  23. #23 Narad
    December 22, 2011

    Disparage however you like, but TCM is descriptive of phenomena.

    No, it’s connotative.

  24. #24 Julia
    December 22, 2011

    “But do traditional medicines actually work? Their personalized nature makes randomized controlled trials — the gold standard for testing drugs — extremely difficult. Rarely are two formulations identical. However, as modern medicine becomes more personalized, using biological and genetic markers, it is inadvertently developing the tools to better test traditional medicines.”

    That made me laugh out loud. They can’t do traditional pharmacology clinical trials because the medicine is too individual, but adding hundreds of thousands of individual genotypes will clarify things. As a statistical geneticist I would love to see that study design.

  25. #25 Scote
    December 22, 2011

    “I don’t understand why the practice of individualized formulation can’t be studied scientifically. …

    Randomize the subjects into two groups….Subjects in the experimental group get their individualized, recommended formulation while subjects in the other group get a placebo. “

    Indeed, I think there was a British study of “individualized” herbalism which did just that, and, wait for it, found individualized herbalism didn’t perform better than placebo.

  26. #26 BA
    December 22, 2011

    It is ridiculous to suggest that individualized approaches cannot be studied through RCTs. It might be expensive but just about any treatment modality can be subjected to targeted study with random assignment to treatment conditions.

  27. #27 Militant Agnostic
    December 23, 2011

    Scote @25 – I believe it was “individualized” homeopathy rather than herbs tat were studied in the British study you were referring to. All subjects received a homeopathic consultation and then were randomly given an individualized homeopathic preparation or water. In a study TCM creating an undetectable placebo would be a little more difficult.

  28. #28 Eric Herboso
    December 23, 2011

    The @NatureNews twitter account just told me I am the unscientific one for expressing disgust at this publication. Can I get some help in showing the person behind this twitter account how wrong (s)he is? See: http://twitter.com/EricHerboso/status/150150713538912257

  29. #29 MikeB
    December 23, 2011

    Fellow skeptics:

    Many people in my circle of friends are Tai Chi people. What the fuck is it?

  30. #30 cvl
    December 23, 2011

    I’m with JB. Leroy Hood and Tommy Cheng’s work on looking at the “multitarget pharmacology” of TCM is rather scientifically vigorous. The challenge is designing an appropriate gimmish that actually does effectively hit multiple targets rather than result in multiple drug-drug interactions. The systems biology approach does make a lot of the hand-wavy Yin/Yang descriptions a bit more scientifically valid.

  31. #31 Orac
    December 23, 2011

    Straw man argument. No one claimed that Leroy Hood’s work on “multitarget pharmacology” isn’t rigorous science. What’s not so rigorous, not to mention a bad analogy, is the likening TCM, which basically throws together herbs in a big gmish without any scientific underpinning, to the way systems biology is done that is the fallacy. Unfortunately, after doing a bit of Googling I see it’s a fallacy that Hood falls for on occasion. The fallacious idea is that somehow all of this is intelligently designed for synergy, when it isn’t. In fact, examples of synergy from multiple natural products are very few and far between.

    In fact, there is nothing about the systems biology approach that makes Yin/Yang, TCM diagnoses and treatments, or any of that more scientifically valid. TCM boosters like to claim that it does, but it just doesn’t.

  32. #32 puppygod
    December 23, 2011

    Fellow skeptics:

    Many people in my circle of friends are Tai Chi people. What the fuck is it?

    Depends.

    Basically, Tai Chi (taijiquan in another transcription) is a system of light exercise based on smooth, slow moves. Even I practice taijiquan – and I am a hardcore sceptic.

    On the other hand the philosophy behind the system is based on traditional Chinese beliefs and include a lot of “chi” “balancing” and “flowing” and other woo. So it all depends whether you take it as a fun light exercise, or a life philosophy. If you don’t take it too seriously, it’s harmless and have about as much advantage as any light exercise.

  33. #33 Beamup
    December 23, 2011

    Beamup: These are clinical descriptions refined in clinical practice over many years. That is the basis of their relevance.

    Utter bollocks. Unless they are EFFECTIVE and USEFUL they are irrelevant. The four humors were also “clinical descriptions refined in clinical practice over many years.”

    As to your second point, I did not mean to imply that herbs can only be beneficial. But when properly tailored to an individual, they ARE generally side-effect free.

    [citation needed] Or, more bluntly, bullshit.

  34. #34 Denice Walter
    December 23, 2011

    @ MikeB:
    Tai Chi can be a form of exercise, a martial art, a religion/ philosophy, self-care (physical and mental), and an avenue for woo-entanglement beckoning all comers with the lure of the Exotic East.

    Because of its early spiritual connections to Taoism, ideas about immortality accompany more prosaic concerns like mobility, CV and ED. There is dietary woo based on the 5 elements theory as well as herbalism, meditation, and accupuncture-based methodologies. Thus lots of material for woo-meisters in need of an ancient hook on which to hang their New Agey bait.

    I’m sure a few realists actually use it for exercise.

  35. #35 JB
    December 23, 2011

    Beamup: Thanks for your thoughtful reply. Whether those descriptions are useful is what is being studied in the context mentioned. Even the Greek notion of humors may lend some unique insights if investigated this way. I don’t know. Certainly many people find it worthy of study, because of experiences of EFFECTIVENESS and USEFULNESS. Your obvious hostility to the idea betrays your lack of objectivity. It also makes conversation impossible, and pedantic arguments inevitable.

    There is an article included in the supplement in question on the subject of herbal safety. Indeed, it has a rather alarmist tone. However, the incidence of serious side-effects is miniscule compared to drugs. (Don’t ask for a citation. I’m sure you know you live in a glass house on this question). And in a given instance, if someone does not tolerate a drug, they may seek an alternative. They do so every day. (Citation! Agh, get it yourself.)

  36. #36 Interrobang
    December 23, 2011

    Citation! Agh, get it yourself.

    Um, no, you don’t get to assign us homework — the way argumentation works is that if you make the claim, you have to back it up. Bring your citations, podnuh, or don’t bother coming at all.

    Also, complaining about the “tone” of something is the first refuge of a rhetorical scoundrel. I’m not a scientist; I’m a rhetorician, and even without judging your argumentation on its scientific merits, I can certainly judge your argumentation on its argumentative merits, and all I’m getting is bullshitting and special pleading. In other words, no matter which way you look at it, you’ve got nothing.

    Parsimony suggests that the reason why a lot of herbal “supplements” don’t have side effects is because they’re inert, by the way. I’m a technical writer with a liberal arts education (a good liberal arts education, FWIW, the kind that winds up being a superbly-calibrated bullshit detection system), and I know that much…next time, bring your A game.

  37. #37 Lawrence
    December 23, 2011

    JB – that’s one mighty big glass house you live in. Citations are necessary to show, you know, actual evidence that what you say is true. When you have access to the PubMed library, citing evidence is easy – with woo, all you have is the word of the person who is spewing it.

    Given that most herbal “remedies” don’t do anything at all, I would be shocked if they had substantial side-effects (you know, other than not treating the illness for which they are taken). Like homeopathy, I would be very surprised if drinking water led to “serious side-effects.”

  38. #38 passionlessDrone
    December 23, 2011

    Leroy Hood and Tommy Cheng’s work on looking at the “multitarget pharmacology” of TCM is rather scientifically vigorous.

    I thought this read: Tommy Chong’s work. . .. It does make a sort of sense within context. I “vigorously” studied “multitarget pharmacology” all the way through college!

    - pD

  39. #39 JB
    December 23, 2011

    Whoa. Folks. I did reference an article in the supplement under discussion. I have been assuming that everyone has read the supplement since they are so up in arms about it. If you had read it, Lawrence, you would see that herbs do in fact have side-effects, especially when wielded by untrained physicians.

    The fact that people seek alt med in droves every day is undisputed. There are statistics everywhere. I’m pretty sure you’re aware of them. So this is childish point-scoring for the sake of it.

    Interrobang, what is the formal term for muddying an argument through continual technical point-scoring?

    I feel like I’m talking to a group of mean-spirited children. Good day.

  40. #40 Beamup
    December 23, 2011

    So you’re admitting that you made up the claim that “properly tailored” herbs are “generally side-effect free?”

  41. #41 Narad
    December 23, 2011

    The fact that people seek alt med in droves every day is undisputed. There are statistics everywhere. I’m pretty sure you’re aware of them.

    At least you have the strength of conviction to extend “Citation! Agh, get it yourself” to straight-up mental implantation when nudged.

  42. #42 Phoenix Woman
    December 23, 2011

    Ah, the irony. The SCAMmers keep claiming that Big Pharma’s only in it for the money, and yet we have woo firms rich enough to buy up Nature many times over, renting the once-respected journal for an advertorial.

    I see that a lot of my favorite killfile occupants have shown up in the comments — have any of them started nattering on about the Shroud of Turin yet?

  43. #43 Antaeus Feldspar
    December 23, 2011

    If you had read it, Lawrence, you would see that herbs do in fact have side-effects, especially when wielded by untrained physicians.

    That’s not surprising, but it’s also not what you need to prove in order to support the argument you chose to make.  You need to provide evidence that herbs, when “wielded” by “trained” herbalists, have fewer side-effects than mainstream medications being “wielded” by mainstream physicians, while having similar or superior effectiveness.

    The fact that people seek alt med in droves every day is undisputed. There are statistics everywhere. I’m pretty sure you’re aware of them.

    Are you expecting us to be impressed with that argument from popularity?

  44. #44 Militant Agnostic
    December 23, 2011

    @45
    Even by the standards of argument from popularity, it was lame.

    Another reasons why “herbs don’t have side effects”* is that surveillance is almost non-existent.

    *except when they do ie Aristolochia

  45. #45 Gil
    December 23, 2011

    It’s a shame Eastern medicine can’t be seen as backwards and primitive but outright barbaric when much is drived from animal endangerment and vile cruelty.

  46. #46 Chris
    December 23, 2011

    Funny, I know lots of herbs that have side effects. Even some that can actually kill you. Around here you need to be careful if you find “wild carrot”, because it could actually be hemlock.

    Though evil pharmaceutical companies found a way to refine them and dose them out so they have benefits to health instead. So would you prefer Big Pharma created digoxin, or just some foxglove tea?

  47. #47 xyz
    December 24, 2011

    Dr O the ingenue. Medical journals with over 50%, even over 90% ad funding, have been droppin’ their drawers for advertisers for generations. Nature takes its course. What’s new?

  48. #48 Matt G
    December 24, 2011

    What a disappointment! Started reading it last night in the subway – dreadful. I’d like to know how much Nature charges for its dignity.

  49. #49 Daniel J. Andrews
    December 24, 2011

    Hm. There’s that ‘we don’t need no steenkin’ citation’ meme again. Somewhere recently there must have been a blog post on a nonscience site telling people they don’t need to provide citations.

    The Dec 15, 2011 issue of Nature (7377) has an Outlook on Multiple Myeloma from Onyx Pharmaceuticals. I haven’t read it thoroughly yet, but they mention the various drugs used, research avenues, possible treatments/better imaging.

    Given Orac’s post, I find I’m now even more skeptical regarding some of these claims in this issue of Nature…in fact, feeling downright suspicious, which is a pity because I don’t have the background or expertise to determine if they have produced a truthful account or a Pharma-sponsored whitewash account. If they did so badly with the Asian medicine supplement, who is to say whether or not they did just as poorly with this (and other) supplements?

  50. #51 Ferdinand Svehla
    December 27, 2011

    Let’s talk alternatives. Science Magazine?

  51. #52 g724
    December 29, 2011

    I’m with Heliantus at #7: “Let’s be positive. Next time some altie shouts “Don’t trust what’s published in scientific journals, they are all sold out to Big Pharma”, we can answer “you mean like this?” and point them to this journal issue.”

    Exactly.

    And also, use this stuff to get their attention, and start talking to them about scientific method. Teaching them methodology may be the best way to get them to start thinking for themselves. Avoid buzzwords, avoid attacks, don’t jump on them for obviously flawed thinking. Just persistently keep asking questions such as “how would you be able to demonstrate this to others?” and so on.

  52. #53 James Chong
    January 2, 2012

    At last the truth of journalism, can you believe them, Yin Yang imbalanced.
    Just like the bad policeman got fired by the department, seeking justice by shorting innocent on street.

    Who is Yin or Yang, perhaps let acupuncture from
    https://sites.google.com/site/jameschongpainfree/
    to eliminating all Yins instead of let them keep toxifying.

  53. #54 Narad
    January 2, 2012

    Are you sure you’re not Tommy Chong?

  54. #55 James Chong
    January 7, 2012

    In 2001, published Hendrik Sch..’s scientific scandal can only fool you a year or 2. But not to the scientific facts and so as acupuncture. It can’t fool you for 4610+ years long. simply because of languages barriers have mislead, . .

    Below another evidence since E² acupuncture science online.
    S/He shop around and now Pain free, ..

    from http://www.examiner.com/holistic-science-spirit-in-national/new-scientific-breakthrough-proves-why-acupuncture-works?fb_comment=16922196

    Anonymous 1 week ago
    Report Abuse

    I never thought acupunture worked, being a skeptic and never seeing any evidence, I had it once before and it didnt work for the condition I had. I recently reluctantly tried it on the urging of a friend at a free birthing clinic in a developing country. I found the acupuncturists to be very knowlegable about my condition which is Hashimotos. And they stuck the needles in deep this time, unlike the last time I had it. That was two months ago. I had been severedly fatigued everyday at the same time for a year without missing a day, and 24-48 hours after the treatment, I was not experiencing any fatigue. Its been 2 months without any fatigue, I would say it was either a miracle or it really does work. The quality may vary with practitioners I have guessed, make sure the needles go deep, you should feel a pressure feeling and a paralysis feeling. You will be unable to move for the duration of the treatment. Even while getting the treatment I was thinking this will not work!! And they moxibusted on the needles to, which gave off a lot of smoke, and I was even more skeptical, hating the idea of smoke for health. But by geez it worked, I still cant beleive it. There is so much we dont know, so much knowlege has been lost, just think of all the wars that are going on now, multiply that times 5,000 years and think of of all the things that were destroyed in the chaos. Hell, maybe god even exists….

  55. #56 pcg
    February 13, 2012

    in japan, korea, china, many TCM(or herb) drugs proven by RCTs. and MDs uses TCM theory to TCM diagnosis and TCM treatment. and that theory has proven by scientific methods and modified by modern science.(e. g. systems biology)

  56. #57 Lawrence
    February 13, 2012

    @pcg – one, anything published in Chinese medical journals is suspect. Their quality control & peer-review process isn’t necessarily independent and has been found to favor government-held research (regardless of the actual results).

    Also, if anything is proven to actually work, it isn’t TCM or CAM anymore, it is just medicine.